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Nygaard HS, Øen KG. Public health nurses' experiences following up children with overweight and obesity according to national guidelines. A qualitative study. Int J Qual Stud Health Well-being 2024; 19:2306658. [PMID: 38262000 PMCID: PMC10810652 DOI: 10.1080/17482631.2024.2306658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 01/14/2024] [Indexed: 01/25/2024] Open
Abstract
PURPOSE This study aimed to develop knowledge of how the follow-up regarding overweight and obesity among children in primary school is experienced by the PHN and how the guidelines may be used to improve health services in this follow-up. METHODS We analysed semi-structured interviews of 9 PHNs using qualitative content analysis. RESULTS Two themes emerged: Following up with children with overweight and obesity is an important but challenging duty; The PHNs call for clearer guidelines. Following five sub-themes: PHNs strive to adhere to the guidelines, show compassion in the follow-up, have difficulty handling parents' feelings and reactions, feel alone with the responsibility, and have suggestions for clearer guidelines. CONCLUSIONS PHNs call for enough resources to communicate the results of the child's weight in a sufficient form. PHNs and families should establish common goals. The PHN should avoid one-way communication but meet the parents' concerns and needs. This requires the PHN to focus on building a secure relation to the child and the families, as described by Peplau. Guidelines must include instructions and tools on how to communicate and meet the family's concerns. Political action and increased funding could strengthen the follow-up and thereby prevent more obesity among children, which can be a predictor of poorer health outcomes later in life.
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Affiliation(s)
- Hanna Skjelbred Nygaard
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Kirsten Gudbjørg Øen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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2
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Timlin U, Rautio A. Communicating and complying with COVID-19 actions in northernmost Finland. Int J Circumpolar Health 2024; 83:2313822. [PMID: 38351741 PMCID: PMC10868415 DOI: 10.1080/22423982.2024.2313822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
In Finland, national and local restrictions were implemented to control the COVID-19 pandemic after the increase of cases, and it changed the everyday life of people. The purpose of our study was to explore public health communication and compliance related to the COVID-19 public health instructions, recommendations, and restrictions in two municipalities in Northernmost Finland, Inari and Utsjoki. We interviewed the representatives and operators working in the municipalities to understand and learn about their experiences. Results suggested that residents complied with different COVID-19 actions, and overall, communication was found to be good. Altogether, guidelines were easy to follow but required the individual's own activity. Guidelines were also published in Sámi language. National border restrictions were a challenging part of communication and information, and guidelines were found to be contradictory at times. National border actions required resources from the municipalities, e.g. testing, which caused more demands on municipalities operating with already low resources. In the future, it is essential to consider the local situation of the pandemic and harmonise actions and put effort on local cooperation. It is important to invest in clear communication, which reaches people of all ages, and in three Sámi languages.
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Affiliation(s)
- Ulla Timlin
- Arctic Health, Biomedicine and Internal Medicine, Faculty of Medicine, University of Oulu, Finland
| | - Arja Rautio
- Arctic Health, Biomedicine and Internal Medicine, Faculty of Medicine, University of Oulu and University of the Arctic, Finland
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Behrend DA, Girgis H, Stevens R. On a need-to-know basis: Young children distinguish conventional and privileged information. Br J Dev Psychol 2024; 42:166-176. [PMID: 38196150 DOI: 10.1111/bjdp.12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
Young children are biased to treat new information communicated to them as conventional, shareable, and known by others in their community. However, some information is privileged in the sense that is not intended to be shared with or known by all. The current study compared judgements regarding sharing conventional versus privileged information. Seventy-four 3- to 5-year-olds and adults responded to vignettes in which a protagonist had to decide whether to share conventional (an object name) or privileged information (surprise). Consistent with our hypothesis, there was no developmental change in sharing judgements for conventional information but a clear decrease with age for sharing privileged information. Nonetheless, even 3-year-olds were more likely to judge that conventional information should be shared more than privileged information, though this difference increased with age. While children overall treat information as shareable, there is an emerging ability to distinguish how conventional versus privileged information should be shared.
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Xia W, Wai Li LM. When and how to share? The role of inspiration. J Soc Psychol 2024; 164:336-350. [PMID: 35659508 DOI: 10.1080/00224545.2022.2080038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
Sharing what we know with others has an important role in facilitating people's social learning and communication across settings. To advance the understanding of when and how people share, the present study examined the role of inspiration, an emotion that contains strong motivational elements, on people's sharing tendencies in three studies. Study 1 showed a positive association between the inspiring level of a given message and its likelihood of being shared. Study 2 replicated the finding with carefully controlling for the effect of positivity of a given message. Study 3 further provided evidence that inspiration shaped how people share. The results showed that participants shared inspiring messages in a more innovative way than when they shared less inspiring messages. The present research has implications for how to promote the sharing process in different settings through the role of inspiration.
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Provvidenza CF, Bonder R, McPherson AC. Putting weight-related conversations into practice: Lessons learned from implementing a knowledge translation casebook in a disability context. Child Care Health Dev 2024; 50:e13257. [PMID: 38587273 DOI: 10.1111/cch.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/31/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Due to reported challenges experienced by healthcare providers (HCPs) when having weight-related conversations with children with disabilities and their families, a knowledge translation (KT) casebook was developed, providing key communication principles with supportive resources. Our aim was to explore how the KT casebook could be implemented into a disability context. Study objectives were to develop and integrate needs-based implementation supports to help foster the uptake of the KT casebook communication principles. METHODS A sample of nurses, physicians, occupational therapists and physical therapists were recruited from a Canadian paediatric rehabilitation hospital. Informed by the Theoretical Domains Framework, group interviews were conducted with participants to understand barriers to having weight-related conversations in their context. Implementation strategies were developed to deliver the KT casebook content that addressed these identified barriers, which included an education workshop, simulations, printed materials, and a huddle and email strategy. Participant experiences with the implementation supports were captured through workshop evaluations, pre-post surveys and qualitative interviews. Post-implementation interviews were analysed using descriptive content analysis. RESULTS Ten HCPs implemented the KT casebook principles over 6 months. Participants reported that the workshop provided a clear understanding of the KT casebook content. While HCPs appreciated the breadth of the KT casebook, they found the abbreviated printed educational materials more convenient. Strategies developed to address participants' need for a sense of community and opportunities to learn from each other did not achieve their aim. Increased confidence in integrating the KT casebook principles into practice was not demonstrated, due, in part, to having few opportunities to practice. This was partly because of the increase in competing clinical demands at the onset of the COVID-19 pandemic. CONCLUSIONS Despite positive feedback on the product itself, changes in the organisational and environmental context limited the success of the implementation plan. Monitoring and adapting implementation processes in response to unanticipated changes is critical to the success of implementation efforts.
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Affiliation(s)
- Christine F Provvidenza
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
| | - Revi Bonder
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Mun KJ, Farag J, Robinson LR. Electrodiagnostic reporting preferences of referring physicians: An exploratory survey. Muscle Nerve 2024; 69:620-625. [PMID: 38308493 DOI: 10.1002/mus.28046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION/AIMS Electrodiagnostic (EDX) studies play a crucial role in the evaluation of patients with peripheral nervous system disorders. Accurate and succinct communication of test results is critical to patient safety and clinical decision-making. The objective of this study was to explore EDX reporting preferences of referring physicians to improve quality of communication and patient care. METHODS An online survey was developed, and a purposive sampling strategy was used to recruit physicians in the authors' professional networks. Quantitative and qualitative survey data underwent frequency and thematic analyses, respectively. RESULTS There were 40 respondents, including: 21 non-surgical specialists, 12 surgical specialists, and 7 family physicians. Sections rated as most critical were diagnostic impression (97%) and summary/interpretation (72%). Only 18% reported numeric data as critical to their needs, preferring this data to be formatted as bullet points or tables without nerve conduction study waveforms. Regarding the format of the data summary and diagnostic impression sections, the majority of respondents preferred bullet points rather than paragraphs. DISCUSSION The results of this exploratory survey suggest that physicians who refer patients for EDX studies prefer reports that emphasize the interpretation of EDX data and a clear diagnostic impression, particularly in bullet point format. This project highlights important preferences and how they compare to recommended reporting guidelines, which may help improve communication and ultimately patient care. Future efforts should explore larger sample sizes with all key stakeholders in the EDX process to better understand reporting styles and preferences with greater nuance and context.
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Affiliation(s)
- Kyung Joon Mun
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Farag
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Lawrence R Robinson
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Davis RJ, Ayo-Ajibola O, Lin ME, Swanson MS, Chambers TN, Kwon DI, Kokot NC. Evaluation of Oropharyngeal Cancer Information from Revolutionary Artificial Intelligence Chatbot. Laryngoscope 2024; 134:2252-2257. [PMID: 37983846 DOI: 10.1002/lary.31191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/12/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE With burgeoning popularity of artificial intelligence-based chatbots, oropharyngeal cancer patients now have access to a novel source of medical information. Because chatbot information is not reviewed by experts, we sought to evaluate an artificial intelligence-based chatbot's oropharyngeal cancer-related information for accuracy. METHODS Fifteen oropharyngeal cancer-related questions were developed and input into ChatGPT version 3.5. Four physician-graders independently assessed accuracy, comprehensiveness, and similarity to a physician response using 5-point Likert scales. Responses graded lower than three were then critiqued by physician-graders. Critiques were analyzed using inductive thematic analysis. Readability of responses was assessed using Flesch Reading Ease (FRE) and Flesch-Kincaid Reading Grade Level (FKRGL) scales. RESULTS Average accuracy, comprehensiveness, and similarity to a physician response scores were 3.88 (SD = 0.99), 3.80 (SD = 1.14), and 3.67 (SD = 1.08), respectively. Posttreatment-related questions were most accurate, comprehensive, and similar to a physician response, followed by treatment-related, then diagnosis-related questions. Posttreatment-related questions scored significantly higher than diagnosis-related questions in all three domains (p < 0.01). Two themes of the physician critiques were identified: suboptimal education value and potential to misinform patients. The mean FRE and FKRGL scores both indicated greater than an 11th grade readability level-higher than the 6th grade level recommended for patients. CONCLUSION ChatGPT responses may not educate patients to an appropriate degree, could outright misinform them, and read at a more difficult grade level than is recommended for patient material. As oropharyngeal cancer patients represent a vulnerable population facing complex, life-altering diagnoses, and treatments, they should be cautious when consuming chatbot-generated medical information. LEVEL OF EVIDENCE NA Laryngoscope, 134:2252-2257, 2024.
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Affiliation(s)
- Ryan J Davis
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | | | - Matthew E Lin
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Mark S Swanson
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Tamara N Chambers
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Daniel I Kwon
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Niels C Kokot
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Ouyang N, Feder SL, Baker JN, Knobf MT. Prognostic Communication Between Parents and Clinicians in Pediatric Oncology: An Integrative Review. Am J Hosp Palliat Care 2024; 41:545-557. [PMID: 37309610 DOI: 10.1177/10499091231183107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Background: Prognostic communication between clinicians and parents in pediatric oncology is complex. However, no review has exclusively examined research on prognostic communication in pediatric oncology. In this review, we synthesize the evidence on prognostic communication in pediatric oncology and provide recommendations for future research. Methods: We conducted an integrative review searching six databases for studies on prognostic communication in pediatric oncology as of August 2022. We applied descriptive and narrative approaches to data analysis. Results: Fourteen quantitative and five qualitative studies were included. All studies were conducted in Western developed countries. In total, 804 parents of 770 children with cancer were included. Across studies, parents were predominately female, Non-Hispanic White, and had high school or higher levels of education. Most parents reported that prognostic communication was initiated in the first year after their children's diagnosis. High-quality prognostic communication was positively associated with trust and hope and negatively associated with parental distress and decisional regret. In qualitative studies, parents suggested that prognostic communication should be open, ongoing, and delivered with sensitivity. Most studies were of moderate quality. The main gaps included inconsistent definitions of prognostic communication, and a lack of comprehensive and validated measurements, high-quality longitudinal studies, and diverse settings and participants. Conclusions: Clinicians should initiate high-quality prognostic communication early on in clinical practice. Future research should consider conducting high-quality longitudinal studies, developing prognostic communication definitions and measurements, and conducting studies across settings with diverse populations.
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Affiliation(s)
- Na Ouyang
- School of Nursing, Yale University, Orange, CT, USA
| | - Shelli L Feder
- School of Nursing, Yale University, Orange, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - M Tish Knobf
- School of Nursing, Yale University, Orange, CT, USA
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Sommers-Spijkerman M, Stukker A, Kavanaugh MS, Ketelaar M, Visser-Meily JMA, Beelen A. What, how and when do families communicate about ALS? A qualitative exploration of parents' and children's perceptions. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:256-263. [PMID: 38069659 DOI: 10.1080/21678421.2023.2290738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/27/2023] [Indexed: 04/18/2024]
Abstract
Objectives: In families with a parent diagnosed with amyotrophic lateral sclerosis (ALS), children's adaptation depends among others on how their parents communicate with them about the disease and its trajectory. The aim of this study was to explore parents' and children's perceptions of ALS-related family communication. Methods: A qualitative analysis using a conventional content analysis approach was applied to interview data previously collected from 21 parents (8 with ALS) and 15 children (age 13-23 years) about their experiences living with ALS. Results: Three themes emerged from the interviews: communication topics, styles and timing. Communication topics include facts about disease and prognosis, feelings, care and equipment, and the end. Although most parents perceived the familial communication style concerning ALS as open, the interviews revealed that both parents and children sometimes avoid interactions about ALS, because they do not know what to say or how to open the dialogue, are afraid to burden other family members, or are unwilling to discuss. Communication timing is directed by changes in the disease trajectory and/or questions of children. A family-level analysis showed that ALS-related family communication is sometimes perceived differently by parents and children. Conclusions: The study provides a better understanding of what, how and when parents and children in families living with ALS communicate about the disease. Most families opened the dialogue about ALS yet encountered challenges which may hamper good familial communication. Through addressing those challenges, healthcare professionals may facilitate better communication and adaptation in families with a parent with ALS.
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Affiliation(s)
- Marion Sommers-Spijkerman
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, and
| | - Anna Stukker
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Melinda S Kavanaugh
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Marjolijn Ketelaar
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, and
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, and
| | - Anita Beelen
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, and
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Tilden DR, Anifowoshe K, Jaser SS. Observed collaborative and intrusive parenting behaviours associated with psychosocial outcomes of adolescents with type 1 diabetes and their maternal caregivers. Diabet Med 2024; 41:e15300. [PMID: 38303663 DOI: 10.1111/dme.15300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
AIMS Maternal caregiver involvement is strongly associated with psychosocial and glycemic outcomes amongst adolescents with type 1 diabetes (T1D); however, previous studies have lacked detailed, objective examinations of caregiver involvement. We examined the relationship between observed parenting behaviors and psychosocial and glycemic outcomes amongst youth with T1D. METHODS Data collected from adolescents with T1D (age 11-17) and their female caregivers as a part of a randomized controlled trial were analyzed. These included structured, observation-based scores of adolescent-caregiver dyads engaged in videotaped interactions and selected psychosocial and glycemic outcome measures. RESULTS In adjusted analyses, higher levels of intrusive parenting behaviors during observed interactions were associated with higher diabetes distress in adolescents, but no difference in HbA1c. Associations between intrusive parenting behaviors and psychosocial outcomes were stronger for females compared to males for both diabetes distress and quality of life. Similarly, associations between collaborative parenting behaviors and quality of life were stronger for female adolescents than males. No associations were observed between collaborative parenting behaviors and glycemic outcomes. Consistent with previous work, we noted higher levels of adolescent-reported family conflict were associated with lower adolescent quality of life and higher diabetes distress with no significant difference between male and female adolescents. CONCLUSION These findings indicate that high levels of intrusive parenting behaviors, such as lecturing or over-controlling behaviors, are associated with lower levels of adolescent well-being, particularly among adolescent girls. This work suggests that interventions to reduce intrusive parenting by maternal caregivers could result in improved psychosocial outcomes for adolescents with T1D.
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Affiliation(s)
- Daniel R Tilden
- Division of Endocrinology, Diabetes and Clinical Pharmacology, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kashope Anifowoshe
- Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah S Jaser
- Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Keller P, Hudders L, Decloedt A. Flemish equine veterinarians' perceptions on the use of and client communication about complementary and alternative veterinary medicine. Equine Vet J 2024; 56:535-543. [PMID: 37658704 DOI: 10.1111/evj.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/10/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Complementary and alternative veterinary medicine (CAVM) is increasingly popular in horses. As CAVM usage could have risks, client-veterinarian communication about CAVM is crucial. OBJECTIVES Evaluating equine veterinarians' attitude towards CAVM, their CAVM usage and veterinarian-client communication about CAVM. STUDY DESIGN Cross-sectional study. METHOD A telephone survey was conducted among equine veterinarians providing ambulatory care on a daily or weekly basis. The first section of the survey included questions about the veterinarians' attitude towards CAVM and their CAVM usage. The second section focused on veterinary-client communication about CAVM. RESULTS When herbs are included as CAVM modality, 83% of the participants applied CAVM. Nighty-eight percent had already communicated with horse owners about CAVM and 81% agreed to be open to talk about CAVM. However, 95% agreed that sometimes CAVM usage takes place without disclosure to the veterinarian. The majority of participants communicated about CAVM on a weekly (40%) or daily (22%) basis, most often in person during consultations (99%) or via phone (32%). The median percentage of conversations about CAVM initiated by the owner was 50% (range 50%-80%). When the veterinarian initiated the conversation, this was usually by mentioning it as a treatment option, mostly in addition to conventional treatments. Some participants directly asked about CAVM use in the information-gathering phase. MAIN LIMITATIONS A convenience sample was used due to lack of data on the number of equine veterinarians in Flanders. Potential favourability bias with higher participation of veterinarians interested in CAVM. CONCLUSION Equine veterinarians generally had a positive attitude towards CAVM use, although this depended on the specific modality. Veterinarian-client communication about CAVM occurs frequently in ambulatory care. An open dialogue with horse owners about CAVM is important to provide information about CAVM and thus enable them to make informed decisions concerning CAVM usage, together with their veterinarian.
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Affiliation(s)
- Pia Keller
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Liselot Hudders
- Centre for Persuasive Communication, Department of Communication Sciences, Faculty of Political and Social Sciences, Ghent University, Ghent, Belgium
| | - Annelies Decloedt
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Martin SC, Scott AM, Stone AM. Examining the communication work of women who have tested BRCA-positive: "I feel this responsibility to let people know". J Genet Couns 2024. [PMID: 38623721 DOI: 10.1002/jgc4.1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/27/2024] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
Inheriting a pathogenic variant in the BRCA1 or BRCA2 gene considerably increases a woman's risk levels for developing breast and ovarian cancer. In addition to serious physical health implications, women with a BRCA pathogenic variant may face psychosocial challenges, including those related to navigating the often demanding process of communicating about topics regarding BRCA with family and other social network members. Based on in-depth interviews with 24 women who tested BRCA-positive, we found that-consistent with the conceptualization of communication work articulated by Donovan-Kicken et al. (2012) as an extension of the theory of illness trajectories (Corbin & Strauss, 1988)-the labor of communicating about BRCA genetic risk entails (a) duties, (b) challenges, (c) strategies, and (d) shared work. Within each category, our results illuminate particular characteristics of communication work for women who have tested BRCA-positive, which are commonly tied to the profound health consequences that a pathogenic variant may have for them and, potentially, for their genetic relatives. Our findings offer useful theoretical implications regarding communication work in this context. Furthermore, our results yield valuable practical insight for genetic counselors and other health care professionals regarding the struggles that can accompany communication work for women who have tested BRCA-positive as well as the strategies that participants reported using to manage or avoid these challenges.
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Affiliation(s)
- Summer C Martin
- Department of Human Communication Studies, California State University, Fullerton, California, USA
| | - Allison M Scott
- Department of Communication, University of Kentucky, Lexington, Kentucky, USA
| | - Anne M Stone
- Department of Communication, Rollins College, Winter Park, Florida, USA
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Major R, Jackson C, Wareham J, Pidcock J. Supporting neurodivergent nursing students in their practice placements. Nurs Stand 2024:e12262. [PMID: 38616773 DOI: 10.7748/ns.2024.e12262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 04/16/2024]
Abstract
Neurodivergent conditions such as autism, attention deficit hyperactivity disorder (ADHD), dyslexia, dyspraxia, dyscalculia and Tourette's syndrome are common, and it is highly likely that practice assessors and supervisors will be asked to support neurodivergent nursing students in their practice learning environments. This article details the strengths that neurodivergent students can bring to nursing, as well as some of the challenges they may experience in practice settings. It outlines how practice assessors and supervisors can develop neuro-inclusive learning environments where neurodivergent students can thrive, as well as how to support them if they are not meeting their required proficiencies. The authors also discuss how appropriate reasonable adjustments can be implemented by using a collaborative approach with students.
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Affiliation(s)
- Rachael Major
- Guernsey Institute University Centre, Princess Elizabeth Hospital, St Martins, Guernsey
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Gybel Jensen C, Gybel Jensen F, Loft MI. Patients' Experiences With Digitalization in the Health Care System: Qualitative Interview Study. J Med Internet Res 2024; 26:e47278. [PMID: 38602748 DOI: 10.2196/47278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/09/2023] [Accepted: 02/27/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The digitalization of public and health sectors worldwide is fundamentally changing health systems. With the implementation of digital health services in health institutions, a focus on digital health literacy and the use of digital health services have become more evident. In Denmark, public institutions use digital tools for different purposes, aiming to create a universal public digital sector for everyone. However, this digitalization risks reducing equity in health and further marginalizing citizens who are disadvantaged. Therefore, more knowledge is needed regarding patients' digital practices and experiences with digital health services. OBJECTIVE This study aims to examine digital practices and experiences with public digital health services and digital tools from the perspective of patients in the neurology field and address the following research questions: (1) How do patients use digital services and digital tools? (2) How do they experience them? METHODS We used a qualitative design with a hermeneutic approach. We conducted 31 semistructured interviews with patients who were hospitalized or formerly hospitalized at the department of neurology in a hospital in Denmark. The interviews were audio recorded and subsequently transcribed. The text from each transcribed interview was analyzed using manifest content analysis. RESULTS The analysis provided insights into 4 different categories regarding digital practices and experiences of using digital tools and services in health care systems: social resources as a digital lifeline, possessing the necessary capabilities, big feelings as facilitators or barriers, and life without digital tools. Our findings show that digital tools were experienced differently, and specific conditions were important for the possibility of engaging in digital practices, including having access to social resources; possessing physical, cognitive, and communicative capabilities; and feeling motivated, secure, and comfortable. These prerequisites were necessary for participants to have positive experiences using digital tools in the health care system. Those who did not have these prerequisites experienced challenges and, in some cases, felt left out. CONCLUSIONS Experiences with digital practices and digital health services are complex and multifaceted. Engagement in digital practices for the examined population requires access to continuous assistance from their social network. If patients do not meet requirements, digital health services can be experienced as exclusionary and a source of concern. Physical, cognitive, and communicative difficulties might make it impossible to use digital tools or create more challenges. To ensure that digitalization does not create inequities in health, it is necessary for developers and institutions to be aware of the differences in digital health literacy, focus on simplifying communication with patients and next of kin, and find flexible solutions for citizens who are disadvantaged.
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Affiliation(s)
| | | | - Mia Ingerslev Loft
- Department of Neurology, Rigshospitalet, Copenhagen, Denmark
- Institute for People and Technology, Roskilde University, Roskilde, Denmark
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15
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Bataille S, Nodimar C. The highlights of dialysis in 2023. Nephrol Ther 2024; 20:5-15. [PMID: 38598185 DOI: 10.1684/ndt.2024.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
There has been a wealth of new developments in dialysis this year with the publication of several trials relating to dialysis technique, physical activity and the use of new dialysis treatments. Quality of life should be assessed and managed in all dialysis patients. Lowering the temperature of the dialysis bath in the MyTemp trial does not appear to have an effect on mortality and cardiovascular events. High volume convective hemodiafiltration currently represents the reference technique in hemodialysis; the Convince study confirms its superiority in terms of all-cause mortality. The DIATT study shows the benefit of the presence of an adapted physical activity professional to promote physical activity in dialysis patients and shows that it is necessary for this support to be reimbursed. The RENAL-AF and AXADIA-AFNET 8 studies lack power to conclude on the use of new oral anticoagulants in hemodialysis. For angiotensin receptor neprilysin inhibitors, studies are too weak to allow their use. SGLT2 inhibitors could be used in peritoneal dialysis to increase diuresis or delay the appearance of peritoneal fibrosis but to date only studies on models animals exist. Factor XI inhibitors are a new therapeutic class that could be used and would reduce the risk of thrombosis and hemorrhage. Increasingly, the feelings of patients and caregivers are more and more taken into account. Patient/caregiver communication must be at the heart of care. We will also be looking at the conservative treatment, the management of pruritus in hemodialysis and finally the care of patients with calciphylaxis.
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Affiliation(s)
| | - Céline Nodimar
- Maison du rein AURAD Aquitaine, 2, allée des Demoiselles, Cs 20023, 33171 Gradignan Cedex, France
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16
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Dalal TC, Liang L, Silva AM, Mackinley M, Voppel A, Palaniyappan L. Speech based natural language profile before, during and after the onset of psychosis: A cluster analysis. Acta Psychiatr Scand 2024. [PMID: 38600593 DOI: 10.1111/acps.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND AND HYPOTHESIS Speech markers are digitally acquired, computationally derived, quantifiable set of measures that reflect the state of neurocognitive processes relevant for social functioning. "Oddities" in language and communication have historically been seen as a core feature of schizophrenia. The application of natural language processing (NLP) to speech samples can elucidate even the most subtle deviations in language. We aim to determine if NLP based profiles that are distinctive of schizophrenia can be observed across the various clinical phases of psychosis. DESIGN Our sample consisted of 147 participants and included 39 healthy controls (HC), 72 with first-episode psychosis (FEP), 18 in a clinical high-risk state (CHR), 18 with schizophrenia (SZ). A structured task elicited 3 minutes of speech, which was then transformed into quantitative measures on 12 linguistic variables (lexical, syntactic, and semantic). Cluster analysis that leveraged healthy variations was then applied to determine language-based subgroups. RESULTS We observed a three-cluster solution. The largest cluster included most HC and the majority of patients, indicating a 'typical linguistic profile (TLP)'. One of the atypical clusters had notably high semantic similarity in word choices with less perceptual words, lower cohesion and analytical structure; this cluster was almost entirely composed of patients in early stages of psychosis (EPP - early phase profile). The second atypical cluster had more patients with established schizophrenia (SPP - stable phase profile), with more perceptual but less cognitive/emotional word classes, simpler syntactic structure, and a lack of sufficient reference to prior information (reduced givenness). CONCLUSION The patterns of speech deviations in early and established stages of schizophrenia are distinguishable from each other and detectable when lexical, semantic and syntactic aspects are assessed in the pursuit of 'formal thought disorder'.
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Affiliation(s)
- Tyler C Dalal
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | | | | | - Alban Voppel
- Robarts Research Institute, London, Ontario, Canada
| | - Lena Palaniyappan
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Robarts Research Institute, London, Ontario, Canada
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, Western University, London, Ontario, Canada
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17
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Schmitz K, Lombardo S, Szabo C. Perceptions of the use of terms of endearment among older adults in an assisted living facility. Nurs Older People 2024:e1467. [PMID: 38595318 DOI: 10.7748/nop.2024.e1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 04/11/2024]
Abstract
BACKGROUND 'Elderspeak' has been defined as a form of communication overaccommodation used with older adults that typically involves inappropriate simplified speech. One aspect of elderspeak is the use of terms of endearment such as 'honey', sweetie' and 'dear'. There is disagreement regarding the use of terms of endearment with older adults, with differing views on whether it is beneficial or harmful. AIM To explore the perceptions of older adults residing in an assisted living facility on the use of terms of endearment by healthcare staff. METHOD This qualitative study used a descriptive phenomenological design. Semi-structured interviews were undertaken with 15 older adults regarding their perceptions of the use of terms of endearment. The data were analysed to identify themes. FINDINGS Two themes emerged from the interview data: 'it's a matter of opinion' and 'context matters'. Not all older adults viewed terms of endearment negatively; some liked them, others were neutral and some viewed them as childish or disrespectful. CONCLUSION Perceptions regarding the use of terms of endearment appear to differ among older adults. Therefore, the use of such terms should be individualised based on the preferences of the older adult.
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Affiliation(s)
- Kendra Schmitz
- School of Nursing, D'Youville University, Buffalo NY, US
| | - Susan Lombardo
- School of Nursing, D'Youville University, Buffalo NY, US
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18
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Kämäräinen P, Mikkola L, Nurmeksela A, Wright M, Kvist T. Nurse leaders' interpersonal communication competence: A mixed-method systematic review. J Adv Nurs 2024. [PMID: 38597426 DOI: 10.1111/jan.16184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/13/2023] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Abstract
AIM(S) To identify and synthesize evidence available on nurse leaders' interpersonal communication competence. DESIGN Systematic mixed-methods review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. METHODS The data were collected following predefined inclusion criteria. Two authors independently performed the study selection using Covidence software. Three authors assessed the quality using Joanna Briggs' Institute's critical appraisal tool and the mixed-methods appraisal tool. The data-based convergent synthesis design and narrative synthesis were used. DATA SOURCES CINAHL, PubMed, Scopus, Business Source Elite, Academic Search Premier, Communication & Mass Media Complete, PsycInfo, Web of Sciences, Medic and Finna.fi were searched and the screening of citations in relevant articles. The final searches were performed on 17 October 2022. RESULTS A total of 26 studies-15 quantitative, 9 qualitative and 1 of both mixed-method and multi-method-met the inclusion criteria. The nurse leaders' interpersonal communication competences described in the extant literature were categorized into three themes: message competence, relational competence and task competence. There were considerable differences in the levels of competence, as some competences were considered basic communication skills, while others required more advanced level competences. Furthermore, three competence levels were identified: novice, competent and expert. CONCLUSIONS This study unravels a unique hierarchical description of communication skills across competence categories, supported by the assumption that communication skills are structured hierarchically. The studies reviewed herein had a narrow perception of nurse leaders' interpersonal communication competence and indicated a transmissional understanding of communication. IMPACT This is the first mixed-methods systematic review that describes and synthesizes the evidence on nurse leaders' communication competencies hierarchically and across competence levels. The study suggests that further research should focus on a broader and more analytical understanding of the cognitive and affective aspects of interpersonal communication competence. PROSPERO ID CRD42023385058. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Petra Kämäräinen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Leena Mikkola
- Department of Communication Sciences, Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Anu Nurmeksela
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mea Wright
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tarja Kvist
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Daponte V, Henke K, Drissi H. Current perspectives on the multiple roles of osteoclasts: Mechanisms of osteoclast-osteoblast communication and potential clinical implications. eLife 2024; 13:e95083. [PMID: 38591777 PMCID: PMC11003748 DOI: 10.7554/elife.95083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024] Open
Abstract
Bone remodeling is a complex process involving the coordinated actions of osteoblasts and osteoclasts to maintain bone homeostasis. While the influence of osteoblasts on osteoclast differentiation is well established, the reciprocal regulation of osteoblasts by osteoclasts has long remained enigmatic. In the past few years, a fascinating new role for osteoclasts has been unveiled in promoting bone formation and facilitating osteoblast migration to the remodeling sites through a number of different mechanisms, including the release of factors from the bone matrix following bone resorption and direct cell-cell interactions. Additionally, considerable evidence has shown that osteoclasts can secrete coupling factors known as clastokines, emphasizing the crucial role of these cells in maintaining bone homeostasis. Due to their osteoprotective function, clastokines hold great promise as potential therapeutic targets for bone diseases. However, despite long-standing work to uncover new clastokines and their effect in vivo, more substantial efforts are still required to decipher the mechanisms and pathways behind their activity in order to translate them into therapies. This comprehensive review provides insights into our evolving understanding of the osteoclast function, highlights the significance of clastokines in bone remodeling, and explores their potential as treatments for bone diseases suggesting future directions for the field.
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Affiliation(s)
- Valentina Daponte
- Department of Orthopaedics, Emory University School of MedicineAtlantaUnited States
- VA Medical CenterAtlantaUnited States
| | - Katrin Henke
- Department of Orthopaedics, Emory University School of MedicineAtlantaUnited States
| | - Hicham Drissi
- Department of Orthopaedics, Emory University School of MedicineAtlantaUnited States
- VA Medical CenterAtlantaUnited States
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20
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Franca K, Swenson KB, Wang C. Counseling in a different language: An analysis of experiences and resources in multilingual genetic counseling. J Genet Couns 2024. [PMID: 38594719 DOI: 10.1002/jgc4.1902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/23/2024] [Accepted: 03/30/2024] [Indexed: 04/11/2024]
Abstract
This study set out to investigate the experiences of bilingual/multilingual genetic counselors in the United States and Canada who have counseled in a non-English language and characterize their training experiences to identify potential areas for improvement. A total of 32 bilingual and/or multilingual genetic counselors completed online surveys. Approximately 83% of participants typically counsel patients in languages for which they believe their proficiency is at least good without the participation of an interpreter. Challenges to providing language-concordant care include insufficient patient-facing translation tools/resources, with roughly half reporting they have created their own resources out of necessity. For training programs, there was a strong desire for more supervision in bilingual/multilingual genetic counseling students' non-English language during training to help foster genetics-related language skills development.
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Affiliation(s)
- Karina Franca
- Graduate Medical Sciences, Master's Program in Genetic Counseling, Chobanian and Avedesian School of Medicine, Boston University, Boston, Massachusetts, USA
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kathleen B Swenson
- Graduate Medical Sciences, Master's Program in Genetic Counseling, Chobanian and Avedesian School of Medicine, Boston University, Boston, Massachusetts, USA
- Department of Medical Sciences and Education, Chobanian and Avedesian School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
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21
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Dzidzornu E, Angmorterh SK, Aboagye S, Angaag NA, Agyemang PN, Edwin F. Communication channels of breast cancer screening awareness campaigns among women presenting for mammography in Ghana. J Am Coll Radiol 2024:S1546-1440(24)00359-4. [PMID: 38599362 DOI: 10.1016/j.jacr.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The channels and content of communication play an integral role in creating breast cancer screening awareness. Although breast cancer screening awareness campaigns are increasing in Ghana, no study has been conducted to investigate the communication channels used by these campaigns. This study aimed to identify the most effective source of breast cancer screening awareness information among women presenting for mammography in Ghana. METHODS Ethical approval was sought prior to data collection. A cross-sectional quantitative approach was adopted for the study and involved 192 women who visited two mammography centers in October 2020 for mammography screening. A self-administered closed-ended questionnaire was used for data collection. Descriptive and inferential statistics were carried out using the Statistical Package for Social Sciences (SPSS) version 26. RESULTS A total of 192 responses were obtained. 72 (37.5%) participants had Diploma/HND/Degree education, with 105 (54.7%) of them being traders/non-professionals. All participants had heard of mammography screening/examination prior to this study. Mass media was the most common source of information on mammography screening [86 (44.8%)], of which radio was the highest subcategory [34 (39.5%)]. Moreover, women presenting for mammography in Ghana demonstrated a high level of knowledge of breast cancer screening. DISCUSSION Mass media is the most common source of information on breast cancer screening awareness in Ghana and has the potential to positively impact sensitization programmes by reaching out to more women. There is a need to engage the Ghanaian population using mass media and health facilities to maximize the impact of breast cancer screening awareness campaigns.
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Affiliation(s)
- Elizabeth Dzidzornu
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences (UHAS), Ho, Ghana
| | - Seth Kwadjo Angmorterh
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences (UHAS), Ho, Ghana.
| | - Sonia Aboagye
- Department of Speech, Language & Hearing Sciences, School of Allied Health Sciences, University of Health and Allied Sciences (UHAS), Ho, Ghana
| | - Nathaniel Awentiirin Angaag
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences (UHAS), Ho, Ghana
| | - Patience Nyamekye Agyemang
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences (UHAS), Ho, Ghana
| | - Frank Edwin
- School of Medicine, University of Health and Allied Sciences, Ho Ghana
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22
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Ben-Arye E, Samuels N, Keshet Y, Golan M, Baruch E, Dagash J. Exploring unmet concerns in home hospice cancer care: Perspectives of patients, informal caregivers, palliative care providers, and family physicians. Palliat Support Care 2024:1-9. [PMID: 38587040 DOI: 10.1017/s1478951524000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
OBJECTIVES The study examines perspectives of patients in home hospice care; their informal caregivers; palliative health-care providers (HCPs); and family physicians, all regarding patients' unmet needs and quality of life (QoL)-related concerns. METHODS Participants from all 4 groups were approached within 2 months after the patient's admission to the home hospice care unit. Participants completed Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Wellbeing (MYCAW) questionnaires, for patient's QoL-related concerns. Qualitative analysis of short narratives was conducted using ATLAS.ti software for systematic coding. RESULTS In total, 78 participants completed the study questionnaires: 24 patients, 22 informal caregivers, 22 palliative HCPs, and 11 family physicians. Informal caregivers gave higher scores (i.e., greater severity) than patients for fatigue on ESAS (p = 0.009); and family physicians lower scores than patients for ESAS drowsiness (p = 0.046). Compared with patients, palliative HCPs gave higher scores for patient emotional-spiritual concerns (77.2% vs. 41.7%, p = 0.02); lower scores for gastrointestinal concerns (p = 0.048); and higher scores for overall function (p = 0.049). Qualitative assessment identified a gap between how patients/informal caregivers vs. palliative HCPs/family physicians regard emotional-spiritual themes, including discussing issues related to death and dying. SIGNIFICANCE OF RESULTS The findings of the present study suggest that exploring a multifaceted cohort of home hospice patients, informal caregivers, palliative HCPs, and family physicians may provide insight on how to reduce communication gaps and address unmet needs of patients, particularly regarding emotional and spiritual concerns. CONCLUSIONS While the 4 groups were similar in their scoring of patient QoL-related concerns, there were discrepancies for some concerns (e.g., patient fatigue) and expectations regarding the need to discuss emotional and spiritual concerns, including on death and dying. Educational initiatives with programs providing training to all 4 groups may help bridge this gap, creating a more open and collaborative hospice care environment.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Keshet
- Department of Sociology, Western Galilee College, Akko, Israel
| | - Miri Golan
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Erez Baruch
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Jamal Dagash
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
- Palliative Care - Home Care Hospice, Clalit Health Services, Haifa, Israel
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Haff PL, Jacobson A, Taylor MM, Schandua HP, Farris DP, Doan HQ, Nelson KC. The New Media Landscape and Its Effects on Skin Cancer Diagnostics, Prognostics, and Prevention: Scoping Review. JMIR Dermatol 2024; 7:e53373. [PMID: 38587890 DOI: 10.2196/53373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The wide availability of web-based sources, including social media (SM), has supported rapid, widespread dissemination of health information. This dissemination can be an asset during public health emergencies; however, it can also present challenges when the information is inaccurate or ill-informed. Of interest, many SM sources discuss cancer, specifically cutaneous melanoma and keratinocyte cancers (basal cell and squamous cell carcinoma). OBJECTIVE Through a comprehensive and scoping review of the literature, this study aims to gain an actionable perspective of the state of SM information regarding skin cancer diagnostics, prognostics, and prevention. METHODS We performed a scoping literature review to establish the relationship between SM and skin cancer. A literature search was conducted across MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus from January 2000 to June 2023. The included studies discussed SM and its relationship to and effect on skin cancer. RESULTS Through the search, 1009 abstracts were initially identified, 188 received full-text review, and 112 met inclusion criteria. The included studies were divided into 7 groupings based on a publication's primary objective: misinformation (n=40, 36%), prevention campaign (n=19, 17%), engagement (n=16, 14%), research (n=12, 11%), education (n=11, 10%), demographics (n=10, 9%), and patient support (n=4, 3%), which were the most common identified themes. CONCLUSIONS Through this review, we gained a better understanding of the SM environment addressing skin cancer information, and we gained insight into the best practices by which SM could be used to positively influence the health care information ecosystem.
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Affiliation(s)
- Priscilla L Haff
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
- Cancer Prevention Research Training Program, Houston, TX, United States
| | | | - Madison M Taylor
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hayden P Schandua
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
- Cancer Prevention Research Training Program, Houston, TX, United States
| | - David P Farris
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hung Q Doan
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kelly C Nelson
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Goldhaber NH, Mehta S, Longhurst CA, Malachowski E, Jones M, Clary BM, Schaefer RL, McHale M, Rhodes LP, Mekeel KL, Reeves JJ. Call me Ishmael: addressing the white whale of team communication in the operating room with labelled surgical caps at an academic medical centre. BMJ Open Qual 2024; 13:e002453. [PMID: 38589054 PMCID: PMC11015231 DOI: 10.1136/bmjoq-2023-002453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 02/12/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Effective communication in the operating room (OR) is crucial. Addressing a colleague by their name is respectful, humanising, entrusting and associated with improved clinical outcomes. We aimed to enhance team communication in the perioperative environment by offering personalised surgical caps labelled with name and provider role to all OR team members at a large academic medical centre. MATERIALS AND METHODS This was a quasi-experimental, uncontrolled, before-and-after quality improvement study. A survey regarding perceptions of team communication, knowledge of names and roles, communication barriers, and culture was administered before and after cap delivery. Survey results were measured on a 5-point Likert Scale; descriptive statistics and mean scores were compared. All cause National Surgical Quality Improvement Project (NSQIP) morbidity and mortality outcomes for surgical specialties were examined. RESULTS 1420 caps were delivered across the institution. Mean survey scores increased for knowing the names and roles of providers around the OR, feeling that people know my name and feeling comfortable communicating without barriers across disciplines. The mean score for team communication around the OR is excellent was unchanged. The highest score both before and after was knowing the name of an interdisciplinary team member is important for patient care. A total of 383 and 212 providers participated in the study before and after cap delivery, respectively. Participants agreed or strongly agreed that labelled surgical caps made it easier to talk to colleagues (64.9%) while improving communication (66.0%), team culture (60.5%) and patient care (56.8%). No significant differences were noted in NSQIP outcomes. CONCLUSIONS Personalised labelled surgical caps are a simple, inexpensive tool that demonstrates promise in improving perioperative team communication. Creating highly reliable surgical teams with optimal communication channels requires a multifaceted approach with engaged leadership, empowered front-line providers and an institutional commitment to continuous process improvement.
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Affiliation(s)
| | - Shivani Mehta
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Christopher A Longhurst
- Department of Pediatrics, Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Elizabeth Malachowski
- Perioperative Services, University of California San Diego, La Jolla, California, USA
| | - Melissa Jones
- Perioperative Services, University of California San Diego, La Jolla, California, USA
| | - Bryan M Clary
- Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - Robin L Schaefer
- Perioperative Services, University of California San Diego, La Jolla, California, USA
| | - Michael McHale
- Department of OBGYN, University of California San Diego, La Jolla, California, USA
| | - Lisa P Rhodes
- Perioperative Services, University of California San Diego, La Jolla, California, USA
| | - Kristin L Mekeel
- Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - J Jeffery Reeves
- Department of Surgery, University of California San Diego, La Jolla, California, USA
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van Gils AM, Rhodius-Meester HFM, Handgraaf D, Hendriksen HMA, van Strien A, Schoonenboom N, Schipper A, Kleijer M, Griffioen A, Muller M, Tolonen A, Lötjönen J, van der Flier WM, Visser LNC. Use of a digital tool to support the diagnostic process in memory clinics-a usability study. Alzheimers Res Ther 2024; 16:75. [PMID: 38589933 PMCID: PMC11003066 DOI: 10.1186/s13195-024-01433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Both memory clinic professionals and patients see value in digital tools, yet these hardly find their way to clinical practice. We explored the usability of a digital tool to support the diagnostic work-up in daily memory clinic practice. We evaluated four modules that integrate multi-modal patient data (1.cognitive test; cCOG, and 2. MRI quantification; cMRI) into useful diagnostic information for clinicians (3. cDSI) and understandable and personalized information for patients (4. patient report). METHODS We conducted a mixed-methods study in five Dutch memory clinics. Fourteen clinicians (11 geriatric specialists/residents, two neurologists, one nurse practitioner) were invited to integrate the tool into routine care with 43 new memory clinic patients. We evaluated usability and user experiences through quantitative data from questionnaires (patients, care partners, clinicians), enriched with thematically analyzed qualitative data from interviews (clinicians). RESULTS We observed wide variation in tool use among clinicians. Our core findings were that clinicians: 1) were mainly positive about the patient report, since it contributes to patient-centered and personalized communication. This was endorsed by patients and care partners, who indicated that the patient report was useful and understandable and helped them to better understand their diagnosis, 2) considered the tool acceptable in addition to their own clinical competence, 3) indicated that the usefulness of the tool depended on the patient population and purpose of the diagnostic process, 4) addressed facilitators (ease of use, practice makes perfect) and barriers (high workload, lack of experience, data unavailability). CONCLUSION This multicenter usability study revealed a willingness to adopt a digital tool to support the diagnostic process in memory clinics. Clinicians, patients, and care partners appreciated the personalized diagnostic report. More attention to education and training of clinicians is needed to utilize the full functionality of the tool and foster implementation in actual daily practice. These findings provide an important step towards a lasting adoption of digital tools in memory clinic practice.
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Affiliation(s)
- Aniek M van Gils
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
- Amsterdam Neuroscience Neurodegeneration, Amsterdam, The Netherlands.
| | - Hanneke F M Rhodius-Meester
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Neurodegeneration, Amsterdam, The Netherlands
- Department of Geriatric Medicine, The Memory Clinic, Oslo University Hospital, Oslo, Norway
- Department of Internal Medicine, Geriatric Medicine Section, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Dédé Handgraaf
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Neurodegeneration, Amsterdam, The Netherlands
| | - Heleen M A Hendriksen
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Neurodegeneration, Amsterdam, The Netherlands
| | - Astrid van Strien
- Department of Geriatric medicine, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands
| | | | - Annemieke Schipper
- Department of Neurology, HagaZiekenhuis, location Zoetermeer, Zoetermeer, The Netherlands
| | - Mariska Kleijer
- Department of Neurology, HagaZiekenhuis, location Zoetermeer, Zoetermeer, The Netherlands
| | - Annemiek Griffioen
- Department of Internal Medicine, Geriatric Medicine Section, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Majon Muller
- Department of Internal Medicine, Geriatric Medicine Section, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | | | | | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Neurodegeneration, Amsterdam, The Netherlands
- Department of Epidemiology and Data Sciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Leonie N C Visser
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Neurodegeneration, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam/AMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Asada K, Akechi H, Kikuchi Y, Tojo Y, Hakarino K, Saito A, Hasegawa T, Kumagaya S. Longitudinal study of personal space in autism. Child Neuropsychol 2024:1-9. [PMID: 38578305 DOI: 10.1080/09297049.2024.2337753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
The size and regulation of personal space are reportedly atypical in autistic individuals. As personal space regulates social interaction, its developmental change is essential for understanding the nature of social difficulties that autistic individuals face. Adolescence is an important developmental period in which social relationships become complex. We conducted a three-year longitudinal study of interpersonal distances in autistic and typically developing (TD) individuals aged 12-18 years at Time 1 and 15-21 years at Time 2. Their preferred interpersonal distances were measured when an experimenter approached the participants with and without eye contact. The interpersonal distances of autistic individuals were shorter than those of TD individuals at both Time 1 and Time 2. Furthermore, the interpersonal distances of autistic individuals at Time 1 and Time 2 were highly correlated, but no such correlation was found in TD individuals. The results suggest that the interpersonal distances of autistic individuals are stable and that the shorter preferred interpersonal distances in autistic individuals compared to those of TD individuals are maintained during adolescence.
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Affiliation(s)
- Kosuke Asada
- Department of Social Psychology, Faculty of Sociology, Toyo University, Tokyo, Japan
| | - Hironori Akechi
- Division of Cognitive Psychology in Education, Graduate School of Education, Kyoto University, Kyoto, Japan
| | - Yukiko Kikuchi
- Center for Evolutionary Cognitive Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Yoshikuni Tojo
- College of Education, Ibaraki University, Ibaraki, Japan
| | - Koichiro Hakarino
- Musashino Higashi Center for Education and Research, Musashino Higashi Gakuen, Tokyo, Japan
| | - Atsuko Saito
- Department of Psychology, Faculty of Human Sciences, Sophia University, Tokyo, Japan
| | - Toshikazu Hasegawa
- Department of Cognitive and Behavioral Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Shinichiro Kumagaya
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
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Tyler LS, Musch KLE, Vest TA, Ivey MF. Essence of influence: Connecting through stories. Am J Health Syst Pharm 2024; 81:270-274. [PMID: 38070194 DOI: 10.1093/ajhp/zxad308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Linda S Tyler
- University of Utah Health Care Salt Lake City, UT, USA
| | - Kellie L E Musch
- OhioHealth Doctors, Dublin, Grady, and O'Bleness Columbus, OH, USA
| | - Tyler A Vest
- Duke University Health System, Durham, NC
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Marianne F Ivey
- University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
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Sear C. Peripheral neuropathic pain: supporting patients with self-management. Nurs Stand 2024; 39:71-75. [PMID: 38495010 DOI: 10.7748/ns.2024.e12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024]
Abstract
Peripheral neuropathic pain is a complex condition that can adversely affect people's quality of life. Alongside pharmacological interventions, nurses can support patients to self-manage their pain using non-pharmacological interventions such as lifestyle changes and exercise. To do this effectively, nurses should be able to recognise the signs and symptoms of peripheral neuropathic pain and be able to educate patients on appropriate self-management approaches. It is important that nurses provide education, advice and information in a way that patients can understand and check this understanding. This article provides an overview of how nurses can support patients to self-manage peripheral neuropathic pain by using various non-pharmacological interventions.
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Affiliation(s)
- Charlotte Sear
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Harefield, England
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Kwan B, Bell JF, Longhurst CA, Goldhaber NH, Clay B. Implementation of an electronic health record-integrated instant messaging system in an academic health system. J Am Med Inform Assoc 2024; 31:997-1000. [PMID: 38287641 PMCID: PMC10990552 DOI: 10.1093/jamia/ocad253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES Effective communication amongst healthcare workers simultaneously promotes optimal patient outcomes when present and is deleterious to outcomes when absent. The advent of electronic health record (EHR)-embedded secure instantaneous messaging systems has provided a new conduit for provider communication. This manuscript describes the experience of one academic medical center with deployment of one such system (Secure Chat). METHODS Data were collected on Secure Chat message volume from June 2017 to April 2023. Significant perideployment events were reviewed chronologically. RESULTS After the first coronavirus disease 2019 lockdown in March 2020, messaging use increased by over 25 000 messages per month, with 1.2 million messages sent monthly by April 2023. Comparative features of current communication modalities in healthcare were summarized, highlighting the many advantages of Secure Chat. CONCLUSIONS While EHR-embedded secure instantaneous messaging systems represent a novel and potentially valuable communication medium in healthcare, generally agreed-upon best practices for their implementation are, as of yet, undetermined.
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Affiliation(s)
- Brian Kwan
- Department of Emergency Medicine, University of California San Diego School of Medicine, San Diego, CA, United States
- Department of Biomedical Informatics, University of California San Diego Health, San Diego, CA, United States
| | - John F Bell
- Department of Biomedical Informatics, University of California San Diego Health, San Diego, CA, United States
- Division of Hospital Medicine, Department of Internal Medicine, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Christopher A Longhurst
- Department of Biomedical Informatics, University of California San Diego Health, San Diego, CA, United States
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Nicole H Goldhaber
- Department of Biomedical Informatics, University of California San Diego Health, San Diego, CA, United States
- Department of Surgery, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Brian Clay
- Department of Biomedical Informatics, University of California San Diego Health, San Diego, CA, United States
- Division of Hospital Medicine, Department of Internal Medicine, University of California San Diego School of Medicine, San Diego, CA, United States
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Cheyne SM, Thompson C, Martin A, K Aulia AA, Birot H, Cahyaningrum E, Aragay J, Hutasoit PA, Sugardjito J. The power of gibbon songs: Going beyond the research to inform conservation actions. Am J Primatol 2024:e23626. [PMID: 38566320 DOI: 10.1002/ajp.23626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
Gibbons (Hylobatidae) are the smallest of the apes, known for their arboreal behavior and stereotyped songs. These species and sex-specific songs are often the subject of detailed studies regarding their evolution, responses to changing environments, involvement in social behavior, and used to design vocalization-based survey techniques to monitor population densities and trends. What is poorly understood is the value and impact of using the science and sound of gibbon vocalization and gibbon stories in education and outreach to complement nongovernmental organizations (NGOs) efforts. We present an example of how Borneo Nature Foundation, a NGOs based in Indonesia, is working to use the recordings of the songs of Bornean white-bearded gibbons (Hylobates albibarbis) to inform conservation actions and education efforts. Gibbons in Indonesia are often poorly known or understood by the public compared to orangutans (Pongo spp). We showcase how a field of study, namely primate acoustics, is an untapped resource to create digital content to engage with local, national and international communities and can be developed into educational tools in the form of storytelling, mobile apps and games, to highlight the plight of these threatened species and how to conserve them.
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Affiliation(s)
- Susan M Cheyne
- Borneo Nature Foundation International, Penryn, UK
- Oxford Brookes University, Oxford, UK
| | - Carolyn Thompson
- Borneo Nature Foundation International, Penryn, UK
- University College London, London, UK
- Institute of Zoology, Zoological Society of London, London, UK
| | | | | | - Helene Birot
- Borneo Nature Foundation International, Penryn, UK
| | | | - Joana Aragay
- Borneo Nature Foundation International, Penryn, UK
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31
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Farid M, Cafferky L, Kirk J, Kershaw M, Slator R. The Incidence and Outcomes for Children with Cleft Palate and/or Lip and CHARGE Syndrome. Cleft Palate Craniofac J 2024; 61:620-630. [PMID: 36471495 DOI: 10.1177/10556656221134558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES Published literature on children with cleft palate and/or lip (CP + /-L) and CHARGE syndrome (CS) is limited. This study investigated cleft characteristics including surgery, and feeding and communication outcomes in children identified with CP + /-L and CS. DESIGN Retrospective cross-sectional review. SETTING Regional Referral Centre for Paediatric Cleft Surgery. PATIENTS All children diagnosed with CP + /-L and CS (based on clinical features and/or CHD7 mutation testing) between 1989-2019. MAIN OUTCOME MEASURES Cleft type, timing of CP + /-L repair, reasons for 'delayed' repair, feeding methods and communication modality. RESULTS Twenty-two children with CP + /-L and CS were identified. Cleft sub-types (%) were: Eleven (50%) had bilateral cleft lip and palate (BCLP), six (27%) had unilateral cleft lip and palate (UCLP) and five (23%) had cleft palate (CP). Cleft repair was delayed compared to protocol care for non-syndromic children with CP + /-L. Median age for lip repair + /- vomerine flap was 9 months (range 4-22 months), and palate repair was 21 months (range 11-40 months). Median age for isolated CP repair was 13 months (range 7-23). Surgery for cardiac anomalies (36%) before cleft repair, and (59%) were classed as having severe systemic disease at the time of cleft surgery. Only 27% of the children in this study had both full oral feeding and verbal communication. CONCLUSIONS Children with CP + /-L and CS had severe cleft types and complex medical problems leading to delayed cleft surgery. Feeding and speech outcomes were better in the children aged over ten years.
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Affiliation(s)
- Mohammed Farid
- West Midlands Cleft Centre, Birmingham Children's Hospital, Birmingham, UK
| | - Louise Cafferky
- West Midlands Cleft Centre, Birmingham Children's Hospital, Birmingham, UK
| | - Jeremy Kirk
- Department of Paediatric Endocrinology, Birmingham Children's Hospital, Birmingham, UK
| | - Melanie Kershaw
- Department of Paediatric Endocrinology, Birmingham Children's Hospital, Birmingham, UK
| | - Rona Slator
- West Midlands Cleft Centre, Birmingham Children's Hospital, Birmingham, UK
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Flower KB, Gutierrez-Wu JC, McBride JP, Sylvester F, Díaz-González de Ferris ME. Spanish-Speaking Parents' Experiences Accessing Care: Evolving Challenges and Promising Approaches. Acad Pediatr 2024; 24:391-393. [PMID: 38253176 DOI: 10.1016/j.acap.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Kori B Flower
- Division of General Pediatrics and Adolescent Medicine (KB Flower, JC Gutierrez-Wu, JP McBride, and ME Díaz-González de Ferris), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC.
| | - Jennifer C Gutierrez-Wu
- Division of General Pediatrics and Adolescent Medicine (KB Flower, JC Gutierrez-Wu, JP McBride, and ME Díaz-González de Ferris), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research (JC Gutierrez-Wu), University of North Carolina, Chapel Hill, NC
| | - Jennifer Pilotos McBride
- Division of General Pediatrics and Adolescent Medicine (KB Flower, JC Gutierrez-Wu, JP McBride, and ME Díaz-González de Ferris), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Francisco Sylvester
- Division of Pediatric Gastroenterology (F Sylvester), Department of Pediatrics, University of North Carolina at Chapel Hill
| | - Maria E Díaz-González de Ferris
- Division of General Pediatrics and Adolescent Medicine (KB Flower, JC Gutierrez-Wu, JP McBride, and ME Díaz-González de Ferris), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC
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He Q, Tong W, Yu Y, Zhang J. Marital quality improves self- and partner-reported psychopathy among Chinese couples: A longitudinal study. J Pers 2024; 92:515-529. [PMID: 37170058 DOI: 10.1111/jopy.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Psychopathy is closely related to many negative interpersonal outcomes in daily life, including violence. Therefore, psychopathy intervention in subclinical individuals has significant application value. OBJECTIVE Guided by the personality-relationship transaction model and social investment theory, this study examined how marital quality affects self- and partner-rated psychopathy. We also used the actor-partner interdependence mediation model to explore the mediating effect of communication. METHODS We examined self-reports and partner reports of psychopathy, marital quality, and communication among 260 married Chinese couples. RESULTS The results indicated that marital quality directly influenced couples' self-rated psychopathy, with both actor and partner effects on husbands' psychopathy and actor effects on wives' psychopathy. Moreover, verbal communication had mediating effects at time 2 between marital quality at time 1 and partner-reported psychopathy at time 3. Meanwhile, the mediating effect of nonverbal communication was not significant. CONCLUSION Our investigation of relationship effects on psychopathy revealed that the underlying mechanisms differed between self- and partner-rated psychopathy. The findings can highlight directions for exploring potential intervention strategies for subclinical psychopathy.
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Affiliation(s)
- Qiong He
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Wei Tong
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Yue Yu
- School of Sociology, China University of Political Science and Law, Beijing, China
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jianxin Zhang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Groves CNH, Coe JB, Grant LE. What do veterinary professionals and clients want? Using discrete choice methods in veterinary research to determine preferences. Am J Vet Res 2024; 85:ajvr.23.10.0228. [PMID: 38382195 DOI: 10.2460/ajvr.23.10.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024]
Abstract
Discrete choice methods (DCMs) are a suite of research techniques for identifying individual preferences using choice information. Widely utilized by other fields yet rarely employed in veterinary research, DCMs have tremendous potential to improve veterinary healthcare by understanding and incorporating owner and veterinary professionals' (encompassing veterinarians, veterinary clinicians, technicians, receptionists, attendants, etc) preferences to optimize the care continuum. DCMs have several advantages over other stated preference methods, such as ranking and ratings, including improved data quality and actionability. However, they are not a panacea, and limitations that may affect DCMs' application to the veterinary field are outlined alongside realistic mitigation strategies. The information provided aims to increase awareness of DCMs and their utility in veterinary research and encourage greater uptake as a more robust method for measuring preferences.
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Arya P, Kolodny NH, Gobes SMH. Tracing the development of learned song preferences in the female zebra finch brain with functional magnetic resonance imaging. Dev Neurobiol 2024; 84:47-58. [PMID: 38466218 PMCID: PMC11009042 DOI: 10.1002/dneu.22934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/12/2024]
Abstract
In sexually dimorphic zebra finches (Taeniopygia guttata), only males learn to sing their father's song, whereas females learn to recognize the songs of their father or mate but cannot sing themselves. Memory of learned songs is behaviorally expressed in females by preferring familiar songs over unfamiliar ones. Auditory association regions such as the caudomedial mesopallium (CMM; or caudal mesopallium) have been shown to be key nodes in a network that supports preferences for learned songs in adult females. However, much less is known about how song preferences develop during the sensitive period of learning in juvenile female zebra finches. In this study, we used blood-oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to trace the development of a memory-based preference for the father's song in female zebra finches. Using BOLD fMRI, we found that only in adult female zebra finches with a preference for learned song over novel conspecific song, neural selectivity for the father's song was localized in the thalamus (dorsolateral nucleus of the medial thalamus; part of the anterior forebrain pathway, AFP) and in CMM. These brain regions also showed a selective response in juvenile female zebra finches, although activation was less prominent. These data reveal that neural responses in CMM, and perhaps also in the AFP, are shaped during development to support behavioral preferences for learned songs.
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Affiliation(s)
- Payal Arya
- Neuroscience Department, Wellesley College, Wellesley, Massachusetts 02481, USA
| | - Nancy H. Kolodny
- Chemistry Department, Wellesley College, Wellesley, Massachusetts 02481, USA
| | - Sharon M. H. Gobes
- Neuroscience Department, Wellesley College, Wellesley, Massachusetts 02481, USA
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Kruser JM, Nadig NR, Viglianti EM, Clapp JT, Secunda KE, Halpern SD. Time-Limited Trials for Patients With Critical Illness: A Review of the Literature. Chest 2024; 165:881-891. [PMID: 38101511 DOI: 10.1016/j.chest.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/08/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023] Open
Abstract
TOPIC IMPORTANCE Since the 1990s, time-limited trials have been described as an approach to navigate uncertain benefits and limits of life-sustaining therapies in patients with critical illness. In this review, we aim to synthesize the evidence on time-limited trials in critical care, establish what is known, and highlight important knowledge gaps. REVIEW FINDINGS We identified 18 empirical studies and 15 ethical analyses about time-limited trials in patients with critical illness. Observational studies suggest time-limited trials are part of current practice in ICUs in the United States, but their use varies according to unit and physician factors. Some ICU physicians are familiar with, endorse, and have participated in time-limited trials, and some older adults appear to favor time-limited trial strategies over indefinite life-sustaining therapy or care immediately focused on comfort. When time-limited trials are used, they are often implemented incompletely and challenged by systematic barriers (eg, continually rotating ICU staff). Predictive modeling studies support prevailing clinical wisdom that prognostic uncertainty decreases over time in the ICU for some patients. One study prospectively comparing usual ICU care with an intervention designed to support time-limited trials yielded promising preliminary results. Ethical analyses describe time-limited trials as a pragmatic approach within the longstanding discussion about withholding and withdrawing life-sustaining therapies. SUMMARY Time-limited trials are endorsed by physicians, align with the priorities of some older adults, and are part of current practice. Substantial efforts are needed to test their impact on patient-centered outcomes, improve their implementation, and maximize their potential benefit.
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Affiliation(s)
- Jacqueline M Kruser
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Nandita R Nadig
- Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth M Viglianti
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Justin T Clapp
- Department of Anesthesiology & Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Katharine E Secunda
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Scott D Halpern
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, PA; Palliative and Advanced Illness Research (PAIR) Center, Philadelphia, PA
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Faysal S, Penn-Kekana L, Day LT, Tripathi V, Khan F, Stafford R, Levin K, Campbell O, Filippi V. Counseling, informed consent, and debriefing for cesarean section in sub-Saharan Africa: A scoping review. Int J Gynaecol Obstet 2024; 165:43-58. [PMID: 37698080 DOI: 10.1002/ijgo.15079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Counseling as part of the informed consent process is a prerequisite for cesarean section (CS). Postnatal debriefing allows women to explore their CS with their healthcare providers (HCPs). OBJECTIVES To describe the practices and experiences of counseling and debriefing, the barriers and facilitators to informed consent for CS; and to document the effectiveness of the interventions used to improve informed consent found in the peer-reviewed literature. SEARCH STRATEGY The databases searched were PubMed, EMBASE, PsycINFO, Africa-wide information, African Index Medicus, IMSEAR and LILACS. SELECTION CRITERIA English-language papers focusing on consent for CS, published between 2011 and 2022, and assessed to be of medium to high quality were included. DATA COLLECTION AND ANALYSIS A narrative synthesis was conducted using Beauchamp and Childress's elements of informed consent as a framework. MAIN RESULTS Among the 21 included studies reporting on consent for CS, 12 papers reported on counseling for CS, while only one reported on debriefing. Barriers were identified at the service, woman, provider, and societal levels. Facilitators all operated at the provider level and interventions operated at the service or provider levels. CONCLUSIONS There is a paucity of research on informed consent, counseling, and debriefing for CS in sub-Saharan Africa.
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Affiliation(s)
- Sumeya Faysal
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Loveday Penn-Kekana
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Louise-Tina Day
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Farhad Khan
- EngenderHealth, Washington, District of Columbia, USA
| | | | - Karen Levin
- EngenderHealth, Washington, District of Columbia, USA
| | - Oona Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Veronique Filippi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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LaMonica-Weier A, Perlia Bavis M. Kids First: A Multicomponent Onboarding for Practitioner Students in a School-Based Health Center. J Sch Nurs 2024; 40:231-236. [PMID: 35253498 DOI: 10.1177/10598405221085682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
School-Based Health Centers (SBHCs) often serve vulnerable populations who have been exposed to adverse childhood experiences (ACEs) which have been tied to an increase in adult health risk factors. At an urban SBHC serving adolescent students, 75% of patients reported three or more ACEs. This SBHC also had multiple practitioner students. A multicomponent onboarding was created to implement the Patient Interaction Standard of Care, addressing the SBHC model, adolescent care, and ACEs. Practitioner students that completed the onboarding demonstrated 97% adherence to the Patient Interaction Standard of Care "Always" or "Most of the Time." By onboarding frequent practitioner students, care provided to this vulnerable patient population was more consistently aligned to evidenced-based care appropriate for the SBHC model, adolescent care, and ACEs. This demonstrates the importance of mandatory onboarding completion compliance and further implementation across other SBCHs.
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Kim S, Liu W, Daack-Hirsch S, Williams KN. Communication Patterns and Characteristics of Family Caregivers and Persons Living With Dementia: Secondary Analysis of Video Observation. West J Nurs Res 2024; 46:264-277. [PMID: 38400741 PMCID: PMC10955794 DOI: 10.1177/01939459241233360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
BACKGROUND It is essential to characterize communication patterns for better health outcomes for family caregivers and persons living with dementia. OBJECTIVE This study aimed to examine the relationships between communication patterns and the characteristics of dyads of family caregivers and persons living with dementia. METHODS A secondary analysis was conducted using 75 video-recorded home care observations from 19 dyads. Participant characteristics and caregiver burden, depression, and sense of competence were collected from the parent study. The video-recorded dyadic communication patterns were assessed using a coding scheme developed based on Communication Accommodation Theory and Classical Test Theory. The relative frequency of the communication patterns was compared between groups. RESULTS Overall, 8311 caregiver and 8024 care recipient communication behaviors were observed. Caregiver communication patterns were categorized as facilitative, disabling, and neutral. Care recipient communication patterns were categorized as engaging, challenging, and neutral. Caregiver gender, care recipient gender, care recipient education level, dementia diagnosis length, types of dementia, dyadic gender difference, burden, depression, and competence of caregiver, and types of communication were significantly associated with caregiver communication. Dementia diagnosis length, caregiver competence, dyadic gender difference, and types of communication were significantly associated with care recipient communication. CONCLUSIONS The findings demonstrated different communication patterns depending on individual and dyad characteristics and evidence for dyadic communication support to promote meaningful interaction for persons living with dementia. Further analysis is needed to identify mediating factors and causal relationships.
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Affiliation(s)
- Sohyun Kim
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, TX, USA
| | - Wen Liu
- The University of Iowa, Iowa City, IA, USA
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Amarante ICJ, Lippman SA, Sevelius JM, Saggese GSR, da Silva AAM, Veras MADSM. Anticipated Stigma and Social Barriers to Communication Between Transgender Women Newly Diagnosed with HIV and Health Care Providers: A Mediation Analysis. LGBT Health 2024; 11:229-238. [PMID: 37910864 PMCID: PMC11001954 DOI: 10.1089/lgbt.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Purpose: We assessed whether anticipated stigma (i.e., fear of public mistreatment due to gender identity) impacts communication between transgender women (TGW) living with HIV and health care providers. Methods: This is a secondary analysis of baseline data from Trans Amigas, a study conducted in Brazil, 2018. The study population consisted of TGW living with HIV, older than 18 years, residing in the São Paulo metropolitan area. We used multivariable logistic regression (α = 0.05), mediation, and bootstrapping for the analysis. Results: One hundred and thirteen participants completed the study. Fear of public mistreatment had an adjusted odds ratio (aOR) of 7.42 (p = 0.003) for difficulty reporting new symptoms to providers. Concerning fear of public mistreatment, we found that unemployment had an aOR of 3.62 (p = 0.036); sex work, an aOR of 2.95 (p = 0.041); and issues related to name change in documents, an aOR of 2.71 (p = 0.033). For the indirect effect on difficulty reporting new symptoms, mediated by fear of public mistreatment, unemployment had an aOR of 1.52 (confidence interval [CI] = 0.88-2.24); sex work, an aOR of 1.48 (CI = 0.81-2.52); and name change issues, an aOR of 1.47 (CI = 0.96-2.43). Conclusions: Anticipated stigma was associated with communication difficulties between TGW living with HIV and providers. Our data suggest that structural factors associated with anticipated stigma could indirectly impact on difficulty reporting new symptoms. These findings indicate the importance of considering social contexts that intersect with individual experiences when analyzing communication barriers between providers and patients, and the need to strengthen social policies for TGW in Brazil. Clinical Trial Registration number: R34MH112177.
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Affiliation(s)
- Isabella Chypriades Junqueira Amarante
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
- Núcleo de Pesquisa em Direitos Humanos e Saúde da População LGBT+ (NUDHES), São Paulo, São Paulo, Brazil
| | - Sheri A Lippman
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jae M. Sevelius
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gustavo Santa Roza Saggese
- Núcleo de Pesquisa em Direitos Humanos e Saúde da População LGBT+ (NUDHES), São Paulo, São Paulo, Brazil
| | | | - Maria Amélia de Sousa Mascena Veras
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
- Núcleo de Pesquisa em Direitos Humanos e Saúde da População LGBT+ (NUDHES), São Paulo, São Paulo, Brazil
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Klein E, Kinsella M, Stevens I, Fried-Oken M. Ethical issues raised by incorporating personalized language models into brain-computer interface communication technologies: a qualitative study of individuals with neurological disease. Disabil Rehabil Assist Technol 2024; 19:1041-1051. [PMID: 36403143 PMCID: PMC10351684 DOI: 10.1080/17483107.2022.2146217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 09/01/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine the views of individuals with neurodegenerative diseases about ethical issues related to incorporating personalized language models into brain-computer interface (BCI) communication technologies. METHODS Fifteen semi-structured interviews and 51 online free response surveys were completed with individuals diagnosed with neurodegenerative disease that could lead to loss of speech and motor skills. Each participant responded to questions after six hypothetical ethics vignettes were presented that address the possibility of building language models with personal words and phrases in BCI communication technologies. Data were analyzed with consensus coding, using modified grounded theory. RESULTS Four themes were identified. (1) The experience of a neurodegenerative disease shapes preferences for personalized language models. (2) An individual's identity will be affected by the ability to personalize the language model. (3) The motivation for personalization is tied to how relationships can be helped or harmed. (4) Privacy is important to people who may need BCI communication technologies. Responses suggest that the inclusion of personal lexica raises ethical issues. Stakeholders want their values to be considered during development of BCI communication technologies. CONCLUSIONS With the rapid development of BCI communication technologies, it is critical to incorporate feedback from individuals regarding their ethical concerns about the storage and use of personalized language models. Stakeholder values and preferences about disability, privacy, identity and relationships should drive design, innovation and implementation.IMPLICATIONS FOR REHABILITATIONIndividuals with neurodegenerative diseases are important stakeholders to consider in development of natural language processing within brain-computer interface (BCI) communication technologies.The incorporation of personalized language models raises issues related to disability, identity, relationships, and privacy.People who may one day rely on BCI communication technologies care not just about usability of communication technology but about technology that supports their values and priorities.Qualitative ethics-focused research is a valuable tool for exploring stakeholder perspectives on new capabilities of BCI communication technologies, such as the storage and use of personalized language models.
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Affiliation(s)
- Eran Klein
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
| | - Michelle Kinsella
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR USA
| | - Ian Stevens
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR USA
| | - Melanie Fried-Oken
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR USA
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Agaronnik ND, Streid JL, Kwok A, Schoenfeld AJ, Cooper Z, Lindvall C. Assessing performance of Geriatric Surgery Verification Program preoperative communication standards in spine surgery. J Am Geriatr Soc 2024; 72:1136-1144. [PMID: 38230892 DOI: 10.1111/jgs.18749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND To assess performance of the American College of Surgeons Geriatric Surgery Verification (GSV) Program preoperative communication standards in older patients undergoing high risk spine surgery. METHODS We performed an external validation of a natural language processing (NLP) method for identifying documentation meeting GSV communication standards. We then applied this method to a retrospective cohort of patients aged 65 and older who underwent spinal fusion procedures between January 2018-December 2020 in a large healthcare system in Massachusetts. Our primary outcome of interest was fulfillment of GSV communication domains: overall health goals, treatment goals, and patient-centered outcomes. Factors associated with the fulfillment of at least one domain were assessed using Poisson regression to adjust for confounding. RESULTS External validation of the NLP method had a sensitivity of 88.6% and specificity of 99.0%. Our study population included 1294 patients, of whom only 0.8% (n = 10) patients contained documentation of all three GSV domains, and 33.7% (n = 436) had documentation fulfilling at least one GSV domain. The GSV domain with lowest frequency of documentation was overall health goals, with only 35 (2.7%) of patients meeting this requirement. Adjusted analysis suggested that patients with a Charlson comorbidity score of one or more had higher fulfillment of GSV criteria (CCI 1-3: prevalence rate ratio (PRR) 1.8, 95% confidence interval (CI) 1.5-2.1; CCI >3: PRR 1.5, 95% CI 1.2-1.9). CONCLUSION A paucity of geriatric patients undergoing spine surgery had preoperative documentation consistent with GSV standards. Given that spine surgery is one of the highest risk surgeries in older adults and GSV standards are relevant to all surgical specialties, wider promulgation of these standards is warranted.
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Affiliation(s)
- Nicole D Agaronnik
- Harvard Medical School, Boston, Massachusetts, USA
- Artificial Intelligence Operations and Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jocelyn L Streid
- Department of Anesthesiology and Perioperative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anne Kwok
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Informatics and Analytics, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Bueno-Guerra N, Provencio M, Tarifa-Rodríguez A, Navarro A, Sempere-Iborra C, Jordi P, de Celis-Ruiz E, Alonso de Leciñana M, Martín-Alonso M, Rigual R, Ruiz-Ares G, Rodríguez-Pardo J, Virués-Ortega J, Fuentes B. Impact of post-stroke aphasia on functional communication, quality of life, perception of health and depression: A case-control study. Eur J Neurol 2024; 31:e16184. [PMID: 38095330 DOI: 10.1111/ene.16184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 03/14/2024]
Abstract
BACKGROUND AND PURPOSE Post-stroke aphasia is associated with a reduced quality of life (QoL) and higher risk of depression. Few studies have addressed the effect of coping with aphasia. Our aim is to evaluate the impact of post-stroke aphasia on self-reported QoL and symptoms of depression. METHODS This was a cross-sectional prospective case-control study. Cases involved patients with post-stroke aphasia included in the DULCINEA trial (NCT04289493). Healthy controls were recruited using snowball sampling. All subjects completed the following questionnaires: General Health Questionnaire (GHQ-12), Stroke Aphasia Quality of Life Scale (SAQOL-39), Communicative Activity Log (CAL) and Stroke Aphasic Depression Questionnaire (SADQ-10). RESULTS Twenty-three patients (eight women; mean age 62.9 years) and 73 controls (42 women; mean age 53.7 years) were included. Cases scored lower than controls in perception of health (GHQ-12: median 3 [IQR 1; 6] vs. 0 [IQR 0; 2]) and perception of QoL (SAQOL-39: median 3.6 [IQR 3.3; 40] vs. 4.6 [IQR 4.2; 4.8]). Functional communication (CAL: median 135 [IQR 122; 148] vs. 94 [IQR 74; 103]) and SAQOL-39 communication subscale (median 2.7 [IQR 2.1; 3.2] vs. 4.8 [IQR 4.6; 5.0]) were also significantly lower in the case group. Notably, cases reported fewer depressive symptoms than controls (SADQ-10: median 11 [IQR 9; 15] vs. 13 [IQR 11; 16]; p = 0.016). A mediational analysis revealed that the relationship between post-stroke aphasia and depression was not mediated by functional communication. CONCLUSIONS Although communication difficulties impact the QoL of patients with post-stroke aphasia, such patients report fewer depressive symptoms on the SADQ-10 scale than healthy people, with no differences in scores related to social participation.
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Affiliation(s)
| | - Marta Provencio
- Faculty of Psychology, Comillas Pontifical University, Madrid, Spain
| | | | - Ana Navarro
- Faculty of Psychology, Comillas Pontifical University, Madrid, Spain
| | | | - Pablo Jordi
- La Paz University Hospital-Autonomous University of Madrid, Madrid, Spain
| | - Elena de Celis-Ruiz
- Department of Neurology and Stroke Unit, Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
| | - María Alonso de Leciñana
- Department of Neurology and Stroke Unit, Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
| | - Marta Martín-Alonso
- Speech Therapy Unit, Department of Rehabilitation, Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
| | - Ricardo Rigual
- Department of Neurology and Stroke Unit, Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
| | - Gerardo Ruiz-Ares
- Department of Neurology and Stroke Unit, Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
| | - Jorge Rodríguez-Pardo
- Department of Neurology and Stroke Unit, Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
| | | | - Blanca Fuentes
- Department of Neurology and Stroke Unit, Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
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Ramprasad A, Casubhoy I, Bachar A, Meister M, Bethman B, Sutkin G. Language in the Teaching Operating Room: Expressing Confidence Versus Community. J Surg Educ 2024; 81:556-563. [PMID: 38383237 DOI: 10.1016/j.jsurg.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/18/2023] [Accepted: 12/17/2023] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Previous work has analyzed residency letters of recommendation for agentic and communal language, but this has not been applied to spoken language. Our objective was to analyze intraoperative spoken language by attending and resident surgeons for the use of agentic and communal language. DESIGN We completed a linguistic inquiry and word count (LIWC) analysis on 16 operating room transcripts (total time 615 minutes) between attendings and resident surgeons for categories associated with agentic and communal speech. Wilcoxon signed rank and Mann-Whitney U tests were used to compare attending versus resident and male versus female speech patterns for word count; "I," clout, and power (agentic categories); and "we," authentic, social (communal categories). SETTING Midwestern academic university teaching hospital. PARTICIPANTS Sixteen male (9 attendings, 7 residents) and 16 female (7 attendings, 9 residents) surgeons, from 6 surgical specialties, most commonly from General Surgery. RESULTS Attending surgeons used more words per minute than residents (40.01 vs 16.92, p < 0.01), were less likely to use "I" (3.18 vs 5.53, p < 0.01), and spoke more language of "clout" (75.82 vs 55.47, p < 0.01). There were no significant differences between attendings and residents in use of analytic speech (23.72 vs 24.67, p = 0.32), "causation" (1.20 vs 1.08, p = 0.72), or "cognitive processing" (10.20 vs 10.54, p = 0.74). Residents used more speech with "emotional tone" (92.91 vs 79.92, p = 0.03), "positive emotion" (4.98 vs 3.86, p = 0.04), more "assent" language (4.89 vs 3.09, p < 0.01), and more "informal" language (9.27 vs 6.77, p < 0.01). There were no gender differences, except for male residents speaking with greater certainty than female residents, although by less than 1% of the total word count. CONCLUSIONS In the operating room, attending surgeons were more likely to use agentic language compared to resident surgeons based on LIWC analysis. These differences did not depend on gender and likely relate to surgeon experience and confidence, learning versus teaching, and power dynamics.
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Affiliation(s)
- Aarya Ramprasad
- Urogynecology and Reconstructive Pelvic Surgery, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Imaima Casubhoy
- Urogynecology and Reconstructive Pelvic Surgery, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Austin Bachar
- Urogynecology and Reconstructive Pelvic Surgery, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Melanie Meister
- Urogynecology and Reconstructive Pelvic Surgery, University of Kansas, Kansas City, Kansas
| | - Brenda Bethman
- Department of Race, Ethnic and Gender Studies, School of Humanities and Social Sciences, University of Missouri Kansas City, Kansas City, Missouri
| | - Gary Sutkin
- Urogynecology and Reconstructive Pelvic Surgery, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.
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Arsenault Knudsen ÉN, Mundt MP, Steege LM. Describing nurses' communication about evidence-based practice change: A social network analysis of hospital nurses. Worldviews Evid Based Nurs 2024; 21:128-136. [PMID: 38489237 DOI: 10.1111/wvn.12708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Nurses play a critical role in providing evidence-based, high-quality care to optimize patient outcomes. Models from implementation science suggest social networks may influence the adoption of evidence-based practices (EBPs). However, few studies have examined this relationship among hospital nurses. Social network analysis (SNA) mathematically evaluates patterns of communication, a critical step in implementation. Exploring hospital nurses' communication networks may provide insight into influences on the adoption of EBPs. AIMS This study aimed to describe complete communication networks of hospital nurses for practice changes on inpatient units, including upper level nursing administrators. METHODS This descriptive, exploratory, cross-sectional study used SNA on two inpatient units from one hospital. A sociometric survey was completed by nurses (unit to executive level) regarding communication frequency about practice changes. Network-level density, diameter, average path length, centralization, and arc reciprocity were measured. Attribute data were used to explore subnetworks. RESULTS Surveys from 148 nurses on two inpatient adult intensive care units (response rates 90% and 98%) revealed high communication frequency. Network measures were similar across the two units and among subnetworks. Analysis identified central (charge nurses and nurse leaders) and peripheral members of the network (new-to-practice nurses). Subnetworks aligned with the weekend and shift worked. LINKING EVIDENCE TO ACTION Established communication channels, including subnetworks and opinion leaders, should be used to maximize and optimize implementation strategies and facilitate the uptake of EBPs. Future work should employ SNA to measure the impact of communication networks on promoting the uptake of EBP and to improve patient outcomes.
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Affiliation(s)
| | - Marlon P Mundt
- Departments of Family Medicine and Community Health and Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Critoph DJ, Cable M, Farmer J, Hatcher HM, Kuhn I, Taylor RM, Smith LAM. Is there scope to do better? Clinical communication with adolescents and young adults with cancer-A scoping review. Psychooncology 2024; 33:e6317. [PMID: 38573227 DOI: 10.1002/pon.6317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/05/2024] [Accepted: 02/24/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION How to communicate effectively with adolescent and young adults with cancer (AYACs) is a research priority. In a UK-wide survey of young people with cancer's research priorities, communication was a striking cross-cutting theme. It is increasingly recognised that AYACs have experiences and communication needs that differ significantly from those of younger children and older adults. The purpose of this review is to explore the features of effective clinical communication with AYACs. METHODS A literature search was undertaken to identify and map the available evidence using a broad scope to get an overview of the pertinent literature, identify knowledge gaps and clarify concepts. The searches yielded 5825 records, generating 4040 unique articles. These were screened and 71 full articles were read by four researchers with disagreements resolved by discussion leaving 29 included articles. Narrative synthesis was undertaken in relation to each of the research questions. RESULTS Three key themes were identified: being an adolescent/young adult, supporters, and healthcare professionals (HCPs). AYACs need to feel that HCPs understand their unique perspective. They want to be involved, this changes over time and in different contexts. Supporters are a central tenet, are most often parents and undertake several roles which are not always universally supportive. HCPs enable involvement of AYACs, and this needs to be actively promoted. AYACs preference for their level of involvement requires continual assessment. The three themes are interlinked and exist within the wider scope of the triadic encounter and cancer experience. CONCLUSION Supporters, most often parents were a key feature across the data and were seemingly paradoxical in nature. Triadic communication, the presence of a third person, is a central tenet of communication with AYACs and we propose a conceptual model to represent the nuances, components, and facets of this complex communication.
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Affiliation(s)
- Deborah J Critoph
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Maria Cable
- Institute of Clinical Sciences, College of Medical and Dental School, University of Birmingham, Birmingham, UK
| | - Jessica Farmer
- Haematology & Oncology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Helen M Hatcher
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - Isla Kuhn
- Isla Kuhn, Head of Medical Library Services, University of Cambridge Medical Library, Cambridge, UK
| | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Luke A M Smith
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospital NHS Trust, Cambridge, UK
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Sagaser A, Pilon B, Goeller A, Lemmon M, Craig AK. Parent Experience of Hypoxic-Ischemic Encephalopathy and Hypothermia: A Call for Trauma Informed Care. Am J Perinatol 2024; 41:586-593. [PMID: 35026852 PMCID: PMC9276837 DOI: 10.1055/a-1739-3388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Therapeutic hypothermia (TH) is the standard treatment for hypoxic-ischemic encephalopathy (HIE). We surveyed parents of infants treated with TH about their experiences of communication and parental involvement in the neonatal intensive care unit (NICU). STUDY DESIGN A 29-question anonymous survey was posted on a parent support (web site: https://www.hopeforhie.org ) and sent to members via e-mail. Responses from open-ended questions were analyzed using thematic analysis. RESULTS A total of 165 respondents completed the survey and 108 (66%) infants were treated with TH. 79 (48%) respondents were dissatisfied/neutral regarding the quality of communication in the NICU, whereas 127 (77%) were satisfied/greatly satisfied with the quality of parental involvement in the NICU. Six themes were identified as follows: (1) setting for communication: parents preferred face to face meetings with clinicians; (2) content and clarity of language: parents valued clear language (use of layman's terms) and being explicitly told the medical diagnosis of HIE; (3) immediate and longitudinal emotional support: parents required support from clinicians to process the trauma of the birth experience and hypothermia treatment; (4) clinician time and scheduling: parents valued the ability to join rounds and other major conversations about infant care; (5) valuing the parent role: parents desired being actively involved in rounds, care times, and decision-making; (6) physical presence and touch: parents valued being physically present and touching their baby; this presence was limited by the novel coronavirus disease 2019 (COVID-19)-related restrictions. CONCLUSION We highlight stakeholder views on parent involvement and parent-clinician communication in the NICU and note significant overlap with principles of trauma informed care: safety (physical and psychological), trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, and voice and choice. We propose that a greater understanding and implementation of these principles may allow the medical team to more effectively communicate with and involve parents in the care of infants with HIE in the NICU. KEY POINTS · Parents of infants with HIE experience trauma both from the birth and the hypothermia treatment.. · Transparent communication and encouraging parental involvement can ameliorate this trauma..
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Affiliation(s)
- Anna Sagaser
- Department of Pediatrics, Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME, USA
| | | | | | - Monica Lemmon
- Division of Pediatric Neurology and Developmental Medicine, Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexa K. Craig
- Department of Pediatrics, Division of Pediatric Neurology, Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME, USA
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Abedini NC, Shulein OM, Berrú-Villalobos S, Ramírez-Quiñones J, Creutzfeldt CJ, Portocarrero J, Zunt JR, Abanto-Argomedo C. Outcomes and Experiences of Patients and Their Caregivers After Severe Stroke Requiring Tube Feeding in Peru. J Pain Symptom Manage 2024; 67:296-305. [PMID: 38215896 DOI: 10.1016/j.jpainsymman.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVES Evaluate clinical outcomes of stroke survivors in Peru discharged with artificial nutrition via a feeding tube (FT), and explore perspectives and experiences of these patients and their caregivers. METHODS Retrospective chart review to describe the prevalence of FT placement and characteristics of patients admitted with stroke to the Instituto Nacional de Ciencias Neurológicas in Lima, Peru between January 2019 and 2021. Follow-up calls to stroke survivors discharged home with FTs or their caregivers included quantitative and qualitative questions to assess long-term outcome and explore perspectives around poststroke care and FT management. We analyzed quantitative data descriptively and applied thematic analysis to qualitative data using a consensus-driven codebook. RESULTS Of 812 hospitalized patients with stroke, 146 (18%) were discharged home with FT, all with nasogastric tubes (NGTs). Follow-up calls were performed a median of 18 months after stroke with 96 caregivers and three patients. Twenty-five patients (25%) had died, and 82% of survivors (n = 61) remained dependent for some care. Four themes emerged from interviews: (1) perceived suffering (physical, emotional, existential) associated with the NGT and stroke-related disability, often exacerbated by lack of preparedness or prognostic awareness; (2) concerns around compromised personhood and value-discordant care; (3) coping with their loved-one's illness and the caregiving role; and (4) barriers to NGT care and skill acquisition. CONCLUSION We identified a high burden of palliative and supportive needs among severe stroke survivors with NGTs and their caregivers suggesting opportunities to improve poststroke care through education, communication, and support.
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Affiliation(s)
- Nauzley C Abedini
- Department of Medicine (N.C.A.), University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence at UW Medicine (N.C.A., C.J.C.), Seattle, Washington, USA
| | - Orli M Shulein
- Department of Rehabilitation (O.M.S.), University of Washington, Seattle, Washington, USA
| | | | | | - Claire J Creutzfeldt
- Cambia Palliative Care Center of Excellence at UW Medicine (N.C.A., C.J.C.), Seattle, Washington, USA; Department of Neurology (C.J.C.), University of Washington, Seattle, Washington, USA.
| | - Jill Portocarrero
- CRONICAS Center of Excellence in Chronic Diseases (J.P.), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Joseph R Zunt
- Departments of Neurology and Global Health (J.R.Z.), University of Washington, Seattle, Washington, USA
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49
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Knight A, Palermo C, Reedy G, Whelan K. Teaching and assessment of communication skills in dietetics: a scoping review. J Hum Nutr Diet 2024; 37:524-537. [PMID: 38206592 DOI: 10.1111/jhn.13276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Communication is a core element of dietetic practice, and although communication skills are a prominent feature of dietetic curricula, research suggests a need for more consistent approaches. The evidence on how communication skills are taught and assessed in dietetics has not been synthesised leaving uncertainty about best practice. This scoping review aimed to examine and map the research literature relating to the teaching and assessment of communication skills in dietetics. METHODS The review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Five electronic databases, two theses databases and eight conference proceedings were systematically searched for research on how communication skills are taught and assessed in dietetics. The search had no geographical or time limits. Studies were independently screened by two authors, summarised thematically using the Kirkpatrick Model and narratively synthesised. RESULTS The 45 included studies were organised thematically into three categories: (i) the inclusion of communication skills education in dietetics, suggesting that dietitians have variable experiences; (ii) approaches to teaching communication skills in dietetics, characterised predominantly by a move away from didactic approaches in favour of experiential opportunities for learning such as simulation; and (iii) assessment of communication skills in dietetics, including the use of both dietetic-specific and generic tools. CONCLUSIONS The included studies demonstrate that although a variety of teaching strategies are used in the development of communication skills in dietetics, there is potential for more robust evaluation and more diverse approaches to support dietetic educators to prepare the dietetic workforce.
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Affiliation(s)
- Annemarie Knight
- Department of Nutritional Sciences, King's College London, London, UK
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Gabriel Reedy
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
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50
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Nedved A, Bizune D, Fung M, Liu CM, Tsay S, Hamdy RF, Montalbano A. Communication Strategies to Improve Antibiotic Prescribing in Pediatric Urgent Care Centers. Pediatr Emerg Care 2024; 40:265-269. [PMID: 37195689 PMCID: PMC10906363 DOI: 10.1097/pec.0000000000002977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Urgent care (UC) clinicians frequently prescribe inappropriate antibiotics for upper respiratory illnesses. In a national survey, pediatric UC clinicians reported family expectations as a primary driver for prescribing inappropriate antibiotics. Communication strategies effectively reduce unnecessary antibiotics while increasing family satisfaction. We aimed to reduce inappropriate prescribing practices in otitis media with effusion (OME), acute otitis media (AOM), and pharyngitis in pediatric UC clinics by a relative 20% within 6 months using evidence-based communication strategies. METHODS We recruited participants via e-mails, newsletters, and Webinars from pediatric and UC national societies. We defined antibiotic-prescribing appropriateness based on consensus guidelines. Family advisors and UC pediatricians developed script templates based on an evidence-based strategy. Participants submitted data electronically. We reported data using line graphs and shared deidentified data during monthly Webinars. We used χ 2 tests to evaluate change in appropriateness at the beginning and end of the study period. RESULTS The 104 participants from 14 institutions submitted 1183 encounters for analysis in the intervention cycles. Using a strict definition of inappropriateness, overall inappropriate antibiotic prescriptions for all diagnoses trended downward from 26.4% to 16.6% ( P = 0.13). Inappropriate prescriptions trended upward in OME from 30.8% to 46.7% ( P = 0.34) with clinicians' increased use of "watch and wait" for this diagnosis. Inappropriate prescribing for AOM and pharyngitis improved from 38.6% to 26.5% ( P = 0.03) and 14.5% to 8.8% ( P = 0.44), respectively. CONCLUSIONS Using templates to standardize communication with caregivers, a national collaborative decreased inappropriate antibiotic prescriptions for AOM and had downward trend in inappropriate antibiotic prescriptions for pharyngitis. Clinicians increased the inappropriate use of "watch and wait" antibiotics for OME. Future studies should evaluate barriers to the appropriate use of delayed antibiotic prescriptions.
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Affiliation(s)
- Amanda Nedved
- Division of Urgent Care, Children’s Mercy Kansas City; University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Destani Bizune
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Melody Fung
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Cindy M. Liu
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Sharon Tsay
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rana F. Hamdy
- Division of Infectious Diseases, Children’s National Hospital, Washington, DC
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Amanda Montalbano
- Division of Urgent Care, Children’s Mercy Kansas City; University of Missouri-Kansas City School of Medicine, Kansas City, MO
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