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Nurse Education Today Jul 2023Institutional racism within the United Kingdom's (UK) Higher Education (HE) sector, particularly nurse and midwifery education, has lacked empirical research, critical...
BACKGROUND
Institutional racism within the United Kingdom's (UK) Higher Education (HE) sector, particularly nurse and midwifery education, has lacked empirical research, critical scrutiny, and serious discussion. This paper focuses on the racialised experiences of nurses and midwives during their education in UK universities, including their practice placements. It explores the emotional, physical, and psychological impacts of these experiences.
METHODS
This paper draws on qualitative in-depth interviews with participants from the Nursing Narratives: Racism and the Pandemic project. Of the 45 healthcare workers who participated in the project, 28 participants obtained their primary nursing and midwifery education in UK universities. Interviews with these 28 participants were selected for the analysis reported in this paper. We aimed to employ concepts from Critical Race Theory (CRT) to analyse the interview data in order to deepen our understanding of the racialised experiences of Black and Brown nurses and midwives during their education.
FINDINGS
The interviews revealed that the healthcare workers' experiences coalesced around three themes: 1) Racism is an ordinary, everyday experience; 2) Racism is operationalised through power structures; and 3) Racism is maintained through denial and silencing. Experiences often touch on a series of issues, but we have highlighted stories within specific themes to elucidate each theme effectively. The findings underscore the importance of understanding racism as a pandemic that we must challenge in response to a post-pandemic society.
CONCLUSION
The study concludes that the endemic culture of racism in nurse and midwifery education is a fundamental factor that must be recognised and called out. The study argues that universities and health care trusts need to be accountable for preparing all students to challenge racism and provide equitable learning opportunities that cover the objectives to meet the Nursing and Midwifery Council (NMC) requirements to avoid significant experiences of exclusion and intimidation.
Topics: Pregnancy; Humans; Female; Midwifery; Qualitative Research; Health Education; United Kingdom; Nurses
PubMed: 37196491
DOI: 10.1016/j.nedt.2023.105840 -
South African Medical Journal =... Dec 2023No matter which benefit option members have chosen, medical schemes are required by the Medical Schemes Act no. 131 of 1998 to pay costs associated with the diagnosis,...
BACKGROUND
No matter which benefit option members have chosen, medical schemes are required by the Medical Schemes Act no. 131 of 1998 to pay costs associated with the diagnosis, treatment, or care of a specified set of benefits known as Prescribed Minimum Benefits (PMBs). Medical scheme beneficiaries have the right to lodge complaints with the Council for Medical Schemes (CMS) when their claims are denied.
OBJECTIVE
To determine and describe the pattern of PMBs complaints received by CMS from January 2014 to December 2018.
METHODS
This was a cross-sectional study that utilised the CMS' clinical complaints. Data for PMBs, complainants, medical scheme types, and reasons for payment denial were extracted. The CMS' lists of chronic conditions, PMBs, and registered schemes were used to confirm PMBs and to categorise schemes as either restricted (i.e., to only members of specific organisations) or open (i.e., to all South Africans). Extracted and coded data were analysed using SAS v.9.4 software.
RESULTS
A total of 2141 complaints were retrieved and 1124 PMBs complaints were included in the study. The median of PMBs complaints per year was 225. Most of the complaints (43.6%, n=490/1124) were lodged by members themselves. Non-Communicable Diseases (NCDs) constituted most of the PMBs conditions that members complained about. Medicine and surgery were the services that were mostly denied full payment by medical schemes. Open medical schemes accounted for more (73.8%, n=830/1124) of the complaints.
CONCLUSION
Chronic conditions are the main diseases that medical scheme members complained about. Member education and clear definition of PMBs should be prioritised by medical schemes and the Council for Medical Schemes.
Topics: Humans; Retrospective Studies; Cross-Sectional Studies; South Africa; Costs and Cost Analysis; Chronic Disease
PubMed: 38525635
DOI: No ID Found -
External and internal influences yield similar memory effects: the role of deception and suggestion.Frontiers in Psychology 2023In legal cases, testimonies can become contaminated because of an amalgam of external and internal influences on memory. It is well-established that external influences... (Review)
Review
In legal cases, testimonies can become contaminated because of an amalgam of external and internal influences on memory. It is well-established that external influences (e.g., suggestive interviews) can hurt memory. However, less focus has been placed on the impact of internal influences (e.g., lying) on memory. In the current review, we show that the available evidence suggests that both external and internal influences exert similar effects on memory. That is, we review studies showing that suggesting non-occurrences and suggesting non-experiences can lead to omission errors and false memories, respectively. Likewise, these memory effects are also observed when focusing on internal influences. That is, false denials, feigning amnesia and fabrication have been shown to affect memory in terms of forgetting (i.e., omissions) and false memories (i.e., commissions). Also, we show that both external and internal influences can lead to changes in the belief that an event occurred. We argue that in legal cases, triers of fact should concentrate on whether both types of influences might have affected testimonial accuracy in witnesses, victims, and suspects.
PubMed: 37701866
DOI: 10.3389/fpsyg.2023.1081528 -
Frontiers in Artificial Intelligence 2024The rapid proliferation of Internet of Things (IoT) devices across various industries has revolutionized the way we interact with technology. However, this widespread... (Review)
Review
The rapid proliferation of Internet of Things (IoT) devices across various industries has revolutionized the way we interact with technology. However, this widespread adoption has also brought about significant security challenges that must be addressed to ensure the integrity and confidentiality of data transmitted and processed by IoT systems. This survey paper delves into the diverse array of security threats faced by IoT devices and networks, ranging from data breaches and unauthorized access to physical tampering and denial-of-service attacks. By examining the vulnerabilities inherent in IoT ecosystems, we highlight the importance of implementing robust security measures to safeguard sensitive information and ensure the reliable operation of connected devices. Furthermore, we explore cutting-edge technologies such as blockchain, edge computing, and machine learning as potential solutions to enhance the security posture of IoT deployments. Through a comprehensive analysis of existing security frameworks and best practices, this paper aims to provide valuable insights for researchers, practitioners, and policymakers seeking to fortify the resilience of IoT systems in an increasingly interconnected world.
PubMed: 38845684
DOI: 10.3389/frai.2024.1397480 -
Cancer Medicine Feb 2024Racial and socioeconomic disparities in receipt of care for non-small-cell lung cancer (NSCLC) are well described. However, no previous studies have evaluated the...
BACKGROUND
Racial and socioeconomic disparities in receipt of care for non-small-cell lung cancer (NSCLC) are well described. However, no previous studies have evaluated the association between mortgage denial rates and receipt of timely and guideline-concordant care for NSCLC and patient outcomes.
METHODS
We identified individuals ≥18 years diagnosed with NSCLC between 2014 and 2019 from the National Cancer Database. Using the Home Mortgage Disclosure Act database, we calculated the proportion of denied home loans to total loans at the zip-code level and categorized them into quintiles. Our outcomes included receipt of guideline-concordant care based on clinical and pathologic stage at diagnosis and the National Comprehensive Cancer Network guidelines, time from surgery to chemotherapy initiation, and overall survival.
RESULTS
Of the 629,288 individuals diagnosed with NSCLC (median age 69; IQR 61-76 years, 49.1% female), 47.8% did not receive guideline-concordant care. Residing in areas with higher mortgage denial rates and lower income was associated with worse guideline-concordant care overall (aRR = 1.28; 95% CI = 1.25-1.32) and for each cancer treatment modality, worse receipt of timely chemotherapy (aHR = 1.14; 95% CI = 1.11-1.17) and worse overall survival (aHR = 1.21; 95% CI = 1.19-1.22), compared with residing in areas with the lowest mortgage denial rate and highest income.
CONCLUSIONS
Area-level mortgage denial rate was associated with worse receipt of timely and guideline-concordant NSCLC care and survival. This highlights the critical need to understand and address systemic practices, such as mortgage denial, that limit access to resources and are associated with worse access to quality cancer care and outcomes.
Topics: Humans; Female; United States; Aged; Male; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Guideline Adherence; Quality of Health Care; Racial Groups
PubMed: 38205942
DOI: 10.1002/cam4.6921 -
Frontiers in Psychiatry 2024The escalating global prevalence of burnout among healthcare professionals poses a serious health concern. Recent studies focus on prevalence and predictors of burnout...
BACKGROUND
The escalating global prevalence of burnout among healthcare professionals poses a serious health concern. Recent studies focus on prevalence and predictors of burnout among healthcare providers, emphasizing the need for well-being interventions. This study investigates burnout and coping mechanisms among healthcare professionals in central Uganda, addressing the dearth of knowledge about coping strategies specific to the region.
METHODS
An analytical facility cross-sectional study was conducted in five healthcare facilities in central Uganda between June to July 2023. Participants included physicians, nurses, and technicians actively engaged in direct patient care. Data were collected using socio-demographic surveys, the Professional Quality of Life (ProQOL-5), and the Brief-COPE tools.
RESULTS
The study revealed a high prevalence of burnout, with 39.8% of participants experiencing significant levels. Active coping, positive reframing, and denial were negatively correlated with low burnout levels. Dysfunctional coping, specifically self-distraction and denial, showed positive correlations with average and high burnout levels. Emotion-focused coping mechanisms were not employed across burnout levels.
CONCLUSIONS
The results emphasize the demanding nature of healthcare roles in the region and highlight the need for comprehensive, context-specific interventions to address burnout globally. While some healthcare professionals utilized adaptive strategies such as seeking social support, engaging in self-care activities, and utilizing problem-solving skills, others resorted to maladaptive coping mechanisms such as substance use and avoidance behaviors. This dichotomy highlights the need for targeted interventions to promote adaptive coping strategies and mitigate the negative impact of maladaptive behaviors on individual well-being and patient care.
PubMed: 38686129
DOI: 10.3389/fpsyt.2024.1373743 -
Scientific Reports Dec 2023The aim of this study was to examine the parenting characteristics of young patients with bipolar disorder (BD) and explore the sex differences. The parental rearing...
The aim of this study was to examine the parenting characteristics of young patients with bipolar disorder (BD) and explore the sex differences. The parental rearing pattern of young patients with BD was measured and compared with the healthy control of young adults. The EMBU scale was used to assess parental rearing patterns. Patients with BD reported significantly higher scores in the punishment and severity index, as well as of the rejection and denial index, but lower scores in the warmth & affectionate index in the paternal rearing pattern, compared with healthy controls. In addition, patients scored higher on the punishment and severity index and rejection and patterns index in maternal rearing patterns. More importantly, we found significant sex differences in maternal rearing patterns (p < 0.05). Specifically, in the maternal rearing patterns, male patients had higher scores on the favoring index than male controls, whereas female patients had lower scores on the warmth & affectionate index than female controls. This study shows significant differences in parental rearing patterns between patients and control subjects. Male patients were overprotective by their mothers and female patients were overlooked by their mothers during upbringing.
Topics: Child; Humans; Male; Female; Young Adult; Bipolar Disorder; Child Rearing; Sex Characteristics; Parent-Child Relations; Parents; Parenting
PubMed: 38066062
DOI: 10.1038/s41598-023-48576-6 -
Journal of Neuromuscular Diseases 2024Spinal muscular atrophy (SMA) is a genetic neurodegenerative disorder with onset predominantly in infants and children. In recent years, newborn screening and three...
BACKGROUND
Spinal muscular atrophy (SMA) is a genetic neurodegenerative disorder with onset predominantly in infants and children. In recent years, newborn screening and three treatments, including gene replacement therapy (Onasemnogene abeparvovec-xioi), have become available in the United States, aiding in the diagnosis and treatment of children with SMA.
OBJECTIVE
To evaluate parents' experiences with newborn screening and gene replacement therapy and to explore best practices for positive newborn screen disclosure and counseling of families.
METHODS
We conducted semi-structured interviews (n = 32) and online surveys (n = 79) of parents whose children were diagnosed with SMA (on newborn screening or symptomatically) and treated with gene replacement therapy.
RESULTS
Gene replacement therapy was most parents' first treatment choice, although concerns regarding long term efficacy (65%) and safety (51%) were common. Information provided during the newborn screening disclosure was quite variable. Only 34% of parents reported the information provided was sufficient and expressed need for more information about treatment. Although many parents experienced denial of the diagnosis at initial disclosure, 94% were in favor of inclusion of SMA on newborn screening. Parents were almost universally anxious following diagnosis and over half remained anxious at the time of study participation with uncertainty of the future being a key concern. Many parents had difficulty processing information provided during their first clinic appointment due to its complexity and their emotional state at the time.
CONCLUSIONS
Utilizing this data, we provide a recommendation for the information provided in newborn screening disclosure, propose adjustments to education and counseling during the first clinic visit, and bring awareness of parents' mental health difficulties.
Topics: Infant; Infant, Newborn; Child; Humans; United States; Neonatal Screening; Muscular Atrophy, Spinal; Parents; Surveys and Questionnaires; Anxiety
PubMed: 38160362
DOI: 10.3233/JND-230082 -
Therapeutic Innovation & Regulatory... Jan 2024The US Food and Drug Administration's Breakthrough Therapy Designation (BTD) program is intended to facilitate and expedite development of investigational drugs to... (Review)
Review
BACKGROUND
The US Food and Drug Administration's Breakthrough Therapy Designation (BTD) program is intended to facilitate and expedite development of investigational drugs to address unmet medical needs. The objective of this study is to provide an update on FDA's process for review of BTD requests.
METHODS
We reviewed Center for Drug Evaluation and Research (CDER) decisions to grant or deny breakthrough therapy designation requests for non-oncology drugs or biological products ("drugs") from January 1, 2017, through December 31, 2019. Data collection included characteristics of the corresponding drug and condition, reasons for granting or denying breakthrough therapy status, reasons for rescinding or withdrawing breakthrough therapy status after a request was granted (if applicable), and subsequent marketing approval status through 2022.
RESULTS
Among 240 requests, 93 (39%) requests were granted and 147 (61%) requests were denied. Granting of requests was more common for conditions where no therapy was available or for orphan diseases. Common reasons for denial included data-related issues, insufficient treatment effect, inadequate study design, endpoint attributes, safety issues, and reliance on post hoc analyses. Among 28 drugs receiving marketing approval as of the end of 2022 for the indication for which BTD was previously granted, 21 (75%) involved a first-in-class mechanism of action.
CONCLUSIONS
This analysis describes CDER's decision-making process related to review of requests for breakthrough therapy designations and enhances public awareness regarding efforts to expedite drug development.
Topics: Humans; Drug Approval; Pharmaceutical Preparations; Drug Development; Drugs, Investigational; Rare Diseases
PubMed: 37926768
DOI: 10.1007/s43441-023-00589-z -
JAMA Health Forum May 2024
PubMed: 38753351
DOI: 10.1001/jamahealthforum.2024.1749