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Health Services Insights 2023Many people in developing countries are struggling with chronic diseases yet traditional health services remain under-utilized in the quest for universal health care....
BACKGROUND
Many people in developing countries are struggling with chronic diseases yet traditional health services remain under-utilized in the quest for universal health care. Thousands patronize these outlets for care yet little is known about provider's competence and how these competencies inform palliative care decisions and practices. The study documented traditional health practitioners (THPs) competencies and practices for traditional palliative cancer care service delivery in Kenya.
METHODS
This study utilized mixed-methods design and was undertaken in major towns across Kenya. A total of 201 Traditional health practitioners were purposely sampled, and interviewed. Five in-depth interviews and 6 focus group discussions were conducted. Quantitative data were analyzed using SPSSv22 while thematic and discourse analysis was carried out for qualitative data.
RESULTS
Majority (92.7%) of the THPs provided general traditional health services. Nearly half of the respondents (47.7%, n = 92) stated that they had received their knowledge and abilities through divine gifting, 71 (36.8%) lineage, 61 (31.6%) apprenticeship, and 39 (20.2%) formal study. Palliative care was determined by patient state and followed consultation with caregivers for 165 (85.5%) of respondents. For 160 respondents (83%), management practices involved a mix of patient examination, conventional medical tests, herbal medicine administration, follow-up or referral. Positive feedback consisted of symptom reduction and function recovery.
CONCLUSION
Core competencies identified include: knowledge acquisition and specialization, assessment, diagnosis and disclosure, decision making, treatment, follow-up, and referral. Traditional palliative care providers share common health-related beliefs, practices and abilities that influence how they approach and make decisions regarding the health management of their patients, despite marked ethnic diversity. The shared pathways offer a chance to develop a cogent traditional palliative care service delivery model and health policy framework to promote its integration within the health workforce. The leading unmet requirements are knowledge of intellectual property rights, disclosure frameworks, and ethical regulation principles.
PubMed: 38028116
DOI: 10.1177/11786329231211780 -
International Journal of Environmental... Jul 2023Climate change is the most urgent and significant public health risk facing the globe. In Australia, it has been identified that Environmental Health...
Climate change is the most urgent and significant public health risk facing the globe. In Australia, it has been identified that Environmental Health Officers/Practitioners (EHOs/EHPs, hereafter EHOs) are a currently underutilized source of knowledge and skills that can contribute to climate change adaptation planning at the local government level. The ability of local government EHOs to utilize their local knowledge and skills in human health risk assessment during a public health emergency was demonstrated through their role in the response to COVID-19. This study used a survey and follow up interviews to examine the roles and responsibilities of EHOs during the COVID-19 pandemic and used the results to examine the potential of the workforce to tackle climate change and health related issues. What worked well, what regulatory tools were helpful, how interagency collaboration worked and what barriers or hindering factors existed were also explored. A workforce review of EHOs in South Australia was also undertaken to identify current and future challenges facing EHOs and their capacity to assist in climate change preparedness. The findings demonstrated that the workforce was used in the response to COVID-19 for varying roles by councils, including in education and communication (both internally and externally) as well as monitoring and reporting compliance with directions. Notably, half the workforce believed they could have been better utilized, and the other half thought they were well utilized. The South Australian Local Government Functional Support Group (LGFSG) was praised by the workforce for a successful approach in coordinating multiagency responses and communicating directions in a timely fashion. These lessons learnt from the COVID-19 pandemic should be incorporated into climate change adaptation planning. To ensure consistent messaging and a consolidated information repository, a centralized group should be used to coordinate local government climate change adaptation plans in relation to environmental health and be included in all future emergency management response plans. The surveyed EHOs identified environmental health issues associated with climate change as the most significant future challenge; however, concerningly, participants believe that a lack of adequate resourcing, leading to workforce shortages, increasing workloads and a lack of support, is negatively impacting the workforce's preparedness to deal with these emerging issues. It was suggested that the misperception of environmental health and a failure to recognize its value has resulted in a unique dilemma where EHOs and their councils find themselves caught between managing current workload demands and issues, and endeavouring to prepare, as a priority, for emerging environmental health issues associated with climate change and insufficient resources.
Topics: Humans; Australia; South Australia; Local Government; Climate Change; Pandemics; COVID-19; Environmental Health; Workforce
PubMed: 37510617
DOI: 10.3390/ijerph20146384 -
Journal of Family Medicine and Primary... Sep 2023Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children, often following a viral infection. Various types of rashes attributed to COVID-19... (Review)
Review
Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children, often following a viral infection. Various types of rashes attributed to COVID-19 infection have been described in the literature; however, HSP has rarely been reported. We report two children with HSP associated with acute COVID-19 infection with a review of the available literature. We highlight the clinical presentation, medical management, outcome and age-related difference of reported patients. A limitation of this article is the retrospective nature, limiting full patient history and associated conditions. The findings of this review show that HSP in the setting of COVID-19 is more common in children than adults, with a male predominance, involving various body systems creating a constellation of presentations. Given that HSP can have long-term morbidity from renal disease if untreated, this review may help guide the practitioner's approach to HSP and recognition in the setting of COVID-19 infection.
PubMed: 38024921
DOI: 10.4103/jfmpc.jfmpc_26_23 -
Australian Journal of General Practice Dec 2023Referrals are a critical component of the Australian healthcare system, with referrals from general practitioners (GPs) to non-GP specialists making up the majority of...
BACKGROUND
Referrals are a critical component of the Australian healthcare system, with referrals from general practitioners (GPs) to non-GP specialists making up the majority of medical referrals. Given the key role referrals have in primary healthcare, it is important that GPs understand their legal and professional responsibilities when providing a referral and ensure they refer appropriately and effectively to provide the best health outcomes for patients.
OBJECTIVE
This article explores GP referrals to other health professionals and aims to describe a doctor's medicolegal obligations and responsibilities when making a referral.
DISCUSSION
The responsibility of GPs in the referral process reflects their central coordinating role as providers of primary care, and the reliance patients place upon them to advise and recommend treatment and investigations. Understanding the medicolegal obligations and responsibilities when writing a referral can help GPs find the right balance between respecting patient autonomy and the professional obligation to take reasonable steps to ensure referrals and investigations are acted upon appropriately. The key to an effective referral process is clear communication between practitioners and patients, to help align the expectations of all involved so they can agree and implement a shared treatment plan in the interests of the patient.
Topics: Humans; General Practitioners; Australia; Referral and Consultation; Specialization; Patients
PubMed: 38049129
DOI: 10.31128/AJGP-08-23-6921 -
BMC Primary Care Dec 2023A high number of drug-related problems has previously been shown among community-dwelling patients in primary healthcare in Skåne County, Sweden. Medication reviews are...
BACKGROUND
A high number of drug-related problems has previously been shown among community-dwelling patients in primary healthcare in Skåne County, Sweden. Medication reviews are one way to solve these problems, but their impact is largely dependent on the process. We aimed to evaluate medication reviews for community-dwelling patients regarding the clinical relevance of the pharmacists' recommendations, and their implementation by general practitioners. We also wanted to investigate if the general practitioners' tendency to act on drug-related problems was correlated to different factors of the process.
METHODS
This was a cohort study, where patients in primary healthcare considered in need of a medication review were selected. Pharmacists identified drug-related problems and gave written recommendations on how to solve the problems to the general practitioner, via the medical record, and in addition in some cases via verbal communication. The clinical relevance of the recommendations was graded according to the Hatoum scale, ranging from one (adverse significance) to six (extremely significant). Descriptive statistics were used regarding the clinical relevance and the general practitioners´ tendency to act on drug-related problems. Multiple logistic regression analysis was used to examine the association between the tendency to act and different factors of the process.
RESULTS
A total of 96.1% of the 384 assessed recommendations from the pharmacists were graded as significant or more for the patient (Hatoum grade 3 or higher). The general practitioners acted on 63.8% of the drug-related problems. Fewer recommendations per patient, as well as verbal communication in addition to written contact, significantly increased the general practitioners' tendency to act on a drug-related problem. No significant association was seen between the tendency to act and the clinical relevance of the recommendation.
CONCLUSIONS
The high proportion of clinically relevant recommendations from the pharmacists in this study strengthens medication reviews as an important tool for reducing drug-related problems. Verbal communication between the pharmacist and the general practitioner is important for measures to be taken. Multiple recommendations for the same patient reduced their likelihood to of being addressed by the general practitioner.
Topics: Humans; Medication Review; Cohort Studies; Independent Living; General Practitioners; Primary Health Care
PubMed: 38042778
DOI: 10.1186/s12875-023-02216-0 -
Child Abuse & Neglect Dec 2023This article reports findings from research commenced in 2019. Stage one assessed the attitudes and beliefs of child protection practitioners towards domestic violence....
BACKGROUND
This article reports findings from research commenced in 2019. Stage one assessed the attitudes and beliefs of child protection practitioners towards domestic violence. Stage two considered the impact of combining Structured Decision Making (SDM - the standard assessment approach) with Response Based Practice (RBP - a contemporary approach to understanding violence), on child protection decisions.
OBJECTIVE
To improve the child protection response to children who experience domestic violence. This article reports on stage three; considering the impact of practitioner attitudes and beliefs on child protection decisions and whether the combined assessment approach (SDM + RBP) moderated the impact of practitioner attitudes and beliefs.
PARTICIPANTS AND SETTING
1041 child protection practitioners participated in the research while attending one of 17 practice conferences across New South Wales, Australia.
METHODS
An innovative video vignette experiment with a between-subjects design was used, relying on professional actors to play the roles of practitioner and mother of the children reported. Participants watched a video interview of a safety assessment and completed a survey.
RESULTS
Practitioner attitudes and beliefs were not significantly correlated with assessments about the children's safety; but attitudes did impact decisions about the likelihood of the children being brought into care. Attitudes and beliefs moderated the impact of misinformed attitudes, to some extent.
CONCLUSIONS
The research confirms the value of the combined SDM + RBP approach to guide practitioners to a more holistic understanding of domestic violence. It also confirms that assessment approaches are only ever as good as the beliefs and attitudes of the people who apply them.
Topics: Child; Humans; Domestic Violence; Attitude; Surveys and Questionnaires; New South Wales; Decision Making
PubMed: 37879256
DOI: 10.1016/j.chiabu.2023.106511 -
British Dental Journal Feb 2024Proliferative verrucous leukoplakia (PVL) is a distinct type of oral leukoplakia which has the potential to enlarge or develop into new areas of leukoplakia coupled with... (Review)
Review
Proliferative verrucous leukoplakia (PVL) is a distinct type of oral leukoplakia which has the potential to enlarge or develop into new areas of leukoplakia coupled with areas of a warty surface texture. PVL is usually diagnosed from the fifth decade onwards and is more common in female patients. The most frequent sites involved tend to be gingivae, followed by buccal mucosa and lateral border of tongue. It is one of the oral potentially malignant conditions with a high risk of malignant transformation. It is important for general dental practitioners (GDPs) to identify such lesions to facilitate referral for further investigation and diagnosis. Management is challenging with long-term monitoring and surgical excision when appropriate; however, PVL tends to recur following surgical excision. This article provides an up-to-date review tailored for GDPs on the present knowledge of PVL and illustrates the management challenges with clinical cases.
Topics: Humans; Female; Dentists; Neoplasm Recurrence, Local; Professional Role; Leukoplakia, Oral; Mouth Mucosa
PubMed: 38388601
DOI: 10.1038/s41415-024-7066-8 -
Frontiers in Public Health 2023Shifts in the age structure, rising needs of care and support, and a lack of (in)formal caregivers require innovative solutions to relieve the whole healthcare system....
INTRODUCTION
Shifts in the age structure, rising needs of care and support, and a lack of (in)formal caregivers require innovative solutions to relieve the whole healthcare system. Applying digital approaches, such as telemedicine, has the potential to support people in need of care, to relieve caregivers in families and professional environments, and to assist medical professionals in their working everyday life: e.g., using telemedicine for acute consultations could contribute to avoid hospitalizations of older people, whereas consultations with the general practitioner could reduce efforts and relive medical personnel. Beyond technical opportunities and potential, the acceptance of future users represents a prerequisite for a sustainable adoption of such innovative approaches, especially in sensitive contexts such as life in older age in nursing homes.
METHODS
This study aimed at collecting users' perceptions and evaluations of telemedicine in nursing homes. Two scenarios of telemedical consultations were applied which were either carried out by an emergency physician in acute situations or by the attending general practitioner. In a first approach, advantages and disadvantages of telemedicine were collected with the help of a qualitative interview study ( = 12) with laypersons and medical staff. The identified acceptance-relevant factors were then quantified in a second study using an online questionnaire ( = 204).
RESULTS
Outcomes revealed that both types of telemedicial consultations would be gladly used. However, for telemedical consultations in acute situations, the perceived disadvantages outweighed the advantages; for telemedical consultations with the general practitioner, the advantages outweighed the disadvantages. A prominent barrier in both scenarios was perceived impersonality, which limited the willingness to use. Nevertheless, participants indicated that telemedical consultations can be a support for nursing staff.
DISCUSSION
Outcomes may help to derive specific implications and recommendations to develop and realize digital technologies tailored to the requirements, needs, and wishes of diverse stakeholders (i.e., patients, medical professionals) as potential future users.
Topics: Humans; Aged; Telemedicine; Delivery of Health Care; Referral and Consultation; Surveys and Questionnaires; General Practitioners
PubMed: 37546320
DOI: 10.3389/fpubh.2023.1223661 -
Trends in Ecology & Evolution Jan 2024We present the results of our 15th horizon scan of novel issues that could influence biological conservation in the future. From an initial list of 96 issues, our... (Review)
Review
We present the results of our 15th horizon scan of novel issues that could influence biological conservation in the future. From an initial list of 96 issues, our international panel of scientists and practitioners identified 15 that we consider important for societies worldwide to track and potentially respond to. Issues are novel within conservation or represent a substantial positive or negative step-change with global or regional extents. For example, new sources of hydrogen fuel and changes in deep-sea currents may have profound impacts on marine and terrestrial ecosystems. Technological advances that may be positive include benchtop DNA printers and the industrialisation of approaches that can create high-protein food from air, potentially reducing the pressure on land for food production.
Topics: Ecosystem; Biodiversity; Conservation of Natural Resources; Forecasting; Food
PubMed: 38114339
DOI: 10.1016/j.tree.2023.11.001 -
Frontiers in Veterinary Science 2023Over the past three decades, the veterinary profession has faced a cultural shift towards postspeciesism that requires a reassessment of the foundations of the existing...
Over the past three decades, the veterinary profession has faced a cultural shift towards postspeciesism that requires a reassessment of the foundations of the existing distinctions between human and non-human animals proclaimed by the speciesism paradigm, which represents institutionalized discrimination against species and recognizes only the subjectivity of humans. Based on ethnographic observations in anthropological fieldwork and using speciesism/postspeciesism distinction, we aimed to explain the main causes of small animal practitioners' work-related stress and apply humanistic knowledge to recommend ways to alleviate the negative effects of the work environment. The explanatory model of disease, illness, and sickness, the example of the concept of family, and the circumstances of the feminization of the veterinary profession are discussed to illustrate the divergence between speciesist naturalistic veterinary knowledge and the postspeciesist cultural framework and its consequences. By failing to accommodate the changing values towards animals and by failing to challenge the anthropocentric hierarchy of values, the speciesist rationale of the veterinary profession contributes to many of the problems faced by practicing veterinarians. The incorporation of a modern moral-philosophical mindset towards animals may not even be possible because veterinary science is subject to a paradigm that is irreversibly tied to institutional discrimination against species and defies reflection on veterinary science itself. However, the veterinary profession has a privileged position in establishing an alternative ontological thinking and an alternative conception of "animal life." Anthropological knowledge was applied to anticipate further intervention of social and cultural sciences in the problems of small animal practitioners. Rather than further diversifying and increasing expectations towards veterinarians by expecting them to acquire additional skills, we propose another practitioner who can support, mediate, and enhance veterinary performance - the cultural anthropologist. With their deep knowledge of cultural differences and social dynamics, they can collaborate with veterinarians to act as a liaison between cultures, paradigms, and species.
PubMed: 37601748
DOI: 10.3389/fvets.2023.1202606