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BMC Palliative Care Jun 2024Only four centers in Egypt provide Palliative Care (PC) for adult cancer patients and one provides care for pediatric cancer patients. While PC is not widely utilized in...
BACKGROUND
Only four centers in Egypt provide Palliative Care (PC) for adult cancer patients and one provides care for pediatric cancer patients. While PC is not widely utilized in Egypt, this study aims to assess patients' need for PC from the providers' perspective. The primary objectives were to assess providers' knowledge about PC, understand patients' needs, and compare children's and adults' needs for PC.
METHODS
A descriptive exploratory design was utilized. Patients were recruited from a cancer center in Qena Governorate, Egypt. All 108 nurses and physicians in the cancer center were interviewed to assess their perspectives about PC and patients' need for it.
RESULTS
Of the 108 care providers, more than 60% of the providers were not familiar with the concept of PC and did not participate in related activities, and more than 77% did not receive any training on the topic. All the providers reported there is no specific policy for end-of-life care. More than 60% of the providers responded that their patients do not need PC as the providers believe that PC provided only for end-stage patients. 50% of the providers see that PC has benefits such as pain relief and symptom management. No major differences were noted between pediatric and adult PC needs.
CONCLUSION
The results of this study provide foundational evidence of providers' lack of experience with and understanding of palliative care. This deficit is creating a barrier to providing palliative care in Egypt.
Topics: Humans; Egypt; Palliative Care; Male; Adult; Female; Health Personnel; Middle Aged; Child; Attitude of Health Personnel; Surveys and Questionnaires; Needs Assessment
PubMed: 38879483
DOI: 10.1186/s12904-024-01469-5 -
BMC Health Services Research Jun 2024Cervical cancer remains the second most common cause of death in women and poses a growing public health challenge. It is urgent to increase cervical cancer screening...
BACKGROUND
Cervical cancer remains the second most common cause of death in women and poses a growing public health challenge. It is urgent to increase cervical cancer screening rates in Kenya as per the 2018 Kenya National Cancer Screening Guidelines. Addressing access to care may serve as a target to achieve this goal; however, how individual dimensions of access to care are associated with the utilization of cervical cancer screening services in low- and middle-income countries, including Kenya, remains unclear. This study aimed to examine how different aspects of access to care (affordability, availability, geographical access, and social influence) were associated with cervical cancer screening among Kenyan women of reproductive age.
METHODS
This cross-sectional study used data from the 2014 Kenya Demographic and Health Survey and the 2010 Kenya Service Provision Assessment. The final sample included 5,563 women aged 25-49 years. Logistic regression models were used to examine the association between different aspects of access to care and the uptake of cervical cancer screening.
RESULTS
Factors such as being in the poorest wealth quintile, lacking health insurance, having difficulty obtaining funds for treatment (affordability), limited availability of screening services at nearby facilities (availability), living in rural areas (geographical access), and having healthcare decisions made solely by husbands/partners or others (social influence) were associated with a decreased likelihood of the uptake of cervical cancer screening.
CONCLUSIONS
Increasing health insurance coverage, enhancing the availability of screening services at health facilities, expanding mobile screening health facilities in rural areas, and empowering women to make their own healthcare decisions are crucial steps for increasing cervical cancer screening uptake in Kenya.
Topics: Humans; Female; Uterine Cervical Neoplasms; Kenya; Cross-Sectional Studies; Health Services Accessibility; Adult; Early Detection of Cancer; Middle Aged; Socioeconomic Factors; Health Surveys
PubMed: 38877555
DOI: 10.1186/s12913-024-11169-8 -
JMIR AI Feb 2024The use of artificial intelligence (AI) for pain assessment has the potential to address historical challenges in infant pain assessment. There is a dearth of...
BACKGROUND
The use of artificial intelligence (AI) for pain assessment has the potential to address historical challenges in infant pain assessment. There is a dearth of information on the perceived benefits and barriers to the implementation of AI for neonatal pain monitoring in the neonatal intensive care unit (NICU) from the perspective of health care professionals (HCPs) and parents. This qualitative analysis provides novel data obtained from 2 large tertiary care hospitals in Canada and the United Kingdom.
OBJECTIVE
The aim of the study is to explore the perspectives of HCPs and parents regarding the use of AI for pain assessment in the NICU.
METHODS
In total, 20 HCPs and 20 parents of preterm infants were recruited and consented to participate from February 2020 to October 2022 in interviews asking about AI use for pain assessment in the NICU, potential benefits of the technology, and potential barriers to use.
RESULTS
The 40 participants included 20 HCPs (17 women and 3 men) with an average of 19.4 (SD 10.69) years of experience in the NICU and 20 parents (mean age 34.4, SD 5.42 years) of preterm infants who were on average 43 (SD 30.34) days old. Six themes from the perspective of HCPs were identified: regular use of technology in the NICU, concerns with regard to AI integration, the potential to improve patient care, requirements for implementation, AI as a tool for pain assessment, and ethical considerations. Seven parent themes included the potential for improved care, increased parental distress, support for parents regarding AI, the impact on parent engagement, the importance of human care, requirements for integration, and the desire for choice in its use. A consistent theme was the importance of AI as a tool to inform clinical decision-making and not replace it.
CONCLUSIONS
HCPs and parents expressed generally positive sentiments about the potential use of AI for pain assessment in the NICU, with HCPs highlighting important ethical considerations. This study identifies critical methodological and ethical perspectives from key stakeholders that should be noted by any team considering the creation and implementation of AI for pain monitoring in the NICU.
PubMed: 38875686
DOI: 10.2196/51535 -
JBRA Assisted Reproduction Jun 2024The development of endometrial receptivity is crucial for successful embryo implantation and the initiation of pregnancy. Understanding the molecular regulatory... (Review)
Review
The development of endometrial receptivity is crucial for successful embryo implantation and the initiation of pregnancy. Understanding the molecular regulatory processes that transform the endometrium into a receptive phase is essential for enhancing implantation rates in fertility treatments, such as in vitro fertilization (IVF). Long non-coding RNAs (lncRNAs) play a pivotal role as gene regulators and have been examined in the endometrium. This review offers current insights into the role of lncRNAs in regulating endometrial receptivity. Considering the significant variation in endometrial remodeling among species, we summarize the key events in the human endometrial cycle and discuss the identified lncRNAs in both humans and other species, which may play a crucial role in establishing receptivity. Notably, there are 742 lncRNAs in humans and 4438 lncRNAs that have the potential to modulate endometrial receptivity. Additionally, lncRNAs regulating matrix metalloproteinases (MMPs) and Let-7 have been observed in both species. Future investigations should explore the potential of lncRNAs as therapeutic targets and/or biomarkers for diagnosing and improving endometrial receptivity in human fertility therapy.
PubMed: 38875127
DOI: 10.5935/1518-0557.20240038 -
International Journal of Hygiene and... Jul 2024The exposure of family caregivers to anticancer drugs for pediatric patients with malignancy is a potential health risk that needs to be minimized. We monitored the...
The exposure of family caregivers to anticancer drugs for pediatric patients with malignancy is a potential health risk that needs to be minimized. We monitored the amount of cyclophosphamide (CPM) that had adhered to the undershirts of patients and the personal protective equipment (PPE) of family caregivers as well as the caregivers' urine levels of CPM within the first three days after the first and second courses of high-dose CPM therapy. Liquid chromatography/mass spectrometry (LC/MS/MS) detected >0.03 ng/ml of CPM in 26% (23/88) of urine samples from 8 of 11 (72.7%) patients' family caregivers, with a peak of 0.7 ng/ml from 24 to 48 h after administration. Since urine CPM concentrations in family caregivers varied after the first and second courses, the exposure risk factors were analyzed by scoring the PPE-wearing time index (caring minutes × PPE points from wearing masks, gloves, and/or gowns) and CPM adhesion of PPE items with the caring patterns of diaper change, washing body care, oral care, eating assistance, emotional support, and co-sleeping. The closest association was observed for CPM adhesion between oral care gloves and undershirts (correlation coefficient 0.67, p = 0.001). The mixed-effect model analysis indicated only a significant correlation between the PPE-wearing time index and emotional care (playing, cuddling, and physical contact) (p = 0.016). These results suggest that prolonged emotional support results in poor PPE protection, which increases the risk of exposure in family caregivers. Strict PPE care within 48 h after high-dose CPM controls the exposure to high-risk anticancer drugs in caregivers of pediatric patients.
Topics: Humans; Caregivers; Cyclophosphamide; Female; Neoplasms; Male; Child; Child, Preschool; Adult; Personal Protective Equipment; Infant; Adolescent; Environmental Exposure; Antineoplastic Agents, Alkylating; Risk Factors; Middle Aged
PubMed: 38870739
DOI: 10.1016/j.ijheh.2024.114402 -
Alternative Therapies in Health and... Jun 2024Hyponatremia is one of the main types of complications of primary nephrotic syndrome in children, which can cause significant damage to the patient's nervous system and...
OBJECTIVE
Hyponatremia is one of the main types of complications of primary nephrotic syndrome in children, which can cause significant damage to the patient's nervous system and can lead to death or shock if not intervened early. In addition, patients are relatively young and often need to pay attention to the nursing cooperation of various key points in order to achieve ideal clinical treatment effects. To analyze the key points of nursing cooperation and the implementation effects of primary nephrotic syndrome in children complicated with hyponatremia.
METHODS
A retrospective analysis of 100 children with primary nephrotic syndrome complicated with hyponatremia admitted to our Hospital from January 2018 to November 2022 was conducted as the study objects. They were divided into a control and observation groups, with 50 cases each. Among them, the control group received routine nursing, while the observation group paid attention to various key points of nursing cooperation. This includes paying close attention to changes in plasma osmotic pressure, blood sodium, and electrocardiogram indicators, being alert to the above situations, and taking appropriate treatment measures in a timely manner; nursing staff need to guide family members to cooperate in alleviating clinical related symptoms, guide family members to avoid giving children irritating foods, and control the intake of sodium chloride. Guide parents to adjust their clothing and keep their skin dry and clean. Guide parents to provide psychological support for children and other key points of nursing cooperation. After different nursing measures were taken for the two groups, the scores of Quality of Life Core Questionnaire Scale related to patients after nursing, renal functions after nursing, and coagulation function indicators after nursing of the two groups were evaluated. Simultaneously compare the nursing efficacy, incidence of adverse reactions, and overall satisfaction rate of their family members between the two groups.
RESULTS
The scores of the core questionnaire scale of quality of life after nursing (physical function, emotional function, cognitive function, social function), coagulation function indexes after nursing (prothrombin time, activated partial thromboplastin), nursing efficacy, and the total satisfaction rate of patients' families were compared between the two groups. The observation group was higher than the control group (P < .05). The renal function indexes after nursing (serum creatinine, urea nitrogen, α1-microglobulin, 24h urine protein quantitative) and the incidence of adverse reactions (gastrointestinal discomfort, hypoglycemia, abnormal liver function) were compared between the two groups. The observation group was lower than the control group (P < .05).
CONCLUSION
As an auxiliary treatment intervention measure, the clinical effects obtained from the practice of nursing cooperation of each key point and the support of family members provide important strategic guidance for the selection of nursing strategies for children with primary nephrotic syndrome and hyponatremia. Such potential improvements have greatly promoted the improvement of the quality and efficiency of the entire department of pediatric nephrology and nursing, and are worthy of clinical promotion. That is, the focus of nursing cooperation should pay attention to the key points of nursing cooperation for children with primary nephrotic syndrome and hyponatremia to improve the quality of life of patients. Future studies can explore the universality of the application effect of relevant nursing points in other children.
PubMed: 38870508
DOI: No ID Found -
Pediatric Quality & Safety 2024Pediatric cardiac surgery is complex and has significant risk, requiring interprofessional teamwork for optimal outcomes. Unhealthy work environments have been linked to...
INTRODUCTION
Pediatric cardiac surgery is complex and has significant risk, requiring interprofessional teamwork for optimal outcomes. Unhealthy work environments have been linked to poor patient outcomes, staff dissatisfaction, and intention to leave. We describe the interprofessional health of pediatric cardiovascular operating room (CVOR) work environments in the United States and the establishment of a healthy work environment (HWE) benchmark score.
METHODS
Utilizing the American Association of Critical Care Nurses Healthy Work Environments Assessment Tool (HWEAT), interprofessional staff from 11 pediatric CVORs were surveyed. Responses were aggregated, summarized, and stratified by role to examine differences. The following phase used an e-Delphi approach to obtain expert consensus on a benchmark target.
RESULTS
Across 11 centers, 179 (60%) completed surveys were reviewed. The interprofessional mean HWEAT score was 3.55 (2.65-4.34). Mean scores for each standard were within the "good" range. Participants reported the highest scores for effective decision-making, with a mean of 3.69 (3.00-4.20). Meaningful recognition scored lowest, mean 3.26 (2.33-4.07). When stratified, surgeons reported higher overall HWE scores (M = 3.79, SD = 0.13) than nurses (M = 3.41, SD = 0.19; = 0.02, two-tailed). The proposed benchmark was 3.50.
CONCLUSIONS
This is the first time the American Association of Critical Care Nurses HWEAT has been used to describe the interprofessional health of work environments in pediatric CVORs in the United States. The targeted benchmark can support pediatric CVOR improvement strategies. Creating and sustaining an HWE is an interprofessional opportunity to support high-quality patient outcomes and clinical excellence.
PubMed: 38868759
DOI: 10.1097/pq9.0000000000000737 -
Pediatric Quality & Safety 2024Asthma exacerbations are common presentations to pediatric emergency departments. Standard treatment for moderate-to-severe exacerbations includes administration of oral...
INTRODUCTION
Asthma exacerbations are common presentations to pediatric emergency departments. Standard treatment for moderate-to-severe exacerbations includes administration of oral corticosteroids concurrently with bronchodilators. Early administration of corticosteroids has been shown to decrease emergency department length of stay (LOS) and hospitalizations. Our SMART aim was to reduce the time from arrival to oral corticosteroids (dexamethasone) administration in pediatric patients ≥2 years of age with an initial Pediatric Asthma Severity Score >6 from 60 to 30 minutes within 6 months.
METHODS
We used the model for improvement with collaboration between ED physicians, nursing, pharmacy, and respiratory therapists. Interventions included nursing education, dosage rounding in the electronic medical record, supplying triage with 1-mg tablets and a pill crusher, updates to an asthma nursing order set and pertinent chief complaints triggering nurses to document a Pediatric Asthma Severity Score in the electronic medical record and use the order set. Our primary outcome measure was the time from arrival to dexamethasone administration. Secondary outcome measures included ED LOS for discharged patients and admission rate. We used statistical process control to analyze changes in measures over time.
RESULTS
From October 2021 to March 2022, the average time for dexamethasone administration decreased from 59 to 38 minutes. ED LOS for discharged asthma exacerbation patients rose with overall ED LOS for all patients during the study period. There was no change in the admission rate.
CONCLUSIONS
Using quality improvement methodology, we successfully decreased the time from ED arrival to administration of dexamethasone in asthma exacerbation patients from 59 to 38 minutes over 10 months.
PubMed: 38868756
DOI: 10.1097/pq9.0000000000000738 -
Heliyon Jun 2024Utilizing the nursing process within clinical settings serves to enhance the scientific stature of the nursing field. Nonetheless, various research findings suggest that...
Exploring the perceptions of nursing internship students and their faculty mentors regarding the complexities and hindrances associated with implementing the nursing process within the clinical setting: An in-depth qualitative investigation.
BACKGROUND
Utilizing the nursing process within clinical settings serves to enhance the scientific stature of the nursing field. Nonetheless, various research findings suggest that nursing internship students encounter difficulties when it comes to implementing the nursing process and may lack the necessary proficiency.
OBJECTIVES
The aim of this investigation is to identify the perceptions of nursing internship students and their faculty mentors regarding the complexities and hindrances associated with implementing the nursing process within the clinical setting.
DESIGN
A qualitative content analysis
PARTICIPANTS
Nursing internship students and their faculty mentors from the Isfahan School of Nursing and Midwifery.
METHODS
In this study, individual interviews were conducted with 13 participants. The data for this study were gathered through these semi-structured interviews and subsequently analyzed using the Granheim and Lundman method. To ensure the validity and reliability of the data, the evaluative criteria of Lincoln and Guba were employed.
RESULTS
The obstacles unveiled in this study can be categorized into three primary domains, each with its own subcategories: 1-Student role ambiguity (1-1 Lack of practical autonomy; 1-2 Insufficient proficiency in the nursing process; 1-3 Motivational deficiency). 2- Organizational Challenges (2-1 Shortage of nursing staff; 2-2 Suboptimal interpersonal dynamics); And 3- Gradual Erosion of the Nursing Process.
CONCLUSION
Recognizing the paramount importance of the nursing process in enhancing patient care quality is universally accepted. Therefore, it is imperative to systematically identify and tackle the challenges associated with its application. This study highlights that these challenges stem from various factors, including the multifaceted roles assumed by nursing students, organizational shortcomings within healthcare institutions, and the neglect or erosion of the nursing process in specific clinical settings. Addressing these issues is crucial for ensuring the effective utilization of the nursing process within the nursing profession and for optimizing patient care outcomes.
PubMed: 38867974
DOI: 10.1016/j.heliyon.2024.e31715