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Frontiers in Sociology 2024Despite the commitment of the Swedish government to ensuring equal access to Sexual Reproductive Health and Rights services for all citizens, shortcomings persist among...
INTRODUCTION
Despite the commitment of the Swedish government to ensuring equal access to Sexual Reproductive Health and Rights services for all citizens, shortcomings persist among the migrant population. In cases where healthcare providers lack sufficient knowledge or hold misconceptions and biases about these contentious issues, it can lead to the delivery of suboptimal care. Therefore, the objective of this study was to assess the level of knowledge of Swedish healthcare providers on global and Swedish migrant Sexual Reproductive Health and Rights.
METHODS
A national cross-sectional study was conducted using a questionnaire consisting of seven questions related to global and Swedish migrant Sexual Reproductive Health and Rights. The questionnaire was distributed among midwives, nurses, gynecologists and obstetricians, and hospital social workers ( = 731). The analysis was guided by the Factfulness framework developed by Hans Rosling to identify disparities between healthcare providers' viewpoints and evidence-based knowledge.
RESULTS
There was an overall lack of knowledge among the health care providers on these issues. The highest correct responses were on the question on abandonment of female genital cutting/mutilation after migration (74%). The findings indicated that healthcare providers originating from Sweden, physicians, those with fewer years of clinical experience, and exhibiting more migrant-friendly attitudes, demonstrated a higher level of knowledge regarding global and Swedish migrant Sexual and Reproductive Health and Rights.
CONCLUSION
This study demonstrates that healthcare providers lacked knowledge of global and Swedish migrant Sexual Reproductive Health and Rights, which was almost uniformly distributed, except among those with more comprehensive and recent education. Contrary to expectations, healthcare professionals did not primarily rely on their education and experiences but were influenced by their personal values and opinions. The study underscores the importance of upgrading knowledge in Sexual Reproductive Health and Rights and encourages policymakers, professionals, and students to base their opinions on well-founded facts, particularly in the context of a diverse and globalized society.
PubMed: 38873341
DOI: 10.3389/fsoc.2024.1356418 -
BJGP Open Jun 2024Early in the Covid-19 pandemic, the use of video consultation (VC) expanded considerably, with GPs indicating high satisfaction with it. However, use of VC declined as...
BACKGROUND
Early in the Covid-19 pandemic, the use of video consultation (VC) expanded considerably, with GPs indicating high satisfaction with it. However, use of VC declined as lock-down measures were eased.
AIM
To explore reasons why VC use has declined in Norwegian general practice by investigating GPs' experiences with VC since the start of the pandemic and their attitudes towards it in a post-pandemic setting.
DESIGN & SETTING
Qualitative study design. Semi-structured interviews with 13 GPs in southern Norway.
METHOD
The method of data analysis was Braun & Clarke's reflexive thematic analysis.
RESULTS
Although the implementation of VCs was unplanned, most participants were able to use this modality without much problem. Several GPs initially envisioned long-term VC use. However, despite certain positives, VCs were largely sidelined in favour of face-to-face and telephone consultations due to their practicality and VC's limited usefulness when considering the extra effort required. Nonetheless, GPs recognised ways of using VC that might exploit its strengths, but they highlighted how its sustained use would require them to replace other consultation modalities. They also identified extrinsic factors that might lead to the increased use of VC, including improved VC technology and patient demand.
CONCLUSION
Although VC is now part of many GPs' consultation toolbox, its perceived relative lack of usefulness and extra effort compared to other remote consultation modalities mean that most GPs have chosen to abandon it as a routine consultation modality.
PubMed: 38866403
DOI: 10.3399/BJGPO.2024.0010 -
Frontiers in Digital Health 2024Implementing and sustaining technological innovations in healthcare is a complex process. Commonly, innovations are abandoned due to unsuccessful attempts to sustain and...
Implementing and sustaining technological innovations in healthcare is a complex process. Commonly, innovations are abandoned due to unsuccessful attempts to sustain and scale-up post implementation. Limited information is available on what characterizes successful e-health innovations and the enabling factors that can lead to their sustainability in complex hospital environments. We present a successful implementation, sustainability and scale-up of a virtual care program consisting of three e-health applications (telemedicine, telehome monitoring, and interactive voice response) in a major cardiac care hospital in Canada. We describe their evolution and adaptation over time, present the innovative approach for their "business case" and funding that supported their implementation, and identify key factors that enabled their sustainability and success, which may inform future research and serve as a benchmark for other health care organizations. Despite resource constraints, e-health innovations can be deployed and successfully sustained in complex healthcare settings contingent key considerations: simplifying technology to make it intuitive for patients; providing significant value proposition that is research supported to influence policy changes; involving early supporters of adoption from administrative and clinical staff; engaging patients throughout the innovation cycle; and partnering with industry/technology providers.
PubMed: 38746777
DOI: 10.3389/fdgth.2024.1346085 -
PLoS Neglected Tropical Diseases May 2024Neglected tropical diseases (NTDs) mainly affect underprivileged populations, potentially resulting in catastrophic health spending (CHS) and impoverishment from... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Neglected tropical diseases (NTDs) mainly affect underprivileged populations, potentially resulting in catastrophic health spending (CHS) and impoverishment from out-of-pocket (OOP) costs. This systematic review aimed to summarize the financial hardship caused by NTDs.
METHODS
We searched PubMed, EMBASE, EconLit, OpenGrey, and EBSCO Open Dissertations, for articles reporting financial hardship caused by NTDs from database inception to January 1, 2023. We summarized the study findings and methodological characteristics. Meta-analyses were performed to pool the prevalence of CHS. Heterogeneity was evaluated using the I2 statistic.
RESULTS
Ten out of 1,768 studies were included, assessing CHS (n = 10) and impoverishment (n = 1) among 2,761 patients with six NTDs (Buruli ulcer, chikungunya, dengue, visceral leishmaniasis, leprosy, and lymphatic filariasis). CHS was defined differently across studies. Prevalence of CHS due to OOP costs was relatively low among patients with leprosy (0.0-11.0%), dengue (12.5%), and lymphatic filariasis (0.0-23.0%), and relatively high among patients with Buruli ulcers (45.6%). Prevalence of CHS varied widely among patients with chikungunya (11.9-99.3%) and visceral leishmaniasis (24.6-91.8%). Meta-analysis showed that the pooled prevalence of CHS due to OOP costs of visceral leishmaniasis was 73% (95% CI; 65-80%, n = 2, I2 = 0.00%). Costs of visceral leishmaniasis impoverished 20-26% of the 61 households investigated, depending on the costs captured. The reported costs did not capture the financial burden hidden by the abandonment of seeking healthcare.
CONCLUSION
NTDs lead to a substantial number of households facing financial hardship. However, financial hardship caused by NTDs was not comprehensively evaluated in the literature. To develop evidence-informed strategies to minimize the financial hardship caused by NTDs, studies should evaluate the factors contributing to financial hardship across household characteristics, disease stages, and treatment-seeking behaviors.
Topics: Neglected Diseases; Humans; Tropical Medicine; Health Expenditures; Financial Stress; Leprosy; Poverty; Cost of Illness; Elephantiasis, Filarial
PubMed: 38739636
DOI: 10.1371/journal.pntd.0012086 -
Journal of Clinical Medicine Apr 2024: The study aimed to describe the phenomenon of leads migrated (MPLE) into the cardiovascular system (CVS). : Retrospective analysis of 3847 transvenous lead extractions...
: The study aimed to describe the phenomenon of leads migrated (MPLE) into the cardiovascular system (CVS). : Retrospective analysis of 3847 transvenous lead extractions (TLE). : Over a 17-year period, 72 (1.87%) MPLEs (median dwell time 137.5 months) were extracted, which included mainly ventricular leads (56.94%). Overall, 68.06% of MPLEs had their cut proximal ends in the venous system. Most of them were pacing (95.83%) and passive fixation (98.61%) leads. Independent risk factors for MPLE included abandoned leads (OR = 8.473; < 0.001) and leads located on both sides of the chest (2.981; = 0.045). The higher NYHA class lowered the probability of MPLE (OR = 0.380; < 0.001). Procedure complexity was higher in the MPLE group (procedure duration, unexpected procedure difficulties, use of additional (advanced) tools and alternative venous approach). There were no more major complications in the MPLE group, but the rate of procedural success was lower due to more frequent retention of non-removable lead fragments. Extraction of MPLEs did not influence long-term survival. : 1. Extraction of leads with MPLE is rare among other TLE procedures (1.9%), 2. risk factors include abandoned leads and presence of leads on both sides of the chest but a higher NYHA class lowers the probability of MPLE, 3. complexity of MPLE extraction is higher regarding procedure duration, unexpected procedure difficulties, use of advanced tools and techniques but rates of major complications are comparable, and 4. extraction of MPLEs did not influence long-term survival.
PubMed: 38731132
DOI: 10.3390/jcm13092602 -
Trials May 2024With roughly 45,000 adult patients each year, distal radius fractures are one of the most common fractures in the emergency department. Approximately 60% of all these...
BACKGROUND
With roughly 45,000 adult patients each year, distal radius fractures are one of the most common fractures in the emergency department. Approximately 60% of all these fractures are displaced and require surgery. The current guidelines advise to perform closed reduction of these fractures awaiting surgery, as it may lead to post-reduction pain relief and release tension of the surrounding neurovascular structures. Recent studies have shown that successful reduction does not warrant conservative treatment, while patients find it painful or even traumatizing. The aim of this study is to determine whether closed reduction can be safely abandoned in these patients.
METHODS
In this multicenter randomized clinical trial, we will randomize between closed reduction followed by plaster casting and only plaster casting. Patients aged 18 to 75 years, presenting at the emergency department with a displaced distal radial fracture and requiring surgery according to the attending surgeon, are eligible for inclusion. Primary outcome is pain assessed with daily VAS scores from the visit to the emergency department until surgery. Secondary outcomes are function assessed by PRWHE, length of stay at the emergency department, length of surgery, return to work, patient satisfaction, and complications. A total of 134 patients will be included in this study with follow-up of 1 year.
DISCUSSION
If our study shows that patients who did not receive closed reduction experience no significant drawbacks, we might be able to reorganize the initial care for distal radial fractures in the emergency department. If surgery is warranted, the patient can be sent home with a plaster cast to await the call for admission, decreasing the time spend in the emergency room drastically.
TRIAL REGISTRATION
This trial was registered on January 27, 2023.
Topics: Humans; Radius Fractures; Casts, Surgical; Emergency Service, Hospital; Middle Aged; Closed Fracture Reduction; Adult; Aged; Treatment Outcome; Adolescent; Female; Randomized Controlled Trials as Topic; Young Adult; Male; Multicenter Studies as Topic; Time Factors; Patient Satisfaction; Pain Measurement; Recovery of Function; Wrist Fractures
PubMed: 38711069
DOI: 10.1186/s13063-024-08118-5 -
American Journal of Perinatology May 2024Recent advances in genetics and imaging have ushered substantial breakthroughs in screening and diagnosis for chromosomal and structural abnormalities. Thus, it is...
Recent advances in genetics and imaging have ushered substantial breakthroughs in screening and diagnosis for chromosomal and structural abnormalities. Thus, it is imperative that health care providers caring for pregnant individuals should reexamine established practices in prenatal screening and diagnosis. In the past, screening for chromosomal abnormalities was based almost entirely on Down syndrome. Pregnant individuals aged > 35 years were considered at "high risk" or of "advanced maternal age" based on age alone; however, the advent of tests with high sensitivity for prenatal detection of chromosomal abnormalities should lead to abandoning that concept, at least from the perspective of chromosomal abnormalities. Given that first-trimester and second-trimester screenings will fail to detect between 5 and 20% of Down syndrome, in most situations, noninvasive testing with cell-free DNA should be the first-line screen for Down syndrome. The fact that over 99% of fetuses with Down syndrome will be detected prenatally with cell-free DNA gives other fetal chromosomal and structural abnormalities increasing prominence. Chromosomal microarray analysis (CMA) permits prenatal detection of several clinically important chromosomal aberrations that cannot be detected by karyotype and may exist in structurally normal fetuses with low-risk cell-free DNA screening. As such, CMA should be more readily conducted when invasive testing is performed, regardless of the presence of a structural abnormality. Isolated sonographic "soft markers" have no clinical significance in patients who have normal cell-free DNA screening, can cause unwarranted anxiety and a negative impact on pregnancy, and perhaps it is time to stop discussing them. Detailed first-trimester ultrasound allows early detection of several severe fetal anomalies and, therefore, in settings with adequately trained personnel and resources, should be used more frequently. This opinion traces the evolution of prenatal screening and diagnosis and advocates for a paradigm shift that aligns with recent developments in prenatal screening and diagnostic capabilities. KEY POINTS: · Noninvasive prenatal testing with cell-free DNA should be available to all pregnant individuals.. · Chromosomal microarray should be available to all pregnant individuals undergoing amniocentesis.. · Patients >35 years with low-risk screening are not at "high risk" for chromosomal abnormalities..
PubMed: 38657662
DOI: 10.1055/a-2312-8824 -
JMIR Formative Research Apr 2024Though there has been considerable effort to implement machine learning (ML) methods for health care, clinical implementation has lagged. Incorporating explainable...
BACKGROUND
Though there has been considerable effort to implement machine learning (ML) methods for health care, clinical implementation has lagged. Incorporating explainable machine learning (XML) methods through the development of a decision support tool using a design thinking approach is expected to lead to greater uptake of such tools.
OBJECTIVE
This work aimed to explore how constant engagement of clinician end users can address the lack of adoption of ML tools in clinical contexts due to their lack of transparency and address challenges related to presenting explainability in a decision support interface.
METHODS
We used a design thinking approach augmented with additional theoretical frameworks to provide more robust approaches to different phases of design. In particular, in the problem definition phase, we incorporated the nonadoption, abandonment, scale-up, spread, and sustainability of technology in health care (NASSS) framework to assess these aspects in a health care network. This process helped focus on the development of a prognostic tool that predicted the likelihood of admission to an intensive care ward based on disease severity in chest x-ray images. In the ideate, prototype, and test phases, we incorporated a metric framework to assess physician trust in artificial intelligence (AI) tools. This allowed us to compare physicians' assessments of the domain representation, action ability, and consistency of the tool.
RESULTS
Physicians found the design of the prototype elegant, and domain appropriate representation of data was displayed in the tool. They appreciated the simplified explainability overlay, which only displayed the most predictive patches that cumulatively explained 90% of the final admission risk score. Finally, in terms of consistency, physicians unanimously appreciated the capacity to compare multiple x-ray images in the same view. They also appreciated the ability to toggle the explainability overlay so that both options made it easier for them to assess how consistently the tool was identifying elements of the x-ray image they felt would contribute to overall disease severity.
CONCLUSIONS
The adopted approach is situated in an evolving space concerned with incorporating XML or AI technologies into health care software. We addressed the alignment of AI as it relates to clinician trust, describing an approach to wire framing and prototyping, which incorporates the use of a theoretical framework for trust in the design process itself. Moreover, we proposed that alignment of AI is dependent upon integration of end users throughout the larger design process. Our work shows the importance and value of engaging end users prior to tool development. We believe that the described approach is a unique and valuable contribution that outlines a direction for ML experts, user experience designers, and clinician end users on how to collaborate in the creation of trustworthy and usable XML-based clinical decision support tools.
PubMed: 38625728
DOI: 10.2196/50475 -
The Journal of Biological Chemistry May 2024DNA replication in Escherichia coli starts with loading of the replicative helicase, DnaB, onto DNA. This reaction requires the DnaC loader protein, which forms a 6:6...
DNA replication in Escherichia coli starts with loading of the replicative helicase, DnaB, onto DNA. This reaction requires the DnaC loader protein, which forms a 6:6 complex with DnaB and opens a channel in the DnaB hexamer through which single-stranded DNA is thought to pass. During replication, replisomes frequently encounter DNA damage and nucleoprotein complexes that can lead to replication fork collapse. Such events require DnaB re-loading onto DNA to allow replication to continue. Replication restart proteins mediate this process by recruiting DnaB/DnaC to abandoned DNA replication forks. Several dnaC mutations that bypass the requirement for replication restart proteins or that block replication restart have been identified in E. coli. To better understand how these DnaC variants function, we have purified and characterized the protein products of several such alleles. Unlike wild-type DnaC, three of the variants (DnaC 809, DnaC 809,820, and DnaC 811) can load DnaB onto replication forks bound by single-stranded DNA-binding protein. DnaC 809 can also load DnaB onto double-stranded DNA. These results suggest that structural changes in the variant DnaB/DnaC complexes expand the range of DNA substrates that can be used for DnaB loading, obviating the need for the existing replication restart pathways. The protein product of dnaC1331, which phenocopies deletion of the priB replication restart gene, blocks loading through the major restart pathway in vitro. Overall, the results of our study highlight the utility of bacterial DnaC variants as tools for probing the regulatory mechanisms that govern replicative helicase loading.
Topics: Escherichia coli Proteins; Escherichia coli; DnaB Helicases; DNA Replication; DNA, Bacterial; DNA, Single-Stranded; Mutation
PubMed: 38588814
DOI: 10.1016/j.jbc.2024.107275 -
Federal Practitioner : For the Health... Sep 2023Inpatient pharmacies receive numerous phone calls from health care professionals and patients. This uncaptured workload poses potential staffing concerns for pharmacy...
BACKGROUND
Inpatient pharmacies receive numerous phone calls from health care professionals and patients. This uncaptured workload poses potential staffing concerns for pharmacy administrators as unequal distribution or misdirected calls to the pharmacy team can lead to accountability and patient safety concerns. We aimed to implement and evaluate the effectiveness of an automated call distribution (ACD) system in an inpatient pharmacy setting at a US Department of Veterans Affairs hospital.
OBSERVATIONS
A new inpatient pharmacy service phone line extension was implemented at the Edward Hines, Jr. Veterans Affairs Hospital in Illinois. The ACD phone system yielded positive performance metrics, including ≤ 30 seconds mean speed to answer and ≤ 5% abandonment rate in the 12 months after implementation.
CONCLUSIONS
The ACD phone system is a promising, new application of available technology implemented in a nontraditional setting. The ACD system provides more actionable information and quality metrics data to pharmacy leadership. The implementation of the ACD system has improved accountability, efficiency, work distribution, and the allocation of resources.
PubMed: 38562161
DOI: 10.1278/fp.0402