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BMC Medical Education Jun 2024Transcultural nursing recognises the significance of cultural backgrounds in providing patients with quality care. This study investigates the opinions of master's...
BACKGROUND
Transcultural nursing recognises the significance of cultural backgrounds in providing patients with quality care. This study investigates the opinions of master's students in nursing and midwifery regarding the attitudes of Jehovah's Witnesses towards refusing blood transfusions.
METHODS
349 master's students in nursing and midwifery participated in a quantitative study and were surveyed via the Web to evaluate their awareness of the stance of Jehovah's Witnesses on blood transfusions and the ethical and legal dilemmas associated with caring for Jehovah's Witness (JW) patients.
RESULTS
The study yielded three significant findings. It unequivocally demonstrates that nursing and midwifery students possess inadequate knowledge regarding Jehovah's Witnesses' stance on blood transfusions and their acceptance of specific blood products and medical procedures. Despite being cognisant of the ethical and legal dilemmas of caring for JW patients, students lack an understanding of patients' autonomy to reject blood transfusions and their need for bloodless medicine. Students also articulated educational needs regarding cultural competencies regarding the Jehovah's Witnesses' beliefs on blood transfusions and non-blood management techniques.
CONCLUSIONS
Healthcare professionals need the knowledge and skills necessary to provide holistic, patient-centred and culturally sensitive care. This study emphasises the urgent need for university curricula and nursing postgraduate training to include modules on transcultural nursing and strategies for minimising blood loss.
Topics: Humans; Jehovah's Witnesses; Blood Transfusion; Cultural Competency; Female; Students, Nursing; Attitude of Health Personnel; Male; Midwifery; Adult; Treatment Refusal
PubMed: 38879475
DOI: 10.1186/s12909-024-05646-1 -
Journal of Stroke and Cerebrovascular... Jun 2024Stump syndrome is defined as a clinical syndrome resulting from a distal intracranial vessel embolic stroke due to an extracranial vessel occlusion. Similar to the...
INTRODUCTION
Stump syndrome is defined as a clinical syndrome resulting from a distal intracranial vessel embolic stroke due to an extracranial vessel occlusion. Similar to the anterior circulation, the recurrence of ischemic strokes in territories supplied by the posterior circulation in the presence of vertebral artery occlusion is termed Vertebral Artery Stump Syndrome (VASS).
MATERIAL AND METHODS
We conducted a literature review, identifying 72 patients with transient ischemic attacks (TIAs) or ischemic strokes attributed to VASS, according to Kawano criteria. We categorized all patients in two groups focusing on the therapeutic management those who underwent primary medical treatment and those who received endovascular or surgical treatment either in acute or chronic phase.
RESULTS
In the anticoagulant therapy group, only 1 patient had a stroke recurrence. Among the 4 on antiplatelets, all had recurrences, but 3 benefited from switching to anticoagulants or endovascular therapy. In the endovascular therapy group, worse outcomes were linked to acute large vessel occlusion. Endovascular treatment of the vertebral artery, in a chronic phase, was explored in literature for recurrent TIAs or minor strokes suggesting that this could be a viable therapeutic alternative when medical treatment failed in preventing recurrence of ischemic stroke.
CONCLUSIONS
Some studies suggest that anticoagulant medical therapy may be beneficial for VASS and endovascular therapy has also been reported for selected patients. However, data on treatment outcomes and prognosis are still underreported, making treatment decisions challenging. Randomized Controlled Trials are needed to establish the optimal treatment approach.
PubMed: 38878845
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107819 -
PloS One 2024After the first COVID-19 vaccines received emergency use authorization from the U.S. FDA in December 2020, U.S. states employed vaccine eligibility and administration...
After the first COVID-19 vaccines received emergency use authorization from the U.S. FDA in December 2020, U.S. states employed vaccine eligibility and administration plans (VEAPs) that determined when subgroups of residents would become eligible to receive the vaccine while the vaccine supply was still limited. During the implementation of these plans, public concern grew over whether the VEAPs and vaccine allocations from the federal government were resulting in an equitable and efficient vaccine distribution. In this study, we collected data on five states' VEAPs, federal vaccine allocations, vaccine administration, and vaccine hesitancy to assess the equity of vaccine access and vaccine administration efficiency that manifested during the campaign. Our results suggest that residents in states which opened eligibility to the vaccine sooner had more competition among residents to receive the vaccine than occurred in other states. Regardless of states' VEAPs, there was a consistent inefficiency in vaccine administration among all five states that could be attributed to both state and federal infrastructure deficits. A closer examination revealed a misalignment between federal vaccine allocations and the total eligible population in the states throughout the campaign, even when accounting for hesitancy. We conclude that in order to maximize the efficiency of future mass-vaccination campaigns, the federal and state governments should design adaptable allocation policies and eligibility plans that better match the true, real-time supply and demand for vaccines by accounting for vaccine hesitancy and manufacturing capacity. Further, we discuss the challenges of implementing such strategies.
Topics: Humans; COVID-19 Vaccines; United States; COVID-19; Vaccination Hesitancy; SARS-CoV-2; Vaccination; Federal Government; Health Equity
PubMed: 38875217
DOI: 10.1371/journal.pone.0304416 -
Genome Biology Jun 2024Genomic data holds huge potential for medical progress but requires strict safety measures due to its sensitive nature to comply with data protection laws. This conflict... (Review)
Review
Genomic data holds huge potential for medical progress but requires strict safety measures due to its sensitive nature to comply with data protection laws. This conflict is especially pronounced in genome-wide association studies (GWAS) which rely on vast amounts of genomic data to improve medical diagnoses. To ensure both their benefits and sufficient data security, we propose a federated approach in combination with privacy-enhancing technologies utilising the findings from a systematic review on federated learning and legal regulations in general and applying these to GWAS.
Topics: Genome-Wide Association Study; Humans; Computer Security; Genetic Privacy
PubMed: 38872191
DOI: 10.1186/s13059-024-03296-6 -
CNS Oncology Jun 2024To evaluate the neuro-oncology providers' experience with patient online access to electronic records. Cross-sectional survey for physicians and advanced care...
To evaluate the neuro-oncology providers' experience with patient online access to electronic records. Cross-sectional survey for physicians and advanced care providers within the field of neuro-oncology in the USA. 65 providers completed the survey, from all major regions of the USA. 58% reported that at least once per month, patients contacted them outside of an office visit about provider notes or a laboratory or imaging finding accessed online. 54% of providers did not think that all laboratory results should be released automatically, and only 25% of providers thought that all radiology reads should be released immediately. 97% thought that some patients suffered substantial distress viewing test results prior to appointments. Qualitative responses aligned with the quantitative results. Most neuro-oncology providers are concerned about the immediate release of laboratory and imaging findings to patients without guidance.
Topics: Humans; Cross-Sectional Studies; Electronic Health Records; Male; Female; Medical Oncology; Patient Access to Records; Attitude of Health Personnel; United States; Surveys and Questionnaires; Neurology
PubMed: 38869443
DOI: 10.1080/20450907.2024.2352414 -
SAGE Open Medicine 2024Do-Not-Attempt-Resuscitation orders originated in the early 1960s with the establishment of advanced cardiopulmonary resuscitation. These orders aim to limit therapeutic...
OBJECTIVE
Do-Not-Attempt-Resuscitation orders originated in the early 1960s with the establishment of advanced cardiopulmonary resuscitation. These orders aim to limit therapeutic efforts in cases where it may be futile. The decision not to resuscitate a patient is a process that involves a series of ethical, legal, and clinical considerations. Still, it also requires a process in which priority is given to the patients and their autonomy. The objective of this study was to describe the knowledge and attitudes of physicians working in Chile toward Do-Not-Attempt-Resuscitation orders.
METHODS
A cross-sectional study was conducted, in which a digital questionnaire was sent to physicians from different regions of Chile. Quantitative variables were analyzed using measures of central tendency and dispersion (e.g., median and interquartile range), while qualitative variables were evaluated using frequencies and percentages.
RESULTS
Four hundred and thirty-one physicians completed the survey. 85.4% were familiar with the ethical and legal guidelines for cardiopulmonary resuscitation and the rights and duties of the patient. 39.2% believed that patients should have the final decision Do-Not-Attempt-Resuscitation orders, especially if they themselves requested not to be resuscitated. 87.7% mentioned that the Do-Not-Attempt-Resuscitation orders should be reassessed if the patient's prognosis improves. In addition, it was found that the decision not to resuscitate was not always discussed with the patient or their family.
CONCLUSIONS
The study revealed an ethical conflict regarding Do-Not-Attempt-Resuscitation orders and their management by Chilean physicians. Therefore, it is necessary to create recommendations and provide training to guide professionals in this process, which should also involve patients and their families.
PubMed: 38867717
DOI: 10.1177/20503121241259285 -
Deutsches Arzteblatt International Apr 2024
Topics: Humans; Informed Consent; Magnetic Resonance Imaging; Germany; Allied Health Personnel
PubMed: 38867548
DOI: 10.3238/arztebl.m2023.0273 -
PloS One 2024To understand motivators, concerns, and factors associated with COVID-19 vaccine initiation for adults in five racial/ethnic communities across Colorado.
PURPOSE
To understand motivators, concerns, and factors associated with COVID-19 vaccine initiation for adults in five racial/ethnic communities across Colorado.
METHODS
Community-based data collectors surveyed participants from five Colorado communities (urban and rural Latina/o/x, urban Black, rural African American immigrant, and urban American Indian) about vaccine attitudes, intentions, and uptake from September to December 2021. Bivariate and multivariable logistic regression models were used to examine factors associated with the primary outcome of COVID-19 vaccine "initiation."
RESULTS
Most participants (71.1%) reported having initiated COVID-19 vaccination; vaccine series completion was 65.1%. Both motivators and concerns about COVID-19 vaccines were prevalent. Vaccine hesitancy (OR: 0.41, 95% CI:0.32-0.53; p < .001) and low perceptions of COVID-19 vaccination social norms (OR: 0.48, 95% CI:0.27-0.84; p = .01) were associated with vaccine initiation.
CONCLUSION
Despite the limitation of a moderate sample size, our findings support the need for further interventions to increase vaccination against COVID-19 by reducing vaccine hesitancy and improving perceived social norms of vaccination in underserved Colorado communities.
IMPLICATIONS
To improve trust in vaccines and promote vaccine uptake, community messaging should be tailored to vaccination motivators and concerns and demonstrate COVID-19 vaccination as the community default.
Topics: Humans; Colorado; COVID-19 Vaccines; Female; Male; COVID-19; Adult; Middle Aged; Vaccination; SARS-CoV-2; Aged; Vaccination Hesitancy; Young Adult; Adolescent
PubMed: 38865424
DOI: 10.1371/journal.pone.0305160 -
Acceptance and hesitancy towards COVID-19 vaccines in rural and tribal areas of Maharashtra (India).Journal of Infection in Developing... May 2024Hesitancy towards COVID-19 vaccines may be a major hindrance to a successful vaccination program. We assessed the vaccine uptake, facilitators, and barriers for the...
INTRODUCTION
Hesitancy towards COVID-19 vaccines may be a major hindrance to a successful vaccination program. We assessed the vaccine uptake, facilitators, and barriers for the COVID-19 vaccine in tribal and rural populations in Maharashtra, India.
METHODOLOGY
The present study is a cross-sectional analysis of data collected from 373 individuals from six villages (three tribal and three rural) from August 2022 to September 2022. Demographic information, COVID-19 history, details about vaccination, and reasons for taking/not taking the vaccine were collected.
RESULTS
In these individuals, 236 (63.3%) had taken two doses, 85 (22.8%) had taken one dose, and 52 (13.9%) had not taken the vaccine. Tribal villagers were less likely to have completed vaccination (50.7% vs 79.3%; p < 0.001). Males were more likely to state 'compulsory at my workplace' (27.7% vs 7.7%; p < 0.001), whereas females were more likely to report 'could not get ration food without it' (52.7% vs 31.5%; p < 0.001) as the reason for vaccination. Common reasons for not taking the vaccine were: fear of side effects (56%); no need for vaccination (41.2%); do not trust the vaccines (40%); and 'there is no such thing as COVID-19'(16%). A majority (94.7%) had completed COVID-19 vaccination at government vaccination centers.
CONCLUSIONS
Tribal villagers, women, and those from lower socioeconomic status were less likely to have taken the vaccine. Fear about side effects and mistrust about vaccines were the main reasons for not having taken the vaccine. Addressing these issues in mass information campaigns may help improve vaccination coverage.
Topics: Humans; India; COVID-19 Vaccines; Male; Female; Cross-Sectional Studies; COVID-19; Adult; Rural Population; Middle Aged; Vaccination Hesitancy; Patient Acceptance of Health Care; Vaccination; SARS-CoV-2; Young Adult; Adolescent; Aged
PubMed: 38865408
DOI: 10.3855/jidc.18213 -
PloS One 2024To study informed consent to midwifery practices and interventions during the second stage of labor and to investigate the association between informed consent and... (Observational Study)
Observational Study
OBJECTIVES
To study informed consent to midwifery practices and interventions during the second stage of labor and to investigate the association between informed consent and experiences of these practices and interventions and women's experiences of the second stage of labor.
METHODS
This study uses an observational design with data from a follow-up questionnaire sent to women one month after giving birth spontaneously in the Oneplus trial, a study aimed at evaluating collegial midwifery assistance to reduce severe perineal trauma. The trial was conducted between 2018-2020 at five Swedish maternity wards and trial registered at clinicaltrials.gov, no NCT03770962. The follow-up questionnaire contained questions about experiences of the second stage of labor, practices and interventions used and whether the women had provided informed consent. Evaluated practices and interventions were the use of warm compresses held at the perineum, manual perineal protection, vaginal examinations, perineal massage, levator pressure, intermittent catheterization of the bladder, fundal pressure, and episiotomy. Associations between informed consent and women's experiences were assessed by univariate and multivariable logistic regression.
FINDINGS
Of the 3049 women participating in the trial, 2849 consented to receive the questionnaire. Informed consent was reported by less than one in five women and was associated with feelings of being safe, strong, and in control. Informed consent was further associated with more positive experiences of clinical practices and interventions, and with less discomfort and pain from interventions involving physical penetration of the genital area.
CONCLUSION
The findings indicate that informed consent during the second stage is associated with feelings of safety and of being in control. With less than one in five women reporting informed consent to all practices and interventions performed by midwives, the results emphasize the need for further action to enhance midwives' knowledge and motivation in obtaining informed consent prior to performance of interventions.
Topics: Humans; Female; Pregnancy; Adult; Informed Consent; Labor Stage, Second; Midwifery; Surveys and Questionnaires; Delivery, Obstetric; Sweden; Young Adult
PubMed: 38865296
DOI: 10.1371/journal.pone.0304418