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Canadian Family Physician Medecin de... Jun 2024To understand how lack of attachment to a regular primary care provider influences patients' outlooks on primary care, ability to address their health care needs, and...
OBJECTIVE
To understand how lack of attachment to a regular primary care provider influences patients' outlooks on primary care, ability to address their health care needs, and confidence in the health care system.
DESIGN
Qualitative descriptive study using semistructured interviews.
SETTING
Canadian provinces of Nova Scotia, Ontario, and Quebec.
PARTICIPANTS
Patients aged 18 years or older who were unattached or had become attached within 1 year of being interviewed and who resided in the province in which they were interviewed.
METHODS
Forty-one semistructured interviews were conducted, during which participants were asked to describe how they had become unattached, their searches to find new primary care providers, their perceptions of and experiences with the centralized waiting list in their province, their experiences seeking care while unattached, and the impact of being unattached on their health and on their perceptions of the health care system. Interviews were transcribed and analyzed using a thematic approach.
MAIN FINDINGS
Two main themes were identified in interviews with unattached or recently attached patients: unmet needs of unattached patients and the impact of being unattached. Patients' perceived benefits of attachment included access to care, longitudinal relationships with health care providers, health history familiarity, and follow-up monitoring and care coordination. Being unattached was associated with negative effects on mental health, poor health outcomes, decreased confidence in the health care system, and greater pre-existing health inequities.
CONCLUSION
Having a regular primary care provider is essential to having access to high-quality care and other health care services. Attachment also promotes health equity and confidence in the public health care system and has broader system-level, social, and policy implications.
Topics: Humans; Qualitative Research; Female; Male; Middle Aged; Adult; Patient Acceptance of Health Care; Primary Health Care; Health Services Accessibility; Canada; Aged; Interviews as Topic; Physician-Patient Relations
PubMed: 38886083
DOI: 10.46747/cfp.7006396 -
RMD Open Jun 2024To understand (1) what guidance exists to assess the methodological quality of qualitative research; (2) what methods exist to grade levels of evidence from qualitative...
Synthesis of guidance available for assessing methodological quality and grading of evidence from qualitative research to inform clinical recommendations: a systematic literature review.
OBJECTIVE
To understand (1) what guidance exists to assess the methodological quality of qualitative research; (2) what methods exist to grade levels of evidence from qualitative research to inform recommendations within European Alliance of Associations for Rheumatology (EULAR).
METHODS
A systematic literature review was performed in multiple databases including PubMed/Medline, EMBASE, Web of Science, COCHRANE and PsycINFO, from inception to 23 October 2020. Eligible studies included primary articles and guideline documents available in English, describing the: (1) development; (2) application of validated tools (eg, checklists); (3) guidance on assessing methodological quality of qualitative research and (4) guidance on grading levels of qualitative evidence. A narrative synthesis was conducted to identify key similarities between included studies.
RESULTS
Of 9073 records retrieved, 51 went through to full-manuscript review, with 15 selected for inclusion. Six articles described methodological tools to assess the quality of qualitative research. The tools evaluated research design, recruitment, ethical rigour, data collection and analysis. Seven articles described one approach, focusing on four key components to determine how much confidence to place in findings from systematic reviews of qualitative research. Two articles focused on grading levels of clinical recommendations based on qualitative evidence; one described a qualitative evidence hierarchy, and another a research pyramid.
CONCLUSION
There is a lack of consensus on the use of tools, checklists and approaches suitable for appraising the methodological quality of qualitative research and the grading of qualitative evidence to inform clinical practice. This work is expected to facilitate the inclusion of qualitative evidence in the process of developing recommendations at EULAR level.
Topics: Humans; Qualitative Research; Research Design; Evidence-Based Medicine; Practice Guidelines as Topic
PubMed: 38886002
DOI: 10.1136/rmdopen-2023-004032 -
BMJ Open Jun 2024The objective of this study is to investigate the relationships between fear of cancer recurrence (FCR), social support and resilience, and further determine whether...
Examining the role of resilience in the relationship between social support and fear of recurrence among patients with gastric cancer on chemotherapy: a cross-sectional study in Jiangsu, China.
OBJECTIVES
The objective of this study is to investigate the relationships between fear of cancer recurrence (FCR), social support and resilience, and further determine whether resilience mediates social support and FCR among Chinese patients with gastric cancer undergoing chemotherapy.
DESIGN
Multicentre cross-sectional survey.
SETTING
Four hospitals in Jiangsu Province, China, with grade-A tertiary hospital settings.
PARTICIPANTS
755 patients with gastric cancer on chemotherapy across four hospitals in China were included from March 2021 to September 2022.
OUTCOME MEASURES
The Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Connor-Davidson Resilience Scale (CD-RISC) and Social Support Rating Scale (SSRS) were used to test the model's constructs. Statistical analyses were conducted by using IBM SPSS V.26.0 software. PROCESS V.3.4 macro was used to analyse the mediating role of resilience in the relationship between social support and FCR.
RESULTS
The mean scores for SSRS, CD-RISC and FoP-Q-SF in patients with gastric cancer receiving chemotherapy were 41.55±7.79, 54.83±18.46 and 30.91±10.11, respectively. 43.3% (n=327) had psychological dysfunction, 56.8% (n=429) had low to medium resilience and 99.1% (n=748) had medium to robust social support. Significant differences exist among three variables, resilience positively correlated with social support, while FCR negatively correlated with resilience and social support (p<0.001). Resilience fully mediated the relationship between social support and FCR (a*b-path=-0.126, 95% CI -0.169 to -0.086).
CONCLUSIONS
Mediation analysis shows resilience mediates social support and FCR in patients with gastric cancer as the negative effect of social support on FCR was fully mediated by resilience. Interventions targeting these variables may reduce FCR in patients with gastric cancer undergoing chemotherapy.
Topics: Humans; Stomach Neoplasms; Social Support; Cross-Sectional Studies; Male; Female; Middle Aged; Resilience, Psychological; China; Fear; Neoplasm Recurrence, Local; Aged; Surveys and Questionnaires; Adult; Antineoplastic Agents
PubMed: 38885993
DOI: 10.1136/bmjopen-2023-078679 -
PloS One 2024Maternal and neonatal complications related to pregnancy and childbirth pose a significant risk of morbidity and mortality to both the mother and the child. Despite its...
Completion and predictors of maternity continuum of care among women in the post-partum period in Gedeb district, southern Ethiopia: A community based cross-sectional study.
INTRODUCTION
Maternal and neonatal complications related to pregnancy and childbirth pose a significant risk of morbidity and mortality to both the mother and the child. Despite its benefits in reducing maternal and neonatal mortality and morbidity associated with pregnancy and childbirth, the majority of Ethiopian mothers were dropped from the maternal continuum of care. Furthermore, there is a dearth of data regarding the status of the maternal continuum of care and its underlying factors in southern Ethiopia.
OBJECTIVE
This study aimed to assess the completion of the maternity continuum of care and its predictors among postpartum women who had given birth in the previous six months in the Gedeb district of Gedio Zone, southern Ethiopia.
METHODS
A community-based cross-sectional survey was conducted among 625 postpartum women selected by simple random sampling from June 1 to 30, 2022. The data was collected through face-to-face interviews using pretested, structured questionnaires. The association between the explanatory variables and the maternity continuum of care was examined using bivariate and multivariable logistic regression models. The adjusted odds ratio (AOR) with a 95% confidence interval was employed to measure the strength of association and the level of significance was set at p<0.05.
RESULTS
In this study, only 32.00% (95% CI: 28.45, 35.77) of the women completed the maternal continuum of care. Attending primary education (AOR = 2.09; 95% CI: 1.23, 3.55), secondary and above education (AOR = 1.97; 95% CI: 1.01, 3.87), receiving counseling during ANC (AOR = 1.89; 95% CI: 1.22, 2.92), being well prepared for birth and complications readiness (AOR = 4.13; 95% CI: 2.23, 7.62), and having good knowledge of pregnancy danger signs (AOR = 4.13; 95% CI: 2.60, 6.55) were all significantly associated with completing the maternity continuum of care.
CONCLUSION
Nearly one-third of the women completed the maternity continuum of care. Enhancing women's knowledge, offering counseling during prenatal visits, ensuring women's awareness of pregnancy danger signs, and implementing health promotion programs targeted at enhancing birth preparedness and complications readiness for all are crucial.
Topics: Humans; Female; Ethiopia; Adult; Cross-Sectional Studies; Pregnancy; Postpartum Period; Continuity of Patient Care; Young Adult; Maternal Health Services; Adolescent; Surveys and Questionnaires; Prenatal Care; Health Knowledge, Attitudes, Practice
PubMed: 38885256
DOI: 10.1371/journal.pone.0303380 -
Epilepsia Open Jun 2024This study investigates the prevalent issues of healthcare access and the impact of antiseizure treatments among people with epilepsy (PWE) in rural Limpopo and...
OBJECTIVE
This study investigates the prevalent issues of healthcare access and the impact of antiseizure treatments among people with epilepsy (PWE) in rural Limpopo and Mpumalanga, South Africa, where healthcare facilities and affordable treatments are often inadequate.
METHODS
Using a cross-sectional survey, 162 PWE were selected using multistage sampling across the provinces. Data were collected via a structured questionnaire and analyzed descriptively using SPSS v27.
RESULTS
Most of the participants experienced seizures intermittently, with 70.6% in Limpopo and 53.3% in Mpumalanga reporting occasional episodes, whereas a significant minority in both regions-20.6% and 40%, respectively-suffered from frequent seizures. A notable portion of PWE also reported recurring side effects from antiseizure drugs, which led to consequential life disruptions, including educational dropout and unemployment.
SIGNIFICANCE
The findings underscore an urgent need for enhanced educational programs and increased awareness to improve the understanding and management of epilepsy in these underserved areas. Optimizing care for PWE requires a multifaceted approach, including evaluating healthcare accessibility, affordability, and societal beliefs influencing treatment adherence. The study advocates for government and policy interventions to mitigate the quality of life deterioration caused by epilepsy and its treatment in rural communities.
PLAIN LANGUAGE SUMMARY
In Limpopo and Mpumalanga, many individuals with epilepsy experience seizures occasionally, while a significant minority have them frequently. Numerous people also suffer recurring side effects from antiseizure medications, impacting their lives severely by causing school dropouts and job losses. This underscores the urgent need for improved education and awareness programs to manage epilepsy in these provinces effectively. The study urges government action and policy reforms to enhance care and support for people with epilepsy in rural areas, aiming to improve their quality of life.
PubMed: 38884148
DOI: 10.1002/epi4.12999 -
Frontiers in Pediatrics 2024Neonatal deaths are still a major leading cause of social and economic crises. Identifying neonatal near-miss events and identifying their predictors is crucial to...
BACKGROUND
Neonatal deaths are still a major leading cause of social and economic crises. Identifying neonatal near-miss events and identifying their predictors is crucial to developing comprehensive and pertinent strategies to alleviate neonatal morbidity and death. However, neither neonatal near-miss events nor their predictors were analyzed in the study area. Therefore, this study is aimed at assessing the predictors of neonatal near-misses among neonates born at Worabe Comprehensive Specialized Hospital, Southern Ethiopia, in 2021.
METHODS
A hospital-based unmatched case-control study was conducted from 10 November 2021 to 30 November 2021. A pre-tested, structured, and standard abstraction checklist was used to collect the data. After checking the data for completeness and consistency, it was coded and entered into Epi-Data 3.1 and then exported to Stata version 14 for analysis. All independent variables with a -value ≤0.25 in bivariable binary logistic regression were entered into a multivariable analysis to control the confounding. Variables with -values <0.05 were considered statistically significant.
RESULTS
In this study, 134 neonatal near-miss cases and 268 controls were involved. The identified predictors of neonatal near-misses were rural residence [adjusted odds ratio (AOR): 2.01; 95% confidence interval (CI): 1.31-5.84], no antenatal care (ANC) follow-up visits (AOR: 2.98; 95% CI: 1.77-5.56), antepartum hemorrhage (AOR: 2.12; 95% CI: 1.18-4.07), premature rupture of the membrane (AOR: 2.55; 95% CI: 1.54-5.67), and non-vertex fetal presentation (AOR: 3.05; 95% CI: 1.93-5.42).
CONCLUSION
The current study identified rural residents, no ANC visits, antepartum hemorrhage, premature rupture of membrane, and non-vertex fetal presentation as being significantly associated with neonatal near-miss cases. As a result, local health planners and healthcare practitioners must collaborate in enhancing maternal healthcare services, focusing specifically on the early identification of issues and appropriate treatment.
PubMed: 38884100
DOI: 10.3389/fped.2024.1326568 -
Frontiers in Cardiovascular Medicine 2024Marginal zone and follicular B cells are known to contribute to the development of angiotensin II-induced hypertension in mice, but the effector function(s) mediating...
INTRODUCTION
Marginal zone and follicular B cells are known to contribute to the development of angiotensin II-induced hypertension in mice, but the effector function(s) mediating this effect (e.g., antigen presentation, antibody secretion and/or cytokine production) are unknown. B cell differentiation into antibody secreting cells (ASCs) requires the transcription factor Blimp-1. Here, we studied mice with a Blimp-1 deficiency in follicular B cells to evaluate whether antibody secretion underlies the pro-hypertensive action of B cells.
METHODS
10- to 14-week-old male follicular B cell Blimp-1 knockout (FoB-Blimp-1-KO) and floxed control mice were subcutaneously infused with angiotensin II (0.7 mg/kg/d) or vehicle (0.1% acetic acid in saline) for 28 days. BP was measured by tail-cuff plethysmography or radiotelemetry. Pulse wave velocity was measured by ultrasound. Aortic collagen was quantified by Masson's trichrome staining. Cell types and serum antibodies were quantified by flow cytometry and a bead-based multiplex assay, respectively.
RESULTS
In control mice, angiotensin II modestly increased serum IgG3 levels and markedly increased BP, cardiac hypertrophy, aortic stiffening and fibrosis. FoB-Blimp-1-KO mice exhibited impaired IgG1, IgG2a and IgG3 production despite having comparable numbers of B cells and ASCs to control mice. Nevertheless, FoB-Blimp-1-KO mice still developed hypertension, cardiac hypertrophy, aortic stiffening and fibrosis following angiotensin II infusion.
CONCLUSIONS
Inhibition of follicular B cell differentiation into ASCs did not protect against angiotensin II-induced hypertension or vascular compliance. Follicular B cell functions independent of their differentiation into ASCs and ability to produce high-affinity antibodies, or other B cell subtypes, are likely to be involved in angiotensin II-induced hypertension.
PubMed: 38883991
DOI: 10.3389/fcvm.2024.1419958 -
Learning Health Systems Jun 2024Poor communication is a leading root cause of preventable maternal mortality in the United States. Communication challenges are compounded with the presence of biases,...
INTRODUCTION
Poor communication is a leading root cause of preventable maternal mortality in the United States. Communication challenges are compounded with the presence of biases, including racism. Hospital administrators and clinicians are often aware that communication is a problem, but understanding where to intervene can be difficult to determine. While clinical leadership routinely reviews incident reports and acts on them to improve care, we hypothesized that reviewing incident reports in a systematic way might reveal thematic patterns, providing targeted opportunities to improve communication in direct interaction with patients and within the healthcare team itself.
METHODS
We abstracted incident reports from the Women's Health service and linked them with patient charts to join patient's race/ethnicity, birth outcome, and presence of maternal morbidity and mortality to the incident report. We conducted a qualitative content analysis of incident reports using an inductive and deductive approach to categorizing communication challenges. We then described the intersection of different types of communication challenges with patient race/ethnicity and morbidity outcomes.
RESULTS
The use of incident reports to conduct research on communication was new for the health system. Conversations with health system-level stakeholders were important to determine the best way to manage data. We developed a thematic codebook based on prior research in healthcare communication. We found that we needed to add codes that were equity focused, as this was missing from the existing codebook. We also found that clinical and contextual expertise was necessary for conducting the analysis-requiring more resources to conduct coding than initially estimated. We shared our findings back with leadership iteratively during the work.
CONCLUSIONS
Incident reports represent a promising source of health system data for rapid improvement to transform organizational practice around communication. There are barriers to conducting this work in a rapid manner, however, that require further iteration and innovation.
PubMed: 38883872
DOI: 10.1002/lrh2.10425 -
Learning Health Systems Jun 2024Consumer-oriented health information technologies (CHIT) such as the patient portal have a growing role in care delivery redesign initiatives such as the Learning Health...
INTRODUCTION
Consumer-oriented health information technologies (CHIT) such as the patient portal have a growing role in care delivery redesign initiatives such as the Learning Health System. Care partners commonly navigate CHIT demands alongside persons with complex health and social needs, but their role is not well specified.
METHODS
We assemble evidence and concepts from the literature describing interpersonal communication, relational coordination theory, and systems-thinking to develop an integrative framework describing the care partner's role in applied CHIT innovations. Our framework describes pathways through which systematic engagement of the care partner affects longitudinal work processes and multi-level outcomes relevant to Learning Health Systems.
RESULTS
Our framework is grounded in relational coordination, an emerging theory for understanding the dynamics of coordinating work that emphasizes role-based relationships and communication, and the Systems Engineering Initiative for Patient Safety (SEIPS) model. Cross-cutting work systems geared toward explicit and purposeful support of the care partner role through CHIT may advance work processes by promoting frequent, timely, accurate, problem-solving communication, reinforced by shared goals, shared knowledge, and mutual respect between patients, care partners, and care team. We further contend that systematic engagement of the care partner in longitudinal work processes exerts beneficial effects on care delivery experiences and efficiencies at both individual and organizational levels. We discuss the utility of our framework through the lens of an illustrative case study involving patient portal-mediated pre-visit agenda setting.
CONCLUSIONS
Our framework can be used to guide applied embedded CHIT interventions that support the care partner role and bring value to Learning Health Systems through advancing digital health equity, improving user experiences, and driving efficiencies through improved coordination within complex work systems.
PubMed: 38883870
DOI: 10.1002/lrh2.10408 -
Sexual Medicine Jun 2024Educational programs that enhance healthcare providers' competence in managing the care of patients with sexual dysfunction following prostate cancer treatments are...
Enhancing care: evaluating the impact of True North Sexual Health and Rehabilitation eTraining for healthcare providers working with prostate cancer patients and partners.
BACKGROUND
Educational programs that enhance healthcare providers' competence in managing the care of patients with sexual dysfunction following prostate cancer treatments are needed to facilitate comprehensive sexual health treatments for patients and their partners.
AIM
In this study we evaluated the impact of a real-world online sexual health educational intervention called the True North Sexual Health and Rehabilitation eTraining Program. This program is designed to increase healthcare providers' knowledge and self-efficacy in providing sexual healthcare to prostate cancer patients and their partners.
METHODS
Healthcare providers were invited to join a 12-week virtual training program. Participants completed precourse surveys (n = 89), retrospective prepost surveys (n = 58), and a 3-month follow-up survey (subset n = 18) to assess retention of relevant outcomes. Additionally, a course satisfaction survey was administered to participants (n = 57) at the end of the course.
OUTCOMES
The main outcomes focused on participants' perceived knowledge and self-efficacy in conducting assessments and providing interventions for various relevant physical, functional, psychological, and relational domains of sexual dysfunction in prostate cancer patients and their partners.
RESULTS
According to the retrospective analysis of post-then-pre-survey results, graduates perceived that their knowledge of and self-efficacy in providing sexual health counseling improved after completing the course. The 3-month follow-up survey indicated that the course graduate self-efficacy remained high 3 months after the course. Furthermore, the satisfaction survey indicated that a vast majority (98.2%) of participants were satisfied with the educational intervention.
CLINICAL IMPLICATIONS
This real-world sexual health educational intervention can increase self-efficacy and knowledge in healthcare providers who are supporting prostate cancer patients dealing with sexual dysfunction.
STRENGTHS AND LIMITATIONS
The use of a retrospective post-then-pre-survey helped to mitigate response shift bias while minimizing data gaps. However, it is important to note that this investigation was not a traditional research study and lacked a control group, thus limiting causal attributions.
CONCLUSION
The True North Sexual Health and Rehabilitation eTraining program acts as an accessible and effective resource for healthcare providers seeking specialized training in providing sexual healthcare for prostate cancer patients and their partners.
PubMed: 38883808
DOI: 10.1093/sexmed/qfae033