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Current status of health systems financing and oversight for end-stage kidney disease care: a cross-sectional global survey

Por: Yeung · E. · Bello · A. · Levin · A. · Lunney · M. · Osman · M. A. · Ye · F. · Ashuntantang · G. · Bellorin-Font · E. · Benghanem Gharbi · M. · Davison · S. · Ghnaimat · M. · Harden · P. · Jha · V. · Kalantar-Zadeh · K. · Kerr · P. · Klarenbach · S. · Kovesdy · C. · Luyckx · V. · Neuen · B.
Objectives

The Global Kidney Health Atlas (GKHA) is a multinational, cross-sectional survey designed to assess the current capacity for kidney care across all world regions. The 2017 GKHA involved 125 countries and identified significant gaps in oversight, funding and infrastructure to support care for patients with kidney disease, especially in lower-middle-income countries. Here, we report results from the survey for the second iteration of the GKHA conducted in 2018, which included specific questions about health financing and oversight of end-stage kidney disease (ESKD) care worldwide.

Setting

A cross-sectional global survey.

Participants

Key stakeholders from 182 countries were invited to participate. Of those, stakeholders from 160 countries participated and were included.

Primary outcomes

Primary outcomes included cost of kidney replacement therapy (KRT), funding for dialysis and transplantation, funding for conservative kidney management, extent of universal health coverage, out-of-pocket costs for KRT, within-country variability in ESKD care delivery and oversight systems for ESKD care. Outcomes were determined from a combination of desk research and input from key stakeholders in participating countries.

Results

160 countries (covering 98% of the world’s population) responded to the survey. Economic factors were identified as the top barrier to optimal ESKD care in 99 countries (64%). Full public funding for KRT was more common than for conservative kidney management (43% vs 28%). Among countries that provided at least some public coverage for KRT, 75% covered all citizens. Within-country variation in ESKD care delivery was reported in 40% of countries. Oversight of ESKD care was present in all high-income countries but was absent in 13% of low-income, 3% of lower-middle-income, and 10% of upper-middle-income countries.

Conclusion

Significant gaps and variability exist in the public funding and oversight of ESKD care in many countries, particularly for those in low-income and lower-middle-income countries.

Study protocol: epidemiological and clinical characteristics of acute viral hepatitis in Brazilian health services

Por: Sitnik · R. · Maluf · M. M. · Oliveira · K. G. · Siqueira · R. A. · Ferreira · C. E. d. S. · Mangueira · C. L. P. · Azevedo · R. S. · Ferraz · M. L. C. G. · Correa · M. C. J. M. · Ferreira · P. R. A. · Mendes Pereira · G. F. · de Souza · F. M. A. · Pimenta · C. · Pinho · J. R. R.
Introduction

Acute viral hepatitis is a disease of great clinical importance. This study proposes actions to better characterise cases of acute hepatitis in Brazil and to provide relevant information to institutionalised health policies within the Unified Health System. Available data on acute hepatitis in Brazil need to be re-evaluated regarding the different hepatotropic agent (hepatitis A to E virus) frequencies, as well as other agents that can cause similar clinical conditions, such as Herpes Simplex Virus 1 and 2(HSV1, HSV2), Varicella Zoster Virus (VZV), Cytomegalovirus (CMV), Epstein Barr Virus (EBV), Human Herpes Virus 6 and 7 (HHV6, HHV7), arbovirus (yellow fever, dengue, chikungunya, Zika), parvovirus B19, adenovirus, parechovirus, enterovirus, HIV, leptospirosis, toxoplasmosis and syphilis, in addition to autoimmune hepatitis. In this context, the primary aim of this study is the clinical-epidemiological and molecular characterisation of acute viral hepatitis in Brazilian health services from all geographical regions of the country. The present article describes the study protocol.

Methods and analysis

This study will evaluate 2280 patients with symptoms and/or signs suggestive of acute liver disease in Brazilian health institutions in all five geographic Brazilian regions. Demographic, epidemiological and clinical data will be collected, as well as blood samples to be analysed at Hospital Israelita Albert Einstein Clinical Laboratory.

Ethics and dissemination

Ethics approval was obtained at the national research ethics committee (Conselho Nacional de Ética em Pesquisa— CONEP–CAAE 00952818.4.1001.0071) and at all participating sites. Results will be published in journals and presented at scientific meetings.

How do children and adolescents experience healthcare professionals? Scoping review and interpretive synthesis

Por: Davison · G. · Kelly · M. A. · Conn · R. · Thompson · A. · Dornan · T.
Objective

Explore children’s and adolescents’ (CADs’) lived experiences of healthcare professionals (HCPs).

Design

Scoping review methodology provided a six-step framework to, first, identify and organise existing evidence. Interpretive phenomenology provided methodological principles for, second, an interpretive synthesis of the life worlds of CADs receiving healthcare, as represented by verbatim accounts of their experiences.

Data sources

Five key databases (Ovid Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Web of Science), from inception through to January 2019, reference lists, and opportunistically identified publications.

Eligibility criteria

Research articles containing direct first-person quotations by CADs (aged 0–18 years inclusive) describing how they experienced HCPs.

Data extraction and synthesis

Tabulation of study characteristics, contextual information, and verbatim extraction of all ‘relevant’ (as defined above) direct quotations. Analysis of basic scope of the evidence base. The research team worked reflexively and collaboratively to interpret the qualitative data and construct a synthesis of children’s experiences. To consolidate and elaborate the interpretation, we held two focus groups with inpatient CADs in a children’s hospital.

Results

669 quotations from 99 studies described CADs’ experiences of HCPs. Favourable experiences were of forming trusting relationships and being involved in healthcare discussions and decisions; less favourable experiences were of not relating to or being unable to trust HCPs and/or being excluded from conversations about them. HCPs fostered trusting relationships by being personable, wise, sincere and relatable. HCPs made CADs feel involved by including them in conversations, explaining medical information, and listening to CADs’ wider needs and preferences.

Conclusion

These findings strengthen the case for making CADs partners in healthcare despite their youth. We propose that a criterion for high-quality child-centred healthcare should be that HCPs communicate in ways that engender trust and involvement.

Interventional treatments for chronic, axial or radicular, non-cancer, spinal pain: a protocol for a systematic review and network meta-analysis of randomised trials

Por: Wang · X. · Martin · G. · Sadeghirad · B. · Darzi · A. J. · Couban · R. J. · Florez · I. D. · Crandon · H. N. · Kum · E. · Chang · Y. · Esfahani · M. A. · Sivananthan · L. · Mehrabi · F. · Sengupta · N. K. · Rathod · P. · Morsi · R. Z. · Buckley · D. N. · Guyatt · G. H. · Rampersaud · Y.
Introduction

Chronic, non-cancer, axial or radicular spinal pain is a common condition associated with considerable socioeconomic burden. Clinicians frequently offer patients various interventional procedures for the treatment of chronic spine pain; however, the comparative effectiveness and safety of available procedures remains uncertain.

Methods

We will conduct a systematic review of randomised controlled trials that explores the effectiveness and harms of interventional procedures for the management of axial or radicular, chronic, non-cancer, spine pain. We will identify eligible studies through a systematic search of Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science from inception without language restrictions. Eligible trials will: (1) enrol primarily adult patients (≥18 years old) with axial or radicular, chronic, non-cancer, spine pain, (2) randomise patients to different, currently available, interventional procedures or to an interventional procedure and a placebo/sham procedure or usual care, and (3) measure outcomes at least 1 month after randomisation.

Pairs of reviewers will independently screen articles identified through searches and extract information and assess risk of bias of eligible trials. We will use a modified Cochrane instrument to evaluate risk of bias. We will use frequentist random-effects network meta-analyses to assess the relative effects of interventional procedures, and five a priori hypotheses to explore between studies subgroup effects. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in evidence for each outcome, including direct, indirect and network estimates.

Ethics and dissemination

No research ethics approval is required for this systematic review, as no confidential patient data will be used. We will disseminate our findings through publication in a peer-reviewed journal and conference presentations, and our review will support development of a BMJ Rapid Recommendations providing contextualised clinical guidance based on this body of evidence.

PROSPERO registration number

CRD42020170667.

Symptoms of common mental disorders and adherence to antiretroviral therapy among adults living with HIV in rural Zimbabwe: a cross-sectional study

Por: Haas · A. D. · Kunzekwenyika · C. · Hossmann · S. · Manzero · J. · van Dijk · J. · Manhibi · R. · Verhey · R. · Limacher · A. · von Groote · P. M. · Manda · E. · Hobbins · M. A. · Chibanda · D. · Egger · M. · IeDEA Southern Africa
Objectives

To examine the proportion of people living with HIV who screen positive for common mental disorders (CMD) and the associations between CMD and self-reported adherence to antiretroviral therapy (ART).

Setting

Sixteen government-funded health facilities in the rural Bikita district of Zimbabwe.

Design

Cross-sectional study.

Participants

HIV-positive non-pregnant adults, aged 18 years or older, who lived in Bikita district and had received ART for at least 6 months.

Outcome measures

The primary outcome was the proportion of participants screening positive for CMD defined as a Shona Symptoms Questionnaire score of 9 or greater. Secondary outcomes were the proportion of participants reporting suicidal ideation, perceptual symptoms and suboptimal ART adherence and adjusted prevalence ratios (aPR) for factors associated with CMD, suicidal ideation, perceptual symptoms and suboptimal ART adherence.

Results

Out of 3480 adults, 18.8% (95% CI 14.8% to 23.7%) screened positive for CMD, 2.7% (95% CI 1.5% to 4.7%) reported suicidal ideations, and 1.5% (95% CI 0.9% to 2.6%) reported perceptual symptoms. Positive CMD screens were more common in women (aPR 1.67, 95% CI 1.19 to 2.35) than in men and were more common in adults aged 40–49 years (aPR 1.47, 95% CI 1.16 to 1.85) or aged 50–59 years (aPR 1.51, 95% CI 1.05 to 2.17) than in those 60 years or older. Positive CMD screen was associated with suboptimal adherence (aPR 1.53; 95% CI 1.37 to 1.70).

Conclusions

A substantial proportion of people living with HIV in rural Zimbabwe are affected by CMD. There is a need to integrate mental health services and HIV programmes in rural Zimbabwe.

Trial registration number

NCT03704805.

SARS-CoV-2 seroprevalence in healthcare workers of a Swiss tertiary care centre at the end of the first wave: a cross-sectional study

Por: Meylan · S. · Dafni · U. · Lamoth · F. · Tsourti · Z. · Lobritz · M. A. · Regina · J. · Bressin · P. · Senn · L. · Grandbastien · B. · Andre · C. · Fenwick · C. · D'Acremont · V. · Croxatto · A. · Guilleret · I. · Greub · G. · Manuel · O. · Calandra · T. · Pantaleo · G. · Lazor-Blanchet · C
Objective

To assess the SARS-CoV-2 transmission in healthcare workers (HCWs) using seroprevalence as a surrogate marker of infection in our tertiary care centre according to exposure.

Design

Seroprevalence cross-sectional study.

Setting

Single centre at the end of the first COVID-19 wave in Lausanne, Switzerland.

Participants

1874 of 4074 responders randomly selected (46% response rate), stratified by work category among the 13 474 (13.9%) HCWs.

Main outcome measures

Evaluation of SARS-CoV-2 serostatus paired with a questionnaire of SARS-CoV-2 acquisition risk factors internal and external to the workplace.

Results

The overall SARS-CoV-2 seroprevalence rate among HCWs was 10.0% (95% CI 8.7% to 11.5%). HCWs with daily patient contact did not experience increased rates of seropositivity relative to those without (10.3% vs 9.6%, respectively, p=0.64). HCWs with direct contact with patients with COVID-19 or working in COVID-19 units did not experience increased seropositivity rates relative to their counterparts (10.4% vs 9.8%, p=0.69 and 10.6% vs 9.9%, p=0.69, respectively). However, specific locations of contact with patients irrespective of COVID-19 status—in patient rooms or reception areas—did correlate with increased rates of seropositivity (11.9% vs 7.5%, p=0.019 and 14.3% vs 9.2%, p=0.025, respectively). In contrast, HCWs with a suspected or proven SARS-CoV-2-infected household contact had significantly higher seropositivity rates than those without such contacts (19.0% vs 8.7%, p

Conclusions

The overall seroprevalence was 10% without significant differences in seroprevalence between HCWs exposed to patients with COVID-19 and HCWs not exposed. This suggests that, once fully in place, protective measures limited SARS-CoV-2 occupational acquisition within the hospital environment. SARS-CoV-2 seroconversion among HCWs was associated primarily with community risk factors, particularly household transmission.

Prayer as a pain intervention: protocol of a systematic review of randomised controlled trials

Por: Ferreira-Valente · A. · Jarego · M. · Queiroz-Garcia · I. · Pimenta · F. · Costa · R. M. · Day · M. A. · Pais-Ribeiro · J. · Jensen · M. P.
Background

Pain is a universal experience and the most common reason for seeking healthcare. Inadequate pain management negatively impacts numerous aspects of patient health. Multidisciplinary treatment programmes, including psychosocial interventions, are more useful for pain management than purely biomedical treatment alone. Recently, researchers showed increasing interest in understanding the role of spirituality/religiosity and spiritual/religious practices on pain experience, with engagement in religious practices, such as prayer, showing to positively impact pain experience in religious individuals. This systematic review will seek to summarise and integrate the existing findings from randomised controlled trials assessing the effects of prayer and prayer-based interventions on pain experience.

Methods

The systematic review procedures and its report will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. Electronic searches in nine databases (Web of Science Core Collection, MEDLINE, SCIELO Citation Index, PubMed, Cochrane Central Register of Controlled Clinical Trial, PsycINFO, Scopus, LILACS and Open-SIGLE) will be performed to identify randomised controlled trials of prayer-based interventions. Two independent researchers will assess studies for inclusion and extract data from each paper. Risk of bias assessment will be assessed independently by two reviewers based on the Consolidated Standards of Reporting Trials statement. Qualitative synthesis of the body of research will be conducted using a narrative summary synthesis method. Meta-analysis will be limited to studies reporting on the same primary outcome. Formal searches are planned to start in June 2021. The final report is anticipated to be completed by September 2021.

Discussion

Findings will be useful to (1) understand the condition of our knowledge in this field and (2) provide evidence for prayer effectiveness in reducing pain intensity and pain-related stress and increasing pain tolerance in adults experiencing acute or chronic pain.

PROSPERO registration number

CRD42020221733.

The Relationship Between Emotional Intelligence and Nurse–Nurse Collaboration

Abstract

Purpose

The purpose of this study was to examine the relationship between emotional intelligence and nurse–nurse collaboration among registered nurses in Jordan.

Design

This study used a cross-sectional, quantitative survey design to query 342 nurses who worked in two hospitals in Jordan.

Methods

We used Arabic versions of valid, reliable instruments to measure emotional intelligence and nurse–nurse communication.

Findings

A total of 311 questionnaires were returned (91% response rate). Nurses’ emotional intelligence was positively and significantly correlated with the nurse–nurse collaboration subscales. The results also indicated a statistically significant mean difference in communication subscale scores by gender and nursing unit.

Conclusions

The present study demonstrated that nurse–nurse collaboration is linked to benefits for nurses in terms of improved job satisfaction, better nurse retention, improved quality of patient care, and enhanced healthcare efficiency and productivity. This suggests that improving nurse–nurse collaboration may have spillover effects of benefits, not only for nurses but for patients, organizations, and the overall healthcare system.

Clinical Relevance

Building an environment that encourages collaboration among nurses can greatly impact the performance of nurses and its benefit to nurses. Encouraging employees to participate in activities and to collaborate in making this an integral part of their evaluation will contribute to improving the teamwork in patient care.

Lymphedema rehabilitation: Provision and practice patterns among service providers: National survey

Abstract

Information on the current practices and quantification of lymphedema service may be beneficial to promote and improve the current health care system. Therefore, this study aimed to describe the characteristics of lymphedema practitioners, and lymphedema patients' profiles, and provide a comprehensive picture of lymphedema service provision in Saudi Arabia. A cross-sectional study design used an online survey to gather data. The survey included information about demographic and professional characteristics of lymphedema practitioners, lymphedema profiles, questions on the services provided, and perceived barriers in providing services. Eighteen lymphedema practitioners (38%) responded to the survey. Most of the respondents were physical therapists (94%), who had completed 135 hours of basic training course, and were certified as lymphedema therapists (89%). Most of these practitioners were in Riyadh (58%), Jeddah (25%), and Dammam (17%). About 75% of patients seen by practitioners had secondary lymphedema, predominately breast cancer-related lymphedema (47%). The average number of lymphedema practitioners per service is three. The perceived barriers reported included an inadequate number of certified therapists (100%), difficulties with transportation and lack of financial support (each; 72%), and limited space for lymphedema practice/management (89%). The results suggest lymphedema practitioners provide reasonable services for lymphedema patients; however, services are still limited and needs are unmet. Therefore, more staffing is required to promote awareness of the condition and related services, to develop and implement appropriate educational strategies, and improve geographical and multidisciplinary coordination of the services in Saudi Arabia.

Youth perceptions and experiences of type 2 diabetes: Protocol for a collaborative knowledge translation approach and qualitative study

Abstract

Aims

The aim of this study is to generate an in‐depth understanding of youth perceptions and experiences of living with type 2 diabetes to inform knowledge translation, research and intervention development.

Design

Interpretive descriptive qualitative study.

Methods

Twenty to 25 youth aged 10–18 years with a diagnosis of type 2 diabetes will be purposively recruited through the Diabetes Education Resource for Children and Adolescents in Winnipeg, Manitoba, and through the Improving Renal Complications in Adolescents With Type 2 Diabetes Through the REsearch [iCARE] cohort. Socio‐demographic information will be collected. Semi‐structured interviews will occur iteratively with inductive thematic analysis. Data will be professionally transcribed and managed using NVivo 1.0 software. The University Ethics Committee approved this study (May 2020).

Discussion

There is a critical gap in understanding youth experiences of type 2 diabetes. Research involving youth with type 2 diabetes is predominantly quantitative in nature, largely reflecting risk factors, underlying mechanisms and treatment outcomes associated with diabetes management. In‐depth qualitative research on youth experiences can help identify youth priorities, provide insight into critical misalignments between stakeholder perspectives, and drive forward a more consolidated youth‐centred research agenda.

Impact

Understanding and applying knowledge of youth experiences is critical as the prevalence of, and challenges associated with, youth onset type 2 diabetes continues to increase worldwide. This research will generate a robust interpretive description of youth lived experiences and perceptions of type 2 diabetes where such research is lacking, to inform basic and applied research within an interdisciplinary investigative and clinical research team with relevance to other jurisdictions. In response to calls for youth‐oriented research in type 2 diabetes, this work will catalyse collaborative knowledge translation using creative and youth‐directed initiatives.

Self-reported health and smoking status, and body mass index: a case-control comparison based on GEN SCRIP (GENetics of SChizophRenia In Pakistan) data

Por: Ayub · M. · Arsalan · A. · Khan · S.-u.-D. A. · Bajwa · S. · Hussain · F. · Umar · M. · Khizar · B. · Sibtain · M. · Butt · A. · Mukhtar-Ul-Haq · M. · Dogar · I. A. · Ansari · M. A. · Shafiq · S. · Tariq · M. · Hussain · M. I. · Nasar · A. · Mustafa · A. B. · Taj · R. · Rehman · R. U. · Rajp
Introduction

Individuals with schizophrenia are at a high risk of physical health comorbidities and premature mortality. Cardiovascular and metabolic causes are an important contributor. There are gaps in monitoring, documenting and managing these physical health comorbidities. Because of their condition, patients themselves may not be aware of these comorbidities and may not be able to follow a lifestyle that prevents and manages the complications. In many low-income and middle-income countries including Pakistan, the bulk of the burden of care for those struggling with schizophrenia falls on the families.

Objectives

To determine the rate of self-reported physical health disorders and risk factors, like body mass index (BMI) and smoking, associated with cardiovascular and metabolic disorders in cases of schizophrenia compared with a group of mentally healthy controls.

Design

A case-controlled, cross-sectional multicentre study of patients with schizophrenia in Pakistan.

Settings

Multiple data collection sites across the country for patients, that is, public and private psychiatric OPDs (out patient departments), specialised psychiatric care facilities, and psychiatric wards of teaching and district level hospitals. Healthy controls were enrolled from the community.

Participants

We report a total of 6838 participants’ data with (N 3411 (49.9%)) cases of schizophrenia compared with a group of healthy controls (N 3427 (50.1%)).

Results

BMI (OR 0.98 (CI 0.97 to 0.99), p=0.0025), and the rate of smoking is higher in patients with schizophrenia than in controls. Problems with vision (OR 0.13 (0.08 to 0.2), joint pain (OR 0.18 (0.07 to 0.44)) and high cholesterol (OR 0.13 (0.05 to 0.35)) have higher reported prevalence in controls. The cases describe more physical health disorders in the category ‘other’ (OR 4.65 (3.01 to 7.18)). This captures residual disorders not listed in the questionnaire.

Conclusions

Participants with schizophrenia in comparison with controls report more disorders. The access in the ‘other’ category may be a reflection of undiagnosed disorders.

Epidemiological trends in COVID-19 pandemic: prospective critical appraisal of observations from six countries in Europe and the USA

Por: Velicu · M. A. · Furlanetti · L. · Jung · J. · Ashkan · K.
Introduction

Europe was the epicentre of the COVID-19 pandemic in March 2020, with the highest number of cases and deaths between March and April. In May, the infection numbers registered a fall followed by a second new rise, not proportionally reflected by an increase in the number of deaths. We aimed to investigate the relationship between disease prevalence and infection fatality rate (IFR), and the number of intensive care unit (ICU) and hospital admissions over time, to develop a predictive model, as well as appraising the potential contributing factors underpinning this complex relationship.

Methods

A prospective epidemiological study using data from six countries collected between 10 March and 4 September 2020. Data on the number of daily hospital and ICU admissions with COVID-19 were gathered, and the IFR and the prevalence were calculated. Trends over time were analysed. A linear regression model was used to determine the association between the fatality rates and the number of admissions.

Findings

The prediction model confirmed the linear association between the fatality rates and the numbers of ICU and hospital admissions. The exception was during the peak of the COVID-19 pandemic when the model underestimated the fatalities indicating that a substantial number of deaths occurred outside of the hospitals. The fatality rates decreased in all countries from May until September regardless of the trends in prevalence, differences in healthcare systems or strategic variations in handling the pandemic.

Interpretation

The observed gradual reduction in COVID-19 fatality rates over time despite varying disease prevalence and public health measures across multiple countries warrants search for a biological explanation. While our understanding of this novel virus grows, hospital and ICU admission rates remain effective predictors of patient outcomes which can be used as early warning signs for escalation of public health measures.

Virtual reality-based relaxation for enhancement of perioperative well-being and quality of life: protocol for a randomised pilot trial

Por: Schrempf · M. C. · Petzold · J. Q. · Vachon · H. · Petersen · M. A. · Gutschon · J. · Wolf · S. · Sommer · F. · Murnauer · M. · Anthuber · M.
Introduction

Patients with cancer undergoing surgery often suffer from reduced quality of life and various forms of distress. Untreated distress can negatively affect coping resources as well as surgical and oncological outcomes. A virtual reality-based stress reduction intervention may increase quality of life and well-being and reduce distress in the perioperative phase for patients with cancer. This pilot trial aims to explore the feasibility of the proposed intervention, assess patient acceptability and obtain estimates of effect to provide data for sample size calculations.

Methods and analysis

Patients with colorectal cancer and liver metastasis undergoing elective surgery will be recruited for this single-centre, randomised pilot trial with a three-arm design. A total of 54 participants will be randomised at 1:1:1 ratio to one of two intervention groups or a control receiving standard treatment. Those randomised to an intervention group will either receive perioperative virtual reality-based stress reduction exercises twice daily or listen to classical music twice daily. Primary feasibility outcomes are number and proportions of participants recruited, screened, consented and randomised. Furthermore, adherence to the intervention, compliance with the completion of the quality of life questionnaires and feasibility of implementing the trial procedures will be assessed. Secondary clinical outcomes are measurements of the effectiveness of the interventions to inform sample size calculations.

Ethics and dissemination

The study protocol, the patient information and the informed consent form have been approved by the ethics committee of the Ludwigs-Maximilians-University, Munich, Germany (Reference Number: 19–915). Study findings will be submitted for publication in peer-reviewed journals.

Trial registration number

DRKS00020909.

Instruments measuring the quality of life among people living with type 2 diabetes mellitus in India: a systematic review protocol

Por: Demla · C. · Thomas · A. · Jose · J. · Joshy · A. L. · Hrishikesh · M. A. · Rajendran · A. · Parsekar · S. S.
Introduction

Type 2 diabetes mellitus affects an individual’s quality of life (QoL); and there are multiple instruments that can be used to measure QoL. The purpose of this systematic review is to identify the existing instruments that have been used to measure QoL in people living with diabetes, and to enlist the major domains (such as physical and psychological components) available in the identified instruments. Additionally, we plan to determine the psychometric properties of the identified QoL instruments using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.

Methods and analysis

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guideline was followed to report this systematic review protocol. Searches will be conducted on MEDLINE (via PubMed, Web of Science), SCOPUS and CINAHL. Predetermined inclusion/exclusion criteria will be applied to the search results, to include studies with adult individuals diagnosed with type 2 diabetes mellitus, with and without complications, and exclude studies with type 1 diabetes or other clinical illness. Studies conducted outside India will be excluded. Five authors in pairs will independently screen the articles and extract the data that meets the inclusion criteria. The COSMIN criteria will be used to assess the risk of bias of included studies. Narrative synthesis will be performed to analyse the findings of the instruments.

Ethics and dissemination

Ethical permission is not applicable, as this is a systematic review. We intend to disseminate the systematic review findings through a national or international conference and publish the findings in a peer-reviewed journal.

PROSPERO registration number

CRD42020180432.

From open to locked doors – From dependent to independent: Patient narratives of participation in their rehabilitation processes

Abstract

Aims and objectives

The present study aimed to explore patients' experiences of participating in their rehabilitation process in the context of specialised rehabilitation in Norway.

Background

The rights of patients to participate in their care and treatment is an ideology that underlines newer international and Norwegian public documents. However, there is a gap between policy statements and clinical practice, and a discrepancy between patients' and professionals' statements about patient participation in rehabilitation.

Design

A qualitative approach with a narrative design.

Methods

Eleven patients were individually interviewed to tell their stories about the rehabilitation processes. We utilised narrative analysis with a three-dimensional space narrative structure including temporality, sociality and spatiality. This study followed the COREQ checklist.

Results

The analysis identified two throughout plots: ‘person-centred culture’ and ‘time’, and three plots which constructed how the patients participate in change through the rehabilitation process: (a) dependent—‘open doors’; (b) motivation from within; and (c) independence—‘locked doors’.

Conclusions

Patient participation in rehabilitation was dependent on person-centred cultures in the unit and on different aspects of time. The dialogue and the power balance between the patients and the health personnel changed as the rehabilitation progressed. Motivation for rehabilitation had to come from within patients. The paternalistic ideology did not seem to dominate the specialised rehabilitation unit in the present study.

Relevance to clinical practice

This study gives new insight into how patients participate in change in the rehabilitation process. This can be valuable for healthcare professionals and governments. Insight into how the lack of person-centred focus can harm the rehabilitation process, and a deeper understanding of the meaning of time in the rehabilitation process is essential. These results may provide a stimulus for discussions on how patients might participate in their rehabilitation process.

A retrospective review of the use of a nanocrystalline silver dressing in the management of open chronic wounds in the community

Abstract

As part of an infection management protocol, antimicrobial dressings offer an appropriate, cost-effective choice for the management of localised bioburden in chronic wounds. The choice of antimicrobial can impact significantly not only on the treatment outcomes and cost but also on the safety and well-being of the patient. This retrospective study investigates these outcomes comparing health care records of 2572 patients with open chronic wounds, who were treated either with an Integrated Care Wound Bundle (ICB) including nanocrystalline silver (NCS) dressings (n = 330) or without NCS dressings and not on a ICB (n = 2242) in the community from March 2016 to March 2018. Wounds treated in the NCS dressing treatment bundle had a mean healing time of 10.46 weeks, vs 25.49 weeks for the non-ICB treated wounds. In addition, the average interval time between dressing changes was in favour of the NCS dressing treatment bundle (3.98 vs 1.87 days), contributing to a substantial reduction in mean treatment labour costs ($1251 vs $6488). The use of a NCS dressing demonstrated improved efficacy and cost effectiveness of labour required for chronic wound management; highlighting the importance of choosing an effective antimicrobial dressing as part of an infection management protocol.

Barriers and enablers of recognition and response to deteriorating patients in the acute hospital setting: A theory‐driven interview study using the Theoretical Domains Framework

ABSTRACT

Aim

To explore barriers and enablers of recognition and response to signs of patient deterioration by nursing staff in an acute hospital.

Design

A theory‐driven interview study underpinned by the Theoretical Domains Framework of behaviour change.

Methods

Between 07/01/2019 and 18/12/2019 a purposive sample of registered nurses and healthcare assistants was recruited to participate in a semi‐structured (audio‐recorded) interview, to explore the determinants of seven specified behaviours of the afferent limb. Anonymised transcripts were deductively coded (using the 14 Theoretical Domains Framework domains as coding categories) and then extracts within each domain were inductively analysed to synthesise belief statements and themes. Prioritisation criteria from published literature were applied.

Results

Thirty‐two semi‐structured interviews were conducted. From 1,888 quotes, 184 belief statements and 66 themes were synthesised. One hundred and forty‐six belief statements, represented by 58 themes, met prioritisation criteria. Nine domains of the Theoretical Domains Framework were of high importance: Knowledge; Social, Professional Role and Identity; Beliefs about Consequences; Reinforcement; Intentions; Goals; Memory, Attention and Decision Processes; Environment, Context and Resources and Social Influences.

Conclusions

Barriers and enablers most likely to impact on nursing staff afferent limb behaviour were identified in nine domains of the Theoretical Domains Framework.

Identifying barriers and facilitators to recognition and response to patient clinical deterioration by clinicians using a behaviour change approach: A qualitative study

Abstract

Background

Failure of clinicians to recognise and respond to patient clinical deterioration is associated with increased hospital mortality. Emergency response teams are implemented throughout hospitals to support direct‐care clinicians in managing patient deterioration, but patient clinical deterioration is often not identified or acted upon by clinicians in ward settings. To date, no studies have used an integrative theoretical framework in multiple sites to examine why clinicians’ delay identification and action on patients’ clinical deterioration.

Aim

To identify barriers and facilitators that influence clinicians’ absent or delayed response to patient clinical deterioration using the Theoretical Domains Framework.

Methods

The Theoretical Domains Framework guided: (a) semi‐structured interviews with clinicians, health consumers and family members undertaken at two sites; (b) deductive analyses of inductive themes to identify barriers and facilitators to optimal care. This study complied with the COREQ research guidelines.

Findings

Seven themes identified: (a) information transfer; (b) ownership of patient care; (c) confidence to respond; (d) knowledge and skills; (e) culture; (f) emotion; and (g) environmental context and resources.

Discussion

The Theoretical Domains Framework identified traditional social and professional hierarchies and limitations due to environmental contexts and resources as contributors to diminished interprofessional recognition and impediments to the development of effective relationships between professional groups. Communication processes were impacted by these restraints and further confounded by inadequate policy development and limited access to regular effective team‐based training. As a result, patient safety was compromised, and clinicians frustrated.

Conclusions

These results inform the development, implementation and evaluation of a behaviour change intervention and increase knowledge about barriers and facilitators to timely response to patient clinical deterioration.

Relevance to clinical practice

Results contribute to understanding of why clinicians delay responding to patient clinical deterioration and suggest key recommendations to identify and challenge traditional hierarchies and practices that prevent interdisciplinary collaboration and decision‐making.

Communicating prognostic information and hope to families of dying patients in intensive care units: A descriptive qualitative study

Abstract

Aims and objectives

To understand how prognostic information is communicated by Jordanian doctors and nurses to the families of dying patients in intensive care units, with an emphasis on exploring how hope and truth telling about patients' poor prognosis are managed.

Background

Improving end‐of‐life care requires a focus on adequate family–professionals prognostic communication, while maintaining a realistic level of hope and family support.

Design

A descriptive qualitative approach was applied.

Methods

Semi‐structured interviews were conducted with 20 nurses and 15 resident doctors caring for dying patients. Bardin's procedure of categorical content analysis was applied. The COREQ checklist for reporting qualitative studies was followed.

Results

Two main categories emerged from the data of this study: ‘perspectives on optimistic hope’ and ‘approaches to prognostic communication’. Health professionals experience extreme difficulty, and therefore, frequently avoid openly disclosing information about patients' poor prognosis to the families. Consequently, the health professionals adopted various methods to balance truth telling against sustaining hope among the patients' families. Providing false assurance was perceived as permissible and understandable, in order to nurture the families' hope.

Conclusions

Improving end‐of‐life care in intensive care units in Jordan requires a focus on family–professional communication. Jordanian intensive care doctors and nurses perceived honest family–professional communication regarding dying patients to be extremely challenging. Healthcare professionals should develop their competency of meeting the informational and emotional needs of patients in ICUs and their families, while also honouring their cultural values, during prognostic communication.

Relevance to clinical practice

Effective training of healthcare professionals is vital on ways to enhance communication of prognostic information and to foster realistic hope among families of dying patients in intensive care units. There is a need to also explore the families' perspectives on prognostic communication in order to understand the similarities and differences between the professionals' and families' perspectives.

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