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How have services for diabetes, eye, hearing and foot health been integrated for adults? Protocol for a scoping review

Por: O'Shea · C. · Manuel · A. · Te Ao · B. · Silwal · P. R. · Harwood · M. · Murphy · R. · Ramke · J.
Introduction

The global population is ageing, and by 2050, there will be almost 2.1 billion people over the age of 60 years. This ageing population means conditions such as diabetes are on the increase, as well as other conditions associated with ageing (and/or diabetes), including those that cause vision impairment, hearing impairment or foot problems. The aim of this scoping review is to identify the extent of the literature describing integration of services for adults of two or more of diabetes, eye, hearing or foot services.

Methods and analysis

The main database searches are of Medline and Embase, conducted by an information specialist, without language restrictions, for studies published from 1 January 2000 describing the integration of services for two or more of diabetes, eye, hearing and foot health in the private or public sector and at the primary or secondary level of care, primarily targeted to adults aged ≥40 years. A grey literature search will focus on websites of key organisations. Reference lists of all included articles will be reviewed to identify further studies. Screening and data extraction will be undertaken by two reviewers independently and any discrepancies will be resolved by discussion. We will use tables, maps and text to summarise the included studies and findings, including where studies were undertaken, which services tended to be integrated, in which sector and level of the health system, targeting which population groups and whether they were considered effective.

Ethics and dissemination

As our review will be based on published data, ethical approval will not be sought. This review is part of a project in Aotearoa New Zealand that aims to improve access to services for adults with diabetes or eye, hearing or foot conditions. The findings will be published in a peer-reviewed journal and presented at relevant conferences.

HFE genotypes, haemochromatosis diagnosis and clinical outcomes at age 80 years: a prospective cohort study in the UK Biobank

Por: Lucas · M. R. · Atkins · J. L. · Pilling · L. C. · Shearman · J. D. · Melzer · D.
Objectives

HFE haemochromatosis genetic variants have an uncertain clinical penetrance, especially to older ages and in undiagnosed groups. We estimated p.C282Y and p.H63D variant cumulative incidence of multiple clinical outcomes in a large community cohort.

Design

Prospective cohort study.

Setting

22 assessment centres across England, Scotland, and Wales in the UK Biobank (2006–2010).

Participants

451 270 participants genetically similar to the 1000 Genomes European reference population, with a mean of 13.3-year follow-up through hospital inpatient, cancer registries and death certificate data.

Main outcome measures

Cox proportional HRs of incident clinical outcomes and mortality in those with HFE p.C282Y/p.H63D mutations compared with those with no variants, stratified by sex and adjusted for age, assessment centre and genetic stratification. Cumulative incidences were estimated from age 40 years to 80 years.

Results

12.1% of p.C282Y+/+ males had baseline (mean age 57 years) haemochromatosis diagnoses, with a cumulative incidence of 56.4% at age 80 years. 33.1% died vs 25.4% without HFE variants (HR 1.29, 95% CI: 1.12 to 1.48, p=4.7x10-4); 27.9% vs 17.1% had joint replacements, 20.3% vs 8.3% had liver disease, and there were excess delirium, dementia, and Parkinson’s disease but not depression. Associations, including excess mortality, were similar in the group undiagnosed with haemochromatosis. 3.4% of women with p.C282Y+/+ had baseline haemochromatosis diagnoses, with a cumulative incidence of 40.5% at age 80 years. There were excess incident liver disease (8.9% vs 6.8%; HR 1.62, 95% CI: 1.27 to 2.05, p=7.8x10-5), joint replacements and delirium, with similar results in the undiagnosed. p.C282Y/p.H63D and p.H63D+/+ men or women had no statistically significant excess fatigue or depression at baseline and no excess incident outcomes.

Conclusions

Male and female p.C282Y homozygotes experienced greater excess morbidity than previously documented, including those undiagnosed with haemochromatosis in the community. As haemochromatosis diagnosis rates were low at baseline despite treatment being considered effective, trials of screening to identify people with p.C282Y homozygosity early appear justified.

Insider versus outsider workplace mistreatment and their impact on affective ill‐being in healthcare professionals: Can personal resources act as buffers?

Abstract

Aims

Workplace stress can negatively impact healthcare providers' professionalism and quality of care. One source of workplace stress is the experience of workplace mistreatment. Drawing on the Job Demands-Resources theory, this study aimed to (a) investigate the impact of mistreatment frequency experienced by healthcare workers from insider sources (i.e. co-workers, supervisors) and outsider sources (i.e. patients, visitors) on affective ill-being and (b) the potential moderating role of trait resilience and trait self-efficacy, as personal resources, in the mistreatment–ill-being relationship.

Design

Lagged design.

Methods

We collected data from 153 Irish healthcare workers between January 2018 and June 2019 via three surveys, separated by 1-week intervals. Personal resources were measured at Time 1, frequency of mistreatment from the two sources was assessed at Time 2 and affective ill-being was assessed at Time 3. We used moderated regression analyses to evaluate the association of mistreatment frequency from the two sources and affective ill-being and the moderating effect of personal resources.

Results

Only insider mistreatment frequency was positively related to affective ill-being. Furthermore, the positive impact of insider mistreatment on affective ill-being was moderated by self-efficacy (but not by trait resilience). In contrast to our expectations, the relationship was stronger at high levels compared to low levels of self-efficacy.

Conclusion

Mistreatment from co-workers and supervisors is linked to higher levels of affective ill-being. Additionally, healthcare workers with high self-efficacy were more vulnerable to the negative consequences of co-worker and supervisor mistreatment as it impacted their affective ill-being.

Impact

These findings extend the literature on workplace mistreatment by integrating insider and outsider perpetrators of mistreatment and examining their differential impact on the employees' affective ill-being. It also highlights mistreatment from organizational insiders as a significant factor in the relationship between mistreatment and affective ill-being.

Patient or Public Contribution

No patient or public contribution.

What Does this Paper Contribute to the Wider Global Community?

The findings underscore the detrimental impact of workplace mistreatment on the well-being of healthcare professionals. The study findings of higher frequency of insider mistreatment being associated with increased affective ill-being call for action, with line managers and supervisors being critical to achieving respective changes in healthcare workers' environment. The findings have implications for policymakers interested in developing a framework to support healthcare professionals in addressing workplace mistreatment, enabling them to effectively fulfil their role as care providers.

The Fit After Baby randomized controlled trial: An mHealth postpartum lifestyle intervention for women with elevated cardiometabolic risk

by Jacinda M. Nicklas, Laura Pyle, Andrey Soares, Jennifer A. Leiferman, Sheana S. Bull, Suhong Tong, Ann E. Caldwell, Nanette Santoro, Linda A. Barbour

Background

Postpartum women with overweight/obesity and a history of adverse pregnancy outcomes are at elevated risk for cardiometabolic disease. Postpartum weight loss and lifestyle changes can decrease these risks, yet traditional face-to-face interventions often fail. We adapted the Diabetes Prevention Program into a theory-based mobile health (mHealth) program called Fit After Baby (FAB) and tested FAB in a randomized controlled trial.

Methods

The FAB program provided 12 weeks of daily evidence-based content, facilitated tracking of weight, diet, and activity, and included weekly coaching and gamification with points and rewards. We randomized women at 6 weeks postpartum 2:1 to FAB or to the publicly available Text4baby (T4B) app (active control). We measured weight and administered behavioral questionnaires at 6 weeks, and 6 and 12 months postpartum, and collected app user data.

Results

81 eligible women participated (77% White, 2% Asian, 15% Black, with 23% Hispanic), mean baseline BMI 32±5 kg/m2 and age 31±5 years. FAB participants logged into the app a median of 51/84 (IQR 25,71) days, wore activity trackers 66/84 (IQR 43,84) days, logged weight 17 times (IQR 11,24), and did coach check-ins 5.5/12 (IQR 4,9) weeks. The COVID-19 pandemic interrupted data collection for the primary 12-month endpoint, and impacted diet, physical activity, and body weight for many participants. At 12 months postpartum women in the FAB group lost 2.8 kg [95% CI -4.2,-1.4] from baseline compared to a loss of 1.8 kg [95% CI -3.8,+0.3] in the T4B group (p = 0.42 for the difference between groups). In 60 women who reached 12 months postpartum before the onset of the COVID-19 pandemic, women randomized to FAB lost 4.3 kg [95% CI -6.0,-2.6] compared to loss in the control group of 1.3 kg [95% CI -3.7,+1.1] (p = 0.0451 for the difference between groups).

Conclusions

There were no significant differences between groups for postpartum weight loss for the entire study population. Among those unaffected by the COVID pandemic, women randomized to the FAB program lost significantly more weight than those randomized to the T4B program. The mHealth FAB program demonstrated a substantial level of engagement. Given the scalability and potential public health impact of the FAB program, the efficacy for decreasing cardiometabolic risk by increasing postpartum weight loss should be tested in a larger trial.

A virtual dissemination framework to inform and evaluate a neonatal project ECHO (NeoECHO)

Abstract

Aim

To present the development, implementation and evaluation of a theoretically grounded novel virtual dissemination evaluation (VDE) framework.

Background

Care of intensive care unit patients requires access to the most up-to-date knowledge and best practices. To address this challenge, we present the development, implementation and evaluation of a theoretically grounded novel VDE framework. This framework is applied to a dissemination strategy, NeoECHO, in neonatal intensive care units. Evidence-based virtual education is implemented to prevent, detect and treat necrotizing enterocolitis in neonates.

Design

Research Methodology: Discussion Paper—Methodology.

Methods

The virtual dissemination evaluation framework is a sequential combination of Integration of Integrated-Promoting Action on Research Implementation in Health Services and Moore's Expanded Outcomes frameworks. The framework's conceptual determinants, virtual facilitators and implementation evaluations were operationalized in the NeoECHO dissemination strategy and evaluated for feasibility. The virtual dissemination evaluation framework was conceptually mapped, and operational activities were examined including theoretical constructs drawing on insights of nursing theorists, especially Fawcett's criteria (2005) for frameworks with practical application (significance, internal consistency, parsimony, testability and design fit). The NeoECHO strategy was evaluated for virtual dissemination evaluation adherence, operationalization and feasibility of implementation evaluation.

Results

The virtual dissemination evaluation framework meets the criteria for a practical application and demonstrates feasibility for adherence and operationalization consistency. The implementation evaluation was usable in the virtual dissemination of best practices for neonatal care for necrotizing enterocolitis and healthcare providers were actively engaged in using NeoECHO as an implementation strategy.

Conclusion

This examination of the foundational aspects of the framework underscores the rigour required for generalization of practical application. Effective virtual dissemination of evidence-based practices to hospital units requires structured delivery and evaluation, enabling engaged healthcare providers to actualize education rapidly. The virtual dissemination evaluation frameworks' potential for narrowing the evidence-based practice gap in neonatal care showcases its wider significance and applicability.

Implications

Care of neonates in NICUs requires a multidisciplinary approach and necessitates access to the most up-to-date knowledge and best practices. More than traditional dissemination methods are required to bridge the implementation gap.

Impact

The effective use of the VDE framework can enhance the design, implementation and evaluation of knowledge dissemination, ultimately elevating neonatal care quality.

Clinical Relevance

This paper introduces the VDE framework, a sequential combination of the iPARIHS and Moore's EO frameworks—as a methodological tool for designing, implementing and evaluating a neonatal strategy (NeoECHO) for virtual dissemination of education in NICUs.

Patient or Public Contribution

No patient or public contribution.

The Healthy Brain Initiative (HBI): A prospective cohort study protocol

by Lilah M. Besser, Stephanie Chrisphonte, Michael J. Kleiman, Deirdre O’Shea, Amie Rosenfeld, Magdalena Tolea, James E. Galvin

Background

The Health Brain Initiative (HBI), established by University of Miami’s Comprehensive Center for Brain Health (CCBH), follows racially/ethnically diverse older adults without dementia living in South Florida. With dementia prevention and brain health promotion as an overarching goal, HBI will advance scientific knowledge by developing novel assessments and non-invasive biomarkers of Alzheimer’s disease and related dementias (ADRD), examining additive effects of sociodemographic, lifestyle, neurological and biobehavioral measures, and employing innovative, methodologically advanced modeling methods to characterize ADRD risk and resilience factors and transition of brain aging.

Methods

HBI is a longitudinal, observational cohort study that will follow 500 deeply-phenotyped participants annually to collect, analyze, and store clinical, cognitive, behavioral, functional, genetic, and neuroimaging data and biospecimens. Participants are ≥50 years old; have no, subjective, or mild cognitive impairment; have a study partner; and are eligible to undergo magnetic resonance imaging (MRI). Recruitment is community-based including advertisements, word-of-mouth, community events, and physician referrals. At baseline, following informed consent, participants complete detailed web-based surveys (e.g., demographics, health history, risk and resilience factors), followed by two half-day visits which include neurological exams, cognitive and functional assessments, an overnight sleep study, and biospecimen collection. Structural and functional MRI is completed by all participants and a subset also consent to amyloid PET imaging. Annual follow-up visits repeat the same data and biospecimen collection as baseline, except that MRIs are conducted every other year after baseline.

Ethics and expected impact

HBI has been approved by the University of Miami Miller School of Medicine Institutional Review Board. Participants provide informed consent at baseline and are re-consented as needed with protocol changes. Data collected by HBI will lead to breakthroughs in developing new diagnostics and therapeutics, creating comprehensive diagnostic evaluations, and providing the evidence base for precision medicine approaches to dementia prevention with individualized treatment plans.

Critical care nursing workforce in crisis: A discussion paper examining contributing factors, the impact of the COVID‐19 pandemic and potential solutions

Abstract

Aims and Objectives

The critical care nursing workforce is in crisis, with one-third of critical care nurses worldwide intending to leave their roles. This paper aimed to examine the problem from a wellbeing perspective, offering implications for research, and potential solutions for organisations.

Design

Discursive/Position paper.

Method

The discussion is based on the nursing and wellbeing literature. It is guided by the authors' collaborative expertise as both clinicians and researchers. Data were drawn from nursing and wellbeing peer-reviewed literature, such as reviews and empirical studies, national surveys and government and thinktank publications/reports.

Results

Critical care nurses have been disproportionately affected by the COVID-19 pandemic with studies consistently showing critical care nurses to have the worst psychological outcomes on wellbeing measures, including depression, burnout and post-traumatic stress disorder (PTSD). These findings are not only concerning for the mental wellbeing of critical care nurses, they also raise significant issues for healthcare systems/organisations: poor wellbeing, increased burnout and PTSD are directly linked with critical care nurses intending to leave the profession. Thus, the wellbeing of critical care nurses must urgently be supported. Resilience has been identified as a protective mechanism against the development of PTSD and burnout, thus offering evidence-based interventions that address resilience and turnover have much to offer in tackling the workforce crisis. However, turnover data must be collected by studies evaluating resilience interventions, to further support their evidence base. Organisations cannot solely rely on the efficacy of these interventions to address their workforce crisis but must concomitantly engage in organisational change.

Conclusions

We conclude that critical care nurses are in urgent need of preventative, evidence-based wellbeing interventions, and make suggestions for research and practice.

Factors that help and hinder transgender and nonbinary youth accessing gender care in Ireland: A multistakeholder exploration

Abstract

Introduction

The purpose of this study was to identify the common factors that help and hinder transgender and nonbinary youth accessing gender-specific health care in Ireland and to identify how these factors may be perceived differently by young people seeking gender-affirming care, their parents, and health-care providers.

Design

Qualitative investigation utilizing framework analysis (FA).

Methods

In-depth one–one interviews were conducted with transgender and nonbinary youth (n = 10), parents of youth (n = 10), and gender-specific health-care providers (n = 10). Maximum variation and snowball sampling were used to recruit participants across Ireland. An interview guide codesigned with an expert panel of gender-diverse youth was utilized. Interviews were audio-recorded and transcribed verbatim. FA was used to code the data and identify key issues and recommendations.

Results

Four themes were derived: (1) “Needing bricks to build” (structural factors); (2) “Enduring and convincing” (diagnostic factors); (3) “Being me, hiding me”; (personal factors); and (4) “It takes a tribe” (interpersonal factors). Each stakeholder group perceived different factors as help or hindrance in accessing care with varying intensities.

Conclusions

Paramount to the future of gender services in Ireland is the investment of resources for children and young adults. Assessment is likely to remain a component of gender care, but youth recommend distinct revisions to the assessment process. Additional research would be useful in exploring the intersection of neurodiversity and gender as it pertains to health-care navigation. Family and peer support is a strong protective factor and enabler of health-care access among youth.

Clinical Relevance

Access to gender-specific health care remains difficult for transgender and non-binary youth. An understanding of the complexity of this healthcare navigation by healthcare professionals may help to mitigate future negative experiences. This study explores some of the clinical considerations that arise for this population from provider perspectives while elucidating the experiences of youth and parents attempting to access care. Further research is needed on longitudinal outcomes following medical and surgical interventions for transgender youth, including nonbinary identities.

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