Showing papers in "Journal of multidisciplinary healthcare in 2018"

Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature

Abstract: In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs - including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don'ts) when setting up MDT-driven cancer care.

Real world data: an opportunity to supplement existing evidence for the use of long-established medicines in health care decision making.

Abstract: Evidence from medication use in the real world setting can help to extrapolate and/or augment data obtained in randomized controlled trials and establishes a broad picture of a medication's place in everyday clinical practice. By supplementing and complementing safety and efficacy data obtained in a narrowly defined (and often optimized) patient population in the clinical trial setting, real world evidence (RWE) may provide stakeholders with valuable information about the safety and effectiveness of a medication in large, heterogeneous populations. RWE is emerging as a credible information source; however, there is scope for enhancements to real world data (RWD) sources by understanding their complexities and applying the most appropriate analytical tools in order to extract relevant information. In addition to providing information for clinicians, RWE has the potential to meet the burden of evidence for regulatory considerations and may be used in approval of new indications for medications. Further understanding of RWD collection and analysis is needed if RWE is to achieve its full potential.

Total knee arthroplasty: improving outcomes with a multidisciplinary approach.

Abstract: Total knee arthroplasty (TKA) is the most commonly performed inpatient surgical procedure within the USA and is estimated to reach 3.48 million procedures annually by 2030. As value-based care initiatives continue to focus on hospital readmission rates and patient satisfaction, it has become essential for health care providers to develop and implement a multidisciplinary approach to enhance TKA outcomes while minimizing unnecessary expenditures. Through this necessity, clinical care pathways have been developed to standardize, organize, and improve the quality and efficiency of patient care while simultaneously encouraging the collaboration among various medical care providers. Here, we review several systems based programs and specialty care practices that can be adopted into the standard orthopedic practice.

Does the medical literature remain inadequately described despite having reporting guidelines for 21 years? - A systematic review of reviews: an update.

Abstract: Purpose Reporting guidelines (eg, Consolidated Standards of Reporting Trials [CONSORT] statement) are intended to improve reporting standards and enhance the transparency and reproducibility of research findings. Despite accessibility of such guidelines, researchers are not required to adhere to them. Our goal was to determine the current status of reporting quality in the medical literature and examine whether adherence of reporting guidelines has improved since the inception of reporting guidelines. Materials and methods Eight reporting guidelines, such as CONSORT, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), Quality of Reporting of Meta-analysis (QUOROM), STAndards for Reporting of Diagnostic accuracy (STARD), Animal Research: Reporting In Vivo Experiments (ARRIVE), Consolidated Health Economic Evaluation Reporting Standards (CHEERS), and Meta-analysis of Observational Studies in Epidemiology (MOOSE) were examined. Our inclusion criteria included reviews published between January 1996 to September 2016 which investigated the adherence to reporting guidelines in the literature that addressed clinical trials, systematic reviews, observational studies, meta-analysis, diagnostic accuracy, economic evaluations, and preclinical animal studies that were in English. All reviews were found on Web of Science, Excerpta Medical Database (EMBASE), MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Results Among the general searching of 26,819 studies by using the designed searching method, 124 studies were included post screening. We found that 87.9% of the included studies reported suboptimal adherence to reporting guidelines. Factors associated with poor adherence included non-pharmacological interventions, year of publication, and trials concluding with significant results. Improved adherence was associated with better study designs such as allocation concealment, random sequence, large sample sizes, adequately powered studies, multiple authorships, and being published in journals endorsing guidelines. Conclusion We conclude that the level of adherence to reporting guidelines remains suboptimal. Endorsement of reporting guidelines by journals is important and recommended.

Anxiety and depression predicted quality of life among patients with heart failure.

Abstract: Purpose Anxiety and depression are prevalent among patients with heart failure. However, their effect on the quality of life (QoL) is not well investigated in developing countries. Therefore, the purpose of this study was to test the effect of anxiety and depression on QoL among Jordanian patients with heart failure. Patients and methods Two hundred patients with a confirmed diagnosis of heart failure from 1 governmental and 1 private hospital in Amman, Jordan, were recruited between March and August, 2017. A descriptive, cross-sectional design was used. Anxiety and depression were measured using the Arabic version of the Hospital Anxiety and Depression Scale. QoL was measured using the Arabic version of the Short Form-36. Results Patients reported poor QoL in both physical component summary (M ± SD; 35.8±9.6) and mental component summary (M ± SD; 41.5±11.3). Prevalence rates for anxiety and depression were 62% and 65%, respectively. In stepwise regression analysis, anxiety and depression were independent predictors for poor QoL in both summaries, p Conclusion Patients with heart failure have poor QoL and high anxiety and high depression prevalence rates. Inclusion of routine assessment and management of anxiety and depression in heart failure protocols is highly recommended.

Ruralization of students' horizons: insights into Australian health professional students' rural and remote placements.

Abstract: Introduction: Health workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students' future rural practice intentions. Methods: Responses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software. Results: The core concept identified from the thematic analysis was "ruralization of students' horizons," a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, "preparation and support," "rural or remote health experience," and "rural lifestyle and socialization," each of which includes multiple subthemes. From the content analysis, factors that promoted students' rural practice intentions were having a "positive" practice experience, interactions with "supportive staff," and interactions with the "community" in general. It was apparent that "difficulties," eg, with "accommodation," "Internet" access, "transport," and "financial" support, negatively impacted students' placement experience and rural practice intentions. Conclusions: The study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and enhancing rural health workforce recruitment, retention, and capacity building.

Factors influencing male participation in reproductive health: a qualitative study.

Abstract: Introduction Male involvement in reproductive health is an essential component in promoting maternal and family health. In Nepal, men are not actively engaged in most maternal and child health (MCH) services nor in other reproductive health programs. There is a need to know about the understanding of key professionals in such practices. This study explores gendered perspectives among teachers and health professionals to understand the factors contributing to male involvement in reproductive health. Methods The data were collected through two focus group discussions (FGDs) and seven key informant interviews (KIIs). FGDs were held among male teachers of selected schools, and KIIs were conducted with health professionals of the health post of Bungamati, Lalitpur. An unstructured interview guide was used to explore their experiences and perceptions. All KIIs and FGDs were recorded, translated and transcribed verbatim. Results Findings show limited male involvement in reproductive health. Participants reported several hindering and challenging factors such as sociocultural and psychological norms, lack of education, and misinformation and dominance of female as health care providers in many MCH clinics. Perceived motivating factors included positive attitude in men, literacy and awareness, inclusion of reproductive health in school curriculum and certain incentives. Participants also recommended a range of strategies for increasing men's involvement in reproductive health in Nepal. Conclusion Men's education and attitude, knowledge and awareness, sociocultural factors, psychological factors, health system factors, and policies play important roles in male involvement in reproductive health. Programs on effective implementation of men involvement in reproductive health initiatives should address the barriers and challenges to men's supportive activities. This study also suggests increasing literacy of reproductive health among men that enhances their positivity and motivates them to participate in reproductive health services.

Long-term health complications following snake envenoming

Abstract: Background Snakebite is an important public health problem in tropical regions of the world. Although devastating effects of envenoming such as kidney failure, tissue necrosis, bleeding diathesis, and neurotoxicity are well known in the acute stage following a snakebite, the long-term effects of snake envenoming have not been adequately studied. Materials and methods A population-based study was conducted among 8707 residents in a rural district in Sri Lanka to assess the long-term sequelae following snakebite. Health-related complaints that snakebite victims had developed immediately or within 4 weeks of the bite and persisted for more than 3 months, were assessed by interviewer-administered questionnaire and in-depth interviews, and further evaluated by physical examination and relevant investigations. Results Of the 816 participants who were identified as ever snakebite victims, 112 (13.7%) presented with at least one snakebite-related long-term health complication. Among them, "migraine-like-syndrome" characterized by headache vertigo, and photosensitivity to sunlight was found in 46 (5.6%); musculoskeletal disorders such as pain, local swelling, muscle weakness, deformities, contractures, and amputations were found in 26 (3.2%); visual impairment in 21 (2.6%); acute kidney injury in 4 (0.5%); skin blisters at the bite site in 5 (0.6%); psychological distress in 2 (0.2%); hemiplegia in 1 (0.1%); right-side facial nerve palsy in 1 (0.1%); paresthesia over bite site in 1 (0.1%); generalized shivering in 1 (0.1%); and chronic nonhealing ulcer in 1 (0.1%). Interestingly, 31 (3.8%) reported nonspecific somatic symptoms such as abdominal colic, chest tightness, wheezing, receding gums, excessive hair loss, and lassitude with body aches following the bite. The average duration of symptoms since snakebite was 12.7 years (SD=11.7). Conclusion This study highlights that a significant proportion of snakebite victims suffer disabling chronic health sequelae. There is a need to place systems to address these unmet health needs.

The evolving role of social media in health-care delivery: measuring the perception of health-care professionals in Eastern Saudi Arabia.

Abstract: Purpose The objective of this study is to evaluate the perception of health-care professionals in Saudi Arabia toward the usages of social media in health-care delivery Methods In this cross-sectional study, an online-based questionnaire was distributed among the health-care professionals residing in the eastern region of Saudi Arabia Their perception toward the uses of social media in health-care service delivery was evaluated by analyzing their attitude toward its benefits and risks involved Results The sample size was 120 participants, and 80% of them agreed with the benefits of using social networks in health-care services and considered that the use of these technologies in the provision of health services improves their professional knowledge and is a suitable tool for patient education and public health awareness However, some respondents (20%) believed that there are several risks associated with the use of social media, such as ethical or legal challenges, the risk to the patient's health status, or the breaching of the privacy and confidentiality of the patient Conclusion The results of this research indicate that social media can be a useful tool by which physicians may promote their services and publish general health information However, there are potential problems in the use of social networks that can have negative consequences for patients and HCPs This implies that precautions must be taken to avoid ruptures of patient privacy and other risks that can result in legal action against health professionals damaging their image and professional status The study also found that the participants are willing to use social media for professional purposes

Specialty-care access for community health clinic patients: processes and barriers.

Abstract: Introduction Community health clinics/centers (CHCs) comprise the US's core health-safety net and provide primary care to anyone who walks through their doors. However, access to specialty care for CHC patients is a big challenge. Materials and methods In this descriptive qualitative study, semistructured interviews of 37 referral coordinators of CHCs were used to describe their perspectives on processes and barriers to patients' access to specialty care. Analysis of data was done using content analysis. Results The process of coordinating care referrals for CHC patients is complex and begins with a provider's order for consultation and ends when the referring provider receives the specialist's note. Poverty, specialist and referral coordinator shortages, lack of insurance, insurance acceptability by providers, transport and clinic-location factors, lack of clinic-hospital affiliations, and poor communication between primary and specialty providers constitute critical barriers to specialty-care access for patients. Conclusion Understanding the complexities of specialty-care coordination processes and access helps determine the need for comprehensive and uninterrupted access to quality health care for vulnerable populations. Guaranteed access to primary care at CHCs has not translated into improved access to specialty care. It is critical that effective policies be pursued to address the barriers and minimize interruptions in care, and to ensure continuity of care for all patients needing specialty care.

Reablement teams’ roles: a qualitative study of interdisciplinary teams’ experiences

Abstract: Introduction Reablement is a service for home-dwelling older people experiencing a decline in health and function. The focus of reablement is the improvement of the person's function and coping of his or he valued daily activities. The health care professionals and the home care personnel are working together with the older person toward his goals. In reablement, health care personnel are organized in an interdisciplinary team and collaborate with the older person in achieving his goals. This organizing changes the roles of home care personnel from working almost alone to collaborating with different health care professionals. There is little scientific knowledge describing the roles of different health care professionals and home care personnel in the context of reablement. This study's objective is to explore and describe the roles of interdisciplinary teams in reablement services in a Norwegian setting. Method Two interdisciplinary teams consisting of 17 health care professionals (i.e. occupational therapists, physiotherapists, nurses, and social educators) and ten home care personnel (auxiliary nurses and nursing assistants) participated in three focus group discussions. In addition, three interviews were conducted with occupational therapists, physiotherapists, nurses, and auxiliary nurses. The focus group discussions and the interviews were all digitally recorded, transcribed verbatim and analyzed using the qualitative content analysis. Results The health care professionals' main role was to be consultants and advisors, consisting of (1) planning, adjusting, and conducting follow-ups of the intervention; (2) delegating tasks; and (3) supervising the home care personnel. The home care personnel's main role was to be personal trainers, consisting of (1) encouraging and counseling the older adults to perform everyday activities; and (2) conveying a sense of security while they performed everyday activities. The role of interdisciplinary collaboration was a common role for both the health care professionals and the home care personnel. Conclusion The health care professionals established the setting, and had the main roles of supervision, delegating tasks, and main responsibility for the intervention. The home care personnel accepted the delegations and had a main role as personal trainers. Their work changed from body care to encouraging and counseling the older person to perform activities themselves in a safe way. The health care professionals and the home care personnel collaborated closely across roles. The home care personnel experienced a shift in role from home care to a person-centered care. This was perceived as strengthening the health care identity of their role.

Farm-based day care in Norway – a complementary service for people with dementia

Abstract: Background Day care services provide meaningful activities and coping experiences in a safe environment for people with dementia, as well as improve quality of life. Such services vary in types and settings. Farm-based day care (FDC) services are described as services that have been adapted from the farm setting, using farm resources to promote health. There is limited knowledge on the service offered in both FDC and regular day care services for people with dementia. The present study aims to investigate FDC in Norway and describe the services and the participants' care environment. Materials and methods We mapped the existing farms offering day care in Norway by the spring 2017 (N=33) and collected information through two cross-sectional surveys (N=32) answered by the service providers at the farms. Results The farms included in this survey provided day care services to 227 people with dementia, located in most regions of Norway. The services varied in terms of group size and half of the services had young people with dementia (≤65 years) and people with dementia at an early stage as their primary target group. About half of the staff had health care education (47.5%), and there were staff with agricultural competence available in most FDCs. All farms reported that the participants spent time outdoors every day, and all services, except two, had animals. The providers highlighted the opportunity to choose activities that were individually tailored for each participant, as the diversity of resources in the farm made it possible to organize different activities. Conclusion FDC services have similarities in organization, daily structure, and number of health education personnel to other day care services, but differ in type of care environment with a wide range of activities and available resources like farm buildings, gardens, animals, and outdoor areas.

Exploring the characteristics, global distribution and reasons for retraction of published articles involving human research participants: a literature survey.

Abstract: Aim Article retraction is a measure taken by journals or authors where there is evidence of research misconduct or error, redundancy, plagiarism or unethical research. Recently, the retraction of scientific publications has been on the rise. In this survey, we aimed to describe the characteristics and distribution of retracted articles and the reasons for retractions. Methods We searched retracted articles on the PubMed database and Retraction Watch website from 1980 to February 2016. The primary outcomes were the characteristics and distribution of retracted articles and the reasons for retractions. The secondary outcomes included how article retractions were handled by journals and how to improve the journal practices toward article retractions. Results We included 1,339 retracted articles. Most retracted articles had six authors or fewer. Article retraction was most common in the USA (26%), Japan (11%) and Germany (10%). The main reasons for article retraction were misconduct (51%, n = 685) and error (14%, n = 193). There were 66% (n = 889) of retracted articles having male senior or corresponding authors. Of the articles retracted after August 2010, 63% (n = 567) retractions were reported on Retraction Watch. Large discrepancies were observed in the ways that different journals handled article retractions. For instance, articles were completely withdrawn from some journals, while in others, articles were still available with no indication of retraction. Likewise, some retraction notices included a detailed account of the events that led to article retraction, while others only consisted of a statement indicating the article retraction. Conclusion The characteristics, geographic distribution and reasons for retraction of published articles involving human research participants were examined in this survey. More efforts are needed to improve the consistency and transparency of journal practices toward article retractions.

Job strain : a cross-sectional survey of dementia care specialists and other staff in Swedish home care services

Abstract: Introduction: An increasing number of older persons worldwide live at home with various functional limitations such as dementia. So, home care staff meet older persons with extensive, complex needs ...

Home care workers in heart failure: a systematic review.

Abstract: Background Home care workers (HCWs), which include home health aides and personal care aides, are increasingly used by heart failure (HF) patients for post-acute care and long-term assistance Despite their growing presence, they have largely been left out of HF research and interventions This systematic review was aimed to 1) describe utilization patterns of HCWs by adults with HF, 2) examine the effect of HCWs on HF outcomes, and 3) review HF interventions that involve HCWs Methods Five electronic databases (Ovid MEDLINE, Ovid EMBASE, Cochrane Library [Wiley], CINAHL [EBSCO], and AgeLine [EBSCO]) were searched from inception through August 4, 2017 The yield was screened using prespecified inclusion and exclusion criteria Two authors independently reviewed references and a third reviewer acted as an arbitrator when needed Data were extracted from articles that met the inclusion criteria The Downs and Black checklist was used for quality assessment Due to study heterogeneity, a narrative synthesis was conducted Results Of the 7,032 studies screened, 13 underwent full-text review, and six met the inclusion criteria Two descriptive studies found that adults with HF who live alone and have functional and cognitive deficits utilize HCWs While three retrospective cohort studies examined the association between having an HCW post-HF hospitalization and readmission rates, their findings were conflicting One quasi-experimental study found that an HCW-delivered educational intervention improved HF patients' self-care abilities Overall, despite some significant findings, the studies assessed were of poor-to-fair quality (Downs and Black score range: 10-16 [28 total points]), with most lacking methodological rigor Conclusion Although HCWs are quite common, the literature on these paraprofessionals in HF is limited Given the paucity of research in this area and the low quality of studies reviewed here, additional research is warranted on the potential role of HCWs in HF self-care and on outcomes among adults with HF

Multidisciplinary approach to the management of pulmonary embolism patients: the pulmonary embolism response team (PERT).

Abstract: Pulmonary embolism (PE) is a potentially fatal disease with a broad range of treatment options that spans multiple specialties. The rapid evolution and expansion of novel therapies to treat PE make it a disease process that is well suited to a multidisciplinary approach. In order to facilitate a rapid, robust response to the diagnosis of PE, some hospitals have established multidisciplinary pulmonary embolism response teams (PERTs). The PERT model is based on existing multidisciplinary teams such as heart teams and rapid response teams. A PERT is composed of clinicians from the range of specialties involved in the treatment of PE, including pulmonology critical care, interventional radiology, cardiology, and cardiothoracic surgery among others. A PERT is a 24/7 consult service that is able to provide expert advice on the initial management of PE patients and convene in real time to develop a consensus treatment plan specifically tailored to the needs of a particular patient and consistent with the capabilities of the institution. In this review, we discuss the rationale for establishing a PERT and its potential benefits. We discuss considerations in forming a PERT and present case studies of several PERTs currently in operation at different institutions. We also discuss potential difficulties in forming a PERT and review evidence that has been generated by some of the PERTs that have been in operation the longest.

Health care quality from the patients' perspective: a comparative study between an old and a new, high-tech hospital

Abstract: Purpose Previous studies show that the hospital environment and the behavior of health care personnel may predict patients' perceptions of care quality. The aim of the study was to explore changes in perceived care quality from the patients' perspective (QPP) when hospital services are relocated from an old to a new high-tech hospital and to describe what is important for patients in the high-tech hospital. Patients and methods A comparative cross-sectional design was used. The questionnaire QPP, which is based on a theoretical model of the quality of care comprising four quality dimensions, was used. Data were collected in 2015 (old hospital) and 2016 (new hospital), with 253 and 324 respondents, respectively, by consecutive sampling. Comparative statistics was used to test differences between patients' care quality perceptions (perceived reality [PR] and subjective importance [SI]) (P≤0.05). Results The patients rated PR of all four quality dimensions (the care organization's physical-technical conditions and sociocultural approach and the caregivers' medical-technical competence and identity-oriented approach) higher in the new hospital. However, only the two quality dimensions concerning the care organization were rated significantly more highly. On an item level, five of the 27 items scored significantly higher on patients' SI than on patients' PR of the care in the new hospital, indicating a quality deficiency from the patients' perspective. This comprised receiving effective pain relief, receiving examination and treatment within an acceptable waiting time, receiving useful information on self-care, receiving useful information on which doctors were responsible for their medical care, and having a comfortable bed. Conclusion The increase in care QPP was associated with improved environmental conditions, and no significant improvement in care quality was associated with the health care personnel. The results indicate that being in a high-tech environment does not improve patients' perceptions of care quality provided by health care personnel. The results gave valuable information for quality improvement in clinical practice, based on the patients' perspective.

Coordination of services for dual diagnosis clients in the interface between specialist and community care.

Abstract: Purpose The aim of this article is to study the coordination of comprehensive services for clients with concurrent substance abuse and mental health disorders (dual diagnosis), which is a very complex client group. In order to achieve comprehensive care and treatment, the service providers need to cooperate and coordinate, but the questions here, are how this is done and how appropriate the coordination is. Data and methods Data were collected from group interviews during a 1-day workshop with clients, relatives, and employees from the various services involved. Results Information exchange between the services was generally in writing. Coordination between substance abuse and mental health services was experienced as fragmented. Employees had an unclear perception of the work and expertise of the other service providers involved. There were examples of disparity between the services a municipality could offer and client needs. A coordinator, if available, was emphasized by both clients and service providers as serving an important function in coordination and relationship building. Conclusion Predominantly written communication and unclear division of responsibilities and duties resulted in employees creating stereotypes of each other, both within specialist health services and between specialist and municipal health services. A coordinator was able to coordinate various inputs, often through informal contact, with a view to establishing appropriate services for individual clients. Coordination in interagency meeting points, such as "responsibility teams", was the most successful solution, but this will involve a greater degree of networking than is common today.

Knowledge, beliefs, and perceptions of tuberculosis among community members in Ntcheu district, Malawi

Abstract: CITATION: Nyasulu, P., et al. 2018. Knowledge, beliefs, and perceptions of tuberculosis among community members in Ntcheu district, Malawi. Journal of Multidisciplinary Healthcare, 11:375-389, doi:10.2147/JMDH.S156949.

Perceived control moderates the relationship between anxiety and in-hospital complications after ST segment elevation myocardial infarction.

Abstract: Purpose Anxiety is a common psychological response after acute myocardial infarction and might be associated with higher levels of in-hospital complications. Perceived control might moderate this relationship, but the effect of this method has not been checked in developing countries. Therefore, the objectives of this study were as follows: 1) to check if anxiety was an independent predictor of in-hospital complications after acute myocardial infarction; and 2) to check if perceived control moderates the relationship between anxiety and in-hospital complications after acute myocardial infarction. Patients and methods This was a prospective observational study among 500 patients with a confirmed diagnosis of ST segment elevation myocardial infarction recruited from three private hospitals in Amman, Jordan. Anxiety was measured by the Anxiety subscale of Hospital Anxiety and Depression Scale, and perceived control was measured by the Arabic version of the Control Attitude Scale-Revised. Results One hundred and forty patients (28%) developed at least one complication during hospitalization. Two hundred and fifty-five patients had low anxiety scores (≤7), and 245 patients had high anxiety scores (≥8). Patients with high levels of perceived control had lower levels of anxiety (mean [SD]; 5.3 [3.6] vs 14.1 [6.3], P<0.001) than those with low perceived control. In logistic regression, anxiety was an independent predictor of in-hospital complications after controlling for sociodemographic and clinical variables (odds ratio: 1.24, 95% CI, 1.08-1.41, P<0.01). Moreover, the interaction of anxiety and perceived control was a significant predictor of complications. Conclusion Anxiety was associated with increased risk of in-hospital complications after acute myocardial infarction independent of sociodemographic and clinical variables. Perceived control had a moderating effect for this association since the combination of low perceived control and high anxiety scores was associated with the greatest risk for complications. Supporting patients' levels of perceived control can decrease complications, morbidities, and mortality after acute myocardial infarction.

Not enough time for research? Use of supported funding to promote allied health research activity.

Abstract: The current project evaluated the impact of a short-term, supported funding initiative that allowed staff from allied health (AH) professions to undertake research activity within rostered employment time. Specifically, the project will report on outcomes pertaining to individual research capacity, research output, and overall satisfaction with the initiative. Sixteen AH clinicians (n=16) from six AH professions participated in the evaluation of the initiative, with data being collected within a service improvement framework. Clinicians received up to 4 weeks of protected time relieved from their clinical duties to undertake research activities, including writing for publication, undertaking a systematic review, data analysis, and preparation of ethics applications. An AH Research Fellow provided additional support and mentorship, including the development of an implementation plan. Evaluation included pre-post measures of individual research capacity using a 15-item self-report Research Capacity and Culture (RCC) survey, a post-implementation satisfaction survey, and monitoring of research output achieved. Statistically significant improvements ( The preliminary findings support the feasibility of implementing a local, clinical funding model to promote individual research capacity and research output for AHPs. The short-term funding should be supported by local mentorship and guidance. Local barriers and suggestions to optimize implementation, including integrating within existing research infrastructure and using flexible "backfill" options, will also be described.

Reducing HIV-related stigma and discrimination in healthcare settings: a systematic review of guidelines, tools, standards of practice, best practices, consensus statements and systematic reviews.

Abstract: Introduction Policy makers and health professionals prefer to use preappraised and summarized evidence. Stigma and discrimination (SAD) reduction activities and programs are needed to improve the quality of care delivered to people living with HIV and the success of HIV-related prevention, care and treatment programs. The objective of this review was to identify and describe systematic reviews, best practices, consensus statements, standards of practice and guidelines that addressed SAD among healthcare workers (HCWs). Methods All documents in the form of systematic reviews, best practices, consensus statements, standards of practice and guidelines were considered for inclusion. The search strategy aimed to find both published and unpublished studies reported in English with unlimited date range in Excerpta Medica Database from Elsevier (EMBASE), Cumulative Index to Nursing and Allied Health (CINAHL), Psychological Information (PsycINFO) database and Medical Literature Analysis and Retrieval System Online (MEDLINE). Websites of organizations and guideline databases were also searched. Two individuals independently appraised the quality of the documents using the Appraisal of Guidelines for Research and Evaluation (AGREE II) checklist and the Joanna Briggs Institute critical appraisal checklist for systematic reviews. Data extraction was done using a customized tool that was developed to record the key information of the source that is relevant to the review question. Results Twelve records (six guideline-related documents and six systematic reviews) were included in the review. Interventions and recommendations developed to reduce HIV-related SAD were categorized into information-based, structural, biomedical, counseling and support, skills building and contact interventions. Conclusion Implications for practice: Interventions that reduce HIV-related SAD are broadly categorized into information-based, structural, biomedical, counseling and support, skills building and contact interventions. Because of limited methodological description of the included documents, it was difficult to draw recommendations for policy and practice. Implications for research: Future studies need to use up-to-date instruments to measure SAD. Further studies of greater methodological quality are needed. Guidelines, tools and best practice documents that aim to reduce HIV-related SAD should be developed with the considerations of research evidence on the specific setting and specific targeted populations.

How good is collaboration between maternity service providers in the Netherlands

Abstract: Aims: To examine the experiences of inter-professional collaboration of maternity service providers in the Netherlands and to identify potential enhancing and inhibiting factors for inter-professional collaboration within maternity care in the Netherlands. Background: Good collaboration between health care professionals is a key element of safe, effective care, but creating a collaborative culture can be challenging. Good collaboration requires, among other things, negotiating different professional orientations and the organizational constraints of hierarchies and scheduling. Good collaboration is especially important in maternity care. In the Netherlands, suboptimal collaboration has been cited as a significant factor in maternal deaths and in adverse incidents occurring in hospitals during evenings, nights, and weekends. In spite of its importance for effective maternity care, little is known about the nature and quality of collaboration between maternity care professionals. In order to fill this gap, we examined the inter-professional collaboration within multi-disciplinary teams (MDTs) providing maternity services in the Netherlands. Methods: Online survey of MDTs (consisting of hospital and PCMs, doctors, and carers) involved in the provision of maternity services in the Netherlands. We used a validated measure of collaboration (the Leiden Quality of Work Questionnaire) to analyze the attitudes of those involved in the provision of maternity services about multi-disciplinary collaboration in their work. We used descriptive and inferential statistics to assess differences between the groups. Results: 40% of all respondents were not satisfied with collaboration within their MDT. Overall, mean collaboration scores (MCS) were low. We found significant differences in MCS between professional groups. Midwives - community and hospital based - were pessimistic about collaboration in future models of maternity care. Discussion: In the Netherlands, collaboration in maternity care is less than optimal. Poor collaboration is associated with negative consequences for patient safety and quality of care. Strategies to address suboptimal collaboration exist; however, no one-size-fits-all approach is identified in the literature. Conclusion: Suboptimal collaboration exists within the midwifery model of care in the Netherlands and the relationship between care providers is under pressure. This could affect patient safety and quality of care, according to the literature. Precis: This paper presents an in-depth examination of the nature of, and attitudes about, collaboration between members of the MDT involved in the provision of maternity services in the Netherlands.

Patient perspectives on transitioning to amyotrophic lateral sclerosis multidisciplinary clinics.

Abstract: Purpose Multidisciplinary clinics (MDC) have become the standard of care for management of amyotrophic lateral sclerosis (ALS). No studies however, have captured patients' perspectives during a transition to ALS MDCs. Recently, an ALS MDC emerged from a single-physician clinic in Saskatoon, Canada, providing patients with a unique exposure to two different models of care. Patients and methods Fifteen patients with ALS participated in semi-structured interviews that were digitally recorded and transcribed. Two independent researchers performed an inductive thematic analysis. Information was coded based on emerging and a priori themes. An iterative process followed involving discussion and reexamination of the themes until consensus was reached. Results All patients cited the convenience of integrated care as an advantage. Other advantages included clinical expertise and advocacy potential. Travel and reduced mobility were the most commonly discussed barriers/disadvantages of MDC attendance. The impact of geography and weather appeared to augment both the appreciation of an integrated approach and the impediment of travel, compared to the existing literature. The need for individualized care was demonstrated by the conflicting viewpoints obtained from participants. Most patients felt additional practitioners and supports for both patients and caregivers were required. Conclusion ALS patients transitioned to MDCs reported many of the advantages and disadvantages reported elsewhere. A novel perspective of a MDC's advocacy potential was recognized, and the need for an innovative approach to meet demands for individualized care was highlighted.

Positive placement experience and future rural practice intentions: findings from a repeated cross-sectional study

Abstract: Objective: To identify the constituents of positive placement experience and explore the association between positive placement experiences and rural and remote practice intentions. Methods: A repeated cross-sectional study was conducted between January 2014 and December 2017. Medical, nursing, dentistry, and allied health students who completed a rural/remote placement were invited to complete a survey questionnaire on placement experience. Information on students' sociodemographic factors, discipline, placement experience, placement satisfaction, and rural/remote practice intentions was collected. Modified Poisson regression was performed to determine the relationships between placement satisfaction and future rural practice intentions. Qualitative data were analyzed by thematic analysis. Results: A total of 873 students responded. The majority of the survey respondents were females (70.06%), with a median age of 22 years (IQR 21–25 years), and 44.46% of respondents were medical students. Students satisfied with their placement were 2.10 times more likely to have rural/remote practice intention than their counterparts. Of all components of rural/remote placement experience, satisfaction with the placement supervision had the highest impact on changing students' rural/remote practice intentions from negative to positive. The major themes from qualitative analysis were as follows: "wide variety of experience and hands-on learning opportunities," "multidisciplinary exposure at home and workplace," "support from the local University Department of Rural Health (UDRH)," "learning of indigenous culture," and "experiencing challenges of rural health care services." Conclusion: There is a strong association between positive placement experience and future rural/remote practice intentions. Therefore, facilitation of positive placement experiences in remote and rural locations could be a key strategy in addressing rural health workforce maldistribution.

Professional dietary coaching within a group chat using a smartphone application for weight loss: a randomized controlled trial.

Abstract: Purpose To test the effectiveness of professional dietary coaching via group chat using a smartphone application (app) for weight loss. Methods This study was a 12-week, assessor-blind, parallel-group, waitlist-controlled randomized trial that included a 4-week follow-up period (trial registration, UMIN000025340). Data were collected between October 2016 and May 2017 and were analyzed between July 2017 and January 2018. Participants were 112 overweight, obese, or abdominally obese Japanese adults, aged 20 to 64 years, with at least one cardiometabolic risk factor. Participants were randomized to the coaching group (n=75) or control group (n=37), with a ratio of 2:1. The coaching group received a commercial weight loss program characterizing dietary coaching by a certified nutrition professional via group chat delivered on a smartphone app. Participants posted photos of every meal into the group chat, and the certified professional gave immediate direct feedback and encouragement. The primary outcome was an 8-week weight change. Secondary outcomes included 8-week changes in cardiometabolic risk factors. The frequency of meal photo uploads was recorded as a measure of adherence. Results Of the 112 randomized participants, 93 (83.0%) and 81 (72.3%) completed 8-week and 12-week visits, respectively. Intention-to-treat analysis demonstrated significantly larger 8-week weight loss in the coaching group (-1.4 kg; 95% confidence interval [CI]: -2.0, -0.8 kg) than that in the control group (-0.1 kg; 95% CI: -0.6, 0.4 kg). Significantly larger improvements in triglyceride and glycated hemoglobin A1c levels were also obtained in the coaching group. These benefits, except for the triglyceride level, were maintained until week 12. The frequent upload of meal photos was associated with a larger 8-week weight loss in a dose-response fashion (P-value for trend <0.001). Conclusion This smartphone-delivered commercial weight loss program characterized as dietary coaching via group chat resulted in modest but significant weight loss. Facilitating participants' active involvement in the program is necessary to achieve greater health benefits.

Patient perspectives of participating in the cardiac CopenHeartRFA rehabilitation program for patients treated with ablation for atrial fibrillation.

Abstract: Purpose The CopenHeartRFA trial was designed and conducted to explore the effects of rehabilitation on patients treated with ablation for atrial fibrillation (AF). It included a cardiac rehabilitation program consisting of physical exercise and psychoeducational consultations over 6 months. As part of the evaluation of the CopenHeartRFA trial, both quantitative and qualitative data were collected. The intervention was delivered by a multidisciplinary team. Aim This study aimed to understand the experience of patients treated for AF with ablation who participated in the CopenHeartRFA cardiac rehabilitation program. Methods A qualitative descriptive design was used. A purposive sample of 10 patients who had completed the intervention consented to participate. The interviews were conducted face-to-face and were audio-recorded and transcribed. Qualitative content analyses were used to analyze the data. The interviews were analyzed individually by two researchers and themes were constructed and discussed. Results The sample included 10 participants, mean age 54.6 years. Four categories were identified and labeled: 1) strengthening belief in one's own physical capacity and survival; 2) still struggling with fear of AF symptoms; 3) a need for support to move on; and 4) regaining confidence in one's own mental strength with support from professionals. Conclusion The four themes describe a positive experience from participating in the rehabilitation program. The rehabilitation program promoted self-efficacy for engaging in physical activity and the benefit of a safe environment for processing the emotional responses and the value of the therapeutic relationship between the patient and the rehabilitation provider.

Risk assessment during preventive home visits among older people.

Abstract: Background Preventive home visits (PHV) may contribute to identify risks and needs in older people, and thereby delay the onset of functional decline and illness, otherwise often followed by home care or admission to hospital or nursing homes. There is a need to increase knowledge about which factors are associated with different risk areas among older people, so that the PHV questionnaire focuses on relevant tests and questions to make the PHV more specific and have a clear focus and purpose. Objective The objective of this study was to examine associations between five kinds of risks: risk of falls, malnutrition, polypharmacy, cognitive impairment, and risk of developing illness and factors related to lifestyle, health, and medical diagnoses among older people living at home. Methods A cross-sectional study design was applied. PHV were conducted by nurses among 77-year-old people in an urban municipality and among ≥75-year-old people in a rural municipality. A questionnaire including tests and a risk assessment score for developing illness was used. Descriptive and inferential statistics including regression models were analyzed. Results The total sample included 166 persons. Poor perceived health was associated with increased risk of developing illness and risk of fall, malnutrition, and polypharmacy. Lifestyle and health factors such as lack of social support, sleep problems, and feeling depressed were associated with risk of developing illness. Risk of falls, malnutrition, polypharmacy, and cognitive impairment were also associated with increased risk of developing illness. None of the independent factors related to lifestyle, health, or medical diagnosis were associated with risk of cognitive impairment. Conclusion Poor perceived health was associated with health-related risks in older persons living at home. Preventive health programs need to focus on social and lifestyle factors and self-reported health assessment to identify older people at risk of developing illnesses.

mHealth for diabetes self-management in the Kingdom of Saudi Arabia: barriers and solutions.

Abstract: Purpose In this paper I present a perspective of mobile health (mHealth) technologies for diabetes in conjunction with an overview of the current status of mHealth technologies for diabetes self-management and the clinical evidence in the Kingdom of Saudi Arabia. In addition, a small survey to identify the barriers to mHealth for diabetes care in the Kingdom and the relevant solutions are discussed. Participants and methods In order to study the relevant obstacles for adopting mHealth solutions for diabetes care and to suggest appropriate solutions, a small survey study was conducted with a specific questionnaire deployed to >40 anonymous leading health care professionals and decision-makers of the Kingdom. The survey was distributed by means of a link to the target population through a WhatsApp group. The data were collected during 1 month, and three reminders were sent to the group to complete the survey. Basic descriptive statistics were used to analyze the survey data. Results The high percentages of agreement among the participants suggest that mHealth expertise and human shortage; funding and infrastructure investments; legal, privacy standardization and regulatory obstacles; and health care organizational and bureaucracy impediments are barriers to the implementation of mHealth technologies in the self-management of diabetes in this region. However, most of these barriers can be mitigated by the creation of the appropriate leadership and clinical environment in the current health care system. Conclusion The mHealth technologies for diabetes self-management have not yet been translated successfully in the Kingdom of Saudi Arabia as it was detected in the literature review carried out in this work. Among other possibilities, the causes of this situation are the existence of human, organizational, funding, bureaucracy, and legal barriers, as shown by the results of the survey conducted among decision-makers and senior clinicians of the Kingdom of Saudi Arabia.

A life put on hold: adolescents' experiences of having an eating disorder in relation to social contexts outside the family

Abstract: Background As suffering from an eating disorder often entails restrictions on a person's everyday life, one can imagine that it is an important aspect of recovery to help young people learn to balance stressful demands and expectations in areas like the school environment and spare-time activities that include different forms of interpersonal relationships. Purpose The aim of the present study was to investigate how adolescents with experience from a restrictive eating disorder describe their illness and their time in treatment in relation to social contexts outside the family. Patients and methods This qualitative study is based on narratives of 15 adolescents with experience from outpatient treatment for eating disorders with a predominately restrictive symptomatology, recruited in collaboration with four specialized eating-disorder units. Data were explored through inductive thematic analysis. Results The adolescents' descriptions of their illness in relation to their social contexts outside the family follow a clear timeline that includes narratives about when and how the problem arose, time in treatment, and the process that led to recovery. Three main themes were found: 1) the problems emerging in everyday life (outside the family); 2) a life put on hold and 3) creating a new life context. Conclusion Young people with eating disorders need to learn how to balance demands and stressful situations in life, and to grasp the confusion that often preceded their illness. How recovery progresses, and how the young people experience their life contexts after recovery, depends largely on the magnitude and quality of peer support and on how school and sports activities affect and are affected by the eating disorder.