Showing papers in "Journal of multidisciplinary healthcare in 2019"
TL;DR: The purpose of this paper is to discuss the factors surrounding person-first language and its integration into health care, including the difference between what is taught and mandated, and what is practiced.
Abstract: Person-first language is taught in most health professions programs and mandated by scholarly journals but is often not practiced by health care practitioners. The disconnection between academia and clinical practice is significant. Students and new practitioners are often faced with the challenge of holding to their training or falling in line with the status quo. While the use of person-first language should be the norm in all health care settings, unfortunately, often the opposite is true. The person-first language movement began in 1974. Since that time, the culture of disability has drastically changed. There is greater integration of individuals with a disability and with that integration has come greater understanding and acceptance. Increased community integration has allowed for greater opportunities for advocacy and has also forced a shift in how the community at large views people with a disability. This shift in how individuals with a disability are viewed has resulted in a change in language. A change in semantics is not enough. Health professions educators need to ensure that students understand why this change has taken place and why it is essential. The power language can have not only on patient care but also on patient outcomes is profound and should be understood by both educators and practitioners alike. The purpose of this paper is to discuss the factors surrounding person-first language and its integration into health care, including the difference between what is taught and mandated, and what is practiced.
56 citations
TL;DR: The molecular understanding of medulloblastoma has improved drastically, and recent improvements in radiotherapy modalities and the reconsideration of craniospinal irradiation according to the molecular status hold promise for survival preservation and the reduction of radiation-induced morbidity.
Abstract: Medulloblastoma is a malignant tumor of the cerebellum and the most frequent malignant brain tumor in children. The standard of care consists of maximal resection surgery, followed by craniospinal irradiation and chemotherapy. Such treatment allows long-term survival rates of nearly 70%; however, there are wide disparities among patient outcomes, and in any case, major long-term morbidity is observed with conventional treatment. In the last two decades, the molecular understanding of medulloblastoma has improved drastically, allowing us to revolutionize our understanding of medulloblastoma pathophysiological mechanisms. These advances led to an international consensus in 2010 that defined four prognostic molecular subgroups named after their affected signaling pathways, that is, WNT, SHH, Group 3 and Group 4. The molecular understanding of medulloblastoma is starting to translate through to clinical settings due to the development of targeted therapies. Moreover, recent improvements in radiotherapy modalities and the reconsideration of craniospinal irradiation according to the molecular status hold promise for survival preservation and the reduction of radiation-induced morbidity. This review is an overview of the current knowledge of medulloblastoma through a molecular approach, and therapeutic prospects currently being developed in surgery, radiotherapy and targeted therapies to optimize the treatment of medulloblastoma with a multidisciplinary approach will also be discussed.
51 citations
TL;DR: A review of clinical psychological phenomena that underlie the notion of therapies can represent a bridge between the medical approach and clinical psychology, in which integration can suggest paths aiming at improving patients’ existential conditions and adaptation.
Abstract: Background: The pathological reality of diabetes and the incidents in following the prescribed therapies have been considered and are still a serious and relevant problem in the health sector.
Objective: This review aims at highlighting the importance of clinical psychological phenomena that underlie the notion of therapies.
Methods: The review was conducted through search engines such as PubMed, Medline, Web of Science and Google Scholar. The articles related to compliance, adherence, concordance, empowerment and the self-management of diabetes were included, in order to highlight the possible similarities and differences that these terms bring with them in them management of diabetes.
Results: Starting from 252 initial publications, 101 articles were selected that highlighted the practical implications that each term has compared to the others.
Conclusion: The review can represent a bridge between the medical approach and clinical psychology, in which integration can suggest paths aiming at improving patients’ existential conditions and adaptation.
46 citations
TL;DR: Age, exercise, level of education, duration of the treatment, and smoking were significantly associated with poor glycemic control, and health facilities should provide continuous education, and barriers of gly glucose control should be explored with further research.
Abstract: Background Diabetes is increasing at an alarming rate throughout the world, and ~80% of diabetics live in developing countries. Similar to the rest of sub-Saharan African countries, Ethiopia is experiencing a significant burden of diabetes, with increased prevalence, complications, and mortality, as well as life threatening disabilities. Reasons for poor glycemic control among type 2 diabetes patients are complex and multivariable. Hence, this study aimed to identify challenges and factors associated with poor glycemic control among type 2 diabetes patients. Method A hospital-based cross-sectional study was conducted among type 2 diabetic patients attending the diabetic clinic of Nekemte Referral Hospital (NRH) from February 1 to April 30, 2018. Fasting blood glucose levels of the last three clinic visits were obtained and the mean fasting blood glucose measurement was used to determine the level of glycemic control. Analysis included both descriptive and inferential statistics with SPSS version 20.0. Predictor variable P 10 years) (AOR=3.94, 95% CI=1.51-27.83, P=0.012), inadequate physical exercise (AOR=3.19, 95% CI=1.05-19.84, P=0.019), and smoking (AOR=4.51, 95% CI=0.00-0.50, P=0.022) were independent predictors of poor glycemic control on multivariable logistic regression analysis. Conclusion Nearly two-thirds of patients had poorly controlled diabetes. Age, exercise, level of education, duration of the treatment, and smoking were significantly associated with poor glycemic control. Health facilities should provide continuous education, and barriers of glycemic control should be explored with further research.
44 citations
TL;DR: The findings emphasize the importance of acquiring knowledge about caregivers’ burden in the course of time in order to develop targeting interventions to decrease caregivers' burden and to prevent hospital admissions of people with dementia due to a crisis of home caring.
Abstract: Purpose Caring for people with dementia is known to be accompanied by burden for the caregiver. This study aims at describing family caregivers' and professional caregivers' burden immediately after hospitalization of the person with dementia. Materials and methods Twenty-five family caregivers and twenty-five professional caregivers of the locked gerontopsychiatric ward of a hospital in Northern Germany completed a questionnaire (BIZA-D-PV), which was evaluated in matched samples. The distribution of frequencies, differences in mean values and correlations were determined. Furthermore, family caregivers were categorized into risk groups. Results Family caregivers perceived a higher burden due to cognitive impairment as well as aggressive and disoriented behavior of the person with dementia compared to professional caregivers. Differences with regard to care tasks were not detected. Female family caregivers rated a higher burden compared to male family caregivers, whereas in the sample of professional caregivers males perceived a higher burden. Correlations between several dimensions of burden and caregivers' age, severity of dementia as well as physical symptoms were described. Categorizing family caregivers into risk groups showed high risks for depression of the caregiver, violence against the person with dementia and institutionalization of the person with dementia within the next months in 44-72% of cases. Conclusion Our findings emphasize the importance of acquiring knowledge about caregivers' burden in the course of time in order to develop targeting interventions to decrease caregivers' burden and to prevent hospital admissions of people with dementia due to a crisis of home caring.
44 citations
TL;DR: Cardiac auscultation - even with its limitations - is still a valid and economical technique for the diagnosis of cardiovascular diseases, and despite the growing demand for sophisticated imaging techniques, clinical use of the stethoscope in medical practice has not yet been abandoned.
Abstract: Cardiac auscultation - even with its limitations - is still a valid and economical technique for the diagnosis of cardiovascular diseases, and despite the growing demand for sophisticated imaging techniques, clinical use of the stethoscope in medical practice has not yet been abandoned. In 1816, Rene-Theophile-Hyacinthe Laennec invented the stethoscope, while examining a young woman with suspected heart disease, giving rise to mediated auscultation. He described in detail several heart and lung sounds, correlating them with postmortem pathology. Even today, a correct interpretation of heart sounds, integrated with the clinical history and physical examination, allows to detect properly most of the structural heart abnormalities or to evaluate them in a differential diagnosis. However, the lack of organic teaching of auscultation and its inadequate practice have a negative impact on the clinical competence of physicians in training, also reflecting a diminished academic interest in physical semiotic. Medical simulation could be an effective instructional tool in teaching and deepening auscultation. Handheld ultrasound devices could be used for screening or for integrating and improving auscultatory abilities of physicians; the electronic stethoscope, with its new digital capabilities, will help to achieve a correct diagnosis. The availability of innovative representations of the sounds with phono- and spectrograms provides an important aid in diagnosis, in teaching practice and pedagogy. Technological innovations, despite their undoubted value, must complement and not supplant a complete physical examination; clinical auscultation remains an important and cost-effective screening method for the physicians in cardiorespiratory diagnosis. Cardiac auscultation has a future, and the stethoscope has not yet become a medical heirloom.
42 citations
TL;DR: Several factors (education, rural residence, anxiety, low quality of life and multiple chronic conditions) associated with herbal medicine use were identified and will support health care providers and policy makers in decision making on the use of herbal medicine.
Abstract: Background The study aimed to assess the prevalence and correlates of herbal medicine use among chronic disease patients in health care settings in Thailand. Methods In a cross-sectional study, 1374 adult chronic disease patients (median age 60 years) were consecutively sampled from health care facilities in Thailand. Logistic regression was used to estimate the independent predictors of herbal medicine use in the past 12 months. Results The prevalence of herbal medicine use in the past 12 months was 35.9%. Of participants who were using herbal medicine in the past 12 month, 53.7% used it for treating a long-term health condition, 40.0% used herbal medicine in order to improve well-being and 6.3% for treating an acute illness. More than half of the herbal medicine users (57.2%) rated their herbal medicine use as very helpful, 33.3% as somewhat helpful and 6.5% not at all helpful or do not know. In adjusted logistic regression analysis, having Grade 6 to 12 education (Odds Ratio-OR: 1.71, Confidence Interval-CI: 1.04, 2.82), rural residence (OR: 0.76, CI: 0.60, 0.97), other religion (OR: 0.57, CI: 0.35, 0.97), anxiety (OR: 1.64, CI: 1.25, 2.16), low quality of life (OR: 0.42, CI: 0.31, 0.56) and having multiple chronic conditions (OR: 1.82, CI: 1.30, 2.56) were associated with past 12-month herbal medicine use. Further, in adjusted logistic regression analysis, having arthritis, asthma, cancer, cardiovascular disease, dyslipidaemia, gastrointestinal disease, dyslipidaemia were positively and hypertension negatively associated with past 12-month herbal medicine use. Conclusions The study found a high prevalence of herbal medicine use among chronic disease patients in Thailand. Several factors (education, rural residence, anxiety, low quality of life and multiple chronic conditions) associated with herbal medicine use were identified. This knowledge will support health care providers and policy makers in decision making on the use of herbal medicine.
35 citations
TL;DR: The article is based on a study that examines the modes of governance adopted by frontline managers in Norway, with a special focus on leadership in collaborations between the Norwegian profession of social educator and other professions.
Abstract: Purpose There is a need to develop more knowledge on how frontline managers in health care services facilitate the development of new roles and ways of working in interprofessional collaborative efforts and the challenges they face in daily practice. The article is based on a study that examines the modes of governance adopted by frontline managers in Norway, with a special focus on leadership in collaborations between the Norwegian profession of social educator and other professions. Materials and methods A qualitative research design was chosen with interviews of eleven frontline managers from district psychiatric centers, municipal health care services and nursing homes. Results The results show that frontline managers largely exercise leadership in terms of self-governance and co-governance and, to a lesser degree, hierarchical governance. Self-governance and co-governance can facilitate substantial maneuverability in terms of professional practice and strengthen both discipline-related and user-oriented approaches in the collaboration. However, one consequence of self-governance and co-governance may be that some occupational groups and professional interests subjugate others, as illustrated by social educators in this study. This may be in conflict with frontline managers' abilities to quality assure the services as well as their responsibility for role development in their staff. Conclusion The results show that frontline managers experience challenges when they try to integrate different professions in order to establish new professional roles and competence. Frontline managers need to support individual and collective efforts in order to reach the overall goals for the services. They must be able to facilitate change and support creativity in a working community that consists of different professions. Moreover, the social educator's role and competence need clarifications in services that traditionally have been dominated by other clinical and health care professions.
31 citations
TL;DR: An inconsistent and, at times, contradictory picture of multidisciplinary team meetings is revealed and the concept of a MDTM should not merely be a group of care professionals who work essentially independently and occasionally liaise with one another.
Abstract: Background In current cancer care, multidisciplinary team meetings (MDTMs) aim at uniting care professionals from different disciplines to decide upon the best possible treatment plan for the patients based on the available scientific evidence. In Belgium, the multidisciplinary approach is mandatory and formally regulated since 2003. Current research indicates that MDTMs are not always truly multidisciplinary, ie, with a mix of medical as well as paramedical disciplines, and that the medical profession (physicians and medical specialists) tends to dominate the interaction in MDTMs. To ensure that MDTMs can benefit from their diverse membership to achieve their full potential, significant attention should be devoted to the multidisciplinary character of these meetings. The aim of this study is to explore and describe the multidisciplinary character in MDTMs and how it is actually shaped in practice in different Flemish medical oncology departments. Methods For this study, we carried out an observational comparative case study. We studied 59 multidisciplinary team meetings at inpatient medical oncology departments in five different Belgian hospitals (academic as well as general) and explored multidisciplinarity and how it is actually shaped in practice. Results The study is unique in identifying and analyzing three distinct types of MDTMs. The analysis of the three types revealed an inconsistent and, at times, contradictory picture of multidisciplinary team meetings. The findings also align with previous studies arguing that MDTMs in oncology are typically driven by doctors, with limited input of nurses and other nonmedical staff in which decisions are argued on biomedical information and far less consideration of psychosocial aspects. Conclusion The concept of a MDTM should not merely be a group of care professionals who work essentially independently and occasionally liaise with one another. Yet, this study has shown a worryingly low awareness of the true character of multidisciplinarity, particularly among medical disciplines.
30 citations
TL;DR: This review exposes the treatments available from a clinical-scientific perspective and also emphasizes the importance of working in specialized units with those professionals who have competencies on the different conditions that may occur.
Abstract: Patients with temporomandibular disorders (TMD) can become very complex. This article aims to highlight the importance of the multimodal and multidisciplinary approach in this type of patients to improve clinical outcomes. At present we have innumerable techniques and tools to approach this type of patients from a biopsychosocial model where active and adaptive type treatments are fundamental. There are various health professions that have competence in the treatment of TMD, however, although in the most complex cases should be treated simultaneously, still too many patients receive unique treatments and only from one point of view. This review exposes the treatments available from a clinical-scientific perspective and also emphasizes the importance of working in specialized units with those professionals who have competencies on the different conditions that may occur.
28 citations
TL;DR: The results of this study reinforce the need for an integrated “whole of system” approach to research capacity building.
Abstract: Purpose The first aim of this study was to evaluate the current research capacity and culture among allied health professionals (AHPs) working in a large regional health service. The second aim of this study was to undertake principal component analyses (PCAs) to determine key components influencing our research capacity and culture. Patients and methods As part of a cross-sectional observational study, the Research Capacity and Culture (RCC) tool was administered to AHPs working in Gold Coast Health to measure self-reported research capacity and culture across Organization, Team, and Individual domains, including barriers to and motivators for performing research. An exploratory PCA was performed to identify key components influencing research capacity and culture in each of the three domains, and the results were compared with the findings of a previous study performed in a large metropolitan health district. Results This study found moderate levels of research capacity and culture across all domains, with higher scores (median, IQR) reported for the Organization domain (7,5-8) compared to the Team (6,3-8) and Individual domains (5,2-7). Two components were identified in each domain. Components in the Organization domain included "research culture" and "research infrastructure"; components in the Team domain included "valuing and sharing research" and "supporting research"; and components in the Individual domain included "skills for conducting research" and "skills for searching and critiquing the literature". These components were found to be highly correlated with each other, with correlations between components within each domain ranging from 0.459 to 0.702. Conclusion The results of this study reinforce the need for an integrated "whole of system" approach to research capacity building. Ongoing investment in tailored support and infrastructure is required to maintain current areas of strengths and build on identified areas of weakness at the level of organizations, teams, and individual AHPs, and consideration should also be given as to how support across these three levels is integrated.
TL;DR: In this article, the effect of patient care education on burden of care and quality of life of caregivers of stroke patients was examined in an educational trial conducted on 100 caregivers of the stroke patients in Al-Zahra educational hospital.
Abstract: Background Care for stroke patients at home is a very complicated and tough activity. Objective The study was conducted to examine the effect of patient care education on burden of care and quality of life of caregivers of stroke patients. Materials and methods The study was an educational trial conducted on 100 caregivers of the stroke patients in Al-Zahra educational hospital, Isfahan, Iran. The intervention group received some training to empower caregivers in family-oriented care in form of an educational counseling program. Data were collected and analyzed using the questionnaires, including demographic, quality of life Short Form-36, and Zarit burden of care questionnaires. Results The mean ages of caregivers were 48.52 years in the intervention and 45.14 years in the control groups. The results indicated significant differences in mean of quality of life and burden of care in the caregivers of the intervention group after intervention (P<0.01), which was insignificant in the control group. The average burden on the caregivers of both groups was significantly associated with health status, economic status, marital status, the number of children, care hours, care days, and familial relationship of the caregivers with the patients (P<0.01) before intervention. In addition, quality of life of both groups was significantly related to their health status (P<0.01) before intervention. Conclusion Patient care education reduced the burden of care and improved quality of life of the caregivers of stroke patients. Thus, to reduce the complications of caring for stroke patients, family education should be the priority of nursing and discharging procedures.
TL;DR: This review identifies the clinical importance of the interdisciplinary team interactions and the lessons learned from past MCE experiences, strengthening healthcare system readiness for such critical incidents.
Abstract: Mass casualty events (MCE) are an infrequent occurrence to most daily healthcare systems however these incidents are the causation for new hospital preparedness and the development of coordinated emergency services. The broad support and operational plans outside the hospital include emergency medical services, local law enforcement, government agencies, and city officials. Modern-day hospital disaster preparedness goals include scheduled training for healthcare personnel to ensure effective and accurate triage for a high-volume of injured patients. This MDT collaboration strengthens the emergency response to optimize the delivery of life-saving care during MCEs. This review identifies the clinical importance of the interdisciplinary team interactions and the lessons learned from past MCE experiences, strengthening healthcare system readiness for such critical incidents.
TL;DR: While different types of interventions (embedded mentoring, visits by mobile mentors, facility twinning and within-facility mentorship by a focal person) were reported to be effective, there is no evidence to recommend one model of mentoring over other types of Mentoring.
Abstract: Introduction: Mentoring programs are frequently recommended as innovative and low-cost solutions, and these have been implemented in many healthcare institutions to tackle multiple human resource-related challenges. This review sought to locate, appraise and describe the literature reporting on mentorship programs that were designed to improve healthcare worker competence and institutional performance in Africa. Methods: This review searched and synthesized reports from studies that assessed the effectiveness of mentorship programs among healthcare workers in Africa. We searched for studies reported in the English language in EMBASE, CINAHL, COCHRANE and MEDLINE. Additional search was conducted in Google Scholar. Results: We included 30 papers reporting on 24 studies. Diverse approaches of mentorship were reported: a) placing a mentor in health facility for a period of time (embedded mentor), b) visits by a mobile mentor, c) a mentoring approach involving a team of mobile multidisciplinary mentors, d) facility twinning, and e) within-facility mentorship by a focal person or a manager. Implication for practice: Mentoring interventions were effective in improving the clinical management of infectious diseases, maternal, neonatal and childhood illnesses. Mentoring interventions were also found to improve managerial performance (accounting, human resources, monitoring and evaluation, and transportation management) of health institutions. Additionally, mentoring had improved laboratory accreditation scores. Mentoring interventions may be used to increase adherence of health professionals to guidelines, standards, and protocols. While different types of interventions (embedded mentoring, visits by mobile mentors, facility twinning and within-facility mentorship by a focal person) were reported to be effective, there is no evidence to recommend one model of mentoring over other types of mentoring. Implications for research: Further research-experimental methods measuring the impact of different mentoring formats and longitudinal studies establishing their long-term effectiveness-is required to compare the effectiveness and cost-effectiveness of different models of mentoring. Further studies are needed to explore why and how different mentoring programs succeed and the meaningfulness of mentoring programs for the different stakeholders are also required.
TL;DR: Findings demonstrate that joint pelvic floor MDT meetings are feasible and contribute to a change in the management of complex patients.
Abstract: Purpose Pelvic floor dysfunction is a common and heterogenous condition with numerous clinical manifestations, making the optimal management challenging. The traditional single-specialty approach may fail to address its complex nature. Currently, there are no published data on the impact of joint pelvic floor multidisciplinary team (MDT) meetings on patient management. Patients and methods This study represents a retrospective analysis of prospectively collected data on female patients discussed at a joint pelvic floor MDT over a 12-month period in a tertiary referral center. Results One hundred fifty-two cases were included with a median age of 55 years (range 18-83) and a BMI of 32 kg/m2 (range 17-58). Lower urinary tract dysfunction was the predominant symptom in 75% (114/152). The pelvic organ prolapse symptom of a vaginal bulge was present in 11% (17/152). All cases of vaginal prolapse were accompanied by either urinary incontinence, 59% (10/17), or obstructive defecation, 41% (7/17). Fecal incontinence was recorded in 10% (15/152). Mesh-related complications were reported in 3% (4/152). The MDT recommended a change in the initial management plan in 20% (31/152) of cases, of whom 80% (25/31) were patients with complex urinary incontinence. The MDT agreed a change in the primary care team in 16% (25/152) of cases. Conclusion There is an increasing regulatory requirement for patients with pelvic floor dysfunction to be discussed in an MDT setting. Findings demonstrate that joint pelvic floor MDT meetings are feasible and contribute to a change in the management of complex patients.
TL;DR: The current narrative review provides data on history, definitions, epidemiology and pathophysiology of the syndrome and highlights the importance of multidisciplinary approach in the management of ACS in adults.
Abstract: Abdominal compartment syndrome (ACS) refers to a severe increase in intra-abdominal pressure associated with single or multiorgan failure. ACS with specific pathophysiological processes and detrimental outcomes may occur in a variety of clinical conditions. Patients with ACS are predominantly managed in critical care settings, however, a wide range of multidisciplinary interventions are frequently required from medical, surgical, radiological and nursing specialties. The medical management, aiming to prevent the progression of intra-abdominal hypertension to ACS, is extensively reviewed. Timing and techniques of surgical decompression techniques, as well as management of open abdomen, are outlined. In summary, the current narrative review provides data on history, definitions, epidemiology and pathophysiology of the syndrome and highlights the importance of multidisciplinary approach in the management of ACS in adults.
TL;DR: Multidisciplinary care increased the survival of ALS patients in the authors' study population and time-dependent multivariate survival analysis of the use of noninvasive mechanical ventilation and gastrostomy showed that the variables associated with reduced mortality were reduced time to NIMV and Gastrostomy and the duration of both, thus reflecting compliance.
Abstract: Purpose Multidisciplinary care has become the preferred model of care for patients with amyotrophic lateral sclerosis (ALS). It is assumed that the sum of interventions associated with this approach has a positive effect on survival. The objective of the study was to evaluate the impact of a multidisciplinary care approach on the survival of patients with ALS. Patients and methods We performed a retrospective review of prospectively collected data in a tertiary referral center in Spain. Participants were patients with definite or probable ALS managed in a multidisciplinary care program. We compared demographic and survival data of patients with definite or probable ALS treated in a referral center without and with implementation of a multidisciplinary care program. We performed time-dependent multivariate survival analysis of the use of noninvasive mechanical ventilation (NIMV) and gastrostomy. Results We evaluated 398 consecutive patients, of whom 54 were treated by a general neurologist and 344 were treated in the multidisciplinary care clinic. Patients receiving multidisciplinary care were older (62 vs 58 years), tended to have bulbar onset disease (30% vs 17.7%), and were more likely to receive riluzole (88.7% vs 29.6%, p 0.001), and nutrition via gastrostomy (32.3% vs 3.7%, p<0.01). Kaplan-Meier analysis showed a 6-month increase in survival (log-rank, 16.03, p<0.001). Application of the Andersen-Gill model showed that the variables associated with reduced mortality were reduced time to NIMV and gastrostomy and the duration of both, thus reflecting compliance. Conclusions Multidisciplinary care increased the survival of ALS patients in our study population. Timely use of respiratory support and gastrostomy are fundamental aspects of this benefit.
TL;DR: Residents in highland areas in Vietnam had a considerably high 12-month prevalence of self-medication and medical products quality management and self-Medication guideline are potential to maximize the effects of self -medication.
Abstract: Background: Monitoring self-medication practice, which refers to individuals using medicine without instructions of physicians, is critical to control its harmful effects. However, in Vietnam, evidence about self-medication among individuals in highland areas is constrained. This study examined self-medication practice among residents living in highland areas in Vietnam and determined associated factors. Materials and methods: A cross-sectional study was performed in five highland provinces with 1000 individuals. Information about individual and household's socioeconomic status and self-medication practice in the last 12 months was surveyed. Multivariate logistic and Poisson regressions were used to identify associated factors with self-medication. Results: 83.3% reported self-medication in the last 12 months, with the mean times of self-medication being 4.5 times (SD=4.1). Female (OR=0.62, p<0.01), ethnic minorities, higher number of members having health insurance in family (OR=0.82, p<0.01) and higher annual household income (OR=0.78, p<0.05) were associated with the lower likelihood of "Only buy medicines at pharmacy stores when having illness in the last 12 month". Moreover, people who were females (OR=0.59, p<0.05), white-collar worker (OR=0.25, p<0.01) and had higher number of children in the family (OR=0.68, p<0.05) were less likely to practice self-medication. People who were ethnic minorities, white-collar worker (Coef.=-0.32, p<0.01) and higher number of members having health insurance in family had lower times of self-medication in the last 12 months compared to other groups. Meanwhile, individuals having higher number of members in the family (Coef.=0.07, p<0.01) and higher annual household income (Coef.=0.08, p<0.01) had highertimes of self-medication in the last 12 months. Conclusion: Residents in highland areas in Vietnam had a considerably high 12-month prevalence of self-medication. Medical products quality management and self-medication guideline are potential to maximize the effects of self-medication. Moreover, promoting the use of health insurance should also be concerned as a solution to address this issue.
TL;DR: It is demonstrated that the majority of healthcare staff in a UK community setting have satisfactory levels of knowledge and attitudes in relation to PU prevention overall, although there were some differences between groups, albeit non-significant.
Abstract: Background: Pressure ulcers (PUs) are a major burden to individuals, impacting their physical, mental and social wellbeing. While PU prevention is traditionally regarded as a nursing issue, an interprofessional approach has been promoted as best practice. However, little is known about current practice or the knowledge and attitudes of the wider interprofessional team (IPT). Purpose: Pre-designed questionnaires were used to explore knowledge and attitudes with healthcare staff in the community. Methods: Questionnaires were disseminated to all healthcare staff within a community healthcare Trust predominantly via an online tool. Data were analyzed using descriptive and inferential statistics. Results: The median values of all professional groups demonstrated satisfactory attitudes (>75%) and levels of knowledge (>60%) to PU prevention. However, there were differences within and between groups. Management staff demonstrated the most positive attitude to PU prevention (89%), followed by occupational therapists (OTs) and healthcare assistants (HCAs) (87%, IQR: 75%→89%). OTs demonstrated the highest scores for knowledge (69%, IQR: 62%→73%), while healthcare and rehabilitation assistants scored the lowest (58%, IQR: 58%-64%). Conclusion: This study has demonstrated that the majority of healthcare staff in a UK community setting have satisfactory levels of knowledge and attitudes in relation to PU prevention overall. Nevertheless, there were some differences between groups, albeit non-significant. There were also differences between sub-themes of the questionnaires, indicating a greater focus of pressure ulcer treatment over prevention. While PU prevention is widely regarded to be a nursing issue, these findings provide some indication of the potential for an interprofessional approach.
TL;DR: This study investigated the experiences of practitioners and patients during a novel interprofessional model of assessment where an urban-based physical therapist used videoconferencing to virtually join a rural nurse practitioner and a rural patient with CBD.
Abstract: Purpose Although rural and remote residents face general challenges accessing health care in comparison to urban dwellers, care for musculoskeletal conditions like chronic back disorders (CBD) is particularly challenging for rural and remote residents due to lack of access to physical yherapists. Telerehabilitation such as secure videoconferencing offers one solution to this disparity in rural care delivery, but incorporating the perspectives of health practitioners and patients is important when developing new sustainable care models. Patients and methods This study investigated the experiences of practitioners and patients during a novel interprofessional model of assessment where an urban-based physical therapist used videoconferencing to virtually join a rural nurse practitioner and a rural patient with CBD. Patient surveys and semi-structured interviews of practitioners and patients were analyzed quantitatively and qualitatively. Results Most patients were "very satisfied" (62.1%) or "satisfied" (31.6%) with the overall experience, and "very" (63.1%) or "somewhat (36.9%) confident" with the assessment. Thematic analysis of interviews revealed that this novel assessment method identified: access to care for CBD, effective interprofessional practice, enhanced clinical care for CBD, and technology considerations. Conclusion Patient satisfaction with the telerehabilitation model of care was high. Patients and practitioners reported their experiences were impacted by access to care, interprofessional practice, enhanced care for CBD and technology. These findings will be useful in the development of patient-centered models of care utilizing telehealth strategies.
TL;DR: How health care professionals understand PCC is studied, and whether their clinical practice is aligned with their theoretical understanding, when starting clinical practice at a novel multidisciplinary clinic in Sweden.
Abstract: Introduction Person-centered care (PCC) appears particularly suitable for patients with complex diseases and in multidisciplinary care. However, previous research tends to focus on each profession and condition separately. Purpose We studied how health care professionals (HCPs) understand PCC, and whether their clinical practice is aligned with their theoretical understanding, when starting clinical practice at a novel multidisciplinary clinic. Methods In total, 16 semi-structured interviews with HCPs and 31 non-participatory observations of outpatient meetings and other activities at the clinic such as team meetings were conducted at a multidisciplinary, integrated outpatient clinic in Sweden. All patients had simultaneous diabetes mellitus, chronic kidney disease and established cardiovascular disease. The clinic employed a PCC approach. Data were analyzed using an inductive thematic approach. Results Two key findings emerged. First, PCC requires a holistic view of the patient at all times during care, with everything focused on the patient. This requires that the HCPs know the patient well enough as an individual to be able to tailor the care together with them. Second, working with a PCC philosophy leads to transformed roles for HCPs in patient meetings, with more active involvement by the patient and often also their next of kin. The observations, in comparison with the interviews, showed that not all HCPs applied their views on PCC in patient meetings. Observations showed that some patient meetings were less person-centered than others, potentially due to stress or lack of time. Conclusion PCC require HCPs to have a holistic view of the patients and a deeper understanding of their situation, as individuals. Working with PCC also leads to a more coaching, supportive role of the HCPs.
TL;DR: The positive impact of rural placement experiences and rural background on future rural practice is well known, but this study highlights the importance of positive supported placement experience for students from both rural and urban backgrounds.
Abstract: Introduction Pre-vocational placement experiences are known to considerably influence the career preferences of health graduates and are a key factor in growing the rural allied health workforce. This paper explores the rural placement experiences and future work intentions of students who attended a placement with the University of Newcastle Department of Rural Health. Methods Part of a larger longitudinal mixed methods study of students' placement experiences and subsequent career choices, this study explored students' placement evaluations responses. Following each placement, students were invited to complete an online survey which asked about their placement experiences and future work intentions. Counts and proportion tests were performed for frequencies of quantitative variables. Wilcoxon signed rank tests were conducted on the paired pre- and post-rural intent scores to determine any perceived differences in intent before and after placement for students both with and without a rural background. Qualitative data from short answer questions were analyzed thematically guided by qualitative content analysis. Data were comparatively analyzed for students of a rural or urban background. Results Four hundred and forty end of placement surveys were completed by 275 students (response rate 69.8%). There was a positive shift in intention to work rurally for students of both rural and urban background post-placement, but this was only statistically significant in the group from an urban background (p≤0.001). From the qualitative analysis three themes emerged: immersed rural supported placement experience, immersed interaction in rural life with other students, and immersed interaction in the rural community. Students from both rural and urban backgrounds indicated similar benefits and challenges. Conclusion While the positive impact of rural placement experiences and rural background on future rural practice is well known, this study highlights the importance of positive supported placement experience for students from both rural and urban backgrounds.
TL;DR: Health promotion to improve health and self-care behaviors among the elderly living along the borders of Thailand should be encouraged through the culture, tradition, and beliefs of particular ethnic groups.
Abstract: Introduction Quality of life among the elderly is an important public health issue. However, few studies have examined the health and quality of life among ethnic minority groups. This research aimed to study the association between self-care behaviors and quality of life among the elderly from ethic minority groups living along the borders of Thailand. Methods Three provinces from the northern part of Thailand, including Tak, Nan, and Phayao, were selected for the area of study. The purposive method was employed to select districts within the province. Simple random sampling was used to select samples. A total number of 810 elderly citizens were recruited from ethnic minority groups as a research sample. The assessment questionnaire WHOQOL-OLD was used for interviewing the elderly. Results The mean age of the elderly in our sample was 68.3 years, representing ethnic groups of Lua (30.9%), Karens (24.6%), Tai Lue (23.3%), and Tai Hmong (21.2%). The level of self-care behaviors of these elderly was moderate (49.5%), low (45.9%), and high (4.6%). More than half of them exhibited the quality of life at a moderate level (69.1%) and low level (26.5%); only a few demonstrated a high level (4.4%). Linear regression analysis revealed that self-care behaviors were positively significantly related to the quality of life among ethnic groups (p-value<0.001). Other variables such as age, ethnic group, education, incurrent disease, and smoking were associated with quality of life among the elderly (p-value<0.05). Conclusion Health promotion to improve health and self-care behaviors among the elderly living along the borders of Thailand should be encouraged through the culture, tradition, and beliefs of particular ethnic groups. Proactive health services and health awareness should be promoted by health agencies and related organizations in order to improve the health, well-being, and quality of life among the elderly people from ethnic minority groups.
TL;DR: The findings suggest that the TRI-O guide is beneficial to help students initiate partnership-based communication and mutual collaboration among health professionals in the socio-hierarchical and socio-cultural context.
Abstract: Objectives Interprofessional education (IPE) and collaborative practice are essential for patient safety. Effective teamwork starting with partnership-based communications should be introduced early in the educational process. Many societies in the world hold socio-hierarchical culture with a wide power distance, which makes collaboration among health professionals challenging. Since an appropriate communication framework for this context is not yet available, this study filled that gap by developing a guide for interprofessional communication, which is best suited to the socio-hierarchical and socio-cultural contexts. Materials and methods The draft of the guide was constructed based on previous studies of communication in health care in a socio-hierarchical context, referred to international IPE literature, and refined by focus group discussions among various health professionals. Nominal group technique, also comments from national and international experts of communication skills in health care, was used to validate the guide. A pilot study with a pre-posttest design was conducted with 53 first- and 107 fourth-year undergraduate medical, nursing, and health nutrition students. Results We developed the "TRI-O" guide of interprofessional communication skills, emphasizing "open for collaboration, open for information, open for discussion", and found that the application of the guide during training was feasible and positively influenced students' perceptions. Conclusion The findings suggest that the TRI-O guide is beneficial to help students initiate partnership-based communication and mutual collaboration among health professionals in the socio-hierarchical and socio-cultural context.
TL;DR: This review will focus on the origins of the Mediterranean diet from its roots and its relationship to cardiovascular disease, with a brief overview of the nutritional mechanisms that influence atherosclerosis.
Abstract: Ancient Greece was the cradle of the Mediterranean food tradition, characterized by the Mediterranean "eternal trinity" wheat - olive oil - wine, the very essence of the country's traditional agricultural and dietary regime, enriched by a culture of sharing and commensality. This food model, subsequently adopted and spread by the Romans, was rediscovered at the end of the Second World War by two American researchers, Leland Allbaugh and Ancel Keys. With the famous Seven Countries Study, Keys demonstrated for the first time that populations practicing a Mediterranean diet - such as the Greeks and southern Italians - showed low mortality rates from ischemic heart disease compared to the peoples of Northern Europe and North America. Since then, numerous subsequent epidemiological studies and randomized clinical trials have confirmed the beneficial effects of the Mediterranean diet both in primary and secondary prevention of cardiovascular diseases. This review will focus on the origins of the Mediterranean diet from its roots and its relationship to cardiovascular disease, with a brief overview of the nutritional mechanisms that influence atherosclerosis.
TL;DR: To promote collaboration among older adults, their children, and health Care professionals in reablement, health care professionals need to proactively involve older adults’ family members in the reablements processes, particularly because older adults and their children do not always express all of their care-related needs to reableMENT services.
Abstract: Background: A shift in the work-divide among generations and an ageing population have altered the balance of care and support between families and welfare states. Although state policy has increasingly acknowledged that older adults ageing in place receive support from family members, how adult children perceive their collaboration with their parents and health care professionals in reablement services remains unclear. The aim of this study is to identify how adult children perceive the collaboration between older parents, family members, and health care professionals in reablement services.
Methods: This study has a qualitative research design with a constructivist grounded theory approach. In total, 15 adult children – 6 sons, 8 daughters, and a daughter-in-law, aged 47–64 years – whose parents had received reablement services, participated in in-depth interviews.
Results: Our findings clarify how children and their older parents’ reablement services can collaborate to support how the adult children manage and maintain both their own and their parents’ everyday lives. The core category derived from our data analysis was the art of maintaining everyday life, with four subcategories indicating the different dimensions of that process: doing what is best for one’s parents, negotiating the dilemmas of everyday life, managing parents’ reablement, and ensuring the flow of everyday life.
Conclusion: To promote collaboration among older adults, their children, and health care professionals in reablement, health care professionals need to proactively involve older adults’ family members in the reablement processes, particularly because older adults and their children do not always express all of their care-related needs to reablement services.
TL;DR: In this article, the authors explored attitudes and perspectives about welfare technology among older people living alone in Norway and found that most participants regarded welfare technology as empowering them to remain in their homes for as long as possible.
Abstract: Background In Norway, as in other European countries, the ageing population is increasing rapidly. Governments seek to enable older people stay in their homes for as long as possible, and welfare technology (WT) has been proposed as a possible solution. Human behaviour modelling (HBM) is a welfare technology that identifies an individual's behaviour patterns and detects abnormal behaviours, including falls and early signs of dementia. However, the successful development of HBM WT requires the consideration of the older people's attitudes on this. Aim The present study sought to explore attitudes and perspectives about welfare technology among older people living alone in Norway. Methods We used an exploratory, qualitative approach in which semi-structured, in-depth interviews were conducted with five women and four men between the ages of 79 and 91. The interviews were analysed using qualitative content analysis. Results Two categories and four subcategories were identified: 1) preferences and concerns of welfare technology (i) feeling confident-proactive approach of future technology, (ii) concerns and dilemmas, and 2) reflections of today and tomorrow- awareness of own health (i) feeling healthy, independent, self-sufficient and safe, (ii) facing own ageing- preparedness on unpredictable scenarios. The main theme, welfare technology - a valuable addition to tomorrow's homes, represents how the participants held positive and proactive attitudes towards the use of WT in their homes. Conclusion Participants trusted the Norwegian healthcare system and did not rely on their families for care. Independence, autonomy, and feeling safe were essential for all participants, and most participants regarded welfare technology as empowering them to remain in their homes for as long as possible. Participants already confidently used various technologies in their daily lives. Surprisingly, they expressed no concerns about privacy, but some mention concerns about loss of autonomy and dignity. We conclude that a person-centred approach to integrating new WT is necessary.
TL;DR: This review examines the epidemiology, clinical subtypes, pathology, psychology, psychology and intervention options for cutaneous lupus erythematosus.
Abstract: Cutaneous lupus erythematosus encompasses a spectrum of cutaneous disease with different phenotypes, and it potentially intersects with many disciplines in medicine. This review examines the epidemiology, clinical subtypes, pathology, psychology and intervention options for this disorder. It is important to understand the psychological distress that cutaneous lupus can cause and if needed actively investigate this possibility with the patient. Careful liaison between disciplines will achieve the optimum outcome.
TL;DR: Overall, clinicians recognise there are greater benefits to IBRs and have a willingness to participate, however, careful consideration is required to introduce and continually achieve the best from IBR as they require changes in organizational context and culture.
Abstract: Purpose: Interdisciplinary bedside ward rounds have the capacity to facilitate coordinated interprofessional patient care. To be an effective means of care coordination, clinicians need an explicit understanding of how these rounds contribute to patient care. By identifying benefits and challenges to the effective use of interdisciplinary ward rounds, clinicians create an opportunity to improve interprofessional teamwork, care planning, and coordination of patient care. Methods: A survey was conducted with frontline professionals in two acute care and two rehabilitation wards from a metropolitan teaching hospital. There were 77 participants, representing medical officers, nurses, and allied health clinicians. Questions examined the perceived benefits and challenges of conducting interdisciplinary ward rounds in their units. Survey findings were coded for meaning and then grouped into themes. Results: Benefits revealed a desired care delivery model challenged by the complexities of organizational and professional cultures. The themes of "being on the same page", "focusing on patients", and "holistic care planning" underpinned the ideas of collaboration and improved patient-centred care, that is, benefits to patients. Challenges centred on health professionals' time constraints and the coordination of teams to enable participation in rounds. The themes were more distinct, logistical barriers of "time", "workforce", and "care planning". Conclusion: Overall, clinicians recognise there are greater benefits to IBRs and have a willingness to participate. However, careful consideration is required to introduce and continually achieve the best from IBR as they require changes in organizational context and culture.
TL;DR: Future interventions to address the key behavioral domains and improve perioperative hypothermia prevention need to be evaluated in the context of feasibility, effectiveness, safety, acceptability, and cost by the target users.
Abstract: Purpose: Inadvertent perioperative hypothermia is a significant problem for surgical patients globally, and is associated with many detrimental side-effects. Despite the availability of rigorously developed international evidence-based guidelines for prevention, a high incidence of this complication persists. This qualitative study aims to identify and examine the domains which act as barriers and enablers to perioperative hypothermia prevention practices, from the perspectives of the key healthcare professionals involved with perioperative temperature management. Methods: A qualitative study employing semi-structured interviews was utilized. A purposive sample of key stakeholders involved in perioperative temperature management, including perioperative nurses, anesthetists, surgeons, and perioperative managers, were recruited via email. The interview guide was developed in reference to the Theoretical Domains Framework. All interviews were recorded, de-identified, transcribed, and coded. Belief statements were generated within each domain, and a frequency score generated for each belief. Finally, the domains were mapped to the COM-B model of the Behavior Change Wheel to develop recommendations for future interventions. Results: Twelve participants were included including eight nurses, two surgeons, and two anesthetists. Eleven key theoretical domains that influence the uptake of perioperative hypothermia practices were identified: knowledge; skills; social/professional role and identity; beliefs about capabilities; optimism; beliefs about consequences; reinforcement; goals; memory, attention, and decision processes; environmental context and resources; social influence. Suggested intervention strategies include training, reminder systems, audit, and feedback, organizational support to resolve lack of control of ambient temperature, as well as provision of accurate temperature measurement devices. Conclusion: Future interventions to address the key behavioral domains and improve perioperative hypothermia prevention need to be evaluated in the context of feasibility, effectiveness, safety, acceptability, and cost by the target users. All suggested intervention strategies need to take a team-based, multi-modal approach, as this is most likely to facilitate improvements in perioperative hypothermia prevention.