Narrative Mapping: A Topography of Listening as Healing.

Across multiple and diverse populations, exigent inquiries, and in and out of the classroom, an ethic for listening as a way of being has been central to the methodological and pedagogical practices that undergird narrative mapping. Additionally, the author suggests that in situating the practice of listening as crucial to both communication and healing, we are equally bound to an ethic of creating space. As listeners for the other, we commit to holding space for those silences where participants meet themselves in stillness, a place where they might listen deeply to the self, first. Where narrative mapping creates space for respite in contemplation, participants speak of gaining greater clarity and keener insights about health, healing, and being. The process of listening promotes healing across diverse entities, underscoring the multifaceted nature of narrative mapping, which serves as a research practice, pedagogy, and intervention.

A national assessment of standards of care for inherited bleeding disorders in Canada.

AIM: The Canadian Integrated and Comprehensive Care Standards for Inherited Bleeding Disorders were adopted in June 2020. In early 2023, a self-assessment of each of the 26 Canadian inherited bleeding disorder treatment centre's (IBDTCs) capacity to meet the Standards was conducted. The goal was to validate the standards by assessing appropriateness and adherence. As a result, centres can compare their own practices and capacity against those of all centres, identify barriers to adherence, identify opportunities for remedial actions and use the results locally as evidence for needed resources. METHODS: Healthcare providers (HCPs) in the 26 IBDTCs were provided with a checklist to assess adherence to each of the 66 standards of care. Centre participation was voluntary but strongly encouraged by the healthcare provider and patient associations. RESULTS: All 26 centres completed the self-assessments. Collectively, centres reported meeting 88.8% of the standards. Adherence to each standard ranged from 40% to 100%. Forty-one (41) of the standards were adhered to by 90% or more of the centres, 12 by 80%-89% of the centres and 13 by fewer than 80% of the centres. A report consolidating all the assessments was sent to the 26 centres. CONCLUSION: None of the comments received in the self-assessment reports indicated that a given standard was irrelevant, unrealistic or unnecessary. These data are strong indicators that the standards, as written, are appropriate. The self-assessments, however, reveal alarming deficiencies in staffing levels, notably in physiotherapy, psychosocial support and data entry and data management. These constitute a barrier to comprehensive care for many centres. The findings echo similar conclusions from a previous assessment conducted in 2015.

Narrative Mapping: Participant-Generated Visual Methodology for Health Communication Research and Pedagogy.

Narrative mapping is a newly emergent form of participant-generated visual methodology. This essay differentiates narrative mapping from other visual methodologies and from other genres of mapping by examining a shared epistemological framework undergirding both the construction of narratives and the crafting of maps. The confluence of these innately human inclinations extends current methodological practices of narrative inquiry, especially in health communication. Narrative maps not only enhance sense-making abilities but they are unique communicative tools through which participants address their lived/ing experience in encounters of care and research. Recognizing both personal and political nature of healthcare, a poststructural feminist commitment further grounds this methodological framework and analysis.

Health Sciences Patron Preference for Library Spaces: A Multisite Observational Study.

Health sciences libraries are often challenged to make decisions regarding physical space allocation without quantitative data to support specific user preferences. This multisite, longitudinal study sought to answer the following questions related to academic health sciences libraries: (1) Which library spaces are popular with health sciences patrons? (2) How does time of day and allocated seating space affect patron choices? (3) What similarities and differences occur in space usage across four different health sciences libraries? Results suggest health sciences libraries must develop a nuanced understanding of their patrons' preferences to best serve patrons' needs regarding space allocation. Libraries can benefit from these types of methodological studies that target specific populations, supporting more informed space allocation decision making.

Pregnancy outcomes in women exposed to cancer chemotherapy.

PURPOSE: There is little data on the effects of cancer chemotherapy in pregnant women. The objective of this study was to describe pregnancy outcomes of women exposed to cancer chemotherapy, recorded in the French Terappel database. METHODS: We performed a descriptive, prospective study of the pregnancies of women exposed to cancer chemotherapy recorded in Terappel between June 1984 and December 2016. Terappel is a French database that has recorded questions of health professionals and/or individuals at the Regional Pharmacovigilance Centres about drugs and pregnancy. For each question, pregnancies are monitored and the outcome is recorded in the database. RESULTS: In total, 75 questions about "anti-cancer drugs and pregnancy" received by 16 Regional Pharmacovigilance Centres between 1997 and 2016 were recorded in Terappel. Breast cancer accounted for 62.7% of the cases, followed by leukaemia (13.3%) and lymphoma (9.3%). Cyclophosphamide is the leading anti-cancer drug with 40.0% of exposed pregnant women, followed by 5-fluorouracil (34.7%), epirubicin (32.0%), tamoxifen (26.7%), and doxorubicin (16.0%). Among the 75 pregnancies, we observed 55 births with 57 children (73.3%) (two cases of twins), nine medical terminations of pregnancy (12.0%), six voluntary terminations of pregnancy (8.0%), three intrauterine foetal deaths (4.0%), and two miscarriages (2.7%). We found a malformation rate of 7.8%. Sixteen of 57 (28.1%) newborns developed one or more neonatal pathologies. CONCLUSION: Pregnancy of women taking anti-cancer drugs resulted in birth in 73% of cases. Nevertheless, pregnant women exposed to cancer chemotherapy remains at risk of malformations and neonatal conditions related to prematurity and drugs.

Physical activity and sedentary behavior in middle-aged intensive care unit survivors discharged home: A systematic review.

OBJECTIVES: The purpose of this study was to review literature on physical activity and sedentary behavior of middle-aged adults post-discharge from the intensive care unit, with a particular focus on studies using wearable activity trackers. METHODOLOGY: Systematic review conducted using correlational, cohort, and intervention studies of physical activity and sedentary behavior of intensive care unit survivors' post-discharge. Literature in PubMed, Embase, and CINAHL was searched using keywords derived from patient status, activity, and activity monitoring. Two independent reviewers used the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to assess quality of articles and potential biases in study design. MAIN OUTCOME MEASURES: Physical activity and sedentary behavior assessed via wearable activity trackers. RESULTS: Two hundred and fifty-six studies met inclusion criteria; six studies comprising 265 participants were retained. Outcomes varied widely and were not synthesized, but instead discussed individually. Average steps/day ranged from 1278 to 4958 and average minutes of activity ranged from 26 to 45 min/day. One study reported 12 hours and 17 min/day spent in sedentary activity and another reported 90 % of hospitalization was in sedentary behavior compared to 58 % post-discharge. CONCLUSION: Few studies have examined physical activity and sedentary levels of middle-aged intensive care unit survivors wearing activity trackers. Findings are limited in generalizability, and no randomized controlled trials were included here. Eliciting support from clinical and post-discharge care teams to encourage activity and/or attend prescribed therapy or rehabilitation sessions is important. IMPLICATIONS FOR CLINICAL PRACTICE: Clinicians should emphasize the importance of physical activity throughout the day to decrease sedentary time during a hospital stay and to continue being active after discharge to home. Physical activity is valuable, even in short spurts, from hospital stay through discharge. Interventions to increase physical activity and decrease sedentary time are needed to improve intensive care unit survivor recovery and quality of life post-discharge.

Adverse drug reactions in pregnant women: Do they differ from those in non-pregnant women of childbearing age?

Pharmacoepidemiological research in pregnant women has focused on adverse drug reactions for the course of pregnancy or for the unborn child, but little is known on the risks for the mother. We reported the results of a study that compared adverse drug reactions in pregnant women with non-pregnant women of childbearing age, and investigated whether which types of adverse reactions were more often reported in pregnant women and which drugs were more often involved. This study was carried out in the French pharmacovigilance database (BNPV). We compared adverse drug reactions reported between 1 January 2010 and 31 December 2019 in pregnant women with those reported in of non-pregnant women of childbearing age. We cross-matched each pregnant woman with three non-pregnant women of childbearing age according to geographic area, age and year the adverse reaction was reported. Data analysis revealed that serious adverse reactions were more frequently reported in pregnant women, including anaphylactic reactions. Other adverse reactions including tachycardia, hypotension and hepatic injury were also more frequent in pregnant women than in non-pregnant women of the same age. This could be explained by physiological changes in pregnancy that lead to greater sensitivity to certain adverse reactions. Some drugs, such as phloroglucinol, metoclopramide, iron, atosiban and nifedipine, were more frequently involved in adverse reactions in pregnant women. These drugs are specifically used during pregnancy, which may explain why they are over-represented in adverse reactions. This is the first comparative descriptive study on drug adverse reactions in pregnant women. Specific epidemiological and pharmacokinetic studies are necessary to confirm these results and better understand the differences observed to improve the monitoring of pregnant women exposed to certain drugs.

Physical and Cognitive Training to Enhance Intensive Care Unit Survivors' Cognition: A Mapping Review.

PURPOSE: The aim of this study was to examine current literature regarding effects of physical or cognitive training and simultaneous (dual-task) physical and cognitive training on cognition in adults surviving an intensive care unit (ICU) stay. DESIGN: Systematic mapping. METHODS: A literature search was conducted to examine effects of physical and/or cognitive training on cognitive processes. RESULTS: Few studies have targeted adults surviving ICU. Independently, physical and cognitive interventions improved cognition in healthy older adults with and without cognitive impairment. Simultaneous interventions may improve executive function. Small sample size and heterogeneity of interventions limited the ability to make inferences. CONCLUSION: Literature supports positive effects of single- and dual-task training on recovering cognition in adults. This training could benefit ICU survivors who need to regain cognitive function and prevent future decline. RELEVANCE TO PRACTICE: With the growing number of ICU survivors experiencing cognitive deficits, it is essential to develop and test interventions that restore cognitive function in this understudied population.

Who's guarding what? A poststructural feminist analysis of gardasil discourses.

In May 2006 the Gardasil vaccine was approved for implementation in the United States to prohibit the spread of four strains of the human papillomavirus (HPV) that can lead to cervical cancer. Through a poststructural feminist reading, I critique ideologies at play throughout the Food and Drug Administration (FDA) approval hearing for this vaccine. I explore the conditions that gave rise to the adoption of the Gardasil vaccine as evidenced in the hearing transcript, and probe contradictions between choices the FDA enacted for the feminine body with those recommendations from lead scientists of Merck that urged the inclusion of males in the vaccination process. Along the way, I respond to appeals from scholars to address matters of health policy formation and implementation as critical and underexplored dimensions of health communication. I offer a vision that makes way for proactive engagement of males in reproductive and sexual health, particularly as the FDA delayed vaccine approval for males until 2009.

Incidence and characteristics of intravascular pulmonary migration of etonogestrel implants: A French nationwide study.

OBJECTIVE(S): To describe the features of etonogestrel implant (Nexplanon and Implanon) migration into the pulmonary vasculature and to estimate its incidence in France. STUDY DESIGN: We retrospectively reviewed French cases of implant migration into the pulmonary vasculature reported up to 2018. Patient clinical data were collected. The annual incidence of migration was estimated from the number of cases reported and number of implants sold. RESULTS: Twenty-seven cases of migration into the pulmonary vasculature were identified. In 19 cases (70%) it was stated that this was into the pulmonary artery (nine into the left branch, four into the right branch and six unspecified) and in the other eight cases (30%) it was it not specified whether this was into the pulmonary artery or one of its branches. The migration was discovered following a request for implant removal in 59% of cases, following respiratory complaints in 24%, and because the implant was no longer palpable in 17%. In the 24 cases for which information on removal (or not) was available, the implant was removed in 15 (60% by an endovascular procedure and 40% by invasive surgery); in the remainder it was left in situ. The incidence of migration into the pulmonary vasculature was 1.23 per 100,000 implants sold [95% CI 0.25-3.58] in 2014, increasing to 3.17 per 100,000 implants sold [1.37-6.24] in 2017. In 2016, the French National Agency for Medicines and Health Products Safety (ANSM) had recommended performing a systematic search for non-palpable implants, including at thorax level. CONCLUSIONS: The incidence of migration into the pulmonary vasculature is low. Nonetheless, because the consequences are potentially serious, in December 2019 the ANSM made recommendations to reduce this risk.

Möbius syndrome in a neonate after mifepristone and misoprostol elective abortion failure.

OBJECTIVE: To report a case of a child born with Möbius syndrome following exposure in utero to mifepristone and misoprostol for elective abortion. CASE SUMMARY: In the seventh week of pregnancy, a woman was administered mifepristone 600 mg and, 2 days later, misoprostol 400 mug for abortion. One month later, despite significant metrorrhagia, an ultrasound examination showed ongoing gestation. At 33 weeks and 3 days of gestation, the woman gave birth to a male with left facial palsy, microretrognathia, and axial hypotonia related to Möbius syndrome. DISCUSSION: Möbius syndrome is characterized by unilateral or bilateral palsy of the abducens (VI) and facial (VII) cranial nerves. Other cranial nerves (eg, the hypoglossal [XII]), craniofacial or orofacial anomalies, and limb malformations are often associated. The etiology of the Möbius syndrome remains largely unknown and probably involves multiple factors. The most likely etiological hypothesis is disruption of the developing vascular system, with transient ischemia (particularly in the vertebral arteries) and fetal hypoxia. A teratogenic cause of Möbius syndrome has been suggested. The critical period for the development of Möbius syndrome following teratogen exposure appears to be 5-8 weeks of gestation. To date, mifepristone alone does not appear to have induced Möbius syndrome. In contrast, oral or vaginal misoprostol administration can lead to a significant increase in Doppler-measured uterine artery resistance and may induce uterine contractions. If these occur during the critical embryonic period, they may cause flexion in the areas of the sixth and seventh cranial nerves and decreased blood flow. CONCLUSIONS: Ineffective use of mifepristone and misoprostol in the first trimester of pregnancy may be associated with a risk of Möbius syndrome, primarily due to misoprostol activity. Women with ongoing pregnancy after failed abortion with misoprostol administration should be informed of this risk.

Identifying depression in a family member: the carers' experience.

BACKGROUND: Current research activity has not focused adequately upon the experience of caring for a person with depression. This study aimed to explore the carer's experience of living with a person with clinical depression. Specific focus was given to the detection and recognition of the disorder. METHODS: A series of focus groups and in-depth interviews was conducted with carers living with a person with clinical depression in rural and metropolitan Australia. Participants were recruited via support agencies and local advertising of the research. RESULTS: Signs and symptoms of depression were recognised by carers, generally in hindsight. Barriers to early detection were identified by carers and these were likely to contribute to the psychological reaction of carers and to the eventual diagnosis of the care recipient. LIMITATIONS: The study would be strengthened by a greater diversity of relationships between the carer and the care recipient. CONCLUSIONS: This research has important implications for clinical practice and health policy, which must evolve to facilitate early detection and intervention, and to address the experience and needs of carers.

Economic evaluation of a crisis resolution service: a randomised controlled trial.

AIMS: The use of specialised services to avoid admission to hospital for people experiencing mental health crises is seen as an integral part of psychiatric services in some countries. The aim of this paper is to assess the impact on costs and cost-effectiveness of a crisis resolution team (CRT). METHODS: Patients who were experiencing mental health crises sufficient for admission to be considered were randomised to either care provided by a CRT or standard services. The primary outcome measure was inpatient days over a six-month follow-up period. Service use was measured, costs calculated and cost-effectiveness assessed. RESULTS: Patients receiving care from the CRT had non-inpatient costs pounds sterling 768 higher than patients receiving standard care (90% CI, pounds sterling 153 to pounds sterling 1375). With the inclusion of inpatient costs the costs for the CRT group were pounds sterling 2438 lower for the CRT group (90% CI, pounds sterling 937 to pounds sterling 3922). If one less day spent as an inpatient was valued at pounds sterling 100, there would be a 99.5% likelihood of the CRT being cost-effective. CONCLUSION: This CRT was shown to be cost-effective for modest values placed on reductions in inpatient stays.

The experience of living with a person with an eating disorder: the impact on the carers.

Using a combination of focus groups and individual in-depth interviews, the experience of living with a person with an eating disorder was explored in 24 carers. Attention was given to the progression of the disorder to understand its impact upon the family throughout the stages of the illness. Caring for a person with an eating disorder impacted upon the primary carer and the family throughout the course of the illness. Despite this, the impact on the carers was seldom acknowledged and the needs of these carers and their families were unrecognized and neglected by health professionals.

Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study.

OBJECTIVE: To evaluate the effectiveness of a crisis resolution team. DESIGN: Randomised controlled trial. PARTICIPANTS: 260 residents of the inner London Borough of Islington who were experiencing crises severe enough for hospital admission to be considered. INTERVENTIONS: Acute care including a 24 hour crisis resolution team (experimental group), compared with standard care from inpatient services and community mental health teams (control group). MAIN OUTCOME MEASURES: Hospital admission and patients' satisfaction. RESULTS: Patients in the experimental group were less likely to be admitted to hospital in the eight weeks after the crisis (odds ratio 0.19, 95% confidence interval 0.11 to 0.32), though compulsory admission was not significantly reduced. A difference of 1.6 points in the mean score on the client satisfaction questionnaire (CSQ-8) was not quite significant (P = 0.07), although it became so after adjustment for baseline characteristics (P = 0.002). CONCLUSION: Crisis resolution teams can reduce hospital admissions in mental health crises. They may also increase satisfaction in patients, but this was an equivocal finding.

Fetal toxic effects of angiotensin II receptor antagonists: case report and follow-up after birth.

OBJECTIVE: To report a child born with renal impairment following severe anhydramnios due to maternal exposure to an angiotensin II receptor type 1 (AT1) antagonist, valsartan, and hydrochlorothiazide during the first 28 weeks of pregnancy. CASE SUMMARY: A hypertensive woman treated with valsartan 80 mg/day, hydrochlorothiazide 12.5 mg/day, prazosin 10 mg/day, lysine acetylsalicylate 100 mg/day, and levothyroxine 250 microg/day became pregnant. At 28 weeks' gestational age, severe anhydramnios associated with high beta2-microglobulin levels in the fetal blood cord was observed. Upon discontinuation of valsartan, fetal renal prognosis improved. In this case, using the Naranjo probability scale, the renal insufficiency of the child was probably related to valsartan. At the age of 2.5 years, the child presented with only mild chronic renal insufficiency. Growth parameters were within the normal range, and there was no evidence of developmental delay. DISCUSSION: Exposure to AT1 antagonists during the second part of pregnancy can lead to abnormalities similar to those observed after exposure to angiotensin-converting enzyme inhibitors, that is, reduced fetal kidney perfusion that may result in oligoamnios and neonatal renal insufficiency. Fourteen previous reports of maternal exposure to AT1 antagonists during this period have been published. In 6 cases, fetal or neonatal death occurred; in 2 cases, pregnancy was terminated because of complete anhydramnios or fetal abnormalities; in 1 case, renal insufficiency persisted at 8 months of age; in 2 cases, kidney function was fairly normal at birth; and in 4 cases, including the one described here, neonatal renal failure improved in the first year of life. CONCLUSIONS: AT1 antagonists should be avoided throughout pregnancy. If these agents are prescribed accidentally to a pregnant woman, monitoring of amniotic fluid volume and beta2-microglobulin fetal blood levels after discontinuation of the AT1 antagonist can provide critical data for advising parents on pregnancy and fetal outcome.

Experience with treatment services for people with bipolar disorder.

OBJECTIVE: To describe the experiences of people with bipolar disorder with primary care and specialist mental health services. DESIGN AND SETTING: Focus groups and indepth interviews were conducted in seven Australian capital cities between July 2002 and April 2003. Thematic analyses were conducted using the QSR NUD*IST software package for qualitative data. PARTICIPANTS: Forty-nine people with bipolar disorder participated in the focus groups and four participated in the interviews. RESULTS: Thematic analyses highlighted eight key themes. Most notably, respondents identified a lack of awareness and understanding about bipolar disorder within the Australian community, which contributed to apparent delays in seeking medical assessment. The burden of illness was exacerbated by difficulties experienced with obtaining an accurate diagnosis and optimal treatment. The healthcare system responses were described as inadequate and included inappropriate crisis management, difficulties accessing hospital care, inappropriate exclusion of carers and families from management decisions, and frequent discontinuities of medical and psychological care. CONCLUSIONS: People with extensive experience of bipolar disorder report barriers to optimal care because of lack of community understanding and healthcare system shortcomings. These barriers exacerbate the social, interpersonal and economic costs of this illness.