Evidence-based models of rural palliative care: A systematic review.

BACKGROUND: Forty-five percent of the world's population lives in rural areas, yet their access to palliative care is quite limited. Identifying the care elements rural populations with palliative care needs require is critical to improving care outcomes. AIM: To identify the key care elements that optimise palliative care for people in rural communities. DESIGN AND DATA SOURCES: A systematic review of articles studying the impact of novel rural model of care interventions was undertaken in May 2022. This study is reported using the PRISMA Statement and was registered with Prospero (CRD42020154273). Three databases were searched, and the data analysed according to Popay's narrative synthesis, and elements classified using the WHO Innovative Care for Chronic Conditions (ICCC) Framework. RESULTS: Of the 9508 identified papers, 15 met the inclusion criteria, reporting on 14 studies involving 1820 rural patients. Care received spanned 12/18 of the WHO ICCC Framework elements, with wide variability in how these elements were operationalised. The five elements that signal improved outcomes were: (1) Promote continuity and coordination; (2) Prepared, informed and motivated health care teams; (3) Prepared, informed and motivated patients and families; (4) Organise and equip health care teams and (5) Promote consistent financing. CONCLUSIONS: A well-coordinated multidisciplinary team approach, led by clinicians with specialist palliative care expertise, integrated across local health care settings, using information systems and care planning, is critical to optimising rural palliative care patient outcomes. Rural patients and their families require timely input from specialist palliative care clinicians and information to address their needs.Prospero registration ID: CRD42020154273 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=154273.

Practitioner perspectives on the use of selected fear of childbirth screening tools within a clinical context.

Fear of childbirth (FOC), or tokophobia, can influence several medical and obstetric variables, and is a significant predictor of maternal and mental health outcomes and birth experiences. Current practice in the UK does not include initial screening for tokophobia, rather, assessment and support occur under extreme circumstances e.g. maternal requests for caesarean sections or pregnancy termination requests in order to avoid childbirth. Moreover, while there are several candidate outcome measures for FOC, none have been evaluated in terms of their perceived suitability by specialist practitioners within perinatal healthcare pathways. The present study explores the perceived barriers and facilitators reported by health professionals working within the maternity and mental health services for the use of FOC candidate outcome measures. Evaluated measures included the Fear of Birth Scale, the Oxford Worries about Labour Scale, The Wijma Delivery Expectancy Scale, the Slade-Pais Expectations of Childbirth Scale the Tokophobia Severity Scale. The Tokophobia Severity Scale, followed by the Slade-Pais Expectations of Childbirth Scales were the most favourable scales selected for use according to clinicians. The identification of preferred scales and how they can be used in the local maternity system is a step towards the application of these consistently in clinical practice, to aid in the identification and assessment of FOC. The use of the correct tool at each stage of contact with the local maternity system will improve clinician confidence in the identification of FOC and facilitate the efficient implementation of treatment and support through the development of pathways of care.

The inter-agency standing committee (IASC) guidelines on mental health and psychosocial support (MHPSS) in emergency settings: a critique.

The bio-medical model of 'mental health' and 'mental illness' that relates to the relationship between wellbeing and distress informs psychopathology and dominates conceptualisation in many Western Educated Industrialised Rich Democratic (WEIRD) populations. This paper aims to critique the model, questioning the appropriateness of psychopathology as a conceptual framework when working as a Western trained clinician with populations such as in China, Japan, Asia, the Middle-East and Africa. The paper also considers the cultural appropriateness of western notions of psychopathology when working inter-culturally in relation to the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings, and the Review of the Implementation of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings.

The Olympia anatomic polished cemented stem is associated with a high survivorship, excellent hip-specific functional outcome, and high satisfaction levels: follow-up of 239 consecutive patients beyond 15 years.

INTRODUCTION: The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term survivorship, radiographic outcome, and patient-reported outcome measures (PROMs) of the Olympia stem. PATIENTS AND METHODS: Between May 2003 and December 2005, 239 patients (264 THAs) underwent a THA with an Olympia stem in our institution. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS), EuroQol-5 dimensions (EQ-5D) score, and patient satisfaction at mean 10 years following THA. Patient records and radiographs were then reviewed at a mean of 16.5 years (SD 0.7, 15.3-17.8) following THA to identify occurrence of complications or revision surgery for any cause following surgery. Radiographs were assessed for lucent lines and lysis according to Gruen's zones RESULTS: Mean patient age at surgery was 68.0 years (SD 10.9, 31-93 years). There were 156 women (65%, 176 THAs). Osteoarthritis was the indication for THA in 204 patients (85%). All cause stem survivorship at 10 years was 99.2% (95% confidence interval [CI], 97.9%-100%) and at 15 years was 97.5% (94.6%-100%). The 15-year stem survival for aseptic loosening was 100%. Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (96.3%-100%) at 10 years and 95.9% (92.4%-99.4%) at 15 years. There were 9 THAs with non-progressive lucent lines in a single Gruen zone and 3 had lines in two zones, and no patient demonstrated signs for lysis. At a mean of 10-year (SD 0.8, 8.7-11.3) follow-up, mean OHS was 39 (SD 10.3, range 7-48) and 94% of patients reported being very satisfied or satisfied with their THA. CONCLUSIONS: The Olympia stem demonstrated excellent 10-year PROMs and very high rates of stem survivorship at final follow-up beyond 15 years.

The Tokophobia Severity Scale (TSS): measurement model, power and sample size considerations.

OBJECTIVE: To examine the measurement model of the Tokophobia Severity Scale and consider issues of statistical power and sample size from the original instrument development study. BACKGROUND: Fear of childbirth (FoC) and tokophobia represents an area of increasing concern within perinatal mental health research and clinical practice. Existing measures of the FoC have been criticised due to either measurement inconsistencies, difficulties in scoring or practical clinical application. Attempting to address these limitations, researchers developed the Tokophobia Severity Scale (TSS). A fundamental assumption underpinning the use of the TSS is unidimensionality, however this assertion may have been based on sub-optimal sample size and approach taken to factor structure determination. METHOD: Parallel analysis (PA), principal components analysis (PCA), exploratory factor analysis (EFA), power analysis and sample size calculation using a reconstruction of the original dataset from published summary data. RESULTS: Following replication of the original PCA, a three-factor model was found to offer a significantly better fit to data than a unidimensional model. Power analysis suggested the original study was underpowered. CONCLUSION: The TSS remains a promising tool but assumptions regarding its measurement model are based on an inadequate sample size. Sample sizes for a sufficiently powered study indicated.

Fear of childbirth measurement: appraisal of the content overlap of four instruments.

OBJECTIVE: To evaluate empirically the degree of content overlap between four self-report measures of fear of childbirth (FoC) identified as 'best in class' by a recent review. BACKGROUND: FoC and tokophobia is an area of increasing clinical concern and has been linked to poor maternal and neonatal outcomes. Clinical pathways have been established to improve care and interventions for FoC however, ambiguity and inconsistency remain regarding the most appropriate assessment measures. METHOD: A multi-rater and consensus content analysis was undertaken to determine the degree of overlap between four 'best in class' measures of FoC/tokophobia. RESULTS: The Slade-Pais expectations of childbirth scale (SPECS) was found to be the preferred measure in terms of symptom overlap of the tools evaluated, however, the overall level of overlap among these measures was weak. CONCLUSION: Limitations inherent to the current battery of preferred measures of FoC suggests both the desirability and urgency to develop a theoretically-grounded, psychometrically robust and accurate FoC assessment measure. Current measures of FoC are not interchangeable.

Psychodermatology in Clinical Practice: Main Principles.

Psychodermatology is a newer and emerging subspecialty of dermatology, which bridges psychiatry, psychology, paediatrics and dermatology. It has become increasingly recognised that the best outcomes for patients with psychodermatological disease is via a multidisciplinary psychodermatology team. The exact configuration of the multidisciplinary team is, to some extent, determined by local expertise. In addition there is a growing body of evidence that it is much more cost effective to manage patients with psychodermatological disease in dedicated psychodermatology clinics. Even so, despite this evidence, and the demand from patients (and patient advocacy groups), the delivery and establishment of psychodermatology services is very sporadic globally. Clinical and academic expertise in psychodermatology is emerging in dermatology and other (often peer-reviewed) literature. Organisations such as the European Society for Dermatology and Psychiatry champion clinical and academic advances in psychodermatology, whist also enabling training of health care professionals in psychodermatology. Emiliano Panconesi, to whom this supplement is dedicated, was at the forefront of psychodermatology research and was a founding member of ESDaP.

Adolescent "Saxophone Penis" Secondary to Crohn's Disease: Misdiagnosed as Being Posttraumatic.

We describe a patient with a "saxophone penis" mistakenly diagnosed as having posttraumatic changes. A careful history and attention to blood tests at presentation may have alerted clinicians that there was a nontraumatic cause for our patient's disease. It is essential that clinicians consider "metastatic" anogenital Crohn's disease as a possible cause of "saxophone penis".

Practice pathways, education, and regulation influencing nurse practitioners' decision to provide primary care: a rapid scoping review.

BACKGROUND/OBJECTIVE: Initially established to improve access to healthcare, particularly for primary care, the full potential of the nurse practitioner role is yet to be realised in most countries. Despite this, most countries are working to meet an ageing population's increasing healthcare needs and reduce healthcare costs and access disparities. Achieving these outcomes requires reform at multiple levels, including nurse practitioner practice pathways, education and regulation, and identifying the barriers and facilitators to optimising their primary care role. METHODS: A rapid scoping review of nurse practitioner practice pathways, education and regulation inclusive of: (1) a systematic search of Medline and CINAHL for peer-reviewed English language articles, including opinion pieces published between January 2015 and February 2022; and (2) a web-based search of nurse practitioner program entry requirements of International Nurse Regulator Collaborative country members with a protected nurse practitioner title and prescribing rights, plus the Netherlands. The individually summarised search data was integrated and synthesised using Popay's narrative approach. RESULTS: Emerging evidence from the included nurse practitioner courses (n = 86) and articles (n = 79) suggests nurse practitioners working in primary care provide safe, effective care and improve healthcare efficiencies. However, different regulatory and educational models are required if the primary care nurse practitioner is to meet growing demand. CONCLUSIONS: International variations in entry criteria, curriculum, and regulation shape the global profile of the nurse practitioner primary care workforce and their practice setting. For countries to grow their primary care nurse practitioner workforce to meet unmet needs, different entry requirements, program content and accredited post-registration transitional programs must be urgently considered.

The use of videofluoroscopy in the assessment of the pharyngeal airway in obstructive sleep apnoea.

This prospective cohort study evaluated the use of videofluoroscopy in assessing changes in both antero-posterior (A-P) and transverse pharyngeal airway dimensions in patients with obstructive sleep apnoea (OSA). Forty patients [32 males and 8 females; mean age of 49.3 (SD = 10.79) years] with confirmed OSA, referred for mandibular advancement appliance (MAA) therapy were recruited. Patients received a customized Herbst MAA, adjusted for maximum comfortable protrusion. A standard lateral cephalogram, supine A-P, and transverse videofluoroscopic investigations were performed. Repeat supine videofluoroscopic investigations were undertaken with the MAA in situ. Parametric tests were used to evaluate the study hypotheses as the data were normally distributed. A paired t-test was employed to determine both the impact of posture on the airway using upright cephalometry and supine videofluoroscopy and the effect of MAA insertion on A-P and transverse pharyngeal airway dimensions. Following a change in posture from upright to supine, highly statistically significant (P < 0.001) changes were observed for all lateral pharyngeal dimensions. Statistically significant increases in minimum lingual airway (P < 0.001) and maximum transverse pharyngeal airway (P < 0.001) were found following MAA insertion. A reduction in soft palate area (P = 0.029) and pharyngeal height (P < 0.001) was also noted. Videofluoroscopy offers a useful dynamic assessment of the pharyngeal airway in both the A-P and transverse planes in patients with OSA.

The Relationship between Maternal Personality Disorder and Early Birth Outcomes: A Systematic Review and Meta-Analysis.

(1) Background: Women with personality disorder are at risk of social and emotional problems which impact deleteriously on everyday functioning. Moreover, a personality disorder diagnosis has been established to have an adverse impact upon pregnancy outcomes and child health. Understanding this impact is critical to improving both maternal and child outcomes. This systematic review and meta-analysis will evaluate the contemporary evidence regarding these relationships. (2) Methods: Prospero and Cochrane were searched for any systematic reviews already completed on this topic. Academic Search Premier, CINAHL Complete, MEDLINE, PsycARTICLES, PsycINFO via the EBSCO host, and the Web of Science Core Collection were searched to include research articles published between 1980 and 2019. A total of 158 records were identified; 105 records were screened by reviewing the abstract; 99 records were excluded; 6 full text articles were assessed for eligibility; 5 records were included in the review. (3) Results: All the included studies reported on preterm birth. The meta-analysis indicates significant risk of preterm birth in women with personality disorder (overall odds ratio (OR) 2.62; CI 2.24-3.06; p < 0.01). Three studies reported on low birth weight, with the meta-analysis indicating a raised risk of low birth weight of the babies born to women with personality disorder (overall OR 2.00 CI 1.12-3.57 (p = 0.02)). Three studies reported on appearance, pulse, grimace, activity, and respiration (APGAR) score, with the meta-analysis of OR's indicating a risk of low APGAR score in women with personality disorder (overall OR 2.31; CI 1.17-4.55; p = 0.02). (4) Conclusions: The infants of women with personality disorder are at elevated risk of preterm birth, low birth weight and low APGAR score.

Estimating and modeling the dynamics of the intensity of infection with schistosoma japonicum in villagers of leyte, Philippines. Part II: Intensity-specific transmission of S. japonicum. The schistosomiasis transmission and ecology project.

A dynamic model of Schistosoma japonicum transmission is presented that incorporates effects of infection intensity, age, and sex. We use four infection intensity classes to investigate the impact of ecologic changes and public health interventions on the burden of infection within communities. Age- and sex-specific infection data from three disease-endemic villages in the Philippines are used to estimate the parameters of the model. The model gives good qualitative agreement with observed fecal egg counts adjusted for the accuracy of the Kato-Katz examination. Our results suggest that differences in infection burden between villages are caused by differences in both the infection process and the recovery process in humans. We describe the potential impact of mass treatment of all humans on the numbers with high infection. Furthermore, we show that a sudden reduction in snail population size would affect high prevalence and low prevalence communities in different ways.