Representations of clinical practice guidelines and health equity in healthcare literature: An integrative review.

AIM: This paper reports an integrative review of international health literature that discusses health equity in relation to clinical practice guidelines (CPGs). BACKGROUND: Healthcare professionals (HCPs), policy makers, and decision makers rely on sound empirical evidence to make fiscally responsible and appropriate decisions about the allocation of health resources and health service delivery. CPGs provide statements and recommendations that aim to standardize care with an implicit goal of achieving equity of care among diverse populations. Developers of CPGs must be careful not to exacerbate inequity when making recommendations. As such, it is important to determine how equity is discussed within the context of CPGs. DESIGN: This integrative review was conducted according to integrative review methods as outlined by Whittemore and Knafl (2005), and Toronto and Remington (2020). These authors outlined a systematic process for the identification of relevant literature across health disciplines to examine the state of knowledge pertaining to a phenomenon such as health equity. SEARCH METHODS: The computerized databases PubMed, CINAHL, Cochrane, Embase, Medline, and Web of Science were searched using a combination of keywords. Search parameters included international peer-reviewed published, full-text, English language articles, editorials, and reports over the last decade (January 2011 to February 2022). A reference search of included articles was conducted to identify any additional articles. Dissertations and theses were not included. SEARCH OUTCOME: A total of 139 peer-reviewed English language articles were identified. RESULTS: The findings of this review revealed five main ways in which health equity is in context of CPGs including if they target or exacerbate inequity among disadvantaged populations, equity and CPG development, implementation, and evaluation, and checklists and tools to assist developers and users of CPG to consider equity. Although critical appraisal tools exist to assist users of CPGs assess and to evaluate how well CPGs address issues of equity, the definition of equity and how CPG development panels should incorporate and articulate it remains unclear and haphazard. As such, recommendations intended to be implemented by HCPs to optimize health equity remains diverse and unclear. CONCLUSION: The way equity is discussed within the reviewed health literature has implications for their uptake by and utility for HCPs. The ability of HCPs to implement CPGs may be hindered without an appreciation and integration of equity considerations across the various phases of CPG conceptualization, development, implementation, and evaluation, and their relevance and appropriateness to diverse geographic and socioeconomic contexts with variable access to health human resources and services. This situation could be improved if equity were more clearly articulated within all aspects of the CPG process. CLINICAL RELEVANCE: Understanding how equity is discussed in the literature relative to CPGs has implications for their uptake by and utility for HCPs in their goal of providing equitable health care. Successful implementation of CPGs with consideration equity could be improved if equity were more clearly articulated within all aspects of the CPG process including conceptualization, development, implementation, and evaluation.

Rapid repeat infection of SARS-CoV-2 by two highly distinct delta-lineage viruses.

An instance of sequential infection of an individual with, firstly, the Delta variant and secondly a Delta-sub-lineage has been identified. The individual was found positive for the AY.26 lineage 22 days after being found positive for the Delta [B.1.617.2] variant. The viruses associated with the cases showed dramatic genomic difference, including 31 changes that resulted in deletions or amino acid substitutions. Seven of these differences were observed in the Spike protein. The patient in question was between 30 and 35 years old and had no underlying health conditions. Though singular, this case illustrates the possibility that infection with the Delta variant may not itself be fully protective against a population of SARS-CoV-2 variants that are becoming increasingly diverse.

Chronic obstructive pulmonary disease as disability: dilemma stories.

The purpose of this work was to develop an understanding of the meaning of disability for individuals living with chronic obstructive pulmonary disease (COPD) in a Canadian midwestern community from an emic perspective. A focused ethnographic design was used. Fifteen individuals participated in interviews. Narrative analysis was used to examine the interview data. Data analysis revealed 65 dilemma stories consisting of two structural components: the impairment, and the justification/explanation of the impairment. Participants' impairment might or might not have been known to others. In both situations, individuals were faced with choices of whether to explain/justify or attempt to conceal the impairment. Participants told these dilemma stories to convey the meaning of COPD as a disability invisible to others, and at times, to themselves. The information gained from this research will serve as an essential complement to the existing knowledge about this important yet often invisible chronic illness.

COPD stories of complex causal 'truths' 'Sure I've smoked all my life/but I also put in 37 years at the mine'.

AIMS AND OBJECTIVES: Secondary analysis was conducted to interpret the causes of illness stories told by patients living with chronic obstructive pulmonary disease. BACKGROUND: Despite the abundance of quantitative evidence regarding the causal relationship between smoking and chronic obstructive pulmonary disease, there is limited research that provides a contextual emic understanding of chronic obstructive pulmonary disease aetiology. DESIGN: Interview data from two earlier focused ethnography studies were examined by retrospective interpretation, a type of secondary qualitative research. Chronic obstructive pulmonary disease causation stories were identified in both primary study data bases, but were not previously systematically examined. METHODS: The analysis was completed using an eclectic, explicit narrative approach that involved the examination of causation story elements. RESULTS: Participants told 104 causal stories about the development of their lung disease. They situated the aetiology of their chronic illness within a psychosocial reality. CONCLUSIONS: The causal stories told by participants demonstrate that those living with chronic obstructive pulmonary disease present a broader causal explanation for their illness, an orientation not commonly presented in the literature. They demonstrate the need for further examination of the important lay accounts of causes of illness in relation to chronic obstructive pulmonary disease. RELEVANCE TO CLINICAL PRACTICE: Clinicians' ability to hear an alternative understanding may be impeded when they only listen for what they already know, 'facts' concerning the relationship between smoking and chronic obstructive pulmonary disease. Addressing vulnerable persons in such a manner may impede patients' efforts to be responsible for the development of their chronic illness and individualised care.

Representations of disability in nursing and healthcare literature: an integrative review.

AIM: This paper is a report of an integrative review to explore the way in which disability has been considered in the multidisciplinary health and nursing literature. BACKGROUND: In the multidisciplinary health and nursing literature, two ways are presented in which disability can be understood: the traditional, functional perspective and a more contemporary, social perspective. DATA SOURCES: Computerized databases of the CINAHL, Proquest Nursing and Allied Health Sources, EBSCO and Evidence Based Medicine Reviews Multifile and Cochrane databases were conducted for papers published in English in the period 1963-2007 using the keywords 'models of disability', 'disability and nursing research' and 'theories of disability'. METHODS: An integrative review was performed and, of the 11,578 papers identified, 65 were included. RESULTS: The concept of functional disability refers to an individual who is physically 'disabled' and unable to perform expected roles. The concepts of social stigmatization and normalcy are associated with functional disability. In contrast, social disability concerns functional limitations within an individual's experience of living with disability, examining how socially constructed barriers actually 'disable' people. Conventionally, disability research has been conducted from an etic perspective. Researchers contend that a shift towards an understanding from the emic perspective is needed for disability research to be emancipatory. CONCLUSION: Adoption of a social perspective is necessary to inform an understanding of disability that addresses stigmatization and oppression. Research-informed nursing practice, complemented by supportive health and social policies, could transform the experience of living with disability.