Being a patient in a crowded emergency department: a qualitative service evaluation.

BACKGROUND: Emergency department (ED) crowding causes increased mortality. Professionals working in crowded departments feel unable to provide high-quality care and are predisposed to burnout. Awareness of the impact on patients, however, is limited to metrics and surveys rather than understanding perspectives. This project investigated patients' experiences and identified mitigating interventions. METHODS: A qualitative service evaluation was undertaken in a large UK ED. Adults were recruited during periods of high occupancy or delayed transfers. Semi-structured interviews explored experience during these attendances. Participants shared potential mitigating interventions. Analysis was based on the interpretative phenomenological approach. Verbatim transcripts were read, checked for accuracy, re-read and discussed during interviewer debriefing. Reflections about positionality informed the interpretative process. RESULTS: Seven patients and three accompanying partners participated. They were aged 24-87 with characteristics representing the catchment population. Participants' experiences were characterised by 'loss of autonomy', 'unmet expectations' and 'vulnerability'. Potential mitigating interventions centred around information provision and better identification of existing ED facilities for personal needs. CONCLUSION: Participants attending a crowded ED experienced uncertainty, helplessness and discomfort. Recommendations included process and environmental orientation.

Decisions and prompts to screen for cervical, bowel, and breast cancer.

OBJECTIVES: To investigate what makes Australians decide to screen and follow through for breast, cervical, and bowel cancer population screening programs. METHODS: A convenience sample (N = 962) answered open-text questions about their decision to screen and what prompted them to act in an online survey. Open text responses were coded based on shared meaning using content analysis. Frequencies of each code were calculated. RESULTS: For breast and cervical screening, decisions were commonly based on screening being routine (32.58%breast and 35.19%cervical) or receiving a reminder (20.53% breast 13.07% cervical), and similarly, common prompts were receiving a reminder (40.68% breast and 29.13% cervical), screening being routine (22.05% breast and 18.65% cervical). Participants reported deciding to screen for bowel cancer due to arrival of home screening test kit (40.50%) or the experience of loved one's cancer (13.57%) and were prompted by arrival of home test kit (23.58%), and convenience (15.72%). CONCLUSIONS: Findings can inform the development of interventions targeting non-participants of cancer screening programs. PRACTICE IMPLICATIONS: Messages to encourage breast and cervical cancer screening should frame screening as part of regular healthcare routine. Messages to encourage bowel cancer screening should encourage immediate use of the screening kit upon arrival.

Egyptian hemodialysis patients' willingness to receive the COVID-19 vaccine booster dose: a multicenter survey.

BACKGROUND: Health authorities have struggled to increase vaccination uptake since the COVID-19 vaccines became available. However, there have been increasing concerns about declining immunity after the initial COVID-19 vaccination with the emergence of new variants. Booster doses were implemented as a complementary policy to increase protection against COVID-19. Egyptian hemodialysis (HD) patients have shown a high rate of hesitancy to COVID-19 primary vaccination, yet their willingness to receive booster doses is unknown. This study aimed to assess COVID-19 vaccine booster hesitancy and its associated factors in Egyptian HD patients. METHODS: A face-to-face interview was conducted with closed-ended questionnaires distributed to healthcare workers in seven Egyptian HD centers, mainly located in three Egyptian governorates, between the 7th of  March and the 7th of April 2022. RESULTS: Among 691 chronic HD patients, 49.3% (n = 341) were willing to take the booster dose. The main reason for booster hesitancy was the opinion that a booster dose is unnecessary (n = 83, 44.9%). Booster vaccine hesitancy was associated with female gender, younger age, being single, Alexandria and urban residency, the use of a tunneled dialysis catheter, not being fully vaccinated against COVID-19. Odds of booster hesitancy were higher among participants who did not receive full COVID-19 vaccination and among those who were not planning to take the influenza vaccine (10.8 and 4.2, respectively). CONCLUSION: COVID-19 booster-dose hesitancy among HD patients in Egypt represents a major concern, is associated with vaccine hesitancy with respect to other vaccines and emphasizes the need to develop effective strategies to increase vaccine uptake.

The Use of Information Communication Technologies in a South African Deaf Older Adult Population Living in a Residential Care Home to Communicate with Emigrant Family Members.

South Africa has experienced considerable international outward migration in the last half century, which has had a severe psychological impact on members of families affected by this phenomenon. Older parents who remain behind may experience feelings of loss and isolation. Information Communication Technologies (ICTs) are useful in maintaining relationships between family members separated by migration and increasingly allow migrant families to experience a virtual co-presence despite geographical separation. However, the process may be challenging, especially for older people with hearing difficulties. This article reports on a qualitative study exploring the perceptions of a group of older adults who have difficulty hearing and who live in a residential care home about using ICTs to communicate with family abroad. Interview data were analysed using thematic analysis. Most of the participants used either a fixed line telephone or a mobile phone. They reported challenges in communicating with family members abroad arising from their deafness, as well as difficulties using technological devices together with their hearing aids. These challenges resulted in feelings of helplessness and frustration. Although the data collection took place prior to the COVID-19 pandemic, these findings may be of particular relevance to situations such as those during the pandemic when many older adults became more reliant on technology to communicate with family members because of restrictions on direct contact. Accordingly, suggestions are made to address challenges in communication between older adults and loved ones who are geographically separated.

A case of retroperitoneal fibrosis secondary to chronic periaortitis.

Retroperitoneal fibrosis is a rare inflammatory disorder causing increased fibrotic deposition in the retroperitoneum, often leading to ureteral obstruction. We present a case report of a 33-year-old male with 2-month history of back pain. Initial imaging showed thickening around the infrarenal aorta. Six months later the patient presented with renal failure; a CT abdomen revealed extensive soft tissue mass around the aorta resulting in ureteral obstruction. Histology results of biopsy of the soft tissue mass revealed retroperitoneal fibrosis. It is important for clinicians to treat periaortitis early as this can prevent progression to retroperitoneal fibrosis which can cause severe secondary complications such as renal failure from ureteral obstruction.

LC3A Silencing Hinders Aggresome Vimentin Cage Clearance in Primary Choroid Plexus Carcinoma.

Aggresomes are transient microtubule-dependent inclusion bodies that sequester misfolded proteins and are ultimately removed by autophagy. Here we report the generation of a choroid plexus carcinoma cell line; Children's Cancer Hospital Egypt (CCHE)-45, which is characterized by the constitutive formation of aggresomes. When examining the autophagy pathway as the main route for aggresomes clearance, CCHE-45 cells displayed increased autophagy flux mediated by MAP1LC3B. MAP1LC3A-Variant1 gene expression was silenced by promoter methylation. Restoring MAP1LC3A-Variant1 expression resulted in the formation of MAP1LC3A positive autophagosmes and the disruption of the aggresomes' vimentin cage independent of MAP1LC3B positive autophagosomes. Our data supports the notion that basal quality control autophagy and vimentin cage clearance in CCHE-45 are mediated by MAP1LC3A. Hence we propose that absence of MAP1LC3A disrupts the autophagic pathway and leads to the failure of aggresome vimentin cage degradation. Consequently, this could represent a targetable pathway in autophagy-dependent cancers.