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1.
Health Psychol ; 40(4): 230-241, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33856830

RESUMEN

OBJECTIVE: Personalized trials have the potential to improve the precision of treatment selection and foster patient involvement in clinical decision making. Little is known about the attitudes of patients with multimorbidities. To address this, stakeholders designed and conducted a national survey that determined general attitudes and features of personalized trials that may increase their use among patients with multimorbidities in clinical and research practice. METHOD: A multistakeholder collaboratory of patients, clinicians, scientists, methodologists, statisticians, and research disseminators designed a survey to determine the conditions, symptoms, and design attributes most applicable to personalized trials according to patients. A sample of U.S. patients with two or more prespecified personalized-trial-amenable chronic conditions completed the online survey. RESULTS: Multimorbid participants (N = 501; M age = 56.1 years) showed that some conditions, symptoms or use cases for personalized trials include pain (57.6%), hypertension (38.8%), diabetes (28.8%), sleep problems (27.4%), and depression (23.0%). Overall, 82.0% of the participants with multimorbidities were interested in participating in personalized trials. The percentage that were interested varied by trial attributes, including physician involvement (86.4%), patient-driven treatment selection (88.0%), clinician blinding (59.2%), placebo treatment options (57.5%), and out-of-pocket costs (41.8%). CONCLUSION: Participants with multimorbidities identified prevalent use cases that are suited to personalized trials. Participants also identified design features of such trials, including patient-driven treatment selection, active comparators, and nonblinding. This study demonstrates that eliciting input from a collaboratory and patients with multimorbidities can inform research priorities for this rapidly growing patient population and increase adoption by researchers and clinicians alike. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Asunto(s)
Participación del Paciente/métodos , Selección de Paciente/ética , Medicina de Precisión/métodos , Participación de los Interesados/psicología , Humanos , Masculino , Persona de Mediana Edad , Investigadores , Encuestas y Cuestionarios
3.
Gac Sanit ; 35 Suppl 1: S30-S32, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33832620

RESUMEN

OBJECTIVE: The large-scale social distancing policy conducted twice was unable to reduce the rate of development of COVID-19 widespread in Makassar, yet it increased. One of the causes was that social awareness is still lacking especially for people in the poverty line. This study attempts to describe the social behavior of people in poverty line toward COVID-19 case in Makassar. METHOD: This research is a qualitative descriptive study based on the case. The data analysis was undertaken qualitatively. RESULTS: The results revealed that the limited understanding of people in poverty line about COVID-19 and health protocols makes their behavior indifferent and disobedient to health protocols. In addition, the government's top-down approach to deal with COVID-19 pandemic was ineffective. However, bottom-up collaborative interventions need to be carried out through a group approach to gain an understanding of the COVID-19 health protocol, especially for people in poverty line and other vulnerable groups.


Asunto(s)
/prevención & control , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Colaboración Intersectorial , Pandemias , Pobreza , Participación de los Interesados , /epidemiología , /transmisión , Participación de la Comunidad , Agencias Gubernamentales , Política de Salud , Humanos , Indonesia/epidemiología , Administración en Salud Pública , Investigación Cualitativa , Responsabilidad Social , Participación de los Interesados/psicología , Población Urbana
4.
Nurse Pract ; 46(5): 34-43, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33882042

RESUMEN

ABSTRACT: In this second article of a three-part series, we explore how stakeholders can be educated on the use of telehealth technology and telemedicine. We address the need for staff and patient support for the transition to telehealth and offer suggestions to NPs for appropriate presentation and interaction with interdisciplinary teams and patients regarding telehealth.


Asunto(s)
Enfermeras Practicantes/psicología , Telemedicina/organización & administración , Personal de Salud/educación , Humanos , Relaciones Interprofesionales , Relaciones Enfermero-Paciente , Educación del Paciente como Asunto , Participación de los Interesados
5.
Health Res Policy Syst ; 19(1): 47, 2021 Mar 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789671

RESUMEN

BACKGROUND: At the height of the COVID-19 pandemic, Thailand had almost depleted its critical care resources, particularly intensive care unit (ICU) beds and ventilators. This prompted the necessity to develop a national guideline for resource allocation. This paper describes the development process of a national guideline for critical resource allocation in Thailand during the COVID-19 pandemic. METHODS: The guideline development process consisted of three steps: (1) rapid review of existing rationing guidelines and literature; (2) interviews of Thai clinicians experienced in caring for COVID-19 cases; and (3) multi-stakeholder consultations. At steps 1 and 2, data was synthesized and categorized using a thematic and content analysis approach, and this guided the formulation of the draft guideline. Within step 3, the draft Thai critical care allocation guideline was debated and finalized before entering the policy-decision stage. RESULTS: Three-order prioritization criteria consisting of (1) clinical prognosis using four tools (Charlson Comorbidity Index, Sequential Organ Failure Assessment, frailty assessment and cognitive impairment assessment), (2) number of life-years saved and (3) social usefulness were proposed by the research team based on literature reviews and interviews. At consultations, stakeholders rejected using life-years as a criterion due to potential age and gender discrimination, as well as social utility due to a concern it would foster public distrust, as this judgement can be arbitrary. It was agreed that the attending physician is required to be the decision-maker in the Thai medico-legal context, while a patient review committee would play an advisory role. Allocation decisions are to be documented for transparency, and no appealing mechanism is to be applied. This guideline will be triggered only when demand exceeds supply after the utmost efforts to mobilize surge capacity. Once implemented, it is applicable to all patients, COVID-19 and non-COVID-19, requiring critical care resources prior to ICU admission and during ICU stay. CONCLUSIONS: The guideline development process for the allocation of critical care resources in the context of the COVID-19 outbreak in Thailand was informed by scientific evidence, medico-legal context, existing norms and societal values to reduce risk of public distrust given the sensitive nature of the issue and ethical dilemmas of the guiding principle, though it was conducted at record speed. Our lessons can provide an insight for the development of similar prioritization guidelines, especially in other low- and middle-income countries.


Asunto(s)
Cuidados Críticos , Enfermedad Crítica , Asignación de Recursos para la Atención de Salud , Accesibilidad a los Servicios de Salud , Pandemias , Guías de Práctica Clínica como Asunto , Toma de Decisiones , Revelación , Ética Médica , Recursos en Salud , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Pronóstico , Discriminación Social , Valores Sociales , Participación de los Interesados , Tailandia , Confianza
11.
BMC Health Serv Res ; 21(1): 174, 2021 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-33627115

RESUMEN

BACKGROUND: The COVID-19 pandemic has posed unprecedented challenges and threats to the health care system, particularly affecting the effective delivery of essential health services in resource-poor countries such as Nepal. This study aimed to explore community perceptions of COVID-19 and their experiences towards health services utilization during the pandemic in Province-2 of Nepal. METHODS: The semi-structured qualitative interviews were conducted among purposively selected participants (n = 41) from a mix of rural and urban settings in all districts (n = 8) of the Province 2 of Nepal. Virtual interviews were conducted between July and August 2020 in local languages. The data were analyzed using thematic network analysis in NVivo 12 Pro. RESULTS: The findings of this research are categorized into four global themes: i) Community and stakeholders' perceptions towards COVID-19; ii) Impact of COVID-19 and lockdown on health services delivery; iii) Community perceptions and experiences of health services during COVID-19; and iv) COVID-19: testing, isolation, and quarantine services. Most participants shared their experience of being worried and anxious about COVID-19 and reported a lack of awareness, misinformation, and stigma as major factors contributing to the spread of COVID-19. Maternity services, immunization, and supply of essential medicine were found to be the most affected areas of health care delivery during the lockdown. Participants reported that the interruptions in health services were mostly due to the closure of health services at local health care facilities, limited affordability, and involvement of private health sectors during the pandemic, fears of COVID-19 transmission among health care workers and within health centers, and disruption of transportation services. In addition, the participants expressed frustrations on poor testing, isolation, and quarantine services related to COVID-19, and poor accountability from the government at all levels towards health services continuation/management during the COVID-19 pandemic. CONCLUSIONS: This study found that essential health services were severely affected during the COVID-19 pandemic in all districts of Province-2. It is critical to expand and continue the service coverage, and its quality (even more during pandemics), as well as increase public-private sector engagement to ensure the essential health services are available for the population.


Asunto(s)
/epidemiología , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Pandemias , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nepal/epidemiología , Investigación Cualitativa , Población Rural/estadística & datos numéricos , Participación de los Interesados , Población Urbana/estadística & datos numéricos , Adulto Joven
12.
Reprod Health ; 18(1): 26, 2021 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-33618726

RESUMEN

BACKGROUND: A coherent sexuality education program for adolescents is part of their sexual and reproductive rights and can help them have a healthier future. Therefore, the aim of this study was to explore the perspectives and intervention preferences of Iranian stakeholders regarding comprehensive sexuality education (CSE) in male adolescents based on the IMB model (information, motivation, behavioral skills). METHODS: This study was a qualitative study that was analyzed through a directed content analysis approach. Individual interviews and focused group discussions (FGDs) were used for data collection. The data were collected through in-depth semi-structured interviews with stakeholders in two schools and the Education Department in Sari and the Ministry of Health and Ministry of Education in Tehran from March 2019 to August 2019. Data saturation was achieved after 28 interviews and 1 FGDs with 9 participants. Finally, two sets of data were coded and analyzed using directed content analysis. RESULTS: In this study, five themes emerged as (1) role of institutions; (2) role of organizations; (3) need for stakeholder's partnership; (4) need for adolescent sexuality socialization management; and (5) need for enhancing the teachers' professional competence, which seemed to influence the implementation of CSE in male adolescents. Participants also expressed a number of intervention preferences for CSE. The most important of these was the change in macro policies, helping to create a culture against all forms of violence and breaking the taboo of sexuality education for children and adolescents. CONCLUSIONS: The results of this study revealed the need for a CSE program for adolescents' sexuality socialization. The finding showed that teachers required training to enhance their professional competence about sexuality issues. Therefore, it is necessary to design and implement culture-appropriate skill based programs to enhance the teachers' professional competence regarding the adolescents' sexual health.


Asunto(s)
Actitud Frente a la Salud , Percepción , Salud Reproductiva/educación , Educación Sexual , Salud Sexual/educación , Adolescente , Conducta del Adolescente/fisiología , Conducta del Adolescente/psicología , Niño , Grupos Focales , Conocimientos, Actitudes y Práctica en Salud , Humanos , Entrevistas como Asunto , Irán , Masculino , Motivación/fisiología , Investigación Cualitativa , Servicios de Salud Escolar , Educación Sexual/métodos , Conducta Sexual/psicología , Participación de los Interesados , Adulto Joven
16.
Cochrane Database Syst Rev ; 2: CD012876, 2021 02 18.
Artículo en Inglés | MEDLINE | ID: mdl-33599282

RESUMEN

BACKGROUND: Critical care telemedicine (CCT) has long been advocated for enabling access to scarce critical care expertise in geographically-distant areas. Additional advantages of CCT include the potential for reduced variability in treatment and care through clinical decision support enabled by the analysis of large data sets and the use of predictive tools. Evidence points to health systems investing in telemedicine appearing better prepared to respond to sudden increases in demand, such as during pandemics. However, challenges with how new technologies such as CCT are implemented still remain, and must be carefully considered. OBJECTIVES: This synthesis links to and complements another Cochrane Review assessing the effects of interactive telemedicine in healthcare, by examining the implementation of telemedicine specifically in critical care. Our aim was to identify, appraise and synthesise qualitative research evidence on healthcare stakeholders' perceptions and experiences of factors affecting the implementation of CCT, and to identify factors that are more likely to ensure successful implementation of CCT for subsequent consideration and assessment in telemedicine effectiveness reviews. SEARCH METHODS: We searched MEDLINE, Embase, CINAHL, and Web of Science for eligible studies from inception to 14 October 2019; alongside 'grey' and other literature searches. There were no language, date or geographic restrictions. SELECTION CRITERIA: We included studies that used qualitative methods for data collection and analysis. Studies included views from healthcare stakeholders including bedside and CCT hub critical care personnel, as well as administrative, technical, information technology, and managerial staff, and family members. DATA COLLECTION AND ANALYSIS: We extracted data using a predetermined extraction sheet. We used the Critical Appraisal Skills Programme (CASP) qualitative checklist to assess the methodological rigour of individual studies. We followed the Best-fit framework approach using the Consolidated Framework for Implementation Research (CFIR) to inform our data synthesis.  We classified additional themes not captured by CFIR under a separate theme. We used the GRADE CERQual approach to assess confidence in the findings. MAIN RESULTS: We found 13 relevant studies. Twelve were from the USA and one was from Canada. Where we judged the North American focus of the studies to be a concern for a finding's relevance, we have reflected this in our assessment of confidence in the finding. The studies explored the views and experiences of bedside and hub critical care personnel; administrative, technical, information technology, and managerial staff; and family members. The intensive care units (ICUs) were from tertiary hospitals in urban and rural areas. We identified several factors that could influence the implementation of CCT. We had high confidence in the following findings: Hospital staff and family members described several advantages of CCT. Bedside and hub staff strongly believed that the main advantage of CCT was having access to experts when bedside physicians were not available. Families also valued having access to critical care experts. In addition, hospital staff described how CCT could support clinical decision-making and mentoring of junior staff.  Hospital staff greatly valued the nature and quality of social networks between the bedside and CCT hub teams. Key issues for them were trust, acceptance, teamness, familiarity and effective communication between the two teams. Interactions between some bedside and CCT hub staff were featured with tension, frustration and conflict. Staff on both sides commonly described disrespect of their expertise, resistance and animosity. Hospital staff thought it was important to promote and offer training in the use of CCT before its implementation. This included rehearsing every step in the process, offering staff opportunities to ask questions and disseminating learning resources. Some also complained that experienced staff were taken away from bedside care and re-allocated to the CCT hub team. Hospital staff's attitudes towards, knowledge about and value placed on CCT influenced acceptance of CCT. Staff were positive towards CCT because of its several advantages. But some were concerned that the CCT hub staff were not able to understand the patient's situation through the camera. Some were also concerned about confidentiality of patient data. We also identified other factors that could influence the implementation of CCT, although our confidence in these findings is moderate or low. These factors included the extent to which telemedicine software was adaptable to local needs, and hub staff were aware of local norms; concerns about additional administrative work and cost; patients' and families' desire to stay close to their local community; the type of hospital setting; the extent to which there was support from senior leadership; staff access to information about policies and procedures; individuals' stage of change; staff motivation, competence and values; clear strategies for staff engagement; feedback about progress; and the impact of CCT on staffing levels. AUTHORS' CONCLUSIONS: Our review identified several factors that could influence the acceptance and use of telemedicine in critical care. These include the value that hospital staff and family members place on having access to critical care experts, staff access to sufficient training, and the extent to which healthcare providers at the bedside and the critical care experts supporting them from a distance acknowledge and respect each other's expertise. Further research, especially in contexts other than North America, with different cultures, norms and practices will strengthen the evidence base for the implementation of CCT internationally and our confidence in these findings. Implementation of CCT appears to be growing in importance in the context of global pandemic management, especially in countries with wide geographical dispersion and limited access to critical care expertise. For successful implementation, policymakers and other stakeholders should consider pre-empting and addressing factors that may affect implementation, including strengthening teamness between bedside and hub teams; engaging and supporting frontline staff; training ICU clinicians on the use of CCT prior to its implementation; and ensuring staff have access to information and knowledge about when, why and how to use CCT for maximum benefit.


Asunto(s)
Cuidados Críticos/organización & administración , Participación de los Interesados , Telemedicina/organización & administración , Canadá , Cuidados Críticos/métodos , Familia , Accesibilidad a los Servicios de Salud , Humanos , Unidades de Cuidados Intensivos , Administración de Personal en Hospitales , Personal de Hospital/educación , Investigación Cualitativa , Red Social , Estados Unidos
19.
J Environ Manage ; 282: 111719, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33413974

RESUMEN

It is widely recognized that stakeholder engagement can lead to improved decision making. However, decision makers must identify and engage appropriate stakeholder groups. This can be challenging when there is a wide and diverse range of potential stakeholders, often the case in environmental management. Some fields, business and public relations for example, have proposed criteria or methodologies for prioritizing stakeholders for inclusion in decision making, but current methods of stakeholder evaluation in environmental management focus on stakeholder identification, categorization, and relationship analysis, none of which explicitly prioritize stakeholders. In this paper we propose a set of ten criteria, drawn from the literature, that can be used to prioritize stakeholders for environmental management decision making. These criteria are: level of interest, level of influence, magnitude of impact, probability of impact, urgency/temporal immediacy, proximity, economic interest, rights, fairness, and underrepresented/underserved populations. Not all criteria will be relevant to all decision makers, but we suggest this set of criteria encompasses those stakeholder engagement factors most commonly considered by decision makers. This paper proposes these criteria that form the basis of future decision support approaches in environmental management contexts and we argue for development and testing of these criteria to connect stakeholder prioritization and environmental decision making.


Asunto(s)
Conservación de los Recursos Naturales , Participación de los Interesados , Toma de Decisiones
20.
Lancet Oncol ; 22(1): e29-e36, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33387502

RESUMEN

In 2011, the International Society of Geriatric Oncology (SIOG) published the SIOG 10 Priorities Initiative, which defined top priorities for the improvement of the care of older adults with cancer worldwide.1 Substantial scientific, clinical, and educational progress has been made in line with these priorities and international health policy developments have occurred, such as the shift of emphasis by WHO from communicable to non-communicable diseases and the adoption by the UN of its Sustainable Development Goals 2030. Therefore, SIOG has updated its priority list. The present document addresses four priority domains: education, clinical practice, research, and strengthening collaborations and partnerships. In this Policy Review, we reflect on how these priorities would apply in different economic settings, namely in high-income countries versus low-income and middle-income countries. SIOG hopes that it will offer guidance for international and national endeavours to provide adequate universal health coverage for older adults with cancer, who represent a major and rapidly growing group in global epidemiology.


Asunto(s)
Geriatría/normas , Accesibilidad a los Servicios de Salud/normas , Oncología Médica/normas , Neoplasias/terapia , Factores de Edad , Investigación Biomédica/normas , Consenso , Conducta Cooperativa , Educación Médica/normas , Geriatría/educación , Humanos , Comunicación Interdisciplinaria , Cooperación Internacional , Oncología Médica/educación , Neoplasias/diagnóstico , Neoplasias/epidemiología , Formulación de Políticas , Pronóstico , Participación de los Interesados
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