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1.
Soins ; 65(842): 26-28, 2020.
Artículo en Francés | MEDLINE | ID: mdl-32245554

RESUMEN

In the Île-de-France region, the medico-social sector is implementing a project to develop digital tools in institutions. With the support of the regional health agency, this project will lead to the selection of publishers by the end of 2019 who will offer the institutions business tools tailored to their needs, secure and interoperable to be part of the e-track programme.


Asunto(s)
Tecnología Biomédica/organización & administración , Participación de los Interesados , Francia , Humanos
5.
J Nurs Adm ; 50(4): 187-189, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32195911

RESUMEN

Conducting high-quality research in hospitals can be challenging. Surveys are a cost-effective method to collect data and conduct research studies in hospitals. However, survey response rates can present a challenge to researchers. This article explores targeted techniques that can be used to maximize the survey response rates among nurses and nurse managers.


Asunto(s)
Enfermeras Administradoras/organización & administración , Personal de Enfermería en Hospital/organización & administración , Proyectos de Investigación/tendencias , Participación de los Interesados/psicología , Encuestas y Cuestionarios , Recolección de Datos , Hospitales , Humanos , Internet
6.
Nephrol Nurs J ; 47(1): 11-20, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32083433

RESUMEN

Patients living with end stage renal disease (ESRD) who are undergoing hemodialysis experience frequent hospitalizations associated with complications of care and exacerbations of illness. Efforts to reduce hospitalizations have had limited success. The purpose of this study was to explore why hospitalizations occur from the perspectives of patients undergoing hemodialysis treatment, their caregivers, and health care providers. Semi-structured interviews and focus groups were conducted with 21 patients living with ESRD, 10 caregivers, and three focus groups with health care professionals. Findings are discussed under four main themes: Graft site/Catheter/Access issues, "My resistance is low," "I could not breathe,"" and "The perfect storm." Results highlight the complexity of care and vulnerability of patients with ESRD. Further interprofessional research is needed to improve transitional care and care delivery for patient populations receiving hemodialysis.


Asunto(s)
Hospitalización/estadística & datos numéricos , Fallo Renal Crónico/terapia , Diálisis Renal , Cuidadores/psicología , Grupos Focales , Humanos , Factores de Riesgo , Participación de los Interesados
7.
PLoS One ; 15(2): e0229338, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32092102

RESUMEN

INTRODUCTION: International medical electives, whereby undergraduates visit an institution in a country other than their own, are a common part of medical training. Visiting students are often asked to provide local teaching, which may be acceptable where the visitor is acting within the bounds of their own competency and the normal practices of both their home and host institutions. However, the extent to which teaching is an accepted student activity globally has not previously been described. This study aims to address this using an international survey approach. METHODS: A voluntary electronic survey, created using the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) framework, was distributed across established international medical student networks. This assessed the involvement of medical students in teaching and the educator training they receive, with the intention of comparing experiences between high-income countries (HICs) and low/middle-income countries (LMICs) to gauge the engagement of both "host" and "visiting" students. RESULTS: 443 students from 61 countries completed the survey, with an equal proportion of respondents from LMICs (49.4%, 219/443) and HICs (50.6%, 224/443). Around two thirds of students reported providing teaching whilst at medical school, with most reporting teaching numerous times a year, mainly to more junior medical students. There was with no significant difference between LMICs and HICs. Around 30 per cent of all medical students reported having received no teacher training, including 40 per cent of those already providing teaching. CONCLUSION: This study suggests that students are engaged in teaching globally, with no difference between HIC and LMIC contexts. However, students are underprepared to act as educators in both settings. Providing teaching as part of an elective experience may be ethically acceptable to both host and home institutions, but needs to be supported by formal training in delivering teaching.


Asunto(s)
Curriculum , Educación Médica , Participación de los Interesados , Estudiantes de Medicina/estadística & datos numéricos , Enseñanza , Adulto , Curriculum/normas , Educación Médica/organización & administración , Educación Médica/normas , Femenino , Geografía , Humanos , Individualidad , Masculino , Grupo Paritario , Participación de los Interesados/psicología , Estudiantes de Medicina/psicología , Encuestas y Cuestionarios , Formación del Profesorado/organización & administración , Formación del Profesorado/normas , Formación del Profesorado/estadística & datos numéricos , Enseñanza/organización & administración , Enseñanza/normas
8.
J Forensic Leg Med ; 69: 101886, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32056803

RESUMEN

In countries emerging from authoritarian rule, a major challenge is ending often widespread and systematic torture and ill-treatment practices. Between 2011 and 2019, Physicians for Human Rights (PHR), in collaboration with the Open Society Foundation (OSF), the Open Society Justice Initiative (OSJI) and regional and local partners, worked to establish effective torture investigation and documentation practices in the Central Asian countries of Kyrgyzstan, Tajikistan, and Kazakhstan. Our approach consisted of activities in three sequential phases - (1) assessment, (2) capacity building, and (3) policy reform. In this paper, we briefly describe activities during each phase and identify key lessons learned from these experiences and resulting policy and program reforms as a model for future efforts in other settings.


Asunto(s)
Medicina Legal/normas , Violaciones de los Derechos Humanos , Tortura , Asia , Creación de Capacidad/organización & administración , Documentación/normas , Humanos , Política Pública , Participación de los Interesados , Naciones Unidas
9.
PLoS One ; 15(2): e0228669, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32074142

RESUMEN

Implementing new diagnostics in public health programs can involve difficult trade-off decisions between individual patient benefits and public health considerations. Such decision-making processes are often not documented and may not include engagement of affected communities. This paper examines the perspectives of stakeholders on the trade-off between over-treatment and missed diagnosis captured during decision-making workshops on the transition from use of Xpert MTB/RIF to diagnose tuberculosis to Xpert MTB/RIF Ultra in Kenya and Swaziland. Xpert MTB/RIF Ultra has an overall increase in sensitivity but a decrease in specificity when compared to its predecessor. We conducted a qualitative study using four focus group discussions with a total of 47 participants and non-participant observation. The analysis reveals how participants deemed Xpert MTB/RIF Ultra's reduced specificity vis-à-vis its increased sensitivity to be an acceptable trade-off. The way participants assessed this trade-off was shaped by their experiences with the general uncertainty of all diagnostic tests, alternative testing options, historical evolution of diagnostic practices, epidemiological factors and resource constraints. In assessing the trade-off community and individual benefit and harm was frequently discussed together. Qualitative research on stakeholder engagement activities for diagnostic development and implementation can identify everyday experiences and situate assessments and perspectives of key stakeholders and as such aid in decision-making, improving implementation as well as patient outcomes. Further research is needed on the intended and unintended consequences of such engagement activities, how findings are being incorporated by decision-makers, and the impact on programmatic implementation.


Asunto(s)
Actitud , Uso Excesivo de los Servicios de Salud , Diagnóstico Erróneo/psicología , Juego de Reactivos para Diagnóstico/normas , Tuberculosis/diagnóstico , Esuatini , Grupos Focales , Humanos , Kenia , Técnicas de Diagnóstico Molecular/normas , Sensibilidad y Especificidad , Participación de los Interesados
10.
PLoS One ; 15(2): e0228634, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32101551

RESUMEN

BACKGROUND: There has been a heightened emphasis on prioritizing data to inform evidence-based HIV responses, including data focused on both defining the content and scale of HIV programs in response to evidence-based need. Consequently, population size estimation (PSE) studies for key populations have become increasingly common to define the necessary scale of specific programs for key populations. This study aims to assess the research utilization of these size estimates in informing HIV policy and program documents across the African continent. METHODS: This study included two phases; Phase 1 was a review of all PSE for key populations, including men who have sex with men (MSM), female sex workers (FSW), people who use drugs (PWUD), and transgender persons in the 54 countries across Africa published from January 2009-December 2017. Phase 2 was a review of 23 different types of documents released between January 2009 -January 2019, with a focus on the US President's Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis and Malaria investments, for evidence of stakeholder engagement in PSE studies, as well as key population PSE research utilization to inform HIV programming and international HIV investments. RESULTS: Of 118 size estimates identified in 39 studies, less than 15% were utilized in PEPFAR Country Operational Plans or national strategic health plan documents, and less than 2% in Global Fund Concept Notes. Of 39 PSE studies, over 50% engaged stakeholders in study implementation and identified target population stakeholders, a third of studies identified policy or program stakeholders, and 15% involved stakeholders in study design. CONCLUSION: The past decade has seen an increase in PSE studies conducted for key populations in more generalized HIV epidemic settings which involve significant investments of finances and human resources. However, there remains limited evidence of sustained uptake of these data to guide the HIV responses. Increasing uptake necessitates effective stakeholder engagement and data-oriented capacity building to optimize research utilization and facilitate data-driven and human rights-affirming HIV responses.


Asunto(s)
Demografía/estadística & datos numéricos , Medicina Basada en la Evidencia , Infecciones por VIH/epidemiología , Regionalización , África , Consumidores de Drogas/estadística & datos numéricos , Femenino , Infecciones por VIH/terapia , Implementación de Plan de Salud , Humanos , Masculino , Trabajadores Sexuales/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Participación de los Interesados
13.
BMC Health Serv Res ; 20(1): 26, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31915003

RESUMEN

BACKGROUND: Iran's Parliament passed a Law in 2010 to merge the existing health insurance schemes to boost risk pooling. Merging can be challenging as there are differences among health insurance schemes in various aspects. This qualitative prospective policy analysis aims to reveal key challenges and implementation barriers of the policy as introduced in Iran. METHODS: A qualitative study of key informants and documentary review was conducted. Sixty-seven semi-structured face-to-face interviews were conducted, with key informants from relevant stakeholders. Purposive and snowball sampling techniques were used for selecting the interviewees. The related policy documents were also reviewed and analyzed to supplement interviews. Data analysis was conducted through an existing health financing World Bank framework. RESULTS: This study demonstrated that for combining health insurance funds, operational challenges in the following areas should be taken into account: financing mechanisms, population coverage, benefits package, provider engagement, organizational structure, health service delivery and operational processes. It is also important to have adequate cogent reasons to "the justification of the consolidation process" in the given context. When moving towards combining health insurance funds, especially in countries with a purchaser-provider split, it is critical for policy makers to make sure that the health insurance system is aligned with the policies and Stewardship of the broader health care system. CONCLUSIONS: Implementation of major reforms in a health system with fragmented insurance schemes with different target populations, prepayment structures, benefit packages and history of development is inherently difficult, especially when different stakeholders have vetoing powers over the proposed reforms. Solving the differences and operational challenges in the main areas of health insurance system generated in this study may provide a platform for the designing and implementing merging process of social health insurance schemes in Iran and other countries with similar situations.


Asunto(s)
Administración Financiera/organización & administración , Política de Salud/legislación & jurisprudencia , Seguro de Salud/economía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Seguro de Salud/organización & administración , Irán , Masculino , Persona de Mediana Edad , Formulación de Políticas , Estudios Prospectivos , Investigación Cualitativa , Seguridad Social/organización & administración , Participación de los Interesados/psicología
14.
PLoS One ; 15(1): e0226808, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31914122

RESUMEN

BACKGROUND: In 1999, Ghana introduced the Community-Based Health Planning and Services (CHPS) as the key primary health care strategy. In this study, we explored the challenges, capacity development priorities, and stakeholder perspectives on improving the CHPS concept as it has been fraught with a myriad of challenges since its inception. Our study is the outcome of the national programme for strengthening the implementation of CHPS Initiative in Ghana (CHPS+) introduced in 2017. METHODS: This exploratory research was a qualitative study conducted in two Systems Learning Districts (SLDs) of CHPS+ in the Volta Region of Ghana from March to May, 2018. Four focus group discussions and two general discussions were conducted among 60 CHPS+ stakeholders made up of health workers and community members. Data analyses were conducted using conceptual content analysis. Statements of the participants were presented as quotes to substantiate the views expressed. RESULTS: Negative attitude, high attrition, inadequacy and unavailability of health professionals at post when needed were challenges associated with the health professionals. Late referrals, lack of proper community entry and engagement, non-availability of essential logistics, distance of CHPS compounds from communities, and inadequate funding were challenges associated with the health system. Lack of community ownership of the CHPS programme, lack of security at CHPS compounds, and late reporting of cases by the community members were also realised as challenges emanating from the community members. Priority areas for capacity development of health workers identified included logistics management, community entry and engagement, emergency delivery, managing referrals at the CHPS level, and resuscitation of newborns. CONCLUSION: Health-worker, community, and health systems-based challenges inhibit the implementation of CHPS in Ghana. Capacity development of health professionals and continuous community engagement are avenues that can improve implementation of the programme.


Asunto(s)
Planificación en Salud Comunitaria/organización & administración , Servicios de Salud Comunitaria/organización & administración , Personal de Salud/normas , Implementación de Plan de Salud , Planificación en Salud/métodos , Atención Primaria de Salud/normas , Participación de los Interesados , Adulto , Femenino , Grupos Focales , Ghana , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Adulto Joven
15.
PLoS One ; 15(1): e0225907, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31923259

RESUMEN

BACKGROUND: Cauda Equina Syndrome (CES) is an emergency condition that requires acute intervention and can lead to permanent neurological deficit in working age adults. A Core Outcome Set (COS) is the minimum set of outcomes that should be reported by a research study within a specific disease area. There is significant heterogeneity in outcome reporting for CES, which does not allow data synthesis between studies. The hypothesis is that a COS for CES can be developed for future research studies using patients and healthcare professionals (HCPs) as key stakeholders. METHODS AND FINDINGS: Qualitative semi-structured interviews with CES patients were audio-recorded, transcribed and analysed using NVivo to identify the outcomes of importance. These were combined with the outcomes obtained from a published systematic literature review of CES patients. The outcomes were grouped into a list of 37, for rating through two rounds of an international Delphi survey according to pre-set criteria. The Delphi survey had an overall response rate of 63% and included 172 participants (104 patients, 68 HCPs) from 14 countries who completed both rounds. Thirteen outcomes reached consensus at the end of the Delphi survey and there was no attrition bias detected. The results were discussed at an international consensus meeting attended by 34 key stakeholders (16 patients and 18 HCPs) from 8 countries. A further three outcomes were agreed to be included. There was no selection bias detected at the consensus meeting. There are 16 outcomes in total in the CESCOS. DISCUSSION: This is the first study in the literature that has determined the core outcomes in CES using a transparent international consensus process involving healthcare professionals and CES patients as key stakeholders. This COS is recommended as the most important outcomes to be reported in any research study investigating CES outcomes and will allow evidence synthesis in CES.


Asunto(s)
Síndrome de Cauda Equina/patología , Personal de Salud/psicología , Pacientes/psicología , Adolescente , Adulto , Anciano , Síndrome de Cauda Equina/terapia , Consenso , Técnica Delfos , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Calidad de Vida , Sistema de Registros , Participación de los Interesados , Vejiga Urinaria/fisiopatología , Adulto Joven
19.
BMC Med Ethics ; 20(1): 98, 2019 12 19.
Artículo en Inglés | MEDLINE | ID: mdl-31856798

RESUMEN

BACKGROUND: Advances in artificial intelligence (AI), robotics and wearable computing are creating novel technological opportunities for mitigating the global burden of population ageing and improving the quality of care for older adults with dementia and/or age-related disability. Intelligent assistive technology (IAT) is the umbrella term defining this ever-evolving spectrum of intelligent applications for the older and disabled population. However, the implementation of IATs has been observed to be sub-optimal due to a number of barriers in the translation of novel applications from the designing labs to the bedside. Furthermore, since these technologies are designed to be used by vulnerable individuals with age- and multi-morbidity-related frailty and cognitive disability, they are perceived to raise important ethical challenges, especially when they involve machine intelligence, collect sensitive data or operate in close proximity to the human body. Thus, the goal of this paper is to explore and assess the ethical issues that professional stakeholders perceive in the development and use of IATs in elderly and dementia care. METHODS: We conducted a multi-site study involving semi-structured qualitative interviews with researchers and health professionals. We analyzed the interview data using a descriptive thematic analysis to inductively explore relevant ethical challenges. RESULTS: Our findings indicate that professional stakeholders find issues of patient autonomy and informed consent, quality of data management, distributive justice and human contact as ethical priorities. Divergences emerged in relation to how these ethical issues are interpreted, how conflicts between different ethical principles are resolved and what solutions should be implemented to overcome current challenges. CONCLUSIONS: Our findings indicate a general agreement among professional stakeholders on the ethical promises and challenges raised by the use of IATs among older and disabled users. Yet, notable divergences persist regarding how these ethical challenges can be overcome and what strategies should be implemented for the safe and effective implementation of IATs. These findings provide technology developers with useful information about unmet ethical needs. Study results may guide policy makers with firsthand information from relevant stakeholders about possible solutions for ethically-aligned technology governance.


Asunto(s)
Inteligencia Artificial/ética , Dispositivos de Autoayuda/ética , Demencia , Europa (Continente) , Femenino , Personal de Salud/psicología , Humanos , Entrevistas como Asunto , Masculino , Investigación Cualitativa , Investigadores/psicología , Robótica/ética , Participación de los Interesados
20.
BMC Med Ethics ; 20(1): 99, 2019 12 21.
Artículo en Inglés | MEDLINE | ID: mdl-31864351

RESUMEN

BACKGROUND: One important ethical issue in randomised controlled trials (RCTs) is randomisation. Relatively little is known about how participating individuals and communities understand and perceive central aspects of randomisation such as equality, fairness, transparency and accountability in community-based trials. The aim of this study was to understand and explore study communities' perspectives of the randomisation process in a cluster RCT in rural Zambia studying the effectiveness of different support packages for adolescent girls on early childbearing. METHODS: In this explorative study, in-depth semi-structured interviews were carried out in 2018 with 14 individuals who took part in the randomisation process of the Research Initiative to Support the Empowerment of Girls (RISE) project in 2016 and two traditional leaders. Two of the districts where the trial is implemented were purposively selected. Interviews were audio recorded and fully transcribed. Data were analysed by coding and describing emergent themes. RESULTS: The understanding of the randomisation process varied. Some respondents understood that randomisation was conducted for research purposes, but most of them did not. They had trouble distinguishing research and aid. Generally, respondents perceived the randomisation process as transparent and fair. However, people thought that there should not have been a "lottery" because they wanted all schools to receive equal or balanced benefits of the interventions. CONCLUSIONS: Randomisation was misunderstood by most respondents. Perceived procedural fairness was easier to realize than substantive fairness. Researchers working on Cluster Randomised Controlled Trials (CRCTs) should consider carefully how to explain randomisation.


Asunto(s)
Comprensión , Ensayos Clínicos Controlados Aleatorios como Asunto/ética , Participación de los Interesados/psicología , Adulto , Análisis por Conglomerados , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Zambia
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