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1.
Arch Argent Pediatr ; 121(1): e202202595, 2023 02 01.
Artículo en Inglés, Español | MEDLINE | ID: mdl-35984671

RESUMEN

Introduction. In Argentina, health care workers have been the first ones to receive the COVID-19 vaccine, but there are still few data on the production of anti-S IgG antibodies. Objectives. To assess specific IgG against the SARS-CoV-2 spike protein (anti-S IgG) after the vaccination of health care workers from a children's hospital. To explore the association between the presence of these antibodies, age, and history of prior infection. Population and methods. Cross-sectional study in 193 workers who received both doses of the two- component Sputnik V vaccine. The anti-S IgG antibody titer was measured and age, history of prior SARS-CoV-2 infection, and date of vaccination were recorded. Results. Anti-S IgG antibodies were produced in 98.6% of the subjects. The titer was higher in those with prior infection (p < 0.001), but no relationship was established with subjects' age. Conclusion. We provide data on post-vaccination production of IgG anti-S antibodies among health care workers from a children's hospital and explore some predictors.


Introducción. En Argentina, el personal de salud ha sido el primero en vacunarse contra COVID-19, pero todavía existen pocos datos sobre la producción de anticuerpos IgG anti-S. Objetivos. Evaluar IgG específica contra glicoproteína spike del SARS-CoV-2 (IgG anti-S) posvacunación en personal de un hospital pediátrico. Explorar la asociación entre presencia de dichos anticuerpos, edad y antecedente de infección previa. Población y métodos. Estudio transversal que incluyó 193 trabajadores vacunados con los dos componentes de la vacuna Sputnik V. Se pesquisó el título de IgG anti-S y se registraron edad, antecedente de infección previa por SARS-CoV-2 y fecha de la vacunación. Resultados. El 98,6 % de los sujetos generó IgG anti-S. El título fue mayor en quienes habían cursado infección previamente (p <0,001), pero no hubo relación con la edad de los sujetos. Conclusión. Aportamos datos de generación de anticuerpos IgG anti-S posvacunación en personal de salud de un hospital pediátrico y exploramos algunos predictores.


Asunto(s)
COVID-19 , Personal de Salud , SARS-CoV-2 , Anticuerpos Antivirales , COVID-19/inmunología , Vacunas contra la COVID-19 , Estudios Transversales , Hospitales Pediátricos , Humanos , Inmunoglobulina G , SARS-CoV-2/inmunología , Glicoproteína de la Espiga del Coronavirus
2.
Rural Remote Health ; 22(1): 7050, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-35119906

RESUMEN

INTRODUCTION: Past studies examined factors associated with rural practice, but none employed newer machine learning (ML) methods to explore potential predictors. The primary aim of this study was to identify factors related to practice in a rural area. Secondary aims were to capture a more precise understanding of the demographic characteristics of the healthcare professions workforce in Utah (USA) and to assess the viability of ML as a predictive tool. METHODS: This study incorporated four datasets - the 2017 dental workforce, the 2016 physician workforce, the 2014 nursing workforce and the 2017 pharmacy workforce - collected by the Utah Medical Education Council. Supervised ML techniques were used to identify factors associated with practice location, the outcome variable of interest. RESULTS: The study sample consisted of 11 259 healthcare professionals with an average age of 46.6 years, of which 36.6% were males and 94.5% Caucasian. Four ML methods were applied to assess model performance by comparing accuracy, sensitivity, specificity and area under the receiver operating characteristic (ROC) curve. Of the methods used, support vector machine performed the best (accuracy 99.7%, precision 100%, sensitivity 100%, specificity 99.4% and ROC 0.997). The models identified income and rural upbringing as the top factors associated with rural practice. CONCLUSION: By far, income emerged as the most important factor associated with rural practice, suggesting that attractive income offers might help rural communities address health professional shortages. Rural upbringing was the next most important predictive factor, validating and updating earlier research. The performance of the ML algorithms suggests their usefulness as a tool to model other databases for individualized prediction.


Asunto(s)
Servicios de Salud Rural , Atención a la Salud , Personal de Salud , Humanos , Aprendizaje Automático , Masculino , Persona de Mediana Edad , Ubicación de la Práctica Profesional , Recursos Humanos
3.
Medicine (Baltimore) ; 101(39): e30662, 2022 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-36181075

RESUMEN

Provider network structure has been linked to hospital cost, utilization, and to a lesser degree quality, outcomes; however, it remains unknown whether these relationships are heterogeneous across different acute care hospital characteristics and US states. The objective of this study is to evaluate whether there are heterogeneous relationships between hospital provider network structure and hospital outcomes (cost efficiency and quality); and to assess the sources of measured heterogeneous effects. We use recent causal random forest techniques to estimate (hospital specific) heterogeneous treatment effects between hospitals' provider network structures and their performance (across cost efficiency and quality). Using Medicare cost report, hospital quality and provider patient sharing data, we study a population of 3061 acute care hospitals in 2016. Our results show that provider networks are significantly associated with costs efficiency (P < .001 for 7/8 network measures), patient rating of their care (P < .1 in 5/8 network measures), heart failure readmissions (P < .01 for 3/8 network measures), and mortality rates (P < .02 in 5/8 cases). We find that fragmented provider structures are associated with higher costs efficiency and patient satisfaction, but also with higher heart failure readmission and mortality rates. These effects are further found to vary systematically with hospital characteristics such as capacity, case mix, ownership, and teaching status. This study used an observational design. In summary, we find that hospital treatment responses to different network structures vary systematically with hospital characteristics..


Asunto(s)
Insuficiencia Cardíaca , Costos de Hospital , Anciano , Personal de Salud , Insuficiencia Cardíaca/terapia , Humanos , Medicare , Readmisión del Paciente , Calidad de la Atención de Salud , Estados Unidos
4.
BMC Health Serv Res ; 22(1): 1225, 2022 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-36183082

RESUMEN

INTRODUCTION: Healthcare workers' adoption of mHealth is critical to the success or failure of clinician based mHealth services in the developing world. mHealth adoption is affected or promoted by certain factors, some of which are peculiar to the developing world. Identifying these factors and evaluating them will help develop a valid and reliable measuring instrument for more successful prediction of mHealth adoption in the future. The aim of this study was to design and develop such an instrument. METHOD: A Healthcare workers' mHealth Adoption Questionnaire (HmAQ) was developed based on five constructs identified through a prior literature review: multi-sectorial engagement and ownership; staffing and technical support; reliable infrastructure; usefulness and stewardship; and intention to adopt. After testing face and content validity, the questionnaire was administered to 104 nurses and midwives in the Ewutu-Senya district of the Central Region of Ghana who used a maternal mHealth intervention. After data collection confirmatory factor analysis and structural equation modelling were applied and the Healthcare Worker mHealth Adoption Impact Model (HmAIM) developed. RESULTS: Exploratory factor analysis showed the eigenvalue of all five components to be significant (cumulative total greater than 1.0). Bartlett's Test of Sphericity was significant, the Kaiser-Meyer-Olkin value was 0.777, and the mean Cronbach's α value was 0.82 (range 0.81-0.83). Confirmatory factor analysis showed that constructs for the HmAQ were within acceptable limits and valid. Structural equation modelling showed the causal relationships between components. This resulted in development of the HmAIM. A modified model was then developed using the averages of individual construct items. This model showed strong correlation among the constructs. Further research will be required to understand new dimensions of mHealth adoption as a result of emerging technology needs, new complexities in the healthcare work environment, and how different cadres of healthcare workers respond to it. CONCLUSION: The study presents a valid and reliable instrument, the HmAIM, to serve as a tool for assessment of healthcare workers' mHealth adoption in the developing world. Use of the instrument will enhance the likelihood of successful adoption of mHealth implementations.


Asunto(s)
Telemedicina , Atención a la Salud , Análisis Factorial , Personal de Salud , Humanos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
5.
Front Public Health ; 10: 881903, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36187624

RESUMEN

Background: The coronavirus disease 2019 (COVID-19) pandemic has posed increasing challenges to global health systems. Vaccination against COVID-19 can effectively prevent the public, particularly healthcare workers (HCWs), from being infected by this disease. Objectives: We aim to understand the factors influencing HCWs' acceptance of COVID-19 vaccines. Methods: We searched PubMed, Embase and Web of Science to collect literature published before May 15, 2022, about HCWs' acceptance of COVID-19 vaccines. The Newcastle-Ottawa quality assessment scale was used to assess the risk of bias and the quality of the included studies. We utilized Stata 14.0 software for this meta-analysis with a random-effects model, and odds ratios (ORs) with 95% confidence intervals (CIs) were reported. This meta-analysis was conducted in alignment with the preferred reporting items for systematic review and meta-analysis (PRISMA) guideline. Results: Our meta-analysis included 71 articles with 93,508 HCWs involved. The research showed that the acceptance of vaccines had significantly increased among HCWs compared to non-HCWs (OR = 1.91, 95% CI: 1.16-3.12). A willingness to undergo COVID-19 vaccination was observed in 66% (95% CI: 0.61-0.67) of HCWs. Among the HCWs involved, doctors showed a generally increased intention to be vaccinated compared with nurses (OR = 2.22, 95% CI: 1.71-2.89). Additionally, males were found to hold more positive attitudes toward vaccination than females (OR = 1.81, 95% CI: 1.55-2.12). When the effectiveness of COVID-19 vaccines was improved, the vaccination acceptance of HCWs was greatly increased accordingly (OR = 5.03, 95% CI: 2.77-9.11). The HCWs who were willing to vaccinate against seasonal influenza showed an increased acceptance of COVID-19 vaccines (OR = 3.52, 95% CI: 2.34-5.28). Our study also showed that HCWs who were willing to be vaccinated against COVID-19 experienced a reduced rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (OR = 0.78, 95% CI: 0.66-0.92). Conclusions: Our analysis revealed that the five factors of occupation, gender, vaccine effectiveness, seasonal influenza vaccines, and SARS-CoV-2 infection presumably affected the acceptance of COVID-19 vaccines among HCWs. It is essential to boost the confidence of HCWs in COVID-19 vaccines for the containment of the epidemic.


Asunto(s)
COVID-19 , Vacunas contra la Influenza , COVID-19/prevención & control , Vacunas contra la COVID-19 , Femenino , Personal de Salud , Humanos , Masculino , Pandemias/prevención & control , SARS-CoV-2
6.
Front Public Health ; 10: 988063, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36187704

RESUMEN

Healthcare workers (HCWs) are at an increased risk of COVID-19 infection because of their direct exposure to suspected and confirmed coronavirus patients in healthcare facilities. This condition is even more acute in low-and lower-middle-income countries (LMICs). Given the poor healthcare settings of Bangladesh, it is challenging to halt the spread of infection without proper knowledge, attitudes, and good behavioral practices (KAPs). Therefore, this study conducted a cross-sectional study from May 5 to 31, 2020, with 203 healthcare professionals to determine the knowledge, attitudes, and practices (KAP) toward COVID-19. Participants were doctors, nurses, dentists, and allied health professionals. A self-administered questionnaire including several KAP-related items aligned with the World Health Organization (WHO) guidelines was distributed over various online platforms to collect data. Bivariate and multivariable logistic regression analyses were conducted to determine the factors influencing KAP levels. The majority of participants were male (52.22%). The prevalence of high knowledge levels, positive attitudes, and good practices were 51.23, 45.81, and 49.75%, respectively. Social media was the most common source for seeking coronavirus information. Workers at private institutions were less likely (OR = 0.56, 95% CI = 0.30-0.95, p < 0.05) to be knowledgeable than workers at public institutions. Doctors had more positive attitudes than other healthcare professionals. Older participants showed high rates of good behavioral practices (OR = 1.05, 95% CI = 1.06-1.32, p < 0.05) than younger ones. Workers at private institutions had a better practice level toward COVID-19 (OR = 2.11, 95% CI = 1.17-3.83) than those at public institutions. These results point to the necessity for proper training programs for medical professionals that help them gain confidence to deliver the correct treatment to their patients and the need to implement preventative steps during pandemics.


Asunto(s)
COVID-19 , Bangladesh/epidemiología , COVID-19/epidemiología , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Humanos , Masculino , SARS-CoV-2
7.
Int J Public Health ; 67: 1604767, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36188750

RESUMEN

Objectives: This study was conducted to explore healthcare workers' knowledge of female genital schistosomiasis (FGS) and describe proposed interventions to raise awareness about FGS and strengthen healthcare facilities' capacity to manage FGS cases. Methods: We conducted four cross-sectional focus group discussions and 16 key informant interviews with purposively selected healthcare workers in Zanzibar. Discussions and interviews were digitally recorded, transcribed, and analyzed using NVivo software. Results: Most participants had limited or no knowledge of FGS and lacked skills for managing it. They confused FGS with urogenital schistosomiasis and thought it was sexually transmitted. A few participants knew about FGS and associated it with Human Immunodeficiency Virus (HIV), ectopic pregnancy, cervical cancer, and infertility. To prevent and control FGS, participants proposed interventions targeting communities (including community-based health education) and the healthcare system (including training healthcare workers on FGS). Conclusion: Healthcare workers lacked knowledge of and skills for managing FGS. Besides, healthcare facilities had no diagnostic capacity to manage FGS. Along with on-going interventions to break S. haematobium transmission and eventually eliminate urogenital schistosomiasis in Zanzibar, we recommend training healthcare workers on FGS and equip healthcare facilities with medical equipment and supplies for managing FGS.


Asunto(s)
Esquistosomiasis Urinaria , Estudios Transversales , Femenino , Genitales Femeninos , Personal de Salud , Humanos , Embarazo , Esquistosomiasis Urinaria/diagnóstico , Esquistosomiasis Urinaria/prevención & control , Tanzanía
8.
Dermatol Ther ; 35(10): e15753, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-36190007

RESUMEN

The medical face mask, widely used by health care providers (HCPs) during the COVID-19 pandemic, is reported to be associated with adverse reactions, among which acne is one of the most common. This study aims to evaluate treatment strategies employed by HCPs affected by acne in association with prolonged medical face mask use, their openness towards accessing telemedicine as a patient, and other lifestyle factors with potential influence on the evolution of their acne. Our online-based cross-sectional survey was distributed between December 17, 2020, and February 17, 2021, and targeted HCPs from different medical centers in Romania. From the n = 134 respondents, 50% reported current acne lesions and 56.7% required treatment. Of the latter, 65.8% self-medicated and 34.2% sought medical advice. The most common treatment associations between anti-acne topical products were: retinoids and salicylic acid (18.18%; n = 8), retinoids and benzoyl peroxide (13.64%; n = 6), salicylic acid and benzoyl peroxide (13.64%; n = 6), and azelaic acid together with salicylic acid (9.09%; n = 4). The health care provider responders were reluctant to use telemedicine, as only 14.2% participants were open to telemedicine. Our results suggest inadequate management of acne in HCPs using medical face masks. As with other occupational hazards and proper usage of personal protective equipment, HCPs should receive adequate screening, training, and treatment for this condition.


Asunto(s)
Acné Vulgar , COVID-19 , Fármacos Dermatológicos , Acné Vulgar/inducido químicamente , Acné Vulgar/epidemiología , Acné Vulgar/terapia , Antibacterianos , Peróxido de Benzoílo , COVID-19/epidemiología , Estudios Transversales , Personal de Salud , Humanos , Pandemias , Retinoides , Ácido Salicílico/uso terapéutico
9.
Front Public Health ; 10: 877624, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36106160

RESUMEN

Background: Health Care Workers (HCWs) are at higher risk of COVID-19 infection with their efforts while protecting the greater community and also exposed to hazards, such as psychological distress, fatigue, and stigma. This study aimed to explore the perception of frontline HCWs on barriers of managing COVID-19 in Fiji. Methods: A qualitative study method was approached to conduct this study among the HCWs who worked on the frontline during the COVID-19 pandemic based at ten purposively selected health facilities in the Suva subdivision in the Central Division of Fiji. The Colonial War Memorial Hospital (CWMH), the Fiji Centre for Communicable Diseases (Fiji CDC), Twomey hospital laboratory, and CWMH laboratory did the main control and most of the operations of other divisions were monitored from these settings. A semi-structured open-ended questionnaire was used to collect data using in-depth interviews. The participants' responses were audio-recorded and were later transcribed and analyzed using thematic analysis. Results: A total of twenty-nine HCWs took part in the in-depth interview and the responses were grouped into four themes, which include: workload, poor communication, lack of resources, and hindrance to education. It was also found through this study that some of the HCWs felt tired, frustrated, got rude to patients, and found it difficult to handle situations, which affected them mentally and physically stressed. Conclusion: Managing the COVID-19 cases has been attributed to the presence of many barriers, such as workload, tiredness, frustration, and sometimes difficult-to-handle situations, and the HCWs were indeed affected mentally and physically. Regular training for HCWs and more awareness programs would help the general public to follow the preventive measures, which reduces the cases and would help the HCWs manage COVID-19 well.


Asunto(s)
COVID-19 , Fiji , Personal de Salud , Humanos , Pandemias , Percepción
10.
JCO Glob Oncol ; 8: e2200151, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36103639

RESUMEN

PURPOSE: This study sought to (1) evaluate the perceived effectiveness of an early childhood cancer warning signs and symptoms (EWSS) training intervention on health care worker (HCW) knowledge, attitudes, and clinical practice; (2) evaluate the ease of implementation of training received, including potential barriers and facilitators; and (3) provide insights into program improvements for future iterations of the intervention. METHOD: Using a qualitative descriptive study design, we conducted in-depth, semistructured interviews with 23 purposively sampled Ghanaian HCW recipients of the EWSS training intervention. We undertook iterative thematic analysis of data concurrently with interviews and used a modified version of the theoretical framework of acceptability to guide the evaluation of the training intervention. RESULTS: We identified six themes-affective attitude, burden, intervention coherence, perceived effectiveness, self-efficacy, and quality improvement-that structure participant perceptions of the effectiveness of the EWSS training. Participants generally had a positive attitude to the training intervention, found the content relatively easy to understand, and communicated the positive impacts of the training on their day-to-day practice. However, they also identified patient- and system-level challenges to the real-world implementation of intervention components, including patients' cultural and religious beliefs about illnesses, patients' financial constraints, and inadequately funded health systems. CONCLUSION: Our findings suggest that although an HCW-focused training intervention has the potential to improve timely diagnosis and referral for childhood cancers in Ghana and comparable health system contexts, complementary interventions to address patient- and system-level implementation challenges are required to translate improvements in HCW knowledge to sustained impact on health outcomes for children with cancer.


Asunto(s)
Neoplasias , Niño , Diagnóstico Precoz , Ghana , Personal de Salud , Humanos , Neoplasias/diagnóstico , Neoplasias/terapia , Derivación y Consulta
11.
Harv Rev Psychiatry ; 30(5): 283-302, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36103683

RESUMEN

LEARNING OBJECTIVES: After completing this activity, practitioners will be better able to:• Discuss and better understand the recently adopted screening standards for adolescents with depression and the potential advantages of using "lifestyle medicine"• Set up a process for providing effective interventions for the increased number of patients with adolescent depression• Design or update their toolbox of treatment options for adolescents with depression based on the new literature and increased demand. ABSTRACT: Recently adopted quality standards recommend that pediatricians screen adolescents for depression and that they document follow-up plans for those who screen positive. As a result of these new recommendations, pediatricians and other pediatric providers, as well as psychiatrists and other mental health professionals, may face an increasing number of referrals and a growing need for effective interventions for adolescent depression. Given the widely acknowledged scarcity of traditional mental health resources, the current study reviewed the rapidly expanding array of evidence-based, but nontraditional, interventions applicable to outpatient pediatric and mental health care settings. Many of these interventions come from a lifestyle medicine framework. Lifestyle medicine interventions are congruent with the cultures of pediatrics and outpatient psychiatry, and offer additional evidence-based tools for providers managing adolescent depression. These interventions can be implemented individually or within group or community settings, and may be used in conjunction with more common interventions such as psychotherapy or psychotropic medications.


Asunto(s)
Depresión , Psiquiatría , Adolescente , Niño , Depresión/terapia , Personal de Salud , Humanos , Estilo de Vida
12.
Database (Oxford) ; 20222022 09 02.
Artículo en Inglés | MEDLINE | ID: mdl-36050787

RESUMEN

Monitoring drug safety is a central concern throughout the drug life cycle. Information about toxicity and adverse events is generated at every stage of this life cycle, and stakeholders have a strong interest in applying text mining and artificial intelligence (AI) methods to manage the ever-increasing volume of this information. Recognizing the importance of these applications and the role of challenge evaluations to drive progress in text mining, the organizers of BioCreative VII (Critical Assessment of Information Extraction in Biology) convened a panel of experts to explore 'Challenges in Mining Drug Adverse Reactions'. This article is an outgrowth of the panel; each panelist has highlighted specific text mining application(s), based on their research and their experiences in organizing text mining challenge evaluations. While these highlighted applications only sample the complexity of this problem space, they reveal both opportunities and challenges for text mining to aid in the complex process of drug discovery, testing, marketing and post-market surveillance. Stakeholders are eager to embrace natural language processing and AI tools to help in this process, provided that these tools can be demonstrated to add value to stakeholder workflows. This creates an opportunity for the BioCreative community to work in partnership with regulatory agencies, pharma and the text mining community to identify next steps for future challenge evaluations.


Asunto(s)
Inteligencia Artificial , Biología Computacional , Biología Computacional/métodos , Minería de Datos/métodos , Personal de Salud , Humanos , Procesamiento de Lenguaje Natural
13.
JBI Evid Synth ; 20(9): 2312-2318, 2022 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-36065911

RESUMEN

OBJECTIVE: This qualitative systematic review will identify, appraise, and synthesize existing qualitative evidence regarding the experiences of pregnant people during a natural disaster to gain a deeper understanding of the complex factors influencing their experiences. INTRODUCTION: During natural disasters, pregnant people would benefit from health workers, including nurses, midwives, and other professionals, considering their needs and providing support to address complex factors, including family relationships, social support, and stress; however, little is known about the experiences of pregnant people during a natural disaster. This study is the first qualitative systematic review of the experiences of pregnant people during a disaster. INCLUSION CRITERIA: This review will include studies that focus on pregnant people's experiences of living in a disaster area during a natural disaster. It will include both published and unpublished qualitative studies, with data collected through interviews and observations, in either English or Japanese. METHODS: The databases and other sources to be searched include MEDLINE, CINAHL, and PsycINFO (in English); and CiNii and Ichushi-Web (in Japanese). Further, we will cross-check the reference lists of included studies with search outcomes to identify any additional studies suitable for analysis. The search for gray literature will be conducted using Google Scholar and ProQuest. We will use the recommended JBI approach for study selection, critical appraisal, data extraction, and data synthesis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021265326.


Asunto(s)
Partería , Desastres Naturales , Femenino , Personal de Salud , Humanos , Embarazo , Investigación Cualitativa , Apoyo Social , Revisiones Sistemáticas como Asunto
14.
Korean J Med Educ ; 34(3): 191-200, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36070989

RESUMEN

PURPOSE: Due to the shortage in the healthcare workforce, insufficient qualifications, a lack of infrastructure and limited resources in Mongolia, it is not always possible for healthcare workers in rural areas who wish to attend continuous training and retraining courses to do so. However, in order to provide high-quality care, the demand for distance learning and the upgrading of knowledge and practice of many medical topics (especially related to morbidity and mortality) are necessary for the rural population. This study aimed to assess the needs of e-learning medical education, of graduates in Mongolia. METHODS: A cross-sectional research design was implemented. We collected data from 1,221 healthcare professionals (nursing professionals, physicians, midwives, and feldshers) who were randomly selected from 69 government hospitals in Mongolia. Data were collected using self-assessment questionnaires which captured the needs assessment in a survey for online continuous medical education in Mongolia. Data were analyzed using descriptive statistics and Kruskal-Wallis statistical test. RESULTS: Ninety percent of the respondents reported that they plan on attending online continuous medical education with the most preferred specialty area being emergency medicine. Results using the Kruskal-Wallis statistical technique suggested the preferred specialty area, educational content, appropriate time schedule, available devices, and tools were statistically significant and were different between the nursing professionals, physicians, midwives, and feldshers (p<0.05). CONCLUSION: Findings provide important evidence for the implementation of measures and strategies which can assist healthcare professionals in low and middle-income areas/countries to constructively address their need for enhanced knowledge and practice through distance learning.


Asunto(s)
Educación Médica Continua , Personal de Salud , Estudios Transversales , Humanos , Mongolia , Evaluación de Necesidades
15.
BMC Med Educ ; 22(1): 670, 2022 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-36088369

RESUMEN

BACKGROUND: Cultural safety training is not yet standard in Colombian medical education. If incorporated, it could address currently adversarial interactions between health professionals and the 40% of people who use traditional medicine practices. In 2019, a randomised controlled trial tested the impact of cultural safety training for medical students using participatory serious game design. The quantitative evaluation showed improved cultural safety intentions of Colombian medical trainees. We report here a qualitative evaluation of the most significant change perceived by trial participants. METHODS: This qualitative descriptive study used the most significant change technique. We invited the trial participants engaged in clinical settings to describe stories of change in their supervised clinical practice that they attributed to the intervention. Using a deductive thematic analysis based on a modified theory of planned behaviour, two independent reviewers coded the stories and, by consensus, created themes and sub-themes. RESULTS: From 27 stories of change, we identified seven themes and 15 subthemes: (a) Conscious knowledge: benefits of cultural safety training, consequences of culturally unsafe behaviour, cultural diversity and cultural practices; (b) Attitudes: respect and appreciation for cultural diversity, openness, and self-awareness; (c) Subjective norms: positive perception of cultural practices and less ethnocentrism; (d) Intention to Change; (e) Agency to accept cultural diversity and to prevent culturally unsafe actions; (f) Discussion; and (g) Action: better communication and relationship with patients and peers, improved outcomes for patients, physicians, and society, investigation about cultural health practices, and efforts to integrate modern medicine and cultural health practices. CONCLUSION: The narratives illustrated the transformative impact of cultural safety training on a results chain from conscious knowledge through to action. Our results encourage medical educators to report other cultural safety training experiences, ideally using patient-related outcomes or direct observation of medical trainees in clinical practice. TRIAL REGISTRATION: Registered on ISRCTN registry on 18/07/2019. REGISTRATION NUMBER: ISRCTN14261595.


Asunto(s)
Aprendizaje , Estudiantes de Medicina , Colombia , Diversidad Cultural , Personal de Salud , Humanos
16.
J Int AIDS Soc ; 25(9): e26003, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36094142

RESUMEN

INTRODUCTION: CUSTOMIZE evaluated the implementation of long-acting (LA) cabotegravir + rilpivirine, a novel healthcare provider-administered injectable antiretroviral therapy regimen, in diverse US healthcare settings. Findings from staff-study participants (SSPs) through 12 months of implementation are reported. METHODS: CUSTOMIZE was a phase IIIb, 12-month, single-arm, hybrid III implementation-effectiveness study conducted from July 2019 to October 2020 at eight US clinics of five clinic types: private practice (n = 2), federally qualified health centre (n = 2), university (n = 2), AIDS Healthcare Foundation (n = 2) and health maintenance organization (n = 1). Eligible patient participants received monthly cabotegravir + rilpivirine LA injections after a 1-month oral lead-in. At baseline, month 4 and month 12, SSPs (n = 3 each per clinic), including physicians, nurses or injectors, and administrators, completed quantitative surveys and semi-structured interviews to assess implementation outcomes (acceptability, appropriateness and feasibility of intervention measures), programme sustainability and SSP perceptions of, attitudes towards, and expectations for cabotegravir + rilpivirine LA. Month 12 data collection occurred during the COVID-19 pandemic. RESULTS: In surveys, SSPs reported high mean total scores for acceptability, appropriateness and feasibility of cabotegravir + rilpivirine LA implementation at baseline (4.43, 4.52 and 4.38 of 5, respectively) and month 12 (4.45, 4.61 and 4.46 of 5, respectively), regardless of clinic type. At month 12, SSPs were positive about the implementation sustainability (mean Program Sustainability Assessment Tool score, 5.83 out of 7). At baseline, SSPs' top concern was patients' ability to maintain monthly appointments (81%); at month 12, 39% had this concern. The proportion of SSPs reporting patient injection pain or soreness as a barrier was consistent at month 12 versus baseline (48% vs. 46%). Most (78%) SSPs reported optimal implementation of cabotegravir + rilpivirine LA in their clinics was achieved in 1-3 months. In interviews, SSP-reported strategies for successful implementation included teamwork, using a web-based treatment planner and having a designated person to track appointment scheduling. In month 12 interviews, SSP-reported structural changes needed for implementation included changing clinic hours and purchasing refrigerators. CONCLUSIONS: In CUSTOMIZE, cabotegravir + rilpivirine LA was successfully implemented across a range of US healthcare settings. Barriers were mitigated with minor process adjustments.


Asunto(s)
Fármacos Anti-VIH , COVID-19 , Infecciones por VIH , Fármacos Anti-VIH/uso terapéutico , Antirretrovirales/uso terapéutico , COVID-19/tratamiento farmacológico , Atención a la Salud , Dicetopiperazinas , Infecciones por VIH/tratamiento farmacológico , Personal de Salud , Humanos , Pandemias , Piridonas , Rilpivirina/uso terapéutico
17.
BMC Health Serv Res ; 22(1): 1153, 2022 Sep 12.
Artículo en Inglés | MEDLINE | ID: mdl-36096844

RESUMEN

BACKGROUND: The uptake of family involvement in health care services for patients with psychotic disorders is poor, despite a clear evidence base, socio-economic and moral justifications, policy, and guideline recommendations. To respond to this knowledge-practice gap, we established the cluster randomised controlled trial: Implementation of guidelines on Family Involvement for persons with Psychotic disorders in community mental health centres (IFIP). Nested in the IFIP trial, this sub-study aims to explore what organisational and clinical barriers and facilitators local implementation teams and clinicians experience when implementing family involvement in mental health care for persons with psychotic disorders. METHODS: We performed 21 semi-structured focus groups, including 75 participants in total. Implementation team members were interviewed at the initial and middle phases of the intervention period, while clinicians who were not in the implementation team were interviewed in the late phase. A purposive sampling approach was used to recruit participants with various engagement in the implementation process. Data were analysed using manifest content analysis. RESULTS: Organisational barriers to involvement included: 1) Lack of shared knowledge, perceptions, and practice 2) Lack of routines 3) Lack of resources and logistics. Clinical barriers included: 4) Patient-related factors 5) Relative-related factors 6) Provider-related factors. Organisational facilitators for involvement included: 1) Whole-ward approach 2) Appointed and dedicated roles 3) Standardisation and routines. Clinical facilitators included: 4) External implementation support 5) Understanding, skills, and self-efficacy among mental health professionals 6) Awareness and attitudes among mental health professionals. CONCLUSIONS: Implementing family involvement in health care services for persons with psychotic disorders is possible through a whole-ward and multi-level approach, ensured by organisational- and leadership commitment. Providing training in family psychoeducation to all staff, establishing routines to offer a basic level of family involvement to all patients, and ensuring that clinicians get experience with family involvement, reduce or dissolve core barriers. Having access to external implementation support appears decisive to initiate, promote and evaluate implementation. Our findings also point to future policy, practice and implementation developments to offer adequate treatment and support to all patients with severe mental illness and their families. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.


Asunto(s)
Trastornos Psicóticos , Centros Comunitarios de Salud Mental , Grupos Focales , Personal de Salud , Humanos , Trastornos Psicóticos/terapia , Investigación Cualitativa
18.
Trials ; 23(1): 770, 2022 Sep 12.
Artículo en Inglés | MEDLINE | ID: mdl-36096948

RESUMEN

BACKGROUND: According to recent legislation, facilitated advance care planning (ACP) for nursing home (NH) residents is covered by German sickness funds. However, the effects of ACP on patient-relevant outcomes have not been studied in Germany yet. This study investigates whether implementing a complex regional ACP intervention improves care consistency with care preferences in NH residents. METHODS: This is a parallel-group cluster-randomized controlled trial (cRCT) with 48 NHs (≈ 3840 resident beds) between 09/2019 and 02/2023. The intervention group will receive a complex, regional ACP intervention aiming at sustainable systems redesign at all levels (individual, institutional, regional). The intervention comprises comprehensive training of ACP facilitators, implementation of reliable ACP processes, organizational development in the NH and other relevant institutions of the regional healthcare system, and education of health professionals caring for the residents. Control group NHs will deliver care as usual. Primary outcome is the hospitalization rate during the 12-months observation period. Secondary outcomes include the rate of residents whose preferences were known and honored in potentially life-threatening events, hospital days, index treatments like resuscitation and artificial ventilation, advance directives, quality of life, psychological burden on bereaved families, and costs of care. The NHs will provide anonymous, aggregated data of all their residents on the primary outcome and several secondary outcomes (data collection 1). For residents who have given informed consent, we will evaluate care consistency with care preferences and further secondary outcomes, based on chart reviews and short interviews with residents, surrogates, and carers (data collection 2). Process evaluation will aim to explain barriers and facilitators, economic evaluation the cost implications. DISCUSSION: This study has the potential for high-quality evidence on the effects of a complex regional ACP intervention on NH residents, their families and surrogates, NH staff, and health care utilization in Germany. It is the first cRCT investigating a comprehensive regional ACP intervention that aims at improving patient-relevant clinical outcomes, addressing and educating multiple institutions and health care providers, besides qualification of ACP facilitators. Thereby, it can generate evidence on the potential of ACP to effectively promote patient-centered care in the vulnerable population of frail and often chronically ill elderly. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT04333303 . Registered 30 March 2020.


Asunto(s)
Planificación Anticipada de Atención , Casas de Salud , Anciano , Alemania , Personal de Salud , Humanos , Estudios Multicéntricos como Asunto , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto
19.
J Health Organ Manag ; 36(9): 196-211, 2022 Aug 31.
Artículo en Inglés | MEDLINE | ID: mdl-36098505

RESUMEN

PURPOSE: Like other European countries, Germany is facing regional physician shortages, which have several consequences on patient care. This study analyzes how hospitals perceive physician shortages and which strategies they adopt to address them. As a theoretical framework, the resource dependency theory is chosen. DESIGN/METHODOLOGY/APPROACH: The authors conducted 20 semi-structured expert interviews with human resource officers, human resource directors, and executive directors from hospitals in the northwest of Germany. Hospitals of different ownership types, of varying sizes and from rural and urban locations were included in the sample. The interviews were analyzed by using qualitative content analysis. FINDINGS: The interviewees reported that human resource departments in hospitals expand their recruiting activities and no longer rely on one single recruiting instrument. In addition, they try to adapt their retaining measures to physicians' needs and offer a broad range of employment benefits (e.g. childcare) to increase attractiveness. The study also reveals that interviewees from small and rural hospitals report more difficulties with attracting new staff and therefore focus on recruiting physicians from abroad. PRACTICAL IMPLICATIONS: Since the staffing situation in German hospitals will not change in the short term, the study provides suggestions for hospital managers and health policy decision-makers in dealing with physician shortages. ORIGINALITY/VALUE: This study uses the resource dependency theory to explain hospitals' strategies for dealing with healthcare staff shortages for the first time.


Asunto(s)
Médicos , Personal de Salud , Política de Salud , Hospitales , Humanos , Recursos Humanos
20.
In Vivo ; 36(5): 2505-2513, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36099132

RESUMEN

BACKGROUND/AIM: Non-medical practitioners (NMPs) are an ill-defined group of professionals offering patient diagnostic and therapeutic methods mostly in the field of complementary and alternative medicine (CAM). Despite a lack of quality-assessed structured professional formation, many patients with cancer visit NMPs for advice. This study aimed to learn more on patients' motives and expectations for consulting an NMP. PATIENTS AND METHODS: A standardized questionnaire was distributed to adult cancer patients addressing attitudes towards NMPs, motives and expectations for consulting an NMP. RESULTS: A total of 279 patients took part in the survey. Of the included patients 44.8% had already visited an NMP and 16.5% planned to do so. Reasons to visit an NMP were seeking for a supplementary treatment (72.0%) or control of side-effects (68.0%). While the oncologist ranked higher than the NMP in all aspects of physician-patient interaction and patients more often trusted in the oncologist, those patients rating their oncologist rather low in any of these questions significantly more often consulted an NMP. The methods applied or recommended by the NMPs were highly heterogenous ranging from biologically-based methods to mind-body-techniques. Most often used methods were homeopathy (72.0%) vitamin D (62.7%), selenium (42.7%), acupuncture (38.7%). CONCLUSION: There is a high proportion of cancer patients visiting NMPs mostly for additional treatment. Biologically-based treatments may induce side-effects and interactions, especially as NMPs are not trained on medically accepted cancer treatment and medications. Offering information on CAM and improving the physician-patient relationship are important means to answer unmet needs from the side of the patient.


Asunto(s)
Terapias Complementarias , Neoplasias , Adulto , Personal de Salud , Humanos , Motivación , Neoplasias/terapia , Encuestas y Cuestionarios
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