Medicina familiar y comunitaria: la especialidad más elegida en el MIR / Family and community medicine: The most chosen specialty in the MIR

Medicina Familiar y Comunitaria es la especialidad más ofertada y elegida en el MIR, sin embargo, cada año se cuestiona su atractivo debido que no se ocupan todas las plazas ofertadas y un determinado número de médicos residentes desisten de continuar en dicha especialidad una vez iniciada. En este contexto algunas de las propuestas que se plantean para abordar el problema se centran en incrementar la oferta cuando los hechos muestran que el reto está en actuar sobre la demanda haciendo más atractiva la especialidad y su ámbito de ejercicio profesional. Se procede a analizar este problema y sus condicionantes abriendo el foco del análisis a 4 elementos que pueden estar influyendo en el mismo: los aspectos vocacionales de los graduados en medicina que acuden a la especialización, las características del programa de la especialidad y de las unidades docentes en las que se lleva a cabo la formación, la presencia de la medicina de familia en la universidad como elemento clave para el conocimiento y la afección a dicha especialidad desde el grado y finalmente la situación de la atención primaria, como espacio en el que se materializa la formación y lugar prioritario de desempeño profesional de los futuros especialistas. (AU)

Family and Community Medicine is the most offered and chosen specialty in the MIR (Spanish medical residency examination), however, every year its attractiveness is questioned due to not all offered positions being filled and a certain number of resident doctors deciding not to continue in this specialty once started. In this context, some of the proposals to address the problem focus on increasing the supply when the facts show that the challenge lies in addressing the demand by making the specialty and its professional scope more attractive. The problem and its determinants are analyzed in this context by focusing on four elements that may be influencing it: the vocational aspects of medical graduates who pursue specialization, the characteristics of the specialty program and the teaching units where training is carried out, the presence of family medicine in the university as a key element for knowledge and affinity to this specialty from undergraduate studies, and finally, the situation of primary care as the space where training is materialized and the priority setting for the professional practice of future specialists. (AU)

Validity and reliability of the palliative care needs assessment tool in Japanese patients with heart failure.

AIMS: Although patients with heart failure (HF) frequently experience considerable symptom burden and require significant care, most HF patients do not receive timely intervention due to the absence of a standardized method for identifying those in need of palliative care. The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) assesses the palliative care needs of patients with HF. However, its validity and reliability have yet to be fully examined. We aimed to assess the validity and reliability of the NAT: PD-HF in Japanese patients with HF. METHODS: We prospectively enrolled 106 consecutive patients with chronic HF admitted to our university hospital between February 2023 and July 2023. Their caregivers (n = 95) and healthcare providers (n = 17) were also included. The NAT: PD-HF was translated from English to Japanese using a forward-backward translation procedure and adapted based on Japanese cultural and medical backgrounds by our professional multidisciplinary team. We assessed the internal consistency of the Japanese NAT: PD-HF version with Cronbach's alpha coefficient and the inter-rater and test-retest reliabilities with Cohen's kappa coefficient. After using the tool, all participants were asked to complete a questionnaire about the tool to determine its validity. RESULTS: The proportion of female patients in this study was 47 (44%). The median age was 72 years [interquartile range (IQR) 59-81]. The median time spent assessing the patients' and their caregivers' needs using the Japanese NAT: PD-HF was 14 min (IQR 12-17). The Cronbach's alpha coefficient was 0.82, and the minimum kappa coefficient was 0.77 for inter-rater reliability and 0.88 for test-retest reliability. In total, 103 patients (97%) and all caregivers responded that the tool was easy to understand. One hundred (94%) patients and 89 (94%) caregivers felt that the tool would improve the quality of care, and 102 (96%) patients and 91 (96%) caregivers indicated that the discussions using this tool allowed them to confide in all their burdens and care needs. All healthcare providers expressed that this tool is helpful in understanding the burden and care needs of both patients and caregivers comprehensively. CONCLUSIONS: The NAT: PD-HF is a reliable and valid tool for Japanese patients with HF and their caregivers. This tool was very well accepted by patients, caregivers and healthcare providers to identify burdens and care needs.

Scientific competence during medical education - insights from a cross-sectional study at a German Medical School.

BACKGROUND: Medical knowledge regarding the pathophysiology, diagnosis and treatment of diseases is constantly evolving. To effectively incorporate these findings into professional practice, it is crucial that scientific competencies are a central component of medical education. This study seeks to analyse the current state of scientific education and students' desires for integration into the curriculum. METHODS: From October to December 2022, a survey was distributed at the Medical Faculty Dresden to all medical students from the 1st to 5th academic year (AY). The survey investigates current expectations of applying scientific competencies later in professional life, and the students were asked to self-assess various scientific skills and in relation to the National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education. The self-assessments were objectified through a competence test with ten multiple-choice questions. The desire for curricular teaching was inquired. RESULTS: 860 students completed the survey. This corresponds to a response rate of 64%. In the 5th AY, approximately 80% of the participants stated that they expected to work with scientific literature on a daily to monthly basis in future professional life and to communicate corresponding scientific findings to patients. Only 30-40% of the 5th AY rate their scientific competencies as sufficient to do this appropriately. This corresponds with the self-assessed competencies that only slightly increased over the 5 AYs from 14.1 ± 11.7 to 21.3 ± 13.8 points (max. 52) and is also reflected in the competence test (1st AY 3.6 ± 1.75 vs. 5th AY 5.5 ± 1.68, max. 10 points). Half of the students in the 4th and 5th AYs were dissatisfied with the current teaching of scientific skills. The majority preferred the implementation of a science curriculum (56%), preferably as seminars dealing with topics such as literature research, analysis, and science communication. CONCLUSIONS: The results show discrepancies between expectations of using scientific knowledge in everyday professional life, self-rated and objectively recorded competencies, and the current state of curricular teaching of scientific competencies. There is a strong need for adequate practical training, particularly in critical analyses of scientific literature, which enables the communication of scientific knowledge to patients.

Interprofessional Educational Needs for Shared Governance of Integrated Care.

Introduction: This study investigated the educational needs of integrated care among professionals in the public sector of healthcare and social care services in South Korea. Methods: A cross-sectional secondary data analysis was performed. Original data were obtained from 10 metropolitan communities with a convenience sample of 210 integrated care professionals. The Borich Needs Assessment Model and the Locus for Focus Model were used to examine the priority educational needs of each integrated care professional. Results: This study analyzed the key details of educational needs in integrated care by focusing on the competencies of integrated care approaches for person-centered care, interprofessional collaboration, and community involvement. The core educational needs of community care administrators, care coordinators, healthcare and social care providers, and community health champions, which are common to all professionals, and the specific educational needs for each type of professional were demonstrated, which contained specific content to implement integrated care. Conclusion: This study provides an opportunity to comprehensively understand the educational needs of integrated care professionals based on their competencies. They want better interprofessional cooperation through networking and collaborative strategies. The results of this study may be utilized as fundamental data by future instructors to provide evidence-based education programs.

St. Louis Enhancing Engagement and Retention in HIV/AIDS Care (STEER): a participatory intersectional needs assessment for intervention and implementation planning.

Background Missouri is one of seven priority states identified by the Ending the HIV Epidemic Initiative, and St. Louis contains almost half of the people living with HIV (PLWH) in Missouri. As St. Louis has a marked history of structural racism and economic inequities, we utilized the Intersectionality Based Policy Analysis (IBPA) framework to guide a participatory needs assessment for planning and program development. Methods The planning team included researchers, the lead implementer from our community partner, and two community representatives, and had biweekly 60-90 minute meetings for 18 months. The planning team discussed and approved all research materials, reviewed and interpreted results, and made decisions about outreach, recruitment, conduct of the needs assessment and development of the planned intervention. The needs assessment integrated information from existing data, (1) interviews with (a) PLWH (n=12), (b) community leaders (n=5), (c) clinical leaders (n=4), and (d) community health workers (CHWs) (n=3) and (e) CHW supervisors (n=3) who participated in a Boston University-led demonstration project on CHWs in the context of HIV and (2) focus groups (2 FG, 12 participants) with front line health workers such as peer specialists, health coaches and outreach workers. A rapid qualitative analysis approach was used for all interviews and focus groups. Results The IBPA was used to guide team discussions of team values, definition and framing of the problem, questions and topics in the key informant interviews, and implementation strategies. Applying the IBPA framework contributed to a focus on intersectional drivers of inequities in HIV services. The effective management of HIV faces significant challenges from high provider turnover, insufficient integration of CHWs into care teams, and organizational limitations in tailoring treatment plans. Increasing use of CHWs for HIV treatment and prevention also faces challenges. People living with HIV (PLWH) encounter multiple barriers such as stigma, lack of social support, co-morbidities, medication side effects and difficulties in meeting basic needs. Conclusions Addressing intersectional drivers of health inequities may require multi-level, structural approaches. We see the IBPA as a valuable tool for participatory planning while integrating community engagement principles in program and implementation design for improving HIV outcomes.

Comparison of Maslow's hierarchy of needs, decision-making, and attention control in individuals with sex addiction and normal people.

BACKGROUND AND PURPOSE: Sexual addiction as a neglected disorder requires investigation and exploration as it affects various aspects of individual's personal and social lives. Therefore, the current research purpose was to examine the afflicted individuals from the standpoints of Maslow's hierarchy of needs, decision-making styles, and the function of attention. MATERIALS AND METHODS: The research population of this study included all students of Isfahan University during the academic year January 2020 to February 2021, and after the screening, a total of 200 individuals were selected as a research sample and divided into two groups: the group with sexual addiction and the healthy group. Subsequently, both groups completed questionnaires related to Maslow's Hierarchy of Needs Questionnaire (MHNQ), General Decision-Making Style Questionnaire, and Attention Control Scale (ACS). FINDINGS: The results of multivariate analysis of variance showed significant differences between two groups, normal and abnormal, in the needs for safety and the need for respect from Maslow's hierarchy of needs, decision-making styles (intuitive, dependent, and spontaneous), and the focus maintenance of attention in attentional functioning (P < 0/001). The variables of physiological needs, belongingness, and self-actualization in Maslow groups, normal and abnormal, decision-making styles, and the subscale of attention switching in attentional functioning did not show any significant difference in the two groups. CONCLUSION: Overall, it appears that fixing (stabilization) in one category and returning (regression) in the stages of Maslow's hierarchy of needs, attention deficits including excessive or hyper-focused attention, malfunctioning in the decision-making process, and an impulsive, desire-driven approach, may significantly account for the difference observed between the two groups in these variables.

Voices unheard, insights into the lives of people with disabilities: A needs assessment study.

BACKGROUND: The phenomenon of disability in society is as ancient as human history itself. Approximately one billion people worldwide experience some form of disability, with a fifth of these individuals facing significant disabilities. Disability affects various life dimensions, including access to health services. This study aimed to identify the needs and challenges encountered by people with disabilities and to propose solutions for these issues. MATERIALS AND METHODS: This qualitative content analysis research was conducted at Isfahan University of Medical Sciences in 2019. Participants included faculty members from the rehabilitation school, senior students, therapists, disabled individuals, and their families (23 interviews in total). These participants were chosen for their extensive knowledge of the challenges faced by people with disabilities. Semi-structured interviews were conducted, with informed consent obtained before each interview. The interviews were analyzed using the Graneheim and Lundman content analysis method and MAXQDA software. To ensure data accuracy, the criteria of conformability, credibility, dependability, and transferability were applied. RESULTS: The analysis of the interviews yielded two main categories and 10 subcategories. In the category of disability-related problems, family problems, therapeutic problems, psychological problems, academic problems, and social problems were identified as the most significant. As for solutions, educational solutions, therapeutic solutions, social solutions, research solutions, and solutions for reintegrating patients into normal life were proposed to address the problems faced by disabled individuals. CONCLUSION: People with disabilities are an integral part of any country's society. To adequately address their therapeutic needs, it is essential to equip our health workers with the knowledge and skills tailored to the specific needs and challenges of disabled individuals.

Community Care Needs of Highly Complex Chronic Patients: An Epidemiological Study in a Healthcare Area.

One of the priorities in family and community care is the epidemiological surveillance of the care needs and dysfunctionality present in populations of highly complex chronic patients (HCCPs) using standardised nursing languages. The aim of this study is to establish the prevalence of care needs and dysfunctionality among HCCPs in a specific health area by municipalities and geographical areas (metropolitan, north, and south) while verifying correlations with sociodemographic, financial, and health characteristics. This is an epidemiological, observational, descriptive, cross-sectional study carried out with a sample of 51,374 HCCPs, whose data were grouped into 31 municipalities. Data were collected on the following variables: sociodemographic, financial, health, functional status (health patterns), and care needs (nursing diagnoses). The mean age of the HCCPs was 73.41 (1.45) years, of which 56.18 (2.86)% were women. The municipalities in the northern area have a significantly higher proportion of older patients, HCCPs, lower incomes, and higher unemployment rates. The southern area had higher proportions of non-Spanish nationals and professionals in the hotel and catering industry, and the metropolitan area had a higher proportion of employed individuals and higher levels of education. Northern municipalities had a higher prevalence of illnesses and anxiolytic and anti-psychotic treatments. Dysfunctionality frequencies did not differ significantly by area. However, a higher prevalence of 13 nursing diagnoses was observed in the north. A high number of correlations were observed between population characteristics, dysfunctionality, and prevalent diagnoses. Finally, the frequencies of dysfunctionality in the population and the most common care needs were mapped by municipality. This research sought to ascertain whether there was an unequal distribution of these two aspects among HCCPs in order to gain a deeper epidemiological understanding of them from a family and community perspective using standardised nursing languages. This study was not registered.

Mapping the supportive care needs and quality of life of adult survivors of childhood cancer at a comprehensive cancer center in the Middle East.

Assessing unmet needs is crucial to achieving quality care and patient satisfaction. Between September and December 2021, we assessed unmet supportive care needs in a consecutive sample of adult survivors of childhood cancer at KHCC (King Hussien Cancer Center). Two hundred and ninety-seven adult survivors of childhood cancer completed the study questionnaire. The average needs score across all domains was 24.80 (SD = 19.65), with the financial domain scoring the highest 30.39 (SD = 31.95) and sexuality scoring the lowest 7.67 (SD = 19.67). Using a multivariate linear regression model, female gender was independently associated with significantly high scores in all need domains (p < 0.001), except for sexuality. Monthly income, comorbidities, socioeconomic challenges, time since diagnosis, and age at diagnosis have emerged as predictors of needs in many domains. Mean quality of life (QoL) was significantly and inversely associated with the mean score in multiple domains: psychological (p < 0.001), sexuality (p = 0.038), financial (p < 0.001), and overall needs (p = 0.004). Following a content analysis of qualitative data, educational difficulties, and work-related challenges were identified as other unmet needs. Cancer experiences during childhood significantly influence supportive care needs in adulthood. There is a need for more tailored studies assessing different populations of cancer survivors and avoiding the one-size-fits-all survivorship care.

Development of A Suicide Prevention Training Module for Social Work Students in India.

Introduction: Social workers constitute a significant task force that serves diverse populations experiencing psychosocial challenges in their daily lives. Lack of suicide prevention content/training in the Master of Social Work program may affect the student's self-esteem/ability to intervene when they come across a person with suicidality in the field. Developing a suicide prevention training module for social work students would be a suitable measure for upbringing their skills in dealing with individuals with suicidality. Method: The purpose of the present study was to develop a suicide prevention training module for social work students at the postgraduate level. The researcher conducted two Focused Group Discussions (FGD) each with social work students (n = 13) and social work educators (n = 15) on an online platform. Notes were taken during the discussion, and the contents were videotaped. The videotaped content was transcribed, and content analysis was used to analyze the data. The content that emerged from the FGD with social work students and educators was discussed in later FGD with mental health experts (two psychiatrists, one psychologist, two psychiatric social workers, and two mental health nurses). The discussion with experts clarified what components to retain for the training program. Results: Five major themes and 22 sub-themes emerged from the two FGDs each with students and educators, and one FGD with mental health professionals are described. The five major themes were understanding of suicidality, understanding suicide education in the master of social work curriculum, experience with suicidality, training content suggestion, and suggestions for future implications. Conclusions: The present study identified the need for suicide prevention training in postgraduate-level social work students. Furthermore, a lack of suicide prevention training was observed indicating the incorporation of suicide education in the postgraduate curriculum.

[Advancing standards for the development of evidence-based health information for consumers: Needs and priorities among members of the Network for Evidence-based Medicine]. / Inhaltliche Weiterentwicklung von Standards zur Erstellung evidenzbasierter Gesundheitsinformationen: Eine Bedarfserhebung und Priorisierung im EbM-Netzwerk.

BACKGROUND: The Good Practice Guidelines for health information, Good Health Information Austria and Guideline Evidence-based Health Information are established resources for developing evidence-based health information in the German-speaking regions. The aim of this project was to capture challenges in applying these standards in practice, identify gaps and development needs and gain insights for their further development. METHODS: In December 2020, members of the working group for patient information and involvement of the Network for Evidence-based Medicine were invited to share their experiences and needs in applying German standards for evidence-based health information through an online survey focussing on open questions (part 1: needs assessment). The feedback was analysed using qualitative content analysis and presented in a workshop at the EbM Congress 2021 with the goal of specifying the feedback from the needs assessment and discussing ideas for the further development of the standards (part 2: specification). In the final step, a second survey was conducted in February 2023 to prioritize the identified topics by the working group members (part 3: prioritization). The results were analysed descriptively. RESULTS: Among the 41 participants, only 23% considered the standards to be sufficient, and only 55% found their application in the development of information to be easy or rather easy. The needs assessment and workshop (n=46) helped to identify various areas of action. With regard to the application of the standards, the following challenges were identified: lack of user orientation, content gaps, methods and risk communication. Gaps in the standards were identified regarding formats, content, and the connection to healthcare provision. For the advancement of the standards ideas for additional content, stakeholder involvement, and improvement of the usability of the standards were identified. In the prioritization survey, the topic areas, "presenting benefits and harms" and "content beyond treatments (in particular, diagnostics and prognosis)" were considered to be the most important (n=36). DISCUSSION: Among members of the working group for patient information and involvement of the German Network for Evidence-based Medicine, a high demand has been identified for the further development of standards for creating evidence-based health information. In addition to content development, the integration of existing documents and tools should also be considered, including products issued by other institutions. The success of advancing the standards also depends on improving their applicability - for example through an attractive online platform. The results are limited by the sample which only included members of the EbM Network's patient information and participation working group and a limited response rate. CONCLUSIONS: The needs assessment showed that the currently established standards and recommendations for the development of evidence-based health information in the German-speaking regions represent important cornerstones but need to be expanded to answer more practice-oriented questions. The challenges and proposed solutions stated by the participants can help further develop the standards. The prioritization can be used to set priorities for the development of the standards, guide the order of possible work packages and allocate resources.

A framework and process for community-engaged, mixed-methods cancer needs assessments.

PURPOSE: Community health needs assessments are required for most state and local public health agencies and non-profit hospitals. Typically based on community health improvement planning models, these assessments encompass overall community health and multiple diseases to inform program planning. National Cancer Institute (NCI)-designated Cancer Centers and community-based cancer-focused programs share the goal of reducing cancer burden in the catchment areas they serve. However, to date, no published models exist to guide cancer-specific needs assessments for a determined geographic area that can inform both public health and research initiatives. The purpose of this article is to outline a cancer needs assessment (CNA) framework and community-engaged, mixed-methods process, along with a case study of how we applied it in Kentucky. METHODS: We convened a steering committee of key organizational partners to provide input throughout the process. We developed a conceptual framework of multi-level determinants affecting cancer-related outcomes. We incorporated both quantitative and qualitative data gathered through a variety of means, including a novel application of group concept mapping to guide definition of priorities. RESULTS: The resulting CNA has helped guide strategic planning and priorities for Kentucky's Cancer Action Plan, Markey Cancer Center, state agencies, and community-based organizations. CONCLUSION: This framework and process can be used collaboratively by cancer center Community Outreach and Engagement offices, public health agencies, oncology programs, and community partners to plan impactful cancer control programs and research in their catchment areas. Universities can also use them to inform the planning of community engagement and health equity research efforts.

Necesidades de cuidado en la persona consumidora de alcohol en un contexto hospitalario / Necessidades de cuidado na pessoa que consome álcool em contexto hospitalar / Care needs in the person consuming alcohol in a hospital context

Introducción: El consumo de alcohol es considerado unode los transcendentales factores de riesgo de discapacidad ymuerte prematura. Develar el sentido de la experiencia de lapersona consumidora de alcohol en cuanto a las necesidades decuidado en el contexto hospitalario e incentiva que enfermeríabrinde un cuidado humano.Objetivo: Comprender las necesidades de cuidado de unapersona consumidora de alcohol durante la estancia hospitalaria.Método: Investigación cualitativa fenomenológica. Muestreopor conveniencia, participaron 07 hombres y 02 mujeres queconsumen alcohol e ingresaron al hospital. Para recolectarlos datos se utilizó una entrevista fenomenológica, previoconsentimiento informado. El análisis se realizó medianteel círculo hermenéutico de Martin Heidegger.Resultados: Fueron develadas cinco categorías: 1) Necesidadesfísicas ante deterioro corporal, 2) Necesidades emocionales yde apoyo con traspaso de energía para vivir, 3) Necesidades deconfort humano dentro de la hospitalización, 4) Agradecimientoverbalizado y escrito ante acompañamiento y preocupación,5) Anhelos de ser cuidado como persona.Conclusiones: Enfermería se encuentra con un ser vulnerableque muestra necesidades físicas debilitadas, necesidadesemocionales que requieren apoyo y confort humano, unser que anhela y agradece al ser enfermera.(AU)

Introduction: Alcohol consumption is consideredone of the transcendental risk factors for disabilityand premature death. Reveal the meaning of theexperience of the person who consumes alcoholin terms of care needs in the hospital context andencourages nursing to provide humane care.Objective: Understand the care needs of a personwho consumes alcohol during the hospital stay.Method: Phenomenological qualitative research.Sampling for convenience, 07 men and 02 womenwho consume alcohol and admitted to the hospitalparticipated. To collect the data, a phenomenologicalinterview was used, with prior informed consent. Theanalysis was carried out through the hermeneuticalcircle of Martin Heidegger.Results: Five categories were revealed: 1) Physicalneeds in the face of bodily deterioration, 2) Emotionaland support needs with the transfer of energy to live,3) Human comfort needs within hospitalization, 4) Verbalized and written gratitude for accompanimentand concern, 5) Desire to be cared for as a person.Conclusions: Nursing meets a vulnerable being thatshows weakened physical needs, emotional needsthat require support and human comfort, a beingthat longs for and appreciates being a nurse.(AU)

Introdução: O consumo de álcool é considerado umdos fatores de risco transcendentais para incapacidade emorte prematura. Revelar o significado da experiência dapessoa que consome álcool em relação às necessidades decuidado no contexto hospitalar e estimular a enfermagema prestar assistência humanizada.Objetivo: Compreender as necessidades de cuidado deuma pessoa que consome álcool durante a internação.Método: Pesquisa qualitativa fenomenológica. Amostragempor conveniência, participaram 07 homens e 02 mulheresque consomem álcool e internados no hospital. Para a coletados dados, foi utilizada uma entrevista fenomenológica,com consentimento prévio informado. A análise foirealizada por meio do círculo hermenêutico de MartinHeidegger.Resultados: Foram reveladas cinco categorias: 1)Necessidades físicas diante da deterioração corporal, 2)Necessidades emocionais e de apoio com transferênciade energia para viver, 3) Necessidades de confortohumano na hospitalização, 4) Gratidão verbalizada eescrita por acompanhamento e preocupação, 5) Desejode ser cuidado como pessoa.Conclusões: A enfermagem atende a um ser vulnerável queapresenta necessidades físicas fragilizadas, necessidadesemocionais que requerem apoio e conforto humano,um ser que anseia e valoriza ser enfermeiro.(AU)

Sociodemographic and Clinical Characteristics of People Living with Dementia and Their Associations with Unmet Healthcare Needs: Insights from the Baseline Assessment of the InDePendent Study.

Background: The healthcare needs of People living with Dementia (PlwD) (such as Alzheimer's disease) are often unmet. Information about the needs of community-dwelling PlwD and their association with sociodemographic and clinical characteristics is needed to fill the knowledge gap regarding factors influencing unmet needs among PlwD and to conduct a comprehensive needs assessment to develop tailored interventions. Objective: To describe sociodemographic and clinical characteristics of the InDePendent study population with particular reference to determinants of unmet needs. Methods: We analyzed baseline data of the multi-centre cluster-randomized controlled trial (InDePendent) using descriptive statistics to describe patients' sociodemographic and clinical characteristics and Poisson regression models to predict unmet needs, separated by sex. Data were collected personally via face-to-face interviews. Results: Most of the n = 417 participating PlwD were mild to moderately cognitively impaired, were not depressed, had an average of 10.8 diagnoses, took 6.7 medications, and had, on average, 2.4 unmet needs (62% of PlwD had at least one unmet need) measured by the Camberwell Assessment of Need for the Elderly (CANE). Low social support, a high body-mass-index, a lower education, functional impairment, and worse health status were associated with more unmet needs, regardless of sex. In women, higher unmet needs were associated with more depressive symptoms, a poor financial situation, living alone and not being recently treated by a general practitioner. In males, unmet needs increased with the number of medications taken. Conclusions: PlwD had a broad array of unmet healthcare needs, indicating primary healthcare provision improvement potentials. The results underscore the significance of early assessment of patient's clinical characteristics and unmet needs as a basis for individualized gender-sensible intervention strategies.∥ClinicalTrials.gov Identifier: NCT04741932, Registered on February 5, 2021.

Towards a taxonomy for assessing and classifying the needs of curly hair: A mixed method, ethnographic and quantitative data study.

Hair defined as curly has an elliptical cross sectional area and unique 3D form. While the chemical, morphological and mechanical characteristics of such hair are being explored using a range of analytical techniques, hair assembly (head of hair) characteristics and individual behaviour are difficult to determine via tress-based instrumental and sensory testing. Since the demand for more efficacious and personalized products is expected to gain pace, this project sets the groundwork for developing a taxonomy for exploring and classifying curly hair needs from an individual's perspective. A mixed-method exploratory sequential design was used to gather information from people with curly hair starting with a novel in the field of cosmetics qualitative research method, Subjective Evidence-Based Ethnography (SEBE) (n = 14) and followed by an online survey (n = 212). The SEBE data analysis identified four common hair goals (aesthetic, haptic, practical and emotive) and a group of perceptions related to hair management routines. The survey explored the relationship of these hair goals with hair perceptions, hair esteem, hair characteristics and demographic variables. The findings suggest that hair goals and perceptions are stronger predictors of hair esteem than other characteristics such as hair length or curl type. Hence, a taxonomy for classifying curly hair should facilitate the development of more appropriate products, and product testing methods should incorporate such personal information in addition to objective fibre and hair assembly data. The focus of this study is on curly hair due to the lack of established methods for its objective evaluation and the personal challenges faced by people with curly and textured hair; however, the approach could be adopted to include straighter hair types.

Les cheveux décrits comme bouclés ont une surface transversale elliptique et une forme tridimensionnelle unique. Si les caractéristiques chimiques, morphologiques et mécaniques de ces cheveux sont étudiées à l'aide de diverses techniques d'analyse, il reste difficile de déterminer les caractéristiques de l'assemblage capillaire (tête du cheveu) et le comportement individuel d'une chevelure via des analyses instrumentales de la tresse et des tests sensoriels. La demande de produits plus efficaces et personnalisés allant sans doute augmenter à l'avenir, ce projet pose les bases d'une taxonomie visant à étudier et à classer les besoins liés aux cheveux bouclés du point de vue de la personne qui les porte. Une approche séquentielle à méthodes mixtes a été utilisée pour recueillir des informations qualitatives auprès de personnes ayant des cheveux bouclés à l'aide d'une ethnographie factuelle subjective (Subjective Evidence­Based Ethnography, SEBE) (n = 14), suivie d'une enquête en ligne (n = 228). L'analyse des données SEBE a permis d'identifier quatre objectifs capillaires fréquents et un ensemble de perceptions liées aux routines de gestion des cheveux. L'enquête a étudié la relation entre ces objectifs capillaires et la perception des cheveux, l'estime de soi liée aux cheveux, les caractéristiques des cheveux et les variables démographiques. Les résultats suggèrent que les objectifs et les perceptions des cheveux constituent des facteurs prédictifs plus puissants de l'estime de soi liée aux cheveux que d'autres caractéristiques comme la longueur des cheveux ou le type de boucle. Par conséquent, une taxonomie pour classer les cheveux bouclés doit faciliter le développement de produits plus appropriés, et les méthodes de test des produits devraient incorporer ces informations personnelles en plus des données objectives sur les fibres et les assemblages capillaires. Cette étude se concentre sur les cheveux bouclés en raison du manque de méthodes établies pour évaluer objectivement ce type de cheveux et des défis personnels auxquels les personnes ayant des cheveux bouclés et à texture sont confrontées. Toutefois, l'approche adoptée ici pourrait aussi permettre d'étudier les cheveux plus raides.

Transitioning to home and beyond following stroke: a prospective cohort study of outcomes and needs.

INTRODUCTION: Understanding of the needs of people with stroke at hospital discharge and in the first six-months is limited. This study aim was to profile and document the needs of people with stroke at hospital discharge to home and thereafter. METHODS: A prospective cohort study recruiting individuals with stroke, from three hospitals, who transitioned home, either directly, through rehabilitation, or with early supported discharge teams. Their outcomes (global-health, cognition, function, quality of life, needs) were described using validated questionnaires and a needs survey, at 7-10 days, and at 3-, and 6-months, post-discharge. RESULTS: 72 patients were available at hospital discharge; mean age 70 (SD 13); 61% female; median NIHSS score of 4 (IQR 0-20). 62 (86%), 54 (75%), and 45 (63%) individuals were available respectively at each data collection time-point. Perceived disability was considerable at hospital discharge (51% with mRS ≥ 3), and while it improved at 3-months, it increased thereafter (35% with mRS ≥ 3 at 6-months). Mean physical health and social functioning were "fair" at hospital discharge and ongoing; while HR-QOL, although improved over time, remained impaired at 6-months (0.69+/-0.28). At 6-months cognitive impairment was present in 40%. Unmet needs included involvement in transition planning and care decisions, with ongoing rehabilitation, information, and support needs. The median number of unmet needs at discharge to home was four (range:1-9), and three (range:1-7) at 6-months. CONCLUSION: Stroke community reintegration is challenging for people with stroke and their families, with high levels of unmet need. Profiling outcomes and unmet needs for people with stroke at hospital-to-home transition and onwards are crucial for shaping the development of effective support interventions to be delivered at this juncture. ISRCTN REGISTRATION: 02/08/2022; ISRCTN44633579.

Advancing One Health through veterinary education: a mixed methods needs assessment for implementing a WOAH-harmonized national veterinary medicine curriculum in Ethiopia.

Introduction: International organizations now actively promote and implement One Health collaborative approaches to prevent, detect, and control diseases in humans and animals, recognizing the critical importance of the veterinary and agricultural sectors. Moreover, Veterinary Services are chronically under-resourced, especially in low- and middle-income countries. Given the importance of National Veterinary Services to food security, nutrition, poverty alleviation, and global health security, strengthening veterinary capacity is a priority for the international community. The World Organisation for Animal Health (WOAH) outlines a set of minimum competencies veterinarians need to support National Veterinary Services effectively. To improve the quality of veterinary education, Ethiopia has developed a new 2020 national curriculum that is harmonized with the WOAH competencies. Methods: A mixed methods needs assessment was conducted to identify barriers and challenges that Ethiopian veterinary medicine programs have faced in implementing the new WOAH-harmonized national curriculum. Representatives from active veterinary programs granting a Doctor of Veterinary Medicine (DVM) degree were invited to share their experiences via an online survey and follow-up focus group discussion. Results: Fourteen veterinary programs, representing 93% of eligible programs nationwide, participated in the needs assessment. Quantitative analysis indicated that the most difficult topics associated with the new curriculum included Organization of Veterinary Services (Competency 3.1), Inspection and Certification Procedures (3.2), and practical applications of the regulatory framework for disease prevention and control (multiple competencies). Challenges associated with specific instructional methodologies, particularly the facilitation of off-site (private and public sector) student training, were also perceived as barriers to implementation. Focus group discussions elucidated reasons for these challenges and included limitations in faculty expertise, resource constraints (e.g., supplies, infrastructure), and access to off-site facilities for hands-on teaching. Conclusion: The results of this needs assessment will be used to identify and prioritize solutions to implementation challenges, helping Ethiopian veterinary medicine programs move the new WOAH-harmonized curriculum from theory to practice. As veterinarians are integral partners in advancing One Health, strengthening the capacity of Veterinary Services can ultimately safeguard animal and human health, grow economies, and improve lives.

Can proactive support prevent unscheduled care? A controlled observational retrospective cohort study in cancer patients in Scotland.

INTRODUCTION: Preventative spend is a global health and social care strategy. Improving Cancer Journeys (ICJ) is a proactive, holistic, multidisciplinary project consistent with this agenda, currently being rolled out across Scotland and parts of UK. ICJ helps people with cancer access whatever support they need to mitigate their most pressing concerns. This study hypothesised that ICJ service users should subsequently use less unscheduled care than matched cohorts not using ICJ. METHODS: Retrospective observational cohort study using linked national datasets. N = 1,214 ICJ users in Glasgow were matched for age, sex, deprivation, cancer type, stage, and diagnosis year to two control groups: 1. Cancer patients from Glasgow before ICJ (pre-2014), 2. Cancer patients from rest of Scotland during study period (2014-2018). Cancer registrations were linked for 12-month baseline and study periods to: NHS24 calls, A&E admissions, inpatient hospital admissions, unscheduled care, number & cost of psychotropic prescriptions. Per-person mean service uses were compared between groups. RESULTS: There was a significant increase in NHS24 calls in the ICJ group (0.36 per person vs. -0.03 or 0.35), more and longer A&E attendances in ICJ (0.37 per person vs. 0.19 or 0.26; 2.19 h per person vs. 0.81-0.92 h), more and longer hospital admissions in ICJ (4.25 vs. 2.59 or 2.53; 12.05 days vs. 8.37 or 8.64), more care pathways involving more steps in ICJ (0.77 spells vs. 0.39 or 0.57; 1.88 steps vs. 1.56 or 1.21), more psychotropic drug prescriptions and higher costs in ICJ (1.88 prescription vs. 1.56 or 1.21; £9.51 vs. £9.57 or £6.95) in comparison to both control groups. DISCUSSION: ICJ users sourced significantly more unscheduled care than matched cohorts. These findings were consistent with much of the comparable literature examining the impact of non-health interventions on subsequent health spend. They also add to the growing evidence showing that ICJ reached its intended target, those with the greatest need. Together these findings raise the possibility that those choosing to use ICJ may also be self-identifying as a cohort of people more likely to use unscheduled care in future. This needs to be tested prospectively, because this understanding would be very helpful for health and social care planners in all countries where proactive holistic services exist.

Residents-as-teachers: A Needs Assessment of Residents' Teaching Skills in the Clinical Setting Using Direct Observation of Teaching.

BACKGROUND AND OBJECTIVES: Residents play a significant role in teaching undergraduate medical students though most residents have not received formal training in teaching and may be adopting ineffective teaching strategies. Many institutions have established a residents-as-teachers (RaT) programme to improve residents' teaching skills. However, many RaT programmes were established without a context-specific needs assessment. This study describes a need assessment survey of residents' teaching skills. The specific objectives of the study were to determine the residents' selfperceived and true learning needs for facilitating clinical teaching, the preferred important topics and methods of instruction for a RaT programme. METHODS: This cross-sectional, prospective, observational, quantitative study involved self-assessment of residents' teaching skills and assessments of those residents by medical students and an observer during actual clinical bedside teachings using the Maastricht Clinical Teaching Questionnaire. RESULTS: Thirty-nine (78%) out of 50 residents participated in the study, of which 20 agreed to direct observation of teaching. Sixty-two (85%) of the 73 medical students completed 82 evaluations of residents' teaching. The residents' self-perceived and true learning needs were in the domains of exploration, scaffolding, modelling, coaching and reflection. The leading preferred topics were communication skills, leadership, the teaching of procedural skills, and bedside teaching. The preferred methods of instruction were interactive sessions with teachers and working in small groups with a facilitator. CONCLUSIONS: Residents performed well in creating a safe learning environment but were poor in exploration, scaffolding, modelling, coaching and reflection domains of teaching. These findings will inform the design of a tailor-made RaT programme.

CONTEXTE ET OBJECTIFS: Les résidents jouent un rôle important dans l'enseignement des étudiants en médecine de premier cycle, bien que la plupart des résidents n'aient pas reçu de formation formelle en enseignement et puissent adopter des stratégies d'enseignement inefficaces. De nombreuses institutions ont mis en place un programme de résidents en tant qu'enseignants (RaT) pour améliorer les compétences pédagogiques des résidents. Cependant, de nombreux programmes RaT ont été établis sans évaluation préalable des besoins spécifiques au contexte. Cette étude décrit une enquête sur les besoins en compétences pédagogiques des résidents. Les objectifs spécifiques de l'étude étaient de déterminer les besoins d'apprentissage auto-perçus et réels des résidents pour faciliter l'enseignement clinique, les sujets importants préférés et les méthodes d'instruction pour un programme RaT. MÉTHODES: Cette étude quantitative prospective observationnelle transversale impliquait une auto-évaluation des compétences pédagogiques des résidents et des évaluations de ces résidents par des étudiants en médecine et un observateur lors d'enseignements cliniques en direct au lit du patient à l'aide du Questionnaire d'Enseignement Clinique de Maastricht. RÉSULTATS: Trente-neuf (78 %) des 50 résidents ont participé à l'étude, dont 20 ont accepté l'observation directe de l'enseignement. Soixantedeux (85 %) des 73 étudiants en médecine ont complété 82 évaluations de l'enseignement des résidents. Les besoins d'apprentissage auto-perçus et réels des résidents étaient dans les domaines de l'exploration, de l'échafaudage, de la modélisation, du coaching et de la réflexion. Les sujets préférés étaient les compétences en communication, le leadership, l'enseignement des compétences procédurales et l'enseignement au lit du patient. Les méthodes d'instruction préférées étaient les séances interactives avec les enseignants et le travail en petits groupes avec un facilitateur. CONCLUSIONS: Les résidents se sont bien comportés dans la création d'un environnement d'apprentissage sûr mais étaient faibles dans les domaines de l'exploration, de l'échafaudage, de la modélisation, du coaching et de la réflexion de l'enseignement. Ces résultats orienteront la conception d'un programme RaT sur mesure. MOTS-CLÉS: Résidents en tant qu'enseignants, évaluation des besoins, enseignement clinique au lit du patient, évaluation, compétencespédagogiques.

Spiritual Needs and Influencing Factors of Postoperative Breast Cancer Women Undergoing Chemotherapy: A Cross-Sectional Study.

Purpose: The purpose of the study was to determine the status of spiritual needs and influencing factors of postoperative breast cancer (BC) women undergoing chemotherapy. Participants and Methods: This study is a cross-sectional study. A total of 173 participants completed a general information questionnaire and a Chinese version of the Spiritual Needs Scale at the Guangxi Medical University Cancer Hospital. Data were collected by purposive sampling from December 2022 to April 2023. Data were analyzed by descriptive statistics, independent t-test, ANOVA, non-parametric test, and logistic regression analysis. Results: The spiritual needs of postoperative BC women undergoing chemotherapy were at a high level (84.20 ± 12.86). The need for "hope and peace" was considered paramount and the need for a "relationship with transcendence" was considered the least important. Significant differences were found in the following: spiritual needs total score (P=0.040) and "hope and peace" (P=0.021) in education level; "love and connection" in disease stage (P=0.021); "meaning and purpose" in education level (P=0.013), household income (P=0.012), and payment method (P=0.015); "relationship with transcendence" in religion (P<0.001); and "acceptance of dying" in marital status (P=0.023). The level of education was the influencing factor of spiritual needs (OR=1.50, P=0.005), especially for "hope and peace" (OR=1.50, P=0.012). Conclusion: The spiritual need of postoperative BC Chinese women undergoing chemotherapy is at a high level and should receive more attention. In clinical work, nurses should fully assess the spiritual needs of patients and meet their specific needs. Results may help nurses to develop targeted and comprehensive spiritual intervention strategies according to the characteristics of patients.