Actions Of Health Care Providers Research Articles

Why are pregnant women physically inactive? A qualitative study on the beliefs and perceptions about physical activity during pregnancy.

This study aimed to describe the beliefs and perceptions of pregnant women and healthcare providers about physical activity during pregnancy. Using a qualitative approach, 30 pregnant women and the 14 healthcare providers caring for them were interviewed in the second trimester of pregnancy. We included women who maintained, decreased, or stopped physical activity since becoming pregnant. They were divided into low (≤ 8 years) and high schooling (> 8 years). Semi-structured, in-depth interviews were conducted and guided by three key questions: (1) When does physical activity during pregnancy start to be considered a wrong behavior?; (2) What are the main barriers (biological or others) to physical activity?; and (3) Do the actions of healthcare providers and people close to pregnant women reinforce barriers? Interviews were audio recorded, transcribed, and analyzed based on recurring themes. All women changed their physical activity behavior (decreased or stopped) when they discovered their pregnancy. Fear of miscarriage, contractions, bleeding, and of causing malformations in the baby were the most reported reasons for decreasing or stopping physical activity. Participants also lacked access to consistent information and healthcare providers' support on the benefits of physical activity. Despite the current international recommendations to regular physical activity during pregnancy, uncertainty regarding its benefits remains. Interventions to promote physical activity during this period should include the training of healthcare providers so they can advise and discard ideas contrary to mother-child health benefits.

Building Trust: Developing an Ethical Communication Framework for Navigating Artificial Intelligence Discussions and Addressing Potential Patient Concerns

Introduction: In an era where technological advancements in large language models and generative artificial intelligence (AI) platforms like ChatGPT continually redefine the boundaries of medicine, the advent of Amazon Web Services (AWS) HealthScribe on July 26th, 2023, heralds a transformative moment in healthcare. This HIPAA-eligible generative AI service, capable of transcribing patient-provider conversations and automatically entering them into an electronic health record (EHR) system, represents a profound intersection of technology and medical practice. As this technology permeates clinical settings, addressing associated patient concerns with AI becomes paramount. Although providers may grasp the intricacies of such technology swiftly, patients are likely to harbor concerns. Patients may be unfamiliar with the technology or question its safety. Clear and precise communication will be essential for physicians to ease patient concerns. Our team interviewed forty-eight subjects to survey their understanding, concerns, and opinions on artificial intelligence. We then classified and visually charted their responses. Based on our data, we created a framework for ethical communication physicians can follow when talking to patients about using artificial intelligence in clinical settings. Method: A multidisciplinary team encompassing physicians, advanced practice providers specializing in hematology and oncology, and bioethicists engaged with forty-eight subjects. The study population represented a diverse cross-section of society, differing in aspects such as age, sex assigned at birth, political orientation, education, income, ethnicity, occupation, and religious affiliation. Our investigative process included a structured interview containing twenty-five foundational questions. No personal health information was collected during the questionnaire, and all questions sought only to garner subject opinion. Questions were designed to probe areas of interest such as: (1) the subject's general feelings about AI in healthcare, (2) their familiarity with AI technologies, (3) the existence of any specific concerns, and (4) a deeper exploration of those concerns. The responses were meticulously collected, categorized, and analyzed to discern emergent trends. Results: Our team developed The TRUST Framework based on our research findings by identifying and addressing the three primary concerns with AI in healthcare; transparency, confidentiality, and consent. The data presented a mosaic of varied opinions, with minimal discernible trends correlating with specific demographic attributes. One of the subtle patterns identified pertained to age. Subjects within the 12-35 age bracket demonstrated a familiarity with artificial intelligence, generally expressing indifference rather than concern or enthusiasm. Those aged 35-65 exhibited greater pronounced indifference than any age demographic and revealed an unfamiliarity with existing artificial intelligence tools. Conversely, respondents aged 65 and older expressed the highest level of concern and a prevalent unfamiliarity with the range of available artificial intelligence applications. Conclusion: Effective communication when introducing the use of artificial intelligence in healthcare settings is imperative. This conclusion is based on abstract reasoning and rooted in real-world feedback received from a diverse subject population. Our research revealed that subjects have varying feelings and concerns with artificial intelligence, irrespective of their background. Therefore, avoiding unconscious bias and having a framework for communicating how AI will be used is essential. As the frontier of AI continues to expand, the need for ethical and transparent communication will only grow. This study serves as a call to action for healthcare providers to commit to clear, honest, and empathetic communication about AI's role in patient care. Doing so will promote the overall acceptance of AI in healthcare, subsequently enhancing patient outcomes and alleviating patient concerns by building trust.

Framework for Classifying Explainable Artificial Intelligence (XAI) Algorithms in Clinical Medicine.

Artificial intelligence (AI) applied to medicine offers immense promise, in addition to safety and regulatory concerns. Traditional AI produces a core algorithm result, typically without a measure of statistical confidence or an explanation of its biological-theoretical basis. Efforts are underway to develop explainable AI (XAI) algorithms that not only produce a result but also an explanation to support that result. Here we present a framework for classifying XAI algorithms applied to clinical medicine: An algorithm's clinical scope is defined by whether the core algorithm output leads to observations (eg, tests, imaging, clinical evaluation), interventions (eg, procedures, medications), diagnoses, and prognostication. Explanations are classified by whether they provide empiric statistical information, association with a historical population or populations, or association with an established disease mechanism or mechanisms. XAI implementations can be classified based on whether algorithm training and validation took into account the actions of health care providers in response to the insights and explanations provided or whether training was performed using only the core algorithm output as the end point. Finally, communication modalities used to convey an XAI explanation can be used to classify algorithms and may affect clinical outcomes. This framework can be used when designing, evaluating, and comparing XAI algorithms applied to medicine.

Advancing anticoagulation stewardship: A call to action for stewardship from the US-based anticoagulation forum

PurposeAnticoagulation Stewardship is urgently needed to improve anticoagulation management and bend the current, negative trajectory on anticoagulation-related harm. This manuscript catalogs the origins and the progression of the Anticoagulation Stewardship model and serves as a call to action for healthcare providers and organizations committed to improving the quality and safety of anticoagulation management. Key elementsTens of millions of patients around the world currently require anticoagulant therapy to prevent or treat thrombotic events. Concerningly, there is a growing body of evidence confirming that increasing volume and complexity of anticoagulant use is significantly impacting the therapeutic landscape, posing major challenges to safe prescribing and management of these high-risk, yet essential therapies, and leading to increased patient harm including life-threatening bleeding and thrombotic complications across the continuum of care. In response, anticoagulation stewardship programs, modeled after highly successful antimicrobial stewardship efforts, are gaining increased traction to counteract this growing health concern. ConclusionsThe current health care system is inadequate to protect patients from avoidable harms and to maximize the benefits of therapy. Apart from anticoagulation stewardship, there does not currently exist another cross-setting, multidisciplinary model for achieving maximum quality and safety for patients. If we are to collectively meet the challenge that stands before us, we must commit ourselves (as individuals and organizations) to leveraging the available resources to advance the anticoagulation stewardship model while also contributing to the burden of evidence and the effective articulation of the stewardship message.

Persisting symptoms after concussion: Time for a paradigm shift.

Persisting symptoms after concussion: Time for a paradigm shift.

Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US

Patients with language barriers have a higher risk of experiencing hospital safety events. This study hypothesized that language barriers would be associated with poorer perceptions of hospital safety climate relating to communication openness. To examine disparities in reported hospital safety climate by language proficiency in a cohort of hospitalized children and their families. This cohort study conducted from April 29, 2019, through March 1, 2020, included pediatric patients and parents or caregivers of hospitalized children at general and subspecialty units at 21 US hospitals. Randomly selected Arabic-, Chinese-, English-, and Spanish-speaking hospitalized patients and families were approached before hospital discharge and were included in the analysis if they provided both language proficiency and health literacy data. Participants self-rated language proficiency via surveys. Limited English proficiency was defined as an answer of anything other than "very well" to the question "how well do you speak English?" Primary outcomes were top-box (top most; eg, strongly agree) 5-point Likert scale ratings for 3 Children's Hospital Safety Climate Questionnaire communication openness items: (1) freely speaking up if you see something that may negatively affect care (top-box response: strongly agree), (2) questioning decisions or actions of health care providers (top-box response: strongly agree), and (3) being afraid to ask questions when something does not seem right (top-box response: strongly disagree [reverse-coded item]). Covariates included health literacy and sociodemographic characteristics. Logistic regression was used with generalized estimating equations to control for clustering by site to model associations between openness items and language proficiency, adjusting for health literacy and sociodemographic characteristics. Of 813 patients, parents, and caregivers who were approached to participate in the study, 608 completed surveys (74.8% response rate). A total of 87.7% (533 of 608) of participants (434 [82.0%] female individuals) completed language proficiency and health literacy items and were included in the analyses; of these, 14.1% (75) had limited English proficiency. Participants with limited English proficiency had lower odds of freely speaking up if they see something that may negatively affect care (adjusted odds ratio [aOR], 0.26; 95% CI, 0.15-0.43), questioning decisions or actions of health care providers (aOR, 0.19; 95% CI, 0.09-0.41), and being unafraid to ask questions when something does not seem right (aOR, 0.44; 95% CI, 0.27-0.71). Individuals with limited health literacy (aOR, 0.66; 95% CI, 0.48-0.91) and a lower level of educational attainment (aOR, 0.59; 95% CI, 0.36-0.95) were also less likely to question decisions or actions. This cohort study found that limited English proficiency was associated with lower odds of speaking up, questioning decisions or actions of providers, and being unafraid to ask questions when something does not seem right. This disparity may contribute to higher hospital safety risk for patients with limited English proficiency. Dedicated efforts to improve communication with patients and families with limited English proficiency are necessary to improve hospital safety and reduce disparities.

Obstetric violence in historical perspective

Although improvements in perinatal care have helped save many lives worldwide, reproductive health inequities remain rife. Racial, geographical, and class-based disparities shape divergent maternal and infant health outcomes, as well as unequal access to vital forms of health care such as abortion. Present-day reproductive injustices are contextualised by many factors, including the under-recognised history of obstetric violence. Obstetric violence refers to harm inflicted during or in relation to pregnancy, childbearing, and the post-partum period. Such violence can be both interpersonal and structural, arising from the actions of health-care providers and also from broader political and economic arrangements that disproportionately harm marginalised populations. By focusing on obstetric violence, we centre the long and enduring history of biological reproduction as a site of social violence. In doing so, we elucidate how obstetric violence has reflected and amplified different forms of social and political discrimination, oppression, and exclusion.

An epidemic and a pandemic collide: Assessing the feasibility of tobacco treatment among vulnerable groups at COVID-19 protective lodging.

Individuals experiencing homelessness have elevated smoking rates in addition to chronic and acute physical and mental health conditions, which may increase chances for complications associated with COVID-19 recovery. Unfortunately, there is underuse of tobacco cessation services in many agencies (e.g., substance use treatment centers, mental health treatment centers) providing care to these individuals. The purpose of the current study was to evaluate the feasibility of providing tobacco cessation treatment alongside local COVID-19 emergency response efforts. Taking Texas Tobacco Free (TTTF) partnered with relevant emergency response teams at 5 isolation centers (repurposed hotels) in Austin, Texas, to address tobacco use among presumed or confirmed COVID-19 positive individuals who had nowhere else to seek care and shelter. TTTF trained staff on tobacco cessation treatment; specifically, the 5A's and use of nicotine replacement therapy. Over 5 months in 2020; 170 of 379 (44.9%) isolation center residents were reached and assessed for cigarette or vape use. Smoking/vaping prevalence was 70.6%, and 41.7% of tobacco users accepted cessation treatment. Results suggest the feasibility and potential acceptability of providing tobacco treatment services in similar care settings during local emergency response efforts, including but potentially not limited to the COVID-19 pandemic. Further, this initiates a call to action for health care providers to deliver tobacco use cessation services for typically hard-to-reach groups (e.g., individuals/families experiencing homelessness) who may have increased contact with service agencies and health providers during times of crisis. Limitations and suggestions for future implementation are also provided. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Developing and Adapting a Mindfulness-Based Group Intervention for Racially and Economically Marginalized Patients in the Bronx

Mindfulness-based interventions (MBIs; e.g., MBSR, MBCT, ACT) have been widely used and disseminated for treatment of myriad physical and psychological problems. However, most MBIs have primarily been used with middle-or upper-class White populations, with some instances where they have been adapted for use with diverse populations (e.g., Burnett-Zeigler et al., 2016; Roth & Robbins, 2004). However, even when adapted, most MBIs have not explicitly addressed unique factors faced by the target population, such as racial discrimination, unemployment, lack of financial means, and other stressors. We developed and used an iterative approach to refine a MBI group based on MBSR and MBCT, for a racially and ethnically diverse population in the Bronx, considered by the U.S. census to be the most diverse in the country. Based on a trauma-informed care and centering people of color approach, we developed a longer than usual (16 weeks) mindfulness-based group, where core skills were broken down into smaller chunks to facilitate easier incorporation into daily life. We also used a longer duration and 1-hour weekly meeting time keeping in mind needs of the individuals, who often had limited time to participate due to work limitations and other comorbid physical conditions. While acknowledging that the individuals this group was catering to had experienced multiple traumatic events, we sought to also highlight and further develop the resilience and courage people in the Bronx community bring to the table. We review two clinically rich case vignettes, and also discuss recommendations for working with racially and economically marginalized people, and include a call to action for health care providers and organizations to engage in activism.

Forced and Coerced Sterilization of Indigenous Peoples: Considerations for Health Care Providers.

Forced and coerced sterilization refers to the provision of permanent contraception without true informed consent. In Canada, this topic is particularly relevant to Indigenous Peoples because of this country's history of racialized eugenics programs. In this commentary, we briefly review the history of forced and coerced sterilization in Canada, describe the clinical considerations for health care providers who work with Indigenous patients in this context, and outline calls to action for health care providers and organizations to support the provision of culturally appropriate reproductive health care to Indigenous people.

Overcoming psychological insulin resistance: A practical guide for healthcare professionals

Despite the demonstrated benefits of using insulin, nearly a third of the patients with type 2 diabetes (T2D) are initially reluctant to initiate insulin therapy when it is first recommended by their healthcare provider (HCP). Several studies have documented the reasons for this phenomenon known as psychological insulin resistance (PIR) and also identified actionable strategies for HCPs to assist people with T2D to overcome their PIR. However, most strategies are based on the experiences of HCPs, rather than of patients. Based on findings from a study exploring real-world patient experience around HCP actions for mitigating PIR, we suggest that HCPs use collaborative strategies throughout the course of T2D treatment to 1) explore reasons for PIR, 2) help patients overcome PIR, and 3) follow-up regarding experience with insulin.

Blood pressure management in an ecosystem context.

The Hippocratic text On Airs, Waters, Places advises physicians to attend to all aspects of the environment-the seasons, the wind direction, and the soil and water quality, i.e., the ecosystem-when addressing people's health. Hippocrates emphasizes that the ecosystem influences health, disease, and therapeutic choices. Now is the time to consider how this medical wisdom can be integrated into healthcare systems and utilized for people's health. This review discusses how the ecosystem can affect blood pressure (BP) in humans and provides a synthesis of the related resources available in the literature to inform the actions of healthcare providers.

Inter-facility transfers for advanced critical care services: Impacts on rural families.

The aim of this article is to provide an integrative review of rural family members' experiences of a relative's inter-facility transfer to an urban tertiary care centre for advanced critical care services. Although there is an increasing awareness of the negative consequences of a relative's critical illness for family members, there has been limited research conducted on the impacts of this experience for families of patients in rural settings who require an inter-facility transfer for advanced services. The search strategy for this review was framed by the study purpose, research question, and a conceptual structure of key constructs. Databases and reference lists were electronically and manually searched. Articles were included if they were research articles, available in English, and focused on family members' experiences of inter-facility transfer during critical illness. Articles focusing on critical care transfers within a single urban setting, elective transfers undertaken for patient or family preference, transfers not associated with critical illness, and systematic or scoping reviews were excluded. Stress and anxiety are central to the rural family members' experience of this phenomenon. These constructs are influenced by modifiable factors, including the actions of health care providers, the financial burden associated with the transfer, the family members' physical proximity to the patient, and their access to information and support networks. Further research is required to explore potential short- and long-term consequences of this experience and the experience of family members who are left behind and to develop and test interventions to support families. This review highlights the concern that health care providers frequently misunderstand the needs of family members who are experiencing this phenomenon. Through a better understanding of this phenomenon, health care providers will be better positioned to effectively support these individuals during this unique experience.

The Effect of Drug-Related Problems on Blood Glucose Level in the Treatment of Patients with Type 2 Diabetes Mellitus.

AIM:The study aimed to investigate the effect of drug-related problems (DRPs) on changes in blood glucose level (BGL) in the treatment of type 2 diabetes mellitus (T2DM) patients.METHODS:This three-month prospective cross-sectional study was conducted to patients of T2DM with complications hospitalised in Haji Adam Malik (HAM) Hospital, Medan, Indonesia period from July to October 2018. DRPs were identified and classified by using Cipolle DRP classification and trustable literature. The data obtained were analysed by Chi-Square test (p < 0.05 implied that there was a significant relationship).RESULTS:This study involved 81 T2DM patients, 52 (64.2%) of the patients were male, and 29 (35.8%) of them were female. Most (30.9%) of patients were at the age of 51-60 years. Combination of rapid-acting and long-acting insulin was the most frequently provided antidiabetic drugs (69.1%). There were 68 DRPs experienced by 32 (39.5%) of the patients. Percentage of DRP experienced by the 32 patients by number: 1 DRP, 53.1; 2 DRPs, 28.1; 3 DRPs, 3.1; 4 DRPs, 3.1; 5 DRPs, 3.1; 7 DRPs, 9.3. This study showed that 27.2% and 12.3 % of the patients had hyperglycemia and hypoglycemia, respectively. There was no significant relationship between BGL and indication without drug therapy (p = 0.064), ineffective provided drug (p = 0.079), and there was a significant relationship between BGL and irrational dose (p = 0.000). Furthermore, there was a significant relationship between hypoglycemia and adverse drug reaction (p = 0.000).CONCLUSION:DRPs are common among T2DM patients and still required the attention and appropriate actions of healthcare providers.

Call to Action to Reduce Tobacco Use During Pregnancy

Tobacco use is a leading preventable cause of adverse maternal and child health outcomes. However, many women in the United States still report smoking during the third trimester of pregnancy. Smoking rates during pregnancy are particularly high among vulnerable women, such as those who experience mental illness, substance use disorder, homelessness, or interpersonal violence. The Tobacco Control Vaccine is a model based on population-level, evidence-based practices to reduce tobacco use. The four elements of the Tobacco Control Vaccine are access to treatment for tobacco dependence, smoke-free policies, increased tobacco taxes, and media campaigns. The purpose of this commentary is a call to action for health care providers to advocate for increased access to treatment for tobacco dependence; stay up-to-date on innovative, tailored treatment practices; and advocate for comprehensive, smoke-free policies, higher tobacco taxes, and media campaigns to help pregnant women quit smoking and avoid relapse in the postpartum period.

Parental Moral Distress and Moral Schism in the Neonatal ICU.

Ethical dilemmas in critical care may cause healthcare practitioners to experience moral distress: incoherence between what one believes to be best and what occurs. Given that paediatric decision-making typically involves parents, we propose that parents can also experience moral distress when faced with making value-laden decisions in the neonatal intensive care unit. We propose a new concept-that parents may experience "moral schism"-a genuine uncertainty regarding a value-based decision that is accompanied by emotional distress. Schism, unlike moral distress, is not caused by barriers to making and executing a decision that is deemed to be best by the decision-makers but rather an encounter of significant internal struggle. We explore factors that appear to contribute to both moral distress and "moral schism" for parents: the degree of available support, a sense of coherence of the situation, and a sense of responsibility. We propose that moral schism is an underappreciated concept that needs to be explicated and may be more prevalent than moral distress when exploring decision-making experiences for parents. We also suggest actions of healthcare providers that may help minimize parental "moral schism" and moral distress.

Poster Number: EI 1 - Psychiatrists as Essential Proponents of Culture Change in the Improved Integration of Advance Care Planning

Introduction: Despite creating standards and publishing calls to action for healthcare providers and institutions, the effective implementation of advance care planning (ACP) in the United States remains alarmingly low. There are myriad barriers to the effective integration of ACP such as time, money, knowledge, comfort, access and lack of resources. While some groups have begun to study barriers to ACP, there still remains an overall lack of a cohesive understanding of the problems and ways forward. Research shows that the potential benefits of ACP for patients, families and providers are very high and yet their utilization and implementation remains low. Interventions studied thus far have generally proven either too costly to the patient and healthcare system or too simplistic to effect meaningful change. The fact then becomes clear that what is truly called for, in addition to discrete interventions, is an overall culture change regarding how the medical community approaches ACP for patients and families. The field of psychiatry sits in a distinct position of being able to lead and advocate for this culture change as a result of psychiatrists' expertise in providing comfort and education while discussing topics that are otherwise uncomfortable to discuss or poorly understood.

Implementing an Evidence-Based Outpatient Program to Reduce Postpartum Weight Retention

In 2009, the Institute of Medicine published the report Weight Gain During Pregnancy: Reexamining the Guidelines as a call to action for health care providers. The report suggests that at 6 months postpartum, approximately 50% of women still retained an excess weight of 10 pounds or more and that 25% retained 20 pounds or more. Long-term consequences of postpartum weight retention and subsequent obesity include postpartum depression, successive pregnancy complications, and chronic health conditions. This article describes Motivated Moms, an evidence-based postpartum weight management program in an outpatient clinic. Motivated Moms uses a multilevel approach including diet, social support, and self-monitoring, with the goal of reducing postpartum weight retention.

Process quality indicators for chronic kidney disease risk management: a systematic literature review.

Quality indicators (QIs) can be used for measuring the quality of actions of healthcare providers. This systematic review gives an overview of such QIs measuring processes of care for chronic kidney disease (CKD), and identifies the QIs that have content, face, operational and/or predictive validity. PubMed and Embase were searched using a strategy combining the terms "quality of care," "quality indicators" and "chronic kidney disease". Papers were included if they focused on developing, testing or applying QIs for assessing the quality of care in adult patients with CKD not on renal replacement therapy. Two hundred and seventy-three QIs from thirty-one papers were extracted, including QIs on adequate monitoring of kidney function and vascular risk factors, on indicated treatment, drug safety, adherence and referral to a specialist. The QIs that were considered content, face and operational valid focused on monitoring of glomerular filtration rate, albumin-creatinine ratio, lipid levels and blood pressure, the use of non-steroidal anti-inflammatory drugs, nitrofurantoin and biphosphonates in patients with CKD, and QIs on monitoring haemoglobin and treatment with angiotensin-converting-enzyme-inhibitors/angiotensin-receptor-II-blockers in patients with CKD and comorbidities. No QIs were tested for predictive validity. In addition, only two QIs focused on diet and no other QIs focused on lifestyle management. Based on this review, sufficiently validated QIs can be selected for measuring the quality of CKD care. This review provides insight in QIs that need further validation, and in areas of care where QIs are still lacking.

County Health Rankings: Relationships Between Determinant Factors and Health Outcomes.

The County Health Rankings (CHR) provides data for nearly every county in the U.S. on four modifiable groups of health factors, including healthy behaviors, clinical care, physical environment, and socioeconomic conditions, and on health outcomes such as length and quality of life. The purpose of this study was to empirically estimate the strength of association between these health factors and health outcomes and to describe the performance of the CHR model factor weightings by state. Data for the current study were from the 2015 CHR. Thirty-five measures for 45 states were compiled into four health factors composite scores and one health outcomes composite score. The relative contributions of health factors to health outcomes were estimated using hierarchical linear regression modeling in March 2015. County population size; rural/urban status; and gender, race, and age distributions were included as control variables. Overall, the relative contributions of socioeconomic factors, health behaviors, clinical care, and the physical environment to the health outcomes composite score were 47%, 34%, 16%, and 3%, respectively. Although the CHR model performed better in some states than others, these results provide broad empirical support for the CHR model and weightings. This paper further provides a framework by which to prioritize health-related investments, and a call to action for healthcare providers and the schools that educate them. Realizing the greatest improvements in population health will require addressing the social and economic determinants of health.