Aspects Of Care Research Articles

Born in Ethiopia

Abstract Background Goal 3 of the United Nation 2030 Agenda states that we want to ensure health and well-being for all. This is even more true for countries in the IV World. The aim of our study is to investigate the timing of childbirth in Ethiopia. Methods The stages of our ethnographic study include: choosing the study topic and location, participating in group life, collecting and analysing data. The field experience, led by a midwife, took place from September 2023 to October 2023 in Ethiopia, within the Saint Luke Catholic Hospital in Wolisso. Results The instruments that the midwives have at their disposal are few and obsolete: the most is Pinard’s stethoscope. The mothers are all very young: the youngest woman was fourteen years old while the oldest woman was thirty-eight years old. As for parity, the fertility rate is around 4.6 live births per woman. Women’s family members take care of them in all aspects of care. Pregnant and new mothers receive support from their attendants, an all-female network. Pregnancy monitoring is almost non-existent. There is no prenatal diagnosis. In 2022, St. Luke’s hospital saw a 20% caesarean section rate, an increase from the previous two years. Poverty and the lack of government facilities that can support a problem child are two of the reasons why many of these children are abandoned. In terms of maternal and child health, mortality indicators are still too high for mothers and children. There are 353 mothers dying per 100,000 live births and 41 babies dying per 1,000 live births. Conclusions The biomedical model exported from the Western world, as shown for example by the increase in caesarean sections, has led to a slow but progressive hospitalisation of childbirth in the search for safety from maternal and neonatal mortality. Key messages • Poverty, malnutrition, lack of sanitation and drinking water, as well as early pregnancies and high parity remain among the leading causes of mortality in Ethiopia. • The biomedical model exported from the Western world has led to a slow but progressive hospitalisation of childbirth in the search for safety.

New House, New Furniture, New Room: Children’s Pandemic Landscapes of Care in Chile

Standing at the intersection between geographies of care and children’s geographies, we present three ethnographic stories (emerging from three ethnographic studies) through which we argue that, as a result of pandemic confinement in Chile, children’s places within their landscapes of care shifted in a twofold sense: First, given the de-mobilisation and spatial concentration of spaces of care at home, children’s place became closer to adults,’ suspending the usual spatial segregation that separates them. And second, in tandem with this new proximity that we refer to as in-person family relationships, new possibilities for the involvement of children in family care practices emerged. This rearrangement of children’s places within landscapes of care brings to the fore two interrelated aspects of family care from children’s perspective. First, the kind and amount of in-person family time spent in a shared space in “normal” times was not enough from the perspective of children’s needs and interests. And second, even though children are usually seen as subjects of care, they are people who care for others and who are able to take on more caring responsibilities than the ones that they usually are expected to.

Leveraging digital platforms to improve Public Health in hospital smart buildings

Abstract The integration of digital platforms into hospital infrastructure represents a significant leap forward in public health management. This session explores how smart hospital buildings, equipped with advanced digital technologies, can enhance public health outcomes through more effective disease surveillance, improved environmental controls and enhanced patient care management. Smart hospital buildings utilize a range of new technologies such as IoT sensors, AI-driven analytics and big data solutions to monitor and optimize various aspects of hospital operations and care. These technologies enable real-time data collection on environmental conditions, patient health metrics and resource utilization, creating an ecosystem that not only supports the immediate health needs of patients but also contributes to broader public health goals. The session will address four key areas where digital platforms can make an impact: -Disease Surveillance and Management: Digital tools can track health data trends and patterns within hospital settings, enabling early detection of infectious outbreaks and more precise tracking of patient outcomes. -Environmental Monitoring: IoT sensors can continuously assess conditions such as air quality, temperature and humidity, which are critical for preventing hospital-acquired infections and ensuring a safe environment for patients and staff. -Resource Optimization: AI algorithms can analyse data to optimize resource allocation, ensuring that medical supplies and human resources are used efficiently, which is crucial in health emergencies. -Patient-Centred Care: Digital platforms can facilitate personalized patient care through real-time health monitoring and data analysis, ensuring timely medical interventions and better health management. This session will highlight case studies demonstrating successful implementation of digital technologies in smart hospital buildings and discuss the challenges and lessons learned from these initiatives.

Improving breast cancer care post-pandemic from the patient perspective

Abstract Background Since the onset of the pandemic, breast cancer (BC) services have been disrupted in most countries. The purpose of this qualitative study is to explore the unmet needs, patient-priorities, and recommendations for improving BC healthcare post-pandemic for women with BC and to understand how they may vary based on socio-economic status (SES). Methods 37 women were invited to take part in follow-up semi-structured qualitative interviews in early 2023. The interviews explored their perspectives of BC care since the easing of COVID-19 government restrictions, including unmet needs, patient-priorities, and recommendations specific to BC care. Thematic analysis was conducted to synthesize each topic narratively with corresponding sub-themes. Additionally, variation by SES was analysed within each sub-theme. Results Of the 28 women who participated in interviews, 39% were categorized as high-SES, while 61% were categorized as low-SES. Women expressed unmet needs in their BC care including routine care and mental and physical well-being care, as well as a lack of financial support to access BC care. Patient-priorities included: developing cohesion between different aspects of BC care; communication with and between healthcare professionals; and patient empowerment within BC care. Recommendations moving forward post-pandemic included: improving the transition from active to post-treatment; enhancing support resources; and implementing telemedicine where appropriate. Overall, women of low-SES experienced more severe unmet needs, which resulted in varied patient-priorities and recommendations. Conclusions As health systems are recovering from the COVID-19 pandemic, the emphasis should be on restoring access to BC care and improving the quality of BC care, with a particular consideration given to those women from low-SES, to reduce health inequalities post-pandemic. Key messages • The pandemic has impacted BC services considerably and this study has identified a range of unmet needs, patient-centered priorities, and recommendations. • Particular consideration needs to be given to those women from lower socioeconomic groups, in order to reduce health inequalities, which have been further exacerbated by the pandemic.

Creating a safe space: medical students’ perspectives on using actor simulations for learning communication skills

BackgroundCommunication skills are an essential part of clinical competence that need to be acquired during health professions education. Simulations are extensively used for learning communication skills and have long been integral to medical degree programmes. In this research we use qualitative methodology to explore fourth-year medical students’ experiences in simulations aimed at improving versatile doctor-patient communication, focusing on their learning with trained actors.MethodsThe data comprises reflective writings from 208 fourth-year medical students, gathered after a communication skills course. These students provided informed consent for their writings to be included in the research. We performed an inductive qualitative content analysis on the textual data, with findings presented as themes, supported by categories, codes, and excerpts from raw data to enhance the trustworthiness of the analysis.ResultsWe identified eight key themes capturing students’ learning experiences through simulations: practising in a safe learning environment, valuing feedback, gaining new perspectives, finding simulations valuable and enjoyable, boosting confidence and self-knowledge, and viewing simulations as authentic and engaging learning opportunities. Some students offered critical perspectives on simulations. Throughout the course, students learned diverse aspects of patient care, emotional and behavioural communication dynamics, and lessons from medical errors. Some students offered critical perspectives on simulations, and a few indicated they did not learn anything new.ConclusionsA safe learning environment is vital for encouraging learners to explore, make errors, and absorb feedback to improve their communication with patients. Students predominantly valued the communication skills training with actors and the constructive feedback received and given in the debriefing discussions. However, some students expressed critical views toward simulations. Simulations are not static; they evolve and require continual improvements. Hence, we advocate for the ongoing exploration and enhancement of communication skills learning methods, including simulations, with careful consideration for students’ vulnerability and the importance of psychological safety. Additionally, it is critical to address students’ perceptions that certain clinical teachers prioritise biomedical knowledge over communication skills. Providing tailored training for teachers regarding the learning methods and the desired outcomes of communication courses is essential.

Building the OAChangeMap to improve the service delivery of the New South Wales Osteoarthritis Chronic Care Program: a worked example of using a co-design framework.

The Osteoarthritis Chronic Care Program (OACCP) has been implemented in Australian public hospitals to deliver best-evidence OA care. It is important to ensure that the OACCP continues to deliver evidence-based OA care as intended. We aimed to identify barriers and enablers to delivering the OACCP, prioritise the barriers, and generate strategies to address them. This study provides a worked example of a seven-step theory-informed co-design framework. We invited OACCP coordinators to participate in semi-structured interviews (analysed thematically) and complete a questionnaire to identify barriers and enablers to delivery of the OACCP. We then invited a broader group of stakeholders (OACCP coordinators, health managers, policy makers, consumers, researchers) to prioritise the barriers via a short survey (survey 2). We held five co-design workshops where we mapped the priority barriers to the Theoretical Domains Framework and developed strategies to address them. Sixteen coordinators were interviewed and the main barriers identified were: 1. patients often have beliefs that are inconsistent with best-evidence care; 2. there are aspects of clinical care that are not delivered optimally; and 3. system level factors are a barrier to optimal patient care and sustainability of the OACCP. We co-designed a plan for action with patient educational materials, shared decision-making tools, and health professional education and training. Our worked example of co-design used a theory-based, data driven approach with key stakeholders, identified and prioritised barriers to the delivery of the OACCP, acknowledged enablers, and generated a plan for feasible strategies to improve the program.

Trends in Medicare Utilization and Reimbursement for Traumatic Brain Injury: 2003–2021

Traumatic brain injury (TBI) is a significant public health issue among Medicare beneficiaries, with many specialties reporting consistent annual decreases in utilization and reimbursement. This study investigates the trends in Medicare utilization and rates of reimbursement for neurosurgical procedures related to TBI from 2003 to 2021, aiming to provide insights into the economic aspects of TBI care. Utilizing the Medicare Part B National Summary Data files, we analyzed 14 neurosurgical procedures over the 18-year period, assessing the changes in procedural volume and mean reimbursement per procedure, adjusted for inflation to the 2021 USD using the Consumer Price Index. From 2003 to 2021, TBI-related neurosurgical interventions showed a total percent change of −15.39% in procedural volume and −3.11% in inflation-adjusted mean reimbursement per procedure. Linear regression analyses indicated a significant downward trend in the overall procedural volume (p < 0.001) but no significant trend in the inflation-adjusted mean reimbursement rates (p = 0.585). Subgroup analyses did not reveal significant changes in the reimbursement rates for decompressive craniotomy/craniectomy, cranioplasty, intracranial pressure management, and traumatic fracture/penetration procedures. Our study indicates a significant decrease in neurosurgical TBI procedural volumes, while reimbursement rates remained stable when adjusted for inflation, highlighting the need for policy adjustments to ensure adequate resources for TBI care.

Navigating the COVID-19 crisis: exploring care arrangements and gendered inequalities for migrant women in transnational families in Berlin

ABSTRACT The COVID-19 pandemic has precipitated a notable shift in care responsibilities, transferring them from institutions to families, with a pronounced impact on migrant women in transnational families who navigate both local and transnational care arrangements. This study explored how the pandemic affected women's care arrangements and exacerbated existing inequalities at the intersection of labour, migration, and welfare regimes. Following a qualitative methodology based on grounded theory and ethnography, this study analysed interviews with migrant women, their family members, and experts to understand their experiences with caregiving and transnational family dynamics during the pandemic, the costs and coping strategies related to gendered aspects of care, and the changing landscape of migration and care policies during the pandemic. This study scrutinised the intricate web of local and transnational caregiving structures, emphasising women's agency in negotiating care needs amid pandemic restrictions and constraints on access to formal social protection.

Humans: An integrative review exploring dehumanisation in advanced dementia.

Background: People living with advanced dementia risk being seen as someone without personhood in contemporary societies, an understanding that has been described and challenged for decades in dementia scholarly literature. Such perception can be characterised as forms of existential dehumanisation, which still asserts itself in dementia care practices, adversely affecting the ethical and caring aspects of such care.Aim: To challenge dehumanisation in dementia care, we must first learn to recognise what foster it in caring relations. Thus, the aim of our study is to identify existing perceptions of care recipients living with advanced dementia, which elicit dehumanising attitudes among formal caregivers.Research design: We conducted an integrative review based on Whittemore and Knafl's updated methodology. This allowed us to identify and analyse 26 articles incorporating both qualitative- and quantitative studies as well as theoretical- and grey literature all describing perceptions of care recipients living with dementia that lead to dehumanisation.Ethical considerations: Studying the darker sides in caring relations was to be beneficial in improving dementia care practices.Findings: Through an analytical process five themes that can sprout dehumanising attitudes in caring relations were identified, which include perceiving people living with advanced dementia as (1) absurd, (2) shadow, (3) perilous, (4) void, or (5) repugnant. We argue that these perceptions can be seen as unintentional and stem from a misled embodied perception, which caregivers should learn to recognise and consequently be able to resist through virtue ethics.Conclusion: Our study indicates that challenging dehumanisation is a practical matter of identifying and reacting in a timely way to ones misled embodied perceptions. We suggest the five themes offer a potential means to warn formal caregivers of impending dehumanising attitudes and help them to review how they ethically are thinking and perceiving the person living with advanced dementia.

System opieki nad małym dzieckiem w Danii z perspektywy osób rozważających emigrację

The purpose of this article is to present the Danish childcare system before starting school, to analyze the types of care available and its provision in the context of children’s developmental needs. The text describes types and terms of care and the care facilities. It also indicates the principles of the pedagogical plan, what values it reflects and what aspects of care and upbringing are paid attention to in Denmark. The system is described in the context of the assumptions of developmental psychology, and so the basis of the assumptions for caring for children and supporting their development is defi- ned. The developmental effects of implementing the pedagogical plan are analyzed.

Does Early Exposure Change Pediatric Residents' Perceptions of Developmental-Behavioral Pediatric Care?

ABSTRACT Objective: To explore the impact of a new “Intro to DBP” rotation on pediatric residents' interest in developmental-behavioral pediatrics (DBP) and comfort in providing DBP care. Methods: All first-year pediatric residents participated in a new 1-week DBP rotation. Experiences included clinic visits; interdisciplinary evaluations; asynchronous online learning; and lectures, journal clubs, and/or case conferences. Participants completed pre- and postrotation surveys. Surveys focused on awareness of the DBP field; career plans; and perceived importance of, comfort with, and interest in learning about DBP care. We analyzed data using descriptive statistics and Bhapkar's test to compare distribution differences on pre- and postrotation Likert scales; we reviewed open-ended questions to identify themes. Results: Thirty-two residents participated; 56% had no previous exposure to DBP. After the rotation, there was a statistically significant increase in resident-reported importance of DBP care (p < 0.0001), comfort in providing DBP care (p < 0.0001), and interest in pursuing a DBP fellowship (p = 0.0048). Themes identified from open-ended responses suggested that the rotation led to a broader understanding of the DBP field, reinforcement and expansion of knowledge pertinent to all pediatric care, and improved understanding of systems of care. Conclusion: Brief, early exposure to DBP during pediatric residency training led to increased awareness of and comfort in providing DBP care. Residents described a broader understanding of the depth and breadth of DBP and its applicability to all aspects of pediatric care. Early introduction to DBP during residency training may stimulate greater interest in the field and greater comfort among general pediatricians to provide DBP care.

Attitudes and Experiences Among Swedish NICU Nurses Regarding Skin-to-Skin Care of Infants Born at 22-23 Weeks of Gestation.

Skin-to-skin care (SSC) is an evidence-based care method for preterm-born infants. Staff may hesitate to initiate early SSC, the first or second week of life, for the most extremely preterm infants; 1 reason could be nurses' attitudes. The aim was to investigate the attitudes and experiences of neonatal nurses regarding early SSC for the most extremely preterm infants, born at gestational week (GW) 22-23, using an exploratory and descriptive approach. A web-based survey was sent to all nurses across the 6 Swedish units routinely caring for the most extremely preterm infants. Descriptive statistics and qualitative content analysis were used to analyze the data. The response rate was 258 out of 547 (47%). This study reveals a spectrum of attitudes and experiences among nurses, ranging from viewing early SSC as an integral aspect of infant care to deeming it very challenging or simply not feasible. The outcomes are presented in 2 categories, describing both facilitators and challenges associated with early SSC. Noteworthy, facilitators include well-implemented guidelines that support early SSC. Conversely, challenges encompass knowledge gaps and the scarcity of scientific evidence demonstrating the safety of all SSC, including early, for the most extremely preterm infants. This study underscores the importance of spreading knowledge, and has clinical adapted guidelines about the practical aspects of SSC for infants born at 22-23 GW. Future research is required to clarify safety aspects pertaining to SSC for the most extremely preterm infants.

Assessment of the sentiments expressed by traumatic brain injury patients and caregivers: A qualitative study based on in-depth interviews

IntroductionTraumatic Brain Injury (TBI) is a significant public health concern that causes death, disability, and economic burden. Its repercussions affect physical, cognitive, emotional, and behavioral aspects of long-term care needs. Despite improvements in communication among multidisciplinary teams, the management of TBI remains fragmented. ObjectiveThis study aimed to assess patients and caregivers’ experiences through sentiment analysis. Materials and methodsA qualitative cross-sectional study utilized structured topic modeling (STM) to analyze in-depth interview data. The study involved 29 patients with TBI and 27 caregivers in Madrid (Spain), using a survey design. The interviews were conducted, transcribed, and coded independently over 5 months. Sentiments such as anticipation, fear, and emotional concerns were analyzed using three dictionaries. The STM analysis identified four key concepts: desire for independence, potential improvement, need for injury information, and psychological consequences. STM diagnostic graphs were used to determine the number of topics relevant to the evaluation of patient and caregiver concerns. Furthermore, an analysis was conducted across four topics. ResultsThe average age of the patients was 44.2 ± 14.9 years (69 % males). Regarding TBI severity, 59 % of patients had severe TBI, whereas the remaining 41 % had experienced moderate TBI. Among the caregivers, the majority were parents (30 %), partners (24 %), or siblings (24 % each). Among the 51 participants, sentiments were analyzed using three dictionaries. While there were no significant age differences (Z = 0.24, p = 0.815), the STM model was adjusted for significant sex differences (p = 0.017) between patients and relatives. Anticipation and fear prevailed in both groups, highlighting the shared emotional patterns. DiscussionThe analysis of diagnostic graphs indicated the optimal number of topics for evaluation, emphasizing key concerns across different phases of TBI. Patients' main worries shifted from physical symptoms to limitations in daily life and independence. Caregivers highlighted the importance of staff interactions, misinformation challenges, and the need for psychological care. ConclusionKey patient concerns, including dependency on daily activities, limitations in autonomy, and caregiver burden, emphasize crucial areas for enhancement in multidisciplinary treatment. Moreover, the lack of long-term psychological support is a significant barrier to optimal patient and caregiver well-being.

Twelve Tips for Engaging Medical Students in Rural-Focused Research

Background The future of rural healthcare depends on training the future rural health workforce, and on rural health research that can guide clinical and policy decisions in rural spaces. Promotion of rural healthcare careers usually focuses on clinical aspects of care, and research may be seen as a lower priority. Supporting students to be involved in rural focused research offers the opportunity to broaden the pool of potentially rural interested students, and to develop research and scholarship skills and capacity in the future rural workforce. Aim and method We identify twelve tips that medical schools can adopt to foster medical student participation in research and promote student interest in rural healthcare and rural medical practice. These recommendations are based on a review of literature and our personal experience of conducting rural-focused research activities with medical students. Conclusion Through these twelve tips, we provide a practical framework for enhancing undergraduate medical student exposure to rural-focused research to foster research capacity. This has potential to inspire student interest in future rural medical practice and could contribute to alleviate workforce and research gaps in rural areas.

Narrative Review: Telemedicine Quality after the COVID-19 Public Health Emergency: Time to Reevaluate?

OBJECTIVE: This narrative review explores concerns and potential solutions for improving the quality of synchronous telemedicine visits for high utilizers like primary care, particularly after the COVID-19 pandemic. METHODS: A literature review identified studies published within the past 10 years focusing on telemedicine quality, primary care, and related aspects like liability, virtual exams, and patient safety. RESULTS: Despite the surge in popularity of telemedicine visits, concerns regarding their quality linger. These concerns encompass various aspects of the patient experience, administrative processes, and potential safety risks. Limitations in physical exam capabilities and the lack of readily available vital signs during telemedicine visits raise concerns about the accuracy of diagnoses. This is particularly true for situations requiring a more comprehensive physical assessment. Incomplete documentation due to abbreviated patient histories, missing physical exam findings, and the reliance on generic templates pose liability risks. This lack of thorough information makes it challenging to accurately capture the patient's condition and raises concerns about the quality of care provided. Patients themselves have expressed concerns about accuracy of a virtual visit, thus raising questions about the effectiveness of telemedicine in building rapport and ensuring clear communication. From an administrative standpoint, fears of misdiagnosis due to the limitations of virtual exams, inconsistencies in insurance coverage for telemedicine services, and unclear reimbursement standards for thorough visits continue to pose challenges. These uncertainties create ambiguity and make it difficult for healthcare providers to fully embrace telemedicine as a viable option. Finally, although mirroring in-person visit protocols for patient safety is considered crucial, many organizations currently lack standardized measures to ensure safety throughout the entire telemedicine journey. This includes potential risks during scheduling, appointment execution, and post-visit follow-up, highlighting the need for more robust safety protocols specifically designed for the telemedicine setting. Addressing these concerns is essential for ensuring the quality and sustainability of telemedicine integration. CONCLUSION: While telemedicine offers significant benefits, improving quality is essential for its sustainable integration into primary care. Standardizing protocols, educating clinicians and patients, implementing comprehensive physical exam procedures, and ensuring patient safety throughout the visit are key areas for improvement. Continuous monitoring and data analysis are crucial for identifying and addressing weaknesses and ensuring quality telemedicine care.

Upper Airway Comorbidities of Asthma.

Asthma, characterized as a chronic heterogeneous airway disease, often presents with common comorbid conditions. The concept of 'one-airway-one-disease' was coined, emphasizing the connection between asthma and upper airway comorbidities (UACs) such as allergic or non-allergic rhinitis, chronic rhinosinusitis with or without nasal polyps, and aspirin/nonsteroidal anti-inflammatory drug-exacerbated respiratory disease more than 20 years ago. Since then, numerous studies demonstrate that UACs are closely related and affect asthma phenotypes. Recognizing and managing these UACs are crucial aspects of comprehensive asthma care. Addressing these conditions as part of asthma treatment can lead to better control of symptoms, improved lung function and the quality of life. Moreover, it is important to explore the field of respiratory biologics that represent the latest advancements in medical treatment options for asthma patients with UACs.

One Hundred Years of Seeking Respectful Maternity Care: History and Evolution.

Growing awareness of poor maternal health outcomes and maternal health disparities in the United States has heightened urgency around the need to promote Respectful Maternity Care (RMC) as a fundamental tenet of obstetric/midwifery care and standardize efforts to improve safety, eliminate obstetric violence and racism, and optimize health outcomes for all birthing people. The historical context of prior and contemporary perspectives around childbirth influences our understanding of RMC and are shaped by varying scholarly, clinical, and community standards (e.g., religion, human rights, government, public health, midwifery, ethics, activism, and the law), which have changed significantly since the mid-19th century. In this commentary, we share results of a contextual question scoped as part of a larger systematic review of RMC to help inform consensus around a shared definition and development of a metric to standardize delivery and evaluation of RMC. Synthesis of this literature identified landmark historical influences on RMC over the past 100 years, highlighting the multidisciplinary scholarship and historical context influencing the progress toward RMC. Further understanding of this history may also inform policies and guidance for ongoing efforts to center respect and accountability in all aspects of maternity care, with particular attention to populations who are disproportionally impacted by disrespectful care.

Improve time to anti-coagulation reversal for hemorrhagic strokes

BackgroundOral anticoagulation (OAC) is a risk factor for intracerebral hemorrhage (ICH) which is an important source of disability and mortality. OAC-associated ICH (OAC-ICH) patients have worse outcomes as compared to ICH patients not on OAC, likely because of the associated larger stroke volumes, higher propensity to intraventricular hemorrhage, and a higher risk of rebleeding. Although current guidelines recommend that OAC should be reversed quickly, many health care systems have not developed a process for optimizing that aspect of care. MethodsThrough the IMPROVE Stroke Care Consortium, a group of nine Hub hospitals and their 57 regional community hospitals, a systems of care improvement project was implemented. Performance reviews identified best practices which were disseminated throughout all centers. We compared the median door-to-reversal (DTR) time before and after an institutional campaign to speed the process with a target time of 60 min. ResultsOver two years of the study, there were 6,699 ischemic strokes, 152 subarachnoid hemorrhages, and 889 intracerebral hemorrhages. During that time, 73 ICH patients received reversal agents emergently. The overall baseline median DTR time was 123 min (IQR 99, 361 minutes). By the end of the program, the median DTR time had trended down to 84 min (IQR 58.5, 151 min) which is a 31.7 % reduction of DTR from baseline, though times remained somewhat variable (p=0.08). ConclusionsAn integrated stroke systems of care approach was associated with a reduction in DTR times for patients presenting with acute ICH and concurrent use of anticoagulants despite lack of definitive guidelines around targets for OAC reversal times or operational guidance on protocols and agents.

Stress management training program to address caregiver burden and perceived stress among family caregivers of patients undergoing hemodialysis: a randomized controlled trial study

BackgroundThe objective of the current study was to assess the effectiveness of stress management training, grounded in Lazarus and Folkman’s stress management model, on reducing caregiving burden and perceived stress among family caregivers of patients on hemodialysis.MethodsThis two-group clinical trial study was conducted in parallel design among 60 family caregivers of patients on hemodialysis in 2023. The participants were divided into two groups of training and control using a random quadruple block allocation method. The intervention took place over two months, in six online group sessions of 35–45 min. Zarit Burden Inventory (ZBI) and Cohen’s Perceived Stress Scale (PSS-14) were used to collect information before and two weeks after the intervention. The study data were analyzed using and analysis of covariance (ANCOVA), pair, and independent t-tests at a significance level of 0.05.ResultsAt baseline, the two groups exhibited homogeneity in terms of mean scores for caregiving burden (Training group = 50.8 ± 4.9; Control group = 49.1 ± 6.0; P = 0.264) and perceived stress (Training group = 32.8 ± 4.7; Control group = 31.5 ± 2.4; P = 0.192). Nevertheless, following the intervention, there was a significant decrease in caregiving burden (Training group = 45.9 ± 4.1; Control group = 49.0 ± 5.8; P = 0.017) and perceived stress (Training group = 28.0 ± 4.4; Control group = 30.7 ± 3.5; P = 0.01) scores within the training group compared to the control group.ConclusionBased on the findings of the current study, given that family caregivers of patients on hemodialysis encounter psychological distress and contend with the negative aspects of care, it is advisable to implement psycho-educational interventions, such as stress management training. Incorporating these interventions into the care plan for hemodialysis could help mitigate these adverse consequences and provide valuable support for family caregivers.Trial registrationIranian Registry of Clinical Trials (IRCT), IRCT20180728040617N6. Registered on 17/04/2023.

Challenges and coping strategies among caregivers of children with cancer receiving care at a national referral hospital in Kenya

BackgroundThe number of children diagnosed with cancer is expected to increase by 2050. The caring aspect of these children is usually left to members of the family, more so the mothers. Caregivers are usually faced with various challenges, such as financial issues, social stigma, and emotional and psychological issues. Caregivers use various coping strategies to manage the challenges they experience in the caring process, which can be positive or negative coping strategies.ObjectiveTo explore the challenges and coping strategies of caregivers of children with cancer receiving care at a national referral hospital in Kenya.MethodsThis study employed a descriptive phenomenological approach to explore the challenges and coping strategies of caregivers of children with cancer receiving treatment at a national referral hospital in Kenya. Purposive and snowball sampling techniques were used to select 44 participants for five focus group discussions (FGDs) conducted between October and December 2023. The data were analysed via inductive thematic analysis.ResultsFour themes arose from the challenges experienced, which included psychological, financial, treatment-related, and social/family-related issues. These eleven subthemes included stress, depression, lack of transport, lack of food, loss of employment, treatment delays, and marital issues, among others. Two themes related to coping strategies were positive adaptation and denial, which were highlighted as negative coping strategies. Positive coping included praying, crying, talking to people, and seeking help.ConclusionCaregivers of children with cancer undergo various challenges and apply various coping strategies to try and adapt to their new normal. Reinforcing positive coping strategies and helping caregivers utilize other coping strategies, such as the use of support groups, could help them better care for their children.