Individual Care Research Articles

Developing a clinical decision support framework for integrating predictive models into routine nursing practices in home health care for patients with heart failure

AbstractBackgroundThe healthcare industry increasingly values high‐quality and personalized care. Patients with heart failure (HF) receiving home health care (HHC) often experience hospitalizations due to worsening symptoms and comorbidities. Therefore, close symptom monitoring and timely intervention based on risk prediction could help HHC clinicians prevent emergency department (ED) visits and hospitalizations. This study aims to (1) describe important variables associated with a higher risk of ED visits and hospitalizations in HF patients receiving HHC; (2) map data requirements of a clinical decision support (CDS) tool to the exchangeable data standard for integrating a CDS tool into the care of patients with HF; (3) outline a pipeline for developing a real‐time artificial intelligence (AI)‐based CDS tool.MethodsWe used patient data from a large HHC organization in the Northeastern US to determine the factors that can predict ED visits and hospitalizations among patients with HF in HHC (9362 patients in 12,223 care episodes). We examined vital signs, HHC visit details (e.g., the purpose of the visit), and clinical note–derived variables. The study identified critical factors that can predict ED visits and hospitalizations and used these findings to suggest a practical CDS tool for nurses. The tool's proposed design includes a system that can analyze data quickly to offer timely advice to healthcare clinicians.ResultsOur research showed that the length of time since a patient was admitted to HHC and how recently they have shown symptoms of HF were significant factors predicting an adverse event. Additionally, we found this information from the last few HHC visits before the occurrence of an ED visit or hospitalization were particularly important in the prediction. One hundred percent of clinical demographic profiles from the Outcome and Assessment Information Set variables were mapped to the exchangeable data standard, while natural language processing–driven variables couldn't be mapped due to their nature, as they are generated from unstructured data. The suggested CDS tool alerts nurses about newly emerging or rising risks, helping them make informed decisions.ConclusionsThis study discusses the creation of a time‐series risk prediction model and its potential CDS applications within HHC, aiming to enhance patient outcomes, streamline resource utilization, and improve the quality of care for individuals with HF.Clinical RelevanceThis study provides a detailed plan for a CDS tool that uses the latest AI technology designed to aid nurses in their day‐to‐day HHC service. Our proposed CDS tool includes an alert system that serves as a guard rail to prevent ED visits and hospitalizations. This tool can potentially improve how nurses make decisions and improve patient outcomes by providing early warnings about ED visits and hospitalizations.

Walking Ability After Microsurgical Reconstruction of Pediatric Popliteal Pterygium Syndrome—A Case Report

Background: Popliteal pterygium syndrome (PPS) is a rare congenital disorder characterized by orofacial, cutaneous, musculoskeletal, and genital anomalies. Surgical interventions are necessary to address the severe knee flexion contracture and equinovarus deformity, but there are no established treatment guidelines. Methods: We present the case of a one-year-old patient with PPS and discuss the challenges in managing the knee deformity. The surgical option chosen for the unilateral knee contracture of 80° consisted of skin management by a large Z-plasty, lengthening of popliteal vessels by grafts, lengthening of the tibial and peroneal nerves by autografts and allografts, capsular releases, and tendon releases to improve mobility and preserve foot sensibility. Results: With a three-year follow-up, the surgical interventions resulted in proper ability to walk freely. Wearing of a foot orthesis was necessary to balance the leg length differences and support the midfoot deformity. Furthermore, sensation of the foot could be restored in terms of touch sensibility and perfusion was always stable during growth. Discussion: The treatment of PPS requires a multidisciplinary approach, considering the rarity and complexity of the syndrome. Surgical interventions aim to release contractures, correct deformities, and preserve foot sensibility. Each treatment option has its advantages and disadvantages, highlighting the need for individualized care.

Gender Incongruence in Danish Youth (GenDa): A Protocol for a Retrospective Cohort Study of Danish Children and Adolescents Referred to a National Gender Identity Service

Background/Objectives In recent years, the national Gender Identity Service for individuals under 18 years of age in Denmark has seen a considerable increase in referrals of youngsters during puberty. Given this development, it is important to deepen our understanding of the characteristics of contemporary youngsters seeking help for gender incongruence. This understanding can serve as the foundation for improving current treatment regimens by ensuring optimal individual assessment and care. In this study, we aim to describe the sociodemographic characteristics, health profiles, and treatment trajectories in detail, as well as any changes in these characteristics, of all transgender and gender-diverse youngsters referred to the Gender Identity Service in Denmark from 2016 through 2022. Methods: This is a retrospective observational study of a national cohort comprising all individuals under 18 years of age referred to the Danish Gender Identity Service from 1 January 2016 to 1 January 2023. We will use data from medical records obtained at routine visits from the first assessment through repeated visits. Data on demographics, physical and mental health profiles, and information regarding gender identity will be collected and analyzed. The characteristics of those individuals who progressed to hormone therapy will be compared to those who did not. Results: This study aims to enhance our understanding of the characteristics and needs of contemporary youngsters with gender identity issues. Conclusions: The scientific evidence for the assessment and treatment of gender incongruence in youngsters is limited. The characteristics of youngsters seeking healthcare for gender incongruence today may differ from earlier.

Amputation-Free Survival, WIfI Stage, and GLASS Classifications in Distal Crural or Pedal Bypass for Chronic Limb-Threatening Ischemia

Background: Chronic limb-threatening ischemia (CLTI) is a severe condition with high risks of amputation and mortality, especially in patients with distal crural or pedal artery disease. Despite advances in endovascular techniques, bypass surgery remains crucial for patients with CLTI. This study aimed to investigate amputation-free survival, Wound, Ischemia, and foot Infection (WIfI) staging, and Global Limb Anatomic Staging System (GLASS) classifications in patients undergoing distal crural or pedal bypass for CLTI. Methods: This retrospective study analyzed all patients who underwent distal crural or pedal bypass for CLTI in a tertiary vascular centre from January 2010 to December 2019. The data were collected from hospital records and preoperative imaging. WIfI stages and GLASS classifications were determined for each patient, and the primary endpoint was amputation-free survival. Secondary outcomes included bypass patency, 30-day morbidity, and mortality. Results: We identified 31 bypasses performed on 29 patients with a median age of 67 years (79% male). Preoperatively, 94% of limbs were staged GLASS III and 55% were classified WIfI stage 4. Failed endovascular revascularization preceded bypass surgery in 65% of the cases. Thirty-day mortality was 3% (n = 1) and 30-day major amputation rate was 10%. Primary patency was 87%, and secondary patency was 94% at 30 days. Median duration of follow-up for survival was 59 months with a mean follow-up index (FUI) of 0.99 ± 0.05, and for major amputation and bypass patency 54 months (mean FUI 0.9 ± 0.19 and 0.85 ± 0.28, respectively). At one year, amputation-free survival was 58%, decreasing to 45% at two years, 39% at three years, and 32% at five years. Most major amputations occurred in WIfI stage 4 patients, but 53% of WIfI stage 4 and 80% of WIfI stage 3 patients were alive without major amputation after one year. Conclusions: Distal crural and pedal bypasses are essential for limb salvage in high-risk CLTI patients, particularly those with failed prior revascularization. However, the procedure is associated with limited long-term amputation-free survival. WIfI and GLASS classifications are useful for stratifying risk and guiding treatment, but outcomes suggest the need for individualized care strategies. Further research into perioperative management and alternative interventions is warranted to improve long-term outcomes in this population.

Experiences of Informal Caregivers Caring for Individuals With Chronic Schizophrenia in Asia: A Systematic Review and Meta-Synthesis.

In Asia, many caregivers are culturally obliged to assume the role of taking care of individuals experiencing chronic schizophrenia, even as they grapple with stigma and compassion fatigue. Despite the significance of this phenomenon, the collective experiences of Asian caregivers remain poorly understood. To synthesise qualitative evidence on the experiences of informal caregivers when caring for individuals with chronic schizophrenia in Asia. A search was conducted on seven databases for studies published between 2013 and 2023. The included studies were appraised using the Critical Appraisal Skills Program tool. Data extraction was based on the Joanna Briggs Institute (JBI) Qualitative Extraction Form. The data synthesis was based on the framework by Sandelowski and Barroso. Our review included the experiences of 1345 informal caregivers from 57 included studies. The analysis yielded the overarching theme of 'Navigating Challenges, Forging Resilience'. Three themes were identified: (i) challenges in caregiving, (ii) lack of support and (iii) coping and resilience. Our findings highlighted the Asian caregivers' stressors, particularly cultural and traditional factors, a facet often overlooked in the literature. Mental healthcare practitioners must provide caregivers with comprehensive information. Anticipatory guidance is essential during the initial stages of the diagnosis. To negate geographical limitations, caregiver-training sessions can be pre-recorded and posted to online platforms. Finally, cultural and spiritual beliefs can be integrated into the treatment plans for individuals with schizophrenia in the community. Within the institutional setting, mental healthcare practitioners are encouraged to provide caregivers with comprehensible information or training in person and through written or online platforms, which can transcend geographical limitations. Anticipatory guidance is essential, especially during the initial stages of the diagnosis, when confusion and uncertainties are prevalent. Periodic home visits by mental healthcare practitioners can help ease caregivers' concerns and enhance their caregiving confidence. Finally, cultural and spiritual beliefs should be integrated into the treatment plans for individuals with schizophrenia in the community as it promotes cultural acceptability, encourages referrals to appropriate institutions and reduces the stigma of mental healthcare.

The Application of Trauma-Informed Care to Health Care for Military-Connected Individuals.

Military families face unique stressors beyond civilian life, such as deployments, frequent relocations, and the potential for combat, all of which can significantly impact well-being. A trauma-informed care (TIC) approach to military medicine is paramount; however, a critical gap exists, with no published curricula to guide practitioners in employing TIC in the care of military-connected individuals. We delivered a 50-minute interactive and virtual session to second-year medical students at the Uniformed Services University (USU) that reviewed the neurobiology of adversity and the relevance of TIC in caring for military-connected populations. Participants completed a 14-question pre- and posttest on perceived knowledge, attitudes, practice, and confidence, as well as posttest questions evaluating session quality. The USU Institutional Review Board approved this evaluation. One hundred sixty medical students participated in the session, with 78 matched pre- and posttest responses. We observed a statistically significant pre-post improvement (p ≤ .05) in all category scores, with the largest changes in knowledge (1.33) and confidence (1.33). On a 5-point Likert scale, with 5 being best, mean scores for overall quality of the session and relevance of the material to participants' learning and future practice were 3.95 and 4.20, respectively. By equipping health care providers with knowledge and confidence to apply TIC in military medicine, we can improve the well-being of service members and their families across both military and civilian health care settings. Broader implementation of this program has potential to improve patient outcomes and overall health care delivery for this population.

The Effect of Ambient Artificial Intelligence Notes on Provider Burnout.

Healthcare provider burnout is a critical issue with significant implications for individual well-being, patient care, and healthcare system efficiency. Addressing burnout is essential for improving both provider well-being and the quality of patient care. Ambient artificial intelligence (AI) offers a novel approach to mitigating burnout by reducing the documentation burden through advanced speech recognition and natural language processing technologies that summarize the patient encounter into a clinical note to be reviewed by clinicians. To assess provider burnout and professional fulfilment associated with Ambient AI technology during a pilot study, assessed using the Stanford Professional Fulfillment Index (PFI). A pre-post observational study was conducted at University of Iowa Health Care with 38 volunteer physicians and advanced practice providers. Participants used a commercial ambient AI tool, over a 5-week trial in ambulatory environments. The AI tool transcribed patient-clinician conversations and generated preliminary clinical notes for review and entry into the electronic medical record. Burnout and professional fulfillment were assessed using the Stanford PFI at baseline and post-intervention. Pre-test and post-test surveys were completed by 35/38 participants (92% survey completion rate). Results showed a significant reduction in burnout scores, with the median burnout score improving from 4.16 to 3.16 (p=0.005), with validated Stanford PFI cutoff for overall burnout 3.33. Burnout rates decreased from 69% to 43%. There was a notable improvement in interpersonal disengagement scores (3.6 vs. 2.5, p<0.001), although work exhaustion scores did not significantly change. Professional fulfillment showed a modest, non-significant upward trend (6.1 vs. 6.5, p=0.10). Ambient AI significantly reduces healthcare provider burnout and may enhance professional fulfillment. By alleviating documentation burdens, ambient AI can improve operational efficiency and provider well-being. These findings suggest that broader implementation of ambient AI could be a strategic intervention to combat burnout in healthcare settings.

Narrative Coherence and Relational Agency: Unraveling Transitions Into and Out of Alberta Correctional Facilities for People Living With HIV.

Incarcerated populations in Canada face significant health and social challenges during transitions into and out of correctional facilities. These transitions around facilities pose disproportionate barriers to care for people living with HIV. Further research is crucial to comprehend these challenges and reimagine care concepts for people who experience structural marginalization. In this article, experiences of transitions into and out of Alberta correctional facilities for people living with HIV are explored using narrative inquiry. Conducted in a Western Canadian city from 2021 to 2022, the inquiry revolved around two men living with HIV and a history of incarceration. Through co-creating field texts and narrative accounts, their unique experiences of transitions were explored through a collaborative process of analysis. Narrative threads from Bruce and Kyle showcased a lack of narrative coherence and the presence of tensions in their lives, while also emphasizing relational agency. The findings provide avenues for health, social, and justice practitioners who support and care for individuals living with HIV and a history of incarceration to think differently about transitions. By highlighting the importance of attending to the unique identities of individuals and relationships from a position of relational agency, the study advances our understanding of transitions. Recommendations for practice and policy include (a) fostering relational agency among practitioners; (b) challenging conventional views of transitions around correctional settings; (c) incorporating peer-based programming into support services; and (d) reconsidering health, justice, and social systems to better support communities disproportionately affected by high rates of incarceration and HIV.

Exploring healthcare professionals' knowledge of how to identify and respond to child sexual abuse.

Evidence on the incidence of child sexual abuse (CSA) indicates it is a global epidemic that adversely affects the short- and long-term physical and mental health outcomes of those affected. Learning from safeguarding practice reviews suggests healthcare professionals (HCPs) are in a unique position to identify and intervene when they suspect CSA. However, research suggests that HCPs have insufficient knowledge to identify CSA, intervene and manage the individual's care. This article reports the findings of a systematic literature review that explored HCAs' knowledge of how to identify and respond to CSA. The findings from the published research on this topic indicate that HCAs have limited knowledge and confidence, which can prevent them from fulfilling their mandatory safeguarding roles. The literature review emphasises the need to improve training to ensure better health outcomes for children and young people who have been sexually abused.

Factors influencing the ability of family caregivers of Alzheimer’s patients within Iranian families to continue and persist in their caregiving roles: a qualitative study

BackgroundUnderstanding the motivations driving family members to continue caring for individuals with Alzheimer’s disease is crucial for enhancing social support programs within community health systems. This study specifically explores the factors influencing Iranian family caregivers’ ability to persist in their caregiving roles.MethodsThis qualitative study was conducted using conventional content analysis with 22 participants in 2022 in Babol (a city in northern Iran). The inclusion criteria for the study included caregivers of Alzheimer’s patients who had been the primary caregivers for at least one year for patients with a confirmed diagnosis of Alzheimer’s disease. The sampling method was purposive, ensuring maximum variation in social position, demographic status, and stages of Alzheimer’s disease after the onset of symptoms. In this research, data were collected from caregivers of Alzheimer’s patients through semi-structured interviews and in-depth individual interviews. The data were analyzed using MAXQDA software.ResultsOne category and four subcategories were identified to explain the continuity of the caring role in family caregivers of Alzheimer’s patients. The category was “on the Fence of the Caring Role.” The subcategories included Commitment to Care (Being Determined, Being Indebted, Feeling Dutiful), Coercion to Care (Giving in to the Caring Role Due to Family Requirements, Patient Care Due to Financial Problems), Socio-Cultural Beliefs and Concerns (Spiritual and Religious Tendencies, Social Stigma and Social Fears), and Attachment and Love for the Patient (Feeling Pity, Feeling Nostalgia for Kinship).ConclusionFamily caregivers are deeply engaged in their roles, often feeling trapped by various pressures. Recognizing these dimensions can inform policymakers and health practitioners in developing targeted interventions, such as respite care programs, financial support, and community resources, aimed at alleviating caregiver burden and enhancing the quality of care for patients. By addressing the complexities of the caregiver experience, effective strategies can be implemented to support both patients and their caregivers, ultimately improving health outcomes within the community.

Incidence, Risk Factors and Predictors of Phantom Shocks in Patients with Implantable Cardioverter Defibrillators: State-of-the-art Review

Background: Extensive research has been devoted to ICDs, but there is still a significant gap in the literature regarding phantom shocks (PSs). Understanding the frequency, predictors, risk factors, management and health implications of PSs is essential. This review aimed to comprehensively investigate PSs in patients with ICDs up to the present day. Specifically, the review explores the incidence of PSs, identifies risk factors that may increase their likelihood and determines predictive factors to help anticipate their occurrence. By addressing these points, the study aimed to enhance the understanding and management of PSs in ICD patients. Methods: This study reviewed central databases from their inception up to March 2024. The primary objective was to examine the occurrence of PSs in patients with ICDs. Data were gathered on patient demographics, incidence rates, and various risk factors and predictors that might affect the occurrence of PSs. Then, a detailed analysis of the collected data was conducted to identify significant associations between these risk factors, predictors and the incidence of PSs. Results: This review identified a significant association between prior ICD shocks, defibrillation threshold testing, the presence of depression and anxiety for the occurrence of PS in patients with ICDs. This underscores the importance of thoroughly evaluating and managing these factors to improve the care of individuals with ICDs. Conclusion: PSs are often associated with various factors, such as previous shock therapy, defibrillation threshold testing, depression, anxiety and higher levels of education. It is crucial for healthcare providers to acknowledge these correlations and provide personalised care to patients experiencing PSs.

Cancer-Related Cognitive Impairment: A Survey of Speech-Language Pathologists' Knowledge, Training, and Attitudes

Purpose: This study examined speech-language pathologists' (SLPs') professional knowledge, training experiences, and attitudes in assessing and treating individuals with cancer-related cognitive impairments (CRCIs). Understanding these concepts is necessary for evaluating SLPs' role in supporting individuals with CRCIs. Method: A web-based survey was completed by 147 SLPs over a 2-month period. The survey explored their professional knowledge, training, and attitudes regarding CRCI assessment and intervention. Results: Three quarters of participants reported some experience with individuals with CRCIs. Most participants reported that providing care for individuals with CRCIs was within the SLP scope of practice (97%) and an ethical responsibility (93%). Approximately 65% of participants completed some form of training for providing services for this population; 98% would pursue diagnostic training in the future, and 66% would pursue intervention training in the future. Regarding attitudes, 80% of participants shared that they were comfortable with the idea of providing cognitive-communication services to individuals with CRCIs, and almost all (97%) felt that cognitive-communication services were a medical necessity for this population. Additional analyses were conducted to assess the effect of years of experience on various aspects of professional knowledge and attitudes. Conclusions: SLPs were trained to assess and treat the cognitive-communication domains impacted by CRCIs. Recommendations for meeting this need are also discussed. Further research regarding the role of SLPs in the assessment and treatment of CRCIs is warranted.

Ethics in the provision of obstetric and gynecologic health care for non-binary and transgender individuals.

Transgender and non-binary individuals often face bias and a lack of awareness, knowledge, and sensitivity from healthcare professionals. This article aims to raise awareness of the concepts of medical ethics among OBGYNs, so they will be better able to approach complex ethical situations in a clear and structured way when providing obstetric and gynecologic health care for transgender and gender-diverse patients.

P17 Infectious sacroiliitis: an uncommon septic arthritis

Abstract Introduction Infectious sacroiliitis, an infection of the sacroiliac joint, can cause severe morbidity if not promptly treated. Staphylococcus aureus is a common pathogen, especially problematic in patients on chronic hydrocortisone therapy due to its immunosuppressive effects. This case report discusses the diagnosis and treatment challenges of infectious sacroiliitis in such immunocompromised patients, highlighting the necessity of a minimum six-week targeted antibiotic regimen to ensure bacterial eradication and prevent relapse. The report emphasises aggressive and sustained treatment for optimal outcomes in these vulnerable patients. Case description A 47-year-old man was admitted with fever, constant feeling of tiredness, and severe right-sided gluteal pain radiating to the right lower extremity, worsening with movement. He has a history of ACTH deficiency, managed with 25 mg of oral hydrocortisone daily. Examination revealed skin eczema, tenderness in the right gluteal region, and an inability to flex the right hip. His temperature was 39 °C, and CRP levels were over 400 mg/L (normal &amp;lt; 5 mg/L). Two sets of blood cultures showed Staphylococcus aureus. Echocardiogram ruled out of infective endocarditis. An MRI of the lumbar spine showed edema in the right posterior paraspinal muscles at L4, while a CT scan of the abdomen and pelvis revealed fat stranding around the second sacral vertebra and significant inflammation in the right iliacus and distal psoas muscles. The patient was treated with 21 days of intravenous flucloxacillin, resulting in negative blood cultures and improved inflammatory markers, leading to discharge. One week later, he was readmitted with severe gluteal pain and fever. Blood cultures again showed Staphylococcus aureus. A repeat MRI indicated an abnormal signal around the right sacroiliac (SI) joint, with extensive edema and swelling in the right gluteal, iliacus, posterior paraspinal, and obturator muscles, suggesting sacroiliitis. The patient received six weeks of intravenous flucloxacillin. After this extended antibiotic therapy, his pain and fever resolved, laboratory parameters normalised, and blood cultures were negative. Discussion Bacterial infection is a serious cause of arthritis, with infective sacroiliitis being particularly rare, accounting for just 1-2% of all septic arthritis cases. Diagnosing this condition can be challenging despite clear symptoms, often leading to delays. This case highlights several important aspects of managing severe musculoskeletal infections. Firstly, it emphasises the need for a comprehensive diagnostic approach, utilising blood cultures, imaging, and echocardiography to precisely identify the source and extent of the infection. Treating deep-seated musculoskeletal infections is especially challenging in patients with underlying conditions which can complicate the clinical picture and impact immune response. The recurrence of infection despite initial appropriate antibiotic therapy suggests the need for prolonged and potentially more aggressive antimicrobial treatment. Close monitoring for complications or recurrence is essential. The decision to restart IV flucloxacillin and extend the antibiotic course to at least six weeks represents a strategic adjustment based on clinical progression and imaging results. Given that the patient is currently on standard hydrocortisone therapy for ACTH deficiency, transitioning to modified-release hydrocortisone therapy may be a better option as it more closely mimics the circadian rhythm of glucocorticoids, normalises the immune cell profile, and reduces the incidence of recurrent infections. This case underscores the necessity for clinicians to remain vigilant for recurrent infections, considering extended or repeated imaging and microbiological studies in patients not responding as expected to initial therapy. It also highlights the importance of individualised treatment plans, especially for patients with complex medical histories and comorbidities, to achieve optimal clinical outcomes. Key learning points • Diagnostic challenges: Infectious sacroiliitis is rare and difficult to diagnose, requiring comprehensive approaches including blood cultures, imaging and echocardiography. • Immunocompromised patients: Patients on chronic hydrocortisone therapy are at higher risk for infections like sacroiliitis due to immunosuppression. Modified hydrocortisone may represent a superior option, as it more closely mimics the physiological circadian rhythm of glucocorticoids, normalises the immune cell profile, and reduces the incidence of recurrent infections. • Rare disease: Infectious sacroiliitis is a rare and often overlooked condition that requires a high index of suspicion for accurate diagnosis. Early recognition and prompt treatment are crucial to prevent serious complications and improve patient outcomes. • Prolonged treatment: Initial antibiotic therapy may lead to temporary improvement, but extended antimicrobial regimens (at least six weeks) are often necessary to prevent relapse. • Relapse management: The recurrent of symptoms and positive cultures necessitates vigilant monitoring and possibly more aggressive and prolonged antibiotic treatment. • Individualised care: Effective management of deep-seated infections in patients with complex medical histories requires tailored treatment plans and ongoing assessment to achieve optimal outcomes.

Addressing US Military Transgender Care Inequalities: Clinical Nurse Specialist Bridging Healthcare Gaps.

There are more than 130 000 US veterans and more than 12 500 active-duty service members who identify as transgender. Lack of training in transgender and gender-affirming care among healthcare providers in the military is still reported. The article aims to explore and advocate for the unique role of advanced practice registered nurses, especially clinical nurse specialists, in providing culturally sensitive and evidence-based care to the transgender population within the US military. The clinical nurse specialists' pivotal role in policy advocacy and translation of evidence to improve the quality of care and patient outcomes for transgender service members is highlighted. The article also explores the historical journey of transgender care in the US military, addressing discriminatory policies and the implications of the ever-evolving regulations in military transgender healthcare. The article aims to create awareness of clinical nurse specialist utilization in US military healthcare services to improve the care of transgender individuals in the military. The uncertain future for transgender service members highlights the ongoing commitment needed to navigate complex military healthcare policies and foster inclusive, evidence-based practices. Therefore, the clinical nurse specialist plays a pivotal role in shaping the future of transgender healthcare within the US military.

Addressing Social and Structural Determinants of Health in the Delivery of Reproductive Health Care: ACOG Committee Statement No. 11.

Social and structural determinants of health include historical, social, political, and economic forces, many of which are rooted in racism and inequality, that shape the relationship between environmental conditions and individual health. Unmet social needs can increase the risk of many conditions treated by obstetrician-gynecologists (ob-gyns), including, but not limited to, preterm birth, unintended pregnancy, infertility, cervical cancer, breast cancer, and maternal mortality. An individual health care professional's biases (whether overt or unconscious) affect delivery of care and may exacerbate and reinforce health disparities through inequitable treatment. Obstetrician-gynecologists and other health care professionals should seek to understand patients' health care decision making not simply as patients' individual-level behavior, but rather as the result of intersecting sociopolitical conditions, structural inequities, and social needs that create and maintain inequalities in health and health care. Recognizing the importance of social and structural determinants of health can help ob-gyns and other health care professionals to better understand patients, effectively communicate about health-related conditions and behavior, and contribute to improved health outcomes, including patients' experience of care and their trust in the health care system.

Effect of individualized anesthesia and analgesia on postoperative pain in patients stratified for pain sensitivity: A study protocol for the PeriOPerative individualization trial randomized controlled trial.

Despite advancements in surgical and anesthesia techniques, acute and persistent postoperative pain are still a common challenge. Postoperative pain has direct effects on individual patient care and outcome, as well as putting strain on limited health care resources. Several prediction methods for postoperative pain have been described. One such method is the assessment of pain during peripheral venous cannulation (VCP). It is not known if different approaches to anesthesia and analgesia, depending on the evaluation of risk for postoperative pain, can improve outcome. The aim of this study is to evaluate if individualized anesthesia and analgesia can affect postoperative pain and recovery after surgery, in patients stratified by VCP. Adult patients scheduled for laparoscopic surgery undergo pain-sensitivity stratification using VCP on the day of surgery. Patients scoring VCP ≥2.0 on the visual analogue scale (pain-sensitive) are randomized to multimodal anaesthesia and analgesia with opioids or standard of care. Patients scoring VCP ≤1.9 (pain-tolerant) are randomized to opioid-free anaesthesia or standard of care. The primary outcome is acute postoperative pain measured with numeric rating scale in the postoperative care unit. Secondary outcomes include analysis of pain after 24 h, persistent postoperative pain and quality of recovery. Individualized perioperative pain management has the potential to improve patient care. This study will examine the impact of different anesthesia and analgesia regimes, in patients with differing pain sensitivity, on postoperative pain. Prospectively posted at ClinicalTrials.gov, identifier NCT04751812.

A life course perspective on mental disorders and psychopharmacologic drug use among persons living with cerebral palsy

In this study, we investigated the prevalence of mental disorders and the use of psychopharmacologic drugs among individuals with cerebral palsy (CP). We studied how the association between CP and mental illness develops over the life course (between ages 5 and 65 years), and how it varies across disability specific factors (intellectual disability, gross motor function and communicative ability). We used logistic regression models on a longitudinal matched case-control data material on all persons with CP in Sweden linked to several administrative registers including, the national patient registers and the pharmaceutical registers.Our results showed that the probability of being diagnosed with mental disorders and being dispensed psychopharmacologic drug was significantly higher among persons with CP compared to persons without CP across the different outcomes [OR=1.52–4.7]. For some mental and neurodevelopmental disorders including sleep disorders, autism, and ADHD, and for the use of anxiolytics and sedatives, there was a sizeable gap already in childhood. However, the excess burden of mental illness appeared to grow over the life course, indicating that adults with CP may be a particularly disadvantaged group. Diagnosis for mental disorders and dispensation for psychopharmacologic drugs were not consistent with respect to disability specific factors, especially communicative and intellectual function, which indicates the need for systematic approaches in the mental health care of individuals with CP.

Your Body, My Business: Risk Governance in A Psychiatric Nursing Home.

A crucial long-term care resource for individuals with severe mental illness (SMI) in Taiwan is provided by psychiatric nursing homes. Given the higher incidence of physical illnesses and accidents among individuals with SMI, ensuring patient safety is an important aspect of quality care. However, there is limited literature exploring how the staff provides safe care for individuals with SMI. Investigates how the staff in a psychiatric nursing home managed residents' activities to mitigate risks and reduce physical injuries. Using a qualitative approach and drawing from Foucault's concept of 'disciplinary power', data were collected from field observations and staff interviews. Three themes emerged: (1) a gaze for efficiency, where checklists, timetables and spatial arrangements were used to efficiently manage residents' bodies; (2) controlling the deviant body, which entailed procedures to monitor and prevent risk behaviours and bodily signs through broad safety measures and (3) your body, my business, which described the reduced autonomy of residents over their behaviours as the responsibility largely shifted to the staff. The predominant risk management framework, driven by safety considerations, comprises residents' autonomy and undermines compassionate caring. Risk management should actively involve both staff and residents in decision-making.

Genetic testing and counseling for hypertrophic cardiomyopathy: An evidence-based practice resource oftheNational Society of Genetic Counselors.

Hypertrophic cardiomyopathy (HCM) is a common hereditary condition affecting approximately 1 in 500 adults. It is characterized by marked clinical heterogeneity with individuals experiencing minimal to no symptoms, while others may have more severe outcomes including heart failure and sudden cardiac death. Genetic testing for HCM is increasingly available due to advances in DNA sequencing technologies and reduced costs. While a diagnosis of HCM is a well-supported indication for genetic testing and genetic counseling, incorporation of genetic services into the clinical setting is often limited outside of expert centers. As genetic counseling and testing have become more accessible and convenient, optimal integration of genomic data into the clinical care of individuals with HCM should be instituted, including delivery via genetic counseling. Drawing on recommendations from recent disease guidelines and systematic evidence reviews, we highlight key recommendations for HCM genetic testing and counseling. This practice resource provides a comprehensive framework to guide healthcare providers in the process of genetic test selection, variant classification, and cascade testing for genetic evaluation of HCM.