Care For People Research Articles

Addiction-Centered Pregnancy Care: Bridging the Gap Between Addiction Treatment and Prenatal Care to Improve Outcomes for Pregnant People and Infants [ID 2683418

INTRODUCTION: Opioid use disorder (OUD) is a leading cause of maternal mortality. This study evaluated a new model of care for pregnant people with OUD, addiction-centered pregnancy care (ACPC), which provides assessment and support for the social, economic, and personal challenges linked to OUD within prenatal care. Unlike integrated models of care providing medication for OUD, ACPC is easier to implement and rapidly scalable. This study compared risk of preterm delivery and infant length of stay for patients receiving ACPC versus standard prenatal care. METHODS: In this retrospective cohort study approved by the Dartmouth Hitchcock IRB, data were abstracted from charts of patients with OUD who received ACPC (n=53) or standard prenatal care (n=41) and delivered at an academic medical center in the Northeast between 2018 and 2021. Risk of preterm delivery was examined using multivariate logistic regressions, and infant length of stay was assessed with negative binomial models. RESULTS: Women in the ACPC cohort had reduced odds of preterm delivery (n=3, 5.7%) compared to the standard prenatal cohort (n=11, 26.8%; odds ratio [OR] 0.40; 95% CI, 0.21, 0.80). Compared to standard prenatal care, infants of patients receiving ACPC stayed in the hospital fewer days after delivery (incidence risk ratio, 0.77; 95% CI, 0.61, 0.97). CONCLUSION: Among a cohort of pregnant patients with OUD in the Northeast, receiving ACPC was associated with reduced risk for preterm delivery and shorter length of infant hospitalization compared to standard prenatal care. Future research should assess if these differences are due to this model’s focus on supporting psychosocial and socioeconomic challenges linked to OUD.

Debate: Involuntary treatment and detention are a necessary part of mental health care for children and young people.

People of all ages are subject to involuntary psychiatric detention and treatment worldwide but there is current discussion about whether this complies with modern human rights law. The use of involuntary psychiatric hospitalisation among children and young people has largely eschewed research and policy interest to date. In this debate section, we hear from people with experience of child mental health services in the UK, USA and low- and middle-income countries about their views on the use of involuntary treatment in young people.

Safety and efficacy in the management of older patients with displaced intracapsular hip fractures

The management of the older person with a displaced intracapsular hip fracture is one of the most significant aspects of musculoskeletal trauma. These patients require prompt, integrated pathway delivered care. The care delivered outside of the operating theatre and that performed within, are intertwined. Traditionally, surgeons have focussed predominantly only on the operative elements. In modern trauma care for older people, this focus must broaden. We provide for the first time a comprehensive overview of all elements of care for this important patient group. This brings together pathway elements from the National Hip Fracture Database Key Performance Indicators and NICE guidance alongside a synthesis of all current research output for intracapsular hip fracture.

Values and Evidence in Gender-Affirming Care.

This commentary responds to the article "What Is the Aim of Pediatric 'Gender-Affirming' Care?," by Moti Gorin, in the same issue of the journal. Gender-affirming care is often treated as exceptional and subject to heightened scrutiny. This exceptionalization results in its being held to stricter evidentiary standards than other forms of medical interventions are. But values and value judgments are inextricable from the practice of evidence-based medicine. For gender-affirming care, values shape what counts as "strong" evidence, whether the legitimacy of transgender identity is assumed versus treated as something to be investigated, how to characterize the testimonial accounts of trans and gender-nonconforming patients, and more. We argue that these kinds of questions are part of the practice of medicine, not exceptional to transgender people and gender-affirming care. However, litigation of evidence for gender-affirming care in state and national policy underscores the moral urgency of thinking carefully about what values ought to guide evidence.

RETHINKING THE MANAGEMENT OF HEALTH IN PEOPLE WITH DIABETES-RELATED FOOT ULCERS FROM AN AEP PERSPECTIVE: AN UPDATE FROM THE DFUEX STUDY

INTRODUCTION & AIMS Current treatments for people with diabetes-related foot ulcers (DFUs) focus on foot outcomes - potentially at the expense of broader health and wellbeing considerations. There are barriers to exercise for people with DFU and hesitancy in promoting physical activity by clinicians. AEPs may have the clinical skills to help people with DFUs engage in safe and effective exercise. The aim of this study was to examine the impact of AEP supervised exercise intervention on cardiorespiratory fitness, health and wound healing in adults with DFU. METHODS Using a randomised control trial design (ANZTR registration: 12622000885796p) adults aged 18 to 70 years (n=32) with active DFU are being recruited from an interdisciplinary High-Risk Foot Service (iHRFS) at Royal Prince Alfred Hospital Sydney Australia, and randomised to receive 12 weeks of supervised exercise (aerobic and resistance) training (Exercise) with usual care or usual care (Control) Measurements including fitness, metabolic and wound outcomes are acquired at baseline and after 12 weeks. RESULTS Preliminary baseline demographic, fitness and health data will be presented. Consideration for the scope of practice for AEPs in the multidisciplinary management of DFUs will be discussed incorporating observations and guidance on implementing exercise in a high risk DFU population, where there is limited patient and practitioner knowledge about safe and effective exercise options, and historical avoidance of physical activity to lessen the risk of wound deterioration. This will include consideration of aspects around exercise which are unique to people with DFUs, such as working with iHRFS, patient ambulation and transport, wound type and location, diversity of wound offloading devices and individual facilitators and barriers to exercise participation. CONCLUSIONS There is a need for robust evidence concerning the efficacy and safety of exercise intervention, and a need for strategies to engage AEPs into the multidisciplinary care of people with DFUs. Supported by the Exercise and Sports Science Australia Research Grant.

Frontline health workers’ experiences of providing care for people living with non-communicable diseases during the COVID-19 pandemic in Ghana: a qualitative study

BackgroundThe COVID-19 pandemic has significantly impacted frontline health workers. However, a neglected dimension of this discourse was the extent to which the pandemic impacted frontline healthcare workers providing non-communicable diseases...

Effects of a dementia educational programme using virtual reality on nurses in an acute care hospital: A pre-post comparative study.

Poor awareness of dementia care by healthcare professionals affects the quality of care for people living with dementia in acute care settings. This study examined the effectiveness of a virtual reality-based educational programme for dementia for nurses working in acute care hospitals in Japan. A dementia education programme for nurses was designed. The programme comprised short movies, virtual reality videos based on the short movies, a lecture, discussions and role-playing based on the experimental learning model. Virtual reality video content was created to promote empathy for people living with dementia through a first-person experience of dementia. The educational programme involved nurses working in an acute care hospital in the Tokyo Metropolitan area. Before and after the programme, we employed structured questionnaires using validated instruments to assess participants' attitudes towards people living with dementia, their intentions of helping behaviour and their confidence in providing dementia care. Seventy-six nurses participated in and completed the pre- and post-tests. The mean age was 34.9 ± 9.2 years, and 90.8% of the participants were female. A paired t-test showed significant before-after improvement in the participants' attitudes towards people living with dementia (41.9 ± 5.1 vs. 44.5 ± 4.8), intentions of helping behaviour towards people living with dementia (10.8 ± 2.5 vs. 12.8 ± 2.1) and confidence in providing dementia care (25.9 ± 6.7 vs. 29.2 ± 6.0). The programme effectively improved nurses' attitudes towards people living with dementia and confidence in providing dementia care in acute care settings. Future research is important to explore the long-term effects of this programme and its effects on actual dementia care. The dementia education programme may promote person-centred care in acute hospitals. Future studies should consider the provision of more flexible programs so that nurses can more easily participate in them.

Évaluation et prise en charge du psychotrauma complexe chez l’enfant et l’adolescent : présentation d’un dispositif expérimental

Recent public mental health policies on psychotrauma call for the development of research and information aimed at the general public, as well as the creation of new tools to improve the assessment and care of people suffering from the impact of traumatic events. There are also recommendations that these aspects be broken down according to age group (child and adolescent/adult) and conditions of exposure to the traumatic event (simple/complex). The establishment of the psychotherapies, psychotrauma and resilience unit (U2PR) at the university hospital service for child and adolescent psychiatry (SHUPEA) in Brest, France, is based on an experimental approach to treating complex psychotrauma in children and adolescents, focusing on three recommended areas (care, prevention, research). This article sets out its foundations, with the aim of contributing to exchanges with other professionals and services involved in supporting children and adolescents in distress. It describes the project's internal workings, its links with care partners in the departmental medical-social network, the socio-political motives behind the project, the reflections arising from group work, and the theoretical-clinical basis that strategically structures the implementation of its axes.

Renal Oxidative Stress May Explain Sex Differences in Blood Pressure in Adult Offspring Exposed to an Impoverished Environment

Background: Nearly 40 million people experience poverty in the United States. Poverty is linked to adverse childhood experiences (ACEs) which affects about 64% of adults in the U.S. Previous studies indicate that those who experience ACEs are at a higher risk of developing hypertension (HTN) and cardiovascular diseases (CVDs) later in life, with a greater severity and earlier onset in males. The mechanisms behind the ACEs-attributed development of sex differences in HTN later in life is unknown. One plausible mechanism for this sex difference is increased oxidative stress. One rodent model to mimic poverty as an ACE is the limited bed and nesting (LBN) model. This model simulates an impoverished and low resource environment, as observed in poverty, in which the nesting material during weaning is reduced. We hypothesize that male offspring exposed to LBN will have elevated blood pressure and oxidative stress, while females will have no change in blood pressure and reduced oxidative stress. Methods: Pregnant Sprague Dawley rats gave birth naturally and weaned their offspring for 3 weeks. During the weaning period, on Days 2-9, the dams and their respective pups were divided into 2 groups: LBN and control (CON). After LBN treatment, all rats received normal bedding. After weaning, offspring were divided by sex and experimental status: LBN male (n=5), LBN female (n=5), CON male (n=6), and CON female (n=6). At 16-17 weeks, mean arterial pressure (MAP) was measured via carotid catheterization and the kidneys, brain, heart, and plasma were collected to measure antioxidant capacity via colorimetric biochemical assays. Results: LBN males had a significant increase (18 mmHg) in MAP compared to CON males (128.17±3.93 vs 110.72± 3.93 mmHg, P>0.001), while female LBN and CON rodents displayed no differences. In males, there were no changes in antioxidant capacity in the brain, heart, and plasma. However, there was a significant 2-fold decrease in renal antioxidant capacity (233±14.0 vs 442±12.3 mM Trolox/mg protein, p>0.0001). In females, there were no changes in the kidneys, heart, and brain antioxidant capacity. Conversely, LBN females showed a trending increase in plasma antioxidant capacity compared to CON (3.33±0.16 vs 2.53±0.35 mM Trolox/mg protein, p=0.053). Conclusion: Only males exposed to an impoverished environment during weaning have elevated blood pressure, while females do not. This difference in blood pressure may be explained by decreases in renal antioxidant capacity in males only. On the other hand, females may be protected from elevated blood pressure because they experience a slight increase in systemic antioxidant capacity. Future studies will examine the role of antioxidants in blood pressure regulation in the kidneys. This study is clinically relevant because ACEs affect a large percentage of the American population with about 17% of adults experiencing 4 or more ACEs, with minorities at a greater risk. Understanding the mechanisms on how ACEs contribute to HTN may alleviate some of the racial and ethnic disparities, along with the financial burden on the healthcare system to care for people with HTN and CVDs. Perhaps, organ and sex-specific antioxidant therapies may be used to alter, prevent, or reduce the development of HTN in adults that were exposed to ACEs, such as poverty during nursing and early childhood. This research was supported by start-up funds and the American Heart Association Early Career Development Award [AHA 18CDA34110264 (Cunningham)]. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Implementing the Serious Illness Care Program in Safety Net Health Systems: A Qualitative Study

ContextInterventions to improve the quality of care for people affected by serious illness commonly fail to reach patients from marginalized and underserved communities, which include those characterized by racialized or indigenous identity, sexual and gender minority status, and rural living. Interventions to improve care through serious illness conversations have demonstrated benefit, but little is known about their implementation in health systems that predominantly serve these patient groups. ObjectivesThe study aimed to understand factors influencing implementation of a serious illness communication-focused intervention—the Serious Illness Care Program in health systems who primarily provide care to marginalized and underserved communities. MethodsQualitative interviews (16) and focus groups (3) were conducted with 19 interdisciplinary team members from six geographically diverse U.S. healthcare systems. Using a template analysis approach, investigators coded data inductively and deductively to identify themes. ResultsThree themes emerged: patient factors, intervention elements, and health system contextual factors. Participants highlighted mission-driven efforts, creativity, interprofessional practice, and trainees as enablers of success. They identified weaknesses in the intervention's communication tool—the Serious Illness Conversation Guide as barriers to implementation of conversations. Resource constraints, socio-economic vulnerability, and mistrust in the health system were seen as additional barriers. ConclusionsHealth systems that provide care to underserved and marginalized communities face unique challenges implementing the Serious Illness Care Program. They also possess assets, some unique to these settings, that support program adoption. Findings suggest that implementation of similar programs in low-resource healthcare settings may help address unmet needs among marginalized populations.

What is current care for people with Long COVID in England? A qualitative interview study

ObjectiveTo investigate current care for people with Long COVID in England.DesignIn-depth, semistructured interviews with people living with Long COVID and Long COVID healthcare professionals; data analysed using thematic analysis.SettingNational Health...

How dare we? The relation between language use, global identity, and climate activism

Identifying with and caring for people all over the world (i.e., a global identity) is positively related to pro-environmental behaviour. However, less is known how to foster such a global identity. Drawing on social identity theory, we investigated whether using inclusive (vs. exclusive) language in the context of demonstrations for climate protection increases people’s global identity. Moreover, we examined whether inclusive language use strengthens people’s intentions to engage in pro-environmental activism and their pro-environmental policy support, while reducing their denial of climate change implications, through a heightened global identity. In our pre-registered online experiment with a convenience sample mostly living in Germany (N = 307), we found no significant impacts of language use. Language effects did also not depend on people’s prior identification with the climate movement. However, our results show that, in line with our assumptions, the stronger people’s global identity, the more they intended to become pro-environmentally active, the more they supported pro-environmental policies, and the less they denied their impact on climate change.

Factors that influence young people’s experiences of emergency suicide care in Australia: a qualitative study

Young people in Australia are increasingly presenting to the emergency department in suicide crisis, where their experiences influence present and future treatment outcomes. Previous research on emergency suicide care has predominantly focused on adults’ experiences. This qualitative study aims to identify the factors that influence perceived positive and negative experiences of emergency suicide care for young people. Semi-structured interviews were conducted with 17 young people aged 16-24 years old (mean age = 18.4 years) who presented to an Australian hospital in the past 12 months for a suicide crisis. Young people reflected on the care they received in the emergency department, and the factors that influenced the quality of care. Data underwent reflexive thematic analysis. Most young people reported a negative hospital experience, attributed to resource constraints and invalidating staff responses, reflecting underlying stigma around suicide. Conversely, when young people reported positive experiences, this was largely attributed to empathetic connections with staff. Our findings highlight the importance of compassionate care from hospital staff for young people’s experience of emergency suicide care. Future research with young people is needed to co-design and trial interventions that promote compassionate care and address the barriers with resource constraints in hospitals.

장애인의 고령화에 따른 돌봄 부담에 대한 탐색적 연구: 담화분석법을 중심으로

The purpose of this study is to explore the meaning of the burden of care that the aging of disabled people brings to disabled people and their families, and to discuss policy measures that can reduce the care of elderly disabled people. For this purpose, five elderly people with disabilities and five families caring for the elderly people with disabilities living in Jeju were selected as purpose sampling and interviews were conducted, and the discourse analysis method that a qualitative research method was used to analyze the burden of care for the elderly and their families with disabilities. As a result of the study, the burden of care experienced by elderly disabled people was analyzed in four categories: ‘fear of new complications’, ‘concern about aging of care providers’, ‘burden of economic poverty’, and ‘expression with various needs’, and the burden of care experienced by families with disabilities was analyzed in three categories: ‘difficulty with increased care’, ‘sadness for the disabled’, and ‘effective institutional improvement’. Based on these results, policy implications and suggestions for follow-up research were made to reduce the burden of care for the elderly with disabilities and families with disabilities.

Identifying Factors of User Acceptance of a Drone-Based Medication Delivery: User-Centered Design Approach.

The use of drones in the health care sector is increasingly being discussed against the background of the aging population and the growing shortage of skilled workers. In particular, the use of drones to provide medication in rural areas could bring advantages for the care of people with and without a need for care. However, there are hardly any data available that focus on the interaction between humans and drones. This study aims to disclose and analyze factors associated with user acceptance of drone-based medication delivery to derive practice-relevant guidance points for participatory technology development (for apps and drones). A controlled mixed methods study was conducted that supports the technical development process of an app design for drone-assisted drug delivery based on a participatory research design. For the quantitative analysis, established and standardized survey instruments to capture technology acceptance, such as the System Usability Scale; Technology Usage Inventory (TUI); and the Motivation, Engagement, and Thriving in User Experience model, were used. To avoid possible biasing effects from a continuous user development (eg, response shifts and learning effects), an ad hoc group was formed at each of the 3 iterative development steps and was subsequently compared with the consisting core group, which went through all 3 iterations. The study found a positive correlation between the usability of a pharmacy drone app and participants' willingness to use it (r=0.833). Participants' perception of usefulness positively influenced their willingness to use the app (r=0.487; TUI). Skepticism had a negative impact on perceived usability and willingness to use it (r=-0.542; System Usability Scale and r=-0.446; TUI). The study found that usefulness, skepticism, and curiosity explained most of the intention to use the app (F3,17=21.12; P<.001; R2=0.788; adjusted R2=0.751). The core group showed higher ratings on the intention to use the pharmacy drone app than the ad hoc groups. Results of the 2-tailed t tests showed a higher rating on usability for the third iteration of the core group compared with the first iteration. With the help of the participatory design, important aspects of acceptance could be revealed by the people involved in relation to drone-assisted drug delivery. For example, the length of time spent using the technology is an important factor for the intention to use the app. Technology-specific factors such as user-friendliness or curiosity are directly related to the use acceptance of the drone app. Results of this study showed that the more participants perceived their own competence in handling the app, the more they were willing to use the technology and the more they rated the app as usable.

Teaching Physician Assistant Students to Care for People With Intellectual and Developmental Disabilities.

The purposes of this educational activity were to instill in students a greater empathy for patients with intellectual developmental disabilities, give students a better understanding of how to obtain a medical history for patients with communication limitations, teach students practical tips for obtaining a medical history and physical examination to increase competence in their future practice, and to build a relationship with a local organization that serves people with intellectual disabilities. An experiential learning activity was added to the curriculum of two courses for first-year PA students to accomplish these goals. The course instructors engaged in several planning meetings with a local residential facility for people with intellectual disabilities, including choosing patients that the students would assess. The students made 3 visits to the facility. The visits included interactive lectures by a physical therapist, occupational therapist, nurse practitioner, medical doctor, and dentist. Two of the facility involved patient visits at designated homes on campus. The students then wrote comprehensive visit notes with patient identifying information removed and submitted them for grading. Students expressed feeling better prepared to assess people with intellectual disabilities and having an increased appreciation for obtaining quality medical histories. The partner facility also reported they received positive feedback from staff participants and indicated they would like to continue this partnership.

Perceptions and Experiences of Nursing Students in Caring for People Living with HIV/AIDS in South Africa: A Qualitative Study

Background: Although previous studies focusing on nurses’ perceptions of caring for people living with HIV (PLHIV) have been done in numerous countries, little is known about first-year student nurses’ perceptions and experiences regarding their role in caring for PLHIV in South Africa. To ensure quality care for PLHIV, it is essential to explore first-year student nurses’ roles in caring for PLHIV.Purpose: The study aimed to describe and explore the perceptions and experiences of first-year nursing students on their role in caring for PLHIV in South Africa.Methods: A qualitative exploratory descriptive design was employed in this study and a purposive sampling method was used to recruit 18 participants. Data were gathered using two focus group discussions, one consisting of eight participants and the other ten participants. The collected data was analyzed using thematic analysis.Results: Four main themes were drawn from two focus group discussions, including (1) students’ unpreparedness in their role to care for PLHIV, (2) disclosure practices and student safety concerns, (3) personal backgrounds and attitudes towards PLHIV care, and (4) physical and psychological wellbeing of students while caring for PLHIV. Furthermore, thirteen (13) sub-themes were subsequently drawn from these main themes. Thematic sub-themes and individual focus group responses were relied on to reach data saturation despite the small number of focus group discussion sessions.Conclusion: First-year nursing students had negative and positive perceptions and experiences when caring for PLHIV. There is a need for these students to acquire adequate theoretical knowledge and practical skills to enhance clinical preparation for their role in clinical facilities. This could improve their perceptions regarding caring for PLHIV in the clinical setting and result in improved care.

Health care: life stories by trans women in Colombia

BackgroundIn Colombia, health care for people with trans life experiences is characterised by countless barriers to health services and care. Commonly, trans people have experienced stigma and discrimination among health professionals, a lack of services and professionals specialized to guarantee affirmative processes from non-hegemonic gender perspectives, and there exists a marked pathologization and medicalization of services. Therefore, it is necessary to provide affirmative health services to improve health and well-being from the recognition of their needs and experiences. The article describes life narratives about health care for the gender transitions of trans women in Colombia.MethodsA qualitative narrative study was conducted with 139 trans women in seven cities in Colombia. In-depth interviews and discussion groups were conducted between June 2019 and March 2020. Data were analyzed using thematic analysis and the Atlas Ti cloud program. National and international ethical guidelines were followed in the development of the research.ResultsThis research provided an overview of the health experiences of Colombian trans women. They reported their experiences of pathologizing approaches to transgender healthcare, stigma, discrimination, and barriers to accessing preventive, specialized, and regular healthcare services. For this reason, they opted for self-medicated gender transition processes and self-management of health care. An important aspect to consider within healthcare is that not all women want binary gender transition processes.ConclusionParticipants felt that in Colombia there is a lack of affirmative health care for transgender women and that there are many limitations to care related to the gender transition processes. This exposes them to more situations that violate their rights and influences their lack of confidence and their search for professional health care. In Colombia, it is important to develop strategies for education, information, and communication, as well as a handbook for health workers on specialized healthcare for trans women.

Nurses Perception and Role of Euthanasia: A Literatur Review

Introduction: Euthanasia is the most controversial ethical topic in the world of health. Nurses have an important role in providing holistic care for people with life-limiting conditions. However, they experience internal moral conflict and helplessness when patients ask them to assist in the dying process. This literature review aims to determine what is known about nurses' perceptions and attitudes toward euthanasia.Methods: The literature search was carried out using three databases, namely Google Scholar, PubMed, and Scient Direct. The inclusion criteria for the literature search were articles with publication years 2014-2022 in Indonesian or English and complete articles that could be open access. The keywords used in searching for articles were adjusted to the Medical Subject Heading (MeSH), namely knowledge, nurses' attitudes, euthanasia, and nursing euthanasia.Results: The literature review identified fifteen studies for inclusion in the final analysis. One article was semi-experimental, eight articles used a descriptive design with a cross-sectional approach, two articles used an epidemiological descriptive design, and two articles used descriptive-analytical methods. Nurses exhibit a range of attitudes towards euthanasia, including both positive and negative perspectives. Conclusion: The issue of euthanasia has presented a significant challenge for nurses in achieving their goal of providing holistic care. Their personal, professional, and transpersonal perspectives influence nurses' perceptions and attitudes. Potential implications for nurses relate to education, practice, and research. Nurses must be informed about existing laws and provided in-depth education and professional guidance to help guide action. Further research is needed to explore the impact on carers' emotional well-being, clarify their role, and determine the support they may require when engaging in euthanasia.

Epilepsy Knowledge, Attitudes and Practices of Front-Line Healthcare Workers in the City of Conakry

Epilepsy is a serious brain disease that affects people of all ages. Evaluating healthcare staff is a key factor in improving the care of people with epilepsy. We studied the knowledge, attitudes and practices of healthcare personnel.