Common Subthemes Research Articles

Measuring the Maturity of Integrated Care in Singapore with the SCIROCCO Exchange Tool.

How have we progressed and where are the gaps of integrated care in Singapore? Social-health care provision in the context of an ageing population is critical in the city-state's management of the unprecedented demand as the proportion of seniors with multiple complex medical needs have almost doubled in the past decade. This study measures the maturity level of Singapore's integrated care, identifies key gaps and discusses their implications using the SCIROCCO Exchange tool, an online self-assessment tool consisting of the 12 dimensions necessary for the provision of integrated care. A three-step mixed method Delphi study was used to derive expert consensus. Participants across the social-healthcare sector as well as representatives from all three public healthcare delivery networks with at least five years of experience were included. Participants rated each of the twelve dimensions of the SCIROCCO Exchange tool on a six-point ordinal scale and provided justifications for each rating. Criteria from the RAND UCLA appropriateness method and thematic analysis were adopted for the analysis. All participants completed the study. The study found five dimensions in the "Initial" maturity level and five dimensions in the "Progressing" maturity level. There were two dimensions which were "Uncertain" because of split responses, possibly due to their differing vantage points and conceptualisations of integrated care. The overall medians were plotted on a spider diagram. The absence of a systematic approach for integrated care was the most common subtheme across all dimensions. This is foundational for integrated care as this would enable stakeholders across health and social care to identify with a common goal. The findings emphasise the imperative to reshape social-health care delivery by focusing on foundational dimensions (such as structure, governance and citizen empowerment) to enable progress in other dimensions. Following the conclusion of this study, Singapore initiated a primary care reform with the launch of Healthier SG in July 2023. Future research may wish to explore the impact of Healthier SG on maturity of integrated care in Singapore.

Enhancing Health Wellbeing of Chronic Patient Through Digital Health; A Systematic Review of Best Nursing Practices and Lessons Learned

Background: Context: Digital health interventions have become essential instruments in contemporary medicine, providing viable means of improving patient outcomes and healthcare provision. The goal of this study is to examine the impact, difficulties, and potential future directions of digital health interventions across a range of healthcare situations by synthesizing results from 12 carefully chosen studies. Aim: This study's objective is to thoroughly examine and summarize the body of research on digital health interventions, with an emphasis on acceptance and utilization as well as implementation and efficacy. Method: Twelve pertinent papers published between 2016 and 2024 were found after a thorough search of electronic databases. Numerous digital health interventions were covered by these research, such as remote monitoring systems, telemedicine, and mobile applications. In order to find common themes, sub-themes, and patterns among the chosen research, thematic analysis was used in the data synthesis process. Results: A number of important themes emerged from the thematic analysis, including interoperability problems, patient engagement, healthcare provider acceptability, regulatory concerns, and usability issues. The sub-themes that fell under these categories emphasized the variables that affect the uptake and efficacy of digital health interventions. Conclusion: The synthesis of data emphasizes how digital health initiatives can increase clinical results, improve patient care, and streamline the delivery of healthcare. But in order to fully reap the benefits, major obstacles like interoperability problems, regulatory difficulties, and usability impediments need to be solved. The recommendations put forth aim to promote innovation and evidence-based practice in digital health by stressing user-centered design, improving digital literacy among medical practitioners, and encouraging interdisciplinary collaboration.

Newly credentialed athletic trainers' onboarding process during the transition to practice.

As new athletic trainers (ATs) transition into their roles, some employers provide orientation and onboarding to assist with the transition to practice. There is a lack of research outlining the ideal onboarding process for new ATs transitioning to practice. Examine the onboarding process for new ATs. Grounded theory. College/university, secondary school, hospital/clinic. Seventeen newly credentialed, employed ATs who recently graduated from professional masters' programs (11 female, 6 male; 25.6±2.2 years) and twelve employers (6 female, 6 male, years in role supervising new ATs: 8.5±4.9) participated in this study. Participants were recruited via purposive sampling. Each participant was interviewed via phone using a semi-structured interview guide. Employees were interviewed approximately 3, 6, 9, and 13-15 months after beginning employment. Employers were interviewed one time. Data saturation guided the number of participants. Data were analyzed through grounded theory, with data coded for common themes and subthemes. Trustworthiness was established via peer review, member checks, and multi-analyst triangulation. Two themes emerged: initial orientation and continued onboarding. Participants reported receiving organizational, departmental, and site-specific orientations for initial orientation. For continued onboarding, participants reported mentoring, site visits, feedback and evaluation, regular meetings, and continuing education and professional development. Onboarding is vital in transitioning to practice for newly credentialed ATs, as it provides support and helps new employees understand and adapt to their roles. Onboarding should go beyond initial orientation and include regular meetings with supervisors, other ATs, and site visits to provide feedback and ensure new ATs adapt to their roles. New ATs should seek support from supervisors and local ATs to help better understand their role.

Evaluation of a Multisectoral Health Security Alliance Program Through Perceptions of Member States: African Partnership Outbreak Response Alliance (APORA).

U.S. DoD global health engagements offer opportunities for strategic engagement and building capability in collaboration with foreign military and civilian counterparts. Global health engagement activities can take the form of health security alliances and allow the USA and its allies and partners to prepare for, mitigate, and respond to emerging biothreats and other harmful health events that may negatively impact national security. One such example is the African Partnership Outbreak Response Alliance (APORA), which was designed to expand African Partner Nation militaries' infectious disease outbreak response capabilities. This publication evaluates the development, implementation, and outcomes of APORA to better understand the program's effectiveness in developing Partner Nation medical capabilities and the efficacy of health security alliances more broadly. Key informant interviews, focus groups, and questionnaires were used to collect responses from a sample of participants who attended an in-person APORA event in May 2022. The research team conducted thematic analysis of all responses to identify common themes and sub-themes in participants' perspectives and to elucidate findings and recommendations for future endeavors. The analysis determined that participants attended the APORA event primarily to disseminate and apply knowledge, skills, and abilities gained at the event to their own health system structures. Overall, participants indicated that APORA contributed to their countries' military medical and civilian cooperation, as well as their countries' military medical capabilities. Longer-term partners (i.e., 4+ years of APORA membership) agreed more strongly with these sentiments; newer partners (i.e., 1-3 years of APORA membership) were more likely to be neutral or agree to some extent. Participants also valued the opportunity to solidify global, regional, local, and peer partnerships and considered the ability to create partnerships of great importance to their countries' national health security. Language barriers were often listed as a hindrance to event participation and the overall integration of a regional health system response. Participants also cited resource scarcity, network erosion (particularly because of the coronavirus disease 2019 pandemic), and a lack of disseminating and communicating value-add in how APORA could/is providing to their member countries' health systems as key barriers. As a whole, these findings support APORA's objectives to develop and leverage partnerships to support medical capacity building, promote collaboration between military and civilian sectors, and increase access to opportunities and financial resources. Further evaluation is required to capture additional civilian perspectives while continuing to expand upon military perspectives in order to produce more generalizable findings. That said, this study enables key stakeholders to understand how to strengthen and expand future alliances to improve both health and security outcomes.

Simulating empathy: A qualitative experiential study of embedded resident learners in an empathy curriculum.

Physician empathy and communication skills are crucial parts of a successful emergency department (ED) interaction. This study aimed to evaluate whether these skills can be improved through a novel curriculum where interns act as patients for their senior residents during simulated ED cases. Twenty-five residents participated in the curriculum. Prior to the cases, participants filled out the Toronto Empathy Questionnaire (TEQ). They then completed three simulated cases, with the 11 interns portraying the patients and the 14 seniors (postgraduate year [PGY]-2 and PGY-3 residents) in the physician role. Following the cases, the residents participated in a recorded, structured focus group. At the conclusion of the session participants again filled out the TEQ and answered a Likert questionnaire on their thoughts about the curriculum. Qualitative analysis was used to determine themes from the debriefs. Twenty-two residents completed all components of the study. The mean (±SD) TEQ scores pre- and postcurriculum for all residents were 46.2 (±4.64) pre and 47.9 (±6.03) post (ns). On qualitative analysis, we derived four major themes: empathy, communication, feedback, and physician experience. The most common subthemes discussed were empathy for the patient situation and the importance of communicating visit expectations. On a 5-point Likert survey related to the simulated cases, respondents rated comfort providing feedback to their peers (mean ± SD 4.41 ± 0.95) and gaining insight into the patient experience (mean ± SD 4.27 ± 0.83). The embedded intern exercise was rated well by resident participants, with no observed change in empathy scores. Qualitative analysis identified empathy and communication as major themes. Residents enjoyed this style of simulation and found it realistic.

Analysis of Anonymous Student Narratives About Experiences with Emergency Medicine Residency Programs.

Academic emergency medicine (EM) communities have viewed anonymous online communities (AOC) such as Reddit or specialty-specific "applicant spreadsheets" as poor advising resources. Despite this, robust EM AOCs exist, with large user bases and heavy readership. Insights about applicants' authentic experiences can be critical for applicants and program leadership decision-making. To date, there are no EM studies to qualitatively assess EM AOC narratives during the application cycle. Our goal was to perform a qualitative analysis of students' EM program experiences through a publicly available AOC. This was a qualitative analysis of a publicly available, time-stamped, user-locked AOC dataset: "Official 2020-2021 Emergency Medicine Applicant Spreadsheet." We extracted and then de-identified all data from selected sub-sheets entitled "Virtual Interview Impressions" and "Rotation Impressions." Four investigators used constant comparative method to analyze the data inductively, and they subsequently met to generate common themes discussed by students. Preliminary thematic analysis was conducted on a random sample of 37/183 (20%) independent narratives to create the initial codebook. This was used and updated iteratively to analyze the entire narrative set consisting of 841 discrete statements. Finally, two unique codes were created to distinguish whether the identified sub-themes, or program attributes, were likely "modifiable" or "non-modifiable." We identified six major themes: living and working conditions; interpersonal relationships; learning experiences, postgraduate readiness, and online/virtual supplements. Common sub-themes included patient population (13%); resident personality (7%); program leadership personality (7%); relationship with faculty/leadership (6%); geography (4%); practice setting (4%); program reputation (4%), and postgraduate year-3 experiences (4%). Modifiable sub-themes outnumbered non-modifiable sub-themes, 60.7% to 39.3%. In this analysis of selected medical students' narratives in an AOC, the majority of identified themes represented topics that may serve as external feedback for EM residency programs and their clerkships. Selective use of AOCs may set a precedent for future program assessments by applicants and inform program leadership of important programmatic elements in the eyes of applicants. It elucidates important themes in their interactions or learning experiences with programs and creates opportunities for learner-centric program improvement.

Why do people get burned? Qualitative analysis of the causes of burns in a large survey of burn survivors

BackgroundUnderstanding the national epidemiology of burns is necessary for effective planning of prevention and treatment services. However, epidemiological studies of burns have often focused on short-term and retrospective investigations of a specific group of burned patients in Iran. Therefore, we conduct a comprehensive study from August 2016 to October 2017, in the Burn Research Center of Iran University of Medical Sciences on approximately 1700 hospitalized burn patients at Motahari Hospital to identify the underlying causes of burns. In this study, an open-ended question was asked about how the burn occurred in the patients. The current study was designed and conducted for the qualitatively analyzing of the responses to this question, using the content analysis method, in order to maximize its use in policymaking and prevention. MethodsContent analysis of written responses to open-ended questions was done as a part of a large questionnaire survey. This survey was conducted by face-to-face interview at a national referral center for burn injuries. ResultsAnswers from 1595 patients were coded and the underlying causes of injury were categorized into three themes and 43 subthemes. These underlying causes were lack of knowledge and awareness, inappropriate equipment, and inevitable accidents. The underlying cause of lack of knowledge and awareness had the highest proportion in causing burns in both men and women. The most common subthemes in descending order included lack of skills, dangerous actions, improper location of hot liquids, individual mistakes, and improper use of flammable materials. The top five subthemes with the highest average percentage of burn in patients in descending order were deficiency of residential equipment, self-immolation, accidents, inappropriate location of flammable materials, and unsafe kitchen appliances. ConclusionThe focus of prevention programs on educating and increasing awareness of individuals, preferably women, is suggested. Educational programs, tailored to occupational standards and workplace and household equipment, are recommended for men in work environments.

Collaborative Mental Health Care in Collegiate Athletics: Behavioral Health Providers' Perceived Role of the Athletic Trainer.

Developing effective interprofessional teams is vital to achieving quality care for those dealing with behavioral health concerns. Athletic trainers (ATs) play a vital role, as they are often the first health care providers to interact with student-athletes participating in intercollegiate athletics. However, research regarding how behavioral health providers view the AT's role on interprofessional behavioral health teams is limited. To explore behavioral health providers' perceived role of ATs in collaborative behavioral health care. Qualitative study. Individual interviews. Nine behavioral health care providers (women = 6, men = 3; age range = 30-59 years, years in clinical practice = 6-25) from National Collegiate Athletic Association Power 5 schools were interviewed. Participants were contacted via publicly available information on their university websites. Participants engaged in individual, audio-only interviews using a commercially available teleconferencing platform. All interviews were recorded, transcribed, and returned to participants for member checking. A phenomenological approach with inductive coding and multianalyst triangulation was performed to analyze the transcripts for common themes and subthemes. Collaborative care models can enhance providers' abilities and maximize support of student-athlete wellness. In this study, we demonstrated that behavioral health providers working within a collaborative care model with ATs had overall positive experiences with such collaboration and that clear role delineation and responsibilities helped to foster high-quality patient care.

Adolescents' and Adults' Perceptions of Sensory-Based Interventions: A Qualitative Analysis.

Adolescents and adults report that their sensory integration and processing differences affect their occupational performance and quality of life, thus requiring effective sensory-focused interventions. Researchers have yet to investigate this population's experience of occupational therapy interventions designed to remediate these challenges. To explore the perceived experience of adolescents and adults with respect to (1) response to intervention, (2) strategies offered to manage sensory differences, and (3) need for services on completion of an intervention. Retrospective, qualitative study. Zoom or phone call. Eleven adolescents and adults with sensory integration and processing differences who had previously completed occupational therapy interventions. Sensory-based intervention based on the principles of Ayres Sensory Integration® (ASI) and the Sensory Therapies and Research Frame of Reference. A semistructured interview to obtain data, followed by an in-depth analysis using an inductive coding process to group initial open codes into themes and common subthemes Results: Open codes were grouped into three core themes: (1) therapist-related factors (what the therapist did in treatment); (2) client-related factors (what the client experienced); and (3) follow-up (future needs of the clients). Four main subthemes of the client-therapist relationship emerged: (1) therapeutic alliance; (2) education and knowledge; (3) strategies, tools, and resources; and (4) future needs. This study provides a perspective on the experience of adolescents and adults specific to the impact of a sensory-focused occupational therapy intervention on their daily lives. This will help occupational therapists when designing interventions for current and future clients. What This Article Adds: This study highlights the need for further research addressing effective sensory-based interventions for adolescents and adults. It also captures which components of intervention clients deemed helpful and identifies potential targets for future intervention.

Reasons for Coronary Artery Bypass Graft Rejection: Patients’ and Surgeons’ Perspectives

Background: Studies have shown improved outcomes following coronary artery bypass grafting (CABG) as compared to percutaneous coronary intervention (PCI) in patients who have left main or multivessel disease or diabetes with concomitant multivessel disease. However, there are various factors influencing the patient’s decision to have surgery. This study aims to elucidate the reasons why some patients with indications for the procedure do not eventually receive CABG. Methods: Cases from a single tertiary referral centre were retrospectively examined and indicated patients who did not undergo CABG were included in this study. The main reasons for not undergoing CABG were identified and classified into sub-themes. The risk of CABG quoted by surgeons during surgical consultation was categorised into high or non-high and compared against the patient’s EuroSCORE II. Subjective risk perception was compared with objective measurements to evaluate if subjective risk perception correlated with objective measurements. Results: A total of 301 cases were reviewed and 127 cases were finally included. Patient choice was the most common reason for not undergoing CABG, followed by surgical reasons, then medical reasons. The most common sub-theme of reasons to not proceed given by patients was fear of the procedure (52%), followed by age (15%). The most common surgeon subtheme was perceived high risk for stroke or mortality (59%). Among the patients quoted as being at high risk by surgeons, only 6% had a high EuroSCORE II and 71% had a low EuroSCORE II. Conclusion: Pertinent patient and surgical reasons for declining CABG were identified. Identifying the reasons why patients indicated for CABG declined the procedure can inform and guide patient counselling. The disparity between subjective and objective risk scores suggests that surgeons’ estimation of risk incorporates factors not captured in objective risk scores, which is an area for future studies.

Faculty Process for Reviewing and Utilizing a School’s Course Evaluation Comments

ObjectiveThis study aimed to explore faculty engagement with qualitative comments from course evaluations. MethodsCourse faculty from the University of North Carolina Eshelman School of Pharmacy were recruited via email to participate in a 30-minute interview session. Previous course evaluation comments were adapted to create a de-identified mock evaluation. Six interviews were conducted via Zoom, consisting of a think-aloud protocol based on the mock course evaluation followed by a cognitive interview focused on goals and current utilization of comments, and common patterns and issues sought by faculty. Interview transcripts were manually cleaned and de-identified. Transcripts were inductively coded by 1 researcher using MAXQDA. ResultsThree overarching themes were identified: general faculty process for reviewing comments (ie, how faculty perceive and analyze comments), comments utilization for course change (ie, how faculty utilize comments in making course changes), and faculty analysis strategy (ie, faculty approach to locating common patterns in evaluation comments). The most common subthemes included usefulness of comments, methods for tracking comment patterns, and challenges with the large number of comments each semester. ConclusionFaculty provided useful insight and feedback regarding the current state of the course evaluation process that can be used to improve the structure, organization, and utilization of course evaluations by faculty. These findings could inform the creation of the course evaluation comment automated analysis program in the next stage of an ongoing project.

The impact of in-centre haemodialysis treatment on the everyday life of older adults with end-stage kidney disease: a qualitative study.

Older adults with end-stage kidney disease experience a diminished ability to perform the activities of their daily life. For those living at home, the initiation of in-centre haemodialysis treatment (ICHD) carries a risk of cascading functional decline leading to early nursing home placement and mortality. Research on how older adults adapt to their newly impacted daily life is scarce. Individual semi-structured interviews were conducted using a purposeful maximum variation sample of older adult (≥65years) ICHD patients living at home. Interviews were conducted between October and December 2018. Interview coding followed an inductive and broad-based approach. Thematic analysis was used to group meaning units into common themes and subthemes. Twenty patients (12 females) were interviewed. Analysis resulted in two main themes and seven subthemes. The first main theme showed the impact of ICHD on everyday roles and functioning through four subthemes: a stepwise decline in daily activities, managing time, role changes and an incomplete retirement. The second main theme showed potential areas of remediation through three subthemes: the social environment, developing new daily activity patterns and meaningful activities and goals. The older adults experienced a process of adaptation that generally progressed from a phase of initial disruption towards a period of mere survival. Being able to accept a life on dialysis was intricately connected with the ability to perform activities that were personally meaningful. Early and continued support of meaningful activities may prove valuable in breaking or delaying the cycle of functional decline.

Electromyography-biofeedback for chronic low back pain: A qualitative cohort study.

Surface electromyography-biofeedback (sEMG-BF) may reduce the burden of CLBP by improving physical functioning, sleep, pain catastrophizing, anxiety, and depression. This qualitative study investigated the impact of weekly EMG-BF sessions on adults with CLBP. Twenty-six individuals with CLBP participated in telephone interviews after completing an 8-week virtual sEMG-BF intervention. Trained interviewers conducted the 10-to-15-minute semi-structured interviews to understand participants' experience with the intervention. Common themes and subthemes were identified and analyzed using MAXQDA 2022 software. Participants were predominantly middle-aged females (M = 45, range of 19 - 66) who have had exposure to utilizing conventional therapies such as physical therapy, chiropractor, and massage for the treatment of CLBP. This study focused on participants who reported their experience of the main outcome study which included perceived reductions in CLBP symptoms, including pain and stress, and positive effects on self-awareness and sleep. Three overarching themes emerged and were further divided into subthemes: participants' involvement (virtual experience, accessibility of device, and future recommendations) perceived benefits (participants gained awareness, recommendations for future treatment, met expectations, and implementation), and desire for flexibility (obstacles and COVID-19 Impact). No adverse effects were reported by any of the participants within the study. Both physical and psychological improvements were reported by participants following an sEMG-BF intervention. Specific implementation procedures and critical barriers were identified. In particular, the ability to receive care for CLBP during the COVID-19 pandemic was important to participants.

The Integrated Electronic Health System in Iranian health centers: benefits and challenges

BackgroundElectronic Health Records (EHRs) were introduced to all Iranian medical universities in 2015 with the launch of Integrated Electronic Health System (which is known as SIB: a Persian backronym in Persian meaning apple), and a number of studies were conducted on SIB. However, most of these studies did not consider the benefits and challenges of adopting SIB in Iran. Therefore, the present study aimed to identify the benefits and challenges of SIB in health centers of Khuzestan Province, Iran.MethodsThis was a qualitative study using qualitative conventional content analysis conducted on 6 experts and 24 users of SIB in six health centers of three cities in Khuzestan province, Iran. The participants were selected using a purposeful sampling method. Maximum variation was considered in selecting the group of users, and snowball sampling was used in the group of experts. Data collection tool was semi-structured interview. Data analysis was performed using thematic analysis.ResultsOverall, 42 components (24 for benefits and 18 for challenges) were extracted from the interviews. Common sub-themes and themes were identified for challenges and benefits. The components formed 12 sub-themes, and they were placed in 3 main themes, namely structure, process and outcome. 1) Structure included four sub-themes of Financial resources, Human resources, Facilities, and Access to the Internet; 2) Process involved three sub-themes of Training, Providing services, and Time and workload; and 3) Outcome incorporated five sub-themes of Quality of health services, Access, Safety and personal distance, Screening and evaluation, and Research.ConclusionsIn the present study, the benefits and challenges of adopting SIB were examined in three themes: structure, process, and outcome. Most of the identified benefits were related to the theme of outcome, and most of the identified challenges were related to the theme of structure. Based on the identified factors, by strengthening the benefits of SIB and also trying to eliminate or reduce its challenges, it is possible to institutionalize and use it more effectively in order to solve health problems.

Patient and Health Care Professional Perspectives on Stigma in Integrated Behavioral Health: Barriers and Recommendations.

Stigma related to mental health is well documented and a major barrier to using mental and physical health care. Integrated behavioral health (IBH) in primary care, in which behavioral/mental health care services are located within a primary care setting, may reduce the experience of stigma. The purpose of this study was to assess the opinions of patients and health care professionals about mental illness stigma as a barrier to engagement with IBH and to gain insight into strategies to reduce stigma, encourage discussion of mental health, and increase uptake of IBH care. We conducted semistructured interviews with 16 patients referred to IBH in a prior year and 15 health care professionals (12 primary care physicians and 3 psychologists). Interviews were transcribed and inductively coded separately by 2 coders for common themes and subthemes under the topic headings of barriers, facilitators, and recommendations. We identified 10 converging themes from interviews with patients and the health care professionals, representing important complementary perspectives, with respect to barriers, facilitators, and recommendations. Barriers included professionals, families, and the public as sources of stigma, as well as self-stigma or avoidance, or internalizing negative stereotypes. Facilitators and recommendations included normalizing discussion of mental health and mental health care-seeking action, using patient-centered and empathetic communication strategies, sharing by health care professionals of their own experiences, and tailoring the discussion of mental health to patients' preferred understanding. Health care professionals can help reduce perceptions of stigma by having conversations with patients that normalize mental health discussion, use patient-centered communication, promote professional self-disclosure, and are tailored to patients' preferred understanding.

Facilitators, Barriers, and Best Practices for In-Person and Telehealth Lactation Support During the COVID-19 Pandemic

ObjectiveTo explore the perspectives of lactation support providers delivering breastfeeding education via in-person and telehealth consultations and assess the impact of COVID-19 on the provision of breastfeeding education. DesignQualitative descriptive study using purposive sampling. SettingMassachusetts-based lactation support providers who provided in-person and/or telehealth consultations in various practice settings (e.g., inpatient; outpatient; private practice; and the Special Supplemental Nutrition Program for Women, Infants, and Children). ParticipantsFourteen Massachusetts-based lactation support providers, ages 36 to 68 years. MeasurementsParticipants completed an online demographic and employment characteristics survey and virtual key informant interviews, from which six main themes were defined. ResultsThe six main themes included Common Questions Asked by Clients, Prenatal and Postpartum Consultation Topics, Facilitators for Telehealth Versus In-Person Consultations, Barriers for Telehealth Versus In-Person Consultations, Best Practices, and COVID-19 Adaptations. From participant interviews, common subthemes emerged. The primary adaptation due to COVID-19 was shifting to telehealth. Content in lactation consultations was similar via in-person and telehealth sessions. Typical content areas included breast pumping and mother’s milk supply. A notable difference was the lack of physical examinations for women and newborns in telehealth sessions. Scheduling flexibility was a key facilitator of telehealth consultations, whereas the inability to provide hands-on assistance and chaotic home environments were common barriers. In-person facilitators included weighing newborns to assess feeding success and insurance billing coverage, whereas unsupportive family members were noted as a barrier. Diversity, equity, and inclusion-related barriers (e.g., language barriers, lack of reflective diversity, lack of stable Internet access) were observed in both settings. Best practices for in-person and telehealth consultations included meeting mothers where they are and focusing on mothers’ goals. ConclusionPractice adaptations adopted during the pandemic and best practice recommendations may be useful for lactation support providers and other health care professionals caring for breastfeeding dyads.

The Socialization and Development of the Coordinator of Clinical Education in Athletic Training

Context Coordinators of Clinical Education (CCEs) play an important role in clinical education, yet they often receive little to no formal training in the role. The experiences of the CCE and preparation for their role is unknown; therefore, the purpose of this study was to explore the professional socialization of CCEs into their roles. Methods A total of 36 CCEs with a minimum of 1-year experience as a CCE (31 women, 5 men; 5.2 ± 4.7 years of experience as CCE) participated in this qualitative study. Data saturation guided the number of participants. Seven focus-group interviews were completed following a semistructured interview guide developed based on previous socialization research. Data were analyzed through consensual qualitative review, with data coded for common themes and subthemes. Trustworthiness was established via peer review and multianalyte triangulation. Results Two themes emerged: role and socialization. Role is described as responsibilities, collaboration, and challenges. Participants described responsibilities including complete oversight of clinical education, preceptor development, evaluation and assessment of clinical skills, and administrative duties. CCEs described the importance of collaboration, both internally and externally. CCEs faced challenges such as time management, conflict management, and navigating institutional policies. Socialization described preparation, integration into the role, resources, and needs. CCEs described minimal preparation, and most did not feel prepared to take on all aspects of the role. CCEs described role integration, which included meeting with the program director, reviewing the job description and the Commission on Accreditation of Athletic Training Education (CAATE) Standards, and trial and error. During socialization, they described a variety of resources such as conferences and the CAATE Standards to provide guidance. Last, participants identified needs including specific job description, a timeline for tasks, and professional development. Conclusions Overall, participants felt adequately prepared for some aspects of their roles, but less prepared for others. Additional professional development is necessary to make CCEs more successful.

Danish heritable retinoblastoma survivors' perspectives on reproductive choices: "It's important for me, not to pass on this condition".

Despite reporting an overall normal life, survivors of heritable retinoblastoma face numerous physical and psychosocial issues. In particular, reproductive decision-making is often complex and difficult. This study aims to examine survivors' reflections on passing on heritable retinoblastoma to their children, how survivors approach their reproductive choices, and how the healthcare system can optimize counseling and support. Semi-structured interviews with Danish adult survivors of heritable retinoblastoma were qualitatively analyzed to explore their experiences. Participants were recruited from the Retinoblastoma Survivorship Clinic, Aarhus University Hospital, Denmark. Thematic data analysis was conducted followed by a condensing process specifically for the subthemes relating to reproductive choices. A common subtheme for all participants was a strong wish to avoid passing on retinoblastoma to their children. The participants emphasized the various medical, practical, emotional, and moral issues impacting their final reproductive choice in the process of family planning to conceive a child unaffected by retinoblastoma. Some had no option other than to conceive naturally and hope for an unaffected baby; while others weighed the pros and cons of choosing natural conception with prenatal testing and then considering termination of pregnancy (in case of an affected fetus) versus choosing fertility treatment with preimplantation genetic testing to achieve an unaffected pregnancy. Several participants underlined the complexity of their decisions, and also expressed feelings of guilt, both toward their affected child, and guilt for putting their partner through many difficult decisions and obstacles due to their genetic condition. Our findings demonstrate how one family-planning decision is not unequivocally "better" or easier than another. Healthcare professionals must provide the necessary information and tools to support the individual's unique decision-making process. Survivors' autonomy and individual needs, as well as the numerous and diverse aspects of heritable retinoblastoma, should be carefully considered.

Parents' Perceptions and Experiences with Their Children's Use of Augmentative/Alternative Communication: A Systematic Review and Qualitative Meta-Synthesis.

Augmentative and alternative communication (AAC) consists of any method of communicating that supplements or completely substitutes oral and/or written language when it is impaired. Therefore, it enables children with complex communication needs to develop their full communicative potential. However, despite the many benefits of AAC and its widespread use, several review studies have underscored the problems faced by parents and children who use AAC in their daily lives. The general objective of this systematic review and qualitative meta-synthesis is to provide a complete overview of parents’ experiences and perceptions with their children’s use of AAC. Specifically, it aimed to identify common themes and subthemes of interest and to analyze the research quality of the selected studies. An exhaustive literature search was carried out using different electronic databases. Nineteen studies were included, involving 297 parents. A thematic synthesis was undertaken. Three main themes and nine subthemes were identified: service support (accessibility, providers and coordination); characteristics of AAC systems (usability and acceptability, features, cost and funding); and integration of AAC in daily life (family, school, social and community). Findings raise a need for more services that support children with complex communication deficits in different contexts, more functional use of AAC systems at school and in real-world situations, as well as service assistance over an extended time period.

Public Perception of SARS-CoV-2 Vaccines Among Psoriasis Patients in Social Media: Content, Sentiment, and Engagement Analysis.

BackgroundPsoriasis patients may seek information about the SARS-CoV-2 vaccine and their disease from social media platforms. Analyses of social media interactions may help guide dermatologists’ educational efforts during this pandemic.ObjectivesThis study analyzes social media interactions among patients with psoriasis and psoriatic arthritis regarding the SARS-CoV-2 vaccine to determine the misinformation circulating and the apprehension to receiving the vaccine.MethodsPublicly accessible Facebook and Reddit groups regarding psoriasis and psoriatic arthritis were identified. Posts uploaded between March 1, 2021 and July 31, 2021 which contained information about the SARS-CoV-2 vaccine were extracted. First-order themes, sub-themes, sentiment scores and engagement scores were assigned to each post.Results345 posts within the first-order theme of vaccination decision and 1379 posts within the first-order theme of vaccine reaction were analyzed. Within vaccination decision, common sub-themes for refusing the vaccine include fear of psoriasis flare up, vaccine is experimental, vaccine is unnecessary, vaccine is dangerous, and concern for reaction/vaccine efficacy while on psoriasis medications. 41.4% of posts contained positive sentiment; whereas, 38.3% contained negative sentiment. Within vaccine reaction, common sub-themes identified were no change to psoriasis, skin/joint flare up, skin flare up attributed specifically to stopping psoriasis medications, skin/joint improvement, and skin flare up but vaccine was worth it. 77.8% of posts contained positive sentiment; whereas, 6.2% contained negative sentiment.ConclusionsOur study identified common SARS-CoV-2 vaccine concerns within the psoriasis community which should be used to guide educational efforts.