Contemporary Health Services Research Articles

Understanding violence in the context of psychosis: contribution of phenomenology and its limitations

SUMMARY Navigating the complex relationship between violence and psychosis can frequently be challenging. Psychiatrists may find assessing and managing the risk of violence in this context daunting. In their article on the topic, Anderson et al helpfully summarise the role that psychopathology can play in this process. However, although careful elucidation of an individual's experiences may assist in the nuanced formulation of their risk and could offer a specific focus for interventions, the approach has potential shortcomings in certain settings. For some phenomena the link with violence is unclear and it may be constellations of symptoms that are important. Causal pathways are not always linear and there may be important mediators linking psychopathological features to behavioural outcomes. In the resource-limited settings in which many contemporary health services operate, a detailed assessment of psychopathology may be hampered by time or other constraints. Alternative, more scalable solutions may therefore be needed in particular scenarios.

Reinforcing the humanity in healthcare: The Glasgow Consensus Statement on effective communication in clinical encounters

Contemporary healthcare is characterized by multidisciplinary teamwork across a vast array of primary, secondary and tertiary services, augmented by progressively more technology and data. While these developments aim to improve care, they have also created obstacles and new challenges for both patients and health professionals. Indeed, the increasingly fragmented and transactional nature of clinical encounters can dehumanize the care experience across disciplines and specialties. Effective communication plays a pivotal role in reinforcing the humanity of healthcare through the delivery of person-centered care – compassionate, collaborative care that focuses on the needs of each patient as a whole person. After convening at the International Conference on Communication in Healthcare (Glasgow, 2022), an interdisciplinary group of researchers, educators and health professionals worked together to develop a framework for effective communication that both acknowledges critical challenges in contemporary health services and reinforces the humanity of healthcare. The Glasgow Consensus Statement is intended to function as a useful international touchstone for the training and practice of health professionals, fully recognizing and respecting that different countries are at different stages when it comes to teaching, assessment and policy. It also provides a vocabulary for monitoring the impact of system-level challenges. While effective communication may not change the structure of healthcare, it can improve the process if health professionals are supported in infusing the system with their own innate humanity and applying the framework offered within this consensus statement to reinforce the humanity in everyday practice.

The discourse of delivering person-centred nursing care before, and during, the COVID-19 pandemic: Care as collateral damage.

The global COVID-19 pandemic challenged the world-how it functions, how people move in the social worlds and how government/government services and people interact. Health services, operating under the principles of new public management, have undertaken rapid changes to service delivery and models of care. What has become apparent is the mechanisms within which contemporary health services operate and how services are not prioritising the person at the centre of care. Person-centred care (PCC) is the philosophical premise upon which models of health care are developed and implemented. Given the strain that COVID-19 has placed on the health services and the people who deliver the care, it is essential to explore the tensions that exist in this space. This article suggests that before the pandemic, PCC was largely rhetoric, and rendered invisible during the pandemic. The paper presents an investigation into the role of PCC in these challenging times, adopting a Foucauldian lens, specifically governmentality and biopolitics, to examine the policies, priorities and practical implications as health services pivoted and adapted to changing and acute demands. Specifically, this paper draws on the Australian experience, including shifting nursing workforce priorities and additional challenges resulting from public health directives such as lockdowns and limitations. The findings from this exploration open a space for discussion around the rhetoric of PCC, the status of nurses and that which has been lost to the pandemic.

Online Mental Health Forums and Rural Resilience: Mixed Methods Study and Logic Model.

Rural mental health is a growing area of concern internationally, and online mental health forums offer a potential response to addressing service gaps in rural communities. The objective of this study was to explore and identify pathways by which online peer support mental health forums help to build resilience for rural residents experiencing mental ill-health by contributing to overcoming their specific contextual challenges. We developed a Theoretical Resilience Framework and applied it to 3000 qualitative posts from 3 Australian online mental health forums and to data from 30 interviews with rural forum users. Drawing on the findings and an abductive approach, a logic model was developed to illustrate links between the resilience resources built and enabling features of forums that make them spaces that facilitate resilience. The study demonstrated that online forums make valuable contributions to social well-being and access to a range of timely support services for rural people experiencing mental ill-health, and, while doing so, involve users in the processes of resilience building. The study provides a new way for practitioners to frame the work of and value produced by forums. It gives a logic model that can be used in evaluation and audit as it facilitates a causal framing of how forums, as an intervention, link with resilience outcomes. Ultimately, the study contributes to developing new knowledge about how rural resilience building can be conceptualized and measured while showing how forums are part of contemporary health service provision in rural places.

Contribution of artificial intelligence and big data in a medical biology laboratory: An experience of the central laboratory CHU Mohammed VI Oujda

The practice of medicine and medical biology is being revolutionized by the development of artificial intelligence (AI) and Big Data analysis in this field, with their ability to process large volumes of structured and unstructured data from different sources with a satisfactory processing speed. Medical analytics provides a huge amount of information and data. However, Big Data and AI allow for innovative applications in the field of medical biology. Thus, this article summarizes some recent promising applications of AI and Big Data in medical biology laboratories, notably in the central laboratory of the Mohammed VI University Hospital Oujda, as the quality improvement and vitamin D prediction threshold, which have potential added value for improving the quality of contemporary health services and reducing the costs of analysis and care.

Wearable Smart Phone Sensor Fall Detection System

One of the most important measures that developed countries need along with economic success is the provision of contemporary health services for the elderly. Inadequate care for the elderly can put them in danger of falls with serious injury or even death. When an older person falls due to illness, immediate lack of care may lead to death. In this paper, a wearable smart phone sensor fall event detection system is introduced. The proposed system utilizes real-time raw sensory accelerometer, gyroscope and gravity data collected from the AndroSensor App and is then processed and applied to a machine learning classifier. The smart phone is positioned at the waistline to yield the most accurate fall detection results. The system is trained and can detect common activities, like sleeping, walking, sitting, jogging, and events, such as falling in any direction. An full accuracy is almost accomplished using Support Vector Machine classifier in comparison with other classifiers as addressed by other previous research works. Nevertheless, the system requires more validation with elderly people under the supervision of caregivers in a controlled environment.

Development of Advanced Artificial Intelligence and IoT Automation in the Crisis of COVID-19 Detection.

Internet of Things (IoT) is a successful area for many industries and academia domains, particularly healthcare is one of the application areas that uses IoT sensors and devices for monitoring. IoT transition replaces contemporary health services with scientific and socioeconomic viewpoints. Since the epidemic began, diverse scientific organizations have been making accelerated efforts to use a wide range of tools to tackle this global challenge and the founders of IoT analytics. Artificial intelligence (AI) plays a key role in measuring, assessing, and diagnosing the risk. It could be used to predict the number of alternate incidents, recovered instances, and casualties, also used for forecasting cases. Within the COVID-19 background, IoT technologies are used to minimize COVID-19 exposure to others by prenatal screening, patient monitoring, and postpatient incident response in specified procedures. In this study, the importance of IoT technology and artificial intelligence in COVID-19 is explored, and the 3 important steps discussed such as the evaluation of networks, implementations, and IoT industries to battle COVID-19, including early detection, quarantine times, and postrecovery activities, are reviewed. In this study, how IoT handles the COVID-19 pandemic at a new level of healthcare is investigated. In this research, the long short-term memory (LSTM) with recurrent neural network (RNN) is used for diagnosis purpose and in particular, its important architecture for the analysis of cough and breathing acoustic characteristics. In comparison with both coughing and respiratory samples, our findings indicate poor accuracy of the voice test.

The Queen’s Nurses collaborative inquiry - understanding individual and collective experiences of transformative learning

Background: In contemporary health and social care services and systems, there is a critical need for nursing care that is agile in its delivery, integrated across sectors, responsive to complex need, and focused on prevention, self-care and wellbeing. Community nurses are at the centre of these services, working in and across a variety of complex systems that depend on the expertise they bring to individuals, communities and populations. However, ensuring this capability is brought to the forefront of quality frameworks is a challenge as care practices are often reduced to moments of interaction or intervention that are tangible and objectively measured. We know, though, that community nurses bring vital and wide-ranging expertise to the health of populations. The Queen’s Nursing Institute Scotland has re-established the Queen’s Nurse Development Programme to address these contemporary agendas and ensure the potential of expert community nursing is demonstrated and recognised. Aim: To engage in a participatory evaluation of the experience of the nine-month development journey of the 2019 Queen’s Nurse Development Programme participants. Methods: A Collaborative Critical Creative Inquiry (CCCI) methodology was used, operationalised through a five-phase inquiry process, informed by Theory U ‘presencing ’and its five movements for attending to and co-shaping reality to achieve presencing. Our embedded and embodied data-collection methods drew specifically on participants ’creative expressions, reflective diaries and journals, and project notes. Findings: The results of each phase of inquiry informed subsequent phases, culminating in a final phase (synthesis) where key themes representing the findings from all phases were derived. These themes were self-growth, community and practical impacts. Conclusion and implications for practice: The importance of slowing and stillness, linked to the spaces created for creative reflective learning and development has been significant in this programme. Being present to listen to self, and engage in self-care and self-growth is something the programme provides and that is highly valued. We would argue that if health systems are serious about the transformation of services and people, then these kinds of programmes are critical to success.

Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Reported increases in attention-deficit/hyperactivity disorder (ADHD) diagnoses are accompanied by growing debate about the underlying factors. Although overdiagnosis is often suggested, no comprehensive evaluation of evidence for or against overdiagnosis has ever been undertaken and is urgently needed to enable evidence-based, patient-centered diagnosis and treatment of ADHD in contemporary health services. To systematically identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents using a published 5-question framework for detecting overdiagnosis in noncancer conditions. This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology, including the PRISMA-ScR Checklist. MEDLINE, Embase, PsychINFO, and the Cochrane Library databases were searched for studies published in English between January 1, 1979, and August 21, 2020. Studies of children and adolescents (aged ≤18 years) with ADHD that focused on overdiagnosis plus studies that could be mapped to 1 or more framework question were included. Two researchers independently reviewed all abstracts and full-text articles, and all included studies were assessed for quality. Of the 12 267 potentially relevant studies retrieved, 334 (2.7%) were included. Of the 334 studies, 61 (18.3%) were secondary and 273 (81.7%) were primary research articles. Substantial evidence of a reservoir of ADHD was found in 104 studies, providing a potential for diagnoses to increase (question 1). Evidence that actual ADHD diagnosis had increased was found in 45 studies (question 2). Twenty-five studies showed that these additional cases may be on the milder end of the ADHD spectrum (question 3), and 83 studies showed that pharmacological treatment of ADHD was increasing (question 4). A total of 151 studies reported on outcomes of diagnosis and pharmacological treatment (question 5). However, only 5 studies evaluated the critical issue of benefits and harms among the additional, milder cases. These studies supported a hypothesis of diminishing returns in which the harms may outweigh the benefits for youths with milder symptoms. This review found evidence of ADHD overdiagnosis and overtreatment in children and adolescents. Evidence gaps remain and future research is needed, in particular research on the long-term benefits and harms of diagnosing and treating ADHD in youths with milder symptoms; therefore, practitioners should be mindful of these knowledge gaps, especially when identifying these individuals and to ensure safe and equitable practice and policy.

The impact of COVID-19 on alcohol and other drug nurses' provision of care: A qualitative descriptive study.

Aims and objectivesTo explore the impact of the COVID‐19 pandemic on alcohol and other drug nurses providing treatment for individuals presenting with problematic alcohol and other drug use.BackgroundCOVID‐19 has caused disruption to contemporary health service delivery, including alcohol and other drug treatment. Provisional research on drug and alcohol consumption patterns shows changes attributable to the pandemic, with implications for service delivery. Research also indicates the impact of the pandemic on healthcare staff is significant, leading to workforce challenges that threaten care provision.DesignQualitative descriptive study design.MethodsData were collected using semi‐structured, individual telephone interviews with practising alcohol and other drug nurses from Australia and New Zealand (n = 19). COREQ reporting guidelines were used.ResultsAfter thematic analysis, three key themes emerged: ‘No room at the inn: Changes to service delivery due to COVID‐19’, ‘We are providing care to a very vulnerable group of people: Consumer factors during COVID‐19’ and ‘Personally, we were very, very stressed: Workforce factors due to COVID‐19’.ConclusionsThe findings from this study indicate that the impact of the pandemic was felt by alcohol and other drug nurses, services and healthcare consumers alike. The experiences of alcohol and other drug nurses through the COVID‐19 pandemic need further exploration both to ensure workforce sustainability and that disruptions to alcohol and other drug services do not occur in future outbreaks of communicable disease.Relevance to clinical practiceCOVID‐19 has had a profound effect on nurses in all settings, and these effects are likely to be felt for some time after the pandemic: nursing specialties require support to ensure ongoing workforce sustainability and well‐being of nursing staff. All nurses need to be aware of changes to alcohol and other drug use during the pandemic and screen healthcare consumers accordingly.

The biopsychosocial-digital continuum of foot orthosis practice and research: the VALUATOR model

Foot orthoses have been used for decades despite uncertainty surrunding their therapeutic efficacy. Orthoses have been used exclusively to affect neuro-biomechanical input and outcome variables, however, there is emerging evidence that therapeutic efficacy may be affected by a psychological stimulus. Critical appraisal of the literature highlights that there is no holistic model upon which foot orthosis practice is taught, practised nor investigated. This paper introduces a conceptual model of foot orthosis practice (Value Based Foot Orthosis Practice (VALUATOR) model) that embraces a broader range of factors that are pertinent to orthosis practice, incorporating contemporary health service behaviours and values into orthosis practice for the first time.Within the VALUATOR model, foot orthosis design and clinical value is considered along a bio-psycho-social-digital continuum that reflects the reality of foot orthosis practice. The model contextualises the variable outcomes that are observed in research and practice within 6 key areas: 1) value, 2) person-centered approach, 3) zone of optimal bio-psycho-social stress, 4) bio-psycho-social assessment, 5) monitoring, 6) primary and secondary clinical strategies.The VALUATOR model is targeted at students, lecturers, scientists and practitioners and includes carefully chosen terminology to support a robust basis for educational and scientific discussion. It is believed that it provides a contemporary viewpoint and a structured conceptual metaphor that builds on existing evidence from a wide range of sources, invites constructive intellectual debate, and is anchored in the experiences of practitioners too. Stress testing the VALUATOR model will help determine its model and support further developments and evolution of orthotic practice in a evidence based way.

The mental health status of faculty members and students as the contemporary and future health system providers

PurposeHealth is one of the most basic human rights. The mental health of contemporary and future health services providers is of great significance. The purpose of this paper is to investigate the mental health of the faculty members and students of Kurdistan University of medical sciencesDesign/methodology/approachThis was an analytical-descriptive and cross-sectional study, which was conducted using the Census method on 249 faculty members and proportionately by using random sampling on 347 students in 2019. Data were collected using the 28-item General Health Questionnaire. Data analysis was done via SPSS 24 software by using statistical tests such as T-test and one-way ANOVA.FindingsThe mean values (standard deviation) of the total score of mental health among students and faculty members were 27.43 (14.37) and 20.17 (11.37), respectively. In total, 57.2% of students and 31% of faculty members had symptoms of mental disorder. The highest mean score among faculty members and students was observed on the subscale of “social dysfunction.” There was a significant relationship between the mental health of students and where they study and the mental health of faculty members and type of faculty member with the faculty in which they work (p < 0.05).Originality/valueThe prevalence of mental disorders’ symptoms among faculty members and students of Kurdistan University of medical sciences was high, and it must be considered by policymakers and managers of the health system to plan appropriate interventions.

Preventive Role of L-Carnitine and Balanced Diet in Alzheimer's Disease.

The prevention or alleviation of neurodegenerative diseases, including Alzheimer’s disease (AD), is a challenge for contemporary health services. The aim of this study was to review the literature on the prevention or alleviation of AD by introducing an appropriate carnitine-rich diet, dietary carnitine supplements and the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, which contains elements of the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet. L-carnitine (LC) plays a crucial role in the energetic metabolism of the cell. A properly balanced diet contains a substantial amount of LC as well as essential amino acids and microelements taking part in endogenous carnitine synthesis. In healthy people, carnitine biosynthesis is sufficient to prevent the symptoms of carnitine deficiency. In persons with dysfunction of mitochondria, e.g., with AD connected with extensive degeneration of the brain structures, there are often serious disturbances in the functioning of the whole organism. The Mediterranean diet is characterized by a high consumption of fruits and vegetables, cereals, nuts, olive oil, and seeds as the major source of fats, moderate consumption of fish and poultry, low to moderate consumption of dairy products and alcohol, and low intake of red and processed meat. The introduction of foodstuffs rich in carnitine and the MIND diet or carnitine supplementation of the AD patients may improve their functioning in everyday life.

Peer review (Dorothee Holscher) - The fundamental violence of physiotherapy: Emmanuel Levinas’s critique of ontology and its implications for physiotherapy theory and practice

Thank you for the opportunity to review this paper, which I enjoyed greatly. I have used Levinas’ work in some of my thinking about social work ethics and have no doubt of its relevance for contemporary human, social and health services. You also articulated your paper’s purpose clearly and provided a convincing rationale: to say that there is an implicit violence within contemporary, professional helping relationships – here, physiotherapy – indeed calls for critical engagement and exploration of possible openings for change. Based on the argument that Levinas enables such a critique, then, your paper aims to introduce him to a wider audience, with a view to making a novel and timely contribution to the theory and practice of physiotherapy. Doubtlessly, this will be relevant wherever physiotherapy is studied, taught and practiced. Your endeavour to introduce Levinas’ work to a new audience informed my feedback below.

Polymers in medicine direction of development

The paper constitutes a brief and subjective review of polymeric materials in the contemporary health service. The range of applications of polymeric materials is discussed, special att ention being paid to such materials for the development of carriers of pharmaceutically active species, stents and vascular prostheses, amongst them to the application of „smart” materials for these purposes, layers and scaff olds for the growth of organs and tissues, antifouling layers. The authors try to turn the att ention of the reader to the research and intellectual eff orts necessary for the development of polymeric materials for the medicine, and conclude about the growing importance of such studies.

Caring for the trans community

The healthcare assistant and assistant practitioner (HCA and AP) are required to care for a range of people in a variety of settings and are expected to offer care that is sensitive, confident and compassionate. This article discusses the care of the trans community who, like others, come from diverse backgrounds. The role and function of the HCA and AP are outlined. There are legal requirements that address gender and these are discussed in the article. The need to adhere to the 6Cs is also considered and described. This article emphasises the importance of inclusion and equality in care provision, making clear that there is no place in any contemporary health and social care service for discrimination, persecution or bullying because of who a person is.

Integrated categories for integrated care - the importance of patient centred categories

Categorisation systems such as DRGs and ICD are fundamental to contemporary health services planning (what gets done where), funding (price and budgeting), operational management (performance metrics) and governance (which interests are recognised). A well implemented system makes a large difference: for example Activity Based Funding (ABF) has revolutionised the acute hospital sector, and driven major improvements in efficiency, management and governance All formal categorisation systems, by the very fact of distinguishing classes, create boundaries. When such systems are used normatively (for example, for budgeting) then those boundaries affect the behaviours of participants, whether clinician, system manager, funder or consumer. The result is that the inherent biases of such a system can become institutionalised, and boundaries risk becoming a border to defend, rather than an obstacle to be removed By their nature, integrated health care systems need to be patient centred (i.e. “follow” patients/ consumers across multiple platforms), extended across time (cover multiple phases) and interdisciplinary (drawing on a range of professions and organisations). This creates interesting issues with respect to the design and development of categorisation systems, which must also be patient centred, stable across time and be meaningful in multiple settings. Such a system can lessen conceptual and practical boundaries between the systems required for integrated care. It is also an opportunity to ensure integrated systems are genuinely patient centred Existing categorisation systems such as ICD, DRGs and the ICF have developed for different reasons, and embody distinctive views of health, disease, care and “patienthood”. For example, the ICD/DRG approach – which embodies a “medical” logic – is largely silent on the variables that need to be considered in funding, providing and evaluating the ongoing care. Many of these variables are already at play within the acute episode, but are unrecognised by coding and classification systems (e.g. disability, social context and self-efficacy). A multidimensional approach : Progress has been made conceptually on recognising the multidimensionality and continuity of care, a prominent example being the multi-axial framework within WHO International Classification of Functioning, Disability and Health (ICF) which, amongst other elements, recognises the patient’s capacity and incapacity to function as variables, while also recognising the significance of medically defined conditions. We propose that the time has now come for a pragmatic approach that adds patient centred “dimensions” to existing classifications. By way of example, we consider the implications for integrated care classification, starting from an ICD/ DRG perspective. By adding a dimension that references ongoing, stable patient attributes germane to service integration, we show that – at least in principle – it is possible to develop stable, meaningful patient centred categories that extend across time and space, thus supporting patient-centred integration By forging those linkages, the broader care integration project can stay centred on maximising patient benefit, rather than being distracted by institutional boundaries. Integrated care needs integrated classification systems.

The effectiveness of the internship in meeting established learning objectives: A qualitative study

Objective: To identify and explore variations in intern (Postgraduate Year 1 doctors) exposure to clinical activities defined by an established early postgraduate curriculum within the contemporary health service environment.Methods: A mixed methods study was undertaken in seven health services comprising (1) a questionnaire regarding interns’ exposure to a range of clinical activities within a two-year early post-graduate curriculum and (2) group interviews with intern supervisors and managers to explore barriers and facilitators of interns’ clinical exposure.Results: One hundred and eleven interns completed the questionnaire and seventeen intern supervisors and managers participated in group interviews. Interns’ exposure to early postgraduate curriculum activities varied significantly, with participation in patient emergency management and procedures being undertaken less frequently than interns wished. These findings were consistent across different regional settings. Of three mandatory terms, exposure to curriculum activities was greater in medicine and emergency medicine than in surgery.Conclusions: Junior doctors’ participation within the complex contemporary health service environment is constrained by barriers relating to clinical governance frameworks and health system performance, particularly in high-risk clinical activities. Solutions will require structural approaches to internship reform to ensure that placements provide the necessary safe clinical experiences required for intern training.

Promoting Interprofessional Collaboration: A Pilot Project Using Simulation in the Virtual World of Second Life

Background: Contemporary health services increasingly call for teamwork and interprofessional collaboration, though undergraduate curricula provide few opportunities for students to develop the necessary skills. This article presents the results of an innovative pilot project focusing on providing an interprofessional clinical learning experience for students using the virtual world of Second Life.Methods and Findings: A pilot project was implemented and tested on a small group of students studying at two institutions in four healthcare programs. Qualitative descriptive methods were employed to analyze semi-structured interview transcripts. The evaluation revealed that participants were easily able to manage the technologies associated with Second Life and the learning and teaching strategies were engaging and useful. While the project provided students with an opportunity to learn more about the role of other health professionals and their contribution to patient care, it will require some development before it achieves in full the aim to promote interprofessional collaboration. Conclusions: Simulation in virtual worlds such as Second Life offers promise in the area of interprofessional education.

A systematic review of women's and health professional's attitudes and experience of preconception care service delivery.

The value and importance of preconception care (PCC) have been acknowledged by leading health organizations as a vital element within preventive medicine and health promotion for the wider population. The translation of PCC from position statement to relevant service and programme delivery is essential for the benefits of PCC to be realized and relies on insights from health services research. This article aims to review contemporary health services research literature examining women's and health professionals' perceptions and experiences of PCC services. A systematic review of original research published between 2003 and 2015 was conducted in November 2015. Multiple databases (PubMed, CINAHL, AMED and Maternity and Infant Care) were searched through two distinct searches to capture research literature reporting the perspective of health professionals and women towards PCC service delivery. The search identified 13 papers (4 reported the perceptions of women, 11 described the views of health professionals [2 papers reported findings from both groups]). The analyses of the contemporary literature revealed five broad areas of focus: women's service needs regarding PCC, PCC training and education requirements, role delineation around PCC, priority and value of PCC and barriers and obstacles to PCC. Despite the mounting evidence supporting the value and importance of PCC, there is insufficient research attention given to the clinical reality of PCC service and programme delivery. The transfer of PCC guidelines from broad policy to grass roots practice requires a more detailed consideration of the practicalities of implementing PCC within contemporary women's health care.