Conventional Medical Services Research Articles

Examining Users’ Assessment of Indigenous Beliefs and Practices of Alternative Medicine in Nde Division, Cameroon

Despite the prevalence of conventional medical services, alternative medicine (AM) remains a vital component of healthcare-seeking choices in many communities across Africa The persistence of indigenous beliefs and practices in healthcare decisions among the population of Nde Division, Cameroon, despite the availability of conventional Western medicine, poses a complex challenge for healthcare providers seeking to deliver effective and culturally sensitive care. This study addresses the phenomenon by exploring the role of indigenous beliefs and practices in shaping healthcare choices, using a mixed-methods approach, which combines questionnaires and semi-structured interviews. Questionnaire findings reveal a significant reliance on alternative medicine, with 79.59% of participants who believe in the efficacy of Indigenous healing traditions and 80% from the semi-structured interviews, who use alternative medicine due to cultural and spiritual beliefs. The strong reliance on AM is also influenced by economic, social, cultural, and individual factors. Concerns around the safety and efficacy of AM highlight the need for more education, regulation, and integration with conventional healthcare, ultimately informing the development of culturally sensitive healthcare approaches.

Potential effects of a mobile stroke unit on time to treatment and outcome in patients treated with thrombectomy or thrombolysis: A Danish-German cross-border analysis.

A mobile stroke unit (MSU) reduces delays in stroke treatment by allowing thrombolysis on board and avoiding secondary transports. Due to the beneficial effect in comparison to conventional emergency medical services, current guidelines recommend regional evaluation of MSU implementation. In a descriptive study, current pathways of patients requiring a secondary transport for mechanical thrombectomy were reconstructed from individual patient records within a Danish (n = 122) and an adjacent German region (n = 80). Relevant timestamps included arrival times (on site, primary hospital, thrombectomy centre) as well as the initiation of acute therapy. An optimal MSU location for each region was determined. The resulting time saving was translated into averted disability-adjusted life years (DALYs). For each region, the optimal MSU location required a median driving time of 35 min to a stroke patient. Time savings in the German region (median [Q1; Q3]) were 7 min (-15; 31) for thrombolysis and 35 min (15; 61) for thrombectomy. In the Danish region, the corresponding time savings were 20 min (8; 30) and 43 min (25; 66). Assuming 28 thrombectomy cases and 52 thrombolysis cases this would translate to 9.4 averted DALYs per year justifying an annual net MSU budget of $0.8M purchasing power parity dollars (PPP-$) in the German region. In the Danish region, the MSU would avert 17.7 DALYs, justifying an annual net budget of PPP-$1.7M. The effects of an MSU can be calculated from individual patient pathways and reflect differences in the hospital infrastructure between Denmark and Germany.

Abstract WMP78: Mobile Stroke Units Enable Hyperacute Interventions for Intracerebral Hemorrhage

Introduction: Mobile stroke units (MSUs) are an evolving means to expedited acute stroke management. Recent landmark trials BEST-MSU and B_PROUD have proven that MSUs facilitate quicker thrombolysis times and improved functional outcomes at 90 days when compared to conventional emergency medical services (EMS) for acute ischemic stroke patients. Despite the growing body of literature surrounding MSUs and acute ischemic stroke, literature describing the intracerebral hemorrhage experience in MSUs has been lacking. Methods: Retrospective analysis of consecutive patients with acute intracerebral hemorrhage triaged by MSU or EMS from January 2018 to December 2022 was performed at two tertiary institutions. In the EMS cohort, only patients seen between 8 am to 8 pm, corresponding to the operating hours of the MSU, were included. Goal blood pressure was defined as systolic blood pressure <160. Chi-squared test for categorical variables and t-test for continuous variables were used for statistical analysis. Results: A total of 146 MSU patients were compared to 221 EMS patients. Both cohorts had similar baseline demographics. Median initial blood pressure in the MSU was 190/99, which dropped to a median blood pressure of 157/80 upon arrival to the hospital. Initial systolic blood pressure in the hospital was significantly higher for EMS compared to MSU patients (166 vs 157, p=0.011). The majority (77%) of MSU patients received anti-hypertensive medications while in the MSU. Times from door to CT completion (14 vs 33 min, p=0.000), anticoagulation reversal (99 vs 139 min, p=0.013), anti-hypertensive medication administration (21 vs 45 min, p=0.020), and goal blood pressure (35 vs 51 min, p=0.000) were significantly faster in the MSU cohort. Conclusions: MSUs provide faster medical treatment for patients with acute intracerebral hemorrhage. The target blood pressure goal was met much quicker in the MSU. Faster time metrics convey a hypothetical benefit towards improved patient outcomes.

Internet hospital response to the COVID-19 pandemic in a tertiary hospital in China: Perspectives based on a mixed-methods.

This study aimed to summarize the characteristics of the Internet hospital services of the Seventh Affiliated Hospital of Sun Yat-sen University (SAHSYSU), describe diagnosis and treatment patterns in each department, determine SAHSYSU Internet hospital's role in pandemic control, and explore development strategies in non-pandemic situations. Mixed-methods was used in this study. Qualitative organizational behavior analysis was conducted on hospital meeting records and semi-structured interview records to determine the research analysis indicators. We quantitatively analyzed online consultation record data of SAHSYSU Internet hospital from January to December 2020, and conduct classification analysis on departmental case studies using K-means clustering algorithm. 29,944 patient data items were retrieved. Internet hospital services synchronized with COVID-19 pandemic development in China and Guangdong province. The service volume peaked during the period of January to March, which coincided with the height of the pandemic. Out of the total visits, 58.90% were conducted during office hours while 41.10% were conducted during non-office hours. The majority of the patients came from Guangdong (19.67%) and Hubei (9.09%) provinces. The cluster analysis identified three clusters, each with different change rates and magnitudes of change for various departments. Internet hospitals complemented conventional medical services, providing crucial medical care during the COVID-19 pandemic. Internet hospitals are the future trend of medical services and should be improved based on each department's treatment characteristics.

Modifying Whole Health Services for Successful Telehealth Delivery: Lessons from Veterans Health Administration's Rapid Transition During the COVID-19 Pandemic.

Introduction: The Veterans Health Administration (VHA) is shifting care from a disease-oriented to health-creating approach that aims to provide whole person care. This Whole Health (WH) system combines person-centered care with delivery of WH services (e.g., health coaching, well-being education and skill-building classes, and evidence-based complementary and integrative health therapies), alongside conventional medical services. During the COVID-19 pandemic, WH services were modified for delivery through telehealth (teleWH). This article characterizes modifications to WH services made to maintain continuity during the transition to telehealth formats. Materials and methods: We conducted semistructured qualitative interviews with a purposive sample of 51 providers delivering teleWH services at 10 VHA medical centers. We examined WH service modifications as well as facilitators and barriers to those modifications using rapid coding and directed content analysis. Results: Modifications were driven by (1) preparing for teleWH service delivery and (2) improving teleWH service delivery. To prepare for teleWH services, modifications were prompted by access, readiness, and setting and resources. Modifications to improve the delivery of teleWH services were motivated by engagement, community-building, safety, and content for a teleWH environment. One-on-one teleWH services required the fewest modifications, while more significant modifications were needed for well-being, skill-building, and movement-based groups, and reconfiguration of manual therapies. Discussion: Findings highlighted the need for modifications to ensure that teleWH services are accessible and safe and support interpersonal relationships between patients and providers, as well as in group-based classes. Successfully delivering teleWH services requires proactive preparation that considers access, readiness, and the availability of resources to engage in teleWH services. Tailoring strategies and considering the unique needs of different teleWH services are critical. Conclusions: The COVID-19 pandemic catalyzed teleWH service implementation, utilization, and sustainment. The challenges faced and modifications made during this transition provide lessons learned for other health care systems as they attempt to implement teleWH services.

Remote Health Monitoring IoT Framework using Machine Learning Prediction and Advanced Artificial Intelligence (AI) Model

Real intervention and treatment standards drew attention to remote health monitoring frameworks. Remote monitoring frameworks for disease detection at an early stage are opposed by most conventional works. Even so, it ran into issues like increased operational complexity, higher resource costs, inaccurate predictions, longer data collection times, and a lower convergence rate. A remote health monitoring framework that uses artificial intelligence (AI) to predict heart disease and diabetes from medical datasets is the goal of this project. Patients' health data is collected via smart devices, and the resulting data is then combined using a variety of nodes, including a detection node, a visualisation node, and a prognostic node. People with long-term illnesses (such as the elderly and disabled) are in such greater demand than ever before that a new approach to healthcare delivery is essential. In the evolved paradigm, conventional physical medical services foundations like clinics, nursing homes, and long haul care offices will be old. Due to recent advancements in modern technology, such as artificial intelligence (AI) and machine learning (ML), the smart healthcare system has become increasingly necessary (ML). This paper will discuss wearable and smartphone technologies, AI for medical diagnostics, and assistive structures, including social robots, that have been created for the surrounding upheld living climate. The review presents programming reconciliation structures that are urgent for consolidating information examination and other man-made consciousness instruments to develop brilliant medical care frameworks (AI).

Key‐aggregate searchable encryption with multi‐user authorization and keyword untraceability for distributed IoT healthcare systems

AbstractAdopting Internet‐of‐Things (IoT) enables pervasive computing by integrating distributed healthcare infrastructures to enhance conventional medical services. Integrated healthcare systems store numerous encrypted electronic health records (EHR) on clouds that multiple users frequently access as per delegated access rights. Sharing any group of selected EHR within any group of users involving different encryption keys potentially heightens security and privacy concerns over inadvertent data leaks. This necessitates a searchable encryption mechanism in distributed IoT requiring secure multi‐user authorization and efficient searchable keys management with compact trapdoors. Contemporary state‐of‐the‐art protocols utilize large numbers of expensive encryption keys and keyword trapdoors while lacking secure multi‐user authorization and keyword untraceability on clouds. This motivates us to design a novel key‐aggregate searchable encryption protocol that jointly achieves multi‐user authorization and keyword untraceability for distributed IoT applications. Key‐aggregation reduces complexity in sharing documents by executing a stand‐alone trapdoor, while token‐based authorization allows keyword search only to legitimate data users. Additionally, secure dynamic indexing achieves keyword untraceability on clouds. Security analysis illustrates correctness and resilience against typical attacks. Performance and empirical analysis demonstrate a relative advantage in storage, communication, and computational costs while incorporating secure multi‐user authorization and keyword untraceability as additional security features.

The efficacy of telemedicine for pain management in patients with cancer: a systematic review and meta-analysis.

Pain is the most common cancer-related symptom, but it is often undertreated. Telemedicine is widely used in cancer treatment, but its effectiveness is uncertain. We aimed to evaluate the impact of telemedicine intervention on pain in patients with cancer. Methodological quality and risk-of-bias evaluation were conducted, and the sources of heterogeneity were explored through subgroup analysis and sensitivity analysis. PubMed, Embase, Web of Science, Cochrane Library, and clinical trial databases were searched up to 16 August 2022. Randomized controlled trials of the impact of telemedicine intervention regarding pain in patients with cancer were included, and the results related to pain were extracted. Twenty-one randomized controlled trials were selected from 1810 articles. A total of 1454 patients received telemedicine interventions, and 2213 received conventional medical services. Telemedical intervention had a positive effect on improving pain intensity [standard mean deviation (SMD) = -0.28, 95% confidence interval (CI): -0.49 to -0.06, p = 0.01] and pain interference (SMD = -0.41, 95% CI: -0.54 to -0.28, p < 0.00001), with statistical difference between the two groups. The subgroup analysis results showed that the telemedicine subgroup based on an application (SMD = -0.54, 95% CI: -0.91 to -0.18, p = 0.004) and the subgroup with intervention time ⩾ 6 months (SMD = -0.33, 95% CI: -0.52 to -0.13, p = 0.001), both demonstrated significant improvement regarding pain intensity, with significant statistical difference between the two groups. When the follow-up time was ⩾ 6 months, there was no significant difference (SMD = -0.24, 95% CI: -0.55 to 0.07, p = 0.13). Compared with conventional medical services, telemedicine intervention can improve the pain of patients with cancer and is effective and acceptable regarding symptom monitoring. Integrating telemedicine interventions into cancer pain management may be a feasible option. But its long-term effects still need to be confirmed with more high-quality randomized controlled trials in the future. https://www.crd.york.ac.uk/PROSPERO/; CRD42022361990.

Efficacy of a new day surgery management mode based on WeChat: a study protocol for randomised controlled trials

IntroductionThere is an enormous imbalance between the rapid development of day surgery and the current conventional medical services. Hence, an effective day surgery management mode should be developed that can...

Effects of community family doctors-led intervention for self-management and medication adherence in type 2 diabetes mellitus patients: study protocol of a cluster randomised controlled trial

IntroductionThe management of diabetes has become a critical public health issue in China. The development of community-based type 2 diabetes management in China has not yet reached an ideal state,...

JURIDICAL OVERVIEW OF MEDICAL TELECONSULTATION PRACTICE DURING THE COVID-19 PANDEMIC: A NARRATIVE REVIEW

The mandate of the 1945 Constitution, that everyone has the right to live in physical and spiritual prosperity, to live and to have a good and healthy living environment, and the right to obtain health services while the ratio or comparison of health workers in this case doctors and the population in Indonesia is not balanced or not at the ideal number. In order to equalize the rights of citizens to obtain adequate and standard health services, the government issued a regulation on telemedicine in this case more often referred to as teleconsultation. Especially in this era of the Covid-19 pandemic, these services are very helpful for the community, so that their health conditions are monitored. It is hoped that services using information and communication technology facilities will have a good impact as well as conventional medical services and still pay attention to the rights and responsibilities of both parties and do not cause losses in their implementation, the preparation of this research uses the type of normative research. The materials for this research come from laws and regulations, regulations issued by the Minister of Health, the Civil Code, as well as other relevant sources.

Telemedicine Adoption during Pandemic Covid19 in Indonesia

This research will investigated adoption of telemedicine in Indonesia during pandemic COVID19 by modifying Unified Theory of Acceptance and Use of Technology (UTAUT). Variables used in this research are performance expectancy, effort expectancy, social influence, attitude an facilitating conditions as moderating variables that use to analyze use behavior of telemedicine in Indonesia. The survey conducted on 317 telemedicine user in Indonesia and analysis using moderated regression analysis. Based on the results of data analysis, as many as 4 hypotheses were rejected while only three were accepted. The accepted hypotheses state that performance expectation and attitude, as well as the moderating effect of facilitating conditions, have an impact on the influence of social influence on telemedicine usage behavior. Meanwhile, the rejected hypotheses are those which state that there is a direct influence of effort expectancy, social influence, attitudes towards telemedicine usage behavior and moderating effects of facilitating conditions on the effect of performance expectancy and attitudes towards telemedicine usage behavior. As implications, telemedicine must be designed to offer greater benefits than conventional medical services, such as time savings and cost savings. Furthermore, despite the lack of a direct physical examination in telemedicine, the results of the diagnosis are expected to be accurate, resulting in the patient being more productive and healthy as a result of adopting telemedicine

Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: Similarities and discontinuities.

As part of formative studies to design a program of collaborative care for persons with psychosis, we explored personal experience and lay attributions of illness as well as treatment among persons who had recently received care at traditional and faith healers' (TFHs) facilities in three cultural groups in Sub-Saharan Africa. A purposive sample of 85 individuals in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya) were interviewed. Data was inductively explored for themes and analysis was informed by the Framework Method. Across the three sites, illness experiences featured suffering and disability in different life domains. Predominant causal attribution was supernatural, even when biological causation was also acknowledged. Prayer and rituals, steeped in traditional spiritual beliefs, were prominent both in traditional faith healing settings as well as those of Christianity and Islam. Concurrent or consecutive use of TFHs and conventional medical services was common. TFHs provided services that appear to meet the therapeutic goals of their patients even when harmful treatment practices were employed. Cultural and linguistic differences did not obscure the commonality of a core set of beliefs and practices across these three groups. This similarity of core worldviews across diverse cultural settings means that a collaborative approach designed in one cultural group would, with adaptations to reflect differences in context, be applicable in another cultural group. Studies of patients' experience of illness and care are useful in designing and implementing collaborations between biomedical and TFH services as a way of scaling up services and improving the outcome of psychosis.

Does a Supplement Cocktail a Day Keep the Doctor Away? An Unusual Case of Alcohol Induced Diabetes Mellitus: A Case Report and Review of Literature

Background: Currently there are no evidence-based medical recommendations to support the use of supplements in type 1 diabetes mellitus (DM), although there is some data that supports glucose lowering in type 2 DM with supplements such as cinnamon. Additionally, there is no evidence regarding the use of supplements in insulin-dependent DM secondary to pancreatic dysfunction from alcohol use disorder. Despite lack of clear evidence, it is estimated that more than 65% of Americans with DM use at least one dietary supplement for perceived health benefits. (1)Clinical Case: A 58-year old male presented with insulin-dependent DM secondary to pancreatic dysfunction from alcohol use disorder. Initial labs were significant for a low C-peptide of 0.13 ng/mL (0.80–3.85 ng/mL), A1c -9.4%, and blood glucoses ranging from 160–300 mg/dL. Patient’s DM regimen consisted of glargine 40 units nightly and aspart 12 units three times a day with meals. On a subsequent visit two months later, the patient stated that he had begun taking numerous supplements in hopes that these would improve his overall medical status. Supplements included Blood Boost Formula, Ultra K2 with MK-7, Chromium Picolinate, Male Enhancement, Super C Immune Complex, Nugenix Total-T, Niacinamide, Omega Q Plus Max, Cortisol Hormone Balancer, and Vitamin D3. Simultaneously, the patient self-discontinued all his maintenance medications except for his aforementioned insulin regimen due to the fear of negatively impacting his pancreas. Unexpectedly, his blood glucoses improved to a range of 90–150 mg/dL after being on these supplements without increasing his insulin dose. Upon literature review, three ingredients showed the most evidence for the possible explanation for his improvement in glucose control: L-arginine, nettle extract, and biotin with chromium. Conclusion: Literature review of in vivo and randomized, placebo-controlled studies demonstrated mechanisms of action for L-arginine, nettle extract, and biotin with chromium that indicate their potential role in lowering blood glucoses and increasing C-peptide levels in insulin-dependent DM secondary to pancreatic dysfunction from alcohol use disorder. Further investigations include exploring long-term impact on pancreatic function, glucose control, and insulin resistance. Reference: (1) Garrow, D., Egede, L. Association Between Complementary and Alternative Medicine Use, Preventive Care Practices, and Use of Conventional Medical Services Among Adults with Diabetes. Diabetes Care 2006 Jan; 29(1): 15–19.

COVID-19 and the Opioid Epidemic: Two Public Health Emergencies That Intersect With Chronic Pain.

The COVID-19 pandemic has affected the entire world and catapulted the United States into one of the deepest recessions in history. While this pandemic rages, the opioid crisis worsens. During this period, the pandemic has resulted in the decimation of most conventional medical services, including those of chronic pain management, with the exception of virtual care and telehealth. Many chronic pain patients have been impacted in numerous ways, with increases in cardiovascular disease, mental health problems, cognitive dysfunction, and early death. The epidemic has also resulted in severe economic and physiological consequences for providers. Drug deaths in America, which fell for the first time in 25 years in 2018, rose to record numbers in 2019 and are continuing to climb, worsened by the coronavirus pandemic. The opioid epidemic was already resurfacing with a 5% increase in overall deaths from 2018; however, the preliminary data show that prescription opioid deaths continued to decline, while at the same time deaths due to fentanyl, methamphetamine, and cocaine climbed, with some reductions in heroin deaths. The health tracker data also showed that along with an almost 88% decline in elective surgeries, pain-related prescriptions declined 15.1%. Despite increases in telehealth, outpatient services declined and only began returning towards normal at an extremely slow pace, accompanied by reduced productivity and increased practice costs. This review, therefore, emphasizes the devastating consequences of concurrent epidemics on chronic pain management and the need to develop best practice efforts to preserve access to treatment for chronic pain.

A Vision on Intelligent Medical Service for Emergency on 5G and 6G Communication Era

Emergency service is the most important research field for welfare of human kind. Some examples are ambulances and fire control truck. However, these conventional emergency services are not equipped with appropriate equipment to provide high QoS. For instance, conventional medical emergency services include ambulances with drivers and oxygen supplies only. Another example is the conventional fire control systems that only include fire control truck, which is not suitable for current scenario due to various challenges, for instance, road traffic. In addition, accidental services are unsatisfactory in current and future emergency services. Emergency service is required by anyone at anytime and anywhere. Therefore, it is the time to redefine and restructure the conventional emergency service for saving more lives. Due to the advent of wireless communication technology, it is possible to provide the emergency service on the spot in nearly real-time to save lives. Moreover, integration of Artificial Intelligence with smart devices can change the definition of emergency services. In this chapter, we envision the various emergency services to advance the healthcare services. Besides, we envision the impact of emergency services on healthcare with the help of Artificial Intelligence, 5G and 6G communication technology.

Estimation Of Quality Of Medical Care

This paper summarizes the arguments and counterarguments within the scientific discussion on the issue of quality of medical care. The main purpose of the research is to analyze the quality of medical care in dispensary №1 of municipal non-profit enterprise «Shostka city center of primary health care» and determine recommendations for its improvement in the context of «MEDSTAR» medical information system implementation. The research methods authors used in the article were systematic analysis, comparative research, and patients’ survey. As the information sources, the authors used internal documentation of the dispensary № 1 (data for September 2018) and its electronic documentation from the MEDSTAR medical information system (data for September 2020). First, the authors analyzed and compared the number of patients who visited the dispensary №1, and the number of patients visited by doctors at home in September 2020 and September 2018. Second, the authors determined the number of referrals for examination issued to patients in September 2020 and September 2018. Third, the authors surveyed the patients on their satisfaction with the quality of medical care. The results of the research showed that the total number of patients’ visits at the dispensary №1 decreased by 32.4%, and the rate of home visits decreased by 5.12% in September 2020 compared to September 2018. The same situation is with the number of referrals for examination. In September 2018 763 patients got referrals for further examinations, and in September 2020 the number of referrals was 169. The survey showed that patients are dissatisfied with some aspects of the quality of medical care, particularly, with the automation of medicine, focus of medicine, as well as with the conditions of appointment and accessibility of conventional medical services. In total, the results of the research helped to highlight problems in the work of family doctors caused by healthcare reform and medical information systems implementation which reduce the quality of medical care. The recommendations for problems solving were suggested. The authors’ research will be useful for further research in the quality of medical care.

HIV Prevention Via Mobile Messaging for Men Who Have Sex With Men (M-Cubed): Protocol for a Randomized Controlled Trial.

BackgroundMen who have sex with men (MSM) continue to be the predominately impacted risk group in the United States HIV epidemic and are a priority group for risk reduction in national strategic goals for HIV prevention. Modeling studies have demonstrated that a comprehensive package of status-tailored HIV prevention and care interventions have the potential to substantially reduce new infections among MSM. However, uptake of basic prevention services, including HIV testing, sexually transmitted infection (STI) testing, condom distribution, condom-compatible lubricant distribution, and preexposure prophylaxis (PrEP), is suboptimal. Further, stronger public health strategies are needed to promote engagement in HIV care and viral load suppression among MSM living with HIV. Mobile health (mHealth) tools can help inform and encourage MSM regarding HIV prevention, care, and treatment, especially among men who lack access to conventional medical services. This protocol details the design and procedures of a randomized controlled trial (RCT) of a novel mHealth intervention that comprises a comprehensive HIV prevention app and brief, tailored text- and video-based messages that are systematically presented to participants based on the participants’ HIV status and level of HIV acquisition risk.ObjectiveThe objective of the RCT was to test the efficacy of the Mobile Messaging for Men (M-Cubed, or M3) app among at least 1200 MSM in Atlanta, Detroit, and New York. The goal was to determine its ability to increase HIV testing (HIV-negative men), STI testing (all men), condom use for anal sex (all men), evaluation for PrEP eligibility, uptake of PrEP (higher risk HIV-negative men), engagement in HIV care (men living with HIV), and uptake of and adherence to antiretroviral medications (men living with HIV). A unique benefit of this approach is the HIV serostatus-inclusiveness of the intervention, which includes both HIV-negative and HIV-positive MSM.MethodsMSM were recruited through online and venue-based approaches in Atlanta, Detroit, and New York City. Men who were eligible and consented were randomized to the intervention (immediate access to the M3 app for a period of three months) or to the waitlist-control (delayed access) group. Outcomes were evaluated immediately postintervention or control period, and again three and six months after the intervention period. Main outcomes will be reported as period prevalence ratios or hazards, depending on the outcome. Where appropriate, serostatus/risk-specific outcomes will be evaluated in relevant subgroups. Men randomized to the control condition were offered the opportunity to use (and evaluate) the M3 app for a three-month period after the final RCT outcome assessment.ResultsM3 enrollment began in January 2018 and concluded in November 2018. A total of 1229 MSM were enrolled. Data collection was completed in September 2019.ConclusionsThis RCT of the M3 mobile app seeks to determine the effects of an HIV serostatus–inclusive intervention on the use of multiple HIV prevention and care-related outcomes among MSM. A strength of the design is that it incorporates a large sample and broad range of MSM with differing prevention needs in three cities with high prevalence of HIV among MSM.Trial RegistrationClinicalTrials.gov NCT03666247; https://clinicaltrials.gov/ct2/show/NCT03666247International Registered Report Identifier (IRRID)DERR1-10.2196/16439

Difficulties in providing palliative care in identified palliative care beds: An exploratory survey

Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP. This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented. From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care. This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey.

Complementary and Alternative Medical Service Use for Mental Health Problems among Chinese Americans: The Roles of Acculturation-related Factors

The author used data from the Collaborative Psychiatric Epidemiology Surveys to examine the 12-month prevalence and predictors of the use of complementary and alternative medicine (CAM) relative to conventional Western medical services among Chinese Americans. The author examined the differences in service utilization patterns between Chinese Americans and non-Hispanic whites and the effects of acculturation factors such as generational status and English proficiency within the population of Chinese Americans. Multinomial logistic regression analyses revealed significant heterogeneity of exclusive CAM use in response to mental health problems by race/ethnicity and generational status, as well as English proficiency, gender, age, marital status, education, employment status, having insurance, and having any probably psychiatric disorder. Specifically, first-generation Chinese immigrants lagged behind second-, third-, or higher generation Chinese Americans and non-Hispanic whites in the likelihood of using exclusive CAM services for mental health problems. In addition, this study revealed that exclusive CAM service use was more popular than the use of only conventional Western medicine or a combination of both among all Chinese Americans except for the second generations. The findings provide a more nuanced understanding of the pattern of mental health service use among Chinese Americans. Implications for policy and research are discussed.