Clinic Environment Research Articles

Ocean Blue by Claudia Diller

Art is integrated into the Mayo Clinic environment. Since the original Mayo Clinic Building was finished in 1914, many pieces have been donated or commissioned for patients and staff to enjoy. Each issue of Mayo Clinic Proceedings features a work of art (as interpreted by the author) that is displayed in a building or on the grounds of Mayo Clinic campuses.

Perspectives of Key Stakeholders on Integrating Wearable Sensor Technology into Rehabilitation Care: A Mixed-Methods Analysis.

Rehabilitation is facing a critical practice gap: Patients seek out rehabilitation services to improve their activity in daily life, yet recent work demonstrates that rehabilitation may be having a limited impact on improving this outcome due to lack of objective data on patients' activity in daily life. Remote monitoring using wearable sensor technology is a promising solution to this address this gap. The purpose of this study was to understand patient and clinician awareness of the practice gap and preferences for integrating wearable sensor technology into rehabilitation care. This study used a mixed-methods approach consisting of surveys and 1:1 interviews with clinicians (physical and occupational therapists or assistants) employed at an outpatient rehabilitation clinic within an academic medical center and patients seeking care at this clinic. Data were analyzed using descriptive statistics and thematic analysis. Data saturation was reached from recruiting nineteen clinicians and ten patients. Both clinicians and patients recognized the importance of measuring activity outside the clinic and viewed wearable sensor technology as an objective measurement tool. Most clinicians (63%) preferred continuous (vs. intermittent) monitoring within a care episode and most patients (60%) were willing to sync their sensor data as often as instructed by their provider. To maximize integration into clinical workflows, clinicians voiced a preference for availability of sensor data in the electronic health record. Clinicians and patients value the use of wearable sensor technology to improve measurement of activity outside the clinic environment and expressed preferences for how this technology could best be integrated into routine rehabilitation care.

The correlation between medical students’ clinical dishonesty, psychological distress, and moral intelligence

IntroductionClinical dishonesty is one of the components of academic dishonesty that deals with the unprofessional behavior of students in hospital and clinic environments (medical students, nursing students, etc.). Psychological distress and low moral intelligence among students can be known as predisposing factors in performing dishonest clinical behaviors. The present research addresses a gap in the scientific literature by investigating dishonest behavior among medical students.MethodsThis cross-sectional study examined medical students’ clinical dishonesty, psychological distress, and moral intelligence. Rafati et al.‘s questionnaire was used to investigate clinical dishonesty, Kessler’s Psychological Distress Questionnaire (K6) was used for psychological distress, and Lenik and Keil’s (2005) questionnaire was used to determine moral intelligence. Cochran’s formula was used to calculate the sample size and the simple random sample (SRS) method was used for sampling. Data were statistically analyzed in SPSS version 27 (SPSS Inc., Chicago, IL, United States). a P-value less than 0.05 was considered significant.Results317 medical students were included in this study, of which 176 (55.5%) were male and 141 (44.5%) were female. We found a direct and significant statistical correlation between clinical dishonesty and students’ distress (Correlation Coefficient: 0.162, P-value < 0.001). In addition, there was a statistically significant inverse correlation between clinical dishonesty and moral intelligence (Correlation Coefficient: -0.241, P-value: 0.004). Moreover, there was a higher rate of clinical dishonesty among senior medical students (P-value < 0.001). Moreover, the most dishonest clinical behaviors are as follows: [1] Disclosure of patient information in public or with non-medical personnel (76%), Incorrect examination of vital signs and physical examinations (69.4%), Not reporting incidents or errors of others involving patients (41.6%).ConclusionFinally, most students have experienced engaging in at least one clinically dishonest behavior. Such actions increase with the progress of the educational level so that it reaches its peak at the internship stage. Moral intelligence is a learnable concept, and mental distress also has its own treatments. Therefore, improving these two factors can reduce clinical dishonesty among medical students.

Leveraging machine learning to enhance appointment adherence at a novel post-discharge care transition clinic.

This study applies predictive analytics to identify patients at risk of missing appointments at a novel post-discharge clinic (PDC) in a large academic health system. Recognizing the critical role of appointment adherence in the success of new clinical ventures, this research aims to inform future targeted interventions to increase appointment adherence. We analyzed electronic health records (EHRs) capturing a wide array of demographic, socio-economic, and clinical variables from 2168 patients with scheduled appointments at the PDC from September 2022 to August 2023. Logistic regression, decision trees, and eXtreme Gradient Boosting (XGBoost) algorithms were employed to construct predictive models for appointment adherence. The XGBoost machine learning model outperformed logistic regression and decision trees with an area under the curve (AUC) of 72% vs 65% and 67%, respectively, in predicting missed appointments, despite limited availability of historical data. Key predictors included patient age, number of days between appointment scheduling and occurrence, insurance status, marital status, and mental health and cardiac disease conditions. Findings underscore the potential of machine learning predictive analytics to significantly enhance patient engagement and operational efficiency in emerging healthcare settings. Optimizing predictive models can help balance the early identification of patients at risk of non-adherence with the efficient allocation of resources. The study highlights the potential value of employing machine learning techniques to inform interventions aimed at improving appointment adherence in a post-discharge transition clinic environment.

Perceptions of Rural Access to Prenatal Care in the United States by Patients, Nurses, Midwives, and Physicians: An Integrative Review.

Despite substantial investments in maternity care, the United States continues to experience higher maternal mortality rates than most high-income countries. Rural regions lack adequate prenatal care services, a contributing factor to disparate maternal health outcomes. This integrative review on patient, nurse, midwife, physician, and community perspectives on accessing prenatal care in rural areas of the United States follows Whittemore and Knafl's integrative review framework, including a systematic literature search in various databases from January 1, 2010, to May 1, 2024. Eligible articles were published in English, peer-reviewed, and focused on subjective accounts of accessing prenatal care in rural areas of the United States. Seven articles met inclusion criteria and were assessed for quality using the Joanna Briggs Institute checklists. Three major categories influencing access to prenatal care in rural areas were developed. Individual factors included transportation, family support, motivation, and work commitments. Socioeconomic factors encompass health insurance, rurality, income, and housing. System factors involved the qualities of nurses, midwives, physicians, the clinic environment, and collaboration within the health care system. The findings emphasized the complexity of rural prenatal care access. Understanding patient and care giver perspectives on accessing prenatal care in rural areas is crucial for addressing the factors influencing maternal outcomes. Rural pregnant women face unique challenges, contributing to an increased risk of maternal morbidity and mortality. Further research is needed to explore their experiences and develop interventions to improve access and outcomes in rural areas.

Integrating virtual-reality into restorative dentistry training: A study on the acceptability and effectiveness of tooth preparation simulations.

Digital education using virtual-reality simulators is essential for precise learning in modern education. This study aimed to develop a virtual-reality dental system for tooth preparation training and assess pre-virtual-reality experiences and perceptions of its potential benefits. We evaluated the post-virtual-reality experience in terms of the effectiveness of the virtual-reality system. The virtual-reality platform development phase involved learning- and assessment-based frameworks for participants. The first step involved creating a storyboard for a virtual dental clinic environment using virtual-reality glasses. This simulated a dental chair-like setup with instruments and tools, allowing participants to practice dental procedures. This study utilized a mixed-methods approach to assess participants' experience with virtual reality in dental education using a tooth preparation simulation system and evaluated post-virtual reality measures, including the system usability scale, usefulness, educational effectiveness, and participant attitudes through structured survey questionnaires. This study included 150 participants (49 dental students, 52 dental interns, and 49 faculty members). Most participants were females (76%). Significant differences were observed in attitude scores between students and faculty members, with third-year dental students having more positive attitudes toward the integration of virtual-reality in dental education. No significant differences were found in system usability, usefulness, or assessment scores between the groups. The virtual-reality dental module system shows promise for improving dental education. The varied responses from different user groups should be considered to ensure successful implementation and acceptance.

Feasibility of acoustic features of vowel sounds in estimating the upper airway cross sectional area during wakefulness: A pilot study

Assessment of upper airway dimensions has shown great promise in understanding the pathogenesis of obstructive sleep apnea (OSA). However, the current screening system for OSA does not have an objective assessment of the upper airway. The assessment of the upper airway can accurately be performed by MRI or CT scans, which are costly and not easily accessible. Acoustic pharyngometry or Ultrasonography could be less expensive technologies, but these require trained personnel which makes these technologies not easily accessible, especially when assessing the upper airway in a clinic environment or before surgery. In this study, we aimed to investigate the utility of vowel articulation in assessing the upper airway dimension during normal breathing. To accomplish that, we measured the upper airway cross-sectional area (UA-XSA) by acoustic pharyngometry and then asked the participants to produce 5 vowels for 3 s and recorded them with a microphone. We extracted 710 acoustic features from all vowels and compared these features with UA-XSA and developed regression models to estimate the UA-XSA. Our results showed that Mel frequency cepstral coefficients (MFCC) were the most dominant features of vowels, as 7 out of 9 features were from MFCC in the main feature set. The multiple regression analysis showed that the combination of the acoustic features with the anthropometric features achieved an R2 of 0.80 in estimating UA-XSA. The important advantage of acoustic analysis of vowel sounds is that it is simple and can be easily implemented in wearable devices or mobile applications. Such acoustic-based technologies can be accessible in different clinical settings such as the intensive care unit and can be used in remote areas. Thus, these results could be used to develop user-friendly applications to use the acoustic features and demographical information to estimate the UA-XSA.

Shifting Paradigms in the Treatment of Systemic Lupus Erythematosus

For many years, therapeutic options for patients with systemic lupus erythematosus (SLE) have been extremely limited. However, over the past decade, with the approval of new drugs and several promising phase II trials, treatment paradigms are gradually shifting toward multi‑targeted therapies for lupus nephritis (LN) and earlier usage of biologics in extra-renal lupus. Below, we will present three patient cases that illustrate how, through a multidisciplinary clinic environment, we have incorporated these shifting treatment paradigms into our delivery of care. Finally, we will conclude with a discussion of emerging therapies, which have the potential to further shift, and ultimately transform, treatment paradigms.

Abstract P319: Organizational Determinants to Hypertension Management: A Qualitative Examination at Two Academic Learning Health Systems

Background: Hypertension management is a national priority. However, hypertension control rates are suboptimal and vary across clinics, even among those in the same health system and geographic region. Objective: To identify organizational barriers and facilitators that impact hypertension management at the provider- and clinic-level. Design: Semi-structured interviews were conducted with primary care providers (N=25) and patients with uncontrolled hypertension (N=22). Participants were recruited from thirteen family and internal medicine clinics across two academic learning health systems. Participants: Twenty-five providers and twenty-two patients were recruited from clinics across North Carolina and Kansas. Approach: Interviews were analyzed using both inductive and deductive coding methodologies. A health equity framework scaffolded interview guide design and codebook development, with thematic analysis employed to categorize emergent themes across the four framework domains. Key Results: Participants discussed organizational and clinic-level barriers and facilitators that impact hypertension management, with health systems’ resource centralization being frequently mentioned. Some participants lauded centralized interventions for improving patient access and increasing touchpoints, while others lamented reductions in their clinic’s staffing to accommodate centralized workflows. Insufficient in-clinic staffing and blood pressure (BP) measurement equipment, limited exam rooms, short appointment duration, and hurried clinic environments were all mentioned as challenges to hypertension management, particularly as they hindered adherence to BP recheck policies. Appointment availability was mentioned as a barrier, however providers referenced clinics’ use of virtual and/or nurse-specific visits as a mechanism to increase patient access. Multiple providers noted that tasks central to hypertension management, like BP telemonitoring and MyChart correspondence, go unaccounted for on their schedules and can lead to unpaid work, which they linked with increased stress and burnout. Conclusions: Primary care clinics experience multiple interrelated organizational barriers to effective hypertension management. Future studies should examine the impact of different clinic staffing models, including multidisciplinary care teams, telemedicine, and remote BP monitoring, on BP outcomes in diverse primary care settings.

Bridging health self-efficacy and patient engagement with patient-centered culturally sensitive health care for Black American adults.

This study investigates whether systems-level interventions, specifically patient-centered culturally sensitive health care (PC-CSHC) from healthcare providers, office staff, and the clinic environment, moderate the relationship between health self-efficacy and patient engagement among Black American adults. An online survey was completed by 198 Black American adults. PC-CSHC from healthcare providers, office staff, and the clinic environment did not mitigate the adverse effects of low health self-efficacy on patient engagement. However, PC-CSHC from healthcare providers (b = 0.38) was as significant as health self-efficacy (b = 0.37) in predicting patient engagement, R2 = 0.47, F(9, 177) = 19.61, p < 0.001. Provider-delivered PC-CSHC can enhance patient engagement among Black American adults. This systems-level approach has the potential to reach more patients than intrapersonal interventions alone and alleviates the undue burden placed on Black Americans to leverage intrapersonal strengths in the face of health disparities rooted in structural racism.

Mixed Methods Evaluation of a Youth-Friendly Clinic for Young People Living with HIV Transitioning from Pediatric Care.

(1) Background: Adolescents and young adults face challenges when transitioning to adult care due to emerging adulthood and changing providers and insurance. Young people living with HIV (YPLHIV) have additional obstacles with mental health and stigma. During transition, only 55% of YPLHIV are retained in care, and 65% are virally suppressed. To address these challenges, the Adolescent and Young Adult Health Care Transition Clinic (AYAHCTC) was created at Vanderbilt University Medical Center in 2017. This mixed methods study evaluates the initial cohort and solicits YPLHIVs' perspectives on transition barriers and facilitators. (2) Methods: Quantitative analyses (n = 21) characterized patients' demographics, clinical engagement, and retention. Qualitative interviews (n = 5) captured patients' transition experiences. (3) Results: This study, conducted in the Southeastern USA, included a cohort where 47.6% were born abroad, with all participants being US citizens by birth or naturalization. Patients' mean age at first visit was 19.6 years. The average AYAHCTC duration was 2.21 years. First-year engagement and retention were 100% and 95.5%, respectively. Viral suppression rates improved from 66.7% at the first visit to 81.0% at the last visit. Eleven patients transitioned out of AYAHCTC. Qualitative analyses indicate that barriers to transition include leaving trusted providers, reduced parental guidance, developing autonomy, and perceived loss of confidentiality in adult clinic environment. Transition was facilitated by youth-friendly services, clear communication, and strong relationships with AYAHCTC providers. (4) Conclusions: YPLHIV positively viewed AYAHCTC experiences. Future directions include optimizing services to build YPLHIVs' independence, supporting YPLHIV experiencing stigma, assuaging concerns about switching providers, collaborating with adult clinics to maintain confidentiality, and designing interventions focused on adherence during transition.

Effectiveness of air cleaner on mitigating the transmission of respiratory disease in a dental clinic environment

In dental clinics with an open floor plan, the risk of patient-to-patient transmission of respiratory disease is a concern. During dental procedures large amounts of bioaerosol are produced and patients cannot wear personal protective equipment. This paper examines how to effectively deploy air cleaner to reduce the infection risk in dental clinics with an open floor plan. Various locations of air cleaners at various clean air delivery rates (CADRs) were investigated. The dispersion of bioaerosol was studied through numerical simulations, and risk assessment was performed by a dose-response method. The findings indicated that dental patients downstream of the background ventilation have a higher infection risk than those to the left and right of an infected patient (i.e., the source). The lowest infection risks for the adjacent patients were found when the air cleaner was place opposite to the dentists, i.e., on the floor at low CADR levels of 2.2 m3/min or on the bench at CADR levels of 4.4 m3/min or greater. The results of this study indicated that air cleaner can mitigate the risk of patient-to-patient transmission of SARS-CoV-2 in dental clinics with an open floor plan. Background CADR levels determine the optimal placement of air cleaners.

Degree of Contamination of Gutta-Percha Points by Staphylococcus aureus (MRSA/MSSA) Strains.

We performed an in vitro analysis of the contamination of GP points, regarding the strains of Methicillin-resistant (MRSA) and Methicillin-sensitive (MSSA) Staphylococcus aureus, using classical microbiology methods and molecular biology techniques. Gutta-Percha points of two different brands from opened packages (already in use for 1 month) were collected for analysis. The assessment involved incubating the GP points in Brain Heart Infusion (BHI) medium to detect microbial growth. Growing microorganisms were plated on a selective and differential chromogenic medium for MRSA/MSSA strains, and the identification of isolates was confirmed by Polymerase Chain Reaction (PCR). In the case of microbial growth, the GP point was submitted to a disinfection protocol. From the 315 collected GP points, only 6 (1.9%) resulted in being positive for microbial growth. After confirmation by PCR, only one sample of the six GP points was contaminated by MRSA, and the remaining five were MSSA-contaminated. The disinfection protocol was effective in all contaminated GP points. The Gutta-Percha points from opened pre-sterilized packages showed a very low degree of contamination by MRSA/MSSA. However, the detection of MSSA and MRSA strains raises concerns about potential contamination in dental clinic environments, and this risk cannot be considered negligible.

Impact of virtual reality on peri-interventional pain, anxiety and distress in a pediatric oncology outpatient clinic: a randomized controlled trial

PurposePain and anxiety-inducing interventions have a major impact on pediatric patients. Pain reduction by virtual reality (VR) during port and vein punctures is well studied. This study investigates peri-interventional reduction of pain, anxiety and distress using VR compared to the standard of care (SOC) in a pediatric oncology outpatient clinic.MethodsIn a randomized, controlled cross-over design, patients aged 6–18 years experience potentially painful interventions accompanied by VR. Observational instruments include NRS, FPS-r, BAADS, mYPAS-SF, PedsQL and SSKJ3-8R. All patients undergo two observations: SOC (A) and VR (B) in a randomized order. In addition, parents and staff are interviewed. Specific conditions for VR in an outpatient clinic setting derived from interprofessional focus group discussion are being explored.ResultsBetween July 2021 and December 2022 57 eligible patients were included and randomized to the orders A/B (n = 28) and B/A (n = 29). Thirty-eight patients completed both observations. Characteristics in both groups did not differ significantly. More than half of the patients had no previous experience with VR, 5% decided to discontinue VR prematurely. Peri-interventional pain, anxiety and distress were significantly reduced by VR compared with SOC. 71% of patients and 76% of parents perceived punctures with VR to be more relaxed than previous ones. 95% of patients perceived fun with VR goggles. Detailed questionnaires on individual stress and anxiety were returned from 26 of 38 patients. Focus group discussion with staff yielded evidence for successful implementation of VR in an outpatient clinic.ConclusionsThe present study shows that VR can be used for peri-interventional reduction of pain, anxiety, and distress in the special environment of a pediatric outpatient clinic. Specific conditions must be met for successful implementation. Further studies are needed to identify particularly susceptible patients and to illuminate alternatives for distraction that are feasible to implement with limited resources.Trial registration number(ClinicalTrials.gov ID): NCT06235723; 01/02/2024; retrospectively registered. This study adheres to the standard checklist of CONSORT guidelines.

Co-producing research study recruitment strategies with and for children and young people for paediatric chronic pain studies.

Children and young people experiencing chronic pain are at greater risk of inequitable and poor-quality pain management, which has implications for future management of pain in adulthood. Most chronic pain research is conducted with adults who are more likely to be middle-class, white and monocultured. Inclusive and diverse recruitment practices in paediatric pain research can be an area in which we can address this imbalance of representation. The aim of this current work was to explore these practices and to co-produce recommendations regarding recruitment strategies for paediatric pain research. The research team worked with Your Rheum, a United Kingdom young person's advisory group (ages 11-24 years) and diagnosed with rheumatic condition(s), the opportunity to input into rheumatology research. At a virtual Your Rheum meeting, eight young people (female = 7, male = 1, age range 12-24) took part in group discussions, sharing their experiences of taking part in research and their decision process. Online tools, including Mentimeter and Miro, were used to aid conversations and share ideas. Most young people had experience of taking part in research as a study participant (n = 5). Recommendations synthesised included increased awareness of research in general. The young people discussed being open to hearing about research opportunities; they reflected that they are rarely exposed to these invitations or hear about current research. The clinic environment was highlighted as a "good and trustworthy" recruitment area - being approached by a member of the research team was considered ideal, even if it was someone they had not met previously. Many young people recalled little discussions of research at their clinical appointments. Deciding to participate in research included the following considerations: benefit/impact; connecting with others; research topic; which is then balanced against convenience, and reimbursement. The young people felt that taking part in research was empowering and helped them take ownership of their pain management. It is essential to understand the perspectives of potential study participants, to plan successful recruitment strategies. Ensuring we consider these factors when designing our studies and recruitment strategies is beneficial to all involved. Co-produced recruitment strategies would aid inclusive (and increased) research participation.

P-719 The fertility clinic landscape in England 2012-2017: a study of the impact of clinic size and environment on success rates

Abstract Study question How are fertility clinics in England distributed and has this changed over time? Does clinic size, geography and local deprivation level influence live birth rates? Summary answer A clinic’s size, urban/rural environment and local deprivation level shows no statistically significant impact on a clinic’s live birth rates. What is known already It has been established that children born through assisted reproduction are more likely to have parents from higher socioeconomic groups compared to those conceived through natural conception. However, studies examining the relationship between socioeconomic status and fertility treatment success rates have varied outcomes and occasionally conflicting results. There has so far been little research internationally as to whether geographical, environmental and socioeconomic markers influence fertility treatment outcomes on a national scale. Study design, size, duration Publicly available HFEA data from 2012 to 2017 for all registered clinics in England was accessed. The total number of IVF/ICSI cycles for all age groups and live birth rate per embryo transferred were recorded. 56 clinics (32,091 treatment cycles) were recorded in 2012, rising to 69 clinics (36,638 treatment cycles) in 2017. Clinic postcode was used to determine Rural-Urban Classification and postcode-level and local authority-level deprivation according to the Index of Multiple Deprivation (IMD). Participants/materials, setting, methods Statistical analysis was performed using R Statistical Software and Datawrapper was used to generate map infographics. Clinic size was categorised by the number of IVF/ICSI cycles conducted per year – small (0-499), medium (500-999) and large (&amp;gt;1000). Clinic environment was classified as urban or rural and IMD was used to categorise clinics into deprivation quintiles. Weighted live birth rates were analysed to determine any difference in clinic success based on its size and environment. Main results and the role of chance The majority of clinics conducted between 0-499 IVF/ICSI cycles per year. There was no statistically significant difference in the live birth rate per embryo transferred based on clinic size with an average success rate of 31.8% in small clinics, 33.9% in medium clinics and 32.2% in large clinics (p-value 0.885). A large proportion of clinics were located in London (28-29% of clinics and 34-40% treatment cycles) between 2012 and 2017 despite only ∼16% of the population of England living in London. There were significantly fewer clinics (p-value 0.047) and treatment cycles (p-value &amp;lt;0.001) conducted in rural, compared to urban locations. There was a small, but not statistically significant, increase in success rate in clinics located in the least, compared to most deprived quintile. The difference in average live births/embryo transferred between the most and least deprived quintile across all years studied was 3.8% (31.1% in most deprived vs 34.9% in least deprived, p-value 0.227). There was also no statistical difference between the live birth rates per embryo transferred across the local-authority deprivation quintiles, although there was a trend for slightly higher success rates in the least deprived quintile compared to most deprived quintile. (30.3% compared to 33.9% (p-value 0.211)). Limitations, reasons for caution Clinic postcode only was used, therefore deprivation may not be representative of the whole population it treats. All IVF/ICSI treatments for all age groups were included, but some clinics may treat an older population of patients. Many IVF laboratories have satellite clinics in surrounding areas, whose postcodes were not included. Wider implications of the findings It is reassuring that local environment and deprivation do not significantly impact on clinic success rates. More detailed analysis of individual patient data on a nationwide level is required to understand this further either through access to primary care records or collaboration between clinics. Trial registration number not applicable

Experiences of Family Medicine Specialists in Providing Health Care for Lesbian, Gay, Bisexual and Transgender Patients: A Qualitative Study in East Coast Peninsular Malaysia

INTRODUCTION: Lesbian, Gay, Bisexual and Transgender (LGBT) patients continue to report discrimination in healthcare setting despite the efforts of the primary healthcare offering community friendly services in Malaysia. This qualitative study aimed to provide understanding of this current issue and to explore the challenges that family medicine specialists (FMSs) from East Coast of Peninsular Malaysia face when dealing with LGBT patients. MATERIALS AND METHODS: 30 FMSs working in East Coast Peninsular Malaysia were interviewed through a phenomenological framework using semi-structured in-depth interviews of LGBT patients. The interviews were recorded in audio format, transcribed verbatim, and subjected to Braun and Clarke’s thematic analysis. We discerned common themes that can be elucidated through the lens of Leininger’s Theory of Culture Care (TCC) and the Sunrise Enabler Model (SEM). RESULTS: Three overlapping themes of the transcriptions were developed; (1) Multidimensional understanding of LGBT described how FMSs saw the LGBT community as diverging from societal norms, yet acknowledge their vulnerability as integral members of the society, (2) obstacles to providing culturally competent care stemmed from inadequate training, an unsupportive clinic environment, and the self-stigma experienced by patients, and (3) barriers to incorporating spiritual needs for holistic care arose in situations where there was insufficient spiritual health training or a preference to concentrate on physical and emotional well-being to uphold trust. CONCLUSION: The findings on this study reflect the need for proper training of healthcare personnel to deliver a holistic, culturally competent care for LGBT patients. A collaborative effort with relevant authorities is also needed to successfully overcome those challenges.

Sunset Over Flint Hill, 2023 by Hong Chun Zhang

Art is integrated into the Mayo Clinic environment. Since the original Mayo Clinic Building was finished in 1914, many pieces have been donated or commissioned for patients and staff to enjoy. Each issue of Mayo Clinic Proceedings features a work of art (as interpreted by the author) that is displayed in a building or on the grounds of Mayo Clinic campuses.

Maximizing Satisfaction in Orthopedic Outpatient Clinics: Evidence From Ireland.

Background Patient satisfaction is a critical metric in healthcare, reflecting the quality of care provided and influencing clinical outcomes and healthcare utilization. In orthopedic outpatient clinics, patient satisfaction affects patient adherence to treatment plans and overall health outcomes. This study aims to identify and analyze key factors influencing patient satisfaction in orthopedic outpatient clinics. Methodology This cross-sectional study was conducted from April to May 2024 across 10 orthopedic outpatient clinics. In this study, family members were included as respondents to the Patient Satisfaction Questionnaire (PSQ) when patients were unable to complete the survey due to age, cognitive impairment, or physical disabilities. This approach was adopted to ensure that the experiences of all patients, particularly minors, elderly individuals, and those with disabilities, were accurately captured. The PSQ assessed various aspects of patient satisfaction, including communication, treatment plans, addressing concerns, clinic environment, and overall satisfaction. Quantitative data were analyzed using SPSS version 27.0 (IBM Corp., Armonk, NY, USA). Results The study included 172 respondents. High levels of overall satisfaction were reported, with 142 (82.6%) respondents very satisfied and 28 (16.2%) somewhat satisfied. Significant associations were found between overall satisfaction and several factors, namely, effective communication, thorough explanation of treatment plans, addressing patient concerns, and a clean, comfortable clinic environment. Shorter waiting times were also associated with higher satisfaction. Regression analysis revealed that staff rating and the thoroughness of treatment plans were significant predictors of overall satisfaction. Conclusions Effective communication, thorough treatment explanations, addressing patient concerns, and maintaining a clean clinic environment are key determinants of patient satisfaction in orthopedic outpatient clinics. Reducing waiting times and investing in staff training on communication and empathetic care can further enhance patient satisfaction. These findings provide valuable insights for healthcare providers and administrators aiming to improve patient experiences in orthopedic outpatient settings. Further research is recommended to explore these relationships in diverse settings and develop targeted interventions.

Latent class analysis of ART barriers among adolescents and young adults living with HIV in South Africa

ABSTRACT This study examined adherence to antiretroviral therapy (ART) among adolescents and young adults living with HIV in South Africa. Using survey data from 857 youth on ART, the study employed latent class analysis to identify subgroups based on self-reported reasons for missed ART doses. Three distinct classes emerged: the largest class (85%) occasionally forgot to take their medication or missed a dose because others were around, the second class (9%) missed doses only due to feeling sick, and the third class (6%) faced multiple barriers such as forgetting, feeling sick, worrying about side effects, or doubting the effectiveness of ART. Youth who reported multiple barriers to adherence had significantly lower adjusted odds (AOR = 0.35, 95% CI = 0.16-0.78) of reporting 90% past month adherence compared to those who occasionally forgot their medication. Additionally, contextual factors such as food security, being treated well at the clinic, and being accompanied to the clinic were associated with higher odds of adherence. The findings highlight the importance of considering co-occurring barriers to adherence and tailoring interventions accordingly. Addressing contextual factors, such as ensuring food security and providing supportive clinic environments, is also crucial for promoting optimal adherence among adolescents and young adults living with HIV.