Front-line Professionals Research Articles

Meta-consent for the secondary use of health data within a learning health system: a qualitative study of the public\u2019s perspective

BackgroundThe advent of learning healthcare systems (LHSs) raises an important implementation challenge concerning how to request and manage consent to support secondary use of data in learning cycles, particularly research activities. Current consent models in Quebec were not established with the context of LHSs in mind and do not support the agility and transparency required to obtain consent from all involved, especially the citizens. Therefore, a new approach to consent is needed. Previous work identified the meta-consent model as a promising alternative to fulfill the requirements of LHSs, particularly large-scale deployments. We elicited the public’s attitude toward the meta-consent model to evaluate if the model could be understood by the citizens and would be deemed acceptable to prepare for its possible implementation in Quebec.MethodsEight focus groups, with a total of 63 members of the general public from various backgrounds were conducted in Quebec, Canada, in 2019. Explicit attention was given to literacy levels, language spoken at home and rural vs urban settings. We assessed attitudes, concerns and facilitators regarding key components of the meta-consent model: predefined categories to personalized consent requests, a dynamic web-based infrastructure to record meta-consent, and default settings. To analyse the discussions, a thematic content analysis was performed using a qualitative software.ResultsOur findings showed that participants were supportive of this new approach of consent as it promotes transparency and offers autonomy for the management of their health data. Key facilitators were identified to be considered in the implementation of a meta-consent model in the Quebec LHSs: information and transparency, awareness campaigns, development of educational tools, collaboration of front-line healthcare professionals, default settings deemed acceptable by the society as well as close partnerships with recognized and trusted institutions.ConclusionsThis qualitative study reveals the openness of a sample of the Quebec population regarding the meta-consent model for secondary use of health data for research. This first exploratory study conducted with the public is an important step in guiding decision-makers in the next phases of implementing the various strategies to support access and use of health data in Quebec.

Segmentation and quantification of COVID-19 infections in CT using pulmonary vessels extraction and deep learning.

At the end of 2019, the World Health Organization (WHO) reported pneumonia that started in Wuhan, China, as a global emergency problem. Researchers quickly advanced in research to try to understand this COVID-19 and sough solutions for the front-line professionals fighting this fatal disease. One of the tools to aid in the detection, diagnosis, treatment, and prevention of this disease is computed tomography (CT). CT images provide valuable information on how this new disease affects the lungs of patients. However, the analysis of these images is not trivial, especially when researchers are searching for quick solutions. Detecting and evaluating this disease can be tiring, time-consuming, and susceptible to errors. Thus, in this study, we aim to automatically segment infections caused by COVID19 and provide quantitative measures of these infections to specialists, thus serving as a support tool. We use a database of real clinical cases from Pedro Ernesto University Hospital of the State of Rio de Janeiro, Brazil. The method involves five steps: lung segmentation, segmentation and extraction of pulmonary vessels, infection segmentation, infection classification, and infection quantification. For the lung segmentation and infection segmentation tasks, we propose modifications to the traditional U-Net, including batch normalization, leaky ReLU, dropout, and residual block techniques, and name it as Residual U-Net. The proposed method yields an average Dice value of 77.1% and an average specificity of 99.76%. For quantification of infectious findings, the proposed method achieves results like that of specialists, and no measure presented a value of ρ < 0.05 in the paired t-test. The results demonstrate the potential of the proposed method as a tool to help medical professionals combat COVID-19. fight the COVID-19.

The Right to Legal Aid in the Context of International Judicial Cooperation: Towards the Improvement of Equal Access to Justice for All?

The present paper seeks to explore the present and prevailing obstacles to the respect of the right to legal aid, on the broader context of access to justice, against the background of the continuous efforts in European Union space for building a fair and inclusive society. We will first look into Directive 2016/1919 itself, as well as its context and provisions, framed in the context of the Europeanisation process in criminal matters. This first moment will allow us to better understand the prevailing critical issues hindering the full implementation of the Directive itself, and, consequently, its implications on restraining the fulfilment of right to legal aid. We will strive to comprehend how these obstacles, which stem from an ongoing – yet fundamentally unachieved – integration project, are further densified by the practices of front-line professionals involved in the provision of legal aid. Ultimately, we conclude that further investment in cooperation, both at the national and European levels, is direly needed for achieving a fairer and more inclusive European Union. Keywords: Legal Aid; European Union; Procedural Rights; Access to Justice; Judicial Cooperation. DOI: 10.7176/RHSS/11-12-04 Publication date: June 30 th 2021

Organisational and Professional Integration Between Specialist and Primary Healthcare Services: A Municipal Perspective.

Introduction:Care transitions between specialist and primary healthcare services for people with concurrent substance abuse and mental health problems are characterised by vulnerability and arbitrariness.Objectives:By studying factors that influence integration in a Norwegian context, this study aims to investigate, from a municipal perspective, why care transitions are still tricky after the introduction of the key Coordination Reform.Methods:This study has an explorative approach based on interviews with managers and front-line professionals in primary care. We applied the conceptual framework of functional and normative integration of the Rainbow Model.Results:The municipal actors emphasise that integration is hampered by limited cooperation with general practitioners in referrals to hospital, challenges of communication and loss of meeting points. They experienced close cooperation with sociomedical polyclinics for substance abuse, while challenges in cooperation with district psychiatric centres indicated an interdependence of functional and normative integration. Questioning hospital discharge of patients to primary care was a recurring theme for the municipal actors. Thus, the governing framework of the Coordination Reform has coexisted with fragmentation in organisational structures and divided professional cultures.Conclusions:The coexistence of the new and the old regimes seems to hamper functional and normative integration in care transitions.

PERCEIVED SOCIAL SUPPORT, DEPRESSION AND INSOMNIA AMONG NURSING STAFFS DURING COVID-19

Coronavirus disease (COVID-19) is affecting the mental health of people especially the frontline health care workers. Frontline professionals might experience sleep disturbances due to work pressure, stress, anxiety, depression and various other psychological factors. Social support plays a protective role in preventing depression and insomnia among frontline health care professionals. Thus, this study focused on “Perceived Social Support, Depression and Insomnia among Nursing Staffs during COVID-19”. Objectives of the study is to explore the levels of depression and insomnia among nursing staffs during the pandemic situation and in finding the relationship between Perceived Social Support,Depression and Insomnia among Nursing Staffs during COVID-19. The hypothesis of the current study is that there will be a significant relationship between Perceived Social Support and Depression among nursing staffs,there will be a significant relationship between Perceived Social Support and insomnia among nursing staffs and there will be a significant relationship between Depression and Insomnia among nursing staffs. Nature of the study was quantitative and purposive sampling technique was used to collect data. Data was collected through Google forms around Chennai using the Multidimensional Scale of Perceived Social Support, Patient Health Questionnaire-9 and Athens Insomnia Scale from a sample of 51 nursing staffs. Data were analysed using Pearson's Coefficient of Correlation through SPSS Software. Results showed that there is a significant negative relationship between perceived social support and depression.There is no statistically significant relationship between perceived social support and insomnia.There is a significant positive relationship between depression and insomnia.The present study gave insight about the importance of social support especially during the pandemic situation. Intervention for depression and insomnia are recommended in the phase of the current pandemic.

Manufacturing Zero-Waste COVID-19 Personal Protection Equipment: a Case Study of Utilizing 3D Printing While Employing Waste Material Recycling.

COVID-19 pandemic outbreak dictated the extensive use of personal protective equipment (PPE) by the majority of the population and mostly by frontline professionals. This need triggered a sudden demand that led to a global shortage of available PPEs threatening to have an immense contribution to the virus contamination spread. In these conditions, the need for a local, flexible, and rapid manufacturing method that would be able to cope with the increased demand for PPE fabrication arose. 3D printing proved to be such a manufacturing technique since its working principles make it an ideal technology for local, decentralized production of PPEs meeting the local demands. While considered to be more environmentally friendly than conventional fabrication techniques and aligning well with the principles of sustainability and circular economy, 3D printing can produce waste as the result of potential failed prints and material used for the fabrication of support structures. This paper describes the case of utilizing pre-existing FDM 3D printing equipment in an academic facility for the production of PPEs (face shields) and their distribution according to local demands. The plastic wastes produced were forwarded to a recycling process that led to their conversion to 3D filament that would be returned to the academic facility as raw material for future 3D printing operations. The followed procedure minimized 3D printing waste and led to a zero-waste fabrication case that was initiated in a pandemic for a greater-good cause (production of COVID-19 fighting PPEs) while assimilating the values of sustainability and circular economy.Graphical abstract

How Do Public Service Professionals Behave in Risky Situations? The Importance of Organizational Culture

Many situations in public service delivery are characterized by uncertainty about the potential negative consequences following decisions. These risky situations make the behavior of frontline professionals particularly important. But what shapes the risk perception and subsequent behavior of frontline professionals in risky situations? This article explores the idea that organizational culture provides part of the answer. To examine this, a comprehensive qualitative study with participant observations and interviews at five public hospital wards was conducted. The findings demonstrate the importance of organizational culture on risk perception and behavior in risky situations. Basic cultural assumptions related to professional discussion, administering medicine, grading of adverse events, and prioritizing follow-up activities matter to behavior in risky situations. In organizational cultures with high levels of trust and dialogue about decision-making, the health professionals rely on each other and ask for second opinions, when making decisions in risky situations. Conversely, in organizational cultures with little trust and professional discussion, the health professionals are less likely to ask for second opinions and follow up on risky situations, which increases the possibility of unintended, negative consequences. In this way, organizational culture can be a driver of risk-reducing and risk-seeking behavior among frontline professionals.

Interprofessional model on speaking up behaviour in healthcare professionals: a qualitative study

ObjectivesDespite training and the recognition that speaking up can mitigate harm to patients and save lives, healthcare professionals do not consistently speak up when they have patient safety concerns. The...

Hong Kong’s response to COVID-19: a glance to the control measures and their enforcement

Purpose This study aims to examine Hong Kong’s responses to COVID-19, arguing that Hong Kong’s relatively low infection rate is due to self-discipline of citizens together with the enforcement measures introduced by the government. Design/methodology/approach This study reviewed the government policy announcements and the prevailing scholarly analyses on Hong Kong society during COVID-19. Findings It starts by examining the partial lockdown and control measures since mid-January, and the roles of different government units in enforcement were examined and assessed. Suppression of viral outbreak in Hong Kong should primarily be attributed to the appropriate lockdown and quarantine actions of the government. Originality/value However, outperformance of the frontline professionals and the highly aware, self-disciplined and mutually aided citizens in the community are also the key to the “interim success” by June 2020 in the highly accessible and densely populated city.

Stress and anxiety among healthcare workers during the COVID-19 pandemic in russia

IntroductionMental health of medical workers treating patients with COVID-19 is an issue of increasing concern worldwide, since previous epidemics have shown high levels of anxiety and stress in front-line healthcare professionals. The available data on stress and anxiety symptoms among healthcare workers during the COVID-19 are relatively limited and have not been evaluated in Russia yet.ObjectivesTo evaluate stress and anxiety symptoms among healthcare workers directly involved in the diagnosis and treatment of patients with COVID-19 during the peak of disease outbreak in Russia.MethodsThe study was a cross-sectional hospital-based anonymous on-line survey in May 2020 of 1,090 healthcare workers practicing treatment of patients with COVID-19. Stress and anxiety symptoms were assessed using the Russian versions of Stress and Anxiety to Viral Epidemic scale (SAVE-9) and Generalized Anxiety Disorder (GAD-7) scales. Logistic regression analysis was performed to determine the influence of different variables.ResultsThe median scores on the GAD-7 and SAVE-9 were 5 and 14, respectively. 49.1% respondents had moderate and 21.9% had severe anxiety according to SAVE-9. 12.3% had severe anxiety, 13.2% had moderate according to GAD-7. Female gender and younger age were associated with higher level of anxiety according to regression model.ConclusionsOur study has shown that healthcare workers in Russia practicing treatment of patients with COVID-19 reported high rates of stress and anxiety similar to other countries. Female gender, younger age and being a physician were associated with higher levels of anxiety. These results demonstrate the importance of supportive programs for health care workers fighting COVID-19.DisclosureNo significant relationships.

The Impact of the COVID-19 Crisis on Marginal Migrant Populations in Italy.

This article analyzes the impact of the COVID-19 pandemic on marginal migrant populations, and the Italian response to cope with the crisis. The first section uses different sources of data to highlight social, political, and economic processes, already present in the pre-emergency stage, that contributed to the exposure of migrants to higher levels of vulnerability. The second part analyzes the impact of the crisis and its management in the response stage, focusing in particular on the perspective of front line professionals and migrants advocates. The discussion shows how some attempts have been made to unveil processes that preserve mainstream ideologies, benefiting those who are interested in the maintenance of migratory inflows of migrants with no rights, and some improvements have been achieved. Nevertheless, even if the COVID-19 crisis has created the possibility to make structural problems more visible, and indicated the direction to “build back better,” the cultural and structural variables that create a condition of hyperprecarity for more marginalized migrants seem to be unchanged.

Multiple meanings of resilience: Health professionals' experiences of a dual element training intervention designed to help them prepare for coping with error.

Consistent data demonstrates negative psychological effects of caregiving on front-line health professionals. Evidence that psychological resilience factors can help minimize distress and the potential for low-cost interventions have created interest in resilience-based development programmes; yet evidence of perceived value amongst health professionals is lacking. This study explored health professionals' experiences and perceptions of a novel, resilience-based intervention designed to pro-actively prepare staff for coping with error; to investigate their perceptions of what resilience meant to them, the relevance of the intervention, and impact of participation on ability to cope with error. Semi-structured interviews 4-6 weeks post intervention with 23 randomly selected participants from seven cohorts (midwives, paediatricians, obstetricians/gynaecologists, paramedics) and trainees (physician associates, mammographers, sonographers). Thematic analysis of interview data. Participants reported various interpretations of, and a shift in perception regarding what the concept of psychological resilience meant to them and their practice. These included for example, resilience as a positive or negative concept and their awareness and response to a range of personal, organizational and system factors influencing personal resilience. They valued the prophylactic, clinically relevant, interactive and applied nature of the intervention; having developed and applied valuable skills beyond the context of involvement in error, noting that individuals needed to be willing to explore their own coping mechanisms and human fallibility to gain maximum benefit. There was also consensus that whilst proactively developing individual level psychological resilience is important, so too is addressing the organizational and system factors that affect staff resilience which are outside individual staff control. Enhancing resilience appears to be considered useful in supporting staff to prepare for coping with error and the wider emotional burden of clinical work, but such interventions require integration into wider system approaches to reduce the burden of clinical work for health professionals.

Preparing public health at the front lines: effectiveness of training received by environmental health inspectors in the Caribbean

Environmental health departments in the Caribbean continue to contend with environmental determinants of health related to an increasingly complex array of challenges, including climatic change, disasters, pollution, bioterrorism, and global pandemics. Building the human resource capacity to meet these challenges requires access to modernized, context-relevant training, especially for environmental health inspectors who interface with the public. This study focuses on the standardized Three-Step training program delivered by education institutions across the Caribbean, which is the primary training required by ministries of health for entry into the environmental health inspectorate. A total of 22 focus groups were completed in five countries—Barbados, Guyana, Jamaica, Saint Lucia, and Trinidad and Tobago—with 94 participants drawn from the education institutions delivering training and the inspectors who have received the training. Findings suggest: program strengths in core academic content; weaknesses in faculty experts to deliver advanced subjects; opportunities for enhancing field-training experiences in collaboration with ministries; and threats to program survival due to bottlenecks in public sector hiring that reduce the attractiveness of entering the profession. Interestingly, academic trainers and practitioners differ on the importance of certain knowledge sets, such as legal and court procedural skills and epidemiological data analysis. As ministries of health in these countries contemplate ways to modernize the inspectorates, these findings can guide how ministries and education institutions work together to modernize the Three-Step training program. Points for practitioners Environmental health inspectors interfacing with the public are well placed to contribute perspectives to the public health modernization discourse. Formal training programs must be periodically and frequently recalibrated to societal needs and the state of the art in subject area knowledge. Strengthening the local teaching institutions’ capacity to deliver relevant educational programs will translate into better-prepared frontline professionals. Formal training lags in integrating some emergent subject areas, such as climate change and environmental health determinants.

Exploring Barriers to Effective Implementation of Public Health Measures for Prevention and Control of COVID-19 Pandemic in Gamo Zone of Southern Ethiopia: Using a Modified Tanahashi Model.

BackgroundSince the occurrence of the COVID-19 pandemic, different public health measures have been implemented to prevent and control the further spread of the disease. However, barriers that influence the effective implementation of public health measures were not explore in Ethiopia especially in study Area. Therefore, this study tried to fill this gap by exploring the barriers to effective implementation of public health measures for prevention and control of the COVID-19 pandemic in the Gamo Zone of southern Ethiopia.MethodsThe study employed a qualitative study with a phenomenology approach among purposely selected 30 individuals in the community and selected institutions. Key informant interview was used to collect the data. The data were transcribed verbatim and translated into the English language. The transcribed data were read several times to clearly understand the content for further analysis. The analysis of the data was conducted based on the modified Tanahashi framework.ResultsThe study identified different barriers under five main themes: accessibility, acceptability, availability, contact and use, and effective implementation of public health measures related to barriers. The main barriers to effective implementation of public health measures were resistance to change, negligence, lack of community engagement, insufficient training for front line workers, poor supportive supervision, poor law enforcement, and lack of continuous community awareness creation. Beside, acceptability related barriers like cultural and religious norms and availability related barriers like shortage of personal protective equipment and shortage of skilled health professional have also lion share barriers for implementation of the public health measures.ConclusionThe study identified different personal, institutional, and societal level barriers for effective implementation of public health measures for the COVID-19 pandemic. Therefore, proper and targeted continuous community awareness creation with further mandatory law enforcement activities should be implemented by the concerned bodies to mitigate individual and societal level barriers. In addition, the government with relevant stakeholders should give due attention to equip and protect the frontline professionals by availing the necessary logistic and provision of continuous capacity-building activities.

Structural disavowal and personal inundation of responsibility – a local perspective on pressure on mental health front-line professionalsStrukturell ansvarsfraskrivelse og individuell ansvarsoversvømmelse – kommunalt perspektiv på dilemmaer i profesjonelt arbeidet med rus og psykisk helse

ABSTRACT This article examines how professionals in front-line mental health and addiction services respond to the dilemmas of implementing policies at the local level of the service system. In their daily work, front-line health and social work professionals must find ways to cope with challenges balancing limited resources, professional ethical standards and client needs for varied and flexible services. Front-line professionals have significant space for discretion in finding ways to cope with these dilemmas. We discuss these ways as a drift towards moral dispositions. Drawing on qualitative interviews with local managers and professionals, we find that front-line professionals find themselves at the bottom of the service line where one cannot ‘decentralise’ responsibilities any more. We describe and denote this as ‘structural disavowal of responsibility’, as patients with severe mental health diagnoses are often discharged from specialist services to primary care that lacks the necessary resources. Furthermore, front-line professionals improvise by including measures found in the local community and even their private lives, making their work exceedingly stressful. This is denoted ‘personal inundation of responsibility’. We argue that the moral disposition of front-line professionals hence should be extended to encompass personal inundation as one perversion of their responsibilities.

Reconsidering Early Detection in Countering Radicalization by Local Frontline Professionals

ABSTRACT In recent years, the fight against terrorism and political violence has focused more on anticipating the threats that they pose. Therefore, early detection of ideas by local professionals has become an important part of the preventive approach in countering radicalization. Frontline workers who operate in the arteries of society are encouraged to identify processes toward violent behavior at an early stage. To date, however, little is known about how these professionals take on this screening task at their own discretion. Research from the Netherlands suggests that subjective assessment appears to exist. In this article, we argue that the absence of a clear norm for preliminary judgments affects prejudice or administrative arbitrariness, which may cause side effects due to unjustified profiling.

Mitigating the impact of COVID-19 on tuberculosis and HIV services: A cross-sectional survey of 669 health professionals in 64 low and middle-income countries.

ObjectiveThe experiences of frontline healthcare professionals are essential in identifying strategies to mitigate the disruption to healthcare services caused by the COVID-19 pandemic.MethodsWe conducted a cross-sectional study of TB and HIV professionals in low and middle-income countries (LMIC). Between May 12 and August 6, 2020, we collected qualitative and quantitative data using an online survey in 11 languages. We used descriptive statistics and thematic analysis to analyse responses.Findings669 respondents from 64 countries completed the survey. Over 40% stated that it was either impossible or much harder for TB and HIV patients to reach healthcare facilities since COVID-19. The most common barriers reported to affect patients were: fear of getting infected with SARS-CoV-2, transport disruptions and movement restrictions. 37% and 28% of responses about TB and HIV stated that healthcare provider access to facilities was also severely impacted. Strategies to address reduced transport needs and costs–including proactive coordination between the health and transport sector and cards that facilitate lower cost or easier travel—were presented in qualitative responses. Access to non-medical support for patients, such as food supplementation or counselling, was severely disrupted according to 36% and 31% of HIV and TB respondents respectively; qualitative data suggested that the need for such services was exacerbated.ConclusionPatients and healthcare providers across numerous LMIC faced substantial challenges in accessing healthcare facilities, and non-medical support for patients was particularly impacted. Synthesising recommendations of frontline professionals should be prioritised for informing policymakers and healthcare service delivery organisations.

SARS-CoV-2 Vaccines: Much Accomplished, Much to Learn

As COVID vaccines roll out, internists and other health care providers are being turned to as trusted sources of information for patients and communities. Here, experts from NIAID outline the current state of knowledge regarding such vaccines. They contrast vaccine platforms, summarize clinical trial data regarding efficacy and safety, and comment on key questions including the ability of current vaccines to protect against infection and to decrease the prevalence of virus in the community.

Religious Support as a Contribution to Face the Effects of Social Isolation in Mental Health During the Pandemic of COVID-19.

Coping with the COVID-19 pandemic has required measures to contain the contagion, including social isolation. However, this and other factors have caused mental health problems, both in patients and health professionals and in family members or asymptomatic population. Religious support can be an ally for this type of confrontation. In the case of the COVID-19 pandemic, spiritual/religious care has been restricted and insufficient. When accessible to patients and frontline professionals, they are offered by virtual means, almost always by recorded media and made available in bulk. This essay argues, based on references in the areas of psychology, psychoneuroimmunology, biosafety, and military, that the face-to-face and personalized relationship between religious leaders, patients, health professionals, family members, and faith communities is as essential as possible for the dignified treatment victims, referral to spiritual needs and resilience of society, in addition to contributing to the improvement of the immune response of all. Practical examples are cited in the areas of military chaplaincy and hospital civilian chaplaincy. The essay also proposes the adoption of protocols already published by WHO and other safety measures such as the use of robotics and the recruitment/training of mass chaplains. In addition to contributing to the improvement of COVID-19 pandemic coping processes, the study also contributes to improving the delivery of spiritual/religious care as an ally to physical and mental, individual, and collective health.

Association of sleep quality and psychological aspects with reports of bruxism and TMD in Brazilian dentists during the COVID-19 pandemic.

Dentists are exposed to contamination by SARS-CoV-2 due to dental interventions, leading to a state of alert and potential risk of negative impact in mental health and sleep quality, associated with Temporomandibular Disorder (TMD) and bruxism.Objective:to evaluate the psychosocial status, sleep quality, symptoms of TMD, and bruxism in Brazilian dentists (DSs) during the COVID-19 pandemic.Methodology:The sample (n=641 DSs) was divided into three groups (quarantined DSs; DSs in outpatient care; and frontline professionals), which answered an electronic form containing the TMD Pain Screening Questionnaire (Diagnostic Criteria for Temporomandibular Disorders – DC/TMD), the Pittsburgh Sleep Quality Index (PSQI), the Depression, Anxiety and Stress Scale (DASS-21), and the sleep and awake bruxism questionnaire. ANOVA test and Mann Whitney post-test were used, with Bonferroni adjustment (p<0.016) and a 95% confidence level.Results:Probable TMD was found in 24.3% (n=156) of the participants, while possible sleep and awake bruxism were diagnosed in 58% (n=372) and 53.8% (n=345) of them, respectively. Among all variables evaluated, only symptoms of depression were significantly greater in the quarantined DSs group when compared to those who were working at the clinical care (p=0.002). Working DSs were significantly less likely (OR=0.630, p=0.001) to have depressive symptoms. Those who were not worried or less worried about the pandemic were less likely to experience stress (OR=0.360), anxiety (OR=0.255), and poor sleep quality (OR=0.256). Sleep had a strong positive and moderate correlation with psychological factors on frontline workers and DSs in outpatient care, respectively.Conclusion:The results suggest confinement may have a more negative impact on the life of DSs than the act of being actively working. The concern about Covid-19 and poor sleep quality was significantly prevalent and may negatively affect the quality of life of DSs. Thus, further research on the topic is needed.