General Healthcare Settings Research Articles

Comparison of Prior Distributions for the Heterogeneity Parameter in a Rare Events Meta-Analysis of a Few Studies.

Bayesian meta-analysis is a promising approach for rare events meta-analysis. However, the inference of the overall effect in rare events meta-analysis is sensitive to the choice of prior distribution for the heterogeneity parameter. Therefore, it is crucial to assign a convincing prior specification and ensure that it is both plausible and transparent. Various priors for the heterogeneity parameter have been proposed; however, the comparative performance of alternative prior specifications in rare events meta-analysis is poorly understood. Based on a binomial-normal hierarchical model, we conducted a comprehensive simulation study to compare seven heterogeneity prior specifications for binary outcomes, using the odds ratio as the metric. We compared their performance in terms of coverage, median percentage bias, width of the 95% credible interval, and root mean square error (RMSE). We illustrate the results with two recently published rare events meta-analyses of a few studies. The results show that the half-normal prior (with a scale of 0.5), the prior proposed by Turner etal. for the general healthcare setting (without restriction to a specific type of outcome) and for the adverse event setting perform well when the degree of heterogeneity is not relatively high, yielding smaller bias and shorter interval widths with similar coverage and RMSE in most cases compared to other prior specifications. None of the priors performed better when the heterogeneity between-studies were significantly extreme.

Primary healthcare practitioners’ perspectives on trauma-informed primary care: a systematic review

BackgroundExposure to domestic and family violence is a pervasive form of complex trauma and a major global public health problem. At the frontline of the health system, primary healthcare practitioners are uniquely placed to support individuals with experiences of trauma, yet their views on trauma-informed primary care are not well understood. This systematic review of qualitative literature sought to explore primary healthcare practitioners’ perspectives on trauma-informed primary care.MethodsEight databases were searched up to July 2023. Studies were included if they consisted of empirical qualitative data, were conducted in general practice or equivalent generalist primary healthcare settings, and included the perspectives of primary healthcare practitioners where they could be distinguished from other participants in the analysis. Thematic synthesis was used for analysis.Results13 papers met inclusion criteria, representing primary care settings from the United States, Canada, Australia, and Norway. Three key themes were developed: Changing the paradigm, Building trust, and Navigating the emotional load. Findings shed light on how primary healthcare practitioners perceive and strive to practise trauma-informed primary healthcare and the challenges of navigating complex, trauma-related work in the primary care environment.ConclusionsThis review supports the need for recognition of the value of primary care in supporting patients with histories of trauma and violence, the development of interventions to mitigate the emotional load worn by primary healthcare practitioners, and further work to develop a deep and consistent understanding of what trauma-informed primary care encompasses.

How can we measure psychological safety in mental healthcare staff? Developing questionnaire items using a nominal groups technique.

There have been growing concerns about the well-being of staff in inpatient mental health settings, with studies suggesting that they have higher burnout and greater work-related stress levels than staff in other healthcare sectors. When addressing staff well-being, psychological safety can be a useful concept. However, there is no measure of psychological safety that is suitable for use in inpatient mental health settings. Edmondson (1999) is the most commonly used measure of psychological safety, but it was designed for use in general physical healthcare settings. As inpatient mental health settings are unique environments, transferability of knowledge from physical to mental healthcare settings cannot be assumed. We sought to develop questionnaire items that capture psychological safety among healthcare staff working in acute inpatient mental healthcare settings. We used the nominal group technique, a consensus method involving rounds of discussion, idea generation, and item rating/ranking to identify priorities. Twenty-eight stakeholders participated, including 4 who had lived experience of mental health problems, 11 academics and 18 healthcare professionals (8 participants identified with more than 1 category). The study involved a workshop with three parts: (i) an overview of current research and limitations of the Edmondson (1999) measure as outlined above, (ii) discussion on what items should be retained from the Edmondson (1999) measure, and (iii) discussion on what items should be added to the Edmondson (1999) measure. Twenty-one items were generated and retained to capture psychological safety in inpatient mental health settings. These measure professionals' sense of being valued by their team and organization, feeling supported at work, feeling physically safe and protected from physical harm, and knowing they can raise concerns about risk and safety. This is the first study to generate questionnaire items suitable for measuring staff psychological safety in mental health settings. These have been generated via a consensus method to ensure stakeholders' views are reflected. Further research is needed to evaluate factor structure, internal reliability, and convergent validity.

Assessing the utility of the PC-PTSD-5 as a screening tool among a cancer survivor sample.

Hematopoietic stem cell transplantation (HCT) is an intensive and invasive procedure used in cancer treatment that can lead to posttraumatic stress disorder (PTSD) symptoms. These symptoms are frequently overlooked in oncology and general health care settings. The suitability and utility of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) within the cancer population remains uncertain. This study aims to evaluate its performance as a brief (five-item) case-finding screening alternative to the longer (20-item) PTSD Checklist for DSM-5 (PCL-5) in survivors who received an HCT 1 to 5 years ago. A total of 817 cancer survivors completed the PC-PTSD-5 and PCL-5 during recruitment for a randomized clinical trial. Optimal cut scores for identifying probable PTSD and item performance were determined using indices correcting for chance and item response theory analyses. Of the HCT sample, 10.4% screened as positive for probable DSM-5 PTSD using the PCL-5. The PC-PTSD-5 exhibited strong internal consistency and significant associations with PCL-5 scores (total, r=.82; items, rs=.56-.61). A cutoff score of 2 provided optimal sensitivity for screening (κ[Se]=.95), whereas a cut score of 4 demonstrated the highest efficiency for detecting a probable DSM-5 PTSD diagnosis on the PCL-5 (κ[Eff]=.39). Item response theory analyses indicated that item 4 (numbing) of the PC-PTSD-5 yielded the most informative data, with other items potentially lacking incremental utility. Although not an instrument validation study, these findings offer efficient evidence for using the PC-PTSD-5 as a succinct screening tool among cancer survivors in a clinical context. ClinicalTrials.gov, NCT04058795, registered 8/16/2019.

Predictive validity of the Standardized Infant NeuroDevelopmental Assessment (SINDA) to identify 4–5 year-old children at risk of developmental delay in a low-risk sample

BackgroundEarly detection of developmental problems is important as it allows for early intervention. Previous studies, in high-risk infants, found high predictive values of atypical scores on the Standardized Infant NeuroDevelopmental Assessment (SINDA) for later neurodevelopmental disorders (i.e., cerebral palsy, intellectual disability). AimsThe present study explored SINDA's predictive values to identify risk of developmental delay at 4–5 years. Study designCohort study. Subjects786 low-risk Dutch children (367 boys; median gestational age: 40 (27–42) weeks; mean birth weight: 3455 (SD 577) grams). Outcome measuresThe SINDA was assessed at 2–12 months and risk of developmental delay was assessed using the Ages and Stages Questionnaire (ASQ) at 4–5 years. SINDA's predictive values were determined for five ASQ domains and the total ASQ score for children at risk of marked (all ASQ domains deviant) and any (one or more ASQ domains deviant) developmental delay. ResultsPresence of one atypical SINDA scale score showed low to moderate sensitivities (12–88 %, depending on the SINDA scale and ASQ domain involved), moderate to high specificities (66–94 %), low positive predictive values (PPVs; 3–16 %), and high negative predictive values (NPVs; 95–100 %) for children at risk of marked and any developmental. Presence of multiple atypical SINDA scale scores predicted deviant ASQ domains slightly better (sensitivities = 11–62 %, specificities = 90–98 %, PPVs = 6–30 %, and NPVs = 95–100 %). ConclusionsIn low-risk infants, SINDA's predictive value is low for detecting children at risk of marked and any developmental delay at 4–5 years, as reflected by the low sensitivities. One of the explanations is the relatively low prevalence of developmental delay in low-risk populations. This might have consequences for the application of the SINDA in general healthcare settings (e.g. child health clinics), but further studies are needed to draw this conclusion.

Mental health services in Gauteng, South Africa: A proxy evaluation using pharmaceutical data.

South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment. The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system. The Public health sector, Gauteng province formed the setting for the study. A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing. General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals. In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended. This study provides insight into service provision for MNS disorders.

Time to Think Antifungal Resistance Increased Antifungal Resistance Exacerbates the Burden of Fungal Infections Including Resistant Dermatomycoses.

Increased antifungal resistance is exacerbating the burden of invasive fungal infections, as well as potentially contributing to the increase in resistant dermatomycoses. In this commentary, we focus on antifungal drug resistance, in contrast to antibacterial resistance. We provide a brief historical perspective on the emergence of antifungal resistance and propose measures for combating this growing health concern. The increase in the incidence of invasive and cutaneous fungal infections parallels advancements in medical interventions, such as immunosuppressive drugs, to manage cancer and reduce organ rejection following transplant. A disturbing relatively new trend in antifungal resistance is the observation of several fungal species that now exhibit multidrug resistance (eg, Candida auris, Trichophyton indotineae). Increasing awareness of these multidrug-resistant species is paramount. Therefore, increased education regarding potential fungus-associated infections is needed to address awareness in the general healthcare setting, which may result in a more realistic picture of the prevalence of antifungal-resistant infections. In addition to education, increased use of diagnostic tests (eg, micro and macro conventional assays or molecular testing) should be routine for healthcare providers facing an unknown fungal infection. Two critical barriers that affect the low rates for Antifungal Susceptibility Testing (AST) are low (or a lack of) sufficient insurance reimbursement rates and the low number of qualified laboratories with the capacity to perform AST. The ultimate aim is to improve the quality of patient care through fungal identification, diagnosis, and, where appropriate, susceptibility testing. Here we propose an all-encompassing call to action to address this emerging challenge.

Personality in individuals with mild intellectual disability to borderline intellectual functioning: a comparative study

PurposeThis study aims to investigate the distinctive personality traits and characteristics of individuals with borderline intellectual functioning (BIF) and mild intellectual disability (MID) within specialized centers for MID-BIF treatment and care compared with individuals without MID-BIF diagnosis gathered from general mental health care (GMH) settings.Design/methodology/approachPatients classified with MID-BIF (n = 58), most with comorbid psychopathology, were thoroughly interviewed by trained clinicians who afterward completed the Shedler–Westen Assessment Procedure (SWAP-200) about the patient. The authors compared SWAP-200 profiles of MID-BIF patients with profiles of GMH individuals. In addition, the authors have compared these profiles for the MID and BIF groups (differentiated based on previously known intelligence quotient scores).FindingsResults show significantly higher scores for the MID-BIF group than the GMH group on scales encompassing emotional instability, impulsivity and antagonism. On scales containing constraint and healthy traits, significantly lower scores were found for the MID-BIF group than for the GMH group. Importance of including SWAP-200 personality assessment for a more comprehensive understanding and treatment planning for individuals with MID-BIF is discussed.Originality/valueThis study offers insights into personality within individuals with an MID-BIF diagnosis, compared with individuals in a GMH setting.

Psychometric Evaluation of Screens for Common Mental Disorders, Severe Mental Disorders, Substance Use Disorders, and Suicide Risk in Mozambican Healthcare.

Globally, mental and substance use disorders are a leading cause of disease burden. In low- and middle-income countries, where there is an extreme shortage of trained mental health specialists, validated, brief screening tools for mental and substance use disorders are required for non-specialists to efficiently identify patients in need of mental health care. Mozambique, one of the poorest countries in the world, has fewer than two mental health specialists for every 100,000 people. In the present study, we evaluated a comprehensive set of seven measures for depression, anxiety, somatization, alcohol use disorder, substance use disorder, psychosis and mania, and suicide risk among N=911 Mozambican adults in general healthcare settings. All instruments demonstrated acceptable internal consistency (α > 0.75). Compared to diagnoses made by the Mini International Neuropsychiatric Interview, all measures showed good criterion validity (AUC > 0.75), except the Psychosis Screening Questionnaire, which showed low sensitivity (0.58) for psychotic disorder. No substantial differences were observed in internal consistency when stratifying by gender, age, education level, primary language, facility-type, and patient status; criterion validity showed some variability when stratified by sub-population, particularly for education, primary language, and whether the participant was seeking care that day. Exploratory factor analyses indicated that the measures best differentiate categories of diagnoses (common mental disorder, severe mental disorders, substance use disorders, and suicide risk) rather than individual diagnoses, suggesting the utility of a transdiagnostic approach. Our findings support the use of these measures in Mozambique to identify common mental disorders, substance use disorders, and suicide risk, but indicate further research is needed to develop an adequate screen for severe mental disorders. Given the limited mental health specialists in this and other LMIC settings, these brief measures can support non-specialist provision of mental health services and promote closure of the treatment gap.

Differentiation of clinically diagnosed patients with aMCI and dementia from cognitively unimpaired older adults using plasma and serum p‐tau 181 and NfL

AbstractBackgroundBlood‐based biomarkers give the possibility of having a less invasive, more acceptable to patients, and cost‐ and time‐efficient screening tool. Therefore, blood‐based biomarkers represent an ideal addition to cerebrospinal fluid (CSF) and neuroimaging biomarkers. Standard examination of neurocognitive disorders, such as lumbar punction or brain PET scan, cannot be performed within general practice. Given the high prevalence of these diseases, alternatives such as blood‐based biomarkers would represent a significant advance. The aim of this study was to investigate whether levels of p‐tau 181 and neurofilament light chain (NfL) in serum and plasma can differentiate cognitively unimpaired (CU) elderly individuals from individuals in the stage of aMCI and dementia.MethodA total of 75 biomarker‐defined individuals from the Czech Brain Aging Study were recruited for the study, including the CU, individuals in the aMCI stage, and individuals in the stage of dementia syndrome with various etiology (AD, FTLD or LBD). Commercial ELISA kits were used for the assessment of standard biomarkers from CSF (Aß42, Aß40, pTau, tTau). Plasma and serum samples were analyzed using a Quanterix SR‐X analyzer with Simoa technology. Receiver operating characteristic analyses of the concentrations of p‐tau 181 and NfL in plasma and serum were performed using the R statistical software and GraphPad Prism.ResultPlasma NfL, AUC 0.9861 (95% CI, 0.9439 to 1.000), and serum NfL with AUC 0.9583 (95% CI, 0.8774 to 1.000) differentiated aMCI and dementia from CU with high predictive accuracy. The results were significant for plasma p‐tau 181 too with AUC 0.7869 (95% CI, 0.6474 to 0.9265), along with serum p‐tau 181 with AUC 0.7623 (95% CI, 0.6292 to 0.8954).ConclusionPlasma and serum p‐tau 181 and NfL may be potentially useful and cost‐effective biomarkers for differentiating cognitively unimpaired elderly individuals from those at aMCI and dementia stages in general health care settings.

Improving Patient Experience through Meaningful Engagement: The Oral Health Patient’s Journey

Healthcare organisations around the world have embraced the valuable role that patient experience plays in the improvement of health care delivery. Engaging with patients is a vital component of understanding how to deliver safe, high-quality, respectful health care that is person-centred and efficient. In oral health services, patient experience is historically predominantly reported as challenging, which is most commonly associated with past traumatic experience with poor oral health treatment. Additionally, the high out-of-pocket costs associated with oral health treatment can mean that people disengage with these services, thereby worsening their oral health conditions. Consequently, oral health has an enormous task to reduce the negative perceptions and experiences. This demands innovative and subtle ways to navigate and address patient and service challenges. Exploring and acknowledging the myriad of historical challenges that exist for oral health patients and utilising these experiences to support change will ensure person-centred improvements are designed and implemented. Therefore, this perspective paper defines patient experience and proposes how oral health patient experience can be improved using the concept of meaningful engagement with a focus on the Australian context. We identified two important concepts that impact oral health patient experience and explored how these concepts may play a role in improving oral health services through improved patient experience. The first concept is person, patient, and user which focusses on general patient experience journey in a general health care setting. The second concept is preservice, current service, and post service which relates to an oral health patient’s experience journey in an oral health service setting. Our findings suggest that the practitioner–patient relationship and use of technology are central to patient engagement to improve patient experience.

Phytochemical Screening and Antimicrobial Activity of Homoeopathic Dilutions of Myristica sebifera against Staphylococcus aureus

Abstract Background The Anti-Microbial Resistance (AMR) has trend of increasing morbidity and mortality which affect the management of variety of infectious disorders in humans. Our skin is native to the bacterium Staphylococcus aureus, which is also a frequent source of infections in both the general population and healthcare settings. On the other side, Myristica sebifera is known for its great antiseptic activity in Homoeopathy. Objective This study was aimed to explore the phytoconstituents & antimicrobial activity of Homoeopathic preparation of Myristica sebifera 12C, 30C & 200C. Materials and Methods Myristica sebifera 12C, 30C & 200C were tested for identification of its phytoconstituents and antimicrobial activity was evaluated following Kirby-Bauer Disk Diffusion (KBDD) method according to clinical and laboratory standard (CLSIM44 A) with slight modifications. The diameter of zone of inhibition was measured and compared with Gentamicin (Positive Control) & Alcohol (62% & 91% as Negative Controls). The experiment was performed thrice to check the accuracy and reproducibility. Result Myristica sebifera 12C & 30C showed maximum zone of inhibition up to (10.33 ± 1.52 & 11.67 ± 1.52 respectively) against Staphylococcus aureus when compared to control (Alcohol 62% & 91%) as 6.00 ± 0.00. Conclusion Phytochemical studies showed presence of alkaloids and carbohydrate in Myristica sebifera 12C and 30C. The maximum percentage of zone of inhibition (94%) was found in Myristica sebifera 30C followed by Myristica sebifera 12C (72%). This antimicrobial study suggests that Myristica sebifera 12C & 30C could be helpful for treating the disorders caused by Staphylococcus aureus.

Alcohol screening during COVID-19 surges in an urban health system the United States

In 2021, over 50% of U.S. adults drank alcohol in the past month with over 25% reporting binge drinking, an increase over previous years. Alcohol use is associated with increased risk of accidents, poor birth outcomes, cancer, chronic diseases, and mortality. During the COVID-19 pandemic alcohol consumption and alcohol-related deaths increased. National organizations recommend screening for unhealthy alcohol use in general health care settings as a prevention strategy.This observational study examined alcohol screening rates in primary care practices in Boston, MA in the context of the COVID-19 pandemic, from July 2019 through May 2022. Screening rates were mapped, by month, to the number of COVID-19 cases. Alcohol screening dropped substantially during the first COVID-19 surge but steadily increased to baseline between the second and third surges. This decline was likely due to competing pandemic-related priorities (e.g., testing, urgent care) and the transition to telemedicine. While some health screening cannot be completed virtually, screening for alcohol is possible. Innovative workflow strategies (e.g., pre-visit screening via patient portals, support staff screening using virtual rooming processes) should be considered to avoid future interruptions of screening for unhealthy alcohol use in primary care.

Decreasing reproductive and abortion care barriers: findings on the student health center's role from a student survey

BackgroundCollege-aged young adults in the US have low utilization and high need for reproductive healthcare. Multiple barriers to reproductive care exist. University Student Health Centers (SHCs) provide varying degrees of reproductive products and services. Recently, California legislated that public university SHCs add medication abortion to their care.MethodsTo examine existing attitudes and barriers to reproductive healthcare for public university students, we conducted an anonymous online survey at a large, diverse, urban coastal California State University. Students were asked about numerous barriers accessing reproductive services in general and at the SHC, which we categorized into three groups: stigma, access and system. Respondents were also asked about knowledge and preferences for accessing and recommending various services. To understand the extent to which inequities exist, we compared differences across racialized/ethnic identity, gender identity, anticipated degree, and living distance from campus using chi-squared tests.ResultsThe majority of survey (n = 273) respondents experienced stigma and access barriers in general healthcare settings which made obtaining reproductive healthcare for themselves or their partners difficult (stigma barriers 55%; 95% CI 49%–61%; access barriers 68%; 95% CI 62–73%). Notably, students reported statistically significant lower rates of access barriers at the SHC, 50%, than in general reproductive healthcare settings, 68%. There were limited differences by student demographics. Students also reported a high willingness to use or recommend the SHC for pregnancy tests (73%; 95% CI 67–78%), emergency contraception pills (72%; 95% CI 66–78%) and medication abortion (60%; 95% CI 54–66%). Students were less likely to know where to access medication abortion compared to other services, suggesting unmet need.ConclusionsOur study provides evidence that students face barriers accessing reproductive healthcare and that SHCs are a trusted and accessible source of this care. SHCs have a key role in increasing health, academic and gender equity in the post-Roe era. Attention and financial support must be paid to SHCs to ensure success as state legislatures mandate them to expand reproductive and abortion care access.

A qualitative analysis of factors influencing healthcare providers’ behaviour toward persons living with HIV in Ghana

BackgroundA positive relationship between a healthcare provider (HCP) and a patient is likely to build trust and improve care for People Living with HIV (PLWH). The study explored the individual and external factors influencing HCP behaviour towards PLWH and compares HCP in antiretroviral therapy clinics (AHCP) with general health care settings HCP (GHCP). MethodsThis qualitative study used a semi-structured interview protocol to guide individual in-depth interviews among 33 HCPs. The interview protocol was informed by empirical literature and included topics such as perceptions and experiences working with PLWH, HIV-related training received, knowledge about HIV, emotions towards PLWH and support related to patient care. The interview data were thematically analysed. ResultsBoth AHCP and GHCP claimed that their thoughts and judgments never influenced the way they managed PLWH, but there appears to be reflections of either sympathy or positive discrimination, especially for AHCP, or stigmatizing behaviours such as using gloves for PLWH-only among GHCP. The findings from this study suggest that individual factors such as perceptions about HIV, attitude towards HIV patients, different emotions, HIV-related training received and external factors such as availability of guidelines, logistics, infrastructural and reimbursement challenges influenced HCP behaviour towards PLWH. ConclusionThe study suggests that individual and external factors influence AHCP and GHCP behaviour towards PLWH. We recommend the use of Intervention Mapping to develop and evaluate interventions addressing the behaviour and emotions of AHCPs and GHCPs to reduce stigmatization of PLWH in the healthcare sector, hence improving hospital visits and medication adherence.

Comparison of a Group-/Home-Based and a Weight-Machine-Based Exercise Training for Patients with Hip or Knee Osteoarthritis-A Secondary Analysis of Two Trial Interventions in a Real-World Context.

This study aimed to compare an individual weight-machine-based strengthening program (MbT) with a group-/homebased training offering strengthening/functional exercises (GHT) in a general health care setting. A total of 657 participants (GHT = 521, MbT = 136) suffering from hip/knee OA were included and analysed with a pre-post design (baseline (T0)/3-months (T1)). Primary outcomes were pain and physical functioning (Western Ontario and McMaster Universities Osteoarthritis Index, range 0-10). Additionally, adherence and perceived patient benefit were measured (T1). Data were analysed with linear mixed models (time, treatment, baseline pain/physical impairment severity) adjusted for patient characteristics. No significant between-group differences in pain reduction/functional improvements (time*treatment*baseline pain/physical impairment severity, pain/function: n.s.; time*treatment, pain: p = 0.884, function: p = 0.067). Within-group improvements were dependent on baseline severity: Higher severity levels demonstrated larger changes from baseline. Perceived patient-benefit (very high to high, GHT: 78%, MbT: 92%) and exercise adherence (Dropouts T1: GHT: 27.8%, MbT: 16.2%; adherence to supervised sessions: GHT: 89%, MbT: 92%) was slightly better in the MbT. In summary, both MbT and GHT, showed positive results for patients with at least moderate disease symptoms. Findings for physical functioning, perceived patient-benefit, exercise adherence hint towards a superiority of MbT. Individual preferences should be considered when prescribing exercise therapy. Trial registration: (1) German Clinical Trial Register DRKS00009251. Registered 10 September 2015. (2) German Clinical Trial Register DRKS00009257. Registered 11 September 2015.

Effectiveness of Topical Cyclosporin A 0.1%, Diquafosol Tetrasodium 3%, and Their Combination, in Dry Eye Disease.

Purpose: To compare the effectiveness of the topical use of cyclosporin A (CsA) 0.1%, diquafosol (DQS) tetrasodium 3% ophthalmic solution, and their combination in treating dry eye disease in a general health care setting. Methods: This prospective, nonrandomized, observational study analyzed 279 patients. Patients instilled topical CsA 0.1% (Ikervis®; Santen Pharmaceutical Co., Ltd., Japan) once daily and/or DQS tetrasodium 3% (Diquas-S®; Santen) six times a day for 12 weeks. Objective signs [tear break-up time (TBUT), National Eye Institute (NEI) corneal and conjunctival staining scores] and symptoms [Symptom Assessment in Dry Eye (SANDE) and Dry Eye-related Quality-of-Life Score (DEQS) questionnaires] were evaluated at baseline, week 4, and week 12. Results: Patients (n = 279) were mainly female (85.0%) with a mean (SD) age of 50.1 (14.8) years, and received CsA (n = 93), DQS (n = 99), or CsA/DQS (n = 87). Both monotherapies and CsA/DQS combination therapy significantly improved TBUT, NEI corneal and conjunctival staining scores, and SANDE and DEQS scores from baseline to week 12 (all P < 0.0001). The mean change in TBUT between baseline and week 12 was significantly higher in CsA/DQS combination therapy (2.13 ± 2.41 s) than in CsA monotherapy (1.07 ± 1.71 s; P = 0.0011). Conclusions: Monotherapy with CsA or DQS and CsA/DQS combination therapy all significantly improved the objective signs and symptoms of dry eyes during 12 weeks of treatment. CsA/DQS combination therapy provides an additional benefit in terms of TBUT compared with CsA alone; however, a randomized controlled trial still needs to be performed to confirm this result.

An investigation into the factors which influence attendance rates for psychology appointments in an adult intellectual disability service

PurposeThis study aims to investigate whether factors previously shown to influence attendance rates for appointments in general practice and general mental health services also influence attendance rates in services for people with intellectual disabilities (ID).Design/methodology/approachPost hoc data from 452 psychology appointments, ID diagnostic and initial screening (triage) appointments were collected from the health-care files of a community adult ID psychology service. Demographic factors (age, sex) and clinical factors (waiting time, time between appointment invitation being sent and appointment being held, presence of prior telephone call or letter, type of appointment, weekday, month) were recorded along with the attendance outcome (attended/did not attend [DNA]). The impact of the COVID-19 pandemic was also explored by documenting whether the appointment predated March 2020.FindingsNo significant associations were found between any variable investigated and attendance outcome when analysing appointment data as a whole and when splitting the data between appointment type. Weekday was found to significantly be associated with attendance outcome for appointments held during COVID-19, in which more DNA appointments occurred on a Wednesday compared to the other days of the week. No other associations were found for appointments held during the COVID-19 pandemic or for appointments held prior to the COVID-19 pandemic. These results suggest that factors which influence attendance rates in general health-care settings do not necessarily generalise to ID services.Originality/valueTo the best of the authors’ knowledge, this study is the first to examine whether certain demographic and clinical factors influenced attendance rates in an adult intellectual disability service.

Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol.

Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands, this is reflective of international primary healthcare nursing trends. However, as nursing care in general practice advances, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to assess the role and facilitate development of services are required. Nursing quality care metrics are an established mechanism which evaluate quality of care. Nursing quality care process metrics (QCP-Ms) specifically refer to measurement of care delivered directly to patients by nurses, benchmarking these interventions adherence to best practice guidance. The use of nursing metrics has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development and implementation of QCP-Ms by Irish GPNs. Aim: To explore and map the literature regarding the development and implementation of QCP-Ms within general practice settings. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O'Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCP-Ms which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about nursing QCP-Ms, their use in general practice or primary healthcare settings, enriching understanding regarding their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary healthcare.

Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol

Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands, this is reflective of international primary healthcare nursing trends. However, as nursing care in general practice advances, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to assess the role and facilitate development of services are required. Nursing quality care metrics are an established mechanism which evaluate quality of care. Nursing quality care process metrics (QCP-Ms) specifically refer to measurement of care delivered directly to patients by nurses, benchmarking these interventions adherence to best practice guidance. The use of nursing metrics has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development and implementation of QCP-Ms by Irish GPNs. Aim: To explore and map the literature regarding the development and implementation of QCP-Ms within general practice settings. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O’Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCP-Ms which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about nursing QCP-Ms, their use in general practice or primary healthcare settings, enriching understanding regarding their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary healthcare.