Education Of Health Care Providers Research Articles

"Dementia Doesn't Mean That Life Doesn't Have More Wonderful Things Ahead": A Qualitative Study Evaluating a Canadian Dementia Support Services Program.

Community support programs can improve quality of life for people living with dementia and their care partners. Important to the successful implementation of such programs is close engagement with end-users to gain a better understanding of their needs. This study describes the perspectives of people living with dementia, care partners, and health-care providers on the First Link® dementia support program provided by the Alzheimer Society of British Columbia (ASBC). Following a large-scale survey (N=1,164), semi-structured interviews were conducted with participants to explore in greater detail the different needs and themes that emerged from the first phase of the study. The interviews explored: 1) experiences with the program; 2) future planning; 3) meaning of independence; and 4) impact of the program on emotional and physical well-being. A total of 48 participants were interviewed in this study. Knowledge and education were key factors that helped participants manage the impact of dementia. Learning about dementia, the experiences of others, strategies on how to manage symptoms, what to plan for in the future, and how to access different services in the community, was tied to increased feelings of confidence and comfort, and decreased stress. Participants also provided suggestions for improvement of the First Link® dementia program such as further embedding the program into the patient journey, providing more services in remote areas, providing education for health-care providers, and increasing awareness of the program. By emphasizing the lived experiences and needs of those living with dementia and their caregivers, this work will inform future research-based program evaluations globally and, in turn, improve the existing services to support people living with-and impacted by-dementia.

Incidence, implications, and management of sense-B-noise failure in subcutaneous cardioverter-defibrillator patients: insights from a large multicentre registry.

Subcutaneous implantable cardioverter-defibrillators (S-ICDs) offer potentially distinct advantages over transvenous defibrillator systems. Recent randomized trials showed significantly lower lead failure rates than transvenous ICD. Still, S-ICDs remain associated with the risk of inappropriate shocks (IAS). While previous studies have reported varying causes of IAS, this study explores a rare cause of IAS, referred to as 'sense-B-noise.' It was recently described in case series, but its incidence has not been studied in a large cohort of S-ICD patients. We retrospectively reviewed data from patients implanted with S-ICD models 1010, A209, and A219 between October 2009 and July 2023 across nine centres in Europe and the USA. The analysis concentrated on determining the incidence and understanding the implications of sense-B-noise events. Sense-B-noise represents a rare manifestation of distinct electrogram abnormalities within the primary and alternate sensing vectors. Data were collected from medical records, device telemetry, and manufacturer reports for investigation. This registry is registered on clinicaltrials.gov (NCT05713708). Subcutaneous implantable cardioverter-defibrillator devices of the 1158 patients were analysed. The median follow-up time for all patients was 46 (IQR 23-64) months. In 107 patients (9.2%) ≥1 IAS was observed during follow-up. Sense-B-noise failure was diagnosed in six (0.5 and 5.6% of all IAS) patients, in all patients, the diagnosis was made after an IAS episode. Median lead dwell time in the affected patients was 23 (2-70) months. To resolve the sense-B-noise defect, in three patients reprogramming to the secondary vector was undertaken, and two patients underwent system removal with subsequent S-ICD reimplantation due to low amplitude in the secondary vector. In one patient, the secondary vector was initially programmed, and subsequently, an S-ICD system exchange was performed due to T-wave-oversensing IAS episodes. This multicentre analysis' findings shed light on a rare but clinically highly significant adverse event in S-ICD therapy. To our knowledge, we provide the first systematic multicentre analysis investigating the incidence of sense-B-noise. Due to being difficult to diagnose and limited options for resolution, management of sense-B-noise is challenging. Complete system exchange may be the only option for some patients. Educating healthcare providers involved in S-ICD patient care is crucial for ensuring accurate diagnosis and effective management of sense-B-noise issues.

Enhancing appendiceal cancer care: Towards evidence-based practice and continuous education for healthcare providers.

e16377 Background: Appendiceal cancers (AC) are a set of rare and histologically diverse malignancies with distinct biological features and treatment implications. Despite surgical advances, there are gaps in the standardization of systemic therapies for AC. Hence, there is a pressing need to understand the current practice patterns amongst oncologists to facilitate unifying management strategies. Methods: A cross-sectional survey was distributed electronically among GI oncology specialists between April – October 2023 to map current practices in AC care. The survey contained 18 questions structured in three sections— participant demographics, treatment experiences, and management preferences for hypothetical cases. The analysis focused on response frequencies informing the need to develop targeted educational and research initiatives. Results: Most of the respondents (N = 104; response rate 22%), primarily from academic (86%) and urban settings (77%), manage up to 10 AC patients annually. Despite over five years of practice experience for 80% of respondents, high confidence in treating AC was modest (38%). The majority (83%) cited lack of guidelines and standardized treatments as a concern. The NCCN guidelines were commonly referred to, but only 13% were satisfied with AC education. For intermediate and high-grade AC, 63% and 53%, respectively, of respondents reported using perioperative chemotherapy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. 40% opted for systemic therapy for low-grade neoplasms. 5FU/Capecitabine and oxaliplatin were the most common regimens of choice, whereas irinotecan, anti-VEGF, and anti-EGFR agents were used less frequently. Surveillance primarily involved serum CEA (91%) and CT scans (99%), with PET, MRI, and ctDNA used by 20-30% of the respondents. Free-text comments noted deficient evidence and educational needs to guide clinical practice. Conclusions: Our study is the first to describe physician attitudes and practice patterns in the management of AC. The survey highlights that even experienced providers feel underconfident when treating AC patients and supports the need for better evidence and data for systemic therapies. About 40% of the respondents noted offering chemotherapy to low grade neoplasms – a disease that is not thought to respond to systemic therapy, highlighting the need for education and clinical trials to guide evidence-based decision-making in this disease. In addition, multidisciplinary, multi-institutional efforts to unify treatment approaches and enhance patient outcomes are needed.

The Lived Experience of Patients with Vascular Malformations: A Qualitative Meta-synthesis

Objective: The purpose of this study was to synthesize the existing qualitative literature on the lived experience of patients with vascular malformations to identify emergent themes and new areas for clinical care and research. Methods: A formal meta-synthesis was conducted, which followed 4 steps: (1) form the clinical question and refine search criteria; (2) complete a literature review following Preferred Reporting Items for Reviews and Meta-Analysis; (3) quality appraisal of included literature with Lett’s Critical Review Form; and (4) completion of team-based reciprocal translation and thematic analysis to synthesize the literature. PubMed, CINAHL, Johanna Briggs, and Embase were used to retrieve English language, peer-reviewed qualitative, and mixed-method articles from 1996 to May 2023. Results: Six articles met the criteria for inclusion. A wide range of vascular malformations were represented, ranging from slow-flow malformation to high-flow or complex with associated overgrowth. Studies were conducted in the United States, France, and Germany, focusing mainly on the adult experience, with 1 article focusing solely on pediatrics. Three main themes emerged: social isolation, uncertainty and hope, and healthcare experiences. Conclusion: The overarching themes of social isolation, uncertainty and hope, and healthcare experiences each offer avenues to inform clinical practice, provide education for healthcare providers managing patients with vascular malformations, and future research to better understand how each of these themes affect patients. This qualitative meta-synthesis is a novel method for this field and provides new insights into the lived experience of those with vascular malformations.

Development and validation of a nomogram for predicting heterotopic ossification following spinal cord injury

ObjectiveHeterotopic ossification (HO) following spinal cord injury (SCI) can severely compromise patient mobility and quality of life. Precise identification of SCI patients at an elevated risk for HO is crucial for implementing early clinical interventions. While the literature presents diverse correlations between HO onset and purported risk factors, the development of a predictive model to quantify these risks is likely to bolster preventive approaches. This study is designed to develop and validate a nomogram-based predictive model that estimates the likelihood of HO in SCI patients, utilizing recognized risk factors to expedite clinical decision-making processes. MethodsWe recruited a total of 145 patients with SCI and presenting with HO who were hospitalized at the China Rehabilitation Research Center, Beijing Boai Hospital, from June 2016 to December 2022. Additionally, 337 patients with SCI without HO were included as controls. Comprehensive data were collected for all study participants, and subsequently, the dataset was randomly partitioned into training and validation groups. Using Least Absolute Shrinkage and Selection Operator regression, variables were meticulously screened during the pretreatment phase to formulate the predictive model. The efficacy of the model was then assessed using metrics including receiver-operating characteristic (ROC) analysis, calibration assessment, and decision curve analysis. ResultsThe final prediction model incorporated age, sex, complete spinal cord injury status, spasm occurrence, and presence of deep vein thrombosis (DVT). Notably, the model exhibited commendable performance in both the training and validation groups, as evidenced by areas under the ROC curve (AUCs) of 0.756 and 0.738, respectively. These values surpassed the AUCs obtained for single variables, namely age (0.636), sex (0.589), complete spinal cord injury (0.681), spasm occurrence (0.563), and DVT presence (0.590). Furthermore, the calibration curve illustrated a congruence between the predicted and actual outcomes, indicating the high accuracy of the model. The decision curve analysis indicated substantial net benefits associated with the application of the model, thereby underscoring its practical utility. ConclusionsHO following SCI correlates with several identifiable risk factors, including male gender, youthful age, complete SCI, spasm occurrence and DVT. Our predictive model effectively estimates the likelihood of HO development by leveraging these factors, assisting physicians in identifying patients at high risk. Subsequently, correct positioning to prevent spasm-related deformities and educating healthcare providers on safe lower limb mobilization techniques are crucial to minimize muscle injury risks from rapid iliopsoas muscle extension. Additionally, the importance of early DVT prevention through routine screening and anticoagulation is emphasized to further reduce the incidence of HO.

Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study

BackgroundMedical Assistance in Dying (MAiD) was legalized in Canada in 2016. Canada’s legislation is the first to permit Nurse Practitioners (NP) to serve as independent MAiD assessors and providers. Registered Nurses’ (RN) also have important roles in MAiD that include MAiD care coordination; client and family teaching and support, MAiD procedural quality; healthcare provider and public education; and bereavement care for family. Nurses have a right under the law to conscientious objection to participating in MAiD. Therefore, it is essential to prepare nurses in their entry-level education for the practice implications and moral complexities inherent in this practice. Knowing what nursing students think about MAiD is a critical first step. Therefore, the purpose of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context.MethodsThe design was a mixed-method, modified e-Delphi method that entailed item generation from the literature, item refinement through a 2 round survey of an expert faculty panel, and item validation through a cognitive focus group interview with nursing students. The settings were a University located in an urban area and a College located in a rural area in Western Canada.ResultsDuring phase 1, a 56-item survey was developed from existing literature that included demographic items and items designed to measure experience with death and dying (including MAiD), education and preparation, attitudes and beliefs, influences on those beliefs, and anticipated future involvement. During phase 2, an expert faculty panel reviewed, modified, and prioritized the items yielding 51 items. During phase 3, a sample of nursing students further evaluated and modified the language in the survey to aid readability and comprehension. The final survey consists of 45 items including 4 case studies.DiscussionSystematic evaluation of knowledge-to-date coupled with stakeholder perspectives supports robust survey design. This study yielded a survey to assess nursing students’ attitudes toward MAiD in a Canadian context.ConclusionThe survey is appropriate for use in education and research to measure knowledge and attitudes about MAiD among nurse trainees and can be a helpful step in preparing nursing students for entry-level practice.

Frailty training among healthcare professionals

As the population ages worldwide, frailty becomes more prevalent, leading to a higher risk of poor outcomes. Therefore, there is an increased need to educate healthcare providers in the areas of frailty screening, assessment, and treatment. In our review of the current state of frailty education worldwide we showed that, with the exception of a few European countries, education of clinicians on frailty screening, assessment, and treatment is inadequate.Interprofessional team competencies, quality measures and clinical guidelines that require screening, assessment and management of frailty are needed to propel frailty education forward. It is evident that there is much-needed collaboration between high-, mid-, and low-income countries to reach consensus and create worldwide recommendations for frailty education

Coccidioidomycosis-Related Hospital Visits, Texas, USA, 2016-2021.

We analyzed hospital discharge records of patients with coccidioidomycosis-related codes from the International Classification of Diseases, 10th revision, Clinical Modification, to estimate the prevalence of hospital visits associated with the disease in Texas, USA. Using Texas Health Care Information Collection data for 2016-2021, we investigated the demographic characteristics and geographic distribution of the affected population, assessed prevalence of hospital visits for coccidioidomycosis, and examined how prevalence varied by demographic and geographic factors. In Texas, 709 coccidioidomycosis-related inpatient and outpatient hospital visits occurred in 2021; prevalence was 3.17 cases per 100,000 total hospital visits in 2020. Geographic location, patient sex, and race/ethnicity were associated with increases in coccidioidomycosis-related hospital visits; male, non-Hispanic Black, and Hispanic patients had the highest prevalence of coccidioidomycosis compared with other groups. Increased surveillance and healthcare provider education and outreach are needed to ensure timely and accurate diagnosis and treatment of coccidioidomycosis in Texas and elsewhere.

The voices of breast cancer survivors with chronic pain: A qualitative thematic analysis of patients’ challenges to pain management

Objectives Recognizing the limitations of the current pain therapies, the study aimed to explore the unique needs and obstacles related to pain management in Breast Cancer Survivors (BCs) with Chronic Pain (CP). Methods 4 focus groups were conducted involving 17 BCs with CP (Mage = 51, SD = 7.99) with varying pain intensities. Thematic analysis was applied to transcribed discussions. Findings Three key themes emerged: (1) Challenges to pain management, including “Doctor-patients communications barriers” and “Contextual and societal barriers”; (2) Self-management needs, encompassing “Psycho-social support,” “Care-related needs,” and “Shared decision-making”; (3) Treatment preferences and perceptions of pain management, with subthemes like “Treatment preferences,” “Institution preference,” and “Decision role perception.” Conclusions This study emphasizes tailored support systems targeting patient hesitancy, countering pain normalization, and addressing healthcare providers’ attitudes. It underscores the importance of integrating caregiver and peer support. Findings advocate refining healthcare provider education, adopting a comprehensive multidisciplinary approach, and strategically incorporating eHealth tools into such care.

Leadership's Perceptions of Palliative Care During the COVID-19 Pandemic: A Qualitative Study

ContextPalliative care (PC) played a leading role in the COVID-19 pandemic. However, little is known regarding health system leadership's perceptions. BackgroundThis study aimed to explore the perceptions, understanding, and utilization of PC before compared to during the COVID-19 pandemic among health system leadership. MethodsSemi-structured, in-depth interviews were conducted with leaders in a large healthcare system based in Massachusetts, United States. ResultsA total of 22 in-depth interviews were completed at four facilities. Emerging themes included the role of PC before compared to during the COVID-19 pandemic, facilitators and barriers to PC delivery, and recommendations for future practice. Participants reported that the COVID-19 pandemic increased PC utilization, reinforced positive perceptions of the specialty, and emphasized its role in maximizing healthcare efficiency. Many participants found PC financing to be a barrier to delivery; some had an inaccurate understanding of how PC is reimbursed. When asked about their recommendations for improving future practice, participants noted improvements in coordination within the healthcare system and education of healthcare providers and future physicians in primary PC skills. ConclusionsOur findings suggest that healthcare leadership increasingly understands the value of PC and its critical role within the health system and during future public health emergencies; this was further reinforced during the COVID-19 pandemic. Healthcare leadership recognizes and highlights the need to increase investments in this specialty, both financially and educationally. In doing so, healthcare costs will be lowered, patient satisfaction will increase, and care will be better coordinated.

The Management of Inflatable Penile Prosthesis Erosion and Infection following Iatrogenic Aspiration

The Management of Inflatable Penile Prosthesis Erosion and Infection following Iatrogenic Aspiration

Resources, relationships, and resilience: The psychosocial experiences of women with lower limb absence during pregnancy and postpartum

BackgroundThere is limited research on the unique needs of women with lower limb absence (LLA) during pregnancy and postpartum. The lack of information can negatively impact women's physical and emotional experiences. ObjectiveThe purpose of this study is to explore the psychosocial experiences of individuals with LLA through the pregnancy and postpartum periods, and to provide information to women and health care providers (HCPs) on what they can expect. MethodsSemi-structured interviews were conducted with 19 women with LLA who had been pregnant in the previous 10 years. Interviews were analyzed using thematic analysis. ResultsParticipants experienced uncertainty due to a lack of information and limited resources related to pregnancy and LLA. While most women had strong support networks including family, other mothers with LLA and HCPs, some women faced stigma or judgement from HCPs and people in their social networks. Some women had periods where they struggled mentally due to a temporary loss of independence. Despite these challenges, they demonstrated tremendous resilience and noted that their ability to adapt helped them to navigate the difficulties they experienced in the perinatal period (PNP). ConclusionThere is an immediate need to fill the ‘information gap’ about pregnancy and LLA. We recommend the development of support networks, informational guidelines, and further education for HCPs to better support women with LLA through the PNP. Further research is warranted to gain a better understanding of the mental health experiences of women with LLA in the PNP.

Assessment of Trichomoniasis Prevalence and Healthcare Provider Knowledge among Pregnant Women: A Study at Luweero General Hospital, Uganda

Trichomoniasis, a prevalent sexually transmitted infection caused by Trichomonas vaginalis, significantly impacts maternal and fetal health, particularly during pregnancy. This study investigated trichomoniasis prevalence and healthcare provider knowledge among pregnant women attending antenatal services at Luweero General Hospital in Uganda. A cross-sectional study involving 385 pregnant women was conducted, with vaginal swabs examined for T. vaginalis presence. Additionally, healthcare providers' knowledge regarding trichomoniasis was assessed. Results indicated a low prevalence (1.8%) of trichomoniasis among the study population. Notably, midwives and nursing aides demonstrated the highest levels of knowledge. The age group most affected was 16-25 years old. These findings highlight the importance of continuous medical education for healthcare providers and targeted interventions to increase awareness among pregnant women, ultimately mitigating the burden of trichomoniasis in maternal health. Keywords: Trichomoniasis, Trichomonas vaginalis, pregnant women, antenatal services, prevalence, healthcare providers, knowledge, Uganda, sexually transmitted infections, maternal health

Integrating pharmacogenomic testing into personalized medicine practices in the USA: Implications for medication quality control and therapeutic efficacy

This concept paper explores the integration of pharmacogenomic testing into personalized medicine practices in the USA and its implications for medication quality control and therapeutic efficacy. By leveraging genetic information to optimize medication selection and dosing, this paper aims to improve patient outcomes and minimize adverse drug reactions, thereby enhancing medication safety and efficacy in clinical practice. Integrating pharmacogenomic testing into personalized medicine practices has the potential to revolutionize healthcare by improving medication quality control and therapeutic efficacy. This concept paper explores the implications of pharmacogenomic testing for personalized medicine practices in the USA. The paper begins by discussing the current landscape of personalized medicine and the role of pharmacogenomic testing in optimizing medication selection and dosing. It then examines the benefits of integrating pharmacogenomic testing into clinical practice, including improved medication safety, efficacy, and cost-effectiveness. Key considerations for implementing pharmacogenomic testing in personalized medicine practices are discussed, including regulatory considerations, reimbursement challenges, and ethical considerations. The paper also highlights the importance of healthcare provider education and patient engagement in the successful implementation of pharmacogenomic testing. Through a comprehensive analysis, this concept paper aims to provide insights into the implications of integrating pharmacogenomic testing into personalized medicine practices in the USA. By leveraging pharmacogenomic testing, healthcare providers can personalize medication selection and dosing, leading to improved medication quality control and therapeutic efficacy for patients.

Analysis of the Federal Section 317 Immunization Program and Routine Adult Immunization Activities, United States, 2022-2023.

The federal Section 317 Immunization Program, administered by the Centers for Disease Control and Prevention (CDC), provides funding to support adult immunization efforts; however, current information on program implementation at the jurisdictional level is limited. We assessed the use of Section 317 and other funding sources to support routine adult immunization activities among the 64 immunization programs ("awardees"). We conducted a survey and key informant interviews with awardees in October to December 2022 to collect quantitative and qualitative data on current adult vaccine purchase and program operation activities funded by Section 317 and other funding sources. We assessed total vaccine cost and data on vaccine purchase projections for each awardee with CDC's Cost and Affordability Tool for 2023. Immunization program managers or their designees from 62 of 64 awardees (97%) completed the survey; 12 awardees participated in key informant interviews. Of 62 awardees, 32 (52%) used a single funding source to support adult vaccine purchases, of which 29 (91%) used only Section 317 funds, 21 (34%) reported not planning to purchase ≥1 age-based recommended vaccine for adults in 2023, and 33 (53%) reported using Section 317 funds only to support adult immunization program operations. Key informant interviews showed varied operational activities among awardees, but 8 awardees stated the need for additional staff to expand adult immunization program services in health care provider education (n = 5), program administration (n = 5), and site visits (n = 6). Additional efforts are needed to understand how to better support routine adult immunization activities implemented at the jurisdictional level.

Association Between Harsh Disciplinary Methods and Child Functioning in Children Aged 7-14 Years in Punjab, Pakistan.

Despite having adverse physical and mental health outcomes, harsh disciplinary methods are commonly practiced all over the world. This study aims to measure the harsh disciplinary actions taken by parents and their association with child functioning in children, aged 7 to 14 years in Punjab, Pakistan. This study is based on secondary data obtained from the United Nations Children's Fund (UNICEF's) Multiple Indicator Cluster Survey, conducted in the Punjab province from 2017 to 2018. Parents/caregivers of 19,721 children were included in the analysis. Questionnaire-based interviews were conducted, and the data collection form included sociodemographic information, questions on different "Methods of Child Discipline" and the "Child functioning module." The data was analyzed using STATA 15.0. Multiple logistic regression analysis was conducted to calculate the adjusted odds ratio and 95% CI exploring the association between harsh disciplinary methods and child functioning. More than 50% of children were exposed to severe physical, psychological, and emotional disciplinary methods. Exposure to severe physical aggression was associated with increased difficulty in learning (2.60 [1.27, 5.31]), remembering (2.83 [1.47, 5.44]), controlling behavior (1.63 [1.21, 2.18]), anxiety (1.98 [1.25, 3.13]), depression (2.57 [1.57, 4.22]) and making friends (1.94 [1.01, 3.79]). Whereas moderate physical aggression and psychological aggression were associated with (1.48 [1.19, 1.84]) and 1.5 times (1.20, 1.84) increase in difficulty in controlling behavior, respectively. Nonviolent actions were associated with protective odds for self-care (0.33 [0.17, 0.65]), communication (0.51 [0.27, 0.96]), learning (0.56 [0.33, 0.95]), remembering (0.62 [0.39, 0.90]), concentration (0.50 [0.31, 0.80]), anxiety (0.60 [0.46, 0.79]) and depression (0.67 [0.49, 0.92]). Severe disciplinary methods are detrimental to the child's personal care, mental, social, emotional, and psychological well-being, whereas nonviolent actions are associated with positive child functioning. In a third-world country such as Pakistan, this topic is widely undiscovered and understudied, thus emphasizing the need for awareness and education of parents and healthcare providers.

The Roots and Clinical Effects of Racial Bias in Medicine

In a growing society, healthcare has become an essential part of a country’s development, standard of living, and life expectancy. The past decade has seen unprecedented growth in both scientific and medical discoveries, leading to improved treatment plans and innovative treatments, yet there are some aspects of healthcare that remain stunted. Discrimination, particularly on the basis of race, is still prevalent and ingrained in the American healthcare system, leading to worsened patient outcomes for people of color and a discomfort with seeking medical care that disproportionately affects those in marginalized groups. This bias continues even into the education of healthcare providers, which perpetuates the cycle of prejudice in the medical field. While the intersection of racism in the medical field varies greatly and maintains its prevalence amongst different races, this dissertation focuses mainly on discrimination of Black patients in the American healthcare system. For further information on the effects of racial bias both abroad and amongst a wider variety of races, valuable resources can be found below the works cited in this review. The sources analyzed in this review are analytical and scientific, with little to no use of primary anecdotal evidence. While such an emotional topic as racism and how it affects patient care relies heavily on personal experience, these sources have confounded the feelings of many patients nationally and adapted them into a well-reviewed analysis of how those feelings reflect nationwide opinions. Furthermore, it includes historical papers detailing the foundations of the medical field and how it was developed in hand with racism. The following sections will include definitions of terminology surrounding the issue, information on the history that led to modern-day biases, the ways in which these biases are seen by patients, and how it affects their care. This will demonstrate the link between past practices and the discriminatory actions in the medical system currently. Furthermore, it will establish evidence that there are effects felt by patients of color as well as offer information on possible solutions to help better their treatment.

A case of co-infection with head lice and varicella in a child: considerations for rational management

A case of co-infection with head lice and varicella in a child: considerations for rational management

Factors influencing the Delivery of Preconception Care Services among Nursing and Midwifery Students at Aga Khan University, Kenya

Preconception care (PCC) is crucial in addressing biomedical conditions, social factors, and risky behaviors that may jeopardize a healthy pregnancy. Despite its significance, nurses, and midwives face challenges in comprehending the importance and components of PCC, hindering their ability to provide comprehensive care. Inconsistencies in training curricula and a lack of in-service training leave students ill-equipped for PCC provision. This study, conducted through a cross-sectional quantitative descriptive approach at Aga Khan University, involved 104 nursing and midwifery students selected through random sampling. The overall knowledge of PCC was 63.35%, 28.8% correctly defined PCC and its components, and while 67.3% of respondents had received PCC training during their previous education 75% had not undergone in-service or refresher training. Moreover, 45% had not provided PCC in the past six months, and only 45.2% of facilities had PCC guidelines, indicating potential standardization gaps. While the study focused on nursing and midwifery students, acknowledging a limitation in representing all healthcare professionals involved in PCC, it emphasized the need to integrate PCC education into curricula. Recognizing PCC as a vital health component underscores its significance, shedding light on gaps in continuing education for healthcare providers. Collaboration among health professionals in delivering PCC services is suggested to enhance care quality. Furthermore, the study advocates for guidelines to standardize PCC services, promoting consistent and high-quality care. Overall, the insights garnered can inform strategies to improve the reproductive and maternal health of women and couples through enhanced PCC services. The health belief model was the theory underpinning the study.

Perceptions of stigma among people with lived experience of methamphetamine use within the hospital setting: qualitative point-in-time interviews and thematic analyses of experiences.

As part of a larger mixed-methods study into harm reduction in the hospital setting and people with lived experience of methamphetamine use, stigma was found to be a prominent issue. The aim of this secondary analysis was to investigate the issue of stigma. Participants completed a one-time qualitative interview component to assess their experiences in the hospital setting. The study setting included secondary and tertiary care in Southwestern Ontario, Canada. Participants who had received care from these settings were also recruited from an overdose prevention site, a primary healthcare center, a national mental health organization, an affordable housing agency, and six homeless-serving agencies between October 2020 and April 2021. A total of 104 individuals completed the qualitative component of a mixed-methods interview. Sixty-seven participants identified as male, thirty-six identified as female, and one identified as non-binary. Inclusion criteria included past or current use of methamphetamine, having received services from a hospital, and being able to communicate in English. Open-ended questions regarding experiences in the hospital setting were asked in relation to the lived experience of methamphetamine. A secondary analysis was conducted post-hoc using a thematic ethnographic approach due to prominent perceptions of stigma. Three themes were identified. The first theme identified that substance use was perceived as a moral and personal choice; the second theme pertained to social stigmas such as income, housing and substance use, and consequences such as being shunned or feeling less worthy than the general patient population; and the third theme highlighted health consequences such as inadequate treatment or pain management. This study revealed that stigma can have consequences that extend beyond the therapeutic relationship and into the healthcare of the individual. Additional training and education for healthcare providers represents a key intervention to ensure care is non-stigmatizing and patient-centered, as well as changing hospital culture.