Healthcare-related Experiences Research Articles

Efficient parameter tuning of neural foundation models for drug perspective prediction from unstructured socio-medical data

The phenomenal popularity of social media platforms over the past decade has accelerated the development of intelligent applications that leverage social media data for informed decision-making in diverse domains like finance, education, public policy and healthcare management practices. While understanding the colloquial language of users on social media remains a challenging problem, access to users’ medical perspectives that conversationally divulge healthcare-related experiences and insights can help reshape healthcare ecosystems like chronic disease management, pandemics, public health, pharmacovigilance and more. Most existing models are constrained to a particular dataset while neglecting model adaptability across data sources and domains. Model generalization across variable data sizes also has received very little research attention. Conventional foundation models can be fine-tuned by adding additional model heads or by appending contributing network layers, however, there has been very little focus on effective parameter calibration for adapting neural foundation models to a specific task. In this study, an Adaptive Learning mechanism for Socio-Medical data (AL4SM) built on generic foundation neural models with efficient parameter learning is proposed, to categorize users’ perspectives on prescription drug-related experiences and adapt to diverse socio-medical data sources of variable sizes. AL4SM aims to lighten the over-parameterized mechanisms adopted by existing foundational techniques by efficiently learning latent medical information based on optimized parameter calibration and weight reinitialization techniques. Comprehensive cross-domain and cross-data analyses are undertaken to explore specific user perspectives related to prescription effectiveness and side effects. Validation experiments conducted on standard datasets obtained from Drugs.com and Druglib.com revealed that the proposed AL4SM outperformed state-of-the-art models, achieving an improvement of 6.06% in accuracy and 7.62% in F1-score for 3-class and 2% in F1-score for 10-class drug perspective categorization. The cross-data experiments further emphasized the superiority of the proposed model, with improved accuracy of 17% on Drugs.com and 9% on Druglib.com datasets, respectively.

Comparing survey data to qualitative themes in patient stories to help researchers better identify pressing community healthcare needs.

Narrative medicine is a powerful approach for strengthening clinicians' therapeutic alliances with patients and helping them understand others' perspectives by giving patients a voice. MyPaTH Story Booth is a cross-sectional observational study that uses narrative medicine concepts to allow community participants to share their health and healthcare-related experiences through relatively unstructured interviews (i.e., stories). The archive forms a qualitative research 'commons' where researchers can learn about patient and caregiver perspectives and tailor research goals to better address community needs. Brief surveys allow storytellers to classify their stories so that the archive is searchable. This study assessed sensitivity, specificity, positive predictiveand negative predictive values of self-reported surveys for categorizing 83 stories, compared with a 'gold standard'(most commonly accepted method for interpreting narratives) of qualitative coding. Stories were classified as either having or not having each of 38 different classifications based on US National Library of Medicine (NLM) Health Topics (Type of disorder or condition and Part of the body discussed) or developed with stakeholder input (Type of health/healthcare experience). Survey data assessing 'Part of the body discussed'and 'Type of disorder or condition'typically was highly sensitive (64%-95%) and specific (73%-99%) suggesting high adequacy of surveys in identifying stories. Questions focused on 'Type of health/healthcare experience'showed inconsistent and relatively lower sensitivities (48%-93%) and specificities (30%-79%) suggesting lower adequacy of surveys in identifying stories. Survey items based on NLM Health Topics allowed people to categorize their health narratives into relevant, searchable topics making the database more accessible.

Lived experience of young people with epilepsy in Bahir Dar city government hospitals, Ethiopia, a qualitative interview study.

Epilepsy is the most common neurological disorder, which is characterized by persistent derangement of the nervous system due to an abrupt excessive discharge of the group of neurons from the cerebrum. For developing young people with epilepsy coping with the challenges of living with epilepsy and adjusting normative tasks associated with adolescence is stressful in all domains of the lives of young people with epilepsy. But in Ethiopia, published literature regarding the lived experience of young people with epilepsy is lacking. This study aims to explore lived experience of young people with epilepsy. A qualitative interview study was conducted in Bahir Dar city government specialized and referral Hospitals, from February to April, 2021. Using the rule of saturation, a total of 11 study participants (age 12-24) were selected using hetrogenious types of purposive sampling technique. The data were collected through semi structured interviews technique with the aid of audio recorder. Semi-structured interview guide and observation checklist for care context in health facilities were used. The collected data was transcribed word by word and translated conceptually. The Data were analyzed using thematic approach. The credibility, dependability, Conformability and transferability of the study were assured using different techniques such as peer debriefing, member checking; audit Trail, thick description and purposeful sampling. Atlas- ti version7 software was used to facilitate data analysis. The participants' narratives revealed two main themes: 'experiences due epilepsy' and 'coping strategies to wards epilepsy'. Experience due to epilepsy' was described by young people with epilepsy in terms of psychosocial, physical, economical and health care related experiences. They described coping strategies towards epilepsy in terms of finding support from family and society as well as religious institutions and other traditions as copping strategy. Even though young people with epilepsy had suffered a lot of hurtful experiences, they reported coping strategies towards epilepsy that include support from various sources. These types of findings have implications for social work interventions for young people living with epilepsy.

A twin data-driven approach for user-experience based design innovation

Data-driven innovation has received increasing attention, which explores big data technologies to gain more insights and advantages for product design. In user experience (UX) based design innovation, user-generated data and archived design documents are two valuable resources for various design activities such as identifying opportunities and generating design ideas. However, these two resources are usually isolated in different systems. Additionally, design information typically represented based on functional aspects is limited for UX-oriented design. To facilitate experience-oriented design activities, we propose a twin data-driven approach to integrate UX data and archived design documents. In particular, we aim to extract UX concepts from product reviews and design concepts from patents respectively and to discover associations between the extracted concepts. First, a UX-integrated design information representation model is proposed to associate capabilities with key elements of UX at the concept, category, and aspect levels of information. Based on this model, a twin data-driven approach is developed to bridge experience information and design information. It contains three steps: experience aspect identification using an attention-based LSTM (Long short-term memory) network, design information categorization based on topic clustering using BERT (Bidirectional Encoder Representations from Transformers) and LAD (Latent Dirichlet allocation) model, and experience needs and design information integration by leveraging word embedding techniques to measure concept similarity. A case study using healthcare-related experience and design information has demonstrated the feasibility and effectiveness of this approach.

Transgender-Competent Health Care: Lessons from the Community.

Transgender (trans) individuals experience high discrimination levels when accessing medical and mental health care, resulting in poorer health outcomes compared with the general population and other minority populations. A community-based research design was used to elicit direct input from the trans community about critical trans-knowledgeable care components to address these disparities. The data collection included several focus groups with individuals recruited from the trans community. The information from this research guided the opening of the Gender Center, a centralized, multidisciplinary center of care for trans individuals within an urban safety-net hospital in Atlanta, Georgia. The research team conducted five focus groups with 27 self-identified trans individuals between December 2016 and April 2017. Focus groups solicited the negative and positive experiences of trans individuals in the healthcare system and sought input about how best to serve this population. Analysis was done January through April 2020. Focus group participants identified financial difficulties, lack of insurance coverage, being underinsured, discrimination within the healthcare system and from providers, and a shortage of trans-competent providers as the most significant barriers to care. Participants emphasized the need to pay attention to creating a welcoming clinic environment, including trans-positive signage, and integrating trans staff members into the care team. This study demonstrates the importance of community-based research in addressing health disparities for trans people. It also offers insight into the unmet healthcare needs of the trans community, describes typical healthcare-related experiences of trans individuals, and identifies critical elements for providing high-quality trans-appropriate health care.

They've been BITTEN: reports of institutional and provider betrayal and links with Ehlers-Danlos Syndrome patients' current symptoms, unmet needs and healthcare expectations.

Patients with rare and/or care-intensive conditions, such as Ehlers-Danlos Syndrome (EDS), can pose challenges to their healthcare providers (HCPs). The current study used the BITTEN framework1 to code EDS patients' open-ended written responses to a needs survey to determine their self-reported prevalence of healthcare institutional betrayal and its link with their expressed symptoms, provider perceptions, unmet needs, and on-going healthcare-related expectations. Patients with EDS (n = 234) were recruited via a rare disease electronic mailing list and snowball sampling. A total of one-hundred and six respondents (45.3%) endorsed having unmet healthcare-related needs; of these, 104 (99%) completed an open-ended prompt about these needs. Responses were coded for components of BITTEN, a framework designed to link patients' past, current, and future healthcare-related experiences in a trauma informed manner. Many respondents with ongoing needs endorsed experiencing past institutional and provider betrayal (43%; n = 45), current mental health symptoms (91.4%; n = 95), negative expectations for future healthcare (40.4%; n = 62), and a lack of trust in their healthcare provider (22.1%; n = 23). There were no significant differences in post-traumatic stress disorder (PTSD)/anxiety, depression/sadness, or isolative symptoms between respondents coded for institutional betrayal (n = 45) compared with those not (n = 59). However, EDS respondents reporting institutional betrayal were significantly more likely to self-report anger and irritability symptoms, a lack of trust in their HCPs, and more negative expectations for future healthcare than those not reporting institutional betrayal. The frequent spontaneous reporting of past healthcare betrayals among patients with EDS implies the need for trauma-informed care and provider education. Given that experiences of institutional betrayal are associated with increased anger and irritability, as well as with negative expectations for future healthcare interactions, efforts to repair healthcare provider and system-wide relationship ruptures might have positive healthcare consequences. Reports of Institutional and Provider Betrayal and Links with Ehlers-Danlos Syndrome Patients' Current Symptoms, Unmet Needs and Future Healthcare Expectations What is EDS? Ehlers-Danlos Syndrome (EDS) refers to a group of rare genetic connective tissue disorders that are primarily characterized by skin hyperelasticity, joint hypermobility, and tissue fragility. Connective tissue is largely responsible for the structural integrity of our bodies, and there are several EDS subtypes which each describe a specific connective tissue problem. In addition, there is significant overlap between EDS types and other kinds of connective tissue disorders. As a result, recognizing, diagnosing, and treating EDS is often challenging. What is Institutional betrayal? Institutional Betrayal here refers to a harmful action (i.e. commission) or lack of action (i.e. omission) on the part of a healthcare institution, individual provider/healthcare team, or insurance company. When a patient trusts that the healthcare system will act in their best interest, and trust is violated, institutional betrayal occurs. What is BITTEN? BITTEN is an acronym for Betrayal, Indicator, Trauma symptoms, Trust, Expectations, and Needs. It is a framework meant to capture previous problematic healthcare-related experiences in EDS patients, then to consider how those experiences influence a patient's current symptoms, provider trust, future expectations in healthcare encounters, and on-going needs. Why was this done? EDS, like many rare diseases, is hard to recognize and manage. We aim to:Give voice to EDS patients and their common unmet needs and healthcare-related expectations.Highlight how healthcare providers can apply BITTEN to improve care practices in rare disease patient encounters. What did we do? Using a newly articulated applied model of healthcare, BITTEN, we analyzed the open-ended responses of EDS patients describing their unmet emotional and mental health needs. What did we find? Nearly half of EDS patients who indicated they had unmet needs reported experiencing institutional betrayal.EDS patients who reported institutional betrayal also expressed anger, a lack of trust in healthcare providers, negative expectations for future healthcare, and more unmet needs more frequently than EDS patients who did not report institutional betrayal. What does this mean? The EDS patients in this sample were not directly asked if they had experienced institutional betrayal, so the exact prevalence is not known. Furthermore, responses were obtained voluntarily via the internet, so caution should be taken when generalizing these findings.However, results indicate that too many patients with EDS have experienced healthcare betrayals; these experiences are associated with current anger and negative expectations for future healthcare interactions.The prevalence of past negative healthcare experiences, along with current unmet needs and future negative healthcare expectations in EDS patients who have experienced institutional betrayal, highlights the need for healthcare providers to tend to these experiences, mend patient-provider barriers, and provide higher quality healthcare.

Social, cultural and experiential patterning of attitudes and behaviour towards assisted suicide in Switzerland: evidence from a national population-based study.

Switzerland has the longest history of the legal practice of non-physician assisted suicide of any country. Assisted suicide is not very tightly regulated in Switzerland, and almost all assisted suicides are supported by a right-to-die organisation. Our study investigates older adults’ attitudes and behaviour towards assisted suicide, and the associations of these with the individuals’ sociodemographic and cultural characteristics, as well as with their own health status and healthcare-related experiences in Switzerland. We performed weighted prevalence and multivariable logistic regression estimation on a nationally representative sample of adults aged 55 and over from wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland (n = 2168). Overall, 81.7% of respondents supported the legality of assisted suicide, as is currently the case in Switzerland, and 60.9% stated that they would potentially consider asking for assisted suicide under certain circumstances; 28.2% of respondents reported either that they are already or that they are likely to become a member of a right-to-die organisation, with 4.9% of respondents reporting to already be a member of such an organisation at the time of the survey. Higher levels of education and previous experience as a healthcare proxy were positively associated with more favourable attitudes and behaviour towards assisted suicide. Compared to individuals aged 55–64, adults aged 65–74 generally showed more favourable attitudes and behaviour towards assisted suicide. By contrast, religious persons displayed more negative attitudes and behaviour towards assisted suicide. Attitudes towards assisted suicide were also more negative in the oldest age group (75+) in comparison to adults aged 55–64, and among persons living in French- and Italian-speaking Switzerland compared to those living in German-speaking Switzerland. While approval for assisted suicide is high overall in Switzerland, more vulnerable population groups, such as older or less educated individuals, have less favourable attitudes towards assisted suicide. In addition, cultural sensitivities to and personal experiences with death and dying are likely to shape the approval or rejection of assisted suicide as it is currently implemented in Switzerland.

Behavioural and psychosocial factors associated with 5-year weight trajectories within the PORTAL Overweight/Obesity Cohort.

SummaryObjectiveThe purpose of this study was to model weight trajectories over a 5‐year time period (2012–2016) and their association with behavioural and psychosocial characteristics and health care–related experiences using data from the Patient Outcomes Research to Advance Learning (PORTAL) overweight/obesity cohort.MethodsWeight trajectories for each eligible patient in the PORTAL overweight/obesity cohort (n = 2864) were identified first using growth modelling; trajectories were then grouped using a hierarchical cluster analysis. Weight trajectory clusters that emerged were compared on demographics, and predictors of cluster membership were examined. Clusters were also compared on responses to a survey assessing health behaviours, quality of life, and health care experience completed in 2015 by 49% of the total sample (n = 1391).ResultsSeven distinct weight trajectory clusters were identified: (a) significant weight loss then maintenance; (b) higher stable weight; (c) moderate stable weight; (d) steady weight loss then relapse; (e) weight gain then weight loss; (f) steady weight gain then maintenance; and (g) lower stable weight. Age, sex, race/ethnicity, and body mass index at baseline predicted patient's weight trajectory (P < .001). Over two thirds of patients maintained their weight over the 5‐year period. Significant weight loss then maintenance, weight gain then weight loss, and higher stable weight patients were more likely to report receiving weight counselling from their provider. Patients in the significant weight loss then maintenance and lower stable weight clusters were more likely to be physically active than the other clusters.ConclusionFindings suggest variability in patterns of weight change among adults with overweight or obesity who have access to health care and that these patterns differ on demographic, behavioural and psychosocial factors, and health care experience.

Health Care Experiences of Youth Living With HIV Who Were Lost to Follow-up in Western Kenya.

HIV is the leading cause of mortality for youth in sub-Saharan Africa. Youth are more likely than any other age group to be lost to follow-up (LTFU) from care. We investigated the health care-related experiences of youth living with HIV (YLWH) who were LTFU (i.e., had not returned to care for at least 4 months), as well as the perceptions of the community health workers who supported them. Data were collected from two focus group discussions with community health workers (n = 18) who worked with YLWH and 27 semistructured interviews with YLWH (ages 15-21 years) who were LTFU. Attitudes toward health care were presented in the context of a social-ecological model. Respondents highlighted the need for improved youth-oriented services, including youth-friendly clinics and training for care providers about specific needs of YLWH. Researchers should develop and test the impact of these interventions to improve retention of YLWH in care.

Caring for Children Living with HIV/AIDS: Family Caregivers Experiences at the Princess Marie Louise Hospital, Ghana

<p class=MsoBodyTextCxSpFirst style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> Abstract <p class=MsoBodyTextCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> Introduction <p class=MsoBodyTextCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> Family caregivers remain the pillar of support for children living with HIV/AIDS. Appreciating their roles and experiences is a significant aspect of family-centered care and has implications for improved care outcomes. This study therefore aimed at exploring the care related experiences of Ghanaian family caregivers of children living with HIV. <p class=MsoNormalCxSpFirst style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> Methods <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> A descriptive qualitative study was conducted among family caregivers of children living with HIV accessing healthcare at the Princess Marie Louise Hospital, Accra. A total of 15 one-on-one interviews had been conducted by the time saturation of data was reached. Thematic content analysis was employed to unravel the data. <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> Results <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> Almost all (n=14,93.3%) of the caregivers were women, less than two thirds (n=10, 66.6%) of the caregivers were below forty years and (n=7, 46.7%) being the non-biological parent(s). Emergent themes were: social experiences (financial constraints, good family support, social isolation/secrecy); spiritual experience (Inner strength derived from increased faith in God); psychological experiences (inner satisfaction in performing caregiver roles; and anxiety over their children’s future); physical experiences (care being demanding); altered quality of life (mainly adverse changes); and health care related experiences (supportive staff a key motivator fostering caregiver role). <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> Conclusion <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> The study found both positive and negative family caregiver experiences with regards to the care of their HIV-infected children. Healthcare providers must capitalize on the positive experiences to provide strength-based care, which involves incorporating the clients’ own strengths and capabilities as well as wider support network in the planning and delivering of services for children and adolescents living with HIV. Available social support from government and non-governmental organizations should also be sustained. <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> Keywords: <span lang=EN-GB style=font-size:10.0pt;color:black;mso-themecolor: text1>Children Living with HIV/AIDS; Family Caregivers; Experiences <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> Abbreviations: <span lang=EN-GB style=font-size:10.0pt; color:black;mso-themecolor:text1>AIDS: Acquired Immune Deficiency Syndrome <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> ARVs: Antiretroviral drugs <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> ART: Antiretroviral Therapy <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> ChilHIV: Children living with HIV/AIDS <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> GAC: Ghana AIDS Commission <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> HAART: Highly Active Antiretroviral Therapy <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> HCPs: Health Care Providers <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> HIV: Human Immunodeficiency Virus <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> NACP: National AIDS/STI Control Programme <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> PLHIV: Persons living with HIV <p class=MsoNormalCxSpMiddle style=text-align:justify;text-justify:inter-ideograph; mso-mirror-indents:yes> UNICEF: The United Nations Children Fund WHO: World Health Organization

A qualitative study of healthcare-related experiences of non-smoking women with lung cancer.

Lung cancer in non-smoking women is a distinct entity, but few studies have examined these patients' healthcare-related experiences. Women with lung cancer and with no smoking history underwent a face-to-face semi-structured, audio-recorded interview that was analyzed with a qualitative inductive approach. Twenty-three patients were interviewed, and three themes emerged. The first theme centered on a delay in cancer diagnosis. One patient described, "The whole initial diagnostic process just fills me with rage… I didn't actually get my Tarceva® until the last week in April." Second, the diagnosis of lung cancer seemed especially challenging in view of patients' non-smoking history and otherwise good health; these factors seem to have contributed to the diagnostic delay. One patient explained, "Well, I was just so adamant that I didn't like smoking… maybe if I had been a smoker, they [the healthcare providers] would've been more resourceful." Finally, the stigma of a smoking-induced malignancy was clearly articulated, "Yeah. Because it's a stigma, and I had read that, too -- people go, 'Well, it's your own damn fault because you were a smoker.'" CONCLUSIONS: Non-smoking women with lung cancer appear to endure a long trajectory from symptoms to cancer diagnosis to the initiation of cancer therapy. An awareness and acknowledgement of this long trajectory might help healthcare providers render more compassionate cancer care to these patients.

Applicants' Interest in International Ophthalmology during Residency Training: Influence in Selecting U.S. Residency Programs

Background In recent years, the Accreditation Council for Graduate Medical Education (ACGME) Residency Committee for Ophthalmology formally recognized international health electives for credit. By engaging in international health experiences, ophthalmology residents achieve the anchors essential to the core competencies set forth by the ACGME. Objective To explore how the availability of international ophthalmology opportunities may influence applicants' selection of U.S. ophthalmology residency programs and to identify applicants' perceived goals and barriers of participation in international ophthalmology experiences. Methods For this cross-sectional study, an electronic invitation to a 22-item questionnaire was sent to all 413 applicants to the ophthalmology residency program at the Penn State Eye Center during the 2017 Match. Results Responses were received from 261 applicants, yielding a response rate of 63.2%. Nearly all respondents (95.4%) reported interest in participating in an international ophthalmology experience during residency training, with 52.1% of respondents reporting being “extremely interested.” More than half of respondents (53.6%) had previously participated in a healthcare-related experience in an international setting. The availability of international opportunities increased the interest of 67.4% of respondents when choosing which residency programs to apply to, and influenced 65.2% of respondents to rank a residency program higher, with the respondents with previous international experience more likely to be favorably influenced (p &lt; 0.001, p = 0.04, respectively). The goal identified by the largest number of respondents as “most important” was to “offer service to the underserved” (59.0%). The most commonly identified anticipated barriers to participating in an international experience during residency training included concern about scheduling conflicts and call coverage (81.7%), followed by lack of funding (71.4%). Conclusion There is significant interest in international ophthalmology among ophthalmology residency applicants, and the availability of international opportunities during training may influence the applicants' selection of programs. Statistically significant differences were found among respondents with and without previous international healthcare-related experience. These findings warrant further investigation into how residency programs can best address this interest and integrate international ophthalmology experiences into the residency curriculum.

International Elective Opportunities in United States Anesthesia Residency Programs

Global health is a recognized component of medical education and is increasingly included in residency programs. International electives have the potential to improve global health training by providing exposure to different populations and the challenges of health disparities. The objective of this study was to describe international elective opportunities in US anesthesiology residency training programs, including an assessment the types of programs offered and the obstacles to providing this type of training. An electronic survey was sent to 122 anesthesiology programs. The survey defined an international experience as "a time in which a current US anesthesiology resident traveled outside of the US to pursue a healthcare-related experience." Details describing international opportunities were collected. Responses were stratified by geographic region, program size, and by the availability of international electives. The websites of all surveyed programs were then reviewed to determine specific mention of international or global health programs. These results were compared to the survey responses. In the website review, 33.6% of programs' websites described international electives for residents. Among all surveyed programs, 56 (45.9%) completed surveys were returned, with 39 (69.6%) of these programs offering international electives. Not all programs with electives described the offering on their websites. There was no relationship between program size or location and the availability of an elective. At most programs with international electives, at least 4 residents participated annually. Funding was the primary barrier to providing international electives. Perceptions of international electives were generally positive. A large proportion of US anesthesia residency programs offer international electives, and perceptions of global health in anesthesiology are positive. This is consistent with developments in global health in other subspecialty fields.

Using patient experiences on Dutch social media to supervise health care services: exploratory study.

BackgroundSocial media has become mainstream and a growing number of people use it to share health care-related experiences, for example on health care rating sites. These users’ experiences and ratings on social media seem to be associated with quality of care. Therefore, information shared by citizens on social media could be of additional value for supervising the quality and safety of health care services by regulatory bodies, thereby stimulating participation by consumers.ObjectiveThe objective of the study was to identify the added value of social media for two types of supervision by the Dutch Healthcare Inspectorate (DHI), which is the regulatory body charged with supervising the quality and safety of health care services in the Netherlands. These were (1) supervision in response to incidents reported by individuals, and (2) risk-based supervision.MethodsWe performed an exploratory study in cooperation with the DHI and searched different social media sources such as Twitter, Facebook, and healthcare rating sites to find additional information for these incidents and topics, from five different sectors. Supervision experts determined the added value for each individual result found, making use of pre-developed scales.ResultsSearches in social media resulted in relevant information for six of 40 incidents studied and provided relevant additional information in 72 of 116 cases in risk-based supervision of long-term elderly care.ConclusionsThe results showed that social media could be used to include the patient’s perspective in supervision. However, it appeared that the rating site ZorgkaartNederland was the only source that provided information that was of additional value for the DHI, while other sources such as forums and social networks like Twitter and Facebook did not result in additional information. This information could be of importance for health care inspectorates, particularly for its enforcement by risk-based supervision in care of the elderly. Further research is needed to determine the added value for other health care sectors.

The practice and clinical implications of tablet splitting in international health

ObjectiveTablet splitting is frequently performed to facilitate correct dosing, but the practice and implications in low-income settings have rarely been discussed.MethodsWe selected eight drugs, with narrow therapeutic indices or critical dosages, frequently divided in the Lao PDR (Laos). These were split, by common techniques used in Laos, by four nurses and four laypersons. The mean percentage deviation from the theoretical expected weight and weight loss of divided tablets/capsules were recorded.ResultsFive of eight study drugs failed, on splitting, to meet European Pharmacopoeia recommendations for tablet weight deviation from the expected weight of tablet/capsule halves with 10% deviating by more than 25%. There was a significant difference in splitting accuracy between nurses and laypersons (P = 0.027). Coated and unscored tablets were less accurately split than uncoated (P = 0.03 and 0.0019 for each half) and scored (0.0001 for both halves) tablets.ConclusionThese findings have potential clinical implications on treatment outcome and the development of antimicrobial resistance. Investment by drug companies in a wider range of dosage units, particularly for narrow therapeutic index and critical dosage medicines, is strongly recommended.

Meeting health and psychological needs of women in drug treatment court

We explored healthcare-related experiences of women drug court participants through combining context from the socio-ecological model with motivation needs for health behavior as indicated by self-determination theory. Five focus groups with 8 women drug court participants, 8 court staff, and 9 community service providers were examined using qualitative framework analysis. Themes emerged across the socio-ecological model and were cross-mapped with self-determination theory-defined motivation needs for autonomy, relatedness, and competence. Socio-ecological levels contained experiences either supporting or eroding women's motivation needs: 1) intrapersonal challenges participants termed an “evil cycle” of relapse, recidivism, trauma, and life challenges; 2) interpersonal context of parenting and stigma involving features of this “evil cycle”; 3) institutions with logistical barriers to legal and medical assistance; 4) community resources inadequate to support living and employment needs. Self-determination theory helps explain motivation required to address the women's healthcare needs and multiple demands at all levels of the socio-ecological model.

Meta‐synthesis and evidence‐based health care – a method for systematic review

Even the systematic reviews of qualitative studies are discussed health literature, the significance of their results is not fully recognised in evidence-based practice. The aim of this article is to describe the systematic reviews of qualitative studies, metasynthesis and its process and consider the meaning of meta-synthesis in evidence-based practice. Meta-synthesis is a method for synthesising knowledge, for example, relating to service users' healthcare-related experiences and the factors that facilitate their involvement in their own care and commitment to a healthy lifestyle. This type of knowledge is needed in evidence-based practice. Meta-synthesis is a concept that includes several methodologies in synthesising qualitative research findings. This article focuses on meta-synthesis with meta-aggregation as a method for combining data from original studies. Following the principles of scientific rigour, systematic reviews synthesise the best available and critically appraised knowledge. The article describes the process and the role of systematic review of qualitative studies and discusses its significance for evidence-based practice when making clinical and administrative decisions, as well as more widely in social and political decision-making.

Educational Preparation of Nurse Practitioners and Physician Assistants

This article provides an overview of the differences and similarities in educational preparation of nurse practitioners (NPs) and physician assistants (PAs) along with requirements for entry into each program, graduation, and certification. Using an exploratory descriptive design, a convenience sample of 50 NP and 50 PA programs was accessed over the Internet. The major finding in this study is that high-quality educational requirements exist for both NPs and PAs. NPs and PAs are educated under very different models of practice. PA programs tend to follow a medical model tradition of education with a generalist preparation, while NP programs build on a baccalaureate nursing educational framework and require students to choose a specialty NP program (i.e., family, adult, women's health, pediatric, acute care, etc.). NP education is completed primarily on a part-time basis while PA education required a full-time commitment. Entry into practice requirements is also different; while all NPs are required to have a minimum of a master's degree in nursing, PAs can currently practice with a certificate, associate, baccalaureate, or master's degree. NP and PA programs also have different requirements for admission. NP candidates must have the equivalent of a bachelor's degree in nursing, and many programs prefer a minimum of 2,000–4,000 hr of professional nursing experience. Requirements for all PA programs consist of 2 years of college coursework in the basic premedical sciences; along with appropriate healthcare experience (most schools prefer some healthcare-related experience; American Academy of Physician Assistants, 2006). A PA student entering a master's level program must also have a baccalaureate degree. In comparing educational curriculums, didactic content is very similar among both programs. Didactic and clinical hours required for graduation are also examined. A detailed discussion of the similarities and differences in educational preparation of NPs and PAs is presented.