Health Professionals In Decisions Research Articles

Decision-making experiences of health professionals in withdrawing treatment for children and young people: A qualitative study.

ObjectiveTo explore factors that influence professionals in deciding whether to withdraw treatment from a child and how decision making is managed amongst professionals as an individual and as a team.Study DesignSemi‐structured interviews were conducted with a purposive sample of health professionals working at a UK Children's Hospital, with children with life‐limiting illnesses whose treatment has been withdrawn. Data were transcribed verbatim, anonymized and analysed using a thematic framework method.ResultsA total of 15 participants were interviewed. Five interrelated themes with associated subthemes were generated to help understand the experiences of health professionals in decision making on withdrawing a child's treatment: (1) understanding the child's best interests, (2) multidisciplinary approach, (3) external factors, (4) psychological well‐being and (5) recommendations to support shared decision making.ConclusionA shared decision‐making approach should be adopted to support professionals, children and their families to make decisions collectively.

Encountering Parents Who Are Hesitant or Reluctant to Vaccinate Their Children: A Meta-Ethnography.

(1) Background: Health professionals play an important role in addressing parents who are hesitant or reluctant to immunise their children. Despite the importance of this topic, gaps remain in the literature about these experiences. This meta-ethnography aimed to synthesise the available body of qualitative work about the care experiences of community and hospital health professionals in encounters with parents hesitant or reluctant to vaccinate their children. The aim is to provide key information for the creation of strategies that address vaccine hesitancy or refusal and ensure public trust in vaccination programs, which are required in a pandemic context such as the current one. (2) Methods: Noblit and Hare’s interpretive meta-ethnography of 12 studies was followed. A line of argument synthesis based on a metaphor was developed. (3) Results: The metaphor “The stone that refuses to be sculpted”, accompanied by three themes, symbolises the care experiences of health professionals in their encounters with parents that hesitate or refuse to vaccinate their children. (4) Conclusions: The creation of clearer communication strategies, the establishment of a therapeutic alliance, health literacy and the empowerment of parents are recommended. The incorporation of health professionals in decision making and the strengthening of multidisciplinary teams interacting with such parents are also included.

Guías de práctica clínica: conceptos, limitaciones y desafíos

Clinical practice guidelines are the most important documents for the incorporation of scientific evidence in health decision making through the formulation of recommendations. There is a variable terminology used to refer to the documents that guide health professionals in decision making. When clinical practice guidelines are of high quality, they appraise contextual aspects such as the use of resources, applicability, and patients values and preferences. Even so, they are not recipe books, since they may have limitations. In this review, we propose to clarify the different denominations across the various types of documents available to guide the health professional when making clinical decisions. We discuss the main characteristics of clinical practice guidelines, quality assessment, challenges, and limitations.

What factors influence the decisions of mental health professionals to release service users from seclusion?

Mental health policy stipulates seclusion should only be used as an intervention of last resort and for the minimum possible duration. Current evidence details which service users are more likely to be secluded, why they are secluded, and what influences the decision to seclude them. However, very little is known about the decision to release service users from seclusion. An integrative review was undertaken to explore the decision-making processes of mental health professionals which guide the ending of seclusion. The review used a systematic approach to gather and thematically analyse evidence within a framework approach. The twelve articles identified generated one overriding theme, maintaining safety. In addition, several subthemes emerged including the process of risk assessing which was dependent upon interaction and control, mediated by factors external to the service user such as the attitude and experience of staff and the acuity of the environment. Service users were expected to demonstrate compliance with the process ultimately ending in release and reflection. Little evidence exists regarding factors influencing mental health professionals in decisions to release service users from seclusion. There is no evidence-based risk assessment tool, and service users are not routinely involved in the decision to release them. Support from experienced professionals is vital to ensure timely release from seclusion. Greater insight into influences upon decisions to discontinue episodes may support initiatives aimed at reducing durations and use of seclusion.

Estimation of Atenolol Transfer Into Milk and Infant Exposure During Its Use in Lactating Women.

Atenolol lactation information is limited, and controversy exists over the safety of its use during breastfeeding. In this study, important parameters including milk-to-plasma ratio, ratio of infant plasma to maternal plasma, infant daily dosage, and relative infant dose were investigated. The findings from this study add information to existing data about atenolol transfer in human milk. This may help guide health professionals in decision making regarding the safety of beta blockers used by mothers during breastfeeding. Research aim: The aims of the study were to quantify concentrations of atenolol in human plasma and milk, to evaluate atenolol pharmacokinetics in lactating women, and to investigate subsequent infant exposure to atenolol via mother's milk. In this prospective, longitudinal observational study, participants were lactating mothers ( N = 3), 1 to 4 months postpartum, who had been taking atenolol for therapeutic reasons, and one 4-month-old breastfed infant. Eight milk samples were collected over 24 hr at different time points, together with a single blood sample from each lactating mother and the infant, and quantified using a new sensitive liquid chromatography mass spectrometry method developed for this study. Peak milk concentrations of atenolol were observed in the women at 4 hr (Tmax) after oral administration. The dose-normalized maximum concentrations (Cmax) of all patients were similar. The mean milk-to-plasma ratio of the patients who were taking 25 to 100 mg of atenolol was 8.57%. In the mother-infant pair study, the ratio (%) of infant plasma drug concentration to maternal plasma drug concentration observed (18.87%) was similar to the relative infant dose estimated (18.20%). The relative infant dose values (13.96%-18.20%) for all patients were within 10% to 25% of maternal dosage. Atenolol use during breastfeeding should be undertaken with some precaution. If clinically indicated, an alternate beta blocker may be preferred.

Using home sensing technology to assess outcome and recovery after joint replacement – findings from the hip and knee study of a sensor platform of healthcare in a residential environment

Purpose: Improving outcomes after joint replacement is a key research priority. After joint replacement, up to 30% of patients report minimal improvement or their symptoms get worse and not all patients are satisfied with their outcome. Poor outcomes include continuing pain, functional limitation and increased healthcare utilisation. Patient Reported Outcome Measures (PROMs) such as the Oxford Hip or Oxford Knee Score and the EQ-5D, a measure of health status, are widely used to assess outcome after joint replacement in practice and research. These measures can assess a variety of health outcomes including pain, function and health related quality of life. Though widely used, many PROMs have methodological limitations and there is debate about how to interpret results and definitions of clinically meaningful change. Previously, research has explored the relationship between PROMs and objective measures, such as timed walks or sit-to-stand tests. Such objective measures are administered in controlled, laboratory style settings, and may not reflect levels of activity in daily life. With the rapid development of monitoring technology, there is opportunity to characterise the relationship between PROMs and behaviour in a natural setting and to develop methods of passive monitoring of outcome and recovery after surgery. We are working with a multidisciplinary team which has developed a system of low powered sensors that can monitor the health-related behaviours of people living at home. The system includes: sensors for the home environment (measuring temperature, humidity, room occupancy, water and electricity usage) a wrist-band body-worn activity monitor and silhouette (body outline) sensors. The SPHERE system of sensors is now being installed in 100 homes belonging to the general population. Within this cohort we are installing the system in the homes of 20 patients who are about to undergo a total hip or knee replacement (THR/TKR). The study aims to: (a) determine to what extent the sensory data obtained from the SPHERE system is comparable to data obtained from routine clinical measures and PROMs in the assessment of patients' activity, function and recovery processes; (b) investigate whether the sensory data can detect meaningful changes in recovery. Methods: To assess the accuracy and usefulness of the sensory data, in this 1-year observational study, patients will be provided with the sensor system to monitor and record daily continuous measurements. We will make and refine appropriate data learning outcomes with the quantitative data e.g., daily measurements in the weeks parallel to the distribution of PROM assessments pre/post-operative (4–9 days, 6 and 12 weeks) and weekly measurements during the other months. The study will assess the relationships between environmental, behavioural and movement data and the parameters of interest from the PROMs assessments over time. Interviews and focus groups with patients and health professional will provide qualitative data and achieve depth in understanding the accuracy of the data, its usefulness for health professionals in decision making, and if the technology is acceptable. Results: The SPHERE sensor system has been installed in the homes of two patients. We aim to recruit up to 20 patients, (aged 18 years or over) whom are due to undergo a TKR or THR in the UK. Conclusions: This study will provide a unique understanding of home and wearable sensor technology in an orthopaedic population and will compare sensor data with current PROMs.

Does the Second Amendment Protect the Gun Rights of Persons With Mental Illness?

Under federal law, persons who have been involuntarily hospitalized for psychiatric reasons are permanently barred from gun possession. That policy was challenged in 2012 by a Michigan man who had been committed 25 years earlier and who was blocked in 2011 from buying a gun. Considering his claim, the Sixth Circuit held that people with mental illness are not categorically excluded from Second Amendment protection and that an irreversible lifetime ban was unconstitutional. Although many mental health organizations and practitioners favor gun restrictions, they oppose discriminatory treatment of persons with mental illness, creating ambivalence about the decision, which presages greater involvement of mental health professionals in decisions regarding gun rights restoration.

Measures for screening for intimate partner violence: a systematic review.

Objective Intimate partner violence (IPV) is a public health priority due to the physical and mental impacts it has on health. No existing reviews have focused on the psychometric properties of IPV screening tools used to screen men and women within a mental health context. This review aimed to identify the best psychometrically tested screening tools available to assess all areas of IPV in men and women in mental health setting. Method Databases psycArticles, PsycINFO, Social Science, CINAHL, PubMed and Cochrane were searched from their starting date through toJuly 2015. Eligible studies were published in peer-reviewed publications in English. Results Thirty-six studies met the inclusion criteria. Ten IPV screening tools were identified. Three tools assessed all areas of IPV and were validated against an appropriate reference standard. One study tested IPV screening tool in a mental health setting. Conclusion Mental health nurses need to incorporate a psychometrically tested IPV tool as part of risk assessment and safety planning for clients. This review identified three tools that are suitable for identifying IPV in a mental health context. However, further research is necessary to validate IPV screening tools that are culturally sensitive and have been validated with men and women.

Is advice incompatible with autonomous informed choice? Women’s perceptions of advice in the context of antenatal screening: a qualitative study

Patient autonomy in antenatal screening is a high priority for policy developers in many countries. This paper presents women's understandings of how health professionals should facilitate informed screening choices with an emphasis on their understandings of autonomy and advice. The study was carried out in 2009 in the UK, using a qualitative approach. Ninety-eight participants of African, British White, Caribbean, Chinese and Pakistani origin had semi-structured interviews, which were analysed using framework analysis. Four themes were identified during the analysis: 'Meanings of advice in antenatal screening: the advice continuum', 'Recognition of the role of health professionals in decision making', 'Understandings of advice in the context of autonomous decision making' and 'Reasons given for wanting advice'. Women said they valued advice from health professionals to make decisions about antenatal screening, but their understandings of 'advice' ranged from information giving only to direction about screening choices. Many women wanted health professionals to support the process of making informed choices by engaging in discussion and did not see advice as incompatible with making autonomous choices. However, some women wanted direction about whether to have a screening test or not, something which policy and guidelines explicitly prohibit. This may cause an ethical dilemma for health professionals who are required to both support women's preference for care and adhere to a policy of non-directiveness. Further clarification is needed on how health professionals should support the process of making informed choices when women ask for clear direction on screening choices.

Las crisis de salud pública en una sociedad desarrollada. Aciertos y limitaciones en España. Informe SESPAS 2010

The perception, acceptability and management of risks are social construction. Consequently, in managing public health crises, the gap between facts, beliefs and feelings tests the responsiveness of official institutions to health alarms that can be objective, potential, or imaginary. On balance, a strong point of the Spanish experience of health crises is the presence of clinicians and public health officers working in an organization capable of responding adequately, although the quasi-federal Spanish political structure has both advantages and disadvantages. Weaknesses include the low profile given to public health and a management structure that relies too heavily on partitocracy. The management of these crises could be improved by transferring greater scope to health professionals in decisions about crisis identification and management (with transparency) and limiting bureaucratic inertia. For some, health crises involve visibility or business opportunities (not always legitimate). Therefore, the perception of crisis will increasingly rest less in the hands of experts and more in those of groups interested in spreading these crises or in providing solutions. While progress is needed to develop participation in strategies to respond to emerging crises, even more essential is the involvement of all healthcare levels in their preparation and dissemination.