Health Care Guidelines Research Articles

2024 Chinese guidelines for the diagnosis and treatment of rheumatoid arthritis

Rheumatoid arthritis(RA) is an autoimmune disease characterized by erosive arthritis, which is an important cause of disability in Chinese population. It is of great significance to formulate and update RA diagnosis and treatment guidelines that meet the standards of international guidelines and clinical practice in China. The update of the Chinese guidelines for the diagnosis and treatment of RA was initiated by National Clinical Research Center for Dermatologic and Immunologic Diseases, jointly with the Chinese Association of Rheumatology and Immunology Physicians, the Rheumatology and Immunology Professional Committee of Chinese Rehabilitation Medical Association, the Rheumatology and Immunology Professional Committee of Chinese Research Hospital Association, and the Rheumatology and Immunology Branch of Beijing Association of Holistic Integrative Medicine. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist were followed to update the guidelines. The guidelines provide evidence-based recommendations on 10 clinical issues which were concerned by Chinese rheumatologists. The aim is to improve the level of diagnosis and standard treatment of RA in China, and to improve the quality of life and prognosis of patients.

Cardiovascular emergency in indonesian primary health care (PUSKESMAS): a national multicentre service evaluation study based on ESC guidelines adherence

Abstract Background Early diagnosis and prompt treatment are crucial in reducing cardiovascular (CVD) burden in the global level, especially in Indonesia with more than a half million CVD death annually. As frontliner, more than 10,000 primary healthcare (PUSKESMAS) spreading around Indonesia are pivotal in delivering CVD emergency care. However, due to the scarcity of healthcare resources, significant disparities exist between guideline recommendations and their implementation in Indonesian primary health care. Purpose Our study aims to describe current cardiovascular emergency care, assess guideline adherence, and identify key factors influencing the trend. Methods This multicentre study was conducted in 40 PUSKESMAS across Indonesia from October to December 2023. Data related to cardiovascular emergencies diagnosis, work-ups, treatment, and outcomes were gathered and then evaluated according to the ESC Guidelines. Recommendations, particularly Class I, were converted into points with respect to diagnostic and treatment domains. Guideline adherence scores were then calculated based on the percentage of accomplished points. Linear regression analysis was employed to identify factors that could explain variations in guideline adherence across all PUSKESMAS. Results 215 CVD emergency patients were reported. The most prevalent diagnosis was hypertensive crisis (n=137; 64%) with ECG done in only 26% of cases and none underwent imaging. Oral amlodipine (59%) and captopril (55%) were mostly used as antihypertensive, with none receiving intravenous. The second most common diagnosis was ACS (n=42; 20%), with ECG performed in only 71% of cases. Among 13 patients with STEMI, 69% only received aspirin, and 46% were given DAPT. Malignant arrhythmia occurred in 26 patients, with none receiving cardioversion. The most used anti-arrhythmic are bisoprolol, propranolol, and atropine. Among 23 cases of acute HF, only 39% received oxygen, while IV furosemide was used in only one case. Cardiac arrest occurred in two patients, both received CPR and epinephrine. In terms of guideline adherence, mean diagnostic score (%) was demonstrated highest in Cardiac Arrest at 100 and the lowest in Hypertensive Crisis and Acute HF at 53, while mean treatment score (%) was highest in Hypertensive Crisis at 86 and lowest in arrhythmia at 25. Linear regression suggests that human resources have a positive and significant association with diagnostic adherence scores (R2: 0.3485, p-value: 0.0450), whereas essential medicine has a strong but non-significant correlation with treatment adherence score (R2: 1.0768, p-value: 0.460). Conclusion This study has demonstrated a huge disparity between the current CVD emergency practices and guidelines in Indonesian primary healthcare. These gaps emphasised the need for improved human resources and essential medicine for primary healthcare along with the implementation of data-driven policy making concerning cardiovascular disease in Indonesia.Cardiovascular Emergency Diagnosis in InCardiovascular Emergency Work-up and Tre

Institutionalising guideline development in a new universal healthcare system: a study in Cyprus

Abstract Issue Guideline development is a lengthy and diligent process that involves the assessment and interpretation of evidence by a committee. Whilst the implementation of high quality healthcare guidelines ensures consistency and quality in healthcare delivery, many countries worldwide, including Cyprus, lack the capacity and resources to develop de novo guidelines. Description of the problem Guidelines developed by internationally recognised organisations, such as NICE, are a valuable resource for countries like Cyprus. The collaboration between NICE and the newly established healthcare system in Cyprus introduced a process for guideline institutionalisation, taking advantage of existing human resources and building guideline development capability in Cyprus. Results This process involved recruiting local professionals to form a guideline secretariat. The secretariat, supported by NICE, is responsible for overseeing the guideline development process including technical expert committee (TEC) recruitment and stakeholder consultation. The TEC contextualise an existing NICE guidelines to reflect local considerations. NICE provides quality assurance to ensure changes are contextual in nature and consistent with the underpinning evidence. Despite initial challenges, getting stakeholder buy-in and engaging healthcare professionals in the TEC, one contextualised guideline has been produced and two others are at the final stage. Lessons Guideline contextualisation is an efficient and sustainable way of building guideline development capability to institutionalize guidelines in settings with limited capacity. Key messages • De-novo guideline development is time consuming and demanding and many countries require an alternative process for producing locally relevant guidelines, capitalising on existing resources. • Support by an established organisation ensures quality, is less resource intensive, and builds capability for the sustainability of the process.

Guideline for rehabilitation assessment and treatment of adolescent idiopathic scoliosis (2024 edition)

Scoliosis is a complex three-dimensional deformity of the spine that affects the growth of the spine in adolescent, leading to a heavy burden on families and society. According to the guidelines for the treatment of scoliosis, most adolescent idiopathic scoliosis (AIS) requires rehabilitative intervention. So far there has been a lack of scientific, evidence-based, and standardized rehabilitation assessment and treatment for AIS in China. Therefore, in order to promote the standardization of rehabilitation assessment and treatment for AIS, Chinese Society of Physical Medicine and Rehabilitation organized the domestic experts in multiple disciplines such as rehabilitation medicine, orthopedics, pediatric surgery, radiology, evidence-based medicine, etc., who has conformed to the principles of scientificity, safety, efficacy and advancement to propose the 19 recommendations of 8 categories using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Reporting Items for Practice Guidelines in Healthcare (RIGHT). Through the steps of literature search, evaluation, and establishment of direction and intensity of recommendation opinions, 19 recommendations were formed, involving AIS screening, assessment and treatment.

Best Practices in Supporting Inpatient Communication With Technology During Visitor Restrictions: An Integrative Review.

Since the onset of the COVID-19 pandemic, healthcare workers around the world have experimented with technologies to facilitate communication and care for patients and their care partners. Our team reviewed the literature to examine best practices in utilizing technology to support communication between nurses, patients, and care partners while visitation is limited. We searched four major databases for recent articles on this topic, conducted a systematic screening and review of 1902 articles, and used the Johns Hopkins Nursing Evidence-Based Practice for Nurses and Healthcare Professionals Model & Guidelines to appraise and translate the results of 23 relevant articles. Our evaluation yielded three main findings from the current literature: (1) Virtual contact by any technological means, especially video visitation, improves satisfaction, reduces anxiety, and is well-received by the target populations. (2) Structured video rounding provides effective communication among healthcare workers, patients, and offsite care partners. (3) Institutional preparation, such as a standardized checklist and dedicating staff to roles focused on facilitating communication, can help healthcare workers create environments conducive to therapeutic virtual communication. In situations that require healthcare facilities to limit visitation between patients and their care partners, the benefits of virtual visitation are evident. There is variance in the types of technologies used to facilitate virtual visits, but across all of them, there are consistent themes demonstrating the benefits of virtual visits and virtual rounding. Healthcare institutions can prepare for future limited-visitation scenarios by reviewing the current evidence and integrating virtual visitation into modern healthcare delivery.

Guidelines to manage women with infertility: an e-Delphi study

Introduction: The psychosocial health problems associated with infertility is compounded in African women when prevailing cultural expectations emphasize the value of parenthood. Despite the social stigma these women endure, they are still mostly managed from a biomedical approach, especially in Ghana, the context of the study. Objective: This study explored the views of a panel of experts to reach consensus on holistic guidelines to manage women with infertility in Ghana. Methods: An e-Delphi technique was employed to retrieve information using a panel of 20 experts. Data collection was conducted in two rounds, and each participating expert was emailed the preliminary guidelines to rate based on certain criteria. Data analysis was done in accordance with the expert participants’ rating of and comments on the guidelines. Results: The final guidelines for holistic healthcare to manage women with infertility include the following interventions: Holistic healthcare assessment, psychological interventions, health education, spiritual support, relevant support from significant others; all within a therapeutic relationship. Conclusion: When healthcare providers use the final set of guidelines to manage women diagnosed with infertility, these women will receive holistic healthcare to attain optimal health and improved chances of conceiving. Keywords: Holistic approach; e-Delphi technique; psychosocial interventions; infertility.

LGGL-02 NURSING CONSIDERATIONS FOR PEDIATRIC PATIENTS WITH PONTINE GLIOMAS: A COMPARATIVE ANALYSIS BETWEEN THE NAIROBI HOSPITAL AND KENYA

Abstract INTRODUCTION Pontine gliomas, aggressive brain tumors predominantly affecting pediatric patients, pose limited treatment options and a grim prognosis, emphasizing the crucial role of nursing care for comprehensive patient and family support. This abstract explores nursing considerations for pediatric pontine glioma patients at The Nairobi Hospital, contrasting them with broader healthcare practices in Kenya. METHODS A thorough literature review focused on nursing practices for pediatric pontine glioma patients, utilizing peer-reviewed journals, healthcare guidelines, expert opinions, and textbooks. Key areas included vital observations, parental support strategies, patient and family empowerment initiatives, palliative care approaches, and nursing intervention impact on outcomes and family satisfaction. RESULTS The analysis highlighted nursing considerations at The Nairobi Hospital, where a patient-centered approach and proactive vital observations were evident. Nurses monitored health status pre-radiotherapy, adjusting care plans promptly. End-of-life care showcased comprehensive palliative support and bereavement guidance, contrasting varied national practices, underscoring the need for standardized protocols and enhanced training nationwide CONCLUSION Nursing care’s pivotal role in optimizing outcomes and quality of life for pediatric pontine glioma patients and families was emphasized. The study’s implications extend to healthcare policy, education, and practice, stressing collaborative efforts to improve standards and patient outcomes.

Diagnostic and therapeutic practice for HFpEF across continents and regions: An international survey.

This study aims to evaluate the worldwide variations in the diagnosis and treatment of heart failure with preserved ejection fraction (HFpEF), using an HF survey distributed internationally to physicians, including both cardiologists and non-cardiologists. A group of HF specialists designed an independent, academic web-based survey focusing on HFpEF care and diagnosis, which was distributed via scientific societies and various social networks between 1 May 2023 and 1 July 2023. The survey included 1459 physicians (1242 cardiologists and 217 non-cardiologists) from 91 countries, with a mean age of 42 (34-49) years and 61% male. Most physicians (89.2%) defined HFpEF as left ventricular ejection fraction ≥50%. Significant regional variations were observed in HFpEF management (P<0.001 for all comparisons unless stated otherwise). Cardiologists managed 63.1% of HFpEF patients overall, with significant variability across regions (P < 0.001). The estimated HFpEF prevalence was highest in Eastern Asia and Western Europe and lowest in Africa and South America. Diagnostic practices varied: natriuretic peptide use ranged from 70%-74% in Africa to 95%-97% in Southern/Western Europe. Echocardiographic parameters showed regional differences, with diastolic stress testing used most in South-Eastern Asia (47% vs. 13-36% elsewhere). HFpEF scoring systems were most common in South-Eastern Asia (78%) and least in Africa (30.1%). Coronary artery disease screening approaches differed, with Eastern Asian physicians more likely to always perform routine angiograms (52%) compared with Northern Europeans (12%). Treatment preferences also varied regionally. Sodium glucose co-transporter-2 inhibitors (SGLT2i) was the preferred first-line treatment (45%-70% across regions), followed by diuretics. In an ideal setting, 52% would primarily use SGLT2i, 33% loop diuretics, and 22% beta-blockers. Drug availability differed significantly: SGLT2i was most available (88% overall), while ARNI was least available (61%). South America and Middle Eastern/Northern Africa reported lower availability of guideline-directed therapies. Multidisciplinary HF programmes were most common in Asia (70%) and least in Africa (24%). The perceived benefit of atrial flow regulator devices also showed significant regional differences. There are considerable global variations in the diagnosis and management of HFpEF. Most physicians favour SGLT2i despite regional disparities in health care resources and guideline adherence. Harmonized practices and improved access to comprehensive care can enhance outcomes of HFpEF patients worldwide.

Adhering to Patient Safety Standards: A Healthcare Imperative for the 21st Century

The ethics of healthcare processes aim to protect patient safety by emphasizing the importance of adhering to rules and avoiding harmful practices. They also suggest practical solutions to prevent such failures. Non-compliance, whether due to human error or technical failure, can result in operational failures and pose severe hazards to patients, healthcare workers, and hospital facilities. This paper discusses intentional non-compliance with healthcare standards and guidelines, referred to as deviation, and demonstrates how adhering to these rules can reduce the risk of harm. Noncompliance can have severe consequences, as it may reveal an organization's fail-safe mechanisms, defenses, or safety nets, potentially resulting in catastrophic events and causing significant harm. These errors typically occur when active errors combine with latent errors, such as flaws or vulnerabilities in a system's defenses. This habit allows the latter to overcome the defenses, gain patient access, and cause harm. There is no such thing as a completely safe environment, even the most advanced ones. Additionally, all humans, regardless of their intelligence, have weaknesses. In healthcare processes, every signal has the potential to cause harm, leading to tragic outcomes or even death. The factors contributing to non-compliance fall under individual, collective, organizational, or sociocultural categories. Reducing non-compliance in healthcare processes and ensuring patient safety requires all stakeholders to commit to patient safety ethics.

Maternal obesity management: a narrative literature review of health policies

Maternal obesity rates are increasing significantly, posing substantial risks to both mothers and their children. This study aims to introduce health policies addressing maternal obesity, identify preventive interventions, and highlight scientific gaps necessitating further research.We identified documents through electronic searches in PubMed, CINAHL Plus, EMBASE, and grey literature sources (ministry of health websites, national gynecology and obstetrics associations) from January 2013 to August 2023, updated in June 2024. The inclusion criteria focused on English-language documents discussing interventions or health policies that promote weight loss through lifestyle changes during pregnancy.A total of 22 documents (10 studies and 12 guidelines) were included. 12 studies (N=1244) identified via databases; included two Clinical Practice Guidelines (CPGs) from Canada and Singapore. Other 10 CPGs sourced from governmental websites and national associations: England (1), Australia (1), New Zealand (1), combined Australia and New Zealand (1), Canada (3), USA (1), Ireland (1), Germany (1). 10 guidelines focused on obesity in pregnancy, two on weight management during pregnancy. Covered interventions across pre-pregnancy, pregnancy, and postpartum periods (9 guidelines); pre-pregnancy and pregnancy (2); exclusively postpartum (1). Seven guidelines offered evidence-based recommendations on maintaining healthy weight in mothers, largely based on expert opinions.Maternal obesity poses significant risks to both mothers and children, underscoring the need for effective health policies and systems. However, few countries have integrated adequate responses into their healthcare policies and guidelines for professionals. Limited evidence exists on optimal practices to improve reproductive health outcomes in obese women. Hence, the crucial need to developing comprehensive guidelines and proactive strategies to manage maternal obesity. These measures can improve outcomes and reduce healthcare costs. Increased focus on research and policymaking is essential to protect the health of mothers and their children.

Clinical practice guidelines and expert consensus statements on rehabilitation for patients with COVID-19: a systematic review

ObjectivesTo appraise the quality of clinical practice guidelines (CPGs) and expert consensus statements on rehabilitation for patients with COVID-19, summarise recommendations of rehabilitation assessments and interventions and evaluate the heterogeneity...

Effects of Recreational Therapy on Anxiety Levels in Patients with Chronic Illness

Purpose: The aim of the study was to assess the effects of recreational therapy on anxiety levels in patients with chronic illness. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The study indicated that engaging in recreational activities, such as art, music, and physical exercise, can significantly alleviate anxiety symptoms. These activities provide a distraction from pain and discomfort, enhance mood, and promote relaxation. For instance, studies have demonstrated that music therapy can lead to decreased levels of cortisol, the stress hormone, and increased production of endorphins, which are natural mood elevators. Similarly, physical activities like yoga and tai chi help in reducing tension and improving overall mental health by fostering a sense of physical well-being and empowerment. Art therapy, through creative expression, allows patients to process their emotions and experiences, leading to reduced feelings of anxiety and depression. Overall, recreational therapy offers a holistic approach to managing anxiety in chronically ill patients, contributing to improved quality of life and better mental health outcomes. Implications to Theory, Practice and Policy: Cognitive-behavioral theory, biopsychosocial model and flow theory may be used to anchor future studies on assessing the effects of recreational therapy on anxiety levels in patients with chronic illness. Practitioners should consider combining different types of recreational therapies to maximize therapeutic benefits. Policymakers should recognize the value of recreational therapy and integrate it into national healthcare guidelines and policies. This integration can promote the widespread adoption of these therapies in various healthcare settings, ensuring that patients with chronic illnesses have access to comprehensive care options.

Information Platform for Antibiotics.

Antibiotic stewardship is continuously evolving to incorporate results from novel research, clinical findings, and specialist recommendations. Numerous dedicated information sources, including web-based solutions, are available to keep medical practitioners informed. However, the provided information is often extensive, requiring users to extract the relevant facts. This study aimed to deliver an information platform that provides references, links, and information in a straightforward and engaging manner. Implementing a high-fidelity prototype prioritized medical and patient-oriented functionalities, structured around questions and quizzes. Additionally, the platform offers access to professional references, such as official healthcare guidelines and scientific articles. The development process adhered to design principles and included user testing with established usability measures (SUS, Nielsen's heuristics), resulting in satisfactory scores from IT experts and somewhat lower scores from users. Although designed to cater to a broader range of users, more work is needed to improve usability for the general public.

High Responsibility, limited authority, and endless expectations: a policy critique of the Community Health Officer’s role in the government healthcare delivery systems in India

BackgroundThe shortage of qualified healthcare providers in rural areas of India has led to a emergence informal and unqualified practitioners and poses significant risks to population health. Community Health Officers (CHOs) were introduced as mid-level health providers (MLHP) at Sub-health Centres (SHC) to bridge the healthcare resource gap and serve as the primary point of contact for rural communities.MethodsThis qualitative cross-sectional study aimed to explore the CHOs experiences and performance at sub-health centre Health and Wellness Centres (SHC-HWCs) in India. CHOs and Medical Officers (MOs) from randomly selected SHC-HWCs and Primary Health Centre-Health and Wellness Centres (PHC-HWCs) across different geographic zones were interviewed. Semi-structured interviews were conducted with CHOs, MOs, and State Nodal Officers (SNOs) to gather information on drug provisioning, prescription practices, and perspectives on the roles and capacities of CHOs. The study is based on 40 in-depth interviews of health providers sampled at different levels of healthcare system in India.ResultsThe study revealed barriers and challenges faced by CHOs in meeting the expectations outlined in the Comprehensive Primary Health Care (CPHC) guidelines. These included a lack of agency, difficulties in team dynamics with existing healthcare professionals, and inadequate availability of medicines at sub-health centres. Due to the existing contradictions and prescription restrictions, CHOs found themselves failing to meet community expectations and foster trust.ConclusionCHOs encounter significant challenges in fulfilling their roles as mid-level health providers. Addressing these challenges is crucial for optimizing their effectiveness and strengthening the delivery of primary healthcare in rural areas. Clear protocols, supportive policies, and capacity-building initiatives are necessary to enhance the role and impact of CHOs in the healthcare system.

Compassionate evidence-based guidelines for progressive veterinary healthcare - do we have what we ordered?

Compassionate evidence-based guidelines for progressive veterinary healthcare - do we have what we ordered?

Management of Patients With a Negative Multiparametric Prostate MRI Examination: AJR Expert Panel Narrative Review.

Multiparametric MRI (mpMRI) of the prostate aids risk stratification of patients with elevated PSA levels. Although most clinically significant prostate cancers are detected by mpMRI, insignificant cancers are less evident. Thus, multiple international prostate cancer guidelines now endorse routine use of prostate MRI as a secondary screening test before prostate biopsy. Nonetheless, management of patients with negative mpMRI results (defined as PI-RADS category 1 or 2) remains unclear. This AJR Expert Panel Narrative Review summarizes the available literature on patients with an elevated screening PSA level and a negative prostate mpMRI result and provides guidance for these patients' management. Systematic biopsy should not be routinely performed after a negative mpMRI examination in patients at average risk but should be considered in patients at high risk. In patients who undergo PSA screening rather than systematic biopsy after negative mpMRI, clear triggers should be established for when to perform a repeat MRI examination. Patients with a negative MRI result followed by negative biopsy should follow their health care practitioners' preferred guidelines concerning subsequent PSA screening for the patient's risk level. Insufficient high-level data exist to support routine use of adjunctive serum or urine biomarkers, artificial intelligence, or PSMA PET to determine the need for prostate biopsy after a negative mpMRI examination.

Chinese national clinical practice guidelines on prevention, diagnosis and treatment of early colorectal cancer.

The incidence and mortality of colorectal cancer (CRC) in China are increasing in recent years. The clarified pathogenesis and detectable precancerous lesions of CRC make it possible to prevent, screen, and diagnose CRC at an early stage. With the development of endoscopic and surgical techniques, the choice of treatment for early CRC is also worth further discussion, and accordingly, a standard follow-up program after treatment needs to be established. This clinical practice guideline (CPG) was developed following the recommended process of the World Health Organization, adopting Grading of Recommendations Assessment, Development and Evaluation (GRADE) in assessing evidence quality, and using the Evidence to Decision framework to formulate clinical recommendations, thereby minimizing bias and increasing transparency of the CPG development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guides to ensure the guideline's completeness and transparency. This CPG comprises 46 recommendations concerning prevention, screening, diagnosis, treatment, and surveillance of CRC. In these recommendations, we have indicated protective and risk factors for CRC and made recommendations for chemoprevention. We proposed a suitable screening program for CRC based on the Chinese context. We also provided normative statements for the diagnosis, treatment, and surveillance of CRC based on existing clinical evidence and guidelines. The 46 recommendations in this CPG are formed with consideration for stakeholders' values and preferences, feasibility, and acceptability. Recommendations are generalizable to resource-limited settings with similar CRC epidemiology pattern as China.

A scoping review of unexpected weight loss and cancer: risk, guidelines, and recommendations for follow-up in primary care.

Cancer diagnoses often begin with consultations with general practitioners (GPs), but the nonspecific nature of symptoms can lead to delayed diagnosis. Unexpected weight loss (UWL) is a common nonspecific symptom linked to undiagnosed cancer, yet guidelines for its diagnostic assessment in general practice lack consistency. To synthesise evidence on the association between UWL and cancer diagnosis, and to review clinical guidelines and recommendations for assessing patients with UWL. Systematic search and analysis of studies conducted in primary care. Four databases searched for peer-reviewed literature from 2012 to 2023. Two reviewers conducted all the steps. A narrative review was conducted detailing the evidence for UWL as a risk factor for undiagnosed cancer, existing clinical guidance, and recommended diagnostic approach. We included 25 studies involving 916,092 patients; 92% provided strong evidence of an association between UWL and undiagnosed cancer. The National Institute for Health Care and Excellence Cancer Guideline in the UK was frequently cited. General suggestions encompassed regular weight monitoring, family history, risk factor evaluation, additional signs and symptoms, and a comprehensive physical examination. Commonly recommended pathology tests included C-reactive protein, complete blood count, alkaline phosphatase, and thyroid-stimulating hormone. Immunochemical faecal occult blood test, abdominal ultrasound, and chest X-ray were also prevalent. One large cohort study provided age, sex, and differential diagnosis-specific recommendations. This evidence review informs recommendations for investigating patients with UWL and will contribute to a computer decision support tool implementation in primary care, enhancing UWL assessment and potentially facilitating earlier cancer diagnosis.

Oral Health Care Among Women in Perimenopause or Menopause: An Integrative Review.

Women in menopause are at a higher risk of developing oral health problems, affecting their overall quality of life. Several studies have identified the role of health care providers in addressing women's oral health needs across various phases of their lives, yet a review in the area of perimenopause and menopause has not been undertaken. Therefore, the aim of this review was to explore current evidence regarding the oral health knowledge, attitudes, and practices of women in perimenopause or menopause and their health care providers. Additionally, guidelines and recommendations to inform strategies for oral health promotion are included. A systematic search was carried out across 5 databases. Inclusion criteria included articles published in English that examined at least one study outcome: oral health knowledge, attitudes, and practices of either women in perimenopause or menopause or of health care providers or guidelines around oral health care. Qualitative, quantitative, mixed-methods, and experimental studies with survey components were included with no restrictions on publication period, quality, or setting. A total of 12 articles met the inclusion criteria, with a majority being of poor quality and mostly from low-income and middle-income countries. Overall findings indicated that there was a lack of knowledge and limited practices in maintaining oral hygiene and visiting the dentist among women in perimenopause or menopause. Health care providers exhibited poor attitudes in advising the importance of periodic dental check-ups and informing oral health changes during this period. There were also insufficient guidelines to adopt care for women and guide health care providers in their practice. Women in perimenopause or menopause have limited oral health knowledge and unmet oral health needs. Appropriate guidelines and supportive strategies are required to assist health care providers in providing comprehensive care and encouragement to women in perimenopause or menopause to improve their oral health.

Design and construct of an assessment tool for the handover of critical patient the in urgent care and emergency setting

ObjectivesTo design and construct an assessment tool for the handover of critical patients in the urgent care and emergency setting. Research methodologyThis metric and descriptive study comprised two phases in accordance with the Clinical practice guidelines for A Reporting Tool for Adapted Guidelines in Health Care: The RIGHT-Ad@pt Checklist. In the first phase, the identification and selection of items related to the handover of critical patients were performed by consensus of a group of experts. The second phase consisted of two stages. In the first stage, the items were selected by applying the e-Delphi technique across two assessment rounds and in the second stage, the items were subjected a pilot test in a real critical patient handover scenario. Professionals from different disciplines and work areas (hospital and prehospital) caring for critically ill patients in the urgency and emergency setting participated in each of the phases. ResultsA total of 58 critical patient care, and urgent and emergency care professionals participated in the design and construction of the assessment tool. The initial list consisted of 14 categories and 57 items, which were reduced to 28 items grouped into five categories after the intervention of the participants. The content validity index (CVI) of the instrument was 0.966. ConclusionsThis study describes an assessment tool developed in Spanish-language designed to assess the handover of critical patients in the urgent care and emergency setting. This tool has a high CVI, and is the only currently available tool that consider all of the dimensions and characteristics of the handover process. Implications for clinical practiceThe assessment tool developed in this study could enable critical care professionals in their clinical practice to work in a systematic way, universalizing the handover of critically ill patients in the urgent care and emergency setting through scientifically proven guidelines.