Involving Healthcare Providers Research Articles

Community-Based Mental Health Improvement Initiatives: A Narrative Review and Indiana Case Study.

There is a global mental health crisis: mental illness is underrecognized, underdiagnosed, and undertreated with adverse effects on mental, physical, and social health. In the United States, there is an insufficient number of traditional psychiatric and psychological resources to provide the mental health care needed to solve this crisis. Community-based interventions could be an important adjunct to traditional mental health care. An evaluation of peer-reviewed articles was performed describing community-based interventions and identified 3 approaches with some evidence of effectiveness: (1) interventions that enhance community mental health literacy to improve recognition of early signs of mental illness for early engagement and provide community, family, and peer support; (2) community clinics providing social, medical, and mental health care and support to transition-age youth (15-25 years); and (3) social networking activities to enhance interactions among elders suffering from social isolation and loneliness. Multisector, multidisciplinary, and multicomponent interventions involving health care providers and community-based organizations had the best evidence of effectiveness and should target transition-age youth and elders.

Monetary Incentives in Clinician Surveys: An Analysis and Systematic Review With a Focus on Establishing Best Practices.

Surveys involving health care providers continue to be characterized by low and declining response rates (RRs), and researchers have utilized various strategies to increase survey participation. An important approach is to employ monetary incentives to improve survey response. Using a systematic review and analyses of 100 randomized comparisons (published in 48 papers) between monetary incentives and a non-incentive condition, this paper seeks to advance the understanding of best practices for using monetary incentives in clinician surveys. These analyses show even small incentives (≤$2) to be effective in improving clinician response relative to non-incentive subgroups, with diminished returns associated with serial incremental increases above that amount up to amounts greater than $25, at which point there is an appreciable improvement, supporting the use of higher incentives in this population. Cash and direct cash equivalents (e.g., cash cards and checks) produced greater odds of survey participation compared to vouchers, lotteries and charitable contributions, with lotteries and charities being the least effective forms of monetary incentive. Survey mode, timing and ethical considerations are also addressed. Noting the challenges associated with surveying clinicians, researchers must make every effort to improve access to this difficult-to-reach population by implementing appropriate incentive-based strategies designed to improve participation rates.

New experience of implementing patient e-referral in the Iranian health system: a qualitative study.

Implementing an electronic system of service categorization and a referral system in healthcare is a strategic approach to improving overall health outcomes and optimizing resource use. This study aimed to investigate challenges experienced with the electronic patient referral system in Mashhad University of Medical Sciences (MUMS). In this qualitative research, data were collected using semi-structured interviews. Participants included physicians, experts, and stakeholders working in the Family Physician Program and the referral system, selected through purposive sampling. The data were analyzed using a thematic analysis framework, in which a thematic framework was developed, and key themes were identified. Data analysis was performed using Atlas.ti8 software. According to the interviewees, the challenges of digitizing the referral system can be categorized into three main themes: structure, process, and outcomes. These themes include ten sub-themes, such as challenges related to Internet Infrastructure and the Sina System, Patients' Choice of Desired Specialists, Receiving Payment for Services, Appointment Scheduling, Interdepartmental Coordination, Recording Definitive Diagnosis Codes Before Referral, False Referrals, Dissatisfaction, Feedbacks, and Health Indicators. To improve the e-referral in Iran's health system, several strategies can be implemented. These include sustainable resource allocation, designing consequence mechanisms within the referral system to motivate collaboration and improving appointment scheduling systems. Furthermore, addressing these challenges requires a collaborative approach involving healthcare providers, IT professionals, and patient representatives to ensure that the system is efficient, user-friendly, and effectively meets the needs of all parties involved. Not paying enough attention to these issues cause reform failure while solving them requires multi-dimensional, systematic and coordinated interventions with a deep understanding of the obstacles and challenges. Disregarding these factors may result in apathy over time, ultimately impacting both the quantity and, more importantly, the quality of services.

7709 Ovotesticular Difference of Sex Development: Prognostic Evaluation, Sex Assignment, and Ethics

Abstract Disclosure: X. Xu: None. Y. Lin: None. B. Shivanna: None. A. Lee: None. J.C. Hakim: None. D.G. Mann: None. L.M. Noll: None. P. Georgiadis: None. S.K. Gunn: None. L.P. Karaviti: None. Background: Our case provides the identification and management of a newborn baby with ovotesticular syndrome, which was formerly known as true hermaphroditism. The term was classically derived from Greek mythology in which the deity 'Hermaphroditus', merging with the nymph Salamis, embodied both male and female attributes. The term 'true hermaphroditism' is now avoided due to its stigmatizing connotations. Ovotesticular difference of sex development (DSD) is an exceedingly rare condition, occurring in fewer than 1 in 20,000 births. This condition involves the coexistence of functional ovarian and testicular tissue within one individual, presenting a challenge in sex assignment due to unpredictable gender development. Clinical Case: This is a single case of the presence of ovarian and testicular differentiation on one side and a transitional zone of mixed pattern. Prenatal genetic testing consistent 46,XX karyotype. Initial ultrasound at the outside hospital revealed a uterus and right testicle. The baby exhibited Prader stage 4 genitalia, with a palpable gonad in the right labioscrotal area and the left gonad not palpable. Prophylactic hydrocortisone was started due to concerns regarding NR5A1/SF1 mutation. Further evaluations, including genetic tests, hormonal assessments, urinalysis and kidney ultrasound for the WT1 mutation, and scrotal and pelvic ultrasounds, were conducted. The high-dose ACTH stimulation test ruled out adrenal insufficiency. The testosterone level was in the male range, and the HCG stimulation test further confirmed functioning Leydig cells. The postnatal karyotype was 46,XX, and chromosome microarray analysis showed no abnormalities. Our approach to this case was multidisciplinary, including our endocrine experts, urologist, gynecologist, ethicist, and psychologist. We discussed the fluidity of sex assignment and addressed the degree of virilization, nature of the gonadal tissue, and emphasized the necessity of regular clinical follow-up. Our main concern was to educate the parents and protect the choices of the child. In this case, the child assumed a male sex assignment, as a result of the decision-making process between our team and the parents. In this context we did emphasize the fluidity of sex assignment. Clinical Lesson: Long-term outcomes for ovotesticular DSD remain understudied. Existing reports highlight varying rates of gender dysphoria, sexual function, and psychological well-being. Our approach to managing ovotesticular DSD involved a framework emphasizing ethical considerations and parental involvement. We advocated for and practiced a shared decision-making model involving healthcare providers, parents, and ultimately the patient. Presentation: 6/3/2024

Remifentanil Target-controlled Infusion Versus Standard of Care for Conscious Sedation During Ultrasound-guided Transbronchial Needle Aspiration and Biopsy: A Randomized, Prospective, Control Study.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure that has become an important tool in the diagnosis and staging of mediastinal lymph node lesions in lung cancer. Adequate sedation is an important part of the procedure as it provides patient comfort and potentially increases diagnostic yield. The sedation modality varies among centers and includes moderate sedation/conscious sedation, deep sedation, and general anesthesia. The object of this study will be the evaluation of patient's comfort and level of satisfaction with the involved health care providers (bronchoscopist and anesthesiologist) of remifentanil administration in target-controlled infusion (TCI) for conscious sedation in patients undergoing EBUS‑TBNA, with a prospective randomized study design versus the of standard sedation protocol with midazolam and/or fentanest and/or propofol. This study was carried out at the "Campus Biomedico di Roma" University Hospital between September 2021 and November 2021, with a total number of 30 patients enrolled who met the eligibility criteria, randomly divided into 2 groups: group 1 "REMIFENTANIL TCI" (experimental group) where the patients performed the EBUS-TBNA procedure under conscious sedation with infusion of remifentanil TCI with a target between 3 ng/mL and 6ng/mL and group 2 "STANDARD" (control group) with patients undergoing conscious sedation with the association of midazolam and/or fentanest and/or propofol in refracted boluses based on clinical needs. Complications, safety, and level of satisfaction of the operator, the anesthesiologist, and the patient were evaluated. The results show that sedation with remifentanil in TCI can improve the comfort level of patients, reducing the risks associated with the procedure (lower frequency of oversedations and hypotension), allowing for greater intraprocedural safety. Furthermore, the level of satisfaction of the anesthesiologist and that of the operator appears to be significantly higher in the Remifentanil group. The execution of a mild to moderate sedation with Remifentanil in TCI in patients undergoing EBUS is safe, tolerated, and allows to obtain greater intraprocedural comfort. Further studies and larger and more representative samples are obviously needed to confirm and strengthen the validity of a remifentanil TCI-based sedation in endoscopic diagnostics.

Advance Care Planning of Patients Undergoing High-Risk Surgery: A Concept Analysis

The aim of this research was to clarify the concept of advance care planning (ACP) for patients undergoing high-risk surgery. The Walker & Avant’s approach to concept analysis was used. ACP for the patient who received a high-risk surgery was defined as follows: patients who are aware of the risks of surgery are initiated voluntarily with the need to participate in anticipatory decision-making. To do this, patients define their life-prolonging treatment, provided that appropriate treatment is guaranteed, and prepare for end-of-life care decisions through discussions involving healthcare providers and surrogate decision-makers. It is a continuous, patient-centered decision that allows the patient’s treatment goals to transition over time. The goal of the ACP is to focus on quality of life and care rather than determining end-of-life care. The development of this concept contributes to an assessment of the value of ACP support, which can lead to improved approaches to help patients recover in a short period.

Evaluating the implementation of the Pediatric Acute Care Education (PACE) program in northwestern Tanzania: a mixed-methods study guided by normalization process theory

BackgroundIn low- and middle-income countries (LMICs), such as Tanzania, the competency of healthcare providers critically influences the quality of pediatric care. To address this issue, we introduced Pediatric Acute Care Education (PACE), an adaptive learning program to enhance provider competency in Tanzania’s guidelines for managing seriously ill children. Adaptive learning is a promising alternative to current in-service education, yet optimal implementation strategies in LMIC settings are unknown.Objectives(1) To evaluate the initial PACE implementation in Mwanza, Tanzania, using the construct of normalization process theory (NPT); (2) To provide insights into its feasibility, acceptability, and scalability potential.MethodsMixed-methods study involving healthcare providers at three facilities. Quantitative data was collected using the Normalization MeAsure Development (NoMAD) questionnaire, while qualitative data was gathered through in-depth interviews (IDIs) and focus groups discussions (FGDs).ResultsEighty-two healthcare providers completed the NoMAD survey. Additionally, 24 senior providers participated in IDIs, and 79 junior providers participated in FGDs. Coherence and cognitive participation were high, demonstrating that PACE is well understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practices, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly those affecting collective action, were noted. Early indicators point toward the potential for long-term sustainability of the PACE, but assessment of reflexive monitoring was limited due to the study’s focus on PACE’s initial implementation.ConclusionThis study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanzanian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges as well as conducting a longer-term study to assess reflexive monitoring is crucial for its successful implementation. Furthermore, the study underscores the value of the NPT as a framework for guiding implementation processes, with broader implications for implementation science and pediatric acute care in LMICs.

Building a learning health care community in rural and remote areas: a systematic review

BackgroundA Learning Health Care Community (LHCC) is a framework to enhance health care through mutual accountability between the health care system and the community. LHCC components include infrastructure for health-related data capture, care improvement targets, a supportive policy environment, and community engagement. The LHCC involves health care providers, researchers, decision-makers, and community members who work to identify health care needs and address them with evidence-based solutions. The objective of this study was to summarize the barriers and enablers to building an LHCC in rural areas.MethodsA systematic review was conducted by searching electronic databases. Eligibility criteria was determined by the research team. Published literature on LHCCs in rural areas was systematically collected and organized. Screening was completed independently by two authors. Detailed information about rural health care, activities, and barriers and enablers to building an LHCC in rural areas was extracted. Qualitative analysis was used to identify core themes.ResultsAmong 8169 identified articles, 25 were eligible. LHCCs aimed to increase collaboration and co-learning between community members and health care providers, integrate community feedback in health care services, and to share information. Main barriers included obtaining adequate funding and participant recruitment. Enablers included meaningful engagement of stakeholders and stakeholder collaboration.ConclusionsThe LHCC is built on a foundation of meaningful use of health data and empowers health care practitioners and community members in informed decision-making. By reducing the gap between knowledge generation and its application to practice, the LHCC has the potential to transform health care delivery in rural areas.

Factors predicting on health behaviors among older adults with hypertension in community

In Thailand the prevalence of hypertension continues to rise and health behavior of older adults is generally suboptimal. The purpose of this study was to identify the characteristics that can identify health behavior in older persons with hypertension. A cross-sectional design study was carried out on 123 hypertensive older persons in Koh Kaew Sub-District, Sela Phum District, Roi Et Province, who were chosen using a simple random selection procedure. In-person interviews with structured questionnaires were used for gathering data. This study utilized surveys to collect demographic information, health beliefs, and health habits. Percentage, mean, standard deviation, and stepwise multiple regression were used to evaluate the data. The results showed that there were four factors together predict and explain the variance of health behaviors among older adults with hypertension accounting R<sup>2</sup> and adjusted R<sup>2</sup> value were 44.10% and 42.20% with statistical significance including female (β=0.242, p=0.001), perceived susceptibility (β=0.419, p<0.001), perceived barriers (β=0.239, p=0.001), and perceived benefits (β=0.181, p=0.013). To improve quality of life among older persons with hypertension, this research proposed involving healthcare providers, families, and health volunteers in promoting their health habits.

The impact of the COVID-19 pandemic on health-related quality of life of cancer patients in British Columbia

BackgroundThe COVID-19 pandemic resulted in unprecedented changes to cancer care in many countries, impacting cancer patients’ lives in numerous ways. This study examines the impact of changes in cancer care on patient’s health-related quality of life (HRQL), which is a key outcome in cancer care. The study aims to estimate patients’ self-reported HRQL before and during the pandemic and identify predictive factors for their physical and mental wellbeing.MethodThe study employed the large-scale Outpatient Cancer Care (OCC) Patient Experience Survey, including the Veterans RAND 12-Item Health Survey, to evaluate cancer patients’ experiences and HRQL before (January to May 2020) and during the COVID-19 pandemic (May to July 2021). Paired t-tests were conducted to compare differences in Physical Component Scores (PCS) and Mental Component Scores (MCS) before and during the pandemic. Multivariable linear regressions were employed to investigate the factors (sociodemographic, clinical, and patient-reported experience) influencing PCS and MCS during the pandemic.ResultsPCS decreased significantly during the pandemic, while MCS remained stable. Lower PCS contributors included older age, more telehealth visits, self-reported hospitalization, and a longer time since the last cancer diagnosis. Higher PCS was associated with urban residence, higher MCS during the pandemic, and perceived active Healthcare Provider (HCP) involvement. For MCS, lower scores related to female gender and more telehealth visits, while higher scores were associated with being white, higher education, high MCS before the pandemic, and perceived active HCP involvement.ConclusionThe OCC Patient Experience Survey provides a unique patient level data set measuring HRQL pre- and post- the onset of the COVID-19 pandemic. The study highlights challenges faced by cancer patients during the pandemic, with a significant reduction in PCS. However, the stability in MCS suggests effective coping mechanisms. Sociodemographic, clinical, and telehealth-related variables play a complex role in shaping both PCS and MCS. Perceived HCP involvement emerges as a crucial factor correlating with higher PCS and MCS. Navigating the post-pandemic era necessitates interventions fortifying patient-provider relationships, optimizing healthcare support systems, such as telehealth services, and prioritizing mental-well-being given its impact on both PCS and MCS.

Risk Factors for Anemia in Adolescent Pregnancies: Evidence From the Lembah Pantai Urban Health District in Malaysia.

Introduction Adolescent pregnant mothers are at higher risk of acquiring anemia during pregnancy, which has detrimental consequences for the mother and baby. Untreated and prolonged anemia can lead toperinatal morbidity and mortality and antepartum, intrapartum, and postpartum maternal morbidity.Anemia among adolescent pregnant mothers can be attributed to many factors, such as poor nutrition and the physiological demands of pregnancy. Hence, this study aimed to determine the prevalence and characteristics of anemia among adolescent pregnancies in Lembah Pantai Health District in an urban setting. Materials and methods This cross-sectional study utilized secondary data from registry records of adolescentpregnant mothers in the Lembah Pantai District Health Office in Kuala Lumpur,Malaysia from 2019 to 2022. All adolescent pregnancies aged 10 to 19 years were included in this study. Those with a prior diagnosis of thalassemia or other hematological disorders, as indicated in their medical records, were excluded from the study. The chi-square (χ2) test was applied to elicit the association at a univariate level, and those variables with a p-value of <0.25 were included in a multiple logistic regression model. Results A total of 307 records were reviewed, and 272 pregnant adolescent cases were eligible for the analyses. The prevalence of anemia among teenage pregnancies from 2019 to 2022 was 28.7% (95% CI: 23.0-33.6). This prevalence was lower than in many lower-income countries and developing countries.Factors that were significant on using multiple logistic regression analysis included marital status (unmarried) (AOR: 1.87, 95% CI: 1.01-3.45, p=0.046), residing area Seputeh (AOR: 0.29, 95% CI: 0.14-0.61, p=0.001), and third trimester of first antenatal visit/booking (AOR: 5.08, 95% CI: 2.02-12.70, p<0.001).The population in the Seputeh area has a higher overall household income in comparison toLembah Pantai. Conclusions According to the WHO classification, the prevalence of anemia among adolescent pregnant women at the Lembah Pantai District Health Office reflects amoderate public health issue. Consequently, anemia may exacerbate the impact of other health conditions in this population.Hence, local health authorities should ensure that anemia is adequately addressed without ignoring other crucial health issues. A multidisciplinary, comprehensive, holistic strategy involving healthcare providers, school health teams, and community assets offers a potential solution. Strategies that can be employed include providing targeted health and nutrition education in schools through school health teams. Additionally, establishing adolescent-friendly health clinics tailored to the specific needs of pregnant adolescents and enhancing antenatal services to ensure comprehensive screening and management of anemia should also be implemented.Hence, this will ensure achieving safe motherhood goals through an effective healthcare response.

Challenges and Opportunities for AI in Healthcare

The integration of artificial intelligence (AI) in healthcare presents a dual challenge: maximizing the efficiency of medical processes while safeguarding patient privacy. This comprehensive review examines the delicate balance between leveraging AI's potential in healthcare and preserving individual data privacy. Through analysis of recent literature, case studies, and regulatory frameworks, we explore the current landscape of AI applications in healthcare, associated privacy risks, and emerging solutions. Findings reveal that while AI significantly enhances diagnostic accuracy and treatment planning, it also raises concerns about data security and patient confidentiality. Key challenges include ensuring GDPR and HIPAA compliance, managing large-scale health data, and maintaining transparency in AI decision-making processes. Promising approaches such as federated learning and differential privacy emerge as potential solutions. This review underscores the need for a multidisciplinary approach involving healthcare providers, AI developers, ethicists, and policymakers to create robust, privacy-preserving AI systems in healthcare.

CT in pediatric trauma patients.

The decision as to whether to perform a computed tomography (CT) examination in severe pediatric trauma poses a challenge. The therapeutic benefit of computed tomography in injured children is lower compared to adults, while the potential negative effects of ionizing radiation may be higher. Thus, the threshold for CT should be higher. Centers that less frequently treat pediatric cases tend to conduct more whole-body CT examinations than dedicated pediatric trauma centers, indicating a clinical overestimation of injury severity with subsequently unnecessary imaging due to inexperience. On the other hand, a CT scan that is not performed but is actually necessary can also have negative consequences if an injury is detected with a delay. An injured child presents a challenging situation for all involved healthcare providers, and thus requires a structured approach to decision-making.Selective literature review of the benefits and risks of CT in injured children, as well as indications for whole-body and region-specific CT imaging.This article provides an overview of current guidelines, recent insight into radiation protection and the benefits of CT in injured children, and evidence-based decision criteria for choosing the appropriate modality based on the mechanism of injury and the affected body region. · Whole-body CT has less of an influence on treatment decisions and mortality in severely injured children than in adults.. · For radiation protection reasons, the indication should be determined more conservatively in children than in adult trauma patients.. · The indication for CT should ideally be determined separately for each region of the body.. · Ultrasound and MRI are a good alternative for the primary diagnostic workup in many situations.. · Appelhaus S, Schönberg SO, Weis M. CT in pediatric trauma patients. Fortschr Röntgenstr 2024; DOI 10.1055/a-2341-7559.

Assessment of women’s needs and wishes regarding interprofessional guidance on oral health in pregnancy – a qualitative study

BackgroundPoor oral and dental health due to oral dysbiosis during pregnancy increases the risk for negative pregnancy outcomes. Communicating the importance of oral health is therefore essential in reducing the risk of adverse pregnancy outcomes. Professional guidance could substantially support women’s positive perception of their own competence. Information on oral health should be provided by healthcare professionals such as midwives, obstetricians and dentists. The aim of this study was to assess the needs, wishes and preferences of pregnant women in Germany, regarding interprofessional collaboration and guidance on oral health during pregnancy.MethodsSources of information, preferences regarding information supply as well as the need for interprofessional collaboration of involved healthcare professions were investigated in six online focus groups with pregnant women. In addition, three expert interviews with a midwife, an obstetrician and a dentist were conducted. The focus groups and interviews were analysed using qualitative content analysis according to Kuckartz.Results25 pregnant women participated in focus groups. Pregnant women in all trimesters, aged 23 to 38 years, were included. Many women did not receive any or received insufficient information on oral health during pregnancy and wished for more consistent and written information from all involved healthcare providers. The extent of oral health counselling women received, heavily relied on their personal initiative and many would have appreciated learning about the scientific connection between oral health and pregnancy outcomes. An overall uncertainty about the timing and safety of a dental visit during pregnancy was identified. Interviews with experts provided additional insights into the working conditions of the involved healthcare professionals in counselling and emphasised the need for improved training on oral health during pregnancy in their respective professional education as well as thematic billing options in relation to this topic.ConclusionGuidance of women on oral health during pregnancy appears to be insufficient. Providing information adapted to the needs, wishes and preferences of women during pregnancy as well as the implementation of this topic in the education of involved healthcare professionals could contribute to an improved prenatal care for pregnant women and subsequently a reduced risk of negative pregnancy outcomes.

A Method for Ocular Disease Diagnosis through Visual Prediction Explainability

Ocular diseases can range in severity, with some being more serious than others. As a matter of fact, there are several common and severe eye diseases, for instance, glaucoma, i.e., a group of eye conditions that damage the optic nerve, often associated with elevated intraocular pressure. Effective management and prevention strategies require a multifaceted approach, involving healthcare providers, public health officials and community education. Regular screenings and early interventions are crucial in reducing the impact of eye diseases on individuals and populations. In this paper, we propose a method aimed to detect the presence of ocular disease from the automatic analysis of eye fundus photographs. We consider deep learning; in detail, we adopt several convolutional neural networks aimed to train several models to be able to discriminate between different eye diseases. Furthermore, to boost the application of deep learning in real-world everyday medical practice, we adopt a method to understand which areas of the images are of interest from the model’s point of view; this allows us to detect disease by providing in this way disease localization by explainability. In the experimental analysis, we provide a set of four different experiments: in the first one, we propose a model to discern between age-related macular degenerations and normal fundus (obtaining an accuracy of 0.91); in the second one, the model is able to discriminate between cataract and normal fundus (obtaining an accuracy of 0.92); the third experiment is related to a model aimed to discriminate between glaucoma and normal ocular fundus (obtaining an accuracy of 0.88); and the last experiment is related to a model aimed to discern between pathological myopia and normal ocular fundus (obtaining an accuracy of 0.95). Thus, the experimental analysis confirms the effectiveness of the proposed method from a quantitative point of view (analysis aimed at understanding whether the model is able to correctly identify the disease) but also from a qualitative one, with a detailed and reasoned analysis aimed at understanding whether the model is able to correctly localize the disease.

Perinatally Acquired HIV: Viral Evolution and its Implications for Adolescents

This literature review explores the implications of viral evolution on the health outcomes of adolescents with perinatally acquired HIV, offering recommendations for enhancing public health practices. Since the emergence of HIV in the 1980s, perinatal transmission from parent to child has become increasingly prevalent in developing countries. Antiretroviral therapy (ART) has greatly improved the life expectancy of children with perinatally acquired HIV, allowing them to reach adolescence. ART plays a critical role in suppressing HIV and reducing the risk of transmission. Nevertheless, low adherence or lack of treatment can lead to viral evolution and drug resistance, posing significant threats to adolescents. Challenges faced by adolescents with perinatally acquired HIV are multifaceted, including increased viral evolution and difficulties in adhering to ART. The impact of stigma, behavioral factors, and social and familial dynamics contribute to low adherence rates. Global inequities and systems-level challenges further complicate the situation, particularly in resource-limited settings. Adequate public health infrastructure and innovative approaches, such as long-acting injectable ART, are imperative to address these structural barriers and reduce drug resistance among adolescents. Comprehensive data collection and longitudinal studies are needed to understand the long-term consequences of perinatally acquired HIV and its impact on viral evolution. A multidisciplinary approach involving healthcare providers, virologists, and social scientists is crucial to meeting global HIV goals and addressing the specific needs of this vulnerable population.

Trust: How It Affects the Use of Telemedicine in Improving Access to Assistive Technology to Enhance Healthcare Services.

Modern telemedicine (TM) technologies play a crucial role in enhancing access to Assistive Technology in healthcare services. However, the full benefits of this technology will not be realized unless it is widely accepted among service users (patients). This study aimed to investigate the impact of patient trust and perceived risk on the acceptance of TM for Assistive Technology in healthcare. A comprehensive survey instrument was developed and refined through expert feedback and a pilot study, leading to data collection from 917 participants. The theoretical framework guiding this research was based on the Trust factors in TM, which helped in conceptualizing the factors influencing patient acceptance of TM. The study revealed a significant gap in patient trust in TM and highlighted the multifaceted nature of perceived risk, emphasizing the need to consider individual risk factors separately. Results also indicated that trust in technological reliability and the perceived effectiveness of TM were critical factors influencing its adoption. The findings underscore the importance of building trust among service users and promoting the reliability of TM for achieving desirable medical outcomes. In conclusion, to facilitate widespread acceptance of TM for Assistive Technology, a multi-faceted approach involving healthcare providers, organizations, and governments is essential to address patient concerns, enhance trust, and promote the benefits of this technology.

Examining Current Vaccination Practices for Neonates, Including Healthcare Provider and Parental Attitudes and the Challenges of Implementing Vaccination Schedules: A Clinical Study.

Vaccination of neonates is crucial for preventing infectious diseases and ensuring public health. However, understanding the attitudes of healthcare providers and parents towards neonatal vaccination and the challenges in implementing vaccination schedules is essential for optimizing vaccination strategies. A clinical study was conducted involving healthcare providers and parents of neonates. Surveys were administered to assess attitudes towards neonatal vaccination, perceived barriers, and adherence to vaccination schedules. Data analysis was performed using statistical methods to identify trends and associations. Among healthcare providers (n = 200), 85% expressed strong support for neonatal vaccination, citing its importance in disease prevention. However, concerns regarding vaccine safety (62%) and parental hesitancy (48%) were identified as significant barriers. Among parents (n = 500), 78% reported willingness to vaccinate their neonates, with 60% adhering strictly to vaccination schedules. Common reasons for non-adherence included fear of adverse reactions (42%) and misinformation (28%). Challenges in vaccine administration, such as access issues (20%) and vaccine shortages (15%), were also reported. Healthcare providers generally endorse neonatal vaccination, recognizing its benefits in preventing infectious diseases. However, addressing concerns about vaccine safety and parental hesitancy is crucial for improving vaccination rates. Strategies aimed at enhancing education, promoting vaccine confidence, and addressing logistical challenges are essential for the successful implementation of neonatal vaccination schedules.

Sickle Cell Anemia – A Societal and Clinical Challenge in a Wardha City

Sickle cell anemia is a hereditary blood disorder that poses significant clinical and societal challenges, predominantly affecting individuals globally. Clinically, it is marked by severe pain episodes, organ damage, heightened infection risk, and limited treatment options. These complications necessitate comprehensive, ongoing medical care. Societal challenges include healthcare disparities, stigma, psychosocial impacts, and barriers to education and employment. Addressing these issues in Wardha city requires improving access to specialized care, enhancing public awareness, investing in research for new treatments, and providing robust support systems for patients and caregivers. A multifaceted approach involving healthcare providers, researchers, policymakers, and communities is essential to effectively manage and mitigate the impacts of this debilitating disease..

Contents and effectiveness of patient- and family-centred care interventions in adult intensive care units: A systematic review.

The need and values of patient- and family-centred care (PFCC) have been globally increasing in the health care landscape. However, the concept of PFCC and the components in adult intensive care units (ICUs) remain wide-ranging. To elucidate the core concepts of PFCC interventions and evaluate the effects of the interventions in adult ICUs. We searched electronic databases (PubMed, Cochrane Central, CINAHL, EMBASE, PsycINFO, RISS, KMbase and KoreaMed) from inception to 20 June 2022, for all studies on PFCC interventions. Three authors independently conducted data screening and extraction. The core concepts and the effects of PFCC interventions in adult ICUs were examined. The effects of patient- and family-centred care interventions in adult ICUs were examined. The quality of the included studies was evaluated using the Mixed Methods Appraisal Tool. Overall, 3507 records were identified, and 14 full-text articles were assessed. Participants in the included studies were patients and/or their family members in adult ICUs. The main concepts of the studies were participation and information-sharing. Only two studies used collaboration as the main concept of intervention. PFCC interventions have shown positive outcomes for patients, including increased satisfaction, improvement of patient health status and reduced incidence of complications. They have also been beneficial for families, leading to higher satisfaction levels and decreased anxiety. Additionally, these interventions have positively impacted health care providers by enhancing satisfaction and improving rounding efficiency. Moreover, they have influenced health care utilization by decreasing hospital costs and length of stay. This review highlights the advantages of PFCC interventions for patients, families and health care providers in adult ICUs. Future research should focus on developing strategies to incorporate collaboration more comprehensively as a core concept in the implementation of PFCC interventions. Future research endeavours must prioritize collaborative efforts involving health care providers, patients and their families by deploying an array of strategies within the intensive care unit setting.