Care Issues Research Articles

Patient Perspectives on Kidney Stone Surgery: A Content Analysis of Instagram Posts by Patients Versus Surgeons

BackgroundBoth clinicians and patients use social media to post about health care issues such as kidney stone disease, but their perspectives may differ. ObjectiveTo evaluate content and themes regarding kidney stone surgery shared by patients and urologists on Instagram. Design, setting, and participantsA search was performed on Instagram using the term “kidney stone surgery”. The first 100 posts from individuals who were clearly identified as a patient were assessed. We also assessed 100 posts from self-identified urologists. Outcome measurements and statistical analysisA previously published system was applied as a framework for categorizing the information collected. Outcomes of interested included pain, recovery, and costs. Results and limitationsSome 71% of the patients were female and most of their posts (52%) were shared postoperatively. The most common themes covered in patient posts were the need for multiple operative sessions (45%), pain (43%), and recovery (42%). Other themes included activities of daily life (18%), return to work (11%), nervousness (16%), stent issues (31%), stent on a string (5%), diet and prevention (9%), gratitude for health care services (10%), disease recurrence (18%), and costs (10%). Some 94% of the urologists were male and their posts covered the following domains: recovery (11%), stent issues (3%), pain (1%), stent on a string (1%), gratitude for health care services (1%), and recurrence 1%. Among the posts from urologists, 79% included self-promotion and 52% covered new technology. Overall, 10% contained false information. The majority of the posts with surgical images had no clear statement regarding patient consent (97%). ConclusionsKidney stone surgery can affect many areas of a patient’s quality of life. Most of the posts shared by patients were negative. Posts shared by urologists do not reflect the same themes. Moreover, there appears to be poor adherence to European Association of Urology recommendations regarding online professional conduct. Patient summaryMany patients use social media to share their experiences of kidney stone surgery. Posts are largely related to quality-of-life issues and are mostly negative. While urologists also use social media, the content they post on professional accounts is mostly focused on new technology and career promotion.

Problematika péče o děti mladší tří let v České republice

The article discusses theoretical and practical issues of child care for under three-yearold children. The article looks at the issue from three perspectives which affect injustices. Firstly, in terms of every day struggles for recognition, which should have been understood as full-fledged activity with appropriate social status. Secondly, in terms of redistribution of public resources and financial reward for caring for children under the age of three. Thirdly, in terms of political injustice, which will inevitably limit people’s capacity to engage in all kinds of civic and political activity. Following the Nancy Fraser’s thinking, article shows that is it necessary to understand recognition and redistribution unconditionally but in the unified horizon. The structures of injustice for children under the age of three are connected and only one of these approaches is not able to solve injustice. The article brings, with the helping hands of critical methods, new perspectives, and approaches to care issues that target breaking actions of national Czech Republic norms and remove rigid social and institutional systems and policies that structure inequality on this field.

Optimizing Virtual Health Technologies Through a Performance-based Readiness Model: Lessons From the Field Deployment of National Emergency Tele-Critical Care Network.

The advancement of the Army's National Emergency Tele-Critical Care Network (NETCCN) and planned evolution to an Intelligent Medical System rest on a digital transformation characterized by the application of analytic rigor anchored and machine learning.The goal is an enduring capability for telecritical care in support of the Nation's warfighters and, more broadly, for emergency response, crisis management, and mass casualty situations as the number and intensity of disasters increase nationwide. That said, technology alone is unlikely to solve the most pressing issues in operational medicine and combat casualty care. A total performance system (TPS) creates opportunities to address vulnerabilities and overcome barriers to success. As applied during the NETCCN project, the TPS captures the best performance-centric information and know-how, increasing the potential to save lives, improve readiness, and accomplish missions. The purpose of this project was to apply a performance-based readiness model to aid in the evaluation of Army telehealth technologies. Through various user-facing surveys, polls, and reporting techniques, the project aimed to measure the perceived value of telehealth technologies within a sample of the project team member population. By providing a detailed approach to the collection of lessons learned, researchers were able to determine the importance of information and methods versus a focus on technology alone. The use of an emoji-based feedback assessment indicated that most lessons learned were helpful to the project team. Through the NETCCN TPS, we have been able to address product-related measures, knowledge of product efficacy, project metrics, and many implementation considerations that can be further investigated by setting and engagement type. Through the Technology in Disaster Environments learning accelerator, it was possible to rapidly acquire, process, organize, and disseminate best practices and learnings in near real time, providing a critical feedback and improvement loop.

Abstract 16845: Heart Failure Hospitalist Service Line Have Decrease All Cause Readmission, Length of Stay and Cost at 3 UPMC Hospitals in Central Pennsylvania in 2022

Introduction: Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days. Methods: Patients with both primary diagnosis HF at UPMC Harrisburg/West Shore/Community General totaled to 1574 in 2022. Hospitalist, Cardiologist, teaching service N= 547 (36%); CHF hospitalist Team N=1027 (64%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups for 2022. Results: All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all other providers (Hospitalist, Cardiologist, teaching service) is 32%. HF Hospitalist team at 3 UPMC hospitals had lower 30 day all cause readmission rates: 8.46%. All other providers length of stay was 7.7 days while length of stay while on HF hospitalist service was 6.3 days. Potential cost savings to UPMC hospitals greater than $2.3 million dollars since start of HF Hospitalist service line. Conclusions: HF patients rarely have a consistent provider when readmitted. To address this health care priority at a system level, UPMC Central Pennsylvania’s strategy of creating a HF hospitalist service line has shown to be a unique method to not only develop trusting relationships with our patients but also attain impressive results. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. At this community-based healthcare system, HF Hospitalist outcomes include decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 5yrs of the HF Hospitalist service line now at 3 hospitals at UPMC.

Study of the Quality of Life of Diabetic Patients Treated at the HMA

Introduction: Maintaining or improving quality of life is a major issue in health care, particularly in the context of chronic diseases such as diabetes. The SF-12 is a generic quality of life questionnaire applicable to patients with diabetes. The aim of this study is to assess the quality of life of diabetic patients using a generic SF-12 questionnaire and to detect factors related to this concept. Materials and methods: This is a descriptive, cross-sectional and analytical observational study that involved 130 diabetic patients followed up in the Endocrinology, Diabetology and Metabolic Diseases Department at the Avicenne Military Hospital in Marrakech. Results: The average age of our population was 50.5 years, with extremes ranging from 7 to 80 years. Females were predominant (52%). The average age of diabetes was 9.55 years (extremes ranging from 15 days to 35 years). The majority of cases (63%) had a history of ketoacidosis and (43%) had a history of hypoglycemia. The results showed that diabetes negatively affects the quality of life of diabetic patients and that the factors associated with their quality of life are multiple : factors related to socio-demographic characteristics (age and sex), socio-economic characteristics (profession, socio-economic level), co-morbidities (hypertension, dyslipidemia, obesity, sedentary lifestyle), and factors related to the disease itself and its acute (hypoglycemia, ketoacidosis) and chronic complications (occlusive arterial disease of the lower limbs (PAOD), myocardial infarction (MI)). Discussion: In order to improve the quality of life of diabetic patients, it is necessary to improve their level of education, to ensure a global management of the diabetic person, of the complications related to diabetes and to implement education strategies and programs as well as community interventions.

Triage Accuracy of Emergency Nurses: An Evidence-Based Review

IntroductionAccurate triage assessment by emergency nurses is essential for prioritizing patient care and providing appropriate treatment. Undertriage and overtriage remain an ongoing issue in care of patients who present to the emergency department. The purpose of this literature review was to examine factors associated with triage accuracy in the emergency department. MethodsWe conducted an evidence-based literature review using the Cumulative Index to Nursing and Allied Health Literature, PubMed, and Embase. The search focused on peer-reviewed articles in English, available in full text, published between January 2011 and December 2021. ResultsA total of 14 articles met inclusion criteria and revealed the following 3 themes for triage accuracy: triage nurse characteristics, patient characteristics, and work environment. Triage nurses’ accuracy rates ranged from 59.3% to 82%, with experience in triage associated with higher accuracy. Patient characteristics influenced triage accuracy, with nontrauma patients being undertriaged and trauma patients often overtriaged. The work environment played a role, as accuracy rates varied based on shift time and patient volume. Competing systems between prehospital and ED triage posed challenges and affected accuracy during fluctuations in patient volumes. DiscussionThis review underscores the complex nature of ED triage accuracy. It highlights the importance of nurse experience, training programs, patient characteristics, and the work environment in enhancing triage decision making. Enhanced understanding of these factors can inform strategies to optimize triage accuracy and improve patient outcomes.

Learning and teaching care within the family: Experiential learning reflecting informal teaching

The present study investigated how caregivers in Finland and the US recount learning and teaching care within the family, drawing on a new educational-psychological framework for care. This study applied thematic analysis to seven focus groups in the US and five focus groups in Finland composed of caregivers ( N = 45). The results suggest one main theme for learning, Imperfect Mirroring of Past Parenting and Present Parenting Practice, and two themes for teaching: Actions Tell More Than Words (US) and Teaching Them To be Independent and Caring Citizens (Finland). For learning, the findings indicate that childhood experiences are transformed into an informal guide for how care should (or should not) be practiced, highlighting how the lack of systematization in learning care contributes to caregivers’ need for self-teaching and unlearning what they experienced. In addition, caregivers tend to reproduce their learning experiences in teaching to care, and within this process, they focus more on pragmatic aspects of care. The various elements theorized in the Psychological Processes for Care Framework used, including identifying and anticipating others’ needs and deciding on the responsibility of addressing needs, were neglected in caregivers’ reports of teaching care. Implications argue in favor of psycho-educational programs for caregivers that can systematically address two pressing issues in learning-teaching care - the complexity involved in care processes and understanding the intersubjective nature of the construction of caring relationships.

Grappling with Issues of Motherhood for Women with Schizophrenia.

Despite the fact that most persons with schizophrenia find steady employment difficult to sustain, many women with this diagnosis embrace and fulfill the most difficult task of all-motherhood. The aim of this paper is to specify the challenges of motherhood in this population and review the treatment strategies needed to keep mothers and children safe, protecting health and fostering growth. The review addresses concerns that had been brought to the author's earlier attention during her clinical involvement with an outpatient clinic for women with psychosis. It is, thus, a non-systematic, narrative review of topic areas subjectively assessed as essential to "good enough" mothering in the context of schizophrenia. Questions explored are the stigma against motherhood in this population, mothers' painful choices, issues of contraception, abortion, child custody, foster care and kin placement of children, the effects of antipsychotics, specific perinatal delusional syndromes, and, finally, the availability of parental support. This review is intended for clinicians. Recommendations are that care providers work collaboratively with mothers, take note of their strengths as well as their failings, offer a wide array of family services, monitor households closely for safety and for treatment adherence, appreciating the many challenges women with schizophrenia face daily.

Enhancing health-care data integration via automated semantic mapping

PurposeThis paper aims to delve into the complexities of terminology mapping and annotation, particularly within the context of the COVID-19 pandemic. It underscores the criticality of harmonizing clinical knowledge organization systems (KOS) through a cohesive clinical knowledge representation approach. Central to the study is the pursuit of a novel method for integrating emerging COVID-19-specific vocabularies with existing systems, focusing on simplicity, adaptability and minimal human intervention.Design/methodology/approachA design science research (DSR) methodology is used to guide the development of a terminology mapping and annotation workflow. The KNIME data analytics platform is used to implement and test the mapping and annotation techniques, leveraging its powerful data processing and analytics capabilities. The study incorporates specific ontologies relevant to COVID-19, evaluates mapping accuracy and tests performance against a gold standard.FindingsThe study demonstrates the potential of the developed solution to map and annotate specific KOS efficiently. This method effectively addresses the limitations of previous approaches by providing a user-friendly interface and streamlined process that minimizes the need for human intervention. Additionally, the paper proposes a reusable workflow tool that can streamline the mapping process. It offers insights into semantic interoperability issues in health care as well as recommendations for work in this space.Originality/valueThe originality of this study lies in its use of the KNIME data analytics platform to address the unique challenges posed by the COVID-19 pandemic in terminology mapping and annotation. The novel workflow developed in this study addresses known challenges by combining mapping and annotation processes specifically for COVID-19-related vocabularies. The use of DSR methodology and relevant ontologies with the KNIME tool further contribute to the study’s originality, setting it apart from previous research in the terminology mapping and annotation field.

Nurse practitioner led implementation of huddles for staff in long term care homes during the COVID-19 pandemic

BackgroundStaff working in long-term care (LTC) homes during COVID-19 frequently reported a lack of communication, collaboration, and teamwork, all of which are associated with staff dissatisfaction, health concerns, lack of support and moral distress. Our study introduced regular huddles to support LTC staff during COVID-19, led by a Nurse Practitioner (NP). The objectives were to evaluate the process of huddle implementation and to examine differences in outcomes between categories of staff (direct care staff, allied care and support staff, and management) who attended huddles and those who did not.MethodsAll staff and management at one LTC home (< 150 beds) in Ontario, Canada were included in this pre-experimental design study. The process evaluation used a huddle observation tool and focused on the dose (duration, frequency) and fidelity (NP’s adherence to the huddle guide) of implementation. The staff attending and non-attending huddles were compared on outcomes measured at post-test: job satisfaction, physical and mental health, perception of support received, and levels of moral distress. The outcomes were assessed with validated measures and compared between categories of staff using Bayesian models.ResultsA total of 42 staff enrolled in the study (20 attending and 22 non-attending huddles). Forty-eight huddles were implemented by the NP over 15 weeks and lasted 15 min on average. Huddles were most commonly attended by direct care staff, followed by allied care/support, and management staff. All huddles adhered to the huddle guide as designed by the research team. Topics most often addressed during the huddles were related to resident care (46%) and staff well-being (34%). Differences were found between staff attending and non-attending huddles: direct care staff attending huddles reported lower levels of overall moral distress, and allied care and support staff attending huddles perceived higher levels of support from the NP.ConclusionsNP-led huddles in LTC homes may positively influence staff outcomes. The process evaluation provided some understanding of why the huddles may have been beneficial: the NP addressed resident care issues which were important to staff, encouraged a collaborative approach to solving issues on the unit, and discussed their well-being.Trial registration numberNCT05387213, registered on 24/05/2022.

Adolescent suicide: a major mental health issue in pediatric care.

Adolescent suicide is a major public health problem, as suicide is one of the leading causes of death for adolescents. Predicting and preventing suicide represent very difficult challenges for clinicians. Youth suicide might be prevented by identifying risk factors for adolescent suicidal behavior. Diagnostic assessment involves identification of multiple factors including gender differences, psychopathology, comorbidity, interpersonal problems, family discord, family psychopathology, accessibility of lethal suicide methods, exposure to suicide, previous attempt, social support, life stressors, and protective factors. The literature clearly indicates a need for suicide awareness and prevention programs and for early identification of adolescents at risk for suicidal behaviors. However, many health care professionals who have frequent contact with adolescents are not sufficiently trained in suicide evaluation techniques and approaches to adolescents with suicidal behavior. Pediatricians and other health professionals involved in adolescents' care need more in-depth information about the characteristics and the warning signs for suicide.

Ochrona zdrowia społeczności żydowskiej na Górnym Śląsku w latach 1945–1950

Health care of the Jewish community in Upper Silesia 1945–1950 The post-war activities of the Jewish health care in Upper Silesia, were part of a centuries-old tradition of activity by Jewish aid organisations. Its task was not only to spread medical aid, but also to provide, under adverse conditions and at short notice, the basis of existence and a sense of security for several thousand people. In the first half of 1945, issues of health care for the Jewish population settled in Upper Silesia after the Second World War remained the responsibility of the health departments at the field committees of the Central Committee of Jews in Poland. Starting from August 1945, the health policy and the protection of the health of Jews in Poland rested on the shoulders of the Society for the Protection of the Health of the Jewish People (TOZ) reactivated within the structures of the CKŻP. The organisation’s functioning was based on provincial branches, with interventions including: primary and specialist medical care, preventive measures including spa stays or maternal and child health. The Katowice branch was established in April 1946. At its busiest, it was the second largest branch of TOZ in Poland and covered five cities in Upper Silesia: Bytom, Chorzów, Zabrze, Gliwice and Opole. Among other things, there were nine outpatient clinics, mother and baby clinics, a maternity home and a dental surgery. Their activities came to an end in 1950, when all social organisations, including Jewish ones, were nationalised in Poland.

Abstract 161: Repeated administration of thrombolytic therapy in the setting of stuttering lacunar infarct

Introduction Tissue plasminogen activator (tPA) is the standard of care for the treatment of acute ischemic stroke with symptom onset within 4.5 hours. One exclusion criterion for tPA administration is stroke within 3 months due to the presumed increased risk of hemorrhage. While the rate of early recurrent stroke (ERS) within 3 months is as high as 14.5‐18.3%, the safety and effectiveness of repeated tPA administration remain unclear. An increasing number of studies pose a challenge to this recommendation. One study identified 19 patients who received tPA for ERS and found no symptomatic intracranial hemorrhage. Fifteen other studies with a cohort of 57 patients (including one patient receiving repeated tPA within 90 minutes) reached the same conclusion that repeated tPA is safe in ERS. We present a patient with stuttering motor weakness who received intravenous (IV) tPA twice, 3 days apart with discharged modified Rankin scale (mRS) of 3. Methods The patient was identified in routine clinical practice. Results Our patient is a 61‐year‐old right‐handed Caucasian woman with a medical history of untreated hypertension presented with sudden onset of left arm and leg weakness. IV tPA was given at the local emergency department (ED) and she was then transferred to our comprehensive stroke center. Upon arrival, her National Institutes of Health Stroke Scale (NIHSS) was 0. Her symptoms were completely resolved. Computed tomography (CT) head was unremarkable and CT angiography (CTA) did not show significant stenosis or occlusion. Magnetic resonance imaging (MRI) of the brain was negative for an acute infarct. She was diagnosed with a transient ischemic attack and was discharged home with aspirin and a high‐intensity statin for secondary stroke prevention. She presented to the ED the next day with identical left‐sided weakness again. Her NIHSS was 5 this time and IV tPA was given again. MRI showed an acute infarct in the right posterior limb of the internal capsule. Transthoracic echo did not reveal an intracardiac shunting or thrombus. The stroke mechanism was small vessel disease, and anti‐hypertensive medications were added to the treatment. She was discharged to an acute rehabilitation center with an mRS of 3 and her 90‐day mRS was 1 on follow up. Conclusion Management of ERS is a challenging issue in stroke care. Our case adds value to the current limited literature demonstrating the safety and effectiveness of repeated tPA in ERS, especially in patients with MR negative stuttering lacunar infarct and subsequent improvement following tPA. Further research with larger registries is needed to identify appropriate selection criteria for repeated tPA use in this patient population.

Contemporary Issues in Contraception and Abortion Care (2023-005JMWH).

Contemporary Issues in Contraception and Abortion Care (2023-005JMWH).

Heavy menstrual bleeding in adolescents: a primary issue in primary care

Heavy menstrual bleeding in adolescents: a primary issue in primary care

Utilization of In-Hospital Orthopaedic Spine Consultations: Evaluating the Impact of Health Care Policy

Access to specialty and private practice providers has been a divisive policy issue over the last decade, complicated by the conflict between a reduction in government-funded health care reimbursement and the need for health care providers to sustain a financially sound practice. This study evaluates the orthopedic spine consult service at an academic tertiary care center at 2 separate time points over a 5-year period to better understand the impact of decreasing orthopedic reimbursement rates and the increasing prevalence of federally supported medical insurance on the access to specialty care. In total 500 patients in 2017 and 480 patients in 2021 were included for the final analysis. A higher percentage of consults in 2021 came from the emergency department (74.0% versus 60.4%, P &lt; 0.001); however, the emergency department saw fewer spinal cord injuries (11.9% versus 21.4%, P &lt; 0.001), and the spinal cord injuries were less severe (3.1% versus 6.2% Association Impairment Scale A or B, P = 0.034). A smaller percentage of patients in 2021 went on to receive orthopedic spine surgery following consultation (35.2% versus 43.8%, P = 0.007), and those receiving surgery had an operation performed farther out from the initial consultation (4.73 versus 4.09 days, P &lt; 0.001). Additionally, fewer patients with Medicare insurance (23.5% versus 30.8%) and more patients with Medicaid insurance (20.2% versus 12.4%) were seen in 2021 compared with 2017 (P = 0.003). Overall, this study found an increased proportion of Medicaid patients seen by the spine consult service but a decrease in the acuity of consults. Measures to improve access to health insurance under the Affordable Care Act have revealed the complexity of this issue in health care. This study’s findings have demonstrated that while more patients did have insurance coverage following the Affordable Care Act, they still face a barrier to accessing outpatient orthopedic spine providers.

How can NHS trusts in England optimise strategies to improve the mental health and well-being of hospital doctors? The Care Under Pressure 3 (CUP3) realist evaluation study protocol

IntroductionThe growing incidence of mental ill health in doctors was a major issue in the UK and internationally, even prior to the COVID-19 pandemic. It has significant and far-reaching implications,...

Palliative Care Issues in Aortic Stenosis #467.

Palliative Care Issues in Aortic Stenosis #467.

To the issue of health care for convicts

To the issue of health care for convicts

유치원 통합학급 교사들의 남성 유아특수교사에 대한 인식과 경험 탐색

Purpose: The purpose of this study is to explore the perceptions and actual experiences of kindergarten teachers working in inclusive classrooms regarding male early childhood special educators (ECSETs).&#x0D; Method: To achieve this, relevant prior studies were analyzed, and a semi-structured interview guide was created. Semi-structured interviews were then conducted with six teachers who had experience working with male ECSETs and operating inclusive classrooms. The interview transcripts were subsequently analyzed using the constant comparative method.&#x0D; Results: First, male ECSETs, like their female counterparts, were viewed as having the necessary competencies, having undergone the same educational process. Furthermore, they expressed the opinion that during consultation hours, male ECSETs offer a perspective different from that of females and are greatly helpful in situations that require physical strength. Second, the presence of male ECSETs was found to be significantly beneficial in various aspects such as physical activity support, gender equality education, field experiential learning, and disability understanding education. However, perceptions on handling personal care issues for female special education students were suggested to need change. The competency of special education teachers was considered more influenced by individual experience and characteristics than by gender. Third, additional support needs for male ECSETs were proposed, such as installing restrooms and rest areas and activating training or gatherings for male ECSETs.&#x0D; Conclusion: This study analyzed perceptions and experiences of male ECSETs, identified their support needs, and proposed directions for future research. The aim was to provide evidence for enhancing the role of male ECSETs and proposing expanded support strategies.