Lack Of Confidence In Treatment Research Articles

Risk Factors Analysis in Recurrent Stroke Events: Literature Review

After the first stroke, according to epidemiological data, there is a 30% risk of recurrent stroke. That events are the population who had suffered stroke and the recurrence rate is 9 times compared to the normal population. Results of research from the Stroke Association stated that the possibility of recurrence stroke was 3.1% in 30 days, 11.1% within one year, 26.4% within five years, and 39.2% within 10 years. This literature review is intended to analyze the risk factors of recurrent stroke events. The literature review was carried out by searching for articles in 2011-2021 in Indonesian and English. There were four databases for providing electronic journal articles, namely Garuda, Google Scholar, Science Direct, and PubMed. The quality of the articles carried out using JBI's Critical Appraisal Tools. Narrative synthesized was used to analyze the data of the review. There were 6 articles synthesized in this review. The review result showed that diabetes mellitus, hypertension, cardiovascular disorders, anemia, obesity, lack of physical activity, high serum of LDL/HDL, non-adherence to treatment, lack of confidence in treatment, lack of knowledge about the disease, and gender can encourage the occurrence of recurrent stroke. Many factors cause recurrent stroke events but diabetes mellitus, hypertension and non-adherence to treatment are most widely discussed in the six articles.

Times Constraints, Lack of Confidence in Treatment, Stigma, and Confidentiality Concerns: Barriers to Care Among First-year Internal Medicine Residents During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has presented unprecedented challenges for frontline health care workers. First-year medical residents have been at high risk of psychological distress given these challenges as well as those related to transitioning to a provider role. Virtual peer discussion groups were organized for first-year residents (N=47) at a large, American academic medical center to process the emotional impacts from the pandemic and provide support. Residents completed an anonymous survey before the initiation of the discussion groups to assess their level of psychological distress, perceived sources of stress, impact of the pandemic on their mental health, and attitudes toward seeking mental health services. Results from the survey identified time constraints as the greatest barrier to accessing mental health care, followed by lack of confidence in treatment, stigma, and concerns about confidentiality. We discuss potential ways to address some of these barriers to improve access and acceptability of mental health support for this specific population during a pandemic.

Barriers to enrolling in voluntary treatment programs in Malaysia: a study of women who use methamphetamine (WWUM)

Women with substance use disorders (SUDs) have been widely reported to face barriers in seeking treatment. We sought to identify barriers that prevented women who use methamphetamine (WWUM) from accessing the decade-old Voluntary Treatment Centers (VTCs) in Malaysia. A total of 153 WWUM who were undergoing rehabilitation for methamphetamine use at a compulsory drug detention center (CDDC) were recruited for this cross-sectional study. Data were collected by canvasing a structured questionnaire through face-to-face meetings. Of the total sample, 131 (86%) were Malays, with a mean age of 32.1 years. The commonly cited treatment barriers were the belief that methamphetamine use was not problematic (42%), not knowing how to seek treatment (38%), feeling embarrassed to seek treatment (33%), the lack of family support (24%), and the long waiting time for enrollment (23%). Logistic analyses indicated that a longer duration of use increased the odds of not acknowledging methamphetamine use as a problem while older participants had lower odds of holding a similar view. A longer duration of use also increased the odds of claiming treatment was not needed but lowered the odds of asserting a lack of confidence in treatment. Furthermore, Malays had higher odds of lacking family support in seeking treatment while being employed lowered the odds of not wanting treatment. Addressing these concerns will hopefully encourage higher participation of WWUM in voluntary treatment programs.

A systematic review and thematic synthesis of qualitative studies exploring GPs' and nurses' perspectives on discussing weight with patients with overweight and obesity in primary care.

SummaryGuidelines and evidence suggest primary care clinicians should give opportunistic interventions to motivate weight loss, but these rarely occur in practice. We sought to examine why by systematically reviewing qualitative research examining general practitioners' (‘GPs’) and nurses' views of discussing weight with patients. We systematically searched English language publications (1945‐2018) to identify qualitative interview and focus group studies. Thematic methods were used to synthesise the findings from these papers. We synthesised the studies by identifying second‐order themes (explanations offered by the original researchers) and third‐order constructs (new explanations which went beyond those in the original publications). Quality assessment using the Joanna Briggs checklist was undertaken. We identified 29 studies (>601 GPs, nurses and GP trainees) reporting views on discussing weight with patients. Key second‐order themes were lack of confidence in treatments and patients' ability to make changes, stigma, interactional difficulty of discussing the topic and a belief of a wider societal responsibility needed to deal with patients with overweight and obesity. The third‐order analytical theme was that discussions about weight were not a priority, and other behavioural interventions, including those relating to smoking, often took precedent. GPs and nurses reported that noting body mass index measurements at every consultation alongside a framework to deliver interventions would likely increase the frequency and perceived efficacy of behavioural weight interventions. GPs and nurses acknowledge the importance of obesity as a health issue, but this is insufficient, particularly amongst GPs, for them to construe this as a medical problem to address with patients in consultations. Strategies to implement clinical guidelines need to make tackling obesity a clinical priority. Training to overcome interactional difficulties, regular weighing of patients and changing expectations and understanding of weight loss interventions are also probably required.

A qualitative study on postoperative disease experience in patients with glioblastoma multiforme

Objective To explore the real postoperative disease experience in patients with glioblastoma multiforme, draw medical staff's attention to the patients' experience when they develop the disease, and offer reference for formulating more targeted interventions. Methods Totally 8 patients with glioblastoma multiforme who were hospitalized in the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University between March 2016 and March 2017 were selected by purposive sampling. The patients were interviewed according to the methods of qualitative studies, with records taken accordingly. The data were then organized and analyzed by Glaizzi's seven-step analysis method. Results The disease experience of these patients with glioblastoma multiforme could boil down to five themes: lack of confidence in treatment, fear for separation from their relatives, changes of social adaptability and reluctance to communicate with others, being hopeful while accepting the fact of poor prognosis, and desire for survival and realization of self-worth. Conclusions Medical staff should attach importance to the real experience of patients with glioblastoma multiforme, enhance humanistic care, provide professional and targeted psychological and mental guidance and support with psychological counselors, address the patients' problems, and improve their quality of life. Key words: Cerebral neoplasms; Glioblastoma; Disease experience; Qualitative study

Are we doing enough to prevent poor-quality antimalarial medicines in the developing world?

BackgroundMalaria is a deadly parasitic disease that affects more than 3 billion people worldwide, in predominantly resource-poor countries. Despite malaria being preventable and treatable, a large number of adults and children, mostly in Africa, die from this disease each year. One contributor to needless morbidity and mortality is the production and distribution of poor-quality antimalarial medicines; indeed, it is estimated that over 122,000 deaths of children under 5 years of age in sub-Saharan countries were caused by poor-quality antimalarial medicines, in 2013 alone.DiscussionPoor-quality medicines include those that are deliberately falsified for monetary gain and may contain incorrect amounts or even no active ingredients at all, as well as products that are inadequate due to poor compliance to conventional quality standards and medicines that have degraded over time. Across a number of studies it has been reported that 4-92% of antimalarials tested are poor quality. This represents a massive risk to the population subjected to the use of these medicines, in the form of more severe and prolonged illness, additional costs to individuals who already have very little money, and lack of confidence in treatments. The continuing circulation of poor-quality medicines results from a number of factors, including insufficient regulatory capacity in susceptible countries, inadequate funding to perform regulatory functions, poor coordination between regulatory authorities, and inefficient import/export control systems.To combat the distribution of poor-quality medicines a number of organisations have developed guidelines for the procurement of antimalarials, and programs to educate consumers about the risks of poor-quality medicines and incentivise retailers to identify and report falsified medicines. The development of new technologies to quickly identify poor-quality medicines in the field is also essential, and some significant advances have been made.ConclusionThere has been considerable improvement in the delivery of high-quality antimalarials to those who need them; however, there is still an urgent need for a collective response by the international community, political leaders, regulatory bodies, and pharmaceutical companies. This should include political commitment for enhanced research and development funding, such as for new innovative track-and-trace field devices, and international efforts to strengthen and harmonise drug regulation practices.

Patients' concern about their medicine after a generic switch: a combined cross-sectional questionnaire and register study.

This study aims to investigate the possible association between patients' concerns about their medicine and generic switch. Cross-sectional survey was carried out comprising responses from 2217 randomly selected persons aged 20 years or older and living in the Region of Southern Denmark, who had redeemed generically substitutable drugs in September 2008. For each patient, we focused on the purchase of one generically substitutable drug (index drug). We applied the specific concerns subscale from the Beliefs about Medicine Questionnaire (BMQ) to analyse lack of confidence in treatment. We also included general beliefs about medicine (BMQ), views on generic medicine and confidence in the health-care system. The information about the patients' generic switch was obtained from a prescription database and not provided by the patients. Data were analysed using linear regression. No statistically significant associations were found between concerns about the index medicine and the generic switch (-0.02 95% CI: -0.10; 0.05). Viewing medicines as harmful in general was associated with increased concerns (BMQ general harm: 0.39 95% CI: 0.30; 0.47 and BMQ general overuse: 0.28 95% CI: 0.20; 0.35). Patients having high confidence in the health-care system showed less concern (-0.16 95% CI: -0.27; -0.06). This study showed that for all three drug categories investigated, the patients who experienced a generic switch did not have more concerns about their index medicine than patients who did not switch.

2906 – Relationship of job-related stress to the big five personality factors among personnel in shaid beheshti hospitalin yasuj, iran

Introduction and aim Job-related stress is considered a main factor to cause illness resulting in increaseing nurses’ absence from work. This study investigated the relationship of job-related stress in nursing career to the big five personality factors in personnel in Shahid Beheshti hospital in Yasuj, Iran. Methodology A correlative study was conducted with statistical population of all nursing personnel in Shahid Beheshti hospital in Yasuj. 83 nurses working in the hospital were randomly selected to form the statistical sample. Findings Results revealed no significant positive link between Neo personality traits and job-related stress, death-related stress, conflict with doctors, problems with colleagues, problems with supervisors, amount of work, lack of confidence in treatments, patient and their families -related stress and discrimination-related stress whereas a significant positive relationship between the lack of adequately emotional intelligence and neuroticism- two neo personality factors- (P = 018 and R = 259)was observed. Results of regression analysis indicated that neuroticism could only predict one of the job-related stress (i.e. lack of adequately emotional intelligence) (β = 259). This variable explained only 0.05% variance of nurses’ job-related stress. Also, no prediction could be made by considering factors such as introversion-extroversion, openness, dutifulness as associated with job-related stress in nurses while agreeability could affect the prediction of problems with colleagues-related stress(β = 364),which determined 12% of total variance. Conclusion Results have shown that nurses’ score is at the higher level than mean regarding stress related to lack of confidence in treatments, which can be mitigated through workshops and scheduled and applicable training programs.

Recruitment to personality disorder treatment trials

PurposeRandomised controlled trial (RCT) methodology is viewed as the gold standard in evaluating the impact of interventions. Recruitment problems present one threat to the validity of RCTs, yet the barriers to recruitment are poorly understood. The purpose of this study is to identify obstacles to recruitment in a personality disorder (PD) treatment trial, with a view to suggesting ways of overcoming these obstacles.Design/methodology/approachA discussion group of 13 staff involved in the trial was held to identify barriers to recruitment. The information was subject to thematic analysis.FindingsEight themes were identified, and three overarching themes: reluctance to diagnose and preference for treating symptoms; increasing the burden and jeopardising other services; and lack of confidence in treatment and in treatment as usual.Practical implicationsSuggestions for minimising recruitment obstacles include careful site selection and protocol negotiation; education and training about PD; continued promotion of both research in general and the specific trial; and assurances about good research practice.Originality/valueRecruitment is a common problem in RCTs, and the paper addresses this issue, not only in identifying obstacles to recruitment but also in offering suggestions to other trialists for minimising the obstacles.

Operational barriers to the implementation of multidrug therapy and leprosy elimination in cameroon

The World Health Organization targeted to eliminate leprosy from the world with multidrug therapy (MDT) by 2000. But, leprosy remains a problem in Essimbiland of Menchum Division of Cameroon, with a prevalence of 1.7/10,000 and high rate of case detection in children. To assess knowledge and practices on the cure of leprosy, treatment duration, drug availability and problems faced by leprosy patients acquiring drugs in order to enhance MDT implementation and leprosy elimination in Menchum and Boyo divisions. Observational study in which a structured questionnaire was administered to leprosy patients, their contacts and a control group. 480 respondents were interviewed and 405 (84.8%) (95% confidence interval [CI]: 81.6-87.2%) knew that leprosy can be cured. These respondents comprised 166 (92.2%) of 180 contacts, 129 (93.5%) of 138 patients and 110 (67.9%) of 162 controls. Two hundred and fourteen (44.6%) (95% CI: 40.1-48.9%) respondents knew that leprosy treatment is free, comprising of 110 (51.4%) patients, 99 (46.3%) contacts and five (2.3%) controls. A statistically significant difference in the knowledge on free treatment of leprosy was found to exist between leprosy patients, contacts and controls, with leprosy patients having a better knowledge (79.71%) (95% CI: 73-86.42%), followed by contacts (55.0%) (95% CI: 47.73-62.26%) and controls (3.1%) (95% CI: 0.43-5.77%) (P = 0.00). Pertinent problems faced by patients in getting MDT included distant health facilities and poor road network (91[19.0%]), lack of confidence in treatment (56 [11.7%]), MDT shortage (45 [9.4%]), few health facilities (52 [10.8%]), gratification demands (25 [5.2%]), disturbance from other illnesses (24 [5.0]), ignorance (21 [4.4%]) and poor relationship with nurses (24 [5.0%]). Patients still face problems in getting free MDT. Better MDT implementation and leprosy elimination strategies are proposed.

Barriers to prompt and effective treatment of malaria in northern Sri Lanka.

For the past 18 years, northern Sri Lanka has been affected by armed ethnic conflict. This has had a heavy impact on displacement of civilians, health delivery services, number of health professionals in the area and infrastructure. The north of Sri Lanka has a severe malaria burden, with less than 5% of the national population suffering 34% of reported cases. Health care providers investigated treatment-seeking behaviour and levels of treatment failure believed to be the result of lack of adherence to treatment. Pre- and post-treatment interviews with patients seeking treatment in the outpatient department (OPD) and focus groups. A total of 271 persons completed interviews: 54.4% sought treatment within 2 days of the onset of symptoms, and 91.9% self-treated with drugs with prior to seeking treatment, mainly with paracetamol. Self-treatment was associated with delaying treatment (RR 3.55, CI 1.23-10.24, P=0.002). In post-treatment interviews, self-reported default was 26.1%. The main reasons for not taking the entire regimen were side-effects (57.6%) and disappearance of symptoms (16.7%). Focus groups indicated some lack of confidence in chloroquine treatment and prophylaxis, and scant enthusiasm for prevention methods. A number of factors contribute to a lack of access and a lower quality of care for malaria: lack of medical staff and facilities because of the fighting; lack of confidence in treatment, and perception of malaria as a routine illness. Prevention efforts need to take into account certain beliefs and practices to be successful.