Medical Experience Research Articles

Sense of failure in end of life care: Perspectives from physicians and nurses

Limited knowledge exists regarding sensed failure resulting provision of end-of-life (EOL) care. Among medical health professionals (MHP), a sense of failure is associated with impaired patientcare and reduced worker wellbeing, including higher rates of burnout and secondary traumatic stress. As part of a larger mixed-methods study on the effects of EOL-care provision on MHP in general hospitals, semi-structured in-depth interviews were conducted with 22 physicians and nurses at three tertiary Israeli hospitals, representing a wide range of medical specialties, training, experience, and cultural backgrounds. Qualitative thematic analysis of the interviews led to the identification of the theme ‘sense of failure’ with the sub-themes ‘sources’ and ‘lived meanings’ of the sensed failure. Apart from the source ‘losing a patient’ all other identified sources were recognized as work-related risk factors, including ‘unsupportive environments’ and ‘shortcomings of the medical practice.’ Two of the lived meaning ‘sense of personal responsibility’ and ‘moral injury’ were also recognized as work-related risk factors. Surprisingly, albeit the adverse context of EOL-care, the two remaining lived meanings ‘learning from failure’ and ‘sense of purpose’ were recognized as protective resilience factors. Changes in workplace norms by focusing on leadership and mentoring programs and implementation of evidence based interventions aimed at reducing the sense of failure and enhancing feelings of purpose are recommended. Finally, the findings described in the study would benefit from continued studies on larger scales.

Enhancing learning in physical therapy education through simulated patients: A meta-analysis

As hands-on instruction gives pupils the chance to apply the information and skills they gain while attending school to a real-world clinical setting, it may be beneficial for those participating in beginning employees physical therapy (PT) education programmes. Experiential learning is presently used in all entry-level PT programs in the form of clinical experiences; however, it has the potential to be included across the curriculum to improve student engagement as well as the application and retention of learned information. The objective of this article is to argue that there should be a greater emphasis placed on hands-on experience in physical therapy (PT) education programs that are designed for new graduates. Simulators, integrating medical experiences, volunteer work, public customer support organisations, and opportunities for professional growth are just a few of the various methods used in experiential education. The opportunity to put theoretical knowledge into practice in a setting free from criticism is very beneficial to students. Learning via experience may be especially helpful in subject preparation area when students have fewer opportunities to preparation their abilities since fewer possibilities are available. Students will be better prepared for the sort of meditative rehearsal that is necessary to make the changeover from learner to the skilled practitioner if they engage in the course of reflecting on their experiences, which is a typical activity that is conducted in combination with experiential learning.

The power of "it will be okay".

As caregivers for critically ill children and their families, there are moments when we find ourselves unsure of how best to offer support. The magnitude of the medical experience can cloud our communication with patients and their families. With years of counseling families through some of their most challenging and darkest hours, I aim to emphasize the profound impact of thoughtful and well-informed reassurance; how we can provide hope in hopeless situations.

The menace of severe adverse events and deaths associated with viral gene therapy and its potential solution.

Over the past decade, in vivo gene replacement therapy has significantly advanced, resulting in market approval of numerous therapeutics predominantly relying on adeno-associated viral vectors (AAV). While viral vectors have undeniably addressed several critical healthcare challenges, their clinical application has unveiled a range of limitations and safety concerns. This review highlights the emerging challenges in the field of gene therapy. At first, we discuss both the role of biological barriers in viral gene therapy with a focus on AAVs, and review current landscape of in vivo human gene therapy. We delineate advantages and disadvantages of AAVs as gene delivery vehicles, mostly from the safety perspective (hepatotoxicity, cardiotoxicity, neurotoxicity, inflammatory responses etc.), and outline the mechanisms of adverse events in response to AAV. Contribution of every aspect of AAV vectors (genomic structure, capsid proteins) and host responses to injected AAV is considered and substantiated by basic, translational and clinical studies. The updated evaluation of recent AAV clinical trials and current medical experience clearly shows the risks of AAVs that sometimes overshadow the hopes for curing a hereditary disease. At last, a set of established and new molecular and nanotechnology tools and approaches are provided as potential solutions for mitigating or eliminating side effects. The increasing number of severe adverse reactions and, sadly deaths, demands decisive actions to resolve the issue of immune responses and extremely high doses of viral vectors used for gene therapy. In response to these challenges, various strategies are under development, including approaches aimed at augmenting characteristics of viral vectors and others focused on creating secure and efficacious non-viral vectors. This comprehensive review offers an overarching perspective on the present state of gene therapy utilizing both viral and non-viral vectors.

How patients experience respect in healthcare: findings from a qualitative study among multicultural women living with HIV

BackgroundRespect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients’ views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians.MethodsWe analyzed 57 semi-structured interviews conducted at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant’s language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about “respect.” After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes.ResultsResults from this study grouped into two overarching classifications: respect manifested in physicians’ orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider’s orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy.ConclusionsFindings suggest a more robust conception of what ‘respect for persons’ entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery.

Expert recommendation on clinical diagnosis and treatment pathway of hydrochloric ear disease

In order to improve the awareness and understanding of hydropic ear disease, the Vertigo Committee of the Chinese Medical Education Association established an expert group and formed the expert recommendation on clinical diagnosis and treatment pathway of hydrochloric ear disease after repeated discussions, based on the existing medical evidence and clinical experience of experts. The article included the understanding process, characteristics, medical history collection and physical examination, diagnosis and clinical pathway of various treatment and rehabilitation methods in hydrochloric ear disease, aiming to promote standardized clinical work and research on hydropic ear disease.

Systemic Bevacizumab for Recurrent Respiratory Papillomatosis: A Single Institution's Experience.

Medical therapies to limit disease recurrence are critically needed for recurrent respiratory papillomatosis (RRP). Systemic bevacizumab is emerging as an exciting adjuvant therapy toward this end, but uptake has been poor due to the lack of experience and awareness of best prescribing practices. The objective of this study was to describe a single tertiary care academic medical center's experience using systemic bevacizumab for the treatment of RRP. A retrospective review was performed to identify patients with RRP on systemic bevacizumab. Demographic and clinical characteristics, findings on imaging reports, and disease response at all anatomic subsites involved in papilloma were documented. Of the 17 RRP patients on systemic bevacizumab, 9 (52.9%) were male, and 12 (70.6%) were diagnosed with juvenile-onset RRP. The total lifetime number of surgeries was high, with more than half (n = 9; 52.9%) undergoing more than 50 surgeries. Following induction of systemic bevacizumab, a significant reduction in patients with laryngeal (n = 15; 94.1% vs. n = 7; 41.2%, p < 0.001) and tracheal (n = 11; 64.7% vs. n = 5; 29.4%, p = 0.04) RRP was noted. Surgical frequency was significantly lower following systemic bevacizumab (2.5 vs. 0.5 surgeries per year; p < 0.001). The most common complications were new-onset hypertension (n = 4; 23.5%) and proteinuria (n = 5; 29.4%). Systemic bevacizumab is effective in reducing the number of surgeries needed for RRP while exhibiting a relatively safe complication profile. Papillomas in the larynx and trachea are most responsive to systemic bevacizumab, while pulmonary RRP is most likely to exhibit a partial-to-stable response. 4 Laryngoscope, 134:3253-3259, 2024.

Relationship between medication burden and medication experience in stable patients with schizophrenia: the mediating effect of medication belief

BackgroundIndividuals with schizophrenia require prolonged antipsychotic medication treatment. But more than 50% of individuals with schizophrenia experience adverse medication experiences during their antipsychotic treatments. Such individuals often adjust or discontinue medication, leading to disease relapse and impaired social functioning. Psychiatric nurses should pay close attention to the medication experiences of individuals with schizophrenia. This research explore the relationship between medication burden and medication experience, as well as the mediating effect of medication belief in stable patients with schizophrenia.MethodsA convenience sample of hospitalized stable patients with schizophrenia were selected from Daqing Third Hospital and Baiyupao Hospital from September 2023 to December 2023. A survey was conducted with them using a questionnaire consisting of general information questionnaire, The Subjective Well-being Under Neuroleptic Treatment Scale(SWN), The Living with Medicines Questionnaire(LMQ), Beliefs about Medicines Questionnaire-Specific (BMQ-Specific). Pearson correlation analysis was used to explore the correlation between LMQ, BMQ-Specific and SWN scores, and multiple linear regression analysis was used to explore the influencing factors of medication experience in patients with schizophrenia. AMOS 24.0 was used to construct the structural equation modeling(SEM), and the mediation effect of the SEM was tested using Bootstrap method.ResultsAccording to the sample size calculation requirements of structural equation model, a total of 300 samples were required in this study, and 400 effective questionnaires were actually collected in this study, which met the sample size requirements for constructing structural equation models. Bootstrap test showed that the mediation effect was significant. The total effect of medication burden on medication experience was significant (Z=-12.146, 95%CI (-0.577, -0.417), P < 0.001). The indirect effect of medication burden on medication experience, that is, the mediating effect of medication belief was significant (Z=-4.839, 95%CI (-0.217, -0.096), P < 0.001). The direct effect of medication burden on medication experience was significant (Z=-7.565, 95%CI (-0.437, -0.257), P < 0.001). This model belongs to partial mediation model.ConclusionsPsychiatric nurses can enhance the patients’ medication experience by reducing medication burden and strengthening medication beliefs. Therefore, the results also provide theoretical references and decision-making foundations for psychiatric nursing professionals to develop appropriate management strategies for individuals with schizophrenia.

Intercultural doctor-patient communication experiences of Indian women living in Singapore

Understanding intercultural medical communication ensures doctor-patient communication accommodates our cultural differences in medical encounters. While there is existing research that explores doctor-patient communication, further examination is needed to understand how intercultural communicative needs can lead to better medical encounters for the patients involved. This study focuses on intercultural medical communication experience of Indian women living in Singapore. Twenty-eight interviews were conducted with participants between the ages of 30 to 75. The transcripts were analyzed using the three steps of thematic analysis. The findings highlight communication differences in medical experiences, and lack of connectedness with providers. Our findings reiterate that individuals compare medical experiences based on one’s own cultural expectations and these expectations carry over into a different intercultural medical context. The articulations of challenges in communication demonstrate key ways culture plays a role in intercultural medical interaction as well as points toward an even greater need for communication accommodation. Thus, the findings suggest the significance and importance of communication accommodation at both interpersonal and intergroup levels in doctor-patient interaction, especially in an intercultural context.

Explaining Medical Students' Experiences of the Challenges of Clinical Education during the COVID-19 Pandemic: a Qualitative Content Analysis

Introduction: The conditions of the COVID-19 disease epidemic have had an undeniable role in the education of students, especially health students, including nurses, and it can potentially affect the clinical competence of these students as a workforce in the future. Therefore, the current study will be conducted to explain the medical students' experiences of the challenges they have experienced in their clinical education during this period.&#x0D; Method: The present qualitative study was conducted using the contractual content analysis method in 2023 in Saveh Medical Sciences Faculty. 17 students were selected purposefully and, the data were collected using in-depth semi-structured interviews and analyzed using Granheim and Lundman's approach.&#x0D; Results: Interviews with participants were conducted individually with 17 students during 3 months. The average duration of the interview was 30 minutes. The findings included one category (lost learning) and five subcategories (fear preventing learning, limitations of the educational system, confusion in interactions and communication, limited clinical learning, and discouragement towards educational conditions).&#x0D; Conclusion: Considering that it is impossible to teach in the hospital environment without encountering infectious diseases, it is necessary to prevent harm to the learning of students of various fields by formulating rules and guidelines. Also, the use of educational methods such as movies and animations, as well as other methods of virtual education, can help to improve the level of students' learning in cases where they can't be present at the patient's bedside.

Exploring the Value of Medical Affairs Learning Experiences for Pharmacy Students and Residents

The objective of this article is 3-fold: to strengthen the understanding of medical affairs (MA) among pharmacy professionals; to provide greater visibility into the value experienced by educators, learners, and the practice of pharmacy across the health care ecosystem when MA learning opportunities are available; and to provide a framework for organizations who seek to establish an MA experiential rotation. The authors collated information from published literature, anecdotal experience, and interviews with experiential education leaders from several colleges of pharmacy. As a result, the article summarizes the current perceptions of MA practice among educators and students and highlights how MA experiences may support pharmacy learners in the future.

Sociocultural factors affecting first-year medical students' adjustment to a PBL program at an African medical school.

Besides regulatory learning skills, learning also requires students to relate to their social context and negotiate it as they transition and adjust to medical training. As such, there is a need to consider and explore the role of social and cultural aspects in student learning, particularly in problem-based learning, where the learning paradigm differs from what most students have previously experienced. In this article, we report on the findings of a study exploring first-year medical students' experiences during the first semester of an undergraduate problem-based learning medical program at an African medical school. We employed a qualitative case study approach using in-depth interviews with 23 first-year medical students. Participants ranged in age from 18 to 25 years. All students were bi/multilingual (some spoke three to five languages), with English as the learning language. We conducted an inductive thematic analysis to systematically identify and analyze patterns in the data using the Braun and Clarke framework. Before medical school, students worked hard to compete for admission to medical school, were primarily taught using a teacher-centered approach, and preferred working alone. At the beginning of medical school, students found it challenging to understand the problem-based learning process, the role of the case, speaking and working effectively in a group, managing a heavy workload, and taking increased responsibility for their learning. By the end of the first semester, most students were handling the workload better, were more comfortable with their peers and facilitators, and appreciated the value of the problem-based learning approach. Our study highlights the importance of interrogating contextual sociocultural factors that could cause tension when implementing problem-based learning in non-western medical schools. Adjustment to problem-based learning requires a conceptual and pedagogic shift towards learner-centered practice, particularly concerning self-direction, the role of the case, and collaborative learning. As such, there is a need to develop and implement research-informed learning development programs that enable students to reflect on their sociocultural beliefs and practices, and enhance their regulatory learning competence to optimize meaningful and early engagement with the problem-based learning process.

Pedro de la Piñuela’s Bencao Bu and the Cultural Exchanges between China and the West

In the 16th and 17th centuries, Catholic missionaries in China adopted the strategy of cultural accommodation and engaged in extensive interactions with Chinese literati and the general population in order to integrate into Chinese society. They left numerous writings in the Chinese language, objectively promoting cultural exchanges between the East and the West. This article focuses on the pharmacological work Bencao Bu (本草補, Supplement to Chinese Materia Medica) by Spanish Franciscan Pedro de la Piñuela (石鐸琭, Shi Duolu, 1650–1704). The article argues that, in addition to questioning whether the works in Chinese left by missionaries have contributed to the progress of Chinese society in science, medicine, humanities and other aspects, we should also explore the process of encounter between two different cultures. Although Bencao Bu did not significantly advance Chinese medicine, la Piñuela incorporated elements of Chinese culture into the book and made an initial attempt to apply Chinese medical concepts in diagnosis and treatment. Furthermore, the book not only introduced certain Western scientific knowledge and pharmaceutical techniques but also could be considered the epitome of the global exchange of botanical knowledge and medical experiences, promoting mutual understanding between different parts of the world. This underscores the cultural significance beyond religious purposes found in Bencao Bu as well as other scientific and cultural works by missionaries during the Ming and Qing periods in China.

Understanding Experiences of Youth with Long COVID: A Qualitative Approach.

There is limited information on the specific impacts of Long COVID in youth. Long COVID presents as persisting or new symptoms following initial COVID-19 infection. The aim of this study was to better understand how children and their families describe their experiences seeking diagnosis and support following the onset of symptoms of Long COVID. Six children and five caregivers located in the United States participated in this study. Study procedures included an online video interview with caregiver-child dyads. Interview transcriptions were then analyzed using a conventional approach to content analysis, with two independent coders generating themes. Eight themes emerged from this analysis including the severity of illness and symptomatology, difficulty surrounding the diagnostic process and not being believed, the impact on family and social connections, poor school functioning, positive coping, subsequent positive medical experiences, mental health, and knowledge of the medical field and healthcare experience. Themes revealed difficulty for youth and families in navigating the medical system and functioning in areas of daily life as well as areas of positive experiences related to coping and medical involvement. These findings also highlighted areas of needed improvement for the medical community and for research on Long COVID in youth.

Competence or Experience

Competence or Experience

Enhancing dental and medical students’ self-regulated learning through multiple choice questions: An evaluative study using machine learning

This article reports a mixed methods study that uses machine learning and thematic analysis to investigate student evaluation of multiple-choice questions (MCQ). The focus is on medical and dental students' experience of self-regulated learning and motivation. We evaluate two systems developed at Aarhus University: "MED MCQ" used by medical students and "MCQ anatomy" used by dental students. We evaluate through two surveys in SurveyXact with responses from 126 medical students and 70 dental students. We use topic modelling over free text responses. The machine-learning model identifies two groups of students who, in different ways, both experience the system as motivating and facilitating their learning process. The students experience increased self-regulated learning by being able to choose the form of presentation of questions and answer questions independently of the instructor. The article discusses how educators and developers can use MCQs to promote student learning and how to analyze open-ended questions. We discuss the potential for using machine learning and integrating MCQ systems into teaching.

Age Differences in Experiences of Pandemic-Related Health and Economic Challenges Among Adults Aged 55 and Older.

The oldest adults faced the highest risk of death and hospitalization from coronavirus disease 2019 (COVID-19), but less is known about whether they also were the most likely to experience pandemic-related economic, healthcare, and mental health challenges. Guided by prior research on vulnerability versus resilience among older adults, the current study investigated age differences in economic hardship, delays in medical care, and mental health outcomes among adults aged 55 and older. Data were from the COVID-19 module and Leave Behind Questionnaire in the 2020 Health and Retirement Study (HRS). We estimated linear probability models to examine differences in experiences of pandemic-related economic and health challenges by age group (55-64, 65-74, 75+) with and without controls for preexisting sociodemographic, social program, health, and economic characteristics from the 2018 HRS. Models accounting for differential mortality also were estimated. Adults aged 65-74 and 75+ experienced fewer economic and mental health challenges and those aged 75+ were less likely to delay medical care than adults aged 55-64. Age gradients were consistent across a broad range of measures and were robust to including controls. For all age groups, economic challenges were less common than delays in medical care or experiences of loneliness, stress, or being emotionally overwhelmed. Even though the oldest adults were at the greatest risk of death and hospitalization from COVID-19, they experienced fewer secondary pandemic-related challenges. Future research should continue to explore the sources of this resilience for older adults.

Deprescribing statinsand other cardiovascular medications Barriers and facilitators

Considering the growing problematic of polypharmacy, this article summarizes barriers and facilitators to deprescribing cardiovascular medications, from the point of view of physicians and patients. Patients seem to be more open to discontinue cardiovascular medications when their physician suggests to do so, or if they dislike the medication. Physicians tend to consider deprescribing more if they had positive experiences with deprescribing in the past, or if their patients ask them to. The most common barrier for patients is the fear of health deterioration. Patient desire to continue with their usual medication or past negative experiences with depresecribing are frequently reported as barriers by physicians.

(184) The Prevalence of Sexual Dysfunction in Women Seeking Infertility Treatment in Vietnam

Abstract Introduction Sexual function plays a crucial role in women's psychosocial and overall well-being, significantly impacting their quality of life. Any decline in sexual function can have detrimental effects on the affected individuals' quality of life Objective (i) To describe the prevalence of sexual dysfunction in women seeking infertility treatment at the Andrology and Fertility Hospital of Hanoi, Viet Nam, and (ii) to analyze the factors associated with sexual dysfunction in the study population. Methods This was a cross-sectional descriptive study. All women (1.039) seeking infertility treatment at the Andrology and Fertility Hospital from December 30, 2022, to March 30, 2023 participate in the study. They were invited to scan a QR code and complete the research questionnaire. Female sexual dysfunction is assessed based on the FSFI scale included six domains: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain (comprising 19 questions). The data were extracted into Excel, cleaned, and analyzed using STATA 17.0 software. The analysis of factors associated with female sexual dysfunction was conducted using logistic regression models. Results Among the 1039 participants in the study, the mean age was 30.9±5.3 years. The overall score for female sexual dysfunction was 25.09 ± 6.20, with individual component scores. The prevalence of female sexual dysfunction was 49.7%. There is a positive correlation among the six components of female sexual dysfunction, p&amp;lt;0.01. In the multivariate regression model, the risk of female sexual dysfunction is higher among individuals who work away from home, have an underweight body mass index, have a poor relationship with their partner, have had no sexual intercourse in the past 4 weeks, experience fear of pain, anxiety, and body image concerns during sexual activity, have infrequent or no discussions with their partner regarding sexual desires, preferred positions, and stimulation, and are dissatisfied with their sexual life. Conclusions Half of the women seeking infertility in late-stage medical care experience sexual dysfunction. Factors that increase the risk of sexual dysfunction include having a job far from home, being underweight based on body mass index, having a poor overall relationship with a partner, not engaging in sexual activity in the past four weeks, fear of pain, anxiety, body image concerns during sexual intercourse, and limited or lack of communication with a partner about sexual issues such as desires, preferred positions, and stimulation. Additionally, dissatisfaction with one's sexual life contributes to the occurrence of sexual dysfunction. Therefore, early screening and timely intervention are necessary for this group of individuals. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Andrology and Fertility Hospital of Hanoi.

Health and medical experience of migrant workers: qualitative meta-synthesis

BackgroundMigrant workers in Korea are contributing to economic development by resolving labour shortages due to the increase in the ageing population, and they have become necessary and important in the Korean economy. However, long working hours, poor working conditions, and cultural differences can cause migrant workers to experience disadvantages in using health and medical services. Therefore, this study aimed to understand and analyse the health and medical service experience of migrant workers in Korea by reviewing previous studies in order to improve their health and access to medical services.MethodThe qualitative meta-synthesis method suggested by Thomas and Harden was used. The key question for searching the literature is ‘What is the status of the use of health and medical service by migrant workers in Korea and the attributes that affect them?' Five electronic databases (RISS, KCI, KISS, Science ON, and KMbase) were searched for Korean literature published in academic journals until 6 November 2022 using a combination of “migrant worker or foreign worker or foreign labourer or migrant” and “medical or health” in Korean.ResultsA total of nine studies out of 1,006 were included in the review after methodological quality assessment using the Critical Appraisal Skills Program (CASP). The results of studies were synthesised into three themes and ten sub-themes: ‘Personal factors’ of personal health beliefs and the financial burden of healthcare costs; ‘Cultural factors’ of cultural differences in the lifestyle, cultural differences in the healthcare environment, and traditional medicine in the country; and ‘Socio-institutional factors’ of poor and difficult working environment, insufficient information about medical institutions, policies with a lack of practical applicability, systems of healthcare institutions, and healthcare services usage.ConclusionsThis study identified the experiences of migrant workers in using health and medical care services. The results of this study can be used as a basis for improving the health of migrant workers and access to healthcare services. Based on the results of this study, it is necessary to improve the health management ability of migrant workers by developing a health management platform that can support Korean medical information and provide professional and accurate self-health management information.