Health Care Research Articles

A CASE STUDY- AN AYURVEDA APPROACH ON POLYCYSTIC OVARIAN SYNDROME

A woman is the best and most precious creation of God. Women’s bodies undergo significant changes through-out their lives, leading to differences in health concerns for varying age groups. The reproductive cycle signifi-cantly affects in every stage of a woman’s life during the transition from a girl to a woman and a woman to a mother. PCOS is the most challenging lifestyle disorder that can affect women’s Multiple system and require a comprehensive perspective on health care for effective treatment. Metabolic derangement and associated com-plications include insulin resistance and diabetes, hyperlipidemia, fatty liver, hypertension, and sleep apnoea. Reproductive complications include oligomenorrhoea /amenorrhea, sub-fertility, endometrial hyperplasia, and cancer. Associate psychological concerns include depression and disordered eating. Additionally, cosmetic is-sues are hirsutism, androgenic alopecia, and acne. This particular feminine disorder is not described word for word in Ayurveda. Ayurveda literature is under the broad heading of Yoni vyapad, Artava dustya, and Artava kshaya. Analyzing the signs and symptoms of diseases, it can be assumed that vitiated Kapha causes Sroto-rodha (blockage of channels), resulting in Vata vaigunya. Agneya property of pitta depleted. Here is a case re-port of 25 a 25-year-old female patient who presented with irregular menstruation, rapid weight gain, and de-pression. On Ultrasonography, she has detected a bilateral polycystic ovary. Depending upon the clinical fea-tures, the patient was given Aampachan. Vatanuloman, Kaphavata hara, Medohara, and Artavajanana proper-ties of medicines and yoga. After almost three and half months of internal medicine, symptoms reduced marked-ly, and menstruation was normal.

An Assessment of Provider Payment Mechanisms (PPMs) in Ethiopia: Implications for Redesign of PPMs and Progress Toward Universal Health Coverage

ABSTRACT Ethiopia has made great strides in improving population health but sustaining health system and population health improvements in the current fiscal environment is challenging. Provider payment, as a function of purchasing, is a tool to use limited health resources better. This study describes the design and implementation of Ethiopia’s provider payment mechanisms (PPMs) and how they influence health system objectives and contribute to universal health coverage goals. The research team adapted the framework and analytical tools of the Joint Learning Network for Universal Health Coverage guide for assessing PPMs. Data were collected through literature review and key informant interviews with 11 purchasers and 17 health care providers. Content analysis was used to describe PPM design and implementation arrangements, and thematic analysis was used to distill effects on equity in resource distribution and access to care, efficiency, quality of care, and financial sustainability. The study revealed the PPMs had positive and negative consequences. Line-item budgets were perceived to be predictable and sustainable but had little effect on efficiency and provider performance. Fee-for-service was perceived to have negative effects on efficiency and financial sustainability but viewed positively on its ability to incentivize quality health services. Capitation and performance-based financing effects were viewed positively on equity in distribution of resources and quality respectively, but both were perceived negatively on their high administrative burden to providers. Ethiopia may consider a more nuanced approach to design blended provider payment to mitigate negative consequences while providing incentives for better quality of care and efficiency.

The U.S. Health Care: A Silhouette in the 2024 Presidential Campaign

Election cycles, especially presidential ones, are rarely held in the United States in a discreet manner and without a unique character that reflects the general political situation in the country and the world as a whole. At the turn of the 20th-21st centuries, they have always been special, always featuring extraordinary elements of spectacle and a certain drama. Scientific integrity requires noting that the 2022 midterm elections were also called “extremely unusual” in the media, which corresponds to reality, the nature and outline of which, in its many forms, change over time: “here and now” is necessarily different from “there” and “yesterday". The electorate is changing, problems and tasks are evolving, and the colors of life, at the very least, are acquiring different shades and accents, altering general characteristics. The political system's relatively constant concern is maintaining the viability and stability of the state structure and social order. Health care topics seem not only urgently relevant, but also attractive from the perspective of electoral spectacle. The combination of health concerns and key interest groups can emerge in critical states and significantly impact the course of the election.

Developing a Green Nursing Practice in a Profession That Contributes to Climate Change: One Nurse's Journey.

The health care industry accounts for 5% of global greenhouse gas emissions, with hospitals being the largest contributor. Critical care units create 3 times the greenhouse emissions of other hospital patient care units. Health care contributions to environmental harm include medical waste disposal, toxicant exposure, and pollutants. Integrating green practices into hospitals, especially in intensive care units, can seem overwhelming, with barriers including time constraints, lack of leadership and organizational support, and ignorance of green practices. Nursing is a socially responsible discipline committed to improving the health of individuals and communities; values of environmental stewardship and the desire to minimize poor health outcomes caused by climate change do not always align with hospital policies or clinician practices. This article addresses how nurses can confront the complex environmental problems in the workplace, apply sustainability principles to develop a green nursing practice, and collectively influence the future of national and global health.

Climate Change: Time for Hospitals to Respond.

Alarm bells are sounding internationally as climate change impacts planet Earth and its inhabitants. Health care organizations must consider the role they play in working toward environmental sustainability in terms of mitigation, resilience, leadership, and equity. Institutions need to address the effects of climate change on the physical health and mental well-being of patients and their families as well as employees. Awareness of the complexities of sustainability initiatives and disaster management related to inclement weather and weather-related events is critical for health care organizations to avoid precipitating the illnesses and diseases they endeavor to prevent and heal.

Climate Change and Emerging Infectious Diseases: A Precarious Relationship.

Climate change is apparent. Temperatures are rising. Floods are more frequent and devastating. Climate changes can favor the development of emerging infectious diseases. The number of animal reservoirs and vector hosts can increase, further spreading pathogens. Many emerging infectious diseases were not historically considered major threats in US but have become a major concern in US territories and various states. In June 2024, the Centers for Disease Control and Prevention issued a Health Alert Network advisory about an increase in local transmission of dengue fever. Preventing the transmission of emerging infectious diseases has become a focus of regulatory agencies. Nurse education at all levels should include infectious diseases and be coordinated with local, state, and regional institutions. Emerging infectious diseases are now formidable challenges to health care.

Impact of multi-modal learning workshop on awareness and knowledge of health care providers about waste management in India

Hospital waste management is crucial in preventing needle stick injuries and exposure to hazards. Adequate knowledge, appropriate safety measure, and methods of handling the wastes are more important in waste management. : The objective of this project is to study the impact of multi-modal training workshops in improving the knowledge and awareness on biomedical waste management among healthcare workers.An eight-hour onsite training workshop was conducted in Ahmedabad, Kolkata, Indore, and Hyderabad from July to September 2023. A validated pre and post-test questionnaire was used to assess the impact of the workshop. At the end of each workshop, responses were analyzed to study the effectiveness of the workshop and to do a gap analysis on the areas that require strategic learning. Analysis was conducted on data aggregated using the Chi-square test.In the above analysis, the pre-test scoring of these participants was 66%. After the workshop, the post-test scoring was 83% with a significant improvement (p < 0.0001). The pre-test and post-test scores in individual regions were 63% and 78% at Ahmedabad, 71% and 86% at Kolkata, 60% and 86% at Indore, and 68% and 83% at Hyderabad respectively.In healthcare facilities, training plays a key role in preventing health hazards for both employees and patients. Training must involve different types of learning methods tailored to the needs and capability of understanding of the participants. The effectiveness of training must be measured using appropriate tools to study the impact of the learning methods.

The health and medical care of people without regular health insurance

The health and medical care of people without regular health insurance

Peripheral Arterial Disease And Diabetes In Canada: Is Health Care Really Equitable?

Canada’s health-care system was historically grounded in equality and access. However, eight decades after its conceptual origins, health care in Canada is not meeting its original principles of equitable access to quality care for all. This is especially true regarding certain populations including marginalized and indigenous groups. Additionally, certain diseases, such as peripheral arterial disease (PAD) and diabetes are highly associated with this lack of access to just and equitable healthcare. These disparities have resulted in poor outcomes for many who suffer from these complex chronic conditions. This article examines the realities of certain Canadian populations with PAD and diabetes in the 21st century, their outcomes and some strategies to bring Canada back to our original health-care principles for all Canadians, not just the few.

Reliability and validity of the Turkish version of the mental health professionals stigma scale for occupational stress and burnout

ABSTRACT The research was conducted to adapt the Mental Health Professionals Stigma Scale for Occupational Stress and Burnout to Turkish culture and make its validity and reliability. This methodological research was conducted in six different tertiary care hospitals and one state hospital. The research sample consisted of n = 188 mental health professionals (psychiatrists, nurses, psychiatric nurses, psychologists, social workers/experts, occupational therapists), and test-re-test analysis was carried out among 30 professionals. Exploratory factor analysis indicated a three-factor structure with 12 items, accounting for 51.65% of the variation. RMSEA, SRMR, GFI, and χ2/df, which explain the fit indices of the 12-item and 3-factor structure of the scale, were all at an acceptable range. Regarding reliability analysis, the scale was determined to be reliable based on the α coefficient. The research identified that the Turkish version of the scale is a valid and reliable tool for the evaluation of stigmatizing attitudes and beliefs regarding occupational stress and burnout among mental health professionals. It is thought that it will contribute to developing help-seeking and mental health interventions among mental health professionals.

A systematic review of training for mainstream mental health professionals working with people with intellectual disabilities and mental health needs

Purpose Policy in the UK and many other countries states that mainstream mental health services should be accessible to people with intellectual disabilities (ID). The purpose of this paper is to systematically review training and development needs assessments and delivered training and development for professionals working in mainstream mental health services who may work with people with IQ. Design/methodology/approach A systematic search of four databases (Web of Science; PsychInfo; PubMed; CINAHL) over the period of 2011–2023 was used. Papers were included if they described training or development delivered to, or specific training or development needs analyses of, mainstream qualified staff to support working with adults who have an ID. Findings Two papers were found that described training and development initiatives and six that described training and development needs analysis, five of these papers originated from Australia and were part of the development of a comprehensive workforce competency framework. Research limitations/implications Training and development approaches for mainstream mental health services to facilitate the support of people with IQ should be systematically developed and trialled. Originality/value To the best of the authors’ knowledge, this is the first study to review training and training needs analysis in this area since 2012. The review finds only a small number of papers in what is an important area for service development.

Service and Treatment Factors as Predictors of Satisfaction with Mental Health Services Among Service Users with Psychosis.

Satisfaction with services among service users is an important aspect of quality in mental health care. This prospective study investigated associations between service and treatment factors at baseline and satisfaction with services at 18-month follow-up among service users with psychosis in specialist mental health services. Data were collected from 119 service users with psychosis and their clinicians from 26 clinical sites across Norway at baseline and after 18 months. Satisfaction with services was measured using the Client Satisfaction Questionnaire-8 (CSQ-8). Linear mixed models with random intercepts for units were estimated to test the association between service- and treatment-related predictors and the CSQ-8. Participating in the Individual Placement and Support program or other interventions to promote work or study, receiving well-coordinated services, and receiving helpful assistance from a general practitioner at baseline were positively associated with satisfaction with services at 18-month follow-up. The present results suggest that receiving integrated and well-coordinated services and targeting the goal of facilitating employment and study opportunities is important for satisfaction with services among service users with psychosis.

EPA guidance on lifestyle interventions for adults with severe mental illness: A meta-review of the evidence.

There is growing interest in lifestyle interventions as stand-alone and add-on therapies in mental health care due to their potential benefits for both physical and mental health outcomes. We evaluated lifestyle interventions focusing on physical activity, diet, and sleep in adults with severe mental illness (SMI) and the evidence for their effectiveness. To this end, we conducted a meta-review and searched major electronic databases for articles published prior to 09/2022 and updated our search in 03/2024. We identified 89 relevant systematic reviews and assessed their quality using the SIGN checklist. Based on the findings of our meta-review and on clinical expertise of the authors, we formulated seven recommendations. In brief, evidence supports the application of lifestyle interventions that combine behavioural change techniques, dietary modification, and physical activity to reduce weight and improve cardiovascular health parameters in adults with SMI. Furthermore, physical activity should be used as an adjunct treatment to improve mental health in adults with SMI, including psychotic symptoms and cognition in adults with schizophrenia or depressive symptoms in adults with major depression. To ameliorate sleep quality, cognitive behavioural informed interventions can be considered. Additionally, we provide an overview of key gaps in the current literature. Future studies should integrate both mental and physical health outcomes to reflect the multi-faceted benefits of lifestyle interventions. Moreover, our meta-review highlighted a relative dearth of evidence relating to interventions in adults with bipolar disorder and to nutritional and sleep interventions. Future research could help establish lifestyle interventions as a core component of mental health care.

Care of the Transgender Surgical Client: A Video Simulation for Baccalaureate Nursing Students.

Nursing curriculum lacks content addressing care of transgender (trans) individuals. Gender diversity in health care education must be enhanced to prevent discrimination and systemic biases. A shared session between pediatric and medical-surgical courses using an interactive video simulation facilitated student preparation to provide inclusive care for trans surgical clients. Considerations for recruiting a cisgender person vs. a trans person to portray the female-to-male trans client are discussed. Script development and filming of the three videos, including the expected student preparation and the interactive classroom session, is examined. The observed experiences of the student participants and their reactions to the session are described. Discrimination and systemic biases can be minimized when nursing students are exposed to curricula that address the needs of marginalized populations. Use of video simulation in the classroom setting should be considered a valid teaching strategy for more topics in nursing and general health care curriculum. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Factors influencing community intensive care unit research participation: a qualitative descriptive study.

Community hospitals account for 90% of hospitals in Canada, but clinical research is mainly conducted in academic hospitals. Increasing community hospital research participation can improve generalizability of study results, while alsoaccelerating study recruitment and increasing staff engagement. We aimed to identify and describe the factors that influence community intensive care unit (ICU) research participation and the development, implementation, and sustainability of a community ICU research program. We conducted a qualitative descriptive study using semistructured interviews. Between April 2022 and May 2023, we interviewed a purposeful sample of individuals interested or involved in community hospital research in Canadian community ICUs. We analyzed qualitative data using both conventional content analysis and rapid qualitative analysis. Findings were deductively mapped out using the Ecological Model of Health Behavior. Quantitative survey data were analyzed using descriptive statistics. Participants included 23 health care workers, ten research staff, and five hospital administrators (n = 38) from 20 community hospitals across six provinces in Canada. The main factors associated with community ICU research participation were 1) infrastructure, 2) personnel characteristics, 3) key relationships and connections, and 4) the COVID-19 pandemic. In this qualitative descriptive study, participants identified the physical resources, skills, and relationships required to start and sustain a clinical research program in a Canadian community ICU. Our findings suggest that all levels of the Canadian health care system need to invest in strengthening community hospital research capacity to increase research participation.

Work Systems Analysis of Emergency Nurse Patient Flow Management Using the Systems Engineering Initiative for Patient Safety Model: Applying Findings From a Grounded Theory Study.

Emergency nurses actively manage the flow of patients through emergency departments. Patient flow management is complex, cognitively demanding work that shapes the timeliness, efficiency, and safety of patient care. Research exploring nursing patient flow management is limited. A comprehensive analysis of emergency nursing work systems is needed to improve patient flow work processes. The aim of this paper is to describe the work system factors that impact emergency nurse patient flow management using the System Engineering Initiative for Patient Safety model. This study used grounded theory methodologies. Data were collected through multiple rounds of focus groups and interviews with 27 emergency nurse participants and 64 hours of participant observation across 4 emergency departments between August 2022 and February 2023. Data were analyzed using coding, constant comparative analysis, and memo-writing. Emergent themes were organized according to the first component of the System Engineering Initiative for Patient Safety model, the work system. Patient flow management is impacted by diverse factors, including personal nursing characteristics; tools and technology; external factors; and the emergency department's physical and socio-organizational environment. Participants raised concerns about the available technology's functionality, usability, and accessibility; departmental capacity and layout; resource levels across the health care system; and interdepartmental teamwork. Other noteworthy findings include obscurity and variability across departments' staff roles titles, functions, and norms; the degree of provider involvement in patient flow management decisions; and management's enforcement of timing metrics. There are significant barriers to the work of emergency patient flow management. More research is needed to measure the impact of these human factors on patient flow outcomes. Collaboration between health care administrators, human factors engineers, and nurses is needed to improve emergency nurse work systems.

Designing recovery-oriented care: a qualitative study to inform service design at Kyrie Therapeutic Farm in Ireland.

Recovery-oriented approaches are gaining increased attention in the mental health sector, including from the World Health Organization and the United Nations, for their potential to support people in recovering and building meaningful lives through strengths-based, person-centered principles. Kyrie Therapeutic Farm (KTF) is a new initiative in Ireland that seeks to develop recovery-oriented model of adult mental health care. The aim of this study was to explore the barriers and facilitators of recovery-oriented models of practice in a small number of therapeutic farm settings across the world in order to inform service design at KTF whilst also addressing a gap in research on this topic. Three semi-structured focus-group interviews were conducted online via MS Teams with ten staff members in different roles and years of experience from three existing therapeutic community farms. reflexive thematic analysis was employed for data analysis. Four themes emerged that illustrate how therapeutic farm communities operate in general and specifically in relation to recovery: 1. common humanity, 2. freedom and responsibility, 3. interdependence and community living, and 4. learning organisations. This study demonstrates the viability of recovery-oriented practices in community therapeutic farms, including KTF, thereby contributing to the broader trend toward more person-centered mental health services. The values inherent in the recovery-oriented approach - such as community, empowerment, and close, equitable, non-hierarchical relationships - act as facilitators. However, embedding these values in practice can generate tensions for staff which warrant attention. Implications for the integration into service design of KTF and further research are offered.

Our Unrealized Imperative: Integrating Mental Health Care into Hospice and Palliative Care.

The field of Hospice and Palliative Medicine (HPM) has its roots in the principles, promulgated by Dame Cicely Saunders, that patient and family are the unit of care and that comprehensive integration of physical, psychological, social, and spiritual care is necessary to address suffering in all its dimensions. Although we aspire to provide comprehensive care for our patients, most hospice and palliative care (HPM) physicians lack basic competencies for identifying and managing patients with psychological distress and mental health distress and disorders, a growing segment of our clinical population. In this article, I argue that we are not living up to the founding values of our field in how we practice, how we educate our trainees, our research, and in how we pursue our own professional development as faculty. The history of our field, the nature of our clinical workforce, the culture of PC, and our educational programs all contribute to our current practice model, which is not adequate to meet the mental health needs of our patients. I propose strategies to address these challenges focused on enhancing integration between psychiatry/psychology and HPM, changes in fellowship education and faculty development, addressing the stigma against people with mental health diagnoses, and addressing system and cultural challenges that limit our ability to provide the kind of comprehensive, integrative care that our field aspires to.

Breakthrough cancer pain management: mixed-methods study of health care professionals

ObjectivesKnowledge gaps in defining, diagnosing, educating health practitioners and treatment options hinder breakthrough cancer pain (BtCP) management. A systematic review revealed a lack of clarity on health professional derived definitions,...

Unusual urinary discoloration: A case report of blue urine in a patient with advanced Prostate cancer

Here, we present a case of blue urine in an 89 -year-old male with advanced prostate cancer and difficult to control hypertension as well as comorbid type II diabetes mellitus (T2DM), hyperlipidemia and chronic urinary retention. The patient was newly diagnosed with COVID-19 and returned to our hospital after 30 days of first admission, this time in respiratory failure. Administration of Urogesic-Blue (methenamine, sodium phosphate, methylene blue and hyoscyamine) can cause this discolorization due to its content in part of methelyene blue as evidenced by the presence after analysis. These cases emphasize the importance of being aware that this is a potential harmless side effect to avoid unnecessary diagnostic procedures. Prostate Cancer, especially when it comes with bone metastasis, increases complexity and difficulty in managing the patient. Comorbidity in the patient and attendant polypharmacy made treatment planning difficult, given that one had to be very cautious about drug-drug interactions so as not only manage mental health effectively but also treat actively existing medical conditions. The situation escalated following the recent COVID-19 infection, which required hospitalization for final comprehensive monitoring and supportive care. High levels of proBNP suggest that the heart was under some stress, probably further increased by the presence of a virus making this case complex and certainly multidisciplinary. This case informs the need for a complete medication history and patient counseling in cases of strange clinical presentations. Recognition of Urogesic-Blue as the agent in bluish urine permits health care providers to reassure patients and avoid unnecessary diagnostic work-ups. This report gives an insight into avoidable handling of intricate past medical history and multi-morbidity and adds knowledge on the bedside approach regarding blue urine. Keywords:Blue Urine, Prostate Cancer, Methylene Blue, Urogesic-Blue, COVID-19 Complications