Need For Individualized Care Research Articles

7635 Severe Osteoporosis in a Patient with Heterotopic Calcification: A Case Report

Abstract Disclosure: D. Salih Bacha: None. L.Z. Khan: None. Background: While osteoporosis and heterotopic ossification (HO) are distinct conditions affecting bone health, their coexistence poses intriguing clinical challenges. Osteoporosis, characterized by increased bone fragility, typically results from various factors such as aging, steroid use, or malabsorption. HO is a condition where bone forms abnormally in soft tissues. Risk factors that predispose to HO include male sex, spinal cord injury, trauma, surgery, and genetic factors. Treatment of HO is typically surgical resection and NSAIDs. Initial evidence supported the use of bisphosphonates for preventing ectopic bone formation post-trauma, but recent data failed to show significant benefit in HO prevention. This case presents a patient with unique challenges of both HO and bone fragility with multiple severe vertebral fractures. Case: A 44-year-old male patient had a major motor vehicle accident necessitating multiple recurrent abdominal surgeries. During one exploratory laparotomy, diffuse mesenteric calcifications were noted, indicative of HO. A baseline Dual X-ray Absorptiometry (DXA) scan revealed bone density of 1.003 g/cm2 and 0.788 g/cm2 at the spine and femoral neck, respectively, concerning for osteopenia. He was started on zoledronic acid in preparation for upcoming intestinal transplant. Few months after the transplant, he was started on daily tacrolimus and hydrocortisone for immunosuppression. Within months, he experienced sudden back pain while riding an elevator, and was found to have acute fractures in T8 and T9 vertebrae. A repeat DXA scan showed a further decline in bone density to 0.909 g/cm2 and 0.748 g/cm2 at the spine and femoral neck, respectively. Within a year, additional fractures occurred in the thoracic and lumbar spine (T10, T11, T12, L1, L2, L3, and L4), requiring multiple kyphoplasty interventions. Over time, worsening kyphosis, back pain, and height loss occurred, significantly affecting the patient's quality of life. He continued receiving yearly zoledronic acid infusions and underwent regular DXA scans, which revealed mild improvement in his bone density. Currently, there are no established guidelines specifying the optimal duration for bisphosphonate treatment in such cases. Therefore, our individualized treatment plan involves a tentative 10-year course of bisphosphonate treatment with yearly assessment of bone mineral density. Conclusion: Although the patient had some risk factors for osteoporosis, including daily steroid and tacrolimus use, the severity and frequency of his fractures suggested a potential synergy between osteoporosis and HO, where the formation of heterotopic calcifications may have been exacerbating his bone loss. The coexistence of osteoporosis and HO in this patient underscores the need for individualized care and establishment of treatment guidelines in patients with multiple bone disorders. Presentation: 6/3/2024

A diagnostic dilemma: distinguishing a sulfasalazine induced DRESS hypersensitivity syndrome from a CD30 + lymphoma in a young patient

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity reaction characterized by cutaneous rash, lymphadenopathy, fever, eosinophilia, leukocytosis, and life-threatening organ dysfunctions. We describe the case of a 26 year old patient admitted to the Emergency Department for DRESS syndrome after sulfasalazine treatment for rheumatoid arthritis in the right knee. Whole body computer tomography showed multiple neck, chest, and abdominal lymphadenopathy with splenomegaly, massive ascites and severe hepatic cytolysis. Serology results for Epstein-Barr Virus (EBV), influenza, measles, rubella, hepatitis A and B were negative. The histologic analysis of skin, lymph node and bone marrow biopsies could not indicate a classical Hodgkin’s Disease or iatrogenic immunodeficiency/EBV-associated lymphoproliferative disorder (LPD), Hodgkin type. The relatively small caliber of the CD30 + immunoreactive blastoid cells in the lymph nodes suggested reactive immunoblasts rather than Hodgkin cells. The morphologic aspects of the lymph node biopsies with predominance of T-cells were compatible with the diagnosis of a sulfasalazine-induced DRESS syndrome as the patient had a high RegiSCAR score for DRESS. [DRESS Syndrome Foundation: Diagnosis and Treatment. (2023)] The patient’s complex clinical course, marked by two hospital admissions, highlights the challenges in diagnosing and managing DRESS. This case underscores the need for individualized care, close patient monitoring, and further research to better understand DRESS’s underlying mechanisms and optimal therapeutic strategies.

Gastric Cancer: A Comprehensive Literature Review.

Gastric cancer stands as a significant global health concern, particularly prevalent in Eastern Asia, with high mortality rates urging urgent attention and research efforts. This article comprehensively explores the epidemiology, anatomy, risk factors, pathophysiology, clinical presentation, diagnosis, staging, treatment modalities, prevention strategies, and survival rates associated with gastric cancer. Notably, Helicobacter pylori infection, dietary choices, and intricate stomach anatomy play pivotal roles in disease development. Early detection, utilizing staging, grading, and genetic testing for personalized treatment approaches is emphasized. Treatment modalities encompass surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Prevention strategies involve lifestyle changes, screening, and genetic counseling. Survival rates vary by stage, highlighting the need for individualized care. In conclusion, a collaborative global effort is essential to address the impact of gastric cancer and improve outcomes.

Cerebral Autoregulation Assessment through Near-Infrared Spectroscopy and Arterial Monitoring: Advancements and Clinical Implications

Cerebral autoregulation, maintaining stable cerebral blood flow across varying arterial pressures, is vital in-patient care during surgery. Traditional views suggest a mean arterial pressure range of 50-150 mm Hg for effective autoregulation. However, patient-specific variations in autoregulatory patterns, particularly in cases of impaired autoregulation, call for personalized hemodynamic and blood pressure management during surgical procedures. In the evaluation of cerebral autoregulation, NIRS serves as a beneficial monitoring tool. The cerebral oximetry index, correlating cerebral oxygen saturation with perfusion pressure, aids in determining autoregulation limits. The literature shows varying impacts of vasoactive drugs on patients with different autoregulatory responses, emphasizing the need for individualized care. In summary, NIRS is crucial for monitoring cerebral autoregulation, and adjusting arterial blood pressure targets based on NIRS data could improve prevention of cerebral hyper/hypoperfusion. This approach, moving away from a generalized strategy, advocates for a more customized, physiology-based patient management.

Women's experiences and needs concerning care and support during the various phases of childbirth and the postnatal period: Analysis of free-text comments based on Quality from the Patient's Perspective in Sweden.

Positive birth experiences can be a decisive factor in the well-being and future health of both women and their newborns. The quality of care is a multidimensional concept influenced by the external structure of the organization, the administrative qualities of the environment, and the individual patient's preferences about care. The aim was to describe women's preferences and experiences concerning support and treatment, and their perception of quality of care during all phases of labor and the postnatal period. Free-text comments of 635 women from four different open comment questions were analyzed. A qualitative content analysis was conducted in two steps: an inductive phase followed by a deductive phase using the Quality of care from a Patient's Perspective framework (QPP). A total of 1148 free-text comments were coded; and 10 sub-categories were created and inserted under the QPP framework covering the latent meaning of the sub-category. Five of the sub-categories were sorted under the identity-oriented approach, four under physical-technical conditions, and one under the sociocultural atmosphere and reflected the women's experiences and needs regarding support and treatment during early labor, the active phase of labor, and the postnatal period. High-quality care and support are important aspects for women during childbirth, irrespective of the phase of labor or postnatal period. The need for individualized care, active participation in one's own birth and using a family centered approach were also emphasized. Organizational factors influenced the quality of care and were particularly noticeable during birth.

PEDIATRIC NURSING IN THE NEONATAL UTI: Systematic review of the literature

Introduction: The neonatal intensive care unit (NICU) is the place intended for the treatment of newborns, premature or full-term, who need specialized assistance due to clinical conditions. Objective: To identify the role of nurses in neonatal care during hospitalization in the NICU. Methodology: Scoping review based on the assumptions of the Joanna Briggs Institute review method. The guiding question was: "What scientific evidence shows the care practices for newborns in the Neonatal Intensive Care Unit? Searches were conducted in five national and international databases, on papers published until December 2022. Of the 5,803 studies found, 302 were selected for reading in full, resulting in a final sample of 08 studies analyzed. Results: The 08 publications analyzed were published from 2018 to 2023 nationally and internationally. Based on the title and abstract, 80 studies were evaluated and 18 studies followed by eligibility for full-text reading step. As for the type of study they were clinical trials, systematic review and scientific articles. This procedure was chosen for allowing the synthesis and analysis of the scientific knowledge already produced on nursing care in intensive care units for premature infants, highlighting some procedures that the health team should undertake, specifically on the care of premature infants in their recovery, due to their fragility and need for individualized care, since their hospitalization period will last months and the process is slow, therefore the importance of the recovery of this newborn extends to the family, where we will have even more success in reducing mortality. Conclusion: The nurse has a crucial role in caring for the newborn during hospitalization in the NICU, being able to approach and assist in building the maternal-infant bond. For this, good care practices are needed during birth, encouraging the approximation between mother and NB immediately after delivery, in skin-to-skin contact (kangaroo method).

Intradialytic Complications and its Associated Factors Among Chronic Kidney Disease Patients in a Tertiary hospital

IntroductionChronic kidney disease is a public health problem affecting millions of people worldwide. Hemodialysis is a life-saving renal replacement therapy for patients with chronic kidney disease(CKD), but it is not without risks. Intradialytic complications, which occur during hemodialysis sessions, can have a significant impact on patients' well-being, treatment outcomes, and overall quality of life. This article aims to identify the intradialytic complications and its associated factors in patients with chronic kidney disease undergoing hemodialysis in a tertiary hospital of eastern Nepal.MethodsAn observational cross-sectional study design was employed among 72 patients receiving hemodialysis treatment at Birat Medical College Teaching Hospital from 28 January to 20 May 2023. Total enumeration sampling technique with a structured questionnaire via interview and observation technique was used for data collection. Collected data was entered in Microsoft Excel sheet and transferred to SPSS version 17. Frequency, mean, range, and standard deviation was calculated. Chi square test was used to determine the association. P-value <0.05 was consideredstatistically significant.ResultsAll patients undergoing hemodialysis experienced at least one intradialytic complication. The most common complications reported were nausea/vomiting 59(81.9%) and chills/rigor 57(79.2%). Hypoglycemia was observed in 23.6% of patients, hyperglycemia in 12.5%, hypotension in 8.3%, and arrhythmia in 2 patients.ConclusionsIntradialytic complications are common among chronic kidney disease patients undergoing hemodialysis.The associations between age, dialysis frequency, preexisting diabetes, hypertension, and specific complications emphasize the need for individualized care and tailored interventions.

Distinct Phenotypes of Non-Citizen Kidney Transplant Recipients in the United States by Machine Learning Consensus Clustering.

Better understanding of the different phenotypes/subgroups of non-U.S. citizen kidney transplant recipients may help the transplant community to identify strategies that improve outcomes among non-U.S. citizen kidney transplant recipients. This study aimed to cluster non-U.S. citizen kidney transplant recipients using an unsupervised machine learning approach; Methods: We conducted a consensus cluster analysis based on recipient-, donor-, and transplant- related characteristics in non-U.S. citizen kidney transplant recipients in the United States from 2010 to 2019 in the OPTN/UNOS database using recipient, donor, and transplant-related characteristics. Each cluster's key characteristics were identified using the standardized mean difference. Post-transplant outcomes were compared among the clusters; Results: Consensus cluster analysis was performed in 11,300 non-U.S. citizen kidney transplant recipients and identified two distinct clusters best representing clinical characteristics. Cluster 1 patients were notable for young age, preemptive kidney transplant or dialysis duration of less than 1 year, working income, private insurance, non-hypertensive donors, and Hispanic living donors with a low number of HLA mismatch. In contrast, cluster 2 patients were characterized by non-ECD deceased donors with KDPI <85%. Consequently, cluster 1 patients had reduced cold ischemia time, lower proportion of machine-perfused kidneys, and lower incidence of delayed graft function after kidney transplant. Cluster 2 had higher 5-year death-censored graft failure (5.2% vs. 9.8%; p < 0.001), patient death (3.4% vs. 11.4%; p < 0.001), but similar one-year acute rejection (4.7% vs. 4.9%; p = 0.63), compared to cluster 1; Conclusions: Machine learning clustering approach successfully identified two clusters among non-U.S. citizen kidney transplant recipients with distinct phenotypes that were associated with different outcomes, including allograft loss and patient survival. These findings underscore the need for individualized care for non-U.S. citizen kidney transplant recipients.

Glycemic Control and its Associated Factors among Elderly Diabetic Patients in a Tertiary Hospital in Lagos, Nigeria

Background: Glycaemic control in the elderly diabetic patient is highly individualized and achieving desired targets in the presence of comorbid conditions could be very challenging. This study was conducted to assess the glycemic control of elderly diabetics and identify associated factors at the Lagos University Teaching Hospital (LUTH). Methods: A hospital-based, cross-sectional descriptive study involving 199 randomly selected elderly diabetic patients receiving care at LUTH. A pretested, interviewer-administered questionnaire was used in data collection, which include sociodemographic characteristics, clinical history, and glycaemic control. Glycemic control was assessed using glycated haemoglobin (HBA1C). HBA1C&lt;7.0% was tight; 7-8% targeted and &gt;8% poor glycaemic control. Associations between glycemic control and independent variables was assessed using the chi-square test and its predictors identified by logistic regression analysis. Level of significance was set at p&lt;0.05. Results: The mean age of the participants was 68.6 years ± 6.7 years. Tight and poor glycemic control was seen in 35.1% and 34.2% respectively. Significant associations existed between glycemic control, age (ꭓ2 =9.310; p – 0.010), and marital status (ꭓ2 = 9.934; p – 0.007). Independent predictors include &gt;2 antidiabetic medication (aOR – 2.55; p – 0.048) Conclusion: Poor glycaemic control was high among the elderly and there was a negative correlation between age and glycaemic control among the participants. Statistically significant association was also found between glycaemic control and marital status of the participants as well as the number of diabetic medications, the presence of co-morbid conditions and adherence to medications. The need for individualized care among elderly diabetics cannot be overemphasized in order to reduce the risk of hypoglycaemia, improve clinical outcome, while considering other factors which could have an impact on glycaemic control among the elderly.

How culture influences patient preferences for patient-centered care with their doctors

ABSTRACT Background: Patient-centered care (PCC) is the prevailing model of care globally. However, most research on PCC has been conducted in Westernized countries or has focused on only two facets of PCC: decision-making and information exchange. Our study examined how culture influences patients’ preferences for five facets of PCC, including communication, decision-making, empathy, individualized focus, and relationship. Methods: Participants (N = 2071) from Hong Kong, the Philippines, Australia, and the U.S.A. completed an online survey assessing their preferences for exchange of information, autonomy in decision-making, expression and validation of their emotions, focus on them as an individual, and the doctor-patient relationship. Results: Participants from all four countries had similar preferences for empathy and shared decision-making. For other facets of PCC, participants in the Philippines and Australia expressed somewhat similar preferences, as did those in the U.S.A. and Hong Kong, challenging East–West stereotypes. Participants in the Philippines placed greater value on relationships, whereas Australians valued more autonomy. Participants in Hong Kong more commonly preferred doctor-directed care, with less importance placed on the relationship. Responses from U.S.A. participants were surprising, as they ranked the need for individualized care and two-way flow of information as least important. Conclusions: Empathy, information exchange, and shared decision-making are values shared across countries, while preferences for how the information is shared, and the importance of the doctor-patient relationship differ.

Assessment and Management Tools for Advancing Disease.

As the population of the United States has aged, the number of home care patients with multiple chronic diseases has also increased. A review of the literature suggested that layering palliative care principles on traditional home healthcare could improve outcomes for patients with advancing disease. The purpose of this quality improvement project was to educate home care staff on the use of assessment and management tools to identify symptoms and provide symptom control, prevent unnecessary hospitalizations, and reduce healthcare costs in patients with advancing disease. This project took place at eight offices of a national home care agency in Kentucky and Indiana. Nurses, social workers, and therapists attended mandatory education sessions over 5 months on integrating palliative care principles into care planning for home care patients and using the Edmonton Symptom Assessment Scale (ESAS) and state-specific end-of-life planning tools. Symptoms were tracked and managed. A paired-samples t-test was used to analyze ESAS scores. Hospitalization and rehospitalization rates and costs were compared and benchmarked. Some symptoms worsened from beginning to end of the episode of care, suggesting a need for additional staff training about symptom management. The wide range of symptoms and symptom worsening suggest the need for individualized care, possibly extended home healthcare, and the inclusion of a more formal palliative care course for staff on symptom management.

The risk of venous thromboembolism in early pregnancy loss: Review of the literature and current guidelines and the need for guidance – Communication from the SSC on Women’s Health Issues for thrombosis and haemostasis

BackgroundThromboembolic disease is one of the major causes of mortality and morbidity in pregnancy and the puerperium, with 1 death per 100 000 births attributed to venous thromboembolism (VTE). Factors associated with development of thrombosis are all present in pregnancy, with some of these changes seen from conception. ObjectiveGiven how common early pregnancy loss is, the aim of this review is to evaluate the uncertainty surrounding the risk of VTE following early pregnancy loss and termination of pregnancy. MethodsA structured literature search was conducted to identify existing evidence as well as international pregnancy‐specific guidelines regarding assessment and prevention of VTE risk in pregnant women. This review was reviewed, critiqued, and approved by all members of the International Society on Thrombosis and Haemostasis subcommittee for Women's Health Issues in Thrombosis and Haemostasis. ResultsFour published original research studies, one clinical comment paper, and six guidelines were reviewed. Despite clear evidence of the increased risk of VTE in pregnancy, there is a lack of guidance regarding evaluation and management after early pregnancy loss. ConclusionInternational collaborative research to determine the risk of VTE and its prevention in women undergoing surgical termination of pregnancy or following surgical management of early pregnancy loss is urgently needed. Pregnancy‐specific risk assessment taking into account preexisting risk factors is advocated. Education of health care professionals involved in early pregnancy care and guidance on management, albeit based on limited existing evidence, are necessary to highlight the need for individualized care.

Evaluating Patient Preferences in Benign Prostatic Hyperplasia Treatment Using Conjoint Analysis

ObjectiveTo quantify benign prostatic hyperplasia (BPH) patient preferences to promote guidelines-compliant, patient-centered care. Discordance between patient and urologist priorities for the treatment of BPH hinders patient-centered care. Physician assumptions regarding patient preferences lead to dissatisfied patients; a poor outcome in any quality of life surgery. American Urologic Association guidelines urge urologists to consider patient preferences when recommending a BPH treatment. MethodsIn this cross-sectional, online survey study using researchmatch.org, participants were required to decide between theoretical BPH treatments in a balanced, choice-based conjoint analysis. The treatments had varying levels of four attributes: efficacy, recovery difficulty, risk of complications (Clavien-Dindo 2+), and risk of de novo ejaculatory dysfunction. Demographic information and International Prostate Symptom Score were collected and analyzed using comparative statistics. Each attribute was analyzed using a conditional logit model, and attribute importance (range in utility between attribute-levels) was calculated. ResultsOut of 1235 recruited participants, 812 (66%) completed the study. Median International Prostate Symptom Score and age was 6 (IQR 3-12) and 56 (IQR 38-67), respectively. Complication risk was the most important attribute, followed by efficacy, recovery difficulty, and risk of ejaculatory dysfunction. In a subgroup analysis of age quartiles, participants age <38 and >67 held efficacy (31%) and complication risk (47%) to the highest relative importance, respectively. ConclusionMales valued BPH treatments that minimize complication risks, while ejaculatory dysfunction was least impactful. Variation in results between age subgroups emphasizes the need for individualized care to maximize patient satisfaction.

Preferences for Gender Affirming Treatment and Associated Factors Among Transgender People in Sweden

IntroductionGender affirming surgery of primary and/or secondary sex characteristics has been shown to alleviate gender dysphoria. A descriptive snapshot of current treatment preferences is useful to understand the needs of the transgender population seeking health care. This study aimed to describe preferences for gender affirming treatment, and their correlates, among individuals seeking health care for gender dysphoria in Sweden after major national legislative reforms.MethodsCross-sectional study where transgender patients (n = 232) recruited from all six Gender Dysphoria centers in Sweden 2016–2019, answered a survey on treatment preferences and sociodemographic, health, and gender identity-related information during the same time-period. Factors associated with preferring top surgery (breast augmentation or mastectomy), genital surgery, and other surgery (e.g., facial surgery) were examined in univariable and multivariable regression analyses in the 197 people without prior such treatment. Main study outcomes were preferences for feminizing or masculinizing hormonal and surgical gender affirming treatment.ResultsThe proportion among birth assigned male and assigned female patients preferring top surgery was 55.6% and 88.7%, genital surgery 88.9% and 65.7%, and other surgery (e.g., facial surgery) 85.6% and 22.5%, respectively. Almost all participants (99.1%) wanted or had already received hormonal treatment and most (96.7%) wished for some kind of surgical treatment; 55.0% wanted both top and genital surgery. Preferring a binary pronoun (he/she) and factors indicating more severe gender incongruence were associated with a greater wish for surgical treatment. Participants with somatic comorbidities were less likely to want genital surgery, while aF with lacking social support were less likely to want internal genital surgery, in the multivariable analyses.ConclusionsIn this sample of Swedish young adults seeking health care for gender dysphoria, preferences for treatment options varied according to perceived gender identity.Policy ImplicationsThe study findings underline the need for individualized care and flexible gender affirming treatment options. The role of somatic comorbidities should be further explored, and support should be offered to transgender people in need. There is an unmet need for facial surgery among aM.

Race and ethnicity in pediatric OCD: An exploratory study of a clinical North American sample.

Influences of race and ethnicity have received limited attention in pediatric obsessive-compulsive disorder (OCD), despite noted importance in other psychiatric diseases. We sought to compare racially defined groups presenting to a North American tertiary care pediatric OCD subspecialty clinic. Clinician-rated and parent/child-reported information was extracted from a research data registry comprising OCD-affected youth assessed between 2011 and 2018. The study population was aggregated into racial groups, defined as Caucasian, Asian, and "other." Country of origin and spoken language were used as ethnicity proxies. Obsessivecompulsive disorder phenotype, clinical course, and family environment were compared, with inclusion of mixed Asian-Caucasians in post-hoc analyses. Asian youth reported significantly later ages of OCD symptom onset, clinical diagnosis, and treatment compared with Caucasian youth and were significantly less likely to have participated in OCD-specific treatment, despite similar clinician recommendation rates. Obsessivecompulsive disorder severity and comorbidities did not differ across groups. Asian parents reported significantly higher levels of family blame and conflict than Caucasian parents, but similar prevalence of OCD family history. Clinically relevant differences were identified between Asians and Caucasians, highlighting the need for individualized care that respects the influences of ethnicity and race in pediatric OCD. Replication and future study of additional racial groups is warranted.

Individualized care for patients with intersex (disorders/differences of sex development): part I

The care of individuals with disorders/differences of sex development aims to enable affected individuals and their families to have the best quality of life, particularly those born with severe genital ambiguity. Two of the biggest concerns for parents and health professionals are: (1) making a gender assignment and (2) the decisions of whether or not surgery is indicated, and if so, when is best for the patient and parents. These decisions, which can be overwhelming to families, are almost always made in the face of uncertainties. Such decisions must involve the parents, include multidisciplinary contributions, have an underlying principle of full disclosure, and respect familial, philosophical, and cultural values. Assignment as male or female is made with the realization that gender identity cannot be predicted with certainty. Because of the variability among those with the same diagnosis and complexity of phenotype-genotype correlation, the use of algorithms is inappropriate. The goal of this article is to emphasize the need for individualized care to make the best possible decisions for each patient's unique situation.

Preeclampsia, gestational diabetes and later risk of cardiovascular disease: Women\u2019s experiences and motivation for lifestyle changes explored in focus group interviews

BackgroundPreeclampsia (PE) and gestational diabetes mellitus (GDM) are both associated with increased risk of future cardiovascular disease (CVD). Knowledge of the relationship between these pregnancy complications and increased CVD risk enables early prevention through lifestyle changes. This study aimed to explore women’s experiences with PE and/or GDM, and their motivation and need for information and support to achieve lifestyle changes.MethodsSystematic text condensation was used for thematic analysis of meaning and content of data from five focus group interviews with 17 women with PE and/or GDM, with a live birth between January 2015 and October 2017.ResultsThis study provides new knowledge of how women with GDM and/or PE experience pregnancy complications in a Nordic healthcare model. It reveals the support they want and the important motivating factors for lifestyle change. We identified six themes: Trivialization of the diagnosis during pregnancy; Left to themselves to look after their own health; The need to process the shock before making lifestyle changes (severe PE); A desire for information about future disease risk and partner involvement; Practical solutions in a busy life with a little one, and; Healthcare professionals can reinforce the turning point.The women with GDM wanted healthcare professionals to motivate them to continue the lifestyle changes introduced during pregnancy. Those with severe PE felt a need for individualized care to ensure that they had processed their traumatic labor experiences before making lifestyle changes. Participants wanted their partner to be routinely involved to ensure a joint understanding of the need for lifestyle changes. Motivation for lifestyle changes in pregnancy was linked to early information and seeing concrete results.ConclusionsWomen with PE and GDM have different experiences of diagnosis and treatment, which will affect the follow-up interventions to reduce future CVD risk through lifestyle change. For GDM patients, lifestyle changes in pregnancy should be reinforced and continued postpartum. Women with PE should be informed by their general practitioner after birth, and given a plan for lifestyle change. Those with severe PE will need help in processing the trauma, and stress management should be routinely offered.

Community-based strategies to identify the unmet need for care of individuals with sexually transmitted infection-associated symptoms in rural South Africa.

To determine the unmet need for care and barriers for consulting sexually transmitted infection (STI) services at six primary healthcare (PHC) facilities in rural South Africa. Cross-sectional study using three community-based strategies to mobilise adult individuals with STI-associated symptoms to access care. Participants were mobilised through clinic posters and referral by community healthcare workers (CHWs) and traditional leaders after training. Men with male urethritis syndrome and women with vaginal discharge syndrome were mobilised to visit participating PHC facilities on two designated days when an expert team visited the facility. Questionnaires were completed and HIV rapid tests offered. The minimal unmet need for care of individuals with STI-associated symptoms was calculated by dividing the number of cases over the adult catchment population of each PHC facility. We successfully mobilised 177 symptomatic individuals: 134 (76%) women and 43 (24%) men. The estimated minimal unmet need for STI care was 1:364 (95% CI 1:350-1:380) individuals in this region; the rate was higher in village than township facilities, and among women. Mobilisation through clinic posters (57%) and by CHWs (23%) was most successful. Three-quarters of individuals (132/177) reported symptoms that had been present for >30days; 49% (87/177) had symptoms >6months. In addition, we identified 14 individuals with untreated HIV infection amounting to a 7% HIV testing yield. Lack of awareness of symptoms (34%), and disappointment in care due to persistent (23%) or recurrent (15%) symptoms after previous treatment, or disappointment with health services in general during previous visit(s) for any reason (10%) was the most common reasons for not consulting health care. We demonstrate a high unmet need for care of individuals with STI-associated symptoms in rural South Africa that requires urgent attention. A multidisciplinary approach that creates service demand through community awareness and information provision by healthcare workers combined with strengthening the quality of STI services is required to improve reproductive health and prevent complications of untreated STIs in this population.

Patient perspectives on transitioning to amyotrophic lateral sclerosis multidisciplinary clinics.

PurposeMultidisciplinary clinics (MDC) have become the standard of care for management of amyotrophic lateral sclerosis (ALS). No studies however, have captured patients’ perspectives during a transition to ALS MDCs. Recently, an ALS MDC emerged from a single-physician clinic in Saskatoon, Canada, providing patients with a unique exposure to two different models of care.Patients and methodsFifteen patients with ALS participated in semi-structured interviews that were digitally recorded and transcribed. Two independent researchers performed an inductive thematic analysis. Information was coded based on emerging and a priori themes. An iterative process followed involving discussion and reexamination of the themes until consensus was reached.ResultsAll patients cited the convenience of integrated care as an advantage. Other advantages included clinical expertise and advocacy potential. Travel and reduced mobility were the most commonly discussed barriers/disadvantages of MDC attendance. The impact of geography and weather appeared to augment both the appreciation of an integrated approach and the impediment of travel, compared to the existing literature. The need for individualized care was demonstrated by the conflicting viewpoints obtained from participants. Most patients felt additional practitioners and supports for both patients and caregivers were required.ConclusionALS patients transitioned to MDCs reported many of the advantages and disadvantages reported elsewhere. A novel perspective of a MDC’s advocacy potential was recognized, and the need for an innovative approach to meet demands for individualized care was highlighted.

Healthcare Professionals’ Views of the Experiences of Children With Cancer and Their Families Living in Tasmania: An Interpretive-Descriptive Study

ABSTRACTThe experience of pediatric cancer can be traumatic for children and their families. Living in rural, remote, and regional areas can add to the complexity of care and potential effects on this patient group. Children with cancer who live in rural, remote, and regional settings may be required to travel large distances and spend long periods of time away from home and their “normal” life during phases of treatment and illness. This can lead to further disruption of family life and to the child experiencing new routines and, eventually, difficulties adjusting to life after cancer. The island state of Tasmania is recognized as being rural, remote, and regional. For Tasmanian families who have a child with cancer, accessing both community and hospital-based services for medical treatment can involve complex travel arrangements. Patients may need to travel over a body of water to specialist mainland centers to receive vital treatment. This study was conducted to explore the experiences of children with cancer and their families in Tasmania from the perspective of healthcare professionals (HCPs). Using interpretive description, as described by Thorne, this qualitative study involved semi-structured interviews with six HCPs who worked in the area of pediatric oncology. HCPs’ identification of the need for individualized care for each child and family was notable. The overarching theme identified was “How a family copes with having a child with cancer is individual… but it’s also very hard.” The five key themes that informed the overarching theme are: (1) The child living with cancer; (2) separation and isolation; (3) financial impact; (4) navigating care systems; and (5) emotional and psychosocial wellbeing. A process of normalization of cancer was described by participants and reflects how children’s cancer treatment becomes a routine experience for a child. Our findings show that children living in rural, remote, and regional settings may have different experiences in comparison to those living in large centers. The impact the geographic location has on children with cancer affects the child and their family and needs to be explored further.