Problem For Health Care Professionals Research Articles

Negative attitudes and lack of Knowledge towards mental health problems

IntroductionNegative thoughts towards mental illness are a global problem for health care professionals. Mainly it leads to late help seeking which aggravates the prognosis of the problem, denial of this situation, refusing long term medication etc.…ObjectivesWe aim to identify the determinants leading to negative attitudes towards psychiatric problems among medical students.MethodsThis is a descriptive and analytical cross-sectional study conducted at the Faculty of Medicine of Sfax through an anonymous questionnaire via google Forms. The degree of stigmatization was evaluated by the score « The Attribution Questionnaires AQ-27 ».ResultsOne hundred and seven students completed the questionnaires. The Sex-ratio was 0.30 (M/F). The percentage of first- and second-year students was 24.42%, third to 6th year students was 34.57% and residents was 41.01%. Students with a personal history of psychiatric disorders presented 45.8% of our population and those with a family history of mental health problems 40.2%. Medical students who studied psychiatry as a discipline and students who had internship in the psychiatry department (third to 6th year students and residents) had lower scores of the Attribution Questionnaires AQ-27 (p=0,003 and p=0,002 respectively). Sixty per cent of the students reported that spreading listening cells when needed, media coverage of mental illness and campaigns of awareness can help us reduce mental disease’s related stigma.ConclusionsTo conclude, in order to lower rates of stigmatization of mentally sick people, spreading awareness among medical students can be an important tool in order to understand this situation and to provide a better health care.Disclosure of InterestNone Declared

Burnout and Suicide Among Physicians During Times of Stress

Burnout is a significant problem for health care professionals. Burnout, which consists of exhaustion, detachment/cynicism, and reduced sense of personal efficacy, can render the practice of medicine untenable and lead to job turnover, medical errors, and instability in the medical system. Moreover, burnout can develop into depression and lead to suicide. The burnout rate for practicing physicians in the United States was already high before the coronavirus 2019 pandemic, and the pandemic has exacerbated the factors underlying burnout by increasing isolation, workload, and uncertainty, as well as a potential clash of organizational decisions with personal safety. Achieving effective strategies to combat burnout and protecting physicians and health care workers from depression and suicide should be a priority for all systems. Early detection and referral to treatment as well as de-stigmatization of treatment are crucial. Additionally, expanding the conversation about the role of structural and organizational changes in promoting wellness is essential, as effective and consistent leadership can help tremendously when combined with individual efforts toward work-life balance. [ Psychiatr Ann . 2020;50(12):536–541.]

Cardiac Cachexia: A Well-Known but Challenging Complication of Heart Failure.

Heart failure (HF) is a common complication of various cardiac diseases, and its incidence constantly increases. This is caused mainly by aging of populations and improvement in the treatment of coronary artery disease. As HF patients age, they tend to develop comorbidities, creating new problems for health-care professionals. Sarcopenia, defined as the loss of muscle mass and function, and cachexia, defined as weight loss due to an underlying illness, are muscle wasting disorders of particular relevance in the heart failure population, but they go mostly unrecognized. The coexistence of chronic HF and metabolic disorders facilitates the development of cachexia. Cachexia, in turn, significantly worsens a patient’s prognosis and quality of life. The mechanisms underlying cachexia have not been explained yet and require further research. Understanding its background is crucial in the development of treatment strategies to prevent and treat tissue wasting. There are currently no specific European guidelines or recommended therapy for cachexia treatment in HF (“cardiac cachexia”).

Building and Deploying a COVID-19 Monitoring Solution in March

COVID-19 has been a challenge for health-care professionals and health-care systems. The wave provides at least two problems for healthcare professionals: first, the risk of infection, and second, the lack of time to treat all the COVID-19 patients while some form of normal care is supposed to continue. The time that health-care professionals have to spend per patient can be reduced if they are able to monitor the patients without meeting them. This can be done if patients report their status using patient-reported outcomes (PROs), defined by the U.S. Food and Drug Administration as "any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else."1 Reports indicate that 80% of COVID-19 patients are able to recover at home without medical assistance. The "worried well"2 are a group of patients that are concerned about their health but do not have health problems that need to be addressed. PROs may also help doctors reassure those patients without meeting them. The same information can also be used to quickly triage patients and refer them to the appropriate caregiver who may or may not be within the same health-care organization.

PDB57 - TRENDS IN USE OF DRUGS FOR DIABETES TREATMENT IN SLOVAKIA: REVIEW OF CONSUMPTION DATA FROM 2007 TILL 2017

Diabetes is considered as one of the top public health priorities in Slovakia. This pandemic is fuelled by the growing prevalence of obesity and unhealthy lifestyle. In almost 30 years, the number of patients with diabetes has risen by 290% (122 000 in 1988 compared to 350 000 in 2017). It is not only the problem for healthcare professionals, but it is becoming local and global economic nightmare due to continually growing costs. Our goal was to look at available drug consumption data in Slovakia (National Health Information Center) from 2007 till 2017 and look for trends in consumption. We performed detailed costs analysis of reimbursed drugs for diabetes treatment. Available data were associated with ATC groups A10A and A10B. We focused on cumulative drug costs in packs and value considering insulin as well as non-insulin therapy. Overall consumption of drugs for diabetes had growing tendency where number of packs used by diabetic patients in 2017 was 13,3% higher (+335 087 packs) compared to 2007 (2 841 187 vs 2 506 100 packs, respectively). Total consumption of reimbursed drugs for diabetes was 73,5 million EUR in 2017 compared to 29,9 million EUR in 2007 (+245%). The total cumulative cost associated with diabetes treatment in Slovakia from 2007 till 2017 was estimated at the level of 600 million €. From total Slovak drug consumption last year, approx. 5,2% were used only for diabetes treatment. With ageing society, healthcare system has to deal with growing demand for innovations and continual increase in prevalence of chronic diseases. We think it is inevitable to review existing epidemiological and costs trends on regular basis to be able to plan for the future. With some of our results, we wanted to stress the importance of regular and adequate cost analysis for public health spending planning.

Decolonising medical curricula through diversity education: Lessons from students

Introduction: The General Medical Council (GMC) expects that medical students graduate with an awareness of how the diversity of the patient population may affect health outcomes and behaviours. However, little guidance has been provided on how to incorporate diversity teaching into medical school curricula. Research highlights the existence of two different models within medical education: cultural competency and cultural humility. The Southampton medical curriculum includes both models in its diversity teaching, but little was known about which model was dominant or about the students’ experience.Methods: Fifteen semi-structured, in-depth interviews were carried out with medical students at the University of Southampton. Data were analysed thematically using elements of grounded theory and constant comparison.Results: Students identified early examples of diversity teaching consistent with a cultural humility approach. In later years, the limited diversity teaching recognised by students generally adopted a cultural competency approach. Students tended to perceive diversity as something that creates problems for healthcare professionals due to patients’ perceived differences. They also reported witnessing a number of questionable practices related to diversity issues that they felt unable to challenge. The dissonance created by differences in the largely lecture based and the clinical environments left students confused and doubting the value of cultural humility in a clinical context.Conclusions: Staff training on diversity issues is required to encourage institutional buy-in and establish consistent educational and clinical environments. By tackling cultural diversity within the context of patient-centred care, cultural humility, the approach students valued most, would become the default model. Reflective practice and the development of a critical consciousness are crucial in the improvement of cultural diversity training and thus should be facilitated and encouraged. Educators can adopt a bidirectional mode of teaching and work with students to decolonise medical curricula and improve medical practice.

Needle stick injuries in restorative dentistry: The need for prevention

Risk of exposure to blood‑borne pathogens has always been a problem for healthcare professionals including dental professionals. The emergence of acquired immunodeficiency syndrome (AIDS) in 1981 brought the issue to the forefront of public health policy. Percutaneous injuries, which include needle stick injuries (NSI), expose dental healthcare workers to deadly blood‑borne pathogens such as Hepatitis C virus (HCV), Hepatitis B virus (HBV), and Human Immunodeficiency Virus (HIV). The risk of transmission of HCV, HBV, and HIV from patient to the healthcare personnel is 3%, 30%, and 0.3%, respectively. [1,2] Although the likelihood of being infected by a blood‑borne virus (BBV) may be low after a single exposure, the consequences for the dental professional who becomes infected are potentially serious and include the potential of transmission of blood‑borne pathogens and associated detrimental effects on their personal and professional lives. [3] Needles used for injecting local anesthesia during restorative procedures and the use of sharps during endodontic and prosthodontic procedures pose a high risk of transmission of BBVs. Procedures in restorative dentistry that may make the patient to cause a sudden jerky movement can lead to increase probability of NSI. Thus, education and training regarding the use of universal precautions when handling body fluids should be conducted. New employees should go through the training program stressing the need to report all injuries and the availability of chemoprophylaxis. Improving sharps disposal by introducing improved sharps containers in the dental clinics. Sharps should be disposed immediately. Recapping and re‑sheathing should be discouraged and new arrangements for sharps disposal should be done to avoid overfilling boxes. NSI prevention strategies for dental professionals should be implemented in the dental curriculum and during the pre‑occupational/occupational training programs. Since a relatively high percentage of patients are positive for major blood‑borne infections, the risk of exposure to blood‑borne pathogens for healthcare workers through NSI should not be ignored. Regular health checkups, tests for serum antibodies and antigens of HBV, and appropriate hepatitis B vaccination are mandatory for occupational safety of healthcare workers. Report of NSI cases should be encouraged since it is needed for root cause analysis of the adverse events and future prevention. The report of NSI events is also highly important for the injured parties in view of risk assessment and implementation of appropriate prophylactic measures for blood‑borne infections.

Challenges in transition from intervention to end of life care in intensive care: A qualitative study

BackgroundProviding quality end of life care is a challenging area in intensive care practice. The most demanding aspect for doctors and nurses in this setting is not the management of care at end of life per se, but facilitating the transition from active intervention to palliation and finally, end of life care. Whilst there is understanding about some aspects of this transition, recognition of the complex and inter-related processes that work to shift the patient's trajectory from cure to end of life care is required. This is important in order to work towards solutions for issues that continue to pose problems for health care professionals. ObjectivesTo identify the challenges for health care professionals when moving from a recovery trajectory to an end of life trajectory in intensive care. DesignQualitative methods of enquiry. Methods and settingSingle semi-structured interviews with 13 medical staff and 13 nurses associated with 17 decedents who underwent treatment withdrawal in intensive care were carried out. Participants were drawn from two Intensive Care Units in a large university-affiliated hospital in England. FindingsPatients who died in intensive care appeared to follow a three-stage end of life trajectory: admission with hope of recovery; transition from intervention to end of life care; a controlled death. The transition from intervention to end of life care was reported as being the most problematic and ambiguous stage in the end of life trajectory, with potential for conflict between medical teams, as well as between doctors and nurses. ConclusionsEnd of life care policy emphasises the importance of end of life care for all patients regardless of setting. These findings demonstrate that in intensive care, there is need to focus on transition from curative intervention to end of life care, rather than end of life care itself so that effective and timely decision making underpins the care of the 20% of intensive care patients who die in this setting each year.

From Bench to Bedside: Understanding the Science behind the Pharmacologic Management of MDMA- and other Sympathomimetic-Mediated Hyperthermia

Objective: To evaluate the scientific rationale and efficacy of pharmacologic and nonpharmacologic treatments for sympathomimetic-induced hyperthermia and related sequelae. Data Sources: Literature was accessed through MEDLINE (1940-September 2010) using the terms MDMA [3,4-methylenedioxymethamphetamine], methamphetamine, toxicity, and hyperthermia. In addition, reference citations from identified publications were reviewed. Study Selection and Data Extraction: All articles written in English identified from data sources were evaluated. Data Synthesis: The treatment of sympathomimetic-induced hyperthermia is a challenging problem for health-care professionals. The lack of clinical trials further complicates the development of evidence-based treatment algorithms. Preclinical studies have mostly been with the sympathomimetic MDMA and have demonstrated a reversal of MDMA-induced hyperthermia with a mixed serotonin 5-HT1A agonist/5-HT2A antagonist or mixed α1- and β1,2,3-adrenergic receptor antagonists. Conclusions: Because of the nature by which patients are exposed to these agents, therapeutic interventions for sympathomimetic-mediated hyperthermia still lack evidence from clinical trials with human subjects. Pharmacologic treatments that should be avoided are antipyretics and the ryanodine receptor antagonist dantrolene. Promising future therapies may involve mixed 5-HT1A agonist/5-HT2A antagonists such as the atypical antipsychotic olanzapine, or mixed α1- and β1,2,3-adrenergic receptor antagonists such as carvedilol, as current preclinical research suggests.

Addiction and Pain Medicine

The adequate cotreatment of chronic pain and addiction disorders is a complex and challenging problem for health care professionals. There is great potential for cannabinoids in the treatment of pain; however, the increasing prevalence of recreational cannabis use has led to a considerable increase in the number of people seeking treatment for cannabis use disorders. Evidence that cannabis abuse liability is higher than previously thought suggests that individuals with a history of substance abuse may be at an increased risk after taking cannabinoids, even for medicinal purposes. Smoked cannabis is significantly more reinforcing than other cannabinoid administration methods. In addition, it is clear that the smoked route of cannabis delivery is associated with a number of adverse health consequences. Thus, there is a need for pharmaceutical-grade products of known purity and concentration using delivery systems optimized for safety. Another factor that needs to be considered when assessing the practicality of prescribing medicinal cannabinoids is the difficulty in differentiating illicit from prescribed cannabinoids in urine drug testing. Overall, a thorough assessment of the risk/benefit profile of cannabinoids as they relate to a patient's substance abuse history is suggested.

Clinical Application of Fresh Fibroblast Allografts for the Treatment of Diabetic Foot Ulcers: A Pilot Study

Diabetic foot ulcers often pose a difficult problem for health care professionals because of the defects associated with fibroblast functioning. Although there has been much interest recently in the use of topical growth factors for the treatment of diabetic foot ulcers, the effects are generally not very dramatic. Cryopreserved fibroblast implants, which are able to adjust to a wound's environment and provide the desired growth factors and other substances that may be lacking in a chronic wound, represent an exciting development and a major advance. These products may well provide growth factors in the right concentration and in the right sequence, something that has proved difficult to achieve with the topical application of recombinant growth factors. However, cell activities are impaired by cryopreservation. The purpose of this study was to assess the effects of fresh human allogeneic fibroblast grafting for the treatment of diabetic foot ulcers. Eight patients with diabetic foot ulcers ranging from 6 to 17 weeks in duration were treated. The size of the wounds ranged from 2.0 to 6.0 cm2, with three patients exhibiting exposed bones. A history of diabetic foot ulcers was present in five patients. Human dermal fibroblasts from healthy teenagers were cultured in Dulbecco's modified Eagle medium/Ham's F-12 supplemented with 10% autologous serum. The cultured cells were applied over the wounds immediately after debridement; fibrin was used as a cell carrier. A dressing was then applied with Tegaderm and kept moist until healing was complete. The progress and time for complete wound closure and patient satisfaction were assessed, with follow-up time ranging from 6 to 18 months. Complete wound healing occurred in all patients. Eleven to 21 days were needed for complete reepithelization of the wound, and no clinical or laboratory abnormalities were noted. Patient satisfaction was also very positive. In this study, the use of fresh human fibroblast allografts was found to be a safe and effective treatment for diabetic foot ulcers.

A comprehensive approach to adrenal incidentalomas

Improvements in abdominal imaging techniques have increased the detection of clinically inapparent adrenal masses, or incidentalomas (AI), the appropriate diagnosis and management of which have become a common clinical problem for health care professionals. Once an adrenal mass has been detected, the clinician needs to address two questions: 1) is the tumor hormonally active? and 2) is there any chance of the mass being malignant? The majority of AI is non-hypersecretory cortical adenomas, but an endocrine evaluation can lead to the identification of subtle hormone excess. An overnight low-dose dexamethasone suppression test, fractionated urinary or plasma metanephrine assay and, in hypertensive patients, establishing the upright plasma aldosterone/plasma renin activity ratio are recommended as preliminary screening steps. Masses greater than 4 cm are at greater risk of malignancy. Morphological imaging features may be helpful in the distinction between benign and malignant forms. Fine-needle aspiration biopsy is an important tool in the evaluation of oncological patients to establish any metastatic disease. Adrenalectomy is indicated by evidence of a functional adrenal mass, or a suspected malignant form. We advocate adrenalectomy of subtle hypercortisolism, especially in the presence of hypertension, obesity, diabetes or osteoporosis potentially aggravated by glucocorticoid excess. A close follow-up is needed, particularly in the first year after diagnosis.

Supporting Knowledge Management in an Online Community of Healthcare Professionals - The Evimed Project

A major problem for healthcare professionals is to do the daily routine in practice and to keep up with scientific advances simultaneously. Issues they have to deal with include an overload with highly specialized information from biomedical research and a lack of clinically relevant information prepared according to the needs of the consultation-hour. This 'information paradox' together with the demand for reliable information has a catalyzing effect on the emergence of a novel medical discipline, the evidence-based medicine. Evidence-based medicine is the conscious, explicit, and judicious application of the currently best evidence in making medical care decisions in favor of an individual patient. Evidence-based medical information services on the Internet have the potential to significantly contribute to the management of knowledge in online communities of healthcare professionals. This study presents such a service – the Evimed project. It particularly considers the aspect of community support which ...

Establishing a Facial Pain Center

Chronic oral, facial, and head pain is common, and appropriate diagnosis and management is a challenging problem for health care professionals. Most patients first seek the care of dentists because of the localization of the pain in the oral cavity, jaw, and surrounding structures. If the symptoms and clinical findings do not appear to be consistent with typical oral disease or if standard treatments do not alleviate the pain, the dental clinician must consider other more complex orofacial pain diagnoses. The dental professional should not hesitate to make referrals to key specialists or a center with an interdisciplinary team, with the expertise to diagnose and manage appropriately chronic oral, facial, and head pain.

Guidelines for advertising on health web sites: who's guarding the Koop.

The Internet is a promising and popular tool for the global dissemination of health information to the public. According to one estimate, “health sites draw two thirds of all online users at least once.”1 Unfortunately, the power of the Internet to facilitate quick, inexpensive, and worldwide publication is also a weakness when it comes to information about health. Distinctions between trained medical professionals and quacks, tested drugs and untested compounds, and advertisements and content are difficult to make. Furthermore, the global nature of the Internet defies most current nation-specific laws regulating the practice of medicine or sales of health-related products based on unverified health claims.2 The use of the Internet has encouraged the blurring of distinctions between content areas and advertising. Criticism of the well-traveled health information web site, drkoop. com, started by the former US Surgeon General C Everett Koop,3 however, illustrates why such ambiguity is a problem for health care professionals and why the criticisms bring to mind images of foxes and henhouses.

Ulcer unionists identify ‘weak links’ in trust care

Pressure sores are a serious problem for health care professionals and the NHS. The Department of Health estimates that 10 per cent of the adult population are affected by them at an annual cost of £60 million to the NHS. This article examines recent guidelines issued by the European Pressure Ulcer Advisory Panel (EPUAP) and the various management options available.

Autonomy or non-compliance in adolescent diabetes?

Many physical, psychological, social and cognitive changes take place in adolescence. Emerging personal values and beliefs, an acute awareness of body image and a desire for peer conformity and increasing independence can make the transition to adulthood troublesome. For teenagers with diabetes, usual adolescent needs and concerns are complicated by the demands of a complex treatment regimen. This can result in non-adherence to the recommended programme of care and, consequently, poor glycaemic control, which increases the risks for diabetes-related complications in later life. This situation poses a major problem for healthcare professionals. Teenagers, however, are frequently preoccupied with the present, and are unable to perceive, or will ignore, their vulnerability to long-term health problems. This article discusses these difficult issues and, taking into account the increasing need for autonomy and independence in adolescence, makes recommendations for nursing practice.

The prevention and management of violence in the community

Although there is little research regarding the violence nurses experience at work recent surveys suggest that violence is becoming an increasing problem for healthcare professionals (Poyner and Warne, 1986; Standini and Nicolini, 1997). Managing violence in the workplace is problematic given the diversity of community settings and the variety of specialist nurse roles. Recent surveys carried out in the community indicate the extent of this problem and have assisted health professionals in the management of risk by enabling them to predict and target high-risk situations and areas (Mirless-Black et al, 1996). This article examines the management of violence and associated risks in five key areas. These include clients, staff members, treatment/interaction, the healthcare setting and the organization as a whole. The article focuses on how violence at work can be managed and explores the role of the employer in providing assistance to healthcare professionals in this area.

An Alcohol and Drug Education Program for Nurses

Alcohol and drug use and abuse present serious problems for health care professionals, both as clinicians and abusers. These topics, however, have not been addressed adequately in nursing curricula. Nurses need to know the effects that alcohol and drug use and abuse have on individuals, families, and society. In this article, the authors outline the framework for a course or presentation that reviews the problems and applies the nursing process to the issues. The course can be adapted to meet the needs of nurses in any discipline, including the perioperative area, as well as for other health care providers and community groups. Course content and teaching strategies are included.

Sudden Infant Death Syndrome

Sudden infant death syndrome (SIDS) is a perplexing and troubling problem for health care professionals and the community. This article discusses the epidemiology of SIDS and nursing interventions to meet the needs of families affected by SIDS.