University Research Ethics Committee Research Articles

Experiences of HIV Positive Serostatus Disclosure to Sexual Partner Among Individuals in Discordant Couples in Mbarara City, Southwestern Uganda.

PurposeDisclosure of HIV status is key in HIV management. Despite many studies on serostatus disclosure, there is a gap in experiences regarding HIV status disclosure among discordant couples. The current study addressed this research gap, and explored the lived experiences of serostatus disclosure among discordant couples in Mbarara City, South Western Uganda.Participants and MethodsWe conducted 12 in-depth interviews with the help of a translated interview guide, and they were audio recorded. Participants were purposively enrolled in the study, which employed a phenomenological qualitative design. The study was conducted at three public health facilities in Mbarara City. The data was analyzed using thematic content analysis. Approval for this research was obtained from the Mbarara University Research Ethics Committee (MUST-REC) and administrative clearance from the city clerk of Mbarara City.ResultsThe mean age of the participants was 38 years old, ranging from 20 to 67 years. An equal number of males (six) and females participated in this study. Most of them had at least secondary level education, and only three had primary education. Half of the participants disclosed their serostatus to partners immediately after testing HIV positive. Key emerging themes as experienced benefits of HIV serostatus disclosure included: 1) social support and care; 2) decisions regarding health, fertility, and child bearing; 3) sharing information on HIV prevention and protection measures; 4) positive living; and 5) ease of HIV serostatus disclosure. The challenges associated with serostatus disclosure were summarized as one theme: misunderstandings in the families of the discordant couples.ConclusionSocially, psychologically and financially HIV positive individuals have benefited from their negative partners. Healthwise, they have been supported, and cared for after disclosing their positive status, but some have faced challenges, such as family misunderstandings. Couple HIV counseling and testing by a trained health worker is beneficial in HIV care and could mitigate the challenges related HIV serostatus disclosure.

Mother's Loneliness: Involuntary Separation of Pregnant Women in Maternity Care Settings and Its Effects on the Experience of Mothers during the COVID-19 Pandemic.

The aim of the study was to investigate the challenges of involuntary separation experienced by women during pregnancy and childbirth in the time of the COVID-19 pandemic. The study was conducted by the means of a self-administered questionnaire. One thousand and eleven women (1011) from Poland took part in the study, with an average age of approximately 30 years. The study was approved by the Research Ethics Committee of Warmia and Mazury University in Olsztyn, Poland. The results show that the majority of the surveyed women experienced involuntary separation from their partners during pregnancy and childbirth: 66.27% had no choice but to give birth alone and 84.37% had not been able to attend medical appointments with their partners. Solitary encounters with healthcare were associated with the feeling of fear (36.4%), anger (41%), a sense of injustice (52.2%), acute sadness (36.6%) and a sense of loss (42.6%), with all the reported levels higher in younger women. Over 74% of respondents were afraid of childbirth without a partner present. Almost 70% felt depressed because of a lonely delivery experience. Nearly a quarter of the mothers surveyed declared that if they could go back in time, they would not have made the decision to become pregnant during the pandemic. Based on our study, we found that adjustments to prenatal and neonatal care arrangements under COVID-19-related regimens are needed. Our proposal is to implement at least three fundamental actions: (1) risk calculations for pandemic-related cautionary measures should take into account the benefits of the accompanied medical appointments and births, which should be restored and maintained if plausible; (2) medical personnel should be pre-trained to recognise and respond to the needs of patients as a part of crisis preparedness. If the situation does not allow the patient to stay with her family during important moments of maternity care, other forms of contact, including new technologies, should be used; (3) psychological consultation should be available to all patients and their partners. These solutions should be included in the care plan for pregnant women, taking into account a risk-benefit assessment.

Clinical information quality of digital health technologies: protocol for an international eDelphi study

IntroductionDigital health technologies (DHTs) such as electronic health records, clinical decision support systems and electronic prescribing systems are widely used in healthcare. While adoption of DHTs can improve healthcare delivery,...

Determination of the healthcare satisfaction of the parents staying in the hospital with their children diagnosed COVID-19 towards family-centered care

To determine the healthcare satisfaction of the parents staying in the hospital with their children diagnosed Covid-19 towards family-centered care and to determine the relationship between them. This was a descriptive, correlational and cross-sectional type study. Data were collected in a pediatric outpatient clinic of a university hospital between March-June 2021. The universe of the study consisted of 141 parents, and the calculated sample size was 59. The study was completed with 64 parents. Data of the study were collected in the light of literature by using Sociodemographic Information Form, The Family-Centered Care Scale and The Pediatric Quality of Life Healthcare Satisfaction Inventory. Data were analyzed by SPSS 21 statistical package program. The ethics approval was taken from the clinical research ethics committee of the relevant university. The mean score of the parents from the Family-Centered Care Scale was 60.58±8.77, the mean PedsQL Healthcare Satisfaction Inventory score of the parents was found to be 71.75±24.21. A positive and moderate level of correlation was found between the Family-Centered Care Scale and PedsQL Healthcare Satisfaction Inventory and their subscales. It was found that nurses helped families and children to feel well cared for; however, they did not get the opinions of the family at a sufficient level while planning care. In the study, the healthcare satisfaction of the parents was at an adequate level. Besides, it was determined that the opinions of parents regarding family-centered care positively affected their satisfaction.

Young voices and visions for tropical restoration science in the UN Decade on Ecosystem Restoration

Young voices and visions for tropical restoration science in the UN Decade on Ecosystem Restoration

Objective and Subjective Stress Parameters in Response to High and Low-Fidelity Simulation Activities.

Nursing graduates are required to have both excellent theoretical and practical skills that should be used during stressful emergency interventions. Since the received knowledge should be practiced to gain skills and trained to achieve competences, simulation exercises can be beneficial to even reduce the stress that each individual may face during emergency management of patients. A total of 146 first-year nursing students participated in the study, including 124 women and 22 men aged between 19 and 50 years, with a mean age of 32 years. The objective method estimated psychophysiological parameters (serum cortisol). Objective and subjective methods were used. The subjective method assessed stress experienced by students based on the standardized Stress Appraisal Questionnaire Version B for dispositional assessment. The study was conducted in the Monoprofile Medical Simulation Centre at the University of Economics and Innovation in Lublin, Poland and was approved by the University Research Ethics Committee. Both participants under and over 25 years of age showed increased levels of stress after low and high-fidelity simulations, with statistically significantly higher stress levels found for the low fidelity method. Low-fidelity simulation methods generated a greater increase in cortisol levels, indicating a higher stress level than the high-fidelity methods. The analysis of the scores obtained in the Stress Appraisal Questionnaire (KOS-B) showed that higher cortisol levels after the low-fidelity simulation reduced the subjective perception of a threat, while higher cortisol levels before the high-fidelity simulation promoted higher intellectual activity among the students. Levels of stress in the education of nursing students using low and high-fidelity methods can limit the sense of threat and activate professional task performance. The use of low and high-fidelity simulation does not generate destructive stress levels.

Explaining population trends in cardiovascular risk: protocol for a comparative analysis of health transitions in South Africa and England using nationally representative survey data

IntroductionCardiovascular diseases (CVD) are the leading cause of death globally and share determinants with other major non-communicable diseases. Risk factors for CVD are routinely measured in population surveys and thus...

Cross-Cultural Adaptation and Reliability of the Berg Balance Scale in Hindi

Context: Use of outcome measurement is an important part of modern professional practice. The Berg Balance Scale (BBS) appears to be used in many Indian rehabilitation centres, but no official version has been previously available in Hindi. The BBS was translated into Hindi by the current authors according to accepted guidelines and tested for reliability. Aims: To translate the Berg Balance Scale into Hindi and investigate the inter-rater reliability when applied to geriatric patients. Setting/Design: Translation of BBS in Hindi according to guidelines for cross-cultural validation of an outcome measurement was conducted at a renowned institute for orthopedic and rehabilitation in India. Methods and Materials: The study was approved by the University Research Ethics Committee. The study involved an initial cross-cultural translation following four stages: 1) Forward Translation 2) Synthesis of translation 3) Backward Translation 4) Expert Committee. Expert committee was formed by purposive sampling comprising of experienced health professionals and language experts. For reliability testing, thirty patient participants were recruited from an Indian Orthopaedic hospital. Reliability testing was done by two experienced physiotherapists. Statistical Analysis Used: Weighted Kappa (Kw) was used to assess inter-rater reliability for the total scores and each individual item of BBS. Intraclass correlation coefficient was calculated to make comparisons of the inter-rater reliability with results of other studies. Results: The Intra-class correlation coefficient (ICC) for the total score of the BBS was 0.977(95% Confidence Interval= 0.951-0.989). The Kw for total score of BBS was 0.819 (95% Confidence Interval = 0.734-0.905). Conclusion: Hindi version of BBS appears to have excellent inter-rater reliability when used by experienced physiotherapists for rehabilitation of geriatric patients.

Are RMGIC restorations as effective with or without selective caries removal in primary molars?

Design A two-arm parallel group, tooth-randomised, controlled, non-inferiority clinical trial.Case selection Participants were cooperative 3-9-year-old children of good health, presenting with at least one International Caries Detection and Assessment System (ICDAS) Grade 5 cavitated dentine occlusal carious lesion, with radiographic depth into dentine. Teeth included were symptom-free, non-mobile and had no more than one-third root resorption.Participants were treated and followed-up at The Paediatric Dental Clinic of the Federal University of Rio Grande do Sul, School of Dentistry, Porto Alegre, Brazil. Ethics approval was granted by the Research Ethics Committee of University of Rio Grande do Sul, Brazil.Data analysis In total, 93 children (n = 698 teeth) were evaluated. Clinical examination was performed by two operators, trained and calibrated for caries assessment, for lesion presence and depth. Kappa statistics were used to determine inter-examiner reliability. All participants received standardised toothbrushing instructions, dietary advice and dental prophylaxis before their intervention.Teeth were randomly allocated into one of the two intervention groups using a random number generator. The 'sealing group' had their occlusal lesions sealed with resin-modified glass ionomer cements (RMGIC), without any caries removal, according to manufacturer's instruction. The 'restoration group' had selective caries removal performed with a round, steel bur according to the clinical hardness criteria and were then restored with the same RMGIC as the 'sealing group', again according to manufacturer's instruction. The treatments were performed by two experienced paediatric dental specialists. No local anaesthetic was needed in either group.Patients were followed-up at 6, 12, 18 and 24 months after treatment for examination, prophylaxis and interproximal radiography. Any asymptomatic teeth with marginal deterioration which could be probed underwent reintervention and were maintained in the sample.Cavity volume in the 'restoration group' was statistically significantly greater (p = 0.01) than the 'sealing group'. All other baseline sample characteristics were not significantly different.Results Overall, 68 teeth were included at the start of the study; n = 31 in the 'sealing group' and n = 37 in the 'restoration group'. At one-year post-intervention, 60 teeth were examined. Overall success rate was 59.3% for the 'sealing group' and 78.8% for the 'restoration group'. At two-years post-intervention, 48 teeth were examined. Overall success rate was 48.8% in the 'sealing group' and 76.0% in the 'restoration group'. Over the follow-up period, no radiographic lesion progression was observed in either group.Conclusions Sealing ICDAS Grade 5 occlusal caries with RMGIC without any caries removal resulted in lower survival rates at two-years compared to the same material following selective caries removal.

Comparison of the Effectiveness of Virtual Reality-based Cognitive Rehabilitation With Classical Cognitive Rehabilitation on Improving Executive Function in Children with Attention Deficit-Hyperactivity Disorder

Background and Aim: Children with Attention Deficit Hyperactivity Disorder are a good target group for cognitive rehabilitation Because their behavioral problems, including inattention, impulsivity, and hyperactivity, have a specific cognitive and cerebral origin. This adaptation of behavior to cognitive function provides an opportunity to repair behavior by strengthening cognitive function. This study aimed to compare the effectiveness of cognitive rehabilitation based on virtual reality technology as a new method and classical cognitive rehabilitation in improving the executive functions of children with attention deficit hyperactivity disorder. Methods & Materials: This research was a quasi-experimental study using a pre-test-post-test design with a control group. The statistical population included all children aged 7-12 years with Attention Deficit Hyperactivity Disorder in Tehran in 1398 who were selected by convenience sampling method and randomly divided into 3 groups of 12 people. In the pre-test stage, participants were assessed with the Attention Deficit Hyperactivity Disorder Rating Scale and the Computer Integrated Visual and Auditory Test (IVA-2). The first group received a virtual reality-based cognitive rehabilitation package and the second group received a Captain Log computer cognitive rehabilitation package, 12 sessions twice a week. No intervention was performed in the control group during this period. Post-tests were taken from all 3 groups after the intervention. Univariate analysis of covariance (ANCOVA) was used to analyze the data using SPSS software v. 26. Ethical Considerations: This study was approved by the Research Ethics Committee of the Islamic Azad University, Central Tehran Branch (Code: IR.IAU.CTB.REC.1400.001). Results: The results showed that both methods of cognitive rehabilitation intervention had a significant effect on cognitive functions (selective attention, sustained attention) of Attention deficit hyperactivity disorder (ADHD) children (P<0.01). But no significant difference was observed between the mean scores of selective attention and sustained attention in the first experimental group and the second experimental group (P>0.05). Conclusion: Virtual reality-based cognitive rehabilitation is as effective as classical cognitive rehabilitation on selective attention and sustained attention in children with ADHD. Virtual reality-based cognitive rehabilitation can be used as a new approach to rehabilitating this disorder.

159 BARRIERS AND FACILITATORS TO IMPLEMENTING NON-PHARMACOLOGICAL STRATEGIES TO MANAGE RESPONSIVE BEHAVIOURS OF NURSING HOME RESIDENTS WITH DEMENTIA

Abstract Background Many nursing home residents with dementia exhibit responsive behaviours including agitation and aggression. Psychotropic drugs are often prescribed to manage responsive behaviours but increase the rate of falls, strokes and death in residents with dementia. Therefore, the aim of this research is to conceptualise the barriers and facilitators to implementing non-pharmacological strategies to manage responsive behaviours. Methods Twenty-five interviews were conducted with nursing home managers, nurses and healthcare assistants from twenty-one private and voluntary nursing homes. Reflexive thematic analysis was used to conceptualise the barriers and facilitators to implementing non-pharmacological strategies to manage responsive behaviours. Ethical approval was obtained from the University Research Ethics Committee (Ref. FHMREC20091). All participants provided written informed consent. Results Three themes were constructed conceptualising the barriers and facilitators to taking a non-pharmacological approach to manage responsive behaviours. Strong leadership, specialised training in gerontology or dementia care and retention of staff long term supported the development of trusting relationships with residents. Treating residents with dementia with love and respect while providing meaningful activities enhanced resident’s self-esteem, facilitating a non-pharmacological approach to managing responsive behaviours. In addition, the engagement of families in residents’ care was found to be a powerful facilitator. However, sub-optimal teamwork between nurses and healthcare assistants and a lack of multidisciplinary collaboration posed barriers to taking a non-pharmacological approach to behaviour management. Furthermore, most healthcare assistants perceived that they were not valued, this also had a detrimental impact on residents’ care. Conclusion Conceptualisation of the barriers and facilitators to taking a non-pharmacological approach to manage responsive behaviours enables formulation of recommendations to address these barriers. These recommendations will assist in the development of dementia policy including the national dementia strategy, to implement sustainable non-pharmacological strategies to manage responsive behaviours of nursing home residents with dementia.

Challenges During Review of COVID-19 Research Proposals: Experience of Faculty of Medicine, Ain Shams University Research Ethics Committee, Egypt

The COVID-19 pandemic resulted in an overwhelming increase in research studies submitted to research ethics committees (RECs) presenting many ethical challenges. This article aims to report the challenges encountered during review of COVID-19 research and the experience of the Faculty of Medicine, Ain Shams University Research Ethics Committee (FMASU REC). From April 10, 2020, until October 13, 2020, the FMASU REC reviewed 98 COVID-19 research protocols. This article addressed the question of how to face an overwhelming amount of research submitted to the REC while applying the required ethical principles. Ethical challenges included a new accelerated mode of review, online meetings, balance of risks vs. benefits, measures to mitigate risks, co-enrolment in different studies, protection of a vulnerable COVID-19 population, accelerated decisions, online research, how to handle informed consent during the pandemic, and justification of placebo arm.

“It's been up and down”—perspectives on living through COVID-19 for individuals who experience homelessness: a qualitative study

BackgroundThe UN describes the COVID-19 pandemic as the greatest public health crisis for the current generation. However, individuals who experienced austerity, adversity, and disadvantage prior to the pandemic have been disproportionately affected with every turn the pandemic has taken, from transmission risk to vaccination take-up. One such population is individuals who experience homelessness. As the UK begins to transition to a stage of post-pandemic recovery, it is imperative to understand the perceived impact COVID-19 has had on the day-to-day lives of individuals who experience homelessness, to ensure they are not left behind and recovery planning can be better targeted to their specific needs. MethodsBetween February and May, 2021, 26 individuals (10 women and 16 men) who self-identified as experiencing homelessness within the Newcastle Gateshead area took part in telephone interviews of 20–80 min in length. Participants provided written or verbal informed consent prior to participating. Recruitment took place through existing networks, housing providers, charities, word of mouth, and snowball sampling. Analysis was co-produced with five individuals with lived experience using interpretative phenomenological analysis. NVivo release 1·5 was used to organise quotes. Ethics approval was granted by the Faculty of Medical Sciences Research Ethics Committee, part of Newcastle University's Research Ethics Committee (ref 2034/6698/2020.) FindingsExperiences shared depicted unique stories with commonalities across the findings through five main themes: (1) surreality of day-to-day life—searching for understanding and lost autonomy; (2) an emotional rollercoaster—confronting negative emotions; (3) loneliness is my best friend—learning from being alone; (4) adversity is the only consistency—recognising past and present hardship, violence, and loss; and (5) coping with uncertainty—using drugs, mindfulness, and technology to survive. InterpretationThe pandemic has affected the daily lives of people who experience homelessness in a variety of ways, including personal growth, no change, and regression. This study is limited by its localised recruitment in Newcastle and Gateshead in the UK; however, this local focus and involvement of individuals with lived experience has strengthened the study's implications for policy and practice in the region. Initiatives or policies developed to support post-pandemic recovery should reflect the array of impacts, while giving special recognition to loneliness, adversity, and resiliency among individuals who experience homelessness. FundingNational Institute for Health Research School for Public Health Research.

Oxford Understanding Relationships, Sex, Power, Abuse and Consent Experiences (OUR SPACE) cross-sectional survey: a study protocol

IntroductionSexual violence among higher education students is a public health concern, threatening the general safety of students, often with significant physical and mental health implications for victims. Establishing the prevalence...

“Dear Doctor” text message intervention to reduce burnout in trainee anaesthetists: an interview study

BackgroundBurnout in doctors is reported in many countries. Following a randomised controlled trial of a novel 10-month fortnightly text message intervention to reduce burnout in trainee anaesthetists, an interview study was conducted. The intervention's format and content were developed based on findings from a preceding literature review and interview study with trainee anaesthetists, and messages incorporated 11 evidenced themes including gratitude and self-efficacy from the wellbeing and behavioural science literatures. Objectives of the interviews were to explore experiences of the intervention, understand perceived mechanisms of impact (or lack thereof), and identify improvements. MethodsIn the trial's endline survey (ISRCTN11418903), all 74 participants in the treatment group (those who received the text messages) were invited to interview and sampled purposively. Semi-structured interviews (audio-recorded and transcribed) were conducted following verbal consent (the participant information sheet and consent questions were sent by email before the interview). Data were managed using the Framework Approach and analysed thematically. The Imperial Joint Research Compliance Office approved this study on July 13, 2020 in an amendment to an original application to the Imperial College Research Ethics Committee (reference number 19IC5205, approval Aug 14, 2019). FindingsThe pool of 23 potential participants (who registered interest) was resampled five times (eg, when the research team did not receive a response to the initial recruitment or subsequent reminder emails) until no volunteers remained. Nine interviews (three women, six men) were conducted, with diversity captured across training location, year, and change in burnout over the trial. Reported engagement (reading or acting on messages) varied. Factors affecting engagement were work pressures, mood, and COVID-19 (due to wearing personal protective equipment and wellbeing information overload). Interviewees described the content as useful, varied and interesting, among other positive descriptors. Critique referenced the intervention's impersonal nature, and that some content was generic or basic. Interviewees enjoyed the low-intensity, passive nature of the intervention. Text message was viewed as a novel, unsaturated (not heavily used) delivery mechanism (better than email). Messages provoking meaningfulness, professional value, and community were highlighted as higher impact, along with those fostering perceptions of shared experience and encouraging communication between colleagues. Suggestions for no perceived impact included personal factors (eg, high existing resilience and support) and the intervention's impersonal nature. Interviewees suggested content to add and remove, and ways of personalising format and content. InterpretationInterviewees generally found the intervention acceptable and recommended it. Although the trial only observed an effect in a subsample, the intervention may benefit from re-evaluation following adaptation based on interviewees' recommendations. FundingNational Institute for Health Research.

“Dear Doctor” text message intervention to reduce burnout in trainee anaesthetists: a randomised controlled trial

BackgroundOver one in five UK doctors reports feeling burnt out because of their work. This study aimed to determine if a novel text message intervention could reduce burnout in UK trainee anaesthetists. MethodsIn this two-arm, non-blinded, randomised controlled trial, we recruited 2nd to 4th year trainees registered with the Royal College of Anaesthetists, UK. Eligible trainees were given information about the trial and asked to provide their mobile phone numbers to indicate consent to participate. Participation was optional. Participants who signed up to the trial were randomly assigned (using a random number generator in the statistical programme Stata) to receive either fortnightly text messages over 10 months (treatment group) or no intervention messages (control group). Randomisation was stratified by training year and region. A literature review and qualitative study informed the intervention design and content: our intervention was low cost to deliver and minimally time-intensive for participants (contrasting many previous interventions), and it aimed to address factors identified as contributing to burnout. The message content also drew on 11 themes from the behavioural science and wellbeing literature (eg, gratitude, social support, self-compassion) to improve burnout and wellbeing. The co-primary outcomes were burnout (measured by the work-related subscale of the Copenhagen Burnout Inventory) and wellbeing (Short Warwick-Edinburgh Mental Wellbeing Scale). Secondary outcomes were meaning in work, professional value, sickness absence, and consideration of career break. Exploratory outcomes were factors potentially affecting wellbeing, including COVID-19. Outcomes were measured via an online survey. Intervention impact for those who completed the endline survey was evaluated using regression adjusting for gender, training year, training region, and baseline measurement. We conducted exploratory analyses of intervention impact in subgroups of participants using the same regression model. The Imperial College Research Ethics Committee approved the study on Aug 14, 2019 (reference number 19IC5205). The Imperial Joint Research Compliance Office approved the additional exploratory outcomes in an amendment on July 21, 2020. This trial is registered with the ISRCTN registry, ISRCTN11418903. FindingsIn September-October 2019, 279 trainees were randomised, of whom 153 (80 female; 73 male) completed the endline survey (74 in the treatment group; 79 in the control group). There were no significant group differences in burnout (β=–1·82, 95% CI –6·54 to 2·91, p=0·45), wellbeing (–0·52, –1·73 to 0·69, p=0·40), or secondary outcomes (all p values ≥0·24). However, 49 (66%) of 74 participants in the treatment group recommended the messages be sent to future trainees. Exploratory analyses found the intervention was associated with reduced burnout in participants who reported personal or work-related difficulties (β=–9·56, –17·35 to –1·77), and those for whom COVID-19 had a large negative wellbeing impact (β=–10·38, –20·57 to –0·19). InterpretationThe intervention had no impact overall, but was recommended by most, and associated with reduced burnout in participants reporting difficult personal or work circumstances. Given this intervention is low cost and requires minimal time commitment, it may warrant adaptation (eg, based on participant feedback) and further evaluation. FundingNational Institute for Health Research.

Utilization of obstetric ultrasonography and findings in a cottage hospital in Nigeria

Objectives: The integration of ultrasound into routine obstetric workup has transformed antenatal care in resource-poor and remote communities in Africa. The present study aims to investigate the utilization of obstetric ultrasound at a cottage hospital in suburban Nigeria. Material and Methods: This retrospective study was conducted at Obio Cottage Hospital, Port Harcourt, Rivers State, South-South Nigeria. Ethical approval was obtained before commencement of the study from the Health Research Ethics Committee of University of Calabar Teaching Hospital with reference number UCTH/HREC/33/533. Reports were retrieved from the records of the radiology unit of the study facility, and data including biometric data and radiological diagnosis were transferred to Microsoft Excel spreadsheet for data analysis. Simple proportions and percentages were used to analyze the data. All statistical analyses were conducted using Statistical Package for the Social Science version 21.0, IBM Inc., Chicago, Illinois, USA. Statistical significance was set at P ≤ 0.05. Results: The total ANC visits at Obio Cottage Hospital was 28,072, with 27% (7689) utilization of ultrasound scan. The mean age and range of parity of attendees were 32 ± 2.3 and 1–5, respectively. Of the total scans performed, 99.93% was routine, while 0.07% (5) was clinical-based (targeted). Normal findings were 7520 (97.8%) of antenatal scans recorded, while abnormal cases, multiple gestation, and uncertain diagnosis accounted for 121 (1.57%), 44 (0.57%), and 4 (0.06%), respectively. Conclusion: The present study has shown a considerable volume of obstetric ultrasound scan in this cottage hospital, albeit, with low utilization compared to the number of antenatal registration. Findings were mainly normal with minimal need for referral for advance care.

Development of the Carers\u2019 Alert Thermometer for Young Carers (CAT-YC) to Identify and Screen the Support Needs of Young Carers: A Mixed Method Consensus Study

This paper reports on a multi-phased, mixed-method consensus-based study conducted with young carers in the UK aged 11–18, and health, social care and education professionals from the UK, USA and Canada, to identify priority items for inclusion in a short screening tool for use with young carers of a family member with a progressive or long-term illness or disability. Following ethical approval from University and local Research Ethics Committees, qualitative and quantitative data were collected between 2017 and 2019 from 267 people (107 young carers; 160 professionals), through interviews, a focus group, a Delphi survey, consensus group meetings and consultations. Qualitative data were analysed thematically, and quantitative data were analysed using measures of central tendency, frequency and levels of dispersion. The resulting Carers’ Alert Thermometer (CAT-YC) contains an identification question followed by ten areas of need across two themes of ‘current caring situation’ and ‘carer’s health and wellbeing,’ along with guidance for possible next steps and space for an action plan to be jointly agreed between the screener and young carer. Preliminary piloting of the CAT-YC provides evidence of identifying and monitoring needs, and is expected to be useful for young carers, a wide range of professionals, and organisations that support young carers.

MP41-15 PROTON PUMP INHIBITOR USE IS A NEGATIVE PROGNOSTIC FACTOR FOR METASTATIC UROTHELIAL CARCINOMA PROGRESSION IN PEMBROLIZUMAB-TREATED PATIENTS

You have accessJournal of UrologyBladder Cancer: Invasive II (MP41)1 Sep 2021MP41-15 PROTON PUMP INHIBITOR USE IS A NEGATIVE PROGNOSTIC FACTOR FOR METASTATIC UROTHELIAL CARCINOMA PROGRESSION IN PEMBROLIZUMAB-TREATED PATIENTS Keitaro Iida, Takashi Nagai, Satoshi Nozaki, Toshiki Etani, Taku Naiki, Akihiro Nakane, Hidetoshi Akita, Hiroki Kubota, Hiroyuki Kamiya, Noriyasu Kawai, and Takahiro Yasui Keitaro IidaKeitaro Iida More articles by this author , Takashi NagaiTakashi Nagai More articles by this author , Satoshi NozakiSatoshi Nozaki More articles by this author , Toshiki EtaniToshiki Etani More articles by this author , Taku NaikiTaku Naiki More articles by this author , Akihiro NakaneAkihiro Nakane More articles by this author , Hidetoshi AkitaHidetoshi Akita More articles by this author , Hiroki KubotaHiroki Kubota More articles by this author , Hiroyuki KamiyaHiroyuki Kamiya More articles by this author , Noriyasu KawaiNoriyasu Kawai More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002062.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recently, the role of the gut microbiome in inflammatory disease and carcinogenesis has become apparent. Specifically, higher gut microbiome diversity is associated with improved responses to anti-PD-1 immunotherapy, suggesting that the gut microbiome impacts immuno-oncology in a systemic manner. The present study elucidated the impact of drugs known to alter gut microbiome balance on pembrolizumab (PEM) efficacy in metastatic urothelial carcinoma (mUC) patients. METHODS: Clinicopathologic data of 115 mUC patients receiving second-line PEM (following failed platinum-based chemotherapy) between January 2018 and January 2021 were retrospectively analyzed. Study protocols were approved by the Nagoya City University research ethics committee (No. 60-18-0060). Impact of gut microbiome-altering medications (proton pump inhibitors (PPI), antibiotics (ATB), metformin, and antipsychotics) taken during — or within 30 days on either side of — the PEM treatment period on progression-free survival (PFS), time-to-treatment failure (TTF), and adverse events was statistically evaluated. Kaplan-Meier survival curves were constructed and survival rates were compared using the log-rank test. Uni- and multivariate analyses were performed using the Cox proportional hazard regression model. RESULTS: Patient mean age was 73 years. Primary affected sites were bladder (48.7 %), upper urinary tract (46.1 %), and a combination of the two (5.2 %). Eastern Cooperative Oncology Group performance status at PEM initiation was 0, 41, 1, 55, 2, and 19. No drug of interest was associated with adverse gastrointestinal events (diarrhea and constipation). Univariate analysis demonstrated that PPI use predicted a significantly shorter PFS interval (p <0.0001), and that PPI or ATB use predicted a significantly shorter TTF interval (p <0.01 and p <0.05, respectively). Multivariate analysis demonstrated that PPI use was an independent prognostic factor for both cancer progression and treatment failure. CONCLUSIONS: Possibly via gut microbiome modulation, PPI use may decrease efficacy of PEM in the treatment of mUC. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e766-e767 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Keitaro Iida More articles by this author Takashi Nagai More articles by this author Satoshi Nozaki More articles by this author Toshiki Etani More articles by this author Taku Naiki More articles by this author Akihiro Nakane More articles by this author Hidetoshi Akita More articles by this author Hiroki Kubota More articles by this author Hiroyuki Kamiya More articles by this author Noriyasu Kawai More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement PDF downloadLoading ...

Does midwifery-led care demonstrate care ethics: A template analysis

Ethical care in maternity is fundamental to providing care that both prevents harm and does good, and yet, there is growing acknowledgement that disrespect and abuse routinely occur in this context, which indicates that current ethical frameworks are not adequate. Care ethics offers an alternative to the traditional biomedical ethical principles. The aim of the study was to determine whether a correlation exists between midwifery-led care and care ethics as an important first step in an action research project. Template analysis was chosen for this part of the action research. Template analysis is a design that tests theory against empirical data, which requires pre-set codes. A priori codes that represent midwifery-led care were generated by a stakeholder consultative group of nine childbearing women using nominal group technique, collected in Perth, Western Australia. The a priori codes were applied to a predesigned template with four domains of care ethics. Ethics approval was granted by the Edith Cowan University research ethics committee REMS no. 2019-00296-Buchanan. The participants generated eight a priori codes representing ethical midwifery care, such as: 1.1 Relationship with Midwife; 1.2 Woman-centred care; 2.1 Trust women's bodies and abilities; 2.2. Protect normal physiological birth; 3.1. Information provision; 3.2. Respect autonomy; 4.1. Birth culture of fear (midwifery-led care counter-cultural) and 4.2. Recognition of rite of passage. The a priori codes were mapped to the care ethics template. The template analysis found that midwifery-led care does indeed demonstrate care ethics. Care ethics takes into consideration what principle-based bioethics have previously overlooked: relationship, context and power. Midwifery-led care has been determined in this study to demonstrate care ethics, which suggest that further research is defensible with the view that it could be incorporated into the ethical codes and conduct for the midwifery profession.