A Longitudinal Study Of Cultural Competence Among Health Science Faculty

The purpose of this study was to measure the process of cultural competence over time in a group of Health Science Faculty teaching nursing and other allied health students. Faculty (n=28) were administered the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals (IAPCC) prior to a cultural competence workshop, immediately after the workshop, and again at three months, six months and 12 months. The mean scores increased significantly with each administration of the IAPCC from the pretest administration (52.17) to the 12 month administration (59.71) demonstrating new knowledge related to cultural competence as a process

Injury characteristics and EQ-5D as predictors of personal wellbeing after injury

Objectives:A longitudinal study examined the relationships of injury severity, whether the injury was accidental or was caused by an assault, and self-reported EQ-5D soon after injury, with long-term personal wellbeing among participants with a range of injury types and severity.Methods:Interviews with participants recruited in the Prospective Outcomes of Injury Study (POIS) were conducted up to four time points in the 24 months after injury. Key explanatory variables were New Injury Severity Score (NISS), whether the injury was accidental or resulted from assault, and self-reported health status (five EQ-5D questions and a similar question about cognition) reported at three months. The main outcome measure at 24 months was the Personal Wellbeing Index (PWI) (PWI <70=‘low’ wellbeing). Univariate and multivariable analyses examined relationships between explanatory variables and low PWI.Results:Even in a group of people with injuries traditionally regarded as being of mild or moderate anatomical severity, wellbeing continues to be affected for an appreciable time post-injury, with a quarter (27%) of study participants having a low level of personal wellbeing 24 months after their injury. Neither anatomical injury severity nor hospitalisation were predictive of low personal wellbeing. An increased risk of low personal wellbeing was observed in participants whose injury was caused by an intentional assault (rather than accident), and in those who reported problems three months post-injury with EQ-5D self-care, anxiety/depression or cognitive functioning.Conclusions:Identification of such individuals early after an injury is of particular importance and ensuring adequate support services are put in place that encourage re-integration back into work and social networks could help prevent on-going poor wellbeing

The Honor Society of Nursing, Sigma Theta Tau International: Diversity resource paper

In 1985, the House of Delegates voted to add international to Sigma Theta Tau\u27s name making possible one action strategy, that of the development of an international network of nursing scholars in the Ten-Year Plan adopted by the 1981 House of Delegates

Establishing a large prospective clinical cohort in people with head and neck cancer as a biomedical resource:head and neck 5000

BACKGROUND: Head and neck cancer is an important cause of ill health. Survival appears to be improving but the reasons for this are unclear. They could include evolving aetiology, modifications in care, improvements in treatment or changes in lifestyle behaviour. Observational studies are required to explore survival trends and identify outcome predictors.METHODS: We are identifying people with a new diagnosis of head and neck cancer. We obtain consent that includes agreement to collect longitudinal data, store samples and record linkage. Prior to treatment we give participants three questionnaires on health and lifestyle, quality of life and sexual history. We collect blood and saliva samples, complete a clinical data capture form and request a formalin fixed tissue sample. At four and twelve months we complete further data capture forms and send participants further quality of life questionnaires.DISCUSSION: This large clinical cohort of people with head and neck cancer brings together clinical data, patient-reported outcomes and biological samples in a single co-ordinated resource for translational and prognostic research.</p

Quality of life of primary brain tumor patients before and 3 months after discharge from a hospital in Bandung, Indonesia

Background: The quality of life of patients with primary brain tumor in Indonesia is poorly understood. Therefore, this study aimed to investigate the health‐related quality of life of patients admitted to the Neurosurgery Department of Dr. Hasan Sadikin Hospital, Bandung, Indonesia, up to 3 months after discharge. Methods: Baseline data were collected from patients aged ≥18 years who were admitted to the hospital between October 9, 2015, and February 17, 2016. In‐person interviews were then conducted 1–2 days pre‐discharge (n = 65) and follow-up telephone interviews were made 1, 2, and 3 months post-discharge (n = 58, 55, and 54, respectively) to collect socio-demographic data, clinical characteristics, and EQ‐5D‐5L data. Results: Prior to discharge, one‐third or less of the 65 patients interviewed reported “no problems” with mobility (32%), self‐care (32%), usual activities (18%), and pain/discomfort (43%), whereas 74% reported “no problems” with anxiety/depression. By contrast, at 3 months post-discharge, an increased proportion of patients reported “no problems” with mobility (61%), self‐care (67%), usual activities (56%), and pain/discomfort (76%), with little change in anxiety/depression (“no problems” 70%). Conclusions: While there was improvement, many patients were still reporting problems at 3 months post-discharge, highlighting the need for ongoing support and care to ensure the best possible outcomes

Tuberculosis care provided by private practitioners in an urban setting in Indonesia: Findings from a standardized patient study

In Indonesia, government-owned Community Health Centers (CHCs) spearhead tuberculosis (TB) care at the primary level, but a substantial proportion of individuals with pulmonary TB also seek care from Private Practitioners (PPs). However, little is known about PPs’ practice in managing patients with TB-associated symptoms. To avoid bias associated with self-administered surveys, we used standardized patients (SPs) to evaluate PPs’ adherence to the national TB guidelines. Four clinical scenarios of individuals presenting complaints suggestive of TB, accompanied by different sputum smear results or TB treatment histories were developed. We assigned 12 trained SPs to PPs practicing in 30 CHC catchment areas in Bandung city, Indonesia. For comparison, two scenarios were also presented to the CHCs. A total of 341 successful SP visits were made to 225 private general practitioners (GPs), 29 private specialists, and 30 CHCs. When laboratory results were not available, adherence to the recommended course of action, i.e., sputum examination, was low among private GPs (31%) and private specialists (20%), while it was requested in 87% of visits to the CHCs. PPs preferred chest X-ray (CXR) in all scenarios, with requests made in 66% of visits to private GPs and 84% of visits to private specialists (vs. 8% CHCs). Prescriptions of incorrect TB drug regimens were reported from 7% and 13% of visits to private GPs and specialists, respectively, versus none of the CHCs. Indonesian PPs have a clear preference for CXR over microbiological testing for triaging presumptive TB patients, and inappropriate prescription of TB drugs is not uncommon. These findings warrant actions to increase awareness among PPs about the importance of microbiological testing and of administering appropriate TB drug regimens. SP studies can be used to assess the impact of these interventions on providers’ adherence to guidelines

Determinants of adherence towards tuberculosis guidelines among Indonesian private practitioners: a qualitative study

IntroductionIn high tuberculosis (TB) burden countries, the private sector manages a large proportion of initial visits by presumptive patients with TB. In Indonesia, the second largest contributor of TB cases globally, private practitioners (PPs) often do not adhere to national TB guidelines. A district public-private mix programme to mitigate this issue was started in 2019, yet engagement remains low. This study examines what affects the decisions of Indonesian PPs regarding TB management.MethodsWe performed semistructured in-depth interviews and focus group discussions (FGDs) with 24 PPs and 6 relevant stakeholders. Data collection and analysis were based on Flottorp's comprehensive and generic checklist on determinants of healthcare professional practice, including seven domains: guideline factors; individual professional barriers; patient factors; professional interactions; incentives and resources; organisational changes capacity and social, legal and political factors. The interviews and FGDs were recorded and transcribed verbatim. Coding and analysis were conducted by using NVivo software.ResultsBarriers that influenced PPs adherence to following the national TB guideline were found in all seven domains, including incoherence between national and international TB management guidelines, the complex referral and financing system, limited access to appropriate diagnostics tools and drugs, and patient preferences. This was further exacerbated by perceived lack of trust between PPs and local governmental stakeholders. In this study, in addition to seventh Flottorp's domain, we also found the complex nature of TB disease, which also complicates the decision-making process of PPs in TB management.ConclusionPPs face several challenges in complying with TB guidelines to enable optimal clinical decision-making

Genome-wide analysis identifies 12 loci influencing human reproductive behavior.

The genetic architecture of human reproductive behavior-age at first birth (AFB) and number of children ever born (NEB)-has a strong relationship with fitness, human development, infertility and risk of neuropsychiatric disorders. However, very few genetic loci have been identified, and the underlying mechanisms of AFB and NEB are poorly understood. We report a large genome-wide association study of both sexes including 251,151 individuals for AFB and 343,072 individuals for NEB. We identified 12 independent loci that are significantly associated with AFB and/or NEB in a SNP-based genome-wide association study and 4 additional loci associated in a gene-based effort. These loci harbor genes that are likely to have a role, either directly or by affecting non-local gene expression, in human reproduction and infertility, thereby increasing understanding of these complex traits