Allied health workers’ role in patient education in the United States

Introduction: Patient education (PE) has been traditionally seen as the role of nurses and physicians, while allied health workers (AHWs)-who make up the biggest population of the US healthcare workforce-are sometimes reduced to providing supportive roles. This article reviews the available literature on the role of AHWs in providing PE in the US.Methods: This review was based on a search of the databases Academic Search Ultimate; Health Source-Consumer Edition; Health Source-Nursing/Academic Edition and MEDLINE initially conducted between January 10 and February 3, 2021, and later re-done between December 20 and December 22, 2021. This review applied guidelines for narrative reviews (Ferrari 2015). The search looked at papers published between 2001 and 2021, which discussed allied health professions relevant to the US health system.Results: The review derived 18 articles from the search and two articles from the reference lists of the 18 articles. The review found that AHWs seldom performed PE, although the profession of physical therapy made efforts to formalize participation in PE. It also found that expansion of roles for AHWs was warranted, although additional training may be required to develop effective PE competencies among AHWs. Finally, it found existing challenges such as interprofessional rivalries and time limitations that affected the incorporation of AHWs in PE.Conclusions: AHWs have untapped potential to contribute more to the US health system through delivery of effective PE. Policy adjustments are needed to maximize the input of AHWs in PE. Increased interprofessional collaboration in the US health system is needed to facilitate the extension of PE roles to AHWs. Further research is needed to better understand the factors limiting AHWs’ involvement in PE

Communication skills training for mental health professionals working with people with severe mental illness

Background: Research evidence suggests that both mental health professionals and people with severe mental health illness such as schizophrenia or schizoaffective disorder find it difficult to communicate with each other effectively about symptoms, treatments and their side effects so that they reach a shared understanding about diagnosis, prognosis and treatment. Effective use of communication skills in mental health interactions could be associated with increased patient satisfaction and adherence to treatment. Objectives: To review the effectiveness of communication skills training for mental health professionals who work with people with severe mental illness. Search methods: We searched the Cochrane Schizophrenia Trials Register (latest search 17 February, 2016) which is compiled by systematic searches of major resources (including AMED, BIOSIS, CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings. There are no language, date, document type, or publication status limitations for inclusion of records into the register. Selection criteria: All relevant randomised clinical trials (RCTs) that focused on communication skills training (CST) for mental health professionals who work with people with severe mental illness compared with those who received standard or no training. We sought a number of primary (patient adherence to treatment and attendance at scheduled appointments as well as mental health professionals' satisfaction with the training programme) and secondary outcomes (patients' global state, service use, mental state, patient satisfaction, social functioning, quality of life). RCTs where the unit of randomisation was by cluster (e.g. healthcare facility) were also eligible for inclusion. We included one trial that met our inclusion criteria and reported useable data. Data collection and analysis: We independently selected studies, quality assessed them and extracted data. For binary outcomes, we planned to calculate standard estimates of the risk ratio (RR) and their 95% confidence intervals (CI) using a fixed-effect model. For continuous outcomes, we planned to estimate the mean difference (MD) between groups, or obtain the adjusted mean difference (aMD) where available for cluster-randomised trials. If heterogeneity had been identified, we would have explored this using a random-effects model. We used GRADE to create a 'Summary of findings' table and we assessed risk of bias for the one included study. Main results: We included one pilot cluster-RCT that recruited a total of 21 psychiatrists and 97 patients. The psychiatrists were randomised to a training programme in communication skills, compared to a no specific training (NST) programme. The trial provided useable data for only one of our prestated outcomes of interest, patient satisfaction. The trial did not report global state but did report mental state and, as global state data were not available, we included these mental state data in the 'Summary of findings' table. There was high risk of bias from attrition because of substantial losses to follow-up and incomplete outcome data. Patient satisfaction was measured as satisfaction with treatment and 'experience of therapeutic relationship' at medium term (five months). Satisfaction with treatment was similar between the CST and NST group using the Client Satisfaction Questionnaire (CSQ-8) (1 RCT, n = 66/97*, aMD 1.77 95% CI - 0.13 to 3.68, low-quality evidence). When comparing patient experience of the therapeutic relationship using the STAR-P scale, participants in the CST group rated the therapeutic relationship more positively than participants in the NST group (1 RCT, n = 63/97, aMD 0.21 95% CI 0.01 to 0.41, low-quality evidence). Mental state scores on the Positive and Negative Syndrome Scale (PANSS) were similar between treatment groups for general symptoms (1 RCT, n = 59/97, aMD 4.48 95% CI -2.10 to 11.06, low-quality evidence), positive symptoms (1 RCT, n = 59/97, aMD -0.23, 95% CI -2.91 to 2.45, low-quality evidence) and negative symptoms (1 RCT, n = 59/97, aMD 3.42, 95%C CI -0.24 to 7.09, low-quality evidence). No data were available for adherence to treatment, service use or quality of life. * Of the total of 97 randomised participants, 66 provided data. Authors' conclusions: The evidence available is from one pilot cluster-randomised controlled trial, it is not adequate enough to draw any robust conclusions. There were relatively few good quality data and the trial is too small to highlight differences in most outcome measures. Adding a CST programme appears to have a modest positive effect on patients' experiences of the therapeutic relationship. More high-quality research is needed in this area

The Effect of Personality on Chrononutrition during the COVID-19 Lockdown in Qatar

The COVID-19 lockdown has had a significant impact on people’s lives worldwide. This study aimed to investigate the effect of personality on chrononutrition during the COVID-19 lockdown. Using a cross-sectional design, a convenient sample of 543 adults in Qatar completed an online questionnaire using validated tools to assess personality and chrononutrition behaviors during the first COVID-19 lockdown. Participants scoring high in openness were more likely to eat at night (mean difference (MD) = 0.41, 95% confidence interval (CI): 0.10, 0.72) compared to those scoring high in agreeableness, while those scoring high in extraversion and openness had a shorter eating window (MD = -76.6, 95%CI: -146.3, -6.93 and MD = -29.8, 95%CI: -56.5, -3.01, respectively). Participants high in extraversion had longer evening latency (MD = 66.3, 95%CI: 25.4, 107.3) and evening eating (MD = -62.0, 95%CI: -114.0, -9.0) compared those high in agreeableness. Participants high in conscientiousness showed evidence of first eating event misalignment during the weekend (MD = 22.0, 95%CI: 0.15, 43.9) and last eating event misalignment during weekdays (MD = -27.8, 95%CI: -47.3, -8.41) compared to those high in agreeableness. Lastly, participants high in openness showed evidence of eating window misalignment during the weekend (MD = 30.6, 95%CI: 5.01, 56.2). This study suggests that personality traits can inform personalized nutritional approaches when aiming for healthy habits during unexpected periods, such as the COVID-19 pandemic.The APC were funded by QU-Health

Cross-sectional evaluation of a longitudinal consultation skills course at a new UK medical school

Background: Good communication is a crucial element of good clinical care, and it is important to provide appropriate consultation skills teaching in undergraduate medical training to ensure that doctors have the necessary skills to communicate effectively with patients and other key stakeholders. This article aims to provide research evidence of the acceptability of a longitudinal consultation skills strand in an undergraduate medical course, as assessed by a cross-sectional evaluation of students' perceptions of their teaching and learning experiences. Methods: A structured questionnaire was used to collect student views. The questionnaire comprised two parts: 16 closed questions to evaluate content and process of teaching and 5 open-ended questions. Questionnaires were completed at the end of each consultation skills session across all year groups during the 2006-7 academic year (5 sessions in Year 1, 3 in Year 2, 3 in Year 3, 10 in Year 4 and 10 in Year 5). 2519 questionnaires were returned in total. Results: Students rated Tutor Facilitation most favourably, followed by Teaching, then Practice & Feedback, with suitability of the Rooms being most poorly rated. All years listed the following as important aspects they had learnt during the session: • how to structure the consultation • importance of patient-centredness • aspects of professionalism (including recognising own limits, being prepared, generally acting professionally). All years also noted that the sessions had increased their confidence, particularly through practice. Conclusions: Our results suggest that a longitudinal and integrated approach to teaching consultation skills using a well structured model such as Calgary-Cambridge, facilitates and consolidates learning of desired process skills, increases student confidence, encourages integration of process and content, and reinforces appreciation of patient-centredness and professionalism

The Development of an Empathy Curriculum (Empathy in Health) for Healthcare Students Using VR Technology

Empathy in Health is an Erasmus + funded project, which aims to design a curriculum for empathetic skill development in healthcare practitioners and home carers based on up-to-date evidence and cutting-edge technology tools. A literature review was carried out that focused on empathy in health care using VR technology. The results of the literature review helped develop a focus group guide for the purposes of the qualitative part of the need assessment exercise. The data from the focus groups were transcribed and analysed using the methodology of content analysis. The themes that emerged from the analysis of the focus groups’ data lent themselves to three major working areas. These informed the development of the qualification framework, which in turn informed the development of the detailed curriculum. The Empathy in Health curriculum involves 21-hour classroom teaching, 3-hour Asynchronous Electronic Learning and 6-hour Directed Self Learning for graduate students or final year undergraduate students or Health Care Professionals. The curriculum covers understanding empathy and competencies necessary for empathy, understanding empathy in relationships and information exchanges in different health care contexts/environments, showing empathy in diverse environments and overcoming barriers/challenges to empathy

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Influence of proton transfer kinetics and natural convection on Proton-Coupled Electron Transfer (PCET) reactions

Les phénomènes de transport de matière ainsi que la cinétique des réactions chimiques sont des processus importants en électrochimie car ceux-ci contrôlent le courant mesuré. Dans ce contexte, nous nous intéressons à de simples réactions électrochimiques et à la classe des réactions de transfert couplés électrons-protons (PCET), jouant un rôle important dans les phénomènes biologiques et la conversion d’énergie. Ces réactions impliquent le transfert d’électron(s) et de proton(s) et sont représentées par un schéma carré. Alors que la cinétique de transfert d’électrons est largement étudiée, la cinétique de transfert de protons l’est plus rarement. Ces réactions sont en effet supposées être très rapides alors qu’il existe des situations où les réactions de protonation constituent l’étape limitante. La première partie de la thèse consiste à étudier la cinétique des réactions de protonation en tenant compte de la catalyse de Brönsted. Par le biais de simulations numériques, nous montrons que la catalyse augmente la réversibilité des voltampérogrammes cycliques, à des pH où le transfert couplé s’opère. Les prédictions numériques ont été comparées aux données expérimentales et les résultats sont encourageants car une même tendance est observée. L’accord quantitatif n’est cependant pas satisfaisant à ce stade. Les phénomènes de transport étant connus pour affecter les processus à l’électrode, la seconde partie de la thèse est consacrée à l’étude de l’influence de la convection. Nous commençons par présenter les différentes raisons qui peuvent expliquer les déviations expérimentales par rapport à la diffusion seule, comme la convection naturelle induite par des gradients de densité ou de tension superficielle. Nous présentons le concept de convection spontanée associé aux mouvements microscopiques de la solution. Bien que les fondements théoriques de la convection spontanée soient discutables, la théorie permet de reproduire les résultats d’un certain nombre d’expériences, souvent pratiquées en conditions non contrôlées. Ensuite, nous évaluons l’influence de la convection naturelle sur de simples réactions électrochimiques, avant de passer à l’étude des réactions PCET. Les simulations numériques nous ont permis de prévoir la déviation des chronoampérogrammes par rapport à une situation diffusive en fonction de la durée de l’expérience et de la contribution de chaque espèce à la densité de la solution. Pour une électrode située au bord supérieur, la production d’espèces plus denses amène une déviation du courant plus importante, dû au développement d’instabilités hydrodynamiques. La convection due aux gradients de densité est supposée être accentuée lorsque que les réactions électrochimiques sont couplées avec des réactions chimiques, ce qui est la définition même des PCET. Cependant, nous avons conclu à un impact négligeable de celles-ci, sauf pour de faibles valeurs de constantes cinétiques. Pour conclure, nous avons évalué d’une part l’impact de la convection due aux effets Marangoni et d’autre part son couplage à la convection induite par des gradients de densité. L’influence de ces mouvements convectifs sur le courant résultant dépend des propriétés des réactifs et des produits de la réaction, mais également de la présence d’une surface libre.Doctorat en Sciencesinfo:eu-repo/semantics/nonPublishe

The lived experience of stigmatisation in patients after stoma reversal

Aim: This small−scale, exploratory, qualitative study was conducted to investigate how the experiences of having a stoma and subsequent stoma reversal affected the lives of the participants.Method: Five participants were interviewed about their experiences. Manual thematic analysis, using Interpretive Phenomenological Analysis (IPA), was employed to interpret the data. Results: Common themes were identified as emerging from the data. Themes before reversal were: acceptance and coping; social impact; and anticipation of returning to normal. Post−reversal themes were: returning to normal; interference with anticipated return to normal; and ongoing social impact. Conclusion: This exploratory study provides a rich account of the experiences of stoma patients who underwent reversal operations. It enhances our understanding of the transition encountered when changing from a person with a stoma into someone without one. This research has found that the anticipated return to normal can be hampered by a mix of physical and psychological processes. </jats:p