Diagnosing and Discussing Sexual Abuse: A Scoping Review on Training Methods for Health Care Professionals

Fiona Elizabeth van Zyl-Bonk, Sibylle Lange, Antoinette Leonarda Maria Lagro-Janssen, Theodora Alberta Maria Teunissen Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the NetherlandsCorrespondence: Theodora Alberta Maria Teunissen, Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Geert Grooteplein 21, Postbus 9101, Nijmegen, 6500 HB, the Netherlands, Tel +31 24 3618181, Email [email protected]: Sexual abuse is a health issue with many consequences. Recognizing and discussing past sexual abuse has proven to be challenging for health care professionals. To improve overall quality of health care for sexual abuse victims, health care professionals need to be properly trained. The aim of this paper is to provide an overview of training methods for health care professionals and to report on their effectiveness.Methods: A scoping review was conducted. A broad search was executed in six databases in December 2022. Study selection was performed by two independent reviewers, followed by quality assessment and data extraction.Results: After screening of titles and abstracts and later full-text assessment for quality appraisal, seven articles were selected, consisting mostly of non-randomized trials, performed among a total of 1299 health care professionals. All studies were assessed to be of moderate to poor quality. The participants attended training courses with a wide variety of durations, settings, formats and methods. The outcomes showed improvements in self-perceived or measured knowledge, skills and confidence to discuss sexual violence. Changes in clinical practice were scarcely investigated. Training courses were most effective when a mix of didactic passive methods, such as lectures and videos, and active participatory strategies, such as discussions and roleplay, were applied. Timely iteration to reinforce retention of gained knowledge and skills also contributed to effectiveness. Participants most enjoyed incorporating opportunities for receiving feedback in small settings and sharing personal experiences.Conclusion: This scoping review summarizes on how to effectively train health care professionals. Flaws and difficulties in measuring the effectiveness of training courses were discussed. Recognition and discussion of past sexual abuse by health care providers can be effectively trained using an alternating mix of multiple active and passive training methods with room for feedback and personal experiences.Keywords: sexual violence, disclosure, recognition, medical education, post-graduate trainin

Gender sensitivity among general practitioners: Results of a training programme

Contains fulltext : 70167.pdf (publisher's version ) (Open Access)BACKGROUND: Gender differences contribute to patients' health and illness. However in current healthcare practices attention to gender differences is still underdeveloped. Recognizing these differences and taking them into account can improve the quality of care. In this study we aimed to investigate whether GPs' gender sensitivity can be stimulated by a training programme. The focus was on three diseases: angina pectoris, depression and urinary incontinence. METHODS: This study had a quantitative, explorative and descriptive design. By means of a training programme 18 GPs were trained to focus on gender-sensitive recommendations for the three diseases. With standardised registration forms, data were collected during a 6-month period. During the registration period, the GPs were visited by the study team to discuss the process of data collection. RESULTS: The GPs filled in registration forms for 100 patients: 39 with angina pectoris (31 women and 8 men), 40 with depression (26 women and 14 men), and 21 with urinary incontinence (20 women and 1 man). The results show that gender sensitivity can be stimulated among trained professionals. The combination of the training programme, clear and practical recommendations, daily discussion of relevant cases between the GP couples, feedback and support during registration by the study team probably contributed to the outcome. CONCLUSION: GPs' gender sensitivity was stimulated by the training programme and the supporting visits. Ideally, structural attention could be realised by embedding gender issues in existing organisational structures of general practices

“Clinical features of women with gout arthritis.” A systematic review

Clinically, gout is generally considered as a preferential male disease. However, it definitely does not occur exclusively in males. Our aim was to assess differences in the clinical features of gout arthritis between female and male patients. Five electronic databases were searched to identify relevant original studies published between 1977 and 2007. The included studies had to focus on adult patients with primary gout arthritis and on sex differences in clinical features. Two reviewers independently assessed eligibility and quality of the studies. Out of 355 articles, 14 were selected. Nine fulfilled the quality and score criteria. We identified the following sex differences in the clinical features of gout in women compared to men: the onset of gout occurs at a higher age, more comorbidity with hypertension or renal insufficiency, more often use of diuretics, less likely to drink alcohol, less often podagra but more often involvement of other joints, less frequent recurrent attacks. We found interesting sex differences regarding the clinical features of patients with gout arthritis. To diagnose gout in women, knowledge of these differences is essential, and more research is needed to understand and explain the differences , especially in the general population

GPs' perspectives of type 2 diabetes patients' adherence to treatment: A qualitative analysis of barriers and solutions

BACKGROUND: The problem of poor compliance/adherence to prescribed treatments is very complex. Health professionals are rarely being asked how they handle the patient's (poor) therapy compliance/adherence. In this study, we examine explicitly the physicians' expectations of their diabetes patients' compliance/adherence. The objectives of our study were: (1) to elicit problems physicians encounter with type 2 diabetes patients' adherence to treatment recommendations; (2) to search for solutions and (3) to discover escape mechanisms in case of frustration. METHODS: In a descriptive qualitative study, we explored the thoughts and feelings of general practitioners (GPs) on patients' compliance/adherence. Forty interested GPs could be recruited for focus group participation. Five open ended questions were derived on the one hand from a similar qualitative study on compliance/adherence in patients living with type 2 diabetes and on the other hand from the results of a comprehensive review of recent literature on compliance/adherence. A well-trained diabetes nurse guided the GPs through the focus group sessions while an observer was attentive for non-verbal communication and interactions between participants. All focus groups were audio taped and transcribed for content analysis. Two researchers independently performed the initial coding. A first draft with results was sent to all participants for agreement on content and comprehensiveness. RESULTS: General practitioners experience problems with the patient's deficient knowledge and the fact they minimize the consequences of having and living with diabetes. It appears that great confidence in modern medical science does not stimulate many changes in life style. Doctors tend to be frustrated because their patients do not achieve the common Evidence Based Medicine (EBM) objectives, i.e. on health behavior and metabolic control. Relevant solutions, derived from qualitative studies, for better compliance/adherence seem to be communication, tailored and shared care. GPs felt that a structured consultation and follow-up in a multidisciplinary team might help to increase compliance/adherence. It was recognized that the GP's efforts do not always meet the patients' health expectations. This initiates GPs' frustration and leads to a paternalistic attitude, which may induce anxiety in the patient. GPs often assume that the best methods to increase compliance/adherence are shocking the patients, putting pressure on them and threatening to refer them to hospital. CONCLUSION: GPs identified a number of problems with compliance/adherence and suggested solutions to improve it. GPs need communication skills to cope with patients' expectations and evidence based goals in a tailored approach to diabetes care

Views on Interprofessional Collaboration in a Dutch Sexual Assault Center: A Qualitative Study Among Workers

Jasmijn Mulder,1 Theodora Alberta Maria Teunissen,1 Veranie Maria Johanna Peters,1 Marie Louise Moors,2 Antoinette Leonarda Maria Lagro-Janssen1 1Department of Primary and Community Care, Gender and Women’s Health, Radboud University Medical Center, Nijmegen, the Netherlands; 2Emergency Department, Radboud University Medical Center, Nijmegen, the NetherlandsCorrespondence: Jasmijn Mulder, Radboudumc, Afdeling Eerstelijnsgeneeskunde, Huispost 121, t.a.v. Jasmijn Mulder, Postbus 9101, Nijmegen, 6500HB, the Netherlands, Email [email protected]: As the response to sexual assault victims proved to be shattered and substandard, sexual assault centers were set up to improve care by providing the victims with medical, psychosocial and legal care. The Dutch Centers for Sexual Assault were launched in 2012. We wished to examine the challenges in interprofessional collaboration experienced in a long-running Dutch Sexual Assault Center.Methods: In this qualitative study, data was collected via semi-structured explorative interviews which were analyzed using thematic analysis in an iterative process. The semi-structured interviews were held with fifteen professionals from medical, psychosocial and legal disciplines. An interview guide was developed based on expert opinion and the Bronstein Index of Interprofessional Collaboration. Qualitative analyses were done using the method of thematic analysis in ATLAS.ti and were reported according to the COREQ criteria. The themes of the experienced challenges in interprofessional collaboration were further clarified using quotations.Results: Participants mentioned three themes that challenged interprofessional collaboration: 1. discrepancies in professional involvement, 2. conflicting goals and 3. a lack of connection. Discrepancies in motivation and affinity to work with victims of sexual violence between professionals proved to be the most pivotal challenge to collaboration, leading to disturbing differences in professional involvement. A low caseload and time restraints complicated gaining expertise, affinity and motivation. Conflicting goals and confidentiality issues arose between the medical and legal disciplines due to their contrasting aims of caring for victims versus facilitating prosecution. Some professionals felt a lack of connection, particularly due to missing face-to-face personal contact, which hindered the sharing of complex or burdensome cases and gaining insight into the other discipline’s competences.Conclusion: Building collective ownership and equal professional involvement are crucial for interprofessional collaboration. Professional involvement should be increased by training courses to clarify conflicting goals and to improve reciprocal personal contact between professionals. Training courses should be facilitated with organizational financial support.Keywords: interprofessional collaboration, sexual assault center, challenges, sexual assault, sexual violence, qualitative method

Urinary incontinence in the elderly: attitudes and experiences of general practitioners. A focus group study.

Contains fulltext : 50429.pdf (publisher's version ) (Open Access)OBJECTIVE: To assess general practitioners' (GPs') attitudes to urinary incontinence in elderly patients and their experiences in the application of the Dutch College of General Practitioners' guideline in daily practice. DESIGN: Two existed groups of six GPs working in villages and seven GPs working in urban practices. METHOD: Two focus-group discussions with recording of discussions and transcription. Transcripts were analysed by two independent researchers. RESULTS: During the discussions three main themes of attitudes came forward: (1) therapeutic nihilism of GPs and low motivation of patients, (2): GPs experienced lack of time because of difficulties in explaining the therapy and because of impaired mobility of older patients, (3) because of the complexity of the problem and co-morbidity, GPs as well as patients were reluctant to treat the UI. The most remarkable findings in the application of the guideline were: (1) because of the barriers mentioned above, physical examination did not take place in spite of GPs' conviction as to the benefit of it; (2) GPs' knowledge of treatment options in the elderly with UI is substandard. CONCLUSION: Several patient (comorbidity, impaired mobility, low motivation, and acceptance of the problem) and GP factors (therapeutic nihilism, lack of time and knowledge) interfere with good management of UI in the elderly

"It can always happen": the impact of urinary incontinence on elderly men and women.

Contains fulltext : 50950.pdf (publisher's version ) (Open Access