Prioritizing solutions to incorporate Prosthetics and Orthotics services into Iranian health benefits package: Using an analytic hierarchy process

Introduction: Health benefits package (HBP) is regarded as one of the main dimensions of health financing strategy. Even with increasing demands for prosthetics and orthotics (P&O) services to approximately 0.5% of the world’s population, only 15% of vulnerable groups have the chance to make use of such benefits. Inadequate coverage of P&O services in the HBP is accordingly one of the leading reasons for this situation in many countries, including Iran. Aims: The main objective of this study was to find and prioritize solutions in order to facilitate and promote P&O services in the Iranian HBP. Study design: A mixed-methods (qualitative-quantitative) research design was employed in this study. Methods: This study was conducted in two phases. First, semi-structured interviews were undertaken to retrieve potential solutions. Then an analytic hierarchy process (AHP) reflecting on seven criteria of acceptability, effectiveness, time, cost, feasibility, burden of disease, and fairness was performed to prioritize them. Results: In total, 26 individuals participated in semi-structured interviews and several policy solutions were proposed. Following the AHP, preventive interventions, infant-specific interventions, inpatient interventions, interventions until 6 years of age, and emergency interventions gained the highest priority to incorporate in the Iranian HBP. Conclusion: A number of policy solutions were explored and prioritized for P&O services in the Iranian HBP. Our findings provide a framework for decision- and policy-makers in Iran and other countries aiming to curb the financial burdens of P&O users, especially in vulnerable group

The effectiveness of educational programmes in ventilator bundle implementation:a systematic review

Abstract Introduction: Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection encountered in critical care settings. Thus, several packages (ventilator bundles, VBs) have been designed to help reduce or eliminate VAP, promote adherence to evidence-based guidelines and thus improve clinical outcomes. The aim of this systematic review was to assess current literature regarding the effectiveness of educational programmes on their implementation. Materials and methods: A comprehensive literature search strategy was formulated in association with an information specialist. We then reviewed studies published between 2003 and 2012 listed in seven multidisciplinary databases (Ovid MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Scopus, Web of Science, Medic and Academic Search Premier). The study selection and quality assessment were carried out by two researchers independently and objectively. Results: Six original studies were included in the final review. Educational programmes were linked to significant improvements in the overall adherence to VBs and a significant decrease in adverse clinical outcomes such as the incidence of VAP, monthly use of sedatives, duration of mechanical ventilation and hospitalisation costs. Conclusions: Education programmes about VBs can promote adherence to evidencebased guidelines and thus reducethe incidence of VAP. However, they are often inconsistently developed, implemented and evaluated. There are needs for both effective educational programmes and a universal method for evaluating their outcome

Hoitoon osallisuuden rnerkitys sekä osallisuutta vahvistavat ja heikentävät tekijät tyypin 1 diabetesta sairastavien nuorten kokemina

Tiivistelmä Tutkimuksen tarkoituksena oii kuvata tyypin 1 diabetesta sairastavien nuorten kokemuksia hoitoon osallisuuden merkityksestä, sekä osallisuutta vahvistavia ja heikentäviä tekijöitä. Aineisto kerättiin teemoihin perustuvilla yksilöhaastatteluilla 12–17-vuotiailta tyypin 1 diabetesta sairastavilta nuorilta (n=10). Aineisto analysoitiin sisällönanalyysilla. Hoitoon osallisuus merkitsi nuorille itsenäisyyttä, keinoja vaikuttaa terveyteen ia hyvinvointiin, sekä sujuvampaa arkea. He halusivat olla osallisia hoitoonsa. Nuoret kokivat osallisuuden vahvistuvan heidän hyväksyessä sairautensa ja ottaessa vastuuta sairauden hoidosta. Tyypin 1 diabetesta sairastavien nuorten hoitoon osallisuutta voidaan vahvistaa kuuntelemalla, tukemalIa, antamalla nuorille riittävästi tietoa ja ottamalla heidät mukaan päätöksentekoon, sekä hoidon suunnitteluun, toteutukseen ja arviointiin. Nuoret kokivat hoitoon osallisuuden heikentyvän riittämättömän tiedonsaannin ja holhoamisen vuoksi, sekä nuoren kokiessa häpeää tai psyykkistä ja fyysistä kuormittumista. Diabetes on pitkäaikaissairaus, jonka hoidosta potilaat vastaavat pitkälti itse. Omahoidolla on vaikutusta nuoren elämänlaatuun. Tyypin 1 diabetesta sairastavien nuorten hoitoon osallisuus voi lisätä hoitoon sitoutumista ja parantaa hoitotasapainoa. Tutkimustuloksia voidaan hyödyntää vahvistettaessa nuorten hoitoon osallisuutta.Abstract The significance of involvement in treatment as described by adolescent type 1 diabetics, and factors strengthening and weakening involvement The purpose of this study was to describe adolescent type 1 diabetics’ experiences of the significance of involvement in treatment, and the factors that strengthen and weaken involvement in treatment. The data were collected using individual thematic interviews (n = 10) among adolescents aged 12–17 with type 1 diabetes. The data was analysed with inductive content analysis. As described by the young respondents, involvement in treatment signified independence, means to influence one’s health and well-being, and smoother everyday life. Adolescents wanted to be involved in their care. According to their experience, involvement in treatment grew stronger as they accepted their illness and took responsibility for treatment. Involvement in treatment among adolescent type 1 diabetics can be strengthened by listening to them, giving psychological support and adequate information, and letting them be involved in decision making, and in the planning, implementation and evaluation of treatment. As described by the respondents, factors that weaken involvement in treatment are inadequate information, patronage, feelings of shame, and psychological and physical stress. Diabetes is a long-term condition that patients take care of largely by themselves. Self-care has an impact on the quality of life of the young patient. Adolescent type 1 diabetícs’ involvement in treatment may increase the compliance to treatment and thus improve therapeutic equilibrium. The research results can be utilized in supporting adolescents’ involvement in treatment among

Sairaanhoitajien toteuttamien interventioiden vaikutus verenpainepotilaiden lääkehoitoon sitoutumiseen ja verenpainearvoihin:systemaattinen kirjallisuuskatsaus

Abstract The aim of this systematic review was to describe the interventions conducted by nurses for promotion on medication adherence and to assess the effect of interventions on hypertensive patients on medication adherence and hypertension management. The data was collected from Medline-, CINAHL- and Medic database and manually from years 2006–2016. During the search 474 studies were found. After the screening process and a quality appraisal nine studies remained for the review. The data was analyzed with narrative synthesis. The interventions, their content and methods used in the studies were described in very different ways and with different accuracy. In addition, several studies used several methods. Intervention methods, conducted by nurses, were motivational interviewing, influencing beliefs and attitudes, education and giving feedback in different ways about adherence and blood pressure control. Nurse interventions had statistically significant (p˂0,05) effecs on medication adherence and blood pressure control. According to four studies there were statistically significant effects on both outcomes. However four studies indicated no significant effects on medication adherence and one study did not find any positive effect on blood pressure control. This review provides evidence that nurse interventions designed to promote medication adherence may be effective and they have potential to improve medication adherence and results in hypertension treatment. Evidence is insufficient to support the use of any specific intervention.Tiivistelmä Systemaattisen kirjallisuuskatsauksen tarkoitus oli kuvata sairaanhoitajien toteuttamien verenpainelääkehoitoon sitoutumisen edistämiseksi toteutettuja interventioita ja arvioida niiden vaikutusta verenpainepotilaiden lääkehoitoon sitoutumiseen ja verenpainearvoihin. Tiedonhaku suoritettiin Medline- CINAHL- ja Medic-tietokannoista sekä manuaalisesti vuosilta 2006–2016. Haku tuotti 474 viitettä. Artikkeleiden valinta- ja laadunarviointiprosessin jälkeen aineistoon valikoitui yhdeksän artikkelia, jotka analysoitiin kuvailevalla synteesillä. Tutkimuksissa käytetyt interventiot, niiden sisältö ja menetelmät oli kuvattu hyvin eri tavoin ja eri tarkkuudella. Lisäksi osassa tutkimuksia käytettiin useaa eri menetelmää. Tässä katsauksessa on pyritty jäsentämään tutkimukset niiden interventioiden sisällön kuvauksen perusteella eri menetelmiin. Sairaanhoitajien toteuttamissa interventioissa menetelminä käytettiin koulutusta, asenteisiin ja uskomuksiin vaikuttamista, eri tavoin annettua palautetta sitoutumisesta ja hoidon toteutumisesta sekä motivoivaa haastattelua. Interventioilla oli tilastollisesti merkitseviä (p˂0,05) vaikutuksia lääkehoitoon sitoutumiseen ja verenpainearvoihin. Neljässä tutkimuksessa todettiin tilastollisesti merkitsevät muutokset molemmissa muuttujissa. Toisaalta neljän tutkimuksen tulokset eivät osoittaneet tilastollisesti merkitsevää muutosta lääkehoitoon sitoutumisessa ja yksi tutkimus ei löytänyt intervention positiivista vaikutusta verenpainearvoihin. Katsaus antaa viitteitä, että sairaanhoitajien toteuttamilla lääkehoitointerventioilla on mahdollista edistää verenpainepotilaiden lääkehoitoon sitoutumista ja parantaa verenpaineen hoitotasapainoa. Katsauksen perusteella ei voida päätellä jonkin tietyn interventiomenetelmän olevan tehokkain

Barriers to not informing patients about radiation in connection with radiological examinations:radiographers’ opinion

Abstract Introduction: In some instances, little knowledge regarding radiological examinations is provided to patients. The purpose was to investigate whether radiographers inform patients about radiation, and if not, the reasons for it. Methods: A questionnaire was sent to radiographers working in the public sector in Northern Finland. Radiographers were asked whether they had informed patients about the radiation dose and risks during the last year. If information was not provided, the reasons for it were investigated using multiple-answer type multiple-choice questions with the option for free text responses. The results were compared between a University Hospital and other departments and between different lengths of work experience. Altogether 174/272 (64%) radiographers responded to the questionnaire; 50% were from the University Hospital and 50% from other departments. Results: Altogether 103/174 (59%) respondents did not inform patients about the radiation dose and 93/174 (53%) did not inform them about the associated risks. Regarding a passive approach to dose information, respondents thought that the referrer had already informed the patient (49/103, 48%), information was not needed (51/103, 50%), or it might cause unnecessary fear (47/103, 46%). Reasons for a passive approach to risk information were similar (66/93, 71%; 33/93, 36%; 47/93, 51%, respectively). Regarding the results, there were no differences between the institutions or work experience levels. According to the open question, some radiographers expected patients to ask questions before informing them. Lack of time was rarely mentioned as a reason. Conclusion: The main reasons for inadequate information were ignorance regarding responsibilities, assumption that information is not needed, and concern about causing unnecessary fear. Implications for practice: Education, guidelines specifying responsibilities and contents for information, and easy-access digital educational material for public and professionals are needed

Well-being supportive home environment of elderly people with visual impairments and health-related quality of life

Abstract The aim of this study was to describe the well-being supportive home environment of elderly people (n = 37) with visual impairment (VI) and its relationship with health-related quality of life (HRQoL). Data were collected during home visits six (6) months after the commencement of individual low vision rehabilitation (LVR) process. A structured well-being supportive environment instrument and a general HRQoL instrument were administered. Background variables had no detectable effect on the HRQoL. The HRQoL correlated significantly with the symbolic environment, living-related fears and feelings of general restrictiveness. The participants generally saw their home environment to be comfortable and supportive of well-being, but many felt that their life was too much restricted to home environment

Issues promoting and hindering girls’ well-being in Northern Finland

Summary Well-being is a complex concept that includes elements of inequality due to socio-economics, living environment or gender. Every person also encounters unique situations and has different experiences of well-being. This qualitative study aims to describe what issues promote and hinder the well-being of girls aged 13–16 in Northern Finland. A total of 117 girls aged 13–16 living in Northern Finland were asked to write about the issues that hinder and promote their well-being. The girls’ responses were analysed using content analysis. After analysis, two combining categories were discovered: issues hindering well-being were a debilitating sphere of life and negative experiences in life, and issues promoting well-being were positive subjective sensations and favourably perceived conditions. The results of this study indicate that girls’ well-being is connected to their social and physical environment. As the girls’ view of the issues that promote or hinder health are connected and interact with their living environment, there is also a need for health promotion measures to take into account both the individuals and the environment in which they function and live. This view challenges us to see health promotion in a broader way—a way which takes into account structural and political factors, individual consultation and empowerment

Technology-based counselling in the management of weight and lifestyles of obese or overweight children and adolescents:a descriptive systematic literature review

Abstract Background: The number of overweight and obese children and adolescents has increased worldwide. Obese children and adolescents need counseling interventions, including technology-based methods, to help them manage their weight by changing their lifestyles. Objective: To describe technology-based counseling interventions in supporting obese or overweight children and adolescents to change their weight/lifestyle. Design: Descriptive systematic literature review. Methods: A literature search was conducted using Cinahl, Medline, PsycINFO, and Medic databases in September 2010 and updated in January 2015. Predefined inclusion criteria were used for the search. After a quality assessment, 28 studies were included in the data extraction. Results: No statistically significant difference in BMI was detected between the intervention and control groups. However, in some studies, it was found that BMI decreases and there were statistically significant differences in fruit and vegetable consumption. In two studies, differences in physical activity were detected between the intervention and control groups, but in eight studies, the difference was not significant. Goal setting and feedback on progress support physical activity and changes in diet. Conclusions: This study identifies available technology interventions for obese or overweight children and adolescents. It seems that using technology-based counseling intervention may encourage obese and overweight children and adolescents to pursue a healthier lifestyle

Feasibility and clinical utility of the Finnish version of the FLACC pain scale in PICU

Abstract Purpose: To describe the feasibility and clinical utility of the Finnish FLACC scale when assessing children’s pain in a Pediatric Intensive Care Unit (PICU). Design and methods: A non-experimental, descriptive cross-sectional study design was used to describe the feasibility and clinical utility in a Finnish PICU between May and August 2018. The nurses were asked to complete a data collection questionnaire about the feasibility and clinical utility of the Finnish FLACC every time they used the scale to assess pain in children. In total, the data consisted of 157 pain assessments cases. Quantitative data were analyzed statistically and responses to open-ended questions were analyzed using content analysis. Results: In most cases, the nurses agreed that the Finnish FLACC scale was clearly structured (97%), easy to use (98%), helpful in assessing pain intensity (77%), and useful when reassessing pain after interventions (67%). Nurses found the scale more useable for children over one year old than for younger children. When assessing cry and consolability, pain was easier to score if the child was not intubated. Conclusions: The Finnish FLACC scale exhibits adequate feasibility and clinical utility when assessing pain in children in a PICU. However, more information is needed about its use during painful short-term procedures and with children under one year old. Practice implications: The Finnish FLACC scale is a helpful tool for nurses when assessing children’s pain in a PICU. However, the Finnish version of the modified FLACC is needed for use with intubated children in the future