How to deal with sexual changes during and after pregnancy

After documenting parenting couples’ needs regarding perinatal sexuality, this study developed and evaluated a brief psycho-educational workshop on perinatal sexuality. Participants(16 future and 17 new parents) completed five steps: 1)online questionnaire (T1) assessing needs toward the workshop and sexoperinatal knowledge, attitudes,and perceptions; 2)two-hour online workshopon perinatal sexuality; 3) post-workshop satisfaction questionnaire; 4) one-month (T2) and 5)two-month (T3) post-workshop questionnaires with the same measures as in T1. One month after the workshop, knowledge, attitudes,and perceptions towards perinatal sexuality increased significantly. Sexoperinatal interventions from healthcare workers are still uncommon, although there is a need forinformation and support. This brief online workshop is promising forbetter educationand empowerment ofparenting couplesregarding perinatal sexuality

Lagunas y obstáculos en la aplicación y el funcionamiento de los programas de administración de antimicrobianos: Resultados de una evaluación de necesidades con métodos mixtos educativos y conductuales en Francia, Estados Unidos, México e India

Antecedentes: La evidencia muestra una adherencia limitada a los principios de administración antimicrobiana (AMS). Objetivos: Identificar las lagunas educativas y las barreras sistémicas que obstaculizan la adhesión a los principios de la AMS. Métodos: Se realizó un estudio de métodos mixtos que combina un análisis temático de entrevistas cualitativas (enero-febrero de 2021) y un análisis inferencial de encuestas cuantitativas (mayo-junio de 2021). Se seleccionaron deliberadamente participantes de Francia, EE.UU., México y la India a partir de paneles en línea de profesionales de la salud para incluir a médicos infectólogos, especialistas en control de infecciones, microbiólogos clínicos, farmacólogos o farmacéuticos que se espera que apliquen los principios de la MGA en su entorno de práctica (por ejemplo, clínica, hospital académico o comunitario). Este estudio se ha guiado por un marco de análisis de carencias. Resultados: La muestra final incluyó 383 participantes (n = 33 entrevistas; n = 350 encuestas). Los resultados de los métodos mixtos indicaron que los conocimientos y habilidades de los participantes no eran óptimos para facilitar la aplicación personal y colectiva de los principios de la MGA. Los datos de la encuesta indicaron un desfase entre el conocimiento ideal y el actual de los protocolos de MGA, especialmente entre los farmacólogos (Δ0,95/4,00, p < 0,001). También se midieron las diferencias entre los niveles de conocimientos ideales y los actuales, que fueron mayores entre los especialistas en control infeccioso (Δ1,15/4,00, P < 0,001), para convencer a los directivos de los hospitales de que asignen recursos a los programas de MGA. Los obstáculos sistémicos ya existentes (por ejemplo, tiempo, financiación o formación insuficientes) se percibieron como agravados durante la pandemia COVID-19 (el 72% de los participantes en la encuesta estuvieron de acuerdo). Las deficiencias más acusadas se registraron en India y Francia. Conclusiones: Las necesidades educativas de los profesionales y los países incluidos en este estudio pueden informar las futuras actividades de desarrollo profesional continuo en AMS. Debería considerarse la posibilidad de obtener financiación adicional para abordar las barreras sistémicas percibidas. Las evaluaciones locales están justificadas para validar los resultados y la idoneidad de las intervenciones.Background: Evidence shows limited adherence to antimicrobial stewardship (AMS) principles. Objectives: To identify educational gaps and systemic barriers obstructing adherence to AMS principles. Methods: A mixed-methods study combining a thematic analysis of qualitative interviews (January-February 2021) and inferential analysis of quantitative surveys (May-June 2021) was conducted. Participants from France, the USA, Mexico and India were purposively sampled from online panels of healthcare professionals to include infectious disease physicians, infection control specialists, clinical microbiologists, pharmacologists or pharmacists expected to apply AMS principles in their practice setting (e.g. clinic, academic-affiliated or community-based hospital). A gap analysis framework guided this study. Results: The final sample included 383 participants (n = 33 interviews; n = 350 surveys). Mixed-methods findings indicated suboptimal knowledge and skills amongst participants to facilitate personal and collective application of AMS principles. Survey data indicated a gap in ideal versus current knowledge of AMS protocols, especially amongst pharmacologists (Δ0.95/4.00, P < 0.001). Gaps in ideal versus current skill levels were also measured and were highest amongst infectious control specialists (Δ1.15/4.00, P < 0.001), for convincing hospital executives to allocate resources to AMS programmes. Already existing systemic barriers (e.g. insufficient dedicated time/funding/training) were perceived as being aggravated during the COVID-19 pandemic (72% of survey participants agreed). Reported gaps were highest in India and France. Conclusions: The educational needs of professionals and countries included in this study can inform future continuous professional development activities in AMS. Additional funding should be considered to address perceived systemic barriers. Local assessments are warranted to validate results and suitability of interventions

A 2‐year dyadic longitudinal study of mothers' and fathers' marital adjustment when caring for a child with cancer

Objective Studies examining interrelationships within parental couples confronted with pediatric cancer are scarce. This study explored dyadic longitudinal associations between both partners' family functioning and mood at diagnosis, and marital adjustment 2 years later. Method Parents of children (n = 47 couples) with acute lymphoblastic leukemia (ALL) completed the Family Well‐Being Assessment and Profile of Mood States‐Bipolar Form at diagnosis, and the Locke–Wallace Marital Adjustment Test 2 years post diagnosis. Multilevel linear models using the actor–partner interdependence model (APIM) and controlling for baseline marital adjustment were conducted to evaluate within subject and dyadic longitudinal effects. Results For mothers, better marital adjustment 2 years post diagnosis was associated with perception of greater family support and less role conflict and role overload at diagnosis. For fathers, better marital adjustment 2 years post‐diagnosis was associated with perception of less role conflict, greater role ambiguity, and being more tired at diagnosis, as well as their partner's perception of less role conflict at diagnosis. Conclusions These findings highlight the importance of considering both partners' perspectives in understanding marital adjustment across treatment phases in parents of children with ALL. Early interventions for couples should be tailored to meet each partner's needs in order to foster resilience within the couple

International challenges in patient-centred care in fertility clinics offering assisted reproductive technology: providers' gaps and attitudes towards addressing the patients' psychological needs

Introduction. Psychosocial care provided to patients undergoing fertility treatment has focused on a small proportion of patients with major psychosocial problems, leaving the remaining patients impacted by psychosocial stressors without follow-up. Factors that could influence the ability or willingness of physicians treating infertility to assess and address patients’ psychosocial needs have not been investigated. This study aimed to identify the practice gaps and educational needs of physicians treating and managing patients with infertility, with the aim of informing future educational interventions. Methods. A cross-sectional, exploratory, mixed-methods study incorporating semi-structured qualitative telephone interviews and a quantitative online survey was designed and deployed to actively practising physicians treating infertile couples from 15 countries across the Americas, Europe, Asia, and the Middle East Region. Triangulation of qualitative and quantitative data was used to increase trustworthiness of findings. Results. Forty-five participants completed a qualitative interview and 271 participants completed the quantitative online survey (response rates were 4 and 9%, respectively). A majority (74%) of respondents reported needing improvement in their psychological assessment skill, which was considered essential to the provision of optimal care by less than half (41%) of respondents. A need for improvement in their skill to assess patients’ parenting skills was reported in 72% of respondents, and this skill was considered as essential by 32% of participants. Similarly, 72% reported needing improvement in their ability to identify the needs of patients for psychological and emotional support, and this ability was considered essential by 45%. Statistical differences were observed between countries (p<0.05). Conclusion. Addressing the gaps highlighted in this study, through educational or performance improvement activities, could optimise the clinical performance of physicians treating infertility and, thus, increase patient satisfaction and outcomes

Challenges in the care of patients with RET-altered thyroid cancer: a multicountry mixed-methods study

Abstract Background The discovery of driver oncogenes for thyroid carcinomas and the identification of genomically targeted therapies to inhibit those oncogenes have altered the treatment algorithm in thyroid cancer (TC), while germline testing for RET mutations has become indicated for patients with a family history of RET gene mutations or hereditary medullary TC (MTC). In the context of an increasing number of selective RET inhibitors approved for use, this paper aims to describe challenges and barriers affecting providers’ ability to deliver optimal care for patients with RET-altered TC across the patient healthcare journey. Methods A mixed-method educational and behavioral needs assessment was conducted in Germany (GER), Japan (JPN), the United Kingdom (UK), and the United States (US) prior to RET-selective inhibitor approval. Participants included medical oncologists (MO), endocrinologists (EN) and clinical pathologists (CP) caring for patients affected with TC. Data collection tools were implemented in three languages (English, German, Japanese). Qualitative data were coded and thematically analyzed in NVivo. Quantitative data were analyzed via frequency and crosstabulations in SPSS. The findings presented here were part of a broader study that also investigated lung cancer challenges and included pulmonologists. Results A total of 44 interviews and 378 surveys were completed. Suboptimal knowledge and skills were self-identified among providers, affecting (1) assessment of genetic risk factors (56%, 159/285 of MOs and ENs), (2) selection of appropriate genetic biomarkers (59%, 53/90 of CPs), (3) treatment plan initiation (65%, 173/275 of MOs and ENs), (4) management of side effects associated with multitargeted tyrosine kinase inhibitors (78%, 116/149 of MOs and ENs), and (5) transfer of patients into palliative care services (58%, 160/274 of MOs and ENs). Interviews underscored the presence of systemic barriers affecting the use of RET molecular tests and selective inhibitors, in addition to suboptimal knowledge and skills necessary to manage the safety and efficacy of targeted therapies. Conclusion This study describes concrete educational needs for providers involved in the care of patients with RET-altered thyroid carcinomas. Findings can be used to inform the design of evidence-based education and performance improvement interventions in the field and support integration into practice of newly approved RET-selective inhibitors

Challenges in diagnosis and biomarker testing for RET-altered lung and thyroid cancer care: an international mixed-method study

Abstract Background The introduction of new targeted therapies for RET-altered lung and thyroid cancers (LC/TC) has impacted pathologists’ practice by making genomic testing more relevant. Variations in health systems and treatment access result in distinct clinical challenges and barriers. This study aimed to assess practice gaps and challenges experienced by pathologists involved in the diagnosis of RET-altered LC/TC, including biomarker testing, to inform educational solutions. Methods Pathologists in Germany, Japan, the UK, and US participated in this ethics-approved mixed-methods study, which included interviews and surveys (data collected January-March 2020). Qualitative data was thematically analysed, quantitative data was analysed with chi-square and Kruskal–Wallis H-tests, and both were triangulated. Results A total of 107 pathologists took part in this study. Knowledge gaps were reported regarding genomic testing for LC/TC in Japan (79/60%), the UK (73/66%), and the US (53/30%). Skill gaps were reported when selecting genomic biomarker tests to diagnose TC in Japan (79%), the UK (73%) and US (57%) and when performing specific biomarker tests, especially in Japan (82% for RET) and in the UK (75% for RET). Japanese participants (80%) reported uncertainty about what information to share with the multidisciplinary team to ensure optimal patient-centered care. At the time of data collection, pathologists in Japan faced access barriers to using RET biomarker tests: only 28% agreed that there are relevant RET genomic biomarker tests available in Japan, versus 67% to 90% in other countries. Conclusions This study identified areas where pathologists need additional continuing professional development opportunities to enhance their competencies and better support delivery of care to patients with RET-altered lung or thyroid tumours. Addressing identified gaps and improving competencies of pathologists in this field should be emphasised in continuing medical education curricula and through quality improvement initiatives. Strategies deployed on an institutional and health system level should aim to improve interprofessional communication and genetic biomarker testing expertise

Use of non‐invasive diagnostic tools for metabolic dysfunction‐associated steatohepatitis: A qualitative exploration of challenges and barriers

BACKGROUND AND AIMS: Non‐invasive tests (NITs) are underutilized for diagnosis and risk stratification in metabolic dysfunction‐associated steatotic liver disease (MASLD), despite good accuracy. This study aimed to identify challenges and barriers to the use of NITs in clinical practice. METHODS: We conducted a qualitative exploratory study in Germany, Italy, United Kingdom and United States. Phase 1 participants (primary care physicians, hepatologists, diabetologists, researchers, healthcare administrators, payers and patient advocates; n = 29) were interviewed. Phase 2 participants (experts in MASLD; n = 8) took part in a group discussion to validate and expand on Phase 1 findings. Finally, we triangulated perspectives in a hybrid deductive/inductive thematic analysis. RESULTS: Four themes hindering the use of NITs emerged: (1) limited knowledge and awareness; (2) unclear referral pathways for patients affected by liver conditions; (3) uncertainty over the value of NITs in monitoring and managing liver diseases; and (4) challenges justifying system‐level reimbursement. Through these themes, participants perceived a stigma associated with liver diseases, and primary care physicians generally lacked awareness, adequate knowledge and skills to use recommended NITs. We identified uncertainties over the results of NITs, specifically to guide lifestyle intervention or to identify patients that should be referred to a specialist. Participants indicated an ongoing need for research and development to improve the prognostic value of NITs and communicating their cost‐effectiveness to payers. CONCLUSIONS: This qualitative study suggests that use of NITs for MASLD is limited due to several individual and system‐level barriers. Multi‐level interventions are likely required to address these barriers