Life with my baby in a neonatal intensive care unit: Embracing the Family Integrated Care model

This paper is a personal narrative that describes the components of the Family Integrated Care Model in a neonatal intensive care unit in Canada. I begin by introducing the reader with a brief story of how my son came to be admitted into a NICU. Next, I discuss three aspects of the Family Integrated Care Model that I found to be most striking: medical rounds, “do-ups” and skin-to-skin contact. I also discuss how my immersion in this healthcare setting for three months was a form of autoethnographic fieldwork, as I experienced the NICU both as a parent and a health researcher. Finally, I outline two recommendations to the Family Integrated Care model that might prove to be useful for healthcare professionals in other NICUs to adopt

Practice recommendations regarding parental presence in NICUs during pandemics caused by respiratory pathogens like COVID-19

AimTo co-create parental presence practice recommendations across Canadian NICUs during pandemics caused by respiratory pathogens such as COVID-19.MethodsRecommendations were developed through evidence, context, Delphi and Values and Preferences methods. For Delphi 1 and 2, participants rated 50 items and 20 items respectively on a scale from 1 (very low importance) to 5 (very high). To determine consensus, evidence and context of benefits and harms were presented and discussed within the Values and Preference framework for the top-ranked items. An agreement of 80% or more was deemed consensus.ResultsAfter two Delphi rounds (n = 59 participants), 13 recommendations with the highest rated importance were identified. Consensus recommendations included 6 strong recommendations (parents as essential caregivers, providing skin-to-skin contact, direct or mothers' own expressed milk feeding, attending medical rounds, mental health and psychosocial services access, and inclusion of parent partners in pandemic response planning) and 7 conditional recommendations (providing hands-on care tasks, providing touch, two parents present at the same time, food and drink access, use of communication devices, and in-person access to medical rounds and mental health and psychosocial services).ConclusionThese recommendations can guide institutions in developing strategies for parental presence during pandemics caused by respiratory pathogens like COVID-1

“But the moment they find out that you are MSM…”: a qualitative investigation of HIV prevention experiences among men who have sex with men (MSM) in Ghana’s health care system

Abstract: The prevalence of HIV in Ghana is 1.3%, compared to 17% among men who have sex with men (MSM). There is limited empirical data on the current health care climate and its impact on HIV prevention services for Ghanaian MSM. The purposes of this study were to investigate (1) MSM’s experiences using HIV prevention resources, (2) what factors, including health care climate factors, influenced MSM’s use of prevention resources and (3) MSM self-identified strategies for improving HIV/sexually transmitted infection (STI) prevention among MSM in Ghanaian communities. Methods: We conducted 22 focus groups (n = 137) with peer social networks of MSM drawn from three geographic communities in Ghana (Accra, Kumasi, Manya Krobo). The data were examined using qualitative content analysis. Interviews with individual health care providers were also conducted to supplement the analysis of focus group findings to provide more nuanced illuminations of the experiences reported by MSM..

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

"Somos Parte de la Solución": Women Activists' Knowledge of Gendered Risk and Their Educational Responses to HIV/AIDS in the Peruvian Amazon

This dissertation is a critical ethnography conducted in the Amazon jungle city of Iquitos, Peru--a city where sex work and sex tourism are becoming increasingly prevalent, and where AIDS cases in women are on the rise. In recent years, HIV positive and sex worker women activists in Iquitos have made significant strides to respond to the AIDS crisis through social movement organizing and educational outreach. This dissertation exposes the nuanced gender relations perspectives of HIV positive and sex worker women activists and underscores the importance of including these subjugated knowledges in solution-oriented discourses in HIV/AIDS education. I deployed a combination of gender relations and postcolonial feminist theories to pursue two lines of inquiry. First, I investigated HIV positive women and sex worker women activists' own understandings of gender relations and gender-related risk factors for HIV. Second, I explored the varied educational spaces that activist women produced to disseminate this knowledge to other affected populations and the wider public. Results show that women activists' collective organizing around their stigmatized identities positioned them to critically comment about how gender influences HIV risk for both women and men and also enabled them to encourage their stakeholders to re-think and re-learn gender in ways that would reduce their risk to HIV. As the title of this dissertation reads, women activists asserted that they are "part of the solution" to combat HIV/AIDS in Peru. My dissertation shows that "activist knowledge" is critical to re-conceptualize the ways that local expressions of masculinities, femininities and gender relations are taken up in HIV/AIDS education initiatives.Ph

Why women suffer domestic violence in silence: Web-based responses to a blog

Background & Aim: Domestic violence (DV) is a global socio-cultural concern faced by a majority of women. DV has a negative impact on women’s social, physical, and psychological wellbeing. Objective was to explore perceptions regarding contributing factors to domestic violence among women.Methods & Materials: A qualitative descriptive exploratory method was applied for the study. Purposive sampling was used to select participants through emails to respond to the web based blog created for the study. 41 worldwide participants shared their perceptions through the blogs in the study. The data were collected using a web-based discussion forum on the Urban Women Health Collaborative (UWHC), an internet-based social networking site, during March 2011. Data were analyzed, and categories and themes were extracted using a content analysis approach.Results: The major theme “Traditional values justifying domestic violence against women” emerged from the analysis of the participants’ blog. Under this major theme, four categories were extracted which include: socio-cultural attitudes towards women; trapped in the vicious cycle of violence; DV is a power game; and the misinterpretation of legal insinuations and religious practices.Conclusion: Women face DV due to social cultural practices and inequities in society. This implies that effective interventions are needed at several levels: individual, family, and community to prevent the violence and to provide a safe and respectful environment for the women in the societ

sj-pdf-1-mpp-10.1177_23814683231168589 – Supplemental material for “To Be or Not to Be”—Cardiopulmonary Resuscitation for Hospitalized People Who Have a Low Probability of Benefit: Qualitative Analysis of Semi-structured Interviews

Supplemental material, sj-pdf-1-mpp-10.1177_23814683231168589 for “To Be or Not to Be”—Cardiopulmonary Resuscitation for Hospitalized People Who Have a Low Probability of Benefit: Qualitative Analysis of Semi-structured Interviews by Daniel Kobewka, Yasmin Lalani, Victoria Shaffer, Tolulope Adewole, Kiefer Lypka and Pete Wegier in MDM Policy & Practice</p