Childhood Disability: Challenges and Theory-Informed Child Life Interventions in the Healthcare Setting

Children with intellectual, sensory, physical, and/or speech disabilities encounter a proliferation of challenges in the healthcare environment. Such challenges are exacerbated by insufficient knowledge in doctors, nurses, child life specialists, and other healthcare providers in bias-free and specialized healthcare delivery. To remedy this, pertinent methods informed by theoretical perspectives of atypical development that ameliorate stress and augment coping in children with disabilities are warranted. Therefore, the purpose of this independent study is to provide a synthesis of the literature that chronicles this topic. Multifarious child life interventions that are premised on contemporary developmental frameworks of childhood disability will be presented. The overall objective is to enlighten healthcare personnel of the valuable and critical approaches to implement and utilize with children with disabilities in clinical practice

From Formulation to Implementation: Investigating the Environmental Policy Process in Nairobi

An examination of the environmental policy process provides insight into the mechanisms of decision-making that create and implement policies, which in turn affect planning outcomes and development directions. Such in-depth scrutiny has rarely emerged in the East African context, with few studies providing an analysis of the entire policy process and the actor network involved. This study offers a thick, descriptive narrative of the environmental policy arena in Nairobi, where rampant environmental degradation due to unconstrained development is occurring despite the existence of an environmental regulatory framework. The effects of newly implemented constitutional and strategic development reforms in this rapidly evolving African metropolis are also interrogated. The study lens shifts from the macro-level perspective of the policy system and context, to the micro-level of the institutional and individual actors, examining their roles, authority, and the interconnections between them. A qualitative case study approach is utilized, consisting of 25 semi-structured interviews conducted with environmental policymaking leaders in Nairobi. Both deductive (themes are applied to the data) and inductive (themes are derived from the data) analyses are applied to examine the research data in detail. The primary data is supplemented with numerous secondary sources, which provide a practical grounding for the primary analysis. The narrative that coalesces around the data themes uncovers the underlying causes for poor environmental regulation thus far, prominent among them being a lack of institutional capacity in state agencies; corrupt and nepotistic governance; and the splintering of the environmental mandate among numerous state institutions, leading to competition and conflict among them. Adam and Kriesi’s Network Approach (2007) is then critically adapted and applied, revealing the concentration of power in state authorities and disproportionate distribution of influence among non-state actors in the environmental policy subsystem. This policy network analysis shows how these conditions create the potential for low to moderate incremental policy change going forward.1 yea

Hyperglycemia-associated Alzheimer’s-like symptoms and other behavioral effects attenuated by Plumeria obtusa L. Extract in alloxan-induced diabetic rats

Diabetes mellitus is a chronic metabolic complaint with numerous short- and long-term complications that harm a person’s physical and psychological health. Plumeria obtusa L. is a traditional medicine used in the treatment of diabetes to reduce complications related to behavior. Plumeria is a genus with antipsychotic activities. The objective of this study was to examine the effects of a methanolic extract of Plumeria obtusa L. in the attenuation of diabetes, on symptoms of Alzheimer disease, and on other associated behavioral aspects. A single dose of alloxan was administered to an experimental group of rats to induce development of diabetes (150 mg/kg, intraperitoneal) and the rats were then administered selected doses of methanolic extract of Plumeria obtusa L. (Po.Cr) or glibenclamide (0.6 mg/kg) for 45 consecutive days. Behavioral effects were evaluated using three validated assays of anxiety-related behavior: the open field test, the light and dark test, and the elevated plus maze. Anti-depressant effects of Plumeria obtusa L. were evaluated using the forced swim test (FST) and memory and learning were assessed using the Morris water maze (MWM) task. Po.Cr was also evaluated for phytochemicals using total phenolic content (TPC), total flavonoid content (TFC), and high-performance liquid chromatography assays, and antioxidant capability was assessed through assays of DPPH radical scavenging, total oxidation capacity, and total reducing capacity. In the alloxan-induced model of diabetes, the administration of Po.Cr and glibenclamide for 45 days produced a marked decrease (p < 0.001) in hyperglycemia compared to control animals. Po.Cr treatment also resulted in improvement in indicators, such as body weight and lipid profile (p < 0.05), as well as restoration of normal levels of alanine transaminase (ALT) (p < 0.001), a biomarker of liver function. Diabetic rats presented more Alzheimer-like symptoms, with greater impairment of memory and learning, and increased anxiety and depression compared to non-diabetic normal rats, whereas treated diabetic rats showed significant improvements in memory and behavioral outcomes. These results demonstrate that Po.Cr reversed alloxan-induced hyperglycemia and ameliorated Alzheimer-related behavioral changes, which supports additional study and assessment of conventional use of the plant to treat diabetes and associated behavioral complications

Medication adherence: understanding the challenges among the elderly

This study explores medication adherence challenges in the elderly population, focusing on the complexities and dynamics of managing polypharmacy in a geriatric care setting. The research was conducted in One Stop Home Care Centre, Sri Damai, Kuantan, Malaysia, involving 10 participants aged between 45 and 72. It employs a mixed-methods approach, utilizing structured questionnaires and in-depth interviews to assess medication adherence behaviours and the influencing factors. The findings indicate a significant discrepancy between self-reported medication adherence and actual practices. While 50% of participants reported managing a single medication, observational data revealed a more intricate medication regimen, with some managing up to four different medications. The study highlights the critical role of social support systems in promoting medication adherence, with all participants adhering to their prescribed schedules due to robust caregiver involvement. However, 30% reported occasional lapses due to the complexity of their medication regimens. Notably, side effects like headaches and sleepiness were identified as key factors affecting medication adherence, underscoring the need for tailored approaches to manage side effects. The study emphasizes the importance of understanding the unique characteristics and challenges of medication adherence in the elderly, especially in the context of polypharmacy. The research also points out the socio-economic impact of an aging population and the growing demand for age-appropriate healthcare services. It emphasises the need for strategic health policy and planning to cater to the unique needs of the elderly. The findings advocate for comprehensive patient education, shared responsibility between residents and caregivers, and the implementation of systems to monitor medication intake and side effects. The study therefore provides valuable insights into medication adherence among the elderly, highlighting the necessity for personalised interventions and strategies to enhance health outcomes in this demographic. The research also acknowledges limitations, including a one-time visit for data collection and the lack of long-term follow-up, suggesting areas for future research

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Microplastics contamination in the gastropod, Telescopium telescopium, from the mangrove area of Versova Creek, Mumbai, India: Microplastics in the gastropod

Microplastic (MP) content in the gastropod, Telescopium telescopium, collected from the mangrove forest of Versova Creek, Mumbai was investigated. In total, 60 specimens were collected and pooled into six groups of 10 animals, each according to their weight and size. The concentration of extracted MP was expressed as the number of MP particles g-1 soft tissue (wet weight) and Ind.-1 (individual). MP was detected in all six groups and ranged from ~1 to 4 MP/g soft tissue and ~4 to 23 MP/individual. The minimum number of MP both in soft tissue and in each individual were 1.12 MP/g and 3.6 MP/Ind, respectively, and were found to be present in the lowest wet weight group (3.21±0.33 g). The size of the longest dimension of MP varied from 21-435 µm, most of which were smaller than 100 µm. The majority of the MP found in each weight group were colorless and transparent fragments were the most prevalent shape (55.20%). FTIR analysis showed polyethylene, polypropylene, and polyurethane were the major polymer types. The study reports the microplastic content in a gastropod, Telescopium inhabiting the mangroves of Mumbai, India. As an algal feeder/detritivore, the presence of MP in its soft tissue suggests molluscans are prone to consuming MP, relative to the environmental availability. They had a higher proportion of MP than body weight, indicating the potential transfer of MP into higher trophic levels of the mangrove ecosystem. Irregular fragment MP dominance indicates Telescopium graze on weathered plastic items covered by fouling algae and contributes to MP formation

Appropriateness of acid-suppressing agents for stress ulcer prophylaxis in non-intensive care unit setting in Saudi Arabia

Objective: To investigate the appropriateness of acid-suppressive therapy (AST) for stress ulcer prophylaxis (SUP) in noncritically ill hospitalized patients. Materials and Methods: A prospective, observational study with 384 subjects was conducted between October and December 2017 in the emergency and internal medicine departments. The Herzig clinical risk scoring system and the guidelines of the American Society of Health-System Pharmacists guidelines were used to assess risk factors and determine risk scores for gastrointestinal (GI) bleeding. Results: The mean age of subjects was 51.9±19.4 years, and 220 (57.3%) of them were males. Among the absolute risk factors, coagulopathy was observed in 2 (0.5%) patients, mechanical ventilation in 15 (3.9%), and a history of GI bleeding in 1 (0.3%). Of 384 patients with SUP, 370 (96.4%) had a clinical risk score ≤ 9 and 14 (3.6%) had a risk score between 10 and 12 for nosocomial GI bleeding. A statistically significant relationship was found between the risk factor indication and demographics. Conclusion: SUP is frequently administered to noncritically ill hospitalized patients lacking risk factors for GI bleeding. Proton pump inhibitors are the overwhelming first choice of AST among prescribers. Practitioners should follow international guidelines when prescribing ASTs outside the critical-care setting

Exploring medical and nursing students\u27 perceptions about a patient safety course: A qualitative study

Background: Educating health professionals on patient safety can potentially reduce healthcare-associated harm. Patient safety courses have been incorporated into medical and nursing curricula in many high-income countries and their impact has been demonstrated in the literature through objective assessments. This study aimed to explore student perceptions about a patient safety course to assess its influence on aspiring health professionals at a personal level as well as to explore differences in areas of focus between medical and nursing students.Methods: A dedicated patient safety course was introduced for year III medical and year II and IV nursing students at the Aga Khan University (2021-2022). As part of a post-course assessment, 577 participating students (184 medical and 393 nursing) wrote reflections on the course, detailing its influence on them. These free-text responses were thematically analyzed using NVivo.Results: The findings revealed five major themes: acquired skills (clinical, interpersonal), understanding of medical errors (increased awareness, prevention and reduction, responding to errors), personal experiences with patient safety issues, impact of course (changed perceptions, professional integrity, need for similar sessions, importance of the topic) and course feedback (format, preparation for clinical years, suggestions). Students reported a lack of baseline awareness regarding the frequency and consequences of medical errors. After the course, medical students reported a perceptional shift in favor of systems thinking regarding error causality, and nursing students focused on human factors and error prevention. The interactive course format involving scenario-based learning was deemed beneficial in terms of increasing awareness, imparting relevant clinical and interpersonal skills, and changing perspectives on patient safety.Conclusions: Student perspectives illustrate the benefits of an early introduction of dedicated courses in imparting patient safety education to aspiring health professionals. Students reported a lack of baseline awareness of essential patient safety concepts, highlighting gaps in the existing curricula. This study can help provide an impetus for incorporating patient safety as a core component in medical and nursing curricula nationally and across the region. Additionally, patient safety courses can be tailored to emphasize areas identified as gaps among each professional group, and interprofessional education can be employed for shared learning. The authors further recommend conducting longitudinal studies to assess the long-term impact of such courses

Incorporating patient safety and quality course into the nursing curriculum: An assessment of student gains

Background: Training nursing students on quality and patient safety (PS) is crucial to ensuring safe healthcare practices given the key role nurses play on the healthcare team. The aim of this study was to evaluate the impact of quality and PS course on the knowledge, and system thinking of students at different stages of the undergraduate nursing course.Methods: A 4.5-day quality improvement and PS course was conducted at the Aga Khan University School of Nursing and Midwifery for 146 second- and 139 fourth-year students. Students\u27 knowledge, self-assessment of knowledge and skills, and system thinking were assessed using pretest and posttest.Results: Of the total of 20 points, the course significantly improved students\u27 knowledge by a mean of 4.91 points for second-year students (95% confidence interval [CI], 4.32-5.51) and 3.46 points for fourth-year students (95% CI, 2.90-4.02) between pretest and posttest. For systems thinking, the Systems Thinking Scale scores increased by 0.41 points (95% CI, 0.29-0.52) for second-year students and 0.33 points (95% CI, 0.22-0.44) for fourth-year students out of the total of 5 points. The self-assessment scores significantly increased on postcourse assessment for second (P \u3c 0.05) and fourth-year students (P \u3c 0.001). Positive experience reported by students in the narrative reflections complemented these results.Conclusions: There was a significant increase in nursing students\u27 knowledge, self-efficacy, and system thinking after participating in this short PS course. Replication at a national level may improve safety knowledge and skills among nursing students with subsequent gains in the safety of healthcare delivery in Pakistan