A narrative study of the illness experience of fibromyalgia in South Africa.

This thesis presents the findings of an exploratory study undertaken to investigate the illness experience of fibromyalgia in the context of South Africa. It contains the literature review and conceptual framework that guided the study. The theoretical discussions reflect the approaches to health and illness, illness experience and narrative study, context, diagnosis, prognosis, sickness, illness career, treatment, institutional interactions and social support. Following this, the methodological approaches and tools used in conducting this study are explained. In-depth interviews and diaries were used to collect narratives from 15 participants and one practitioner. Additionally, a brief media content analysis was included in order to assess the public perceptions of fibromyalgia in South African news articles. The themes of legitimacy, credibility, flexibility, and accommodation are continually developed throughout the thesis. The Analysis of Findings chapter presents and discusses the evidence gathered from the investigations undertaken in this study. This chapter shows how the contested and confusing illness experience of fibromyalgia can be understood, by viewing the interactions that patients have with their practitioners, families, peers and colleagues. The meanings ascribed to fibromyalgia as a label, and the uncertain prognosis attached to the diagnosis, as well as infrequently effective treatment options are explored here. The gains found in successful practitioner-patient interactions, and the limitations of medical aid coverage for chronic conditions like fibromyalgia in South Africa are discussed in this chapter. The role of family and peers, as well as workplaces and colleagues in offering support to those living with fibromyalgia is analysed. Finally, the conclusions arising from this study are presented, and recommendations for areas of future engagement and research are offered in order to attain a better understanding of the experience and impact of fibromyalgia in the South African context

Communicating decisions about care with patients and companions in emergency department consultations

INTRODUCTION: This paper explores doctor-patient and companion communication about care decisions in a UK emergency department (ED). Doctors interface between patients and healthcare systems and facilitate access to care across a range of encounters, drawing on information and authority to make and communicate clinical care decisions. MATERIALS AND METHODS: We explored characteristics of communication through ethnographic observation of 16 video-recorded case studies of ED consultations (average length: 1 h) collected over 6 months. Companions were present in 10 cases. We conducted a framework analysis to understand the roles of doctors, consultants, patients and companions in relaying ED care decisions. FINDINGS: We present two cases to reflect companion roles and their effect on the consultation. The urgency for care and scarcity of resources means clinicians justify decisions and strategize to move patients along ED pathways. DISCUSSION: Everyday care interactions between patients and doctors are goal-oriented and companions participate by providing case information, querying decisions and advocating for care. Our findings reflect how doctors justify decisions made in communicating the next steps in ways that characterize the clinical encounter. CONCLUSION: By exploring everyday interactions our study contributes to a growing understanding of patient-clinician and companion communication in the ED. PATIENT OR PUBLIC CONTRIBUTION: Patients and caregivers voluntarily participated in data collection and consented to video recordings being conducted of ED consultations between them and junior doctors. There was extensive consultation with all grades of staff about the acceptability of the work and the best way to conduct it to minimize the impact on patients and staff. Through this manuscript, we have demonstrated the presence and important role of companions. On reflection it would have been valuable to have included patients and companions in discussions about the work; however, this project was conducted with very limited funding and no resources were committed to patient and public involvement. Given the setting and scope of the study, it was not feasible to involve patients or members of the public in other stages of the research or preparation of the manuscript. We recognize this as a potential limitation of the work

Why has the US opioid crisis not spread to the UK? Thank the NHS

The US is currently experiencing an epidemic of opioid use - a crisis which has yet to cross the Atlantic to the United Kingdom. But why has opioid use reached crisis point in the US but not in the UK? Diarmuid Denneny and Silvie Cooper argue that the US crisis has its roots in the promotion of opioids for chronic pain management more than 20 years ago which led to a culture of attempting to end chronic pain rather than to manage it. The National Health Service in the UK, by contrast, made pain management services universally accessible and offers pain-management strategies beyond opioids

The role of peer educators in the peers' negotiation of sexual decisions : a Wits University case study.

This research report presents the research topic and the discussion and motivations behind the chosen subject area and case study selection relating to the research study of “how peer educators assist their peers in negotiating sexual decisions: a Wits University case study”. The report will outline the literature review that was undertaken to develop the theoretical framework underpinning this project, which incorporated elements of behavioural change, social identity, knowledge dissemination and life-cycle theories. The research questions guiding the research project are then presented. The report goes on to assess the ways in which socialization sources and agents shift in influence and importance during different phases of social life. Following this, the details of the study will be outlined, including the methodology comprising research design, methods, sampling techniques used and ethical considerations involved in conducting this research project. The usefulness of diaries in capturing personal narratives when conducting informal peer education is discussed in this section. Next the findings arising from the data collection phase of this research project will be presented and analysed into four interrelated themes. These include “The social environment of student life at Wits University”; “Peer educators’ social identity and its influence on informal peer education interactions in different contexts”; “Just Jokes- Icebreakers, Innuendo, Teasing, Tantalising and Talking- The influence of humour in informal peer education” and “The multi-dimensional continuum of discussion”. Finally the conclusions and programmatic recommendations arising from this research study are given

Évaluations anthropologiques rapides sur le terrain

This SSHAP Practical Approaches brief provides guidance on undertaking rapid anthropological assessments in the context of an epidemic. During an epidemic, rapid anthropological assessments are used to collect data with and from affected populations and public health officials to (a) understand key social, cultural, political, and economic dynamics; (b) identify relevant authorities and trusted leaders for message dissemination; (c) gather communities’ understanding of the disease and health decision-making processes; and (d) inform appropriate and effective response efforts.Cette synthèse des approches pratiques SSHAP fournit des orientations relatives à la réalisation d’évaluations anthropologiques rapides dans le contexte d’une épidémie. Lors d’une épidémie, des évaluations anthropologiques rapides sont utilisées pour collecter des données avec et auprès des populations affectées et des autorités publiques afin (a)de comprendre la dynamique sociale, culturelle, politique, et économique clé ; (b) d’identifier les autorités et les dirigeants dignes de confiance pertinents pour la diffusion de messages ; (c) de recueillir la compréhension des communautés de la maladie et des processus de prise de décision sanitaire ; et (d) d’informer des initiatives de riposte appropriées et efficaces.UNICEFUSAI

The Development of Ambulatory Cancer Care in the UK: A Scoping Review of the Literature

INTRODUCTION: Ambulatory Care (AC), where patients receive inpatient cancer treatment on an outpatient basis, was introduced into the United Kingdom (UK) National Health Service (NHS) in 2004. Although now well established within some services, the development of AC across the NHS is yet to be described. We report findings of a scoping review that set out to understand the provenance of the clinical pathway, whilst exploring drivers for the development of AC in the UK. METHODS: Using scoping review methods, database citation, and grey literature, searches were undertaken to map the storyline of AC’s development internationally. The Joanna Briggs Institute guidance was followed; this included consultation with six professionals considered critical to the development of AC. RESULTS: From the 57 records identified between 1979 and 2022, four domains were identified through a narrative synthesis that reflected the following drivers for AC: financial; optimisation of bed capacity; advances in technology and supportive care; and professional motivation to improve patient experience. CONCLUSION: We report the first descriptive analysis of the international development of AC, locating the UK cancer service within its commissioning, operational, and philosophical foundations. The review additionally highlights limited research exploring the experience of the AC model from the patients’ perspective

Barriers and facilitators of use of analytics for strategic health and care decision-making: a qualitative study of senior health and care leaders' perspectives.

OBJECTIVE: This study investigated the barriers and facilitators that senior leaders' experience when using knowledge generated from the analysis of administrative health or care records ('analytics') to inform strategic health and care decision-making. SETTING: One London-based sustainability and transformation partnership (STP) in England, as it was on the cusp of forming an integrated care system (ICS). PARTICIPANTS: 20 senior leaders, including health and social care commissioners, public health leads and health providers. Participants were eligible for inclusion if they were a senior leader of a constituent organisation of the STP and involved in using analytics to make decisions for their own organisations or health and care systems. DESIGN: Semi-structured interviews conducted between January 2020 and March 2020 and analysed using the framework method to generate common themes. RESULTS: Organisational fragmentation hindered use of analytics by creating siloed data systems, barriers to data sharing and different organisational priorities. Where trusted and collaborative relationships existed between leaders and analysts, organisational barriers were circumvented and access to and support for analytics facilitated. Trusted and collaborative relationships between individual leaders of different organisations also aided cross-organisational priority setting, which was a key facilitator of strategic health and care decision-making and use of analytics. Data linked across health and care settings were viewed as an enabler of use of analytics for decision-making, while concerns around data quality often stopped analytics use as a part of decision-making, with participants relying more so on expert opinion or intuition. CONCLUSIONS: The UK Governments' 2021 White Paper set out aspirations for data to transform care. While necessary, policy changes to facilitate data sharing across organisations will be insufficient to realise this aim. Better integration of organisations with aligned priorities could support and sustain cross-organisational relationships between leaders and analysts, and leaders of different organisations, to facilitate use of analytics in decision-making

Global changes to the chemotherapy service during the covid-19 pandemic.

PURPOSE: In response to the COVID-19 pandemic, changes to chemotherapy services were implemented as a means of managing imposed workload strains within health services and protecting patients from contracting COVID-19. Given the rapidly evolving nature of the pandemic many changes were rapidly adopted and were not substantiated by robust evidence. This study aimed to describe the changes adopted internationally to chemotherapy services, which may be used to guide future changes to treatment delivery. METHODS: A survey was developed to understand the impact of COVID-19 on the delivery of systemic anti-cancer therapies (SACT). It comprised 22 questions and examined the strategies implemented during the pandemic to prioritise and protect patients receiving SACT and the participants' professional opinion of the strategies employed. The survey was available in English, Spanish and French and was distributed via professional bodies. RESULTS: 129 responses were obtained from healthcare professionals working across 17 different countries. 45% of institutions had to implement treatment prioritisation strategies and all hospitals implemented changes in the delivery of treatment, including: reduction in treatments (69%), using less immunosuppressive agents (50%), allowing treatment breaks (14%) and switching to oral therapies (45%). Virtual clinic visits were perceived by participants as the most effective strategy to protect patients. CONCLUSIONS: The pandemic has forced chemotherapy healthcare professionals to adopt new ways of working by reducing health interactions. Many areas of research are needed following this period, including understanding patients' perceptions of risks to treatment, utilisation of oral treatments and the impact of treatment breaks on cancer outcomes

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Retreatment for hepatitis C virus direct-acting antiviral therapy virological failure in primary and tertiary settings: The REACH-C cohort

Virological failure occurs in a small proportion of people treated for hepatitis C virus (HCV) with direct-acting antiviral (DAA) therapies. This study assessed retreatment for virological failure in a large real-world cohort. REACH-C is an Australian observational study (n = 10,843) evaluating treatment outcomes of sequential DAA initiations across 33 health services between March 2016 to June 2019. Virological failure retreatment data were collected until October 2020. Of 408 people with virological failure (81% male; median age 53; 38% cirrhosis; 56% genotype 3), 213 (54%) were retreated once; 15 were retreated twice. A range of genotype specific and pangenotypic DAAs were used to retreat virological failure in primary (n = 56) and tertiary (n = 157) settings. Following sofosbuvir/velpatasvir/voxilaprevir availability in 2019, the proportion retreated in primary care increased from 21% to 40% and median time to retreatment initiation declined from 294 to 152 days. Per protocol (PP) sustained virological response (SVR12) was similar for people retreated in primary and tertiary settings (80% vs 81%; p = 1.000). In regression analysis, sofosbuvir/velpatasvir/voxilaprevir (vs. other regimens) significantly decreased likelihood of second virological failure (PP SVR12 88% vs. 77%; adjusted odds ratio [AOR] 0.29; 95%CI 0.11–0.81); cirrhosis increased likelihood (PP SVR12 69% vs. 91%; AOR 4.26; 95%CI 1.64–11.09). Indigenous Australians had lower likelihood of retreatment initiation (AOR 0.36; 95%CI 0.15–0.81). Treatment setting and prescriber type were not associated with retreatment initiation or outcome. Virological failure can be effectively retreated in primary care. Expanded access to simplified retreatment regimens through decentralized models may increase retreatment uptake and reduce HCV-related mortality