Background: To understand what life is like for US children with a diagnosis of Growth Hormone Deficiency or Idiopathic Short Stature, the impact of short stature on Health related Quality of Life (HrQoL) was qualitat...Background: To understand what life is like for US children with a diagnosis of Growth Hormone Deficiency or Idiopathic Short Stature, the impact of short stature on Health related Quality of Life (HrQoL) was qualitatively examined and needs for care from the young patients and their parents perspective were identified. Methods: Focus group discussions with 26 American-English speaking and nine American-Spanish speaking children and their parents were conducted, transcribed verbatim and subsequently qualitatively analyzed by two independent raters, using an existing coding guideline, based on the multidimensional HrQoL concept and a special software (VERBI-Software MAXQDA 10). Results: A total of 1313 statements for the English-speaking and 447 statements for the Spanish-speaking families were categorized. In the US, the strongest frequency of mention was found for the HrQoL dimension “Social” across respondents, followed by “Treatment” and “Emotion”. Conclusion: Conducting and analyzing data generated from focus groups ensure that young patients’ experiences of disease are represented in the measure of outcomes for use in clinical trials and patient care.展开更多
Racial/ethnic minority populations are under- represented in clinical trials and Hispanic participation rates are particularly low. This study assessed barriers and facilitators to clinical trials participation by Med...Racial/ethnic minority populations are under- represented in clinical trials and Hispanic participation rates are particularly low. This study assessed barriers and facilitators to clinical trials participation by Medicaid eligible Mexican- Americans and their serving physicians. Qualitative data from two focus groups conducted among Mexican-American Medicaid eligible patients and four physician focus groups were analyzed. Mexican-American patients have a basic understanding of clinical trials. While most are open to participating in clinical research, not speaking English, time, and transportation were identified as barriers. Physicians believe that desperation and financial need are the primary patient motivators for participation. Barriers to physician recruitment and referral include: lack of information about clinical trials, concern that study participation may not be in the patient’s best interest, and lack of staffing and time to conduct trials. Ample opportunities exist to engage providers and patients in future efforts to increase Mexican-American patient recruitment into clinical trials.展开更多
This study is to investigate the effectiveness and safety of bloodletting puncture(BP)for acute ischemic stroke(AIS)when used in combination with standard treatment,as well as the patients'feelings and attitudes t...This study is to investigate the effectiveness and safety of bloodletting puncture(BP)for acute ischemic stroke(AIS)when used in combination with standard treatment,as well as the patients'feelings and attitudes toward the treatment.This is a mixed method research which includes a multi-center,superiority,randomized controlled clinical trial,and focus group interview.A total of 360 AIS participants will be enrolled.They will be randomized into one of the following two groups for 7 d:(a)BP with standard treatment group(n=180);(b)standard treatment group(n=180).The primary outcome will be National Institute of Health stroke scale(NIHSS)score at day 7 after treatment.Secondary outcomes will be changes of Glasgow Coma Scale score,NIHSS score,mRS and Traditional Chinese Medicine syndrome score from baseline to 7,14,and 30 d after treatment,recurrence rate and all-cause mortality rate within 30 d,and the safety assessments.The focus group will be conducted with a purposive sample of 1-2 acupuncturists and 1-2 patients respectively at each center at 7 and 30 d after treatment.We designed a mixed method study to evaluate the effect of BP,an acupuncture therapy for patients with AIS.If the findings of this study confirm the effectiveness of BP to reduce the NIHSS score and other related outcomes and patients are willing to accept the therapy,we believe this study will help the implementation of this therapy in clinical practice,and provide new evidence for the treatment of AIS.展开更多
Objective:Barriers to healthcare in Ghana are multifaceted.Many people,including patients and providers,face them at different levels.To address these barriers,there is a need to explore the role of an intercultural h...Objective:Barriers to healthcare in Ghana are multifaceted.Many people,including patients and providers,face them at different levels.To address these barriers,there is a need to explore the role of an intercultural healthcare system.This paper explores and provides the first evidence on ways through which an intercultural healthcare system can reduce the sociocultural and economic barriers to healthcare in Ghana.Methods:Focus group discussions with 35 participants comprising 17 healthcare users,11 formal healthcare providers and 7 alternative healthcare providers were conducted to gather data.Thematic analyses were performed on the transcribed data and presented based on a posteriori inductive reduction approach.Results:Findings reveal that an intercultural healthcare system in Ghana can help reduce barriers to healthcare,especially cultural,social and economic barriers,by fostering an enhanced relationship between culture and healthcare,promoting affordable healthcare and promoting effective communication between healthcare providers and users.Weak institutional support,lack of strong political will and commitment,lack of training to meet standards of practice,poor registration and regulatory measures,and lack of universal acceptance inhibit implementation of an intercultural healthcare system in Ghana.Conclusion:The support for intercultural healthcare system and the agreement on its perceived ability to reduce social,cultural and economic healthcare barriers for service users offer an opportunity for policymakers to demonstrate a stronger political will and improved commitment for effective education and training,enforcement of regulatory measures,inclusion of intercultural healthcare in medical school curricula across the country,and community engagement.展开更多
Objective:Chronic nonspecific musculoskeletal pain(CNMP)is a complex idiopathic condi-tion that causes significant disruption to patients’lives,their relationships,and functionality.The cause of CNMP is not fully und...Objective:Chronic nonspecific musculoskeletal pain(CNMP)is a complex idiopathic condi-tion that causes significant disruption to patients’lives,their relationships,and functionality.The cause of CNMP is not fully understood,which makes diagnosis and management challenging.As general practitioners(GPs)are central to the management of chronic pain,their perspectives on managing CNMP are important.Purpose:To explore the clinical reasoning GPs use when diagnosing and managing CNMP.Methods:A qualitative study design using focus group discussion was conducted with Australian GPs.Five focus group discussion were conducted across Adelaide.All focus group discussions were audio-recorded,and transcripts were coded and analyzed thematically with the program NVivo.Results:The main themes remained consistent across the five focus group discussion’s:the ambiguous cause of CNMP;sex differences;developing the“right strategy”;patient-centered care;and verifying vitamin D levels.Conclusion:The findings show that GPs use a patient-centered approach tailored to indi-vidual patients’medical history,physical examination findings,and psychosocial health.There was general concern about low levels of vitamin D in patients with CNMP,and vitamin D supplements were recommended if indicated by a patient’s history.展开更多
In the southwest of Mali, pastoral resources play an important role in the production and reproduction of livestock. These pastoral resources are very sensitive to climatic hazards and negatively affected their availa...In the southwest of Mali, pastoral resources play an important role in the production and reproduction of livestock. These pastoral resources are very sensitive to climatic hazards and negatively affected their availability in quantity and quality. The main objective of this study was to analyze the risks and influences of climate hazards on pastoral resources and the strategies taken by agropastoralists to cope with them. To achieve this objective, meteorological data trends from 1950 to 2022 were analyzed. The socio-economic data were collected through a semi-structured survey administered to 404 head households, from focus groups through discussion with local stakeholders by using climatic risks matrix. The results obtained indicate a concordance between agropastoralists perception on climate change and meteorological observations concerning the decrease of rainfall (−213 mm;63.3%), the increase of maximum and minimum temperature (+1.33˚C, +1.24˚C;93.1%), and the increase of wind speed (+0.59 m/s;97%) over the past 70 years. Respondents noted a deterioration in the conditions of pastoral resources due to climatic hazards compared to the last 40 years (44.8% for watering points;23.5% for pastures;63.1% for salty lands). Agro pastoralists have adopted measures that allow them to be resilient. These include the collection and storage of crop residues (49.5%), regular watering of animals (39.6%), changing of animals rhythms driving (35.9%), protection of pruning species (31.7%), and concerted reforestation (37.9%). Climatic risk-related hazards constitute a real threat to pastorals resources in the district of Bougouni.展开更多
目的:抑郁症发病率较高,常伴有不同程度的认知功能减退,指南推荐采用药物治疗合并心理治疗减缓抑郁症状。焦点解决团体治疗(solution focused group therapy,SFGT)是一种较新的团体心理治疗技术。本研究旨在探讨SFGT联用艾司西酞普兰与...目的:抑郁症发病率较高,常伴有不同程度的认知功能减退,指南推荐采用药物治疗合并心理治疗减缓抑郁症状。焦点解决团体治疗(solution focused group therapy,SFGT)是一种较新的团体心理治疗技术。本研究旨在探讨SFGT联用艾司西酞普兰与单一服用艾司西酞普兰对抑郁症患者抑郁症状和认知灵活性的影响。方法:纳入84例符合《疾病和有关健康问题的国际统计分类(第10版)》抑郁症诊断标准的患者,按照入组先后顺序将患者分为联合组(n=42)和对照组(n=42),对照组单一服用艾司西酞普兰,联合组在对照组的基础上联用SFGT,对患者进行为期8周的治疗。使用24项汉密尔顿抑郁量表(24-item Hamilton Depression Scale,HAMD-24)和认知灵活性问卷(Cognitive Flexibility Inventory,CFI)分别在基线时(T_(0))、第4周(T_(1))、第8周(T_(2))对患者进行测评,比较与分析2组患者抑郁症状和认知灵活性的差异。结果:在T_(2)时,联合组脱落8例,对照组脱落10例。2组患者在T0时HAMD、CFI总分和维度分的差异均无统计学意义(均P>0.05)。在T_(1)、T_(2)时,联合组患者的HAMD-24总分及焦虑躯体化、认知障碍、迟缓、绝望感等维度分均低于对照组,CFI总分及维度分均高于对照组,差异均具有统计学意义(均P<0.05)。结论:SFGT能够改善抑郁症患者抑郁症状中的焦虑躯体化症状、认知障碍、迟缓症状及绝望感症状,且能够提高认知灵活性。展开更多
文摘Background: To understand what life is like for US children with a diagnosis of Growth Hormone Deficiency or Idiopathic Short Stature, the impact of short stature on Health related Quality of Life (HrQoL) was qualitatively examined and needs for care from the young patients and their parents perspective were identified. Methods: Focus group discussions with 26 American-English speaking and nine American-Spanish speaking children and their parents were conducted, transcribed verbatim and subsequently qualitatively analyzed by two independent raters, using an existing coding guideline, based on the multidimensional HrQoL concept and a special software (VERBI-Software MAXQDA 10). Results: A total of 1313 statements for the English-speaking and 447 statements for the Spanish-speaking families were categorized. In the US, the strongest frequency of mention was found for the HrQoL dimension “Social” across respondents, followed by “Treatment” and “Emotion”. Conclusion: Conducting and analyzing data generated from focus groups ensure that young patients’ experiences of disease are represented in the measure of outcomes for use in clinical trials and patient care.
文摘Racial/ethnic minority populations are under- represented in clinical trials and Hispanic participation rates are particularly low. This study assessed barriers and facilitators to clinical trials participation by Medicaid eligible Mexican- Americans and their serving physicians. Qualitative data from two focus groups conducted among Mexican-American Medicaid eligible patients and four physician focus groups were analyzed. Mexican-American patients have a basic understanding of clinical trials. While most are open to participating in clinical research, not speaking English, time, and transportation were identified as barriers. Physicians believe that desperation and financial need are the primary patient motivators for participation. Barriers to physician recruitment and referral include: lack of information about clinical trials, concern that study participation may not be in the patient’s best interest, and lack of staffing and time to conduct trials. Ample opportunities exist to engage providers and patients in future efforts to increase Mexican-American patient recruitment into clinical trials.
基金Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences:Research Design and Application of Mixed Methods in Traditional Chinese Medicine (No.CI2021B003)Evidence-based Ability Construction Project of National Administration of Traditional Chinese Medicine:Evidencebased Ability Improvement and Platform Construction of Traditional Chinese Medicine in Encephalopathy (No.2019XZZX-NB014)+2 种基金CACMS Innovation Fund:Research Priorities on Screening and Evaluating Appropriate and Effective Health Technologies in Specific Disease Field of TCM (No.CI2021A05503)CACMS Innovation Fund:Evaluation Method and Demonstration Research of Traditional Chinese Medicine Health Technology Assessment (No.CI2021A00701-3)the Fundamental Research Funds for the Central Public Welfare Research Institutes:Evidence Mapping and Scoping Review of Chinese Patent Medicines for Clearing Heat and Detoxifying (No.ZZ13-YQ-075)
文摘This study is to investigate the effectiveness and safety of bloodletting puncture(BP)for acute ischemic stroke(AIS)when used in combination with standard treatment,as well as the patients'feelings and attitudes toward the treatment.This is a mixed method research which includes a multi-center,superiority,randomized controlled clinical trial,and focus group interview.A total of 360 AIS participants will be enrolled.They will be randomized into one of the following two groups for 7 d:(a)BP with standard treatment group(n=180);(b)standard treatment group(n=180).The primary outcome will be National Institute of Health stroke scale(NIHSS)score at day 7 after treatment.Secondary outcomes will be changes of Glasgow Coma Scale score,NIHSS score,mRS and Traditional Chinese Medicine syndrome score from baseline to 7,14,and 30 d after treatment,recurrence rate and all-cause mortality rate within 30 d,and the safety assessments.The focus group will be conducted with a purposive sample of 1-2 acupuncturists and 1-2 patients respectively at each center at 7 and 30 d after treatment.We designed a mixed method study to evaluate the effect of BP,an acupuncture therapy for patients with AIS.If the findings of this study confirm the effectiveness of BP to reduce the NIHSS score and other related outcomes and patients are willing to accept the therapy,we believe this study will help the implementation of this therapy in clinical practice,and provide new evidence for the treatment of AIS.
文摘Objective:Barriers to healthcare in Ghana are multifaceted.Many people,including patients and providers,face them at different levels.To address these barriers,there is a need to explore the role of an intercultural healthcare system.This paper explores and provides the first evidence on ways through which an intercultural healthcare system can reduce the sociocultural and economic barriers to healthcare in Ghana.Methods:Focus group discussions with 35 participants comprising 17 healthcare users,11 formal healthcare providers and 7 alternative healthcare providers were conducted to gather data.Thematic analyses were performed on the transcribed data and presented based on a posteriori inductive reduction approach.Results:Findings reveal that an intercultural healthcare system in Ghana can help reduce barriers to healthcare,especially cultural,social and economic barriers,by fostering an enhanced relationship between culture and healthcare,promoting affordable healthcare and promoting effective communication between healthcare providers and users.Weak institutional support,lack of strong political will and commitment,lack of training to meet standards of practice,poor registration and regulatory measures,and lack of universal acceptance inhibit implementation of an intercultural healthcare system in Ghana.Conclusion:The support for intercultural healthcare system and the agreement on its perceived ability to reduce social,cultural and economic healthcare barriers for service users offer an opportunity for policymakers to demonstrate a stronger political will and improved commitment for effective education and training,enforcement of regulatory measures,inclusion of intercultural healthcare in medical school curricula across the country,and community engagement.
文摘Objective:Chronic nonspecific musculoskeletal pain(CNMP)is a complex idiopathic condi-tion that causes significant disruption to patients’lives,their relationships,and functionality.The cause of CNMP is not fully understood,which makes diagnosis and management challenging.As general practitioners(GPs)are central to the management of chronic pain,their perspectives on managing CNMP are important.Purpose:To explore the clinical reasoning GPs use when diagnosing and managing CNMP.Methods:A qualitative study design using focus group discussion was conducted with Australian GPs.Five focus group discussion were conducted across Adelaide.All focus group discussions were audio-recorded,and transcripts were coded and analyzed thematically with the program NVivo.Results:The main themes remained consistent across the five focus group discussion’s:the ambiguous cause of CNMP;sex differences;developing the“right strategy”;patient-centered care;and verifying vitamin D levels.Conclusion:The findings show that GPs use a patient-centered approach tailored to indi-vidual patients’medical history,physical examination findings,and psychosocial health.There was general concern about low levels of vitamin D in patients with CNMP,and vitamin D supplements were recommended if indicated by a patient’s history.
文摘In the southwest of Mali, pastoral resources play an important role in the production and reproduction of livestock. These pastoral resources are very sensitive to climatic hazards and negatively affected their availability in quantity and quality. The main objective of this study was to analyze the risks and influences of climate hazards on pastoral resources and the strategies taken by agropastoralists to cope with them. To achieve this objective, meteorological data trends from 1950 to 2022 were analyzed. The socio-economic data were collected through a semi-structured survey administered to 404 head households, from focus groups through discussion with local stakeholders by using climatic risks matrix. The results obtained indicate a concordance between agropastoralists perception on climate change and meteorological observations concerning the decrease of rainfall (−213 mm;63.3%), the increase of maximum and minimum temperature (+1.33˚C, +1.24˚C;93.1%), and the increase of wind speed (+0.59 m/s;97%) over the past 70 years. Respondents noted a deterioration in the conditions of pastoral resources due to climatic hazards compared to the last 40 years (44.8% for watering points;23.5% for pastures;63.1% for salty lands). Agro pastoralists have adopted measures that allow them to be resilient. These include the collection and storage of crop residues (49.5%), regular watering of animals (39.6%), changing of animals rhythms driving (35.9%), protection of pruning species (31.7%), and concerted reforestation (37.9%). Climatic risk-related hazards constitute a real threat to pastorals resources in the district of Bougouni.
文摘目的:抑郁症发病率较高,常伴有不同程度的认知功能减退,指南推荐采用药物治疗合并心理治疗减缓抑郁症状。焦点解决团体治疗(solution focused group therapy,SFGT)是一种较新的团体心理治疗技术。本研究旨在探讨SFGT联用艾司西酞普兰与单一服用艾司西酞普兰对抑郁症患者抑郁症状和认知灵活性的影响。方法:纳入84例符合《疾病和有关健康问题的国际统计分类(第10版)》抑郁症诊断标准的患者,按照入组先后顺序将患者分为联合组(n=42)和对照组(n=42),对照组单一服用艾司西酞普兰,联合组在对照组的基础上联用SFGT,对患者进行为期8周的治疗。使用24项汉密尔顿抑郁量表(24-item Hamilton Depression Scale,HAMD-24)和认知灵活性问卷(Cognitive Flexibility Inventory,CFI)分别在基线时(T_(0))、第4周(T_(1))、第8周(T_(2))对患者进行测评,比较与分析2组患者抑郁症状和认知灵活性的差异。结果:在T_(2)时,联合组脱落8例,对照组脱落10例。2组患者在T0时HAMD、CFI总分和维度分的差异均无统计学意义(均P>0.05)。在T_(1)、T_(2)时,联合组患者的HAMD-24总分及焦虑躯体化、认知障碍、迟缓、绝望感等维度分均低于对照组,CFI总分及维度分均高于对照组,差异均具有统计学意义(均P<0.05)。结论:SFGT能够改善抑郁症患者抑郁症状中的焦虑躯体化症状、认知障碍、迟缓症状及绝望感症状,且能够提高认知灵活性。
