Intensive care environment: Perspective of relatives of critically ill patient sustained by health technology

The intensive care unit(ICU)is a complex setting by nature,and some have described it as bizarre due to its numerous sirens that sound when anything is dangerous,constant activity,equipment,bright lights,and high fatality rate.The demands placed on nurses to care for critically ill patients in this environment frequently prevent nurses and other health‑care professionals from acknowledging the feelings of patient’s relatives or family caregivers,resulting in a hostile environment from the patient’s relative’s perspective.When a patient’s family enters the ICU,they feel that hospital administrators do little to nothing to alleviate their discomfort and fear.Despite research demonstrating the importance of providing a homely environment for patients’families,In Nigeria ICU is still far behind how a conventional ICU environment should be structured to accommodate patient’s relations in the unit.The goal of this study was to look at the patient’s relative’s perspective on providing care for a critically ill patient in an ICU,with a focus on the unit’s complexity and overall experience.Based on the findings of this study,we recommend that hospital administrators ensure that the environment of the upcoming ICU is designed to meet the needs of patient’s relatives by addressing identified environmental concerns,like caring neglect,by providing a friendly and stress‑free environment.

Outcomes and patients' perspectives of transition from paediatric to adult care in inflammatory bowel disease

AIM: To describe the disease and psychosocial outcomes of an inflammatory bowel disease (IBD) transition cohort and their perspectives.METHODS: Patients with IBD, aged > 18 years, who had moved from paediatric to adult care within 10 years were identified through IBD databases at three tertiary hospitals. Participants were surveyed regarding demographic and disease specific data and their perspectives on the transition process. Survey response data were compared to contemporaneously recorded information in paediatric service case notes. Data were compared to a similar age cohort who had never received paediatric IBD care and therefore who had not undergone a transition process.RESULTS: There were 81 returned surveys from 46 transition and 35 non-transition patients. No statistically significant differences were found in disease burden, disease outcomes or adult roles and responsibilities between cohorts. Despite a high prevalence of mood disturbance (35%), there was a very low usage (5%) of psychological services in both cohorts. In the transition cohort, knowledge of their transition plan was reported by only 25/46 patients and the majority (54%) felt they were not strongly prepared. A high rate (78%) of discussion about work/study plans was recorded prior to transition, but a near complete absence of discussion regarding sex (8%), and other adult issues was recorded. Both cohorts agreed that their preferred method of future transition practices (of the options offered) was a shared clinic appointment with all key stakeholders.CONCLUSION: Transition did not appear to adversely affect disease or psychosocial outcomes. Current transition care processes could be optimised, with better psychosocial preparation and agreed transition plans.

Hello,can you hear me?Orthopaedic clinic telephone consultations in the COVID-19 era-a patient and clinician perspective

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has resulted in seismic changes in healthcare delivery.As a result of this,hospital footfall required to be reduced due to increased risk of transmission of infection.To ensure patients can safely access healthcare,we introduced orthopaedic clinic telephone consultations in our busy district general hospital.AIM To investigate patients’and clinicians’perspective of telephone consultations during COVID-19,and whether this method of consultation could be a viable option in the post-pandemic future.METHODS This is a single centre,prospective study conducted in a busy National Health Service district general hospital.In May 2020,100 non-consecutive adult patients were contacted by independent investigators within 48 h of their orthopaedic clinic telephone consultation to complete a telephone satisfaction questionnaire.The questions assessed satisfaction regarding various aspects of the consultation including overall satisfaction and willingness to use this approach long term.Satisfaction and perspective of 25 clinicians conducting these telephone consultations was also assessed via an online survey tool.RESULTS 93%of patients were overall satisfied with telephone consultations and 79%were willing to continue this method of consultation post-pandemic.Patients found telephone consultations to reduce personal cost and inconvenience associated with attending a hospital appointment.72%of clinicians reported overall satisfaction with this service and 80%agreed that telephone consultations should be used in the future.The majority found it less laborious in time and administration in comparison to face to face consultations.Patients and clinicians expressed their desire for video consultations as a method of further improving their experience with remote consultations.CONCLUSION Our study has shown that telephone consultations are a safe and rapid method of adaptation to the COVID-19 pandemic,achieving the aim of reducing hospital footfall.This method of consultation has resulted in immense clinician and patient satisfaction.Our findings suggest that this tool has benefits in post pandemic healthcare delivery.It has also highlighted that telephone consultations can act as a steppingstone to the introduction of the more complex platform of video consulting.

Experience of the patient's success in facing post-stroke urinary incontinence: the patient's perspective

Objective:Post-stroke urinary incontinence(UI)is one of the sequelae of stroke.This situation affects all aspects of the patient’s life–physically,psychologically,socially,and spiritually.This study aimed to investigate the experience of patients’success in facing a post-stroke UI.Methods:A qualitative study using the Rapid Assessment Procedure(RAP)approach was used in this study.Informants were selected using purposive sampling.In-depth interviews with as many as 8 patients who had recovered from post-stroke UI and living in the greater area of Southeast Sulawesi(Indonesia)were conducted.In-depth interviews were also conducted with 8 caregivers and 2 nurses.Data were analyzed using a thematic analysis approach and interpretation of data was based on Humanbecoming theory and Self-care deficit theory of nursing.Results:Five successful things the patients experienced during post-stroke UI were identified.The five successes were as follows:they provided information to get to know and understand post-stroke UI,followed the procedures to overcome post-stroke UI,conducted self-control exercises and stayed motivated,performed daily activities independently according to ability,and made use of family suppor t and peers’attention.Conclusions:These findings indicated that persistence,belief,independence,and social support(family and peer)made patients to successfully face their post-stroke UI and improved their quality of life.These findings also became the basis for developing a poststroke UI management model based on Humanbecoming theory and Self-care deficit theory of nursing.

Satisfaction of Patients Examined with Mobile X-Ray vs. X-Ray at the Hospital—A Randomized Controlled Trial

Background: In the Municipality of Aarhus, Denmark, mobile X-ray is offered to selected patients when a transfer to the Department of Radiology may be an obstacle. To our knowledge, no studies have examined patient’s satisfaction with mobile X-ray in a randomized controlled trial, but international qualitative and quantitative studies report a high level of patient satisfaction with mobile X-ray. Purpose: The purpose of the study was to investigate whether patients in aged care facilities who were offered mobile X-ray were more satisfied with the X-ray examination compared to patients examined with X-ray at the Department of Radiology, Aarhus University Hospital. Design: A part of a randomized controlled trial. Methods: Satisfaction was measured using a self-developed questionnaire, containing 13 questions measuring satisfaction from different perspectives. Participants: Due to patient’s fragility, healthcare staff members answered questions concerning satisfaction on behalf of the patients, who had been examined with mobile X-ray (n = 66) or X-ray at the hospital (n = 63). The patients were living in nursing homes and homes for the elderly in Aarhus Municipality. Data: Data were collected and stored using the computer program REDCap. Data were statistically analyzed using Fisher’s exact test. Results: Patients examined with mobile X-ray had a significantly higher satisfaction rate than those examined with X-ray at the hospital. Conclusion: Satisfaction of patients examined with X-ray was reported by healthcare staff to be in favor of mobile X-ray.

Patients’ Experiences and Opinions on Pulmonary Rehabilitation and Use of It as a Tool of Palliative Care on Idiopathic Pulmonary Fibrosis (IPF)

Background: Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, and life-limiting condition. It has no cure hence it is vital to establish effective methods of improving the quality of remaining life in these patients. One of the key components of improving quality of life is pulmonary rehabilitation. However little research has been conducted to understand the perspectives and lived experience of people with IPF on pulmonary rehabilitation. Hence, we aim to fill this gap in the existing literature. Methods: We sought to understand how patients coped with pulmonary rehabilitation. A patient-centred approach was used to explore the physical and psychological impact of pulmonary rehabilitation. Semi-structured interviews were conducted by experienced academics. Interviews used a topic guide but mostly led by the participants. An inductive thematic approach was used to analyse data, allowing us to identify common themes in the participants’ experiences. Results: Of fifty invited participants, ten took part in the study (aged 53 - 81 years). Inductive analysis of interviews identified seven second-order themes and eleven first-order themes, represented by two General Dimensions: “motivation” and “Advantages and disadvantages”. Overall, participants found the pulmonary rehabilitation programme to be useful and they experienced an increase in their quality of life following rehabilitation.

Clinical utilities and end-user experience of pharmacogenomics:39 mo of clinical implementation experience in an Australian hospital setting

BACKGROUND Pharmacogenomics(PG)testing is under-utilised in Australia.Our research provides Australia-specific data on the perspectives of patients who have had PG testing and those of the clinicians involved in their care,with the aim to inform wider adoption of PG into routine clinical practice.AIM To investigate the frequency of actionable drug gene interactions and assess the perceived utility of PG among patients and clinicians.METHODS We conducted a retrospective audit of PG undertaken by 100 patients at an Australian public hospital genetics service from 2018 to 2021.Via electronic surveys we compared and contrasted the experience,understanding and usage of results between these patients and their clinicians.RESULTS Of 100 patients who had PG,84% were taking prescription medications,of which 67% were taking medications with actionable drug-gene interactions.Twenty-five out of 81 invited patients and 17 out of 89 invited clinicians completed the surveys.Sixty-eight percent of patients understood their PG results and 48% had medications changed following testing.Paired patient-clinician surveys showed patient-perceived utility and experience was positive,contrasting their clinicians’hesitancy on PG adoption who identified insufficient education/training,lack of clinical support,test turnaround time and cost as barriers to adoption.CONCLUSION Our dichotomous findings between the perspectives of our patient and clinician cohorts suggest the uptake of PG is likely to be driven by patients and clinicians need to be prepared to provide information and guidance to their patients.

Social Aspects of the Quality of Life of Persons Suffering from Schizophrenia

Background: Several studies have shown that persons with schizophrenia (PWS) suffer from severely reduced quality of life (QoL). Impaired social functioning is a defining characteristic of schizophrenia (SZ) and social cognition deficits affect interpersonal relations and outcomes such as independent living, vocational functioning and employment status. Some studies have demonstrated important socio-cultural aspects of SZ, for instance by examining experiences of SZ in different developing countries and among minority groups in the Western world. The socio-cultural context is central to understanding patients’ experiences in any society, however. Using an anthropological approach, we use qualitative research methods to examine patient perspectives on SZ. Sampling and Methods: In-depth qualitative interviews are carried out with SZ patients in France, the UK and the USA representing diversity in Western mental health systems. Results: To the participants, the most important QoL aspects are close relations and support from loved ones, a safe home and comfort zone, and meaningful daily activities. Normalisation and independence act as central themes to patients’ QoL and hopes for social integration. The participants need a buffer zone consisting of social relations, a home and daily occupation that is flexible and may balance issues of equality/inequality, abnormality/normality, and dependence/independence. Conclusion: By using participatory methods, PWS may be involved in shaping their own treatment and recovery plans based on what is subjectively meaningful and beneficial to their mental health. QoL and functioning are closely linked to the socio-cultural context in which health care structures go hand in hand with health care cultures that shape patients’ expectations and preferences.

TCM in Canada:Health Care and the Importance of Alternative Medicines that Complement Medical Practice

This article explores the introduction and growth of traditional Chinese medicine(TCM)through the lens of Chinese immigration to Canada.It further explores how it has spread to other cultural groups in Canada.Several theories are described to explain why it has attracted attention by non-Chinese ethnicities:the interest in organic and nature-based approaches,the underfunding health care,lack of family doctors,expensive drugs from big pharmaceutical companies,and respect for Chinese cultural practices.The regulatory practice of TCM is described along with the organization,types of educational program and certification as well as a patient’s perspective of TCM treatment.

Perspectives of caregivers towards physiotherapy treatment for children with burns in Harare, Zimbabwe: A cross-sectional study

Background:Physiotherapy is an integral part of treatment for paediatric burns.In Zimbabwe,children are admitted in paediatric burn unit with their caregivers,who play important roles such as providing explanation and obtaining cooperation of the child during physiotherapy,which is often uncomfortable or painful to the patient.The aim of this study was to determine the perspectives of caregivers towards physiotherapy interventions administered to hospitalized children at central hospitals in Harare,Zimbabwe.Methods:A descriptive cross-sectional study was conducted using self-administered questionnaires.The study was carried out at two large central hospitals(Parirenyatwa Hospital and Harare Central Hospital).The study targeted all the caregivers of children below the age of 12 years with a diagnosis of burns,irrespective of severity or area affected,who were admitted in the two paediatric burn units.Of the 34 caregivers eligible to participate,31(91.1%)questionnaires had complete data and were analysed.The analyses were done using Statistica version 12.0.Results:The median age of the caregivers was 28 years(IQR=24–33 years).Female caregivers constituted 90.3%of the sample.The majority of the caregivers(n=26,83.9%)were biological mothers to the hospitalised child.The majority of children(n=20,64.5%)hospitalised were between 0 and 4 years.The commonest cause of burns was scalding(n=19,61.2%).The burns were mainly in the upper extremities(n=11,35.5%).Physiotherapy for the burns was mainly active and passive joint range of motion exercises(n=30,96.8%).The caregivers’perceptions towards physiotherapy were mainly positive(n=20,64.5%)indicating that physiotherapy plays an important role in burn management.Of the 21 caregivers given a ward exercise programme,13(61.9%)were not compliant.Conclusions:Caregivers’perspectives towards physiotherapy were largely positive and are similar to those found in other studies.The majority of the caregivers indicated that physiotherapy was important in the overall management of burns leading to proper healing of the wounds without complications.