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The vision of the International Menopause Society (IMS) is that all women across the world will have easy and equitable access to evidence-based knowledge and health care, empowering them to make fully informed midlife health choices. The aim of this White Paper is to provide a well-balanced educational narrative of the menopause and menopause hormone therapy (MHT) from IMS experts, leading into World Menopause Day 2024. This is achieved by exploring the anthropology and history of menopause, the principles and controversies of prescribing MHT, and by placing this into regulatory and menopause society contexts. The White Paper also lays the groundwork for the forthcoming updated IMS recommendations on menopause and will act as a blueprint for the future ethical management of menopause from practical and aspirational perspectives. An important section of the paper is 'The 5Ws of prescribing MHT': WHO is MHT for; WHAT types and doses of MHT; WHEN should MHT be started and stopped; WHY is MHT important; WHERE can MHT be accessed? A key points summary of this information is provided for healthcare professionals and the public. The summary provides 'easy to access' advice regarding several recent controversial MHT prescribing issues in the healthcare and media spotlights. [ABSTRACT FROM AUTHOR]

Dassieu and colleagues conducted a qualitative study examining the impact of the opioid epidemic on 22 individuals living with chronic pain, who, in 2019, were taking opioids for pain, had taken them in the past, or had never used them. Public coverage of the opioid epidemic could provide a more balanced portrayal of opioid use in people with chronic pain and make an effort to destigmatize the legitimate use of opioids for chronic pain.[7] In the span of a few years, the landscape has begun to change for the better for most people taking opioids for chronic pain. The backlash[[8], [10]] that occurred in response to the 2016 Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain and the 2017 Canadian "Guideline for Opioid Therapy and Chronic Non-Cancer Pain"[2] has resulted in a sober second look at the damage done to people taking opioids for chronic pain. [Extracted from the article]

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For the clinician as for any parent, having a child with cognitive disabilities heightens one's sense of vulnerability and insufficiency. One is confronted with unbearably intractable limits, which generates doubt about one's therapeutic potential. The ability to empathize with a parent's distress is crucial, but only the starting point in treating a patient whose child is disabled. What may be most constructive is the dialectic between the analyst's relative detachment (involving compassion but also a willingness to dredge up disavowed negative feeling) and the parent's attached dismay. Lacanian and existentialist theories remind us that, whether normal or handicapped, we are all existentially in a state of lack. This perspective provides a useful touchstone for analyzing the experience of disability in one's own life and that of one's patients. In further response to Lauren Levine's paper, it is argued that it is tricky to prove (beyond showing that a training analysis promotes maturation in the broadest sense) that a given aspect of an analyst's own personal analysis resulted in the capacity to heal a particular patient. The point can be made most persuasively when the actual analytic exchange, messy and circuitous as it may be, is offered in great detail. [ABSTRACT FROM AUTHOR]

Interprofessional education (IPE) is being built into the mainstream of professional education for all health and social care professions throughout the United Kingdom (UK) driven by the Labour Government elected in 1997, coincidentally the year that this Journal hosted the first All Together Better Health conference in London. The incoming government prioritized pre-qualifying IPE to be provided in partnership by universities and service agencies supported regionally by workforce development confederations, later absorbed into strategic health authorities (SHAs), and centrally by educational, professional and regulatory bodies. Ambitious agenda for pre-qualifying IPE set by government are being tempered by realistic assessment of current outcomes borne of experience and corroborated by evidence. This paper suggests some ways to ease constraints and improve outcomes, but emphasizes the need to generate continuing interprofessional learning opportunities that build on the basics. It argues that accumulating experience and evidence must be brought to bear in formulating criteria for the approval and review of IPE within regulatory systems for professional education. Can IPE be sustained within mainstream professional education once initial enthusiasm ebbs and earmarked funds run dry? That is the issue. [ABSTRACT FROM AUTHOR]

The author introduces her collage of portrait painting, titled "Foundation of Kindness, Shared Experiences, Shared Burden," with participation of staff members of the Critical Care Unit at the Royal Marsden Hospital in Chelsea, London, England. She notes the aim to the project to improve staff well-being in the postpandemic era. She recalls her drawing sessions with the staff during the pandemic and offers a view of how healthcare workers support one another in the hospital through the collage.

[ABSTRACT FROM AUTHOR]

An earlier version of this paper was read at the Journal of Child Psychotherapy Symposium on Ethical Publishing, 2022. The question under discussion was: how can we write about our patients in a safe and respectful way, while making a contribution to the development of our field. The author describes her experience of sharing a draft paper with a young person towards the end of the treatment, with a view to submitting the paper for publication. Some thought is given to the clinical and ethical complexity of this process, and the questions that arose through the process are explored. The paper proposes that it might sometimes be possible to aim for a collaborative form of writing that involves children, young people and families in writing up their stories. [ABSTRACT FROM AUTHOR]

The article presents a study which identifies that general practice registrars regard the current Membership of the Royal College of General Practitioners (MRCGP) written paper with short answer and Modified Easy Question (MEQ) formats as a valid assessment of approach to practice. The study found that almost 90 percent of the respondents thought that the questions were relevant to every general practice. The study showed that the educational impact of preparing for the paper was high.

The written paper (Paper 1) in the modular MRCGP is due to end in October 2008 as the new MRCGP assessment becomes the compulsory qualification for entry into general practice. As part of quality assurance in the old examination, candidate feedback was sought on the written module immediately after sitting the Spring 2006 paper. This showed high levels of satisfaction with the paper and provides evidence of the validity of the questions set. These results reinforce some of the findings of an original study exploring the views of a cohort of candidates from the Northern Deanery. Further, it supports the idea that the MRCGP written paper has driven educational goals, particularly in the area of critical appraisal skills. It also provides some assurance that the paper did not discriminate against minority groups taking the paper. [ABSTRACT FROM AUTHOR]

Issues relating to limited healthcare resources are relevant to all health professionals. Allocation of such resources is increasingly linked to evidence based practice. Thus, involvement in decision-making by health professionals will allow for accurate and meaningful interpretation of clinical results and evidence. Inherent in resource allocation are issues of economic origin. An understanding of the basics of economic evaluation and costing will enhance health professionals' participation in service development and funding procurement. The types of economic evaluation utilised in health care are cost minimisation analysis, cost effectiveness analysis, cost utility analysis and cost benefit analysis. Each type of evaluation measures the costs and consequences of health care programmes in a unique way. [ABSTRACT FROM AUTHOR]

This paper provides a review of the use of action learning in healthcare organisations, or by healthcare professionals, in the past decade, as evidenced in peer-reviewed journals. Action learning has a long history in healthcare and is perhaps particularly suited to an environment where wicked problems abound, where professional development is prized, and where many of the professions subscribe to reflective practice as a vehicle of development. A systematic search for literature in peer-reviewed English language journals was undertaken, followed by a process of pursuing references from the publications revealed by that search. Papers that provided accounts or evaluations of programmes and projects that included action learning were analysed. Common themes concerning purposes, processes, benefits and challenges were identified. Action learning was used for three purposes in the projects and programmes: to improve an aspect of healthcare services; to develop skills of the participants; to enhance collective capability. Whilst in some cases the intention was to achieve all three beneficial outcomes, it was apparent that in the majority of examples one or another of these purposes was prioritised as the principal aim of the programme or project. [ABSTRACT FROM AUTHOR]

Background: Psychology as applied to health and illness has a relatively short history. Nevertheless, that history shows a rapid development of the theoretical models that guide the field over the past 60 years. Core theoretical approaches are concisely reviewed, in the context of Kaplan's paper 'Behavior as the central outcome in health care' (1990), which is used as a model to examine the extent to which these approaches embrace Kaplan's notions. Advances: Empirical studies from the health psychology domain are used, which demonstrate the gains in terms of quality of life and behavioural outcomes in patients with (chronic) somatic diseases. Over a period of some 60 years, theoretical models and core concepts in psychology as applied to health and illness have evolved from psychosomatic views to neuropsychology, quality of life, patient education, self-management, illness perceptions, patient-reported outcome measures (PROMs), shared decision-making (SDM) and health humanities (HH). The more recent models (SDM, HH) appear to align to a considerable degree with adopting 'behavior as the central outcome an outcome in health care'; shared decision-making and health humanities focus on encouraging patients to make sense of and give meaning to their illness in order to attain optimal psychosocial adjustment. Conclusions: In addition to 'behavior as the central outcome in health care', a new definition of the concept of health (i.e. 'the ability to adapt and to self-manage' – Huber et al., 2011) seems to favour patients, healthcare providers, society, and health psychology. Incorporating this concept into medical care may be viewed as a challenge for health psychologists – and as a source of continual struggle with strong biomedical forces. [ABSTRACT FROM AUTHOR]

Acquiring information about one's child's cancer diagnosis is a complex and ever-changing process, and parents' needs change over time. As yet, we know little about what information parents require at different stages of their child's illness. This paper is part of a larger randomized control trial studying the parent-centered information given to mothers and fathers. The aim of this paper was to describe the topics addressed in person-centered meetings between nurses and parents of children with cancer and how those changed over time. Using qualitative content analysis, we analyzed nurses' written summaries of 56 meetings with 16 parents and then computed for each topic the percentage of parents who brought it up at any time during the intervention. The main categories were Child's disease and treatment (addressed by 100% of parents), Consequences of treatment (88%), Emotional management for the child (75%), Emotional management for the parent (100%), Social life of the child (63%), and Social life of the parent (100%). Different topics were addressed at different points in time, and fathers raised more concerns about the child's emotional management and the consequences of treatment than mothers. This paper suggests that parental information demands change over time and differ between fathers and mothers, implying that information should be person-centered. Registered at Clinicaltrials.gov (NCT02332226). [ABSTRACT FROM AUTHOR]

The emergence of augmented reality (AR) and mixed reality (MR) modalities has increased the potential of simulation in paramedicine education. The integration of AR/MR into education programmes should be underpinned by sound learning design; however, little is known about their effective use. The purpose of this scoping review was to identify the application and integration of AR/MR within paramedicine education. The review searched MEDLINE, EMBASE, PsychInfo, CINAHL and ERIC up to February 2020 to identify peer-reviewed articles describing the application or integration of any AR/virtual reality (VR) in the context of paramedicine education. The search yielded 11 records for qualitative synthesis from 170 unique records. The quality assessment showed diversity, from good to very poor quality papers. Categories of AR/MR were identified: computer-based avatar worlds, headset-based VR and screen-projection immersive spaces. An application was diverse, with triage and management of mass casualty featuring prominently. One paper described cost-effectiveness, and none discussed issues associated with volume or frequency of exposure required to achieve sustained outcomes. This review identified a small and heterogeneous evidence base describing AR/MR in paramedicine education. Limited, weak evidence demonstrates outcomes of equal to or better than traditional simulation when using AR/VR in paramedicine education. [ABSTRACT FROM AUTHOR]

This study proposed multiple revised variable neighborhood search (VNS) approaches applying the greedy concept to solve a nurse scheduling problem (NSP). In this paper, we developed three greedy-neighbourhood-swapping mechanisms (greedy-2-exchange, greedy-3-exchange, and greedy-4-exchange) to conduct local searches based on one-, two-, or three-neighbourhood structures that accounted for constraints imposed by government and hospital regulations. The greedy-neighbourhood-swapping mechanisms were used to identify medical staff members with the highest soft-constraint (e.g. nurses' preferences) violation weights on a given day who then swapped their shifts with others. To validate the proposed VNS approaches, we also conducted a case study. Based on the testing instances, all of the proposed VNS approaches generated optimal or near-optimal solutions, and the differences between them were small. The optimal number of the neighbourhood structures was determined to be two, confirming that a larger number of neighbourhoods in a neighbourhood structure would not necessarily be associated with more easily escaping local optima. Furthermore, the resulting outcomes supported the conclusion that the proposed modified VNS approaches generated better schedules for the medical staff members of hospitals than the compared meta-heuristic algorithms. [ABSTRACT FROM AUTHOR]

This scoping study examined how “leadership” is referred to and used in interprofessional education and practice. A total of 114 refereed articles were reviewed to determine how leadership is defined, conceptualised, and theorised. The review also examined what capabilities were identified for effective interprofessional leadership. The majority of papers were empirical studies undertaken by researchers based in North America. The majority of articles did not refer to a specific leadership approach, nor did they define, describe, or theorise leadership. Moreover, “leadership” capabilities were rarely identified. Articles generally focused on health practitioners and educators or students as leaders with little exploration of leadership at higher levels (e.g. executive, accrediting bodies, government). This review indicates the need for a more critical examination of interprofessional leadership and the capabilities required to lead the changes required in both education and practice settings. The goal of this article is to stimulate discussion and more sophisticated, shared understandings of interprofessional leadership for the professions. Recommendations for future research are required in both education and practice settings. [ABSTRACT FROM PUBLISHER]

This scoping review aims to (1) synthesise the research findings on the experiences of individuals with acquired brain injuries, and their families, when interacting with, or accessing, community-based services and (2) identify where gaps in service provision may exist and their cause. A systematic search strategy was employed across multiple databases to identify all studies relating to the experiences of individuals with acquired brain injuries and their families when interacting with, or accessing, community-based services. Inclusion was assessed by at least two reviewers at each stage and data extraction was completed by one researcher and validity checked by another. A narrative synthesis was employed. A total of 101 papers met the inclusion criteria with the narrative synthesis identifying three main themes of (1) unmet needs, (2) types of access, and (3) barriers to access. The results identify that those with acquired brain injuries, and their families, experience significant difficulties interacting with community-based services and often do not receive appropriate access. Many barriers to access were identified including a lack of knowledge of the long-term effects of acquired brain injury amongst professionals working in health and social care services. Brain injury is a leading cause of disability worldwide with a range of physical, cognitive, emotional, and behavioural difficulties. It is important that service users and families are given appropriate information about the long-term difficulties associated with ABI so they are better informed about the types of support they may need upon discharge from hospital. Rehabilitation professionals need to ensure they have good level of knowledge of the difficulties associated with ABI to ensure appropriate access to services for individuals and their families. Understanding more about unmet needs allows community rehabilitation services to be tailored and person-centred. [ABSTRACT FROM AUTHOR]

Background: Paperwork can transform organisational aims into action in group homes, but it can also be problematic for staff. The aim of this study was to explore frontline staff perspectives on paperwork in group homes for people with intellectual disability. Methods: Constructivist grounded theory methodology guided the study. Data were collected from 29 participants through semi-structured interviews, participant observations and journaling. Coding and sorting methods were used to analyse participants’ perspectives. Results: Staff have nuanced paperwork perspectives. They described and evaluated paperwork in terms of its value and fit with resident-focused practice. They identified gaps in paperwork and reimagined its design and use. Conclusions: Frontline staffs’ reflection suggests some paperwork hinders them from supporting residents well. This suggests organisations could consult better with staff to design paperwork that has a goodness of fit to their practice. Further research could explore how staff manage the limiting characteristics of paperwork. [ABSTRACT FROM AUTHOR]

Background: Data entry at the point of collection using mobile electronic devices may make data-handling processes more efficient and cost-effective, but there is little literature to document and quantify gains, especially for longitudinal surveillance systems. Objective: To examine the potential of mobile electronic devices compared with paper-based tools in health data collection. Methods: Using data from 961 households from the Rufiji Household and Demographic Survey in Tanzania, the quality and costs of data collected on paper forms and electronic devices were compared. We also documented, using qualitative approaches, field workers, whom we called ‘enumerators’, and households’ members on the use of both methods. Existing administrative records were combined with logistics expenditure measured directly from comparison households to approximate annual costs per 1,000 households surveyed. Results: Errors were detected in 17% (166) of households for the paper records and 2% (15) for the electronic records (p < 0.001). There were differences in the types of errors (p = 0.03). Of the errors occurring, a higher proportion were due to accuracy in paper surveys (79%, 95% CI: 72%, 86%) compared with electronic surveys (58%, 95% CI: 29%, 87%). Errors in electronic surveys were more likely to be related to completeness (32%, 95% CI 12%, 56%) than in paper surveys (11%, 95% CI: 7%, 17%).The median duration of the interviews (‘enumeration’), per household was 9.4 minutes (90% central range 6.4, 12.2) for paper and 8.3 (6.1, 12.0) for electronic surveys (p = 0.001). Surveys using electronic tools, compared with paper-based tools, were less costly by 28% for recurrent and 19% for total costs. Although there were technical problems with electronic devices, there was good acceptance of both methods by enumerators and members of the community. Conclusions: Our findings support the use of mobile electronic devices for large-scale longitudinal surveys in resource-limited settings. [ABSTRACT FROM PUBLISHER]

The Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions was first convened in 1985 in Ottawa. Since then, what has become known as the Ottawa conference has been held in various locations around the world every 2 years. It has become an important conference for the community of assessment – including researchers, educators, administrators and leaders – to share contemporary knowledge and develop international standards for assessment in medical and health professions education. The Ottawa 2022 conference was held in Lyon, France, in conjunction with the AMEE 2022 conference. A diverse group of international assessment experts were invited to present a symposium at the AMEE conference to summarise key concepts from the Ottawa conference. This paper was developed from that symposium. This paper summarises key themes and issues that emerged from the Ottawa 2022 conference. It highlights the importance of the consensus statements and discusses challenges for assessment such as issues of equity, diversity, and inclusion, shifts in emphasis to systems of assessment, implications of 'big data' and analytics, and challenges to ensure published research and practice are based on contemporary theories and concepts. [ABSTRACT FROM AUTHOR]

The text discusses the structural constraints that affect decisions about participation in genomic and precision medicine. It highlights disparities and delays in access to genetic services for patients with low incomes and underserved racial and ethnic groups. These disparities can be attributed to inadequate preparation for genomic medicine at the health system and provider levels. The text also mentions barriers at the patient level, such as high out-of-pocket costs and lack of coverage for clinical genetic testing. The importance of empirical research in understanding and resolving these barriers is emphasized, particularly in underrepresented populations. The text includes four primary research papers that explore the influence of context and diverse lived experiences on decisions about participation in genomic and precision medicine. These papers highlight the need for further study and collaboration within the ELSI research community. [Extracted from the article]

Healthcare services are customer-intensive services and usually accompanied by other treatment-related consumptions, e.g. medications. Traditionally in China, prescribing and dispensing are both made by hospitals, which causes high drug expenses. To solve this problem, the Chinese government has begun exploring the separation of prescribing and dispensing. Against this background, this paper analyses the optimal designs for healthcare services considering separated medications. We consider a service system with one monopolistic healthcare service provider, which could be a revenue-maximiser or social-welfare maximiser, and assume patients are bounded-rational with demands affected by price and quality of both service and medications. We analyse the optimal service price and service rate for cases involving either single or multiple medications. Revenue-maximiser usually prefers cost-effective medications, and when its service quality is low, more irrational patients are preferred. Its revenue increases with the number of medication types. For the social-welfare-maximiser, as the number of medication types or improved quality of certain medications does not ensure greater social welfare, its benefits depend on the prices and quality of the entire medications. For a social planner, it is effective to institute price caps to achieve socially optimal results. This paper lays theoretical foundations for price regulations of public healthcare systems. [ABSTRACT FROM AUTHOR]

Background: Lack of participation from staff when developing information and communication technologies (ICT) has been shown to lead to negative consequences and might be one explanation for failure. Management during development processes has rarely been empirically studied, especially when introducing ICT systems in a municipality context.Objective: To describe and interpret experiences of the management during change processes where ICT was introduced among staff and managers in elderly care.Design: A qualitative interpretive method was chosen for this study and content analysis for analyzing the interviews.Results: “Clear focus–unclear process” demonstrated that focus on ICT solutions was clear but the process of introducing the ICT was not. “First-line managers receiving a system of support” gave a picture of the first-line manager as not playing an active part in the projects. First-line managers and staff described “Low power to influence” when realizing that for some reasons, they had not contributed in the change projects. “Low confirmation” represented the previous and present feelings of staff not being listened to. Lastly, “Reciprocal understanding” pictures how first-line managers and staff, although having some expectations on each other, understood each other’s positions.Conclusions: Empowerment could be useful in creating an organization where critical awareness and reflection over daily practice becomes a routine. [ABSTRACT FROM PUBLISHER]

AbstractPurposeMaterials and methodsResultsConclusions\nImplications for rehabilitationTo identify factors that contribute to the enhanced life of people with spinal cord injury (SCI) in Sweden.This cross-sectional study combined workshops (n = 38) and survey data (n = 243) from people living with SCI and their relatives, health professionals, and personal care assistants working with people living with SCI. The data were first categorized using Bronfenbrenner’s bioecological model, followed by a conventional content analysis.The factors that contribute to an enhanced life for people living with SCI are similar to those of the general population, including relationships, leisure activities, and occupation within the mesosystem. However, the unique components of the exosystem and macrosystem are specifically associated with people living with SCI. The exosystem, particularly in healthcare, plays a major role for medical reasons but also tends to obtrude and minimize the mesosystem. The macrosystem is essential, as it sets the rules that govern the actors in the other layers, creating prerequisites for meeting the needs of the mesosystem and exosystem.The needs that contribute to an enhanced life are multifaceted and individualized. Therefore, these systems must be flexible throughout the lifespan of individuals with SCI.This paper reports needs that contribute to an enhanced life for people living with spinal cord injury in Sweden.The factors that contribute to an enhanced life are multifaceted and individual, and these must be considered throughout the entire life span, including getting help if secondary complications arise, aging and other life events.Individuals’ willingness to take ownership is strong but requires support from the surrounding systems that can accommodate individual’s unique needs.The exosystem (ea health care) plays a major role but risk to obtrude and minimize the mesosystem (individual’s immediate relations).Positive attitudes toward oneself, from family members and loved ones, from health care professionals and authorities are crucial for an enhanced life.This paper reports needs that contribute to an enhanced life for people living with spinal cord injury in Sweden.The factors that contribute to an enhanced life are multifaceted and individual, and these must be considered throughout the entire life span, including getting help if secondary complications arise, aging and other life events.Individuals’ willingness to take ownership is strong but requires support from the surrounding systems that can accommodate individual’s unique needs.The exosystem (ea health care) plays a major role but risk to obtrude and minimize the mesosystem (individual’s immediate relations).Positive attitudes toward oneself, from family members and loved ones, from health care professionals and authorities are crucial for an enhanced life. [ABSTRACT FROM AUTHOR]

Coaching has become increasingly popular as a mechanism to support learning across the health professions education (HPE) continuum. While there is a growing body of literature in this area, there is minimal guidance related to the design and implementation of academic coaching in health professional courses. This paper seeks to contribute to this literature by presenting guidance for academic developers who are considering introducing academic coaching into a health professional course. The 12 tips are based on the authors' collective experiences of designing and implementing academic coaching in university medical courses in Australia and the UK. Although focused on medical education, this paper is intended to have applicability across the health professions, and potentially across university and postgraduate training contexts. Together, the tips offer a strategic and operational framework to guide the design and implementation of academic coaching initiatives in health professions education. [ABSTRACT FROM AUTHOR]

The Essential Science IndicatorsSM (ESI) database, Published by Thomson Scientific/ISI, presents an array of data that ranks scientists/health professionals, their individual papers, and that journals in which they are published, as well as countries and institutions that perform scientific research. By using this resource, it is possible to prepare ranked statistical lists. The resource covers 6,000 journals Published in both the United States and from international publishers. Users should note that ESI covers scientific information in the broadest possible scope, so this is not just limited to biomedical topics and resources. [ABSTRACT FROM AUTHOR]

Gender diverse people experience significantly high levels of mental health difficulties, face significant barriers accessing mental healthcare, and often report negative experiences with mental health professionals. At the same time, healthcare professionals describe feeling deskilled when providing care for gender diverse adults. This paper aims to systematically review research into mental health professionals' experiences of providing care for gender diverse individuals, and the kind of research methods employed in these investigations. PubMed, SCOPUS, psycARTICLES, and psychINFO were searched, as well citation and reference lists of relevant articles. From 268 search results, 12 articles were deemed relevant to be included in the review. The studies used quantitative, qualitative and mixed methods approaches. Each article was evaluated against established quality guidelines. All studies were likely to have been affected by social desirability bias, and had limited exploration of participants' contexts, or social discourse. The quality of the articles varied. Clinicians reported having minimal training about gender diversity, and they tended to be less competent working with gender diverse clients compared to LGB clients. Participants described uncertainty working with gender diverse clients, and all the studies identified the need for improved training for mental health professionals working with gender diverse adults. [ABSTRACT FROM AUTHOR]

The unintended consequences experienced by healthcare professionals while using health ICTs at points-of-care are disruptive to their work activities. Failure to address these consequences inhibits efforts to support the delivery of quality healthcare services in hospital settings. Hence, the aim of this paper is to identify how unintended consequences disrupt technology-enabled work activities of healthcare professionals in hospital settings. An interpretive stance was adopted to investigate healthcare professionals' experiences with the use of health ICTs for their work activities through open-ended interview questions, to acquire in-depth information about unintended consequences events. A total of 19 participants were selected using a purposive sampling technique to identify healthcare professionals from two tertiary hospitals with varying levels of technology implementation. The participants included doctors and nurses in clinical departments that use health ICTs for medical imaging, referrals and reporting. Ethics clearance for data collection were granted by the University research ethics committee and the hospitals. Thematic analysis was adopted to identify and interpret patterns that emerged from participants' responses. Findings indicated that the unintended consequences experienced by healthcare professionals are protracted time to complete tasks; interruption of tasks and workarounds at points-of-care. The unintended consequences are caused by contradictions that result from tensions between contextual conditions that inhibit perceived usefulness, and a lack of fit between tasks of work activities and health ICTs. Hospital managers and health technology vendors should actively consider the likely undesirable experiences or disruptions from feedback recorded during the pilot implementation phase within use contexts. [ABSTRACT FROM AUTHOR]

The growing use of software in biomedicine has enlarged the capacities of researchers and clinicians. This, one might expect, would enhance the precision and safety of biomedicine. However, it has been recognized that software can bring about new risks to the field of medicine and medical devices, requiring at least some degree of caution from the different players responsible for technology governance and risk management. This phenomenon is focused on in this paper, from the viewpoint of 3D bioprinting. Bioprinting is the production of bioactive structures in a layer-by-layer deposition of cells, with the use of devices called bioprinters. The latter can only function by receiving instructions from software. This paper focuses on some software-supported techniques that are key for bioprinting. It shows that a growing range of software packages has been used in bioprinting, a trend that is greatly fostered by open source software. In this evolution, the clinical potentialities of bioprinting come closer to their realization. At the same time, however, uncertainties emerge, related to issues such as data protection, use of biological samples, and others. The growing use of open source software complexifies the scenario, because it leads to a multiplication of actors directly or indirectly involved in the technology's development, making it difficult to trace liabilities and damages. As no national regulation has been produced to tackle such uncertainties, they have been (provisionally and precariously) addressed in the licenses of software packages. In the years to come, as clinical products eventually spring from bioprinting research, more robust governance schemes will have to emerge in which risks and liabilities are dealt with more carefully by different players. Moreover, regulations will have to address the practice of combining different software packages in the same bioprinting process, as well as the growing globalization of bioprinting research and commercial exploration. [ABSTRACT FROM AUTHOR]

Sodium azide is a highly toxic chemical. Its production has increased dramatically over the last 30 years due to its widespread use in vehicular airbags, and it is available for purchase online. Thus, accidental exposure to azide or use as a homicidal or suicidal agent could be on the rise, and secondary exposure to medical personnel can occur. No antidote exists for azide poisoning. We conducted a systematic review of azide poisoning to assess recent poisoning reports, exposure scenarios, clinical presentations, and treatment strategies. We searched both medical and newspaper databases to review the literature between 01/01/2000 and 12/31/2020, pairing the controlled vocabulary and keyword terms "sodium azide" or "hydrazoic acid" with terms relating to exposures and outcomes, such as "ingestion," "inhalation," "exposure," "poisoning," and "death." We included all peer-reviewed papers and news articles describing human azide poisoning cases from English and non-English publications that could be identified using English keywords. Data abstracted included the number, age, and gender of cases, mode of exposure, exposure setting, azide dose and route of exposure, symptoms, outcome, and treatment modalities. We identified 663 peer-reviewed papers and 303 newspaper articles. After removing duplicated and non-qualifying sources, 54 publications were reviewed describing 156 cases, yielding an average of 7.8 reported azide poisoning cases per year. This rate is three times higher than in a previous review covering the period of 1927 to 1999. Poisoning occurred most commonly in laboratory workers, during secondary exposure of medical personnel, or from a ripped airbag. Hypotension occurred commonly, in some cases requiring vasopressors and one patient received an intra-aortic ballon pump. Gastric lavage and/or activated charcoal were used for oral azide ingestion, and sodium nitrite, sodium thiosulfate, and/or hydroxocobalamin were used in severely poisoned patients. Recent increases in azide poisoning reports may stem from greater commercial use and availability. Treatment of systemic poisoning may require aggressive hemodynamic support due to profound hypotension. Based on mechanistic considerations, hydroxocobalamin is a rational choice for treating azide poisoning. [ABSTRACT FROM AUTHOR]

Colonial administrations introduced various social infrastructures in Africa. This paper analyses and compares the development of colonial governments' health care provision and policies in Ghana and Côte d'Ivoire from circa 1900 to 1955. Using qualitative and quantitative information from colonial reports, a new dataset captures the development of four factors relevant to these aims: health care expenditures, health care facilities, medical staff, and patients. Deflated health care expenditures per capita were found to be higher in Ghana than in Côte d'Ivoire in almost all years. The number of health care facilities per capita was larger in Côte d'Ivoire than in Ghana, and facilities were more geographically dispersed. Ghana had a lower number of medical staff per capita than Côte d'Ivoire as of the 1920s. Medical staff from Côte d'Ivoire formed the majority of the staff base as early as the mid-1910s. Finally, the analysis shows that the number of patients treated in health care facilities in Ghana was low until the 1920s, and took off as more facilities became available during the 1940s. These findings provide evidence that even two countries that are relatively similar (apart from their colonial history) can have different colonial health care trajectories. [ABSTRACT FROM AUTHOR]

In the news, there is frequent mention of adolescents' mental health nowadays being 'in crisis'. This paper offers the perspective of two psychotherapists working in a crisis service, trying to engage adolescents and their families in therapeutic work. There is an argument for a combined developmental, psychoanalytic and systemic approach to understand and work with the perceived mental health crisis in adolescence. This paper explores the desire of some adolescents today to have a mental health diagnosis and use specific, psychiatric-oriented language to frame and understand their distress. A cultural and theoretical exploration of this phenomenon is offered, viewing it as an expression of adolescents' need for establishing their identity within peer groups, online and offline. The paper underlines the necessity for an approach where the whole network around the adolescent – the school, the parents, the therapist – work together to address the occurring crisis. The crisis this paper refers to is conceptualised as one involving developmental adolescent turmoil, expressed through mental health language. [ABSTRACT FROM AUTHOR]

In Malawi, there is a cadre of mid-level health workers called clinical officers (COs) who undertake duties conventionally performed by medical doctors in the wake of an acute shortage of the latter. This paper argues that excessive workload and long hours of work are psychosocial hazards at public hospitals in Malawi that contribute to occupational stress (OS) and burnout among COs. The study from which this paper is derived adopted a qualitative research design with a case study as a research strategy. The study was conducted at four district hospitals and one central hospital, which are state-owned in Malawi. This paper argues, firstly, that before the COVID-19 pandemic, COs experienced OS and burnout due to excessive workloads and long hours of work at public hospitals. Secondly, the COVID-19 pandemic aggravated the problem of excessive workloads and long hours of work at public hospitals. Thirdly, OS and burnout among COs are associated with various impacts that can be categorised as psychological consequences and physical consequences. The psychological and physical consequences of OS and burnout are manifestations of poor quality of life among COs, which ultimately negatively affects public health. Finally, this paper recommends formulating and implementing comprehensive occupational safety and health (OSH) policies at public hospitals. Among others, these OSH policies should provide frameworks for regularly assessing the impact of OSH hazards on the mental health of hospital staff and then informing the development of appropriate measures for mitigation. [ABSTRACT FROM AUTHOR]

To establish literature regarding healthcare professionals' perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease. A critical interpretive synthesis was conducted; CINAHL, PsychINFO and MEDLINE were searched between 1988 and August 2019, using MeSH headings and key terms. Reference lists of accepted papers were also searched. Qualitative, quantitative and mixed methods studies, written in English, including healthcare professionals' perceptions of pulmonary rehabilitation were included. The search yielded 133 papers which were assessed for eligibility; 20 met the inclusion criteria. Two themes were identified, the first explored "Barriers to Pulmonary Rehabilitation" from a healthcare professional's perspective. This incorporated a lack of knowledge, a lack of resources, practical barriers, patient barriers, and healthcare professional's being unsure it is their role to refer. The second entitled "General Perceptions of Pulmonary Rehabilitation", highlighted ways in which the programme could be improved, the perceived positives and negatives, facilitators to referral, and perceptions of patients referred. This is the first systematic review to encompass the perceptions of healthcare professionals with ability to refer and those who deliver pulmonary rehabilitation. Referral was low, highlighting potential influencing factors such as a lack of programme knowledge, pulmonary rehabilitation beliefs, and communication skills. Given inclusion of studies from multiple geographical locations, the findings provide implications for any healthcare system that develops and delivers pulmonary rehabilitation. With respect of a lack of referrals to the programme, further research should highlight healthcare professionals' perceptions of the referral process, and the views of those in Secondary Care. Chronic obstructive pulmonary disease: •Pulmonary rehabilitation is a proven cost-effective management strategy for patients with chronic obstructive pulmonary disease, which reduces associated hospital admissions and increases quality of life. •Due to a lack of knowledge and negative perceptions surrounding pulmonary rehabilitation, further training and education is required for healthcare professionals surrounding non-pharmacological management strategies. •Pulmonary rehabilitation programmes should consider ways to increase awareness of the service amongst those with chronic obstructive pulmonary disease. •Those delivering pulmonary rehabilitation should consider ways to support healthcare professionals referring to the programme. [ABSTRACT FROM AUTHOR]

Medication abortion has been established globally as safe and effective. This modality has increased accessibility and the opportunity to centre individual autonomy at the heart of abortion care, by facilitating self-managed abortion. Previous research has shown how self-managed abortion is beneficial in myriad settings ranging from problematic to (relatively) unproblematic contexts of access. In this paper we explore the relationship between self-management and sources of support (including health professionals, family, and friends); as well as considering issues of reproductive control and autonomy. Drawing on qualitative, experience-centred interviews, we utilise the concept of social connectedness to examine how supported self-managed abortion was experienced in the United Kingdom during the COVID-19 pandemic. Overall, self-management was welcomed, with participants speaking positively about managing their own abortion at home. However, a sense of connectedness was crucial in helping participants deal with difficult experiences; and functioned to support individual autonomy in self-care. This paper is the first to examine factors of connection, support, and isolation, as experienced by those undergoing self-managed abortion in the UK in detail. Our research suggests a continued need to advocate for high quality support for self-managed abortion, as well as for choice of abortion method, to support patient-centered care. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) has garnered tremendous attention in health care, and many hope that AI can enhance our health system's ability to care for people with chronic and degenerative conditions, including Parkinson's Disease (PD). This paper reports the themes and lessons derived from a qualitative study with people living with PD, family caregivers, and health care providers regarding the ethical dimensions of using AI to monitor, assess, and predict PD symptoms and progression. Thematic analysis identified ethical concerns at four intersecting levels: personal, interpersonal, professional/institutional, and societal levels. Reflecting on potential benefits of predictive algorithms that can continuously collect and process longitudinal data, participants expressed a desire for more timely, ongoing, and accurate information that could enhance management of day-to-day fluctuations and facilitate clinical and personal care as their disease progresses. Nonetheless, they voiced concerns about intersecting ethical questions around evolving illness identities, familial and professional care relationships, privacy, and data ownership/governance. The multi-layer analysis provides a helpful way to understand the ethics of using AI in monitoring and managing PD and other chronic/degenerative conditions. [ABSTRACT FROM AUTHOR]

Institutional ethnography (IE), a term coined by sociologist Dorothy Smith, explores the nuances of institutions and their complex relationships in sociology. IE is an approach to studying and analysing social organization, and it provides a more holistic understanding of 'invisible' relationships that govern institutions and how those relationships interact with each other. Health sciences researchers in patient care, patient experience, and allied health professionals have recently become more interested in the use of this methodology and how to incorporate it into their research. However, in health professions education (HPE) there is little use of IE. We hypothesize this may be because of limited practical knowledge of this methodology. This paper serves as an introduction to the use of IE in HPE, describing the differences between IE and traditional ethnographies, recognizing the common pitfalls when utilising IE, and incorporating texts into IE. While ethnographies may be daunting to researchers less familiar with these approaches, the tips in this paper will provide an introduction and help educators and researchers successfully navigate the use of IE in health profession scholarship and education. [ABSTRACT FROM AUTHOR]

Peace through Health (PtH), developed in practice in the 1980s and conceptualized soon after by international institutions and scholars, has become a field focusing on the unique role of health in making, building and promoting peace. PtH advocates that health professionals, the actors of PtH, should play an active role in any peace process and should, therefore, be trained accordingly. There is, however, no agreed and established training which addresses PtH for health professionals. It is because each particular type of violence, which is the opposite of peace in the Galtungian sense, and the conditions and the geography in which it takes place have different characteristics. This paper attempts to examine the theoretical and practical aspects of PtH in Turkey and to lead the development of systematic training for PtH in the country. Considering that an advanced health system in the country stands out in the international arena, it is necessary to develop interdisciplinary modules as a part of this for the Turkish tertiary curricula. [ABSTRACT FROM AUTHOR]

This paper problematizes micro-level conceptualizations of extreme work to develop new research directions. The paper shows how frontline healthcare workers interpret and articulate ideas about doing extreme work during the COVID-19 pandemic. Two interconnected themes are discussed: a narrative of professional opportunity, related to identifying the extreme context as a space of opportunity to re-shape understandings about their professional purpose and gain professional legitimacy, and a narrative of occupational heroism, related to a way of doing extreme work that focuses on establishing dependable relational dynamics and working extremely as a means to become indispensable. The article reinforces the importance of the situated understanding of work settings and suggests a research agenda that can help to inform HRM policies and practices to manage and develop specific groups of professionals. [ABSTRACT FROM AUTHOR]

The paper explored the extent to which hospital appointed official root cause analysis (RCA) panels consider antecedent and proximal events when they investigate communication related sentinel events (CRSEs) in hospitals. It also explored which CRSEs are most common in the hospital setting in Hong Kong and the communication modes most commonly associated with CRSEs. The data consisted of Risk Alert and Annual Report on SEs issued by the Hong Kong Hospital Authority from October 2007 to September 2017. Over the period studied, there were 379 reported sentinel events (SEs). In 186 of these SEs we identified communication as a contributing factor. We examined the RCA panels' reports on contributing factors and subsequent recommendations in these 186 SEs and found that their recommendations only highlighted the proximal contributing factors and not antecedent factors that may be relevant. RCA panels most often recommended that communication should be enhanced or documentation improved. We propose that it is time to review the RCA process to recognize that many CRSEs may occur because of antecedent factors that result from the complex hospital organizational structure and its associated hierarchical culture. We suggest two ways forward, 1) applying a language and social psychology perspective to the investigations of CRSEs and, 2) the involvement of experts from different disciplines who can work with clinicians during RCA investigations. [ABSTRACT FROM AUTHOR]

The authors collaborated closely with elders, knowledge keepers and indigenous community members to design an online training intervention to educate public health staff in indigenous protocols and cultural safety protocols. User-centred design was utilized in every stage of the design process to better understand and assess user needs and to adapt the design to these needs. [Extracted from the article]

Existing literature on international health partnerships is largely normative, with an evaluative interest in their impacts in terms of learning and knowledge transfer. Rarely has research attended to how learning and knowledge transfer transpire in practice. This paper addresses this gap with a case study of a partnership between two hospitals in Canada and China. Conceptually, drawing on Actor Network Theory, it posits learning and knowledge transfer as a process of translation. Empirically, it traces the assembling of the programme, and identifies the pedagogical features at nodes of associations. It reveals that health professionals in both countries have expanded their clinical and medical knowledge and practices, and professional senses and sensitivities, which were subsequently amplified, deferred or diminished within their respective practices. It argues that the capacity of individuals to translate learning into practice is contingent on institutional and cultural differences that constitute the ecology of work for health professionals. [ABSTRACT FROM AUTHOR]

In recent years, Internet-delivered treatments have been largely used for pain monitoring, offering healthcare professionals and patients the ability to interact anywhere and at any time. Electronic diaries have been increasingly adopted as the preferred methodology to collect data related to pain intensity and symptoms, replacing traditional pen-and-paper diaries. This article presents a multisensor data fusion methodology based on the capabilities provided by aerospace systems to evaluate the effects of electronic and pen-and-paper diaries on pain. We examined English-language studies of randomized controlled trials that use computerized systems and the Internet to collect data about chronic pain complaints. These studies were obtained from three data sources: BioMed Central, PubMed Central and ScienceDirect from the year 2000 until 30 June 2012. Based on comparisons of the reported pain intensity collected during pre- and post-treatment in both the control and intervention groups, the proposed multisensor data fusion model revealed that the benefits of technology and pen-and-paper are qualitatively equivalent . We conclude that the proposed model is suitable, intelligible, easy to implement, time efficient and resource efficient. [ABSTRACT FROM AUTHOR]

This paper introduces a special issue of the Journal of Forensic Psychiatry and Psychology dedicated to violent extremism and mental health. We address three challenges faced by mental health practitioners who work with people whose harm potential may be ideologically motived. First, how can practitioners engage in good practice in risk assessment and management when the evidence base for such practice in the violent extremism field is limited? Second, how can a mental health practitioner establish and understand the role of an extremist ideology in a client in their care and differentiate it from motivational drivers that may result in broadly similar kinds of actual, attempted or threatened violence? Third, how can practitioners and their services respond to the risks posed in ways that recognise and balance the needs of both the client and those multiple other agencies dedicated to public protection? Following the examination of these challenges, and a brief comment about the relevance of coronavirus to risk of violent extremism, each paper in the special issue will be introduced and their contribution to the work of practitioners who carry such responsibility summarised. The paper concludes with key points and recommendations linked to the three challenges addressed. [ABSTRACT FROM AUTHOR]

Background: Reflective practice is a skill that serves as a model for continuous learning. Like any skill, reflective practice can be improved and health professional curricula should include opportunities to develop these skills. The clinical component of health professional curriculum is a natural component where reflective practice skills can be developed. Electronic means will help students and faculty stay in contact during clinical internships. Aims: The purpose of this study was to evaluate the feasibility of an electronic reflective practice exercise during a clinical internship and explore the potential trends on students' reflective practice skills and self-directed learning readiness. Methods: We used a prospective pre-post intervention design in a cohort of physiotherapy students to examine feasibility and explore trends. Faculty also rated the depth of reflection papers. In addition, students completed a reflective practice exercise questionnaire and the self-directed learning readiness scale (SDLRS) was completed pre- and post-internship. Results: All 84 students completed the reflective practice questionnaire. Sixty-six students consented to complete the questionnaire and 17 consented to complete the SDLRS pre- and post-internship. It took an average of 7 min for faculty to review each student's reflection and there were no significant electronic difficulties encountered. Initial reflection papers were rated at a descriptive (23%), descriptive-analytical (28%) or analytical level (33%). Eighty-six percent of students rated faculty feedback as helpful and 92% rated peer feedback as helpful. Almost all students (97%) students reported that they followed through on some or all of the items on their reflective practice learning plans. The SDLRS significantly improved with the exercise (mean difference 6.8 ± 9.9; p < 0.05). Conclusions: This electronic reflective practice exercise during the physiotherapy students' clinical internship was feasible and demonstrated trends to positively impact the learners' skills and self-directed learning readiness. [ABSTRACT FROM AUTHOR]

Different stakeholders, such as authors, research institutions, and healthcare professionals (HCPs) may determine the impact of peer-reviewed publications in different ways. Commonly-used measures of research impact, such as the Journal Impact Factor or the H-index, are not designed to evaluate the impact of individual articles. They are heavily dependent on citations, and therefore only measure impact of the overall journal or researcher respectively, taking months or years to accrue. The past decade has seen the development of article-level metrics (ALMs), that measure the online attention received by an individual publication in contexts including social media platforms, news media, citation activity, and policy and patent citations. These new tools can complement traditional bibliometric data and provide a more holistic evaluation of the impact of a publication. This commentary discusses the need for ALMs, and summarizes several examples – PlumX Metrics, Altmetric, the Better Article Metrics score, the EMPIRE Index, and scite. We also discuss how metrics may be used to evaluate the value of "publication extenders" – educational microcontent such as animations, videos and plain-language summaries that are often hosted on HCP education platforms. Publication extenders adapt a publication's key data to audience needs and thereby extend a publication's reach. These new approaches have the potential to address the limitations of traditional metrics, but the diversity of new metrics requires that users have a keen understanding of which forms of impact are relevant to a specific publication and select and monitor ALMs accordingly. Different readers have different ways of deciding how important scientific articles are. The usual methods used to measure the impact of research, like the Journal Impact Factor or the H-index, are not meant to measure this for individual articles. These methods mainly look at how many times the articles are mentioned by others, and it can take a long time to see the impact. But in the past ten years, new tools called article-level metrics (ALMs) have been created. These tools measure how much attention an article gets online, like on social media, in the news, or when other researchers talk about it. ALMs are better at explaining how important a specific article is. They can work together with the usual methods to measure impact. This paper talks about why ALMs are important and gives examples of these tools, like PlumX Metrics, Altmetric, the Better Article Metrics score, the EMPIRE Index, and scite. It also explains how these tools can help us see the value of animations, videos, or summaries in simple language. These make it easier for more people to understand and learn from the articles. These new ways of measuring impact can help us see how important articles are in a more complete way. But because there are many different ways to measure this, it's important for users to understand which methods are relevant for a specific article and keep track of them. [ABSTRACT FROM AUTHOR]