Developing a measure of blind patients’ interactions with their healthcare providers

BackgroundPeople who are blind (PWB) are often perceived as being incompetent with common tasks and functions. When patients detect that their healthcare providers (HCPs) have negative perceptions of them, they often report less satisfaction with their healthcare and disengage in their own healthcare.ObjectiveA scale assessing the experiences of PWB interacting with HCPs was developed and validated across two studies.MethodsIn Study 1, 144 participants completed the scale and provided feedback. In Study 2, 214 participants completed the scale and 4 additional scales to assess construct validity.ResultsAn exploratory factor analysis in Study 1 revealed a two-factor model consisting of General Quality of Health Care (30.5% variance explained) and Stereotype Content-related items (9.4% variance explained). Study 2 confirmed and validated this two-factor structure (RMSEA (90% CI) = 0.068 (0.057, 0.079), CFI = 0.898, SRMR = 0.066, AIC = 14568.902).ConclusionsThis scale is one of the first tools developed from the perspectives of PWB. Results from these studies highlight and elaborate on how PWB perceive that they are viewed by their HCPs in terms of competence and how they perceive to be treated by these HCPs. This scale can be used in training HCPs to better serve their patients with disabilities.     

European survey of hepatitis B vaccination policies for healthcare workers: An updated overview

BackgroundThe risk of transmission of bloodborne pathogens, including hepatitis B virus (HBV) to healthcare workers (HCWs) is well known. In 2005 we performed a survey on HBV prevention in HCWs in the European Union (EU). An update of the 2005 survey deemed necessary as an EU Council Directive (2010/32/EU) on sharps injuries was to be implemented into national legislation by 11 May 2013 and more countries were starting universal HBV vaccination.MethodsWe performed an electronic survey in 2016, among national representatives from the Occupational Medicine section of the European Union of Medical Specialists (UEMS), to find out how policies have been put into practice in the European Union countries (plus Norway and Switzerland). The data were updated in 2019.ResultsAnswers were received from 21 countries (among them 19 EU Member States), representing 78% of the population and 60% of HCWs in the EU-28. HBV vaccination was mandatory for medical and nursing staff in 10 countries; for other paramedical staff, medical and nursing students in 9 countries; for paramedical students in 8 countries; for cleaning staff in 7 countries; and for technical staff in 5 countries; it was recommended in all but one of other countries. Serotesting before vaccination was done in 7 countries. The vaccination schedule most often used was 0, 1, 6 months (18countries), monovalent HBV vaccine was used in 14 countries, and combined (HAV + HBV) vaccine in 11 countries. Serotesting after vaccination was done in 18 countries and boosters were recommended in 14 countries. A non-responder policy was present in 18 countries. HBV vaccination coverage (5 countries) was 70–95%. Sharps injuries were reported in 13 countries, nationwide in 7 of them; European-wide reporting was not mentioned by respondents.DiscussionThese results show the variation in the implementation of EU legislation in the participating countries. More consultation between actors at EU level, including enhancing medical surveillance in occupational medicine could help to optimise policies in European countries in order to further reduce HBV transmission to HCWs.     

Cost of postoperative complications: How to avoid calculation errors

Postoperative complications(PC) are a basic health outcome, but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs. Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency. The payment system in place often rewards the volume of services provided rather than the quality of patients' clinical outcomes. Without a thorough registration of PC, the economic costs involved cannot be determined. An accurate, reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results, and bring down the economic costs. This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index, discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established, and makes various recommendations. The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs. Patients, the health authorities, and society as a whole are sure to benefit.     

Impact of a decision-aid tool on influenza vaccine coverage among HCW in two French hospitals: A cluster-randomized trial

IntroductionNosocomial outbreaks of seasonal influenza are frequent, and vaccination is largely recommended for healthcare workers (HCWs). Vaccine coverage in French HCWs does not exceed 20%. Decision-aids (DA) are potential useful interventions to increase vaccine coverage (VC). Our aim was to evaluate the impact of a DA on HCWs influenza vaccine coverage.Material and methodsProspective cluster-randomized trial conducted in 83 departments in two public hospitals (a teaching and a non-teaching hospital) during the 2018–2019 flu season.Distribution of the DA and of questionnaire about decisional conflict and knowledge in the departments randomized in the intervention group.ResultsA total number of 3 547 HCWs were concerned by the study (1 953 in the intervention group, 1 594 in the control group). Global VC was 35.6% during the 2018–2019 season, instead of 23.6% in the 2017–2018 season (p < 0.005). During the 2018–2019 season, VC was 31% (95% CI 28.7–33.3) in the control group and 38.7% (95% CI 36.5–40.9) in the intervention group (p < 0.005). Among the 158 HCWs exposed to the DA who answered the survey, 51.3% had no decisional conflict. HCWs without decisional conflict were more prone to get vaccinated before flu season.ConclusionThe use of the DA was associated with a 25% relative increase in VC among HCWs against seasonal influenza. This modest increase remained far from the WHO 75% target, but may have reduced the number of nosocomial. Multi-component interventions are needed to increase VC in HCWs.     

Telerehabilitation intervention for type 2 diabetes

Diabetes has become an increasingly important health problem worldwide due to its prevalence. Although effective treatments for diabetes management have been developed, many patients have difficulty in achieving their therapeutic goals.Regular exercise training is suggested to prevent or delay the symptoms and complications of type 2 diabetes along with other medical treatments. It has become necessary to develop new rehabilitation models and practices in order to cope with the changing needs of the population. Treatment models using technology can be effective in disease management. Telerehabilitation may be effective as part of the rehabilitation program in the home environment,especially for patients who are unable to participate in conventional center-based rehabilitation due to transport difficulties or work resumption. Telerehabilitation is defined as the delivery of rehabilitation services via telecommunication technology, including phone, internet, and videoconference communications between the patient and health care provider. It is possible that telerehabilitation may benefit people with type 2 diabetes in similar ways with telemonitoring and interactive health communication systems. Although the applicability of telehealth methods has been proven in previous studies, telerehabi-litation studies in type 2 diabetes are inadequate in the literature. With larger, multicentered randomized controlled studies, established clinical guidelines can be developed that will ultimately improve patient outcomes.     

Evolución del gasto en servicios sanitarios antes y después del ictus isquémico: análisis de base poblacional

IntroductionDespite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset.MethodsThe information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient.ResultsWe identified 36,044 patients with ischaemic stroke (mean age, 74.7 ± 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was €3,230 the year before stroke, €11,060 for year one after stroke, €4,104 for year 2, and €3,878 for year 3. The greatest determinants of cost in year one were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment.ConclusionAfter ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.     

“一带一路”医疗援外项目卫生人员不同培养方式结果分析

目的探讨援外医疗救助"爱心行"项目中,针对柬埔寨医务人员不同培养形式初步结果。方法 2017年12月-2019年3月,横断面调查方法。近5年卫生人力资源培养相关文献查询,参加"爱心行"项目中国柬埔寨政府多部门,中国援外医疗队员,柬埔寨西部大学教授,参加培养柬埔寨卫生管理及医疗卫生人员等为访谈对象。半结构式访谈收集培养时间、内容类型及过程,分析比较长短期不同培训形式优缺点及初步结果。结果 7种形式共培养柬埔寨医生167人,来自柬埔寨4个省及金边市。其中硕士1名;长期进修(3月及以上)2名,会议及培训40名,与柬大学联合短期培训24名学员,来华现场培训实习5名,中国援外医疗队现场带教33人,中国流动医疗车现场带教培训70名。培训内容包括项目管理组织,筛查技能,心脏B超检查,Intensive Care Unit(ICU),心导管,经皮介入治疗结构性心脏病及车载心电图机,X线,生化分析仪使用等。结论援外项目应长短期培养相结合,多种培养形式有利于兼顾项目实施现场需求及长期项目影响。     

Stroke and stroke risk factors in women of reproductive age with a history of metabolic or bariatric surgery

ObjectiveTo determine the odds of stroke in women of reproductive age who have had metabolic or bariatric surgery (MBS).MethodsWe used the National Inpatient Sample (NIS), a publicly available dataset that samples 20% of hospital discharges. The study population includes women between the ages of 20 and 44 without a maternal admission code. Weighted logistic regression analyses were conducted to assess the odds of stroke in women with history of MBS compared to other women of reproductive age. Adjustment of odds was done for the following covariates: age, race, primary payer, severity of illness, depression, and obesity.ResultsWomen with a history of MBS had 52% lower adjusted odds of having a stroke than women who did not have MBS (OR = 0.48, 95%CI = 0.42-0.55). Additionally, women who had MBS had lower odds of risk factors for stroke, including diabetes (OR = 0.61, 95%CI = 0.59-0.63), hypertension (OR = 0.82, 95%CI = 0.81-0.84), hypercholesterolemia (OR=0.72, 95%CI =0.68-0.77), and migraine with aura (OR = 0.86, 95%CI = 0.74-0.99).ConclusionsAmong women of reproductive age with a history of MBS, there were lower odds of having a stroke and stroke risk factors when compared to women who did not have MBS. Additionally, this study showed a modest decrease in the odds of stroke among women with obesity when adjusted for other risk factors. Future research should focus on examining this finding further, with a focus on the moderation of the impact of having obesity on stroke risk independent of other stroke risk factors.