Peripheral health workers' knowledge and practices related to filarial lymphedema care: a study in an endemic district of Orissa, India

The Global Program to Eliminate Lymphatic Filariasis (GPELF), which includes alleviation of disability and suffering of patients, is run primarily in India by the primary health care system. The present study assessed the knowledge and practices related to lymphedema care among peripheral health workers of the primary health care system in a filarial-endemic district of Orissa, India. A total of 41 health workers sampled across the district were subjected to in-depth interviews. The results showed that many lymphedema patients visit the peripheral health institutions mostly for the treatment of acute episodes of lymphangitis. Many health workers do not know the concept of foot care and its importance in lymphedema management. However, a few health workers advised the patients to follow some components of foot care. The knowledge levels and practices of peripheral health workers are not at desirable levels. The medical and paramedical staff of the peripheral health institutions should be oriented about the management of lymphedema and peripheral health workers should promote the foot care practices. For the GPELF as a whole to prove successful, the patients who already have lymphedema need to be cared for and have their morbidity relieved as much as possible.     

Physicians' perspectives on caring for cognitively impaired elders

PURPOSE: This study aims to develop an in-depth understanding of the issues important to primary care physicians in providing care to cognitively impaired elders. DESIGN AND METHODS: In-depth interviews were conducted with 20 primary care physicians. Text coded as "cognitive impairment" was retrieved and analyzed by use of grounded theory analysis techniques. RESULTS: A patient's impaired ability to provide an accurate history and to participate in self-care hindered the usual process of care, often resulting in greater medical uncertainty and feelings of inadequacy and frustration for the physician. Shifting the goal of care from "curing" the patient's illness to "caring" for the patient's quality of life was also problematic. The doctor-patient relationship changed dramatically as others became involved in care, often with attendant ethical dilemmas related to patient autonomy and the locus of decision making. Many physicians described a deep sense of loss and grief as the personhood of patients faded. The increased complexity and prominent social and emotional issues were difficult to manage in the context of the current model of practice. IMPLICATIONS: Profound changes occur in the process of care with cognitively impaired patients. The increased complexity mandates an expanded model of care that addresses the prominent psychosocial and ethical aspects of care as well as the medical ones.     

Exploring Sacred Moments in Hospitalized Patients: An Exploratory Qualitative Study

Background“Sacred moments” are brief periods of time in which people experience a deep interconnectedness that may possess spiritual qualities and emotions. This concept has been shown to have a positive impact on individuals’ overall well-being and stress in mental health settings. The concept of sacred moments has not been studied in acute care hospital settings.ObjectiveTo better understand the occurrence of sacred moments among hospitalized patients and their healthcare workers.DesignAn exploratory qualitative study that included in-depth interviews with patients and healthcare workers at two academic medical centers in the Midwestern United States.ParticipantsHospital healthcare workers (e.g., physicians, nurses, ancillary staff) and discharged patients with a recent hospital stay.ApproachSemi-structured telephone interviews were conducted with 30 participants between August 2020 and April 2021. Interviews were recorded and transcribed before conducting thematic analysis.Key ResultsBoth healthcare workers and patients reported having experienced at least one sacred moment. Interview findings were organized into three main domains including (1) several common elements described by participants as marking these moments; (2) benefits experienced by both patients and healthcare workers; and (3) suggestions for fostering sacred moments within the hospital setting.ConclusionsAmong our participants, sacred moments were extremely common with the vast majority reporting to have experienced at least one in their lifetime. These moments were described as profound and important and shared many common elements. Our findings can be used to help recognize, understand, and promote sacred moments between hospitalized patients and healthcare workers.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07999-z.KEY WORDS: sacred moment(s), whole health, spirituality, religiosity in medicine     

Insuring continuity of care for chronic disease patients after a disaster: key preparedness elements

BACKGROUND: Care for patients with chronic diseases is a challenge after a disaster. This is particularly true for individuals from health disparate populations as they are less likely to evacuate, have fewer financial resources and often depend on resource-strapped institutions for their care. The specific aim of the study presented here was to elicit challenges and solutions in the provision of health care to those with chronic diseases after Hurricane Katrina in coastal Alabama and Mississippi. METHODS: Focusing on agencies providing care to health disparate populations, a qualitative methodology was employed using in-depth interviews with health and social service providers. Participants identified key elements essential to disaster preparedness. RESULTS: Predisaster issues were patient education and preparedness, evacuation, special needs shelters, and health care provider preparedness. Postdisaster issues were communication, volunteer coordination, and donation management. CONCLUSIONS: Lessons learned from those on the ground administering health care during disasters should inform future disaster preparations. Furthermore, the methodological approach used in this study engendered collaboration between health care institutions and may enhance future interagency disaster preparedness.     

Diabetes Self-care among a Multiethnic Sample of Older Adults

Type 2 diabetes constitutes a leading and increasing cause of morbidity and mortality among older adults, particularly African Americans, Native Americans, Mexican Americans, and rural dwellers. To understand diabetes self-care, an essential determinant of diabetic and overall health outcomes, 80 middle aged and older adults from these four disproportionately affected racial/ethnic/residential groups engaged in in-depth interviews, focusing on approaches to and explanations for diabetes self-care. Certain self-care activities (medication-taking, diet, foot care) were performed regularly while others (blood glucose monitoring, exercise) were practiced less frequently. Despite research suggestions to the contrary, only one in four elders used unconventional diabetes therapies, and only one-third listed someone other than a health care provider as a primary information source. Few self-care differences emerged according to race/ethnicity/residence, perhaps because of the influential and common circumstance of low income. Thematic analyses suggest that inadequate resources, perceived efficacy of medication, great respect for biomedical authority, and lack of familiarity with and concerns about unconventional therapies are influential in establishing these patterns of self-care. We discuss the similarity of self-care practices and perspectives irrespective of race/ethnicity/residence and the predominance of biomedical acceptability.     

Conference for Seniors Citizens to Promote Self-Care Strategies

The U.S. Department of Health and Human Services (1990) stated in its publication "Health People 2000: Full Report" that preventable risk factors can be reduced by changes in health related behaviors, and these behaviors can be influenced by early health care intervention. "Senior Conference-Target Heatlh '93" offered a specific program for African-American Senior Citizens to promote independent living and self-care strategies while fostering participation in the management of their own health. One hundred thirty seven African-American seniors attended this conference. The topics presented included self-care for chronic diseases, health promotion activities, and availability of community resources. The conference approach used adult learning principles and brought health professionals, health services, and community leaders to the seniors for improving their health related knowledge and communication skills.     

Identity and experience: a study of selected female physicians in five provincial states of Mexico

The aim of this paper is to analyse the identity(ies) and experiences of a selected group of female physicians in five provincial states of Mexico. In the last 30 years the number of female physicians in Mexico has grown considerably and yet little is known about these women. Data for this work were drawn from two in-depth interviews with 99 female physicians during 1995-1996. In addition, physicians were asked to complete a personal diary to illustrate the nature of their daily experiences over a three-month period; the gap between the two interviews. Analysis reveals female physician identity is shaped by Mexican health care service structures, personal characteristics and goals, and career development choices and opportunities. Association with particular spaces and places influences female physician career development and identity. The multiple identities of these professional women and their lived experiences can result in various pressures and tensions in family and career life. As a result these women make choices about career development; some reassess their career goals given their family and household circumstances and thus their career development may appear to be constrained. The paper concludes by suggesting that changes in Mexican health institutions and the science of medicine may lead to changes in female physician identity.     

An outbreak of scabies: a forgotten parasitic disease still present in Switzerland

INTRODUCTION: Scabies, a contagious parasitic dermatosis, has a worldwide distribution but is considered a "disease of the poor" in resourcerich countries. However, it can cause major public health problems following outbreaks in industrialised countries. The following study describes a large outbreak of scabies involving several health care institutions in the canton of Neuchatel, Switzerland. PATIENTS AND METHODS: After reporting a case of crusted scabies hospitalised for several months (for other comorbidities) in various health care institutions, a "scabies task force" was created in order to detect further cases by contact tracing. Suspected cases were reported to public health authorities, with notification of the health care institutions where cases or exposed patients had been transferred, and information to general practitioners and dermatologists of the entire area (100,000 inhabitants), RESULTS: Three health care institutions (a rehabilitation clinic, a 200-bed acute care hospital, a small hospital with a haemodialysis unit) were involved. Overall, 24 cases of scabies were detected, 12 among inpatients after exposure within the health care institutions, and 12 among household or other close contacts. 116 health care providers exposed to cases within the health care institutions were investigated with negative results for scabies. After the creation of the task force, no further transmission of scabies was observed. Prolonged misdiagnosis of crusted scabies as well as frequent transfers of cases between various health care institutions facilitated the outbreak. Barrier precautions for health care workers caring for patients with skin lesions even in the absence of a diagnosis of transmissible disease appeared to be efficacious since no transmission to health care workers could be detected. CONCLUSIONS: This is the first reported observation of a large scabies outbreak involving health care institutions in Switzerland. Our outbreak demonstrates that it is not an obsolete disease and that a high index of suspicion must be maintained in order to promptly detect difficult cases and to curb potential outbreaks.     

Factors influencing knowledge of and adherence to self-care among patients with heart failure.

BACKGROUND: Patient education has been shown to be a key component in comprehensive heart failure management. Few data, however, are available regarding patients' knowledge of and adherence to self-care recommendations for the disease. OBJECTIVES: To assess the knowledge level of and adherence to self-care among patients with heart failure and to determine associated factors. METHODS: We conducted a needs-assessment survey among new patients visiting a heart failure clinic from April 1997 through June 1998. Multiple linear regression analysis was used to assess the factors predictive of patients' knowledge level and adherence behaviors. RESULTS: Of the 113 patients surveyed, 77% were referred by cardiologists and 60% had New York Heart Association class III or IV status. Two thirds of the patients reported receiving information or advice about self-care from health care providers. When asked how much they knew about congestive heart failure, however, 37% said "a little or nothing," 49% said "some," and only 14% said "a lot." Approximately 40% of the patients did not recognize the importance of weighing themselves daily and 27% weighed themselves twice a month or less often. Although 80% of the patients knew they should limit their salt intake, only one third always avoided salty foods. Additionally, 25% of the patients did not appreciate the risk of alcohol use and 36% believed they should drink a lot of fluids. The multiple linear regression analysis indicated that a higher knowledge score was associated with being married, prior hospitalization, and having received both advice and information about self-care from physicians or nurses. A poor adherence behavior score was associated with being unmarried, lower perceived self-efficacy, a lack of knowledge about self-care, and no prior hospitalization. CONCLUSIONS: We observed a gap between patients receiving and absorbing or retaining information on self-care for congestive heart failure supplied by health care providers. Self-care education needs to be directed to outpatients in addition to inpatients.     

Gender influences handwashing rates in the critical care unit

BACKGROUND: Nurses tend to wash their hands more often than physicians, and among nonhealth care workers, women tend to wash their hands more often than men. This study examined the influence of gender on the handwashing rates of health care workers (HCWs). The null hypotheses were that there would be no intergender difference in (a) handwashing rates in HCWs across professions and (b) within professional groups. METHODS: Handwashing by nurses, physicians, wardspersons, x-ray technicians, and physiotherapists after patient contact in a critical care unit (CCU) was determined through covert observation. The gender and profession of the subjects were recorded, but their identity was not. RESULTS: Female CCU staff washed their hands significantly more often than did their male counterparts after patient contact (P =.0001). When the results were examined for the influence of profession on handwashing, significant intergender differences remained for physicians (P =.0468) and wardspersons (P =.0001). There was also a nonsignificant trend (P =.07) toward higher rates of handwashing among female x-ray technicians. There were no statistically significant intergender differences in handwashing rates among nurses (P =.7588) and physiotherapists. CONCLUSIONS: It appears that gender may influence handwashing rates in HCWs in the CCU, although this difference appears to be modified in particular professional groups. Further research should examine factors that modify handwashing rates within professional groups and in settings other than the CCU.     

Striving for Control: Cognitive, Self-Care, and Faith Strategies Employed by Vulnerable Black and White Older Adults with Multiple Chronic Conditions

The average older adult reaches age 65 with at least two chronic, co-occurring illnesses, or multiple morbidities (MM). We currently lack critical information about the specific strategies older adults use to attempt to control these MM. To increase our understanding of how older adults attempt to manage these MM and retain control of their health, in-depth interviews were conducted with 41 Black and White middle aged and older men and women with MM. We were particularly interested in representing the experience of those groups more vulnerable to adverse health outcomes due to greater disease prevalence and low income. During in-depth interviews, we asked open-ended questions on life and health history and open-ended and semi-structured questions about self-care for multiple morbidities. Participants expressed a strong desire to remain in control of their health; to do so they employed a wide range of strategies including cognitive structuring techniques (being health vigilant, normalizing, resignation/relinquishing control, and social comparison), self-care activities (emphasizing diet, exercise, medication taking, modifying existing activities, going to the doctor), and faith orientations (prayer as a constructive support strategy, gaining strength from God, church as a central part of life). With the exception of faith orientations, there were no race/ethnicity differences in the strategies participants use. Future studies should expand on this knowledge by exploring the contextual, cultural, and psychological backdrop and characteristics that shape the use of these coping strategies.

A qualitative study exploring diabetes resilience among adults with regulated type 2 diabetes mellitus

Background and aimsType 2 diabetes mellitus (T2DM) patients often experience unregulated blood glucose due to the lack of resilience. The aim of this study was to explore diabetes resilience among adults with regulated T2DM.MethodsThis study used a qualitative case study design. A total of 15 participants with T2DM were recruited through snowball sampling. The study was conducted in four Health Primary Centers in Surabaya, Indonesia. The indicators of diabetes resilience were proper management of diet, activity, stress, and drugs. Interview guidelines were used to collect the data through in-depth interviews. The data were subjected to thematic analysis.ResultsIn this study, the results identified four themes, namely, resilient, support, benefits, and self-care agency. These themes were found among the participants with a resilient condition and regulated blood glucose.ConclusionsResilient, support, benefits, and self-care agency are the themes for achieving diabetes resilience by adults with T2DM. Policymakers and health workers need to consider health interventions for increasing the resilience of T2DM patients so that they can achieve a better glycemic control condition, and manage their diet, medication, activity and stress properly.     

Relationships between home care clients and their workers: implications for quality of care

In-depth interviews were conducted with 54 home care clients and their home health aides and personal care attendants. The interview data reveal that home care relationships tend to be both formal and informal, in that job responsibilities tend to be diffusely defined and home care workers often become involved in the "backstage" world of their clients. The study also suggests, however, that personal bonds may be problematic for both workers and clients. For workers there is the risk of exploitation; for clients, there is the potential for loss of control over their own care. The quality of relationships also affects quality of care.     

Spheres of Influence and Strategic Advocacy for Equity in Medicine

As the extent of health disparities in the USA has been revealed, particularly during the COVID-19 pandemic, physicians have increasingly attended to their roles as advocates for their patients and communities. This article presents "spheres of influence" as a concept that can help physicians think strategically about how to build upon their clinical work and expertise to promote equity in medicine. The physician’s primary sphere of influence is in direct patient care. However, physicians today often have many other roles, especially within larger health care institutions in which physicians often occupy positions of authority. Physicians are therefore well-positioned to act within these spheres in ways that draw upon the ethical principles that guide patient care and contribute materially to the cause of equity for colleagues and patients alike. By making changes to the ways they already work within their clinical spaces, institutional leadership roles, and wider communities, physicians can counteract the structural problems that undermine the health of the patients they serve.     

Systematic bias in recording the history in patients with chest pain

Because of its central importance in medical diagnosis, sources of bias in the patient history must be identified. We report here a study of interobserver agreement in chest pain histories. Histories were obtained by physicians, nurse practitioners, and self-administered questionnaires. We used a discriminant rule to classify the histories as being more or less typical of angina pectoris. A sub-group of the subjects underwent coronary arteriography after the histories were obtained. In subjects with positive coronary arteriograms, physicians consistently obtained histories typical of angina pectoris more often than a self-administered questionnaire. There was no significant systematic bias when comparing physician interviews to the questionnaire among subjects with negative arteriograms nor when comparing two physicians' interviews or a nurse practitioner interview to a questionnaire. When compared to physician interviews, nurse practitioner interviews produced histories less typical of angina pectoris. We conclude that there are systematic differences between the histories obtained by physicians, nurse practitioners, and self-administered questionnaires. Questionnaires can produce biased patient histories and should be carefully validated before being used in patient care activities or health care research.     

Is the risk of occupational tuberculosis higher for young health care workers?

SETTING: Health care workers in Finland. OBJECTIVE: Occupational tuberculosis (TB) was studied separately in nurses, assistant nurses, physicians, psychiatric nurses, medical laboratory workers and radiographers during the period 1971-1995. DESIGN: All 447 notified cases between 20 and 59 years of age were included. Incidence ratios by age and occupation were compared to the corresponding general population. RESULTS: A common profile, with a higher rate of TB towards older age, was seen in the general population but not among health care workers. Among nurses, assistant nurses and physicians, the incidence ratio was higher among those aged 20-39 than among those aged 40-59 years. Compared to the controls, the risk of TB was significantly smaller in the older group of nurses during 1971-1990 and in assistant nurses during 1971-1995. The risk among the older group of physicians was significantly lower during 1971-1980, and among the younger group it was significantly higher during 1976-1990. CONCLUSIONS: We speculate that in certain fields of health care, young workers are at the greatest risk of TB.     

Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study.

AIMS: To examine patient- and provider-reported psychosocial problems and barriers to effective self-care and resources for dealing with those barriers. METHODS: Cross-sectional study using face-to-face or telephone interviews with diabetic patients and health-care providers in 13 countries in Asia, Australia, Europe and North America. Participants were randomly selected adults (n = 5104) with Type 1 or Type 2 diabetes, and providers (n = 3827), including primary care physicians, diabetes specialist physicians and nurses. RESULTS: Regimen adherence was poor, especially for diet and exercise; provider estimates of patient self-care were lower than patient reports for all behaviours. Diabetes-related worries were common among patients, and providers generally recognized these worries. Many patients (41%) had poor psychological well-being. Providers reported that most patients had psychological problems that affected diabetes self-care, yet providers often reported they did not have the resources to manage these problems, and few patients (10%) reported receiving psychological treatment. CONCLUSIONS: Psychosocial problems appear to be common among diabetic patients worldwide. Addressing these problems may improve diabetes outcomes, but providers often lack critical resources for doing so, particularly skill, time and adequate referral sources.     

Early effects of "Guided Care" on the quality of health care for multimorbid older persons: a cluster-randomized controlled trial

BACKGROUND: The quality of health care for older Americans with multiple chronic conditions is suboptimal. We designed "Guided Care" (GC) to enhance quality of care by integrating a registered nurse, intensively trained in chronic care, into primary care practices to work with physicians in providing comprehensive chronic care to 50-60 multimorbid older patients. METHODS: We hypothesized that GC would improve the quality of health care for this population. In 2006, we began a cluster-randomized controlled trial of GC at eight practices (n = 49 physicians). Older patients of these practices were eligible to participate if they were at risk for using health services heavily during the coming year. Teams of two to five physicians and their at-risk older patients were randomized to either GC or usual care (UC). Six months after baseline, participants rated the quality of their health care by answering validated closed-ended questions from telephone interviewers who were masked to group assignment. RESULTS: Of the 13,534 older patients screened, 2391 (17.7%) were eligible to participate in the study, of which 904 (37.8%) gave informed consent and were cluster-randomized. After 6 months, 93.8% and 93.2% of the GC and UC participants who remained alive and eligible completed telephone interviews. GC participants were more likely than UC participants to rate their care highly (adjusted odds ratio = 2.0, 95% confidence interval, 1.2-3.4, p =.006), and primary care physicians were more likely to be satisfied with their interactions with chronically ill older patients and their families (p <.05). CONCLUSIONS: GC improves important aspects of the quality of health care for multimorbid older persons. Additional data will become available as this trial continues.     

苏州市医务人员主动提供的HIV检测咨询服务实施状况的定性研究

目的从医生角度了解苏州市医务人员主动提供的艾滋病病毒（HIV）检测咨询服务（PITC）的实施情况及存在问题,探讨PITC的影响因素。方法采用深入访谈的方法,对苏州市辖区内12个区县的13家综合医院PITC门诊医生进行访谈。结果共有40名来自皮肤性病科、妇产科、泌尿科、肛肠科和结核病防治科的门诊医生接受访谈。访谈结果表明,整体来说就诊者PITC接受性不高。实施过程中主要的困难有：门诊工作量大无暇顾及PITC,如何最大限度地保护就诊者的隐私,以及避免误解等方面的问题。结论亟需加强对医务人员的培训,优化服务流程,明确PITC检测重点人群,加强HIV防治知识的宣传和PITC政策的公示,从而提高PITC的接受度。