The impact of language barriers and immigration status on the care experience for Spanish-speaking caregivers of patients with pediatric cancer

This paper explores the changing postcolonial and racialised politics of belonging in East London. In particular it draws on research with multi-sector professionals and 15 to 18 year old young separated migrants. Separated from parents, these teenagers include those who had applied for asylum and were living under social services care as ‘unaccompanied’ and those living with their extended family. It also includes separated migrants wanting sanctuary, but who had insecure immigration status because their asylum claim had failed, or because they had not yet applied for asylum and had no other visa status. The research focuses on healthcare issues and the broader life-situations of young separated migrants as a way to examine the changing politics of belonging in East London. Features of this politics include a rise in popularity of the Far Right, the impact of immigration and healthcare legislation and practice, and racial hostility. As well as looking at this, there is an exploration of resistance to this racialised political context by teenagers and certain professionals, and the struggle for a convivial multiculture that is a feature of their resistance. The argument here is that the changing racialised politics of belonging in East London: (1) show how underdevelopment, geo-political and postcolonial forces contribute to shaping local experiences of racism (2) sometimes involves, rather than aggressively targets, British citizens from NCWP (New Commonwealth and Pakistani) backgrounds and their descendants, as skin colour becomes less of an articulated symbol of ‘otherness’ than immigration status (3) therefore excludes ‘new migrants’ and especially those seeking sanctuary, such as the young people in this paper, from belonging (4) faces local resistance. However resistance to this politics might be better informed by a greater understanding of how postcolonialism shapes local racism and militates against a convivial multiculture, with sociology playing a role in accomplishing this

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The Impact of COVID-19 on the Delivery of Critical Health Care: Experience From a Non–High-Income Country

Asia Pacific Journal of Public Health ◽

10.1177/1010539520963626 ◽

2020 ◽

Vol 32 (8) ◽

pp. 473-475

Author(s):

Thirunavukarasu Kumanan ◽

Chrishanthi Rajasooriyar ◽

Mahesan Guruparan ◽

Nadarajah Sreeharan

Keyword(s):

Health Care ◽

High Income ◽

Income Country ◽

High Income Country ◽

Care Experience ◽

Health Care Experience ◽

The Impact ◽

Critical Health Care

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“My heart was so painful ”: A Narrative Inquiry into the Impact of Immigration Status, Violence, Disability and Poverty on Identity Construction

Arts and Social Sciences Journal ◽

10.4172/2151-6200.s1-007 ◽

2014 ◽

Vol s1 ◽

Author(s):

Joanne Neille Claire Penn

Keyword(s):

Narrative Inquiry ◽

Identity Construction ◽

Immigration Status ◽

The Impact

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Barriers to symptom management care pathway implementation in pediatric Cancer

BMC Health Services Research ◽

10.1186/s12913-021-07047-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

L. Lee Dupuis ◽

Allison Grimes ◽

Emily Vettese ◽

Lisa M. Klesges ◽

Lillian Sung

Keyword(s):

Clinical Research ◽

Pediatric Oncology ◽

Pediatric Cancer ◽

Symptom Management ◽

Care Pathway ◽

The United States ◽

Care Pathways ◽

Research Activities ◽

Pediatric Cancer Patients ◽

The Impact

Abstract Background Objectives were to describe barriers to pediatric cancer symptom management care pathway implementation and the impact of the COVID-19 pandemic on clinical research evaluating their implementation. Methods We included 25 pediatric oncology hospitals in the United States that supported a grant submission to perform a cluster randomized trial in which the intervention encompassed care pathways for symptom management. A survey was distributed to site principal investigators prior to randomization to measure contextual elements related to care pathway implementation. Questions included the inner setting measures of the Consolidated Framework for Implementation Research (CFIR), study-specific potential barriers and the impact of the COVID-19 pandemic on clinical research. The Wilcoxon rank sum test was used to compare characteristics of institutions that agreed that their department supported the implementation of symptom management care pathways vs. institutions that did not agree. Results Of the 25 sites, one withdrew because of resource constraints and one did not respond, leaving 23 institutions. Among the seven CFIR constructs, the least supported was implementation climate; 57% agreed there was support, 39% agreed there was recognition and 39% agreed there was prioritization for symptom management care pathway implementation at their institution. Most common barriers were lack of person-time to create care pathways and champion their use (35%), lack of interest from physicians (30%) and lack of information technology resources (26%). Most sites reported no negative impact of the COVID-19 pandemic across research activities. Sites with fewer pediatric cancer patients were more likely to agree that staff are supported to implement symptom management care pathways (P = 0.003). Conclusions The most commonly reported barriers to implementation were lack of support, recognition and prioritization. The COVID-19 pandemic may not be a major barrier to clinical research activities in pediatric oncology.

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Notification of biochemistry critical results and its clinical impact on outpatient care: experience in a Spanish tertiary hospital

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2021-0495 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Javier Laguna ◽

Laura Macias-Muñoz ◽

José Luis Bedini ◽

Naira Rico

Keyword(s):

Outpatient Care ◽

Clinical Laboratory ◽

Tertiary Hospital ◽

Clinical Impact ◽

Care Experience ◽

Specific Protocol ◽

Ensure Patient Safety ◽

Frequent Event ◽

The Impact ◽

Critical Results

Abstract Objectives The communication of critical results (CR) is considered an essential role in clinical laboratories to ensure patient safety. This is especially relevant to outpatients, who are non-hospitalized and more difficult to locate. In our laboratory, there is a specific protocol for CR management that sets up the communication pathway to adequately provide these results to clinicians. The aim of this study is to evaluate the impact of CR reporting on outpatient care. Methods This is a retrospective study focused on CR for biochemistry parameters in a clinical laboratory of a Spanish tertiary hospital during 2019. A total of 156 CR were determined and properly provided to clinicians. We collected CR, age, gender, and the requesting department. We also collected the medical action data resulting from the communication of the CR. Results Seventy-six outpatients (49%) were properly treated because of effective CR communication. Hypoglycemia was the most frequent event (33%), however, the greatest clinical impact was observed for patients with hyponatremia (100%), hyperkalemia (62%), hypokalemia (60%), and hypercalcemia (57%). Based on these findings, we evaluated new glucose alert thresholds depending on whether or not the outpatient was diabetic (1.7 and 2.2 mmol/L, respectively). Based on these new thresholds, we established a CR reporting protocol with 69% effectiveness in outpatients. Conclusions We demonstrate that CR communication in outpatients has a significant clinical impact. To increase the effectiveness of the CR reporting protocol, we propose to adjust alert thresholds according to pathology, department, and patient population.

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Resident Physician Experience and Duration of Electronic Health Record Use

Applied Clinical Informatics ◽

10.1055/s-0041-1732403 ◽

2021 ◽

Vol 12 (04) ◽

pp. 721-728

Author(s):

A. Jay Holmgren ◽

Brenessa Lindeman ◽

Eric W. Ford

Keyword(s):

Care Delivery ◽

Well Being ◽

Early Career ◽

Ambulatory Setting ◽

Care Experience ◽

Resident Physicians ◽

Physician Time ◽

After Hours ◽

Electronic Health ◽

The Impact

Abstract Background Electronic health records (EHRs) demand a significant amount of physician time for documentation, orders, and communication during care delivery. Resident physicians already work long hours as they gain experience and develop both clinical and socio-technical skills. Objectives Measure how much time resident physicians spend in the EHR during clinic hours and after-hours, and how EHR usage changes as they gain experience over a 12-month period. Methods Longitudinal descriptive study where participants were 622 resident physicians across postgraduate year cohorts (of 948 resident physicians at the institution, 65.6%) working in an ambulatory setting from July 2017 to June 2018. Time spent in the EHR per patient, patients records documented per day, and proportion of EHR time spent after-hours were the outcome, while the number of months of ambulatory care experience was the predictor. Results Resident physicians spent an average of 45.6 minutes in the EHR per patient, with 13.5% of that time spent after-hours. Over 12 months of ambulatory experience, resident physicians reduced their EHR time per patient and saw more patients per day, but the proportion of EHR time after-hours did not change. Conclusion Resident physicians spend a significant amount of time working in the EHR, both during and after clinic hours. While residents improve efficiency in reducing EHR time per patient, they do not reduce the proportion of EHR time spent after-hours. Concerns over the impact of EHRs on physician well-being should include recognition of the burden of EHR usage on early-career physicians.

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Nitric Oxide as a Potential Adjuvant Therapeutic for Neuroblastoma: Effects of NO on Murine N2a Cells

Veterinary Sciences ◽

10.3390/vetsci7020051 ◽

2020 ◽

Vol 7 (2) ◽

pp. 51

Author(s):

Jenna L. Gordon ◽

Melissa M. Reynolds ◽

Mark A. Brown

Keyword(s):

Nitric Oxide ◽

Cell Viability ◽

Pediatric Cancer ◽

Clinical Management ◽

Colony Formation ◽

Neuroblastoma Cells ◽

Dermal Fibroblasts ◽

Cell Analysis ◽

Monosodium Salt ◽

The Impact

Neuroblastoma, the most common extracranial solid tumor in children, accounts for 15% of all pediatric cancer deaths. Pharmaceutical applications of S-Nitrosylation, which, under normal conditions is involved with a host of epigenetic and embryological development pathways, have exhibited great potential for use as adjuvant therapeutics in the clinical management of cancer. Herein, an evaluation of the impact of nitric oxide (NO) as a potent anticancer agent on murine neuroblastoma cells is presented. Excitingly cell viability, colony formation, and non-carcinogenic cell analysis illustrate the significance and practicality of NO as a cytotoxic anticancer therapeutic. Resazurin, WST-8 (2-(2-methoxy-4-nitrophenyl)-3-(4-nitrophenyl)-5-(2,4-disulfophenyl)-2H-tetrazolium, monosodium salt), and MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphyltetrazolium bromide) assays consistently displayed a moderate, ~20–25% reduction in cell viability after exposure to 1 mM S-Nitrosoglutathione (GSNO). A colony formation assay demonstrated that treated cells no longer exhibited colony formation capacity. Identically GSNO-treated Adult Human Dermal Fibroblasts (HDFa) exhibited no decrease in viability, indicating potential discrimination between neoplastic and normal cells. Collectively, our findings indicate a potential application for NO as an adjuvant therapeutic in the clinical management of neuroblastoma.

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