scholarly journals Development and evaluation of guidelines for prevention of retraumatisation in torture survivors during surgical care: protocol for a multistage qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053670
Author(s):  
Ana Carla Schippert ◽  
Ellen Karine Grov ◽  
Tone Dahl-Michelsen ◽  
Juha Silvola ◽  
Bente Sparboe-Nilsen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Guidelines ◽  
Interpretative Phenomenological Analysis ◽  
Healthcare Professionals ◽  
Surgical Care ◽  
Torture Survivors ◽  
Care Protocol ◽  
Informed Consent Form ◽  
Study Results ◽  
Group Interviews

IntroductionHealthcare professionals working in somatic departments are not trained to recognise signs of torture or provide appropriate healthcare to torture survivors, which may result in retraumatisation during surgical treatment.Methods and analysisThis protocol outlines a four-stage qualitative-method strategy for the development and evaluation of guidelines for prevention of retraumatisation of torture survivors during surgical care. The systematic search for literature review in stages 1 and 2 was conducted in August 2019 and March 2021, respectively, using nine databases. The search strategies employed in stage 1, without imposing any date limits, resulted in the inclusion of eight studies that addressed inadequate healthcare strategies associated with retraumatisation. The clinical guidelines review in stage 2 will include publications from 2000 onwards, which will be appraised using the Appraisal of Guidelines Research and Evaluation Version II instrument. Following multi-institutional recruitment in Norway, stage 3 will explore survivors’ experiences of receiving surgical treatment using indepth interviews (n=8–12), which will be audio-recorded, transcribed verbatim and analysed using the interpretative phenomenological analysis approach. In stage 4a, based on the findings from stages 1, 2 and 3, a set of clinical guidelines for preventing retraumatisation during surgical treatment will be developed. Next, the feasibility and acceptability of the guidelines will be assessed in stage 4b in three interdisciplinary focus group interviews (n=5 per group) and text condensation analyses.Ethics and disseminationThe Regional (South-East C) Committee for Medical and Health Research Ethics approved the study in May 2021 (#227624). In stages 3 and 4, an informational letter and an informed consent form will be distributed to the participants to sign before the interview. The study results will be disseminated through publications, conference presentations, and national and local public forums to healthcare professionals, service managers, policymakers and refugee-supporting agencies.

Problems of surgical treatment of the anterior pelvic ring chronic injuries

2021 ◽  
Vol 19 (3) ◽  
pp. 47-54
Author(s):  
A. F. LAZAREV ◽  
◽  
E. I. SOLOD ◽  
YA. G. GUDUSHAURI ◽  
E. I. KALININ ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pelvic Ring ◽  
Metal Structure ◽  
Complex Problem ◽  
Long Term Results ◽  
Fixation Method ◽  
Surgical Interventions ◽  
Anterior Section ◽  
Pelvic Injuries ◽  
Study Results

A surgical treatment of the joints of the pelvic ring, especially the pubic joint is a separate and complex problem. When using standard plates, which are applied in the treatment of patients with fresh injuries to stabilize old injuries of the pelvic ring, problems arise with fatigue fracture of plates, destabilization of the metal structure and the need for repeated surgical interventions. Therefore, in the case of old injuries, during surgical treatment, it is necessary to use other tactical approaches to fixing pelvic injuries and to search for adapted structures for such cases. The purpose — to study the features of fixation of old injuries of the pelvic ring and to determine the results of different methods of the anterior pelvis fixation in old cases. Materials and methods. A retrospective analysis of the performed surgical treatment was carried out. In 2000-2015, in the first department of National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov, 117 patients underwent surgical treatment of old injuries of the anterior pelvic ring under our supervision using standard reconstructive plates applied in the surgical treatment of new injuries of the pelvic ring. Results. Of the 65 patients who underwent fixation of an old injury of the anterior semiring with AO reconstructive plates and AO pelvic plates, installed in a standard manner as in new injuries, 12 patients (10,2%) experienced migration or fracture of structures within 2 to 6 months from the operation. In 52 patients, fixation of the anterior section with two AO plates was applied, one of which was located in a standard way along the upper edge of the pubic bones, the second was implanted additionally along the anterior surface of the pelvic ring perpendicular to the first one. In this group, migration and destabilization of the structures was observed in 7 patients (13,4%) within a period from 2 weeks to 2 months from the date of the operation. Conclusion. The analysis of the study results suggests that surgical treatment of old injuries of the anterior pelvic ring requires a special approach to the choice of the surgical fixation method, which differs from the treatment of new injuries. Over time, in the absence of treatment for injuries and ruptures of the pelvic ring, cicatricial-fibrous adhesions of the pelvic ring occur, which does not always ensure the stability of the pelvic ring, but leads to rigid post-traumatic deformity of the pelvis. Taking into account the cases of destabilization in groups 1 — 10,2% and 2 — 13,4%, as well as the assessment of the long-term results according to the Majeed scale, the use of standard methods for fixing the anterior pelvic semiring can be considered ineffective in old pelvic injuries.

scholarly journals Surgical treatment of rectal prolapse: experience and late results with 51 patients

2004 ◽  
Vol 59 (4) ◽  
pp. 168-171 ◽  
Author(s):  
Carlos Walter Sobrado ◽  
Desidério Roberto Kiss ◽  
Sérgio C. Nahas ◽  
Sérgio E. A. Araújo ◽  
Victor E. Seid ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Fecal Incontinence ◽  
Rectal Prolapse ◽  
Late Results ◽  
Long Term Results ◽  
Complete Rectal Prolapse ◽  
Presacral Space ◽  
Perineal Rectosigmoidectomy ◽  
Study Results ◽  
Low Incidence

The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. CONCLUSION: Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

scholarly journals Barriers of Adherence among Palestinian Healthcare Professionals towards the Protocol of Health Education and Counselling on Healthy Behaviours for Non-Communicable Diseases

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Ahmed Hassan Albelbeisi ◽  
Ali Albelbeisi ◽  
Abdel Hamid El Bilbeisi ◽  
Mahmoud Taleb ◽  
Amirhossein Takian ◽  
...  
Keyword(s):  
Health Education ◽  
Psychometric Properties ◽  
Healthcare Professionals ◽  
Gaza Strip ◽  
Communicable Diseases ◽  
Arabic Version ◽  
Validity And Reliability ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
Study Results

BACKGROUND፡ Despite the huge numbers of the universally produced and employed protocols, the adherence with them is still low to moderate in the healthcare settings. This study was employed to assess the attitudes of Palestinian healthcare professionals in Gaza Strip to health education and counseling on healthy behaviours protocol (WHO-PEN Protocol 2), for patients with non-communicable diseases in the Ministry of Health primary healthcare centers.METHODS: This cross-sectional study was conducted with a census sample of all governmental family physicians and nurses (n=175). The study questionnaire was developed based on Cabana theoretical framework. The Arabic version questionnaire was developed based on the cross-cultural adaptation framework. The psychometric properties of the Arabic version questionnaire was finally evaluated.RESULTS: The psychometric properties of the Arabic version questionnaire showed good construct validity and internal consistency reliability. The overall adherence level to WHO-PEN Protocol 2 was 70.0, SD=6.9. The main perceived barriers were lack of incentive, patients’ factors, and lack of time. In general, most of healthcare professional respondents had a positive attitude toward the protocol, but this attitude was not predictor to protocol adherence.CONCLUSION: The good validity and reliability of the questionnaire can provide support for the accuracy of the study results. Varied implementation strategies targeting the major barriers derived from the study are extremely required for addressing the lack of incentives, patients’ factors and time constraints.

scholarly journals Understanding of Teachers and Healthcare Professionals about their Professional Development

2021 ◽  
Author(s):  
Oskars Kaulēns ◽  
◽  
Reinis Upenieks
Keyword(s):  
Professional Development ◽  
Labor Market ◽  
Informal Learning ◽  
Technology Use ◽  
Healthcare Professionals ◽  
Technological Development ◽  
Professional Performance ◽  
Market Participants ◽  
Study Results ◽  
The Impact

Changes in technology use and globalization are leading to significant changes in the structure of the labor market, emphasizing the need for labor market participants to learn continuously and acquire new knowledge and skills in order to adapt to a rapidly changing work environment. Economists point to the risks posed by technological development, such as the reduction of low-skilled jobs as a result of digitalization and automation processes. Although professionals working with people, such as healthcare professionals and teachers, are less exposed to the risk of automation, they are still increasingly unstable as technology and artificial intelligence compete with human experts. This means that medical and education staff will also need more targeted, regular and labor market-oriented professional development in order to remain competitive and demonstrate demand-driven performance. In line with changes in the quality standards of professional performance for healthcare professionals and teachers, changes are also taking place in how the professional development of these groups is implemented. In addition to formal development activities such as courses and seminars, the need to accept the impact of informal learning is emphasized, not only expanding the aims and content of professional development activities but also offering new learning formats. The aim of the qualitative research conducted by the authors is to study the understanding of teachers and healthcare professionals about their professional development by analyzing their answers regarding their professional development. The focus of the study has been chosen to test the assumption that healthcare professionals and teachers view their continuing education more in the context of formal training, with less emphasis on professional development through informal learning. Within the framework of the research, a survey of random respondents within the said target groups has been conducted and the answers of the respondents have been analyzed, with attention paid to the aspects of formal and informal learning. The article presents the results of the content analysis, highlighting the most important trends of study results and the problematic aspects related to the improvement of the quality of professional development.

scholarly journals The Experiences of Patients with Deep Brain Stimulation in Parkinson’s Disease: Challenges, Expectations, and Accomplishments

2020 ◽  
Vol 49 (1) ◽  
pp. 36
Author(s):  
Özlem İbrahimoğlu ◽  
Sevinc Mersin ◽  
Eda Akyol
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Healthcare Professionals ◽  
Focus Group Interviews ◽  
The Mean ◽  
Group Interviews ◽  
Deep Brain

<p><strong>Objectives. </strong>Deep brain stimulation (DBS) is a safe and effective alternative treatment of some movement disorders such as Parkinson's disease. Although DBS is an effective treatment for Parkinson's disease, because of the necessity of surgical intervention, follow-up and the effects on symptoms, this study was carried out to determine the challenges, expectations and accomplishments of patients with DBS in Parkinson’s disease.</p><p><strong>Materials and Methods. </strong>This qualitative study was carried out at the Neurosurgery Department of a research hospital in Turkey with seven patients who underwent DBS between 2008 and 2018. In the study, the challenges, expectations, and accomplishments of patients were investigated by using three focus group interviews in October 2018.</p><p><strong>Results. </strong>Among the participants, six patients were male, and one patient was female. The mean age of the patients was 56.85}16.48. Three main themes were revealed in the study. These were (1) Reborn; decrease in dependence, sense of accomplishment, enjoyment of life, (2) Prejudice; perceived as severely ill by others and (3) Fear; not being accustomed to the device, loss of device function.</p><p><strong>Conclusion. </strong>The results obtained from this study can be used in the process of adaptation to this process by discussing and evaluating the challenges, expectations and accomplishments of the Parkinson's patient in DBS with healthcare professionals and other patients.</p>

scholarly journals INFLUENCE OF SURGICAL INTERVENTION ON PATIENTS WITH OVARIAN APOPLEXY IN THE ASPECT OF OVARIAN RESERVE PRESERVATION

World Science ◽  
2019 ◽  
Vol 2 (5(45)) ◽  
pp. 7-10
Author(s):  
O. M. Ishchak
Keyword(s):  
Surgical Treatment ◽  
Ovarian Reserve ◽  
Antral Follicle ◽  
Disease Recurrence ◽  
Reproductive Age ◽  
Hemodynamic Parameters ◽  
Bipolar Coagulation ◽  
Study Results ◽  
Duration Of Surgery ◽  
First Time

Ovarian apoplexy is the women’s disease of reproductive age, 75% of which are under the age of 30 years old, about 30% undergo surgery, and 40-62% of them are subjected to repeated surgeries because of disease recurrence [3, 10]. Goal of study: improvement of surgical treatment of the patients with ovarian apoplexy for maximal preservation of ovarian reserve.Materials and methods. A total of 120 women were included in the study. These include 55 patients with ovarian apoplexy, who underwent laparoscopic surgery for the first time. These patients were included in the prospective study and divided into two groups, depending on the hemostasis method used during the surgery. Group 1 included 30 patients with hemostasis, which was carried out using bipolar coagulation, group 2 included 25 patients, whose bleeding from the ovary was stopped by applying sutures. In each group, the patients were selected with the “blind” method. The study included patients with stable hemodynamic parameters before surgery and duration of hospitalization of not more than 24 hours. The comparison group consisted of 45 patients with laparoscopic confirmation of pain form of the ovarian apoplexy, who underwent conservative treatment. Study results and their discussion. Patients with ovarian apoplexy with stable hemodynamic parameters should undergo surgery using laparoscopic access, which allows to clarify the diagnosis, stop bleeding, prevent development of sexually transmitted infections and carry out surgical correction of the associated pathological processes of the internal genital organs. Stop of bleeding at the patients with ovarian apoplexy with bipolar electrosurgery is faster (shorter duration of surgery by 13 minutes), but this leads to more significant decrease in ovarian reserve (Anti-Mullerian hormone (AMH) by 30%, antral follicle count (AFC) by 10%) than use of hemostatic sutures (AMH by 22%, PAF by 8%) (p <0.05). In order to maximize the maintenance of the ovarian reserve at surgeries by women with ovarian apoplexy, it is always better to carry out hemostasis by enucleating the cyst capsule within healthy tissues and saturation with absorbable synthetic areactive sutures on the ovarian wound following by intracorporal knot tying. Regardless of the hemostasis, used during surgical treatment of ovarian apoplexy by patients of the age of 36 years old and older, there is a greater decrease in ovarian reserve (AMH by 30%, AFC by 20%) than at patients whose age is less than 35 years old (AMH by 20%, AFC by 12%) (p <0.05). By patients with implemented fertility function regardless of age and by all patients under the age of 35, undergoing surgery because of ovarian apoplexy for the first time, bipolar coagulation is permissible to stop bleeding. At implementation of bipolar hemostasis of patients with ovarian apoplexy, point coagulation of bleeding vessels should be performed, avoiding damage to surrounding tissues.

scholarly journals Gastric bypass - ingen snarvei til ny livsstil. Pasienterfaringer to år etter kirurgi

2017 ◽  
Vol 13 (1) ◽  
Author(s):  
Åshild Torgersen ◽  
Rebecca Jane Foreman ◽  
Sissel Eikeland Husebø ◽  
Marit Hegg Reime
Keyword(s):  
Social Support ◽  
Change Process ◽  
Healthcare Service ◽  
Healthcare Professionals ◽  
Lifestyle Changes ◽  
Focus Group Interviews ◽  
Knowledge To Action ◽  
Group Interviews ◽  
Patients Experience

The aim of the study was to examine which factors affect the patient's ability to cope with lifestyle changes, the importance of social support to maintain lifestyle changes and how patients experience follow-up from healthcare professionals, two years after surgery. A qualitative exploratory design was chosen. Three focus group interviews were conducted with 13 patients. Content analysis was used to analyse the interviews. The findings revealed three themes; from knowledge to action, the importance of social support, and insufficient follow-up from the healthcare service. The patients need structure in everyday life, self-discipline and social support to reinforce self-efficacy and to manage and maintain lifestyle changes. Information and support from healthcare professionals should be tailored to where the patient is in the change process.

Is Ovarian Cancer Being Managed According to Clinical Guidelines? Evidence From a Population-Based Clinical Audit

2016 ◽  
Vol 26 (9) ◽  
pp. 1615-1623 ◽  
Author(s):  
Simona Sobrero ◽  
Eva Pagano ◽  
Elisa Piovano ◽  
Lorenzo Bono ◽  
Manuela Ceccarelli ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Surgical Treatment ◽  
Clinical Guidelines ◽  
Clinical Audit ◽  
Population Based ◽  
Pattern Of Care ◽  
Curative Intent ◽  
Adherence To Guidelines ◽  
Cox Models ◽  
Risk Of Death

BackgroundIn the northwestern Italian region of Piedmont, current statistics on hospitalizations show that surgical treatment for ovarian cancer (OC) is taking place in many small hospitals, as opposed to a more centralized approach. A population-based clinical audit was promoted to investigate whether OC is being managed according to clinical guidelines, identify determinants of lack of adherence to guidelines, and evaluate the association between adherence to guidelines and survival.Patients and MethodsResidents diagnosed with OC in 2009 were identified in the regional hospital discharge records database. All hospitalizations within 2 years from diagnosis were reviewed. Patients were classified according to their initial pattern of care, defined as “with curative intent” (CIPC) if including debulking surgery aimed at maximal cytoreduction. Adherence to guidelines for surgery and chemotherapy and the effects of this adherence on OC survival were investigated with logistic regression and Cox models.ResultsThe final study sample consisted of 344 patients with OC, 215 (62.5%) of whom received CIPC. Increasing age, comorbidities, and metastases were negatively associated with receiving CIPC. In the CIPC group, surgical treatment was adherent to guidelines in 35.2%, whereas chemotherapy was adherent in 87.8%. Surgical treatment that was adherent to guidelines [hazard ratio (HR), 0.72; 95% confidence interval (CI), 0.45–1.15] and absence of residual tumor (HR, 0.55; 95% CI, 0.32–0.94) were associated with better survival in the CIPC group, and chemotherapy that was adherent to guidelines was associated with a significant reduction in the risk of death (HR, 0.49; 95% CI, 0.28–0.87).ConclusionsResults support the need to reorganize the clinical pathway of patients with OC in the Piedmont Region and the need for better adherence to current guidelines.

Providing Patient Centered Care for Adolescents with Chronic Conditions

2016 ◽  
Vol 6 (1) ◽  
pp. 22-29
Author(s):  
Nabeel Al-Yateem
Keyword(s):  
Young Adults ◽  
Healthcare Professionals ◽  
Transition Process ◽  
Healthcare Services ◽  
Adolescents And Young Adults ◽  
Study Phase ◽  
Patient Centered ◽  
Centered Care ◽  
Group Interviews ◽  
Depth Interviews

Background: It is well acknowledged that clear, structured healthcare services that are mutually developed between the patient and the healthcare professionals are likely to be of high quality, desirable, and effective. Such service should address the complexity of the illness-health experience in terms of the factors that influence it as well as the physical and psychosocial consequences on the patient. The required focus should be on treating the patient rather than just treating the disease.Objectives: To develop relevant and feasible care guidelines that may inform more competent and patient centered services for adolescents and young adults with chronic conditions.Methodology: A sequential exploratory mixed method design guided this study. The first qualitative phase employed in-depth interviews to explore the experiences of adolescents and young adults about the health services they were receiving. This was followed by focus group interviews with healthcare professionals to discuss the patients’ reported needs and to suggest interventions that would address them. Finally, a second quantitative phase was carried out through a survey to explore the views of a larger sample of service stakeholders about the relevance and feasibility of the suggested guidelines for clinical practice.Results: The in-depth interviews revealed four main themes, as follows: a current amorphous service, sharing knowledge, the need to be at the center of service, and easing the transition process to adulthood. The second study phase yielded 32 proposed guidelines that may contribute to more competent and patient centered health care.

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