scholarly journals Implementing radical cure diagnostics for malaria: user perspectives on G6PD testing in Bangladesh

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Nora Engel ◽  
Cristian Ghergu ◽  
Mohammad Abdul Matin ◽  
Mohammad Golam Kibria ◽  
Kamala Thriemer ◽  
...  
Keyword(s):  
Health Care Providers ◽  
G6pd Deficiency ◽  
New Technologies ◽  
Routine Practice ◽  
Radical Cure ◽  
Care Providers ◽  
Structured Interviews ◽  
Drug Induced ◽  
User Perspectives ◽  
The Impact

Abstract Background The radical cure of Plasmodium vivax requires treatment with an 8-aminoquinoline drug, such as primaquine and tafenoquine, to eradicate liver hypnozoite stages, which can reactivate to cause relapsing infections. Safe treatment regimens require prior screening of patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency to avoid potential life-threatening drug induced haemolysis. Testing is rarely available in malaria endemic countries, but will be needed to support routine use of radical cure. This study investigates end-user perspectives in Bangladesh on the introduction of a quantitative G6PD test (SD Biosensor STANDARD™ G6PD analyser) to support malaria elimination. Methods The perspectives of users on the SD Biosensor test were analysed using semi-structured interviews and focus group discussions with health care providers and malaria programme officers in Bangladesh. Key emerging themes regarding the feasibility of introducing this test into routine practice, including perceived barriers, were analysed. Results In total 63 participants were interviewed. Participants emphasized the life-saving potential of the biosensor, but raised concerns including the impact of limited staff time, high workload and some technical aspects of the device. Participants highlighted that there are both too few and too many P. vivax patients to implement G6PD testing owing to challenges of funding, workload and complex testing infrastructure. Implementing the biosensor would require flexibility and improvisation to deal with remote sites, overcoming a low index of suspicion and mutual interplay of declining patient numbers and reluctance to test. This approach would generate new forms of evidence to justify introduction in policy and carefully consider questions of deployment given declining patient numbers. Conclusions The results of the study show that, in an elimination context, the importance of malaria needs to be maintained for both policy makers and the affected communities, in this case by ensuring P. vivax, PQ treatment, and G6PD deficiency remain visible. Availability of new technologies, such as the biosensor, will fuel ongoing debates about priorities for allocating resources that must be adapted to a constantly evolving target. Technical and logistical concerns regarding the biosensor should be addressed by future product designs, adequate training, strengthened supply chains, and careful planning of communication, advocacy and staff interactions at all health system levels.

scholarly journals Implementing Radical Cure Diagnostics for Malaria: User Perspectives on G6PD Testing in Bangladesh

2020 ◽  
Author(s):  
Nora Engel ◽  
Cristian Ghergu ◽  
Mohammad Abdul Matin ◽  
Mohammad Golam Kibria ◽  
Kamala Thriemer ◽  
...  
Keyword(s):  
Health Care Providers ◽  
G6pd Deficiency ◽  
New Technologies ◽  
Routine Practice ◽  
Radical Cure ◽  
Care Providers ◽  
Structured Interviews ◽  
Drug Induced ◽  
User Perspectives ◽  
The Impact

Abstract Background: The radical cure of Plasmodium vivax requires treatment with an 8-aminoquinoline drug, such as primaquine and tafenoquine, to clear the liver of parasites which can reactivate to cause relapsing infections. Safe treatment regimens require prior screening of patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency to avoid potential life-threatening drug induced hemolysis. Testing is rarely available in malaria endemic countries, but will be needed to support routine use of radical cure. This study investigates end-user perspectives in Bangladesh on the introduction of a quantitative G6PD test (SD Biosensor STANDARD™ G6PD analyser) to support malaria elimination.Methods: The perspectives of users on the SD Biosensor test were analysed using semi-structured interviews and focus group discussions with health care providers and malaria programme officers in Bangladesh. Key emerging themes regarding the feasibility of introducing this test into routine practice, including perceived barriers, were analysed.Results: In total 63 participants were interviewed. Participants emphasized the life-saving potential of the biosensor, but raised concerns including the impact of limited staff time, high workload and some technical aspects of the device. Participants highlighted that there are both too few and too many P. vivax patients to implement G6PD testing owing to challenges of funding, workload and complex testing infrastructure. Implementing the biosensor would require flexibility and improvisation to deal with remote sites, overcoming a low index of suspicion and mutual interplay of declining patient numbers and reluctance to test. This approach would generate new forms of evidence to justify introduction in policy and carefully consider questions of deployment given declining patient numbers. Conclusions: The results of the study show that, in an elimination context, the importance of malaria needs to be maintained for both policy makers and the affected communities, in this case by ensuring P. vivax, PQ treatment, and G6PD deficiency remain visible. Availability of new technologies, such as the biosensor, will fuel ongoing debates about priorities for allocating resources that must be adapted to a constantly evolving target. Technical and logistical concerns regarding the biosensor should be addressed by future product designs, adequate training, strengthened supply chains, and careful planning of communication, advocacy and staff interactions at all health system levels.

scholarly journals The impact of using primaquine without prior G6PD testing: a case series describing the obstacles to the medical management of haemolysis

2019 ◽  
Vol 4 ◽  
pp. 25 ◽  
Author(s):  
Cindy S. Chu ◽  
Germana Bancone ◽  
Nay Lin Soe ◽  
Verena I. Carrara ◽  
Gornpan Gornsawun ◽  
...  
Keyword(s):  
Health Care Providers ◽  
G6pd Deficiency ◽  
Case Series ◽  
Radical Cure ◽  
Care Providers ◽  
Medical Treatments ◽  
Normal Individuals ◽  
High Index Of Suspicion ◽  
Glucose 6 Phosphate Dehydrogenase ◽  
The Impact

Radical cure of Plasmodium vivax malaria in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals employs weekly primaquine dosing. This is the only recommended regimen for this patient sub-group. If national malaria programs mandate daily primaquine dosing (the recommended regimen for G6PD normal individuals), then G6PD testing before prescription is necessary to avoid iatrogenic haemolysis in G6PD deficient individuals. In this case series, two P. vivax infected patients with unknown G6PD status from two different countries were prescribed primaquine as per national malaria program guidelines. During treatment both patients presented to the clinic with symptoms of anaemia after taking primaquine incorrectly. The clinical management of the iatrogenic severe haemolysis that occurred in these patients demonstrates the various adverse effects primaquine can cause, that other common medical treatments also have haemolytic potential, and how the diagnosis of G6PD deficiency can be elusive during acute haemolysis. Health care providers should provide careful instructions about primaquine dosing, be watchful for haemolysis, and have a high index of suspicion for G6PD deficiency in the presence of haemolysis if the G6PD status is previously unknown.

scholarly journals The impact of using primaquine without prior G6PD testing: a case series describing the obstacles to the medical management of haemolysis

2019 ◽  
Vol 4 ◽  
pp. 25
Author(s):  
Cindy S. Chu ◽  
Germana Bancone ◽  
Nay Lin Soe ◽  
Verena I. Carrara ◽  
Gornpan Gornsawun ◽  
...  
Keyword(s):  
Health Care Providers ◽  
G6pd Deficiency ◽  
Case Series ◽  
Radical Cure ◽  
Care Providers ◽  
Medical Treatments ◽  
Normal Individuals ◽  
High Index Of Suspicion ◽  
Glucose 6 Phosphate Dehydrogenase ◽  
The Impact

Radical cure of Plasmodium vivax malaria in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals employs weekly primaquine dosing. This is the only recommended regimen for this patient sub-group. If national malaria programs mandate daily primaquine dosing (the recommended regimen for G6PD normal individuals), then G6PD testing before prescription is necessary to avoid iatrogenic haemolysis in G6PD deficient individuals. In this case series, two P. vivax infected patients with unknown G6PD status from two different countries were prescribed primaquine as per national malaria program guidelines. During treatment both patients presented to the clinic with symptoms of anaemia after taking primaquine incorrectly. The clinical management of the iatrogenic severe haemolysis that occurred in these patients demonstrates the various adverse effects primaquine can cause, that other common medical treatments also have haemolytic potential, and how the diagnosis of G6PD deficiency can be elusive during acute haemolysis. Health care providers should provide careful instructions about primaquine dosing, be watchful for haemolysis, and have a high index of suspicion for G6PD deficiency in the presence of haemolysis if the G6PD status is previously unknown.

The Use of and Attitude Towards Telehealth in Rural Communities

2007 ◽  
Vol 13 (3) ◽  
pp. 29 ◽  
Author(s):  
Emily Mauldon
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Routine Practice ◽  
Care Providers ◽  
Urban Hospital ◽  
Primary Health ◽  
The Impact ◽  
Rural Patients

This paper reports on the attitudes of a sample of health care providers towards the use of telehealth to support rural patients and integrate rural primary health and urban hospital care. Telehealth and other information technologies hold the promise of improving the quality of care for people in rural and remote areas and for supporting rural primary health care providers. While seemingly beneficial for rural patients, study participants believed that telehealth remains underused and poorly integrated into their practice. In general, participants thought that telehealth is potentially beneficial but places constraints on their activities, and few actually used it. Published literature usually reports either on the success of telehealth pilot projects or initiatives that are well resourced and do not reflect the constraints of routine practice, or has an international focus limiting its relevance to the Australian context. Because of the paucity of systematic and generalisable research into the effects of the routine use of telehealth to support rural patients, it is unclear why health care professionals choose to provide such services or the costs and benefits they incur in doing so. Research and policy initiatives continue to be needed to identify the impact of telehealth within the context of Australian primary health care and to develop strategies to support its use.

scholarly journals Stakeholder Perspectives on the Biopsychosocial and Spiritual Realities of Living With ALS: Implications for Palliative Care Teams

2019 ◽  
Vol 36 (10) ◽  
pp. 851-857 ◽  
Author(s):  
Klaudia Kukulka ◽  
Karla T. Washington ◽  
Raghav Govindarajan ◽  
David R. Mehr
Keyword(s):  
Palliative Care ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Quantitative Data ◽  
Well Being ◽  
Social Needs ◽  
Care Providers ◽  
Structured Interviews ◽  
Palliative Care Teams ◽  
The Impact

Context: Amyotrophic lateral sclerosis (ALS) is an all-encompassing, life-limiting disease, resulting in the eventual paralysis of all voluntary muscles and concurrent loss of independence. As the disease advances, both patients and their family caregivers develop complex biological, psychological, and social needs, leading to increasing calls for the involvement of palliative care teams in the management of ALS. Objective: The purpose of this study was to generate a rich description of the realities of living with ALS, equipping palliative care teams with an in-depth understanding of the experiences and needs of patients with ALS and their family caregivers. Methods: This study employed a mixed-methods design, with quantitative data supplementing a larger body of qualitative data. Semi-structured interviews with 42 key stakeholders, including patients, family caregivers, and health-care providers, were analyzed for themes essential for effective understanding of ALS. Results: Identified themes were organized into 2 broad categories: (1) biopsychosocial needs of patients with ALS and family caregivers and (2) the impact of ALS on spiritual and emotional well-being. Quantitative data supported the recognized themes, particularly with regard to challenges associated with preserving independence, securing sufficient social support, and managing the emotional complexities of the disease. Conclusion: Study findings illustrate the intricacies of living with ALS and the importance of eliciting individualized values when caring for patients with ALS and their families. The complex biopsychosocial needs experienced by patients and family caregivers suggest numerous opportunities for meaningful palliative care involvement.

Youth health in a digital world: Approaching screen use in clinical practice

2020 ◽  
Vol 25 (3) ◽  
pp. 662-671
Author(s):  
Monique Jericho ◽  
April Elliott
Keyword(s):  
Health Care Providers ◽  
Screen Time ◽  
New Technologies ◽  
Care Providers ◽  
Youth Health ◽  
Social Challenges ◽  
Digital World ◽  
Clinical Interactions ◽  
The Impact ◽  
Screen Use

New technologies, such as smartphones, have altered our behaviours and cultural structures more dramatically than televisions of our past. The array of today’s electronic devices have pulled our eyes closer to the screens and our focus further into the boxes behind those screens. Screens may serve us; simultaneously, they are increasingly giving rise to health and social challenges that researchers are only beginning to understand. There is a growing dis-ease among parents and health care providers (HCPs) about how screens are affecting youth. As the push for increased screen time continues in both educational and workplace settings, HCPs are not only tasked with helping parents and youth cope, but they must find ways to manage the impact of increased personal and professional screen time on their own wellbeing. This article considers the impact of increased screen time on two groups: youth and the HCPs supporting them. Furthermore, the authors explore the impact of screen use on clinical interactions, and patient care, suggesting a process for addressing screen use and provide specific tools including a reflective query for HCPs to better evaluate the impact of their own screen usage, ‘the Coaching Stance’ and TGROW, a questioning approach derived from coaching theory.

scholarly journals EXPLORING EMPATHY IN PEDIATRICS RESIDENTS AT AN URBAN CHILDREN’S HOSPITAL IN CANADA

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e51-e51
Author(s):  
Surabhi Rawal ◽  
Laura Nimmon ◽  
Caron Strahlendorf
Keyword(s):  
Compassion Fatigue ◽  
Residency Training ◽  
Health Care Providers ◽  
Care Providers ◽  
Structured Interviews ◽  
Physician Patient Relationship ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Resident Resilience ◽  
The Impact

Abstract BACKGROUND Empathy is fundamental to the physician-patient relationship, promoting both patient compliance and increased treatment efficacy. Studies attempting to quantify changes in empathy during residency are inconsistent in their findings; those examining paediatrics training specifically, are no more definitive. The mixed conclusions may stem from the use of self-reporting scores, which may fail to capture the essence of the effect. OBJECTIVES This study aimed to explore the state, and map a trajectory, of empathy in paediatrics residents, to identify factors influencing the learning and retention of empathy. DESIGN/METHODS This qualitative descriptive study was conducted at an urban children’s hospital in Canada. A constructivist phenomenological approach was used. Participants were recruited for semi-structured interviews via a purposive sampling strategy; thereafter, a thematic analysis was employed. Emerging themes were discussed at research meetings. Sufficiency was felt to be achieved after ten interviews. RESULTS Senior residents reported an overall increase in empathy, in part attributed to a better understanding of paediatric illnesses and greater perspective of the impact on families. There appeared to be a reconciliation with the changing shape of their empathy: managerial and administrative responsibilities could be performed empathically if patient priorities remained a central objective. Challenges to the retention of empathy correlated with published literature: time constraints, compassion fatigue and burnout with poor coping, and the hidden curriculum. Empathy was learned from role modelling by peers, preceptors, and other health care providers. Resident resilience, as a product of personal adversity, was protective against the loss of empathy; this could be considered in the postgraduate admissions process, and should be fostered with resident wellness strategies. Residents advocated for increased autonomy and patient ownership, and fuller exposure to longitudinal care, including the patient’s social context and home life, both of which could be considered as additions to residency training curricula to increase resident empathy. CONCLUSION Residents demonstrated an increase in empathy during training. Resident resilience is valuable in protecting empathy and could be considered in admissions processes. Longitudinal clinics and home visits should be considered as additions to residency training curricula.

Acceptance of the HPV Vaccine in a Multiethnic Sample of Latinx Mothers

2021 ◽  
Vol 31 (3) ◽  
pp. 472-483
Author(s):  
Ana Cristina Lindsay ◽  
Madelyne J. Valdez ◽  
Denisse Delgado ◽  
Emily Restrepo ◽  
Yessica M. Guzmán ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Thematic Analysis ◽  
Hpv Vaccine ◽  
Female Adolescents ◽  
Future Research ◽  
Care Providers ◽  
Foreign Born ◽  
Structured Interviews ◽  
Direct Benefits ◽  
Multiethnic Sample

This descriptive qualitative study explored Latinx mothers’ acceptance of the human papillomavirus (HPV) vaccine for their adolescent children. Data were collected through individual, semi-structured interviews and analyzed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Twenty-two ( n = 22), mostly foreign-born, Latinx mothers of male and female adolescents participated in the study. Three main themes and nine subthemes emerged from the analyses. Findings identified the need for increased efforts to raise awareness and knowledge among Latinx mothers of the direct benefits of the HPV vaccine for sons, including stressing prevention of HPV-associated cancers in males. Findings also underscore the need for improved health care providers’ communication and recommendation of the HPV vaccine for Latinx adolescent males. Future research should intervene upon the study’s findings to address barriers that remain and affect Latinx mothers’ acceptance and uptake of the HPV vaccine for their children, in particular their sons.

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