scholarly journals A Qualitative Study on Concerns, Needs, and Expectations of Hospital Patients Related to Climate Change: Arguments for a Patient-Centered Adaptation

2021 ◽  
Vol 18 (11) ◽  
pp. 6105
Author(s):  
Benedikt Lenzer ◽  
Christina Hoffmann ◽  
Peter Hoffmann ◽  
Ursula Müller-Werdan ◽  
Manuel Rupprecht ◽  
...  
Keyword(s):  
Climate Change ◽  
Climate Change Adaptation ◽  
Tertiary Care ◽  
Climatic Conditions ◽  
Care Hospital ◽  
Structured Interviews ◽  
Work Processes ◽  
Patient Centered ◽  
Hospital Patients ◽  
Centered Care

This study explores the concerns, needs, and expectations of inpatients with the goal to develop a patient-centered climate change adaptation agenda for hospitals. Statements of patients from geriatrics, internal medicine, psychiatry, and surgery (N = 25) of a German tertiary care hospital were analyzed using semi-structured interviews and the framework method. Areas of future adaptation were elaborated in joint discussions with transdisciplinary experts. Concerns included the foresight of severe health problems. The requested adaptations comprised the change to a patient-centered care, infrastructural improvements including air conditioning, and adjustments of the workflows. Guidelines for the behavior of patients and medical services appropriate for the climatic conditions were demanded. The patient-centered agenda for adaptation includes the steps of partnering with patients, reinforcing heat mitigation, better education for patients and medical staff, and adjusting work processes. This is the first study demonstrating that hospital patients are gravely concerned and expect adjustments according to climate change. Since heat is seen as a major risk by interviewees, the fast implementation of published recommendations is crucial. By synthesizing inpatients’ expectations with scientific recommendations, we encourage patient-centered climate change adaptation. This can be the start for further collaboration with patients to create climate change resilient hospitals.

scholarly journals Farmers’ Perceived Vulnerability and Proactive versus Reactive Climate Change Adaptation in Chile’s Maule Region

2021 ◽  
Vol 13 (17) ◽  
pp. 9907
Author(s):  
Alejandra Engler ◽  
Marieke L. Rotman ◽  
P. Marijn Poortvliet
Keyword(s):  
Climate Change ◽  
Human Capital ◽  
Climate Change Adaptation ◽  
Agricultural Sector ◽  
Farming Systems ◽  
Climatic Conditions ◽  
Structural Factors ◽  
Structured Interviews ◽  
Adaptation To Climate Change ◽  
Perceived Vulnerability

Changes in climatic conditions are unavoidable and irreversible and an early and effective adaptation in farming systems will be vital for resilient agriculture. Although the extant literature has described factors that explain climate change adaptation, the roles of proactive versus reactive adaptation related to perceived vulnerability are still underexplored. The aim of our study was to open a new angle of discussion by linking farmers’ perceptions of vulnerability with their adaptation response, and exploring the dynamic of such a relationship. Semi-structured interviews with farmers were held in the Maule Region of central Chile (n = 36). The interview included questions o about main agricultural challenges, perceptions of climate change and its impact, adaptation strategies, and perceptions of vulnerability, exposure, sensitivity, and ability to adapt. In order to interpret the interview data, a content analysis procedure was followed. The results indicate that farmers respond differently by either engaging in proactive or reactive adaptation behavior. Furthermore, the patterns of either proactive or reactive adaptation behavior can be explained by structural factors and social and human capital. While structural factors, such as production systems and financial capital, explain engaging in adaptation to climate change, social and human capital act as enhancing factors that explain proactive adaptation. Future policies on adaptation behavior should focus on promoting proactive forms of adaptation behavior by developing and enhancing social connections and access to information, as well as on the provision of financial schemes to enable efficient and effective adaptation within the agricultural sector.

scholarly journals Reframing the Medication Experience in Pharmacy Using Seminal Concepts of Patient-Centered Care—Implications for Practice

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 9
Author(s):  
Brian Isetts ◽  
Anthony Olson ◽  
Jon Schommer
Keyword(s):  
Therapeutic Relationship ◽  
Secondary Analysis ◽  
Patient Centered Care ◽  
National Sample ◽  
Patient Specific ◽  
Structured Interviews ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care ◽  
Medication Experience

Team-based, Patient-Centered Care is essential to chronic disease prevention and management but there are differing ideas about the concept’s meaning across healthcare populations, settings and professions. This commentary’s objective is to empirically evaluate the theoretical relationships of the [a] Medication Experience, [b] Patient-Centeredness and other relevant component concepts from pharmaceutical care (i.e., [c] Therapeutic Relationship, [d] Patient-specific preferences for achieving goals of therapy and resolving drug therapy problems) so as to provide practice-based insights. This is achieved using a secondary analysis of 213 excerpts generated from in-depth semi-structured interviews with a national sample of pharmacists and patients about Patient-Centeredness in pharmacist practice. The four component concepts (i.e., a–d) related to the objective were examined and interpreted using a novel 3-archetype heuristic (i.e., Partner, Client and Customer) revealing common practice-based themes related to care preferences and expectations in collaborative goal setting, enduring relationships, value co-creation and evolving patient expectations during challenging medical circumstances. Most practice-based insights were generated within the Partner archetype, likely reflecting high congruence with pharmacist and patient responses related to the Medication Experience and Therapeutic Relationship. The practice-based insights may be especially useful for new practitioners and students accelerating their advancement in providing effective and efficient Patient-Centered Care.

scholarly journals EVALUATION OF RATIONAL USE OF ANTIBIOTIC DRUGS IN SURGERY DEPARTMENT AT A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 145-149
Author(s):  
SREEJA NYAYAKAR ◽  
MANDARA MS ◽  
HEMALATHA M ◽  
LALLAWMAWMI ◽  
MOHAMMED SALAHUDDIN ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Rational Use ◽  
Post Surgery ◽  
Antibiotic Drugs ◽  
Before And After ◽  
Hospital Patients ◽  
Surgery Department

Objective: Antibiotics are the only drug where use in one patient can impact the effectiveness in another, so antibiotic misuse adversely impacts the patients and society. Improving antibiotic use improves patient outcomes and saves money. Antibiotic resistance has been identified as a major threat by the WHO due to the lack of development of new antibiotics and the increasing infections caused by multidrug resistance pathogens became untreatable. Methods: A prospective observational study was conducted for a period of 6 months. Data were collected from prescriptions and inpatient record files at the surgery department of the tertiary care hospital. Patients above age of 18 years of either gender whose prescription containing the antibiotics and patients who are willing to participate in the study were included in the study. Microsoft Excel was used for recording and analyzing the data of recruited subjects. Results: During our study period, we have collected 100 cases as per inclusion criteria, in total collected 100 cases, 52% are male and 48% are female. The mean age and standard deviation of the study population were found to be 46.61±16.12. The most commonly prescribed classification before and after the surgery is cephalosporin’s that is 57%. Results show that in pre-surgery, almost 93% of prescriptions have chosen the drugs as per ASHP guidelines, whereas in post-surgery, 95% of drugs have selected the drug as per ASHP guidelines. Conclusion: Our study has observed that some of the prescriptions are irrationally prescribed so the pharmacist has to take the responsibility to improve the awareness regarding rational prescribing of antibiotics. The national wide monitoring of antibiotics use, national schemes to obtain rational use of antibiotics, reassessing the prescriptions, education to practitioners, and surveys on antibiotics should be implemented.

scholarly journals Institutional Barriers to Climate Change Adaptation in Burkina Faso: How could We Go around Them?

2020 ◽  
Vol 13 (5) ◽  
pp. 67
Author(s):  
Fiacre Basson ◽  
Djibril S. Dayamba ◽  
Joel Korahire ◽  
Jean M. Dipama ◽  
Francois Zougmore ◽  
...  
Keyword(s):  
Climate Change ◽  
Burkina Faso ◽  
Climate Change Adaptation ◽  
Focal Point ◽  
Monitoring And Evaluation ◽  
Political Support ◽  
Structured Interviews ◽  
Institutional Barriers ◽  
Strategic Objectives ◽  
Key Stakeholders

Despite the existence of a National Adaptation Plan to climate change (NAP) in Burkina Faso, operationalizing adaptation still face a number of challenges. The current study focused on identifying institutional barriers to the strategic objectives of climate change adaptation (CCA) using a literature review and semi-structured interviews conducted with key stakeholders / resource persons involved in the implementation of the NAP. The results revealed a weak collaboration between the NAP steering institution and the ministerial departments covered by the NAP. This situation, first, hampers the implementation of adaptation actions and secondly, the monitoring reporting and verification of adaptation initiatives. Further, the analysis revealed that lack of financial resources poses constraints to many actions that were to be taken by the steering institution and therefore creates poor ownership of the NAP by the main stakeholders that should be actively involved in the NAP process. To cope with the various constraints, it is necessary to have strong political support in many aspects. For instance, it was judged that institutionalizing the role of climate change (CC) focal point within the ministries and embedding NAP monitoring and evaluation (M&E) objectives and indicators with existing functional M&E systems in the sectorial ministries will ease CCA actions integration in operational plans, their implementation and documentation. Moreover, it is relevant to have a continuous capacity building plan to keep stakeholders updated on climate change issues as this will support them in their mandate of mainstreaming CC into ministerial operational plans and lead to optimal CCA implementation and monitoring.

“How I kept track of it of course was my business”: Cancer patient self-monitoring as self-stylized work

2013 ◽  
Vol 12 (5) ◽  
pp. 355-361 ◽  
Author(s):  
Carol J. Hermansen-Kobulnicky ◽  
Mary Anne Purtzer
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
Cancer Center ◽  
Structured Interviews ◽  
Patient Centered ◽  
Work Lives ◽  
Self Monitoring ◽  
Centered Care ◽  
Cancer Experience ◽  
Present Opportunity

AbstractObjectives:Self-monitoring behaviors of cancer patients benefit patients, caregivers, and providers, and yet the phenomenon of self-monitoring from the cancer-patient perspective has not been studied. We examined cancer patients' self-monitoring preferences and practices, focusing on the meaning of self-monitoring within the cancer experience.Methods:Semi-structured interviews were conducted among adult cancer patients who had been seen at least once at a rural United States cancer center. Questions sought out the meaning of self-monitoring and its practical aspects. Qualitative data were analyzed by adapting the four-stepped method by Giorgi for empirical phenomenological analysis.Results:Twenty participants were interviewed (11 women and 9 men). Transcribed interviews revealed that cancer patient self-monitoring is self-stylized work that ranges from simple to complex, while being both idiosyncratic and routine. Participants reported using tools with systems for use that fit their distinctive lives for the purpose of understanding and using information they deemed to be important in their cancer care. Three conceptual categories were discerned from the data that help to elucidate this self-stylized work as fitting their individual priorities and preferences, reflecting their identities, and being born of their work lives.Significance of results:Findings highlight patients' unique self-monitoring preferences and practices, calling into question the assumption that the sole use of standardized tools are the most effective approach to engaging patients in this practice. Self-monitoring efforts can be validated when providers welcome or adapt to patients' self-stylized tools and systems. Doing so may present opportunity for improved communications and patient-centered care.

scholarly journals Adapting Cultural Heritage to Climate Change Risks: Perspectives of Cultural Heritage Experts in Europe

Geosciences ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. 305 ◽  
Author(s):  
Elena Sesana ◽  
Alexandre Gagnon ◽  
Chiara Bertolin ◽  
John Hughes
Keyword(s):  
Climate Change ◽  
Cultural Heritage ◽  
Climate Change Adaptation ◽  
Best Practice ◽  
Climate Change Impacts ◽  
Structured Interviews ◽  
Adaptation To Climate Change ◽  
Participatory Workshop ◽  
Climate Change Risks ◽  
The Uk

Changes in rainfall patterns, humidity, and temperature, as well as greater exposure to severe weather events, has led to the need for adapting cultural heritage to climate change. However, there is limited research accomplished to date on the process of adaptation of cultural heritage to climate change. This paper examines the perceptions of experts involved in the management and preservation of cultural heritage on adaptation to climate change risks. For this purpose, semi-structured interviews were conducted with experts from the UK, Italy, and Norway as well as a participatory workshop with stakeholders. The results indicate that the majority of interviewees believe that adaptation of cultural heritage to climate change is possible. Opportunities for, barriers to, and requirements for adapting cultural heritage to climate change, as perceived by the interviewees, provided a better understanding of what needs to be provided and prioritized for adaptation to take place and in its strategic planning. Knowledge of management methodologies incorporating climate change impacts by the interviewees together with best practice examples in adapting cultural heritage to climate change are also reported. Finally, the interviewees identified the determinant factors for the implementation of climate change adaptation. This paper highlights the need for more research on this topic and the identification and dissemination of practical solutions and tools for the incorporation of climate change adaptation in the preservation and management of cultural heritage.

Patient perception regarding privacy and confidentiality: A study from the emergency department of a tertiary care hospital in Karachi, Pakistan

2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Syed Ghazanfar Saleem ◽  
Saima Ali ◽  
Nida Ghouri ◽  
Quratulain Maroof ◽  
Muhammad Imran Jamal ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Patient Perception ◽  
Care Hospital ◽  
Structured Interviews ◽  
Privacy Concerns ◽  
Creative Commons ◽  
Privacy And Confidentiality ◽  
And Behavior

Background and Objective: Maintaining privacy and ensuring confidentiality with patients is paramount to developing an effective patient-provider relationship. This is often challenging in over-crowded Emergency Departments (EDs). This survey was designed to explore patients’ perceptions on maintenance of privacy and confidentiality and their subsequent interactions with providers in a busy tertiary care hospital in Karachi. Methods: Trained nursing staff conducted structured interviews with 571 patients who presented to The Indus Hospital (TIH) ED from January to December 2020. All patients were 14 years of age or older, could speak and understand Urdu, and provide informed consent. Patients were asked about their perceptions of privacy and confidentiality in the ED and whether this affected their interactions with providers. Results: Respondents were primarily men (64%) under the age of 45 (62%) presenting for the first time (49%). The majority of patients felt that privacy and confidentiality were maintained, however 10% of patients reported that they had rejected examination due to privacy concerns and 15% of patients reported that they had changed or omitted information provided to a provider due to confidentiality concerns. There was correlation between privacy and confidentiality concerns and patient-provider interactions (p<0.0001). Conclusions: Despite the often over-crowded and busy environment of the ED, patients generally felt that privacy and confidentiality were maintained. Given the correlation between perception and behavior and the importance of an effective patient-provider relationship, particularly in the acute setting when morbidity and mortality is high, initiatives that focus on maintaining privacy and confidentiality should be pursued. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5785 How to cite this:Saleem SG, Ali S, Ghouri N, Maroof Q, Jamal MI, Aziz T, et al. Patient perception regarding privacy and confidentiality: A study from the emergency department of a tertiary care hospital in Karachi, Pakistan. Pak J Med Sci. 2022;38(2):351-355.  doi: https://doi.org/10.12669/pjms.38.ICON-2022.5785 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

P5477Usefulness of hypocalcemia at admission as a prognostic marker in patients with acute coronary syndromes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J C Gomez Polo ◽  
C F Ferrera ◽  
V Ruiz-Pizarro ◽  
Z Gomez-Alvarez ◽  
T Romero-Delgado ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Prognostic Marker ◽  
Serum Calcium ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Care Hospital ◽  
Bleeding Events ◽  
Killip Class ◽  
St Segment Elevation ◽  
Hospital Patients

Abstract Background Few studies have focused on the role of serum calcium levels (SCa) in patients with acute myocardial infarction (AMI). Purpose This study aimed to analyze the value of SCa as a prognostic marker in patients with AMI, including both with or without ST elevation. Methods From January-2015 to December-2017, all consecutive patients with AMI admitted to a tertiary care hospital were included. For the purpose of this study, total SCa levels were recorded at admission in each patient. Blood samples were obtained at the first medical contact when the patient arrived to the hospital. Patients were classified according to quartiles depending on their SCa at admission: Q1, under 8.3 mg/dl (N=300); Q2, between 8.4–8.7 mg/dl (N=264); Q3, between 8.8–9.1 mg/dl (N=279) and Q4, over 9.1 mg/dl (N=283). Results A total cohort of 1126 patients was included, 679 (60.3%) had STEMI and 447 (39.7%) were NSTEMI patients. Patients in the Q1 had more in-hospital complications, such as heart failure, bleeding events, new onset AMI, atrioventricular block and contrast induced nephropathy. Patients in the Q1 had higher in-hospital and one-year mortality as compared to that of patients in the Q2-Q4. After multivariate adjustment (Table), low SCa (<8.3mg/dl) remained as an independent predictor of in-hospital mortality (OR 2.91, 95% CI (1.15–7.41), p=0.025). These results were consistent in STEMI and NSTEMI patients. Multivariable analysis Variable OR (95% CI) p GRACE score 1.00 (0.99–1.02) 0.727 CRUSADE score 1.03 (1.01–1.06) 0.011 Age (per year) 1.05 (1.00–1.09) 0.034 STEMI 1.35 (0.41–4.46) 0.617 Diabetes 2.57 (0.97–6.79) 0.056 Low SCa (<8.3) 2.91 (1.15–7.41) 0.025 Killip class at admission   1 Reference   2 4.73 (1.31–17.1) 0.018   3 6.83 (1.70–27.5) 0.007   4 9.83 (1.44–67.1) 0.020 STEMI: ST segment elevation myocardial infarction; SCa: Serum calcium levels; OR: Odds ratio; CI: Confidence interval. Conclusion In patients with AMI, low SCa levels at admission (<8.3mg/dl) are independently associated with higher mortality.

Performance Assessment of a Multifaceted Unfractionated Heparin Dosing Protocol in Adult Patients on Extracorporeal Membrane Oxygenator

2020 ◽  
pp. 106002802096040
Author(s):  
Abdulrazaq Al-Jazairi ◽  
Shahad Raslan ◽  
Rayd Al-mehizia ◽  
Hani Al Dalaty ◽  
Edward B. De Vol ◽  
...  
Keyword(s):  
Unfractionated Heparin ◽  
Tertiary Care ◽  
Factor Xa ◽  
Controlled Study ◽  
Care Hospital ◽  
Strong Correlations ◽  
Membrane Oxygenator ◽  
Monitoring Methods ◽  
Extracorporeal Membrane Oxygenator ◽  
Hospital Patients

Background The use of extracorporeal membrane oxygenator (ECMO) support devices are associated with complications, including bleeding and thrombosis. Unfractionated heparin (UFH) is the gold standard anticoagulant in ECMO patients. Clinically, UFH is monitored through activated clotting time (ACT), activated partial thromboplastin time (aPTT), and anti–factor Xa assay. It is unknown which assay best predicts anticoagulation effects in adults. Objective To assess the correlation of UFH dosing and monitoring using an established protocol. Methods A pilot, prospective cohort, historically controlled study was conducted at a tertiary care hospital. Patients ≥18 years-old who received ECMO on the multifaceted anticoagulation protocol were included and compared with those on the conventional method of anticoagulation. The primary end point was to assess the correlation between UFH dose and different monitoring methods throughout 72 hours using the new protocol guided by ACT and anti–factor Xa assay. Results In each arm, 20 patients were enrolled. The study revealed that anti–factor Xa assay had the largest number of “strong” correlations 11/20 (55%), followed by both aPTT and aPTT ratio 10/20 (50%), and, finally, ACT 2/20 (10%). Concordance between anti–factor Xa assay and the other monitoring parameters in the prospective arm was generally low: 31% with aPTT ratio, 26% with ACT, and 23% with aPTT. Conclusion and Relevance The adaption of a multifaceted anticoagulation protocol using anti–factor Xa assay may provide a better prediction of heparin dosing in adults ECMO patients compared with the conventional ACT-based protocol. Further studies are needed to assess the safety and different monitoring modalities.

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