Optimizing the Diagnosis and Biomarker Testing for Patients with Intrahepatic Cholangiocarcinoma: A Multidisciplinary Approach

Cholangiocarcinoma (CCA) is a heterogenous group of malignancies originating in the biliary tree, and associated with poor prognosis. Until recently, treatment options have been limited to surgical resection, liver-directed therapies, and chemotherapy. Identification of actionable genomic alterations with biomarker testing has revolutionized the treatment paradigm for these patients. However, several challenges exist to the seamless adoption of precision medicine in patients with CCA, relating to a lack of awareness of the importance of biomarker testing, hurdles in tissue acquisition, and ineffective collaboration among the multidisciplinary team (MDT). To identify gaps in standard practices and define best practices, multidisciplinary hepatobiliary teams from the University of California (UC) Davis and UC Irvine were convened; discussions of the meeting, including optimal approaches to tissue acquisition for diagnosis and biomarker testing, communication among academic and community healthcare teams, and physician education regarding biomarker testing, are summarized in this review.

Exploring the knowledge, attitudes, practices and lived experiences of frontline health workers in the times of COVID-19 : a qualitative study from Bangladesh

ObjectiveThis study explored Frontline Health Workers’ (FLWs) knowledge, attitude and practice (KAP) on COVID-19 and their lived experiences, in both their personal and work lives, at the early stage of the pandemic in Bangladesh.Design, setting and participantsThis was a qualitative study conducted through telephone interviews in May 2020. A total of 41 FLWs including physicians, nurses, paramedics, community healthcare workers and hospital support staff from 34 public and private facilities of both urban and rural parts of Bangladesh participated in the interview. A purposive sampling technique supplemented by a snowball sampling method was followed to select the participants. The in-depth interviews followed a semi-structured interview guide, and we applied the thematic analysis method for the qualitative data analysis.FindingsExcept physicians, the FLWs did not receive any institutional training on COVID-19, including its prevention and management, in most instances. Also, they had no training in the use of personal protective equipment (PPE). Their common source of knowledge was the different websites or social media platforms. The FLWs were at risk while delivering services because patients were found to hide histories and not maintaining safety rules, including physical distancing. Moreover, inadequate supply of PPE, fear of getting infected, risk to family members and ostracisation by the neighbours were mentioned to be quite common by them. This situation eventually led to the development of mental stress and anxiety; however, they tried to cope up with this dire situation and attend to the call of humanity.ConclusionThe uncertain work environment during the COVID-19 pandemic simultaneously affected FLWs’ physical and emotional health in Bangladesh. However, they showed professional devotion in overcoming such obstacles and continued to deliver essential services. This could be further facilitated by a quick and targeted training package on COVID-19, and the provision of supplies for delivering services with appropriate safety precautions.

Managers do it their way: How managers act in a decentralised healthcare services provider organisation – a mixed methods study

Purpose: Decentralisation is considered a way to get managers more committed and more prone to respond to local needs. This study analyses how managers perceive a decentralised management model within a large public healthcare delivery organisation in Sweden. Design/methodology/approach: A programme theory evaluation was performed applying direct content analysis to in-depth interviews with healthcare managers. Balance score card data were used in a blinded comparative content analysis to explore relations between performance and how the delegated authority was perceived and used by the managers. Findings: Managers’ perceptions of the decentralised management model supported its intentions to enable the front-line to make decisions to better meet customer needs and flexibly adapt to local conditions. The managers appreciated and used their delegated authority. Central policies and control on human resources and investments were accepted as those are to the benefit of the whole organisation. Leadership development and organisation-wide improvement programmes were of support. Units showing high organisational performance had proactive managers, although differences in manager perceptions across units were small. Originality: This, one of the first of its kind, study of a decentralisation in service delivery organisation shows a congruence between the rationale of a management model, the managers’ perceptions of the authority and accountability as well as management practises. These observations stemming from a large public primary and community healthcare organisation has not, to our knowledge, been reported and provide research-informed guidance on decentralisation as one strategy for resolving challenges in healthcare service delivery organisations.

Hiệu quả của mô hình ECHO đối với đào tạo Y khoa liên tục theo phương pháp đánh giá của Moore

Mô hình đào tạo trực tuyến ECHO viết tắt của tiếng Anh là "Extension of Community Healthcare Outcomes", có nghĩa là "Nối dài Chăm sóc Sức khỏe Cộng đồng", là mô hình giáo dục từ xa nhằm tạo điều kiện học tập và giám sát hỗ trợ các cơ sở chăm sóc sức khỏe ban đầu ở nông thôn, vùng sâu và vùng xa. Nghiên cứu đã tiến hành tầm soát và tham khảo nhiều bài viết về mô hình ECHO và các ứng dụng trong đào tạo Y khoa liên tục trên thế giới và Việt Nam. Vì vậy, chúng tôi tiến hành nghiên cứu này với mục tiêu mô tả hiệu quả của mô hình ECHO đối với đào tạo Y khoa liên tục theo phương pháp đánh giá của Moore. Đồng thời đưa ra một số đánh giá tác động của mô hình ECHO đến đào tạo Y khoa liên tục theo phương pháp đánh giá Moore. Các nghiên cứu đã cho thấy việc áp dụng và kế thừa mô hình ECHO sao cho phù hợp với bối cảnh văn hóa - kinh tế - xã hội của mỗi quốc gia là cần thiết. Sự vận dụng từ các mô hình này là bài học kinh nghiệm quý giá để triển khai mô hình ECHO tại Việt Nam đạt hiệu quả.

Prospective Risk Factors of Toxoplasmosis Seropositivity in Pregnant Women: The Fundamental Role of Community Healthcare Education

Background: The present study conducted a survey on awareness of toxoplasmosis infection, with an emphasis on risk factors, and an assessment of toxoplasmosis prevalence in pregnant women in Al-Kharj province of KSA. Methods and Results: A cross-sectional study with a qualitative approach was carried out from August 2018 to February 2019. The study recruited all pregnant women who attended maternity and children’s outpatient clinics. The non-probability sampling approach was used to select 345 blood samples from study subjects. T. gondii-specific IgG and IgM antibodies were identified using ELISA. Each participant enrolled in the study was provided with a validated questionnaire to fill out by an assistant of the laboratory technician or an antenatal care nurse. In addition to socio-demographic data, simple closed-ended questions about established risk factors for T. gondii exposure were included in the questionnaire items, and answers were listed in a three-point Likert scale (agree, disagree, I am not sure). The overall prevalence of T. gondii-specific antibodies among study subjects was 12.75%; 29(8.40%) women were positive for IgG only, 9(2.6%) - for IgM, and 6(1.7%) - for both IgG and IgM antibodies. About 41.4% of participants were in the first trimester of pregnancy; among them 31(9%) were positive for T. gondii antibodies. 82.8% of pregnant women had chronic infection in the first trimester, while 44.4% of those women also had an acute infection. The number of respondents to the questionnaire was 345 participants with a response rate of about 100%. It is important to note that 81.5% of women were unaware that toxoplasmosis is dangerous, and two-thirds of them didn't know the dangerous complications for the fetus and newborn. Conclusion: The current study concludes that there is a low prevalence of toxoplasmosis among Saudi pregnant women in Al-Kharj province. A general program must be implemented to increase population awareness, especially among the at-risk populations.

Emergency Department Utilisation by Palliative Patients in a Regional Australian Setting

Background: Many palliative care patients attend emergency departments (EDs) in acute Hospital. However, very limited studies inform about their presentations and appropriateness. Objectives: This study explored the reasons and appropriateness of palliative care presentations in a regional Australian ED setting. Methods: A retrospective, single-centre observational study was conducted in a regional Australian hospital. All patients between January and December 2018 known to palliative care services presented to ED were included. Appropriateness of presentations was determined based on urgency of tests and treatments received, and practicability of obtaining these in a different setting. Results: A total of 35 patients made 85 presentations to the ED in 2018. The most common individual presenting complaints were shortness of breath (18.9%) followed by pain (14.1%), fever (11.8%), fall (8.2%), reduced oral intake or dehydration (8.2%), and bleeding (8.2%). The patients were brought by an ambulance in 56.5% presentations, and 63.5% presentations were admitted. About 93% presentations were referred by community healthcare professionals or required urgent investigation or management. Conclusions: This study found the majority of presentations were appropriate since their management could not be delivered at other primary care settings. This study adds value to the growing body of evidence and supports future multi-site longitudinal studies.

Aging With Intellectual and Developmental Disabilities: When Dementia Is Diagnosed or Suspected

Individuals with lifelong intellectual and developmental disabilities (IDD) have unique needs associated with aging that pose challenges for them and their families. In particular, an increased likelihood for early onset Alzheimer’s disease is a major concern that can place individuals at risk for a host of biomedical, psychological, and social challenges. Faced with providers not trained in how to properly screen for, diagnose, and treat conditions, individuals and families are often left with inadequate care, services, and support. To address these concerns, education for professionals is essential in providing accurate information based on clinical best practices. This symposium presents an innovative and interprofessional model developed by a partnership of geriatrics and IDD educational and service organizations based on Project ECHO (Extension for Community Healthcare Outcomes) methodology. A virtual community is created in which participants both teach and learn from each other through a combination of didactic and case presentations. The first paper describes the ECHO model, including the development of the hub and spoke structure, recruitment of providers, and collaborative and multidisciplinary process of curriculum development. The second paper explores educational experiences of participating spoke agencies in the program, including professionals’ and clients’ outcomes. The third paper presents the implications of creating a foundation based on interprofessional education and networking principles to bridge the gap between health and social care disciplines and parallel service systems. The final paper provides recommendations and implications for developing and refining methods to address the need for provider education in this rapidly expanding field.

Effectiveness and experiences of the Extension for Community Healthcare Outcomes (ECHO) Model in developing competencies among healthcare professionals: a mixed methods systematic review protocol

Background The Extension for Community Healthcare Outcomes (ECHO) Model of continuing tele-education is an innovative guided-practice model aiming at amplifying healthcare professionals’ competencies in the management of chronic and complex health conditions. While data on the impact of the ECHO model is increasingly available in the literature, what influences the model effectiveness remains unclear. Therefore, the overarching aim of this systematic review is to identify, appraise, and synthesize the available quantitative (QUAN) and qualitative (QUAL) evidence regarding the ECHO Model effectiveness and the experiences/views of ECHO’s participants about what influences the development of competencies in healthcare professionals. Methods The proposed systematic review was inspired by the Joanna Briggs Institute (JBI) methodology for Mixed Methods Systematic Reviews (MMSR) and will follow a convergent segregated approach. A systematic search will be undertaken using QUAN, QUAL and mixed methods (MM) studies of ECHO-affiliated programs identified in six databases. A publication date filter will be applied to find the articles published from 2003 onwards. Sources of unpublished studies and gray literature will be searched as well. Retrieved citations will independently be screened by two reviewers. Disagreements will be resolved through discussion until a consensus is reached or by including a third reviewer. Studies meeting the predefined inclusion criteria will be assessed on methodological quality and the data will be extracted using standardized data extraction forms. Separate QUAN and QUAL synthesis will be performed, and findings will be integrated using a matrix approach for the purpose of comparison and complementarity. Discussion This MMSR will fulfill important gaps in the current literature on the ECHO Model as the first to provide estimates on its effectiveness and consider simultaneously the experiences/views of ECHO’s participants. As each replication of the ECHO Model greatly varies depending on the context, topic, and targeted professionals, a better understanding of what influences the model effectiveness in developing healthcare professionals’ competencies is crucial to inform future implementation. Systematic review registration PROSPERO CRD42020197579