“Just Throw It Behind You and Just Keep Going”: Emotional Labor when Ethnic Minority Healthcare Staff Encounter Racism in Healthcare

Encountering racism is burdensome and meeting it in a healthcare setting is no exception. This paper is part of a larger study that focused on understanding and addressing racism in healthcare in Sweden. In the paper, we draw on interviews with 12 ethnic minority healthcare staff who described how they managed emotional labor in their encounters with racism at their workplace. Data were analyzed using thematic analysis. The analysis revealed that experienced emotional labor arises from two main reasons. The first is the concern and fear that ethnic minority healthcare staff have of adverse consequences for their employment should they be seen engaged in discussing racism. The second concerns the ethical dilemmas when taking care of racist patients since healthcare staff are bound by a duty of providing equal care for all patients as expressed in healthcare institutional regulations. Strategies to manage emotional labor described by the staff include working harder to prove their competence and faking, blocking or hiding their emotions when they encounter racism. The emotional labor implied by these strategies could be intense or traumatizing as indicated by some staff members, and can therefore have negative effects on health. Given that discussions around racism are silenced, it is paramount to create space where racism can be safely discussed and to develop a safe healthcare environment for the benefit of staff and patients.

Electrochemical Devices to Monitor Ionic Analytes for Healthcare and Industrial Applications

Recent advances in electrochemical devices have sparked exciting opportunities in the healthcare, environment, and food industries. These devices can be fabricated at low costs and are capable of multiplex monitoring. This overcomes challenges presnted in traditional sensors for biomolecules and provides us a unique gateway toward comprehensive analyses. The advantages of electrochemical sensors are derived from their direct integration with electronics and their high selectivity along with sensitivity to sense a wide range of ionic analytes at an economical cost. This review paper aims to summarize recent innovations of a wide variety of electrochemical sensors for ionic analytes for health care and industrial applications. Many of these ionic analytes are important biomarkers to target for new diagnostic tools for medicine, food quality monitoring, and pollution detection. In this paper, we will examine various fabrication techniques, sensing mechanisms, and will also discuss various future opportunities in this research direction.

The use of pine in a healthcare environment

This month, George Winter discusses the history of using pine in a healthcare setting and how it could still have therapeutic virtues today

Music in Waiting Rooms: A Literature Review

Objective: We aim to review existing literature on the effects of background music in waiting rooms on patients. Furthermore, we examine existing neurobiological research for potential mechanisms by which music may affect patients. Background: Music has been studied in healthcare in various forms, from formal interventions such as music therapy to passive listening as therapy. However, music is also present in the healthcare environment in the form of background music in waiting rooms. There has been interest in whether background music in such a setting may have beneficial effects on patient anxiety in order to potentially inform healthcare workers whether and what type of music may be suitable for waiting rooms. Methods: We reviewed existing literature on music in healthcare waiting rooms and the neurobiological mechanisms by which music affects anxiety. Results: We located several small studies performed in a range of settings, including physician office waiting rooms and preoperative waiting areas. The studies generally reported that most patients viewed music in these areas positively; some, but not all, studies showed positive effects on patient anxiety. A variety of theories by which music may impact patient anxiety was noted. Conclusions: We conclude that there exists some evidence to support an anxiety-reducing effect of background music on patients, though studies vary widely in methodology and music selection. A small amount of neurobiological research into the pertinent mechanisms has been conducted, but further research will be required to elucidate the exact mechanisms by which this intervention may reduce anxiety.

Antimicrobial resistance determinants are associated with Staphylococcus aureus bacteraemia and adaptation to the healthcare environment: a bacterial genome-wide association study

Staphylococcus aureus is a major bacterial pathogen in humans, and a dominant cause of severe bloodstream infections. Globally, antimicrobial resistance (AMR) in S. aureus remains challenging. While human risk factors for infection have been defined, contradictory evidence exists for the role of bacterial genomic variation in S. aureus disease. To investigate the contribution of bacterial lineage and genomic variation to the development of bloodstream infection, we undertook a genome-wide association study comparing bacteria from 1017 individuals with bacteraemia to 984 adults with asymptomatic S. aureus nasal carriage. Within 984 carriage isolates, we also compared healthcare-associated (HA) carriage with community-associated (CA) carriage. All major global lineages were represented in both bacteraemia and carriage, with no evidence for different infection rates. However, kmers tagging trimethoprim resistance-conferring mutation F99Y in dfrB were significantly associated with bacteraemia-vs-carriage (P=10-8.9-10-9.3). Pooling variation within genes, bacteraemia-vs-carriage was associated with the presence of mecA (HMP=10-5.3) as well as the presence of SCCmec (HMP=10-4.4). Among S. aureus carriers, no lineages were associated with HA-vs-CA carriage. However, we found a novel signal of HA-vs-CA carriage in the foldase protein prsA, where kmers representing conserved sequence allele were associated with CA carriage (P=10-7.1-10-19.4), while in gyrA, a ciprofloxacin resistance-conferring mutation, L84S, was associated with HA carriage (P=10-7.2). In an extensive study of S. aureus bacteraemia and nasal carriage in the UK, we found strong evidence that all S. aureus lineages are equally capable of causing bloodstream infection, and of being carried in the healthcare environment. Genomic variation in the foldase protein prsA is a novel genomic marker of healthcare origin in S. aureus but was not associated with bacteraemia. AMR determinants were associated with both bacteraemia and healthcare-associated carriage, suggesting that AMR increases the propensity not only to survive in healthcare environments, but also to cause invasive disease.

Development of models of care coordination for rare conditions: A qualitative study

Introduction: Improving care coordination for people with rare conditions may help to reduce burden on patients and carers and improve the care that patients receive. We recently developed a taxonomy of different ways of coordinating care for rare conditions. It is not yet known which models of care coordination are appropriate in different situations. This study aimed to: i) explore what types of care coordination may be appropriate in different situations, and ii) use these findings to develop hypothetical models of care coordination for rare conditions. Methods: To explore appropriateness of different types of care coordination, we conducted interviews (n=30), four focus groups (n=22) and two workshops (n=27) with patients, carers, healthcare professionals, commissioners, and charity representatives. Participants were asked about preferences, benefits and challenges, and the factors influencing coordination. Thematic analysis was used to develop hypothetical models of care coordination. Models were refined following feedback from workshop participants. Results: Stakeholders prefer models of care that: are nationally centralised or a hybrid of national and local care, involve professionals collaborating to deliver care, have clear roles and responsibilities outlined (including administrative, coordinator, clinical and charity roles), provide access to records and offer flexible appointments (in terms of timing and mode). Many factors influenced coordination, including those relating to the patient (e.g., condition complexity, patient's location and ability to coordinate their own care), the healthcare professional (e.g., knowledge and time), the healthcare environment (e.g., resources) and societal factors (e.g., availability of funding). We developed and refined ten illustrative hypothetical models of care coordination for rare conditions. Conclusion: Findings underline that different models of care coordination may be appropriate in different situations. It is possible to develop models of care coordination which are tailored to the individual in context. Findings may be used to facilitate planning around which models of care coordination may be appropriate in different services or circumstances. Findings may also be used by key stakeholders (e.g. patient organisations, clinicians and service planners) as a decision-making tool.