Haemophilia in France: Modelisation of the Clinical Pathway for Patients

Process-of-care studies participate in improving the efficiency of the care pathway for patient with haemophilia (CPPH) and rationalize the multidisciplinary management of patients. Our objective is to establish a current overview of the different actors involved in the management of patients with haemophilia and to provide an accurate description of the patient trajectory. This is a qualitative exploratory research based on interviews of the principal health professionals of four haemophilia services, between November 2019 and February 2020, in France. Mapping of the CPPH processes within the different institutions and/or services, as well as the rupture zones, were identified. Treatment delivery and biological analyses were carried out exclusively in healthcare institutions. The main liberal health professionals solicited were nurses, physiotherapists and general practitioner. Obstacles and barriers within the specialized service, with other hospital services and external hospital or private services, community health care providers et community environment and individual one was complex and multiples. Our research identified potential concerns that need to be addressed to improve future studies to identify influential elements. Similarly, other qualitative studies will have to be conducted on the perceptions and literacy of patients with haemophilia to develop a global interactive mapping of their trajectories.

Congenital Zika Virus Syndrome: care in light of the Brazilian Unified Health System principles

ABSTRACT Objective: to know health professionals’ perceptions about care actions provided to children with Congenital Zika Virus Syndrome and their families. Methods: this is a qualitative study, carried out in a capital of center-western Brazil, based on the Unified Health System theoretical precepts. Data were collected in September and October 2020, through audio-recorded interviews with 12 health professionals from a specialized service and submitted to analysis of content, thematic modality. Results: the implementation of care actions with these children occurs through multidimensional assessment of children and their families, use of the Unique Therapeutic Project, therapeutic interventions for the development of children and the communication and exchange of interprofessional and family experiences, in addition to considering professionals’ prior knowledge and their search for it. Final considerations: children with CZS and their families need individualized, frequent, integrated and continuous care.

Validation of a Booklet on the Use of BI-RADS® in Mammography Examination

Background: The Breast Imaging-Reporting and Data System (BI-RADS ® ) is an international classification developed to systematize breast assessment, exam interpretation, and the preparation of reports of specific breast imaging exams. Objective: The objective of this study was to validate with experts a booklet directed to medical and nursing professionals in the Family Health Strategy on the categorization of Breast Imaging Reporting and Data System in order to describe the reports of mammography. Methods: This was a technology-validation study of the methodological-development type. The evaluation was performed with 11 experts, including seven radiologists and four mastologists, four men and seven women, with a mean age of 45 years, meantime of being in the profession of 22 years, and an average 15 years of working experience of in the field. Results: The individual, mean, and global Content Validity Index (CVI) was calculated. The booklet was validated with a CVI of 0.89. The suggestions of the experts were analyzed, and some of them were implemented for the final version of the booklet. Conclusion: The booklet was validated and will contribute significantly to the daily activities of medical and nursing professionals in the Family Health Strategy in relation to the interpretation of the mammographic report and the orientation regarding the referral, agility, and qualification of the patient to the specialized service.

Ethnomedical specialists and their supernatural theories of disease

Religious healing specialists such as shamans often use magic. Evolutionary theories that seek to explain why laypersons find these specialists convincing focus on the origins of magical cognition and belief in the supernatural. In two studies, we reframe the problem by investigating relationships among ethnomedical specialists, who possess extensive theories of disease that can often appear “supernatural,” and religious healing specialists. In study 1, we coded and analyzed cross-cultural descriptions of ethnomedical specialists in 47 cultures, finding 24% were also religious leaders and 74% used supernatural theories of disease. We identified correlates of the use of supernatural concepts among ethnomedical specialists; incentives and disincentives to patronize ethnomedical specialists; and distinct clusters of ethnomedical specialists that we label prestigious teachers, feared diviners, and efficacious healers. In study 2, we interviewed 84 Maasai pastoralists and their traditional religious and non-religious healing specialists. We found that laypersons relied on medicinal services based on combinations of efficacy, religious identity, and interpersonal trust. Further, laypersons and specialists largely used abstract concepts that were not conspicuously supernatural to describe how local medicines work. We conclude that religious healers in traditional societies often fulfill a practical and specialized service to local clients, and argue that supernatural theories of disease often reflect abstract cognition about rare phenomena whose causes are unobservable (e.g., infection, mental illness) instead of a separate “religious” style of thinking.

Results of HIV and STD Tests: What Contribution of Internet? What Ethical Issues?

"A specialized service for anonymous and free HIV and STD (sexual transmitted diseases) screening asked us, as a Clinical Ethics Centre, to reflect on the opportunity of making the results available to patients on the internet. Several options are possible: the provision might apply only to negative results or also to positive results, only for STD or also for HIV, to all patients or according to their own choice. In addition, if we consider that patients can manage alone the reception of their results, and to learn that they need to be treated, they might even choose to do the screening alone. Based on the caregivers’ appreciation of these issues (secretary, laboratory manager, nurses and physicians) and the work of the multidisciplinary clinical ethics group, this presentation will discuss: - The ethical issues raised by these differtents possibilities. Do they contribute to a higher level of empowerment for patients? Do they constitute a benefit or a risk for either single patients or public health? What ethical considerations should ground the doctor-patient relationship in this context? - The impact of the use of the internet or other technological means of communication in medicine. In the specific case of sexual health, technology can question the particular status with which information related to HIV testing is processed. Perhaps these new procedures might help to fight the stigma related to HIV by treating the result of the screening process like that of other STD. "

Trajectories of the deaf: a retrospective study based on the deaf and their family members

The article aims to analyze the narrative of deaf and family members of an assistance service for the deaf people, identifying more striking perceptions in their life trajectories. The qualitative approach research was carried out through semi-structured interviews with three hearing mothers and three deaf children, former members of a university service for the deaf offered in the inland cities of the state of São Paulo, since the 1970’s. The results showed that the aspects with the greatest impact for the participants return to the moment of diagnosis and forwarding to the referred specialized service; the challenges experienced in the school trajectory and the communication barriers still faced in the interaction with society.

Association between Human Development Index and Delay on Arrival to Stroke Unit

Background: Stroke outcomes depend somehow on the time taken from the symptoms onset until arrival to the specialized service. However, as it lacks literature exploring the impact of socio-demographics factors on this time, we investigated the association between Human Development Index and delay on arrival to specialized service. Design and setting: Cross-sectional study from a prospective cohort (PMID=33719516) at Hospital Geral Roberto Santos. Methods: From a total of 454 stroke patients, 156 were included in this study because they had registered address, time of admission and of symptoms onset. Patients had HDI defined by their address and were grouped into HDI categories. Results: In our sample, 57 (36,5%) individuals had medium HDI, 70 (44,9%) high HDI and 29 (18,6%) very high HDI. Very high HDI patients’ delay (2:01; 1:22-2:57) was lower than high HDI (3:05; 2:05-5:26) and medium HDI (2:25;1:45-4:04) patients. There was statistical significance comparing these groups (X²=11,41;p<0,05), but a post-hoc test revealed statistical difference just between the very high HDI and high HDI groups (p<0.05). Conclusions: We expected to find a direct relation between delay on arrival to the stroke service and HDI categories. However, this was not observed. *Authors contributed equally.

Social Foundations of Education and Service-Based Field Experiences

This chapter highlights one social foundations of education program's initiative to develop specialized service-based projects on which each course's field experience, readings, and assignments would center. Utilizing both a justice-oriented and intersectional foundation, professors developed projects meant to engage the program's mostly white and female students in more critical and meaningful experiences that would help pre-service educators reflect on power, privilege, and oppression and their roles in this process. The authors focus on two example projects for this chapter with a goal of examining successes and difficulties experienced in developing such projects, including the challenge of maintaining strong community partnerships. These two case studies are not meant to provide generalized experiences, but the authors hope that sharing the development, implementation, and outcomes can help other programs create field experiences for pre-service educators that will teach pre-service educators the importance of safe yet critical classroom spaces.