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2021 ◽  
Vol 61 (5) ◽  
pp. S98-S107
Amanda Wahnich ◽  
Anisha D. Gandhi ◽  
Eve Cleghorn ◽  
Katrina Estacio ◽  
Oni J. Blackstock ◽  

2021 ◽  
Armando Zavala ◽  
Christopher M Stark

ABSTRACT The coronavirus disease 2019 (COVID-19) global pandemic has posed unique challenges to healthcare providers that work in austere environments. Military healthcare providers advise commanders on endemic disease risk, prevention, and management during field training exercises. Healthcare workers are at increased risk of exposure to infectious pathogens. We present a case of a military healthcare provider who presented with fever, cough, and fatigue during the COVID-19 global pandemic that was diagnosed with a primary pulmonary coccidioidal infection. Treatment after appropriate diagnosis consisted of supportive care. Respiratory and pain symptoms resolved by 2 months post-diagnosis. Although COVID-19 must be closely monitored in the field training environment, it is important to maintain a high index of suspicion of endemic infectious diseases as a potential etiology for respiratory illnesses.

2021 ◽  
Anca Vasiliu ◽  
Georges Tiendrebeogo ◽  
Muhamed Mbunka Awolu ◽  
Cecilia Akatukwasa ◽  
Boris Youngui Tchakounte ◽  

Abstract BackgroundOne of the main barriers of the management of household tuberculosis child contacts is the necessity for parents to bring healthy children to the facility. We assessed the feasibility of a community intervention for tuberculosis (TB) household child contact management and the conditions for its evaluation in a cluster randomized controlled trial in Cameroon and Uganda.MethodsWe assessed three dimensions of feasibility using a mixed method approach: (1) recruitment capability using retrospective aggregated data from facility registers; (2) acceptability of the intervention using focus group discussions with TB patients and in-depth interviews with healthcare providers and community leaders; and (3) adaptation, integration and resources of the intervention in existing TB services using a survey and discussions with stakeholders.ResultsReaching the sample size is feasible in all clusters in 15 months with the condition of regrouping 2 facilities in the same cluster in Uganda due to decentralization of TB services. Community health worker (CHW) selection and training and simplified tools for contact screening, tolerability and adherence of preventive therapy were key elements for the implementation of the community intervention Healthcare providers and patients found the intervention of child contact investigations and TB preventive treatment management in the household acceptable in both countries due to its benefits (competing priorities, transport cost) as compared to facility-based management. TB stigma was present, but not a barrier for the community intervention. Visit schedule and team conduct were identified as key facilitators for the interventionConclusionsThis study shows that evaluating a community intervention for TB child contact management in a cluster randomized trials is feasible in Cameroon and Uganda.Trial registration:, NCT03832023. Registered on February 6th 2019

2021 ◽  
Joy Blaise Bucyibaruta ◽  
Carl Heese ◽  
Leah Maidment ◽  
Mmapheko Doriccah Peu ◽  
Lesley Bamford ◽  

Healthcare acceptability is critical in global debates for improving service delivery across all health specialities. The concept of healthcare acceptability reflects interactions between patients and healthcare providers and is expressed through attitudes, beliefs, perceptions, experiences and expectations. These terms are often used to describe human behaviour in psychology science. The concept of healthcare acceptability is widely used in healthcare, particularly in psychology literature, and is still ill-defined and poorly conceptualized. This scoping review will explore and describe the depth and breadth of evidence on healthcare acceptability definitions, conceptual frameworks and applications through the lens of patients and healthcare providers in HIV, TB and maternal healthcare services. We will search electronic databases and grey literature, guided by a search strategy in accordance with eligibility criteria. Two researchers will independently screen and chart data from retrieved and included articles. An agreement of 80% between reviewers’ results will be considered appropriate and a third reviewer will resolve any conflict between them. The results will be presented in graphical, charted or tabular form accompanied by a summary linking the results to the objectives. The researchers will discuss and disseminate important findings, limitations and propose potential implications and future research projects.

Dunja Begović

AbstractMaternal–fetal surgery (MFS) encompasses a range of innovative procedures aiming to treat fetal illnesses and anomalies during pregnancy. Their development and gradual introduction into healthcare raise important ethical issues concerning respect for pregnant women’s bodily integrity and autonomy. This paper asks what kind of ethical framework should be employed to best regulate the practice of MFS without eroding the hard-won rights of pregnant women. I examine some existing models conceptualising the relationship between a pregnant woman and the fetus to determine what kind of framework is the most adequate for MFS, and conclude that an ecosystem or maternal–fetal dyad model is best suited for upholding women’s autonomy. However, I suggest that an appropriate framework needs to incorporate some notion of fetal patienthood, albeit a very limited one, in order to be consistent with the views of healthcare providers and their pregnant patients. I argue that such an ethical framework is both theoretically sound and fundamentally respectful of women’s autonomy, and is thus best suited to protect women from coercion or undue paternalism when deciding whether to undergo MFS.

2021 ◽  
Vol 0 ◽  
pp. 1-10
Michelle Normen ◽  
Femil E. Sahaya ◽  
Kshitija Kulkarni ◽  
E. Vidhubala ◽  
Hemant D. Shewade ◽  

Objectives: Routine screening for distress is a guideline prescribed by the National Comprehensive Cancer Network (NCCN) to adequately assess distress in a cancer setting. Our centre conducted routine screening but failed to utilize psycho-oncology services. Our aim was to assess the extent of self-reported distress, referrals to psycho-oncology services and healthcare provider perspectives about the existing distress management system and psycho-oncology services. Materials and Methods: We conducted a record review of adult patients (n=372) who reported to the Out-patient department of the tertiary cancer centre. Semi-structured interviews were conducted with fourteen healthcare providers. We used a concurrent mixed methods study design. Adult patients were screened for distress using NCCN-Distress Thermometer and problem checklist. Healthcare providers from different oncology specialties were interviewed and the data was analyzed using descriptive thematic analysis. Results: Patients screened for distress were found to report moderate to extreme levels of distress (53.5%). The total referrals to psycho-oncology support services were low (8.6%). Interviews with healthcare providers revealed three major themes: Enablers, barriers and solutions for utilization of distress management system and psycho-oncology services. Conclusions: Moderate to extreme distress was found among patients routinely screened for distress, although there was poor utilization of distress management system and psycho-oncology support services due to time constraints, patient’s negative attitudes towards mental health referrals, generic screening tools and use of own clinical judgement to make referrals by healthcare providers. Future research warrants implementation of strategies to integrate psycho-oncology services into routine cancer care by focusing on improving visibility of services.

2021 ◽  
Vol 23 (1) ◽  
Hilda A. Mwangakala

Background: The access to quality maternal health information amongst pregnant women plays an important role in determining woman’s health behaviour during pregnancy. Yet, access to maternal health information remains a major challenge in Tanzanian rural communities especially for pregnant women leading to low utilisation of skilled maternal health services.Objectives: The study aimed at examining the accessibility of maternal health information amongst pregnant women in rural Tanzania.Methods: A qualitative phenomenological study involving 25 pregnant women, 5 skilled healthcare providers (SHPs) and 5 traditional birth attendants (TBAs) was carried out in Chamwino District, Dodoma Region, Tanzania for a period of 6 months. Data were analysed thematically using the six-stage guide to thematic data analysis with NVivo Software.Results: The acute shortage of healthcare personnel and traditional beliefs influenced pregnant women’s access to quality maternal health information. The majority of women used mothers-in-law and TBAs as their primary source of maternal health information rather than skilled healthcare providers.Conclusion: Despite the acute shortage, healthcare providers need to play a leading role in providing maternal health information amongst the rural populations. Furthermore, skilled health providers need to work in collaboration with the TBAs to increase access to maternal health information and build a well-informed healthy society.

2021 ◽  
Hironori Ohinata ◽  
Maho Aoyama ◽  
Mitsunori Miyashita

Abstract Background: Understanding the factors of complexity of patients in palliative care is very important for healthcare providers in addressing the care needs of their patients. However, the healthcare providers’ perception of the factors of complexity in palliative care lacks a common understanding. This study aimed to determine the scope of research activities and specific factors of complexity in the context of palliative care.Methods: A scoping literature review was performed, following the methods described by the Joanna Briggs Institute. We conducted an electronic literature search in MEDLINE (Ovid), PsycINFO, Web of Science Core Collection, and CINAHL, examining literature from May 1972 to 2020.Results: We identified 32 peer-reviewed articles published in English before 2020. The target literature mainly originated in Europe and the United States. The research methods included quantitative studies (n=13), qualitative studies (n=12), case studies (n=3), and reviews (n=4). We reviewed 32 studies and summarized the factors of complexity into three levels: the patient’s level, the healthcare setting level, and the socio-cultural landscape level. We identified factors affecting patient-specific complexity, including sex, race, age, living situation, family burden, resources, treatment, decision-making, communication, prognosis, disease, and comorbidity/complexity. Other factors identified as contributing to patient complexity were the interaction of physical, psychological, social, and spiritual categories, as well as the healthcare providers’ confidence and skills, and the socio-cultural components.Conclusions: This scoping review shows specific factors of complexity and future challenges in the context of palliative care. Future research should include the factors of complexity identified in this review and conduct longitudinal studies on the interactions among them. In addition, it is necessary to examine specific complexity factors in patients from various social and ethnic backgrounds.

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1938
Davide Biondini ◽  
Marco Damin ◽  
Martina Bonifazi ◽  
Elisabetta Cocconcelli ◽  
Umberto Semenzato ◽  

Bronchoscopy has several major diagnostic and therapeutic indications in pulmonology. However, it is an aerosol-generating procedure that places healthcare providers at an increased risk of infection. Now more than ever, during the spread of the coronavirus disease 2019 (COVID-19) pandemic, the infectious risk during bronchoscopy is significantly raised, and for this reason its role in diagnostic management is debated. In this review, we summarized current evidence regarding the indications for bronchoscopy and the measures that should be applied to decrease risk exposure. Indeed, seeing the long-lasting period of the pandemic, resuming standard of care for all patients is required.

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