“It’s Not Just the Right Thing . . . It’s a Survival Tactic”: Disentangling Leaders’ Motivations and Worries on Social Care

Health care organizations face growing pressure to improve their patients’ social conditions, such as housing, food, and economic insecurity. Little is known about the motivations and concerns of health care organizations when implementing activities aimed at improving patients’ social conditions. We used semi-structured interviews with 29 health care organizations to explore their motivations and tensions around social care. Administrators described an interwoven set of motivations for delivering social care: (a) doing the right thing for their patients, (b) improving health outcomes, and (c) making the business case. Administrators expressed tensions around the optimal role for health care in social care including uncertainty around (a) who should be responsible, (b) whether health care has the needed capacity/skills, and (c) sustainability of social care activities. Health care administrators could use guidance and support from policy makers on how to effectively prioritize social care activities, partner with other sectors, and build the needed workforce.

Telemedicine Technologies

This chapter provides an overview of telemedicine technologies, including hardware, software and peripheral devices, along with their use in emergency and other clinical settings. Telemedicine comes in many forms, reflecting the complex ways health care is delivered. The earliest examples of telemedicine were simply phone calls between clinicians. Now, telemedicine encompasses live videoconferences involving the full spectrum of stakeholders in the health care continuum, a wide array of diagnostic devices, as well as an ever increasing number of patient-driven modalities. Lessons learned from the implementation of telemedicine technologies and a checklist of factors for clinicians and health care administrators to consider prior to deploying telehealth solutions are included at the end of the chapter.

Multiparameter Continuous Physiological Monitoring Technologies in Neonates Among Health Care Providers and Caregivers at a Private Tertiary Hospital in Nairobi, Kenya: Feasibility, Usability, and Acceptability Study

Background Continuous physiological monitoring technologies are important for strengthening hospital care for neonates, particularly in resource-constrained settings, and understanding user perspectives is critical for informing medical technology design, development, and optimization. Objective This study aims to assess the feasibility, usability, and acceptability of 2 noninvasive, multiparameter, continuous physiological monitoring technologies for use in neonates in an African health care setting. Methods We assessed 2 investigational technologies from EarlySense and Sibel, compared with the reference Masimo Rad-97 technology through in-depth interviews and direct observations. A purposive sample of health care administrators, health care providers, and caregivers at Aga Khan University Hospital, a tertiary, private hospital in Nairobi, Kenya, were included. Data were analyzed using a thematic approach in NVivo 12 software. Results Between July and August 2020, we interviewed 12 health care providers, 5 health care administrators, and 10 caregivers and observed the monitoring of 12 neonates. Staffing and maintenance of training in neonatal units are important feasibility considerations, and simple training requirements support the feasibility of the investigational technologies. Key usability characteristics included ease of use, wireless features, and reduced number of attachments connecting the neonate to the monitoring technology, which health care providers considered to increase the efficiency of care. The main factors supporting acceptability included caregiver-highlighted perceptions of neonate comfort and health care respondent technology familiarity. Concerns about the side effects of wireless connections, electromagnetic fields, and mistrust of unfamiliar technologies have emerged as possible acceptability barriers to investigational technologies. Conclusions Overall, respondents considered the investigational technologies feasible, usable, and acceptable for the care of neonates at this health care facility. Our findings highlight the potential of different multiparameter continuous physiological monitoring technologies for use in different neonatal care settings. Simple and user-friendly technologies may help to bridge gaps in current care where there are many neonates; however, challenges in maintaining training and ensuring feasibility within resource-constrained health care settings warrant further research. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-035184

Fear of Nurses During COVID-19 Pandemic in Saudi Arabia: A Cross-Sectional Assessment

Objective: We aimed to assess the level of fear among nurses in Saudi Arabia during the COVID-19 outbreak.Methods: A cross-sectional survey-based study was conducted from June to August 2020. All nurses currently working in public and private hospitals in Saudi Arabia during the COVID-19 pandemic were invited to complete an online survey. We used the 7-item unidimensional Fear of COVID-19 Scale (FCV-19S) to assess the level of fear of COVID-19. Multiple regression analysis was used to identify predictors associated with fear of COVID-19.Results: A total of 969 nurses participated in this study. The participants were relatively young with a mean age of 35.5 ± 10.46 years. About two-thirds of the participants were women (65.9%), married (57.2%), and were non-Saudi nationals (67%). The total mean score for the FCV-19S was 19.7 SD 7.03 (range 7–35), which is near the mid-point, indicating a moderate level of fear of COVID-19. Out of the eight variables measured in the analysis, three variables emerged as a significant predictor (i.e., gender, marital status, and age). A higher level of fear (FCV-19S) was associated with being a woman, married, and older age (p ≤ 0.05).Conclusion: This study demonstrated the level of fear of COVID-19 among nurses in Saudi Arabia. Overall, nurses in Saudi reported moderate levels of fear of COVID-19. Assessing the level of fear of nurses who work during the COVID-19 pandemic should be a priority to health care administrators to prevent mental health difficulties or psychological injury.

Pseudomembranous colitis after COVID-19 antibacterial therapy

A new coronavirus infection poses a challenge to infectious disease specialists, health care administrators, and subspecialty physicians in the search for the most eff ective treatment options. The past year has allowed us to clarify the main aspects of pathogenesis with a focus on the most severe versions of the COVID-19 course. Most signifi cant is to understand that the severe course is associated with prolonged viremia and T-cell lymphocyte defi ciency leading to activation of innate immunity, manifested by a burst of macrophage activity known as the “cytokine storm”. This inadequate response is a major factor in both pulmonary and multiple organ failure. Fever, pulmonary infi ltrates with leukocytosis and neutrophilia are traditionally perceived by doctors as indications for antibiotic therapy, which is nevertheless erroneous in the absence of signs of bacterial infection. We present a case that illustrates the severe course of pseudomembranous colitis and secondary myocarditis in an elderly woman with comorbid pathology and massive antibiotic therapy received during hospitalization for COVID-19.

Preparation, Expectations, Experience, and Environment of a College/University Athletic Training Residency: An Ethnographic Study

Context Athletic training residency programs are proliferating rapidly, yet only 1 accredited residency is housed outside of physician-practice or clinic settings. Objective The focus of this article was to explore the structural and cultural factors that support a residency program in a college/university athletic training facility. Design Qualitative ethnographic study. Setting Boston University Commission on Accreditation of Athletic Training Education–accredited residency program. Patients or Other Participants The unit includes 16 full-time athletic trainers (2 of whom are residents, 6 of whom are residency faculty/preceptors) and 3 fellowship-trained primary care sports medicine physicians. Data Collection and Analysis I made observations, engaged in discussions, and conducted interviews for 34 days (159.5 hours) over 4 months. Data analysis involved examining transcriptions, field notes, and observational summaries of dialogue and behaviors, reactions, and my own interpretations. I used an inductive coding process to develop meaningful concepts, grouping them together to classify the data and identify themes and subthemes characterizing the structures of the culture. Results I identified 3 themes: resident preparation and expectations, residency experience, and environment. In the first theme, I identified that the residents came into the residency having some deficiencies and incongruent expectations of the program. In the second theme, I observed the residents gained depth of knowledge, skills, and abilities in their focused area of practice, and they improved self-reflective practices through their exposure to clinical specialists and the varied pedagogical approaches within the program. The environment included both benefits and challenges in having a residency. Engagement in interprofessional and collaborative practice and a culture of teaching and learning supported the residency environment. Conclusions Athletic health care administrators must clearly communicate expectations when recruiting candidates, consider the training and commitment of their staff, and ensure culture of health care education within their unit before developing a residency, regardless of setting.

A Conversation about Ageism: Time to Deinstitutionalize Long-Term Care?

Ageism is arguably one of the least challenged forms of discrimination globally and manifests in many obvious and subtle ways. Situating our conversation within the context of COVID-19, we discuss peculiar and unchallenged forms of ageism in current times as well as the intersections with other forms of discrimination such as ableism, racism, sexism, and heterosexism. We highlight the limits of current understandings of ageism, specifically those that seek to identify positive aspects of ageism without appreciating how these forms of ageism reinforce inequalities among older adults. With regards to spatial manifestations of ageism, we explore the failure of critiques of institutionalization to include older people. Only in the context of “mass death” during COVID-19 has the public eye turned toward the problems of long-term residential care facilities as spaces of care, yet disabled, mad, and D/deaf people and allies have challenged the mass institutionalization of disabled people for decades, highlighting how physical and social segregation constitutes an obvious form of ableism. Institutions are notorious for their physical, spiritual, and emotional harms, but when it comes to residential long-term care for older people, especially older people living with dementia, responses to segregation and isolation have generally been ambivalent. Even aging studies scholars call for “transformation” but do not call for the elimination of large-scale institutions (e.g., Theurer et al.). We discuss this softer critique from aging studies, raising questions about whether institutionalized and segregated congregate living for older people is inherently discriminatory, and we consider the implications for families, health care administrators, researchers, and scholars working in the field of long-term residential care.

Multilevel Influences on Black Cancer Patient Experiences With Care: A Qualitative Analysis

PURPOSE: Black patients with cancer report worse experiences with health care compared with White patients; however, little is known about what influences these ratings. The objective of this study is to explore the multilevel factors that influence global ratings of care for Black cancer survivors. METHODS: We conducted semistructured in-depth interviews with 18 Black cancer survivors. We assessed the global ratings of their personal doctor, specialist, health plan, prescription drug plan, and overall health care, and asked patients to elaborate on their rating. We analyzed the interviews with a deductive grounded theory approach using the socioecologic model to identify the individual, interpersonal, organizational, and environmental influences on Black cancer patient experiences with global ratings of care. We used an inductive constant comparison approach to identify additional themes that emerged. Two coauthors separately coded a set of transcripts and met to refine the codebook. RESULTS: On average, participants reported the highest mean rating for their specialist (9.39/10) and the lowest mean rating for their personal doctor (7.33/10). Emerging themes that influenced patient ratings were perceptions about their interaction with medical providers, physician communication, the doctor's expertise, and aspects of the physical facilities. Global ratings of care measures were widely influenced by patient interactions with their providers that were empathetic, nondiscriminatory, and where the doctors addressed all concerns. CONCLUSION: This grounded theory study identifies multiple aspects of health care that intervention researchers, health care administrators, and providers may target to improve Black cancer patient experiences with care.

Multiparameter Continuous Physiological Monitoring Technologies in Neonates Among Health Care Providers and Caregivers at a Private Tertiary Hospital in Nairobi, Kenya: Feasibility, Usability, and Acceptability Study (Preprint)

BACKGROUND Continuous physiological monitoring technologies are important for strengthening hospital care for neonates, particularly in resource-constrained settings, and understanding user perspectives is critical for informing medical technology design, development, and optimization. OBJECTIVE This study aims to assess the feasibility, usability, and acceptability of 2 noninvasive, multiparameter, continuous physiological monitoring technologies for use in neonates in an African health care setting. METHODS We assessed 2 investigational technologies from EarlySense and Sibel, compared with the reference Masimo Rad-97 technology through in-depth interviews and direct observations. A purposive sample of health care administrators, health care providers, and caregivers at Aga Khan University Hospital, a tertiary, private hospital in Nairobi, Kenya, were included. Data were analyzed using a thematic approach in NVivo 12 software. RESULTS Between July and August 2020, we interviewed 12 health care providers, 5 health care administrators, and 10 caregivers and observed the monitoring of 12 neonates. Staffing and maintenance of training in neonatal units are important feasibility considerations, and simple training requirements support the feasibility of the investigational technologies. Key usability characteristics included ease of use, wireless features, and reduced number of attachments connecting the neonate to the monitoring technology, which health care providers considered to increase the efficiency of care. The main factors supporting acceptability included caregiver-highlighted perceptions of neonate comfort and health care respondent technology familiarity. Concerns about the side effects of wireless connections, electromagnetic fields, and mistrust of unfamiliar technologies have emerged as possible acceptability barriers to investigational technologies. CONCLUSIONS Overall, respondents considered the investigational technologies feasible, usable, and acceptable for the care of neonates at this health care facility. Our findings highlight the potential of different multiparameter continuous physiological monitoring technologies for use in different neonatal care settings. Simple and user-friendly technologies may help to bridge gaps in current care where there are many neonates; however, challenges in maintaining training and ensuring feasibility within resource-constrained health care settings warrant further research. INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2019-035184

Children with disabilities in the United States and the COVID-19 pandemic

Children with disabilities are disproportionately impacted by COVID-19 and the containment response. Their caregivers must now adapt to increased stressors such as lack of access to needed therapies, medical supplies, and nursing care. Prior to COVID-19 these families were already marginalized, and this has only worsened during the pandemic. As a vulnerable population, children with disabilities have not been the focus of much discussion during the pandemic, likely because the disease disproportionately impacts older individuals. Nonetheless, children with disabilities should be a focus of evaluation and intervention to mitigate the negative consequences of COVID-19 and the resulting containment strategies. Their needs should be included in future crisis planning, as well. In order to raise awareness of pediatric rehabilitation professionals, health care administrators, policy makers, and advocates, this manuscript provides a discussion of the following topics: the immediate and ongoing impacts on children with disabilities and their families, the ethical concerns and implications of triage protocols for scarce resources that consider disability in their scoring systems, and optimizing medical care and educational needs in the time of COVID.