Perceptions of European medical staff on the facilitators and barriers to physical closeness between parents and infants in neonatal units

AIM: Studies have provided insights into factors that may facilitate or inhibit parent-infant closeness in neonatal units, but none have specifically focused on the perspectives of senior neonatal staff. The aim of this study was to explore perceptions and experiences of consultant neonatologists and senior nurses in five European countries with regard to these issues. METHODS: Six small group discussions and three one-to-one interviews were conducted with 16 consultant neonatologists and senior nurses representing nine neonatal units from Estonia, Finland, Norway, Spain and Sweden. The interviews explored facilitators and barriers to parent-infant closeness and implications for policy and practice and thematic analysis was undertaken. RESULTS: Participants highlighted how a humanising care agenda that enabled parent-infant closeness was an aspiration, but pointed out that neonatal units were at different stages in achieving this. The facilitators and barriers to physical closeness included socio-economic factors, cultural norms, the designs of neonatal units, resource issues, leadership, staff attitudes and practices and relationships between staff and parents. CONCLUSION: Various factors affected parent-infant closeness in neonatal units in European countries. There needs to be the political motivation, appropriate policy planning, legislation and resource allocation to increase measures that support closeness agendas in neonatal units. This article is protected by copyright. All rights reserved.

Upplevelser av bemötande i vården hos patienter med fibromyalgi- en litteraturöversikt

Bakgrund: Fibromyalgi är ett långvarigt kroniskt smärttillstånd som grundar sig på individens subjektiva smärtupplevelse. Syfte: Syftet var att beskriva hur patienter med fibromyalgi upplevt bemötande i vården. Metod: Denna litteraturöversikt baseras på tretton vetenskapliga artiklar. Resultat: Resultatet resulterade i två huvudkategorier "Patienters upplevelser av bemötande" och "Kunskap och stöd från vårdpersonalen". Patienterna med fibromyalgi upplever dåligt bemötande och att vårdpersonal saknar kunskap om både diagnos och behandling av fibromyalgi. I vården upplever dessa patienter misstro och att de blir dåligt bemötta när de söker för sina smärtsymtom. Patienter med fibromyalgidiagnos önskar ett personcentrerat bemötande och mer tid av sina läkare. Slutsatser: Litteraturöversikten visar att patienter med fibromyalgi i stor utsträckning uppger att de upplever dåligt bemötande, okunskap och brist på engagemang i vården. Framtida forskningen bör fokusera på hur vården kan arbeta mer personcentrerat i denna patientgrupp till exempel genom interventionsstudier.

Bidragande faktorer som påverkar patientens följsamhet i ögondroppsbehandlingen vid glaukomsjukdom – en litteraturstudie

Bakgrund: Glaukom är en kronisk progressiv ögonsjukdom och en av den främsta orsaken till blindhet i världen. Intraockulärt trycksänkande ögondroppar är den vanligaste behandlingsmetoden och följsamhet är mycket viktigt för att minska progression av sjukdomen och risken att bli blind. Tidigare studier har visat att det finns en bristande följsamhet hos patienter med denna behandling. Syfte: Att belysa de faktorer som påverkar patientens följsamhet så att sjuksköterskan ska få en bättre förståelse och kunna vägleda patienten till en bättre följsamhet. Metod: En systematisk litteraturstudie genomfördes baserad på 14 vetenskapliga artiklar med både kvalitativ och kvantitativ ansats. Resultat: Det finns många olika faktorer som påverkar patientens följsamhet i behandlingen med ögondroppar. Det kan vara faktorer som är orsakade av sjukvårdspersonal, av patienten själv samt av miljö/socioekonomiska skäl. Slutsats: Det är viktigt att fortsätta forska på de faktorer som påverkar patienters följsamhet vid ögondroppsbehandling för att sjuksköterskan ska kunna vägleda till en ökad följsamhet.

Sjuksköterskans stöd till personer med psykiska funktionsnedsättningar i utövandet av fysisk aktivitet och dess hälsoeffekter Litteraturstudie

Det har forskats mycket om fysisk aktivitets positiva effekter på människokroppen rent fysiskt. Tidigare har det inte varit en naturlig del av behandlingen inom psykiatrin vilket gjorde författarna nyfikna på hur det kan lyftas fram i vården av personer med psykiska funktionsnedsättningar. Syfte: Syftet med litteraturstudien var att beskriva hälsoeffekterna av fysisk aktivitet för personer med psykiska funktionsnedsättningar och sjuksköterskans stöd genom handledning. Metod: Litteraturstudie. Resultat: Under sammanställningen av resultatet framkom att sjuksköterskor kan ge stöd genom Motiverande samtal (MI) som var av central betydelse. Då patienten själv hörsammas och bygger upp sina mål som ska vara mätbara tillsammans med utbildad vårdpersonal, men även genom stöd i patienternas egen utbildning och kunskap av den fysiska aktivitetens positiva inverkan på psykisk ohälsa. Slutsats: Sjuksköterskans metod att stödja och motivera personer med psykiska funktionsnedsättningar till att utöva fysisk aktivitet visade sig vara flera. Då det var viktigt med personcentrarad metod, var viktigt att de behärskade och kände till olika vägar att kunna motivera personer med psykiska funktionsnedsättningar. Andra betydelsefulla tillvägagångssätt var god vårdrelation, individualiserade träningsprogram, samt stöd och utbildning i de positiva hälsoeffekterna som fysisk aktivitet gav.

“Who wants to go repeatedly to the hospital?” : Perceptions and experiences of simplified medical abortion in Rajasthan, India

The aim of this study is to explore women's experiences and perceptions of home use of misoprostol and of the self-assessment of the outcome of early medical abortion in a low-resource setting in India. In-depth interviews were conducted with 20 women seeking early medical abortion, who administered misoprostol at home and assessed their own outcome of abortion using a low-sensitivity pregnancy test. With home use of misoprostol, women were able to avoid inconvenience of travel, child care, and housework, and maintain confidentiality. The use of a low-sensitivity pregnancy test alleviated women's anxieties about retained products. Majority said they would prefer medical abortion involving a single visit in future. This study provides nuanced understanding of how women manage a simplified medical abortion in the context of low literacy and limited communication facilities. Service delivery guidelines should be revised to allow women to have medical abortion with fewer visits.

Clustering Lab value working with medical data

Data mining is a relatively new field of research that its objective is to acquire knowledge from large amounts of data. In medical and health care areas, due to regulations and due to the availability of computers, a large amount of data is becoming available [27]. On the one hand, practitioners are expected to use all this data in their work but, at the same time, such a large amount of data cannot be processed by humans in a short time to make diagnosis, prognosis and treatment schedules. A major objective of this thesis is to evaluate data mining tools in medical and health care applications to develop a tool that can help make rather accurate decisions. In this thesis, the goal is finding a pattern among patients who got pneumonia by clustering of lab data values which have been recorded every day. By this pattern we can generalize it to the patients who did not have been diagnosed by this disease whose lab values shows the same trend as pneumonia patients does. There are 10 tables which have been extracted from a big data base of a hospital in Jena for my work .In ICU (intensive care unit), COPRA system which is a patient management system has been used. All the tables and data stored in German Language database.

First-principle data-driven models for assessment of motor disorders in Parkinson’s disease

Parkinson’s disease (PD) is an increasing neurological disorder in an aging society. The motor and non-motor symptoms of PD advance with the disease progression and occur in varying frequency and duration. In order to affirm the full extent of a patient’s condition, repeated assessments are necessary to adjust medical prescription. In clinical studies, symptoms are assessed using the unified Parkinson’s disease rating scale (UPDRS). On one hand, the subjective rating using UPDRS relies on clinical expertise. On the other hand, it requires the physical presence of patients in clinics which implies high logistical costs. Another limitation of clinical assessment is that the observation in hospital may not accurately represent a patient’s situation at home. For such reasons, the practical frequency of tracking PD symptoms may under-represent the true time scale of PD fluctuations and may result in an overall inaccurate assessment. Current technologies for at-home PD treatment are based on data-driven approaches for which the interpretation and reproduction of results are problematic.  The overall objective of this thesis is to develop and evaluate unobtrusive computer methods for enabling remote monitoring of patients with PD. It investigates first-principle data-driven model based novel signal and image processing techniques for extraction of clinically useful information from audio recordings of speech (in texts read aloud) and video recordings of gait and finger-tapping motor examinations. The aim is to map between PD symptoms severities estimated using novel computer methods and the clinical ratings based on UPDRS part-III (motor examination). A web-based test battery system consisting of self-assessment of symptoms and motor function tests was previously constructed for a touch screen mobile device. A comprehensive speech framework has been developed for this device to analyze text-dependent running speech by: (1) extracting novel signal features that are able to represent PD deficits in each individual component of the speech system, (2) mapping between clinical ratings and feature estimates of speech symptom severity, and (3) classifying between UPDRS part-III severity levels using speech features and statistical machine learning tools. A novel speech processing method called cepstral separation difference showed stronger ability to classify between speech symptom severities as compared to existing features of PD speech. In the case of finger tapping, the recorded videos of rapid finger tapping examination were processed using a novel computer-vision (CV) algorithm that extracts symptom information from video-based tapping signals using motion analysis of the index-finger which incorporates a face detection module for signal calibration. This algorithm was able to discriminate between UPDRS part III severity levels of finger tapping with high classification rates. Further analysis was performed on novel CV based gait features constructed using a standard human model to discriminate between a healthy gait and a Parkinsonian gait. The findings of this study suggest that the symptom severity levels in PD can be discriminated with high accuracies by involving a combination of first-principle (features) and data-driven (classification) approaches. The processing of audio and video recordings on one hand allows remote monitoring of speech, gait and finger-tapping examinations by the clinical staff. On the other hand, the first-principles approach eases the understanding of symptom estimates for clinicians. We have demonstrated that the selected features of speech, gait and finger tapping were able to discriminate between symptom severity levels, as well as, between healthy controls and PD patients with high classification rates. The findings support suitability of these methods to be used as decision support tools in the context of PD assessment.

Medical students’ knowledge, attitudes, and perceptions on contraceptive use and counselling : a cross-sectional survey in Maharashtra, India

Objectives. This study aimed to investigate the knowledge, attitudes and perceptionstowards contraceptive use and counselling among medical students in Maharashtra, India. Setting. Considerable global maternal mortality and morbidity could be avoided through theuse of effective contraception. In India, contraception services are frequently unavailable or there are obstacles to obtaining modern, reversible contraceptives. Participants. A cross-sectional descriptive study using a self-administered questionnaire was conducted among 1996 medical students in their fifth year of study at 27 medical colleges in the state of Maharashtra, India. Descriptive and analytical statistics interpreted the survey instrument and significant results were presented with 95% CI. Results. Respondents expressed a desire to provide contraceptive services. A few studentshad experienced training in abortion care. There were misconceptions about moderncontraceptive methods and the impact of sex education. Attitudes towards contraceptionwere mainly positive, premarital counselling was supported and the influence of traditional values and negative provider attitudes on services was recognised. Gender, area of upbringing and type of medical college did not change the results. Conclusions. Despite mostly positive attitudes towards modern contraceptives, sex education and family planning counselling, medical students in Maharashtra have misconceptions about modern methods of contraception. Preservice and in-service training in contraceptive counselling should be implemented in order to increase women's access to evidence-based maternal healthcare services.