The latest medical research on Medical Administration

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about medical administration gathered by our medical AI research bot.

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'It all dials back to safety': A qualitative study of social and economic vulnerabilities among transgender women participating in HIV research in the USA.

BMJ Open

Transgender women (TW) are highly burdened by HIV infection in the USA. Research is needed into drivers of the HIV epidemic for TW, including longitudinal studies to identify risks for incident HIV infection and optimal intervention targets. This formative research sought to understand TW's experiences with, perceptions of and barriers and facilitators to HIV research participation to inform future research implementation.

Participants identified as TW≥18 years and resided in one of the six metropolitan areas or outlying regions. 33 participants elected to partake in English focus groups and eight participated in Spanish-led groups.

The geographically diverse sample had a mean age of 41.1 years (SD=13.6), and 34% identified as Black African American and 29% as Hispanic/Latina. Social and economic factors were found to shape HIV research participation for TW. Barriers to HIV research participation included limited research opportunities, mistrust, fear of mistreatment, safety and confidentiality, competing priorities and HIV stigma. Facilitators to HIV research participation were peer involvement and engagement, monetary and non-monetary incentives, flexibility and choices, multiple modalities and methods, and transcenteredness.

It is critical to address the social and economic vulnerabilities surrounding HIV research participation for TW. Results from this study can inform the design and implementation of gender-affirming and culturally tailored approaches to HIV research with TW.

Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial.

BMJ Open

Patients with multiple chronic health conditions are often managed in a disjointed fashion in primary care, with annual review clinic appointments offered separately for each condition. This study aimed to determine the cost-effectiveness of the 3D intervention, which was developed to improve the system of care.

The 3D approach: comprehensive 6-monthly general practitioner consultations, supported by medication reviews and nurse appointments.

The primary economic evaluation assessed the cost per quality-adjusted life year (QALY) gained from the perspective of the National Health Service (NHS) and personal social services (PSS). Costs were related to changes in a range of secondary outcomes (QALYs accrued by both participants and carers, and deaths) in a cost-consequences analysis from the perspectives of the NHS/PSS, patients/carers and productivity losses.

Very small increases were found in both QALYs (adjusted mean difference 0.007 (-0.009 to 0.023)) and costs (adjusted mean difference £126 (£-739 to £991)) in the intervention arm compared with usual care after 15 months. The incremental cost-effectiveness ratio was £18 499, with a 50.8% chance of being cost-effective at a willingness-to-pay threshold of £20 000 per QALY (55.8% at £30 000 per QALY).

The small differences in costs and outcomes were consistent with chance, and the uncertainty was substantial; therefore, the evidence for the cost-effectiveness of the 3D approach from the NHS/PSS perspective should be considered equivocal.

ISCRTN06180958.

Burnout in consultants in child and adolescent mental health services (CAMHS) in Ireland: a cross-sectional study.

BMJ Open

Physician burnout has reached epidemic levels in many countries, contributing to adverse personal, patient and service outcomes. Adverse socioeconomic conditions, such as the economic downturn in the Ireland post 2008, contribute to a situation of increased demand but inadequate resources. Given a recent unprecedented increase in referrals to Irish child and adolescent mental health services (CAMHS), coupled with a fragmented and poorly resourced service, it is important to reflect on consultant child psychiatrists' well-being.

To report on the level of burnout among consultants working in CAMHS in Ireland using a cross-sectional design.

Questions assessed demographic and occupational details, career satisfaction and perceived management, government and public support. The Copenhagen Burnout Inventory measured personal, work and patient-related burnout.

The prevalence of moderate or higher levels of work-related and personal burnout was 75% and 72.3%, respectively. Fewer (n=14, 26.9%) experienced patient-related burnout. There was a strong correlation between work burnout and personal (r=0.851, n=52, p<0.001) and patient-related burnout (r=0.476, n=52, p<0.001). Lack of confidence in government commitment to investment in CAMHS (p<0.001) and perceived ineffective management by health authorities (p=0.002) were associated with higher burnout scores. Few consultants (n=11, 21%) felt valued in their job. The majority (n=36, 69%) had seriously considered changing jobs, and this was positively associated with higher burnout (p<0.001). Higher burnout scores were present in those (n=15, 28.8%) who would not retrain in child psychiatry (p=0.002).

The high level of burnout reported by respondents in this study, and ambivalence about child psychiatry as a career choice has huge professional and service implications. Urgent organisational intervention to support consultant psychiatrists' well-being is required.

Cross-cultural validation of the Retinopathy Treatment Satisfaction Questionnaire status version (RetTSQs) in Serbian community: a cross-sectional study.

BMJ Open

Cross-cultural translation and validation of the Serbian version of the Retinopathy Treatment Satisfaction Questionnaire status version (RetTSQs).

Validation of Serbian version of the RetTSQs was the major outcome.

Cronbach alpha coefficient of the subscales ranged from 0.783 (positive scale) to 0.811 (negative scale) and for all domains it was excellent at α=0.829. The intraclass correlation coefficient was greater than 0.8 for all of the subscales. Univariable analyses revealed that age, gender, education, marital status and working status did not affect the RetTSQ scores, whereas participants with non-proliferative DR reported significantly higher treatment satisfaction (TS) than those with proliferative retinopathy (p=0.001). The group who received laser treatment scored significantly lower than the group without it (p=0.004) regardless of type of performed laser. Positive and statistically significant correlations were found between the RetTSQ score and most of the National Eye Institute Visual Functioning Questionnaire-25 subscales.

Translated Serbian adaptation of the RetTSQs showed adequate psychometric characteristics as an acceptable, reliable and valid questionnaire. It was well understood by Serbian diabetic patients and it promises to be used in daily clinical work as an instrument for the assessment of TS for patients with DR.

Knowledge level and motivation of Hong Kong young adults towards blood donation: a cross-sectional survey.

BMJ Open

This study aimed to (1) determine the knowledge level of young adults towards blood donation, and (2) to understand their donor identity and the meanings of blood donation to them.

The questionnaire which consisted of three parts was used for data collection. Part 1 collected sociodemographic information and items associated with blood donation; part 2 related to knowledge on blood donation and part 3 focused on blood donor identity. Univariate and multivariate logistic regression analyses were conducted to determine the OR and identify the predictors for blood donation.

Among the 542 respondents, 274 were non-blood donors and 268 were blood donors. Blood donors generally have a better knowledge towards blood donation than non-blood donors. The results of univariate analyses indicated that being a female (OR=1.99, p<0.001), aged 22 years or above (OR=234, p<0.001), studying at year 4 or 5 (OR=2.12, p=0.003), studying health-related programmes (OR=1.96, p<0.001), being registered as an organ donor (OR=6.59, p<0.001), had prior experience of receiving blood (OR=7.60, p<0.001) or prior experience of being refused for blood donation (OR=5.14, p<0.001) were significantly associated with being a blood donor. Having prior experience of receiving blood was the strongest predictor for being a blood donor, followed by being registered as an organ donor, after controlling for all other factors in the logistic regression model.

The findings are consistent with self-determination theory, which hypothesises that people are more likely to abide with blood donation behaviours that are internally rather than externally motivated.

Does chronic hyperglycaemia increase the risk of kidney stone disease? results from a systematic review and meta-analysis.

BMJ Open

DM, n=5 89 791; MetS, n=1 78 050; IGT, n=2 93 852 patients. Adjusted risk for DM cohort studies, RR=1.23 (0.94 to 1.51) (p<0.001). Adjusted ORs for: DM cross-sectional/case-control studies, OR=1.32 (1.21 to 1.43) (p<0.001); IGT, OR=1.26 (0.92 to 1.58) (p<0.0001) and MetS, OR=1.35 (1.16 to 1.54) (p<0.0001). There was no significant difference between IGT and DM (cross-sectional/case-control), nor IGT and MetS. There was a moderate risk of publication bias. Statistical heterogeneity remained significant in adjusted DM cohort values and adjusted IGT (cross-sectional/case-control), but non-signficant for adjusted DM (cross-sectional/case-control).

To examine the association between chronic hyperglycaemia, in the form of DM and impaired glucose tolerance (IGT) in the context of MetS and KSD.

2340 articles were screened with 13 studies included for meta-analysis, 7 DM (three cohort) and 6 MetS. Five of the MetS studies provided data on IGT alone. These included: DM, n=28 329; MetS, n=31 767; IGT, n=12 770.

Chronic hyperglycaemia increases the risk of developing kidney stone disease. In the context of the diabetes pandemic, this will increase the burden of stone related morbidity and mortality.

CRD42018093382.

Cancer caregivers' experiences of prognosis in Australia: a qualitative interview study.

BMJ Open

Forecasting survival in cancer is a particularly challenging facet of oncological work and can involve complex interactions with patients and their families. While there is considerable research on patient experiences of being provided with, or becoming aware of, their prognosis, there has been much less emphasis placed on the experiences of caregivers. The aim of this paper was to examine caregivers' experiences of prognosis.

50 caregivers of patients living with cancer and receiving treatment at two metropolitan hospitals (32% male, 68% female) participated in this study.

Four main themes were identified: (1) caregivers' uncertainty around the meaning and implications of prognosis, (2) caregivers' sense of exclusion in prognostic conversations, (3) the practice of situating prognosis within a context of hope and (4) the precarious balance between realism, optimism and strategic 'ignorance'.

Caregivers are in many respects the unseen third party of prognostic communication. Developing a better understanding of caregivers' perceptions of prognosis, including how this may be challenged, accepted or otherwise, is important in engaging caregivers in the process of communicating prognostic information. Facilitating greater participation by caregivers in prognostic conversations could potentially address evident complexities and even improve the experiences of all stakeholders in cancer care settings.

Forging a new identity: a qualitative study exploring the experiences of UK-based physician associate students.

BMJ Open

To explore student physician associates' (PAs) experiences of clinical training to ascertain the process of their occupational identity formation.

A theoretical sample of 19 PA students from two UK medical schools offering postgraduate PA studies courses.

A conceptual model detailing student PA identity formation is proposed. Factors facilitating identity formation include clinical exposure and continuity. Barriers to identity formation include ignorance and negativity regarding the PA role. Difficulties navigating identity formation and lacking support resulted in identity dissonance.

Although similarities exist between PA and medical student identity formation, unique challenges exist for student PAs. These include navigating a new role and poor access to PA role models. Given this, PA students are turning to medicine for their identity. Educators must provide support for student PA identity development in line with this work's recommendations. Such support is likely to improve the job satisfaction and retention of PAs within the UK NHS.

What do we know about demand, use and outcomes in primary care out-of-hours services? A systematic scoping review of international literature.

BMJ Open

To synthesise international evidence for demand, use and outcomes of primary care out-of-hours health services (OOHS).

English language studies in UK or similar international settings, focused on services in or directly impacting primary care.

105 studies included: 54% from mainland Europe/Republic of Ireland; 37% from UK. Most focused on general practitioner-led out-of-hours cooperatives. Evidence for increasing patient demand over time was weak due to data heterogeneity, infrequent reporting of population denominators and little adjustment for population sociodemographics. There was consistent evidence of higher OOHS use in the evening compared with overnight, at weekends and by certain groups (children aged <5, adults aged >65, women, those from socioeconomically deprived areas, with chronic diseases or mental health problems). Contact with OOHS was driven by problems perceived as urgent by patients. Respiratory, musculoskeletal, skin and abdominal symptoms were the most common reasons for contact in adults; fever and gastrointestinal symptoms were the most common in the under-5s. Frequent users of daytime services were also frequent OOHS users; difficulty accessing daytime services was also associated with OOHS use. There is some evidence to suggest that OOHS colocated in emergency departments (ED) can reduce demand in EDs.

Policy changes have impacted on OOHS over the past two decades. While there are generalisable lessons, a lack of comparable data makes it difficult to judge how demand has changed over time. Agreement on collection of OOHS data would allow robust comparisons within and across countries and across new models of care. Future developments in OOHS should also pay more attention to the relationship with daytime primary care and other services.

CRD42015029741.

HEV study protocol : design of a cluster-randomised, blinded trial to assess the safety, immunogenicity and effectiveness of the hepatitis E vaccine HEV 239 (Hecolin) in women of childbearing age in rural Bangladesh.

BMJ Open

The trial is registered at clinicaltrials.gov with the registry name "Effectiveness Trial to Evaluate Protection of Pregnant Women by Hepatitis E Vaccine in Bangladesh" and the identifier NCT02759991.

Enrolment of a target of approximately 20 000 non-pregnant women, aged 16-39 years, started on 2 October 2017 in Matlab, Bangladesh. Sixty-seven villages were randomised by village at a 1:1 ratio to receive either the HEV vaccine or the control vaccine (hepatitis B vaccine). A 3-dose vaccination series at 0, 1 and 6 months is ongoing, and women are followed up for 24 months. The primary outcome is confirmed HEV disease among pregnant women. After vaccination, participants are requested to report information about clinical hepatitis symptoms. Participants who become pregnant are visited at their homes every 2 weeks to collect information about pregnancy outcome and to screen for clinical hepatitis. All suspected hepatitis cases undergo laboratory testing for diagnostic evaluation. The incidence of confirmed HEV disease among pregnant and non-pregnant women will be compared between the HEV vaccinated and control groups, safety and immunogenicity of the vaccine will also be evaluated.

The protocol was reviewed and approved by the International Centre for Diarrhoeal Disease Research, Bangladesh Research Review Committee and Ethical Review Committee, and the Directorate General of Drug Administration in Bangladesh, and by the Regional Ethics Committee in Norway. This article is based on the protocol version 2.2 dated 29 June 2017. We will present the results through peer-reviewed publications and at international conferences.

KMBARC registry: protocol for a multicentre observational cohort study on non-cystic fibrosis bronchiectasis in Korea.

BMJ Open

KCT0003088.

The Korean Multicenter Bronchiectasis Audit and Research Collaboration (KMBARC) is a prospective, non-interventional observational cohort study on bronchiectasis in Korea. The inclusion criteria of this registry are as follows: (1) adult patients (aged ≥18 years) with or without respiratory symptoms (cough, chronic sputum and/or recurrent respiratory infection) and chest computed tomography revealing bronchiectasis affecting one or more lobes and (2) stable status at the time of registration: patients with bronchiectasis who were admitted for a respiratory aetiology can be enrolled at least 4 weeks after hospital discharge. The exclusion criteria are as follows: (1) bronchiectasis due to cystic fibrosis; (2) traction bronchiectasis associated with interstitial lung disease; (3) patients actively being treated for pneumonia, pulmonary tuberculosis or non-tuberculous mycobacterial infection; (4) patients who are unable or unwilling to provide informed consent; and (5) pregnant patients. Although the KMBARC questionnaires for baseline and annual follow-up data are similar to the European Multicentre Bronchiectasis Audit and Research Collaboration questionnaires, KMBARC has distinctive features such as use of Bronchiectasis Health Questionnaires, measurement with fatigue and depression scales, blood tests, use of consensus definition of exacerbations and information on emergency room or hospitalisation.We aim to recruit at least 1200 patients over the study period from more than 26 hospitals in South Korea. Patients will undergo a detailed baseline and yearly assessment for up to 5 years. The study objectives of the KMBARC registry are as follows: (1) uncovering the natural course of bronchiectasis; (2) aiding in establishing evidence-based bronchiectasis guidelines in Korea; and (3) encouraging and facilitating studies on bronchiectasis in Korea.

This study received necessary approval from the Institutional Review Boards of all participating institutions. The Asan Medical Center Institutional Review Board gave overall approval for the study. Results will be disseminated via peer-reviewed publications and conference presentations.

Postnatal care following hypertensive disorders of pregnancy: a qualitative study of views and experiences of primary and secondary care clinicians.

BMJ Open

To explore clinicians' views and experiences of caring for postnatal women who had hypertensive disorders of pregnancy (HDP), awareness of relevant National Institute for Health and Care Excellence (NICE) guidance to inform their postnatal management, the extent to which NICE guidance was implemented, barriers and facilitators to implementation and how care could be enhanced to support women's future health.

A maximum variation, purposive sample of 20 clinicians with experience of providing postnatal care to women following HDP.

Four main themes were generated: variation in knowledge and clinical practice; communication and education; provision of care; locus of responsibility for care. Perceived barriers to implementation of NICE guidance included lack of postnatal care plans and pathways, poor continuity of care, poor antihypertensive medication management, uncertainty around responsibility for postnatal care and women's lack of awareness of the importance of postnatal follow-up for their future health. Some clinicians considered that women were discharged from inpatient care too soon, as primary care clinicians did not have specialist knowledge of HDP management. Most clinicians acknowledged the need for better planning, communication and coordination of care across health settings.

Evidence of longer term consequences for women's health following HDP is accumulating, with potential for NICE guidance to support better outcomes for women if implemented. Clinicians responsible for postnatal care following HDP should ensure that they are familiar with relevant NICE guidance, able to implement recommendations and involve women in decisions about ongoing care and why this is important. The continued low priority and resources allocated to postnatal services will continue to promote missed opportunities to improve outcomes for women, their infants and families.