Type 1 diabetes care delivery in Yaoundé, Cameroon: Social and political representations

Background: Increasing chronic diseases challenges the health systems of low- and middleincome countries, including Cameroon. Type 1 diabetes (T1D), among the most common chronic diseases in children, poses particular care delivery challenges. Aim: We examined social representations of patients' roles and implementation of T1D care among political decision-makers, healthcare providers and patients within families. Setting: The study was conducted in Yaoundé, Cameroon. Methods: Eighty-two individuals were included in the study. The authors conducted semistructured interviews with policy makers (n = 5), healthcare professionals (n = 7) and patients 'parents (n = 20). Questionnaires were administered to paediatric patients with T1D (n = 50). The authors also observed care delivery at a referral hospital and at a T1D-focused nongovernmental organisation over 15 days. Data were analysed using thematic content analysis and descriptive statistics. Results: Cameroonian health policy portrays patients with T1D as passive recipients of care. While many practitioners recognised the complex social and economic determinants of adherence to T1D care, in practice interactions focused on specific biomedical issues and offered brief guidance. Cultural barriers and policy implementation challenges prevent patients and their families from being fully active participants in care. Parents and children prefer an ongoing relationship with a single clinician and interactions with other patients and families. Conclusion: Patients and families mobilise experience and lay knowledge to complement biomedical knowledge, but top-down policy and clinical practice limit their active engagement in T1D care. Contribution: Children with T1D and their families, policy makers, healthcare professionals, and civil society have new opportunities to contribute to person-centred care, as advocated by the Sustainable Development Goals.

Third party disability of family members of adults with dysphagia

Background: Third-party disability (TPD) has been studied in multiple patients including those with aphasia and hearing loss. Only one study has been done in relation to caregivers of adults with dysphagia. Third-party disability has been analysed using the International Classification of Function and Disability (ICF) framework. This study, therefore, used the ICF model to explore TPD of caregivers of adults with dysphagia for the context of Johannesburg in South Africa. Objectives: To describe how caregivers experience TPD when caring for adults with a dysphagia in Johannesburg. Methods: Data were collected from five primary adult caregivers, who were all family members, from government clinics in Johannesburg. This article reports the findings from the interviews that were analysed thematically using a top-down analysis approach. Results: Caregivers experienced challenges related to TPD mostly related to difficulties of being able to do activities of daily living for themselves, their household chores and attending social engagements. The use of body structure and function from the ICF model was not overtly applicable to the caregiver population. A new visual representation has been suggested to highlight the key themes to augment the social and psychological changes as seen on the ICF framework and demonstrated the specific interaction that these factors had on one another. Conclusion: Third-party disability is present in caregivers of patients with dysphagia. Healthcare workers need to be aware of the impact that this can have when preparing home management strategies. This newly devised representation can assist in creating a locally relevant patient-centred care approach but requires future input.

A Practical Approach to the Patient with Obesity

@#The prevalence of obesity and obesity-related comorbidities is rising. Primary care physicians are the frontline of healthcare and play a central role in the management of obesity. In this article, we discuss the 5As framework (Ask, Assess, Advise, Agree, and Assist) as a practical framework for obesity counselling, focusing on initiating the conversation and assessing the person with obesity. The assessment includes taking a weight history, excluding secondary causes, understanding lifestyle factors contributing to weight gain and assessing for complications of obesity. This assessment then makes it possible for subsequent patient engagement, including advising, agreeing (goal setting), and assisting the patient on an individualised care plan.

El modelo de recuperación de la salud mental y su importancia para la enfermería colombiana

El objetivo es describir el modelo de recuperación de la salud mental (Recovery), el modelo de la marea en la recuperación de la salud mental (Tidal Model) y su relevancia hacia la implementación dentro de la práctica de la enfermería colombiana. Algunos conceptos sobre la recuperación de la salud mental y el modelo teórico propuesto por Phil Barker se presentan en el texto, y se analizan con los desafíos del profesional de enfermería para mejorar la atención de la salud mental, teniendo en cuenta el contexto actual de la práctica asistencial. Los principios propuestos con el modelo de recuperación ayudan a centrar los cuidados en la persona y no en los síntomas de la enfermedad, entendiendo que la persona tiene diversas dimensiones que le permiten explorar su propio camino hacia la recuperación. Se puede concluir que, a través de la teoría, pueden desarrollarse intervenciones y actividades de enfermería que contribuyan a mejorar la calidad de vida de las personas diagnosticadas de alguna enfermedad mental modificando los modelos tradicionales de atención sanitaria.

The article aims to describe the Mental Health Recovery Model, the Tidal Model in Mental Health Recovery and their relevance to implementation within the practice of Colombian nursing. Some concepts about mental health recovery and the theoretical model proposed by Phil Barker are presented in the text, analysing these with the challenges of the nursing professional to improve mental health care, taking into account the current context of care practice. The principles proposed with the Recovery model help to focus care on the person and not on the symptomatology of the illness, understanding that the person has different dimensions which make it possible for him/her to explore his/her own path to recovery. We can conclude that, through the theory, we can develop interventions and nursing activities that contribute to improving the quality of life of people who have been diagnosed with a mental illness, modifying the traditional healthcare models.

O médico de família e a abordagem centrada na pessoa: desfechos do processo ensino-aprendizagem / The family doctor and the patient-centered approach: outcomes of the teaching-learning process

A abordagem centrada na pessoa se constitui em um dos pilares da Medicina de Família e Comunidade. O aprendizado desta competência tão importante é fundamental para a atuação do médico de família. A Residência Médica continua a ser o padrão ouro para a sua formação. O Método Clínico Centrado na Pessoa se apresenta como principal método nos escopos de formação e com diversos desfechos favoráveis relacionados a ele. Este estudo tem como objetivo analisar o processo ensino-aprendizagem do Método Clínico Centrado na Pessoa, no âmbito das residências médicas de Medicina de Família e Comunidade no município do Rio de Janeiro. Trata-se de um estudo descritivo, exploratório com abordagem quanti-qualitativa. O trabalho de campo foi realizado através da realização de entrevistas com coordenadores dos programas de residência médica, com preceptores e residentes. Também foram aplicados questionários para avaliação sobre a percepção do cuidado centrado na pessoa aplicado aos residentes e usuários, acompanhados nas unidades de saúde família previamente selecionadas no município do Rio de Janeiro. Para a coleta dos dados foi utilizado o instrumento validado Percepção do Cuidado Centrado na Pessoa (PCCP). Como resultados o estudo apresentou discordância sobre a percepção do cuidado centrado na pessoa entre os residentes e os usuários atendidos, prevalecendo uma pior percepção por parte dos residentes. Os piores aspectos avaliados foram os fatores pessoais e familiares que poderiam afetar a saúde das pessoas. Nas entrevistas, a principal dificuldade encontrada nas falas se relacionava aos cenários de ensino, apontadas principalmente pelos residentes. Em segundo lugar as dificuldades com a mudança de paradigma e a tomada de decisão conjunta na prática. O município do Rio de Janeiro viveu uma intensa crise no setor saúde no período de 2017 a 2020 que

The patient-centered model is one of the components of Family and Community Medicine, and developing this competence is regarded fundamental for the family doctor's performance. The patient-centered clinical model is the primary method in the scopes of training and particularly of Medical Residency, and considered "gold standard" for training in the area. This study aims to analyse the patient-centered clinical model teaching and learning process in the Family and Community medical residency scopes in the municipality of Rio de Janeiro. It is a quantitative-and-qualitative-based descriptive and exploratory study.Field work was carried out through interviews done with Medical Residency Program Supervisors, preceptors and residents. Furthermore, residents and patients overseen at Family Health Care units previously selected in the municipality of Rio de Janeiro were required to answer questionnaires in order to assess the patient-centered care perception. In its outcomes the study presented disagreements concerning the patient-centered care perception among residents and the cared-for patients, with a worse perception from residents standing out. Personal and family factors which could influence the patients' health care had the worst assessment. The interviews with the residents pointed out teaching-setting-related difficulties, and also difficulties with paradigm shift and in-practice joint decision-taking. It should be highlighted that the health sector crisis in the municipality of Rio de Janeiro between 2017-2020 seems to have influenced the teaching-learning process.

Oral Glucose-Lowering Agents for the Treatment of Type 2 Diabetes Mellitus

@#Family physicians manage the majority of patients with type 2 diabetes mellitus (T2DM) in Singapore. Hence, they should be familiar with the profile of the many available oral glucose-lowering agents. These drugs vary in their mechanisms of action, glucose-lowering efficacy, safety profiles and treatment costs between classes – even within classes in some cases. These factors should be carefully considered for a patient-centred approach to selecting oral glucose-lowering therapy. This review aims to describe the characteristics of various oral glucose-lowering agents available to family physicians in the management of T2DM and the impact of these characteristics on the patient-centric approach to treatment decision-making.

Can we understand population healthcare needs using electronic medical records?

INTRODUCTION@#The identification of population-level healthcare needs using hospital electronic medical records (EMRs) is a promising approach for the evaluation and development of tailored healthcare services. Population segmentation based on healthcare needs may be possible using information on health and social service needs from EMRs. However, it is currently unknown if EMRs from restructured hospitals in Singapore provide information of sufficient quality for this purpose. We compared the inter-rater reliability between a population segment that was assigned prospectively and one that was assigned retrospectively based on EMR review.@*METHODS@#200 non-critical patients aged ≥ 55 years were prospectively evaluated by clinicians for their healthcare needs in the emergency department at Singapore General Hospital, Singapore. Trained clinician raters with no prior knowledge of these patients subsequently accessed the EMR up to the prospective rating date. A similar healthcare needs evaluation was conducted using the EMR. The inter-rater reliability between the two rating sets was evaluated using Cohen's Kappa and the incidence of missing information was tabulated.@*RESULTS@#The inter-rater reliability for the medical 'global impression' rating was 0.37 for doctors and 0.35 for nurses. The inter-rater reliability for the same variable, retrospectively rated by two doctors, was 0.75. Variables with a higher incidence of missing EMR information such as 'social support in case of need' and 'patient activation' had poorer inter-rater reliability.@*CONCLUSION@#Pre-existing EMR systems may not capture sufficient information for reliable determination of healthcare needs. Thus, we should consider integrating policy-relevant healthcare need variables into EMRs.

Lo visible y lo menos visible en el padecimiento de un trastorno conversivo en niños y adolescentes. Un estudio cualitativo sobre los modelos explicativos de la enfermedad que ofrecen los cuidadores de niños y adolescentes con trastorno conversivo / The Visible and Less Visible in the Suffering of a Conversion Disorder in Children and Adolescents. A Qualitative Study of Illness Explanatory Models Presented to Caregivers of Children and Adolescents with Conversion Disorder

RESUMEN Antecedentes: El trastorno conversivo es un reto para los clínicos por los vacíos conceptuales en lo que respecta a la patogenia y cómo confluyen otras entidades psiquiátricas y la falta de aproximaciones a las vivencias tanto de pacientes como de familiares con la enfermedad. Objetivo: Describir los modelos explicativos (ME) que utilizan los cuidadores de niños y adolescentes con trastorno conversivo que consultan al Hospital Pediátrico de La Misericordia. Métodos: Se realizó un estudio cualitativo con una muestra por conveniencia de 10 casos atendidos entre mayo de 2014 y abril de 2015. La herramienta usada fue una entrevista en profundidad con padres y/o cuidadores. Resultados: Los cuidadores tienen diversas creencias en torno al origen de los síntomas, y consideran principalmente enfermedad, factores mágicos místicos y factores psicosociales. Se explican los síntomas en cada caso de varias maneras, y no se encontró una relación directa entre estas creencias, el patrón de síntomas y los comportamientos de búsqueda de ayuda. La presentación sintomática es polimorfa y genera interferencia principalmente en la actividad escolar de los pacientes. La atención médica se percibe como pertinente y la atención psiquiátrica, como insuficiente. Entre los itinerarios terapéuticos, se describen consultas con diversos agentes, además de la atención médica, incluidas medicinas alternativas y enfoques mágico-religiosos. Conclusiones: Los ME en trastorno conversivo son variados, pero incluyen con frecuencia elementos mágico-religiosos y factores psicosociales. Las creencias subyacentes no se relacionan directamente con la búsqueda de ayuda u otras variables.

ABSTRACT Background: Conversion disorder is a challenge for clinicians due to the conceptual gaps as regards its pathogenesis, the way in which it converges with other psychiatric disorders, and the lack of approaches to the experiences of both patients and family members with the disease. Objective: To describe Explanatory Models (EM) offered to caregivers of paediatric patients with conversion disorder who attended the Hospital de la Misericordia. Methods: A qualitative study was conducted with a convenience sample of 10 patients who attended the Hospital de La Misericordia, ¿Bogotá? between May 2014 and April 2015. The tool used was an in-depth interview applied to parents and/or caregivers. Results: Caregivers have different beliefs about the origin of the symptoms, especially considering sickness, magical-mystical factors, and psychosocial factors. The symptoms are explained in each case in various ways and there is no direct relationship between these beliefs, the pattern of symptoms, and help-seeking behaviours. Symptomatic presentation is polymorphous and mainly interferes in the patient's school activities. The medical care is perceived as relevant, and psychiatric care as insufficient. Among the therapeutic routes, consultations with various agents are described, including medical care, alternative medicine, and magical-religious approaches. Conclusions: EMs in conversion disorder are varied, but often include magical-religious elements and psychosocial factors. The underlying beliefs are not directly related to help-seeking behaviours or other variables.

Atenção centrada no paciente na prática interprofissional colaborativa / Atención centrada en el paciente y práctica interprofesional colaborativa / Patient centred care in interprofessional collaborative practice

Este estudo foi realizado com o objetivo de descrever os elementos-chave da atenção centrada no paciente e sua relação com a prática interprofissional colaborativa na atenção primária à saúde, no contexto do Sistema Único de Saúde, apoiado em revisão de literatura nacional e internacional. Os resultados mostram que, à medida que os profissionais centram atenção no paciente e suas necessidades de saúde, operam simultaneamente um deslocamento de foco para um horizonte mais amplo e além de sua própria atuação profissional. Esse deslocamento é reconhecido como componente de mudança do modelo de atenção à saúde na perspectiva da integralidade, com potencial de impacto na qualidade da atenção.

El objetivo de este estudio es describir los elementos clave de la atención centrada en el paciente y su relación con la práctica interprofesional colaborativa en la Atención Primaria de la Salud. El mismo se apoya en la revisión de literatura nacional e internacional. Los resultados muestran que cuando los profesionales desplazan su actuación hacia la atención centrada en el paciente y hacia las necesidades del paciente, amplían sus horizontes de actuación más allá de los límites de su propia profesión. Este desplazamiento es un componente positivo para el cambio del actual modelo de Atención a la Salud desde la perspectiva de la integralidad y con potencial impacto en la calidad de los servicios.

The aim of this study is to describe key-elements of patient-centred care and its relationship with interprofessional collaborative practice in Primary Health Care, in the context of Unified Health System. Based on national and international review. The outcomes show that as professionals shift their focus towards patient centred care and patient’s needs, their scope of view is broadened beyond the limits of their own professional activities. This shift is an enabler for changes in the current health care model towards comprehensive care and potentially impacting the quality of services.

HANDLING DIFFERENT PERSONALITIES IN ACP CONVERSATIONS

Documented advance care planning (ACP) discussions with patients enable doctors to have continuity and collaboration across all settings as patients move from one setting to another. These shared decision-making discussions generally consist of 3 steps: giving information; assisting patients to understand the options in the context of their situations; and helping these patients make informed decisions based on their individual preferences. Primary care physicians should take advantage of their position as healthcare providers to continue the care of the patient and the relationship they have with the patient by initiating ACP discussions. The National Medical Ethics Committees recommendation in 2010 is that such discussions should be started as part of routine care in primary care and outpatient settings before individuals become acutely unwell. Important barriers that need to be overcome are negative encounters with different personalities who can present themselves as difficult - the angry patient, the anxious patient, the patient in collusion, and the patient in denial. In this paper are some guiding principles on how to carry out ACP discussions with such patients. There is also a need for doctors to recognise that as caregivers, they may be exhibiting blocking behaviours to ACP discussions that patients are trying to initiate. These should be avoided.

Reliability and validity of Chinese version of the Client-Centred Care Questionnaire / 中国实用护理杂志

Objective To translate the English version of the Client-Centred Care Questionnaire (CCCQ) into Chinese and to test the reliability and validity of the Chinese version of CCCQ.Methods The English version of CCCQ was translated into Chinese by the method of double translation-translation.Totally 320 chronic patients were recruited and they were investigated by the Chinese version of CCCQ.Results The Cronbach coefficient of the Chinese version of CCCQ was 0.925,P＜0.01.The retest reliability was 0.807,P＜0.01.The split-half reliability with r=0.883,P＜0.01.The content validity index (CVI) was 0.956,and every purpose CVI values were above 0.8.Factor analysis got one factor,which explained 52.549％ of the total variance,and each objective factor loading was above 0.4.Conclusions The Chinese version of CCCQ has been proved to be reliable and valid.It can be used as a valid tool for the chronic patients to measure their perceptions of the quality of nursing care.