Motivations for and outcomes of graduate education amongst dental hygienists: A pan-Canadian study.

OBJECTIVES: Motivations and career outcomes of dental hygienists with baccalaureate degrees have been recently reported; however, few studies have explored Canadian dental hygienists pursuing graduate education. There is limited evidence to inform career outcomes and motivating factors for advanced education, limiting knowledge of how professional outcomes have evolved alongside advancements in graduate program offerings. This study focused on understanding motivating factors to pursue graduate education and the professional outcomes of dental hygienists with graduate degrees. METHODS: This nested online anonymous survey was conducted between November and December 2021 with dental hygienists who graduated from one of four Canadian baccalaureate-level dental hygiene degree programs and had further indicated that they were pursuing or had obtained additional graduate-level education (n = 60). Participants were asked to report on any advanced graduate-level education. Open-ended questions on graduate degree education were analysed through thematic analysis. RESULTS: Motivations for pursuing graduate degrees were influenced by personal and professional preferences. Master's degree recipients cited expanded career opportunities, alternate interests, convenience, and dissatisfaction with/desire to leave clinical practice as major motivators. Doctoral degree holding dental hygienists identified expanded/alternate career opportunities as major motivation but also cited program convenience as an influencer. The availability of distance and flexible programming is a novel finding that positively influences the pursuit of advanced education. CONCLUSION: Dental hygienists are pursuing graduate education to expand their scope of knowledge and create new career opportunities. Graduate degree programs that accommodate work-life balance through flexible and online offerings are very attractive to dental hygienists.

"We talk teeth": Exploring faculty EDIA (equity, diversity, inclusivity, and access) capacity in dental education.

PURPOSE: There are increasing concerns regarding inequitable educational access and experiences for underrepresented populations in health education, prompting dental faculties to recognize EDIA (equity, diversity, inclusivity, and access) capacity as a strategic priority. Faculty members contribute to the establishment and reinforcement of institutionally engrained norms within learning settings with significant influence on the experience of students. Currently, there is limited literature on faculty EDIA capacity within dental education and minimal evidence to inform barriers to development. This study sought to explore how dental faculty members perceive their personal and institutional EDIA capacity and to identify current strengths and weaknesses of EDIA development within the institution of study and dental education. METHODS: Using a hermeneutic study design, semi-structured interviews were conducted on a convenience sampling of dental faculty members (n = 10) and a thematic, interpretative analysis was applied. RESULTS: Findings revealed six dominant themes impacting EDIA capacity. Knowledge of EDIA language, interfaculty communication, and institutional messaging are identified as weaknesses, whereas informal, community building events for EDIA development are identified as novel strengths meriting prioritization. Motivation to engage in EDIA by faculty members overall is illuminated in relation to emotionally provocative experiences. CONCLUSION: Current institutional communication of EDIA is unconsciously restricting capacity building based on hierarchical and prescribed parameters. Developing capacity in dental education requires a redirection of resources to initiatives valuing social bonding over prescribed box-checking. This study reveals a new narrative of EDIA capacity within dental education and sustainable pathways for development with high transferability to other health programs.

COVID-19 incidence and vaccination rates among Canadian dental hygienists.

Background: Oral health care settings potentially carry a high risk of cross-infection due to close contact and aerosol-generating procedures. There is limited evidence of the impact of COVID-19 among dental hygienists. This longitudinal study aimed to 1) estimate COVID-19 incidence rates among Canadian dental hygienists over a 1-year period; and 2) estimate vaccination rates among Canadian dental hygienists. Methods: A prospective cohort study design was used to collect self-reported COVID-19 status from 876 registered dental hygienists across Canada via an online baseline survey and then 6 follow-up questionnaires delivered between December 2020 and January 2022. Bayesian Poisson and binomial models were used to estimate the incidence rate and cumulative incidence of self-reported COVID-19. Results: The estimated cumulative incidence of COVID-19 in dental hygienists in Canada from December 2020 to January 2022 was 2.39% (95% CrI, 1.49%-3.50%), while the estimated cumulative incidence of COVID-19 in corresponding Canadian provinces was 5.12% (95% CrI, 5.12%-5.13%) during the same period. At last follow-up, 89.4% of participants self-reported that they had received at least 1 dose of a COVID-19 vaccine. Conclusion: The low infection rate observed among Canadian dental hygienists between December 2020 and January 2022 is reassuring to the dental hygiene and general community.

Contexte: Les milieux de soins buccodentaires présentent potentiellement un risque élevé d'infections croisées en raison des contacts étroits et des procédures qui produisent des aérosols. Il y a peu de preuves de l'effet de la COVID-19 chez les hygiénistes dentaires. La présente étude longitudinale visait à 1) estimer les taux d'incidence de la COVID-19 chez les hygiénistes dentaires canadiens sur une période d'un an; et 2) estimer les taux de vaccination chez les hygiénistes dentaires canadiens. Méthodologie: Une méthodologie prospective des cohortes a été utilisée pour recueillir le statut de COVID-19 autodéclaré de 876 hygiénistes dentaires autorisés au Canada par l'intermédiaire d'une enquête initiale en ligne, puis de 6 questionnaires de suivi, distribués entre décembre 2020 et janvier 2022. Des modèles bayésiens de Poisson et binomiaux ont été utilisés pour estimer le taux d'incidence et l'incidence cumulative de la COVID-19 autodéclarée. Résultats: L'incidence cumulative estimée de la COVID-19 chez les hygiénistes dentaires au Canada entre décembre 2020 et janvier 2022 était de 2,39 % (intervalle de crédibilité à 95 %, 1,49 % ­ 3,50 %), alors que l'incidence cumulative estimée de la COVID-19 dans les provinces canadiennes correspondantes était de 5,12 % (intervalle de crédibilité à 95 %, 5,12 % ­ 5,13 %) au cours de la même période. Lors du dernier suivi, 89,4 % des participants ont déclaré avoir reçu au moins une dose du vaccin contre la COVID-19. Conclusion: Le faible taux d'infection constaté chez les hygiénistes dentaires canadiens entre décembre 2020 et janvier 2022 est rassurant pour la communauté d'hygiène dentaire et la communauté générale.

Canadian dental hygienists' experiences and perceptions of regulatory guidelines during the COVID-19 pandemic: a qualitative descriptive analysis.

BACKGROUND: In Spring of 2020, due to the COVID-19 pandemic, Canadian provincial dental hygiene regulatory bodies implemented new practice guidelines. Reports of stress, anxiety and conflict experienced by dental hygienists have been linked to miscommunication between oral health regulators at this time. Limited data exists on the perceptions and experiences of dental hygienists navigating new guidelines for dental hygiene care during the pandemic. Therefore, the objective of our study was to explore via descriptive thematic analysis how dental hygienists experienced and perceived: i) dental hygiene practice during the COVID-19 pandemic, and ii) their regulatory body's COVID-19 guidelines. METHODS: Participants were identified through provincial dental hygiene licensing bodies. Online bi-monthly questionnaires were administered to participants (n = 876) from December 2021 to January 2022. Two open-ended questions were asked in the questionnaire. A qualitative descriptive thematic analysis was applied to these two questions. RESULTS: Major themes at baseline relayed challenges related to workplace compliance, patient treatment and communication of practice protocols. Across responses, hygienists confirmed conflicting messaging from regulators and guideline interpretations as stressors impacting their professional practice and satisfaction within the profession. Participant responses at endpoint cited increased satisfaction with regulatory guidelines as the pandemic evolved, yet inconsistencies in regulators' messaging was noted as a prevailing issue. CONCLUSION: Inconsistent guideline messaging reflects an increased need for collaboration amongst oral health care regulators to streamline protocols for practice and reduce interprofessional conflict in pandemic circumstances. A national unified approach is warranted in establishing guidelines for dental hygiene practice in Canada.

Burnout syndrome in Nova Scotia dental hygienists during the COVID-19 pandemic: Maslach Burnout Inventory.

Background: Burnout syndrome is the result of prolonged occupational stress. The syndrome has 3 dimensions: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). This study aimed to examine the prevalence of the 3 dimensions of burnout in dental hygienists in Nova Scotia, Canada, (N = 745) as they returned to work during the COVID-19 pandemic following a furlough; to explore the effect of burnout during COVID-19 on dental hygienists' professional lives; and to determine the tools and methods that dental hygienists use to overcome burnout. Methods: In this cross-sectional study, participants were asked to complete an anonymous survey inclusive of demographic information, employment characteristics, the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS [MP]), and 2 open-ended questions. Results: The response rate was 34.9% (n = 260). Approximately one-third (36.2%) of respondents met the criteria for burnout. Contributors to burnout were time, providing dental hygiene care, expectations of dentists, physical and mental health, lack of autonomy, and the COVID-19 pandemic. Reported mechanisms to overcome occupational stress centred on work-life balance, social support networks, working in a positive environment, and physical activity. Discussion: This study took place during the first wave of the COVID-19 pandemic, which may have influenced the rate of burnout among dental hygienists, particularly within the EE domain where scores were twice as high as those reported in pre-COVID-19 studies. Conclusion: Dental hygienists may be at risk for burnout. Recognizing the signs and symptoms of burnout and implementing healthy behaviours may reduce its detrimental effects.

Contexte: La prolongation du stress professionnel entraîne le syndrome de l'épuisement professionnel. Le syndrome comporte 3 volets : l'épuisement émotionnel (ÉÉ), la dépersonnalisation (DP) et la diminution de l'épanouissement personnel (ÉP). La présente étude visait à examiner la prévalence des 3 volets de l'épuisement professionnel chez les hygiénistes dentaires en Nouvelle-Écosse, Canada, (N = 745) à leur retour au travail après avoir eu un congé pendant la pandémie de la COVID-19; à explorer l'effet de l'épuisement professionnel sur la vie professionnelle des hygiénistes dentaires pendant la COVID-19; et à établir quels outils et méthodes les hygiénistes dentaires utilisent pour remédier à l'épuisement professionnel. Méthodologie: Les participants ont été invités à répondre à un sondage anonyme pour cette étude transversale, comprenant les données démographiques, les caractéristiques d'emploi, le sondage Maslach Burnout Inventory Human Services pour le personnel médical (MBI-HSS [PM]) et 2 questions ouvertes. Résultats: Le taux de réponse était de 34,9 % (n = 260). Environ le tiers (36,9 %) des répondants a satisfait aux critères de l'épuisement professionnel. Les facteurs qui y ont contribué étaient le temps, la prestation de soins d'hygiène dentaire, les attentes des dentistes, la santé physique et mentale, le manque d'autonomie et la pandémie de la COVID-19. La conciliation travail­vie personnelle, les réseaux de soutien social, travailler dans un environnement positif et l'activité physique étaient cités comme mécanismes qui permettent de surmonter le stress professionnel. Discussion: Cette étude a été effectuée pendant la première vague de la pandémie de la COVID-19, ce qui peut avoir influencé le taux d'épuisement professionnel chez les hygiénistes dentaires, particulièrement en matière d'ÉÉ où les cotes étaient 2 fois plus élevées que celles signalées dans les études d'avant la COVID-19. Conclusion: Les hygiénistes dentaires peuvent être à risque d'épuisement professionnel. Reconnaître les signes et les symptômes de l'épuisement professionnel et mettre en œuvre des comportements sains peuvent réduire ses effets adverses.

Demographic and psychological predictors of community pharmacists' cancer-related conversations with patients: a cross-sectional analysis and survey study.

BACKGROUND: There is increasing interest in the role of community pharmacy in the early diagnosis and prevention of cancer. This study set out to examine how often community pharmacists (CPs) encourage patients to spot or respond to potential signs and symptoms of cancer, and how often they help people to make an informed decision about taking part in bowel cancer screening. METHODS: Data from 400 UK CPs, who completed the 2018 Cancer Research UK Healthcare Professional Tracker survey, were analysed. The primary outcomes were: 'how often CPs encourage patients to spot or respond to potential signs and symptoms of cancer' and 'how often CPs encourage eligible people to make an informed decision to participate in bowel cancer screening'. Associations between behaviours and demographic and psychological variables (Capability, Opportunity and Motivation) were assessed using multivariate logistic regression. RESULTS: Most (n = 331, 82.8%) CPs reported occasionally, frequently or always encouraging patients to spot or respond to potential signs and symptoms of cancer, while only half (n = 203, 50.8%) reported occasionally, frequently or always helping people make an informed decision to participate in bowel cancer screening. Female sex (aOR: 3.20, 95%CI: 1.51, 6.81; p < 0.01) and increased Opportunity (aOR: 1.72, 95%CIs: 1.12, 2.64; p < 0.05) and Motivation (aOR: 1.76, 95%CIs: 1.37, 2.27; p < 0.001) were associated with encouraging patients to spot or respond to potential signs and symptoms of cancer; all three psychological variables were associated with helping people to make an informed decision to participate in bowel cancer screening (Capability: aOR: 1.39, 95%CIs: 1.26, 1.52, p < 0.001; Opportunity: aOR: 1.44, 95%CIs: 1.11, 1.87; p < 0.01; Motivation: aOR: 1.45, 95%CIs: 1.05, 2.00; p < 0.05). CONCLUSIONS: Most CPs encourage patients to spot or respond to potential cancer symptoms, while only half help them make an informed decision to participate in bowel cancer screening. A multifaceted approach, targeting multiple COM-B components, is required to change these behaviours.

A Model of the Cosmos in the ancient Greek Antikythera Mechanism.

The Antikythera Mechanism, an ancient Greek astronomical calculator, has challenged researchers since its discovery in 1901. Now split into 82 fragments, only a third of the original survives, including 30 corroded bronze gearwheels. Microfocus X-ray Computed Tomography (X-ray CT) in 2005 decoded the structure of the rear of the machine but the front remained largely unresolved. X-ray CT also revealed inscriptions describing the motions of the Sun, Moon and all five planets known in antiquity and how they were displayed at the front as an ancient Greek Cosmos. Inscriptions specifying complex planetary periods forced new thinking on the mechanization of this Cosmos, but no previous reconstruction has come close to matching the data. Our discoveries lead to a new model, satisfying and explaining the evidence. Solving this complex 3D puzzle reveals a creation of genius-combining cycles from Babylonian astronomy, mathematics from Plato's Academy and ancient Greek astronomical theories.

How do patients and General Practitioners talk about pain and negotiate empathy in consultations? A direct observational study.

The objective of this qualitative study in New Zealand was to investigate how general practitioners and patients discuss chronic pain in consultations. Chronic pain is a complex condition that defies many commonsense understandings. It is challenging to manage and patients can come to conclude that there is an empathy deficit. To our knowledge most, if not all, studies on this topic have recruited participants whose main presenting complaint is chronic pain. Forms of chronic pain are relatively common in the population and we thought it likely that at least some discussions may be rendered invisible via these recruiting practices. The study analysed data from the Applied Research on Communication in Health repository of audio transcripts and video-recorded consultations collected from a range of studies on a variety of topics, none of which were about chronic pain specifically. We searched the 256 transcripts looking for key words that might indicate that pain was at least part of the consultation. This yielded a large number of potentially relevant transcripts. These transcripts were assessed and reduced to 18 by excluding those that were about non-physical pain or pain that was expected to resolve relatively quickly. A medical specialist in chronic pain reviewed the resulting 18 and excluded two further transcripts giving us a final sample of 16. We conducted in-depth analysis of these consultations. Rather than confirming an empathy deficit, we found a much more complex deployment of empathy in the space where the two complex systems of chronic pain and general practice meet. These findings highlight the utility of analysing data originally generated for other purposes, with permission, and in a practical sense, highlight the importance of understanding empathy as highly contextual in 'real world' practice.

Preparing Veterinarians to Address the Health Impacts of Climate Change: Student Perceptions, Knowledge Gaps, and Opportunities.

Climate change poses a significant and increasing threat to global health. While veterinarians play integral roles in public and environmental health, the profession has been less engaged in the topic of climate change relative to their human medical counterparts. The objective of this study was to synthesize veterinary students' perceptions and knowledge about the relationship between veterinary medicine and climate change to identify educational gaps and opportunities. An online questionnaire was disseminated to American Veterinary Medical Association (AVMA)-accredited veterinary colleges through the Student American Veterinary Medical Association newsletter. Respondents were overwhelmingly confident that climate change is happening, is due to human activities, and is impacting both human and animal health. Veterinary students also expressed the belief that veterinarians should take a leadership role on the issue of climate change, especially through promoting environmental sustainability in clinical practice. Despite this enthusiasm, most students reported a lack of educational opportunities within their veterinary programs. The results of this survey highlight opportunities for the development of educational resources on the topic, many of which could complement existing material such as that devoted to practice management, economics, and client communication. Veterinarians have the potential to meaningfully contribute to both mitigation and adaptation efforts around climate change; however, they must be equipped with the tools to do so.

Communication in high risk ante-natal consultations: a direct observational study of interactions between patients and obstetricians.

BACKGROUND: Effective communication is crucial to any doctor-patient consultation, not least in pregnancy where the outcome affects more than one person. While higher levels of patient participation and shared decision making are recognised as desirable, there is little agreement on how best to achieve this. Most previous research in this area is based on reported data such as interviews or surveys and there is a need for more fine-grained analysis of authentic interaction. This study aimed to identify the discourse characteristics and patterns that exemplify effective communication practices in a high-risk ante-natal clinic. METHODS: We video-recorded 20 consultations in a high-risk ante-natal clinic in a large New Zealand city with patients attending for the first time. Post-consultation interviews were conducted with the 20 patients and 13 obstetricians involved. Discourse analysis of the transcripts and videos of the consultations was conducted, in conjunction with thematic analysis of interview transcripts. RESULTS: Most patients reported high quality communication and high levels of satisfaction; the detailed consultation analysis revealed a range of features likely to have contributed. On the clinician side, these included clear explanations, acknowledgement of the patient's experience, consideration of patient wishes, and realistic and honest answers to patient questions. On the patient side, these included a high level of engagement with technical aspects of events and procedures, and appropriate questioning of obstetricians. CONCLUSIONS: This study has demonstrated the utility of combining direct observation of consultations with data from patient experience interviews to identify specific features of effective communication in routine obstetric ante-natal care. The findings are relevant to improvements needed in obstetric communication identified in the literature, especially in relation to handling psychosocial issues and conveying empathy, and may be useful to inform communication training for obstetricians. The presence of the unborn child may provide an added incentive for parents to develop their own health literacy and to be an active participant in the consultation on behalf of their child. The findings of this study can lay the groundwork for further, more detailed analysis of communication in ante-natal consultations.

Smartphone screening for neonatal jaundice via ambient-subtracted sclera chromaticity.

Jaundice is a major cause of mortality and morbidity in the newborn. Globally, early identification and home monitoring are significant challenges in reducing the incidence of jaundice-related neurological damage. Smartphone cameras are promising as colour-based screening tools as they are low-cost, objective and ubiquitous. We propose a novel smartphone method to screen for neonatal jaundice by imaging the sclera. It does not rely on colour calibration cards or accessories, which may facilitate its adoption at scale and in less economically developed regions. Our approach is to explicitly address three confounding factors in relating colour to jaundice: (1) skin pigmentation, (2) ambient light, and (3) camera spectral response. (1) The variation in skin pigmentation is avoided by imaging the sclera. (2) With the smartphone screen acting as an illuminating flash, a flash/ no-flash image pair is captured using the front-facing camera. The contribution of ambient light is subtracted. (3) In principle, this permits a device- and ambient-independent measure of sclera chromaticity following a one-time calibration. We introduce the concept of Scleral-Conjunctival Bilirubin (SCB), in analogy with Transcutaneous Bilirubin (TcB). The scleral chromaticity is mapped to an SCB value. A pilot study was conducted in the UCL Hospital Neonatal Care Unit (n = 37). Neonates were imaged using a specially developed app concurrently with having a blood test for total serum bilirubin (TSB). The better of two models for SCB based on ambient-subtracted sclera chromaticity achieved r = 0.75 (p<0.01) correlation with TSB. Ambient subtraction improved chromaticity estimates in proof-of-principle laboratory tests and screening performance within our study sample. Using an SCB decision threshold of 190µmol/L, the sensitivity was 100% (specificity 61%) in identifying newborns with TSB>250µmol/L (area under receiver operating characteristic curve, AUROC, 0.86), and 92% (specificity 67%) in identifying newborns with TSB>205µmol/L (AUROC 0.85). These results are comparable to modern transcutaneous bilirubinometers.

Health Care Providers' Perceptions of Antimicrobial Use and Stewardship at Acute Care Hospitals in Nova Scotia.

BACKGROUND: Antimicrobial use is the major factor in the development of antimicrobial resistance. Antimicrobial stewardship has been recommended as a strategy to improve antimicrobial use. OBJECTIVE: To learn about health care providers' perceptions of current antimicrobial use and stewardship, including barriers and facilitators to improving antimicrobial use at acute care hospitals in Nova Scotia. METHODS: This qualitative research study was conducted at acute care hospitals in Nova Scotia using focus groups and semistructured interviews. Health care providers (nurses, nurse practitioners, pharmacists, pharmacy students, and physicians) were invited to participate. Focus groups and interviews were conducted at each participant's place of employment. Interviews and focus groups were facilitated with an interview guide, audio-recorded, and transcribed verbatim. Transcripts were independently coded by 2 investigators and analyzed using thematic analysis. RESULTS: A total of 9 focus groups and 3 individual interviews were conducted between June and August 2017. Fifty-four health care professionals and trainees (24 pharmacists and pharmacy students, 14 physicians, and 16 nurses and nurse practitioners) from 5 hospitals participated. The following themes were identified: current practices, prescribing influences, access to information, collaboration and communication, resources, and antimicrobial stewardship. Within each theme, barriers and facilitators to improving antimicrobial use were identified as subthemes. CONCLUSION: Participants identified current barriers to appropriate use of antimicrobials and suggested facilitators that might improve the use of these drugs. The results of this study could be used by antimicrobial stewardship teams and decision-makers to improve antimicrobial use and stewardship initiatives throughout Nova Scotia, and may be applicable to hospitals outside the province.

CONTEXTE: L'utilisation des antimicrobiens est le principal facteur de développement de la résistance à cette classe de médicaments. La gestion des antimicrobiens a été recommandée comme stratégie visant à améliorer leur utilisation. OBJECTIF: Découvrir la perception des fournisseurs de soins de santé au sujet de l'utilisation et de la gestion actuelles des antimicrobiens, y compris les obstacles et les moyens destinés à favoriser l'amélioration de leur utilisation dans des hôpitaux de soins actifs en Nouvelle-Écosse. MÉTHODES: Cette recherche qualitative a été menée dans des hôpitaux de soins actifs en Nouvelle-Écosse à l'aide de groupes de discussion et d'entretiens semi-structurés. Les fournisseurs de soins de santé (infirmières, infirmières praticiennes, pharmaciens, étudiants en pharmacie et médecins) ont été invités à y participer. Les groupes de discussion et les entretiens ont été menés sur chaque lieu de travail des participants. Ils ont été facilités grâce à un guide d'entretien. Ils ont aussi été enregistrés (audio) et retranscrits textuellement. Les transcriptions ont été codées de façon indépendante par deux enquêteurs et étudiées à l'aide d'une analyse thématique. RÉSULTATS: Neuf groupes de discussion et trois entretiens individuels ont été menés entre juin et août 2017. Cinquante-quatre professionnels et stagiaires de la santé (24 pharmaciens et étudiants en pharmacie, 14 médecins, 16 infirmières et infirmières praticiennes) provenant de cinq hôpitaux y ont participé. Les thèmes suivants ont été soumis à la discussion : pratiques actuelles, influences en matière de prescription, accès aux informations, collaboration et communication, ressources et gestion des antimicrobiens. Chaque thème comportait deux sous-thèmes abordant les obstacles et les mesures favorisant l'amélioration de l'utilisation des antimicrobiens. CONCLUSION: Les participants ont relevé les obstacles actuels nuisant à une bonne utilisation des antimicrobiens et ont proposé des moyens pour améliorer l'utilisation de ces médicaments. Les résultats de cette étude pourraient être utilisés par les équipes de gestion des antimicrobiens ainsi que par les décideurs qui doivent favoriser l'amélioration de l'utilisation des antimicrobiens et les initiatives relatives à leur gestion partout en Nouvelle-Écosse. Ils sont aussi applicables aux hôpitaux extérieurs à la province.

Jaundice Eye Color Index (JECI): quantifying the yellowness of the sclera in jaundiced neonates with digital photography.

The sclera is arguably a better site than the skin to measure jaundice-especially in dark-skinned patients-since it is free of skin pigment (melanin), a major confounding factor. This work aims to show how the yellowness of the sclera can be quantified by digital photography in color spaces including the native RGB and CIE XYZ. We also introduce a new color metric we call "Jaundice Eye Color Index" (JECI) which allows the yellowness of jaundiced sclerae to be predicted for a specific total serum bilirubin level in the neonatal population.

Daily decision-making about food during pregnancy: a New Zealand study.

Pregnancy has always been a life-changing event for women and their families, but societal concern about pregnancy and motherhood has become intense in the digital age. The role of health promotion agencies and others supplying health-related resources about lifestyle behaviours is both important and in need of scrutiny. Ever increasing advice for pregnant women, their families and health professionals, abounds. This study of decision making during pregnancy investigated how women made everyday decisions during pregnancy about food and drink, as well as dietary supplements and medications, alcohol and recreational drugs. This qualitative interview study was a side-arm to a double-blind randomized, placebo-controlled trial conducted with pregnant women in Wellington New Zealand, 2013-2016. Data from interviews with 20 women were analysed using inductive thematic analysis. In relation to decision-making about lifestyle behaviours, five themes emerged-Information about food; Wanted and unwanted advice; Worry, anxiety and indecision; Making daily decisions about food; Changes in decision making over time. Participating women talked more about food selection and restriction advice than any other lifestyle topic. Analysis demonstrated concern about information accuracy and overload from multiple, diverse sources. Women described learning how to assess resource credibility, how to develop decision-making skills, and who to trust. The study raises important questions about how the health information environment, despite best intentions, can be confusing or potentially harmful. The study underlines the continued importance of the role health professionals have in not only interpreting information to discuss individualized advice, but also in empowering pregnant women to develop lifestyle-related decision-making skills.

A taboo topic? How General Practitioners talk about overweight and obesity in New Zealand.

INTRODUCTION Obesity is overtaking tobacco smoking in New Zealand as the leading potentially modifiable risk to health. International obesity guidelines recommend that health professionals opportunistically encourage weight management with their patients. However, research shows consistently low rates of weight management discussion, suggesting that health professionals may not be realising their full potential to address obesity. AIM To identify communication strategies used by General Practitioners (GPs) to open the topic of weight and weight management in routine consultations. METHODS A secondary analysis was conducted of 36 video-recorded consultations in general practices, selected for relevance from a database of 205 consultations. Content and interactional analysis was conducted in the context of the entire consultation. RESULTS The topic of weight was initiated more often by GPs than patients and was raised mostly once or twice in a consultation and occasionally as many as six times. GPs employed opportunistic strategies twice as often as they used structured strategies. DISCUSSION This study of naturally occurring consultations confirmed GPs do engage in opportunistic discussions about weight. However, such discussions are challenging and interactionally delicate. Highlighting the clinical relevance of weight appears to be effective. The high frequency of patient contact with GPs provides opportunity to reach and work with people at risk of chronic conditions associated with excess weight. Further research is required to identify suitable training and brief intervention tools for use in routine consultations that may be beneficial for both GPs and patients.

A Longitudinal Study of Interactions Between Health Professionals and People With Newly Diagnosed Diabetes.

PURPOSE: We undertook a study to observe in detail the primary care interactions and communications of patients with newly diagnosed diabetes over time. In addition, we sought to identify key points in the process where miscommunication might occur. METHODS: All health interactions of 32 patients with newly diagnosed type 2 diabetes were recorded and tracked as they moved through the New Zealand health care system for a period of approximately 6 months. Data included video recordings of patient interactions with the health professionals involved in their care (eg, general practitioners, nurses, dietitians). We analyzed data with ethnography and interaction analysis. RESULTS: Challenges to effective communication in diabetes care were identified. Although clinicians showed high levels of technical knowledge and general communication skill, initial consultations were often driven by biomedical explanations out of context from patient experience. There was a perception of time pressure, but considerable time was spent with patients by health professionals repeating information that may not be relevant to patient need. Health professionals had little knowledge of what disciplines other than their own do and how their contributions to patient care may differ. CONCLUSIONS: Despite current high skill levels of primary care professionals, opportunities exist to increase the effectiveness of communication and consultation in diabetes care. The various health professionals involved in patient care should agree on the length and focus of each consultation.

Exploring interprofessional, interagency multimorbidity care: case study based observational research.

BACKGROUND: The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. OBJECTIVE: To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. DESIGN: Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. RESULTS: The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. CONCLUSION: Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them.

"I can't bend it and it hurts like mad": direct observation of gout consultations in routine primary health care.

BACKGROUND: Gout is the most common form of inflammatory arthritis and is associated with considerable co-morbidity. It is usually managed in the primary care setting with a combination of lifestyle modification and pharmacological therapy. This study describes patterns of communication about gout observed in interactions between patients and primary care practitioners during routine consultations. METHODS: Secondary analysis of video-recordings of individual healthcare consultations between patients and a range of primary care practitioners (including general practitioners, practice nurses, podiatrists and dietitians) from an archived database. Consultations that included any discussion about gout were eligible for inclusion (n = 31) and were not restricted to those where gout was the main presenting complaint. The consultation transcripts were analysed using a qualitative inductive approach from clinical and linguistic perspectives and supplemented with visual observation of the interactions. RESULTS: Two main themes emerged from the data; the importance of gout and 'telling' versus 'listening' in consultations. The first theme had two distinct strands; gout as an incidental part of the consultation and the impact of gout on patients. A trend towards more didactic practitioner communication encompassed by the second theme occurred at many different consultation points including diagnosis, in more general post-diagnosis discussion, and when discussing biochemical test results and lifestyle advice. In contrast, when discussion about treatment with medicines occurred a tendency towards a greater degree of listening to patients was observed. CONCLUSION: Our observation of the communication patterns in these consultations illustrates an inherent complexity of gout consultations in primary care. Gout may be more important to patients than is often apparent to practitioners in routine consultations. Consultation management needs to take into account the impact of the condition and the balance of information provided around lifestyle advice versus long-term management with medicines.