Mentorship experiences during registrar training: reflections of Black African specialists in the Western Cape

In order to meet the significant staffing challenges to health care provision in South Africa, the need to support the training and retention of Black medical specialists has been identified. This small qualitative study aimed to explore experiences of mentorship among a group of Black medical specialists in hopes of understanding the value and potential challenges that these relationships raise. Ten Black medical specialists were interviewed about their experiences of being mentored during their registrar training. The interview data was analysed using discourse analysis, and the results comprise of three main themes, namely: Difficulty accessing mentorship, a lack of Black and/or female role models and finally, experiences of feeling excluded from soft networks. The experiences explored in this study indicate the need for open dialogue within the mentorship dyad regarding certain taken-for-granted assumptions surrounding race, so as to aid the provision of more effective and satisfying mentorship outcomes.     

Designing Graphs that Promote Both Risk Understanding and Behavior Change

Graphs show promise for improving communications about different types of risks, including health risks, financial risks, and climate risks. However, graph designs that are effective at meeting one important risk communication goal (promoting risk‐avoidant behaviors) can at the same time compromise another key goal (improving risk understanding). We developed and tested simple bar graphs aimed at accomplishing these two goals simultaneously. We manipulated two design features in graphs, namely, whether graphs depicted the number of people affected by a risk and those at risk of harm (“foreground+background”) versus only those affected (“foreground‐only”), and the presence versus absence of simple numerical labels above bars. Foreground‐only displays were associated with larger risk perceptions and risk‐avoidant behavior (i.e., willingness to take a drug for heart attack prevention) than foreground+background displays, regardless of the presence of labels. Foreground‐only graphs also hindered risk understanding when labels were not present. However, the presence of labels significantly improved understanding, eliminating the detrimental effect of foreground‐only displays. Labels also led to more positive user evaluations of the graphs, but did not affect risk‐avoidant behavior. Using process modeling we identified mediators (risk perceptions, understanding, user evaluations) that explained the effect of display type on risk‐avoidant behavior. Our findings contribute new evidence to the graph design literature: unlike what was previously feared, we demonstrate that it is possible to design foreground‐only graphs that promote intentions for behavior change without a detrimental effect on risk understanding. Implications for the design of graphical risk communications and decision support are discussed.     

Loss and grief: The experience of transition to residential aged care

There is growing recognition of the experience of non-death-related loss and grief. One unexplored area of non-death-related loss and grief is associated with older people’s transition from home to residential aged care (RAC). This paper reports findings from a qualitative study that explored the experiences of people living in RAC, carer-relatives of people living in RAC and RAC staff. Using theories of loss and grief, the paper identifies features of the transition to RAC that are associated with unresolved loss and maladaptation to changed circumstances, and the types of support that would mitigate these. Using a series of focus groups with both residents and carer-relatives, as well as staff, the study found that residents and their families need more support to negotiate the multiple, often necessarily hasty decisions and bureaucratic requirements associated with transitioning to RAC, while simultaneously experiencing loss and grief. The types of support that families would welcome from service providers include facilitating shared decision making, valuing family and community carer expertise and providing practical information and assistance to fulfil administrative obligations.     

Pregnancy after loss during the COVID19 pandemic

BackgroundRapid changes to how maternity health care is delivered has occurred in many countries across the globe in response to the COVID-19 pandemic. Maternity care provisions have been challenged attempting to balance the needs and safety of pregnant women and their care providers. Women experiencing a pregnancy after loss (PAL) during these times face particularly difficult circumstances.AimIn this paper we highlight the situation in three high income countries (Australia, Ireland and USA) and point to the need to remember the unique and challenging circumstances of these PAL families. We suggest new practices may be deviating from established evidence-based guidelines and outline the potential ramifications of these changes.FindingsRecommendations for health care providers are suggested to bridge the gap between the necessary safety requirements due to the pandemic, the role of the health care provider, and the needs of families experiencing a pregnancy after loss.DiscussionChanges to practices i.e. limiting the number of antenatal appointments and access to a support person may have detrimental effects on both mother, baby, and their family. However, new guidelines in maternity care practices developed to account for the pandemic have not necessarily considered women experiencing pregnancy after loss.ConclusionBereaved mothers and their families experiencing a pregnancy after loss should continue to be supported during the COVID-19 pandemic to limit unintended consequences.     

人工智能背景下医疗法律责任的现实困境与完善路径

医疗人工智能利用深度学习和计算机算法等现代化技术，实现辅助诊疗、医学影像、药物发掘、健康诊疗等功能，是人工智能应用最具前景的领域之一。随着人工智能技术发展，具备自主思维和决策能力的智能机器人医生等人工智能将对现有的医疗法律责任制度带来颠覆性影响。在人工智能背景下，医疗人工智能是否具有独立法律主体地位、传统的医疗过错责任归责能否适用、因果关系如何认定等成为现代民事法律责任制度的严峻挑战，也成为实践中的必答之问。因此，在借鉴欧美人工智能领域的探索经验的基础上，在当前阶段通过修正和完善我国民事法律责任制度，提出针对不同的人工智能侵权情形适用差别化归责原则，并尝试建立人工智能强制保险或储备金制度，设置人工智能监管机构及行业标准，以实现既保障患者合法公平权益，又鼓励人工智能技术有效发展之间的平衡。     

Using Generational Intelligence to Examine Community Care Work between Younger and Older Adults

Exploring the factors that contribute to sustainable forms of an intergenerational relationship is becoming an important conceptual and practical challenge, not least because of the growing need for an aged care workforce that is both motivated and suitably trained. Generational intelligence is a means of examining interaction between younger and older people which has been applied to community care settings. Dimensions of generational intelligence include recognising and valuing generational differences, finding common ground, plus negotiating social and practical outcomes from the situation. A case study plus a series of qualitative interviews are used to examine the value of this approach both as a means of exploring the processes involved in generational exchange and in providing recommendations for work preparation and training. It is suggested that intergenerational relations have been a missing factor in the understanding of sustainable care and that in future, service delivery should not simply be analysed as comprising professional and lay perspectives but also as containing generationally distinctive perspectives that require negotiation.     

Evaluation of an intervention supporting breastfeeding among late-preterm infants during in-hospital stay

BackgroundLate-preterm infants show lower breastfeeding rates when compared with term infants. Current practice is to keep them in low-risk wards where clinical guidelines to support breastfeeding are well established for term infants but can be insufficient for late-preterm.ObjectiveThe aim of this study was to evaluate an intervention supporting breastfeeding among late-preterm infants in a maternity service in the Basque Country, Spain.MethodsThe intervention was designed to promote parents’ education and involvement, provide a multidisciplinary approach and decision-making, and avoid separation of the mother-infant dyad. A quasi-experimental study was conducted with a control (n = 212) and an intervention group (n = 161). Data was collected from clinical records from November 2012 to January 2015. Feeding rate at discharge, breast-pump use, incidence of morbidities, infant weight loss and hospital stay length were compared between the two groups.ResultsInfants in the control group were 50.7% exclusive breastfeeding, 37.8% breastfeeding, and, 11.5% formula feeding at discharge, whereas in the intervention group, frequencies were 68.4%, 25.9%, and 5.7%, respectively (p = 0.002). Mothers in the intervention group were 2.66 times more likely to use the breast-pump after almost all or all feeds and 2.09 times more likely to exclusively breastfeed at discharge. There were no significant differences in morbidities and infant weight loss between groups. Hospital stay was longer for infants who required phototherapy in the intervention group (p = 0.009).ConclusionThe intervention resulted in a higher breastfeeding rate at discharge. Interventions aimed to provide specific support among late-pretem infants in maternity services are effective.     

Caring for families experiencing stillbirth: Evidence-based guidance for maternity care providers

BackgroundEvidence-based guidance is needed to inform care provided to mothers and families who experience stillbirth. This paper focuses upon how meaningful and culturally appropriate care can be provided to mothers and families from when they are informed that their baby will be stillborn to many years after the experience. Avoidable suffering may be occurring in the clinical setting.AimsTo promote and inform meaningful and culturally appropriate evidence-informed practice amongst maternity care providers caring for mothers and families who experience stillbirth.MethodsA comprehensive systematic review was conducted which primarily synthesised relevant qualitative research studies. An expert advisory group comprised of stillbirth researchers, clinicians, and parents who have experienced stillbirth provided guidance for the review and the development of implications for practice.FindingsGrieving parents want staff to demonstrate sensitivity and empathy, validate their emotions, provide clear, information, and be aware that the timing of information may be distressing. Parents want support and guidance when making decisions about seeing and holding their baby. Sensitivity, respect, collaboration, and information are essential throughout the experience of stillbirth. Culturally appropriate care is important and may require staff to accommodate different cultural practices.ConclusionThe findings of the review and expert consensus inform the provision of meaningful and culturally appropriate care for mothers and families that have experienced stillbirth. Evidence informed implications for practice are provided to guide the actions, communication, and behaviours of maternity care providers.     

Designing centralized waiting lists for attachment to a primary care provider: Considerations from a logic analysis

Access to a regular primary care provider is essential to quality care. In Canada, where 15 % of patients are unattached (i.e., without a regular provider), centralized waiting lists (CWLs) help attach patients to a primary care provider (family physician or nurse practitioner). Previous studies reveal mechanisms needed for CWLs to work, but focus mostly on CWLs for specialized health care. We aim to better understand how to design CWLs for unattached patients in primary care.In this study, a logic analysis compares empirical evidence from a qualitative case study of CWLs for unattached patients in seven Canadian provinces to programme theory derived from a realist review on CWLs. Data is analyzed using context-intervention-mechanism-outcome configurations.Results identify mechanisms involved in three components of CWL design: patient registration, patient prioritization, and patient assignment to a provider for attachment. CWL programme theory is revised to integrate mechanisms specific to primary care, where patients, rather than referring providers, are responsible for registering on the CWL, where prioritization must consider a broad range of conditions and characteristics, and where long-term acceptability of attachment is important. The study provides new insight into mechanisms that enable CWLs for unattached patients to work.