The Central Appalachian region of the United States disproportionately experiences higher rates of cardiovascular diseases (CVD) and associated risk factors. Primary risk factors for CVD include hypertension, hypercholesterolemia, and tobacco use, all of which have the potential to be mitigated through lifestyle behavior changes. Dietary and physical activity practices are the two main driving forces for the development of hypertension and hypercholesterolemia, while tobacco use is a behavioral choice on its own. Subsequentially, shifting lifestyle choices to emphasize healthier living has the potential to reduce CVDs within the Central Appalachian region. Considering behavioral choices are not made in isolation and are the result of internal and external influences, it is necessary to contemplate the multitude of factors driving these rates. Additionally, healthcare systems within this region ability to provide patient-centered care (PCC) is another consideration, as effective point of care also can address these rates from a disease treatment and management level. The purpose of this study was to explore the knowledge, perceptions, and influences among patients with cardiovascular diseases and non-licensed caregivers within these communities, at the behavioral and community levels, in addition to the perceptions of essential components of PCC among professional stakeholders. Seven focus group discussions with CVD patients and non-licensed caregivers were conducted, with a total of 78 participants; additionally, 20 interviews were held with professional stakeholders within the healthcare field. At the behavioral level participants identified internal and external barriers to sustaining healthy diets, the impact of interpersonal relationships on diet and stress, and influential role of cardiac rehabilitation in physical activity following a major cardiac event. At the community level participants discussed the economic characteristics of communities, a need for community infrastructure expansion, and the role of community organizations. Professional stakeholders addressed PCC in the current healthcare system, constructs of effective patient-provider interactions and the role of community outreach. This research serves as a look into the challenges and opportunities within this region and provides insight to inform future research and interventions.

Syfte: Studiens syfte är att med hjälp av enkäter utvärdera ungdomars upplevelser under besök hos ortodontist eller ortodontiassistent i samband med behandling med fast apparatur. Målsättningen är också att belysa om det eventuellt finns några skillnader i upplevelsen beroende på vilken behandlingsteknik som används vid tandreglering.  Material och metod: Studien är en del av ett större forskningsprojekt som har syftet att jämföra självligerande brackets (Damon) med konventionella brackets (Victory). Deltagarna i denna studie har efter varje behandlingstillfälle tilldelats en enkät. Frågorna handlar om hur vårdtagaren upplevt vårdgivarens kunskap, bemötande, acceptans och delgivning av information.  Resultat: Totalt ingår 113 vårdtagare i studien (54 pojkar och 59 flickor). Medelåldern vid behandlingsstart var 14,7 år. Båda teknikerna fick höga betyg, vilket innebär att vårdtagarna generellt är nöjda med behandlingarna. Fem av frågorna visade signifikanta skillnader vid jämförelse mellan Damon och Victory. Frågorna som handlade om information, förståelse, acceptans samt om vårdgivaren var hårdhänt, visade skillnad vid besök 4. För frågan gällande noggrannhet visades skillnad vid besök 3, 4 och 5. Ingen signifikant skillnad mellan könen visades för någon fråga.  Slutsats: Utfallet indikerar att svensk ortodontisk vård fungerar bra ur vårdtagarnas perspektiv, vilket är något som bör upprätthållas inom tandvården. Få skillnader noterades vid jämförelse mellan behandling med Damon och Victory. Resultatet kan indikera att vårdtagarens upplevelse av bemötande är mer positivt vid behandling med Damon, samt att den ortodontiska behandlingen upplevs mindre hårdhänt jämfört med Victory. / Aim: The aim of this study is to examine the experiences of adolescents, during visits at the orthodontist or orthodontic assistant, for fixed appliances treatment. The purpose is also to examine possible differences in experience when treated with self-ligating or conventional brackets.  Material and method: This study is a part of a larger project that aims to compare self-ligating brackets (Damon) with conventional brackets (Victory). After each treatment session the patients received a questionnaire. The questions concerning the patients experience of the care givers way of showing knowledge, acceptance, responsibility of interaction and the way of communication the information.  Result: In total 113 participants were included in the study (54 boys and 59 girls). At the beginning of the treatments the average age of the participants were 14,7 years. Both techniques received high grades, meaning the patients generally were satisfied with the treatments. Five questions showed significant differences in comparison between the techniques. The questions about information, understanding, acceptance and whether the caregiver was harsh in handling, showed differences at visit 4. Regarding the question about accuracy, a difference was noted during visit 3, 4 and 5. No significant difference between the sexes was shown for any question.  Conclusion: From the patient ́s point of view Swedish orthodontic care is satisfying. Few differences were noted when comparing the appliances. The results may indicate that treatment with Damon gives a more positive and less harshly experience in comparison with Victory. / CROWDIT

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Patient-care skills in medicine have become more important over time to promote the health and well-being of patients. It has become critical to research how medical schools can best teach students patient-care skills. This is a mixed-method study on the experiences of first and second-year Boston University School of Medicine students and faculty about the relationship between their medical school curriculum and patient-centered care skills including communication, empathy, and the cultural context of care. Patient-centered care and its accompanying skills (empathy, communication, and cultural context of care) are supported and developed at the Boston University school of Medicine. These skills are promoted through curricular adaptation influenced by changing concerns within biomedicine. As well as Doctoring 1 and 2 courses, their patient-actor events, and the development of students’ professional physician identity. Methods will include participant observation and review of curriculum and program documents. This study also includes surveying first and second-year students and in-depth interviews with students and faculty. The conclusion of this study is the importance of evaluating medical school curriculum as it relates to patient-centered care skills, and particularly how those skills are utilized in the clinical world.

Background and Purpose: Just over 15% of children under 18 years of age in the UnitedStates, or approximately 11.2 million children, are estimated to have special healthcare needs.Although children with special healthcare needs (CSHCN) make up a small percentage of thepediatric population, they account for over one third of pediatric medical care. Parental attitudesregarding immunization play a significant role in vaccination rates among children. The purposeof this research is to explore parental attitudes regarding immunization of CSHCN.Methods: This qualitative study focused on parental perceptions and beliefs aboutimmunizations for CSHCN. Sixteen participants, who were parents of CSHCN from onepediatric specialty care clinic participated in focus groups. Institutional review board approvalwas received prior to data collection.Results: While the purpose of this study was to determine the attitudes of parents ofCSHCN regarding immunizations, analysis revealed parents simply wanted to share their lifeexperiences rearing these children, with issues of immunization being secondary. Participantsdescribed the experience of caring for their CSHCN related to isolationism and the weight ofresponsibility as leader of their childs care. Additionally, the majority of parents thatparticipated viewed childhood vaccinations in a positive light. Parents acknowledged that it wasimportant for their own children to receive vaccines. Participants also recognized that it wasimportant for the community to be vaccinated in order to protect their child. However, the desirefor individualized care, at times, caused parents to disregard the immunization schedulerecommended by Center for Disease Control and Prevention.Conclusions: Health care providers can be effective and influential members of the healthcare team by engaging in community based education about vaccines, building trustingrelationships with parents and helping parents understand the need to follow the recommendedschedule for immunizations.

Bakgrund Missfall drabbar ca 20% av alla kvinnor med bekräftade graviditeter i Sverige. Den vanligaste orsaken till missfall är kromosomavvikelser hos fostret. Riskfaktorer för missfall är bland annat om kvinnan har diabetes mellitus eller en sköldkörtelsjukdom som inte är medicinskt välinställd. Även livsstilsrelaterade riskfaktorer föreligger. Vid missfall kan kvinnan uppleva en känsla av att sakna kontroll och hjälplöshet. Ett missfall kan upplevas traumatiskt och förlusten kan påverka kvinnan under en längre tid. Viktiga omvårdnadsåtgärder som lyfts upp är information om vem kvinnan kan kontakta och allmän information, samt även att vara lyhörd som sjuksköterska. Syfte Syftet var att belysa kvinnors upplevelse av omvårdnad vid missfall.​ Metod En litteraturöversikt som inkluderat 7 kvalitativa artiklar samt 3 artiklar med mixad metod. Litteratursökningen genomfördes i databaserna Cinahl complete och PubMed. Resultat Resultatet presenteras i tre huvudteman: Vårdmiljön skapar oro och ovisshet, Vikten av omvårdnadsinformatik och Vikten av psykosocialt stöd. Resultatet visar bland annat på att kvinnor upplevde att väntan på svar kring diagnostiseringen av missfallet skapade ångest och oro, medan snabb hantering och behandling värdesattes. Även en bristande medkänsla från sjuksköterskor i samband med missfall framkom och bristande information kring missfall samt att många kvinnor kände att de lämnades frågandes efter ett missfall. Slutsats Trots vissa positiva upplevelser av omvårdnad vid missfall, såsom tydlig information och emotionellt stöd från sjuksköterskor, var de negativa upplevelserna övervägande. Kvinnor upplevde en otrygg vårdmiljö, bristande bemötande och bristande information. Kvinnor efterfrågade mer information samt tydlig och direkt kommunikation samt uppföljning. Den känslomässiga hanteringen av förlusten upplevdes lättare om sjukvårdspersonal hade ett bemötande med medkänsla då det upplevdes som tröstande. / Background Miscarriage affetcs around 20% of all women with confirmed pregnancies in Sweden. The most common cause of miscarriage is chromosomal abnormalities in the fetus. Various diseases can consitute risk factors, such as diabetes mellitus or thyroid disease that’s not medicaly well-controlled. Lifestyle-related risk factors also exist. During a miscarriage, the women can experience a sense of lacking control and helplessness. A miscarriage can be perceived as traumatic and the loss can impact the woman for an extended period. Essential nursing measures that were highlighted include providing information about who the women can contact and general information. Additionally, being attentive as a nurse is important. Aim The aim was to enlighten women’s experience of nursing care in the context of miscarriage. Method A literature review including 7 qualitative atricles and 3 articles with mixed method. The literature search was conducted in the databases Cinahl complete and PubMed. Results The results are presented in three main themes: The healthcare environment creates anxiety and uncertainty, The importance of nursing informatics and The importance of psychosocial support. The findings indicated, among other things, that women experience anxiety and worry during the wait for diagnostic results of the miscarriage, quick handling and treatment was valued. A lack of compassion from nurses in connection with miscarriage was evident, leaving many women with unanswered questions after a miscarriage.​ Conclusions Despite some positive experiences of care during miscarriage, such as clear information and emotional support from nurses, the negative experiences were dominant. Women perceived an insecure care environment, inadequate treatment och lack of information. Women sought more information as well as clear and direct communication and follow-up. The emotional handling of the loss was perceived easier if the nurses approached it with compassion, as it was found to be comforting.

OBJECTIVE: Immigrants to the United States represent a variety of ethnocultural backgrounds, experiences, and languages. They face stressors unique to migration that may exacerbate or cause mental health concerns. Despite this increased risk, immigrants access treatment at rates far below their native-borne counterparts. Structural and cultural barriers to mental health service utilization expound this disparity. The present thesis proposes a novel system to provide psychosocial support for US immigrants seeking treatment at Massachusetts General Hospital (MGH).  METHODS: Recognizing the need for a new paradigm of care, an Immigrant Mental Health Center prototype was conceptualized using a Human-Centered Design approach. The foundations for this prototype align with the Patient-Centered Medical Home approach to integrated primary and mental healthcare. Narrative reviews informed the theoretical basis of the prototype. A brief review of the existing literature yielded five integrated care themes, forming the basis for prototype evaluation criteria. Communication materials for stakeholder meetings and expert advisory panels were prepared as the next step in the Human-Centered Design approach.  RESULTS: The prototype extended care to a diverse spectrum of US immigrants within the MGH healthcare network. It involved a multidisciplinary team of specialists, whole-patient orientation, a personal practitioner, increased accessibility, and viable internal (MGH) and external (community) linkages.  CONCLUSIONS: The next steps in the Human-Centered Design approach include iteratively designing solutions to co-optimize the prototype for implementation at the MGH Center for Immigrant Health. Recommendations for the iterative refinement stage include clarifying financial metrics and addressing structural barriers to treatment accessibility. A series of feasibility pilot trials and efficacy randomized-controlled trials precede implementation. Future directions include extending the target population to second or third-generation immigrants, attending to severe mental illnesses, and fostering inpatient mental healthcare linkages as a bridge to long-term care.

‎Nursing is a trusted profession aimed at delivering quality, patient-centered care perceived by patients as caring and satisfactory. While empiric care components are measurable as associated with clinical outcomes, patients’ perceptions of care are increasingly important in determining satisfaction with the patient care experience. Not clearly defined, nor empirically measurable, the “art” of nursing is taking on increasing importance as a component of satisfaction with the patient experience. The purpose of this integrative literature review was to review the literature in order to find common themes influencing determination of the art of nursing on patient satisfaction in acute care settings. Fourteen studies were selected and reviewed after a search of CINAHL Plus with Full Text, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ERIC, MEDLINE, PsycARTICLES, and PsycINFOCINAHL databases. Four themes that emerged: building a relationship with the patient; conducting a thorough assessment of the patient; meaningful communication with the patient, and availability of nurses for their patients. The findings suggest that the art of nursing, as grounded in the demonstration of nursing care behaviors, is a component of patients’ satisfaction with the provision of care. This evidence-based knowledge is transferable to efforts in modifying nursing practices that exemplify patient-centered care.

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