Plos One
-
Place of death is an important outcome of end-of-life care. Many people do not have the opportunity to express their wishes and die in their preferred place of death. Advance care planning (ACP) involves discussion, decisions and documentation about how an individual contemplates their future death. ⋯ The likelihood of in-hospital death is substantially higher in patients without documented preferred place of death (OR = 1.43, 95% CI 1.26-1.62, p<0.001), in those who prefer to die in hospital (OR = 2.30, 95% CI 1.60-3.30, p<0.001) and who prefer to be cared in hospital (OR = 2.77, 95% CI 1.94-3.96, p<0.001). "Not for resuscitation" individuals (OR = 0.43, 95% CI 0.37-0.50, p<0.001) and who preferred symptomatic treatment (OR = 0.36, 95% CI 0.33-0.40, p<0.001) had a lower likelihood of in-hospital death. Effective advance care planning is necessary for improved end-of-life outcomes and should be included in routine clinical care. Electronic palliative care registers could empower patients by embedding patients' wishes and personal circumstances in their care plans that are accessible by urgent care providers.
-
The strong geographic variations in the incidence rates of renal replacement therapy (RRT) for end-stage renal disease are not solely related to variations in the population's needs, such as the prevalence of diabetes or the deprivation level. Inequitable geographic access to health services has been involved in different countries but never in France, a country with a generous supply of health services and where the effect of the variability of medical practices was highlighted in an analysis conducted at the geographic scale of districts. Our ecological study, performed at the finer scale of townships in a French area of 8,370,616 inhabitants, investigated the association between RRT incidence rates, socioeconomic environment and geographic accessibility to healthcare while adjusting for morbidity level and medical practice patterns. ⋯ These data confirm the influence of deprivation level, the prevalence of diabetes and medical practices on RRT incidence rates across a large French area. For the first time, an association was found with the distance to nephrology services. These data suggest possible inequitable geographic access to RRT within the French health system.
-
Cognitive and other biases can influence the quality of healthcare decision making. While substantial research has explored how biases can lead to diagnostic or other errors in medicine, fewer studies have examined how they impact the decision making of other healthcare professionals. This scoping review aimed to identify and synthesise a broad range of research investigating whether decisions made by allied health professionals are influenced by cognitive, affective or other biases. ⋯ This scoping review provides an overview of studies investigating whether decisions made by allied health professionals are influenced by cognitive, affective or other biases. Biases have the potential to seriously impact the quality, consistency and accuracy of decision making in allied health practice. The findings highlight a need for further research particularly in professional disciplines outside of psychology, using methods that reflect real life healthcare decision making.
-
Women's underrepresentation in science, technology, engineering, and mathematics (STEM) impedes progress in solving Africa's complex development problems. As in other regions, women's participation in STEM drops progressively moving up the education and career ladder, with women currently constituting 30% of Africa's STEM researchers. This study elucidates gender-based differences in PhD performance using new survey data from 227 alumni of STEM PhD programs in 17 African countries. ⋯ Becoming a parent during the PhD training was a key reason that women took longer to complete the PhD, according to our results. Findings suggest that having a female supervisor, attending an institution with gender policies in place, and pursuing the PhD in a department where sexual harassment by faculty was perceived as uncommon were enabling factors for women's timely completion of their doctoral studies. Two priority interventions emerge from this study: (1) family-friendly policies and facilities that are supportive of women's roles as wives and mothers and (2) fostering broader linkages and networks for women in STEM, including ensuring mentoring and supervisory support that is tailored to their specific needs and circumstances.
-
The spread of COVID-19 implied a large and fast increase of demand for intensive care services. To face this increase in demand, health care systems need to adapt their response by increasing hospital beds, intensive care unit (ICU) capacity and by (re-)deploying doctors and other personnel. This paper proposes a forecast approach based on the Vector Error Correction model for the daily counts of hospitalized patients with symptoms and of patients in ICU, using publicly available data on the current COVID-19 outbreak in Italy, Switzerland and Spain. ⋯ The one-week-ahead forecasts are validated with out-of-sample data over successive weeks; they are found to provide timely and robust prediction of ICU capacity needs in Lombardy, the most-affected Italian region, starting from the sample of the first 2 weeks of data. The same methodology is successfully validated on other Italian regions, Switzerland and Spain. This approach may be used in other countries/regions/provinces to help adapt the health care system response to COVID-19 (or other similar disease); for this purpose, the open-source software code to produce the forecasts is provided with the paper.