BACKGROUND: Telemedicine has the potential to remove geographic and temporal obstacles to health care access. Whether and how telemedicine can increase health care access for underserved populations remains an open question. To address this issue, we integrated facilitated telemedicine encounters for the management of hepatitis C virus (HCV), a highly prevalent condition among people with opioid use disorder (OUD), into opioid treatment programs (OTPs). In New York State, OTPs are methadone-dispensing centers that provide patient-centered, evidence-based treatment for OUD. We investigated the integration and impact of facilitated telemedicine into OTP workflows in these settings.
OBJECTIVE: This study aims to understand OTP staff experiences with integrating facilitated telemedicine for HCV treatment into OTPs, including best practices and lessons learned.
METHODS: We conducted semistructured interviews with 45 OTP staff members (13 clinical, 12 administrative, 6 physicians, and 14 support staff members) at least one year after the implementation of facilitated telemedicine for HCV management. We used hermeneutic phenomenological analysis to understand OTP staff experiences.
RESULTS: We identified 4 overarching themes illustrating the successful integration of facilitated telemedicine for HCV care into OTPs. First, integration requires an understanding of the challenges, goals, and values of the OTP. As OTP staff learned about new, highly effective HCV therapies, they valued an HCV cure as a \"win\" for their patients and were excited about the potential to eliminate a highly prevalent infectious disease. Second, the integration of facilitated telemedicine into OTPs fosters social support and reinforces relationships between patients and OTP staff. OTP staff appreciated the ability to have \"eyes on\" patients during telemedicine encounters to assess body language, a necessary component of OUD management. Third, participants described high levels of interprofessional collaboration as a care team that included the blurring of lines between disciplines working toward a common goal of improving patient care. Study case managers were integrated into OTP workflows and established communication channels to improve patient outcomes. Fourth, administrators endorsed the sustained and future expansion of facilitated telemedicine to address comorbidities.
CONCLUSIONS: OTP staff were highly enthusiastic about facilitated telemedicine for an underserved population. They described high levels of collaboration and integration comparable to relevant integrative frameworks. When situated within OTPs, facilitated telemedicine is a high-value application of telemedicine that provides support for underserved populations necessary for high-quality health care. These experiences support sustaining and scaling facilitated telemedicine in comparable settings and evaluating its ability to address other comorbidities.
BACKGROUND: ClinicalTrials.gov NCT02933970; https://clinicaltrials.gov/study/NCT02933970.

BACKGROUND: Patients diagnosed with hematological malignancies residing in low-middle-income countries undergo significant physical and psychological stressors. Despite this, only 16% of them receive proper care during the terminal stages. It is therefore crucial to gain insight into the unique experiences of this population.
OBJECTIVE: To have a better understanding of the needs and experiences of adult patients with advanced hematological malignancy by exploring their perspectives.
METHODS: A qualitative interpretive design was employed to collect and analyze data using a phenomenological approach. The study involved in-depth interviews with ten participants aged between 49 and 65 years, utilizing a semi-structured approach.
RESULTS: Two primary themes emerged from the participants\' experiences of reaching the terminal stage of illness: \"Pain, Suffering, and Distress\" and \"Spiritual Coping.\" The first theme encompassed physical and emotional pain, suffering, and distress, while the second theme was centered on the participants\' spiritual coping mechanisms. These coping mechanisms included seeking comfort in religious practices, relying on spiritual support from family and friends, and finding solace in their beliefs and faith.
CONCLUSIONS: Patients with hematological malignancies in the terminal stages of their disease experience severe pain, considerable physical and psychosocial suffering, and spiritual distress. While they require support to cope with their daily struggles, their experiences often go unnoticed, leading to disappointment and loss of dignity. Patients mainly rely on their spirituality to cope with their situations. Healthcare providers must acknowledge these patients\' needs and provide more holistic and effective care.

The human papillomavirus (HPV) carries a significant health risk for people with a cervix. Among transgender and nonbinary people, however, testing and treatment for HPV can pose difficulties, and even be traumatic at times. This current study is part of a larger mixed methods study conducted in Michigan in 2020, and it explores the experiences of transmasculine and nonbinary people with at-home self-swabbing HPV test kits and knowledge of HPV transmission/screenings. Phenomenological methods were used by conducting virtual qualitative interviews with ten transmasculine and nonbinary individuals with cervixes, ages 23-59. Interviews were independently coded by members of the research team and a tabletop theming method was used. Four themes were generated from the data: 1) Multilevel barriers; 2) \"Get it done, so I know that I am safe\"; 3) Contrasting preferences for care; and 4) Community calls for change. The discussion focuses on the implications of these findings for improving sexual health care for the transgender and nonbinary community, along with directions for further research.

While virtual care services existed prior to the emergence of COVID-19, the pandemic catalyzed a rapid transition from in-person to virtual care service delivery across the Canadian health care system. Virtual care includes synchronous or asynchronous delivery of health care services through video visits, telephone visits, or secure messaging. Patient advisors are people with patient and caregiving experiences who collaborate within the health care system to share insights and experiences in order to improve health care.
This study aimed to understand patient advisors\' perceptions related to virtual care and potential impacts on health care quality.
We adopted a phenomenological approach, whereby we interviewed 20 participants who were patient advisors across Canada using a semistructured interview protocol. The protocol was developed by content experts and medical education researchers. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Data collection stopped once thematic saturation was reached. The study was conducted at Queen\'s University, Kingston, Ontario. We recruited 20 participants from 5 Canadian provinces (17 female participants and 3 male participants).
Six themes were identified: (1) characteristics of effective health care, (2) experiences with virtual care, (3) modality preferences, (4) involvement of others, (5) risks associated with virtual care encounters, and (6) vulnerable populations. Participants reported that high-quality health care included building relationships and treating patients holistically. In general, participants described positive experiences with virtual care during the pandemic, including greater efficiency, increased accessibility, and that virtual care was less stressful and more patient centered. Participants comparing virtual care with in-person care reported that time, scheduling, and content of interactions were similar across modalities. However, participants also shared the perception that certain modalities were more appropriate for specific clinical encounters (eg, prescription renewals and follow-up appointments). Perspectives related to the involvement of family members and medical trainees were positive. Potential risks included miscommunication, privacy concerns, and inaccurate patient assessments. All participants agreed that stakeholders should be proactive in applying strategies to support vulnerable patients. Participants also recommended education for patients and providers to improve virtual care delivery.
Participant-reported experiences of virtual care encounters were relatively positive. Future work could focus on delivering training and resources for providers and patients. While initial experiences are positive, there is a need for ongoing stakeholder engagement and evaluation to improve patient and caregiver experiences with virtual care.

As smart structures are becoming increasingly ubiquitous in our daily life, the need for efficient modeling electromechanical coupling devices is also rapidly advancing. Smart structures are often made of piezoelectric materials such as lead zirconate titanate (PZT), which exhibits strong nonlinear behavior known as hysteresis effect under a large applied electric field. There have been numerous modeling techniques that are able to capture such an effect; some techniques are suitable for obtaining physical insights into the micro-structure of the material, while other techniques are better-suited to practical structural analyses. In this paper, we aim to achieve the latter. We propose a simplified phenomenological macroscopic model of a nonlinear ferroelectric actuator. The assumption is based on the direct relation between the irreversible strain and irreversible electric field, and the consequently irreversible polarization. The proposed model is then implemented in a finite element framework, in which the main features such as local return mapping and the tangent moduli are derived. The outcomes of the model are compared and validated with experimental data. Therefore, the development presented in this paper can be a useful tool for the modeling of nonlinear ferroelectric actuators.

People may assume that the counseling profession functions with a shared set of values that promote well-being and mental health to individuals, families, and communities across the globe. Common values, such as described in training programs, ethical codes, and other areas, reflect the approach and direction for providing professional counseling services among counseling professionals throughout the world. The researchers designed this qualitative study using a phenomenological approach to explore how counseling values are experienced and implemented across various cultures. The 16 participants of the study include counseling professionals from different countries to increase representation from eight regions of the world. The researchers recognize valued approaches commonly identified among the participants implementing counseling services, including marital and family counseling, child and school counseling, faith integration, indigenous practices, and person-centered safe spaces. While each of these valued approaches is described in detail, final applications of the data offer proposed steps to improve the advancement of counseling on a global scale, including strategies for transcultural counseling training, resource adaptability, and bilateral development in the profession.

Psychiatric hospitals and centers have more complex conditions than other hospitals in responding to emergencies, given the differences in the design of their buildings and in non-structural elements. This is a qualitative study aimed at reviewing and investigating the experiences and challenges faced by psychiatric hospital staff in response to different fire incidents. A phenomenological approach was employed to conduct the study, believing that human experiences and beliefs are substances in phenomena and can be understood and examined. The contents of interviews and focus group discussion (FGD) sessions were extracted and classified into five categories, 14 themes, and 49 sub-categories. Many psychiatric hospitals in Iran are not ready to respond properly to incidents like fires. The study revealed that in order to ensure appropriate management of incidents and disasters in the hospitals, it is necessary to focus on five areas called the 5s framework, which includes structures, staff, supplies (facilities, equipment etc.), sick persons and systems. This framework is proposed to enhance preparedness, reduce vulnerability, and provoke an effective response to incidents in psychiatric hospitals.
La réponse à une urgence est plus compliquée qu’ailleurs dans les hôpitaux psychiatriques, en raison de contraintes architecturales comme fonctionnelles. Cette étude a pour but d’explorer les expériences et les difficultés rencontrées par le personnel des hôpitaux psychiatriques face à un incendie dans leur institution. L’approche phénoménologique permet d’évaluer le rôle des croyances et de l’expérience dans ce type de situation. Les résultats d’interviews et de groupes de discussion ont pu être classées en 5 catégories, 14 thèmes et 49 sous-catégories. De nombreux hôpitaux psychiatriques iraniens ne sont pas à même de répondre correctement à un incendie. Pour y parvenir, il faudrait organiser la réponse autour de 5 thèmes : architecture, personnel, patients, équipement et systèmes de réponse. Ceci afin d’améliorer la préparation, diminuer la vulnérabilité et in fine obtenir une réponse efficace en cas d’incendie.

Objective: Breast cancer is a multidimensional crisis for women and their spouses that affects every aspect of their life. Coping with this disease requires investigating and resolving the challenges faced by all those affected by it. The present study was conducted to clarify these challenges on the basis of lived experiences of the spouses of women with breast cancer. Method : The present qualitative research performed an interpretive phenomenological analysis in Iran.Purposive sampling was employed to select twenty spouses of women with breast cancer. The data collected through unstructured face-to-face interviews were analyzed using van Manen\'s method. To ensure the rigor of the study, Lincoln and Guba\'s criteria were evaluated in the qualitative process. Results: Lived experiences of the spouses of the women with breast cancer in coping with challenges included the four themes of emotional confusion, shouldering the burden of care, psychophysical suffering caused by the disease and life without cohesion. Conclusion: Spouses of the women with breast cancer in the Iranian community faced several challenges and issues. The socioeconomic support provided by supporting organizations and medical personnel appear to help moderate these challenges and improve coping in this group.

UNASSIGNED: Neurofeedback is a neurostimulatory biofeedback behavioural therapy that regulates brain wave levels for optimal cognitive functioning. It has shown promising results for the treatment of attention-deficit hyperactivity disorder (ADHD).
UNASSIGNED: To explore and describe the experiences of neurofeedback therapists (NTs) using neurofeedback to treat children and adults with ADHD and their experience of its role and value in treating this condition.
UNASSIGNED: Interviews were conducted in participants\' private consultation rooms in Gauteng, South Africa.
UNASSIGNED: In this qualitative study using a descriptive phenomenological approach, six registered NTs with experience of treating ADHD were interviewed. Participants were asked: \'Tell me about your experiences of neurofeedback with ADHD patients in your practice.\' Responses were audio-recorded, transcribed and underwent thematic analysis.
UNASSIGNED: Participants experienced neurofeedback as an effective treatment for ADHD and other coexisting conditions, such as anxiety and insomnia. Participants felt that the neurofeedback process facilitates a beneficial therapeutic relationship and integrates well with other treatment methods. Challenges faced in practice included certain underlying comorbidities, home environment, poor patient compliance and NTs\' level of expertise, which impact treatment outcomes.
UNASSIGNED: Neurofeedback therapists expressed an overall positive perception of the value of neurofeedback to reduce ADHD symptom severity and improve quality of life, particularly when used as part of a multimodal approach. Participants identified a need for further education and awareness regarding the use of neurofeedback for ADHD.
UNASSIGNED: This study has contributed to our understanding of the role of neurofeedback in treating ADHD in the South African setting.

Parents\' lived experiences of having a child with ADHD may shape their decision making regarding ADHD treatment options for their child. The aim of this study was to explore parents\' experiences of living with a child with ADHD in the family and how their experiences influence their perspectives on treatment preferences and priorities.
A phenomenological qualitative design was used. Semistructured interviews were conducted with parents of children with ADHD who were enrolled in a multisite randomized controlled trial. Interviews were transcribed verbatim, and transcripts at each site were double coded. Initial codes were derived directly from the text. Qualitative data were analysed with an inductive approach.
Twenty-three parents were interviewed: eight from Alberta, Canada; eight from Portland, Oregon, USA; and seven from Columbus, Ohio, USA. Among the parents, 69% were married, 86% completed college education and 52% reported household income over $80,000. Among the children, the mean age was 9.6 years (SD = 1.8 years), 78% were boys and 48% were never medicated for their ADHD. Two major themes emerged from the analysis. Theme 1 was \'impact of ADHD on families within and outside the home\' with the following subthemes: \'reconfiguring the home life\', \'trial-and-error of accommodations at school\' and \'responding to social pressures to fit in\'. Theme 2 was \'enabling appropriate and accessible treatments for families\' with the following subthemes: \'finding the \"right fit\" with professionals and treatments\' and \'factors influencing inequitable access to treatments\'.
Parents described shared experiences and identified similar barriers, preferences and priorities for ADHD treatments regardless of demographic differences by site. Families desired access to family-centred, multimodal approaches to ADHD treatment. Further research is needed to identify the specific structural changes to healthcare, services and policies that will better support this approach.