Background Primary care professionals (PCPs) face mounting pressures associated with their work, which has resulted in high burn-out numbers. Increasing PCPs’ job satisfaction is proposed as a solution in this regard. Positive Health (PH) is an upcoming, comprehensive health concept. Among others, this concept promises to promote PCPs’ job satisfaction. However, there is limited research into PH’s effects on this topic. This study, therefore, aims to provide insight into how adopting PH in a general practice affects PCPs’ job satisfaction. Methods An ethnographic case study was conducted in a Dutch general practice that is currently implementing PH. Data collected included 11 semi-structured interviews and archival sources. All data were analyzed thematically. Results Thematic analysis identified three themes regarding PCPs’ adoption of PH and job satisfaction, namely [1] adopting and adapting Positive Health, [2] giving substance to Positive Health in practice, and [3] changing financial and organizational structures. Firstly, the adoption of PH was the result of a match between the practice and the malleable and multi-interpretable concept. Secondly, PH supported PCPs to express, legitimize, and promote their distinctive approach to care work and its value. This strengthened them to further their holistic approach to health and stimulate autonomy in practice, with respect to both patients and professionals. Thirdly, the concept enabled PCPs to change their financial and organizational structures, notably freeing time to spend on patients and on their own well-being. This allowed them to enact their values. The changes made by the practice increased the job satisfaction of the PCPs. Conclusions PH contributed to the job satisfaction of the PCPs of the general practice by functioning as an adaptable frame for change. This frame helped them to legitimize and give substance to their vision, thereby increasing job satisfaction. PH’s malleability allows for the frame’s customization and the creation of the match. Simultaneously, malleability introduces ambiguity on what the concept entails. In that regard, PH is not a readily implementable intervention. We recommend that other organizations seeking to adopt PH consider whether they are willing and able to make the match and explore how PH can help substantiate their vision.
Objectives This study aims to gain insight into the care provided to patients with antiphospholipid syndrome (APS) in The Netherlands, and to identify areas for improvement from the perspective of both patients and medical specialists. Methods APS care was evaluated using qualitative and quantitative methods. Perspectives on APS care were explored using semi-structured interviews with medical specialists, patient focus groups and a cross-sectional, online patient survey. In order to assess current practice, medical records were reviewed retrospectively to collect data on clinical and laboratory manifestations and pharmacological treatment in six Dutch hospitals. Results Fourteen medical specialists were interviewed, fourteen patients participated in the focus groups and 79 patients completed the survey. Medical records of 237 patients were reviewed. Medical record review showed that only one-third of patients were diagnosed with APS within three months after entering specialist care. Diagnostic approach and management varied between centres and specialists. Almost 10% of all patients and 7% of triple positive patients with thrombotic APS did not receive any anticoagulant treatment at the time of medical record review. Correspondingly, poor recognition and fragmentation of care were reported as the main problems by medical specialists. Additionally, patients reported the lack of accessible, reliable patient education, psychosocial support and trust in physicians as important points for improvement. Conclusion Delayed diagnosis, variability in management strategies and fragmentation of care were important identified limitations of APS care in this study. A remarkable 10% of patients did not receive any anticoagulant treatment.
Background Antiphospholipid Syndrome (APS) is a known cause of thrombotic disorders, including Acute Myocardial Infarction (AMI). Although its incidence in AMI patients is not known, it may be an important factor in precipitating infarction, especially in younger adults. Methods This is a case-control study consisting in 73 patients with Acute Myocardial Infarction, hospitalized at Cardiovascular Reanimation Clinic from 10 December 2015-10 October 2019. All patients included in the study were from 23 to 50 years old. In the case-group were included 24 patients with Antiphospholipid Syndrome and Acute Myocardial Infarction, and 49 patients were included in the control group, which consisted only in patients with AMI, with no presence of APS. In every patient were gathered data such as complete blood count + ESR, Antinuclear Antibodies (ANA), Anti-cardiolipin antibodies (ACA), C3 and C4 complement fraction, Anti-ds-DNA, CRP and Ejection Fraction (EF) in echocardiography. Female patients were asked about their abortion history. As recommended in the guidelines, in positive results for APS, ACA levels were repeated after 12 weeks in order to establish the diagnosis. All data were gathered and statistically analyzed using Excel 2010 and IBM SPSS. Results After comparing all gathered data, it was found that the patients with APS and AMI had a more significant tendency to have C3 hypocomplementemia (p=0.006), thrombocytopenia (p=0.002), a lower ejection fraction on transthoracic echocardiography (p=0.04) and a more elevated number of abortions before acute myocardial infarction (p=0.03) in comparison to the controls. Conclusions From our study it was found that APS is not rare in young adults with AMI. It should be always suspected in young patients with no cardiovascular risk factors and there may be a characteristic clinical and laboratory picture in patients with AMI, which may suggest the APS diagnosis. Acknowledgements The authors declare no conflict of interest.
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