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Jaspal R. Chemsex, Identity and Sexual Health among Gay and Bisexual Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12124. [PMID: 36231424 PMCID: PMC9564711 DOI: 10.3390/ijerph191912124] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
This article focuses on some of the social, cultural and psychological aspects of drug use in sexualized settings in gay and bisexual men (referred to as "chemsex"). Using a narrative review approach, the article examines previous empirical research in this area and presents a novel theoretical approach for understanding and predicting chemsex behavior. Tenets of identity process theory from social psychology are drawn upon to offer an integrative theoretical framework within which the social, cultural and psychological underpinnings of chemsex can be collectively examined. Existing empirical research suggests that gay and bisexual men may experience sexuality-related stressors that can undermine feelings of self-esteem, self-efficacy, continuity and positive distinctiveness. Identity process theory examines how individuals react to threats to identity brought about by these stressors. In response to identity threat, gay and bisexual men may engage in chemsex as a coping response that encompasses and facilitates various, largely maladaptive, coping strategies and tactics. The more chemsex is perceived as enhancing identity processes and as averting identity threat, the more central it is likely to be to the identities of participants. The centrality of chemsex to one's identity may preclude self-withdrawal from the practice. Several directions for future research are presented based on existing work on chemsex viewed through the lens of identity process theory. These should form the basis of future empirical research in the sphere of sexual health among gay and bisexual men and the outcomes of this research should inform policy and practice in this area.
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Affiliation(s)
- Rusi Jaspal
- Vice-Chancellor's Office, University of Brighton, Brighton BN2 4GJ, UK
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102
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Stellata AG, Rinawan FR, Winarno GNA, Susanti AI, Purnama WG. Exploration of Telemidwifery: An Initiation of Application Menu in Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710713. [PMID: 36078428 PMCID: PMC9517915 DOI: 10.3390/ijerph191710713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 05/31/2023]
Abstract
The midwifery continuity-of-care model improves the quality and safety of midwifery services and is highly dependent on the quality of communication and information. The service uses a semi-automated chatbot-based digital health media service defined with the new term "telemidwifery". This study aimed to explore the telemidwifery menu content for village midwives and pregnant women in the Purwakarta Regency, West Java, Indonesia. The qualitative research method was used to explore with focus group discussion (FGD). The data collection technique was purposive sampling. The research subjects were 15 village midwives and 6 multiparous pregnant women. The results of this study involved 15 characteristics of menu content: (1) Naming, (2) Digital Communication, (3) Digital Health Services, (4) Telemidwifery Features, (5) Digital Check Features, (6) Media Services, (7) Attractiveness, (8) Display, (9) Ease of Use, (10) Clarity of Instructions, (11) Use of Language, (12) Substances, (13) Benefits, (14) Appropriateness of Values, and (15) Supporting Components. The content characteristics of this telemidwifery menu were assigned to the ISO 9126 Model standards for usability, functionality, and efficiency. The conclusion is that the 15 themes constitute the characteristic menu content required within the initiation of telemidwifery.
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Affiliation(s)
- Alyxia Gita Stellata
- Master of Midwifery Study Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia
| | - Fedri Ruluwedrata Rinawan
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Ir. Soekarno KM. 21, Jatinangor, Sumedang 45363, Indonesia
- Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia
- Indonesian Society for Remote Sensing Branch West Java, Gedung 2, Fakultas Perikanan dan Ilmu Kelautan Universitas Padjadjaran, Jl. Ir. Soekarno KM. 21, Sumedang 45363, Indonesia
| | - Gatot Nyarumenteng Adhipurnawan Winarno
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
- Hasan Sadikin Hospital Bandung, Bandung 40161, Indonesia
| | - Ari Indra Susanti
- Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia
- Mother and Child Health Division, Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia
| | - Wanda Gusdya Purnama
- Informatics Engineering Study Program, Faculty of Engineering, Universitas Pasundan, Jl. Dr. Setiabudi No.193, Bandung 40153, Indonesia
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103
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Klas J, Grzywacz A, Kulszo K, Grunwald A, Kluz N, Makaryczew M, Samardakiewicz M. Challenges in the Medical and Psychosocial Care of the Paediatric Refugee-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10656. [PMID: 36078371 PMCID: PMC9517743 DOI: 10.3390/ijerph191710656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND After the invasion of Ukraine, neighbouring countries were forced to find systemic solutions to provide medical care to those fleeing the war, including children, as soon as possible. In order to do this, it is necessary to know the communication problems with refugee minors and find proposals for their solutions. METHODS A systematic review of the literature from 2016 to 2022 was conducted according to PRISMA criteria. RESULTS Linguistic diversity and lack of professional readiness of teachers are the main constraints hindering the assistance of refugee children in schools. Problems during hospitalization include lack of continuity of medical care and lack of retained medical records. Solutions include the use of the 3C model (Communication, Continuity of care, Confidence) and the concept of a group psychological support program. CONCLUSIONS In order to provide effective assistance to refugee minors, it is necessary to create a multidisciplinary system of care. It is hoped that the lessons learned from previous experiences will provide a resource to help refugee host countries prepare for a situation in which they are forced to provide emergency assistance to children fleeing war.
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104
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Muntean LM, Nireștean A, Mărușteri M, Sima-Comaniciu A, Lukacs E. Occupational Stress and Personality in Medical Doctors from Romania. Healthcare (Basel) 2022; 10:healthcare10091612. [PMID: 36141224 PMCID: PMC9498482 DOI: 10.3390/healthcare10091612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022] Open
Abstract
Occupational stress amongst doctors has been intensively studied as doctors are exposed to several stress factors daily. The purpose of this study was to investigate if there are associations between personality dimensions and the factors that generate stress at work. We conducted a cross-sectional study of 280 medical doctors from Romania between February 2021 and September 2021 who were evaluated using the DECAS and ASSET Scales. Our results showed that the agreeableness and emotional stability dimensions of personality, according to the Big Five model, were statistically associated with work relationships (A p < 0.0001; ES p = 0.0005), work-life balance (A p = 0.008; ES p = 0.01), overload (A p = 0.01; ES p = 0.001), job security (A p < 0.0001; ES p = 0.002), job control (A p = 0.001; ES p = 0.009), resources and communication (A p = 0.0002; ES p < 0.0001), and job conditions (A p = 0.005; ES p = 0.03). The conscientiousness dimension was statistically associated with job control (p = 0.02). Doctors from different specialties experienced stress differently, with psychiatrists and doctors from preclinical specialties reporting the lowest levels of stress. Internists and surgeons reported higher levels of stress. This study showed that the dimensions of agreeableness and emotional stability were both associated with variables indicative of the level of stress felt at work.
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Affiliation(s)
- Lorena Mihaela Muntean
- Department of Psychiatry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
| | - Aurel Nireștean
- Department of Psychiatry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
- Correspondence: (A.N.); (M.M.)
| | - Marius Mărușteri
- Department of Medical Informatics and Biostatistics, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
- Correspondence: (A.N.); (M.M.)
| | - Andreea Sima-Comaniciu
- Department of Psychiatry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
| | - Emese Lukacs
- Department of Psychiatry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
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105
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Rojas-Ocaña MJ, García-Navarro EB, García-Navarro S, Macías-Colorado ME, Baz-Montero SM, Araujo-Hernández M. Influence of the COVID-19 Pandemic on Medication Reconciliation in Frail Elderly People at Hospital Discharge: Perception of Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10348. [PMID: 36011982 PMCID: PMC9408442 DOI: 10.3390/ijerph191610348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
The current demographic panorama in Spain corresponds to an aging population; this situation is characterized by the need to care for an elderly population, which contains polymedicated and pluripathological individuals. Polymedication is a criterion of frailty in the elderly and a risk factor for mortality and morbidity due to the increased risk of drug interactions and medication errors. There are numerous studies that measure reconciliation at hospital discharge and at admission, and even the methodology of reconciliation, but we have not found many studies that measure reconciliation in the context of the COVID-19 pandemic from the point of view of health professionals regarding difficulties and the strategies carried out, which is essential to begin to glimpse solutions. METHODS This was a qualitative study based on 21 in-depth interviews and two discussion groups, conducted between January and April 2021 (13 nurses and 8 doctors, in rural and urban areas). The discourse was analyzed according to the Taylor-Bodgan model and processed using Atlas.ti software. RESULTS The areas altered by the health crisis were access to patients, their reconciliation of medication, and changes in the care modality, including the greater use of telephone communication, changes in work organization, and time dedicated to patient care and family work. Difficulties encountered during COVID-19: change in medication format, the specific characteristics of the patient and their pathologies, and difficulties arising from communication with the patient and their family. The strategies applied: the collaboration of home assistants and caregivers, emphasis on patient-health professional communication, and the use of Information and Communication Technologies (ICT). CONCLUSION The discharge was interrupted by the health crisis caused by COVID-19, in terms of both the traditional access of patients and by the remote care modalities generated by telemedicine.
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Affiliation(s)
- María Jesús Rojas-Ocaña
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Huelva, Av. de las Fuerzas Armadas, s/n, 21007 Huelva, Spain
| | - E. Begoña García-Navarro
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Huelva, Av. de las Fuerzas Armadas, s/n, 21007 Huelva, Spain
| | - Sonia García-Navarro
- Distrito Huelva Costa Condado Campiña, Andalusian Health Service, 21700 Huelva, Spain
| | | | | | - Miriam Araujo-Hernández
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Huelva, Av. de las Fuerzas Armadas, s/n, 21007 Huelva, Spain
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106
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Kristek J, Johannesson L, Clemons MP, Kautznerova D, Chlupac J, Fronek J, Testa G, dePrisco G. Radiologic Evaluation of Uterine Vasculature of Uterus Transplant Living Donor Candidates: DUETS Classification. J Clin Med 2022; 11:jcm11154626. [PMID: 35956241 PMCID: PMC9369657 DOI: 10.3390/jcm11154626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/31/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Uterus transplantation is a treatment solution for women suffering from absolute uterine factor infertility. As much as 19.5% of uterus-transplanted patients underwent urgent graft hysterectomy due to thrombosis/hypoperfusion. The necessity to identify candidates with high-quality uterine vasculature is paramount. We retrospectively evaluated and compared the imaging results with actual vascular findings from the back table. In this article, we present a novel radiologic grading scale (DUETS classification) for evaluating both uterine arteries and veins concerning their suitability for uterus procurement and transplantation. This classification defines several criteria for arteries (caliber, tapering, atherosclerosis, tortuosity, segment, take-off, and course) and veins (caliber, tapering, plethora, fenestrations, duplication/multiplicity, dominant route of venous drainage, radiologist’s confidence with imaging and assessment). In conclusion, magnetic resonance angiography can provide reliable information on uterine venous characteristics if performed consistently according to a well-established protocol and assessed by a dedicated radiologist. The caliber of uterine arteries seems to be inversely related to the time passed since the last delivery. We recommend that the radiologist comments on the reliability and confidence of the imaging study. It cannot be over-emphasized that the most crucial aspect of surgical imaging is the necessity of high-quality communication between a surgeon and a radiologist.
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Affiliation(s)
- Jakub Kristek
- Department of Transplantation Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague, Czech Republic
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic
- Correspondence: ; Tel.: +420-236-054-105; Fax: +420-236-052-822
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, 3410 Worth St Ste 950, Dallas, TX 75246, USA
- Department of Obstetrics and Gynecology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246, USA
| | - Matthew Paul Clemons
- Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246, USA
| | - Dana Kautznerova
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague, Czech Republic
| | - Jaroslav Chlupac
- Department of Transplantation Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague, Czech Republic
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic
| | - Jiri Fronek
- Department of Transplantation Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague, Czech Republic
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic
- First Faculty of Medicine, Charles University, Katerinska 1660/32, 121 08 Prague, Czech Republic
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, 3410 Worth St Ste 950, Dallas, TX 75246, USA
| | - Gregory dePrisco
- Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246, USA
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107
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Dehghani A, Sobhanian M, Faseleh Jahromi M. The effect of communication skills training on nurses’ moral distress: A randomized controlled trial. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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108
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Difficult Conversations. Plast Reconstr Surg 2022; 150:237-241. [PMID: 35895519 DOI: 10.1097/prs.0000000000009087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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109
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Kotzé C, Parrish A. Reasonable requests: echocardiography referral forms as a measure of coherent clinical communication. BMC MEDICAL EDUCATION 2022; 22:538. [PMID: 35831886 PMCID: PMC9277864 DOI: 10.1186/s12909-022-03602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Well performed clinical communication is a cornerstone of collaborative care in medicine but may be confounded by inconsistent intentions of the messenger and biased interpretation by the recipient. A comparison of the findings of electronic echocardiography reports with clinician-completed standardised request forms provided an opportunity to assess communication quality. AIM The study aimed to determine clinician aptitude to complete written echocardiography referral forms by assessing the completeness, appropriateness, accuracy, and coherency of the reported clinical findings, conclusions and requests made on the referral forms. The study explored factors that may influence the quality of communication through this referral medium. METHODS A retrospective cohort study was conducted on patients who underwent trans-thoracic echocardiography imaging at Cecilia Makiwane Hospital in East London over 26 months. Paper echocardiography request forms that recorded the requesting clinician's findings on examination, the provisional clinical diagnosis, and the specific echocardiographic information sought, were compared with the actual findings on echocardiography. RESULTS Of 613 request forms reviewed, 97 cases were excluded due to illegibility or because they lacked analysable information or requester details, leaving 516 forms suitable for study. No pathology was found on echocardiography in 31%. Of the murmurs expected from the echocardiography findings, only half were recorded on the request form (sensitivity and positive predictive value both 52%.). Only 35% of request forms that mentioned a mitral systolic murmur gave a working diagnosis of mitral regurgitation and only 38% of request forms that mentioned an aortic systolic murmur considered aortic stenosis. Clinically suspected cardiomyopathy (CMO) had a PPV of 43% and echocardiographic CMO was missed clinically in 41%. Apex beat displacement reported clinically was not associated with echocardiographic LV dilatation in 65% of cases. One-third (34%) of forms reporting murmurs did not request valve function assessment and 17% considering cardiomyopathy did not request left ventricular function assessment. CONCLUSION Echocardiography request forms highlight vulnerabilities in clinical communication. Specifically, important clinical features were missing and more concerningly, included when unlikely to be present. There was a lack of concordance between recorded clinical findings and postulated diagnoses. Clinicians sometimes appeared unclear about the value or appropriateness of the requested assistance. Greater emphasis on teaching examination and communication skills may foster safer and more efficient use of scarce resources.
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Affiliation(s)
- C Kotzé
- Cecilia Makiwane Hospital, East London, South Africa.
| | - A Parrish
- Department of Internal Medicine, Faculty of Health Sciences, Walter Sisulu University and Head of Department, Internal Medicine, Frere and Cecilia Makiwane Hospitals, East London, South Africa
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110
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Timmins L, Kern LM, O'Malley AS, Urato C, Ghosh A, Rich E. Communication Gaps Persist Between Primary Care and Specialist Physicians. Ann Fam Med 2022; 20:343-347. [PMID: 35879085 PMCID: PMC9328695 DOI: 10.1370/afm.2781] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 11/09/2022] Open
Abstract
A survey conducted with data from 2008 found that physicians often do not communicate with each other at the time of referral or after consultation. Communication between physicians might have improved since then, with the dissemination of electronic health records (EHRs), but this is not known. We used 2019 survey data to measure primary care physicians' perceptions of communication at the time of referral and after consultation. We found that large gaps in communication persist. The similarity between these survey results suggests that despite the dissemination of EHRs, physicians still do not consistently communicate with each other about the patients they share.
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111
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Alidousti-Shahraki N, Farzi S, Tarrahi MJ. Patient Safety Competencies among Senior Students of Health Professions: An Iranian Evaluation Study. Open Nurs J 2022. [DOI: 10.2174/18744346-v16-e2205090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Patient safety refers to preventing and reducing adverse events that might harm the patient while providing care. Enhancing patient safety competence upon entering the clinical environment requires introducing and integrating it in health professions' education.
Aim:
This study aimed to investigate patient safety competence among senior health professions students.
Methods:
This study was conducted in 2020 using a cross-sectional study. In total, 390 senior health professions students of Isfahan University of Medical Sciences, Isfahan, Iran, including medicine, nursing, pharmacy, midwifery, surgical technologist (operating room technician), and anesthesia were selected through a stratified convenience method. Data were collected using the Health Professional Education in Patient Safety Survey – H-PEPSS from August to September 2020 and analyzed using descriptive and analytical statistics. All statistical computations were carried out using SPSS version 16. A significant level of 5% was considered (P <0.05).
Results:
The mean scores of patient safety in health professions education in the classroom and clinical setting were 0.51 and 0.47, respectively. Among Health Professional Education in Patient Safety Survey – H-PEPSS domains, the highest mean score was obtained in the effective communication domain (0.61 in the classroom and 0.57 in the clinical setting). In contrast, domains of working in teams with other health professions showed the lowest mean score (0.39 in the classroom and 0.38 in the clinical setting).
Conclusion:
Patient safety in health profession education, particularly working in teams with other health professions, is at a moderate level in the classroom and a weak level in the clinical setting. Regarding the importance of interprofessional collaboration in promoting patient safety, it is recommended that the health sciences curriculum in Iran be reviewed to motivate students for interprofessional collaboration and the perception of its significance in reducing health profession's errors.
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112
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Hossain MZ, Chew-Graham CA, Sowden E, Blakeman T, Wellwood I, Tierney S, Deaton C. Challenges in the management of people with heart failure with preserved ejection fraction (HFpEF) in primary care: A qualitative study of general practitioner perspectives. Chronic Illn 2022; 18:410-425. [PMID: 33401942 PMCID: PMC9163769 DOI: 10.1177/1742395320983871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To explore the perspectives of general practitioners (GPs) on the identification and management of people, including those from ethnic minority groups, with Heart Failure with Preserved Ejection Fraction (HFpEF). METHODS Qualitative study. Semi-structured, face-to-face or telephone interviews and focus groups were conducted with 35 GPs in England, which were audio-recorded and transcribed verbatim. Framework analysis was used to manage and interpret data. RESULTS Themes presented reflect four inter-related challenges: GPs' 1) lack of understanding HFpEF, impacting on 2) difficulties in communicating the diagnosis, leading to 3) uncertainty in managing people with HFpEF, further hindered by (4) discontinuity across the primary/secondary interface. All were considered more challenging by GPs when managing people from different cultures and languages. DISCUSSION HFpEF is not well understood by GPs, leading to diagnostic difficulty, management uncertainty and potential inequity in care offered. People with HFpEF are seen as complex, with multiple long-term conditions and requiring personalised care. Challenges in their management occur across the healthcare system. This study has identified learning needs for GPs around identification and on-going support for people with HFpEF in primary care. It will contribute to the development of more flexible and patient-centred pathways across the primary/secondary care interface.
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Affiliation(s)
- Muhammad Z Hossain
- Faculty of Medicine and Health Sciences, School of Medicine, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- Faculty of Medicine and Health Sciences, School of Medicine, Keele University, Keele, UK
| | - Emma Sowden
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Tom Blakeman
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Ian Wellwood
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge, UK
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Buja A, Damiani G, Manfredi M, Zampieri C, Dentuti E, Grotto G, Sabatelli G. Governance for Patient Safety: A Framework of Strategy Domains for Risk Management. J Patient Saf 2022; 18:e769-e800. [PMID: 35067624 DOI: 10.1097/pts.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adverse events in healthcare are primarily due to system failures rather than individuals. Risk reduction strategies should therefore focus on strengthening systems, bringing about improvements in governance, and targeting individual practices or products. The purpose of this study was to conduct a scoping review to develop a global framework of management strategies for sustaining a safety-oriented culture in healthcare organizations, focusing on patient safety and the adoption of good safety-related practices. METHODS We conducted a search on safety-related strategies in 2 steps. The first involved a search in the PubMed database to identify effective, broadly framed, cross-sector domains relevant to clinical risk management strategies in healthcare systems. In the second step, we then examined the strategies adopted by running a scoping review for each domain. RESULTS Our search identified 8 strategy domains relevant to patient safety: transformational leadership, patient engagement, human resources management quality, innovation technology, skills certification, education in patient safety, teamwork, and effective communication. CONCLUSIONS This scoping review explores management strategies key to healthcare systems' efforts to create safety-oriented organizations. Improvement efforts should focus particularly on the domains identified: combined together, they would nurture an overall safety-oriented culture and have an impact on preventable adverse events.
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Affiliation(s)
- Alessandra Buja
- From the Department of Cardiological, Thoracic, Vascular Sciences and Public Health, Padova
| | | | - Mariagiovanna Manfredi
- From the Department of Cardiological, Thoracic, Vascular Sciences and Public Health, Padova
| | - Chiara Zampieri
- From the Department of Cardiological, Thoracic, Vascular Sciences and Public Health, Padova
| | - Elena Dentuti
- University of Padua School of Nursing Sciences, Padova
| | - Giulia Grotto
- From the Department of Cardiological, Thoracic, Vascular Sciences and Public Health, Padova
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Rathiram V, Neilson LO, Syed Kassim A, Mokone WT, Green CC. Communication experiences of healthcare students whilst managing adults with communication disorders. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2022; 69:e1-e9. [PMID: 35695421 PMCID: PMC9210191 DOI: 10.4102/sajcd.v69i1.870] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background Research has found that people with communication disabilities are three times more likely to encounter medical mishaps. Almost a third of patients with speech-language therapy (SLT) diagnoses have other medical conditions across more than one of the burden of disease categories. Fifty per cent of these patients present with communication disorders. Student healthcare curriculums focus on patient dynamics and field-specific diversities. It does not often include the skills and knowledge required to effectively communicate and treat those with communication disorders. Objectives This study aims to describe the communication challenges and strategies employed by a group of final year Nursing, Medicine, Dietetics and Human Nutrition, Physiotherapy and Occupational Therapy students when managing adults with communication disorders. Method A qualitative, phenomenological study design was used. Questionnaires were electronically distributed, and results were analysed thematically. Results The most significant challenges whilst managing adults with communication disorders were patients’ receptive and expressive language difficulties. Further challenges included lack of knowledge surrounding communication disorders, lack of training in the use of appropriate communicative assistive devices, factors within the physical environment and gaps in students’ clinical performance. Strategies used to facilitate communication included caregiver assistance, gestures and written language. Conclusion This study revealed that there is a need to develop healthcare students’ skills in managing adults with communication disorders. This is because of the challenges faced and inefficiency of the strategies used. Future research should focus on determining solutions for improved communication with adults with communication disorders. The study highlights the need for further education and training to address students’ communication needs with patients.
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Affiliation(s)
- Vrinda Rathiram
- Department of Speech-Language Pathology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
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Gammon RR, Blanton K, Gilstad C, Hong H, Nichols T, Putnam H, Marinaro L, Segura T, Tay S, Bocquet C. How do we obtain and maintain patient blood management certification? Transfusion 2022; 62:1483-1494. [PMID: 35616174 DOI: 10.1111/trf.16929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 04/09/2022] [Accepted: 04/10/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The creation of a patient blood management (PBM) certification program by The Joint Commission (TJC) and Association for the Advancement of Blood and Biotherapies (AABB) provides validation of an existing PBM program. MATERIALS AND METHODS A team of subject matter experts in PBM formed a working group to develop a structured approach to guide PBM programs through the PBM certification. Program challenges and metrics were reviewed. RESULTS Initial steps to establishing PBM certification include a multidisciplinary working group and hospital administration buy-in. Development of policies and procedures individualized to the facility will standardize practice. An institutional transfusion committee can provide PBM oversight including enforcing compliance. Using resources such as TJC and AABB standards and tools including electronic medical records (EMR) can track and trend hospital PBM performance and identify improvement opportunities. A gap analysis tool helps implementation. Challenges might include maintaining a PBM program during a merger, slow responsiveness of information systems (IS) to requests, PBM education for both the Transfusion Safety Officer (TSO) and hospital staff with constant turnover. Available metrics from one hospital system showed good compliance with transfusion thresholds (average all products: 97.9%, 2019, 2020). In 2020, through educational efforts the cost savings were $124,856.70 compared to 2019. Regarding single unit transfusion of RBCs, this was 62.25% (2019), 63.75% (2020), 72.00% (2021), and surpassed the target goal of 60%. CONCLUSIONS Obtaining PBM certification highlights the success of an institution's PBM program. Facilities that have achieved PBM certification have seen significant reductions in transfusions and considerable cost savings.
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Affiliation(s)
- Richard R Gammon
- OneBlood, Scientific, Medical, Technical Direction, Orlando, Florida, USA
| | | | - Colleen Gilstad
- MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Hong Hong
- Northwell Health, Manhasset, New York, USA
| | | | - Hannah Putnam
- The Joint Commission, Oakbrook Terrace, Illinois, USA
| | - Liz Marinaro
- Pathology Associates of Albuquerque, Albuquerque, Mexico
| | - Teresa Segura
- Transfusion Services, Adventist Health White Memorial, Los Angeles, California, USA
| | - Sulyn Tay
- Transfusion Services, Redlands Community Hospital, Redlands, California, USA
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Melariri HI, Kalinda C, Chimbari MJ. Indicators for measuring health promotion practice among healthcare workers in the Nelson Mandela Bay Municipality, South Africa: A cross-sectional study. S Afr Fam Pract (2004) 2022. [DOI: 10.4102/safp.v64i1.5401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Nes E, White BAA, Malek AJ, Mata J, Wieters JS, Little D. Building Communication and Conflict Management Awareness in Surgical Education. JOURNAL OF SURGICAL EDUCATION 2022; 79:745-752. [PMID: 34952815 DOI: 10.1016/j.jsurg.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/16/2021] [Accepted: 11/27/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE A group of surgeons and a medical educator constructed a curriculum to strengthen communication and emotional intelligence skills in the surgical setting. DESIGN The curriculum consisted of a small group discussion series occurring during medical students' eight-week surgery clerkship. The curriculum targeted the following objectives: building team rapport, exploring self-management strategies in team communication, recognizing communication styles, diagnosing conflict, identifying opportunities in professional and personal development, and discussing professionalism in medicine. Students completed pre-post Likert style tests about their knowledge and understanding of the above-mentioned topics. SETTING Texas A&M University College of Medicine, Surgical Clerkship at Baylor Scott and White Medical Center, a level 1 trauma center, in Temple, TX. PARTICIPANTS Twenty-four students in their third year of medical school completed the communication curriculum. RESULTS Wilcoxon sign test was used to analyze the non-parametric data and multiple repeat tests required the significance level (p-Value) be adjusted to 0.003. Students showed significant increase in understanding of conflict management, their ability to communicate effectively, and their awareness of communication preferences (p < 0.001). In addition, they recognized better ways to engage with other students, residents, and staff on their rotation (p = 0.002) and felt more confident in their ability to handle feedback (p = 0.001). Open-ended responses on the post-test had overwhelmingly positive feedback with themes of awareness, psychological safety, and team rapport. Finally, students requested that the curriculum be taught longitudinally throughout their third-year clerkships. CONCLUSIONS Our curriculum enabled students to improve their awareness of communication, conflict management, team dynamics, and professionalism. These important competencies will support students throughout their training and in their practice as future surgeons.
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Affiliation(s)
- Emily Nes
- Boston Children's Hospital, Department of Surgery, Boston, Massachusetts; Baylor Scott and White Health System, Department of Surgery, Temple, Texas
| | - Bobbie Ann Adair White
- Baylor Scott and White Health System, Department of Surgery, Temple, Texas; MGH Institute of Health Professions, Health Professions Education Program, Boston, Massachusetts; Texas A&M, College of Medicine, Temple, Texas.
| | - Adil Justin Malek
- Baylor Scott and White Health System, Department of Surgery, Temple, Texas
| | - Jonaphine Mata
- Johns Hopkins, Department of Medicine, Baltimore, Maryland; Texas A&M, College of Medicine, Temple, Texas
| | - J Scott Wieters
- Baylor Scott and White Health System, Department of Emergency Medicine, Temple, Texas; Texas A&M, College of Medicine, Temple, Texas
| | - Dan Little
- Baylor Scott and White Health System, Department of Surgery, Temple, Texas; Texas A&M, College of Medicine, Temple, Texas
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Hamberger M, Ikonomi N, Schwab JD, Werle SD, Fürstberger A, Kestler AM, Holderried M, Kaisers UX, Steger F, Kestler HA. Interaction Empowerment in Mobile Health: Concepts, Challenges, and Perspectives. JMIR Mhealth Uhealth 2022; 10:e32696. [PMID: 35416786 PMCID: PMC9047725 DOI: 10.2196/32696] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/13/2021] [Accepted: 02/20/2022] [Indexed: 12/25/2022] Open
Abstract
In its most trending interpretation, empowerment in health care is implemented as a patient-centered approach. In the same sense, many mobile health (mHealth) apps are being developed with a primary focus on the individual user. The integration of mHealth apps into the health care system has the potential to counteract existing challenges, including incomplete or nonstandardized medical data and lack of communication, especially in the intersectional context (eg, patients, medical forces). However, concerns about data security and privacy, regional differences in regulations, lack of accessibility, and nontransparent apps hinder the successful integration of mHealth into the health care system. One approach to address this is to rethink the interpretation of empowerment. On that basis, we here examine existing approaches of individual empowerment and subsequently analyze a different view of empowerment in digital health, namely interaction empowerment. Such a change of perspective could positively influence intersectoral communication and facilitate secure data and knowledge sharing. We discuss this novel viewpoint on empowerment, focusing on more efficient integration and development of mHealth approaches. A renewed interpretation of empowerment could thus buffer current limitations of individual empowerment while also advancing digitization of the health system.
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Affiliation(s)
| | - Nensi Ikonomi
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Julian D Schwab
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Silke D Werle
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Axel Fürstberger
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | | | - Martin Holderried
- Department of Medical Development and Quality Management, University Hospital Tübingen, Tübingen, Germany
| | - Udo X Kaisers
- Chief Executive Officer, University Hospital Ulm, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Hans A Kestler
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
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Nursing interventions that humanise care for patients affected by COVID-19 in isolation units: An integrative review. Infect Dis Health 2022; 27:163-174. [PMID: 35459625 PMCID: PMC8971055 DOI: 10.1016/j.idh.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/25/2022] [Accepted: 03/06/2022] [Indexed: 11/20/2022]
Abstract
Background During the global pandemic, the increasing number of hospitalised patients affected by COVID-19 led to a shortage of nurses. This situation can cause nurses to focus their care on managing the acute aspects of the disease, neglecting interventions that can humanise their practices and improve quality of care. This review aims to identify nurses' interventions that can humanise care for patients affected by COVID-19 in isolation units. Methods Whittemore and Knafl's integrative review methodology was used to structure and conduct the review. The literature search was conducted using CINAHL, MEDLINE, Nursing & Allied Health, MedicLatina, Sciencedirect, LILACS, and PubMed databases. Researchers performed the final search in January 2021. Results A total of seven articles were included in this review. Interventions by nursing staff that may humanise care for patients affected by COVID-19 in isolation units fall within two themes: “expressive dimension interventions”, related to the establishment of communication with patients and their families, providing psychological comfort, shared decision-making and patient education; and “instrumental dimension interventions”, associated with providing patients physical comfort, and symptom management. Conclusion This review provides insight into both “expressive dimension” and “instrumental dimension” of nursing interventions that may humanise care to patients affected by COVID-19 in isolation units. This knowledge will allow nurses to improve their care practices, providing more holistic, humanised care for these patients.
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Hyvämäki P, Kääriäinen M, Tuomikoski AM, Pikkarainen M, Jansson M. Registered Nurses' and Medical Doctors' Experiences of Patient Safety in Health Information Exchange During Interorganizational Care Transitions: A Qualitative Review. J Patient Saf 2022; 18:210-224. [PMID: 34419989 DOI: 10.1097/pts.0000000000000892] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This systematic review aimed to identify, critically appraise, and synthesize the best available literature on registered nurses' and medical doctors' experiences of patient safety in health information exchange (HIE) during interorganizational care transitions. METHODS The review was conducted according to the JBI methodology for systematic reviews of qualitative evidence. A total of 5 multidisciplinary databases were searched from January 2010 to September 2020 to identify qualitative or mixed methods studies. The qualitative findings were pooled using JBI SUMARI with the meta-aggregation approach. RESULTS The final review included 6 original studies. The 53 distinct findings were aggregated into 9 categories, which were further merged into 3 synthesized findings: (1) HIE efficiency and accuracy support patient safety during interorganizational care transitions; (2) inaccuracies in content and structure, along with poor HIE usability, jeopardize patient safety during interorganizational care transitions; and (3) health care professionals' (HCP) actions in HIE are associated with patient safety during interorganizational care transitions. CONCLUSIONS The results of this review identified several advantages of HIE, namely, improvements in patient safety based on reduced human error. Nevertheless, a lack of usability and functionality can amplify the effects of human error and increase the risk of adverse events. In addition, HCPs' individual actions in HIE were found to influence patient safety. Hence, the cognitive and sociotechnical perspectives of work related to HIE should be studied. In addition, HCPs' experiences of each stage of HIE deployment should be clarified to ensure a high standard of patient safety. Registration: PROSPERO CRD42020220631, registered on November 13, 2020.
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Gibson C, Smith D, Morrison AK. Improving Health Literacy Knowledge, Behaviors, and Confidence with Interactive Training. Health Lit Res Pract 2022; 6:e113-e120. [PMID: 35522855 PMCID: PMC9126053 DOI: 10.3928/24748307-20220420-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/16/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ensuring that health care professionals are knowledgeable about the influence limited health literacy has on health outcomes and how to apply health literate strategies is crucial to transform quality and safety in care settings. Although many organizational efforts to address health literacy have focused on hospital settings, few have focused on primary care. The designation of a patient-centered medical home requires the need to address integrating health literacy and the training needs of primary care settings. Brief description of activity: An interactive health literacy training intervention was developed, implemented, and evaluated for 25 primary care clinics. This included an online educational module, in-person application activities, and a sustainability plan to continue skill building, reinforce behaviors, and support practice. IMPLEMENTATION Using a descriptive pre- and post-training design, three survey measures were used to rate health literacy knowledge, behaviors, and confidence levels of more than 475 primary care staff. A pre-training survey was completed prior to completion of an interactive online health literacy module and attendance at an in-person training session which followed. A post-training survey was then completed. Sustainment activities, including lunch and learns, and reinforcement activities by clinic leaders, were initiated to promote use of the strategies in practice. A 1-year follow-up survey was then administered to measure sustainability. RESULTS The interactive training intervention improved primary care staff's knowledge, behaviors, and confidence in using health literacy strategies with patients and families. Common barriers and facilitators around the use of these strategies were also identified. LESSONS LEARNED Careful consideration should be taken when developing health literacy training to ensure it will be effective, efficient, and sustainable. Using elements that facilitate the transfer of training to practice will help improve success. Addressing barriers and promoting facilitators, as well as integrating and connecting health literacy strategies with existing organizational goals and initiatives offer additional ways to reinforce and sustain the practice change. [HLRP: Health Literacy Research and Practice. 2022;6(2):e113-e120.] Plain Language Summary: Clinic staff can improve how they provide information and education to children and families. Interactive training about health literacy led clinic staff to (1) know more about health literacy, (2) use health literacy strategies more, and (3) feel more confident using health literacy strategies. Training over time, supporting staff, and connecting to organizational goals are important for sustainment.
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Affiliation(s)
- Cori Gibson
- Address correspondence to Cori Gibson, MSN, RN, CNL, Children's Wisconsin Corporate Center, Suite 650, 999 N. 92nd Street, Milwaukee, WI 53226;
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Thapi S, Agrawal S, Trivedi A, Masci JR. Barriers to Follow Up Care in the South Asian Immigrant Population at High Risk of Acute Coronary Syndrome at Elmhurst Hospital Center. J Immigr Minor Health 2022; 24:1543-1549. [PMID: 35348985 PMCID: PMC8961098 DOI: 10.1007/s10903-022-01353-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/02/2022]
Abstract
We studied South Asian immigrant patients who did not return to Elmhurst Hospital Center (EHC) after emergent cardiac catheterization in order to propose interventions to improve follow up care. We identified 74 eligible patients, interviewed 30 about follow up practices, and analyzed findings. Most patients are Bangladeshi and 77% preferred a foreign language. Some were visiting the US during the admission without intent to follow up. Half were dissatisfied with EHC providers, complications, and inadequate care at follow up appointments. Some patients were unaware of scheduled appointments or the necessity of follow up. Most follow with private providers due to language accessibility, availability, and proximity. We found that language barriers contribute to loss to follow up and the true loss to follow up rate is lower than reported at EHC. This can inform practices at hospitals with immigrant populations, minimize resource waste, and improve quality of care.
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Affiliation(s)
- Sahityasri Thapi
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Saloni Agrawal
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Ashesh Trivedi
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Joseph R Masci
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
- Department of Global Health, Elmhurst Hospital Center, Elmhurst, NY, USA
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Bahlol M, Sum ZZ, Dewey RS. Barriers to Community Pharmacists Referring Patients With Suspected COVID-19 Symptoms. J Pharm Pract 2022:8971900221074952. [PMID: 35331048 PMCID: PMC8958289 DOI: 10.1177/08971900221074952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background With the necessary skills available to community pharmacists, they are well equipped to relieve pressure on hospitals and general practices by providing referral services for symptomatic patients for COVID-19 testing. Objective The assessment of potential barriers that limit the successful implementation of a community pharmacy referral service for patients with suspected COVID-19 symptoms. Methods A questionnaire comprising of 100 questions was administered to one pharmacist by interview in 1023 working community pharmacies in 4 regions of Egypt between May 17 and May 30th 2020. Results Forty-five barriers were identified. Respondents (79%, n = 803) had difficulty obtaining an accurate patient history. Patient data confidentiality was a significant issue for pharmacists who had not received referral training, with these respondents being significantly (P = .010) less able to differentiate between COVID-19 and similar conditions. Respondents (68.8%, n = 698) were not confident in determining whether COVID-19 was the cause of the patient’s presenting symptoms. A large majority (73.7%, n = 747) of respondents were worried about referring misdiagnosed patients and were concerned about the negative implications of proceeding with such a referral, including legal consequences. Of Respondents (71.7%, n = 727) reported that online referral was not easy, and 71.6% (n = 722) were unable to locate paper referral forms. Only a small number of pharmacists (11%, n = 112) preferred to report a referral in their own name. Conclusions This study has demonstrated the potential of the community pharmacist’s role as a point of referral for COVID-19 testing, and identified some major barriers to implementation of this. The lack of pharmacists’ education, legal support, availability of referral forms, clarity of responsibility and unsupportive management teams are key obstacles that must be overcome for the successful implementation of a COVID-19 referral service.
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Affiliation(s)
- Mohamed Bahlol
- Specialty of Pharmaceutical Management and Economics, Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, 501249Egyptian Russian University, Cairo, Egypt.,Specialty of Pharmaceutical Management and Economics, Department of Clinical Pharmacy, Faculty of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Zachary Z Sum
- National Institute of Independent Pharmacist Research, Melbourne, VIC, Australia
| | - Rebecca Susan Dewey
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, 6123University of Nottingham, Nottingham, UK
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Card EB, Lejbman J, Trueblood E, Bennett BC, Dunham BP, Swain AJ, Delisser HM. Drawing for Visual Communication in Medicine: A Novel Pilot Course for Senior Medical Students. JOURNAL OF SURGICAL EDUCATION 2022; 79:389-396. [PMID: 34674979 DOI: 10.1016/j.jsurg.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/18/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Visual aids such as drawings have been reported to improve patient comprehension, retention, and adherence. We sought to determine the feasibility of teaching live drawing for clinical communication to medical students. DESIGN We designed a course to teach basic drawing skills and visual communication of health information to senior medical students. Data was gathered from both an intervention and control group via written pre- and post-course surveys. The intervention group also completed a survey six months after the course. SETTING The course was offered as an elective at the University of Pennsylvania Perelman School of Medicine during February 2020. PARTICIPANTS The intervention group consisted of 17 enrolled students, while 17 students not taking the course served as a control group. Third year, fourth year, and research year medical students were invited to enroll in the course. RESULTS The intervention group had significantly greater comfort with visual communication for patient care and increased objective drawing and visual communication scores compared to the control group. Visual abilities not targeted by the curriculum did not change between the intervention and control groups. At 6-months follow-up, course participants reported persistently elevated comfort in visual communication, as well as utilization of visual communication skills in their clinical practice. CONCLUSIONS These data provide initial evidence of the efficacy of an elective course aimed at developing the skill and confidence to draw for visual communication in medicine as well as support for continued efforts to further develop and disseminate this type of curriculum.
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Affiliation(s)
- Elizabeth B Card
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Julian Lejbman
- Department of Internal Medicine, University of California Los Angeles, Los Angeles, California
| | - Eo Trueblood
- The Children's Hospital of Philadelphia Stream Studios, Philadelphia, Pennsylvania
| | - Brittany C Bennett
- Department of Radiology, The Children's Hospital of Philadelphia, The Children's Hospital of Philadelphia Stream Studios, Philadelphia, Pennsylvania
| | - Brian P Dunham
- Division of Otolaryngology, The Children's Hospital of Philadelphia, The Children's Hospital of Philadelphia Stream Studios, Philadelphia, Pennsylvania
| | - Amanda J Swain
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Horace M Delisser
- Academic Programs Office and the Pulmonary Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Doyle C. The importance of supportive relationships with general practitioners, hospitals and pharmacists for mothers who 'give medicines' to children with severe and profound intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:29-49. [PMID: 32815761 DOI: 10.1177/1744629520951003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A purposeful sample of 15 mothers of children with severe and profound intellectual disabilities participated in this hermeneutic phenomenological study through interviews and completion of a diary. The aim of the study was to explore mothers' lived experience of 'giving medicines' to children with severe and profound intellectual disabilities. Findings yielded multiple themes, one of which gave insight into the importance of supportive relationships with health professionals. The general practitioner (GP), hospital and pharmacist are key in providing supportive elements to mothers' daily role. Having the support of a helpful GP was key in helping mothers cope on a daily basis for child related queries on illness, getting prescriptions or seeking advice. Accessibility to the hospital and avoiding the emergency department with their child was recommended. The pharmacist was central to the daily activities relating to 'giving medicines' and a good relationship resulted in a happier mother.
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Affiliation(s)
- Carmel Doyle
- School of Nursing and Midwifery, 214057Trinity College, Dublin, Ireland
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Davidson N, Hammarberg K, Romero L, Fisher J. Access to preventive sexual and reproductive health care for women from refugee-like backgrounds: a systematic review. BMC Public Health 2022; 22:403. [PMID: 35220955 PMCID: PMC8882295 DOI: 10.1186/s12889-022-12576-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Globally, the number of forcibly displaced women is growing. Refugee and displaced women have poorer health outcomes compared to migrant and host country populations. Conflict, persecution, violence or natural disasters and under-resourced health systems in their country of origin contribute to displacement experiences of refugee and displaced women. Poor health outcomes are further exacerbated by the migration journey and challenging resettlement in host countries. Preventive sexual and reproductive health (SRH) needs of refugee and displaced women are poorly understood. The aim was to synthesise the evidence about access to preventive SRH care of refugee and displaced women. Methods A systematic review of qualitative, quantitative and mixed methods studies of women aged 18 to 64 years and health care providers' (HCPs’) perspectives on barriers to and enablers of SRH care was undertaken. The search strategy was registered with PROSPERO in advance of the search (ID CRD42020173039). The MEDLINE, PsycINFO, Embase, CINAHL, and Global health databases were searched for peer-reviewed publications published any date up to 30th April 2020. Three authors performed full text screening independently. Publications were reviewed and assessed for quality. Study findings were thematically extracted and reported in a narrative synthesis. Reporting of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Results The search yielded 4083 results, of which 28 papers reporting 28 studies met inclusion criteria. Most related to contraception and cervical or breast cancer screening. Three main themes and ten subthemes relating to SRH care access were identified: interpersonal and patient encounter factors (including knowledge, awareness, perceived need for and use of preventive SRH care; language and communication barriers), health system factors (including HCPs discrimination and lack of quality health resources; financial barriers and unmet need; HCP characteristics; health system navigation) and sociocultural factors and the refugee experience (including family influence; religious and cultural factors). Conclusions Implications for clinical practice and policy include giving women the option of seeing women HCPs, increasing the scope of practice for HCPs, ensuring adequate time is available during consultations to listen and develop refugee and displaced women’s trust and confidence, strengthening education for refugee and displaced women unfamiliar with preventive care and refining HCPs’ and interpreters’ cultural competency. More research is needed on HCPs’ views regarding care for refugee and displaced women. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12576-4.
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House S, Wilmoth M, Stucky C. Relational coordination as a merger and acquisition framework for healthcare organizations. Nurs Manag (Harrow) 2022; 53:36-42. [PMID: 35105844 DOI: 10.1097/01.numa.0000816256.13974.1b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sherita House
- Sherita House is a postdoctoral fellow at Indiana University School of Nursing in Indianapolis, Ind. Margaret Wilmoth is the executive vice dean of academic affairs at the University of North Carolina at Chapel Hill School of Nursing in Chapel Hill, N.C. Christopher Stucky is the deputy chief of the Center for Nursing Science and Clinical Inquiry at Landstuhl Regional Medical Center in Landstuhl, Germany
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Abstract
Background: By 2040, the predicted global cancer burden is expected to be more than 27 million new cancer cases per year. Understanding primary health care workers’ (HCWs) perception on cancer can highlight new ways in which cancer advocacy can be increased. This study aimed to explore the perceptions of primary HCWs in Lautoka, Fiji, towards common cancers with focus on knowledge, risk perceptions, barriers and preventive approaches. Methods: The study used a qualitative method approach. The study was conducted among primary HCWs at four purposively selected health centres in Lautoka Subdivision, Fiji, from 1 March 2021 to 1 April 2021. Focus group discussions (FGDs) were conducted with primary HCWs. A semi-structured open-ended questionnaire was used to collect data, and the FGDs were audio-recorded. These audio recordings were transcribed and analysed using thematic analysis. Results: The responses from the four FGDs with six primary HCWs in each group emerged four major themes. These themes were cancer knowledge, health professional training, barriers and challenges and awareness strategies. Primary HCWs were not fully aware about common cancers and were not confident to discuss about cancer with their patients which is an important role of primary HCWs in cancer management. This lack of knowledge was attributed to less training received in primary care setting. Barriers to accessing cancer screening included misconceptions about cancer, negative attitudes from patients, stigmatization, lack of resources at health facility and less informed health staff. Community outreach programmes, opportunistic screening, community HCWs and the concept of a cancer hub centre were awareness strategies highlighted by primary HCWs. Conclusions: Lack of knowledge about common cancers among primary HCWs is a concern that is depicted well in this study. This low knowledge was attributed to lack of training on cancers received by primary HCWs. Guidelines on cancer screening and diagnosis can be developed by the health ministry to assist primary HCWs in detecting patients at pre-cancerous stage.
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129
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Schuster M, Deitmerg U, Gantner S. [Vocal tract discomfort and wellbeing of caregivers for the elderly during the pandemic]. Laryngorhinootologie 2022; 101:797-804. [PMID: 35016249 DOI: 10.1055/a-1727-6012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND During the Sars-CoV2-pandemic, people working in healthcare such as caregives for the elderly face additional burden, e.g. by the use of face masks. METHODS In a prospective study, the emotional and physical wellbeing as well as the vocal tract discomfort of caregivers of two municipal homes for the elderly were assessed by questionnaires, the Mini-SCL and the Vocal Tract Discomfort Scale (VTDS), and one on personal data (sex, age, lung disease, previous SARS-CoV2-infection) and on voice symptoms. RESULTS 67% of the questionnaires were answered by 56 women and 11 men aged 45.2 ± 11.5. In the Mini-SCL, increased scores were found in depression in 23.8%, anxiety in 49.3%, somatization in 55.2% and in the global score in 44.7%. 52%. showed increased scores in the VTDS Significant correlations were found in between the subscales of the Mini-SCL and the VTDS as well as to dysphonia symptoms. DISCUSSION Psychological problems, somatization and vocal tract discomfort is more frequently reported by caregivers for the elderly than in the normal population. The VTDS, voice symptoms and the Mini-SCL scales are significantly related. Training on vocal hygiene should be included in workplace health promotion during the pandemic.
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Affiliation(s)
- Maria Schuster
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Chirurgie, Ludwig-Maximiians-Universität München, München, Germany.,Praxis für Hals-Nasen-Ohrenheilkunde, Phoniatrie und Pädaudiologie, Nuremberg, Germany
| | | | - Sophia Gantner
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Chirurgie, Ludwig-Maximiians-Universität München, München, Germany
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130
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Rouleau G, Gagnon MP, Côté J, Richard L, Chicoine G, Pelletier J. Virtual patient simulation to improve nurses' relational skills in a continuing education context: a convergent mixed methods study. BMC Nurs 2022; 21:1. [PMID: 34983509 PMCID: PMC8725454 DOI: 10.1186/s12912-021-00740-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective provider-patient communication is crucial to the delivery of high-quality care. Communication roadblock such as righting reflex is widely observed among providers and can lead to relational disengagement. In previous work, nurses felt ill-equipped to communicate effectively with HIV-positive patients to support medication adherence. Providing nurses with continuing education opportunities to improve their relational skills is a major target for optimizing the quality of care. Virtual patient simulation is one promising strategy that needs to be evaluated among graduate nurses. This study aimed to assess the acceptability of a virtual patient simulation to improve nurses' relational skills in a continuing education context. METHODS We conducted a convergent mixed methods study by combining a quantitative pre-experimental, one-group post-test design and a qualitative exploratory study. We used convenience and snowball sampling approaches to select registered nurses (n = 49) working in Quebec, Canada. Participants completed an online sociodemographic questionnaire, consulted the automated virtual patient simulation (informed by motivational interviewing), and filled out an online post-test survey. Descriptive statistics (mean, SD, median, interquartile range) were used to present quantitative findings. From the 27 participants who completed the simulation and post-test survey, five participated in a focus group to explore their learning experience. The discussion transcript was subjected to thematic analysis. At the final stage of the study, we used a comparison strategy for the purpose of integrating the quantitative and qualitative results. RESULTS Nurses perceived the simulation to be highly acceptable. They rated the global system quality and the technology acceptance with high scores. They reported having enjoyed the simulation and recommended other providers use it. Four qualitative themes were identified: motivations to engage in the simulation-based research; learning in a realistic, immersive, and non-judgmental environment; perceived utility of the simulation; and perceived difficulty in engaging in the simulation-based research. CONCLUSIONS The simulation contributed to knowledge and skills development on motivational interviewing and enhanced nurses' self-confidence in applying relational skills. Simulation holds the potential to change practice, as nurses become more self-reflective and aware of the impact of their relational skills on patient care. TRIAL REGISTRATION ISRCTN18243005 , retrospectively registered on July 3 2020.
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Affiliation(s)
- Geneviève Rouleau
- Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry, 1050 De la Médecine Ave., Québec City, QC, G1V 0A6, Canada.
- Research Chair in Innovative Nursing Practices, 850 St-Denis St., Tour S, Montréal, QC, H2X0A9, Canada.
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry, 1050 De la Médecine Ave., Québec City, QC, G1V 0A6, Canada
- Vitam Research Center in Sustainable Health, Université Laval, 2525 De la Canardière Rd., Québec City, QC, G1J 0A4, Canada
- Population Health and Optimal Health Practices Axis, CHU de Québec-Université Laval Research Centre, 1050 Sainte-Foy Rd., Québec City, QC, G1S 4L8, Canada
| | - José Côté
- Research Chair in Innovative Nursing Practices, 850 St-Denis St., Tour S, Montréal, QC, H2X0A9, Canada
- Faculty of Nursing, Université de Montréal, 2375 Côte Ste-Catherine Rd., Pavillon Marguerite d'Youville, Montréal, QC, H3T 1A8, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 850 St-Denis St, Tour S, Montréal, QC, H2X0A9, Canada
| | - Lauralie Richard
- Faculty of Nursing, Université de Montréal, 2375 Côte Ste-Catherine Rd., Pavillon Marguerite d'Youville, Montréal, QC, H3T 1A8, Canada
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, 55 Hanover Street, Dunedin, 9016, New Zealand
| | - Gabrielle Chicoine
- Research Chair in Innovative Nursing Practices, 850 St-Denis St., Tour S, Montréal, QC, H2X0A9, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 850 St-Denis St, Tour S, Montréal, QC, H2X0A9, Canada
| | - Jérôme Pelletier
- Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry, 1050 De la Médecine Ave., Québec City, QC, G1V 0A6, Canada
- Université du Québec à Rimouski, 300 Allée des Ursulines, Rimouski, QC, G5L 3A1, Canada
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Randall C, Johns L, Mey A, Parker-Tomlin M, Reeves N, Chan PC, Cardell E, Bialocerkowski A, Rogers GD. Facilitating interprofessional affective learning in health professional students through digital client documentation: a comparison of simulation modes. J Interprof Care 2022; 36:810-819. [PMID: 34979855 DOI: 10.1080/13561820.2021.2002832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Digital Interprofessional Learning Client Documentation (D-IPL Client Docs) is an initiative designed to develop student interprofessional communication skills through electronic record writing and a virtual simulation (VS) or live virtual simulation (LVS) case conference. The aims of the study were to (a) identify whether D-IPL Client Docs supports student learning in the affective domain and (b) compare the learning outcomes for students participating in the VS versus the LVS case conference. Data were drawn from 83 Bachelor of Social Work students who had participated with other health professional students in the D-IPL Client Docs activities. The reflective journals submitted by this cohort of social work students were analyzed qualitatively and quantitatively using the Griffith University Affective Learning Scale. Qualitative analyses revealed that the activities enabled students in both groups to learn about themselves, their roles, and the roles of others, and the benefits of interprofessional collaboration in optimizing client outcomes. Quantitatively, the VS mode appeared to be more effective in supporting students to develop higher order affective learning; however, the effect size was small. Future studies should involve a larger sample size and include students from various professions to ascertain the transferability of findings.
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Affiliation(s)
- Christine Randall
- School of Health Sciences and Social Work, & The Hopkins Centre, Griffith University, Brisbane, Australia
| | - Lise Johns
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Amary Mey
- Griffith Health, Griffith University, Brisbane, Australia
| | | | - Nathan Reeves
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Pit Cheng Chan
- Griffith Health, Griffith University, Brisbane, Australia
| | - Elizabeth Cardell
- School of Medicine and Dentistry, & The Hopkins Centre, Griffith University, Brisbane, Australia
| | | | - Gary D Rogers
- School of Medicine, Deakin University, Geelong, Australia.,School of Medicine and Dentistry, Griffith University, Brisbane, Australia
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132
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Faujdar D, Kaur M, Singh T, Sahay S, Kumar R. Evaluating scope of mobile technology for bridging health care gaps in impoverished population in LMICs. J Family Med Prim Care 2022; 11:90-96. [PMID: 35309632 PMCID: PMC8930115 DOI: 10.4103/jfmpc.jfmpc_809_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/04/2022] Open
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Hamel LM, Moulder R, Ramseyer FT, Penner LA, Albrecht TL, Boker S, Eggly S. Nonverbal Synchrony: An Indicator of Clinical Communication Quality in Racially-Concordant and Racially-Discordant Oncology Interactions. Cancer Control 2022; 29:10732748221113905. [PMID: 35801386 PMCID: PMC9272474 DOI: 10.1177/10732748221113905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this cross-sectional study was to apply a novel software to
measure and compare levels of nonverbal synchrony, as a potential indicator
of communication quality, in video recordings of racially-concordant and
racially-discordant oncology interactions. Predictions include that the
levels of nonverbal synchrony will be greater during racially-concordant
interactions than racially-discordant interactions, and that levels of
nonverbal synchrony will be associated with traditional measures of
communication quality in both racially-concordant and racially-discordant
interactions. Design This is a secondary observational analysis of video-recorded oncology
treatment discussions collected from 2 previous studies. Setting Two National Cancer Institute-designated Comprehensive Cancer Centers and
another large urban cancer center. Participants Participants from Study 1 include 161 White patients with cancer and 11 White
medical oncologists. Participants from Study 2 include 66
Black/African-American patients with cancer and 17 non-Black medical
oncologists. In both studies inclusion criteria for patients was a recent
cancer diagnosis; in Study 2 inclusion criteria was identifying as
Black/African American. Main outcome measures Nonverbal synchrony and communication quality. Results Greater levels of nonverbal synchrony were observed in racially-discordant
interactions than in racially-concordant interactions. Levels of nonverbal
synchrony were associated with indicators of communication quality, and
these associations were more consistently found in racially-discordant
interactions. Conclusion This study advances clinical communication and disparities research by
successfully applying a novel approach capturing the unconscious nature of
communication, and revealing differences in communication in
racially-discordant and racially-concordant oncology interactions. This
study highlights the need for further exploration of nonverbal aspects
relevant to patient-physician interactions.
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Affiliation(s)
- Lauren M Hamel
- 12267Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
| | | | | | - Louis A Penner
- 12267Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
| | | | - Steven Boker
- 2358University of Virginia, Charlottesville, VA, USA
| | - Susan Eggly
- 12267Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
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Alrasheed AA, Alharbi AH, Alotaibi AF, Alqarni AH, Alshahrani AM, Almigbal TH, Batais MA. Prevalence, Reasons and Determinants of Patients' Nondisclosure to Their Doctors in Saudi Arabia: A Community-Based Study. Patient Prefer Adherence 2022; 16:245-253. [PMID: 35125866 PMCID: PMC8811268 DOI: 10.2147/ppa.s347796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/15/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Patient-doctor communication is a fundamental component of patients' care. Withholding important information to the doctor can negatively affect the patients' health and patient-doctor communication. AIM This study aimed to explore the fundamental types of information that patients hide from doctors, eg, the use of medication, health-related lifestyle, or disagreement with the doctor's plan. In addition, this study examines the prevalence and reasons for this nondisclosure and factors associated with it. METHODOLOGY An online survey was conducted using a self-designed questionnaire, which was distributed to social media, targeting the residents of Saudi Arabia from February 1, 2021 to February 28, 2021. Respondents under 18 years of age and those who provided incomplete/incorrect data were excluded from the study. Types of nondisclosed information and their reasons were evaluated. RESULTS A total of 2725 participants completed the questionnaire, and 1392 (51.1%) were males. About 43.2% of the participants were 18-29 years. Most (82%) responded "yes" to the question "Have you ever withheld any information from your doctor?" Nondisclosed information commonly involved disagreements with the recommendation (44.7%), not taking prescription medication as instructed (40.6%), and not understanding the instructions (37.4%). The most frequent reasons (68.7%) for nondisclosure were that the participants wanted to undergo further tests, did not like the doctor's attitude (48.7%) and felt it did not matter to the doctor (43.2%). Those under 40 were more apt to withhold information (70.4%) than older participants (29.6%) p value = 0.0034. Other factors like gender, education level, and marital status were not associated with nondisclosure. CONCLUSION The prevalence of nondisclosure to doctors is high. Effective communication skills and sound doctor-patient relationships may reduce this risk and improve the care delivered to the patients.
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Affiliation(s)
- Abdullah A Alrasheed
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Abdullah A Alrasheed, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia, Tel +966 55 644 0445, Email
| | | | | | | | - Abdullah M Alshahrani
- Department of Family Medicine, College of Medicine, University of Bisha, Bisha, Saudi Arabia
| | - Turky H Almigbal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Vision College of Medicine, Vision Colleges in Riyadh, Riyadh, Saudi Arabia
| | - Mohammed A Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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135
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Matsumura S, Ozaki M, Kanno T, Iioka T, Bito S. Essential information for transition of care for frail elderly patients in Japan: A qualitative study. J Gen Fam Med 2022; 23:24-30. [PMID: 35004107 PMCID: PMC8721333 DOI: 10.1002/jgf2.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/20/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Information exchange between hospitals and primary care physicians is suboptimal. Most physicians are dissatisfied with the current referral process, and poor communication leads to negative care transition outcomes. METHOD To identify the key information needed for a successful transition of care, we conducted a qualitative study using consecutive, semistructured in-person interviews and focus group sessions. We recruited five participants engaged in clinical work for individual interviews and 16 participants for focus groups. We analyzed all data using qualitative thematic analysis. All results were returned to the participants and modified based on their feedback. RESULTS The five individual interviews provided a general picture of the current referral process and an interview guide for the following focus group sessions. The focus group discussions were used to identify the essential information needed at admission and discharge from the hospital. Essential information on hospital admission was as follows: (1) basic medical and care information, (2) care resources available at home, (3) the purpose of admission and the goals of care during hospitalization, and (4) status of advance care planning (ACP) and patient's will in an emergency. Essential information on hospital discharge was as follows: (1) clinical course, (2) explanation of medical condition during hospitalization, (3) status of ACP and patient's will in an emergency, and (4) medical procedures to be continued at home. CONCLUSIONS We identified the essential information needed for a successful transition of care in Japan. The clinical effectiveness of a template that contains the information identified in our study warrants further investigation.
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Affiliation(s)
- Shinji Matsumura
- Department of Clinical EpidemiologyNational Hospital Organization Tokyo Medical CenterTokyoJapan
- Matsumura ClinicTokyoJapan
| | - Makiko Ozaki
- Internal MedicineMurasakino Kyoritsu ClinicKyotoJapan
| | | | - Tomomi Iioka
- Department of Clinical EpidemiologyNational Hospital Organization Tokyo Medical CenterTokyoJapan
| | - Seiji Bito
- Department of Clinical EpidemiologyNational Hospital Organization Tokyo Medical CenterTokyoJapan
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136
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Pocock LV, Purdy S, Barclay S, Murtagh FEM, Selman LE. Communication of poor prognosis between secondary and primary care: protocol for a systematic review with narrative synthesis. BMJ Open 2021; 11:e055731. [PMID: 34949630 PMCID: PMC9066345 DOI: 10.1136/bmjopen-2021-055731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION People dying in Britain spend, on average, 3 weeks of their last year of life in hospital. Hospital discharge presents an opportunity for secondary care clinicians to communicate to general practitioners (GPs) which patients may have a poor prognosis. This would allow GPs to prioritise these patients for Advance Care Planning.The objective of this study is to produce a critical overview of research on the communication of poor prognosis between secondary and primary care through a systematic review and narrative synthesis. METHODS AND ANALYSIS We will search Medline, EMBASE, CINAHL and the Social Sciences Citation Index for all study types, published since 1 January 2000, and conduct reference-mining of systematic reviews and publications. Study quality will be assessed using the Mixed-Methods Appraisal Tool; a narrative synthesis will be undertaken to integrate and summarise findings. ETHICS AND DISSEMINATION Approval by research ethics committee is not required since the review only includes published and publicly accessible data. Review findings will inform a qualitative study of the sharing of poor prognosis at hospital discharge. We will publish our findings in a peer-reviewed journal as per Preferred Reporting for Systematic review and Meta-analysis (PRISMA) 2020 guidance. PROSPERO REGISTRATION CRD42021236087.
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Affiliation(s)
- Lucy V Pocock
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Sarah Purdy
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Stephen Barclay
- General Practice Research Unit, University of Cambridge, Cambridge, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lucy E Selman
- Population Health Sciences, University of Bristol, Bristol, UK
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Fernando SS, Paige EK, Dendle C, Weinkove R, Kong DCM, Omond P, Routledge DJ, Szer J, Blyth CC. Consensus guidelines for improving patients' understanding of invasive fungal disease and related risk prevention in the haematology/oncology setting, 2021. Intern Med J 2021; 51 Suppl 7:220-233. [PMID: 34937138 DOI: 10.1111/imj.15593] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patients with invasive fungal disease (IFD) are at significant risk of morbidity and mortality. A productive partnership between patients, their carers/families, and the multidisciplinary team managing the infection and any underlying conditions, is essential. Sharing information and addressing knowledge gaps are required to ensure those at risk of IFD avoid infection, while those with suspected or confirmed infection optimise their therapy and avoid toxicities. This new addition to the Australian and New Zealand consensus guidelines for the management of IFD and antifungal use in the haematology/oncology setting outlines the key information needs of patients and their carers/families. It specifically addresses risk factor reduction, antifungal agents and adherence, and the risks and benefits of complementary and alternative therapies. Knowledge gaps are also identified to help inform the future research agenda.
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Affiliation(s)
| | - Emma K Paige
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Claire Dendle
- Infection and Immunity Service, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert Weinkove
- Wellington Blood and Cancer Centre, Capital and Coast District Health Board, Wellington, New Zealand.,Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - David C M Kong
- Pharmacy Department, Ballarat Health Service, Ballarat, Victoria, Australia.,Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.,National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Paul Omond
- National Centre for Infections in Cancer, Melbourne, Victoria, Australia.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - David J Routledge
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeff Szer
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine WA, QEII Medical Centre, Perth, Western Australia, Australia
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138
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Dec-Pietrowska J, Szczepek AJ. A Study of Differences in Compulsory Courses Offering Medicine Humanization and Medical Communication in Polish Medical Schools: Content Analysis of Secondary Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413326. [PMID: 34948930 PMCID: PMC8706785 DOI: 10.3390/ijerph182413326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
Medical humanity is an essential element of medical education, and the respective courses are introduced to the curricula of medical schools worldwide. However, significant differences in this type of medical education were identified in Italy, Spain, and the UK. In Poland, this issue was not yet analyzed. The classes offered on a compulsory and not elective basis secure the uniform skills of future physicians. Therefore, we were prompted to ask a question: do Polish medical students receive equal compulsory education in medical humanities? To answer that question, we performed a content analysis of mandatory classes’ frequency, types, and content on medical humanization and communication in Polish medical schools. The study used publicly available information provided on the home pages of the universities to perform content and comparative analyses. Of 22 identified universities, 15 had publicly listed teaching programs, and nine had freely available syllabi. The names and types of courses varied from school to school. The number of hours the courses offered throughout medical education ranged from 15 to 216. In some medical schools, the classes were scheduled during the early, pre-clinical part of the study, whereas in other schools they were offered each year. The content of the courses always covered the topics of physician–patient communication but rarely offered protocols, such as the Calgary Cambridge guide. We conclude that the medical humanities represented by medical humanization and communication courses are included in the publicly available compulsory curriculum of most Polish medical schools. However, to secure equal education of future Polish physicians, there is a need to unify the medical humanities program.
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Affiliation(s)
- Joanna Dec-Pietrowska
- Faculty of Medicine and Health Sciences, University of Zielona Góra, 65-046 Zielona Góra, Poland
- Correspondence: (J.D.-P.); (A.J.S.)
| | - Agnieszka J. Szczepek
- Faculty of Medicine and Health Sciences, University of Zielona Góra, 65-046 Zielona Góra, Poland
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Correspondence: (J.D.-P.); (A.J.S.)
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139
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Gohal G. Models of teaching medical errors. Pak J Med Sci 2021; 37:2020-2025. [PMID: 34912437 PMCID: PMC8613064 DOI: 10.12669/pjms.37.7.4506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/20/2021] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
Medical errors are relatively common causes of preventable iatrogenic adverse events. We have focused on teaching models in certain courses of study that have been reported to have significant positive impacts on the outcomes of teaching about medical errors. All healthcare organizations must establish suitable models of teaching about patient safety and medical errors as a preventive measure and as an early intervention strategy. Teaching undergraduate medical students and physicians in training how to manage and disclose medical errors helps them develop lifelong skills that can effectively reduce such errors. The literature search was conducted in international databases such as PubMed/MEDLINE and Google Scholar search engine using English equivalent keywords, from 1998 up to April, 2020. The search strategy used the following subject headings terms: “Medical error(s)” AND “Teaching”. Out of 40 Studies included, 6 studies were selected to have evaluated models of health care training and simulation based teaching of medical errors and patient safety in undergraduate and postgraduate medical education.
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Affiliation(s)
- Gassem Gohal
- Dr. Gassem Gohal, MD, FRCPC, ABP. Department of Pediatrics, Jazan University, Faculty of Medicine, Jazan, Saudi Arabia
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Jn Pierre CE, Weber GM, Abramowicz AE. Attitudes towards and impact of letters of recommendation for anesthesiology residency applicants. MEDICAL EDUCATION ONLINE 2021; 26:1924599. [PMID: 33960915 PMCID: PMC8118394 DOI: 10.1080/10872981.2021.1924599] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 05/24/2023]
Abstract
Background: This survey aims to identify the relative value and the critical components of anesthesiology letters of recommendation(LORs) from the perspective of Program Directors (PDs) and Associate/Assistant Program Directors (APDs). Knowledge and insights originating from this survey might add to the understanding of the anesthesiology residency selection process and mitigate unintended linguistic biases.Methodology: Anonymous online surveys were sent to anesthesiology PDs/APDs from the Accreditation Council for Graduate Medical Education (ACGME) accredited anesthesiology residency Programs in the USA (US), as listed on the ACGME website and the American Medical Association Fellowship and Residency Electronic Interactive Database (AMA FREIDA) Residency Program Database. The survey authors were blinded to the identity of the respondents.Results: 62 out of 183 (33.8%) invited anesthesiology PDs/APDs completed the survey anonymously. In our survey, LORs are reported as more important in granting an interview than in making the rank list. 64% of respondents prefer narrative LORs. 77.4% of respondents look for specific keywords in LORs. Keywords such as 'top % of students' and 'we are recruiting this candidate' indicate a strong letter of recommendation while keywords such as 'I recommend to your program' or non-superlative descriptions indicate a weak letter of recommendation. Other key components of LORs include the specialty of the letter-writer, according to 84% of respondents, with anesthesiology as the most valuable specialty. Although narrative LORs are preferred, 55.1% of respondents are not satisfied with the content of narrative LORs.Conclusion: LORs containing specific keywords play an important role in the application to anesthesiology residency, particularly when submitted by an anesthesiologist. While narrative LORs are still the preferred format, most of our respondents feel they need improvements. The authors suggest specific LOR improvements including creating formalized LOR training, adding a style guide, and applying comparative scales, with standardized vocabulary in the narrative LOR.
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Affiliation(s)
- Carl E. Jn Pierre
- New York Medical College, School of Medicine, Valhalla, New York
- Department of Anesthesiology, New York Medical College, Westchester Medical Center, NY, New York
| | - Garret M. Weber
- New York Medical College, School of Medicine, Valhalla, New York
- Department of Anesthesiology, New York Medical College, Westchester Medical Center, NY, New York
| | - Apolonia E. Abramowicz
- Department of Anesthesiology, New York Medical College, Westchester Medical Center, NY, New York
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141
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Marques Cavalcante-Santos L, Carvalho Silvestre C, Andrade Macêdo L, Mônica Machado Pimentel D, Dias de Oliveira-Filho A, Manias E, Pereira de Lyra D. Written communication about the use of medications in medical records in a Brazilian hospital. Int J Clin Pract 2021; 75:e14990. [PMID: 34710266 DOI: 10.1111/ijcp.14990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/23/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Effective communication regarding the use of medications in hospital environments is a process that contributes to patient safety. Despite its importance, written communication about the medication use process in medical records remains insufficiently investigated. AIM To describe the documentation in medical records regarding the medication use process by pharmacists, physicians and nurses on admission, during the hospital stay, and at hospital discharge. METHOD A retrospective cross-sectional chart review study was carried out in medical records of patients admitted to a teaching hospital in Northeast Brazil. The study considered all patients admitted between December 2016 and February 2017, aged 18 or older and hospitalised for at least 48 hours. Clinical notes made by pharmacists, physicians and nurses were examined at three transition points of care. Data were collected using a questionnaire relating to the use of medications prior to hospital admission, changes in the prescribed medications during the hospital stay and discharge, as well as prescription non-conformities. Communication failures between the three healthcare professional groups were analysed and classified. The study was authorised by the Hospital's Board of Directors and approved by the Research Ethics Committee of the Federal University of Sergipe. RESULTS This study included 202 medical records of patients with a mean age of 51.48 (SD 6.42, range: 19-97) years. There was no record of a patient or relative interview on allergies and adverse drug reactions in 54 (26.8%) physician notes, 44 (21.9%) nursing notes, and 9 (25.0%) pharmacist notes. Moreover, 1,588 changes in prescriptions were identified during data collection, and 1,198 (75.4%) of these were unjustified. CONCLUSION Medication-related information in medical records was incomplete and inconsistent in the clinical notes of the three studied professions, especially in pharmacists' documentation. Future studies should focus on investigating the consequences of interprofessional communication in patient care.
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Affiliation(s)
- Lincoln Marques Cavalcante-Santos
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Carina Carvalho Silvestre
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
- Department of Pharmacy, Life Sciences Institute, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Luana Andrade Macêdo
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | | | | | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Divaldo Pereira de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
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142
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Evaluation of an occupational medicine patient consultation note assessment tool. Occup Med (Lond) 2021; 72:99-104. [DOI: 10.1093/occmed/kqab154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
Medical education focuses on assessment, diagnosis and management of various clinical entities. The communication of this information, particularly in the written form, is rarely emphasized. Though there have been assessment tools developed to support medical learner improvement in this regard, none are oriented to occupational medicine (OM) practice.
Aims
This study was aimed to develop and evaluate an assessment tool for consultation letters, by modifying a previously validated assessment tool to suit practice in OM.
Methods
Using an iterative process, OM specialists added to the Consultation Letter Rating Scale (CLRS) of the Royal College of Physicians and Surgeons of Canada (henceforth abbreviated as RC) additional questions relevant to communication in the OM context. The tool was then used by two OM specialists to rate 40 anonymized OM clinical consultation letters. Inter-rater agreement was measured by percent agreement, kappa statistic and intraclass correlation.
Results
There was generally good percent agreement (>80% for the majority of the RC and OM questions). Intraclass correlation for the five OM questions total scores was slightly higher than the intraclass correlations for the five RC questions (0.59 versus 0.46, respectively), suggesting that our modifications performed at least as well as the original tool.
Conclusions
This new tool designed specifically for evaluation of patient consultation notes in OM provides a good option for medical educators in a variety of practice areas in providing non-summative, low-stakes assessment and/or feedback to nurture increased competency in written communication skills for postgraduate trainees in OM.
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143
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Alshammari H, Al-Saeed E, Ahmed Z, Aslanpour Z. Reviewing Potentially Inappropriate Medication in Hospitalized Patients Over 65 Using Explicit Criteria: A Systematic Literature Review. Drug Healthc Patient Saf 2021; 13:183-210. [PMID: 34764701 PMCID: PMC8572741 DOI: 10.2147/dhps.s303101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022] Open
Abstract
Potentially inappropriate medication (PIM) is a primary health concern affecting the quality of life of patients over 65. PIM is associated with adverse drug reactions including falls, increased healthcare costs, health services utilization and hospital admissions. Various strategies, clinical guidelines and tools (explicit and implicit) have been developed to tackle this health concern. Despite these efforts, evidence still indicates a high prevalence of PIM in the older adult population. This systematic review explored the practice of using explicit tools to review PIM in hospitalized patients and examined the outcomes of PIM reduction. A literature search was conducted in several databases from their inception to 2019. Original studies that had an interventional element using explicit criteria detecting PIM in hospitalized patients over 65 were included. Descriptive narrative synthesis was used to analyze the included studies. The literature search yielded 6116 articles; 25 quantitative studies were included in this systematic literature review. Twenty were prospective studies and five were retrospective. Approximately, 15,500 patients were included in the review. Various healthcare professionals were involved in reviewing PIM including physicians and hospital pharmacists. Several tools were used to review PIM for hospitalized patients over 65, most frequently Beer’s criteria and the STOPP/START tool. The reduction of PIM ranged from 3.5% up to 87%. The most common PIM were benzodiazepines and antipsychotics. This systematic review showed promising outcomes in terms of improving patient outcomes. However, the reduction of PIM varied in the studies, raising the question of the variance between hospitals in the explicit tools used for review. Additional studies need to be conducted to further investigate the outcomes of reviewing PIM at different levels, as well as assessing the cost-effectiveness of using explicit tools in reducing PIM.
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Affiliation(s)
- Hesah Alshammari
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Correspondence: Hesah Alshammari Email
| | - Eman Al-Saeed
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Zamzam Ahmed
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Zoe Aslanpour
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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144
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ALFadhalah T, Al Mudaf B, Alghanim HA, Al Salem G, Ali D, Abdelwahab HM, Elamir H. Baseline assessment of patient safety culture in primary care centres in Kuwait: a national cross-sectional study. BMC Health Serv Res 2021; 21:1172. [PMID: 34711229 PMCID: PMC8555195 DOI: 10.1186/s12913-021-07199-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022] Open
Abstract
Background Assessments of the culture surrounding patient safety can inform healthcare settings on how their structures and processes impact patient outcomes. This study investigated patient safety culture in Primary Health Care Centres in Kuwait, and benchmarked the findings against regional and international results. This study also examined the association between predictors and outcomes of patient safety culture in these settings. Methods This cross-sectional quantitative study used the Medical Office Survey on Patient Safety Culture. The study was targeted at staff of all the Primary Health Care Centres in Kuwait with at least one year of experience. Data were analysed using SPSS 23 at a significance level of ≤ .05. Univariate (means, standard deviations, frequencies, percentages) and bivariate (chi-squared tests, student t-tests, ANOVA F-tests, Kruskal–Wallis tests, Spearman’s correlation) analyses provided an overview of participant socio-demographics and the association between patient safety culture composites and outcomes. We undertook a multivariate regression analysis to predict the determinants of patient safety culture. Results were benchmarked against similar local (Kuwait, 2014), regional (Yemen, 2015) and international (US, 2018) studies. Results The responses of 6602 employees from 94 centres were included in the study, with an overall response rate of 78.7%. The survey revealed Teamwork (87.8% positive ratings) and Organisational Learning (78.8%) as perceived areas of strength. Communication about Error (57.7%), Overall Perceptions of Patient Safety and Quality (57.4%), Communication Openness (54.4%), Owner/Managing Partner/Leadership Support for Patient Safety (53.8%) and Work Pressure and Pace (28.4%) were identified as areas requiring improvement. Benchmarking analysis revealed that Kuwait centres are performing at benchmark levels or better on four and six composites when compared to international and regional findings, respectively. Regression modelling highlighted significant predictions regarding patient safety outcomes and composites. Conclusions This is the first major study addressing the culture of patient safety in public Primary Health Care Centres regionally. Improving patient safety culture is critical for these centres to improve the quality and safety of the healthcare services they provide. The findings of this study can guide country-level strategies to develop the systems that govern patient safety practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07199-1.
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Affiliation(s)
- Talal ALFadhalah
- Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Buthaina Al Mudaf
- Assistant Undersecretary of Public Health Affairs, Ministry of Health, Kuwait City, Kuwait
| | - Hanaa A Alghanim
- Safety Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Gheed Al Salem
- Accreditation Affairs Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Dina Ali
- Safety Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hythem M Abdelwahab
- National Blood Transfusion Services, Ministry of Health and Population, Giza, Egypt
| | - Hossam Elamir
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait.
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145
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How can communication to GPs at hospital discharge be improved? A systems approach. BJGP Open 2021; 6:BJGPO.2021.0148. [PMID: 34620598 PMCID: PMC8958742 DOI: 10.3399/bjgpo.2021.0148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/05/2022] Open
Abstract
Background Poor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries that are commonly written by the most junior doctors. Previous quality improvement efforts have largely focused on adherence to standardised templates, with limited success. A lack of understanding has been identified as a cause of the issue’s resistance to decades of improvement work. Aim To understand the system of communication to GPs at hospital discharge, with a view to identifying potential routes to improvement. Design & setting A qualitative exploration of the secondary-to-primary care communication system surrounding a large UK hospital. Method A systems approach, recently defined for the healthcare domain, was used to structure and thematically analyse interviews (n = 18) of clinical and administrative staff from both sides of the primary–secondary care interface, and a subsequent focus group. Results The largely one-way communication system structure and the low level of hospital stakeholder insight into recipient GP needs emerged as consistent hindrances to system performance. More open lines of communication and shared records might enable greater collaboration to share feedback and resolve informational deficits. Teaching sessions and assessments for medical students and junior doctors led by GPs could help to instil the importance of detail and nuance when using standardised communication templates. Conclusion Facilitating the sharing of performance insights between stakeholder groups emerged as the key theme of how communication might be improved. The empirical measures proposed have the potential to mitigate the safety risks of key barriers to performance such as patient complexity.
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146
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Danishuddin, Kumar V, Faheem M, Woo Lee K. A decade of machine learning-based predictive models for human pharmacokinetics: Advances and challenges. Drug Discov Today 2021; 27:529-537. [PMID: 34592448 DOI: 10.1016/j.drudis.2021.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/21/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
Traditionally, in vitro and in vivo methods are useful for estimating human pharmacokinetics (PK) parameters; however, it is impractical to perform these complex and expensive experiments on a large number of compounds. The integration of publicly available chemical, or medical Big Data and artificial intelligence (AI)-based approaches led to qualitative and quantitative prediction of human PK of a candidate drug. However, predicting drug response with these approaches is challenging, partially because of the adaptation of algorithmic and limitations related to experimental data. In this report, we provide an overview of machine learning (ML)-based quantitative structure-activity relationship (QSAR) models used in the assessment or prediction of PK values as well as databases available for obtaining such data.
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Affiliation(s)
- Danishuddin
- Department of Bio & Medical Big Data (BK4), Division of Life Sciences, Research Institute of Natural Sciences (RINS), Gyeongsang National University (GNU), 501 Jinju-daero, Jinju 52828, Republic of Korea
| | - Vikas Kumar
- Department of Bio & Medical Big Data (BK4), Division of Life Sciences, Research Institute of Natural Sciences (RINS), Gyeongsang National University (GNU), 501 Jinju-daero, Jinju 52828, Republic of Korea
| | - Mohammad Faheem
- Department of Biotechnology, Indian Institute of Technology, Roorkee, Uttarakhand 247667, India
| | - Keun Woo Lee
- Department of Bio & Medical Big Data (BK4), Division of Life Sciences, Research Institute of Natural Sciences (RINS), Gyeongsang National University (GNU), 501 Jinju-daero, Jinju 52828, Republic of Korea.
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147
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Alberto L, Marshall AP, Walker RM, Pálizas F, Aitken LM. Improving sepsis screening and care in a developing nation health setting: A description of implementation. Nurs Health Sci 2021; 23:936-947. [PMID: 34558793 DOI: 10.1111/nhs.12884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/01/2022]
Abstract
Evidence on sepsis screening and care in developing nations is insufficient to inform implementation practices in hospital wards. The aim of this multi-method study was to describe and evaluate the implementation of a three-step intervention (sepsis screening, alert activation, care) in five wards in Argentina in 2017. The implementation involved three stages: (1) context assessment, (2) development/participation in implementation strategies, and (3) evaluation of intervention adherence. Results were variable. The context assessment (Stage 1) demonstrated the value of education, proactivity towards care and team structures. Strategies developed (Stage 2) included sepsis screening and response guide, education, team rounding, posters, champions, audit/feedback and knowledge brokering. In Stage 3, staff screened 92% patients (506/547) for sepsis at ≥60% of set times; only 33% (21/64) patients had a sepsis alert activated when needed. A similar proportion of patients who had alerts activated (n = 16, 76%) or not (n = 32, 74%) received at least one element of care. The use of implementation strategies resulted in adherence to some aspects of the intervention. Future research is needed to improve sepsis screening and alert activation and care in this setting.
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Affiliation(s)
- Laura Alberto
- School of Nursing & Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Andrea P Marshall
- School of Nursing & Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Gold Coast University Hospital, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Rachel M Walker
- School of Nursing & Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Fernando Pálizas
- Intensive Care Units, Clínicas Bazterrica and Santa Isabel, Ciudad Autónoma de Buenos Aires, Argentina
| | - Leanne M Aitken
- School of Nursing & Midwifery, Griffith University, Gold Coast, Queensland, Australia.,School of Health Sciences, City, University of London, London, UK
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148
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Jones K, Davies B, Stubbs DJ, Komashie A, Burnstein RM, Hutchinson P, Santarius T, Joannides AJ. Can compliment and complaint data inform the care of individuals with chronic subdural haematoma (cSDH)? BMJ Open Qual 2021; 10:bmjoq-2020-001246. [PMID: 34535455 PMCID: PMC8451295 DOI: 10.1136/bmjoq-2020-001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/31/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the frequency and nature of complaints and compliments reported to Patient Advice and Liaison (PALS) in individuals undergoing surgery for a chronic subdural haematoma (cSDH). DESIGN A retrospective study of PALS user interactions. SUBJECTS Individuals undergoing treatment for cSDH between 2014 and 2019. METHODS PALS referrals from patients with cSDH between 2014 and 2019 were identified. Case records were reviewed and data on the frequency, nature and factors leading up to the complaint were extracted and coded according to Healthcare Complaints Analysis Tool (HCAT). RESULTS Out of 531 patients identified, 25 (5%) had a PALS interaction, of which 15 (3%) were complaints and 10 (2%) were compliments. HCAT coding showed 8/15 (53%) of complaints were relationship problems, 6/15 (33%) a management problem and 1/15 (7%) other. Of the relationship problems, 6 (75%) were classed as problems with communication and 2 (25%) as a problem with listening. Of the compliments, 9/10 (90%) related to good clinical quality and 1/10 (10%) to staff-patient relationship. Patients were more likely to register a compliment than family members, who in turn were more likely to register a complaint (p<0.005). Complaints coded as a relationship problem had 2/8 (25%) submitted by a patient and 6/8 (75%) submitted by a relative. CONCLUSIONS Using the HCAT, routinely collected PALS data can easily be coded to quantify and provide unique perspective on tertiary care, such as communication. It is readily suited to quality improvement and audit initiatives.
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Affiliation(s)
- Katherine Jones
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Benjamin Davies
- Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - Daniel J Stubbs
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Alexander Komashie
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Rowan M Burnstein
- Neurocritical Care Department and Department of Anaesthesia, University of Cambridge, Cambridge, Cambridgeshire, UK
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149
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Hunt Brendish K, Patel D, Yu K, Alexander CK, Lemons J, Gunter A, Carmany EP. Genetic counseling clinical documentation: Practice Resource of the National Society of Genetic Counselors. J Genet Couns 2021; 30:1336-1353. [PMID: 34390070 DOI: 10.1002/jgc4.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 07/08/2020] [Accepted: 07/17/2021] [Indexed: 11/08/2022]
Abstract
Clinical documentation is an important extension of a genetic counseling encounter. The traditional types of clinical documentation include the clinical visit note (including follow-up visit note), letter to the referring physician, letter to the patient, and result summary to the patient and referring physician. Increasing patient volumes, new genetic counseling service delivery models, transition to electronic medical records (EMR), new specialty clinics in genetics, and advances in genetic testing technologies challenge the practice of writing multiple types of clinical documents. This practice resource (PR) seeks to provide best practices for U.S.-based genetic counselors to write efficient and comprehensive clinical documentation using a hybrid clinical document designed to facilitate communication between individual providers, providers, and patients/families, and providers and payers. The content of the hybrid clinical documentation will vary by genetic specialty but may include a summary of genetic services evaluation, genetic testing options and eligibility information, genetic test results, potential risks for genetic conditions, implications for family members, and medical management recommendations. An outline of a general hybrid document along with examples of hybrid clinic notes for three types of genetic counseling specialties is included in this document.
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Affiliation(s)
| | - Devanshi Patel
- Center for Cancer Risk Assessment, Mass General Hospital, Boston, MA, USA
| | - Kristen Yu
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | | | - Jennifer Lemons
- Department of Pediatrics, The University of Texas Health Science, Houston, TX, USA
| | | | - Erin P Carmany
- Wayne State University School of Medicine, Detroit, MI, USA
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150
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Paediatric nurses’ satisfaction with organisational communication, job satisfaction, and intention to stay: A structural equation modelling analysis. Collegian 2021. [DOI: 10.1016/j.colegn.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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