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Gilsenan M, Van Der Linde S, Hill G, Lambros B. Review of advanced practice nurse role in infection throughout the hematopoietic stem cell transplant journey. Transpl Infect Dis 2024; 26:e14268. [PMID: 38477039 DOI: 10.1111/tid.14268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Prolonged periods of immunosuppression during hematopoietic stem cell transplant (HSCT) can result in serious infectious complications and contribute to transplant-related morbidity and mortality. Adherence to standardized pre and postinfection screening guidelines, prescribed medications, and early identification of infectious symptoms through comprehensive patient and family education are crucial to minimizing infectious complications. Advanced practice nurses (APNs) are key members of the multidisciplinary care team in the HSCT specialty, maintaining a specialized skillset and scope of practice which includes a holistic based, preventative medicine and risk mitigation approach. METHODS This review sought to describe the role of the APN in HSCT care and to further examine existing APN led models of care which focus on infection prevention and education throughout the HSCT treatment journey. RESULTS No studies specifically examined the APN role in infectious diseases risk assessment, screening, and management throughout the HSCT journey were identified throughout our review, however, there was considerable evidence to demonstrate the benefits of APN led care in the oncology and solid organ transplantation specialty which led to improvements in continuity of care, overall patient outcomes, and multidisciplinary team collaboration. The key themes identified in our review, were the role of the APN in the delivery of comprehensive patient and family education, the role of the APN in supporting, mentoring, and educating junior medical and nursing teams, the collaboration between the APN and the multidisciplinary care team, and the role of the APN in prompt recognition, triage, and management of treatment related complications, such as infection.
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Affiliation(s)
- Maddie Gilsenan
- Children's Cancer Centre, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Sam Van Der Linde
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Geoff Hill
- Health Sciences Library, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Belinda Lambros
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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Chaney A, Beliles G, Keimig A, Porter I. Advanced Practice Provider Care Team Models: Best Practices From an Academic Medical Center. J Ambul Care Manage 2022; 45:126-134. [PMID: 35202029 DOI: 10.1097/jac.0000000000000412] [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: 11/25/2022]
Abstract
Health care leaders must be innovative to meet the demands of patient access and cost efficiency, all while never compromising patient safety or experience. A clear understanding of the care team model with optimal utilization of all team members is paramount to success. This article discusses 5 nurse practitioner and physician assistant (collectively called advanced practice providers) care team models that regularly occur in health care organizations across the country. Examples of each practice model, a discussion on when each model would be appropriate, as well as data on patient experience and financial return of investment of each model are provided.
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Affiliation(s)
- Amanda Chaney
- Departments of Transplant (Dr Chaney) and Nephrology (Dr Porter), Mayo Clinic, Jacksonville, Florida; and Administration, Mayo Clinic, Jacksonville, Florida (Messrs Beliles and Keimig)
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Al-Judaibi B, Dokus MK, Al-hamoudi W, Broering D, Mawardi M, AlMasri N, Aljawad M, Altraif IH, Abaalkhail F, Alqahtani SA. Saudi association for the study of liver diseases and transplantation position statement on the hepatology workforce in Saudi Arabia. Saudi J Gastroenterol 2022; 28:101-107. [PMID: 35295066 PMCID: PMC9007080 DOI: 10.4103/sjg.sjg_576_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The field of hepatology has evolved significantly over the last two decades. Hepatology practice in Saudi Arabia (SA) was dominated by hepatitis B and C viruses but is now being overtaken by patients with non-alcoholic fatty liver disease. These patients require greater medical attention as their care is more complex compared to patients with viral hepatitis. In addition, liver transplantation (LT) has expanded significantly in SA over the last three decades. There is a necessity to increase the hepatology workforce to meet the demand in SA. The time has come to reinforce the transplant hepatology fellowship program, that was launched recently, and to develop a nurse practitioner practice model to meet these demands. In addition, SA is going through a health care reform to enhance health care delivery which may affect the financial compensation polices of various specialties including gastroenterology and hepatology. Therefore, the Saudi Association for the Study of Liver diseases and Transplantation (SASLT) established a task force to discuss the current and future demands in the hepatology workforce in SA, as well as to discuss different avenues of financial compensation for transplant hepatologists in LT centers.
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Affiliation(s)
- Bandar Al-Judaibi
- Division of Gastroenterology, Department of Medicine, University of Rochester, City of Rochester, New York State, United States of America,Address for correspondence: Dr. Bandar Al-Judaibi, University of Rochester, 500 Joseph C. Wilson Blvd., Rochester, NY - 14627, United Sates of America. E-mail:
| | - M. Katherine Dokus
- Division of Gastroenterology, Department of Medicine, University of Rochester, City of Rochester, New York State, United States of America
| | - Waleed Al-hamoudi
- Division of Gastroenterology, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Dieter Broering
- Organ Transplant Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammad Mawardi
- Department of Medicine, Gastroenterology Section, King Faisal Special Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Nasser AlMasri
- Department of Gastroenterology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed Aljawad
- Department of Liver Transplant, Multi-organ Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ibrahim H Altraif
- Division of Gastroenterology, Department of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,Division of Hepatology, Hepatobiliary Sciences and Organ Transplant Center, Ministry of National Guard-Health Affairs, Saudi Arabia
| | - Faisal Abaalkhail
- Department of Medicine, Section of Gastroenterology, King Faisal Special Hospital and Research Centre, Riyadh, Saudi Arabia,College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
| | - Saleh A Alqahtani
- Organ Transplant Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia,Division of Gastroenterology and Hepatology, John Hopkins University, Baltimore, MD, United States of America, Riyadh, Saudi Arabia
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Chambers HE, Reinschmidt K, Smith G, Agudelo E, Brodahl K, Herriman E, Hoy H, Pont K, Seawright A, Stearns E, Torres AM, Weldon E, Blackstock DM. Examining the critical role of advanced practice providers on a multidisciplinary transplant team. Am J Transplant 2021; 21:3840-3846. [PMID: 34101989 DOI: 10.1111/ajt.16715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 01/25/2023]
Abstract
It is well documented that Physician Assistants (PAs) and Nurse Practitioners (NPs), collectively known as Advanced Practice Providers (APPs), have a beneficial role beyond the field of primary care. APPs broad spectrum of knowledge make them particularly well suited for specializing in complex fields such as transplant. Variations in practice across transplant centers lead to questions regarding optimal use of APPs. Using job descriptions from transplant centers currently employing APPs, we sought to examine the critical role of transplant APPs beyond clinical care alone. In this review, we explore not only the general training of APPs and current utilization of APPs in transplant, but also safety, cost effectiveness, and comparison of APPs to other transplant providers. We aimed to highlight the importance of recruitment and retention of transplant specific trained APPs to provide continuity in transplant programs. Additionally, APPs expansion into transplant research, quality improvement, leadership, and management must be considered. We challenge transplant centers utilizing APPs to consider these important aspects when seeking ways to expand and optimize the critical role APPs provide on the transplant team.
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Affiliation(s)
- Heather E Chambers
- Infectious Diseases Program, Alegent Immanuel Medical Center, Omaha, Nebraska, USA
| | - Kristi Reinschmidt
- Transplant Surgery Division, Intermountain Health Care Inc, Salt Lake City, Utah, USA
| | - Georgeine Smith
- Transplant Surgery Division, Penn Transplant Institute, Philadelphia, Pennsylvania, USA
| | - Eliana Agudelo
- Transplant Surgery Division, UCSF, San Francisco, California, USA
| | - Katherine Brodahl
- Transplant Surgery Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emily Herriman
- Transplant Surgery Division, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Haley Hoy
- Transplant Surgery Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kylie Pont
- Transplant Surgery Division, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ashley Seawright
- Transplant Surgery Division, University of Mississippi, Oxford, Mississippi, USA
| | - Elizabeth Stearns
- Transplant Surgery Division, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ana-Marie Torres
- Transplant Surgery Division, UCSF, San Francisco, California, USA
| | - Elaina Weldon
- Transplant Surgery Division, NYU Langone Health, New York, New York, USA
| | - Daryle M Blackstock
- Transplant Surgery Division, New York Presbyterian Hospital, New York, New York, USA
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Nargiso S, Tristan V, Ramos L, Muriel JA, Sachs RE. The evolving role of advanced practice providers in transplantation: a literature review. Curr Opin Organ Transplant 2021; 26:482-487. [PMID: 34369400 DOI: 10.1097/mot.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Solid organ transplantation is a life-saving procedure, often performed in critically ill patients, and advanced practice providers (APPs) have increasingly been incorporated into the multidisciplinary transplant team. A literature review was performed and reinforces the value of transplant APPs, details their evolving roles and responsibilities, and highlights innovative solutions created to address complex problems. RECENT FINDINGS The literature review revealed a deficit of quality quantitative data supporting the utilization of APPs in transplantation. Thus, data regarding the value of APPs in critical care was also analyzed. SUMMARY The limited data despite decades long integration of transplant APPs into the multidisciplinary team, suggests there are likely positive outcomes and innovations that go undocumented. Thus, there are missed opportunities for learning and improvement. Transplant programs investing time and mentorship to support APP research will identify strengths and weaknesses within our existing care models, discover cost saving innovations, and continue to optimize the role of APPs in delivering high quality care that is efficient and evidence based.
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Affiliation(s)
| | | | | | - Jaira A Muriel
- Department of Hepatobiliary and Abdominal Transplant Surgery
| | - Robert E Sachs
- Department of Cardiothoracic Surgery, Keck Hospital of USC, Los Angeles, California, USA
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Azoulay D, Eshkenazy R, Pery R, Cordoba M, Haviv Y, Inbar Y, Zisman E, Lahat E, Salloum C, Lim C. The Impact of Establishing a Dedicated Liver Surgery Program at a University-affiliated Hospital on Workforce, Workload, Surgical Outcomes, and Trainee Surgical Autonomy and Academic Output. ANNALS OF SURGERY OPEN 2021; 2:e066. [PMID: 37636559 PMCID: PMC10455269 DOI: 10.1097/as9.0000000000000066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/31/2021] [Indexed: 02/07/2023] Open
Abstract
Objective To detail the implementation of a dedicated liver surgery program at a university-affiliated hospital and to analyze its impact on the community, workforce, workload, complexity of cases, the short-term outcomes, and residents and young faculties progression toward technical autonomy and academic production. Background Due to the increased burden of liver tumors worldwide, there is an increased need for liver centers to better serve the community and facilitate the education of trainees in this field. Methods The implementation of the program is described. The 3 domains of workload, research, and teaching were compared between 2-year periods before and after the implementation of the new program. The severity of disease, complexity of procedures, and subsequent morbidity and mortality were compared. Results Compared with the 2-year period before the implementation of the new program, the number of liver resections increased by 36% within 2 years. The number of highly complex resections, the number of liver resections performed by residents and young faculties, and the number of publications increased 5.5-, 40-, and 6-fold, respectively. This was achieved by operating on more severe patients and performing more complex procedures, at the cost of a significant increase in morbidity but not mortality. Nevertheless, operations during the second period did not emerge as an independent predictor of severe morbidity. Conclusions A new liver surgery program can fill the gap between the demand for and supply of liver surgeries, benefiting the community and the development of the next generation of liver surgeons.
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Affiliation(s)
- Daniel Azoulay
- From the Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, AP-HP, Université Paris-Saclay, Villejuif, France
- Department of General Surgery B, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Rony Eshkenazy
- Department of General Surgery B, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
- Intensive Care Unit, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ron Pery
- Department of General Surgery B, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN
| | - Mordechai Cordoba
- Department of General Surgery B, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yael Haviv
- Intensive Care Unit, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yael Inbar
- Department of Radiology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Eliyahu Zisman
- Department of Anesthesiology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Eylon Lahat
- Department of General Surgery B, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Chady Salloum
- From the Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, AP-HP, Université Paris-Saclay, Villejuif, France
| | - Chetana Lim
- Department of HPB and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
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Hains T, Rowell D, Strand H. Effectiveness of the Non-Medical Surgical Assistant measured by patient outcome assessment. Int J Nurs Pract 2020; 27:e12822. [PMID: 31999401 DOI: 10.1111/ijn.12822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/11/2019] [Accepted: 01/14/2020] [Indexed: 11/28/2022]
Abstract
AIMS To investigate effectiveness of the nurse clinician as a Non-Medical Surgical Assistant compared with the Medical Surgical Assistant. BACKGROUND Non-Medical Surgical Assistants are clinicians who are not medical practitioners. The surgical assistant works directly with the primary surgeon intraoperatively. DESIGN A pragmatic, retrospective, observational study on patients undergoing Laparoscopic Inguinal Hernia Repair or Primary Unilateral Total Hip Arthroplasty. Each patient received intraoperative care from a consultant surgeon and a Medical Surgical Assistant or Non-Medical Surgical Assistant. All surgical assistants were registered with the Australian Health Practitioner Regulation Agency. METHODS Data were collected between 01/07/2014 and 30/06/2017. The effect that surgical assistant choice had on patient outcomes was estimated using regression statistical models. Six dependent variables, including length of stay, for clinical outcome assessment were specified. RESULTS/FINDINGS The groups were equivalent in age, gender, and American Society of Anaesthesiologists scores. There were more emergency procedures in the Medical Surgical Assistant group and more hip surgery in the Non-Medical Surgical Assistant group. Patient outcome assessment showed no statistically significant differences for surgical assistant types. CONCLUSION The nurse clinician in the role of Non-Medical Surgical Assistant was shown to be effective with equivalent patient outcomes compared with the Medical Surgical Assistant.
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Affiliation(s)
- Toni Hains
- School of Nursing, Midwifery, and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - David Rowell
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Haakan Strand
- College of Nursing and Midwifery, Charles Darwin University, Casuarina, Northern Territory,, Australia
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Chaney AJ, Yataco ML. The Emerging Role of Nurse Practitioners and Physician Assistants in Liver Transplantation. Liver Transpl 2019; 25:1105-1109. [PMID: 31013382 DOI: 10.1002/lt.25474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/17/2019] [Indexed: 02/07/2023]
Abstract
The evolving role of nurse practitioners (NPs) and physician assistants (PAs) in the United States continues to progress. NP and PA responsibilities have expanded from primary care practices to medical and surgical specialties. They provide acute care in hospitals and intensive care units, and they serve as educators, lobbyists, and researchers. Questions have arisen from NP/PA leaders, physician leaders, and administrators on how to best implement a successful NP/PA model within their practice. This article reviews some common themes in the literature by looking at the current state of NP/PA practice, outlines some practice models established therein, and provides recommendations for implementing a successful NP/PA model in a liver transplant practice.
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Affiliation(s)
- Amanda J Chaney
- Division of Transplant Medicine, Mayo Clinic, Jacksonville, FL
| | - Maria L Yataco
- Division of Transplant Medicine, Mayo Clinic, Jacksonville, FL
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Hooker RS, Cawley JF, Carpenter D, Chalupa RL, Maurer BT, Hills KJ. Commentaries on health services research. JAAPA 2017. [DOI: 10.1097/01.jaa.0000515542.82322.c6] [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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