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Chen CW, Lee MC, Wu SFV. Effects of a collaborative health management model on people with congestive heart failure: A systematic review and meta-analysis. J Adv Nurs 2024; 80:2290-2307. [PMID: 38093471 DOI: 10.1111/jan.16011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/16/2023] [Accepted: 11/26/2023] [Indexed: 05/12/2024]
Abstract
AIM To determine the effects of collaborative health management of congestive heart failure through the rigorous evaluation and extraction of evidence. BACKGROUND Over the past two decades, cardiovascular disease has been the leading cause of death worldwide. Multidisciplinary team intervention for congestive heart failure has increased with population ageing and congestive heart failure incidence rate as well as cost of care. However, the effectiveness and feasibility of collaborative health management need to be explored. DESIGN Systematic review and meta-analysis. METHODS We conducted systematic literature searches in the Cochrane Library, PubMed, CINAHL and Medline for articles published between 2002 and 2022. After screening based on the inclusion and exclusion criteria, 13 articles were included in a rigorous review and evidence extraction process, evaluated methodological quality using the Jadad Quality Scale. Statistical heterogeneity was evaluated using Review Manager (RevMan Version 5.4) for the meta-analysis. RESULTS In this study, a systematic review and meta-analysis were performed on 13 studies regarding the collaborative health management of people with congestive heart failure. The common result is that the collaborative health management model enables the enhancement of self-care and monitoring abilities, the strengthening of cardiac function, the alleviation of physiological and psychological symptoms and the improvement of readmission rates, mortality rate and quality of life. CONCLUSION The congestive heart failure collaborative health management model could decrease the hospitalization rate related to congestive heart failure, all-cause mortality rate, and all-cause hospitalization rate, and improve the quality of life. IMPLICATIONS FOR PRACTICE The collaborative health management model could effectively coordinate interdisciplinary team cooperation and provide information, which decreases hospitalization and mortality risks and improves their quality of life. NO PATIENT OR PUBLIC CONTRIBUTION Our paper is a systematic review and meta-analysis, and such details do not apply to our work. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The Collaborative Health Management Model provides in-depth insights, aiding in the design tailored to the specific circumstances of each country. Highlighting its critical role in the context of a global shortage of nursing staff, the model emphasizes the integration of multidisciplinary professional roles and the strengthening of collaboration as essential elements in addressing challenges posed by workforce shortages. Implementation of the Collaborative Health Management Model not only enhances patient care outcomes but also relieves pressure on healthcare systems, lowers medical costs, and addresses challenges arising from the shortage of nursing staff. Consequently, this model not only contributes to individual patient care improvement but also holds broader implications for enhancing the efficiency and sustainability of global healthcare systems. TRIAL AND PROTOCOL REGISTRATION The detailed study protocol can be found on the PROSPERO website.
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Affiliation(s)
- Chih Wen Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Antai Medical Care Cooperation Antai Tian-Sheng Memorial Hospital/Department of Nursing/Nurse Practitioner Leader, Tungkang, Taiwan
| | - Mei-Chen Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Fang Vivienne Wu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Queensland University of Technology, Brisbane City, Australia
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Peduzzi M, Fernandes Agreli HL, da Silva JAM, Hara Koyama MA, Fracolli LA, Xyrichis A. Team climate and patients' perception of primary healthcare attributes in Brazil: a cross-sectional study. J Interprof Care 2024:1-8. [PMID: 38755950 DOI: 10.1080/13561820.2024.2351006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 04/28/2024] [Indexed: 05/18/2024]
Abstract
Team climate and attributes of primary healthcare (PHC) are key elements for collaborative practice. Few researchers have explored the relationship between team climate and patients' perceptions of PHC. This study aimed to assess the association between team climate and patients' perceptions of primary healthcare attributes. A quantitative approach was adopted. In Stage 1, Team climate was assessed using Team Climate Inventory in 118 Family Health Strategy (FHS) teams at a PHC setting. In Stage 2, Patients' perceptions of PHC attributes were assessed using the Primary Care Assessment Tool (PCATool) in a sample of 844 patients enrolled in teams studied in Stage 1. Cluster analysis was used to identify team climate groups. The analysis used multilevel linear regression models. Patients assigned to teams with the highest team climate scores had the highest PHC attributes scores. Patients who reported affiliation at the team level had the highest PCATool scores overall. They also scored higher on the attributes of comprehensiveness and coordinated care compared to patients with affiliation to the health unit. In conclusion, patients under the care of FHS teams exhibiting a more favorable team climate had more positive patient perceptions of PHC attributes.
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Affiliation(s)
- Marina Peduzzi
- School of Nursing, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
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Davidson AR, Morgan M, Ball L, Reidlinger DP. Patients' experiences of and roles in interprofessional collaborative practice in primary care: a constructivist grounded theory study. Prim Health Care Res Dev 2024; 25:e24. [PMID: 38721698 DOI: 10.1017/s1463423624000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
AIM This constructivist grounded theory study aimed to (1) explore patients' experiences of and roles in interprofessional collaborative practice for chronic conditions in primary care and (2) consider the relevance and alignment of an existing theoretical framework on patients' roles and based on the experiences of patient advocates. BACKGROUND High-quality management of chronic conditions requires an interprofessional collaborative practice model of care considering an individual's mental, physical, and social health situation. Patients' experiences of this model in the primary care setting are relatively unknown. METHODS A constructivist grounded theory approach was taken. Interview data were collected from primary care patients with chronic conditions across Australia in August 2020 - February 2022. Interviews were recorded, transcribed verbatim, and thematically analysed by (1) initial line-by-line coding, (2) focused coding, (3) memo writing, (4) categorisation, and (5) theme and sub-theme development. Themes and sub-themes were mapped against an existing theoretical framework to expand and confirm the results from a previous study with a similar research aim. FINDINGS Twenty adults with chronic conditions spanning physical disability, diabetes, heart disease, cancer, autoimmune, and mental health conditions participated. Two themes were developed: (1) Adapting to Change with two sub-themes describing how patients adapt to interprofessional team care and (2) Shifting across the spectrum of roles, with five sub-themes outlining the roles patients enact while receiving care. The findings suggest that patients' roles are highly variable and fluid in interprofessional collaborative practice, and further work is recommended to develop a resource to support greater patient engagement in interprofessional collaborative practice.
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Affiliation(s)
- Alexandra R Davidson
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, The University of Queensland, Brisbane, Queensland, Australia
| | - Dianne P Reidlinger
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Cucolo DF, de Campos Oliveira JL, Rossit RAS, Mininel VA, Perroca MG, Silva JAMD. Effects of interprofessional practice on nursing workload in hospitals: A systematic review. Int J Health Plann Manage 2024; 39:824-843. [PMID: 38353613 DOI: 10.1002/hpm.3779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE To synthesise scientific evidence on interprofessional practice in hospital care and the effects on nursing workload. METHODS Systematic mixed method review, registered in PROSPERO (CRD42021225627) and conducted in the following databases: CINAHL, Medline, Web of Science and Scopus, with no restrictions on the publication period of the studies. Primary studies were recruited on nurses' interprofessional practice (actions and interactions with other professional categories) in hospitals and the effects on one or more dimensions of nursing workload (quantitative, qualitative, physical, cognitive, emotional, time and variation). Scientific articles available in open access, in English, Spanish or Portuguese, were included. The searches were carried out in January 2021. The studies were evaluated by pairs of independent researchers to verify methodological quality, through the Mixed Method Appraisal Tool, and data extraction. To summarise the studies, thematic analysis was adopted. RESULTS A total of 1774 publications were assessed for eligibility and 17 studies were included. Of these, two were mixed methods, four were qualitative, and 11 were quantitative, published between 2011 and 2020. The main scenarios investigated were Intensive Care Units and/or Inpatient Units. During data analysis, three thematic categories emerged: Interprofessional practice in coping with emotional overload; Time dedicated by nurses to professional communication; and Working conditions and patient care. The third category consisted of three subthemes: Conflict and flexibility in the context of practice; Working conditions and interprofessional practice; and Effects on patient care. CONCLUSIONS The evidence points to the emotional overload of nurses in the face of uncooperative practices. Interprofessional actions, especially communicative ones, demand nurses' time and impact the care provided. The results contribute to political decisions and health work management.
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Affiliation(s)
- Danielle Fabiana Cucolo
- Postgraduate Program, Multiprofessional Residency in Health at the Pontifícia Universidade Católica de Campinas, Campinas, Brazil
- Postgraduate Program, Masters Course in Nursing at the Medical School of São José do Rio Preto, São José do Rio Preto, Brazil
| | - João Lucas de Campos Oliveira
- Nursing School of the Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Postgraduate Program in Nursing at the UFRGS and Clinical Nursing Service at Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Vivian Aline Mininel
- Postgraduate Nursing Program at the Federal University of São Carlos (UFSCar), Sao Carlos, Brazil
- Nursing Department at the UFSCar, Sao Carlos, Brazil
- Center de Recherche sur le Travail et le Développement, Conservatoire National des Arts et Métiers (CRDT-Cnam), Paris, France
| | - Marcia Galan Perroca
- Postgraduate Program, Masters Course in Nursing at the Medical School of São José do Rio Preto, São José do Rio Preto, Brazil
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Chambers AJ, Enoch JF, Wong J, Spigelman A. When teams disagree: Investigating the incidence and causes of dissent occurring in cancer multidisciplinary team meetings. Asia Pac J Clin Oncol 2024; 20:234-239. [PMID: 36670329 DOI: 10.1111/ajco.13919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/05/2022] [Accepted: 12/26/2022] [Indexed: 01/22/2023]
Abstract
AIM Multidisciplinary teams (MDT) are commonly involved in the care of patients with cancer. How frequently dissent occurs within MDT has not been studied. This study aimed to determine how frequently dissent was documented in cancer MDT meetings at our institution, the reasons for this, and the opinions of MDT members on how dissent should be documented and communicated. METHODS A retrospective review of records from cancer MDT meetings at our institution from 2016 to 2020 was performed to identify cases where dissent was documented and the reasons for this. MDT members were invited to complete an online survey assessing their perceptions of how frequently dissent occurred, how comfortable they felt voicing dissenting opinions, and their opinions on how dissent should be documented and communicated. RESULTS Dissent was recorded in 30 of 7737 MDT case discussions (0.39%). The incidence of dissent varied from 0 to 1.2% between cancer streams. The most common reason for dissent involved the role of surgery. 27% of survey respondents felt either very or somewhat uncomfortable voicing dissenting opinions. Only 3% felt that dissent should not be documented, and none that it should not be communicated in some way, although there were wide ranging of views on how this should occur. CONCLUSION Dissent was rarely documented within cancer MDT meetings at our institution, likely due to underreporting. Measuring the incidence of dissent within an MDT may be a useful performance metric. MDT should develop policies for how dissent should be managed, documented, and communicated.
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Affiliation(s)
- Anthony J Chambers
- Department of Surgical Oncology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jade F Enoch
- Department of Surgical Oncology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jasmine Wong
- Department of Surgical Oncology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Allan Spigelman
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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Li O, Lee R, Boss RD, Wang MH. Palliative Care for Pediatric Urology. J Pain Symptom Manage 2024:S0885-3924(24)00676-6. [PMID: 38521421 DOI: 10.1016/j.jpainsymman.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
Palliative care in the field of urology has largely been limited to adult oncologic conditions. Although there is a plethora of established literature suggesting the advantageous impact of palliative care, there is limited integration of palliative care in adult urology. This underutilization is further exacerbated in pediatric urology, and palliative care in pediatric urology remains an underexplored area despite the prevalence of several life-limiting conditions in this patient population. This paper highlights the potential need for palliative care intervention in a variety of urologic conditions in the pediatric population, including congenital lower urinary tract obstruction, neurogenic bladder dysfunction, exstrophy-epispadias complex, and congenital bilateral renal agenesis. Each condition poses unique challenges that can be addressed with the inclusion of a palliative care team, including decision-making spanning prenatal-neonatal-pediatric periods, acute and chronic symptom management, family relations, body image issues, risk of recurrent hospitalizations and surgeries, and potentially fatal complications. Alongside standard urologic interventions, palliative care can serve as an additional means of addressing physical and psychosocial symptoms experienced by pediatric urology patients to enhance the quality of life of patients and their families.
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Affiliation(s)
- Oscar Li
- Johns Hopkins University School of Medicine (O.L., R.L.), Baltimore, Maryland, USA.
| | - Royce Lee
- Johns Hopkins University School of Medicine (O.L., R.L.), Baltimore, Maryland, USA
| | - Renee D Boss
- Department of Pediatrics (R.D.B.), Johns Hopkins University School of Medicine, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ming-Hsien Wang
- Jeffs Division of Pediatric Urology (M.H.W.), Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Carmo HDO, Peduzzi M, Tronchin DMR. Team climate and job satisfaction in a mobile emergency service: a multilevel study. Rev Lat Am Enfermagem 2024; 32:e4110. [PMID: 38511733 PMCID: PMC10949847 DOI: 10.1590/1518-8345.6872.4110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/12/2023] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE to investigate the relationship between team climate and job satisfaction among professionals working in mobile pre-hospital care. METHOD this is a quantitative, correlational study carried out in a mobile pre-hospital care service in the São Paulo Metropolitan Region. The participants were 95 professionals, allocated to 40 teams, who answered three questionnaires: sociodemographic/labor data, Team Climate Scale and S20/23 Job Satisfaction Scale. Descriptive statistics and multilevel linear models were used for the analysis, including moderation effects. The Backward method was used to ascertain the order of significance. RESULTS in the models, the relationships between satisfaction with hierarchical relationships and the factor "support for new ideas" moderated for men and "task orientation" for women were significant. For satisfaction with the physical environment, "working hours" and "participation in the team" were significant and, for intrinsic satisfaction, the regime, working hours and the factors "team objectives", "participation in the team" and "support for new ideas" remained significant, as did the moderation effect between length of service, "participation in the team" and "support for new ideas". CONCLUSION team climate is influenced by job satisfaction in a heterogeneous way and the moderating effect of this relationship is associated with gender and length of service. BACKGROUND (1) There was a positive perception of the team climate and job satisfaction. BACKGROUND (2)The team climate influenced job satisfaction in a heterogeneous way. BACKGROUND (3) The moderating effect of this relationship was associated with gender and working hours. BACKGROUND (4) The working regime and working hours directly affected intrinsic satisfaction.
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Affiliation(s)
| | - Marina Peduzzi
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil
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Tobiano G, Chaboyer W, Tong MYT, Eskes AM, Musters SCW, Colquhoun J, Herbert G, Gillespie BM. Post-operative nursing activities to prevent wound complications in patients undergoing colorectal surgeries: A scoping review. J Clin Nurs 2024; 33:890-910. [PMID: 38013213 DOI: 10.1111/jocn.16933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/15/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
AIMS To identify postoperative interventions and quality improvement initiatives used to prevent wound complications in patients undergoing colorectal surgeries, the types of activities nurses undertake in these interventions/initiatives and how these activities align with nurses' scope of practice. DESIGN A scoping review. DATA SOURCES Three health databases were searched, and backward and forward citation searching occurred in April 2022. Research and quality improvement initiatives included focussed on adult patients undergoing colorectal surgery, from 2010 onwards. Data were extracted about study characteristics, nursing activities and outcomes. The 'Dimensions of the scope of nursing practice' framework was used to classify nursing activities and then the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework was used to synthesise the review findings. RESULTS Thirty-seven studies were included. These studies often reported negative wound pressure therapy and surgical site infection bundle interventions/initiatives. Nurses' scope of practice was most frequently 'Technical procedure and delegated medical care' meaning nurses frequently acted under doctors' orders, with the most common delegated activity being dressing removal. CONCLUSION The full extent of possible interventions nurses could undertake independently in the postoperative period requires further exploration to improve wound outcomes and capitalise on nurses' professional role. IMPACT STATEMENT Nurses' role in preventing postoperative wound complications is unclear, which may inhibit their ability to influence postoperative outcomes. In the postoperative period, nurses undertake technical activities, under doctors' orders to prevent wound infections. For practice, nurses need to upkeep and audit their technical skills. New avenues for researchers include exploration of independent activities for postoperative nurses and the outcomes of these activities. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE There may be opportunities to broaden nurses' scope of practice to act more autonomously to prevent wound complication. REPORTING METHOD Scoping Reviews (PRISMA-ScR) checklist. PATIENT OR PUBLIC CONTRIBUTION A health consumer interpreted the data and prepared the manuscript.
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Affiliation(s)
- Georgia Tobiano
- Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Wendy Chaboyer
- Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Parklands, Queensland, Australia
| | - Mavis Ying Ting Tong
- School of Nursing and Health Studies, The Metropolitan University of Hong Kong, Kowloon, Hong Kong
| | - Anne M Eskes
- School of Nursing and Midwifery, Griffith University, Parklands, Queensland, Australia
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Selma C W Musters
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Janelle Colquhoun
- Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia
| | - Georgina Herbert
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Brigid M Gillespie
- Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
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Yun S, Park HA, Na SH, Yun HJ. Effects of communication team training on clinical competence in Korean Advanced Life Support: A randomized controlled trial. Nurs Health Sci 2024; 26:e13106. [PMID: 38452799 DOI: 10.1111/nhs.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
We conducted a randomized controlled trial to study the effects of interprofessional communication team training on clinical competence in the Korean Advanced Life Support provider course using a team communication framework. Our study involved 73 residents and 42 nurses from a tertiary hospital in Seoul. The participants were randomly assigned to the intervention or control group, forming 10 teams per group. The intervention group underwent interprofessional communication team training with a cardiac arrest simulation and standardized communication tools. The control group completed the Korean Advanced Life Support provider course. All participants completed a communication clarity self-reporting questionnaire. Clinical competence was assessed using a clinical competency scale comprising technical and nontechnical tools. Blinding was not possible due to the educational intervention. Data were analyzed using a Mann-Whitney U test and a multivariate Kruskal-Wallis H test. While no significant differences were observed in communication clarity between the two groups, there were significant differences in clinical competence. Therefore, the study confirmed that the intervention can enhance the clinical competence of patient care teams in cardiopulmonary resuscitation.
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Affiliation(s)
- Soyeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeoun-Ae Park
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Sang-Hoon Na
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee Je Yun
- Seoul National University Hospital, Seoul, Republic of Korea
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Moita Gonçalves E, Lanzaro C, Silva LC, Correia P, Gonçalves JV, Azevedo M, Carrapatoso I, Silva JP, Carvalho C, Cruz A. Enhancing functional recovery following postpartum femoral neuropathy: early neurorehabilitation and multidisciplinary obstetric care. Int J Gynaecol Obstet 2024; 164:830-834. [PMID: 37537869 DOI: 10.1002/ijgo.15025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/26/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023]
Abstract
Postpartum femoral neuropathy has a reported incidence of less than 1% and its total recovery time extends up to 6 months to a year. A multidisciplinary approach is vital to rule out permanent disability and to assure a correct diagnosis and earlier rehabilitation. We report a case of a 37-year-old puerperal woman with a history of intrapartum epidural analgesia, who presented post-labor unilateral lower-limb motor weakness and sensory loss, with functional compromise on independent gait. A multidisciplinary team consisting of an anesthesiologist, a physiatrist, a neurologist, and an obstetrician was then established. In the initial physiatry and neurology assessment, the patient reported pain (numerical rating scale 7/10) over the inguinal ligament, lower limb hypoesthesia, and muscle weakness. Femoral neuropathy was suspected. Magnetic resonance imaging ruled out potential complications related to the anesthetic procedure. The patient was then enrolled in a supervised rehabilitation program and, 3 weeks later, electrodiagnostic studies confirmed the initial suspicion. Two months later, the patient had regained lower-limb active range of motion and no pain nor paresthesia was reported. Our case report describes how an early multimodal rehabilitation program within a multidisciplinary framework allows for sooner neuromotor function improvement and activities of daily living independence.
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Affiliation(s)
- Eugénio Moita Gonçalves
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Vila Nova de Gaia-Espinho, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Egas Moniz Health Alliance Clinical Academic Center, Aveiro, Portugal
| | - Camile Lanzaro
- Anesthesiology Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Luísa Cunha Silva
- Gynecology and Obstetrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Pedro Correia
- Neurology Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - José Vítor Gonçalves
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Vila Nova de Gaia-Espinho, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Azevedo
- Physical Medicine and Rehabilitation Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Inês Carrapatoso
- Anesthesiology Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - João Pedro Silva
- Gynecology and Obstetrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Carolina Carvalho
- Physical Medicine and Rehabilitation Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - André Cruz
- Physical Medicine and Rehabilitation Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
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Bouchez T, Cagnon C, Hamouche G, Majdoub M, Charlet J, Schuers M. Interprofessional clinical decision-making process in health: A scoping review. J Adv Nurs 2024; 80:884-907. [PMID: 37705486 DOI: 10.1111/jan.15865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
AIMS To describe the key elements of the interprofessional decision-making process in health, based on published scientific studies. To describe the authors, reviews and subject matter of those publications. DESIGN Scoping review of the literature. DATA SOURCES MEDLINE, APA Psycinfo OpenGrey, Lissa and Cochrane databases were searched in December 2019 and January 2023. REVIEW METHODS References were considered eligible if they (i) were written in French or English, (ii) concerned health, (iii) studied a clinical decision-making process, (iv) were performed in an interprofessional context. 'PRISMA-scoping review' guidelines were respected. The eligible studies were analysed and classified by an inductive approach RESULTS: We identified 1429 sources of information, 145 of which were retained for the analysis. Based on these studies, we identified five key elements of interprofessional decision-making in health. The process was found to be influenced by group dynamics, the available information and consideration of the unique characteristics of the patient. An organizational framework and specific training favoured improvements in the process. CONCLUSION Decision-making can be based on a willingness of the healthcare organization to promote models based on more shared leadership and to work on professional roles and values. It also requires healthcare professionals trained in the entire continuum of collaborative practices, to meet the unique needs of each patient. Finally, it appears essential to favour the sharing of multiple sources of accessible and structured information. Tools for knowledge formalization should help to optimize interprofessional decision-making in health. IMPACT The quality of a team decision-making is critical to the quality of care. Interprofessional decision-making can be structured and improved through different levels of action. These improvements could benefit to patients and healthcare professionals in every settings of care involving care collaboration. IMPACT STATEMENT Interprofessional decision-making in health is an essential lever of quality of care, especially for the most complex patients which are a contemporary challenge. This scoping review article offers a synthesis of a large corpus of data published to date about the interprofessional clinical decision-making process in healthcare. It has the potential to provide a global vision, practical data and a list of references to facilitate the work of healthcare teams, organizations and teachers ready to initiate a change.
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Affiliation(s)
- Tiphanie Bouchez
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
| | - Clémence Cagnon
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Gouraya Hamouche
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Marouan Majdoub
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Jean Charlet
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
- Assistance Publique-Hôpitaux de Paris/DRCI, Paris, France
| | - Matthieu Schuers
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
- Department of General Practice, University of Rouen, Rouen, France
- Department of Medical Informatic, Academic Hospital of Rouen, Rouen, France
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12
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Clarke E, Newman E, Dravid M, Ricciardello M, Jones E, Caudle K, Kilshaw L, Hilmi S, Flicker L. Assessment and management of delirium in a tertiary hospital-Improvements in cognitive screening and use of non-pharmacological strategies with a multidisciplinary approach. Australas J Ageing 2024; 43:175-182. [PMID: 38317569 DOI: 10.1111/ajag.13266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE This series of audits aimed to determine current best practice in delirium management in a tertiary teaching hospital and to identify strategies to improve the quality of care in delirium with a focus on prevention. METHODS We completed a series of audits following the formation of the Cognitive Impairment Reference Group, a multidisciplinary team that was created to implement delirium management guidelines and monitor compliance. Audit 1 focused on antipsychotic use in patients aged 66 years and older. Audit 2 reviewed delirium care in the Acute Medical Ward. Audit 3 included ethnographic data and investigated the use of non-pharmacological methods to prevent and manage delirium in the Geriatric Ward. Two years on, Audit 4 is a repeat of Audit 1. RESULTS There were improved rates of cognitive screening between Audits 2 and 3 from 65% n = 40 to 86% n = 102, respectively. Most patients had one form of non-pharmacological strategy in place to prevent delirium however few had a multicomponent approach. Fewer patients were prescribed benzodiazepines alongside antipsychotics 28.57% n = 35 in Audit 1 compared to Audit 4 12.5% n = 32. CONCLUSIONS Improved quality of care in delirium management is achievable via a co-ordinated multidisciplinary approach. These audits demonstrated improvements in both rates of cognitive screening, and use of non-pharmacological strategies prior to antipsychotic medication use and better adherence to guidelines for antipsychotic prescribing. Areas for further development in delirium prevention include the uptake of screening and individualised non-pharmacological strategies.
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Affiliation(s)
- Emily Clarke
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ellie Newman
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Madhu Dravid
- Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Emma Jones
- Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Lucy Kilshaw
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Samantha Hilmi
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Leon Flicker
- Royal Perth Hospital, Perth, Western Australia, Australia
- Western Australian Centre for Health & Ageing, Medical School, University of Western Australia, Perth, Western Australia, Australia
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Al-Harbi S. Impact of Rapid Response Teams on Pediatric Care: An Interrupted Time Series Analysis of Unplanned PICU Admissions and Cardiac Arrests. Healthcare (Basel) 2024; 12:518. [PMID: 38470629 PMCID: PMC10931051 DOI: 10.3390/healthcare12050518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024] Open
Abstract
Pediatric rapid response teams (RRTs) are expected to significantly lower pediatric mortality in healthcare settings. This study evaluates RRTs' effectiveness in decreasing cardiac arrests and unexpected Pediatric Intensive Care Unit (PICU) admissions. A quasi-experimental study (2014-2017) at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, involved 3261 pediatric inpatients, split into pre-intervention (1604) and post-intervention (1657) groups. Baseline pediatric warning scores and monthly data on admissions, transfers, arrests, and mortality were analyzed pre- and post-intervention. Statistical methods including bootstrapping, segmented regression, and a Zero-Inflation Poisson model were employed to ensure a comprehensive evaluation of the intervention's impact. RRT was activated 471 times, primarily for respiratory distress (29.30%), sepsis (22.30%), clinical anxiety (13.80%), and hematological abnormalities (6.7%). Family concerns triggered 0.1% of activations. Post-RRT implementation, unplanned PICU admissions significantly reduced (RR = 0.552, 95% CI 0.485-0.628, p < 0.0001), and non-ICU cardiac arrests were eliminated (RR = 0). Patient care improvement was notable, with a -9.61 coefficient for PICU admissions (95% CI: -12.65 to -6.57, p < 0.001) and a -1.641 coefficient for non-ICU cardiac arrests (95% CI: -2.22 to -1.06, p < 0.001). Sensitivity analysis showed mixed results for PICU admissions, while zero-inflation Poisson analysis confirmed a reduction in non-ICU arrests. The deployment of pediatric RRTs is associated with fewer unexpected PICU admissions and non-ICU cardiopulmonary arrests, indicating improved PICU management. Further research using robust scientific methods is necessary to conclusively determine RRTs' clinical benefits.
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Affiliation(s)
- Samah Al-Harbi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Pediatrics, King Abdulaziz University Hospital, Jeddah 22252, Saudi Arabia
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de Moraes MVA, de Almeida ÍLS, de Carvalho REFL. Patient safety culture assessment before and after safety huddle implementation. Rev Esc Enferm USP 2024; 57:e20230270. [PMID: 38358114 PMCID: PMC10868519 DOI: 10.1590/1980-220x-reeusp-2023-0270en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/28/2023] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE To identify whether safety huddle implementation enabled a change in patient safety culture. METHOD Quasi-experimental research that assessed patient safety culture before and after safety huddle implementation. RESULTS. The study revealed that 53.98% completed the two safety culture assessments, with 60.1% adherence from the nursing team, with a statistically significant difference in the second assessment regarding perception of patient safety and adverse events notified (p < 0.00). Regarding good practice indicators, a statistically significant difference (p < 0.00) was observed in item 43 and improvement in almost all dimensions in the second safety culture assessment. The huddles totaled 105 days, with 100% adherence from the nursing team. Regarding checklist items, all presented satisfactory responses (above 50%). CONCLUSION Safety huddles proved to be an effective tool for communication between healthcare professionals and managers, demonstrating positive impacts on good practice indicators and most safety culture dimensions.
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15
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Son HM, Lee H. Association Between Nurse-Led Multidisciplinary Education and Cardiac Events in Patients With Heart Failure: A Retrospective Chart Review. Asian Nurs Res (Korean Soc Nurs Sci) 2024; 18:60-67. [PMID: 38311228 DOI: 10.1016/j.anr.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE This study examined the modifiable factors, including nurse-led multidisciplinary education and in/out-of-hospital rehabilitation, to predict cardiac events in patients with heart failure (HF) in South Korea. METHODS A retrospective review of the medical records was conducted using data of patients admitted for HF between June 2021 and April 2022. A total of 342 patients were included in this study. Information related to HF education, cardiac rehabilitation, and demographic and clinical characteristics were collected. Cardiac events, including emergency department visits, readmissions, and deaths, were defined as a composite of events. After adjusting for covariates, a multivariate Cox proportional hazard regression model was used to explore the association between modifiable factors and cardiac events in patients with HF. RESULTS During the follow-up period (median, 823 days), 123 patients (36.0%) experienced at least one cardiac event. In the Cox regression model, patients who received nurse-led multidisciplinary HF education during hospitalization were less likely to experience cardiac events (hazard ratio: 0.487; 95% confidence interval [CI]:0.239-0.993). Additionally, high NT-pro BNP levels were associated with an increased risk of cardiac events. CONCLUSIONS The education led by nurses on HF was a factor that reduced adverse prognoses in patients with HF. Our results highlight the importance of a nurse-led multidisciplinary approach during hospitalization.
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Affiliation(s)
- Haeng-Mi Son
- Department of Nursing, University of Ulsan, Ulsan, Republic of Korea.
| | - Hyeongsuk Lee
- College of Nursing, Gachon University, Incheon, Republic of Korea.
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Vervullens S, Breugelmans L, Beckers L, VAN Kuijk SM, VAN Hooff M, Winkens B, Smeets RJ. Clinical prediction model for interdisciplinary biopsychosocial rehabilitation in osteoarthritis patients. Eur J Phys Rehabil Med 2024; 60:84-94. [PMID: 38059576 PMCID: PMC10938038 DOI: 10.23736/s1973-9087.23.08071-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/18/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Osteoarthritis (OA) is a heterogenous condition, in which different subgroups are present. Individualized interdisciplinary multimodal pain treatments (IMPT) based on the biopsychosocial model have resulted in positive improvement of pain, health and disability in OA patients. Moreover, predictive factors for treatment success of IMPT in different musculoskeletal pain populations have been examined, but a clinical prediction model which informs whether an OA patient is expected to benefit or not from IMPT is currently lacking. AIM The aim was to develop and internally validate a clinical prediction model to inform patient-tailored care based on identified predictors for positive or negative outcomes of IMPT in patients with OA. DESIGN Longitudinal prospective cohort study. SETTING Center for Integral Rehabilitation at six locations in the Netherlands. POPULATION Chronic OA patients. METHODS Data in this study were collected during January 2019 until January 2022. Participants underwent a 10-week IMPT program based on the biopsychosocial model. Treatment success was defined by a minimal decrease from baseline of 9 points on the Pain Disability Index (PDI). Candidate predictors were selected by experts in IMPT and literature review. Backward logistic regression analysis was performed to develop the clinical predication model and bootstrap validation was performed for internal validation. RESULTS Overall, 599 OA patients were included, of which 324 experienced treatment success. Thirty-four variables were identified as possible predictors for good IMPT outcome. Age, gender, number of pain locations, PDI baseline score, maximal pain severity, use of pain medication and alcohol, work ability, brief illness perceptions questionnaire subscales timeline, consequences, identity and treatment control, pain catastrophizing scale and self-efficacy questionnaire score were found as predictors for treatment success. The internally validated model has an acceptable discriminative power of 0.71. CONCLUSIONS This study reports a specific clinical prediction model for good outcome of IMPT in patients with OA. The internally validated model has an acceptable discriminative power of 0.71. CLINICAL REHABILITATION IMPACT After external validation, this model could be used to develop a clinically useful decision tool.
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Affiliation(s)
- Sophie Vervullens
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Care and Public Health Research Institute (CAPHRI), Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
| | - Lissa Breugelmans
- Care and Public Health Research Institute (CAPHRI), Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Division of Biodiversity Informatics, Department Collections and Library, Meise Botanical Garden, Meise, Belgium
| | - Laura Beckers
- Care and Public Health Research Institute (CAPHRI), Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
| | - Sander M VAN Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Miranda VAN Hooff
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bjorn Winkens
- Care and Public Health Research Institute (CAPHRI), Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Rob J Smeets
- Care and Public Health Research Institute (CAPHRI), Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands -
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- CIR Clinics in Revalidatie, Eindhoven, the Netherlands
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Delgado-Corcoran C, Wawrzynski SE, Mansfield K, Fuchs E, Yeates C, Flaherty BF, Harousseau M, Cook L, Epps JV. Grieving Children' Death in an Intensive Care Unit: Implementation of a Standardized Process. J Palliat Med 2024; 27:236-240. [PMID: 37878371 PMCID: PMC10825263 DOI: 10.1089/jpm.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/26/2023] Open
Abstract
Background: The grief that accompanies witnessing the death of a child puts health care professionals at risk of secondary trauma, burnout, and turnover when left unaddressed. Objective: Support staff well-being and promote resiliency. Methods: Descriptive implementation of a structured, peer-to-peer bereavement support program for intensive care unit (ICU) staff at a tertiary children's hospital. Results: Thirty-five virtual sessions were held over the period of one year.Through these sessions, participants shared perspectives and normalized reactions, and explored potential coping strategies. Post-session feedback surveys demonstrated the negative impact of a death on the personal or work life of ICU staff. Additionally, nearly all reported some level of burnout. Conclusions: The sessions were feasible and positively impacted staff coping and well-being. Barriers and facilitators to session attendance, as well as suggestions for improvement, were also explored. Implications for practice and future research are discussed. No clinical trial registration is applicable.
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Affiliation(s)
- Claudia Delgado-Corcoran
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
- Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Sarah E. Wawrzynski
- Center for HealthCare Delivery Science, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Kelly Mansfield
- College of Nursing, Division of Acute and Chronic Care, University of Utah, Salt Lake City, Utah, USA
| | - Erin Fuchs
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Chelsea Yeates
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Brian F. Flaherty
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Mark Harousseau
- Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Lawrence Cook
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Jake Van Epps
- Department of Educational Psychology, University of Utah, Salt Lake City, Utah, USA
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18
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Collis JM, Barradell S, Broman P, Brownie S. University Staff Insights on Interprofessional Education and Student-Led Clinic Opportunities at an Australian University. J Multidiscip Healthc 2024; 17:305-315. [PMID: 38268850 PMCID: PMC10807446 DOI: 10.2147/jmdh.s447690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024] Open
Abstract
Purpose Organizational and university staff buy-in and advocacy are critical considerations in planning successful interprofessional education (IPE) initiatives in healthcare, such as interprofessional student-led clinics (SLCs). This study was designed with the purpose of gaining deeper insight into current views and perspectives of academic and professional staff at an Australian university, as a precursor to planning IPE and SLC activities. Methods All academic and professional staff from within the School of Health Sciences were invited to participate in the study. In-depth-qualitative interviews were conducted with 16 staff to explore academic and professional staff perspectives on IPE and SLCs. Reflexive thematic analysis was used to analyse the data. Results Findings are grouped within five themes that incorporate broad perspectives on the tensions and possibilities of IPE and establishment of SLCs: Academic and professional staff commitment; Better/smarter IPE; Student-led clinic potential; Vision and innovation; and Strategy and resourcing. The themes reflect the high value placed on IPE by academic and professional staff and incorporate innovative ideas on how to prepare students for a rapidly changing and evolving healthcare environment. A reticence towards standard models of university based SLCs was expressed. Conclusion Academic and professional staff insights suggest university leaders need to develop a greater strategic focus on improving IPE. Effective engagement with staff is required to support IPE planning and implementation. If considering implementation of SLCs, contemporary fit-for-purpose models should be explored such as partnerships with primary healthcare providers, community wellness facilities, and hospital clinics rather than traditional university-based clinics.
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Affiliation(s)
- Julie M Collis
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Sarah Barradell
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Patrick Broman
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand
| | - Sharon Brownie
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand
- Griffith Health, Griffith University, Gold Coast, QLD, Australia
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19
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Mysler E, Monticielo OA, Al-Homood IA, Lau CS, Hussein H, Chen YH. Opportunities and challenges of lupus care in Latin America, the Middle East, and Asia-Pacific: A call to action. Mod Rheumatol 2024:roae001. [PMID: 38531074 DOI: 10.1093/mr/roae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/27/2023] [Indexed: 03/28/2024]
Abstract
Lupus remains a disease with a low prioritisation in the national agendas of many countries in Latin America, the Middle East, and Asia-Pacific, where there is a dearth of rheumatologists and limited access to new or even standard lupus treatments. There is thus an important need for education, advocacy, and outreach to prioritise lupus in these regions to ensure that patients receive the care they need. This article reviews some of the specific challenges facing the care and management of people with lupus in these regions and suggests strategies for improving patient outcomes. Specifically, we review and discuss (with a focus on the aforementioned regions) the epidemiology of lupus; economic costs, disease burden, and effects on quality of life; barriers to care related to disease assessment; barriers to effective treatment, including limitations of standard treatments, high glucocorticoid use, inadequate access to new treatments, and low adherence to medications; and strategies to improve lupus management and patient outcomes. We hope that this represents a call to action to come together and act now for the lupus community, policymakers, health authorities, and healthcare professionals to improve lupus management and patient outcomes in Latin America, the Middle East, and Asia-Pacific.
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Affiliation(s)
- Eduardo Mysler
- Organización Medica de Investigación, Buenos Aires, Argentina
| | - Odirlei Andre Monticielo
- Rheumatology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Chak Sing Lau
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | | | - Yi-Hsing Chen
- Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
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20
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Gu BD, Wang Y, Ding R. Impact of a multidisciplinary collaborative nutritional treatment model in patients who are critically ill with neurological disorders: A randomized controlled trial. Technol Health Care 2024; 32:1767-1780. [PMID: 38073348 DOI: 10.3233/thc-230791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Malnutrition is a widespread problem in critically ill patients with neurological disorders. OBJECTIVE The purpose of this study is to investigate the effect of a multidisciplinary collaborative nutritional treatment mode based on a standardized unit for nutritional support on the outcome metrics in patients with neurological disorders who are critically ill. METHODS We enrolled 84 participants who were hospitalized in the intensive care unit (ICU) of Yancheng No. 1 People's Hospital for neurological disorders between June 2018 and December 2021. The participants were randomly assigned to the control group and the test group. The control group received traditional nutritional support, while the test group was treated with a multidisciplinary collaborative nutritional treatment mode based on a standardized unit for nutritional support. We collected the general information, feeding tolerance (FT), nutritional risk score, and laboratory indicators before intervention, after intervention for one week, and after intervention for 2 weeks, and other data of the participants. RESULTS After the intervention, the test group scored significantly lower than the control group in the incidence of gastroparesis and diarrhea, as well as the NUTRIC score, with statistically significant differences (P< 0.001). The prealbumin levels in the test group increased progressively prior to intervention, after intervention for one week, and after intervention for two weeks. Compared to the control group, the test group had higher prealbumin levels prior to intervention, after intervention for one week, and after intervention for two weeks, with statistically significant differences (P< 0.001). CONCLUSION We developed a multidisciplinary collaborative nutritional treatment model based on a standard unit for nutritional support. This model can improve neural function, FT, and pertinent outcome indicators and is generally applicable.
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Affiliation(s)
- Bao-Di Gu
- Department of Critical Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Yun Wang
- Department of Neurology, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Rong Ding
- Department of Nursing, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng, Jiangsu, China
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21
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Yang TY, Chang TY. Prenatal Ultrasound Imaging of Orofacial Clefts: A Pictorial Essay. J Med Ultrasound 2024; 32:8-13. [PMID: 38665338 PMCID: PMC11040495 DOI: 10.4103/jmu.jmu_123_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/01/2023] [Indexed: 04/28/2024] Open
Abstract
Orofacial clefts (OFCs), including cleft lip (CL), cleft palate (CP), and CL with palate (CL/P), are relatively common congenital birth defects occurring in approximately 1 in 500 to 1 in 2500 live births. Detecting OFCs during prenatal ultrasound screening is crucial for informed decision-making and multidisciplinary medical care. This review provides a practical guide for routine and advanced screening for OFCs during mid-pregnancy. The Maarse classification system facilitates effective communication among the multidisciplinary team, categorizing OFCs into five types. Basic ultrasound views encompass coronal, sagittal, and axial imaging of the face and hard palate. Additional visualization techniques are employed in case of suspected anomalies during the initial screening. Advanced ultrasound views provided by the expert in prenatal OFC diagnosis include imaging of the posterior edge of the hard palate and the posterior part of the soft palate. Detected OFCs exhibit a range of severity and affect different structures, underscoring the importance of accurate detection and classification for appropriate treatment planning. Implementing a standardized screening protocol for OFCs is essential. By enhancing detection rates and enabling early diagnosis, prenatal ultrasound screening contributes to improved patient outcomes and facilitates timely intervention by the multidisciplinary team. In conclusion, this review emphasizes the significance of standardized protocols and specialized techniques for prenatal ultrasound screening of OFCs. Early detection and classification of these malformations play a vital role in comprehensive management, ensuring that affected individuals and their families receive the appropriate care and support they need.
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Affiliation(s)
- Tze-Yi Yang
- Department of Fetal Medicine, Taiji Clinic, Taipei, Taiwan
| | - Tung-Yao Chang
- Department of Fetal Medicine, Taiji Clinic, Taipei, Taiwan
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22
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Bray M, Heruc G, Evans L, Wright ORL. The imperative of collaboration: Lived experience perspectives on team approaches in outpatient eating disorder treatment. Int J Eat Disord 2024; 57:116-123. [PMID: 37902406 DOI: 10.1002/eat.24084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Across healthcare broadly, team treatment approaches range from siloed multidisciplinary treatment to synergistic Interprofessional Collaborative Practice (IPCP), with IPCP increasingly favored. In eating disorders, clinical practice guidelines endorse team outpatient treatment, and these approaches are widely used in clinical practice. However, there is limited evidence to describe attitudes toward and experiences of team approaches, including IPCP, among individuals with a lived experience. METHOD Twenty-seven participants (aged 20-51 years) with a formal eating disorder diagnosis were recruited. Each had received outpatient eating disorder treatment from a team or teams comprising a mental health professional, dietitian, and general practitioner (GP) in the past 2 years. Qualitative data were collected via semi-structured interviews and analyzed using Braun and Clarke's reflexive thematic analysis. RESULTS Four themes were derived from the qualitative analysis. Themes included: (1) working together is better; (2) the linchpin of teamwork is communication; (3) teams should foster autonomy with limit-setting; and (4) systemic failures negatively affect team treatment. Participants favored highly collaborative treatment from a team including a mental health professional, dietitian, and GP at a minimum, where the team engaged in high-quality communication and fostered autonomy with limit-setting. Systemic failures negatively affecting team treatment were reported across the care continuum. DISCUSSION Findings endorse the application of IPCP to outpatient eating disorder treatment as a strategy to improve treatment satisfaction, engagement, and outcomes. Given the paucity of evidence exploring IPCP in this field, however, the development and evaluation of interprofessional education and treatment models is a foundational necessity. PUBLIC SIGNIFICANCE Team eating disorder treatment is widely used in clinical practice, although there is limited evidence to guide interventions. This study explores attitudes toward and experiences of team outpatient eating disorder treatment among individuals with a lived experience. Understanding preferred team treatment characteristics delivers important information to improve treatment satisfaction, engagement, and outcomes for individuals receiving outpatient eating disorder treatment.
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Affiliation(s)
- Megan Bray
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Gabriella Heruc
- Eating Disorders and Nutrition Research Group (ENRG), Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Lacey Evans
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
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Radhakrishnan A, Subramanian L, Rankin AJ, Fetters MD, Wittmann DA, Ginsburg KB, Hawley ST, Skolarus TA. Primary Care Physician and Urologist Perspectives on Optimizing Active Surveillance for Low-Risk Prostate Cancer. Ann Fam Med 2024; 22:5-11. [PMID: 38253492 DOI: 10.1370/afm.3057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE We conducted a study to understand primary care physician (PCP) and urologist perspectives on determinants of active surveillance care delivery for men with low-risk prostate cancer. METHODS We conducted in-depth, semistructured, virtual interviews with a purposive sample of 19 PCPs and 15 urologists between June 2020 and March 2021. We used the behavioral theory-informed Theoretical Domains Framework to understand barriers to and facilitators of active surveillance care delivery. Interviews were recorded, transcribed, and deductively coded into framework domains and constructs by 3 independent coders. Participant recruitment continued until data saturation by group. RESULTS Our study included 19 PCPs (9 female; 4 in community practices, 15 in academic medical centers) and 15 urologists (3 female; 5 in private practice, 3 in academic medical centers). The most commonly reported Theoretical Domains Framework domains affecting active surveillance care were (1) knowledge and (2) environmental context and resources. Although urologists were knowledgeable about active surveillance, PCPs mentioned limitations in their understanding of active surveillance (eg, what follow-up entails). Both groups noted the importance of an informed patient, especially how a patient's understanding of active surveillance facilitates their receipt of recommended follow-up. Physicians viewed patient loss to follow-up as a barrier, but identified a favorable organizational culture/climate (eg, good communication between physicians) as a facilitator. CONCLUSIONS With patients increasingly involving their PCPs in their cancer care, our study presents factors both PCPs and urologists perceive (or identify) as affecting optimal active surveillance care delivery. We provide insights that can help inform multilevel supportive interventions for patients, physicians, and organizations to ensure the success of active surveillance as a management strategy for low-risk prostate cancer.
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Affiliation(s)
- Archana Radhakrishnan
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lalita Subramanian
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Aaron J Rankin
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Kevin B Ginsburg
- Department of Urology, Wayne State University, Detroit, Michigan
| | - Sarah T Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Ted A Skolarus
- Department of Urology, University of Chicago, Chicago, Illinois
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Allaire C, Yong PJ, Bajzak K, Jarrell J, Lemos N, Miller C, Morin M, Nasr-Esfahani M, Singh SS, Chen I. Guideline No. 445: Management of Chronic Pelvic Pain. Journal of Obstetrics and Gynaecology Canada 2024; 46:102283. [PMID: 38341225 DOI: 10.1016/j.jogc.2023.102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To provide evidence-based recommendations for the management of chronic pelvic pain in females. TARGET POPULATION This guideline is specific to pelvic pain in adolescent and adult females and excluded literature that looked at pelvic pain in males. It also did not address genital pain. BENEFITS, HARMS, AND COSTS The intent is to benefit patients with chronic pelvic pain by providing an evidence-based approach to management. Access to certain interventions such as physiotherapy and psychological treatments, and to interdisciplinary care overall, may be limited by costs and service availability. EVIDENCE Medline and the Cochrane Database from 1990 to 2020 were searched for articles in English on subjects related to chronic pelvic pain, including diagnosis, overlapping pain conditions, central sensitization, management, medications, surgery, physiotherapy, psychological therapies, alternative and complementary therapies, and multidisciplinary and interdisciplinary care. The committee reviewed the literature and available data and used a consensus approach to develop recommendations. Only articles in English and pertaining to female subjects were included. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Family physicians, gynaecologists, urologists, pain specialists, physiotherapists, and mental health professionals. TWEETABLE ABSTRACT Management of chronic pelvic pain should consider multifactorial contributors, including underlying central sensitization/nociplastic pain, and employ an interdisciplinary biopsychosocial approach that includes pain education, physiotherapy, and psychological & medical treatments. SUMMARY STATEMENTS RECOMMENDATIONS.
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Miquilussi PA, Santos RS, Massi GADA. Multi-professional screening instrument for risk of broncho-aspiration in a hospital environment for the elderly population: validity evidence based on response processes. Codas 2023; 36:e20220228. [PMID: 38126426 PMCID: PMC10750859 DOI: 10.1590/2317-1782/20232022228pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 02/15/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE The objective of this study was to validate the Multiprofessional Screening Instrument for Broncho-aspiration Risk in Hospital Environment, which is aimed at the elderly population, based on response processes. METHODS Judges applied the instrument to different patients and randomly selected. After the application, the judges were interviewed so that it was possible to verify their impression regarding the relevance of the items about their interpretation of the written content, as well as grammatical and semantic issues. Suggestions for adding alternative questions and answers were considered, as well as proposals for adapting the questions that made up the instrument. Non-verbal reactions, such as facial expressions that suggested doubts or hesitations, by the judges concerning the instrument were also analyzed. RESULTS The agreement of the judges concerning each item of the device was calculated by the Content Validity Index (CVI) and by the Intraclass Correlation Coefficient (ICC), and their results showed a high level of agreement. Through the suggestions of the judges, a new version of the Multi-professional Screening Instrument for the Risk of Broncho-aspiration in a Hospital Environment in the Elderly was elaborated. CONCLUSION The results obtained showed that the validity of the Multi-professional Instrument for Screening the Risk of Broncho-aspiration in the Hospital Environment with the elderly population, based on the response processes, was achieved and makes it a promising device to assist professionals in hospital care for the elderly.
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Affiliation(s)
- Paloma Alves Miquilussi
- Programa de Pós-graduação em Distúrbios da Comunicação, Universidade Tuiuti do Paraná – UTP - Curitiba (PR), Brasil.
| | - Rosane Sampaio Santos
- Programa de Pós-graduação em Distúrbios da Comunicação, Universidade Tuiuti do Paraná – UTP - Curitiba (PR), Brasil.
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Zanetoni TC, Cucolo DF, Perroca MG. Interprofessional actions in responsible discharge: contributions to transition and continuity of care. Rev Esc Enferm USP 2023; 57:e20220452. [PMID: 38047743 PMCID: PMC10695169 DOI: 10.1590/1980-220x-reeusp-2022-0452en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 09/28/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE To analyze the interprofessional team's perception of the actions carried out by means of responsible hospital discharge, and their contribution to improving the transition and continuity of patient care. METHODS A qualitative study was carried out in two hospitalization units, in October - November 2020, interviewing health professionals from a teaching hospital in the state of São Paulo. The reports were transcribed and subjected to thematic content analysis. RESULTS Twelve professionals participated (doctor, nurse, physiotherapist, nutritionist, speech therapist and social worker) and three thematic categories emerged from the interviews: 1. informational continuity in responsible discharge; 2. interaction between professionals and services for the transition of care; and 3. workload management for better transition and continuity of care. CONCLUSION The team recognized interprofessional advances and challenges in responsible discharge related to the informational and relational continuity of patient care and highlighted the (over)workload as an unfavorable aspect in the transition process, generating impacts for patients, professionals and health services.
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Affiliation(s)
- Tatiane Cristina Zanetoni
- Faculdade de Medicina de São José do Rio Preto, Programa de Pós-Graduação em Enfermagem, São José do Rio Preto, SP, Brazil
| | - Danielle Fabiana Cucolo
- Pontifícia Universidade Católica de Campinas, Programa de Residência Multiprofissional em Saúde, Campinas, SP, Brazil
| | - Marcia Galan Perroca
- Faculdade de Medicina de São José do Rio Preto, Programa de Pós-Graduação em Enfermagem, São José do Rio Preto, SP, Brazil
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May HP, Herges JR, Anderson BK, Hanson GJ, Kashani KB, Kattah AG, Cole KC, McCoy RG, Meade LA, Rule AD, Schreier DJ, Tinaglia AG, Barreto EF. Posthospital Multidisciplinary Care for AKI Survivors: A Feasibility Pilot. Kidney Med 2023; 5:100734. [PMID: 37964784 PMCID: PMC10641567 DOI: 10.1016/j.xkme.2023.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Rationale & Objective Innovative models are needed to address significant gaps in kidney care follow-up for acute kidney injury (AKI) survivors. Study Design This quasi-experimental pilot study reports the feasibility of the AKI in Care Transitions (ACT) program, a multidisciplinary approach to AKI survivor care based in the primary care setting. Setting & Participants The study included consenting adults with stage 3 AKI discharged home without dialysis. Interventions The ACT intervention included predischarge education from nurses and coordinated postdischarge follow-up with a primary care provider and pharmacist within 14 days. ACT was implemented in phases (Usual Care, Education, ACT). Outcomes The primary outcome was feasibility. Secondary outcomes included process and clinical outcomes. Results In total, 46 of 110 eligible adults were enrolled. Education occurred in 18/18 and 14/15 participants in the Education and ACT groups, respectively. 30-day urine protein evaluation occurred in 15%, 28%, and 87% of the Usual Care, Education, and ACT groups, respectively (P < 0.001). Cumulative incidence of provider (primary care or nephrologist) and laboratory follow-up at 14 and 30 days was different across groups (14 days: Usual care 0%, Education 11%, ACT 73% [P < 0.01]; 30 days: 0%, 22%, and 73% [P < 0.01]). 30-day readmission rates were 23%, 44%, and 13% in the Usual Care, Education, and ACT groups, respectively (P = 0.13). Limitations Patients were not randomly assigned to treatment groups. The sample size limited the ability to detect some differences or perform multivariable analysis. Conclusions This study demonstrated the feasibility of multidisciplinary AKI survivor follow-up beginning in primary care. We observed a higher cumulative incidence of laboratory and provider follow-up in ACT participants. Trial Registration ClinicalTrials.gov (NCT04505891). Plain-Language Summary Abrupt loss of kidney function in hospitalized patients, acute kidney injury (AKI), increases the chances of long-term kidney disease and a worse health care experience for patients. One out of 3 people who experience AKI do not get the follow-up kidney care they need. We performed a pilot study to test whether a program that facilitates structured AKI follow-up in primary care called the AKI in Care Transitions (ACT) program was possible. ACT brings together the unique expertise of nurses, doctors, and pharmacists to look at the patient's kidney health plan from all angles. The study found that the ACT program was possible and led to more complete kidney care follow-up after discharge than the normal approach to care.
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Affiliation(s)
| | | | | | - Gregory J. Hanson
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Kianoush B. Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Andrea G. Kattah
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Kristin C. Cole
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Rozalina G. McCoy
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Laurie A. Meade
- Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, MN
| | - Andrew D. Rule
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | - ACT Study Group
- Department of Pharmacy, Mayo Clinic, Rochester, MN
- Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, MN
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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O'Donohue E, Aguey-Zinsou M, Yule E, Fairhurst I, Debaets M. Mental health consumer perspectives of a person-centred multidisciplinary care planning meeting on a rehabilitation inpatient unit. Int J Ment Health Nurs 2023; 32:1701-1712. [PMID: 37477147 DOI: 10.1111/inm.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/22/2023]
Abstract
Mental health consumers are seeking genuine involvement in the planning regarding their treatment and care; however for many consumers in inpatient mental health settings, there is not the opportunity to participate. Current research evaluating person-centred multidisciplinary care planning initiatives in inpatient settings from the consumer perspective is limited. The aim of this study was to explore the consumer perspective of a person-centred multidisciplinary care planning meeting implemented in an Australian inpatient mental health rehabilitation unit. This study used a focused ethnographic design with data collection including fieldnotes, observations of meetings and interviews. Ten individuals participated in the study, with two participating in meeting observations and eight participating in structured interviews. Participants were consumers with a mental health diagnosis admitted to a mental health rehabilitation unit for assistance with achieving their goals for community living. Findings were analysed utilizing thematic analysis. Findings showed that consumers' experiences of the care planning meetings were positive. Themes included; 'It's about you', 'Making decisions and expressing opinions', 'Staff involvement in care planning' and 'Supporting consumer recovery'. These findings add the consumer perspective to the existing evidence base and support the implementation of person-centred multidisciplinary care planning meetings in inpatient mental health settings.
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Affiliation(s)
- Eliza O'Donohue
- Occupational Therapy, School of Allied Health, Faculty of Health Sciences, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Melissa Aguey-Zinsou
- Occupational Therapy, School of Allied Health, Faculty of Health Sciences, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Elisa Yule
- Occupational Therapy, School of Allied Health, Faculty of Health Sciences, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Ian Fairhurst
- South Eastern Sydney Local Health Service, Sydney, New South Wales, Australia
| | - Marcie Debaets
- South Eastern Sydney Local Health Service, Sydney, New South Wales, Australia
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Duke DO, Allard D, Dysart S, Hogan KO, Phelan S, Rawlings L, Stoklosa H. Automated informatics may increase the detection rate of suspicious cases of human trafficking-a preliminary study. JAMIA Open 2023; 6:ooad097. [PMID: 38106607 PMCID: PMC10722470 DOI: 10.1093/jamiaopen/ooad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Objectives Worldwide, there is an estimated 40.3 million victims trapped in modern day slavery, including 24.9 million in forced labor and 15.4 million in forced marriage. A majority of labor and sex trafficking survivors report at least one healthcare encounter during their victimization. An approach to an informatics technology solution for identifying trafficked persons in real time, in the hospital / emergency department settings is the primary focus of this paper. Materials and methods Octavia, a software application implemented in 3 California hospitals, scanned all patient encounters for social and clinical determinants that are consistent predictors of HT. Any encounter that matched these criteria was forwarded to a specially trained High-Risk Navigator who screened the data and when able, made direct contact in an effort to build rapport and possibly provide victim assistance. Results During the observation period, the automated scanning of hospital patient encounters resulted in a notable increase in the detection of persons who had a likelihood of being trafficked when compared to a pre-project baseline. Discussion Our experience demonstrated that automated technology is useful to assist healthcare providers in identification of potentially trafficked persons, improving the likelihood of care provision.
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Affiliation(s)
| | - Derin Allard
- Family Medicine Residency Program, Marian Medical Center, Santa Maria, CA, United States
| | - Suzanne Dysart
- Obstetrics and Gynecology, Marian Medical Center, Santa Maria, CA, United States
| | - Keenan O Hogan
- Pathology and Laboratory Medicine, University of Kansas Health System, Kansas City, KS, United States
| | - Suzanne Phelan
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, United States
| | - Luke Rawlings
- Family Medicine Center, Pacific Central Coast Health Centers, Santa Maria, CA, United States
| | - Hanni Stoklosa
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- HEAL Trafficking, Long Beach, CA, United States
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Lai YH, Wu MJ, Chen HH, Lin SP, Wu CY, Chin CS, Lin CH, Shiu SI, Lin YC, Chen HC, Hou SC, Chang CW. Impacts of Huddle Intervention on the Patient Safety Culture of Medical Team Members in Medical Ward: One-Group Pretest-Posttest Design. J Multidiscip Healthc 2023; 16:3599-3607. [PMID: 38024136 PMCID: PMC10680486 DOI: 10.2147/jmdh.s434185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Objective A huddle is a short, regular meetings to discuss existing or emerging patient safety issues. Hospital administrators can encourage healthcare staff to voluntarily examine the potential occurrence and severity of risks, thereby enhancing awareness of patient safety. The purpose of this study is to explore the effects of huddle intervention on patient safety culture among medical team members and related factors. Methods We used a one-group pretest-posttest research design and convenience sampled 109 members of the general internal medicine ward team members from a medical center in central Taiwan. They participated 2 times per week in 15-min huddles from 08:15 to 08:30 in the morning, which lasted for a total of 4 weeks. The process was based on submitted ideas, approved ideas, research ideas and standardization, and data on the safety attitudes questionnaire (SAQ) were collected during the huddles' intervention pretest and posttest. Results After the huddle intervention, we found significantly improved scores for safety attitude, teamwork climate (76.49±16.13 vs 83.26±13.39, p < 0.001), safety climate (75.07±16.07 vs 82.63±13.72, p < 0.001), job satisfaction (73.67±19.84 vs 83.39±17.21, p < 0.001), perceptions of management (77.87±19.99 vs 84.86±16.03, p < 0.001) and working conditions (78.96±18.16 vs 86.18±14.90, p < 0.001). Correlation analyses on the differences between pretest and posttest showed that age had a significant correlation with safety climate (r = 0.22, p = 0.022) and working conditions (r = 0.20, p = 0.035). The number of times to participate in a huddle had a significant correlation with teamwork climate (r = 0.33, p =<.001), safety climate (r = 0.30, p = 0.002), job satisfaction (r = 0.19, p = 0.043), and work conditions (r = 0.28, p = 0.003). Conclusion Huddles improve clinical team members' understanding of different dimensions and relate factors of safety attitudes. Implementation of the huddles involved standardized process will help hospital administrators understand the steps to parallel expansion to other wards.
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Affiliation(s)
- Yi-Hung Lai
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsin-Hua Chen
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Ping Lin
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Infection, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Yi Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Shih Chin
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Hsien Lin
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sz-Iuan Shiu
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ying-Cheng Lin
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hui-Chi Chen
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shu-Chin Hou
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Wein Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
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Qidwai M, Ahmed K, Tahir MF, Shaeen SK, Hasanain M, Malikzai A. Cognitive implications of rheumatoid arthritis: A call for comprehensive care and research focus. Immun Inflamm Dis 2023; 11:e1065. [PMID: 38018596 PMCID: PMC10629235 DOI: 10.1002/iid3.1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 11/30/2023] Open
Affiliation(s)
- Marium Qidwai
- Department of MedicineDow Medical CollegeKarachiPakistan
| | - Khadija Ahmed
- Department of MedicineDow Medical CollegeKarachiPakistan
| | - Muhammad Fawad Tahir
- Department of Medicine and SurgeryHBS Medical and Dental CollegeIslamabadPakistan
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Lo SHS, Chau JPC, Lau AYL, Choi KC, Shum EWC, Lee VWY, Hung SS, Mok VCT, Siow EKC, Ching JYL, Mirchandani K, Lam SKY. Virtual Multidisciplinary Stroke Care Clinic for Community-Dwelling Stroke Survivors: A Randomized Controlled Trial. Stroke 2023; 54:2482-2490. [PMID: 37551588 PMCID: PMC10519295 DOI: 10.1161/strokeaha.123.043605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Stroke survivors constantly feel helpless and unprepared after discharge from hospitals. More flexible and pragmatic support are needed for their optimized recovery. We examined the effects of a virtual multidisciplinary stroke care clinic on survivors' health and self-management outcomes. METHODS A randomized controlled trial was conducted. Survivors were recruited from 10 hospitals and randomized at 1:1 ratio into the intervention or the control groups. Intervention group participants received the Virtual Multidisciplinary Stroke Care Clinic service (monthly online consultations with a nurse, follow-up phone calls, and access to an online platform). Control group participants received the usual care. Outcomes of self-efficacy (stroke self-efficacy questionnaire; primary), self-management behaviors (Stroke Self-Management Behaviors Performance Scale), social participation (reintegration to normal living index), and depression (Geriatric Depression Scale; secondary) were measured at baseline, and 3 and 6 months after commencing the intervention (post-randomization). A generalized estimating equations model was used to compare the differential changes in outcomes at 3 and 6 months with respect to baseline between 2 groups. RESULTS Between July 2019 and June 2022, 335 eligible participants were enrolled in the study. Participants (intervention group; n=166) showed significantly greater improvements in outcomes of self-efficacy (group-by-time interaction regression coefficient, B=4.60 [95% CI, 0.16 to 9.05]), social participation (B=5.07 [95% CI, 0.61 to 9.53]), and depression (B=-2.33 [95% CI, -4.06 to -0.61]), and no significant improvement in performance of self-management behaviors (B=3.45, [95% CI, -0.87 to 7.77]), compared with the control group (n=169) right after the intervention (6 months after its commencement). Hedges' g effect sizes of the intervention on outcomes: 0.19 to 0.36. CONCLUSIONS The results provide some positive evidence on the usefulness of the Virtual Multidisciplinary Stroke Care Clinic service. The effect sizes are regarded as small to medium, which may not be of clinical relevance. The baseline levels in outcomes were in favor of the control group, the intervention effects might be overestimated. The service must be tested further to determine its effectiveness. REGISTRATION URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1800016101.
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Affiliation(s)
- Suzanne Hoi Shan Lo
- The Nethersole School of Nursing (S.H.S.L., J.P.C.C., K.C.C., K.M., S.K.Y.L.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing (S.H.S.L., J.P.C.C., K.C.C., K.M., S.K.Y.L.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Alexander Yuk Lun Lau
- Department of Medicine and Therapeutics (A.Y.L.L.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Kai Chow Choi
- The Nethersole School of Nursing (S.H.S.L., J.P.C.C., K.C.C., K.M., S.K.Y.L.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | | | - Vivian Wing Yan Lee
- Centre for Learning Enhancement And Research, The Chinese University of Hong Kong, Hong Kong SAR (V.W.Y.L.)
| | - Sheung Sheung Hung
- Hong Kong Institute of Integrative Medicine (S.S.H.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Vincent Chung Tong Mok
- Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | | | - Jessica Yuet Ling Ching
- Department of Medicine and Therapeutics (J.Y.L.C.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Kashika Mirchandani
- The Nethersole School of Nursing (S.H.S.L., J.P.C.C., K.C.C., K.M., S.K.Y.L.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Simon Kwun Yu Lam
- The Nethersole School of Nursing (S.H.S.L., J.P.C.C., K.C.C., K.M., S.K.Y.L.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
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Zamzam A, McLaren A, Ram E, Syed MH, Rave S, Lu SH, Al‐Omran M, de Mestral C. A novel Canadian multidisciplinary acute care pathway for people hospitalised with a diabetic foot ulcer. Int Wound J 2023; 20:3331-3337. [PMID: 37150835 PMCID: PMC10502294 DOI: 10.1111/iwj.14214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/09/2023] Open
Abstract
This manuscript describes the implementation and initial evaluation of a novel Canadian acute care pathway for people with a diabetic foot ulcer (DFU). A multidisciplinary team developed and implemented an acute care pathway for patients with a DFU who presented to the emergency department (ED) and required hospitalisation at a tertiary care hospital in Canada. Processes of care, length of stay (LOS), and hospitalisation costs were considered through retrospective cohort study of all DFU hospitalizations from pathway launch in December 2018 to December 2020. There were 82 DFU-related hospital admissions through the ED of which 55 required invasive intervention: 28 (34.1%) minor amputations, 16 (19.5%) abscess drainage and debridement, 6 (7.3%) lower extremity revascularisations, 5 (6.1%) major amputations. Mean hospital LOS was 8.8 ± 4.9 days. Mean hospitalisation cost was $20 569 (±14 143): $25 901 (±15 965) when surgical intervention was required and $9279 (±7106) when it was not. LOS and hospitalisation costs compared favourably to historical data. An acute care DFU pathway can support the efficient evaluation and management of patients hospitalised with a DFU. A dedicated multidisciplinary DFU care team is a valuable resource for hospitals in Canada.
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Affiliation(s)
- Abdelrahman Zamzam
- Division of Vascular Surgery, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
| | - Ann‐Marie McLaren
- Chiropody TeamUnity Health Toronto—St. Michael's HospitalTorontoOntarioCanada
| | - Emily Ram
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
| | - Muzammil H. Syed
- Division of Vascular Surgery, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
| | - Sreenath Rave
- Chiropody TeamUnity Health Toronto—St. Michael's HospitalTorontoOntarioCanada
| | - Suzanne H. Lu
- Chiropody TeamUnity Health Toronto—St. Michael's HospitalTorontoOntarioCanada
| | - Mohammed Al‐Omran
- Division of Vascular Surgery, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
- Department of SurgeryKing Faisal Specialist Hospital and Research CenterRiyadhKingdom of Saudi Arabia
- Diabetes Action CanadaTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Charles de Mestral
- Division of Vascular Surgery, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
- Department of SurgeryKing Faisal Specialist Hospital and Research CenterRiyadhKingdom of Saudi Arabia
- Diabetes Action CanadaTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
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Dicpinigaitis PV, Altman KW, Ulger Isci I, Ke X, Blaiss M. Interdisciplinary collaboration in the diagnosis and management of chronic cough: the role and importance of primary care providers. Curr Med Res Opin 2023; 39:1375-1381. [PMID: 37736002 DOI: 10.1080/03007995.2023.2255128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023]
Abstract
Chronic cough (CC) is associated with many conditions, so identifying contributing causes poses a diagnostic challenge. However, guidelines written for US physicians do not explicitly outline suggested roles for primary care providers (PCPs) in the approach to patients with CC, including refractory or unexplained CC. The objective of this review is to describe the role of PCPs in the diagnosis and treatment of CC in adults. This narrative review draws upon literature (identified via a PubMed search performed January 9, 2023, using primary care/disease state-related terms) and expertise from specialist physicians to provide recommendations for CC management in primary care. Cough is one of the top reasons patients seek care from PCPs; accordingly, PCPs are often the first physicians to conduct workup and initiate treatment. Patients with CC often experience a burdensome cough that lasts for years, have high healthcare resource utilization (HCRU), undergo multiple or failed treatment trials, and have limited success finding an etiology. Although specialist referral may be needed for many diagnostic tests, initial aspects of CC workup and management should be completed in primary care. Often more accessible than specialists, real-world evidence on HCRU suggests PCPs are important stakeholders in diagnosing and managing CC, including during initial workup and treatment for the most common causes of CC (i.e. upper-airway cough syndrome, asthma, noneosinophilic asthmatic bronchitis, and gastroesophageal reflux disease). Thorough workup at the primary care level may facilitate earlier identification of CC cause(s), improving patient journey to diagnosis and management.
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Affiliation(s)
| | - Kenneth W Altman
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | | | | | - Michael Blaiss
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Hong JQY, Chua WL, Smith D, Huang CM, Goh QLP, Liaw SY. Collaborative practice among general ward staff on escalating care in clinical deterioration: A systematic review. J Clin Nurs 2023; 32:6165-6178. [PMID: 37154497 DOI: 10.1111/jocn.16743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/30/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023]
Abstract
AIM To understand the issues surrounding collaborative practice and collaboration experiences among general ward staff in the escalation of care for clinically deteriorating patients. DESIGN A systematic synthesis without meta-analysis. REVIEW METHODS Seven electronic databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, Scopus and ProQuest Theses and Dissertations) were searched from their inception to 30 April 2022. Two reviewers independently screened titles, abstracts and full text for eligibility. The critical appraisal skill programme, Joanna Briggs Institute checklist for analytical cross-sectional studies and mixed methods appraisal tool were used to appraise the quality of the included studies. Both quantitative and qualitative research data were extracted, analysed and then synthesised using the data-based convergent qualitative synthesis approach. This review adhered to the Synthesis without meta-analysis (SWiM) reporting guidelines. RESULTS A total of 17 studies were included. Two themes and six sub-themes were generated: (1) intraprofessional factors-inadequate handover, workload and mutual support, raising and acting on concerns, and seeking help from seniors and (2) interprofessional factors-differences in communication styles, and hierarchical approach versus interpersonal relationships. CONCLUSIONS This systematic review highlights the need to address the intra- and interprofessional issues surrounding collaborative practice in escalation of care among general ward staff. IMPLICATIONS FOR THE PROFESSION Findings from this review will inform healthcare leaders and educators on the development of relevant strategies and multi-disciplinary training to foster effective teamwork among nurses and doctors, with the goal of improving the escalation of care for patients with clinical deterioration. NO PATIENT OR PUBLIC CONTRIBUTION This systematic review did not directly involve patient or public contribution to the manuscript.
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Affiliation(s)
- Jordan Qi Yang Hong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Duncan Smith
- Department of Nursing, School of Health and Psychological Sciences, City University of London, London, UK
- Patient Emergency Response & Resuscitation Team (PERRT), University College London Hospitals, NHS Foundation Trust, London, UK
| | - Chi Ming Huang
- Nursing Service, National Healthcare Group, Tan Tock Seng Hospital, Singapore, Singapore
| | - Qin Ling Pearlyn Goh
- Department of Nursing, National Healthcare Group, Khoo Teck Puat Hospital, Yishun Health Campus, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 91] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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Acharya DK, Nilmanat K, Boonyasopun U. Institutional ethnography of hemodialysis care: Perspectives of multidisciplinary health care teams in Nepal. Belitung Nurs J 2023; 9:359-368. [PMID: 37645580 PMCID: PMC10461162 DOI: 10.33546/bnj.2691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 08/31/2023] Open
Abstract
Background Hemodialysis is the most commonly used renal replacement therapy for end-stage renal disease. The collaborative efforts of multidisciplinary teams comprising nephrologists, nurses, pharmacists, and dietitians play a crucial role in enhancing patient outcomes, improving the quality of care, and reducing treatment costs. However, various factors such as healthcare cost reduction, limited resources, profit-driven systems, organizational structure, and involvement in patient care decisions impact the provision of hemodialysis care by the multidisciplinary teams. Objective This study aimed to explore the institutional practices of multidisciplinary teams within a hemodialysis unit. Methods This institutional ethnography study was conducted between April 2019 to February 2020 in a hemodialysis unit of a public university hospital in Kathmandu, Nepal. Data were collected through face-to-face interviews with ten nurses (including supervisors and incharge), two nephrologists, two dietitians, two pharmacists, and two technicians. Additionally, 167 hours of observation, two focus groups with nurses, analysis of institutional texts, and field notes were conducted. Participants were purposively selected based on their ability to provide diverse information regarding institutional practices in hemodialysis care. Interviews were recorded and transcribed. Results The analyzed data were presented in: 1) the context of hemodialysis care, 2) textual practices: the ruling relations of hemodialysis care (staffing, protocol, job description), 3) hemodialysis decision, and 4) institutional support. Conclusion Hemodialysis care provided by multidisciplinary teams is constrained by limited resources, particularly in terms of physical space, dialysis machines, nurses, doctors, and dietitians. The hospital's cost-cutting policies lead to reduced investment in patient care equipment, particularly dialysis machines, which significantly impact the workload of nurses and technicians. Insufficient nurse staffing necessitates the provision of other renal care responsibilities, resulting in increased workload, reduced time available for hemodialysis care, and unfinished tasks. The absence of clear job descriptions for hemodialysis care places an additional burden on nurses, who are often required to fulfill the responsibilities of other healthcare teams. Doctors hold the authority in making care decisions, which are subsequently followed by other team members.
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Affiliation(s)
- Devaka Kumari Acharya
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- Faculty of Nursing, Tribhuvan University, Kathmandu, Nepal
| | - Kittikorn Nilmanat
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Umaporn Boonyasopun
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Pini JDS, Nacamura PAB, Harmuch C, Costa MAR, Giacon-Arruda BCC, Radovanovic CAT, Salci MA, Paiano M. Assessment of the Psychosocial Care Center multidisciplinary team from users' and family members' perspective. Rev Bras Enferm 2023; 76:e20220645. [PMID: 37610952 PMCID: PMC10441209 DOI: 10.1590/0034-7167-2022-0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/23/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES to assess the multidisciplinary team of a Psychosocial Care Center I from users' and family members' perspective. METHODS an evaluative study, anchored in the fourth generation evaluation theoretical-methodological framework, carried out in a Psychosocial Care Center I, from September 2021 to March 2022. Eleven users and 06 family members participated. Data were collected through non-participant observation, individual interviews and negotiation sessions, and analyzed using the Constant Comparative Method, using the MAXQDA software. RESULTS the team develops its care based on individual and collective care, with integrated and complementary work by professionals. They seek to facilitate treatment initiation and continuation, considering health needs and offering support, understanding and guidance to users and their families. FINAL CONSIDERATIONS the multidisciplinary team's work is based on the psychosocial paradigm, which can qualify care and strengthen the service role in the mental health network.
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Affiliation(s)
- Jéssica dos Santos Pini
- Universidade Estadual de Maringá. Maringá, Paraná, Brazil
- Universidade Estadual do Paraná. Paranavaí, Paraná, Brazil
| | | | - Camila Harmuch
- Universidade Estadual de Maringá. Maringá, Paraná, Brazil
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Brás CPDC, Ferreira MMC, de Figueiredo MDCAB. Construction and validity of the Interprofessional Communication in Health Scale. Rev Bras Enferm 2023; 76:e20220483. [PMID: 37556693 PMCID: PMC10405407 DOI: 10.1590/0034-7167-2022-0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/20/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES to construct and validate the Interprofessional Communication Scale in Health. METHODS a psychometric study was carried out on a sample of 360 nurses from a hospital and university center in central Portugal. Reliability was assessed through internal consistency and construct validity through exploratory and confirmatory factor analysis. RESULTS the Interprofessional Communication in Health Scale, consisting of 27 items, is organized into 3 factors: "Teamwork", "Conflict management" and "Leadership", with a total variance of 51.1%. Good internal consistency was obtained, with a Cronbach's alpha of 0.842, and adequate Goodness of Fit Index model. CONCLUSIONS the Interprofessional Communication in Health Scale presents a factorial structure with adequate validity and reliability results, and may constitute a useful self-report instrument in assessing interprofessional communication in health.
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Affiliation(s)
- Cláudia Patrícia da Costa Brás
- Instituto de Ciências Biomédicas Abel Salazar. Porto, Portugal
- Escola Superior de Enfermagem de Coimbra. Coimbra, Portugal
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Rodríguez-Carrio J, Cavalli G, Gwinnutt J, Wieczorek M, Guillemin F, Verstappen SMM. Developing a framework for the implementation of recommendations for lifestyle factors for people with RMDs across Europe: assessment of current materials and implementation needs. RMD Open 2023; 9:e003443. [PMID: 37652556 PMCID: PMC10476113 DOI: 10.1136/rmdopen-2023-003443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
Lifestyle factors (such as diet, physical activity or smoking habits, among others) are known to influence the progression of rheumatic and musculoskeletal diseases (RMDs). Despite contemporary improvements in RMD care, the management of lifestyle factors is suboptimal. In the context of a recent European Alliance of Associations for Rheumatology (EULAR) task force, existing informative materials regarding lifestyle factors for people with RMDs were collected from national organisations across European countries. Current materials show important limitations in terms of coverage, literature support and access, which may make the implementation of successful interventions difficult. In the present viewpoint, a roadmap to cover these gaps at the European level with the recent EULAR recommendations on lifestyle factors is discussed from an implementation perspective. This analysis may pave the ground for future implementation endeavours at the European level related to non-pharmacological interventions that may also be applicable beyond rheumatology.
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Affiliation(s)
- Javier Rodríguez-Carrio
- Area of Immunology, Universidad de Oviedo, Oviedo, Spain
- Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Giulio Cavalli
- Internal Medicine and Clinical Immunology, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Milano, Lombardia, Italy
| | - James Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- IQVIA Ltd, Reading, UK
| | - Maud Wieczorek
- APEMAC, Université de Lorraine, Nancy, Grand Est, France
| | | | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Wythenshawe, UK
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Parodis I, Gomez A, Tsoi A, Chow JW, Pezzella D, Girard C, Stamm TA, Boström C. Systematic literature review informing the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. RMD Open 2023; 9:e003297. [PMID: 37532469 PMCID: PMC10401222 DOI: 10.1136/rmdopen-2023-003297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Through this systematic literature review, we assembled evidence to inform the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). We screened articles published between January 2000 and June 2021. Studies selected for data extraction (118 for SLE and 92 for SSc) were thematically categorised by the character of their intervention. Of 208 articles included, 51 were classified as robust in critical appraisal. Physical activity was the most studied management strategy and was found to be efficacious in both diseases. Patient education and self-management also constituted widely studied topics. Many studies on SLE found psychological interventions to improve quality of life. Studies on SSc found phototherapy and laser treatment to improve cutaneous disease manifestations. In summary, non-pharmacological management of SLE and SSc encompasses a wide range of interventions, which can be combined and provided either with or without adjunct pharmacological treatment but should not aim to substitute the latter when this is deemed required. While some management strategies i.e., physical exercise and patient education, are already established in current clinical practice in several centres, others e.g., phototherapy and laser treatment, show both feasibility and efficacy, yet require testing in more rigorous trials than those hitherto conducted.
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Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Tsoi
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jun Weng Chow
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Denise Pezzella
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Girard
- Division of Rheumatology, Department of Medicine, University of Geneva, Geneva, Switzerland
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Ludwig Boltzmann Gesellschaft, Vienna, Austria
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Alunno A, Avcin T, Haines C, Ramiro S, Sivera F, Badreh S, Baraliakos X, Bijlsma JWJ, Buttgereit F, Chaudhuri K, Da Silva JAP, Dudler J, Ferreira RJO, Gudu T, Hachulla E, Holland-Fischer M, Iagnocco A, Kragstrup TW, Nagy G, Romão VC, Stones SR, van Onna M, Edwards CJ. Points to consider: EULAR-UEMS standards for the training of European rheumatologists. Ann Rheum Dis 2023; 82:1107-1113. [PMID: 37188497 DOI: 10.1136/ard-2023-223941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Postgraduate rheumatology training programmes are already established at a national level in most European countries. However, previous work has highlighted a substantial level of heterogeneity in the organisation and, in part, content of programmes. OBJECTIVE To define competences and standards of knowledge, skills and professional behaviours required for the training of rheumatologists. METHODS A European Alliance of Associations for Rheumatology (EULAR) task force (TF) of 23 experts, including two members of the European Union of Medical Specialists (UEMS) section of rheumatology, was convened. The mapping phase consisted of the retrieval of key documents on specialty training in rheumatology and other related specialties across a broad set of international sources. The content of these documents was extracted and represented the foundation for the document draft that underwent several rounds of online discussion within the TF, and afterwards was also distributed to a broad group of stakeholders for collecting feedback. The list of generated competences was voted on during the TF meetings, while the level of agreement (LoA) with each statement was established by anonymous online voting. RESULTS A total of 132 international training curricula were retrieved and extracted. In addition to the TF members, 253 stakeholders commented and voted on the competences through an online anonymous survey. The TF developed (1) an overarching framework indicating the areas that should be addressed during training, (2) 7 domains defining broad areas that rheumatology trainees should master by the end of the training programme, (3) 8 core themes defining the nuances of each domain and (4) 28 competences that trainees should acquire to cover each of the areas outlined in the overarching framework. A high LoA was achieved for all competences. CONCLUSION These points to consider for EULAR-UEMS standards for the training of European rheumatologists are now defined. Their dissemination and use can hopefully contribute to harmonising training across European countries.
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Affiliation(s)
- Alessia Alunno
- Internal Medicine and Nephrology Division, Department of Clinical Medicine Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Tadej Avcin
- Unit of Allergy, Rheumatology and Clinical Immunology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Catherine Haines
- Education Committee, EULAR, Zurich, Switzerland
- Clinical Education, King's College London, London, UK
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Francisca Sivera
- Faculty of Medicine, Miguel Hernandez University of Elche, Sant Joan D'Alacant, Spain
- Rheumatology, Hospital General Universitario Elda, Elda, Spain
| | - Sara Badreh
- EULAR Patient Research Partner, Stockholm, Sweden
| | | | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Buttgereit
- Department of Rheumatology and Immunology, Charité University, Berlin, Germany
| | - Kaushik Chaudhuri
- Rheumatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jose A P Da Silva
- Reumatologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Jean Dudler
- Service de Rhumatologie, Médecine Physique et Rééducation, HFR Fribourg, Hôpital Cantonal, Fribourg, Switzerland
| | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Health Sciences Research Unit, Nursing School of Coimbra, Coimbra, Portugal
| | - Tania Gudu
- Rheumatology, Sf Maria Hospital, Universitatea de Medicina si Farmacie Carol Davila, Bucuresti, Romania
| | - Eric Hachulla
- Internal Medicine, Univ. Lille & Lille Inflammation Research International Center, Hôpital Claude Huriez, Lille, France
| | | | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Tue Wenzel Kragstrup
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
- Department of Rheumatology, Aarhus Universitetshospital, Aarhus, Denmark
| | - György Nagy
- Immunology and Medicine, Semmelweis University Medical School, Budapest, Hungary
| | - Vasco C Romão
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Marloes van Onna
- Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
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Hu PL, Tan CYL, Nguyen NHL, Wu RR, Bahadin J, Nadkarni NV, Tan NC. Integrated care teams in primary care improve clinical outcomes and care processes in patients with non-communicable diseases. Singapore Med J 2023; 64:423-429. [PMID: 35706106 PMCID: PMC10395801 DOI: 10.11622/smedj.2022067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 08/18/2020] [Indexed: 11/18/2022]
Abstract
Introduction Primary care physicians face the increasing burden of managing multimorbidities in an ageing population. Implementing an integrated care team (ICT) with defined roles and accountability to share consultation tasks is an emerging care model to address this issue. This study compared outcomes with ICT versus usual care for patients with multimorbidities in primary care. Methods Data was retrospectively extracted from the electronic medical records (EMRs) of consecutive adult Asian patients empanelled to ICT and those in UC at a typical primary care clinic (polyclinic) in eastern Singapore in 2018. The study population had hypertension, and/or hyperlipidaemia and/or type 2 diabetes mellitus (T2DM). Clinical outcomes included the proportion of patients (ICT vs. UC) who attained their treatment goals after 12 months. Process outcomes included the proportion of patients who completed annual diabetic eye and foot screenings, where applicable. Results Data from 3,302 EMRs (ICT = 1,723, UC = 1,579) from January 2016 to September 2017 was analysed. The ICT cohort was more likely to achieve treatment goals for systolic blood pressure (SBP) (adjusted odds ratio [AOR] = 1.52, 95% confidence interval [CI] = 1.38-1.68), low-density lipoprotein cholesterol (AOR = 1.72, 95% CI = 1.49-1.99), and glycated haemoglobin (AOR = 1.28, 95% CI = 1.09-1.51). The ICT group had higher uptake of diabetic retinal screening (89.1% vs. 83.0%, P < 0.001) and foot screening (85.2% vs. 77.9%, P < 0.001). Conclusion The ICT model yielded better clinical and process outcomes than UC, with more patients attaining treatment goals.
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Affiliation(s)
- Pei Lin Hu
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | - Cynthia Yan-Ling Tan
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | | | - Rebekah Ryanne Wu
- Department of Medicine, Duke University, Durham, NC, USA
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
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Heidarzadeh A, Alvandi M, Hedayati B, Rezaei M, Abedi F, Madani ZH, Hekmat SN, Dadgaran I, Mirkazemi R. The Roles of the Nurses in Family Physician Team: A Qualitative Systematic Review. Iran J Nurs Midwifery Res 2023; 28:361-370. [PMID: 37694211 PMCID: PMC10484375 DOI: 10.4103/ijnmr.ijnmr_244_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 05/13/2023] [Accepted: 05/31/2023] [Indexed: 09/12/2023]
Abstract
Background There are various approaches in primary health care regarding the key role of nurses. This systematic review investigates the roles of nurses, as part of the family medicine team. Materials and Methods All published articles related to the role of nurses in the family medicine team from January 2000 to March 2022 were the subjects of this study. The eligibility criteria included original articles published in English or Persian in the last two decades. International credible scholarly databases (PubMed, Scopus, Magiran, IranMedex, and SID) were searched using keywords and syntax. Some of the keywords included "Family Health Nurse," "Nurses in Primary Care," "Family Medicine," "Family Physician Care Program," "General Physician Program," "Role," and "Nurse." Data were extracted based on Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) technique and reported based on the structure of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results Of 147 identified publications by the search strategy, eight eligible empirical studies were included. The results showed that besides providing nursing care, nurses play vital roles in communication and teamwork, assessment, securing health services relevant to communities' needs, education, empowerment, clinical practice, health promotion, prevention, reflective research practice, and counseling. Conclusions This study identified different roles nurses could play in providing primary health care. These findings are helpful for the replanning or reform of primary health care in countries, which aimed to expand the Family Physician Program (FPP) in their countries, including Iran.
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Affiliation(s)
- Abtin Heidarzadeh
- Department of Community and Family Medicine, School of Medicine, Guilan University of Medical Science and Health Services, Rasht, Iran
| | - Mehdi Alvandi
- Department of Public Administration, Faculty of Management, University of Tehran, Tehran, Iran
| | - Bita Hedayati
- Farzanegan Nik Andish Institute for the Development of Knowledge and Technology, Tehran, Iran
| | - Mostafa Rezaei
- Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farshid Abedi
- Birjand University of Medical Sciences, Faculty of Medicine, Infectious Diseases Research Center, Birjand, Iran
| | - Zahra Hamidi Madani
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Somayeh Noori Hekmat
- Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ideh Dadgaran
- Medical Education Research Center, Education Development Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Roksana Mirkazemi
- Founder and Managing Director of Farzanegan Nik Andish Institute for the Development of Knowledge and Technology, Tehran, Iran
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Garg S, Ferguson S, Chewning B, Gomez S, Keevil J, Bartels C. Clarifying misbeliefs about hydroxychloroquine (HCQ): developing the HCQ benefits versus harm decision aid (HCQ-SAFE) per low health literacy standards. Lupus Sci Med 2023; 10:e000935. [PMID: 37500292 PMCID: PMC10387621 DOI: 10.1136/lupus-2023-000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Up to 83% of patients with SLE stop taking hydroxychloroquine (HCQ) within the first year due to knowledge gaps regarding the survival benefits of HCQ versus inflated fears of rare toxicity. Thus, there is a need for a shared decision-making tool that highlights HCQ's significant benefits versus rare harms to improve patients' understanding and align treatments with their values. The objective of this study was to describe development and piloting of a decision aid (HCQ-SAFE) to facilitate HCQ adherence, and safe, effective use by engaging patients in therapeutic decision-making. METHODS HCQ-SAFE was developed via a collaborative process involving patients, clinicians, implementation scientists and health literacy experts. The initial prototype was informed by Agency for Healthcare Research and Quality (AHRQ) low literacy principles and key themes about HCQ use from six prior patient and clinician focus groups, with iterative expert and stakeholder feedback to deliver a final prototype. We implemented HCQ-SAFE in four clinics to examine usability and feasibility on Likert scales (0-7) and net promoter score (0%-100%). RESULTS The final HCQ-SAFE shared decision-making laminated tool organises data using pictograms showing how HCQ use reduces risk of organ damage, early death and blood clots versus low risk of eye toxicity.HCQ-SAFE was reviewed in all eligible patient visits (n=40) across four clinics on an average of ~8 min, including 25% non-English-speaking patients. All patients scored 100% on the knowledge post-test; no decisional conflicts were noted after using HCQ-SAFE. HCQ-SAFE garnered high clinician and patient satisfaction with 100% likelihood to recommend to peers. CONCLUSIONS HCQ-SAFE is a stakeholder-informed feasible shared decision-making tool that enhances communication and can potentially improve knowledge, clarify misbeliefs and engage patients in treatment decisions, including those with limited English proficiency.
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Affiliation(s)
- Shivani Garg
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sancia Ferguson
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Betty Chewning
- Department of Pharmacy, School of Pharmacy, Madison, Wisconsin, USA
| | - Shelby Gomez
- Department of Pharmacy, School of Pharmacy, Madison, Wisconsin, USA
| | | | - Christie Bartels
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Gomide GPM, Pereira LHDM, Camargo FC, Rodrigues LM, Souza RDS, de Melo IV, Pereira TAR, de Oliveira CDCHB. Measures to Contain the Transmission of Hepatitis C in a Chronic Kidney Care Hospital Unit in the Triângulo Mineiro in Brazil: A Case Study. Int J Public Health 2023; 68:1605914. [PMID: 37325177 PMCID: PMC10266461 DOI: 10.3389/ijph.2023.1605914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Objectives: Hepatitis C virus elimination is complex. The objective was to analyze measures to eliminate virus transmission in a hemodialysis unit. Methods: Case study composed of multiple units of analysis. The scenario is the hemodialysis unit of a Brazilian public hospital. Population composed of health service records. Descriptive analyzes were performed and the beginning of the event was considered as the moment of increased incidence of HCV. The intentional and purposeful collection of information for understanding the event and implementing interventions. Results: The subunits of analysis were related to: clinical-epidemiological profile, active search, transmission routes, management protocol and results achieved. In August 2019, out of 45 patients, six were reactive for anti-HCV. All received treatment. Patients had exposure to contaminated medical equipment, objects or hands of professionals. Preventive measures were adopted and routine techniques were corrected. Situational Analysis Committee guided the management of the event. No new cases were detected. Conclusions: Strategies for the microelimination of the C virus in a dialysis environment are demonstrated and it shows the multidisciplinary efforts in conducting the event.
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Affiliation(s)
| | | | - Fernanda Carolina Camargo
- Teaching and Research Management, Hospital de Clínicas, Federal University of Triângulo Mineiro, Uberaba, Brazil
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Serrano C, Ehrig JC, Hofkamp MP. A 29-year-old woman presenting for urgent cesarean hysterectomy: a multidisciplinary care challenge. Proc AMIA Symp 2023; 36:528-529. [PMID: 37334093 PMCID: PMC10269407 DOI: 10.1080/08998280.2023.2210795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
This case describes a patient who needed an urgent cesarean hysterectomy for new-onset fetal heart rate abnormalities and preexisting placenta accreta spectrum. Rapid assembly of a multidisciplinary team consisting of obstetrics, anesthesiology, neonatology, and nursing contributed to a favorable clinical outcome.
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Affiliation(s)
- Claudia Serrano
- Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Jessica C. Ehrig
- Department of Obstetrics and Gynecology, Baylor Scott & White Medical Center – Temple, Temple, Texas
| | - Michael P. Hofkamp
- Department of Anesthesiology, Baylor Scott & White Medical Center – Temple, Temple, Texas
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Guzman-Perez G, Jurado CA, Azpiazu-Flores FX, Munoz-Luna H, Afrashtehfar KI, Nurrohman H. Soft Tissue Grafting Procedures before Restorations in the Esthetic Zone: A Minimally Invasive Interdisciplinary Case Report. Medicina (Kaunas) 2023; 59:medicina59050822. [PMID: 37241054 DOI: 10.3390/medicina59050822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023]
Abstract
An esthetically pleasing smile is a valuable aspect of physical appearance and plays a significant role in social interaction. Achieving the perfect balance between extraoral and intraoral tissues is essential for a harmonious and attractive smile. However, certain intraoral deficiencies, such as non-carious cervical lesions and gingival recession, can severely compromise the overall aesthetics, particularly in the anterior zone. Addressing such conditions requires careful planning and meticulous execution of both surgical and restorative procedures. This interdisciplinary clinical report presents a complex case of a patient with esthetic complaints related to asymmetric anterior gingival architecture and severely discolored and eroded maxillary anterior teeth. The patient was treated using a combination of minimally invasive ceramic veneers and plastic mucogingival surgery, resulting in a successful outcome. The report emphasizes the potential of this approach in achieving optimal esthetic results in challenging cases, highlighting the importance of an interdisciplinary team approach in achieving a harmonious balance between dental and soft tissue aesthetics.
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Affiliation(s)
- Gerardo Guzman-Perez
- Department of Graduate Periodontics, Multidisciplinary Educational Center in Oral Rehabilitation (CEMRO), Tarímbaro 58893, Mexico
| | - Carlos Alberto Jurado
- Department of Prosthodontics, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA 52242, USA
| | - Francisco X Azpiazu-Flores
- Department of Restorative Dentistry, Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB R3E 3N4, Canada
| | | | - Kelvin I Afrashtehfar
- Division of Restorative Dental Sciences, Clinical Sciences Department, Ajman College of Dentistry, Ajman City P.O. Box 346, United Arab Emirates
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
| | - Hamid Nurrohman
- Missouri School of Dentistry & Oral Health, A.T. Still University, Kirksville, MO 63501, USA
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Gill L, Coborn JE, Hoovler AR, Sherif K. Polycystic Ovary Syndrome and Obesity: A Cross-Sectional Survey of Patients and Obstetricians/Gynecologists. J Womens Health (Larchmt) 2023. [PMID: 37074669 DOI: 10.1089/jwh.2022.0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder commonly affecting women of reproductive age. Compared with women without PCOS, women with PCOS are more likely to have overweight or obesity. Materials and Methods: To better understand the role of obstetricians/gynecologists (OB/GYNs) in diagnosis and treatment of patients with PCOS and obesity, we conducted an anonymous, United States population-based, cross-sectional online survey with 251 patients with PCOS and obesity and 305 health care professionals (HCPs), of which 125 were OB/GYNs. Results: In the most common patient journey, most patients were diagnosed (66%) and treated (59%) by OB/GYNs. Most patients (51%) considered OB/GYNs to be the coordinator of their PCOS care. For ongoing management of patients with PCOS and obesity, OB/GYNs reported prescribing general improvements in lifestyle (91%), oral contraceptives (91%), metformin (85%), letrozole (74%), spironolactone (71%), specific diets (60%), medroxyprogesterone (45%), and anti-obesity medications (27%). OB/GYNs were significantly more likely than other HCPs surveyed to strongly agree with the statement that they do not know enough about anti-obesity medications to feel comfortable prescribing them to their patients with PCOS and obesity (p < 0.05). Most OB/GYNs believed that consultation with a dietitian/nutritionist (75%) or access to a physician who specializes in obesity (67%) were the most beneficial types of support for their patients with PCOS and obesity. Conclusions: OB/GYNs recognize the importance of obesity management for the treatment of PCOS; however, utilization of effective obesity tools to treat these patients is low. OB/GYNs may benefit from additional education on obesity management strategies.
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Affiliation(s)
- Lisa Gill
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | - Katherine Sherif
- Jefferson Women's Primary, Jefferson University, Philadelphia, Pennsylvania, USA
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