The management of non-traumatic wrist disorders: A national survey of practice.

Agreement in Infant Growth Indicators and Overweight/Obesity between Community and Clinical Care Settings

BACKGROUNDSurprisingly, it is estimated that about half of type 2 diabetics remain undetected. The possible causes may be partly attributable to people with normal fasting plasma glucose (FPG) but abnormal postprandial hyperglycemia. We attempted to develop an effective predictive model by using the metabolic syndrome (MeS) components as parameters to identify such persons.SUBJECTS AND METHODSAll participants received a standard 75-g oral glucose tolerance test, which showed that 106 had normal glucose tolerance, 61 had impaired glucose tolerance, and 6 had diabetes-on-isolated postchallenge hyperglycemia. We tested five models, which included various MeS components. Model 0: FPG; Model 1 (clinical history model): family history (FH), FPG, age and sex; Model 2 (MeS model): Model 1 plus triglycerides, high-density lipoprotein cholesterol, body mass index, systolic blood pressure and diastolic blood pressure; Model 3: Model 2 plus fasting plasma insulin (FPI); Model 4: Model 3 plus homeostasis model assessment of insulin resistance. A receiver-operating characteristic (ROC) curve was used to determine the predictive discrimination of these models.RESULTSThe area under the ROC curve of the Model 0 was significantly larger than the area under the diagonal reference line. All the other 4 models had a larger area under the ROC curve than Model 0. Considering the simplicity and lower cost of Model 2, it would be the best model to use. Nevertheless, Model 3 had the largest area under the ROC curve.CONCLUSIONWe demonstrated that Model 2 and 3 have a significantly better predictive discrimination to identify persons with normal FPG at high risk for glucose intolerance.

HIV Testing Strategies for Health Departments to End the Epidemic in the U.S.

Future directions for research and education

Our objectives were to assess rates of perceived stigma in health care (clinical) settings reported by racially diverse New York City residents and to examine if this perceived stigma is associated with poorer physical and mental health outcomes. We analyzed data from the 2016 New York City Community Health Survey. We applied bivariable and multivariable methods to assess rates of perceived stigma, and perceived stigma's statistical relationship with health care access, physical health status, and mental health status controlling for sociodemographics and health insurance status. Perceived stigma was associated with poorer health care access [odds ratio (OR)=7.07, confidence interval (CI)=5.32-9.41), depression (OR=3.80, CI=2.66-5.43), diabetes (OR=1.86, CI=1.36-2.54), and poor overall general health (OR=0.43, CI=0.33-0.57). Hispanic respondents reported the highest rate of perceived stigma among racial and ethnic minority groups (mean=0.07, CI=0.05-0.08). We found that perceived stigma in health care settings was a potential barrier to good health. Prior studies have illustrated that negative health outcomes are common for patients who avoid or delay care; thus, the unfortunate conclusion is that even in a diverse, heterogeneous community, stigma persists and may negatively affect well-being. Therefore, eliminating stigma in clinical settings should be a top priority for health care providers and public health professionals seeking to improve health equity.

Background: Managers, including those in nursing environments, may spend much of their time addressing employee conflicts. If not handled properly, conflict may significantly affect employee morale, increase turnover, and even result in litigation, ultimately affecting the overall well-being of the organization. A clearer understanding of the factors that underlie conflict resolution styles could lead to the promotion of better management strategies. Objective: The aim of this research was to identify the predominant conflict resolution styles used by a sample of Spanish nurses in two work settings, academic and clinical, in order to determine differences between these environments. The effects of employment level and demographic variables were explored as well. Design: Descriptive cross-sectional survey study. Participants: Our sample consisted of professional nurses in Madrid, Spain, who worked in either a university setting or a clinical care setting. Within each of these environments, nurses worked at one of three levels: full professor, assistant professor, or scholarship professor in the academic setting; and nursing supervisor, registered staff nurse, or nursing assistant in the clinical setting. Methods: Conflict resolution style was examined using the standardized Thomas–Kilmann Conflict Mode Instrument, a dual-choice questionnaire that assesses a respondent’s predominant style of conflict resolution. Five styles are defined: accommodating, avoiding, collaborating, competing, and compromising. Participants were asked to give answers that characterized their dominant response in a conflict situation involving either a superior or a subordinate. Descriptive and inferential statistics were used to examine the relationship between workplace setting and conflict resolution style. Results: The most common style used by nurses overall to resolve workplace conflict was compromising, followed by competing, avoiding, accommodating, and collaborating. There was a significant overall difference in styles between nurses who worked in an academic vs. a clinical setting (p = 0.005), with the greatest difference seen for the accommodating style. Of those nurses for whom accommodation was the primary style, 83% worked in a clinical setting compared to just 17% in an academic setting. Conclusion: Further examination of the difference in conflict-solving approaches between academic and clinical nursing environments might shed light on etiologic factors, which in turn might enable nursing management to institute conflict management interventions that are tailored to specific work environments and adapted to different employment levels. This research increases our understanding of preferred approaches to handling conflict in nursing organizations.

To explore and compare nurses' and patients' viewpoints of disrespectful behaviours that threaten patient dignity during hospitalised care. Patient's dignity is an important ethical consideration for nursing care practice. In clinical settings, nurse-patient interactions can generate behaviour considered disrespectful and undignified, often due to a disruptive hospital atmosphere and emotional frustrations of nurses and patients. How behaviours and attitudes threaten patient dignity in Indonesian clinical care settings has not been well studied. Qualitative descriptive study. This multi-site study purposively recruited nurses and inpatients from six public hospitals in four districts in Eastern Java, Indonesia. Individual, face-to-face semi-structured interviews were conducted with 35 inpatients and 40 registered nurses from medical and surgical wards. Data from verbatim transcriptions of digital audio recordings were analysed with inductive content analysis. The COREQ checklist for qualitative research was used for reporting this study. Five categories emerged which described disrespectful behaviours that threaten patient dignity. Three categories were important for both nurses and patients: negligence, impoliteness and dismissal. Descriptions of the behaviours were comparable for both groups. The forth category, inattentiveness, was highlighted by nurses, while the fifth category, discrimination, was highlighted by patients. Examining behaviours considered to be disrespectful in an Indonesian healthcare setting expand on perspectives towards dignity in care. The comparable viewpoints of nurses and patients provide knowledge of how undignified behaviours could be reduced in cross-cultural healthcare settings. Behaviours perceived as undignified primarily by nurses or patients might result from differences in social roles and responsibilities. Understanding nurses' and patients' perspectives of undignified care is an important step in reducing behaviours that violate patient dignity in clinical practice. Nurses' commitment to patient-centred care should include being responsive, compassionate, communicative and attentive, which could ameliorate instances of undignified behaviours.

Professional Doctorate in Clinical Exercise Physiology

This article is focused mainly on the role of the remote presence robot in health care facilities. This article has a view of the advantages, disadvantages, objectives, uses of RPRT in health care settings, and in different departments, and precautions to be taken while using RPR. In recent decades the usage of remote presence robots has been used in many clinical settings like ICU, emergency departments, medical, surgical, neurological units, and operating rooms. Remote presence robot technology RPRT, is an advanced robotics device technology that enables health care professionals to provide real-time clinical services to patients. This has been increasing in both outpatient and inpatient settings. RPRT in medical education can teach the professional curriculum to students in an interactive way as teachers do. RPR can even enable teachers to teach and interact with students remotely. The world's first hospital to introduce remote presence robots in the university of California, Los Angeles in its neurosurgery intensive care unit. The application of RPRT will increase doctor access for patients, families, and hospital staff in clinical care settings.

This article is focused mainly on the role of the remote presence robot in health care facilities. This article has a view of the advantages, disadvantages, objectives, uses of RPRT in health care settings, and in different departments, and precautions to be taken while using RPR. In recent decades the usage of remote presence robots has been used in many clinical settings like ICU, emergency departments, medical, surgical, neurological units, and operating rooms. Remote presence robot technology RPRT, is an advanced robotics device technology that enables health care professionals to provide real-time clinical services to patients. This has been increasing in both outpatient and inpatient settings. RPRT in medical education can teach the professional curriculum to students in an interactive way as teachers do. RPR can even enable teachers to teach and interact with students remotely. The world's first hospital to introduce remote presence robots in the university of California, Los Angeles in its neurosurgery intensive care unit. The application of RPRT will increase doctor access for patients, families, and hospital staff in clinical care settings.

This article is focused mainly on the role of the remote presence robot in health care facilities. This article has a view of the advantages, disadvantages, objectives, uses of RPRT in health care settings, and in different departments, and precautions to be taken while using RPR. In recent decades the usage of remote presence robots has been used in many clinical settings like ICU, emergency departments, medical, surgical, neurological units, and operating rooms. Remote presence robot technology RPRT, is an advanced robotics device technology that enables health care professionals to provide real-time clinical services to patients. This has been increasing in both outpatient and inpatient settings. RPRT in medical education can teach the professional curriculum to students in an interactive way as teachers do. RPR can even enable teachers to teach and interact with students remotely. The world's first hospital to introduce remote presence robots in the university of California, Los Angeles in its neurosurgery intensive care unit. The application of RPRT will increase doctor access for patients, families, and hospital staff in clinical care settings.

When introducing artificial intelligence (AI) into clinical care, one of the main objectives is to improve workflow efficiency because AI-based solutions are expected to take over or support routine tasks. This study sought to synthesize the current knowledge base on how the use of AI technologies for medical imaging affects efficiency and what facilitators or barriers moderating the impact of AI implementation have been reported. In this systematic literature review, comprehensive literature searches will be performed in relevant electronic databases, including PubMed/MEDLINE, Embase, PsycINFO, Web of Science, IEEE Xplore, and CENTRAL. Studies in English and German published from 2000 onwards will be included. The following inclusion criteria will be applied: empirical studies targeting the workflow integration or adoption of AI-based software in medical imaging used for diagnostic purposes in a health care setting. The efficiency outcomes of interest include workflow adaptation, time to complete tasks, and workload. Two reviewers will independently screen all retrieved records, full-text articles, and extract data. The study's methodological quality will be appraised using suitable tools. The findings will be described qualitatively, and a meta-analysis will be performed, if possible. Furthermore, a narrative synthesis approach that focuses on work system factors affecting the integration of AI technologies reported in eligible studies will be adopted. This review is anticipated to begin in September 2022 and will be completed in April 2023. This systematic review and synthesis aims to summarize the existing knowledge on efficiency improvements in medical imaging through the integration of AI into clinical workflows. Moreover, it will extract the facilitators and barriers of the AI implementation process in clinical care settings. Therefore, our findings have implications for future clinical implementation processes of AI-based solutions, with a particular focus on diagnostic procedures. This review is additionally expected to identify research gaps regarding the focus on seamless workflow integration of novel technologies in clinical settings. PROSPERO CRD42022303439; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=303439. PRR1-10.2196/40485.

Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: (1) What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? (2) Which strategies do nurses use to provide compassionate care? (3) What is the specific model of compassionate care for the nursing context? A grounded theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: (a) contextual factors affecting compassionate care, (b) the compassionate care actions, and (c) the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses' ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses' ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model (CNCM) provides a model to guide nursing care and research.

President's message-Maintaining a program of research: Deep work.

The ACGME requires all residency programs to assess residents on specialty-specific milestones. Optimal assessment of competence is through direct observation of performance in clinical settings, which is challenging to implement. The authors developed the Stanford Pediatric Residency Coaching Program to improve residents' clinical skill development, reflective practice, feedback, and goal setting, and to improve learner assessment. All residents are assigned a dedicated faculty coach who coaches them throughout their training in various settings in an iterative process. Each coaching session consists of four parts: (1) direct observation, (2) facilitated reflection, (3) feedback from the coach, and (4) goal setting. Coaches document each session and participate in the Clinical Competency Committee. Initial program evaluation (2013 -2014) focused on the program's effect on feedback, reflection, and goal setting. Pre- and postintervention surveys of residents and faculty assessed the quantity and quality of feedback provided to residents and faculty members' confidence in giving feedback. Review of documented coaching sessions showed that all 82 residents had 3 or more direct observations (range: 3-12). Residents and faculty assessed coaches as providing higher-quality feedback and incorporating more reflection and goal setting than noncoaches. Coaches, compared with noncoaches, demonstrated increased confidence in giving feedback on clinical reasoning, communication skills, and goal setting. Noncoach faculty reported giving equal or more feedback after the coaching program than before. Further evaluation is under way to explore how coaching residents can affect patient-level outcomes, and to better understand the benefits and challenges of coaching residents.