Areas Of Care Research Articles

Representation of published core outcome sets in practice guidelines

ObjectivesA core outcome set (COS) is an agreed standardized set of outcomes that should be measured and reported, as a minimum, in specific areas of health or health care. A COS is developed through a consensus process to ensure health care outcomes to be measured are relevant to decision-makers, including patients and health-care professionals. Use of COS in guideline development is likely to increase the relevance of the guideline to those decision-makers. Previous work has looked at the uptake of COS in trials, systematic reviews, health technology assessments and regulatory guidance but to date there has been no evaluation of the use of COS in practice guideline development. The objective of this study was to investigate the representation of core outcomes in a set of international practice guidelines. Study Design and SettingWe searched for clinical guidelines relevant to ten high-quality COS (with focus on the United Kingdom, Germany, China, India, Canada, Denmark, United States and World Health Organisation). We matched scope between COS and guideline in terms of condition, population and outcome. We calculated the proportion of guidelines mentioning or referencing COS and the proportion of COS domains specifically, or generally, matching to outcomes specified in each guideline populations, interventions, comparators and outcome (PICO) statement. ResultsWe found 38 guidelines that contained 170 PICO statements matching the scope of the ten COS and of sufficient quality to allow data extraction. None of the guidelines reviewed explicitly mentioned or referenced the relevant COS. The median (range) of the proportion of core outcomes covered either specifically or generally by the guideline PICO was 30% (0%–100%). ConclusionThere is no evidence that COS are being used routinely to inform the guideline development process, and concordance between outcomes in published guidelines and those in COS is limited. Further work is warranted to explore barriers and facilitators in the use of COS when developing clinical guidelines.

Contributions of mobile applications to pre-hospital care: integrative review

Objective: Analyze the scientific contribution of mobile applications developed for pre-hospital care. Methods: Integrative literature review study; the databases used were the following: Scopus, Web of Science, CINAHL, SciELO, Embase, Lilacs, BDENF, Medline/PubMed, Brazilian Digital Library of Theses and Dissertations, and ProQuest Dissertations & Theses Global; (period 2017-2022), including all article categories (with abstract and full texts available with free access) in Portuguese, English, or Spanish, containing the keywords “Pre-Hospital Assistance”, “Pre-Hospital Care”, “Pre-Hospital Services”, “Pre-Hospital Emergency Care”, “Nursing”, “Mobile applications”, “Portable Software Applications”, and “Mobile Apps” in titles and/or abstracts. Two researchers applied the eligibility criteria of the studies and collected data using a previously prepared instrument. Results: From a total of 944 studies, seven were selected for evaluation. Mobile applications developed for the pre-hospital care area are technological tools that have contributed to triage, pediatric first aid, patient safety, preparation of medications during cardiac arrest, quality of cardiopulmonary resuscitation, and communication between the emergency team and the electronic nursing record. Conclusions: The studies highlighted the potential related to the use of mobile applications in pre-hospital care, contributing especially to improving patient safety and the quality of care provided in pre-hospital urgency and emergencies. The optimization of assistance and early diagnosis times was also shown as a contribution of applications to assistance, in addition to alerting to details that may be unnoticed.

Sarcoid-Induced Uveitis: A Tattooed Journey

When a patient presents with an anterior uveitis that is suspicious for a systemic etiology, it is important to explore all areas of clinical care to determine the cause. Traditionally, the initial approach is to perform an appropriate lab work-up. Beyond this, areas of specialty that are typically considered include rheumatology, radiology, and infectious disease. However, this case report will present a patient that required intervention from dermatology to confirm the source of ocular inflammation.

Achievement of adequate nutrition contributes to maintaining the skeletal muscle area in patients with sepsis undergoing early mobilization: a retrospective observational study

BackgroundThe onset of muscle loss in critically ill patients, known as intensive care unit-acquired weakness (ICU-AW), worsens their outcomes. Preventing muscle loss, which begins in the early phase of critical illness, is crucial in patient care. Adequate nutrition management may contribute to maintaining muscles; however, its evidence in patients with sepsis is insufficient. This study aimed to analyze the association between energy achievement rate in the first 7-days of critical care and muscle area changes evaluated by computed tomography (CT).MethodsThis was a retrospective observational study. Patients with sepsis admitted to the intensive care (ICU) of a tertiary care hospital in Japan were included. They were divided into three groups according to tertiles of the first 7-day energy achievement rate calculated using administered energy doses and basement energy expenditure. Skeletal muscle area (SMA) and changes in SMA were determined by CT on ICU admission and within days 7–10 of ICU admission. SMA maintenance was defined as SMA change ≥ 100%. Logistic regression analyses were performed to analyze the association of energy achievement rate with SMA changes (primary outcome) and in-hospital 28-day mortality (secondary outcome).ResultsPatients (n = 93) were classified into low, middle, and high groups according to their 7-day energy achievement rate (median rates, 16.8%, 38.8%, and 73.4%, respectively). The CT scans showed that SMA decreased between the CT scans in the low and middle groups, whereas it was maintained in the high group (median changes, -8.5%, -11.7%, and 2.8%, respectively). Univariate and multivariate logistic regression analyses showed that high energy achievement rate was significantly associated with SMA maintenance (reference, middle energy achieved group; univariate, odds ratio [95% confidence interval] 6.23 [2.04–19.10], P = 0.0013; multivariate, odds ratio [95% confidence interval] 5.92 [1.90–18.40], P = 0.0021). There was no significant difference in the association between energy achievement rate and mortality among the three groups.ConclusionsOur study found that a fulfillment of energy achievement in the first 7 days of hospitalization was associated with maintenance of muscle area. Thus, satisfying adequate energy should be considered even in patients with sepsis.

The strategic use of AI in the public sector: A public values analysis of national AI strategies

Governments worldwide are strategically investing in artificial intelligence (AI) to improve public services and streamline internal operations. In this context, national AI strategies play a pivotal role. This study uses combined qualitative research methods analyzing 28 national AI strategies (i.e., the texts). Our aim is to delve into how governments define and position AI applications within the public sector. Specifically, the study explores how the texts convey AI's application in this context employing a public value(s) perspective. Its discursive analytical approach coupled with a comprehensive take on public value theory (Moore, 1995) engenders novel insights into national discourses on AI in the public sector. Against this background we draw on public administration and policy research in our analysis of three dominant discourses that we identify in the texts, i.e. empowerment through information, enhanced administrative practices, and improved service delivery. We find that the discourses involve different positions in relation to governments' use of AI and depend on particular actors and types of public service. Commonly, they concern government objectives to tackle critical societal issues through AI, such as in the areas of health and social care and employment. In particular, the discourse of enhanced administrative practices commonly positioned AI as a tool to optimize internal processes, resource allocation, and organizational management. On the other hand, the discourse of improved service delivery similarly placed public services front and center, while the discourse of empowerment through information framed AI as being able to enhance citizens' service experiences. Interestingly, discourses emphasizing the policymaking function, i.e., AI applied to the development of public policy,—receives limited attention. Our findings underscore strategic prioritizations. While efficiency and service delivery dominate the discourse, citizen engagement remains underemphasized. We argue that policymakers must strike a balance, ensuring AI aligns with broader societal outcomes while addressing democratic imperatives.

Periodontal Health and Pregnancy Outcomes: Time to Deliver

(Acta Obstet Gynecol Scand. 2023;102:648–651) One often overlooked area of health care is oral care. Oral diseases and conditions are often neglected but are incredibly common, and pregnancy-associated hormonal changes can affect periodontal health. This editorial gives a big-picture view of recent literature relating to periodontal health in pregnancy and the associations with significant pregnancy outcomes.

Effectiveness of subcutaneous morphine in the treatment of pain crises in cancer patients

Objective: The purpose of this study was to evaluate the efficacy of subcutaneous morphine for managing pain crises resulting from various causes in cancer patients attended by the Pain Clinic in the immediate care area of the National Cancer Institute in Mexico City.
 Materials and Methods: This study was analytical, observational, retrospective, and descriptive. The oncology patients treated in the immediate care area for pain crises between August 1, 2020, and July 1, 2023, made up our study population. We documented the management of pain crises for patients who needed subcutaneous morphine treatment.
 Results: Considering a reduction in Numeric Rating Scale (NRS) score >30% as effective and a reduction <30% as ineffective, 566 patients didn’t require an additional dose of subcutaneous morphine to control the pain crisis; 11 patients reported a decrease of <30%. A total of 24 patients needed a second rescue. Among this group, only 5 responded well to the second morphine rescue; in the remaining 19 patients, the rescue was deemed ineffective if the NRS decreased by at least 30%. Only 5 individuals experienced moderate pain, and only one patient reported severe pain. The variables were compared using the non-parametric Mann-Whitney U test with significance <0.05. Consequently, it may be said that there is a statistically significant difference between the first and subsequent NRS values obtained.
 Conclusion: For oncology patients treated by the Pain Clinic in the immediate care section of the National Cancer Institute in Mexico City, subcutaneous morphine is beneficial in managing pain crises of different origins.
 Keywords: Morphine, Subcutaneous Pain crises, Efficacy, Numeric rating scale

Developing a set of emergency department performance measures to evaluate delirium care quality for older adults: a modified e-Delphi study

BackgroundOlder adults are at high risk of developing delirium in the emergency department (ED); however, it is under-recognized in routine clinical care. Lack of detection and treatment is associated with poor outcomes, such as mortality. Performance measures (PMs) are needed to identify variations in quality care to help guide improvement strategies. The purpose of this study is to gain consensus on a set of quality statements and PMs that can be used to evaluate delirium care quality for older ED patients.MethodsA 3-round modified e-Delphi study was conducted with ED clinical experts. In each round, participants rated quality statements according to the concepts of importance and actionability, then their associated PMs according to the concept of necessity (1–9 Likert scales), with the ability to comment on each. Consensus and stability were evaluated using a priori criteria using descriptive statistics. Qualitative data was examined to identify themes within and across quality statements and PMs, which went through a participant validation exercise in the final round.ResultsTwenty-two experts participated, 95.5% were from west or central Canada. From 10 quality statements and 24 PMs, consensus was achieved for six quality statements and 22 PMs. Qualitative data supported justification for including three quality statements and one PM that achieved consensus slightly below a priori criteria. Three overarching themes emerged from the qualitative data related to quality statement actionability. Nine quality statements, nine structure PMs, and 14 process PMs are included in the final set, addressing four areas of delirium care: screening, diagnosis, risk reduction and management.ConclusionResults provide a set of quality statements and PMs that are important, actionable, and necessary to a diverse group of clinical experts. To our knowledge, this is the first known study to develop a de novo set of guideline-based quality statements and PMs to evaluate the quality of delirium care older adults receive in the ED setting.

Digital technologies in bronchiectasis physiotherapy services: a survey of patients and physiotherapists in a UK centre.

We aimed to explore how digital technology is currently used, could be used and how services could be improved in order to optimise bronchiectasis physiotherapy care. Online surveys were designed and distributed amongst people with bronchiectasis and physiotherapists in Northern Ireland. Responses to closed and open question formats were collected and analysed. The survey was completed by 48 out of 100 physiotherapists (48%) between January 2020 and January 2021 and by 205 out of 398 people with bronchiectasis (52%) between October 2020 and October 2021. 56% of physiotherapists (27 out of 48) reporting using some type of digital technology to facilitate services, whereas 44% (21 out of 48) reported that they had never used a digital technology in this patient group. When physiotherapists were asked whether they would be likely to use certain remote and/or digital options to deliver follow-up care for airway clearance techniques, most (31-38 out of 48; 65-79%) indicated that they would. Regarding patient responses, most reported that they would use telephone consultation (145 out of 199, 73%) and a smaller proportion were likely to use video consultation (64 out of 199, 32%). The most commonly mentioned theme for improvement amongst patients was follow-ups, while improved access, quality of services and treatments were the most commonly mentioned amongst physiotherapists. Despite a large proportion of physiotherapists in this survey reporting no current use of digital technology in bronchiectasis physiotherapy care, there was significant interest and willingness to do so, amongst both physiotherapists and patients. This survey highlighted a range of care areas, specifically follow-up visits, where digital methods could be further explored.

Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline Part II: Treatment Delivery for Non-metastatic Biochemical Recurrence After Primary Radical Prostatectomy.

The summary presented herein covers recommendations on salvage therapy for recurrent prostate cancer intended to facilitate care decisions and aid clinicians in caring for patients who have experienced a recurrence following prior treatment with curative intent. This is Part II of a three-part series focusing on treatment delivery for non-metastatic biochemical recurrence (BCR) after primary radical prostatectomy (RP). Please refer to Part I for discussion of treatment decision-making and Part III for discussion of evaluation and management of recurrence after radiotherapy (RT) and focal therapy, regional recurrence, and oligometastasis. The systematic review that informs this Guideline was based on searches in Ovid MEDLINE (1946 to July 21, 2022), Cochrane Central Register of Controlled Trials (through August 2022), and Cochrane Database of Systematic Reviews (through August 2022). Update searches were conducted on July 26, 2023. Searches were supplemented by reviewing electronic database reference lists of relevant articles. In a collaborative effort between AUA, ASTRO, and SUO, the Salvage Therapy for Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance for the care of patients who experience BCR after initial definitive local therapy for clinically localized disease. Optimizing and personalizing the approach to salvage therapy remains an ongoing area of work in the field of genitourinary oncology and represents an area of research and clinical care that requires well-coordinated, multi-disciplinary efforts.

Surveying the Moral Landscape: How Ethical Frameworks Influence the Structure of Return-to-Sport Decision Making.

SYNOPSIS: Similar to all areas of health care, sports medicine has ethical considerations when making decisions-return to sport being one. Despite a general consensus on criteria to determine when an athlete is ready to return to sport, there are various scenarios that clinicians encounter that may not fall into a clear "yes" or "no" decision. These scenarios leave the clinician asking what is the "right" decision in a given circumstance? A line of questioning that invokes a moral dimension in supporting athletes when they are returning to sport. To address the moral aspect of a clinical decision, ethical frameworks and theories can guide decisions and resolve ethical dilemmas. The aim of this Viewpoint is to briefly describe 4 ethical frameworks and explore how they might apply in a clinical scenario to guide different ethical analyses and influence the final decision. J Orthop Sports Phys Ther 2024;54(4):1-4. Epub 14 February 2024. doi:10.2519/jospt.2024.12310.

Towards a set of competencies in palliative care nursing in Spain: what’s getting in the way of consensus?

BackgroundSpain currently lacks a competency framework for palliative care nursing. Having such a framework would help to advance this field in academic, governmental, and health management contexts. In phase I of a mixed-methods sequential study, we collected quantitative data, proposing 98 competencies to a sample of palliative care nurses. They accepted 62 of them and rejected 36.MethodsPhase II is a qualitative phase in which we used consensus techniques with two modified nominal groups to interpret the quantitative findings with the objective of understanding of why the 36 competencies had been rejected. Twenty nurses from different areas of palliative care (direct care, teaching, management, research) participated. We conducted a thematic analysis using NVivo12 to identify meaning units and group them into larger thematic categories.ResultsParticipants attributed the lack of consensus on the 36 competencies to four main reasons: the rejection of standardised nursing language, the context in which nurses carry out palliative care and other factors that are external to the care itself, the degree of specificity of the proposed competency (too little or too great), and the complexity of nursing care related to the end of life and/or death.ConclusionsBased on the results, we propose reparative actions, such as reformulating the competencies expressed in nursing terminology to describe them as specific behaviours and insisting on the participation of nurses in developing institutional policies and strategies so that competencies related to development, leadership and professional commitment can be implemented. It is essential ​​to promote greater consensus on the definition and levels of nursing intervention according to criteria of complexity and to advocate for adequate training, regulation, and accreditation of palliative care expert practice. Locally, understanding why the 36 competencies were rejected can help Spanish palliative care nurses reach a shared competency framework. More broadly, our consensus methodology and our findings regarding the causes for rejection may be useful to other countries that are in the process of formalising or reviewing their palliative care nursing model.

Burnout syndrome in a single cohort of chiropractic students: A longitudinal study.

Physician well-being impacts all areas of health care. There is, however, a paucity of evidence regarding burnout among chiropractic students. The purpose of this project is to evaluate burnout among a single cohort of chiropractic students as they progress through their clinical rotation. The Professional Fulfillment Index (PFI) was administered to chiropractic students (n = 108) at the start of their internship in January of 2021. The PFI was also distributed to students at the end of each of their 3 internship terms. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was administered at the end of interns' eighth term of study to assess validity with the PFI. The MBI and PFI were analyzed via pairwise correlation. Demographic and relevant term questions were asked at baseline and respective terms and analyzed with descriptive statistics. Of the study's 78 respondents (72.2% response rate), 55.8% were male with an average age of 28.6 years. Pairwise comparisons revealed statistically significant burnout differences between the baseline timepoint and the end of the eighth term, and between the baseline and the end of the ninth term. PFI burnout was correlated to emotional exhaustion in the MBI. Our study found that approximately half of the participating chiropractic students suffered from burnout. This percentage is similar to burnout rates seen in other health care providers. Moreover, there is no widely accepted burnout threshold used in the literature. As such, studies examining standardization of burnout calculations may be warranted.

Evaluating if Ghana's Health Institutions and Facilities Act 2011 (Act 829) Sufficiently Addresses Medical Negligence Risks from Integration of Artificial Intelligence Systems

With artificial intelligence (AI) integrated increasingly to enhance personalized diagnosis and data-driven treatment recommendations, this analysis examines the legal sufficiency of Ghana’s Health Institutions and Facilities Act 2011 (Act 829) to address medical negligence risks from reliance on AI systems in clinical settings. The CREAC framework structures evaluating gaps where existing health regulations may lack clarity for emerging issues of accountability. Explanation contextualizes the probabilistic nature of AI inferences and how general principles of medical negligence could have ambiguous application currently if erroneous AI contributions result in patient harm. Application to a hypothetical scenario assesses if adequate protections for appropriate integration exist across developers, systems, healthcare facilities, and practitioners under applicable interpretations of existing laws. Finding liability rules insufficient absent targeted AI governance, conclusions recommend amending Act 829 in key areas to codify expectations for responsible innovation and prevent ambiguity in liability.
 This work carries scientific novelty as one of the first structured jurisdictional analyses internationally of healthcare AI accountability gaps through a legal lens. Practical significance lies in setting the stage for strengthening protections in Ghana through proposed statutory reforms that reduce uncertainty around this crucial area for quality care. The method and recommendations offer a model for modernizing medical negligence law and AI policy amidst ongoing digitization in healthcare worldwide.

Building a Sustainable Learning Health Care System for Pregnant and Lactating People: Interview Study Among Data Access Providers.

In many areas of health care, learning health care systems (LHSs) are seen as promising ways to accelerate research and outcomes for patients by reusing health and research data. For example, considering pregnant and lactating people, for whom there is still a poor evidence base for medication safety and efficacy, an LHS presents an interesting way forward. Combining unique data sources across Europe in an LHS could help clarify how medications affect pregnancy outcomes and lactation exposures. In general, a remaining challenge of data-intensive health research, which is at the core of an LHS, has been obtaining meaningful access to data. These unique data sources, also called data access providers (DAPs), are both public and private organizations and are important stakeholders in the development of a sustainable and ethically responsible LHS. Sustainability is often discussed as a challenge in LHS development. Moreover, DAPs are increasingly expected to move beyond regulatory compliance and are seen as moral agents tasked with upholding ethical principles, such as transparency, trustworthiness, responsibility, and community engagement. This study aims to explore the views of people working for DAPs who participate in a public-private partnership to build a sustainable and ethically responsible LHS. Using a qualitative interview design, we interviewed 14 people involved in the Innovative Medicines Initiative (IMI) ConcePTION (Continuum of Evidence from Pregnancy Exposures, Reproductive Toxicology and Breastfeeding to Improve Outcomes Now) project, a public-private collaboration with the goal of building an LHS for pregnant and lactating people. The pseudonymized transcripts were analyzed thematically. A total of 3 themes were identified: opportunities and responsibilities, conditions for participation and commitment, and challenges for a knowledge-generating ecosystem. The respondents generally regarded the collaboration as an opportunity for various reasons beyond the primary goal of generating knowledge about medication safety during pregnancy and lactation. Respondents had different interpretations of responsibility in the context of data-intensive research in a public-private network. Respondents explained that resources (financial and other), scientific output, motivation, agreements collaboration with the pharmaceutical industry, trust, and transparency are important conditions for participating in and committing to the ConcePTION LHS. Respondents also discussed the challenges of an LHS, including the limitations to (real-world) data analyses and governance procedures. Our respondents were motivated by diverse opportunities to contribute to an LHS for pregnant and lactating people, primarily centered on advancing knowledge on medication safety. Although a shared responsibility for enabling real-world data analyses is acknowledged, their focus remains on their work and contribution to the project rather than on safeguarding ethical data handling. The results of our interviews underline the importance of a transparent governance structure, emphasizing the trust between DAPs and the public for the success and sustainability of an LHS.

Zarządzanie i popularyzacja dziedzictwa kulturowego na przykładzie military reenactmentu jako przykład działań służących edukacji patriotycznej i budowaniu poczucia tożsamości regionalnej

Aim: The aim of the article was to present the concept of military renaissance in relation to the implementation of sustainable development goals in the area of caring for cultural heritage through grassroots initiatives understood as the activities of organizations dealing with historical reconstruction in Poland.Methods: The research covered groups actively operating in the Pomeranian Voivodeship in 2023. It included an in-depth analysis of data obtained through online research, literature review, observation.Results: The article introduces the concept of military renaissance and presents the types of activities that promote patriotic education and build a sense of regional identity in the promotion of military history. During the considerations, the issues of the activities of this type of organizations and their impact on the implementation of the assumptions of the 2030 Agenda in terms of preserving, protecting and promoting cultural heritage were raised.Coclusion: Grassroots initiatives of organizations to which historical reconstruction groups belong are among the important activities aimed at promoting global and regional cultural heritage, as well as maintaining traditions.Oryginality: Research addressing the problem of the functioning of organizations such as historical reconstruction groups in Poland from the perspective of management and quality sciences is basic research with interesting research potential. Keyword: cultural heritage, organizations, grassroots initiatives, military history, patriotism, historical reconstruction groups, sustainable development

Evaluating an epilepsy clinical nurse specialist development programme

There is a demand across the country for highly trained epilepsy specialist nurses (ESNs) due to the increasing number of patients that this long-term condition affects. It is estimated that 65 million people worldwide are affected by epilepsy. If not treated and supported effectively, epilepsy comes with high risk of mortality, comorbidities, stigma and high potential costs to the NHS. Patients who do not have access to a highly trained ESNs can be significantly and negatively affected by wrong diagnosis, gaps in knowledge when facing general care, incorrect and, on occasion, detrimental treatment options, poor epilepsy education and advocacy. Furthermore, patients living in rural areas often do not have access to large tertiary centres or neurologists with an interest in epilepsy. Due to this, access to ESNs running nurse-led clinics in smaller hospitals and community settings is vital to improving patient care. Nonetheless, there is a shortage of highly trained ESNs. The ESN development programme discussed in this article was formed as a concerted action to address recruitment challenges and widen the area and scope of care for people with an epilepsy diagnosis.

CLINICIAN-LEADERS IN CARDIAC REHABILITATION: CLINICAL EXERCISE PHYSIOLOGISTS

https://youtu.be/5aocJv-Xyk0 BACKGROUND Clinical exercise physiologists (CEP) are members of the multidisciplinary team in cardiac rehabilitation (CR). CEPs undertake multiple roles, including individualizing patient care to help restore or improve daily functioning in patients with heart disease. CEPs are equipped with a wide range of knowledge and skills for successful patient care and also have the skillset to propel career development to serve in leadership roles. The Million Hearts Cardiac Rehabilitation Collaborative (CRC) is working to achieve the goal of increasing enrollment to 70% CR participation in eligible patients. However, given the critical healthcare staffing shortage, the workforce poses a unique challenge to adequately staff clinics to improve access to CR, especially in historically marginalized rural and urban communities. PURPOSE: Describe the prevalence of CR programs that are solely staffed by CEPs and the job tasks they perform in the United States. METHODS CR program managers in the United States were sent an email invitation to participate in an electronic survey from the American Association of Cardiovascular and Pulmonary Rehabilitation. Depending on the participant’s responses, the final survey could be as few as 11 and up to 44 required multiple choice questions. RESULTS Among 297 CR programs that responded to the survey, 86% (n= 256) stated they staff a CEP and 12% (n= 30) stated their program is run entirely by CEPs. Among the programs run entirely by CEPs, the minimum degree for CEP staff was a bachelor’s in 93% (n= 28) and a master’s in 7% (n= 2). The ACSM clinical exercise physiology credential was preferred or required in 73% (n= 22) of programs. Job tasks performed by CEPs in these CR programs were provided patient education (100%), monitored ECG during exercise (100%), assessed patient symptoms (100%), screened patients entering CR (100%), measured blood pressure via auscultation (97%), measured blood glucose (97%), and administered supplemental oxygen (93%). CEPs can hold a leadership position in 83% (n= 25) of these institutions. CONCLUSIONS Leveraging the CEP practice patterns to serve as CR clinical leaders permits other health care professionals, such as nurses, to be used in other areas of health care. Although no formal framework exists on the educational preparation for a CEP career ladder, findings suggest that CEPs are competent to run and oversee CR programs. Innovative strategies to improve referral, enrollment, and retention of patients with heart disease into CR will require increases in CR capacity which can be filled by CEPs.

State scope of practice restrictions and nurse practitioner practice in nursing homes: 2012-2019.

Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012-2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations. Control variables included county demographic, socioeconomic, and health care workforce characteristics; state fixed effects; and year indicators. The proportion of nursing home visits conducted by NPs increased from 24% in 2012 to 42% in 2019. Expanded scope of practice regulation was associated with a greater proportion and total volume of nursing home visits conducted by NPs in counties with at least 1 NP visit. These relationships were concentrated among short-stay patients in urban counties. Removing scope of practice restrictions on NPs may address clinician shortages in nursing homes in urban areas where NPs already practice in nursing homes. However, improving access to advanced clinician care for long-term care residents and for patients in rural locations may require additional interventions and resources.

Multimodal strategies to hand hygiene in Ghanaian hospitals: a cross-sectional study in the Eastern Region of Ghana

BackgroundHand hygiene (HH) is one of the core components of infection prevention and control and is critical for a high quality of care. Multimodal approaches are recommended to strengthen and...