Clinical Rounds Research Articles

Ethics, Abortion Access, and Emergency Care Post-Dobbs: The Gray Areas.

Clinical management of emergency pregnancy care, such as ectopic pregnancy or heavy bleeding with pregnancy of unknown location, includes upholding legal and ethical standards. For health care providers unwilling to provide evidence-based life-saving abortion care due to personal beliefs, clear guidance dictates disclosure of these limitations to the patient and colleagues, followed by immediate referral for appropriate care. However, this decision-making pathway may not be engaged due to a variety of factors: providers' beliefs preclude adherence to referral responsibilities, political discourse confuses patients as to their options and rights, and a constantly changing state and national legal landscape leads providers to question their ability to practice to their full scope of clinical care. Although this disruption of evidence-based standard of care existed pre-Dobbs, the moral disorder is now heightened. This Clinical Rounds highlights a patient vignette describing the risks of abortion restrictions for patients and providers alike, particularly when an individual provider's concerns for violating institutional guidelines sets a precedent for nursing response and forecloses on collaborative input or ethics consultation. The history of physician-only abortion exceptionalism and exclusion of nurses and midwives despite a significant history of nurses and midwives in abortion care grounds an argument for focusing on the impact of unethical and substandard care on the interprofessional care team leading to moral distress and negative patient outcomes. Patient-centered models of care, such as frameworks common in nursing and midwifery, offer opportunities to consider how all providers practicing to their full scope in interprofessional and collaborative ways, such as in emergency rooms and labor departments, might mitigate obstructions to abortion care that risk pregnant people's lives.

Synergistic strategies: Optimizing outcomes through a multidisciplinary approach to clinical rounds

Multidisciplinary rounds (MDR) constitute a patient-centered care model wherein professionals from diverse disciplines collaborate in real time to provide specialized expertise. The MDR team, encompassing care partners, hospitalists, nurses, pharmacists, and more, employs a collaborative approach that optimizes patient care through shared goals, electronic record access, regular reviews, and patient involvement. MDRs have evolved to reduce patient mortality, complications, length of stay, and readmissions, and they enhance patient satisfaction and utilization of ancillary services. Family engagement in MDRs further transforms relationships from adversarial to collaborative, leading to improved comprehension of treatment strategies and smoother navigation of challenging conversations. Despite challenges such as time constraints, limited patient coverage, and hierarchical barriers, MDRs are being increasingly conducted across healthcare settings, with positive outcomes.

SURGICAL EDUCATION AND TRAINING ADAPTATION IN RESPONSE TO THE COVID-19 PANDEMIC: A LITERATURE REVIEW

Background: As a global health emergency, the COVID-19 pandemic has affected all medical education and training, including surgical specialities. The number of elective surgeries dropped significantly as both an impact of the pandemic and a way of limiting the spread of the disease. There was confusion about continuing surgical education and training at the beginning of the pandemic. However, as the pandemic continued, we adapted to the new conditions and regulations. Social distancing, testing, and quarantine were promoted. The study aimed to show how surgical education and training adapt to the COVID-19 pandemic worldwide and share how we do it in Indonesia.Methods: The authors gathered relevant literature from several publications sites, using the keywords “surgical education,” “surgical adaptation,” and “COVID-19.”Results: In order to decrease contacts, the number of people in the operating room was reduced, clinical rounds were cancelled, and face-to-face training and lectures were moved to online platforms, namely Zoom and Google Meet. The number of residents on clinical duties was decreased to limit the transmission. They are encouraged to study using different models by themselves to keep up with the required skills. They were required to learn and then be tested or reviewed by the supervisor. The use of simulation models and online learning platforms provided by several worldwide institutions has become popular.Conclusion: We learn that surgical education and training from the pandemic can develop into a more modern way of learning, consisting of a virtual learning strategy and simulation model. This hybrid learning of offline and online courses can aid the growth of not only the residents but also the experienced surgeon.

An exploration of faculty perspectives towards interprofessional education and collaborative practice during international electives in health professions training institutions in Africa

Background Faculty perspectives are key drivers of learning during international electives (IEs). However, in Africa, there is limited literature on these perspectives on interprofessional education and collaborative practice (IPECP) during IEs. Therefore, this study explored faculty perspectives toward IPECP within an international elective context from selected African institutions. Methods This was an exploratory qualitative study. The study participants included faculty from four health professional training universities in Africa. Thematic analysis was used to analyze the data. Common codes were identified and grouped to create subthemes and major themes. Results Four themes were identified: (i) The importance of IPECP during IEs, (ii) Approaches to IPECP during IEs, (iii) Perceived key barriers, and (iv) Perceived institutional support for IPECP during IEs. Most of the participants perceived IEs as a platform that can be used to cultivate IPECP with a multicultural perspective while promoting cross-border partnerships to advance health care. Suggested teaching approaches included case studies, joint clinical ward rounds, and simulations, among others, with an openness to having an online, blended, or physical mode of delivery. A framework to guide the implementation of IPECP during IEs was considered important, and most participants thought that their institutions had the infrastructure to support IPECP-IEs. Conclusions Faculty reported enabling perspectives of IPECP during IEs, emphasizing the need for a framework to guide and structure implementation. IPECP-IEs were perceived as a unique platform to cultivate IPECP skills with a multicultural component.

Clinical Rounds.

Clinical Rounds.

Complex decision making in an intensive care environment: Perceived practice versus observed reality.

Advancing our understanding of how decisions are made in cognitively, sociallyand technologically complex hospital environments may reveal opportunities to improve healthcare delivery, medical educationand the experience of patients, familiesand clinicians. Explore factors impacting clinician decision making in the Boston Children's Hospital Cardiac Intensive Care Unit. A convergent mixed methods design was used. Quantitative and qualitative data sources consisted of a faculty survey, direct observations of clinical rounds in a specific patient population identified by a clinical decision support system (CDSS)and semistructured interviews (SSIs). Deductive and inductive coding was used for qualitative data. Qualitative data were translated into images using social network analysis which illustrate the frequency and connectivity of the codes in each data set. A total of 25 observations of eightfaculty-led interprofessional teams were performed between 12 Februaryand 31 March 2021. Individual patient characteristics were noted by faculty in SSIs to be the most important factor in their decision making, yet ethnographic observations suggested faculty cognitive traits, team expertiseand value-based decisions were more heavily weighted. The development of expertise was impacted by role modeling. Decisions were perceived to be influenced by the system and environment. Clinician perception of decision making was not congruent with the observed behaviours in a complicated and dynamic system. This study identifies important considerations in clinical curricula as well as the design and implementation of CDSS. Our method of using social network analysis to visualize components of decision making could be adopted to explore other complex environments.

Clinical Rounds.

Clinical Rounds.

Maternal mental health after infant discharge: a quasi-experimental clinical trial of family integrated care versus family-centered care for preterm infants in U.S. NICUs

BackgroundInvolvement in caregiving and tailored support services may reduce the risk of mental health symptoms for mothers after their preterm infant’s neonatal intensive care unit (NICU) discharge. We aimed to compare Family-Centered Care (FCC) with mobile-enhanced Family-Integrated Care (mFICare) on post-discharge maternal mental health symptoms.MethodThis quasi-experimental study enrolled preterm infant (≤ 33 weeks)/parent dyads from three NICUs into sequential cohorts: FCC or mFICare. We analyzed post-discharge symptoms of perinatal post-traumatic stress disorder (PTSD) and depression using intention-to-treat and per protocol approaches.Results178 mothers (89 FCC; 89 mFICare) completed measures. We found no main effect of group assignment. We found an interaction between group and stress, indicating fewer PTSD and depression symptoms among mothers who had higher NICU-related stress and received mFICare, compared with mothers who had high stress and received FCC (PTSD: interaction β=-1.18, 95% CI: -2.10, -0.26; depression: interaction β=-0.76, 95% CI: -1.53, 0.006). Per protocol analyses of mFICare components suggested fewer PTSD and depression symptoms among mothers who had higher NICU stress scores and participated in clinical team rounds and/or group classes, compared with mothers who had high stress and did not participate in rounds or classes.ConclusionOverall, post-discharge maternal mental health symptoms did not differ between the mFICare and FCC groups. However, for mothers with high levels of stress during the NICU stay, mFICare was associated with fewer post-discharge PTSD and depression symptoms.

Clinical Rounds

Clinical Rounds

Clinical Rounds.

Clinical Rounds.

Establishment and implementation of a nurse-led interdisciplinary management strategy for central line maintenance: A single-center experience

ObjectivesThis study aimed to establish and implement an interdisciplinary management strategy led by senior nurses via a vascular access specialist team (VAST) at a teaching hospital. MethodsIn 2021, the hospital established and implemented a nurse-led VAST management strategy to improve the quality of clinical central line maintenance. The VAST comprised senior nurses specialized in intravenous therapy, ultrasound/radiology technologists, medical doctors with central venous catheterization certificates, central line maintenance nurses, and administrative coordinators. The management strategy mainly included systemic on-the-job training for VAST members, the establishment of an interdisciplinary central line emergency “green channel,” the formation of a VAST-based, nurse-led standardized clinical rounding system, and the standardization of central line self-care instructions for patients. During the pre- (July 2020 to April 2021) and post- (May 2021 to May 2022) of the implementation the interdisciplinary management strategy, overall patients’ self-care ability, the success rate of catheterization at first time, central line management compliance rate, and patients’ satisfaction with catheter maintenance were investigated and compared. ResultsThe results showed the score self-care ability was increased from 74.75 ± 18.4 (pre-VAST) to 99.10 ± 23.65 (post- VAST); the success rate for catheterization at first time was improved to 100% (225/225), compared to 92.9% (209/225) at pre-VAST; the central line management compliance rate was also increased to 99.6% (224/225) at post-VAST from 93.3% (210/225) at pre-VAST. A patient satisfaction survey on catheter maintenance showed improvements in all five indicators were compared to the pre- VAST (P < 0.05). ConclusionsThe nurse-led VAST interdisciplinary strategy can effectively improve the quality of clinical central line management and should be used to reinforce clinical catheterization and maintenance of central lines.

Clinical Rounds.

In Brief Survey results indicate a potential significant loss in the nursing workforce... Ultrasound ablation for improved motor function... Novel risk variants for prostate cancer identified in men of African ancestry... Women at higher risk for adverse outcomes after coronary artery bypass... Smartphones could expand anemia screening... Stimulation for upper-limb paresis... Possible biomarker identified for vascular dementia

Clinical Rounds.

In Brief New US cancer statistics and predictions for 2023... Presymptomatic diagnosis for Alzheimer disease with plasma biomarkers... Fully closed-loop insulin delivery shows promise in type 2 diabetes... A new autism questionnaire may be useful... Adolescent postoperative alcohol use disorder risk heightened after metabolic and bariatric surgery.

Medical Faculty and Medical Student Opinions on the Utility of Questions to Teach and Evaluate in the Clinical Environment.

We sought to report medical student and faculty perceptions of the purpose and utility of questions on clinical rounds. We developed and administered a survey to third and fourth-year medical students and teaching physicians. The survey elicited attitudes about using questions to teach on rounds in both benign and malignant learning environments. Ninety-seven percent of faculty and 85% of students predicted they will use questions to teach. Nine percent of students described learning-impairing stress during benign bedside teaching. Fifty-nine percent of faculty felt questions were mostly for teaching; 74% of students felt questions were mostly for evaluation. Forty-six percent of students felt questions underestimated their knowledge. Students felt questions were more effective for classroom teaching than bedside teaching. Faculty and students agreed that a malignant environment detrimentally affected learning and performance. Students and faculty supported the use of questions to teach and evaluate, especially in benign teaching environments. Many students described stress severe enough to affect their learning and performance, even when questioned in benign teaching environments. Faculty underestimated the degree to which students experience stress-related learning impairment and the degree to which students see questions as evaluation rather than teaching. Nearly half of students felt that questions underestimated their own knowledge. Students feel more stress and less learning when questioned with a patient present. Faculty must realize that even in the best learning environment some students experience stress-impaired learning and performance, perhaps because of the conflict between learning and evaluation.

Clinical Rounds.

In Brief Updated guidelines on cognitive rehabilitation... Cognition performance may influence viral shedding, symptom severity... Voice recognition may rely on visual memory... QI strategies reduce racial disparities in BP control... Social media, rewards, and punishments...

Early Exposure to Child and Adolescent Psychiatry Through a Preclinical Elective: Unexpected Lessons From the Medical Student Perspective

Medical school can feel like a race to the finish given the whirlwind of endless information, systems to learn, and pressure to quickly find one’s life calling. There tends to be urgency to become an expert for United States Medical Licensing Examination exams, shelf exams, and clinical rounds. Students don’t want to lose any time in finding their path so they can focus on optimizing their residency applications. Child and adolescent psychiatry is a specialty that is often overlooked given the minimal time allocated to it.1,2 Not all medical schools have capacity or faculty to encourage and promote its concepts or clinical experiences.

Clinical Rounds.

In Brief Understaffing a likely cause of shortage... Link between extreme temperatures, excess deaths... AUD-ED injury visits associated with increased mortality risk... Early-onset type 2 diabetes a growing adolescent concern

ASSESSMENT OF THE STUDENTS IN PHARMACY EDUCATIONAL INSTITUTES OF LAHORE, PAKISTAN, REGARDING COVID-19 AND ITS IMPACT ON THEIR EDUCATION: AN ONLINE CROSS-SECTIONAL SURVEY

Background: Globally, COVID-19 pandemic has drastically trembled day to day activities, including education. Objective: This study aims to assess students studying at pharmacy institutes that are located in Lahore, Pakistan. Methodology: An online cross-sectional survey was performed from 25th August to 25th December, 2020 in order to collect the data from students. The Statistical Package for Social Sciences (SPSS Version: 25) was used to commute descriptive statistics and independent t-test. Results: Total 471 responses were received out of which 261 (55.4%) females and 210 (44.6%) males participated in this study. The majority of population 429 (91.1%) belonged to Doctor of Pharmacy (Pharm-D) in comparison to 33 (6%) M.Phil./MS and 9 (1.9%) PhD scholars. The summary of the results with maximum response against each question is: 201 (42.7%) participants were not satisfied by e-lectures, 435 (92.4%) had internet availability, 354 (75.2%) replied they were guided before switching to online teaching, 201 (42.7%) claimed they understood e-lectures thoroughly, 420 (89.2%) faced internet and voice interruptions, 420 (89.2%) said their lab and research work got disturbed during pandemic, 261 (55.4%) were satisfied with their assessment, 273 (58%) said that pandemic had affected their mental health and 366 (77.7%) students were optimistic and wished they could study physically in their institutes. Conclusion: COVID-19 pandemic affects the education system in a worst possible way. Once this pandemic is over, proper policies should be developed by the government and pharmacy institutes to facilitate students regarding clinical rounds, industrial internships and retail rotations so they can perform well in their professional field.

A glycemic diet improves the understanding of glycemic control in diabetes patients during their follow-up.

A glycemic diet improves the understanding of glycemic control in diabetes patients during their follow-up.

Clinical Rounds.

In Brief 30 years... Study finds declining dementia rates among older adults... Innovative means to clean smartphone screens... Pediatric survival of in-hospital cardiac arrests... Lucid dreams reportedly experienced during CPR