Current Healthcare Practices Research Articles

Factors influencing the length of stay in patients with lumbar pedicle screw fixation

Background:Current health care practices aim for cost reduction to achieve maximal benefit. Because of the increasing number of spinal fusions, this area has become a target for both hospitals and payment organizations. Length of stay (LOS) is one potentially modifiable variable to help reduce overall cost. Attempting to predict the LOS in spinal surgery based on patient factors has not revealed a set of variables that are consistently associated with increased stay.Methods:Medical records from all patients who underwent posterior lumbar spinal fusion by a single neurosurgeon at a single facility were retrospectively examined in a blind fashion. Data were obtained including age, gender, body mass index (BMI), American society of Anesthesiologists (ASA) and analyzed to determine a potential relationship with LOS.Results:A total of 1360 patients were identified for analysis. There were significant but small correlations between age, ASA, BMI, and LOS.Conclusions:There is an effect of age, ASA, and BMI on LOS. However, the significance of this effect is small. Future studies aiming to identify additional factors, which could potentially be modifiable, in order to work on decreasing LOS in lumbar spinal fusion patients.

An exploration of role model influence on adult nursing students’ professional development: A phenomenological research study

Patients' expectations of being cared for by a nurse who is caring, competent, and professional are particularly pertinent in current health and social care practice. The current drive for NHS values-based recruitment serves to strengthen this. How nursing students' development of professionalism is shaped is not fully known, though it is acknowledged that their practice experience strongly shapes behaviour. This study (in 2013-14) explored twelve adult nursing students' lived experiences of role modelling through an interpretive phenomenological analysis approach, aiming to understand the impact on their development as professional practitioners. Clinical nurses influenced student development consistently. Some students reported that their experiences allowed them to learn how not to behave in practice; a productive learning experience despite content. Students also felt senior staff influence on their development to be strong, citing 'leading by example.' The impact of patients on student professional development was also a key finding. Through analysing information gained, identifying and educating practice-based mentors who are ready, willing, and able to role model professional attributes appear crucial to developing professionalism in nursing students. Those involved in nurse education, whether service providers or universities, may wish to acknowledge the influence of clinical nurse behaviour observed by students both independent of and in direct relation to care delivery and the impact on student nurse professional development. A corollary relates to how students should be guided and briefed/debriefed to work with a staff to ensure their exposure to a variety of practice behaviours.

Current Standards and Advances in Diabetic Ulcer Prevention and Elderly Fall Prevention Using Wearable Technology

The deleterious effects of diabetes on the lower extremity are numerous, costly, and complicated to treat. Many patients who develop a diabetes-related ulceration will eventually require lower extremity amputation, an outcome with well-described morbidity and mortal complications. Foremost in the many deteriorating effects of aging on lower extremity health are the development of peripheral neuropathies, development of peripheral arterial disease, loss of proprioceptive feedback, and loss of adequate function leading to increased falls. Current healthcare practice guidelines substantially improve the long-term care of older adults; however, they are often limited to semi-regular screenings and patient-reported symptoms. Future implementation of wearable, constant-monitoring technology has the potential to revolutionize healthcare by early detection and “pre-habilitative” therapy before the patient even needs to visit the clinic. This article addresses the current and future trends of lower extremity risk prevention with an emphasis on the implications of wearable, transdermal, and implantable constant-monitoring devices and powered exoskeletons.

Bactericidal effect on Foley catheters obtained by plasma and silver nitrate treatments

New medical, materials, and surgical procedures keep improving current health-care practices. Many of these innovations involve polymeric devices that must meet certain clinical and cost requirements. Novel antimicrobial technologies and nanotechnologies are being implemented in more applications such as implant interphases, coatings, and others to avoid postoperatory infections. Here we present a novel approach to create antimicrobial surfaces on Foley catheters widely used in hospitals in order to avoid a variety of harms including infection, pain, and trauma. The combination of plasma and silver nitrate wet treatments demonstrates to be a fast, easy, and convenient method for obtaining colonization-resistant catheter surfaces.

Indigenous people's experiences at the end of life.

The primary purpose of this metasynthesis study was to explore the end-of-life experiences of Indigenous peoples by synthesizing the findings of qualitative research. Sandelowski and Barroso's methodology for synthesizing qualitative research was used and included (a) a comprehensive search, (b) appraising reports of qualitative studies, (c) classification of studies, and (d) synthesis of the findings. Research team members guided this process. This team was multidisciplinary and included Indigenous and non-Indigenous researchers from Canada, Australia, New Zealand, and the United States. Following a comprehensive search, 2255 studies were reviewed and assessed against five inclusion criteria: (a) studies on the experiences of Indigenous populations (all genders, 18 + years of age) at the end of life, (b) studies published in English from any country, (c) studies using qualitative and mixed-methods designs, and (d) studies published between 1993 and 2013. Some 18 studies met the inclusion criteria, and their findings were synthesized. "Preparing the spirit" for transition to the next life was the overarching theme. "Preparing the spirit" occurred within the context of "where we come from." Processes involved in "preparing the spirit" were healing, connecting, and protecting; through these processes, "what I want at the end of life" was realized. Although not the focus of the metasynthesis, a significant finding was that the studies reviewed identified very clear barriers within healthcare systems and current healthcare provider practices to "preparing the spirit." The findings provide a beginning understanding of the end-of-life experiences of Indigenous peoples and a foundation for future research. More interpretive qualitative research is critical if palliative care services, the healthcare system, and healthcare providers are to reduce current barriers to "preparing the spirit" for the journey at the end of life.

Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization

Tubal sterilization during the immediate postpartum period is 1 of the most common forms of contraception in the United States. This time of the procedure has the advantage of 1-time hospitalization, which results in ease and convenience for the woman. The USCollaborative Review of Sterilization Study indicates the high efficacy and effectiveness of postpartum tubal sterilization. Oral and written informed consent is the ethical and legal standard for the performance of elective tubal sterilization for permanent contraception for all patients, regardless of source of payment. Current health care policy and practice regarding elective tubal sterilization for Medicaid beneficiaries places a unique requirement on these patients and their obstetricians: a mandatory waiting period. This requirement originates in decades-old legislation, which we briefly describe. We then introduce the concept of health care justice in professional obstetric ethics and explain how it originates in the ethical concepts of medicine as a profession and of being a patient and its deontologic and consequentialist dimensions. We next identify the implications of health care justice for the current policy of a mandatory 30-day waiting period. We conclude that Medicaid policy allocates access to elective tubal sterilization differently, based on source of payment and gender, which violates health care justice in both its deontologic and consequentialist dimensions. Obstetricians should invoke health care justice in women's health care as the basis for advocacy for needed change in law and health policy, to eliminate health care injustice in women's access to elective tubal sterilization.

An Introduction to the Centers for Disease Control and Prevention's Efforts to Prevent Older Adult Falls.

An Introduction to the Centers for Disease Control and Prevention's Efforts to Prevent Older Adult Falls.

Factors Enabling Communication-Based Collaboration in Interprofessional Healthcare Practice

The healthcare system has moved from autonomous practice to a cross-disciplinary interprofessional team-based approach in which communication for collaborative care is vital. Ineffective communication contributes to the team's inability to work collaboratively and significantly increases the possibilities of mistakes occurring in the delivery of patient care. So, effective communication for collaborative care becomes necessary for ensuring patient safety. This paper aims to advance our understandings of current communication-based collaborative healthcare practices. Specifically, it explores the factors enabling communication-based inter-professional practice. A qualitative study was selected for obtaining real life experiences of healthcare professionals. Twenty-five participants participated in the study, and the descriptive interview method was used to obtain qualitative data. The enabling factors were grouped into five main themes: communication, coordination, cooperation, trust, and collaboration. Quotes from the participants are presented to augment the interpretation and enhanced description of the enabling factors. Managerial implications, areas for future research, and limitations are given besides the conclusions of the study.

An integrative review of experiences of patients with rheumatoid arthritis.

To provide an overview of evidence on the experiences and needs of adults living with rheumatoid arthritis (RA). Many research have studied the impact of RA on one's quality of life, but no reviews have examined the overall experiences of patients living with RA. An integrative review was performed to synthesize the experiences and/or needs of adult patients with RA based on articles retrieved from databases of CINAHL, Scopus, PubMed, PsycINFO and Web of Science, and published between January 2003 and March 2014 in English. A total of 38 studies were reviewed. RA has adverse effects on patients' quality of life due to its negative impacts in their physical and psychosocial aspects of health. Patients with RA cope with these impacts using various methods and are frequent users of healthcare services. However, few studies have evaluated patients' further needs in coping or the effectiveness of their coping mechanisms, and patients' experiences with health care. This review provides evidence for healthcare professionals to gain a better understanding of RA patients' experiences and needs. Future studies can explore interventions that will enhance the quality of current healthcare practices and ultimately improve patients' quality of life. Establishing a positive healthcare professional-patient relationship is crucial and healthcare professionals are in a position to provide greater informational and emotional support to patients. Policy makers and healthcare organizations need to look into ways to enhance the healthcare services to better suit RA patients' needs.

Bioethical principles and professionalism for South African medical laboratory technologists

As allied healthcare professionals, medical laboratory technologists are an integral part of the healthcare team, tasked with carrying out essential technical and scientific services in the laboratory. These key technical and scientific resources aid the pathologist and/or clinician in attaining an accurate diagnosis and hence providing the appropriate treatment. In South Africa, pathology services represent an integral part of the clinical consultation and most healthcare diagnosis and treatment involves these services, which are thus fundamental to current healthcare practices. Medical laboratory technologists practice their profession guided by ethical codes and high ethical standards are expected of them. This manuscript explains the four principles of bioethics as they apply to the profession of medical laboratory technology and describes the principles of professionalism for medical laboratory technologists in regard to the social responsibility and the importance of the professional and also the moral contract between society and the profession.

Glocalization: the outlook for Taiwan evidence based health care

Public attention to evidence-based health care (EBHC) has increased significantly in recent years. Key problems related to applying EBHC in current healthcare practice include the timely update of up-to-date knowledge and skills and the methodology used to implement EBHC in clinical settings. EBHC has been introduced to the Taiwan healthcare system for the past two decades. The annual EBM (Evidence based medicine) National Competition is a unique and important EBHC activity in Taiwan. EBHC has been promoted widely in medicine, nursing, pharmacy, public health and other professions, and EBHC-related organizations such as the Taiwan Evidence Based Medicine Association (TEBMA), and Taiwan Evidence Based Nursing Association (TEBNA), have increased in number and grown in membership. In addition to domestic developments, Taiwan is also actively involved in global organizations, such as the Cochrane Collaboration, East Asian Cochrane Alliance (EACA), and the International Society for Evidence Based Health Care (ISEHC). In Taiwan, most medical professionals work cooperatively to promote EBHC, which facilitates the gradual improvement of healthcare quality.

Knowledge, Attitudes, and Personal Use of Complementary and Alternative Medicine among Occupational Therapy Educators in the United States

ABSTRACTThe purpose of this study was to establish a baseline description of American occupational therapy educators’ knowledge, attitudes, and personal use of complementary and alternative medicine (CAM) as a first step in exploring the larger issue of future occupational therapy practitioners’ preparedness for meeting clients’ occupational needs in today's evolving healthcare environment. Results of this cross-sectional survey highlighted limitations of occupational therapy educators’ knowledge of common CAM concepts and therapies across all demographic variables, varying attitudes towards CAM in general and its inclusion in occupational therapy education, and personal use of common CAM therapies. Without increased occupational therapy educator knowledge about CAM and engagement in the current healthcare practices, occupational therapy practitioners are at risk for having a limited role in integrative healthcare.

Higher integrity health care: evidence-based shared decision making.

Two recent books1,2 have added to the body of work3–6 describing how the pharmaceutical industry has influenced medical research in its favor. By selective reporting, targeted educational efforts, and incentivizing prescriber behavior, the industry also has a profound impact on the way medicine is practiced. The medical device industry, promoting advances in procedural and diagnostic arenas, has not yet had the spotlight so carefully focused on it, but any future examination is likely to reveal similar influence. Many companies walk a thin line when it comes to providing free equipment and offering training when promoting the use and uptake of novel technologies.7 In both industries, the interests of patients often take second place to marketing. The accounts in Goldacre’s and Gotzsche’s books cast serious doubt on the governance of current healthcare practice. In addition, billions of dollars are invested in direct-to-consumer advertising and the manufacture of consumer interest in healthcare services, either by creating new disease labels, so-called disease mongering,8 or by promoting the use of drugs to address spurious risk predictions. This has become particularly noticeable given the recent promotion of drugs to reduce cholesterol, control blood pressure, and more recently, prevent bone loss, where in many circumstances, there is increasing debate about the appropriate thresholds for pharmaceutical intervention for these conditions.9 Many have spotted the problem. Physicians and patients tend to assume that newer and more technologically advanced care means better care.10 The practice of medicine has also been heavily influenced by efforts to lower diagnostic thresholds, thereby intervening more often, without paying attention to the increasingly small level of benefit, or to the substantial potential harms.11–13 In 2013, the first international conference was held on the theme of overdiagnosis: >300 researchers, clinicians, and policy …

Evaluating the effects of cognitive support on psychiatric clinical comprehension.

Clinicians' attention is a precious resource, which in the current healthcare practice is consumed by the cognitive demands arising from complex patient conditions, information overload, time pressure, and the need to aggregate and synthesize information from disparate sources. The ability to organize information in ways that facilitate the generation of effective diagnostic solutions is a distinguishing characteristic of expert physicians, suggesting that automated systems that organize clinical information in a similar manner may augment physicians' decision-making capabilities. In this paper, we describe the design and evaluation of a theoretically driven cognitive support system (CSS) that assists psychiatrists in their interpretation of clinical cases. The system highlights, and provides the means to navigate to, text that is organized in accordance with a set of diagnostically and therapeutically meaningful higher-level concepts. To evaluate the interface, 16 psychiatry residents interpreted two clinical case scenarios, with and without the CSS. Think-aloud protocols captured during their interpretation of the cases were transcribed and analyzed qualitatively. In addition, the frequency and relative position of content related to key higher-level concepts in a verbal summary of the case were evaluated. In addition the transcripts from both groups were compared to an expert derived reference standard using latent semantic analysis (LSA). Qualitative analysis showed that users of the system better attended to specific clinically important aspects of both cases when these were highlighted by the system, and revealed ways in which the system mediates hypotheses generation and evaluation. Analysis of the summary data showed differences in emphasis with and without the system. The LSA analysis suggested users of the system were more "expert-like" in their emphasis, and that cognitive support was more effective in the more complex case. Cognitive support impacts upon clinical comprehension. This appears to be largely helpful, but may also lead to neglect of information (such as the psychosocial history) that the system does not highlight. The results have implications for the design of CSSs for clinical narratives including the role of information organization and textual embellishments for more efficient clinical case presentation and comprehension.

Optimizing chronic HIV care in the Dutch Caribbean: a questionnaire based study on experience and perception of healthcare workers.

Human immunodeficiency virus (HIV) infection has become a chronic disorder for which adaptation of current healthcare practices is needed. In Curaçao, a new organization of chronic HIV care is being set up based on task shifting in which healthcare workers (HCWs) will deliver HIV care more prominently within the primary healthcare system. In preparation for implementation of the proposed task-shifting model, we investigated the perception of HCWs regarding existing HIV care in Curaçao and the need for training in HIV/AIDS among HCWs. An in-depth questionnaire based study was used. Nineteen HCWs of seven different cadres were interviewed. The questionnaire constituted four sections: quality of existing HIV care, respondents own knowledge and willingness to be trained, need for training in HIV/AIDS and preferred educational approaches. Quality of existing HIV services in Curaçao is considered acceptable but needs improvement mainly to facilitate integration of chronic HIV care. All respondents indicated that training in HIV/AIDS is needed among HCWs in Curaçao, especially for nurses and general practitioners. All were willing to participate in training with varying amounts of time to be spent. Training should be tailored to the level of expertise of HCWs and to the role a HCW is expected to have in the new healthcare delivery framework. There is need for training to ensure the effective integration of chronic HIV care into the existing healthcare delivery system in Curaçao.There is a willingness and need in all cadres for training with e-learning as a preferred educational tool.

Increasing Provider Engagement in Clinical Research Starts with Research Awareness

The advancement of current healthcare practices and knowledge requires continued clinical study enrollment and healthcare provider awareness of research opportunities. Bolstered by healthcare reform, meaningful use, and innovations in technology, health-care research has potential for meaningful

Disruptive Innovation in the Nordic Countries’Healthcare Systems

study establishes that there is a fundamental shortcoming in the system that supports healthcare innovation: It is strongly biased towards micro-level innovation projects focusing on new products, alternative processes, and new financial solutions. The problem with this approach to support new projects is that the results are created as inventions within the system thus lacking holistic perspectives. This has consequently contributed with increasing costs that are out of proportion with existing budgets. Therefore this study seeks to analyze the current understanding of the Nordic healthcare system from a business model perspective. Here other aspects of the healthcare system are explored to determine if they could be redesigned to promote new types of innovation projects. The purpose of undertaking this task is to challenge the established patterns of the current healthcare innovation support practices. Here the vertical innovation process (VIP) framework, which is a systematic radical innovation model that seeks macro-level outcomes based on standalone inventions (see more below), is applied to analyze the current state-of-the-art in Nordic healthcare innovation projects. The results determine that very little attention is given to rethink and redesign the healthcare system at a macro-level, and it is discussed that stand-alone inventions ought to be rethought into the entire healthcare system to create a larger impact. Finally, it is argued that existing performance measures are inappropriate to foster projects that innovate the existing system: New measuring points should be developed to promote macro-level projects and to avoid the current rapid increase of costs in the Nordic healthcare system.

The Oz craze

The Oz craze

Mentoring undergraduate nursing students in research.

doi: 10.5480/11-555.1As one way to equip students for current health care practice (Reising, 2003), an increasing number of nursing programs are engaging students in the research process early in the curriculum. This engagement can prepare students to competently conduct all components of the research process. However, not all students feel prepared to participate in the research process after graduation, even though they received research training early on and throughout their undergraduate programs (Ax & Kincade, 2001). According to Spatz (2008), students often experience frustration and perceive nursing research as boring or believe that the teaching strategies are ineffective. This lack of enthusiasm for the research process can follow students into their professional careers.One way to help undergraduates better appreciate and gain expertise in the research process is to engage them in student-faculty collaborative projects. While few BSN programs offer opportunities for collaborative research outside the traditional nursing curriculum, undergraduate student-faculty collaborative research is gaining support within the academic community. Organizations such as the Council on Undergraduate Research (www.cur.org/about_cur/) advocate for the inclusion of research experiences that foster student involvement across baccalaureate curricula. Nursing faculty need to follow the direction of our colleagues in other disciplines by designing strategies to engage nursing students in collaborative undergraduate research.There are multiple models for including students in planned curricular research projects with faculty (Mandleco & Schwartz, 2002; Ravert, Boyer, Harmon, & Scoffield, 2004; Wheeler, Hardie, Schell, & Plowfield, 2008). One approach is to develop a curriculum where undergraduates begin the research strand early in the program and have a variety of courses that integrate research content. Other programs develop a capstone model, where students collaborate with other students and faculty to review current evidence and design research strategies for improved practice. Programs also continue to utilize the traditional strategy of including a nursing research course that focuses on the steps of the research process within the upper division of course work.Historically, undergraduate nursing programs have emphasized the role of research consumer rather than the role of researcher (Cole, 1995). The literature lacks innovative examples of involving undergraduate nursing students in the entire research process outside the planned curriculum. This article addresses mentoring as a strategy that promotes and expands the role of undergraduate nursing students as collaborators in the production of original research.Mentoring is a strategy that may be used in different settings and venues to promote research quality and quantity (Byrne & Keefe, 2002). While faculty are often experienced in mentoring colleagues within the faculty roles of teaching, research or scientific inquiry, and community service, functioning as faculty mentors with students can be rewarding (Wheeler et al., 2008). Not only can the process increase confidence in the mentees' skills, it increases the mentor's expertise as well. One of the greatest rewards can come from inspiring students' realization that they are capable of appraising, conducting, and disseminating research (Wheeler et al.).our methodUndergraduate research has been an ongoing process at our private, comprehensive university located in the Midwest. Within the college of nursing, we began a program of study that uses undergraduate students as members of a collaborative research team. For the past 17 years, this research program has been conducted as independent study beyond the required BSN research course.Each year, two faculty members serve as project mentors and three to six undergraduate nursing students -sophomores, juniors, and seniors who are selected to participate - are the research team members (RTMs). …

Primary care nurses’ experiences of how the mass media influence frontline healthcare in the UK

BackgroundMass media plays an important role in communicating about health research and services to patients, and in shaping public perceptions and decisions about health. Healthcare professionals also play an important role in providing patients with credible, evidence-based and up-to-date information on a wide range of health issues. This study aims to explore primary care nurses’ experiences of how mass media influences frontline healthcare.MethodsIn-depth telephone interviews were carried out with 18 primary care nurses (nine health visitors and nine practice nurses) working in the United Kingdom (UK). Interviews were recorded and transcribed. The data was analysed using thematic analysis, with a focus on constant comparative analysis.ResultsThree themes emerged from the data. First, participants reported that their patients were frequently influenced by controversial health stories reported in the media, which affected their perceptions of, and decisions about, care. This, in turn, impinged upon participants’ workloads as they had to spend additional time discussing information and reassuring patients. Second, participants also recalled times in their own careers when media reports had contributed to a decline in their confidence in current healthcare practices and treatments. Third, the participants in this study suggested a real need for additional resources to support and expand their own media literacy skills, which could be shared with patients.ConclusionIn an ever expanding media landscape with greater reporting on health, nurses working in the primary care setting face increasing pressure to effectively manage media stories that dispute current health policies and practices. These primary care nurses were keen to expand their media literacy skills to develop critical autonomy in relation to all media, and to facilitate more meaningful conversations with their patients about their health concerns and choices.