Influence Patient Care Research Articles

How do we transfuse children in Italy? Results of a national survey.

Adherence to optimal practices in the preparation and issuance of pediatric blood components can significantly influence patient care outcomes. This study aims to examine the blood banking procedures across prominent Italian children's hospitals, with the goal of identifying both consistent and potentially divergent standards within this field. A survey was conducted among the blood banks affiliated with the Italian Association of Pediatric Hospitals. Modeled after the AABB Neonatal and Pediatric Blood Bank Practices Survey, the questionnaire comprised 25 questions covering hospital characteristics, definitions of the neonatal period, pre-transfusion tests, blood component availability, and irradiation protocols. Fourteen out of the sixteen invited blood banks participated in the survey. The findings revealed a wide range of practices among the surveyed hospitals. Major differences were noted in the neonatal period definition, pre-transfusion compatibility procedures, and platelet transfusion protocols. All hospitals provided leukodepleted packed red blood cells (pRBCs), with differences in availability of autologous blood and reconstituted whole blood. Irradiated blood components were universally accessible, with differences in post-irradiation acceptable storage time. Additionally, differences in dosages for packed red blood cells (pRBCs) and platelet concentrates (PCs) were observed across hospitals. Standardized guidelines for pediatric transfusion practices within Italian blood banks are of paramount importance. The observed variability underscores the necessity for sharing best practices among centers supplying blood components to pediatric patients.

KAP ANALYSIS OF NURSES REGARDING PREVENTION OF OSTEOPOROSIS AND ITS ASSOCIATION WITH NUTRITIONAL BEHAVIORS

Osteoporosis is a significant public health concern, affecting millions globally. Nurses play a vital role in educating and guiding patients about preventive measures. However, their knowledge, attitudes, and practices (KAP) regarding osteoporosis prevention, along with their own nutritional behaviours, are crucial factors that can influence patient care and health outcomes. Objective: To determine the knowledge, attitudes, and practice of nurses regarding osteoporosis prevention and its association with nutritional behaviours. Methods: A cross-sectional study was conducted in the Nursing Department of Nishtar Hospital, Multan from September 2023 to August 2024. A total of 100 nurses with at least a bachelor’s degree and a minimum of one year of work experience were included in the study. The data was collected through a questionnaire divided into five sections to collect demographic information, levels of knowledge, attitudes and practices, and nutritional habits of nurses. Results: The mean knowledge score was 19.24 ± 4.10 with 55% of nurses possessing good knowledge. The mean attitude score was 71.68 ± 7.05 with 80% of nurses having positive attitudes. The mean attitude score was 47.32 ± 7.44 with 58% of nurses having good practices. 58% of nurses had good nutritional behaviours with a mean score of 111.08 ± 14.73. A strong direct association was observed between nutritional behaviors and KAP scores (p=0.001). Conclusion: Good knowledge, attitudes, practices, and nutritional behaviours were noted in nurses regarding osteoporosis prevention. The KAP scores had a direct and strong association with nutritional behaviors promoting lifestyle changes.

Hepatobiliary scintigraphy with SPECT/CT.

Hepatobiliary scintigraphy with single-photon emission computed tomography (SPECT) is an essential Nuclear Medicine exam for assessing hepatobiliary abnormalities and planning therapy. We aim to offer a thorough and all-encompassing analysis of hepatobiliary imaging with SPECT to emphasize the practicality, precision in diagnosis, surgical or transplant planning, and advanced uses of SPECT/CT in assessing hepatobiliary disease. Readers can anticipate acquiring a comprehensive understanding of the subsequent facets. The manuscript will explore in detail the diverse clinical uses of SPECT/CT imaging in hepatobiliary system, recent technological breakthroughs in SPECT/CT imaging techniques, specifically addressing quantitative analysis methodologies, and the integration of SPECT/CT with other imaging modalities. This article will provide readers with information on current research trends and future prospects in SPECT/CT imaging for hepatobiliary applications, such as strategies for monitoring therapy, the use of artificial intelligence and machine learning for quantitative imaging biomarkers, how these advanced techniques influence patient care, treatment choices, and prognostic predictions. The goal of the review is to help the readers acquire useful knowledge about the latest hepatobiliary SPECT/CT imaging, their clinical applications, and their prospective contribution to the advancement.

Exploring the Plastic Surgery Related Experiences, Needs, Confidence and Knowledge Gaps of Foundation Year Doctors

Plastic surgery is a diverse speciality relevant to non-plastic doctors, as plastic surgeons frequently collaborate with other specialities and its basic principles are transferable across multiple specialities. Foundation-year (FY) doctors are the most junior doctors in the workforce and may need to apply plastic surgery knowledge and principles during their clinical duties. Despite this, formal plastic surgery education for junior doctors is limited, resulting in an educational gap. This study gains insight into the perceived confidence, knowledge gaps, skills, educational activities and needs related to plastic surgery. This qualitative study uses phenomenology through semi-structured individual interviews with eight FY doctors. Data was analysed using reflexive thematic analysis. This study revealed that plastic surgery features diversely in the work life of FYs, who often manage patients with a lack of knowledge and confidence, influencing patient care and FY wellbeing. FYs primarily acquire knowledge and confidence through experiential learning and individual initiative. A need for curriculum improvements was expressed. FYs are an essential part of the workforce who exhibited educational gaps and a lack of confidence in plastic surgery knowledge. We suggest improved integration of plastic surgery into the FY curriculum for improved FY knowledge and patient care.

Incidence and clinical characteristics of cardiac amyloidosis in Tuscany and Umbria

Abstract Background Recent advances in imaging and increased disease awareness have led to a significant rise in newly diagnosed cases of cardiac amyloidosis (CA) over the past decade. However, there remains a lack of epidemiological data regarding the true incidence of the disease. Purpose To determine the incidence and clinical characteristics of newly diagnosed cases of CA in a large Italian population. Methods Subjects with suspected CA underwent diagnostic work-up in 20 Centers in Tuscany and Umbria regions within the Cardiac Amyloidosis RegistRY (CARRY), between January 1st 2022 and December 31st 2022. Results A total of 551 subjects were enrolled in the registry, with complete data on the final diagnosis available for 448 individuals. CA was diagnosed in 179 patients (40%), with 28 (16%) classified as light chain CA (AL-CA), 114 (64%) wild-type transthyretin CA (ATTR-CA), 12 (7%) variant ATTR-CA, and 25 (13%) undetermined CA. Considering a reference population in Tuscany and Umbria in 2022 (4,518,388, according to the Italian National Institute of Statistics), this yields an estimated cumulative incidence of 39.6 cases per million inhabitants per year. Alternative diagnoses in the remaining patients mostly included hypertensive heart disease (n=157, 58%), hypertrophic cardiomyopathy (n=25, 9%), moderate-to-severe valvular heart disease (n=11, 4%), or a mixed phenotype (n=72, 27%). The primary referral pathway for the suspicion of CA was cardiological (n=345, 77%), followed by incidental finding during screening visits (n=58, 13%), and haematology referral (n=33, 7%). Patients with confirmed CA were older (81 [75-85] vs. 77 [72-83] years, p<0.001), and more frequently reported musculoskeletal red flags of CA, such as carpal tunnel syndrome (85 [48%] vs. 53 [20%] years, p<0.001), and spontaneous tendon rupture (39 [22%] vs. 18 [7%] years, p<0.001). Median time to diagnosis from clinical suspicion was 73 (37-140) days for CA and 84 (36-156) days for alternative diagnoses (p=0.564). Conclusions The diagnosis of CA is on the rise globally, with an estimated incidence of 39.6 new cases per million inhabitants per year in two large regions of Italy. These findings should inform policymakers in redefining the status of CA as a rare disease, potentially influencing patient care and treatment costs.

Caring in crisis: Addressing patient safety, burnout, and long hours in healthcare.

Madam, The World Health Organization defines patient safety as preventing errors and adverse effects to patients associated with health care and “to do no harm to patients”. Specifically, in low and middle-income countries (LMICs), about 134 million adverse events occur each year due to unsafe care in hospitals, resulting in 2.6 million deaths annually. [1] Along with other determining factors, professional well-being, long hours, and burnout syndromes also influence patient care. [2] Burnout is a condition directly linked to workplace environment, stemming from occupational stress and extended working hours. Garcia, C.L. et al., through meta-analysis, found a relationship between the development of burnout and patient safety actions, with a probability of superiority of 66.4%. High levels of burnout and worsening patient safety are related to external factors such as high workload, long working hours, lack of a secure environment, and interpersonal relationships. [3] These findings raise concerns, particularly in a country like Pakistan, where the extent of understaffing and high workload can be inferred from the following statistics: The doctor-to-population ratio in Pakistan was 1:1000 in 2018 [4]. In contrast, the doctor-to-population ratio in Malaysia was 2.2:1000 in 2018 [5]. As a result of this shortage, the current workforce in Pakistan is negatively affected. In a study by Kasi PM et al. on postgraduate trainees in Pakistan, individuals under stress were more likely to report longer working hours. This increased workload made them prone to medical errors, which ultimately undermines the patient safety culture. A study conducted at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC) compared the benchmarks from hospitals in the USA and discovered that high staff workload is a significant concern among staff [6] In Pakistan, where healthcare resources are limited, fostering a culture of effective work-hour management and breaks is essential for creating a healthier and safer environment for health professionals and patients. Ensuring adequate staffing levels to distribute the workload and prevent overburdening is essential. Providing designated areas for relaxation, offering mental health resources and mindfulness programmes like yoga or meditation can help doctors to cope with stress. Furthermore, promoting a culture of multidisciplinary teamwork, a mentorship program, and effective handover protocols during shift changes can ensure continuity of care. Medical institutes should invest in technology that can streamline administrative tasks and reduce paperwork burden. ---Continue

The Impact of Healthcare Pressures on the COVID-19 Hospitalisation Fatality Risk in England.

As the impact of the SARS-CoV-2 pandemic extends into 2023 and beyond, the treatment and outcomes of infected patients continues to evolve. Unlike earlier in the pandemic there are now further infectious disease pressures placed on hospitals, which influence patient care and triage decisions. The manuscript uses individual patient records linked with associated hospital management information of system pressure characteristics to attribute COVID-19 hospitalisation fatality risks (HFR) to patients and hospitals, using generalised additive mixed effects models. Between 01 September 2022 and 09 October 2023, the COVID-19 hospitalisation fatality risk in England was estimated as 12.71% (95% confidence interval (CI) 12.53%, 12.88%). Staff absences had an adjusted odds ratio of 1.038 (95% CI 1.017, 1.060) associatedwith the HFR when accounting for patient and hospital characteristics. This observational research presents evidence that a range of local hospital effects can have a meaningful impact on the risk of death from COVID-19 once hospitalised and should be accounted for when reporting estimates. We show that both the patient case mix and hospital pressures impact estimates of patient outcomes.

How do emergency departments respond to ambulance pre-alert calls? A qualitative exploration of the management of pre-alerts in UK emergency departments

BackgroundCalls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve...

Hybrid emergency care at the home for patients – A multiple case study

IntroductionHealthcare systems worldwide are facing numerous challenges, such as an aging population, reduced availability of hospital beds, staff reductions and closure of emergency departments (ED). These issues can exacerbate crowding and boarding problems in the ED, negatively impacting patient safety and the work environment. In Sweden a hybrid of prehospital and intrahospital emergency care has been established, referred to in this article as Medical Emergency Team (MET), to meet the increasing demand for emergency care. MET, consisting of physicians and nurses, moving emergency care from EDs to patients’ home. Physicians and nurses may encounter challenges in their healthcare work, such as limited resources for example medical equipment, sampling and examination, in unfamiliar varying home environments. There is a lack of knowledge about how these challenges can influence patient care. Therefore, the aim of this study was to explore the healthcare work of the METs when addressing patients’ emergency care needs in their homes, with a focus on the METs reasoning and actions.MethodsUsing a qualitative multiple case study design, two METs in southwestern Sweden were explored. Data were collected from September 2023 – January 2024 and consist of field notes from participant observations, short interviews and written reflections. A qualitative manifest content analysis with an inductive approach was used as the analysis method.ResultThe result of this study indicates that physicians and nurses face several challenges in their daily work, such as recurring interruptions, miscommunication and faltering teamwork. Some of these problems may arise because physicians and nurses are not accustomed to working together as a team in a different care context. These challenges can lead to stress, which ultimately can expose patients to unnecessary risks.ConclusionWhen launching a new service like METs, which is a hybrid of prehospital and intrahospital emergency care, it is essential to plan and prepare thoroughly to effectively address the challenges and obstacles that may arise. One way to prepare is through team training. Team training can help reduce hierarchical structures by enabling physicians and nurses to feel that they can contribute, collaborate, and take responsibility, leading to a more dynamic and efficient work environment.

Career advancement insights from certified pharmacy technicians: Enhanced opportunities for the pharmacy technician workforce

BackgroundSustainable career advancement opportunities for pharmacy technicians will be a critical part of patient-centered community pharmacy environments as the role of the pharmacist provider expands. Objective(1) To determine the impact of a Pharmacy Technician Certification Board (PTCB) pharmacy certification on career advancement and professional growth metrics; (2) To assess technicians’ role in advanced pharmacy services before and after certification; and (3) To identify changes in pharmacist services when a certified pharmacy technician (CPhT) was added to the provider team. MethodsA 73-question web-based survey was distributed to all PTCB CPhT in the United States, Washing DC, Puerto Rico, Guam, and the US Virgin Islands. The survey was distributed by PTCB in April 2021 with a 28-day collection period. The survey included multiple choice, rating scale, and free text questions centered on 5 domains: practice experience, career aspirations, compensation, pharmacy practice motivations, and impact of COVID-19 pandemic. ResultsA total of 23,007 CPhTs completed the survey. Respondents were primarily females (85.5%), age 30-39 (32.8%), and ≥10 years CPhT experience (42.8%). The majority of respondents cited improvement of patient health (77.4%), career advancement opportunities (53.5%), the ability to expand their role during emergencies (e.g., COVID-19) (52.6%), and future career advancement opportunities (51.7%) as benefits of CPhT certification. Increases in job responsibility after certification included changes occurring in roles related to clinical pharmacy services, patient education, preventive health services, provider communication, and staff training. Respondents agreed that PTCB-certification allowed for the expansion of pharmacists’ services where they practiced, including clinical services (18.5%), patient education (18.3%), and preventive health services (18.1%). ConclusionCPhT’s value certification for its benefits on career advancement, personal growth, and salary enhancement. Affirmation of skill and training through certification is also recognized to positively influence patient care and the pharmacy's ability to provide advanced patient care and services.

2269 Preventing frailty crises: improving the care of frail patients in an acute hospital Ward setting

Abstract Introduction Frailty is common in hospitalised older patients and hospitalisation can lead to negative outcomes. Our study aimed to provide insights into current decision-making processes on treatment, care and discharge by clinical teams. Methods We conducted a prospective cohort study in frail older patients ≥65 years old admitted to acute medical and surgical wards. Clinical Frailty Scale ≥5 was used to identify frail patients and process mapping was undertaken to identify common themes, trajectories and potentially modifiable factors. We followed patient journeys from admission to discharge and examined factors contributing to longer hospitalisation. We documented existing processes, environmental, system and clinical factors influencing patient care. Comprehensive geriatric assessments identified underlying geriatric syndromes and where gaps in management were identified, we recommended frailty interventions. Results Fifteen patients provided informed consent, of whom 73% were female and average age 80 years, ranging 69–95 years. 67% were frail (CFS 5–6) and 33% were severely frail (CFS 7–9). Most patients were sarcopenic with a SARC-F score of ≥4 and had functional and gait impairment. 60% were underweight (BMI <22). Process mapping revealed gaps in frailty-focused care and included delayed transfer to acute wards, delayed investigations, and multiple unidentified geriatric syndromes which were prevalent in this cohort. Patients fell into three broad groups, short (1–6 days), intermediate (7–14 days), or long (>14 days) length of stay and delays in discharge-planning were common, mean of 4.17 days, as were delays in identification of a caregiver. Recommendations for community support services were provided to >50% patients. Conclusion Our study shows that mapping the frail patient’s journey can identify gaps in existing processes and opportunities for improvement and collaboration. Integrating geriatric care into general wards could improve patient outcomes. We aim to use this work to guide frailty-attuned care for hospitalised older patients.

Effect of a Point-of-Care Ultrasound-Driven vs Standard Diagnostic Pathway on 24-Hour Hospital Stay in Emergency Department Patients with Dyspnea-Protocol for A Randomized Controlled Trial.

Point-of-care ultrasound (POCUS) helps emergency department (ED) physicians make prompt and appropriate decisions, but the optimal diagnostic integration and potential clinical benefits remain unclear. We describe the protocol and statistical analysis plan for a randomized controlled trial. The objective is to determine the effect of a POCUS-driven diagnostic pathway in adult dyspneic ED patients on the proportion of patients having a hospital stay of less than 24 hours when compared to the standard diagnostic pathway. This is a multicenter, randomized, investigator-initiated, open-labeled, pragmatic, controlled trial. Adult ED patients with chief complaint dyspnea are eligible. Patients are randomized (1:1) to the POCUS-driven diagnostic pathway or standard diagnostic pathway, with 337 patients in each group. The primary outcome is the proportion of patients having a hospital stay (from ED arrival to hospital discharge) of less than 24 hours. Key secondary outcomes include hospital length-of-stay, 72-hour revisits, and 30-day hospital-free days. Sparse evidence exists for any clinical benefit from a POCUS-integrated diagnostic pathway. The results from this trial will help clarify the promising signals for POCUS to influence patient care among ED patients with dyspnea.

Cultivating and Sharing Tacit Knowledge in the Medical Field

This study explores tacit knowledge transfer in healthcare, aiming to identify barriers and opportunities in sharing this nuanced expertise among practitioners and its impact on patient care standards. Employing a mixed-methods approach, it gathers data from healthcare professionals, analyzing it via reliability, statistical tests, and multinomial logistic regression. Results show moderate scale reliability, significant relationships between responses, and various factors influencing patient care quality, such as patient confidentiality, effectiveness of mentoring programs, and engagement in online forums. Challenges in tacit knowledge transfer were found insignificant, yet specific factors like mentoring and online participation are crucial for care quality. The study concludes that mentorship and organizational strategies play vital roles in enhancing care delivery by facilitating tacit knowledge sharing, underlining the importance of addressing confidentiality issues, and promoting innovation through active online engagement and effective knowledge use.

Genetic counselors outside of the genetics clinic: Roles, practices, and ethico‐legal implications in light of lagging legal recognition across Canada

AbstractAdvances in medical genetics have led to a significant increase in demand for genetic services and expertise across almost all medical specialties. Genetic counselors (GCs) in Canada play key roles in genetic services both within and outside of the Genetics Clinic, while not being regulated or legally recognized as healthcare professionals (HCPs) in most provinces. Understanding whether GCs outside of the “traditional” Genetics Clinic influence patient care, their level of professional autonomy and supervisory structure is, therefore, important. In this study, we explore the current landscape of GC practice outside of the Genetics Clinic by describing positions, determining the professional scope of practice, as defined by the Canadian Association of Genetic Counselors (CAGC) and Canadian Board of Genetic Counseling (CBGC) core competencies, and by elucidating associated ethico‐legal implications. An online survey was developed and distributed to GCs working with patient‐related data in Canada in positions outside of the Genetics Clinic through the CAGC ListServ and accessed between March 5 and April 9, 2021. Thirty GCs were included in the study, with 16/30 in public healthcare system positions. Most respondents held roles with direct (11/30) and indirect (14/30) impact on patient care and management, and the majority reported performing their primary roles with minimal supervision (56%) or complete independence (36%). Most roles (22/25) elicited by respondents were considered to be within the GC scope of practice, except for administrative tasks and special projects. GCs were the only genetics‐trained professional(s) in 8/30 of respondents' workplaces. The results of the current study support the value of GCs translatable skillset in positions beyond the Genetics Clinic, and outline ethico‐legal implications for GCs, regulated HCPs, patients, and health institutions in the absence of legal recognition, including medical‐legal liability and title protection. This study provides evidence in support of regulation of GCs as HCPs.

Using AI-based virtual triage to improve acuity-level alignment of patient care seeking in an ambulatory care setting

Objective: Evaluate how an AI-based virtual triage (VT) and care referral technology impacted live triage and care referral in an outpatient/ambulatory care network.Methods: Analysis of a dataset of 8,088 outpatient online encounters assessed how VT influenced patient care seeking action/behavior.Results: There were modest decreases in patients seeking outpatient care, including in-person or video face-to-face encounters (-12.5%), or engaging self-care (-8.2%). Patient engagement of virtual care through e-visits and telephone calls increased moderately (19.1%). One-third (35.0%) of patients changed care seeking likely as a result of VT care referral. Another third (32.3%) reported a pre-VT care intent aligned with the VT care recommendation, and a third (32.7%) did not change care sought when their pre-VT intent was not aligned. A total of 12.0% de-escalated acuity of care seeking as recommended by VT, most frequently from outpatient care to virtual care (6.5%) or self-care (4.3%). When VT recommended care de-escalation, 53.5% de-escalated care. In 21.2% care acuity was escalated, of whom 10.6% pursued virtual care and 7.5% pursued outpatient care instead of self-care, while 3.1% whose care intent was virtual care instead pursued outpatient care. When VT recommended care escalation, 96.2% escalated care. Overall, 26.7% of patients required no further action or involvement of clinical staff.Conclusions: Virtual triage impacted patient care seeking action/behavior among almost half of patients whose pre-VT intent differed from the VT recommendation, with patients nearly twice as likely to follow recommendations to seek higher rather than lower levels of care acuity, while modestly reducing the number of face-to-face visits and increasing virtual care. Overall, a quarter of patients using VT were able to perform self-care without interacting with the healthcare team. Virtual triage has the potential to efficiently and effectively redirect patients to more appropriate levels of care.

Mapping the Palette: A Bibliometric Journey into Art in Health Research

Arts in healthcare is a broad worldwide movement that includes how the arts influence patient care, hospital surrounds. Art in health research is crucial to prove its effectiveness and guide its practical application in healthcare, addressing current gaps in knowledge and ensuring optimal integration into patient care. The objective of this article is to present a literature review and bibliometric analysis of the mapping art in health research from 2018 to 2023. Text queries on Scopus (1, 670 documents) and PubMed (550 documents) using the term (“art therapy” OR “art in medicine” OR “arts-based interventions” OR “creative arts therapies” OR “Art in Health”) have done on 15 October 2023 obtaining 2220 documents for in-depth analysis. Rstudio 4.2.1 and biblioshiny for bibliometrix were used to analyze research trends. The most popular journal in Scopus is the journal Arts in Psychotherapy while the journal Frontiers in Psychology in PubMed. In Scopus, the most frequently used author keywords and add keywords are “art therapy” while in PubMed it shows “humans” REGEV D., (Scopus) and TESTONI I., (PubMed) are the most popular authors. The United States of America produces the most scientific articles in Scopus and PubMed. The most notable affiliations from Scopus and PubMed is University of Haifa. In conclusion, PubMed and Scopus databases, it can be observed that a significant proportion of European researchers exhibit a broader range of research interests in the field of art in health.

Analysis of the use of electronic medical records and its effect on improving patient care

Introduction: One of the most important contemporary events related to the health field is the implementation of the electronic health record (EHR), which allows the logical and chronological consolidation of information concerning a patient. Objective: To analyze the influence of the implementation of electronic medical records on the improvement of patient care. Method: The study corresponds to a quantitative approach, non-experimental design, and causal correlational scope. The population and sample were 94 health and administrative workers of a health center in Metropolitan Lima. The questionnaire had 30 items, with response options using a Likert-type scale. Results: The use of electronic medical records was found to be 78.7% high, and patient care was found to be 70.2% efficient. It was found that the use of EHRs significantly influences patient care, given that p-value is 0.047<0.05. The dimensions of patient care, reliability, responsiveness, safety, empathy, and tangible aspects also obtained a p-value<0.05. Conclusions: It was found that most workers positively perceive the use of electronic medical records and that the existence of this system has beneficial effects on patient care, considering that the staff perceives high levels of reliability, responsiveness, safety, empathy, and tangible aspects.

FDA's proposed rule and its regulatory impact on emerging and reemerging neglected tropical diseases in the United States.

Diagnosing infectious diseases significantly influences patient care, aiding in outbreak identification, response, and public health monitoring. However, the range of FDA-approved molecular tests remains notably limited, especially concerning neglected tropical diseases (NTDs). Drawing upon our experience as one of the largest healthcare networks in the greater New York metropolitan area, this viewpoint manuscript aims to spotlight the existing diagnostic landscape and unmet clinical needs for 4 emerging NTDs increasingly prevalent in the United States, additionally, it delves into the possible adverse effects of the FDA's Proposed Rule on Laboratory-Developed Tests for these clinical conditions and the broader spectrum of NTDs.

Improving Indigenous health equity within the emergency department: a global review of interventions

IntroductionIndigenous health equity interventions situated within emergency care settings remain underexplored, despite their potential to influence patient care satisfaction and empowerment. This study aimed to systematically review and identify Indigenous equity interventions and their outcomes within acute care settings, which can potentially be utilized to improve equity within Canadian healthcare for Indigenous patients.MethodsA database search was completed of Medline, PubMed, Embase, Google Scholar, Scopus and CINAHL from inception to April 2023. For inclusion in the review, articles were interventional and encompassed program descriptions, evaluations, or theoretical frameworks within acute care settings for Indigenous patients. We evaluated the methodological quality using both the Joanna Briggs Institute checklist and the Ways Tried and True framework.ResultsOur literature search generated 122 publications. 11 articles were selected for full-text review, with five included in the final analysis. Two focusing on Canadian First Nations populations and three on Aboriginal Australians. The main intervention strategies included cultural safety training, integration of Indigenous knowledge into care models, optimizing waiting-room environments, and emphasizing sustainable evaluation methodologies. The quality of the interventions was varied, with the most promising studies including Indigenous perspectives and partnerships with local Indigenous organizations.ConclusionsAcute care settings, serving as the primary point of access to health care for many Indigenous populations, are well-positioned to implement health equity interventions such as cultural safety training, Indigenous knowledge integration, and optimization of waiting room environments, combined with sustainable evaluation methods. Participatory discussions with Indigenous communities are needed to advance this area of research and determine which interventions are relevant and appropriate for their local context.

A nurse by any other name? An international comparison of nomenclature and regulation of healthcare assistants

BackgroundAcross international healthcare systems, healthcare assistant roles have proliferated, in part to decrease nursing costs and support workplace staffing. There is a lack of consensus about the professional title for healthcare assistants, and whether this group requires professional regulation. The variety of terms for healthcare assistants has resulted in confusion around their scope of practice and role within the healthcare team, which may influence patient care. AimWe aimed to identify the terminology used for healthcare assistants across English speaking countries and determine the international status of professional regulation of healthcare assistants. MethodWe conducted a deductive, structured search for healthcare assistant roles that were codified on English-language nursing regulator websites in each jurisdiction in Australia, New Zealand, USA, Canada, Ireland, and the United Kingdom. We assessed what terminology were used for healthcare assistant roles in each area, and whether they were regulated by a professional regulator, such as a college of nursing. ResultsAcross 77 jurisdictions, we identified 37 different terms for healthcare assistants. The most frequent term was Certified Nurse Aid with 24 uses, and Certified Nursing Assistant with 13 uses. The majority of healthcare assistants are not professionally regulated. Only 12 jurisdictions have professional regulation programs for healthcare assistants, all in the USA. ConclusionThere is an urgent need for international consensus about the nomenclature for healthcare assistants, so the healthcare assistant workforce can be supported, and their work evaluated via research studies. Regulators can consider how to engage with healthcare assistants and protect the public, as healthcare assistants provide an increasing proportion of patient care.