Involvement Of Healthcare Professionals Research Articles

English

INTRODUCTION: Spirituality has been integral part of medicine and health since ancient age. This has been accepted in various developed countries as evident by a plethora of published articles. However, the extent of spiritual component in medical practice in India is largely unknown. The present study is a questionnaire based study to assess the extent of knowledge (awareness), attitude and practices among medical professionals at a tertiary care Hospital regarding role of spirituality in management of health and diseases. METHODS: A predesigned validated list of questionnaire was distributed among 250 doctors of all specialties at the hospital along with brief introduction on purpose and scope of the study. The questions were collected back personally after giving sufficient time to attempt them. Doctors were evaluated regarding their knowledge, attitude and practice about spirituality in medicine using multiple choice question format. RESULTS: The response rate from participants was 80% (200/250). More than 90% participants had a good deal of knowledge of spirituality but unable to distinguish between truly spiritual practices from traditionally followed religious rituals. More than 70% felt that there is relevance of spiritual practices in health and diseases but pointed out lack of credible scientific data to incorporate these in health management strategy. There was wide variation among participants regarding underlying mechanism/s responsible for spiritual healing. Most of them believed this to be Psychological (90%), Neuroendocrine (70%) or Immunology (26%) and only (4%) attributed it to all these factors. Majority of the participants agreed that spirituality offers maximum health benefits in chronic and incurable diseases. Participants vouched for introduction of spiritual medicine in medical curriculum to be taught by medical professionals with expertise in spirituality. They also opined that there is need to involve health care professionals in spirituality related research work.

Barriers and facilitators of nutritional intervention after hip fracture in integrated care as perceived by the different health care professionals: A qualitative interview study

summary Background & aims: Nutritional intervention in elderly hip fracture patients is important, but implementation is difficult. In order to identify barriers and facilitators for implementation, we conducted a qualitative interview study within the setting of a multicentre RCT, and evaluated the experiences of health care professionals with an applied intensive nutritional intervention comprised of dietetic counselling and oral nutritional supplements. Methods: Individual semi-structured interviews were held with 22 involved health care professionals (i.e. clinicians, nursing staff, dieticians, and nutritional assistants) from different health care settings, and three focus group interviews were held with 13 dieticians and nurses. Results: At a professional level, some health care professionals experienced lack of knowledge about nutritional care. At a system level, health care professionals reported lack of structured attention for patients’ nutritional status, and nurses reported limited time available. Continuity of nutritional care was perceived to be at risk due to: 1. Incomplete communication between institutions, 2. Lack of clarity in nutrition-related responsibilities, and 3. Diversity in nutritional care policy between institutions. Conclusions: Barriers for implementation of the nutritional intervention are related to communication problems and differences in nutritional care policies between institutions. These barriers may be improved by clearly assigning nutrition-related responsibilities, by extensive cooperation between involved disciplines, and by monitoring patients until at home. The trial was registered at http://clincialtrials.gov/ as NCT00523575.

Awareness, Knowledge, and Concern About Age-Related Macular Degeneration

Age-related macular degeneration (AMD)—a common eye disease causing vision loss—can be detected early through regular eye-health examinations, and measures can be taken to prevent visual decline. Getting eye examinations requires certain levels of awareness, knowledge, and concern related to AMD. However, little is known about AMD-related awareness, knowledge, and concern levels of population groups who may be affected by or at risk for AMD. The purpose of this descriptive study was to assess these factors among—and health information seeking patterns of—four groups of individuals: [a] the general population, [b] a group at-risk for AMD due to race and advanced age, [c] a group at high-risk for AMD due to race, advanced age, and smoking behavior, and [d] a group diagnosed with AMD. Data were collected through telephone interviews with 894 adults using a computer assisted telephone interview method. Results demonstrate that while AMD awareness is high, knowledge about AMD risk factors and concern about the disease is lacking. The most prominent source of AMD awareness was knowing someone who had been diagnosed, and physicians were the main source for health-related information. AMD-related awareness campaigns should focus on educating older adults about AMD risk factors and involving healthcare professionals and older adults with AMD as peer educators.

Linking Six Sigma to simulation: a new roadmap to improve the quality of patient care

Improving the quality of patient care is a challenge that calls for a multidisciplinary approach, embedding a broad spectrum of knowledge and involving healthcare professionals from diverse backgrounds. The purpose of this paper is to present an innovative approach that implements discrete-event simulation (DES) as a decision-supporting tool in the management of Six Sigma quality improvement projects. A roadmap is designed to assist quality practitioners and health care professionals in the design and successful implementation of simulation models within the define-measure-analyse-design-verify (DMADV) or define-measure-analyse-improve-control (DMAIC) Six Sigma procedures. A case regarding the reorganisation of the flow of emergency patients affected by vertigo symptoms was developed in a large town hospital as a preliminary test of the roadmap. The positive feedback from professionals carrying out the project looks promising and encourages further roadmap testing in other clinical settings. The roadmap is a structured procedure that people involved in quality improvement can implement to manage projects based on the analysis and comparison of alternative scenarios. The role of Six Sigma philosophy in improvement of the quality of healthcare services is recognised both by researchers and by quality practitioners; discrete-event simulation models are commonly used to improve the key performance measures of patient care delivery. The two approaches are seldom referenced and implemented together; however, they could be successfully integrated to carry out quality improvement programs. This paper proposes an innovative approach to bridge the gap and enrich the Six Sigma toolbox of quality improvement procedures with DES.

Coordinating the Medical Home With Hospitalist Care

The Patient Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for children, youth, and adults.1 PCMH facilitates partnerships with individual patients, their personal physicians, and family. In pediatrics, PCMH is usually referred to as the Patient and Family Centered Medical Home, or just the Medical Home (MH). The MH was named over 40 years ago as a way to maintain centralized medical records of children and has evolved over the years to the current concept. The MH should be accessible, continuous, comprehensive, patient- and family-centered, coordinated, compassionate, community-based and culturally effective.2,–,4 The principles of the MH are: 1. Each patient has an ongoing relationship with a personal physician; 2. The personal physician participates in a team of individuals who take responsibility for the ongoing care of that patient; 3. The personal physician is responsible for providing all of the patient’s health care needs or appropriately arranging care with other qualified professionals; 4. The patients’ health care is coordinated across all elements of the health care system (including hospitals) as well as with community-based organizations (schools, mental health centers, etc). Care coordination is one of the key principles of the MH.5 Care coordination tracks ancillary studies, referrals, and transitions in care to ensure completion and document outcomes. Consistent, timely, bidirectional communication is at the heart of care coordination. Such communication includes the primary care MH, the other involved health care professionals, and the patient or family. Knowing the patient and family’s preferences and wishes for care and sharing that information with other caregivers is essential.6 When a child requires hospitalization the child may arrive self-referred, by ambulance, or by referral from the MH. Hospitalization is a significant …

Risk Minimization Activities of Centrally Authorized Products in the EU

: Since the new legislation on risk management, which came into force in November 2005, an EU Risk Management Plan (EU-RMP) is a required part of the authorization dossier of innovative drugs licensed in the EU. The EU-RMP can include additional risk minimization activities (RMAs) to strengthen the benefit-risk balance of a drug. This study describes the additional RMAs of centrally authorized medicinal products authorized between 1 January 1995 and 1 January 2010. : The European Public Assessment Reports of all centrally authorized products were analysed to identify characteristics of the product (active substance, authorization date, Anatomical Therapeutic Chemical classification), the additional RMAs and the corresponding safety concerns (classified at Medical Dictionary for Regulatory Activities (MedDRA) System Organ Class level). : Additional RMAs were identified for 58 of the 391 active substances that were authorized as of 1 January 2010. The proportion of active substances with additional RMAs was 5% among those authorized before, and 29% among those approved after the new risk management legislation. Since the new legislation, blood products and antineoplastic and immunomodulating agents most often had additional RMAs. All active substances with additional RMAs required the provision of educational material, most frequently involving healthcare professionals (n = 57) and the patient (n = 31). Thirty-three active substances required additional RMAs on top of the provision of educational material, most frequently including patient monitoring and screening (n = 19). : The proactive pharmacovigilance approach is evolving and the number of products with additional RMAs is growing since the introduction of the EU-RMP. The provision of educational material is the primary additional risk minimization strategy in the EU. The effect of additional RMA implementation has to be explored.

Improving pharmacovigilance in psychiatry

BackgroundIn the last years, Regione Lombardia, on behalf of the Italian Regulatory Agency (AIFA), promoted some pharmacovigilance projects: our hospital, that since 1980 has become one of the most representative...

The Female Athlete Triad

Context:The female athlete triad (the triad) is an interrelationship of menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density; it is relatively common among young women participating in sports. Diagnosis and treatment of this potentially serious condition is complicated and often requires an interdisciplinary team.Evidence Acquisition:Articles from 1981 to present found on PubMed were selected for review of major components of the female athlete triad as well as strategies for diagnosis and treatment of the conditions.Results:The main goal in treatment of young female athletes with the triad is a natural return of menses as well as enhancement of bone mineral density. While no specific drug intervention has been shown to consistently improve bone mineral density in this patient population, maximizing energy availability and optimizing vitamin D and calcium intake are recommended.Conclusions:Treatment requires a multidisciplinary approach involving health care professionals as well as coaches and family members. Prevention of this condition is important to minimize complications of the female athlete triad.

Assessment and treatment of malnutrition in Dutch geriatric practice: consensus through a modified Delphi study

scientific evidence regarding the optimal management of malnutrition in geriatric patients is scarce. Our aim was to develop a consensus statement for geriatric hospital practice concerning six elements: (i) definition of malnutrition, (ii) screening and assessment, (iii) treatment and monitoring, (iv) roles and responsibilities of involved health care professionals, (v) communication and coordination of care between hospital and community health care professionals, (vi) quality indicators for malnutrition management. a modified Delphi study. eleven geriatricians with special interest in malnutrition participated. In four rounds the experts rated the relevance of 204 statements, which were based on a literature review, on a five-point Likert scale. From the responses, means and 95% CIs were calculated. Consensus was defined as a lower 95% confidence limit ≥4.0. the panel reached consensus that malnutrition should be considered a geriatric syndrome. The nutritional status should be assessed using the Mini Nutritional Assessment combined with comprehensive geriatric assessment. Nutritional interventions should be combined with interventions targeting underlying factors. Specific goals for nutritional therapy and ways to achieve them were agreed upon. According to the experts, malnutrition is best managed by a multidisciplinary team for whom roles and responsibilities were specified. At discharge written information about the nutritional problem, treatment plan and goals should be provided to the patient, caregiver and community health care professionals. this study shows that a qualitative study based on a modified Delphi technique can result in national consensus on essential ingredients for a practical malnutrition guideline for geriatric patients.

Overview of systematic reviews - a new type of study: part I: why and for whom?

Healthcare decision-making is complex and should involve healthcare professionals, patients and the best level of evidence. The speed of information production creates barriers against keeping up to date. In this light, methodologists have proposed a new type of study: overviews of systematic reviews (OoRs). The aim here was to introduce and demonstrate the role of OoRs in information synthesis for healthcare professionals, managers, researchers and patients. Time-series study conducted at the Brazilian Cochrane Center, jointly with the Postgraduate Program on Internal Medicine and Therapeutics, Discipline of Emergency Medicine and Evidence-Based Medicine, Department of Medicine, Federal University of São Paulo. To show the growth in the numbers of published papers that provide high-level evidence and thus demonstrate the importance of OoRs for synthesis and integration of information, three filters for study designs were applied to two databases. An equation for predicting the expected number of published papers was developed and applied. Over the present decade, the number of randomized controlled trials in Medline might reach 2,863,203 and the number of systematic reviews might reach 174,262. Nine OoRs and 15 OoRs protocols have been published in the Cochrane Library. With the exponential growth of published papers, as shown in this study, a new type of study directed especially towards healthcare decision-makers was proposed, named "overview of systematic reviews". This could reduce the uncertainties in decision-making and generate a new hierarchy in the pyramid of evidence.

A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 2. Provision of professional services

BackgroundCrisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the second paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the provision of professional services by the team.MethodsThe project was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, constituted the complete registration of patients of this team in the period from February 2008 to July 2009.ResultsThe average length of service by the team was about 15 days, and those with depression as the major symptom had the longest mean length of stay on the team. The team was engaged in providing a variety of services including individual treatments involving multiple professionals, group treatment meetings, and coordination activities involving external service sectors. While the type of professionals providing individual treatment was not associated with the severity level of clinical problems, those receiving various group treatment meetings had more serious level of clinical symptoms than those not receiving group treatment meetings. In addition coordination activities involving healthcare professionals and social services in the community were in line with the patients' clinical and social needs. The results of the study show that the team functioned effectively in addressing the general guidelines for the functioning of CRHT teams.

Perspectives and Experience of Healthcare Professionals on Diagnosis, Prognosis, and End-of-Life Decision Making in Patients with Disorders of Consciousness

In the care of patients with disorders of consciousness (DOC), some ethical difficulties stem from the challenges of accurate diagnosis and the uncertainty of prognosis. Current neuroimaging research on these disorders could eventually improve the accuracy of diagnoses and prognoses and therefore change the context of end-of-life decision making. However, the perspective of healthcare professionals on these disorders remains poorly understood and may constitute an obstacle to the integration of research. We conducted a qualitative study involving healthcare professionals from an acute care university medical center. A short questionnaire captured demographic data as well as the experience of participants with DOC patients. A semi-structured interview was used to explore attitudes toward ethical issues identified in a previous literature review. Qualitative content analysis of interviews was conducted with the NVivo software. Accurate diagnosis among DOC is often regarded as a challenge, but this was generally not the case for our participants because most reported high confidence in DOC diagnoses. However, participants reported struggling with prognosis, especially because of its essential role for end-of-life decision making and communication with families. Variability of opinion between healthcare professionals was reported and identified by some as a minor issue while others stressed how families struggle with different medical opinions. End-of-life decision making encompassed a large proportion of ethical challenges in these patients, and the removal of artificial nutrition and hydration created significant discomfort in a minority of participants. The concept of futility was subject to wide-ranging understandings with both favorable and unfavorable opinions. Our data suggest that to ensure the incorporation of new evidence-based advances, attention should be directed to the real-world practices and challenges of accurate diagnosis and prognosis. Given pervasive challenges in end-of-life care, we recommend improved training of healthcare professionals in the care of patients with DOC, particularly in end-of life care, understanding the context of decision making, and determining how to optimally integrate new neuroscience research on the care of patients with DOC.

Assessing quality of care for the dying: The development and initial validation of a postal self-completion questionnaire for bereaved relatives

Background: Evaluating ‘quality of care for the dying’ from the patients’ perspective has practical and ethical difficulties: an alternative is to use bereaved relatives’ views as ‘proxy’ measures. Currently, within the United Kingdom, there is no validated instrument which specifically examines quality of care in the last days of life or the impact of the Liverpool Care Pathway (LCP) for the Dying Patient. Aim: To develop and validate a questionnaire for use with bereaved relatives assessing the quality of care for patients and families in the last days of life and the immediate period after the bereavement. Design: The instrument, ‘Evaluating Care and Health Outcomes – for the Dying’ (ECHO-D), was developed in four distinct phases: 1. Question formulation, 2. Expert panel review (n = 6), 3. Wider audience review (n = 25), 4. Pilot, including cognitive pre-testing interviews and preliminary test–retest reliability assessment with bereaved relatives (n = 80) Setting: The study was conducted within a hospice and an acute hospital involving healthcare professionals, lay members and bereaved relatives. Results: The systematic and robust process of questionnaire development generated evidence for ECHO-D’s face and content validity. Response rate for the pilot stage with bereaved relatives, however, was comparatively low (23.4%). Test–retest analysis from the pilot showed moderate or good stability for 13 out of 17 key questions, although small sample numbers limited the interpretation. Conclusions: ECHO-D is the first instrument specifically to assess ‘quality of care for the dying’, focussing on the last days of life, and has direct links with the use of the LCP Programme.

Administrative Law Adjudications Involving Healthcare Professionals: Mental Health Expert Testimony

Mental health experts are often needed to provide expert testimony about a respondent healthcare professional's retrospective mental state and prospective fitness for duty. This calls for the expert to parse the degree to which educational deficiency and mental illness were substantial contributing factors to any alleged past misconduct, and to offer recommendations for prospective mental health treatment and educational and supervisory remediation of any diagnosed disorders or deficiencies. Unlike adjudication of malpractice—in which the goal is to make an injured party whole by financial compensation for negligent harm—the goal of administrative agency investigation, adjudication, and peer review is to protect the public by serving as an overseer of the quality of the profession. Health care agency investigators and finders of fact require mental health experts who can discern applicable standards of care and procedure and who can offer opinions that may differ in nature substantially from those typically required in ordinary malpractice litigation.

Developing a community action plan to eliminate cancer disparities: lessons learned.

African Americans bear an unequal burden of breast, cervical, and colorectal cancer. The Deep South Network for Cancer Control (DSN) is a community-academic partnership operating in Alabama and Mississippi that was funded by the National Cancer Institute (NCI) to address cancer disparities using community-based participatory research approaches. In addition to reporting on the plans of this work in progress, we describe the participatory process that local residents and the DSN used to identify needs and priorities, and elaborate on lessons learned from applying a participatory approach to the development of a community action plan. We conducted 24 community discussion groups involving health care professionals, government officials, faith-based leaders, and other stakeholders to identify cancer health disparity needs, community resources/assets, and county priorities to eliminate cancer health disparities. To develop a community action plan, four working groups explored the themes that emerged from the discussion groups, taking into consideration evidence-based strategies and promising community practices. The DSN formulated a community action plan focusing on (1) increasing physical activity by implementing a campaign for individual-level focused activity; (2) increasing the consumption of fruits and vegetables by implementing NCI's Body and Soul Program in local churches; (3) increasing cancer screening by raising awareness through individual, system, and provider agents of change; and (4) training community partners to become effective advocates. A community-academic partnership must involve trust, respect, and an appreciation of partners' strengths and differences. The DSN applied these guiding principles and learned pivotal lessons.

Final responsibility for treatment choice: the proper role of medical doctors?

To analyse whether the traditional allocation of decision-making responsibility is still justifiable. And, if not to analyse the strength of claims made by other health care professions and by patients.Traditionally doctors have been responsible for choices of treatment, both in terms of deciding and in terms of taking responsibility for the decisions. But modern health care work often takes place in teams involving health care professionals from different professions as well as the patient. In such teams it may not be obvious who should be responsible for treatment choice.Philosophical analysis of epistemic, ethical and organizational arguments, including analysis of the historical origins of these arguments.The epistemic, ethical and organizational arguments for maintaining a primary decision making role for doctors are not sound. Other health care professionals can, in some circumstances make stronger and more justified claims. The arguments against allocation decision making authority to patients are also invalid or unsound in many circumstances.There are many situations in which final responsibility for treatment choice should rest with health care professionals who are not doctors and with patients.

Closing the Gap between Guidelines and Practice in Perioperative Care

Closing the Gap between Guidelines and Practice in Perioperative Care

Parents’ self-efficacy, outcome expectations, and self-reported task performance when managing atopic dermatitis in children: Instrument reliability and validity

BackgroundSupport and education for parents faced with managing a child with atopic dermatitis is crucial to the success of current treatments. Interventions aiming to improve parent management of this condition are promising. Unfortunately, evaluation is hampered by lack of precise research tools to measure change. ObjectivesTo develop a suite of valid and reliable research instruments to appraise parents’ self-efficacy for performing atopic dermatitis management tasks; outcome expectations of performing management tasks; and self-reported task performance in a community sample of parents of children with atopic dermatitis. MethodsThe Parents’ Eczema Management Scale (PEMS) and the Parents’ Outcome Expectations of Eczema Management Scale (POEEMS) were developed from an existing self-efficacy scale, the Parental Self-Efficacy with Eczema Care Index (PASECI). Each scale was presented in a single self-administered questionnaire, to measure self-efficacy, outcome expectations, and self-reported task performance related to managing child atopic dermatitis. Each was tested with a community sample of parents of children with atopic dermatitis, and psychometric evaluation of the scales’ reliability and validity was conducted. Setting and participantsA community-based convenience sample of 120 parents of children with atopic dermatitis completed the self-administered questionnaire. Participants were recruited through schools across Australia. ResultsSatisfactory internal consistency and test–retest reliability was demonstrated for all three scales. Construct validity was satisfactory, with positive relationships between self-efficacy for managing atopic dermatitis and general perceived self-efficacy; self-efficacy for managing atopic dermatitis and self-reported task performance; and self-efficacy for managing atopic dermatitis and outcome expectations. Factor analyses revealed two-factor structures for PEMS and PASECI alike, with both scales containing factors related to performing routine management tasks, and managing the child's symptoms and behaviour. Factor analysis was also applied to POEEMS resulting in a three-factor structure. Factors relating to independent management of atopic dermatitis by the parent, involving healthcare professionals in management, and involving the child in the management of atopic dermatitis were found. Parents’ self-efficacy and outcome expectations had a significant influence on self-reported task performance. ConclusionsFindings suggest that PEMS and POEEMS are valid and reliable instruments worthy of further psychometric evaluation. Likewise, validity and reliability of PASECI was confirmed.

Physician Effectiveness in Interventions to Improve Cardiovascular Medication Adherence: A Systematic Review

Medications for the prevention and treatment of cardiovascular disease save lives but adherence is often inadequate. The optimal role for physicians in improving adherence remains unclear. Using existing evidence, we set the goal of evaluating the physician's role in improving medication adherence. We conducted systematic searches of English-language peer-reviewed publications in MEDLINE and EMBASE from 1966 through 12/31/2008. We selected randomized controlled trials of interventions to improve adherence to medications used for preventing or treating cardiovascular disease or diabetes. Articles were classified as either (1) physician "active"-a physician participated in designing or implementing the intervention; (2) physician "passive"-physicians treating intervention group patients received patient adherence information while physicians treating controls did not; or (3) physicians noninvolved. We also identified studies in which healthcare professionals helped deliver the intervention. We did a meta-analysis of the studies involving healthcare professionals to determine aggregate Cohen's D effect sizes (ES). We identified 6,550 articles; 168 were reviewed in full, 82 met inclusion criteria. The majority of all studies (88.9%) showed improved adherence. Physician noninvolved studies were more likely (35.0% of studies) to show a medium or large effect on adherence compared to physician-involved studies (31.3%). Among interventions requiring a healthcare professional, physician-noninvolved interventions were more effective (ES 0.47; 95% CI 0.38-0.56) than physician-involved interventions (ES 0.25; 95% CI 0.21-0.29; p < 0.001). Among physician-involved interventions, physician-passive interventions were marginally more effective (ES 0.29; 95% CI 0.22-0.36) than physician-active interventions (ES 0.23; 95% CI 0.17-0.28; p = 0.2). Adherence interventions utilizing non-physician healthcare professionals are effective in improving cardiovascular medication adherence, but further study is needed to identify the optimal role for physicians.

Acidentes de trabalho com profissionais de saúde de um hospital universitário

Esta pesquisa almejou estudar os registros de acidentes de trabalho envolvendo profissionais de saúde em um hospital universitário, determinando as categorias profissionais com maiores índices de ocorrências e os setores mais críticos da organização. Os dados dos registros de acidentes analisados foram: sexo, idade, profissão, local do acidente, tipo de acidente, agente da lesão, área afetada e número de horas entre o início da jornada e a ocorrência do acidente. Os documentos foram obtidos através da Comissão Interna de Prevenção de Acidentes (CIPA) do hospital e os dados foram analisados com a aplicação do teste do Qui-Quadrado para avaliar as diferenças entre dados. As mulheres e a equipe de enfermagem foram os mais acometidos e a maioria dos acidentes envolveu material biológico. Houve ocorrência significativa entre 0 e 4 horas após o início da jornada. Estas informações deverão embasar medidas preventivas entre os profissionais de saúde e da administração.