Licensed Health Care Providers Research Articles

Genital Modifications in Prepubescent Minors: When May Clinicians Ethically Proceed?

When is it ethically permissible for clinicians to surgically intervene into the genitals of a legal minor? We distinguish between voluntary and nonvoluntary procedures and focus on nonvoluntary procedures, specifically in prepubescent minors (“children”). We do not address procedures in adolescence or adulthood. With respect to children categorized as female at birth who have no apparent differences of sex development (i.e., non-intersex or “endosex” females) there is a near-universal ethical consensus in the Global North. This consensus holds that clinicians may not perform any nonvoluntary genital cutting or surgery, from “cosmetic” labiaplasty to medicalized ritual “pricking” of the vulva, insofar as the procedure is not strictly necessary to protect the child’s physical health. All other motivations, including possible psychosocial, cultural, subjective-aesthetic, or prophylactic benefits as judged by doctors or parents, are seen as categorically inappropriate grounds for a clinician to proceed with a nonvoluntary genital procedure in this population. We argue that the main ethical reasons capable of supporting this consensus turn not on empirically contestable benefit–risk calculations, but on a fundamental concern to respect the child’s privacy, bodily integrity, developing sexual boundaries, and (future) genital autonomy. We show that these ethical reasons are sound. However, as we argue, they do not only apply to endosex female children, but rather to all children regardless of sex characteristics, including those with intersex traits and endosex males. We conclude, therefore, that as a matter of justice, inclusivity, and gender equality in medical-ethical policy (we do not take a position as to criminal law), clinicians should not be permitted to perform any nonvoluntary genital cutting or surgery in prepubescent minors, irrespective of the latter’s sex traits or gender assignment, unless urgently necessary to protect their physical health. By contrast, we suggest that voluntary surgeries in older individuals might, under certain conditions, permissibly be performed for a wider range of reasons, including reasons of self-identity or psychosocial well-being, in keeping with the circumstances, values, and explicit needs and preferences of the persons so concerned. Note: Because our position is tied to clinicians’ widely accepted role-specific duties as medical practitioners within regulated healthcare systems, we do not consider genital procedures performed outside of a healthcare context (e.g., for religious reasons) or by persons other than licensed healthcare providers working in their professional capacity.

Bleeding Control Protections Within US Good Samaritan Laws.

In the United States, all 50 states and the District of Columbia have Good Samaritan Laws (GSLs). Designed to encourage bystanders to aid at the scene of an emergency, GSLs generally limit the risk of civil tort liability if the care is rendered in good faith. Nation-wide, a leading cause of preventable death is uncontrolled external hemorrhage. Public bleeding control initiatives aim to train the public to recognize life-threatening external bleeding, perform life-sustaining interventions (including direct pressure, tourniquet application, and wound packing), and to promote access to bleeding control equipment to ensure a rapid response from bystanders. This study sought to identify the GSLs in each state and the District of Columbia to identify what type of responder is covered by the law (eg, all laypersons, only trained individuals, or only licensed health care providers) and if bleeding control is explicitly included or excluded in their Good Samaritan coverage. Good Samaritan Laws providing civil liability qualified immunity were identified in all 50 states and the District of Columbia. One state, Oklahoma, specifically includes bleeding control in its GSLs. Six states - Connecticut, Illinois, Kansas, Kentucky, Michigan, and Missouri - have laws that define those covered under Good Samaritan immunity, generally limiting protection to individuals trained in a standard first aid or resuscitation course or health care clinicians. No state explicitly excludes bleeding control from their GSLs, and one state expressly includes it. Nation-wide across the United States, most states have broad bystander coverage within GSLs for emergency medical conditions of all types, including bleeding emergencies, and no state explicitly excludes bleeding control interventions. Some states restrict coverage to those health care personnel or bystanders who have completed a specific training program. Opportunity exists for additional research into those states whose GSLs may not be inclusive of bleeding control interventions.

The Value of Strength as a Predictor of Musculoskeletal Injury in Canadian Armed Forces Basic Infantry Candidates.

Musculoskeletal injuries (MSKI) impact military organizations by threatening their operational readiness, warranting investigation into relevant factors to inform risk reduction strategies. While several self-reported and physical performance measures have been associated with MSKI among military personnel, few have been validated and none have been reported in Canadian basic infantry candidates. The purpose of this study was to investigate associations between self-reported and physical performance measures and MSKI, and determine their validity as predictors of MSKI, in Canadian basic infantry candidates. This was a planned secondary analysis of a study tracking MSKI at a basic infantry training facility in Ontario, Canada approved by Defence Research & Development Canada. Before the basic infantry training, consenting candidates completed a baseline testing session including self-reported questionnaires, measures of anthropometry, and physical performance previously associated with MSKI (ankle dorsiflexion test, Y-Balance Test, Isometric Mid-Thigh Pull, and the Fitness for Operational Requirements of CAF Employment (FORCE) evaluation). All MSKI reported by candidates were diagnosed by licensed healthcare providers. From a total sample of 129 candidates, 76% (n = 98) were used to determine any associations between baseline testing variables and MSKI and to develop a predictive model (Development Sample), while 24% (n = 33) were used to offer preliminary validation of the same predictive model (Validation Sample). The binary logistic regression and independent sample t-testing determined independent associations with MSKI in the Development Sample. All continuous variables and dichotomous variables previously associated with MSKI risk (Smoker Yes/No, previous history of MSKI, and physical inactivity) were entered into a backward stepwise logistic regression analysis to assess the predictive association with MSKI incidence in the Development Sample. The regression model was then applied to the Validation Sample. A total of 35 MSKI were diagnosed by Health Services Centre staff. The majority of the MSKI were acute (63%), sustained to the hip, knee, and ankle (74%). The most common diagnoses were strains and sprains (71%). Uninjured participants performed significantly better on the Relative Isometric Mid-Thigh Pull, FORCE 20 mR, FORCE ILS, and FORCE Estimated VO2peak compared to injured participants. Logistic regression analysis showed that the only variable with significant independent association with diagnosed MSKI incidence was self-reported previous history of MSKI. However, the backward stepwise logistic regression analysis retained self-reported previous history of MSKI, FORCE SBD, FORCE Estimated VO2peak, and Isometric Mid-Thigh Pull Peak Force as predictors of MKSI. The logistic regression model including these variables could predict MSKI with an accuracy of 79% in the Development Sample and 67% in the Validation Sample. This study provides preliminary support for the value of measures of absolute muscular strength and cardiorespiratory fitness as predictors of MSKI in Canadian basic infantry candidates. Given the associations between physical performance measures and MSKI, and their necessity during occupational tasks, it is recommended that Canadian basic infantry training facilities integrate resistance training with external loads to best prepare their candidates to meet their occupational demands and potentially minimize MSKI. Further investigations to confirm the predictive capacity of these variables in a larger sample across additional facilities are warranted.

Provider-Perceived Impacts of Social Vulnerability on Patients’ Access to Care During the COVID-19 Pandemic

Objective: To study the provider-perceived impacts of social vulnerability on patients’ access to care during the COVID-19 Pandemic. Data Sources and Study Settings: Survey data was collected from healthcare providers in a medium-sized county within a south-eastern state in the U.S. during the COVID-19 pandemic. Study Design: A cross-sectional mixed-method survey design was utilized to collect qualitative and quantitative data from study participants. Data Collection: Healthcare providers were recruited from all major healthcare-related state licensure boards, including nurses, physicians, psychologists, social workers, and mental health counselors. The final study sample consisted of 141 licensed healthcare providers. Principal Findings: Healthcare providers in our study indicated that the social vulnerability factors impacted patients’ access to care. This study provides recommendations for improving access to care among socially vulnerable populations during pandemics as a means to reduce health disparities. The study also identifies areas for future research.

A collaboration between first- and second-line healthcare for persons with a disability in Flanders to strengthen quality of care, continuity of care and affordability of care.

The introduction of personal financing within the disability sector, in Flanders, in 2017, created the opportunity to enter into broader collaborations with other professional services. This allows us to strengthen the quality of care and support for people with disabilities. We therefore started a collaboration between first and second line healthcare. This collaboration is based on 3 major pillars, quality of care, continuity of care and affordability of care. With the introduction of personal financing in the disability sector, care focusses more on the person with a disability. The adult person is allocated a budget based on his need for support and can buy care and support with it. These can be purchased more widely than only from the healthcare providers licensed by the VAPH (Flemish Agency for Persons with Disabilities). When we look at quality of care, we use the expertise of both partners. The licensed care provider mainly directs the disability-specific part whereas support in the daily ADL activities comes from home care. Both partners always coordinate with each other and the first focus is always on the person with a disability, which takes a central role. Drawing up individual support plans, linked to objectives, is one of the tasks of the licensed healthcare provider. Home care provides value in carrying out this objective together with the person with a disability. In a concrete example: the residential supporter indicates that the resident is learning to handle money, the home care supporter takes this into account during the purchases at the bakery together with the client and gives feedback to the residential supporter about the experience. We strengthen the quality of care by combining the expertise of both parties and create more time to work at the person's pace. In doing so, we focus on talent, rather than starting from the disability.Two components are important for the continuity of care: the effective presence, but also the fixed character of the employees who are present. People with disabilities are more sensitive to change than other target groups. That is why focusing on continuity, both in time and in person, is important in this partnership. The home care selects a group of employees to commit as a team. The residents therefore can always rely on the same people for support at home: the number of faces remains limited and a bond of trust is created. To ensure continuity in time, the team members replace each other when needed, so the support is continuous. With home care we enter the (replacing) home situation and we focus the tasks on supporting the person. As a result, we can also invoice the person according to the regulations within home care. We only have to calculate the customer contribution and that makes it affordable. We work in 1-on-1 situations, but we also support in groups. In the latter case, the costs are shared by all persons who use the support. Through this partnership, we create a more high-quality, affordable care for people with disabilities.

COLLABORATION IN CARING FOR OLDER ADULTS WITH DEMENTIA LIVING IN LONG-TERM CARE FACILITIES

Abstract Current evidence calls for an interdisciplinary, team approach to caring for older adults with dementia. Registered dietitian nutritionists (RDNs) are interdisciplinary team members who play an important role in nutrition and dementia care. Our study explored how RDNs collaborate with licensed healthcare providers and direct care staff to provide nutrition care for older adults with dementia living in long-term care (LTC) facilities. RDNs who work with residents with dementia in the U.S. (n = 18) were recruited to participate in one of five focus groups, where they described the various disciplines they collaborate with. Focus groups were led by a trained moderator using a semi-structured interview guide, transcribed verbatim, and audited by the research team for accuracy. Transcripts underwent descriptive content analyses using NVivo© software. Descriptive content analyses revealed the following diverse groups who work collaboratively with RDNs: 1) nursing staff, 2) foodservice staff, 3) therapists, 4) physicians, and 5) other non-clinical staff, including activities staff and nursing home administrators. Additionally, RDNs reported they worked closely with residents’ family members and resident members of the food committee. In conclusion, in LTC settings, RDNs collaborate with various groups, encompassing clinical, non-clinical, and even residents/family to care for older adults with dementia. However, collaboration is not limited to clinical staff. To provide optimal nutrition care for older adults with dementia, it is important to recognize the value of collaborating with both clinical and non-clinical stakeholders to meet resident needs.

CONTEXTUALIZING THE RANGE OF MEDICATION-RELATED REGULATORY REQUIREMENTS IN ASSISTED LIVING

Abstract Prior research has investigated the severity and scope of medication-related deficiency citations; less is known about the specificity of regulatory requirements governing medication-related practices in assisted living (AL). We examine the variation of regulatory specificity for two common policies: medication record review and administration. We coded state requirements for 196 AL licenses linked to 33,246 ALs in the U.S for the presence of specific requirements, weighted for increasing precision (1-4), summed and divided by the maximum value to produce a score ranging from no specificity (0) to maximum specificity (1). Medication record review specificity includes: regularly scheduled review of resident medications generally (1), by AL staff (2), or by a licensed healthcare professional (3). Specificity of staff who administer oral medication includes: direct care staff permitted (1), certified nursing assistant or medication aide required (2), licensed practical/vocational nurse required (3), registered nurse required (4). Most facilities operate under licenses that only require general review of residents’ medications (62%) and 32% required medication review by a licensed healthcare provider. Most facilities’ licensure requirements permit direct care workers to administer medications (63%) and 16% require a licensed nurse to administer. One in six facilities have requirements that do not address who is permitted or required to administer oral medications. Overall, 36% of facilities operated under regulations that had an overall specificity score ( management and administration) of 0.5 or higher. While most ALs are licensed with low medication policy specificity, understanding regulatory expectations can contextualize and inform medication practices within these settings.

ENGAGEMENT OF NURSING HOME COMMUNITY EXPERTS TO MODIFY THE DIGNITY INTERVENTION

Abstract Voices of Nursing Home (NH) residents, family caregivers, staff and leaders (community experts) are underrepresented in research development but integral when developing interventions for implementation these complex organizations. This study aimed to explore opinions of NH community experts in the development of a novel person-centered risk management intervention for residents with dementia. Community engagement studios (CES) engaged 62 community experts to gain their perspectives on the DIGNITY (Decision-making in aging and dementia for autonomy) study procedures and instruments. CESs (N=4) were led by an experienced moderator and co-moderator, recorded, and transcribed verbatim. Content analysis was used to summarize responses in a rapid feedback loop. Descriptive statistics of standard measures describe community experts’ ratings of acceptability, appropriateness, and feasibility of DIGNITY intervention. Most community experts identified as female (85%), ranging from 22 - 86 years. Participants were residents with dementia (n=4); family caregivers (n=4); NH administrators (n=16), care manager/ supervisors (n=10), direct-care workers (n=6) licensed healthcare providers (n=6), other NH staff (n=8), ombudsman (n=4) and state surveyors (n=4). Community experts provided suggestions to adapt the study instruments and delivery methods. The study team made changes to all six intervention elements based on expert feedback. Most experts agreed that the DIGNITY intervention was acceptable (M=17.7, SD= 2.08), appropriate (M= 17.24, SD= 2), and feasible (M=16.91, SD= 2.22) to implement in the NH community. Results support practical modifications to the DIGNITY intervention to make it feasible to implement in an upcoming pilot clinical trial.

The Role of Peer Providers to Scale Up Psychological Treatments for Perinatal Populations Worldwide.

Psychological treatments remain largely inaccessible to perinatal populations despite their robust effectiveness. This gap ispartly due to the limited numberof available treatment providers. In this review, we critically evaluate recent literature on task-sharing to peer providers and propose future directions. There is a growing evidence base demonstrating that peer providers can effectively deliver psychological treatments for perinatal populations, as well as engage in processes critical to quality assurance, such as measurement-based peer supervision. Findings have also highlighted some benefits of peers over licensed healthcare providers, such as enhanced collaborative relationships, reduced stigma, provision of social comparisons, and increased accessibility. Peer providers may be one solution to improve access to psychological treatments for perinatal populations. However, there is a need to address clinical, professional, and health-system level barriers to effectively leverage this cadre of treatment providers.

Impact of Statewide Statute Limiting Days’ Supply to Opioid-Naive Patients

To address the ongoing opioid crisis, states use policy enactment to restrict prescribing by licensed healthcare providers and mandate the use of Prescription Drug Monitoring Programs. There have been mixed results regarding the effectiveness of such state policies. The purpose of this study is to evaluate the impact of Colorado Senate Bill 18-022, which limits opioid prescriptions to ≤7-day supply among patients without an opioid prescription in the previous year (i.e., are opioid naive). This is a retrospective interrupted time-series analysis of opioid prescribing to evaluate the weekly percentage of opioid prescriptions consistent with statutory limits for ≤7-day supply among opioid-naive patients before and after enactment using Prescription Drug Monitoring Programs data from May 21, 2017 to May 25, 2019. Statistical analysis was performed in 2021-2022. The weekly percentage of opioid prescriptions ≤7-day supply increased by an average of 0.12% per week (p<0.0001) from 79.7% to 87.4% in the week before enactment. The week after enactment, the average increased by 0.2% (p=0.67). The year after enactment, the average weekly percentage change was 0.07% per week, a 0.05% decrease (p=0.01). Statutory limits on days' supply among opioid-naive patients had little impact on opioid prescribing in Colorado. Legislating limits on opioid prescribing should be evaluated using Prescription Drug Monitoring Program data and considered for deimplementation when not impactful.

A-10 Virginians Report Unequal Access to Appropriate Licensed Healthcare Providers for Concussion

Abstract Purpose Virginia state law requires athletes with suspected concussions to be evaluated and receive written clearance from an appropriately licensed healthcare provider (HCP) before returning to play. This HCP is defined as a physician, physician assistant, athletic trainer (AT), neuropsychologist, physical therapist, or nurse practitioner. However, little is known regarding whether access to HCPs in Virginia differs by locality. We explored stakeholders’ access to HCPs. Methods An electronic survey assessed school and community stakeholders’ perceptions of accessibility to HCPs. Results were stratified by locale (National Center for Education Statistics locality classifications). Participants were a convenience sample recruited through collaboration with state professional organizations. Results 400 respondents (city [n=61, 15%], suburban [n=142, 36%], town [n=67, 17%], and rural [n=130, 33%]) completed the survey. Overall, three out of four (77%) reported having access to community HCPs, though rates were substantially higher among those from cities (92% city, 80% suburban, 80% town). However, only 66% of respondents from rural areas reported access to an HCP. Additionally, when asked about access to an AT, 45% of stakeholders responded that they had no access to an AT. Most respondents with no AT access were from suburban (34%) or rural (39%) locales, and 43% reported traveling &amp;gt;30 minutes to access an HCP. Conclusions Our findings indicate access disparities such that rural Virginians report less access to licensed HCPs for concussion clearance. In communities without an AT, it may require considerable travel to reach an HCP. Further investigation is needed into strategies that promote equal access to HCPs.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

Cross-Sectional Survey of Acupuncturists in the United States Who Prescribed Chinese Herbal Medicine for Patients with Symptoms Likely Related to COVID-19.

Objective: The objective of this study was to examine the prescribing of Chinese herbal medicine (CHM) by licensed acupuncturists in the United States during the COVID-19 pandemic. Methods: A 28-question survey with nine branching questions was disseminated through collegial networks, paid advertisements, and a study website in April-July 2021. Participants indicated that they were licensed acupuncturists who treated more than five patients for symptoms likely related to COVID-19 to gain entry to the full survey. Surveys were undertaken electronically through the Research Electronic Data Capture (REDCap) system. Results: The survey was undertaken by 103 participants representing all US geographic regions and had an average of 17 years in practice. Sixty-five percent received or intended to receive the COVID-19 vaccine. Phone and videoconference were the predominant methods of patient contact; granules and pill forms of CHM were the most prescribed. A wide variety of information sources were used in devising patient treatments inclusive of anecdotal, observational, and scientific sources. Most patients were not receiving biomedical treatment. Ninety-seven percent of participants reported that they had no patients die of COVID-19, and the majority reported that <25% of their patients developed long hauler syndrome (post-acute sequelae SARS-CoV-2 infection). Conclusions: This study demonstrates that licensed acupuncturists were treating COVID-19 infected individuals in the United States during the early stages of the pandemic, and for many such patients this was the only therapeutic intervention they had access to from a licensed health care provider. Information disseminated from China through collegial networks, along with published sources including scientific studies, informed the approach to treatment. This study provides insight into an unusual circumstance in which clinicians needed to establish evidence-based approaches to the treatment of a new disease during a public health emergency.

Extending health care access via telemedicine in public libraries.

Despite the potential for telemedicine in public libraries to expand health care access to those living a long distance from care and in broadband poor areas, there are few libraries that collaborate with providers to extend access. To explore licensed health care providers' perspectives on telemedicine in public libraries as a method of improving equitable access to care for populations lacking the ability to connect to telemedicine from home. We used a two-phase explanatory sequential mixed methods design with a quantitative strand followed by a qualitative strand. Surveys were analyzed descriptively. Interviews were analyzed thematically using descriptive content analysis. Of the 50 survey respondents, 13 were physicians and 36 were nurse practitioners (NPs); 12 NPs were interviewed. NPs were overwhelmingly supportive of telemedicine in public libraires, describing how connecting at-risk populations to a video visit (VV) allowed for a more thorough and accurate assessment than a phone call. Although several NPs were concerned with privacy, others considered a library to be more private than the home. Interviews revealed how chronic illness management may be the ideal visit type for public library-based telemedicine. Given the importance of expanding access sites for telemedicine, NPs should consider partnering with libraries in their catchment areas where broadband access is sparse and patients must travel long distances to care. Managing chronic illnesses using telemedicine in public libraries may be an important approach toward reducing health disparities in populations who live in long distances from care and do not have home-based internet access.

Do Сovid-19 vaccines cause shoulder injuries: a survey among health care providers at Najran University hospital

Background: Shoulder injury related to vaccine administration (SIRVA) is a rare but serious side effect of the COVID-19 vaccine. The incidence of SIRVA among healthcare providers is not well understood. Aim: To investigate the incidence of SIRVA among healthcare providers working at a National University Hospital in Saudi Arabia and to assess their knowledge of SIRVA. Methodology: A cross-sectional online survey was distributed to all licensed healthcare providers currently employed by the National University Hospital. The survey collected information on personal, professional, and demographic characteristics, as well as symptoms and experiences related to SIRVA. Results: Of the 81 participants, 69.1% reported experiencing pain in their shoulder after receiving the COVID-19 vaccine, with 50% rating their pain as average (4-6 on a scale of 1-10) and 41.1% rating their pain as severe (7-10). Only 4.9% of participants reported visiting an orthopedic clinic for SIRVA and 76.5% did not receive treatment for their symptoms. A majority of participants (58%) believed that SIRVA occurs when the vaccine is injected too high up on the upper arm, with 34.6% believing it occurs in the middle of the upper arm and 7.4% believing it occurs too low down on the upper arm. It was also found that only 14.3% of participants were able to correctly identify the cause of SIRVA as accidental injection into the subdeltoid bursa. Additionally, a majority of participants believed that SIRVA is a rare condition (49.4%), and only a small percentage had received training about SIRVA (5.9%). Conclusions: These findings indicate a significant incidence of SIRVA among healthcare providers working at the National University Hospital and highlight the need for increased education and awareness about SIRVA among healthcare providers, as well as proper training in injection techniques to reduce the incidence of SIRVA.

The current state of transplant advanced practice providers: results of the advanced practice provider practice survey

Advanced practice providers (APPs) are trained, licensed health care providers. The American Society of Transplant APP community of practice developed an electronic survey to investigate transplant APP demographics, scope of practice, and academic activities. We defined the top of scope of practice as delivering health care to the fullest extent of APP education and training as allowed by state laws and regulations. From July 11, 2020, to August 31, 2020, 307 invitations were e-mailed and survey links were distributed electronically on the community of practice hub and social media. Two hundred fifty-three APPs responded. APPs practice in inpatient and outpatient settings. Among the respondent APPs, 11.5% assist in the operating room (OR), 46.3% of inpatient and 46.6% of outpatient APPs perform procedures, and 17.8% run specialized APP clinics. 26.2% feel they do not function at the top of their scope of practice and 29.7% were expected to function as a coordinator some or all of the time. Forty-three percent gave invited lectures, 41.5% have published, and 69.2% teach physician trainees. 74.7% and 35.1%, respectively, would like to participate in research and teach but are limited by time, opportunity, and experience. APPs should practice at the top of their scope of practice. Clinical workloads and lack of time limit the ability of APP to teach and contribute to evidence-based practice.

Antibiotic Resistance: An upcoming Pandemic

Antibiotics are medications that are used to both prevent and treat bacterial infections. Antibiotic resistance arises when bacteria adapt to the usage of antibiotics. Antibiotic resistance develops in bacteria rather than in humans or other animals. These germs can infect both humans and animals, and their infections are more difficult to treat than those caused by non-resistant bacteria. Antibiotic resistance causes greater mortality, longer hospital stays, and higher medical expenses. Our capacity to cure widespread infectious illnesses is being threatened by the emergence and worldwide dissemination of new resistance mechanisms. As antibiotics lose their potency, an increasing range of ailments, such as gonorrhoea, blood poisoning, pneumonia, and tuberculosis (TB), become difficult to treat and, in some cases, incurable. In every region of the globe, antibiotic resistance is increasing to dangerously high levels. It poses a serious danger to public health on a global scale, killing at least 1.27 million people and contributing to approximately 5 million deaths in 2019 [1]. More than 4.6 billion dollars a year is the projected cost to treat infections brought on by six multidrug-resistant pathogens that are often seen in healthcare settings. Escherichia coli is the pathogen that is most commonly reported in Pakistan (68.8% in 2018) [2, 3].&#x0D; Antibiotic resistance jeopardizes advances in contemporary medicine. The main issues and concerns in Pakistan are a large number of surplus registered drugs (approximately 50,000), self-medication by more than 50% of the population, and a substantial number of quacks in the country. On average, each patient is given more than three drugs, and antibiotics are given to 70% of patients which is the highest number of prescriptions as compared to rest of the world. General practitioners (GPs) and public hospitals, which favor expensive broad-spectrum antibiotics, are more prone to prescribe these medications impulsively and without consideration [3]. Antibiotic abuse and misuse, as well as inefficient infection prevention and control, all contribute to the rapid spread of antibiotic resistance. Actions can be taken at all societal levels to mitigate the consequences and prevent resistance. Antibiotics should only be used as advised by a licensed healthcare provider. Doctors should only prescribe and give antibiotics when absolutely required, according to current recommendations. To address antibiotic resistance, the government must implement a comprehensive national action plan.

The impact of follow-up calls after a pediatric emergency department visit

Pediatric emergency department (ED) visits can be a stressful time for patients and their caregivers. This high stress environment can lead to questions and needed clarifications post-discharge. We implemented a post-discharge callback system to resolve these concerns for a focused subset of patients who historically have provided the most negative comment feedback on ED patient experience surveys. We hypothesized that comment types would shift to more positive than negative and the themes of the comments received would change. We developed a discharge callback process that focused on patients who were triaged as ESI level 4 during their emergency department visit. Over a 6-week period, patients were called the day after discharge and asked if they had questions regarding their recent ED visit in addition to questions regarding current health, post-discharge instructions, prescriptions, or follow-up instructions if applicable. A maximum of 3 discharge calls were made if needed in order to contact the patient or family. Any questions regarding health care needs were followed up by a licensed healthcare provider within 24 hours with a maximum of 3 attempts. At the end of the project timeframe we analyzed comments received from our patient experience surveys to identify if there was a shift in comment types and their themes. In addition, we analyzed ED return rates within 72 hours of discharge. During the 6-week period, 2710 calls were made to contact 1618 patients’ caregivers. Follow up was requested by 149 families with a healthcare provider. There was no significant change in the number of comment types received. Thematic analysis of the patient experience survey comments received during this time period, revealed a reduction in questions regarding the recent ED visit and post discharge needs. There was no significant change in 72-hour ED return rates. The institution of an ED discharge callback system can effectively reduce patients’ and families’ questions regarding post-discharge care by providing an opportunity to clarify care after they have left the emergency department.

Type 2 Diabetes Self-Management Interventions Among Asian Americans in the United States: A Scoping Review.

Introduction:Type 2 diabetes (T2D) is one of the leading causes of death among Asian Americans. Despite being a culturally diverse racial group with differences in history, language, religion, and values, Asian Americans are often viewed as a monolith. With the high prevalence rate of T2D, a careful examination of self-management interventions across Asian Americans is needed to develop effective and culturally sensitive interventions.Objective:To describe existing literature by examining study characteristics, different intervention components, and outcome measures of various T2D interventions among Asian Americans.Methods:Using Arksey and O'Malley's framework to ground this review, six online databases were used to identify studies.Results:A total of 18 publications were included. Thirteen studies were published after 2013, with 44% and 22% of these studies focused on Chinese Americans and Korean Americans. We found a lack of geographic diversity in the location of the studies. Majority of the participants were females. Most of the interventions were implemented in person. Licensed health care providers were the most common interventionists, with a number of studies using community health workers. Outcome measures focused on three key areas: physiological, psychosocial and behavioral, and program-related outcomes. Many of the studies measured changes in HbA1C, self-efficacy, distress, depression, and quality of life. Overall, we saw improvements in physiological measures in most of the studies. For example, majority of the studies showed a decline in the participants' HbA1C. Most studies showed an increase or improvement in healthy behaviors. Studies that measured efficacy, knowledge, attitude, motivation, quality of life, or general health showed improvement from baseline. All the studies that measured distress or depression showed a reduction of symptoms postintervention.Conclusion:Overall, we found that culturally tailored interventions that focus on specific Asian American subpopulations saw an improvement in physiological, psychosocial, or behavioral measures. There were several gaps in the existing T2D self-management programs or interventions among Asian Americans studied in the United States. Based on our analysis, we recommend when designing or implementing self-management interventions among Asian Americans, considerations should be made for targeted recruitment for understudied Asian American subgroups, gender, and location.

Effect of Concussion on Reaction Time and Neurocognitive Factors: Implications for Subsequent Lower Extremity Injury.

BackgroundRecent evidence has demonstrated that athletes are at greater risk for a lower extremity injury following a return-to-sport (RTS) after sport-related concussion (SRC). The reason for this is not completely clear, but it has been hypothesized that persistent deficits in neurocognitive factors may be a contributing factor.Hypothesis/PurposeThis study assessed simple reaction time, processing speed, attention, and concentration in a group of athletes, post-concussion upon clearance for RTS for potential deficits that may result in slower reaction time, processing speed, attention, and concentration. The researchers hypothesized that the concussion group would demonstrate worse scores on both assessments compared to a sex-, age-, and sport-matched cohort.Study DesignCase-controlled studyMethodsTwelve participants who had suffered a SRC and eight healthy individuals who were matched to the concussed group by age, sex, and sport were evaluated. Those with a concussion had been cleared for RTS by a licensed healthcare provider. Each participant underwent neurocognitive tests that included a simple reaction time test (SRT) and the King-Devick Test (K-D). Independent t-tests were performed to compare the groups with significance set a priori at p<0.05.ResultsThere was a significant difference (p =0.024) between groups for SRT with the concussed group demonstrating a better SRT than the control group. There were no significant differences (p =0.939) between the groups for the K-D.ConclusionWith no significant differences between groups in the K-D assessment and, surprisingly, the concussed group having a better SRT compared to the healthy group, our hypothesis was not supported.Clinical RelevanceThese specific measures, compounded with extensive post-concussion time lapse until RTS clearance, may have limited capacity in revealing potential persistent deficits in relevant neurocognitive characteristics.Level of EvidenceLevel of Evidence 3