Members Of Health Care Team Research Articles

Cognitive Symptoms Across Diverse Cancers

Psychosocial health services for adults with cancer should include support for cognitive symptoms and symptom clusters. To characterize the frequency and severity of cognitive symptoms and to identify demographic and clinical risk factors associated with moderate to severe cognitive symptoms among outpatient adults with cancer seeking psychosocial support. This cross-sectional study analyzed data from routine patient-reported symptom screening during clinic appointments at the Princess Margaret Cancer Centre in Toronto, Canada, between January 1, 2013, and December 31, 2019. Participants were outpatient adults (aged ≥18 years) with diverse cancer diagnoses who endorsed interest in receiving psychosocial support from a health care team member. Data analysis was performed from April 2020 to June 2024. The presence and severity of cognitive symptoms as self-rated by participants were characterized across 12 cancer types: brain or central nervous system (CNS), breast, gastrointestinal, head and neck, gynecological, thyroid, lung and bronchus, sarcoma, genitourinary, melanoma, hematological, and all other cancers. Multivariable logistic regression was used to explore the associations between demographic, clinical, and symptom factors and moderate to severe cognitive symptoms. Across the sample of 5078 respondents (2820 females [55.5%]; mean [SD] age at time of survey, 56.0 [14.1] years) requesting psychosocial support, 3480 (68.5%) reported cognitive symptoms of any severity, ranging from 59.5% in sarcoma to 86.5% in brain or CNS cancer. Moderate to severe cognitive symptoms were reported by 1544 patients (30.4%), with the proportions being 51.3% for patients with brain or CNS, 37.0% for breast, 36.2% for thyroid, 30.9% for melanoma, 29.6% for head and neck, 28.3% for gastrointestinal, 28.2% for hematological, 28.1% for gynecological, 24.9% for lung and bronchus, 24.9% for sarcoma, 21.0% for genitourinary, and 26.8% for all other cancers. Across the entire sample, moderate to severe cognitive symptoms were associated with recurrence or progression involving the CNS (odds ratio [OR], 2.62; 95% CI, 1.80-3.81), depression (OR, 1.92; 95% CI, 1.59-2.31), tiredness (OR, 1.82; 95% CI, 1.52-2.19), drowsiness (OR, 1.64; 95% CI, 1.39-1.93), anxiety (OR, 1.57; 95% CI, 1.30-1.89), shortness of breath (OR, 1.38; 95% CI, 1.16-1.61), female sex (OR, 1.33; 95% CI, 1.14-1.56), first-line chemotherapy received (OR, 1.22; 95% CI, 1.05-1.41), and metastatic disease at diagnosis (OR, 0.74; 95% CI, 0.61-0.89). Within individual cancer types, tiredness and depression were consistently associated with moderate to severe cognitive symptoms. This cross-sectional study found that cognitive symptoms were frequently reported by patients across a wide range of cancer types; higher severity of cognitive symptoms was consistently associated with higher symptom burden. The findings could be used to inform decision-making regarding access to cognitive screening, assessment, and supportive care in outpatient oncology clinics.

Advancing ocular oncology care through teleophthalmology: a patient-centric perspective

ObjectiveAssessing patient satisfaction is an important component of understanding a program's efficacy and quality. The purpose of this study is to evaluate patient satisfaction with a teleophthalmology program tailored for ocular oncology that provides screening, remote assessment, care planning, and follow-up. Study designRetrospective survey. MethodsAn adapted version of the Telehealth Satisfaction Scale, consisting of the 8 questions plus 5 additional questions specific to the teleophthalmology program, was used to survey patients. The teleophthalmology program involves diagnostic imaging, remote physician assessments, and follow-up phone calls from health care team members to deliver results to patients. For reporting, the Consensus-Based Checklist for Reporting of Survey Studies was used. T-tests explored satisfaction differences across demographics and teleophthalmology visits. ResultsAmong the 95 patients contacted, 91 agreed to participate in the survey (96% response rate). Participants exhibited high overall satisfaction with the teleophthalmology program, reflected in a mean Telehealth Satisfaction Scale score of 28.88 (SD = 3.35 of 32). The median number of teleophthalmology visits completed was 4.0 (range of 1–8 appointments). No significant differences in satisfaction were found on the basis of age (P = 0.56), urban or rural residence (P = 0.17), or the number of telemedicine appointments (P = 0.51). ConclusionsThis analysis displays high satisfaction levels among patients within an ocular oncology clinic participating in the current telemedicine program, irrespective of age, geography, or number of teleophthalmology visits. Participants reported having their health care needs met with minimal clinical encounters due to remote consultations and telephone communications.

Virtual Patient/Family Communication in the Acute Care Setting.

Patient and family-centered care strategies see patients and families as valuable healthcare team members and are therefore treated as essential clinical partners to achieve safe, high-quality care. Traditionally, hospitals have relied on physical presence as the primary strategy for including families in shared decision-making. During COVID-19, widespread visitor restrictions removed this primary strategy. Hospitals rapidly deployed virtual communication tools to address the challenges visitor restrictions created. The rapid deployment produced benefits and unintended consequences, especially for the healthcare providers. Through a series of qualitative interviews with family members and healthcare providers, consistent themes were identified and mapped to the sociotechnical model. This project identified barriers to adoption and proposed corresponding success criteria. Although the project focused on implementing virtual communication in the context of the COVID-19 pandemic, virtual communication strategies can likely support family-centered care goals outside of the pandemic context.

Unmasking the Contributing Factors to Oxygen Disruption Events in the Inpatient Environment and Emergency Department

Background Medical oxygen is frequently used in healthcare settings. Challenges with oxygen disruption, such as oxygen tanks running out due to communication issues between staff or tanks not being set up properly, have been noted in the limited existing literature. Challenges and patient safety issues associated with oxygen disruption persist. Utilizing a human factors approach, our study aims to understand the contributing factors and context of oxygen disruption–related patient safety event reports in the inpatient setting and provide person-based and system-based solutions. Methods Through keyword matching, we identified and then qualitatively analyzed 298 patient safety event reports to understand the factors contributing to oxygen disruption, patient location when the oxygen disruptions occurred, hand-off breakdowns by healthcare team member role, and whether high supplemental oxygen was being administered. Results The most frequent contributing factor to oxygen disruption was the patient not being transferred to another source of oxygen (n=135 of 298, 45.3%), followed by tank found empty (n=107, 35.9%), patient connected to a functioning oxygen source, no oxygen flowing (n=25, 8.4%), oxygen delivery device malfunction (n=22, 7.4%), and no oxygen available (n=9, 3.0%). Over one-third of all oxygen disruption events occurred on the unit where the patient was admitted (n=109 of 298, 36.6%). Roughly 40% of reports involved a hand-off breakdown (n=123 of 298, 41.3%) and the most frequent breakdowns occurred between a nurse and a patient transporter (n=47 of 123, 38.2%). Almost one quarter of reports involved a patient with high supplemental oxygen requirements (n=74 of 298, 24.8%). Conclusion Oxygen disruption events can have serious patient safety implications. Many of the oxygen disruption events we reviewed occurred due to lack of situational awareness and hand-off breakdowns. Combining person-based solutions, such as paper-based tools and checklists, with system-based solutions involving central monitoring and supervisory systems may help reduce the risk of oxygen disruption events.

Leadership and Followership Dynamics in Interprofessional Health Care Teams: Attending Physician Perspectives.

Effective interprofessional health care team (IHT) members collaborate to reduce medical errors, use resources effectively, and improve patient outcomes, making interprofessional collaboration imperative. Because physicians are often designated as the positional leaders of IHTs, understanding their perspectives on collaboration within IHTs could help to mitigate the disconnects between what is suggested in theory and what is happening in practice. This study aimed to explore leader-follower dynamics within medical teams that are commonly working in clinical care contexts. Using a constructivist approach, the authors conducted 12 individual, semistructured interviews from November 2022 to September 2023 with attending physicians who have led IHTs in perioperative (i.e., preoperative clinic, operating room, postoperative and recovery unit) or emergency department settings. The transcripts were analyzed from December 2022 to December 2023 using inductive thematic analysis. Three themes explained the physician perceptions of IHT leadership-followership dynamics: (1) physicians are comfortable sharing leadership intraprofessionally, (2) the clinical culture and environment constrain interprofessional followership and shared leadership, and (3) hierarchical models hold true even while active followers are appreciated, when appropriate. The data in this study suggest that, in perioperative and emergency department settings, shared leadership largely may not occur interprofessionally but occurs intraprofessionally. Participants suggested that the clinical culture and environment (i.e., legal concerns, hierarchical assumption, patient care ownership responsibilities) constrained interprofessional followership and shared leadership. On the basis of the study's findings and how they align with previous research, future research into interprofessional collaboration and followership roles should focus on what factors enable and constrain active followership and shared leadership. Such collaboration can only be achieved when active followership and shared leadership are allowed and promoted. These findings and others suggest that not all contexts are enabling such types of interprofessional collaboration due to legal concerns, hierarchical traditions, and patient ownership considerations.

Infringement of clinical pharmacist's authority.

Clinical pharmacists are healthcare practitioners who have advanced education and training in comprehensive medication management. Clinical pharmacists work with other members of the healthcare team to manage particular medications or disease states. Even though clinical pharmacists are members of healthcare teams, there are still many cases of challenge in the interprofessional relationship with other healthcare team members, especially related to drug management. Increasing interprofessional communication between physicians and clinical pharmacists within the healthcare system could enhance the role of clinical pharmacists. Earlier studies reported that physicians were comfortable with pharmacists detecting and preventing prescription errors, but were uncomfortable with them recommending drug therapy to patients. Acceptance of pharmacists' suggestions by prescribers is a necessary component of the evaluation of clinical pharmacy services. The role of clinical pharmacists could be improved by increasing interprofessional communication between doctors and clinical pharmacists in the healthcare system.

Experiences of the Parents of Children Admitted to PICU.

A pediatric intensive care unit (PICU) is a highly technological and fast-paced setting in a hospital. To explore the experiences of the parents in the critical care area of a selected tertiary care facility. In a qualitative study, we interviewed 10 purposively selected parents of the children admitted to PICU using a pre-validated in-depth interview schedule. All parents, whose children were admitted to PICU for more than 5 days, who understood Hindi or English and were willing to participate in the study, were enrolled in the study. Parents of critically ill children having readmission to PICU or prolonged stay of more than 15 days and not accompanied by parents were excluded. Parents had unmet needs, such as the need for information, counseling and education from the healthcare team (HCT) members, having trusting relationship with the HCT, and expecting receiving orientation of the routines and the protocols of PICU, and empathy from the various levels of PICU team. The majority of subjects expressed the desire to talk to a dedicated person for their queries. The parents had multiple feelings of distress, hopelessness, helplessness, guilt, and the fear of losing the child and used various coping strategies. Parents of critically ill children in the PICU have unmet needs. Healthcare team members should take initiative in relieving parental distress and improving their coping abilities. Kichu S, Joshi P, Bhandari S, Lodha R, Jaykrishnan K. Experiences of the Parents of Children Admitted to PICU. Indian J Crit Care Med 2024;28(7):696-701.

Emotional Intelligence and Clinical Performance in Psychiatric Nursing Students

Emotional Intelligence (EI) has gained considerable attention in nursing due to its positive effects on nurses' well-being and its beneficial impact on patients and families. Emotional intelligence involves understanding and managing one's own emotions and the emotions of others, which is crucial for nurses who build relationships with patients, families, and healthcare team members. Despite the recognised importance of emotional intelligence, non-academic factors like emotional intelligence are rarely considered in nursing program admissions, with GPA being the primary indicator of academic performance. Given the limited studies on emotional intelligence and academic performance in the Philippines, this study aimed to determine the relationship between nursing students' emotional intelligence and their psychiatric nursing clinical practice performance. This study employed a descriptive correlational design and included a substantial sample of 173 fourth-year nursing students who completed their psychiatric nursing clinical practice and were enrolled in the academic year 2017. Total population sampling was utilised, ensuring a comprehensive representation of the student population. The Pearson product-moment correlation coefficient (Pearson-r) was used to determine the correlation between emotional intelligence and clinical performance. The results, based on these methods, indicated that all respondents had moderate to high levels of emotional intelligence. Nearly half of the respondents achieved a satisfactory grade, with the majority having average to satisfactory performance. Female respondents had slightly higher grades than male respondents, and there was a significant difference in performance based on the respondents' school but not their age. Importantly, there was no significant correlation between emotional intelligence and clinical performance in psychiatric nursing, a finding that was consistent with the literature. This insight is valuable for educators and curriculum developers, as it underscores the need to consider a broader range of factors beyond academic performance in nursing education. It also highlights the importance of providing support and resources to enhance students' emotional intelligence skills. Further research is recommended to explore the role of emotional intelligence in nursing education and consider additional factors that may influence academic and clinical performance.

Through our eyes: A birth mom and adoptive parent share their perspectives on bias in obstetric care.

Understanding the impacts of bias, and how to mitigate these impacts, on clinical care is critically important for all healthcare team members. However, the concerns and needs in our current system are likely even more fundamental, as we are continuing to hear about the experiences of patients who are struggling to seek care that contains even the most basic tenants of respect and decency. Creating inclusive and diverse environments requires constant proactive evaluation, commitment, and energy. This piece shares the experiences of a Black birth mom and a White adoptive dad (who is also an Ob/Gyn and anti-racism researcher) and the experiences surrounding the birth of their daughter.

NURS-09. FERTILITY PRESERVATION AND PALLIATIVE CARE: RECOGNIZING THE NURSING ROLE IN THE PROMPT IMPLEMENTATION OF SUPPORTIVE CARE INTERVENTIONS IN THE PEDIATRIC CENTRAL NERVOUS SYSTEM TUMOR PATIENT POPULATION

Abstract BACKGROUND Given the complexity of pediatric central nervous system (CNS) tumors, an interdisciplinary approach is necessary to incorporate supportive care interventions that complement oncologic treatment plans. However, early implementation of both palliative care and fertility preservation services presents challenges within the pediatric neuro-oncology population. METHODS An extensive literature review was conducted for articles published between 2013-2023 using PubMed, Google Scholar, and CINAHL databases. The articles focused on nurses’ roles in pediatric oncology, palliative care, fertility preservation, and barriers to supportive care. Furthermore, the review incorporated collective knowledge sharing among pediatric neuro-oncology nursing specialists. This joint initiative applied evidence-based practices to showcase the successful implementation of palliative care and fertility preservation services, broadening this project’s scope. RESULTS One prevalent theme that emerged highlighted the delay in supportive care referrals attributed to perceived obstacles by healthcare team members. The misconception that palliative care is solely for end-of-life situations or the assumption that families are not ready to acknowledge an incurable diagnosis causes delays in palliative care referrals. Fertility preservation in pediatric oncology encounters obstacles, including the urgency to commence treatment, determining optimal candidate criteria, and navigating discussions with younger patients. Nurses are uniquely positioned in their role to bridge gaps between oncologic treatment interventions and the incorporation of supportive care measures. Recognizing the supportive care needs of patients, nurses can educate families, advocate for early referrals, and coordinate integrative care. Advanced Practice Nurses (APNs) can offer clinical consultation, and order appropriate screening, testing, medications, and referrals. CONCLUSION Disseminating nursing education across pediatric oncology practices and institutions is essential for identifying perceived barriers and reforming the early supportive care intervention process. This collaborative and proactive approach is designed to optimize the overall care experience, with the goal of enhancing the delivery of supportive care for pediatric neuro-oncology patients.

Developing Provincial Nutrition Guidelines For Wound Prevention And Management: A Guideline For British Columbia’s Registered Dietitians

In late 2021, the British Columbia Provincial Interprofessional Skin & Wound Committee, led by Shannon Handfield, saw the need for a nutrition-focused dietitian sub-committee to develop provincial resources for health-care team members caring for clients with, and at-risk for, wounds. Over the course of 18 months, the document Nutrition for Wound Prevention & Management: Guideline for Dietitians was created. This article documents the process.

Yemeni Physicians' Attitudes and Perceived Barriers Toward Ward-Based Clinical Pharmacist in Hospital Settings.

Clinical pharmacy services (CPSs) are still in their infancy in Yemen. Furthermore, pharmacists are not members of a multidisciplinary healthcare team, so their responsibilities are limited to drug dispensing and marketing. This study examines physicians' attitudes and perceived obstacles regarding the inclusion of clinical pharmacists in hospital medical wards. A descriptive observational study was carried out using a validated, self-administered bilingual questionnaire. The study's questionnaire was conducted among physicians in three leading hospitals. Those hospitals were at the forefront of establishing clinical pharmacy units and embracing clinical pharmacy services. Data were analyzed using descriptive statistics. Sixty-five responses were included. Our data results indicated that physicians believed the most important contributions for clinical pharmacists to improve patient care were "attending medical rounds", followed by "order review". About 75% of physicians showed positive attitudes toward the clinical pharmacist role. However, more than 70% of physicians believed that clinical pharmacists should leave patient care to other healthcare professionals and focus on drug products. Not enough clinical pharmacist staff working in the health center was considered the top perceived barrier (83.1%), followed by "clinical pharmacist responsibilities were not clearly defined" and "clinical pharmacist recommendations are not properly documented". Strategies to expand clinical pharmacy services in Yemen should focus on several key areas. Protocols must be established to clearly outline the collaboration between clinical pharmacists and physicians. Additionally, fostering inter-professional relationships is crucial to overcoming resistance and increasing awareness and understanding of CPS adoption among healthcare team members.

Care Bermuda, families of the patients with chronic mental disorders in Iran surrounded by psychosocial problems and needs: a qualitative study

Background: A mental disorder is characterized by a clinically significant impairment of cognition, emotion regulation, or behavior. As a result of the shift in care from medical centers and hospitals to home care, we now see a change in the treatment of patients with chronic mental disorders. Consequently, families have become the main support system in the progressive care of these patients, leading to psychological and social problems. The current qualitative study investigated the social and psychological health needs and problems of family caregivers of patients with chronic mental disorders in Iran’s cultural and social context. Methods: This was a content analysis qualitative study. The study was conducted in three psychiatric hospitals in Farabi, Noor, Modares. Purposive sampling was done and continued until data saturation. Semi-structured, face-to-face, and individual interviews were conducted with 49 participants (15 family caregivers of patients with CMD and 34 members of the mental health care team). Data analysis was done using the conventional content analysis method. Results: Eight hundred seventy-five primary codes were obtained, which were classified into 10 subcategories and 3 main categories of ʻhealth challenges of caregiverʼ, ʻconfused concept of careʼ and “the need for a coherent support system. Conclusion: In Iranian society, after the patient is discharged from the hospital or care center, family members will change their role to the most important caregivers of these patients. The psychological and social health of these caregivers is destroyed because of the problems they have in providing care for their patients and their needs, which are not met.

Implementing Inpatient Social Needs Screening in an Urban Tertiary Care Children's Hospital.

The American Academy of Pediatrics recommends screening for unmet social needs, and the literature on inpatient screening implementation is growing. Our aim was to use quality improvement methods to implement standardized social needs screening in hospitalized pediatric patients. We implemented inpatient social needs screening using the Model for Improvement. An interprofessional team trialed interventions in a cyclical manner using plan-do-study-act cycles. Interventions included a structured screening questionnaire, standardized screening and referrals workflows, electronic health record (EHR) modifications, and house staff education, deliberate practice, and feedback. The primary outcome measure was the percentage of discharged patients screened for social needs. Screening for social needs was defined as a completed EHR screening questionnaire or a full social work evaluation. Process and balancing measures were collected to capture data on screening questionnaire completion and social work consultations. Data were plotted on statistical process control charts and analyzed for special cause variation. The mean monthly percentage of patients screened for social needs improved from 20% at baseline to 51% during the intervention period. Special cause variation was observed for the percentage of patients with completed social needs screening, EHR-documented screening questionnaires, and social work consults. Social needs screening during pediatric hospitalization can be implemented by using quality improvement methods. The next steps should be focused on sustainability and the spread of screening. Interventions with greater involvement of interdisciplinary health care team members will foster process sustainability and allow for the spread of screening interventions to the wider hospitalized pediatric population.

Healthcare personnel’s perspectives on health technology in home-based pediatric palliative care: a qualitative study

BackgroundIn the context of pediatric palliative care, where the quality of life of children with life-limiting or life-threatening conditions is of utmost importance, the integration of health technology must support the provision of care. Research has highlighted the role of healthcare personnel when utilizing health technology in home-based pediatric palliative care, but specific knowledge of healthcare personnel’s views on the technological relevance remains limited. Therefore, our study has explored potentials and limitations of health technology in home-based pediatric palliative care from the perspectives of healthcare personnel.MethodsOur study utilized a qualitative, descriptive, and exploratory design, including five focus groups with a total of 22 healthcare personnel. The participants were selected from various health regions in Norway and were experienced in providing home-based pediatric palliative care. Using reflexive thematic analysis, we interpreted data obtained from focus groups, identified patterns, and developed themes.ResultsThe analysis resulted in the development of three intersecting themes: balancing in-person interaction and time in home-based pediatric palliative care; exchange of information can improve timely and appropriate care; and the power of visual documentation in pediatric palliative care. The healthcare personnel acknowledged difficulties in fully replacing in-person interaction with health technology. However, they also emphasized potentials of health technology to facilitate information sharing and the ability to access a child’s health record within interdisciplinary teams.ConclusionThe results underscored that technology can support pediatric palliative care but must be thoughtfully integrated to ensure an individualized patient-centered approach. To maximize the benefits of health technology in enhancing home-based pediatric palliative care, future research should address the limitations of current health technology and consider the opinions for information sharing between relevant healthcare team members, the child, and their family.

Same-day discharge strategy in a heart rhythm management clinic - what about patients' reported experience?

Abstract Background and aims Same-day discharge (SDD) has been adopted for many interventional cardiology procedures, however data on patients’ experience are scarce. The aim of this study was to investigate patient-reported experience of a SDD strategy following electrophysiology procedures (EP) in a Heart Rhythm Management Department. Methods Consecutive patients undergoing EP procedures in our centre, who fulfilled pre-defined eligibility criteria for SDD, were asked to complete the study questionnaire, right before hospital discharge. Procedures suitable for SDD ranged from non-invasive (electric cardioversion, tilt test) to invasive ones (EP studies, device replacement, rhythm recorders implantation, ablation of supraventricular tachycardias including atrial fibrillation). The questionnaire aimed to assess patients’ experience before and during the procedure, their satisfaction with the quality of the provided information and their comprehension of the given instructions regarding the post-discharge period and their medication. Results The study questionnaire was completed by 501 patients. The majority of participants described SDD as a good or a quite good experience (n=440, 87,8%), while 94,6% of them (n=474) would not hesitate to undergo a second SDD procedure, if necessary. A direct interview with a healthcare team member was viewed as the preferred method of obtaining information on the procedure. At discharge, 1 out of 10 patients were still unsure of the instructions given by the healthcare team, including their anticoagulation treatment. Patient reported satisfaction rates did not differ between invasive and non-invasive procedures. However, after an invasive procedure, patients seemed to significantly have a better understanding of post-discharge instructions. Conclusion Patients reported a high level of satisfaction with SDD EP procedures. However, significant efforts need to be made in order to ensure their understanding of post-discharge instructions.Figure : Patients' reported experience

The role of community health workers in non-communicable diseases in Cape Town, South Africa: descriptive exploratory qualitative study

BackgroundCommunity health workers (CHW) are an integral part of primary health care re-engineering in South Africa. Cape Town is developing community-orientated primary care, with a central role for CHWs. Their role in human immunodeficiency virus, tuberculosis, maternal and child health has been articulated, but is less clear for non-communicable diseases (NCDs). Non-communicable diseases are now a major contributor to the burden of disease. The aim was to explore the current role of CHWs regarding NCDs in the Eastern sub-district of Cape Town, South Africa.MethodsAn exploratory descriptive qualitative study made use of non-participant observation and qualitative interviews with CHWs, their managers, and nurse coordinators. Data from nine semi-structured interviews and ten observations were analysed with the framework method and Atlas-ti.ResultsThe CHWs were embedded in their communities and provided services via support groups, household visits and delivery of medication. They linked people to care with assistance of nurse coordinators. They could also provide physical care in the home. They lacked the ability to counsel people on the risk factors for NCDs and their role in rehabilitation and palliative care was unclear. More nurse coordinators were needed to provide supportive supervision. Inter-sectoral collaboration was weak and hindered CHWs from addressing social issues. More standardised and comprehensive training should equip CHWs for health promotion and disease prevention during household visits. Data collected in the community needed to be analysed, reported on and integrated with data from the primary care facility. This should also contribute to a community diagnosis. Their relationship with facility-based members of the primary health care team needed to be improved. Attention needed to be given to the requirements for and conditions of employment, as well as working hours and remuneration. Some equipment was absent and hindered their services for NCDs.ConclusionsCHWs have the potential to provide a comprehensive approach to NCDs, but community-orientated primary care needs to be strengthened in many of the key areas to support their activities. In relation to NCDs, they need training in basic and brief behaviour change counselling and risk factors as well as in the areas of rehabilitation and palliative care.

Physician-nurse collaboration in the relationship between professional autonomy and practice behaviors.

Nurses and physicians are key members of healthcare teams. While physicians are responsible for the diagnosis and treatment of patients, nurses are part of the treatment and the primary practitioners of patient care. Nurses' professional autonomy, collaboration with physicians, and practice behaviors in treatment and patient care practices are interrelated. In the present study, we examined the mediating effect of physician-nurse collaboration on the relationship between nurses' practice behaviors and their professional autonomy. The present study utilized a cross-sectional survey design following quantitative methods. This study was conducted in the Istanbul Province of Turkiye from September to October 2022. The sampling method used was a convenience sampling strategy to provide easier access to participants when selecting nurses from different health institutions. The mean age of the 295 nurses was 31.23 years, with ages ranging from 21 to 59years. The data analysis was conducted using IBM's SPSS 24.0 software package and the Process Macro 4.0 plug-in. Research ethics approval was obtained from the researcher's university. Physician-nurse collaboration is positively associated with practice behaviors and professional autonomy. Nurses' professional autonomy in practice behaviors through physician-nurse collaboration is significant (95% CI [0.043, 0.135]). Our results revealed the relationships among physician‒nurse collaboration, professional autonomy, and practice behaviors among nurses. Our results provide evidence on the underlying factors of nurses' practice behaviors in patient care and guide the development of an intervention program to enhance this collaboration. Hospital managers can contribute to a collaborative physician‒nurse working environment.

Point of Care Ultrasounds Obtained by Novice Physician Assistant Residents (POCUS ON PAR).

The integration of Point of Care Ultrasound (POCUS) into the care of trauma patients, specifically the E-FAST, has improved the accuracy of initial diagnoses and improved time to surgical intervention in critically ill patients. Physician assistants (PAs) are critically important members of any military trauma resuscitation team and are often team leaders in a pre-hospital setting. They may receive training in ultrasound but there are little data to support their use or evaluate their effectiveness in using POCUS. We designed a study to evaluate the image quality of an E-FAST Exam performed by Emergency Medicine Physician Assistant (EMPA) Fellows and Emergency Medicine (EM) Interns following identical training. Our hypothesis is that image quality obtained by EMPAs will be non-inferior to those images obtained by EM Interns. This is a prospective single-blinded study comparing the image quality of E-FAST exams performed by first year EM interns and first year EMPA fellows. All participants completed standard POCUS training prior to enrollment in the study. A total of 8 EMPAs and 8 EM first year residents completed 10 recorded E-FAST exams to be used as study images. Participants also viewed a 15-question slide show containing images of positive (6) and negative (9) E-FAST exams and recorded their interpretations. Images were reviewed by expert reviewers who were blinded to which images were collected by which group. An image quality score was recorded for each view as well as an overall image quality score. Image quality was rated on a 1 to 5 image quality scale. For overall image quality, the mean score for EMPAs was 3.6 ± 0.5 and for EM residents was 3.2 ± 0.5 with statistical significance favoring better image quality from the EMPAs. The time to completion for the EFAST exam for EMPAs was 4.8 ± 1.3 minutes and for interns it was 3.4 ± 1.4 minutes (P value = 0.02). There was no difference in image interpretation quiz scores between the groups (mean score 92% among interns and 95% among PAs). POCUS is an imaging modality which is very portable and relatively inexpensive which makes it ideal for military medicine. PAs are essential members of military trauma teams, and often run an initial trauma resuscitation. Being able to correctly identify patients who have free fluid early in the course of treatment allows for more correct evacuation criteria to ensure the sickest patients get to care the fastest. Although there are limited data to support POCUS use by non-physicians, our data support a growing body of evidence that it is not the profession or baseline medical education that determines an individual's ability to use and incorporate ultrasound into bedside and clinical practice. Our study shows that with training and experience PAs or other members of the military health care team can use the EFAST to better care for trauma patients.

US neonatal intensive care unit registered dietitian nutritionists salary description and correlates: results of a survey.

This survey described the compensation of neonatal intensive care unit (NICU) registered dietitian nutritionists (RDNs) in the United States and examined correlates of higher salaries within this group. A cross-sectional online survey was completed in 2021 by 143 NICU RDNs from 127 US hospitals who reported hourly wage in US dollars (USD). We used initial bivariate analyses to assess the relationship of selected institution-level and individual-level variables to hourly wage; the rank-sum test for binary variables; bivariate regression and Pearson correlation coefficients for continuous variables; the Kruskal-Wallis test for categorical variables. Variables with a compelling relationship to the hourly wage outcome were considered in model creation. Final model selection was based on comparisons of model fit. Median hourly compensation was USD 33.24 (interquartile range [IQR] 29.81, 38.49). Seven variables had a compelling bivariate relationship with hourly wage: cost of living, employer facility with a paediatric residency, employer facility with a neonatal fellowship, NICU bed: full-time equivalents (FTE) RDN ratio, years in neonatal nutrition, having a certification and order writing privileges. In the final adjusted model (R2 = 0.42), three variables remained associated with increased hourly wage: higher cost of living, longer length of career in neonatal nutrition and fewer NICU beds per NICU RDN FTE. US NICU RDNs earn similar or slightly higher wages than other US paediatric RDNs; they earn substantially less than other NICU healthcare team members. Employers need to improve compensation for NICU RDNs to incentivise their retention and recognise their additional non-clinical responsibilities.