Point Of Patient Care Research Articles

Diversity, equity and inclusiveness in healthcare: A primary care perspective.

Addressing Diversity, Equity and Inclusion in health care is a multidimensional challenge. From a US perspective, the third-party payment system has disempowered and depersonalized health-care delivery. The net result is wasteful and inefficient use of human and financial resources, burnout among providers, as well as care inequities. Financial integration at the point of patient care is essential to aligning the needs of patients with advances in medical technology. Complexity theory offers valuable insights into the roles of government, intermediaries and patients. The government must focus on equity as a rule compiler and referee of the system. Patient and providers who are actively engaged in shared decision-making will naturally address the diverse needs of multitudinous communities. Intermediaries address inclusion by connecting resources with the point of care. In a dynamic, emerging health-care system that serves diverse communities, patient and community-based financing, vouchers and defined contributions are necessary first steps in addressing cultural diversity, inclusion and equity.

Safety and biological outcomes following a phase 1 trial of GD2-specific CAR-T cells in patients with GD2-positive metastatic melanoma and other solid cancers

BackgroundChimeric antigen receptor (CAR) T cell therapies specific for the CD19 and B-cell maturation antigen have become an approved standard of care worldwide for relapsed and refractory B-cell malignancies. If...

Experiences of Australian emergency doctors and nurses using advance care directives in the provision of care at the end of life.

An advance care directive is a legal document outlining the wishes made by a person about treatment options. However, there is increasing evidence that an advance care directive that has previously been documented may not always benefit the current prognosis of the patient. Therefore, the aim of the present study was to explore the experiences of Australian emergency doctors and nurses concerning the use of previously documented advance care directives at the point of care for patients and their families. A qualitative study guided by a phenomenological interpretive approach was employed. Semi-structured interviews were conducted with ED doctors and nurses across Australia. Data were thematically analysed using a seven-stage data analysis framework. An analysis of the interview data resulted in four major themes: (i) Benefits of Advance Care Directives; (ii) Knowledge and Awareness; (iii) Communication; and (iv) Availability of Advance Care Directive Information. From the findings, advance care directives were believed to be beneficial in decision making when patients, families, and ED staff agreed with the decisions made. Advance care directives were often made a long time ago but were useful to start conversations around goals of care and end-of-life care relevant to the patient's current situation. Findings in the present study further reinforced that an advance care directive was beneficial when used alongside goals of care at the point of care in EDs.

'It's all about ticks': A secondary qualitative analysis of nurse perspectives about documentation audit.

To understand how nurses talk about documentation audit in relation to their professional role. Nursing documentation in health services is often audited as an indicator of nursing care and patient outcomes. There are few studies exploring the nurses' perspectives on this common process. Secondary qualitative thematic analysis. Qualitative focus groups (n = 94 nurses) were conducted in nine diverse clinical areas of an Australian metropolitan health service for a service evaluation focussed on comprehensive care planning in 2020. Secondary qualitative analysis of the large data set using reflexive thematic analysis focussed specifically on the nurse experience of audit, as there was the significant emphasis by participants and was outside the scope of the primary study. Nurses': (1) value quality improvement but need to feel involved in the cycle of change, (2) highlight that 'failed audit' does not equal failed care, (3) describe the tension between audited documentation being just bureaucratic and building constructive nursing workflows, (4) value building rapport (with nurses, patients) but this often contrasted with requirements (organizational, legal and audit) and additionally, (5) describe that the focus on completion of documentation for audit creates unintended and undesirable consequences. Documentation audit, while well-intended and historically useful, has unintended negative consequences on patients, nurses and workflows. Accreditation systems rely on care being auditable, but when individual legal, organizational and professional standards are implemented via documentation forms and systems, the nursing burden is impacted at the point of care for patients, and risks both incomplete cares for patients and incomplete documentation. Patients participated in the primary study on comprehensive care assessment by nurses but did not make any comments about documentation audit.

SG-APSIC1038: Hospital-wide study to evaluate the tolerability and acceptability of alcohol-based hand rubs according to WHO protocol, and healthcare worker hand hygiene behavior during the COVID-19 pandemic

Objectives: To evaluate the tolerability and acceptability of 3 different alcohol-based hand rub (ABHR) products, and to determine factors influencing hand hygiene (HH) behavior among healthcare workers (HCWs) during the COVID-19 pandemic. Methods: A cross-sectional study was conducted in Sarawak General Hospital, a 1,034-bed tertiary-care state hospital. A self-administered 7-point Likert scale questionnaire was adapted from the WHO ‘Protocol for Evaluation of Tolerability and Acceptability of ABHR.’ The study was conducted between November 12 and 26, 2021, based on 3 types of ABHR products. Participation in answering the questionnaire was voluntary, so consent was implied. The Student t test was used to determine the significant differences among the ABHR product. The χ2 distribution test was performed to evaluate the characteristics of ABHR products. Results: We received a response rate of 35% (1,598 of 4,628); 82% of respondents were female, and the overall cohort had a mean age of 35 years. Also, 972 (61%) of 1,598 respondents were nurses, and 1,490 (93%) of 1,598 respondents used ABHR at least 5 days every week. Of 1,598 respondents, 1,156 (72%) indicated that ABHR products were easily accessible at the point of patient care. Evaluation of ABHR products showed that respondents were receptive to all product colors (P < .0114) and had no color preference (P > .05). Comparison among ABHR products yielded no statistical difference (P > .05) for ‘smell,’ ‘stickiness,’ ‘irritation,’ or ‘drying speed.’ ‘Drying effect’ of all products was statistically significant (P < .0252). The overall satisfaction for all products was good (P < .0022). HCWs did not expect their HH compliance to improve even if they were provided with their preferred choice of ABHR. Of 1,598 respondents, 783 (49%) correctly used a palm-full of ABHR for HH, and 1, 275 (80%) indicated that hospital management should organize more HH-related awareness and continuous medical education on HH. Conclusions: A comparison among different ABHR characteristics mostly showed no statistically significant difference regarding tolerability and acceptability. These findings suggest that different ABHR products will not influence HH behavior during COVID-19 pandemic.

Seven Benefits of Employing Dynamic Health in Clinical Settings

Dynamic Health™, from EBSCO Information Services, is an evidence-based clinical decision support resource designed for quick retrieval of diagnosis and treatment information at the point of patient care.

Cover Feature: Disposable Passive Electrochemical Microfluidic Device for Diagnosis of Congenital Disorders of Glycosylation (Anal. Sens. 1/2022)

The cover feature shows disposable passive electrochemical microfluidic devices which were developed using a lamination technique for the diagnosis of congenital glycosylation disorders. The key assay steps were integrated on board with high reproducibility. It was possible to successfully discriminate between patients and healthy individuals by taking short analysis times with minimal analyst intervention and requiring low clinical sample volumes. These results suggest that these devices have potential as future tools at the point of patient care. The cover was drawn by Víctor de la Asunción and co-designed with the authors. More information can be found in the Full Paper by Alberto Escarpa, Agustín G. Crevillén and co-workers.

Availability of patient information in the emergency department : Wish and reality

Fast access to information from other healthcare service providers is particularly important in emergency medicine, as the patients are often unknown and treatment decisions have to be made promptly. The study aims to identify the challenges that emergency departments face in obtaining information on patient history, the expected benefits of easier access to information and which information is most urgently needed. An online survey throughout Germany was carried out among medical staff working in emergency departments. In all, 181 questionnaires were fully completed and could be included in the data analysis. Of the respondents, 77.9% said it was difficult or very difficult to receive external data at the point of patient care. The survey participants estimate that they need an average of around 47 min to obtain information about one patient. 99.4% believe that patient care would benefit from an easier and faster information exchange. Medication lists, discharge letters, information on previous illnesses and allergies were classified as the most important data elements. There is an urgent need for action with regard to the considerable effort involved in obtaining information on emergency patients. Digital solutions such as the recently introduced emergency data set can offer additional value for clinical emergency care if they are widely used.

Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries.

BackgroundPrimary care has a crucial role in responding to the COVID-19 pandemic as the first point of patient care and gatekeeper to secondary care. Qualitative studies exploring the experiences of healthcare professionals during the COVID-19 pandemic have mainly focused on secondary care.AimTo gain an understanding of the experiences of European primary care professionals (PCPs) working during the first peak of the COVID-19 pandemic.Design and settingAn exploratory qualitative study, using semi-structured interviews in primary care in England, Belgium, the Netherlands, Ireland, Germany, Poland, Greece, and Sweden, between April and July 2020.MethodInterviews were audiorecorded, transcribed, and analysed using a combination of inductive and deductive thematic analysis techniques.ResultsEighty interviews were conducted with PCPs. PCPs had to make their own decisions on how to rapidly transform services in relation to COVID-19 and non-COVID-19 care. Despite being overwhelmed with guidance, they often lacked access to practical training. Consequently, PCPs turned to their colleagues for moral support and information to try to quickly adjust to new ways of working, including remote care, and to deal with uncertainty.ConclusionPCPs rapidly transformed primary care delivery despite a number of challenges. Representation of primary care at policy level and engagement with local primary care champions are needed to facilitate easy and coordinated access to practical information on how to adapt services, ongoing training, and access to appropriate mental health support services for PCPs. Preservation of autonomy and responsiveness of primary care are critical to preserve the ability for rapid transformation in any future crisis of care delivery.

Streamlining genetic testing for women with ovarian cancer in a Northern California health care system

ObjectiveReferral to Genetics for pre-testing counseling may be inefficient for women with ovarian cancer. This study assesses feasibility of gynecologic oncologists directly offering genetic testing. MethodsA prospective pilot study was conducted at two gynecologic oncology hubs in an integrated healthcare system from May 1 to November 6, 2019. Gynecologic oncologists offered multigene panel testing to women with newly diagnosed ovarian cancer, followed by selective genetic counseling. Outcomes were compared between study participants and women from other hubs in the health system. ResultsOf ovarian cancer patients at study sites, 40 participated and all underwent genetic testing. Of 101 patients diagnosed at other sites, 85% were referred to genetics (p = .0061 compared to pilot participants) and 67% completed testing (p < .0001). The time from diagnosis to blood draw and notification of result was 18.5 and 34 days for the pilot group compared to 25.5 and 53 days at other sites. Panel testing detected 9 (22.5%) and 7 (10.3%, p = .08) pathogenic mutations in each group, respectively. Patients and providers were highly satisfied with the streamlined process. ConclusionGenetic testing performed at the gynecologic oncology point of care for patients with ovarian cancer is feasible, increases uptake of testing, and improves time to results.

Intervention on knowledge and perception of hand hygiene among healthcare workers

Abstract Background Many studies conducted in healthcare settings with limited resources reported healthcare associated infections (HAIs) rates higher than in developed countries. Hand hygiene is considered as the most effective procedure for reducing infection in a wide variety of settings. The aim of this study was to assess the effectiveness of an intervention program to improve knowledge and perception of hand hygiene among healthcare workers (HCWs). Methods We conducted a prospective before-and-after study design in university hospital Sahloul, Sousse, Tunisia, from January 2015 to December 2016. The same questionnaire, constructed by the WHO was distributed and collected at HCWs’ workplace. Results A total of 149 and 146 HCWs were enrolled, respectively at pre and post intervention. The majority was nursed women aged between 20 and 35 in pre intervention, whereas in post intervention the majority where physicians. Globally, our results showed tendencies toward improvement, but only two items were significant: the HW is the appropriate technique after injury (73.5% vs 86.8%; p = 0.006) and the hands of HCWs are the lead vehicle of HAIs (65.1% vs 83.6%; p = 0.01). On the other hand, judging by the HCWs’ responses, the probably most effective intervention to enhance hand hygiene compliance was that an alcohol-based hand-rub is available at each point of patient care. In contrast, empowering patients to remind HCWs to perform hand hygiene was mostly rated to be the least effective intervention both in pre and post intervention. Conclusions Our intervention to positively influence hand hygiene knowledge was unfortunately less effective than we had hoped it would be, which suggests a HCWs’ reluctance to attend the training program. Key messages Hand hygiene is considered as the most effective procedure for reducing nosocomial infection. the intervention to positively influence hand hygiene knowledge was effective.

Psychological impact of traumatic events in rural nursing practice: An Integrative review

Purpose: The purpose of this article is to present findings from a pilot quality improvement evidence-based new nurse transition program that facilitates clinical leadership skills in novice nurses at the point of patient care at a rural critical access hospital. Descriptive data from pre- and post-intervention scores are reported, and the percent change was evaluated. Sample: Due to the solitary nature of rural nursing, new graduate nurses in rural areas need support in transitioning to their new role as registered nurses. The author designed, and pilot tested a quality improvement evidence-based new nurse transition program in a rural critical access hospital utilizing complexity science as a framework. Method: A quality improvement pilot program designed for new graduate nurses was provided at a critical access hospital in a rural Midwestern State. Data was collected using pre- and post- intervention scores on the Leadership Characteristics and Skills Assessment and TeamSTEPPS Teamwork Attitudes Questionnaire. Descriptive data was evaluated. Findings: Participant post- test percent change scores increased in perceptions of ability to lead but decreased in attitudes about teamwork. Observations of participant interactions in the quality improvement project suggested that the new nurses were developing new ideas, patterns and structures regarding their roles as a team member in the healthcare setting. Conclusion: In a rural midwestern critical access hospital a quality improvement leadership program that used a complexity science framework was provided to novice nurses in transition. After the program participant total mean post scores increased in perception of what makes a good leader and in the participant’s perception of their ability to lead. An overall mean score decrease in attitudes about teamwork was noted among the small group of rural novice nurses. Keywords: rural, frontier, new registered nurse graduate, transition program, complexity science, leadership

Working towards a master patient index and unique identifiers to improve health systems: the example of Myanmar.

In the health systems of many countries, there is neither a requirement to collect a minimum set of demographic information during patient registration nor a standard way of identifying patients. This impedes the provision of integrated, good-quality care for individual patients and, at the system level, prevents generation of the high-quality data necessary for effective management and continuous improvement. Assigning each patient a unique identifier (UID) to create a master patient index (MPI) is therefore essential to ensure data interoperability across all the points of patient care within a health system. Although advances in technology are shifting the boundary between civil registration and personal identification, the additional value of an MPI/UID system lies in the technical and operational capacity to ensure that clinical data are safely and securely managed. Moreover, operationalization of MPI/UID data enables the establishment of an evidence-based, constantly improving “learning health system” with feedback loops that allow measurement, evaluation and visualization of performance over time. The Ministry of Health and Sports of Myanmar is actively engaged in a multistakeholder collaborative process working towards a nationwide MPI/UID system. Demonstration pilots are planned for both online and offline modes of operation for HIV/AIDS, mother and child health (including eliminating mother-to-child transmission of HIV and syphilis) and hospital settings, which are expected to open up the potential for expansion to all health interventions and facilities. With the implementation of the MPI/UID system under way in Myanmar, the Ministry of Health and Sports is laying the foundation to put individuals at the centre of care and deliver a lifelong service for all.

Elimination of hepatitis C. Positioning document of the Spanish Association for the Study of the Liver (AEEH).

The Spanish Association for the Study of the Liver (AEEH) is convinced that the elimination of hepatitis C virus (HCV) in Spain is possible as long as we are able to use the resources and tools necessary for it. This document reflects the position of the AEEH regarding the elimination of HCV, establishing a wide range of recommendations that can be grouped into five categories: 1) Screening of HCV according to age, of the existence of classic acquisition risk factors of infection, active search of previously diagnosed patients and development of microelimination strategies in vulnerable populations; 2) Simplification of HCV diagnosis (one-step diagnosis and diagnosis at the point of patient care); 3) Simplification of patient treatment and improvement of care circuits; 4) Health policy measures, and, finally, 5) Establishment of HCV elimination indicators.

Point-of-care brain injury evaluation of conscious awareness: wide scale deployment of portable HCS EEG evaluation.

Survivors of severe brain injury may remain in a decreased state of conscious awareness for an extended period of time. Clinical scales are used to describe levels of consciousness but rely on behavioural responses, precipitating misdiagnosis. We have previously utilized event-related potentials (ERPs) to circumvent reliance on behavioural responses. However, practical implementation barriers limit the clinical utility of ERP assessment at point-of-care (POC). To address this challenge, we developed the Halifax Consciousness Scanner (HCS)—a rapid, semi-automated electroencephalography system. The current study evaluated: (i) HCS feasibility in sub-acute, POC settings nationwide; (ii) ERP P300 responses in patients with acquired brain injury versus healthy controls; and (iii) correlations within and between clinical measures and P300 latencies. We assessed 28 patients with severe, chronic impairments from brain injuries and contrasted the results with healthy control data (n = 100). Correlational analyses examined relationships between P300 latencies and the commonly used clinical scales. P300 latencies were significantly delayed in patients compared to healthy controls (P < 0.05). Clinical assessment scores were significantly inter-correlated and correlated significantly with P300 latencies (P < 0.05). In sub-acute and chronic care settings, the HCS provided a physiological measure of neurocognitive processing at POC for patients with severe acquired brain injury, including those with disorders of consciousness.

Preference phenotypes to facilitate shared decision-making in rheumatoid arthritis

ObjectiveImplementing treat-to-target (TTT) strategies requires that patients with rheumatoid arthritis (RA) and their rheumatologists decide on how best to escalate care when indicated. The objective of this study was to...

Promoting Good Laboratory Practices for Waived Infectious Disease and Provider-Performed Microscopy Testing

Laboratory testing at the point of patient care was documented hundreds of years ago and has greatly expanded in the last 25 years due to improvements in technology, miniaturization, and the availability of rapid tests for a wide variety of analytes and microorganisms. Since the implementation of the Clinical Laboratory Improvement Amendments of 1988, the number of non-traditional testing sites that provide testing with minimal oversight through a Certificate of Waiver (CW) or Certificate of Provider-Performed Microscopy (PPM) has increased. Concerns have been expressed about some practices, and data have identified quality gaps in these sites where testing may be performed by personnel who do not have laboratory training or experience. The Centers for Disease Control and Prevention has developed free educational tools to promote regulatory compliance and good laboratory practices in CW and PPM sites. Uptake and positive reviews of these materials indicate their value as a resource to improve testing quality.

Choosing Opioid Policies Our Patients Can Live With.

In 1997, the American Academy of Pain Medicine and the American Pain Society jointly issued recommendations regarding the care of patients with chronic pain.(1) Several years later, the Joint Commission on Accreditation of Healthcare Organizations issued pain management standards "recommending" that hospitals identify patients with pain upon initial screening and collect data to monitor the effectiveness of pain management.(2) Nearly two decades later, we find ourselves in the midst of a opioid epidemic triggered, in part, by excessive utilization of opioid pain medications.(3) We now find ourselves playing "catch up," as we try to undo some of the practices of the past, and change the culture to better balance benefit and risk. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved. Language: en

Diagnosis of Ebola Virus Disease: Past, Present, and Future.

Laboratory diagnosis of Ebola virus disease plays a critical role in outbreak response efforts; however, establishing safe and expeditious testing strategies for this high-biosafety-level pathogen in resource-poor environments remains extremely challenging. Since the discovery of Ebola virus in 1976 via traditional viral culture techniques and electron microscopy, diagnostic methodologies have trended toward faster, more accurate molecular assays. Importantly, technological advances have been paired with increasing efforts to support decentralized diagnostic testing capacity that can be deployed at or near the point of patient care. The unprecedented scope of the 2014-2015 West Africa Ebola epidemic spurred tremendous innovation in this arena, and a variety of new diagnostic platforms that have the potential both to immediately improve ongoing surveillance efforts in West Africa and to transform future outbreak responses have reached the field. In this review, we describe the evolution of Ebola virus disease diagnostic testing and efforts to deploy field diagnostic laboratories in prior outbreaks. We then explore the diagnostic challenges pervading the 2014-2015 epidemic and provide a comprehensive examination of novel diagnostic tests that are likely to address some of these challenges moving forward.

The management of thoracic trauma: Principles and practice

The principles of airway control, breathing and circulation maintenance provide the starting point of care for patients with thoracic injury. Intravenous access, thoracostomy tube insertion and balanced resuscitation can address most of the issues seen. Endovascular techniques have altered the course of care for patients with blunt aortic injury. Rib plating holds promise regarding enhanced recovery from a flail chest. This article reviews the basic principles and highlights the changing landscape in thoracic trauma.