Practitioner Practice Research Articles

State Full Practice Authority Regulations and Nurse Practitioner Practice Autonomy: Evidence From the 2018 National Sample Survey of Registered Nurses.

State full practice authority (FPA) laws are designed to permit NPs to practice autonomously from physicians. Little is known regarding how FPA laws affect NPs' practice autonomy in daily practice. This study used nationwide survey data from 20,830 NPs to estimate how NPs' practice autonomy differs between NPs in FPA and non-FPA states. NPs in states with FPA laws were more than twice as likely as NPs in non-FPA states to practice in clinic settings with no onsite physicians and were twice as likely to not have a physician collaborator. Associations between FPA laws and four other indicators of practice autonomy were positive but smaller in magnitude. States with FPA laws more than 10 years experienced larger changes in nurse practitioner (NP) autonomy compared with states with FPA laws in effect less than 10 years. FPA laws may promote the development of autonomous NP practice sites, thereby expanding access in underserved populations.

Knowledge, attitudes and practices of Italian general practitioners on food supplements

Abstract Background Food supplements are widely used, but they can be dangerous if used inappropriately, as they often interaction with patients’ treatment. Their misuse has public health and patient out-of-pocket expenditure implications; general practitioners (GPs) play a central role in managing patient safety. This study aims to investigate the knowledge, attitudes and practices (KAP) of Italian GPs’ toward the use of food supplements. Methods From March to April 2024, an online survey was conducted via the EU-Survey platform among Italian GPs invited through their professional organization. The 62-question survey, adapted from a tool used among pharmacists, comprises two sections: A) KAP questions (28 true/false, 34 on a 5-point Likert scale) and B) socio-demographic questions (i.e. age, sex, years of experience, urban/extra-urban environment). Survey reliability was evaluated using Cronbach alfa and responses were analysed to look for differences between sub groups using Kruskal Wallis Test. Results 202 GPs participated in the survey, 46.0% were male, 53.5% female and 0.5% non-binary, with a mean age of 47±2 years. The majority (70.3%) came from an urban environment and 54.9% worked in group medicine. Only 53.5% of GPs showed an adequate knowledge of the topic (more than 60% of correct answers), with a mean of 18 correct answers. The overall reliability of the test was evaluated as acceptable (alfa>0.7). The 99.5% of GPs interview agreed (score 4 or more on the Likert scale) that they have an important role in food supplements prescription and 98% are involved in life styles counselling activities, but only 66.3% felt they have adequate formation on the topic. No statistically significant differences between population groups were found (p < 0.05). Conclusions Although GPs have recognized their key role in prescribing food supplements, there seem to be a general lack of knowledge on the subject that requires targeted educational interventions to ensure patient safety. Key messages • Food supplements are often taken by patients because they are under the impression that these products are always and completely safe. • Clinical recommendations for the use of food supplements are much more limited than their actual use.

Future proof competencies for nurses working in primary care; a mixed methods study

Abstract Background Healthcare services, also those provided by nurses, are challenged by the increasing care demands of an ageing population and people with chronic conditions. To improve care efficiency and quality, now and in the future, nurses must have competencies regarding self-management support of patients, electronic communication, preventive care, and engaging relatives in care. This study aimed to assess primary care registered nurses’ (RNs) time allocation to these competencies and their perceived needs for further development of these competencies. Methods A mixed methods design was used, involving a nationwide survey (n = 303) and focus groups (12 participants), both with RNs working in community care services or general practitioners (GPs) practices. Survey data were analysed descriptively, and focus group transcripts underwent qualitative thematic analysis. Results The majority of RNs invest significant time in client self-management support (90%), preventive care (82%), and involving relatives in care (74%). RNs also recognized an increasing demand for these competencies in the future and the need to motivate patients and relatives to self-manage their health. Furthermore, RNs reported that competencies regarding electronic communication skills will become extra important in the future, yet currently only 37% dedicate substantial time to this. RNs face challenges in effectively utilizing electronic communication with patients and thus need opportunities to improve digital skills. Additionally, RNs desire enhanced collaboration with other healthcare professionals, such as GPs and medical specialists. Conclusions RNs’ limited time allocation and perceived inadequacy in electronic patient communication, underscore the importance of targeted training in this area, and prioritizing this by healthcare organizations. In addition, fostering collaboration between nursing staff and other healthcare professionals could support future proof nursing in primary care. Key messages • Nurses demonstrate resilience in addressing healthcare challenges, emphasizing client care, prevention and family engagement. • Training nurses in competencies for electronic communication with patients is essential to meet the anticipated increase in demand for this aspect in their practice.

Patient characteristics and incidence of cardiac amyloidosis: an observational study in the UK clinical setting using electronic health records

Abstract Background Cardiac amyloidosis (CA) is associated with a high mortality rate due to sudden or progressive heart failure. It is often misdiagnosed due to non-specific symptoms, and its true incidence and prevalence in the United Kingdom (UK) remain uncertain. Purpose To describe patient characteristics and incidence of CA in the UK clinical setting using electronic health records. Methods In this retrospective observational study, anonymised, linked primary and secondary care data (Clinical Practice Research Datalink, CPRD and Hospital Episode Statistics, HES) were used to describe individuals diagnosed with CA. The CPRD database contains de-identified patient data sourced from a sample of general practitioner (GP) practices in the UK. Patients aged 18 years and older with a recorded Read or SNOMED-CT diagnosis code for CA or record of treatment with tafamidis (a licensed but not reimbursed treatment for transthyretin amyloid cardiomyopathy, ATTR-CM in the UK) in the period between January 2004 to December 2021 were included. The index date was defined as the earliest recorded date of CA diagnosis or tafamidis treatment. Demographic and clinical data were summarised using descriptive statistics. Incidence rates were reported per 100,000 person-years (PY). Results There were a total of 3,788 patients with CA (mean age: 67 years; 61% males) of which only 277 were coded as having wild-type transthyretin (ATTRwt) CA in mostly older patients (mean age: 79 years). The low patient counts of ATTRwt amyloidosis could be attributed to the lack of specificity in CA types and the low utilisation of ATTR amyloidosis codes. Heart Failure, essential hypertension and dyspnoea were the most common clinical presentations recorded in the 12 months to first diagnosis code or tafamidis prescription for CA (Table). The incidence of CA varied from 0.75 in 2004 to a peak of 1.96 in 2021, per 100,000 PY; a 2.9-fold increase in newly coded diagnoses in CA. There was a slight decline in the rates in 2020 and 2021 (Figure). Incidence rates in males and females increased over the 17-year period, with males consistently having higher rates than females. The incidence rate in females started from a lower base at 0.62/100,000 PY in 2004, increased by a factor of 1.9 to 1.1/100,000 PY, whereas in males it started at 0.88/100,000 PY and rose by a factor of 2.9 to 2.5 /100,000 PY. Incidence rates in subgroup populations have also been analysed. Conclusions In the UK clinical setting, the incidence rate of newly coded CA increased overall between 2004 and 2021, as well as in both male and female subgroups. The data suggest CA is becoming more common, or that awareness has improved, and there is now an urgent need for enhanced methods of detection, characterisation, and the need for thorough data capture to shape future pathway advancements.

Exploring Interoceptive Awareness With Adults: Occupational Therapy Practitioner Knowledge, Perception, and Practice Patterns.

As the literature states, interoception is important in health and wellness. Disruption of this system can negatively impact occupational performance. We completed a descriptive study to understand how occupational therapy practitioners working with adults address interoceptive awareness. A researcher-developed survey gathered data on knowledge acquisition of interoception and perceived practice patterns related to assessment, intervention, and outcomes. Participants (N = 44) reported acquiring knowledge of interoception through professional websites, browsing databases, and continuing education as the most common information sources. Client self-report (56.8%) and clinical observation (54.5%) were the most commonly reported assessments. Rehabilitation practitioners (n = 8) reported no use of formal assessments. Most participants (63.89%) reported interoceptive awareness interventions to be effective. Further research is needed on best practices for interoception assessment and intervention related to occupational performance.

Prescribing by level of deprivation in Wales: an investigation of selected medicine groups

BackgroundPrescribing is the most common intervention made by healthcare professionals. Our study aimed to compare prescribing between general practitioner (GP) practices with the highest and lowest levels of deprivation.MethodsThe deprivation...

Investigating a novel population health management system to increase access to healthcare for children: a nested cross-sectional study within a cluster randomised controlled trial

BackgroundEarly intervention for unmet needs is essential to improve health. Clear inequalities in healthcare use and outcomes exist. The Children and Young People’s Health Partnership (CYPHP) model of care uses...

A machine learning algorithm for the detection of paroxysmal nocturnal haemoglobinuria (PNH) in UK primary care electronic health records

BackgroundParoxysmal Nocturnal Haemoglobinuria (PNH) is an ultra-rare, acquired disorder that is challenging to diagnose due to varied symptoms, heterogeneous patient presentations, and lack of awareness among healthcare professionals. This leads to frequent misdiagnosis and delays in diagnosis. This study evaluated the feasibility of a machine learning model to identify undiagnosed PNH patients using structured electronic health records.MethodsThe study used data from the Optimum Patient Care Research Database, which contains electronic health records from general practitioner (GP) practices across the United Kingdom. PNH patients were identified by the presence, and control patients by the absence of a PNH diagnosis code in their records. Clinical features (symptoms, diagnoses, healthcare utilisation) from 131 patients in the PNH group and 593,838 patients in the control group, were inputted to a tree-based XGBoost machine learning model to classify patients as either “positive” or “negative” for PNH suspicion. The algorithm was finalised after additional exclusions and inclusions applied. Performance was assessed using positive predictive value (PPV), recall and specificity. As the sample used to develop the algorithm was not representative of the true population prevalence, PPV was additionally adjusted to reflect performance in the wider population.ResultsOf all the patients in the PNH group, 27% were classified as positive (recall). 99.99% of the control group were classified as negative (specificity). Of all the patients classified as positive, 60.4% had a diagnosis of PNH in their record (PPV). The PPV adjusted for the population prevalence of PNH was 19.59 suggesting nearly 1 in 5 patients flagged may warrant further PNH investigation. The key clinical features in the model were aplastic anaemia, pancytopenia, haemolytic anaemia, myelodysplastic syndrome, and Budd-Chiari syndrome.ConclusionThis is the first study to combine clinical understanding of PNH with machine learning, demonstrating the ability to discriminate between PNH and control patients in retrospective electronic health records. With further investigation and validation, this algorithm could be deployed on live health data, potentially leading to earlier diagnosis for patients who currently experience long diagnostic delays or remain undiagnosed.

An Examination on the Planning and Practice of Bilingual Education in Primary and Secondary Schools in Taiwan

Over the past few years, several reforms in language education have been outlined to implement the full-scale bilingualization of the education system in Taiwan. Among the 3392 public primary and secondary schools, nearly one-third of them have been implementing bilingual education in certain subjects. The vast majority of these schools have adopted Immersion, CLIL, or EMI as models for bilingual education. It has been argued that these exotic models cannot be “transplanted” to the education context of Taiwan, and he proposes the FERTILE model. Adopting this model as the theoretical framework, this qualitative study aims to examine how school practitioners plan and practice bilingual education in Taiwan. Data were collected through the document analysis of the progress reports from thirty-five primary and secondary schools and three focus group discussions (FGDs) with nine subject teachers. The findings show that the participants made considerable efforts to construct a bilingual environment and have an identical understanding about the strategies for bilingual instruction that emphasize subject knowledge and students’ comprehension. However, the participants experienced a diverse ecology of bilingual teacher learning communities and received differential support from the principals. Qualified and stable teaching manpower was identified as the key to sustain bilingual education. Implications to different education stakeholders are also discussed.

The UK Prevent Strategy’s ‘fundamental British values’: a qualitative systematic review of perspectives from the education sector

The education sector is a key point of implementation for the UK Prevent Strategy, particularly with the introduction of the Prevent duty, which makes the promotion of ‘fundamental British values’ mandatory for educational practitioners. This article aims to explain the views and experiences that those within the education sector have of fundamental British values. A systematic search of four bibliographic databases and existing systematic reviews was conducted, yielding 26 studies which were included in the synthesis. The findings of the meta-ethnography yielded five third-order constructs: (1) cultural imperialism; (2) bifurcated Britishness; (3) assimilation versus pluralism; (4) educator agency; and (5) depoliticising Prevent. These culminated in a line-of-argument synthesis, which suggests that the mandatory requirement to promote fundamental British values can have a restrictive effect on the pedagogical practice of educational practitioners. It also alludes to ethnic minority practitioners as being more affected than their White counterparts. This review revealed evidence that is overwhelmingly England-centric. Research on the implementation of fundamental British values in the Scottish and Welsh educational contexts could be a valuable addition.

Going Underground: Demographics, Services, and Best Practices Endorsed by Practitioners Providing Support for Naturalistic Psychedelic Use

ABSTRACT Psychedelic-assisted therapy (PAT) has shown preliminary efficacy for psychiatric and physical health conditions. Although some people report naturalistic psychedelic use with so-called “underground” practitioners, little is known about PAT that occurs outside of controlled clinical settings or perspectives of these practitioners. We conducted an anonymous online survey of individuals who reported providing psychedelic support services (e.g. trip sitting and/or preparatory/follow-up psychotherapy) in naturalistic settings. We investigated demographics, including education and licensing, details about services provided, and reported client outcomes. Among 107 participants, 40.2% held a full or in-progress license and 44.9% had not obtained a relevant graduate degree. Almost all participants reported pre-screening clients before treatment, offering preparation, integration, and trip-sitting services, and most employed a range of therapeutic modalities, centering primarily on non-directive approaches. Participants reported that clients most commonly consumed psilocybin, and treated numerous conditions, primarily aligning with indications targeted in psychedelic clinical research. Perceptions of clients’ symptom changes were largely positive, although a small proportion reported worsened personality disorder symptoms. Further research delineating client and practitioner perspectives of naturalistic PAT services is warranted, and such work may shed light on the benefits and risks specific to naturalistic PAT as well as inform best practices for practitioners.

A handbook for Rhythmic Relating in autism: supporting social timing in play, learning and therapy.

We present a handbook for Rhythmic Relating, an approach developed to support play, learning and therapy with young autistic children, unconventional communicators, and autistic people who have additional learning needs. Rhythmic Relating is based on the Movement Sensing perspective, a growing body of research that recognizes that autistic social difficulties stem from more basic sensory and motor differences. These sensorimotor differences directly affect embodied experience and social timing in communication. The Rhythmic Relating approach acknowledges that autistic/non-autistic interactive mismatch goes both ways and offers bidirectional support for social timing and expressive action in play. This handbook is presented in an accessible fashion, allowing the reader to develop at their own pace through three skill-levels and encouraging time out to practice. We begin with the basics of building rapport (seeing, copying, and celebrating interactional behaviors), introduce the basic foundations of sensory stability, and then move on to developing reciprocal play (using mirroring, matching, looping, and "Yes…and" techniques), and further to understanding sensory impetus (using sensory contours, accents and flows) and its potential in support of social timing. Rhythmic Relating is offered in support of each practitioner's creative practice and personal sense of fun and humor in play. The model is offered as a foundation for interaction and learning, as a base practice in schools, for Occupational Therapists, Speech Therapists and Physiotherapists, and can also provide a basis for tailoring creative arts therapies when working with autistic clients.

Understanding dental practitioners' knowledge and practices of smokeless tobacco: South Texas Oral Health Network study

ObjectiveThis study, conducted by the South Texas Oral Health Network, evaluated dental practitioners' knowledge, attitudes, and practice behaviors regarding cultural forms of smokeless tobacco (SLT) use and effects, using the 5As (Ask, Advise, Assess, Assist, and Arrange) framework. MethodsChi-squared tests examined associations between dental practitioners’ characteristics, self-confidence, knowledge, attitudes, and practices. The 5As tobacco cessation intervention steps were analyzed using the Wilcoxon rank sum test to measure changes in the frequency of use between successive steps. ResultsThe study finds that higher knowledge scores about SLT forms (chewing tobacco, snuff, dip, paan, betel quid, gutka areca nut) were linked to greater adherence to the Assess and Assist of the 5As cessation intervention steps. However, adherence rates to the 5As declined progressively from Ask to Arrange, representing a gap in SLT cessation practice among active dental practitioners. Dental practitioners were found to be more familiar with conventional SLT forms (e.g., snuff) and less with cultural SLT forms (e.g., paan). ConclusionThese findings underscore the need for improved culturally relevant training to enhance practitioner awareness concerning cultural SLT forms and increase progression through the 5As cessation intervention. Practice implicationsWe anticipate that our findings will highlight the critical need for dental practitioners to be aware of diverse cultural forms of SLT and their associated oral and systemic effects to support cessation efforts effectively, primarily due to the growth of culturally diverse communities in the United States and the corresponding rise in the use of previously unrecognized forms of SLT in dental practices. This study is designed to understand the cultural nuances the practitioner needs to develop and communicate the health hazards and importance of cessation of SLT use in the immigrant and refugee populations. Clinical significanceThis study is significant because it highlights the importance of understanding diverse cultural forms of SLT and cessation practices among dental practitioners. Understanding this will enhance awareness and guide training to improve SLT cessation efforts, improve oral health outcomes, and address disparities in diverse patient populations, particularly amidst increasing immigration trends.

Knowledge, attitude and practice of general practitioners in Bujumbura regarding stroke

Knowledge, attitude and practice of general practitioners in Bujumbura regarding stroke

Exploring General Practitioners' Knowledge, Attitudes, and Practices towards E-Cigarette Use/Vaping in Children and Adolescents: A Pilot Cross-Sectional Study in Sydney.

(1) Background: The increasing use of e-cigarettes/vaping in children and adolescents has been recognised as a global health concern. We aim to explore the Knowledge, Attitude, and Practice of General Practitioners (GPs) in Sydney regarding the use of e-cigarettes in children and adolescents and identify the barriers to addressing this issue. (2) Methods: This pilot study was a cross-sectional study conducted using an electronic questionnaire with a Likert scale and free-text responses. (3) Results: Fifty-three GPs participated in the study (male = 24 and female = 29) with a mean age of 50 ± 5.5 years. There was strong agreement (mean 4.5) about respiratory adverse effects and addictive potential. However, there was less awareness of cardiac side effects and the occurrence of burns. There is a lack of conversation about e-cigarettes in GP practice and a deficit of confidence in GPs regarding managing e-cigarette use in children and adolescents. (4) Conclusions: Our pilot study has shown that GPs are somewhat knowledgeable about the potential adverse effects of the use of e-cigarettes in children and adolescents, though there is a lack of knowledge of the complete spectrum of adverse effects and more importantly, there is a paucity of a structured approach to discuss the use of e-cigarettes with children and adolescents, and there is a low level of confidence in addressing these issues. There is a need for educational interventions for GPs to increase awareness of the potential adverse effects of using e-cigarettes and build confidence in providing management to children and adolescents regarding the use of e-cigarettes.

An Observational Study on the Management of Medico-Legal Maxillofacial Trauma Cases by General Practitioners.

This study included 113 general practitioners from St. Spiridon Hospital in Iasi, Romania. Participants completed a self-administered structured questionnaire assessing the knowledge, attitudes, and practices of general practitioners regarding the handling of medico-legal cases. The scores obtained for the level of knowledge, attitudes, and practices indicate a good level of knowledge on the part of the responding doctors, with the average value being 38, in a range from 0 to 49 (min. value 28-max wave. 47). The score regarding the attitudes of doctors related to the management of medico-legal cases is modest, with the average value being 37 points out of a maximum of 60 points (min. 14-max. 51). The same situation is recorded in the case of practices regarding the management of medico-legal cases, with the average value being 68 out of a maximum value of 90 (min. 38-max. 84). This study's results revealed the absence of a well-defined protocol for the recognition and handling of medico-legal cases among general practitioners from Iasi and the need to improve the level of attitudes and practices regarding the management of medico-legal cases. The limitations of this study included the relatively small sample from a single hospital and the use of a methodology based on self-administered questionnaires, which may be subjective. Accordingly, future studies should involve larger and more diverse samples to monitor changes in knowledge and practices over time and qualitative methodologies to gain deeper physician-related insights into medical case management.

The practical use of artificial intelligence in Transfusion Medicine and Apheresis

BackgroundBlood and plasma volume calculations are a daily part of practice for many Transfusion Medicine and Apheresis practitioners. Though many formulas exist, each facility may have their own modifications to consider. ChatGPT (Generative Pre-trained Transformer) provides a new and exciting pathway for those with no programming experience to create personalized programs to meet the demands of daily practice. Additionally, this pathway creates computer programs that provide accurate and reproducible outputs. Herein, we aimed to create a step-by-step process for clinicians to create customized computer programs for use in everyday practice. MethodsWe created a process of inputs to ChatGPT-40, which generated computer programming code. This code was copied and pasted into Notepad (and saved as a Python file) and Google Colaboratory to verify functionality. We validated the durability of our process by repeating it over a 5-day timeframe and by recruiting volunteers to reproduce our outputs using the suggested process. ResultsComputer code generated by ChatGPT-40 in response to our common language inputs was accurate and durable over time. The code was fully functional in both Python and Colaboratory. Volunteers reproduced our process and outputs with minimal assistance. ConclusionWe analyzed the practical application of ChatGPT-40 and artificial intelligence (AI) to perform daily calculations encountered in Transfusion Medicine. Our results provide a proof of concept that people with no programming experience can create customizable solutions for their own facilities. Our future work will expand to the creation of comprehensive and customizable websites designed for each individual user.

Antimicrobial resistance related knowledge, attitude and practice of general practitioners, patients and farmers: A cross-sectional study in Uzbekistan

ObjectivesThe objective was to identify antimicrobial resistance related knowledge, attitudes and practice gaps of general practitioners, patients and farmers. MethodsCross-sectional, mixed-mode (in-person and distance) survey conducted out among the key antimicrobial prescribers and consumers in Uzbekistan, from March to October 2020. We calculated knowledge and attitude scores and applied multivariable adaptive linear regression. ResultsData were collected from 718 adults (236 - GPs, 251 - patients and 231 - farmers) aged 18 years and older. 66.5 % (n = 157) of general practitioners didn't base their antimicrobials prescription on guidelines. A third were not familiar with the delayed antibiotic prescriptions strategy. Most general practitioners prescribe antibiotics on patients' request; one third if patients have fever, almost 60 % (n = 142) if patients have cough with sputum.Majority of patients believed that antibiotics can cure influenza and cold. Every third farmer thought that antibiotics is an antiviral and every fifth a tool to increase productivity. Almost two third of them used antibiotics to protect livestock/poultry/fish from disease.For all three groups, the strongest predictor for the right attitude was the knowledge level. ConclusionsAll three groups had knowledge gaps in the form of misconception and problem underestimation which manifests itself as a wrong practice. Interventions are needed at the national, institutional and individual levels, in particular in the trainings of general practitioners and farmers.

Primary Prevention of Addictive Behavior of Patients Encountered in the Practice of General Practitioners and Family Doctors

The article presents the results of a theoretical study of the problem of increasing the effectiveness of preventive activities of general practitioners and family doctors by developing a technology for the primary prevention of addictive behavior in patients using the method of developing personal self-regulation and a method for developing the competencies of doctors in preventing addictive behavior in patients using medical simulation.

Embedding work coaches in GP practices: Findings from an interview-based study in the UK

BackgroundThe integration of work coaches (WCs) and disability employment advisors (DEAs) into General Practitioner (GP) practices in the UK aims to address the interplay between health and employment by facilitating access to employment support, especially to people with disabilities and health conditions affecting their ability to work. This study seeks to explore the perspectives and perceptions of WCs, DEAs and GPs regarding the benefits and challenges of embedding WCs and DEAs in GP practices. MethodsData was collected between May and July 2023 through semi-structured interviews with four GPs, four WCs and four DEAs working in NHS GP practices. The interviews were audio-recorded, transcribed verbatim and thematically analysed using the Thematic Framework method. Emergent themes were pre-structured and classified as perceived benefits, barriers and challenges or drivers and strategies. ResultsThe integration of WCs & DEAs within GP practices was perceived by respondents as fostering a direct collaboration between professionals as well as a greater openness of patients which benefited patients, WCs/DEAs and GPs. While all respondents emphasised the various benefits, they also identified several barriers and challenges. The implementation stage was perceived as particularly challenging, especially by WCs and DEAs, whereas the lack of human, financial and logistical resources hindered the service beyond this stage. Several strategies and drivers to support the service were identified, including the importance of receiving support from all professionals involved as well as making the service visible to both healthcare professionals and patients. ConclusionEmbedding WCs and DEAs in GP practices emerges as a promising approach which can benefit patients, GPs and WCs/DEAs. Exploring patients' perspectives directly is crucial to fully assess this type of service and identify any additional challenges and benefits.