Advanced Practitioners Research Articles

Psilocybin Therapy for Clinicians With Symptoms of Depression From Frontline Care During the COVID-19 Pandemic

The psychological morbidity experienced by physicians, advanced practice practitioners (APPs), and nurses from working during the COVID-19 pandemic includes burnout, depression, and posttraumatic stress disorder (PTSD). To investigate whether psilocybin therapy could improve symptoms of depression, burnout, and PTSD in US clinicians who developed these symptoms from frontline clinical work during the pandemic. This double-blind randomized clinical trial enrolled participants from February to December 2022. Participants included physicians, APPs, and nurses who provided frontline care for more than 1 month during the pandemic and had no prepandemic mental health diagnoses but had moderate or severe symptoms of depression at enrollment. Participants were randomly assigned to either the psilocybin or niacin arm. Data analysis was conducted between December 2023 and May 2024 and was based on the intention-to-treat principle. One intervention episode consisted of 2 preparation visits, 1 medication session, and 3 integration visits. At the medication session, participants received psilocybin, 25 mg, or niacin, 100 mg, orally. The primary outcome was a change from baseline (preparation 1 session) to day 28 (after medication administration) in symptoms of depression as measured by the clinician-administered Montgomery-Asberg Depression Rating Scale (MADRS) used by blinded raters. The secondary outcomes were a change in symptoms of burnout (measured with the Stanford Professional Fulfillment Index [SPFI]) and symptoms of PTSD (measured with the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5]). A total of 30 clinicians (15 females [50%]; mean [range] age, 38 [29-60] years) participated, of whom 15 were randomly assigned to receive psilocybin and 15 to receive niacin. The mean change in symptoms of depression (MADRS scores) from preparation 1 session to day 28 was -21.33 (7.84) in the psilocybin arm compared with -9.33 (7.32) in the niacin arm, with a mean difference between arms of -12.00 (95% CI, -17.67 to -6.33; P < .001), a decrease in MADRS scores indicating improvement. The mean change in SPFI scores from preparation 1 session to day 28 showed a numerically larger improvement in symptoms of burnout in the psilocybin compared with the niacin arm (-6.40 [5.00] vs -2.33 [5.97]; P = .05) but was not statistically significant. Since the SPFI score change did not reach statistical significance, the PCL-5 score change was evaluated descriptively. The mean change in PCL-5 scores showed a numerically larger decrease in symptoms of PTSD from preparation 1 session to day 28 in the psilocybin vs the niacin arm (-16.67 [15.04] vs -6.73 [10.69]), but this difference was not statistically tested. This randomized clinical trial found that psilocybin therapy resulted in a significant, sustained reduction in symptoms of depression experienced by clinicians after frontline work during the COVID-19 pandemic. The findings establish psilocybin therapy as a new paradigm of treatment for this postpandemic condition. ClinicalTrials.gov Identifier: NCT05163496.

Secure Messaging Use and Wrong-Patient Ordering Errors Among Inpatient Clinicians

Use of secure messaging for clinician-to-clinician communication has increased exponentially over the past decade, but its association with clinician work is poorly understood. To investigate the association between secure messaging use and wrong-patient ordering errors. This cohort study included inpatient attending physicians, trainee physicians, and advanced practice practitioners (APPs) from 14 academic and community hospitals. Secure messaging volume was assessed over a 3-month period (February 1 to April 30, 2023). Secure messaging volume per clinician-day, measured as the count of secure messages sent and received by a clinician on a given clinician-day. Retract-and-reorder events were used to identify wrong-patient ordering errors, and the presence of any retract-and-reorder event on a clinician-day was the primary outcome. Multilevel logistic regression was used to examine the association between secure messaging volume and wrong-patient ordering errors after adjusting for clinician age, sex, patient load, order volume, and clinical service. A total of 3239 clinicians (median [IQR] age, 37 [32-46] years; 1791 female [55.3%]; 1680 attending physicians [51.2%], 560 trainee physicians [17.3%], and 999 APPs [30.8%]) with 75 546 clinician-days were included. Median secure messaging volume was 16 (IQR, 0-61) messages per day. Retract-and-reorder events were identified on 295 clinician-days (0.4%). Clinicians with secure messaging volume at the 75th percentile had a 10% higher odds of wrong-patient ordering errors compared with those at the 25th percentile (odds ratio [OR], 1.10; 95% CI, 1.01-1.20). After stratifying by clinician role, the association between secure messaging and wrong-patient ordering errors was observed only for attending physicians (OR, 1.20; 95% CI, 1.02-1.42) and APPs (OR, 1.18; 95% CI, 1.00-1.40). In this cohort study of inpatient clinicians, higher daily secure messaging was associated with increased odds of wrong-patient ordering errors. Although messaging may increase cognitive load and risk for wrong-patient ordering errors, these results do not provide conclusive evidence regarding the direct impact of secure messaging on errors, as increased messaging may also reflect greater care coordination, increased patient complexity, or communication of the presence of a wrong-patient ordering error.

Emerging Educational and Networking Platforms in Interventional Cardiology: Expanding Beyond Traditional Social Media.

With ubiquitous use of smartphones and other Internet-enabled devices, clinicians have access to a plethora of multimedia platforms that enable them to network, share educational content, and learn. Several platforms also enable resources that support clinical decision making. Traditional social media has been used extensively by cardiologists for several years and now extends to the entire care team including trainees, advanced practitioners, nurses and technologists. Numerous challenges include concerns about patient privacy and security, lack of peer-review and organization, and chances of propagating misinformation. More recently, newer networking platforms have emerged within cardiology to overcome several of the limitations of traditional social media. Additionally, mobile applications have emerged as an educational tool that provides clinicians with easy access to the latest information including guidelines, consensus documents, risk estimators and treatment algorithms. These point-of-care learning and decision-making tools are especially relevant and impactful in a procedural field like interventional cardiology. While professional societies are major drivers of these emerging platforms, there are also other stakeholders including educational institutions and the medical device industry. In this review article, we examine the role of traditional social media and describe newer networking platforms as well as mobile applications applicable to interventional cardiology with a discussion about their relative advantages and disadvantages.

Deconstructing the self and reshaping perceptions: An intensive whole-brain 7T MRI case study of the stages of insight during advanced investigative insight meditation.

The stages of insight (SoI) are a series of psychological realizations experienced through advanced investigative insight meditation (AIIM). SoI provide a powerful structured framework of AIIM for understanding and evaluating insight-based meditative development through changes in perception, experiences of self, cognition, and emotional processing. Yet, the neurophenomenology of SoI remains unstudied due to methodological difficulties, rarity of suitable advanced meditation practitioners, and dominant research emphasis on attention-based meditative practices. We investigated the neurophenomenology of SoI in an intensively sampled adept meditator case study (4 hr 7T fMRI collected in 26 runs with concurrent phenomenology) who performed SoI and rated specific aspects of experience immediately thereafter. Linear mixed models and correlations were used to examine relations among the cortex, subcortex, brainstem, and cerebellum, and SoI phenomenology. We identified distinctive whole-brain activity patterns associated with specific SoI, and that were different from two non-meditative control states. SoI consistently deactivated regions implicated in self-related processing, including the medial prefrontal cortex and temporal poles, while activating regions associated with awareness and perception, including the parietal and visual cortices, caudate, several brainstem nuclei, and cerebellum. Patterns of brain activity related to affective processing and SoI phenomenology were also identified. Our study presents the first neurophenomenological evidence that SoI shifts and deconstructs self-related perception and conceptualization, and increases general awareness and perceptual sensitivity and acuity. Our study provides SoI as a foundation for investigative, and advanced meditation in particular.

Implementation of a Urologic Surgery Skills Fair for Medical Students

To increase the proportion of applicants to urology residencies, we created a surgical skills fair to introduced urology early in undergraduate medical education. Funded by the Department of Urology, the fair was designed to have student rotations through 12 hands-on practice stations supervised by faculty and an advanced care practitioner or resident physicians. At conclusion, medical students completed a voluntary survey about their experience. Surgical skills fairs were organized at Yale School of Medicine (New Haven, CT) in 2022 and 2023. The fair was designed to encourage interaction between medical students, urology residents, and urology faculty by highlighting common urologic procedures and skills. The fair was well received by medical students at all levels of training. Over 2 years, 155 medical students attended, including 67 (43%) first-year and 60 (39%) second-year medical students. Eighty-two medical students completed the survey. An average of 19 attendings, advanced care practitioners and residents attended each event. Of the survey respondents, 42.7% reported prior interest in a surgical specialty but had not considered urology. Students reported increased interest in urology and greater confidence in urologic skills after the event (p < 0.001). We demonstrate that creating a surgical fair in urology is feasible and enhances early exposure and interest in urology. For students who do not pursue urology, the fair provides knowledge of urological pathologies and valuable skills for all physicians.

Examining Provider Attitudes and Barriers toward Prescribing PrEP within Primary Care Settings in Alabama.

Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) is an effective HIV prevention tool. Expanding PrEP access and utilization is made possible by incorporating it into primary care practice. This study explored the barriers in and attitudes toward prescribing PrEP to adults among primary care providers (PCPs) in Alabama, a priority HIV jurisdiction with low PrEP uptake. We conducted in-depth interviews grounded in the Health Belief Model with Alabama physicians and advanced practice practitioners in general internal and family medicine, exploring provider experiences in collecting sexual history information from patients and prescribing PrEP. Authors used thematic analysis of transcripts to further investigate the emerging themes. From September 2022 to April 2023, eight PCPs participated in our study. Several themes regarding barriers in and attitudes toward discussing sexual health history emerged: time constraints, knowledge and training, comfort levels, and competing priorities. We identified stigma and knowledge as themes when exploring provider attitudes toward and barriers in prescribing PrEP. When discussing the benefit of PrEP provision in primary care, we also identified themes such as longevity of the patient-provider relationship and accessibility. Participants identified multiple opportunities to increase PrEP provision in primary care beyond provider education and training, such as normalizing the language, consistency in discussing sexual health history, and using streamlined efforts of gathering sexual history information. With barriers hindering PrEP prescribing by Alabama's PCPs, in addition to preexisting healthcare barriers experienced by patients in the US Deep South, immediate attention is warranted. Further exploration into developing policies for streamlining sexual history intake and inclusive medical education and training regarding PrEP is needed in Alabama.

Dermatological assessment: history-taking and examination.

Skin problems are common, affecting up to one-third of the population during their lifetime, and they are frequently encountered by advanced clinical practitioners (ACPs) in both primary and secondary care settings. Despite the prevalence of dermatological presentations, ACPs often feel unprepared to conduct a thorough dermatological history and examination. This article aims to provide guidance to trainees and qualified ACPs, whether in acute hospital settings or primary care, to perform dermatological assessments and examinations systematically. This is the first article in a two-part series on dermatological assessment.

Group medical visits in cancer survivorship care: a scoping review

Abstract Background More than 60% of cancer survivors report unmet physical, psychosocial, and informational needs. The care of cancer survivors includes surveillance, health maintenance monitoring, referral for long-term adverse effects of cancer treatment, and coordination of care. Group medical visits (GMV) include medical care, education, and peer support and can be used to facilitate the delivery of multidisciplinary survivorship care. We aimed to characterize the current state of related research describing the role of GMV in cancer survivorship care. Methods For this scoping review, we searched for published literature using PubMed, Embase, and other resources. We included intervention studies of multidisciplinary care involving GMVs of adult patients with a history of cancer requiring the presence of medical personnel, physicians, advanced practitioners, or oncology nurses. We included studies that focused on broad cancer survivorship care, rather than those using specific modalities, such as yoga, or limited to specific aspects of cancer survivorship care, such as weight loss. We characterized the studies by cancer type, structure of GMVs, and reported outcomes. Results We identified 2311 studies (2122 from PubMed and 189 from Embase). We excluded 1524 duplicates and screened 787 studies for title and abstract review. Finally, 63 studies were retrieved for full-text review, and six were included in this scoping review. Of the included studies, four were non-randomized, and two were randomized. Breast cancer was the most common site (4); other studies included breast and other cancers (1) and hematopoietic transplant cancer survivors (1). There was heterogeneity in the structure and frequency of sessions and the survivorship domains addressed. The outcomes studied included quality of life, healthcare utilization, and costs. Conclusions Limited high-quality research exists on the role of GMV in cancer survivorship. Though shown to be effective in chronic disease, the evidence for the effectiveness of this important and widely used approach in multidisciplinary survivorship care remains inconsistent and preliminary; the literature to date provides a starting point for larger-scale studies of GMV in cancer survivorship care. Implications for Cancer Survivors While Group medical visits are a promising intervention to provide multidisciplinary care, larger studies are needed to support their benefit in the care of cancer survivors.

Safety of inpatient care in surgical settings: cohort study

ObjectivesTo estimate the frequency, severity, and preventability of adverse events associated with perioperative care, and to describe the setting and professions concerned.DesignMulticenter retrospective cohort study.Setting11 US hospitals.Participants1009 patients from a...

HPB SO06 - An advanced clinical practitioner (ACP) led pancreatic cyst surveillance programme

Abstract Background The prevalence of pancreatic cysts (PCs), including intraductal papillary mucous neoplasms (IPMNs), has increased substantially over recent decades. This rising prevalence is due largely to the increasing volume and quality of medical imaging technology. Although PC's are often an incidental finding in asymptomatic individuals, a small number do harbour a certain malignant potential and thus raise warranted concern. The challenge therefore is identifying the high-risk lesions for early resection through robust, guideline-driven surveillance. To ensure a consistent and evidence-based approach to PC surveillance, our trust has adopted a dedicated surveillance programme led by an Advanced Clinical Practitioner (ACP) in gastroenterology. Method A PC surveillance clinic was designed and delivered from April 2023. The service underwent a formal inauguration and was promoted at the regional HPB MDT. All patients receive a standardised approach to surveillance in-line with the current international guidelines or regional MDT recommendation. Surveillance diagnostics are arranged by the ACP and patients are updated with regard to their results and next steps during a telephone or face-to-face consultation. A robust database was designed to capture relevant patient details and serve as a future research aid. Results 144 referrals have been received (04/23-04/24). 134 are undergoing surveillance, with discontinuation due to frailty, patient choice, diagnosis of an inflammatory cyst or relocation in 10 cases. Most PCs under surveillance are side-branch IPMNs (70.9%). Malignant transformation has not yet been observed, however 18 cases display worrisome features and 3 have high-risk stigmata. These are undergoing intensive surveillance or awaiting MDT discussion. 93% of surveyed patients (16) report a greater sense of involvement in their PC surveillance and a greater awareness of their surveillance protocol (93%). Referrer feedback (7) has been positive and staff are satisfied with this service (100%). Conclusion Robust surveillance of patients with PC will likely improve early detection and prognosis of pancreatic cancer by enabling early identification of resectable cases. A centralised service that adopts a single agreed guideline will reduce variation in the management of these cysts, ensure these complex lesions are under specialist observation and offer a single point of contact which will improve retainment and follow-up of these patients. It is intended that synchronous data collection will serve to generate a comprehensive repository of information relating to PC. This databases will aid future research into this evolving field and steer future guideline development.

Evolving HIV service delivery: scalability of pharmacist-led care

Abstract Introduction With declining healthcare budgets and numbers of HIV medical trainees1, workforce innovation is crucial to sustain delivery of HIV care. Since local introduction of an advanced pharmacist practitioner (APP) role, we have demonstrated the ability of pharmacists to provide holistic care to people living with HIV, including those with complex medical needs. Scaling up pharmacist-led care may be a potential solution to sustain service delivery2 whilst addressing the needs of an ageing cohort3. Further APP clinics were introduced with consultant support and supervision. Aim We aim to evaluate the impact and outcomes of these APP clinics. Method Prospective data collection of consultations conducted by four pharmacist practitioners (PP) across four HIV clinics between January to December 2023. Surveys were distributed after the appointment to capture service users’ opinions on the pharmacists’ role and care provided. Ethical approval was not required as this does not constitute as research. This was registered as a service evaluation with the research and innovation team at Chelsea and Westminster NHS Foundation Trust. All patient information is anonymised. Results A total of 634 consultations (513 individuals) within 170 clinical sessions were conducted during the 12 month period: 585 (92%) in person; 176 (34%) female; median age 52 (IQR 43-58); 233 (45%) non-white ethnicity; mean number of co-morbidities 2 (0-8); 87 (17%) had more than 5 co-medications (0-21); 87% virologically suppressed [viral load (VL) &amp;lt;50cp/mL]. Of 55 individuals seen with detectable VL, 32 (58%) resuppressed within 6 months. PPs have made 522 interventions and investigations in total, for example 147 referrals to other specialities such as dietitians and mental health services, 112 imaging requested (e.g DEXA and liver ultrasounds) and 99 initiation or switching of antiretroviral therapy (ART). Following investigations, 44 new medical conditions were identified and managed by the PPs which included namely 18 cases of micronutrient deficiencies, 8 cases of skin conditions and 6 cases of metabolic disorders. From the survey, 55% (30/55) of service users were aware that pharmacists could review their overall health. All (100%) respondents felt that the quality of care received met or exceeded expectations and 54 (98%) would attend a pharmacist-led appointment in future. Discussion/Conclusion We have previously successfully demonstrated implementation of pharmacist practitioner clinics as a novel way of utilising and developing the pharmacist workforce. We demonstrate scalability of this service delivery model in our large, urban multi-site centre by successfully increasing the number of pharmacist practitioner clinics from three clinics to six clinics week. The positive feedback from service users indicates high acceptability of this model. HIV services may consider investment into mobilising senior pharmacists to facilitate expansion of this advanced practitioner role in order to address increasing levels of co-morbidities, polypharmacy and complex medical needs observed in our ageing population. The knowledge base of HIV pharmacists means they are ideally placed to facilitate communication across sectors, specialties and disciplines. Future development plans include expanding to other specialist areas such as HIV pre-exposure prophylaxis, contraception, gender health and research delivery and enhanced skills such as phlebotomy, injectable ART administration.

Assessing and managing lower limb oedema: a clinical review.

Lower limb oedema is a common condition in clinical practice, frequently affecting the distal lower limbs. Whereas benign causes such as prolonged sitting or standing are typical, oedema can also indicate serious systemic diseases such as cardiac failure, liver disease, or renal impairment. Identifying the cause is crucial to prevent irreversible skin and tissue changes. This clinical review aims to increase the knowledge of advanced clinical practitioners (ACPs) and generalist practitioners, including practice and community nurses, by providing an overview of how to approach patients with lower limb oedema, encompassing history-taking, examinations, investigations, and management plans. The main focus is on lymphoedema, which can be primary or secondary. Primary lymphoedema results from genetic abnormalities, while secondary lymphoedema arises from acquired defects due to factors such as obesity, infections, neoplasms, and trauma. Effective management includes addressing the underlying cause, ensuring proper skin care, recommending appropriate exercises, and the use of compression garments. Referral to a lymphoedema specialist is recommended for patient education on managing and treating the condition when required. Additionally, the article discusses the importance of regular skin inspections, minor injury management, environmental considerations, and the critical role of compression garments in lymphoedema management. This comprehensive approach aims to enhance patient outcomes and provide a thorough strategy for ACPs and generalist practitioners.

Survey of learning-based approaches for robotic in-hand manipulation.

Human dexterity is an invaluable capability for precise manipulation of objects in complex tasks. The capability of robots to similarly grasp and perform in-hand manipulation of objects is critical for their use in the ever changing human environment, and for their ability to replace manpower. In recent decades, significant effort has been put in order to enable in-hand manipulation capabilities to robotic systems. Initial robotic manipulators followed carefully programmed paths, while later attempts provided a solution based on analytical modeling of motion and contact. However, these have failed to provide practical solutions due to inability to cope with complex environments and uncertainties. Therefore, the effort has shifted to learning-based approaches where data is collected from the real world or through a simulation, during repeated attempts to complete various tasks. The vast majority of learning approaches focused on learning data-based models that describe the system to some extent or Reinforcement Learning (RL). RL, in particular, has seen growing interest due to the remarkable ability to generate solutions to problems with minimal human guidance. In this survey paper, we track the developments of learning approaches for in-hand manipulations and, explore the challenges and opportunities. This survey is designed both as an introduction for novices in the field with a glossary of terms as well as a guide of novel advances for advanced practitioners.

The role of advanced clinical practitioners in gastroenterology: a phenomenological perspective from practice and research

This comprehensive review explores the pivotal role of advanced clinical practitioners (ACPs) in gastroenterology care and the integration of phenomenological approaches in both practice and research domains. ACPs in gastroenterology play multifaceted roles encompassing clinical assessment, triage, diagnosis, treatment and patient management. By adopting a phenomenological approach in practice, ACPs can transcend traditional biomedical models, prioritise patients' lived experiences and provide personalised, holistic care. In research, phenomenological methods offer valuable insights into patients' subjective experiences, informing evidence-based practice and contributing to the advancement of gastroenterology care. Through illustrative examples and critical analysis, this review highlights the significance of integrating phenomenological approaches in enhancing patient outcomes and improving the quality of care in gastroenterology services.

Sharing Genomic Tumor Sequencing Results With Patients: Experiences of Advanced Practice Oncology Providers

Background: Patients with cancer routinely undergo genomic tumor sequencing, a component of molecular profiling (MP), to better characterize their cancer and identify potential targetable alterations. Targeted treatments potentially confer higher response rates and better efficacy. With increasing complexity, patients may require detailed explanations of MP results. Patient understanding of MP results increases the likelihood that eligible patients receive targeted treatment. Advanced practice providers (APPs), defined as nurse practitioners, physician assistants, and pharmacists, frequently review and discuss MP results with patients. Purpose: The aim of this study is to understand APP experiences discussing MP results with adult cancer patients. Methods: A qualitative study was conducted through virtual semi-structured interviews with APPs recruited via study invitation shared through the Advanced Practitioner Society for Hematology and Oncology (APSHO). Eligibility criteria included APPs with &gt; 1 year of oncology experience and involvement in discussing MP results. Data were analyzed utilizing a constant comparative analysis and coded in three stages: open, axial, and selective. Results: Thirteen participants were enrolled from across the United States. Participants discussed learning to understand and explain MP findings primarily through on-the-job experiences. Barriers to patient education were also described. Initially coded participant statements (open codes) produced six themes (axial codes). Conclusions: With MP now standard practice in oncology, APPs frequently discuss these results with patients. This study highlights that additional and continuing education related to MP is needed in communicating complex results. Patient educational tools, specific to patients’ MP findings and tailored to their preferences and literacy levels, are critically needed.

Implementing a multidisciplinary approach for older adults with multiple sclerosis: Geriatric neurology in practice

BackgroundOlder adults with multiple sclerosis (MS) face unique challenges arising from age-related changes in MS pathophysiology and overlapping geriatric syndromes. There is a need for geriatrics-focused multidisciplinary care for the rapidly growing older MS population. ObjectiveTo design and implement a geriatric multidisciplinary clinic for older adults with MS. MethodsWe describe the development of a multidisciplinary approach to geriatric MS care within a single institution through the implementation of the Aging with MS Clinic. The clinic model was conceived through collaboration between neurology and geriatric medicine to provide comprehensive care for older adults with MS who are uniquely affected by overlapping symptoms of aging and MS (e.g., frailty, falls, functional decline, multiple comorbidities, polypharmacy, cognitive impairment, nutritional deficits, barriers to access healthcare). Multidisciplinary specialists were recruited to staff the clinic, and initial patient satisfaction outcomes were collected. ResultsThe team of multidisciplinary specialists staffing the clinic consists of a MS advanced practice practitioner, MS pharmacist, physical therapist, neuropsychologist, dietitian, and social worker. A clinic template was devised where 4 patients with MS over age 60 are seen by each specialist during each half-day clinic session. Initial patient satisfaction surveys from 25 participants showed overwhelmingly positive feedback. A majority of participants (92%) agreed that the clinic was well-organized, while 92% felt they benefitted from attending. Additionally, 80% of participants reported that the clinic improved their overall quality of care. ConclusionThe Aging with MS clinic outlines a model for comprehensive geriatric assessment and care in older adults with MS by a team of multidisciplinary specialists. Initial feedback from patients who attended the clinic conveyed improved quality of care.

Door de ogen van de patiënt: tele- en zelfmonitoring voor zwangere vrouwen met een verhoogd risico op hypertensie

Through the patient’s eyes: remote monitoring and patient self-measurement for women at risk of gestational hypertensive disorders Remote monitoring (RM) and patient self-measurement (PSM) are new technologies that enable blood pressure monitoring at home for pregnant women at risk of gestational hypertensive disorders (GHD). As patient satisfaction is increasingly considered as an indicator of the quality of care, this study aimed to compare patients’ perceptions on RM and PSM with those on conventional care for women at risk of GHD. The data collection was part of a multicentric RCT with 2 intervention groups (RM and PSM) and 1 control group. 254 participants completed the survey, determining the patients’ perceptions regarding the care they received at 4 measurement points. Linear probability models were used to assess the impact of RM and PSM on patients’ perceptions. Women at risk of GHD were significantly more likely to be satisfied with the care outcomes, to feel confident about their role as a mother and to be satisfied with their delivery after a follow-up by RM than after a follow-up by conventional care. In addition, they were significantly less likely to be concerned about their general health. The perceptions of women in the PSM group were not significantly better than those of the control group. The positive perceptions of patients regarding RM may be partly explained by the reduction in complications and the role of the study midwife as ‘advanced midwifery practitioner’.

A qualitative study exploring the experiences of advanced clinical practitioner training in emergency care in the South West of England, United Kingdom

BackgroundAttempting to improve emergency care (EC) advanced clinical practitioner (ACP) training, Health Education England (HEE) South West (SW) implemented a pilot, whereby emergency departments (ED) were provided with enhanced funding...

Critical Result Notifications: What Do Providers Really Think?

Abstract Introduction/Objective Timely communication of critical test results, those that are significantly outside expected ranges and potentially life-threatening, is crucial in patient care. The Joint Commission and other regulatory bodies, such as CMS, CAP, mandate that hospitals have an alert system for reporting critical values. Traditionally, our hospital system communicates these results through phone calls to the responsible licensed provider, a system that has remained unchanged despite the rise of electronic health records. To assess the perception of this system and providers’ readiness to utilize new communication methods, we conducted a survey among healthcare professionals in our institution. Methods/Case Report We sent a survey to all providers via broadcast email. It contained 10 questions, some with free-text input, others with categorical or multiple-choice responses. The survey was open for 4 weeks with 2 reminder emails. Of 544 providers who opened the survey, 191 completed it (35.1% completion rate). The majority (84%) of respondents were physicians, with a smaller portion (15%) identifying as advanced practitioners. Results (if a Case Study enter NA) Most providers reported using multiple modes to check critical results and did not rely solely on lab notifications, though a minority (7%) depended on phone calls. Only 2 respondents used the smartphone app (EPIC Haiku) for checking results. Notably, over 67% of providers were unfamiliar with different methods of critical result notification, yet nearly 82% indicated they were open to adopting a new system. A significant proportion (more than a third) felt that phone calls distracted from patient care, suggesting that alternate methods of communication could be beneficial. Despite this, 62% of respondents found these calls useful. However, more than a third did not find the calls helpful, indicating a possible need for improved communication methods. Conclusion The survey indicates that while the current system of critical result notifications is useful to many providers, there are clear opportunities for improvement. Implementing secure, smart systems and increasing awareness of these new communication modalities may help reduce distractions and streamline critical result communication. This could also offer providers a customizable approach to receiving notifications, enhancing both patient care and workflow efficiency.

Barriers to Adoption of a Child-Abuse Clinical Decision Support System in Emergency Departments.

Child abuse is a leading cause of morbidity and mortality in children. The rate of missed child abuse in general emergency departments (ED), where 85% of children are evaluated, is higher than in pediatric EDs. We sought to evaluate the impact of an electronic health record (EHR)-embedded child-abuse clinical decision support system (CA-CDSS) in the identification and evaluation of child maltreatment in a network of EDs three years after implementation. We anonymously surveyed all 196 ED attending physicians and advanced practice practitioners (APP) in the University of Pittsburgh Medical Center network. The survey evaluated practitioner awareness of, attitudes toward, and changes in clinical practice prompted by the CA-CDSS. We also assessed practitioner recognition and evaluation of sentinel injuries. Of the 71 practitioners (36%) who responded to the survey, 75% felt the tool raised child abuse awareness, and 72% had a face-to-face discussion with the child's nurse after receiving a CA-CDSS alert. Among APPs, 72% consulted with the attending physician after receiving an alert. Many practitioners were unaware of at least one function of the CA-CDSS; 38% did not know who completed the child abuse screen (CAS); 54% were unaware that they could view the results of the CAS in the EHR, and 69% did not recognize the clinical decision support dashboard icon. Slightly over 20% of respondents felt that the CA-CDSS limited autonomy; and 4.5% disagreed with the recommendations in the physical abuse order set, which reflects American Academy of Pediatrics (AAP) guidelines. Greater than 90% of respondents correctly identified an intraoral injury and torso bruise in an infant as sentinel injuries requiring an evaluation for abuse. A child-abuse clinical decision support system embedded in the electronic health record was associated with communication among practitioners and was overall perceived as improving child abuse awareness in our system. Practitioners correctly recognized injuries concerning for abuse. Barriers to improving identification and evaluation of abuse include gaps in knowledge about the CA-CDSS and the presence of practitioners who disagree with the AAP recommendations for physical abuse evaluation and/or felt that clinical decision support in general limited their clinical autonomy.