Care Practitioners Research Articles

Design and Development Process of a Youth Depression Screening m-Health Application for Primary Health Care Workers in South Africa and Zambia: An Overview of the MEGA Project

Literature indicates a high prevalence and burden of mental illness in youths world-wide, which may be even higher in low- and middle-income countries (LMIC), such as South Africa and Zambia. Additionally, there is a lack of knowledge regarding youth depression amongst many primary health care (PHC) practitioners. The principal goal of the MEGA project is to provide youth with better access to mental health services and appropriate care, by developing a mental health screening mobile application tool to be used in PHC settings in South Africa and Zambia. In this study, we will use a mixed methods multi-center study design. In phase one, we will investigate the mental health literacy of PHC practitioners to identify areas in need of development. Based on the needs identified, we will develop and test a mobile health application to screen for common youth mental health problems in phase two. In phase three, we will implement and evaluate a tiered education and training program in the use of the m-health application. In the final phase, we will evaluate the acceptability and feasibility of the m-health application in PHC centres across South Africa and Zambia. Evidence suggests that PHC practitioners should routinely consider mental illness when assessing youth. However, common psychiatric disorders remain largely undetected and untreated in PHC settings. By identifying limitations in PHC workers knowledge with regard to youth mental health, we aspire to improve the depression care provided to youth in Southern Africa and Zambia by developing and implementing a locally relevant m-health application.

Post-Discharge Services for Different Diagnoses Than Index Hospitalization Predict Decreased 30-Day Readmissions Among Medicare Beneficiaries.

Efforts to reduce hospital readmissions include post-discharge interventions related to the illness treated during the index hospitalization (IH). These efforts may be inadequate because readmissions are precipitated by a wide range of health conditions unrelated to the primary diagnosis of the IH. To investigate the relationship between post-discharge health services utilization for the same or a different diagnosis than the IH and unplanned 30-day readmission. The study sample included 583,199 all-cause IHs among 2014 Medicare fee-for-service beneficiaries. For all-cause IH, as well as individually for heart failure, myocardial infarction, and pneumonia IH, we used multivariable logistic regressions to investigate the association between post-discharge services utilization and readmission. The outcome was unplanned 30-day readmission. Primary independent variables were post-discharge services utilization, including institutional outpatient, office-based primary care, office-based specialist, office-based non-physician practitioner, emergency department, home health care, and skilled nursing facility providers. Among all-cause IH, 11.7% resulted in unplanned 30-day readmissions, and only 18.1% of readmissions occurred for the same primary diagnosis as IH. A substantial majority of post-discharge health services were utilized for a primary diagnosis differing from IH. Compared with no visit, institutional outpatient visits for the same primary diagnosis as IH (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.31-0.34) and for a different primary diagnosis than IH (OR, 0.36; 95% CI, 0.35-0.37) were similarly strongly associated with decreased unplanned 30-day readmission. Primary care physician, specialist, non-physician practitioner, and home health care showed similar patterns. IH for heart failure, myocardial infarction, and pneumonia manifested similar patterns to all-cause IH both in terms of post-discharge services utilization and in terms of its impact on readmission. To reduce unplanned 30-day readmission more effectively, discharge planning should include post-discharge services to address health conditions beyond the primary cause of the IH.

Medical apologies by hospitals in case of adverse events: progress and inspirations

Medical apology is the most difficult part of doctor-patient communication in an adverse event, while it bears paramount importance for both the patients and hospital as it conveys responsibilities and emotional concerns.This article reviewed the progress of medical apology studies overseas, and described the significance, connotations, types, methods and obstacles.In the end, the authors mentioned the present importance in China, in order to provide references for health care managers, practitioners and educators in China. Key words: Doctor-patient communication; Adverse event; Disclosure; Apology; Research progress

Healthcare costs associated with varicella and herpes zoster in Norway

BackgroundNorway does not implement routine vaccination against varicella or herpes zoster. Despite substantial health burden associated with both diseases, their economic impact is not well described. The aim of the present study was to document the healthcare costs associated with both conditions in a Norwegian setting. MethodsWe used registry data about patients’ contacts with primary and specialized healthcare services from 2008 to 2014 to estimate the costs associated with varicella and herpes zoster in the primary and hospital care sector. We calculated the individual costs by treatment facility (general practitioner and emergency primary care clinic) in primary care and by treatment level (inpatient, outpatient or ambulatory treatment) at hospitals. ResultsWe estimate that the annual healthcare cost of patients with varicella and herpes zoster are NOK 85 million (approximately € 9 million). Of the annual costs, 73% are associated with herpes zoster and 27% are due to varicella. The majority (54%) of the total annual cost is represented by patients with herpes zoster treated in hospital. ConclusionVaricella and herpes zoster impose a substantial financial burden on the national healthcare services in Norway. Most of the costs are incurred by herpes zoster, which could be prevented by vaccination.

HOME palliative care-Nepal: A cell-phone/website it system.

e23134 Background: Worldwide, major clinical barriers to effective palliative care are the absence of: 1. Current data on symptom type and intensity; 2. Immediately accessible information on practical, affordable, and effective interventions; and 3. Self-sustaining systems to facilitate currently limited physician engagement in continuing palliative care. In Nepal, essentially all families have a cell phone, the majority of which are Android smart phones. 80% of the population lives in rural settings. Methods: Following a cross sectional study in 383 Nepalis with advanced cancers using a cell-phone “app” on the Android platform with a validated 15-item symptom questionnaire, in which all approached patients agreed and were able to complete the instrument in under 3 minutes, we assembled a Nepali/US development team of clinicians and computer scientists to create a tele-home palliative care system centered on use of this app. Results: We have developed an internet website (homepalliativecareNepal.net) with patient/family and physician information pages, a guest health professional site, and a password-protected physician site with organized patient demographic and medical summary data, and telephone-submitted app-symptom reports, local clinical practice guidelines, and an intervention menu of 30 written and mini-video items and links (the majority non-pharmacologic) including start-up drug prescriptions (5), which can be personalized and directly sent to the patient by phone. The system is managed by a local organization that also ensures regular physician/clinic visits by the patient, or by a family member with a patient phone check-in, at least every two weeks, with creation of documentation of provided services. Conclusions: Our adaptable, patient-centered, IT-tools-facilitated, and economical system offers significant potential for addressing the need to engage all types of health care practitioners in palliative care in different cultural settings.

Social Media and 21st-Century Child and Youth Care Practice

The exponential growth of online information and communication technologies such as texting and social media sites like Facebook, Instagram, and Snapchat have opened up new possibilities for child and youth care (CYC) practitioners to engage with children, youth, and families. Yet very little is known about the therapeutic use of these technologies as a direct CYC practice method. Hence, this qualitative, course-based research project aimed to explore the use of social media as a therapeutic practice by CYC students at MacEwan University. The Instagram social networking site was used to collect data. A thematic analysis identified four overarching themes: (a) a relationship, engagement, and communication building tool, (b) a source of support and information, (c) a creative space for self-expression, and (d) a safe place. The results of this course-based study indicate that CYC students use social media responsibly in their work with children, youth, and families. The use of social media appears to have a positive impact and beneficial use in CYC as long as it is utilized and maintained in a professional manner. More research into social media is, however, required to help CYC practitioners keep pace with information and communication technologies and become well-informed about their use and misuse.

Increased access to nurse practitioner care in rural Nebraska after removal of required integrated practice agreement.

Nebraska is a largely rural state with many communities defined as medically underserved by primary care providers. In 2014, the state legislature voted to eliminate the requirement for an integrated practice agreement (IPA) between nurse practitioners (NPs) and physicians. This report describes changes in access to primary health care in rural and underserved areas of Nebraska after removal of the IPA barrier to practice. The report compares the number of primary care NPs working in medically underserved areas before and after the legislation that ended the required IPA. In addition, anecdotes will be provided of NP and patient experiences in rural, NP-owned practices in Nebraska after IPA requirements were eliminated.

Suitability of the German version of the Manchester Triage System to redirect emergency department patients to general practitioner care: a prospective cohort study

ObjectivesTo investigate the suitability of the German version of the Manchester Triage System (MTS) as a potential tool to redirect emergency department (ED) patients to general practitioner care. Such tools...

Compassion in Medical Practice

Compassion and kindness can be cultivated and enhanced. Over the years in medical practice I have witnessed many healthcare workers, after having worked with kind and caring practitioners, become progressively more humane. Those of us who are teachers need to be mindful of that. In educating new physicians, compassion should play a central role and we as practicing doctors are well placed to model a caring and empathetic approach to our patients. There is also a fundamental need to look after ourselves and maintain a healthy balance between professional and private life, in order to become effective healers. Kindness and compassion are strengths, not weaknesses. When we place kindness and compassion at the core of our work, we can find and enrich meaning and joy in caring for patients. Then both we and our patients are empowered.

Daily Pain Measurements and Retrospective Pain Measurements in Hip Osteoarthritis Patients With Intermittent Pain.

ObjectiveTo examine the value of daily pain measurements in patients with hip osteoarthritis (OA), and whether the reliability of retrospective measurements was lower in patients with intermittent pain than in patients with more constant pain.MethodsWe used data from a randomized controlled trial that investigated the effectiveness of general practitioner care plus exercise therapy in 203 patients with hip OA. During the first 6 weeks, patients scored their pain each day. These daily measurements were available for 185 patients. At 6‐week follow‐up, patients filled in a questionnaire rating their pain during the previous week. We examined whether the daily measurements provided results for pain other than those provided by retrospective measurements, using a linear mixed‐effects model. We also explored differences between subgroups, based on the frequency and severity of intermittent pain, during the pain course and reliability between retrospective measurements and daily measurements.ResultsDaily measurements showed no different effect of exercise therapy on pain compared with retrospective measurements. We found statistical differences (by analysis of variance) during the course of pain between the subgroups based on the intensity of intermittent pain. Reliability between retrospective and daily measurements was lower in the subgroup with severe intermittent pain (Cronbach's α = 0.642) than in other subgroups (Cronbach's α >0.843).ConclusionIn this specific trial, daily measurements did not yield more precise or additional information compared with retrospective measurements at the 6‐week follow‐up. However, reliability of retrospective measurements may be lower in patients with a higher intensity of intermittent pain.

The Economic Impact of the Expansion of Nurse Practitioner Scope of Practice for Medicaid

Introduction The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. healthcare system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges. Aim To estimate the impact of expanded NP scope of practice (SOP) regulations on the costs of total outpatient visits, prescription drugs, and total care days received by Medicaid beneficiaries nationwide from 1999–2011. Methods We used a longitudinal data policy analysis framework and built a fixed-effect model, a generalized form of a difference-in-differences model, to identify the effect of changes in NP SOP regulations on the outcome variables. The models included controls for state income and unemployment rates. Results Compared to states with reduced SOP, states with full SOP had 17% lower outpatient costs (i.e., $160.45 per beneficiary per year) and 10.9% lower prescription drug costs (i.e., $145.44 per beneficiary per year). States with restricted SOP had 11.6% higher outpatient costs (i.e., $107.31 per beneficiary per year) and 5.1% higher prescription drug costs (i.e., $67.89 per beneficiary per year). Annual total care days were 8% (i.e., 819,905.9 days) higher in states with full SOP compared to states with reduced SOP (p = .05). Conclusion States that expand NP SOP may provide greater intensity of care (measured using total care days) to Medicaid patients without increasing total costs of care. The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. healthcare system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges. To estimate the impact of expanded NP scope of practice (SOP) regulations on the costs of total outpatient visits, prescription drugs, and total care days received by Medicaid beneficiaries nationwide from 1999–2011. We used a longitudinal data policy analysis framework and built a fixed-effect model, a generalized form of a difference-in-differences model, to identify the effect of changes in NP SOP regulations on the outcome variables. The models included controls for state income and unemployment rates. Compared to states with reduced SOP, states with full SOP had 17% lower outpatient costs (i.e., $160.45 per beneficiary per year) and 10.9% lower prescription drug costs (i.e., $145.44 per beneficiary per year). States with restricted SOP had 11.6% higher outpatient costs (i.e., $107.31 per beneficiary per year) and 5.1% higher prescription drug costs (i.e., $67.89 per beneficiary per year). Annual total care days were 8% (i.e., 819,905.9 days) higher in states with full SOP compared to states with reduced SOP (p = .05). States that expand NP SOP may provide greater intensity of care (measured using total care days) to Medicaid patients without increasing total costs of care.

Quality of life and cognitive health in hypertension: is it possible?

The article deals with topical issues of arterial hypertension, as an interdisciplinary problem, maintaining the quality of life and the level of cognitive functions in such patients. The program of care for patients with hypertension has gained interdisciplinary importance. Of primary importanceis the problem of the lack of real knowledge and practicals kills for early diagnosis of CI in the stage of primary care of general practitioners – family medicine, therapists – those who see the patient first and have the opportunity to observe the dynamics of the cardiovascular disease. The necessity of early detection of cognitive impairment in patients with arterial hypertension is grounded, the option of correcting cognitive impairment using the combined nootropic drug Cognifen is proposed.All patients with hypertension should pay close attention to the state of higher mental functions. The management of patients with hypertension in all age groups with CI should be based on achieving adequate control of blood pressure and as soon as possible include adequate neuroprotective therapy.

Reflections on Literature and Medicine, Their Interactions and Influence

Reflections on Literature and Medicine, Their Interactions and Influence Shu-Fang Lai (bio) and Peih-Ying Lu (bio) The present double issue originated in the guest editors' joint attempt to associate literary studies with medics, medicine, and the health profession. In response to the global outbreaks of the recent pandemics that have caused deaths worldwide, along with public health and socioeconomic issues that have been challenging humankind in recent times as they have throughout recorded history, we initiated recruiting original and cross-boundary investigations into the dynamic interactions between literature and medicine in hopes of highlighting the multidisciplinary field of medical humanities. This special double issue aims to explore the topic of literature in the broader sense of expressing ideas and creative imagination in various forms (from poetry and fiction to spoken language and graphic novels) and its relation to medicine; to trace their reciprocal influences; to encompass inquiries into medical humanities with diversified scopes in not only literary studies, but also other disciplines such as history, ethics, medical discourse, applied linguistics, psychology, education, and art. Our principal objective is to gaze at the vast research horizon for medical humanities, and an array of six articles with this introductory account attend to the dialogue between literature and medicine; to probe the medical profession, the human conditions of diseases and illness, pains and suffering; and to grasp the nature of life and the meaning of living. Regarding literature and medicine, we set out to consider first the role of medical practitioners and their practice of healing as imagined in literature. Epistemologically speaking, in Western literature, the image of a person with the knowledge to assist the ill to overcome physical pains and disease emerged as early as in mythological legends and the Bible. For example, as seen in one of the earliest illustrated manuscripts, "The Great Cauldron in the Underworld," the witches in Irish tales had the power of healing the wounded and bringing the dead back to life; they were also endowed with the secret knowledge about other worlds.1 Christian writings from the 2nd-century BCE mention a band of rebel angels who descended to Earth: they "defile[d] themselves" with human women and "taught them charms and enchantments, and the cutting of roots, and made them acquainted with [End Page v] plants" (Charles 192).2 These angels hence trained the first witches (or magic-makers) to learn the art of healing. In Arthurian legend, Morgana le Fay, King Arthur's half-sister apprenticed to the enchanter Merlin, is said to give healing ointments and to carry the fatally wounded Arthur off to the Isle of Apples (Avalon). Then Paracelsus (1493-1541), the Swiss-German Renaissance physician (also botanist, alchemist, astrologer, and general occultist), is referred to recurrently in fiction and poetry.3 Nevertheless, the sorceress could be harmful to Queen Guinevere, toward whom she showed enmity.4 In England, during the reign of Henry VIII, Parliament passed an act in 1542 "to protect herbalists from persecution by the Company of Physicians and Chirurgeons" (Leyel 96).5 More classic examples can be found to highlight the healer's special knowledge about nature and their unusual power, though sometimes tinged with negative qualities such as the ability to harm people. Nicholas Culpeper's The English Physician or Astrologo-physical Discourse of the Vulgar Herbs (1652) includes a list of magic healers and physicians who blur the distinction between astrological herbalism and medicine as in the modern conception. In the contexts of the above Western classics, the medical practitioner's knowledge, power, labor, and care for the patient are often at the core. Following the advances in medical science, many Romantic and Victorian writers began to press the moral issues about physicians and surgeons. The famous case of the trials of Burke and Hare in Edinburgh is typical of skepticism about the ethics of the medical profession. A surgeon might likely be subject to moral degradation, just as Robert Louis Stevenson's famous Strange Case of Dr. Jekyll and Mr. Hyde (1886) shows. After the Parliament decreed in 1752 that all executed murderers could be dissected, the Anatomy Act of 1832 legalized the use of "unclaimed" bodies for dissection by the...

Application of Curriculum Mapping Concepts to Integrate Multidisciplinary Competencies in the Care of Older Adults in Graduate Nurse Practitioner Curricula

The number of Americans ages 65 and older is projected to more than double over the next four decades and to equal nearly one-fourth of the entire population by 2060. Recognizing that the health care workforce in the United States is not sufficiently prepared to meet the care needs of this growing population, the National Academy of Medicine has recommended curricular enhancements for health professional educational programs. To meet this challenge, the University of South Florida College of Nursing applied curriculum mapping principles and concepts to examine and align Family Nurse Practitioner and Adult-Gerontology Primary Care Nurse Practitioner program curricula for congruence with Partnership for Health in Aging multidisciplinary geriatric competencies. Through this process, we developed a geriatric-specific curriculum map and threaded geriatric-specific content, learning experiences, and learning assessment strategies to promote attainment of all 23 competencies. Given the growing role that nurse practitioners are projected to play in the delivery of primary care for older adults in the future, it is imperative that colleges and schools of nursing provide students with learning experiences to support attainment of the knowledge and skills graduates will need to care for older adults in practice. The techniques and strategies described here represent our approach.

Health care utilization after hospitalization following a road traffic accident

Purpose: In recent years, there has been an increasing interest in measuring and modeling health care utilization. However, only limited research has been performed in the field of health care utilization following road traffic accidents. This article aims to measure the incremental health care utilization after hospital discharge after a road traffic accident and explore the association between socio-demographic and injury-related variables and health care utilization.Material and methods: Generalized linear models with negative binomial distribution and log-link were executed per type of health care provider (general practitioner, medical specialists, rehabilitation services and outpatient nursing care) and per type of discharge location (discharged to home, discharged to in-hospital rehabilitation). Health care utilization of the 6 months after discharge was compared with the 6 months before the accident (baseline care).Results: Health care utilization six months after discharge is significantly higher than baseline care, except for outpatient nursing care and general practitioners in in-hospital rehabilitation. The increase in visits to medical specialists ranged on average between 1 and 2.2 visits. For general practitioner, there was an increase of 0.4 visits and 0.8 in outpatient nursing care for those who returned home after acute hospitalization. The average increase in rehabilitation services ranged between 3.6 and 20. Associated influential factors differ per health care provider and discharge destination.Conclusion: Evidence of this study suggests higher health care utilization during the first 6 months following hospitalization due to a road traffic injury, compared with baseline care. Associated variables differ per type of health care provider and discharge-destination. More in-depth research on subgroups is needed.Implications for rehabilitationHealth care utilization varies across different patient characteristics and type of injuries which should be considered in the communication with patients on their care trajectory post-discharge.General descriptions of health care utilization in traffic victims at the population level are lacking. Output similar to our study could serve as a reference for post-discharge care planning.The research output can be a starting point for future research on quality indicators of the expected quantity of care.Efforts must be made to estimate suchlike reference tables on post-discharge services in other patient groups and secondary data are a suitable data-source for those analyses.

Patient satisfaction and outcomes of MSK pain patients accessing advanced physiotherapy practitioner in primary care; a service evaluation

Patient satisfaction and outcomes of MSK pain patients accessing advanced physiotherapy practitioner in primary care; a service evaluation

Community Based Cross Sectional Study upon the Knowledge, Attitude and Practices of Traditional Medicine in West Ares Zone of South West Ethiopia

Background: Traditional medicine (TM) has sustained its approval in a developing country and an extensive acceptance is a well predictable fact particularly in rural developing countries like Ethiopia. Objective: To assess community knowledge, attitude and practice of traditional medicine in Kofele town, West Ares Zone, Southwest Ethiopia. Materials and Methods: The study was carried out on a total of 271 sampled participants recruited by systematic random sampling from May 15 to June 15, 2017, at Kofele town of West Ares Zone, South-East Ethiopia. Data were analysed using SPSS version 20. Observations and Results: Among 271 samples, 50.2% of participants were female. The mean (±s.d.) age of the participants was 32.5 (±12.4) years. Most of them had heard about traditional medicine (98.5%) and more than half of participants (62.2%) had heard about TM from family. The majority (73.1%) of people knew traditional medicine as one of the components of the health care system, from those 72.7% of them knew at least one preparation of the plant product. The majority (99.72%) of the participants were aware of the major side effects of TM (52.4.4%). Remedies were reported to be administered through oral (77%), dermal or tropical (8.1%) and buccal routes (6.2%). About 61.3% of them prefer traditional medical practices (TMP) because they are cheap. About 78.1 % of the respondents agreed upon providing necessary training on dosage and side effect of traditional medicine to the traditional medical practitioners. After the utilisation of TM, 72.7% of the respondents showed improvement and 27.3% of the participants had worsened their complaints with no changes. Conclusion: The study showed that most proportion of the participants did not prefer to use TM withstanding that they lived in urban communities with better access to modern medical care and medical practitioners. To use TM as a valuable alternative to predictable medicine, further investigation must be undertaken to determine the efficiency of alternative medicine to human beings.

A Pilot Study to Evaluate Appropriateness of Empirical Antibiotic Use in Intensive Care Unit of King Saud Medical City, Riyadh, Saudi Arabia

Background: Antibiotics are commonly administered therapies in ICU. There has been a concern over antibiotic misuse recently. ICU is both a victim and a contributor to the ongoing antibiotic misuse problem and a cause of emerging resistance among the pathogens commonly acquired in intensive care units. Because of high mortality associated with sepsis, it is a great challenge for intensive care physicians to select appropriate antibiotic sometimes without any culture and sensitivity. Similarly the time to deescalate also remains a tough call. Selection of appropriate antibiotics empirically has always been a topic of debate among Intensive Care and Infectious Disease practitioners. Objective: The aim of our pilot study was not only to assess the appropriateness of use of antibiotics in our ICU but to help us guide to design a bigger study and structure a stewardship program for ICU; also to assess the differences among prescription of ICU and Infectious Disease Consultants. Method: A prospective observational study in King Saud Medical City ICU following antibiotics started and stopped from 6th November 2014 to 23rd November 2014. Study included 23 adult patients admitted with different etiologies. All 23 patients’ records were shared with two alien referees (one was infectious diseases and other was ICU consultant) from other hospital. Prescribers were blinded to the fact that data was being collected for auditing and the referees were blinded to prescribers and to each other’s. Results: Total 46 antibiotics were used. 40 among them were started on empirically, 6 were culture based. 31 antibiotics were stopped by ICU. 28 among these 31 antibiotics were empirical. Most of included patients responded to combination or monotherapy. Piperacillin-Tazobactam was the most commonly prescribed antibiotic. No major difference was noted among the choice of intensive care or infectious disease consultant. Conclusion: Empirical antibiotics are vital for patients admitted in ICU. We need to follow hospital's anti-biogram and stewardship programs with prompt de-escalation wherever appropriate.

Radiation Doses to Practitioners Caring for Victims of a Radiological Accident

Radiation Doses to Practitioners Caring for Victims of a Radiological Accident

Pharmacotherapeutics in Cardiovascular Dysrhythmias

Abstract Nurse practitioners (NPs) in primary care often encounter patients experiencing cardiovascular dysrhythmias. These changes may vary in severity from minor to life-threatening including paroxysmal symptoms, emergent symptoms, and those seen after hospital discharge for stabilization. The knowledge required to manage these patients is extensive and depends on the experience and expertise of the NP. This article focuses on common treatment plans for common cardiac dysrhythmia management after hospital discharge, including a review of antiarrhythmic agents and the benefits and related risks of each pharmacologic class, which is especially useful for NPs who may not have a cardiology specialty.