Practitioners In Clinical Settings Research Articles

Interrater Reliability and Precision of a Novel Hand Strength Assessment and Treatment Device: The GripAble.

Occupational therapy practitioners need modern tools for the assessment of maximal grip strength in clinical and remote settings. To establish the (1) interrater reliability and (2) precision of the GripAble among three raters with different expertise in occupational therapy when testing healthy participants, and to (3) evaluate the relative reliabilities of different approaches to estimating grip strength (i.e., one trial, mean of two trials, and the mean of three trials). Measurement study. Minnesota Translational Musculoskeletal and Occupational Performance Research Lab, University of Minnesota, Minneapolis. Thirty volunteers, age ≥18 yr, without any hand problems. Using GripAble, three occupational therapy raters with varied experience measured the maximal grip strength of the dominant and nondominant hands of all participants. Using the mean of three trials when testing grip strength with GripAble adds precision. GripAble has excellent interrater reliability (i.e., intraclass correlation coefficient > .75) and acceptable precision (minimal detectable change < 15%) among healthy adults. GripAble allows occupational therapy practitioners with different experiences to assess grip strength in healthy hands quickly, precisely, and with excellent reliability. Additional research is needed on its psychometrics in clinical populations and capacities in remote monitoring and exergaming. Plain-Language Summary: The results of this study show that grip strength, an important biomarker and commonly assessed construct in occupational therapy, can be evaluated reliably, precisely, and rapidly with GripAble. The use of GripAble by occupational therapy practitioners in clinical settings may help to build an infrastructure for remote measurements and exergaming interventions in the future.

The Efficacy of Drug-Coated Balloons and Drug-Eluting Stents in Infrapopliteal Revascularization: A Meta-analysis.

The study aimed to compare the effectiveness of drug-coated balloon (DCB) and drug-eluting stents (DESs) to standard endovascular techniques like percutaneous transluminal angioplasty (PTA) and bare metal stent (BMS) for treating infrapopliteal artery disease. Including 8 DCB trials and 4 DES trials, this meta-analysis of 12 recent randomized controlled trials (RCTs) is comprehensive. We searched MEDLINE, EMBASE, Science of Web, Cochrane, and PubMed for this meta-analysis. We searched these databases for papers from their inception to February 2023. We also analyzed the references given in the listed studies and any future study that cited them. No language or publication date restrictions were applied to the 12 RCTs. The experimental group includes 8 DCB studies and 4 DES investigations, the DCB group is primarily concerned with the paclitaxel devices, whereas the DES group is preoccupied with the "-limus" devices. Key clinical outcomes in this study were primary patency and binary restenosis rates. This study's secondary outcomes are late lumen loss (LLL), clinically-driven target lesion revascularization (CD-TLR), limb amputation, and all-cause mortality. The evidence quality was assessed using Cochrane risk-of-bias. The PROSPERO registration number for this study is CRD42023462038. Only 108 of 1152 publications found satisfied qualifying criteria and contained data. All 13 RCTs have low to moderate bias. Drug-coated balloons and DESs were compared in the excluded study. The analysis comprised 2055 participants from 12 RCTs that met the inclusion criteria, including 1417 DCB patients and 638 DES patients. Drug-coated balloons outperform traditional methods in short-term monitoring of primary patency, binary restenosis, and CD-TLR. The benefits fade over time, and the 2 techniques had similar major amputation rates, mortality rates, and LLL. Drug-eluting stents outperform conventional procedures in primary patency, binary restenosis, and CD-TLR during medium-term to short-term follow-up. Comparing the 2 methods, major and minor amputations, death rate, and LLL were similar. Comparison of DES and DCB with PTA or BMS shows that DES had better follow-up results. DCB has positive short-term results, but long-term effects differ, however, more research is needed to determine when DES and DCB should be used in medical procedures. The provision of additional evidence to substantiate the advancement of drug-coated balloon (DCB) therapy in the treatment of lower limb arteriosclerosis obliterans, particularly in the below-the-knee area characterized by high calcium load and significant occlusion, is comparable in efficacy to conventional procedures. This finding is advantageous for the progress of interventional revascularization. The advancement and efficacy of DCB have resulted in improved treatment outcomes for medical practitioners in clinical settings. Our research incorporates the most recent randomized experiments.

Structural Factors in Health Care Associated With the Mental Health Needs of Black Women in California During the Perinatal Period

ObjectiveTo identify structural factors associated with the receipt of mental health care treatment among Black women in California during pregnancy and after childbirth. DesignSecondary analysis of data from the population-based Listening to Mothers in California survey. ParticipantsThe sample included 194 non-Latina Black women in the postpartum period. MethodsWe used descriptive statistics, including differences between means and logistic regression, to conduct a series of bivariate analyses. ResultsMost respondents (84.4%, n = 163) reported symptoms of perinatal mood and anxiety disorders prenatally, and half (50% n = 97) reported symptoms of perinatal mood and anxiety disorders in the postpartum period. Only 12.3% to 14.6% of those who reported symptoms received mental health care treatment. Furthermore, 21.2% (n = 38) of respondents were not screened for postpartum depression. Respondents with private insurance coverage were more likely to report receipt of mental health care after childbirth (OR = 4.6; 95% confidence interval [1.5, 13.5]) compared to respondents with public insurance coverage. ConclusionOur results suggest a high prevalence of unmet mental health needs among non-Latina Black women who lived in California during the perinatal period. Practitioners in clinical settings may be more likely to make referrals to mental health care for women with private insurance coverage in the postpartum period.

Artificial Intelligence-Enabled Chatbots in Mental Health: A Systematic Review

Clinical applications of Artificial Intelligence (AI) for mental health care have experienced a meteoric rise in the past few years. AI-enabled chatbot software and applications have been administering significant medical treatments that were previously only available from experienced and competent healthcare professionals. Such initiatives, which range from “virtual psychiatrists” to “social robots” in mental health, strive to improve nursing performance and cost management, as well as meeting the mental health needs of vulnerable and underserved populations. Nevertheless, there is still a substantial gap between recent progress in AI mental health and the widespread use of these solutions by healthcare practitioners in clinical settings. Furthermore, treatments are frequently developed without clear ethical concerns. While AI-enabled solutions show promise in the realm of mental health, further research is needed to address the ethical and social aspects of these technologies, as well as to establish efficient research and medical practices in this innovative sector. Moreover, the current relevant literature still lacks a formal and objective review that specifically focuses on research questions from both developers and psychiatrists in AI-enabled chatbot-psychologists development. Taking into account all the problems outlined in this study, we conducted a systematic review of AI-enabled chatbots in mental healthcare that could cover some issues concerning psychotherapy and artificial intelligence. In this systematic review, we put five research questions related to technologies in chatbot development, psychological disorders that can be treated by using chatbots, types of therapies that are enabled in chatbots, machine learning models and techniques in chatbot psychologists, as well as ethical challenges.

Refinements and considerations for trio whole-genome sequence analysis when investigating Mendelian diseases presenting in early childhood

SummaryTo facilitate early deployment of whole-genome sequencing (WGS) for severely ill children, a standardized pipeline for WGS analysis with timely turnaround and primary care pediatric uptake is needed. We developed a bioinformatics pipeline for comprehensive gene-agnostic trio WGS analysis of children suspected of having an undiagnosed monogenic disease that included detection and interpretation of primary genetic mechanisms of disease, including SNVs/indels, CNVs/SVs, uniparental disomy (UPD), imprinted genes, short tandem repeat expansions, mobile element insertions, SMN1/2 copy number calling, and mitochondrial genome variants. We assessed primary care practitioner experience and competence in a large cohort of 521 families (comprising 90% WGS trios). Children were identified by primary practitioners for recruitment, and we used the UK index of multiple deprivation to confirm lack of patient socio-economic status ascertainment bias. Of the 521 children sequenced, 176 (34%) received molecular diagnoses, with rates as high as 45% for neurology clinics. Twenty-three of the diagnosed cases (13%) required bespoke methods beyond routine SNV/CNV analysis. In our multidisciplinary clinician user experience assessment, both pediatricians and clinical geneticists expressed strong support for rapid WGS early in the care pathway, but requested further training in determining patient selection, consenting, and variant interpretation. Rapid trio WGS provides an efficacious single-pass screening test for children when deployed by primary practitioners in clinical settings that carry high a priori risk for rare pediatric disease presentations.

Online Searching as a Practice for Evidence-Based Medicine in the Neonatal Intensive Care Unit, University of Malaya Medical Center, Malaysia: Cross-sectional Study.

BackgroundThe use of the internet for research is essential in the practice of evidence-based medicine. The online search habits of medical practitioners in clinical settings, particularly from direct observation, have received little attention.ObjectiveThe goal of the research is to explore online searching for information as an evidence-based practice among medical practitioners.MethodsA cross-sectional study was conducted to evaluate the clinical teams’ use of evidence-based practice when making clinical decisions for their patients' care. Data were collected through online searches from 2015 to 2018. Participants were medical practitioners and medical students in a Malaysian public teaching hospital’s neonatal intensive care unit who performed online searches to find answers to clinical questions that arose during ward rounds.ResultsIn search sessions conducted by the participants, 311 queries were observed from 2015 to 2018. Most participants (34/47, 72%) were house officers and medical students. Most of the searches were conducted by house officers (51/99, 52%) and medical students (32/99, 32%). Most searches (70/99, 71%) were directed rather than self-initiated, and 90% (89/99) were completed individually rather than collaboratively. Participants entered an average of 4 terms in each query; three-quarters of the queries yielded relevant evidence, with two-thirds yielding more than one relevant source of evidence.ConclusionsOur findings suggest that junior doctors and medical students need more training in evidence-based medicine skills such as clinical question formulation and online search techniques for performing independent online searches effectively. However, because the findings were based on intermittent opportunistic observations in a specific clinical setting, they may not be generalizable.

Penile Length Measurement: Methodological Challenges and Recommendations, a Systematic Review

BackgroundPenile length measurement techniques vary widely in published studies leading to inaccurate and nonstandardized measurements. AimTo review the methodology used to report data in studies evaluating penile length and provide a detailed recommendation in conducting future high-quality research. MethodsThe MEDLINE database was searched for randomized clinical trials and open-label prospective or retrospective studies. OutcomesThe panel reviewed the modality of data reporting on these specific areas: patients’ age and assessment, patient position, type of measurement instrument used, penile length technique description, examination conditions, and actual examiner. ResultsOverall, 70 studies investigating penile length were selected; among these, 72.85% included at least 50 patients: 16 prospective studies, 5 randomized clinical trials, and 49 retrospective cross-sectional studies. Amongst all studies, 90% reported to measure penile length by health care practitioners in clinical settings. Penile length was assessed in all 70 studies, whereas penile girth was measured in 57.14% of patients. A semi-rigid ruler was the most commonly used measurement aid to assess penile length/girth in 62.86% of studies. Penile measurements were reportedly obtained: (i) stretched state, 60%; (ii) flaccid state only, 52.68%; and (iii) during erection, 27.43%. All studies investigating the penile length in an erect state were simultaneously assessing penile length in the flaccid state. About 90% of studies investigated penile length in adults, whereas 10% were conducted in adolescents. Clinical ImplicationsThe use of shared methodology to assess penile length in both adults and adolescents allows more accurate and standardized measurements. Strength & LimitationsA systematic review of the published literature allowed proper data interpretation in order to provide accurate recommendations. Main limitations of the study relied on a relatively limited number of databases for the identification of potentially eligible studies. ConclusionThe methodology used in studies measuring penile length should be precise and standardized in order to provide accurate data to both clinicians and researchers.Cakir OO, Pozzi E, Castiglione F, et al. Penile Length Measurement: Methodological Challenges and Recommendations, a Systematic Review. J Sex Med 2020;XX:XXX–XXX.

Under-appreciated and Overlooked Modes of Exercises on Key Vascular Functions.

The arterial system has two primary functions. The conduit function is to transport adequate supply of oxygen and nutrients to the tissues, and the cushioning function is to buffer and cushion the pulsatile pressure exerted by intermittent ventricular contractions. The impairments in these two functions often result from physiological changes characterized by endothelial dysfunction and arterial stiffening. Habitual physical exercise has been advocated to combat these physiological dysfunctions. However, exercise is remarkably diverse, as it can be performed in different media (water, land or snow), seasons (winter or summer), and settings (individual, pair or team). In contrast to mainstream modes of exercise including walking and running, many of the alternative or "minor" forms of exercise have been under-researched by investigators in research fields and overlooked by clinicians and practitioners in clinical settings. It remains largely unknown whether these alternative forms of exercise are associated with favorable changes in arterial stiffness and endothelium-dependent vasodilation. The current review introduces and summarizes research investigations that evaluated the impacts of these under-appreciated and overlooked exercises and their impacts on key markers of vascular functions in humans.

Health practitioners' readiness to address domestic violence and abuse: A qualitative meta-synthesis.

Health practitioners play an important role in identifying and responding to domestic violence and abuse (DVA). Despite a large amount of evidence about barriers and facilitators influencing health practitioners’ care of survivors of DVA, evidence about their readiness to address DVA has not been synthesised. This article reports a meta-synthesis of qualitative studies exploring the research question: What do health practitioners perceive enhances their readiness to address domestic violence and abuse? Multiple data bases were searched in June 2018. Inclusion criteria included: qualitative design; population of health practitioners in clinical settings; and a focus on intimate partner violence. Two reviewers independently screened articles and findings from included papers were synthesised according to the method of thematic synthesis. Forty-seven articles were included in the final sample, spanning 41 individual studies, four systematic reviews and two theses between the years of 1992 and 2018; mostly from high income countries. Five themes were identified as enhancing readiness of health practitioners to address DVA: Having a commitment; Adopting an advocacy approach; Trusting the relationship; Collaborating with a team; and Being supported by the health system. We then propose a health practitioners’ readiness framework called the CATCH Model (Commitment, Advocacy, Trust, Collaboration, Health system support). Applying this model to health practitioners’ different readiness for change (using Stage of Change framework) allows us to tailor facilitating strategies in the health setting to enable greater readiness to deal with intimate partner abuse.

Repetita Iuvant: Exploring and Supporting Redundancy in Hospital Practices

This paper discusses the role of redundancy in hospital work, especially in facilitating the cognitive and coordinative tasks of health practitioners in clinical settings. It also investigates the ways in which health information technology can preserve, support and even enhance this role by being grounded in the observations and analyses that two research groups in Italy and Norway carried out in independent studies. In the present study, this previous research is reassessed and shaped into a unified and coherent design-oriented framework. This framework considers four kinds of data redundancy and outlines their peculiarities and the typical conditions in which they occur. In particular, the paper reports how these kinds of redundancies are exploited in both written artifacts and oral communications and how they affect each other. The paper also reports the impact of redundancies on the articulation work of physicians and nurses by playing either a negative or, more often, a positive role depending on the context. A series of lessons learnt are then proposed for the design of suitable coordination mechanisms that could preserve or even utilize this neglected phenomenon, which is strongly related to the interpretative and coordinative practices that are articulated in the patient’s record.

Raman spectral post-processing for oral tissue discrimination – a step for an automatized diagnostic system: erratum

[This corrects the article on p. 5218 in vol. 8, PMID: 29188115.].

Raman spectral post-processing for oral tissue discrimination - a step for an automatized diagnostic system.

Most oral injuries are diagnosed by histopathological analysis of a biopsy, which is an invasive procedure and does not give immediate results. On the other hand, Raman spectroscopy is a real time and minimally invasive analytical tool with potential for the diagnosis of diseases. The potential for diagnostics can be improved by data post-processing. Hence, this study aims to evaluate the performance of preprocessing steps and multivariate analysis methods for the classification of normal tissues and pathological oral lesion spectra. A total of 80 spectra acquired from normal and abnormal tissues using optical fiber Raman-based spectroscopy (OFRS) were subjected to PCA preprocessing in the z-scored data set, and the KNN (K-nearest neighbors), J48 (unpruned C4.5 decision tree), RBF (radial basis function), RF (random forest), and MLP (multilayer perceptron) classifiers at WEKA software (Waikato environment for knowledge analysis), after area normalization or maximum intensity normalization. Our results suggest the best classification was achieved by using maximum intensity normalization followed by MLP. Based on these results, software for automated analysis can be generated and validated using larger data sets. This would aid quick comprehension of spectroscopic data and easy diagnosis by medical practitioners in clinical settings.

Validation of the AUDIT-C in adults seeking help with their drinking online

BackgroundThe abbreviated Alcohol Use Disorder Identification Test for Consumption (AUDIT-C) is rapidly becoming the alcohol screening tool of choice for busy practitioners in clinical settings and by researchers keen to limit assessment burden and reactivity. Cut-off scores for detecting drinking above recommended limits vary by population, setting, country and potentially format. This validation study aimed to determine AUDIT-C thresholds that indicated risky drinking among a population of people seeking help over the Internet.MethodThe data in this study were collected in the pilot phase of the Down Your Drink trial, which recruited people seeking help over the Internet and randomised them to a web-based intervention or an information-only website. Sensitivity, specificity, and positive and negative likelihood ratios were calculated for AUDIT-C scores, relative to weekly consumption that indicated drinking above limits and higher risk drinking. Receiver-operating characteristic (ROC) curves were created to assess the performance of different cut-off scores on the AUDIT-C for men and women. Past week alcohol consumption was used as the reference-standard and was collected via the TOT-AL, a validated online measure of past week drinking.ResultsAUDIT-C scores were obtained from 3720 adults (2053 female and 1667 male) searching the internet for help with drinking, mostly from the UK. The area under the ROC curve for risky drinking was 0.84 (95% CI 0.80, 0.87) (female) and 0.80 (95% CI 0.76, 0.84) (male). AUDIT-C cut-off scores for detecting risky drinking that maximise the sum of sensitivity and specificity were ≥8 for women and ≥8 for men; whereas those identifying the highest proportion of correctly classified individuals were ≥4 for women and ≥5 for men. AUDIT-C cut-off scores for detecting higher risk drinking were also calculated.ConclusionsAUDIT-C cut-off scores for identifying alcohol consumption above weekly limits in this largely UK based study population were substantially higher than those reported in other validation studies. Researchers and practitioners should select AUDIT-C cut-off scores according to the purpose of identifying risky drinkers and hence the relative importance of sensitivity and/or specificity.

Visualizing Motion Patterns in Acupuncture Manipulation.

Acupuncture manipulation varies widely among practitioners in clinical settings, and it is difficult to teach novice students how to perform acupuncture manipulation techniques skillfully. The Acupuncture Manipulation Education System (AMES) is an open source software system designed to enhance acupuncture manipulation skills using visual feedback. Using a phantom acupoint and motion sensor, our method for acupuncture manipulation training provides visual feedback regarding the actual movement of the student's acupuncture manipulation in addition to the optimal or intended movement, regardless of whether the manipulation skill is lifting, thrusting, or rotating. Our results show that students could enhance their manipulation skills by training using this method. This video shows the process of manufacturing phantom acupoints and discusses several issues that may require the attention of individuals interested in creating phantom acupoints or operating this system.

Visualizing Motion Patterns in Acupuncture Manipulation

Acupuncture manipulation varies widely among practitioners in clinical settings, and it is difficult to teach novice students how to perform acupuncture manipulation techniques skillfully. The Acupuncture Manipulation Education System (AMES) is an open source software system designed to enhance acupuncture manipulation skills using visual feedback. Using a phantom acupoint and motion sensor, our method for acupuncture manipulation training provides visual feedback regarding the actual movement of the student's acupuncture manipulation in addition to the optimal or intended movement, regardless of whether the manipulation skill is lifting, thrusting, or rotating. Our results show that students could enhance their manipulation skills by training using this method. This video shows the process of manufacturing phantom acupoints and discusses several issues that may require the attention of individuals interested in creating phantom acupoints or operating this system.

A program to reduce musculoskeletal disorders and promote health in nursing students

Background: Work-related musculoskeletal disorders (MSDs) in health care are estimated to cost between $24 billion and $64 billion each year. Nurses and nursing students are prone to occupational injuries because of repetitive movements and poor biomechanics. Recent data from the CDC indicates that such injuries are contributing to the ongoing nursing shortage, as well as, the 260,000 vacancies in the profession projected by 2025. Objective : This project has the potential to increase knowledge regarding prevention of injuries, decreasing stress on the body, maintaining muscular strength, and avoidance of physical pain related to MSDs. Purpose: To address the informational gap in nursing education concerning musculoskeletal injuries. Aims: 1) Offer educational modules for implementation into nursing curricula; 2) Provide examples of primary prevention interventions for nursing students to avoid MSDs; 3) Offer “correct vs. incorrect” body mechanics exemplars with a tool to evaluate mastery. Nursing education implications: This self-learning curriculum has the potential to fill the gap related to prevention of MSDs for students in nursing school and for practitioners in clinical settings.

Examining the interface between interprofessional practice and education: Lessons learned from Norway for promoting teamwork

Promoting teamwork in health and social care requires an understanding of the interface between interprofessional practice (IPP) and interprofessional education (IPE). A study with two parts, one qualitative and one quantitative, examined this interface in Norway. The first used focus groups to assess IPP rewards, barriers, and facilitating factors among practitioners in clinical settings. The second utilized an online survey to measure IPE attitudes, barriers, and facilitating factors among senior administrators in the educational system. Results of Part 1 indicate that providers report many intrinsic rewards of IPP; however, the more extrinsic impacts of collaborative practice on patient care need to be emphasized to system managers. Results of Part 2 suggest strong general support by academic deans and directors for IPE, though addressing specific potential barriers to its implementation has become increasingly important. Overall, bridging the IPP–IPE gap requires educating leaders in both settings about the resources needed for teamwork, linking clinical and educational settings through continuing professional development, and generally advocating more effectively for both IPP and IPE.

Prevalence, Incidence, and Predictors of Dating Violence: A Longitudinal Study of African American Female Adolescents

Few longitudinal studies have examined predictors of dating violence, a public health issue that may be more prevalent among African Americans. Our objective was to examine the prevalence, incidence, and predictors of dating violence in an African American sample using the theory of gender and power. A longitudinal design with a 1-year follow-up period was used. Recruiters screened adolescents from a variety of venues, including school health classes, county health department clinics, and adolescent health clinics. Study participants were 522 African American females 14-18 years of age. This study achieved an 85.7% participation rate. Dating violence was defined as ever having experienced verbal or physical abuse perpetrated by a boyfriend. At baseline, 28% of adolescents reported a history of dating violence. To calculate the 1-year incidence of dating violence, adolescents reporting a history of dating violence at baseline were excluded from subsequent longitudinal analyses. In longitudinal analyses, the 1-year incidence of dating violence was 12%. Logistic regression analyses identified four factors at baseline that were predictive of dating violence. This four-factor model correctly classified 87.6% of adolescents according to whether or not they experienced dating violence during the 1-year follow-up. Controlling for public financial assistance, relative to adolescents not experiencing dating violence, those who did were 2.0 times more likely to report less understanding of healthy relationships (CI = 1.1-3.9, p = 0.02), 2.0 times more likely to report using drugs (CI = 1.0-3.7, p = 0.02), and 1.9 times more likely to have viewed X-rated movies (CI = 1.0-3.7, p = 0.03). These findings suggest that secondary prevention of dating violence necessitates educating clinicians on the importance of screening and training practitioners in clinical settings on how to effectively screen adolescents for dating violence, including risk factors for victimization.

Student nurses as peer-mentors: Collegiality in practice

Mentoring is promoted as a key strategy for supporting nursing students and new practitioners in clinical settings. However, mentoring is also a complex process, requiring the development of bounded and purposeful relationships underpinned by knowledge, experience and opportunities for reflection. This paper reports the findings of an evaluation by second-year nursing student mentors and first-year mentee students of a short peer-mentoring programme. The main objective of the programme was to support students making the transition to the university and nursing. At a more focused professional level, the programme also provided the opportunity for students to be a mentor or to be mentored, as a learning precursor to being mentored in the clinical setting. The programme provided rich learning opportunities for the development of the qualities and skills required for mentoring roles and was a vehicle for encouraging collegial interaction and learning. The students' evaluation of the programme also demonstrated that formal mentoring programmes require considerable organisational investment and ongoing commitment in educational and clinical settings. Mentors and mentees require time for face-to-face meetings and discussion, effective and on-going communication channels, and adequate role preparation.

Research on Day Treatment Programs for Preschoolers With Disruptive Behavior Disorders

Research on Day Treatment Programs for Preschoolers With Disruptive Behavior Disorders