Role Of Practitioner Research Articles

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) <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.

Preconception care.

Preconception care (PCC) entails a comprehensive suite of interventions to improve the health of potential parents, their babies and future generations. PCC is not limited to a first pregnancy, and addressing health and wellbeing is equally important in the interconception period. The aims of this paper are to discuss the evidence for and components of PCC, as well as the role of the general practitioner in the delivery of PCC. It is estimated that 90% of women and over 50% of men have preconception health issues to address. Although all people stand to benefit from PCC, certain population groups experience increased risk of adverse outcomes and require more targeted attention. Although most do not present for a dedicated PCC consultation, asking about pregnancy intention can start the conversation. Evidence shows that interventions delivered in primary care can improve preconception health knowledge and reduce preconception risk factors.

Burnout in Infection Control Practitioners During Public Health Crisis Events: A Mixed Methods Systematic Review Protocol

Background Infection prevention and control work environments are highly complex in nature and have long been associated with crisis events including serious infectious disease outbreaks. The role of infection control practitioners shifted exponentially during the COVID-19 pandemic and with this rapid and nebulous change came anxiety, emotional exhaustion and ultimately burnout. Burnout at work generally occurs as a response to chronic and prolonged exposure to emotionally challenging events, causing emotional exhaustion, feelings of cynicism, and lack of accomplishment at work. This systematic review aims to investigate burnout in infection control practitioners during public health crisis events (major outbreaks, epidemics, and pandemics) in upper-middle and high-income countries on a global scale. Methods A mixed-methods systematic review will be carried out and will include qualitative, quantitative and primary mixed-methods studies that investigate the different elements of burnout, during public health crisis events. After an initial scoping literature search, up to six databases will be searched for studies on burnout in relation to infection prevention practitioners. Study quality will be checked using standardised JBI critical appraisal tools. The proposed review will follow the JBI convergent integrated approach for mixed methods systematic reviews. Following data extraction, quantitative data will then be converted into ‘qualitized data’ in the form of textual descriptions. Discussion It is well documented that adverse conditions during public health crisis events can lead to burnout. This systematic review will investigate of burnout in infection control practitioners in upper-middle and high-income countries during public health crisis events. The findings will inform healthcare professionals, senior policy makers and researchers and will help contribute to a richer understanding of burnout and associated factors in infection control practitioners. Protocol registration number PROSPERO 2024 CRD42024508996.

The role of emergency medicine specialists and general practitioners in yellow zone patient management: A case in the Sakarya Province

AbstractBackgroundEmergency departments in Turkey employ both emergency medicine specialists (EMSs) and general practitioners due to an insufficient number of EMSs. Patients are triaged into green, yellow, and red codes based on urgency. Typically, EMSs manage more critical patients (yellow and red codes), while general practitioners handle less urgent cases (green codes).ObjectiveThis study investigates differences in patient management approaches between EMSs and general practitioners in the yellow zone of an emergency department in the Sakarya Province.MethodThis retrospective, cross‐sectional study was conducted at the Sakarya Training and Research Hospital from 31 December 2020 to 31 December 2021. The study included patients aged 18 and older who were assigned to the yellow zone and discharged by the attending physician. Data on patient monitoring times, consultation requests, hospitalization rates, resource utilization, readmission rates, and hospital revenue contributions were collected and analyzed. Statistical analyses were performed using IBM SPSS version 21, comparing the performance of EMSs and general practitioners.ResultThe study included 59 physicians (14 EMSs and 45 general practitioners) and a large number of patients. EMSs had significantly more experience, shorter consultation request times, and higher ICU admission rates. They also ordered fewer MRIs and USGs per patient and made more consultation requests. There was no significant difference between EMSs and general practitioners in terms of the number of examinations, patient observation times, ward hospitalization rates, CT orders, readmission rates, and hospital revenue contributions.ConclusionEMSs demonstrated more efficient use of emergency department resources, effective consultation processes, and higher ICU admission rates, indicating better patient management. Despite the limited scope of this single‐center study, the findings highlight the importance of EMSs in improving emergency care quality. Further research is needed to validate these results across multiple centers.

The role of dental practitioners in managing medically complex patients.

The role of dental practitioners in managing medically complex patients.

Adherence to recommended follow-up in opportunistic versus non-opportunistic cervical screening: a registry-based cohort study from Denmark.

Organised cervical screening programmes often allow for opportunistic screening. Previous studies have shown that adherence to follow-up protocols after cervical screening is poor. This study aims to investigate if non-adherence to recommended screening intervals - that is, opportunistic screening, is associated with adherence to follow-up after non-negative cervical screening. Using national registries we included 42,399 Danish women with a non-negative screening result from 2015 to 2017. Non-adherence was divided into insufficient and excessive follow-up. We calculated relative risks (RRs) of adherence to follow-up among different groups of opportunistically screened women, representing both too frequent and delayed screening participation, compared with non-opportunistically screened women. Compared with non-opportunistically screened women, opportunistically screened women who were delayed 1-3 years on their screening schedule had a higher risk of no follow-up (RR 1.99) and insufficient follow-up (RR 1.10). Women who were delayed 3-7 years on their screening also had a higher risk of no follow-up (RR 1.92). Women who attended screening up to 6 months too early had a higher risk of insufficient follow-up (RR 1.08) as well as excessive follow-up (RR 1.39). Finally, women screened more than 6 months too early had a higher risk of all deviations, but most pronounced was the risk of excessive follow-up (RR 1.67). We found a higher risk of insufficient follow-up among women delayed in their screening schedule, and a higher risk of excessive follow-up among those with frequent screening. Screening participation behaviour seems to transfer to follow-up adherence. This underscores the important role of general practitioners in acting as gatekeepers in cervical screening follow-up.

The Role of Neonatal Nurse Practitioners in the Implementation of a Bedside Point-of-Care Ultrasound Program.

Point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) is becoming increasingly utilized, with the focus of training aimed at physicians. However, the role of neonatal nurse practitioners (NNPs) in the development of POCUS programs is not well described. To describe the NNP role in the implementation of a NICU POCUS program and exemplify the potential to expand the professional scope and educational advancement of NNPs. In 2018, a multidisciplinary team assembled to develop a POCUS program in the NICU at Lucile Packard Children's Hospital (LPCH). Three NNPs received formal POCUS training in order to provide onsite training, perform and supervise POCUS imaging, and participate in quality assurance sessions. NNPs also assisted with the development of a REDCap database and imaging protocols. The LPCH POCUS NNP providers contributed to the advancement of the profession by practicing to the full scope of their role, providing leadership in program development, research, and education. Incorporating NNPs into the programmatic structure of a POCUS program can be a model for others. With advancing skill set, NNPs can be positioned to be national leaders and educators. NICUs developing POCUS programs can benefit from the integration of NNPs to serve as consistent content experts to expand the number of trained providers while assuring the quality of image capture. POCUS is becoming increasingly essential to the care of newborns. NNPs can play a central role in performing POCUS, participating in quality improvement and research, and educating other NICU providers.

Defining the urology nurse practitioner in Australia and New Zealand: A Delphi study.

Nurse practitioners with roles in specialty environments face challenges including uncertain role expectations and achieve urology expertise with on-the-job training, mentoring, and independent study. This creates a wide variety of preparation and role descriptions. This study employed Delphi methodology to identify essential components of the urology nurse practitioner (NP) role in Australia and New Zealand, representing an inaugural description of the role. This Delphi study was completed in two rounds. Participants were a nonrandom panel of experts with experience as a full-time urology NP. A definition for the urology NP in Australia and New Zealand is proposed: "The urology nurse practitioner uses critical thinking, complex decision-making, clinical reasoning, advanced assessment skills and clinical expertise, offering acute and chronic care to individuals needing urologic health care, including office-based urology procedures as appropriate. This care is provided in an environment of autonomous practice, with a basis of graduate education and relevant specialty clinical experience, and this practice can extend across health care settings and serve as a model to the wider NP profession." Outpatient urology procedures were ranked highly and deemed integral to the Urology NP role. This may reflect the declining number of urologists and efforts to maintain urology access for local populations. Professional roles of the NP were given less weight by participants. The project offers a contemporary definition of the urology NP role that can be offered to educators and other stakeholders as the role continues to evolve in Australia and New Zealand.

Obstructive sleep apnoea, sleep bruxism and gastroesophageal reflux - mutually interacting conditions? A literature review.

The purpose of the present manuscript is to provide an overview for researchers and clinicians summarizing the knowledge concerning the relationship between some of the main sleep-related conditions of dental interest: sleep bruxism (SB), obstructive sleep apnoea (OSA) and gastroesophageal reflux disease (GERD). Starting with the discussion of the evolving current knowledge on SB, the interconnections are discussed. Most of the available literature focused on the possible relationship between OSA and SB, but a clear pathophysiological connection or temporal relationship has not been identified. Despite the paucity of data on the possible commonalities, SB, OSA and GERD constitute a complex network of conditions that may affect the clinical and research dental practice, and they are rarely found in isolation. In this scenario, the key role of dental practitioners as sentinel in the case of these sleep-related conditions is important, thanks to their ability and the knowledge to identify signs, symptoms and risk factors that are signs of ongoing sleep-related conditions. Thus, dental practitioners are recommended to view bruxism as a potential gateway to medicine.

The Holistic Intelligent Healthcare Theory (HIHT): Integrating AI for Ethical, Transparent, and Human-Centered Healthcare Innovation

The rise of artificial intelligence (AI) in healthcare has the potential to significantly increase the efficiency, personalization, and overall efficacy of medical care delivery. However, its integration needs to be improved regarding ethical norms, data quality, openness, and human-centered care. This study proposes the Holistic Intelligent Healthcare Theory (HIHT), a comprehensive theory for guiding AI's ethical and practical use in healthcare. It draws on insights from theories such as the Technology Acceptance Model (TAM), the Unified Theory of Acceptance and Use of Technology (UTAUT), Socio-Technical Systems Theory (STS), Ethics of Care, Data Governance and Information Quality Theory, and Augmented Intelligence Theory. The HIHT highlights the importance of centralized governance, strong data quality, transparent AI methods, human-AI collaboration, and a reimagined role for healthcare practitioners—the "Intelligent Doctor." The study presents the theory's structures and investigates their implications for AI integration in healthcare, offering a road map for responsible and practical AI applications.

The Role, Contribution and Impact of Independent Nurse Prescribers and Advanced Nurse Practitioners to the Children's Hospice Workforce

The care needs of babies, children and young people who use children's hospices have changed over the last decade, with children living for longer, with more complexity. Children's hospice workforces have evolved to continue to meet these needs, including a growth in the number of nurses working at specialist and advanced levels, particularly prescribing. A 15-question survey was sent to all 54 UK children's hospices, which aimed to explore the impact of independent nurse prescribing, and specialist and advanced level nursing practice in UK children's hospices. Forty-one organisations responded, representing 76% of UK children's hospices. Increased autonomy and the ability to respond to the dynamic needs of families, and enabling family choice was recognised and valued by prescribers. Challenges included the breadth of needs of children with life-limiting conditions, and the use of medicines that are either unlicenced or used off-licence. Access to clinical supervision and continuing professional development were highlighted as enablers of prescribing practice.

Analyzing the roles, workflows, and communication dynamics of social workers within interprofessional care teams

ABSTRACT Social workers frequent interprofessional healthcare teams, but few studies examine the day-to-day experiences of these providers on interprofessional teams. Our study utilized semi-structured interviews with 54 medical social workers practicing on interprofessional healthcare teams. A thematic analysis was used to analyze the day-to-day functions of these social workers. The analysis resulted in three primary themes: 1) Social Workers’ Self-Perceptions of their Roles within Interprofessional Teams, 2) Social Workers Shifting Roles on Interprofessional Teams, and 3) Interprofessional Team Dynamics that Impact the Role of a Social Worker. Social workers perceived their primary roles as contributing a unique systems approach to interprofessional healthcare teams while emphasizing patient self-determination. These self-perceptions influenced their shifting roles on interprofessional healthcare teams (e.g. clinician, case manager, bridge builder). In addition to individual self-perceptions, the healthcare system infrastructure influenced social work roles. For example, social workers in outpatient settings more frequently assumed the role of a mental health practitioner compared to those in inpatient settings. Last, there was variation in interprofessional communication and workflow assignment based on the healthcare infrastructure. Future research should examine the education and training efforts of social workers and other allied health professions for interprofessional healthcare teams.

Advanced practitioners working with older people in primary care and community settings: a survey of roles and use of technology.

Advanced practitioner (AP) roles are becoming increasingly common in primary care and community settings for supporting older people and those living with frailty. The aim of this study was to explore health and social work AP roles in primary care and community settings in the UK, and understand how they support older people and factors that may impact on APs use of technology in practice. A cross-sectional, web-based survey was adopted to explore the views and perspectives of APs. The survey received 111 responses. There were different views as to whether technology was suitable for older people. Although digital exclusion was a concern, it was perceived that this would change in the future as generations become more digitally literate. Respondents suggested that using technology brought about efficiencies and the ability to respond sooner to symptom changes, with some concerns mentioned regarding the accuracy of technology that may miss signs and symptoms. This is the first national survey to explore advanced practice roles with older people in non-hospital settings. While APs have wide-ranging skills, few currently use technology in their practice. Findings will inform a future study on digitally enhanced comprehensive geriatric assessments.

The role of primary care practitioners in cancer control in South Africa: a systems-based case study

Aim Cancer care has largely been the domain of oncology specialists. With increased awareness of the importance of primary care in the context of universal health coverage, there has been a shift to explore the role of primary care in comprehensive cancer management. This includes health promotion, screening, diagnosing, referral to oncology services, and longitudinal care that includes co-ordination of care, survivorship, and palliative care. This paper focuses on the role of primary care practitioners in health promotion, early detection and care co-ordination. Nurses and doctors who work in primary care are included as primary care practitioners. Methods Using a patient vignette narrative tool, the triad of patient empowerment in the form of enhanced health literacy, clinical competence, and system effectiveness, are discussed as the basis for early cancer detection. A complex intervention to improve primary-level cancer care and the implications thereof for the important role of care co-ordination undertaken by primary care practitioners, is also presented. Findings For effective patient assessment, primary care practitioners must be trained in screening and diagnostic techniques as part of their clinical competencies as generalists. These competencies include risk identification, counselling skills, expert clinical examination, interpretation of basic x-rays, minor surgical skills, interpreting blood tests, and point-of-care ultrasound. Against a backdrop of ongoing budget constraints, consumables and equipment needed for diagnosis should be readily available and referral pathways for patients and specimens should be clearly defined and resourced. Conclusions Primary care practitioners in community-based facilities are well-placed to engage with the psychosociocultural dimensions of care. The SA health system places primary care at the point of closest contact with communities. Efficient care pathways are needed by primary care practitioners to adopt the role of care co-ordinator when patients with suspected or confirmed cancer enter these pathways. When considered alongside the overburdened primary care patient-load and the ever-increasing mix of co-morbidities, the complexity of primary care is appreciated. Understanding the complexities of primary care in the context of cancer control is an important component of a holistic cancer control programme.

Early Identification and Management of Chronic Kidney Disease: A Narrative Review of the Crucial Role of Primary Care Practitioners.

Early-stage (stage1-3) chronic kidney disease (CKD) has an asymptomatic presentation such that most people with CKD are unaware of their disease status and remain undiagnosed. CKD is associated with multiple long-term conditions (MLTC), or multimorbidity, the most common of these being cardiovascular disease, hypertension, and type2 diabetes. Primary care practitioners (PCPs) are crucial in the early identification and management of patients with CKD. For individuals at high risk of CKD, measurements of estimated glomerular filtration rate, urine albumin-creatinine ratio, and blood pressure should be obtained regularly and recorded in a timely manner. The importance of lifestyle changes in the prevention and management of CKD should also be highlighted. A recent addition to the treatment of CKD in people with and without type2 diabetes has been the recommendation by clinical practice guidelines of a sodium-glucose co-transporter2 (SGLT2) inhibitor alongside a renin-angiotensin-aldosterone system inhibitor as foundational therapy. SGLT2 inhibitors prevent CKD progression and reduce fatal and non-fatal kidney and cardiovascular events, hospitalization for heart failure, and all-cause mortality, and they have a favorable safety and tolerability profile. However, uptake has been slow, particularly in people with CKD without type2 diabetes. A multifaceted approach is required to ensure that people with CKD receive optimal kidney protection. Measures to raise awareness of the importance of early identification and intervention include local/national campaigns via social media and practice-based education; clinical education programs; integration of clinical decision support tools into electronic health records; detection programs built around electronic health records; and good interdisciplinary communication. PCPs at the forefront of multidisciplinary care are best placed to implement the evidence-based clinical practice CKD guidelines for lifestyle modification and guideline-directed medical therapy.

The American Academy of Emergency Nurse Practitioners: The First Years.

In 2014, Dr. Elda Ramirez, alongside Dr. Arlo Weltge and Dr. Kyle Kincaid, founded the American Academy of Emergency Nurse Practitioners (AAENP) to support nurse practitioners working in emergency care. With initial support from 39 dedicated individuals, AAENP was incorporated in Texas and received pro bono management from an association management company. Over the years, AAENP has focused on defining the emergency nurse practitioner (ENP) role, developing a board certification examination, and creating standardized curricula for ENP programs. Strong collaborations with organizations such as the American Association of Nurse Practitioners (AANP) and the American College of Emergency Physicians (ACEP) have been pivotal. AAENP has grown significantly, now boasting over 1100 members, and has produced numerous evidence-based position statements and publications. This article highlights AAENP's achievements, and the challenges faced in its formative years, showcasing its commitment to advancing the ENP profession and ensuring quality care in emergency settings.

Breaking Barriers and Navigating the Future of Emergency Care: The Role of the Emergency Nurse Practitioner.

Over the past two decades, the emergency nurse practitioner (ENP) role has significantly enhanced emergency care in the United States. With the increasing complexity of emergency care, ENPs have expanded into nontraditional settings, necessitating regulatory updates to maintain patient safety. The Consensus Model for Advanced Practice Registered Nurse Regulation has influenced ENP practice, yet consistent regulatory recognition is still needed due to the marked evolution in ENP practice. Despite collaborative efforts to prepare the ENP workforce and ensure competency through standardized education, certification, and licensure, recent unethical publications and skewed statistics have threatened the specialty's progress. Addressing these challenges is crucial for advancing the ENP role and ensuring high-quality emergency care delivery.

What are the attitudes and perceptions of general practitioners about the role of nurse practitioners in the community care setting: A scoping review

BackgroundThe Nurse Practitioner role in Australia is slowly expanding, with a well-established body of evidence supporting their introduction. Yet, there is a lack of consistent support from the medical profession for this role. Nurse Practitioners wishing to work in the community setting may, therefore, experience resistance from General Practitioners. ObjectiveTo identify and explore the attitudes and perceptions of Australian General Practitioners about Nurse Practitioners' community settings. To explore what is the view of GPs outside of Australia on this topic. MethodA scoping review of the Cochrane, MEDLINE, Psych INFO, and CINHAL databases was undertaken from 1995 to April 2023 and reported using PRISMA. Quality evaluation tools devised by Dixon-Woods et al. (2005) and previously used by Paterson et al. (2015) were used to evaluate the included studies. A narrative synthesis was then undertaken using the method described by Whittemore and Knafl (2005). FindingsThe scoping review identified 1623 potential publications. After a comparison of the title and abstract to the inclusion and exclusion criteria, 20 publications underwent an in-depth review, eight publications met the inclusion criteria for a full review. The review did not identify a publication from Australia. Elsewhere the attitudes of General Practitioners were influenced by the lack of definition of the Nurse Practitioner role, a lack of knowledge of the Nurse Practitioner skill level, fear of service duplication, deterioration in patient relationships, who had responsibility for the role and funding for the role. ConclusionThere is a lack of evidence in an Australian context to determine if General Practitioners in Australia have similar views to their international counterparts. Careful planning needs to be undertaken to overcome potential issues and to enable the Nurse Practitioner role to be effectively implemented in an Australian community setting.

Improving the evaluation of novice advanced practice nurse transition.

Novice advanced practice registered nurses (RNs) experience decreased self-confidence, anxiety, and identity confusion in their first year of practice, which leads to poor job satisfaction and turnover. Advanced practice RN fellowship programs, developed to bridge the gap from the RN to the advanced practice role, lack standardized measures for program evaluation. A large Midwestern pediatric hospital's advanced practice nurse fellowship program lacks a structured program evaluation. A quasi-experimental evidence-based improvement project was implemented to evaluate fellowship program outcomes for novice nurse practitioner transition and retention. All novice advanced practice RNs (APRNs) were enrolled in the site's 12-month APRN fellowship program. The transition experiences of enrollees who completed the fellowship program were assessed using the novice nurse practitioner role transition scale. In addition, role transition scores were compared for two subgroups: fellows in acute care and fellows in primary care roles. Fellowship participant retention 1 year after hire was measured. Postintervention data showed that most fellowship graduates had a positive transition experience as evidenced by at least a 4.33/6.0 mean total novice nurse practitioner role transition score. There was not a statistically significant difference between the transition scores of the acute care fellows and primary care fellows. The APRN fellowship program was effective in promoting a successful role transition from RN to novice APRN. Similar APRN fellowship programs may benefit from using this tool for program evaluation.

Surgical Care In The Global Health Agenda: The Role Of Frontline Academic And Clinical Practitioners In Implementing World Health Assembly Recommendations

Surgical Care In The Global Health Agenda: The Role Of Frontline Academic And Clinical Practitioners In Implementing World Health Assembly Recommendations