Supervision Of Healthcare Professionals Research Articles

TEMPORARY REMOVAL: Research progress and considerations on oral rehydration therapy for the prevention and treatment of severe burn shock: A narrative review

Severe burns are an important cause of life-threatening situations, whether in times of peace or war. Shock represents a critical complication during the early stages of burn injury and is a significant contributor to mortality and long-term disability. Effective fluid resuscitation is a crucial intervention for preventing and treating shock, and prompt administration is paramount. In numerous instances, prompt initiation of intravenous fluid resuscitation proves challenging and research indicates that resuscitation errors remain a critical contributor to the mortality of injured patients. Hence, it is imperative to explore a more expedient and efficacious non-invasive method for fluid resuscitation that can serve as a fundamental basis for the subsequent treatment of such individuals. There has been extensive research recently on the utilisation of oral rehydration, which exhibits vast potential for application in austere settings. This paper summarizes the historical development and research progress in oral rehydration therapy, briefly discusses the pathogenesis of burns, summarizes the characteristics of burn fluid resuscitation and discusses the application status of oral rehydration therapy in the early anti-shock treatment of burns. It aims to explore an effective fluid resuscitation method suitable for special conditions and provides ideas for improving the level of treatment for shock in peacetime and wartime. Oral rehydration therapy is generally considered safe; however, there are potential complications to be aware of. These include gastrointestinal discomfort such as diarrhoea, vomiting, and abdominal discomfort, particularly when the rehydration rate is too fast or there are preexisting gastrointestinal issues in the patient. Furthermore, it is important to note that oral rehydration therapy may not be appropriate for individuals suffering from gastrointestinal tract impairments. Therefore, when administering oral rehydration therapy, it is imperative for the physician to carefully assess the patient’s condition and closely monitor their response and tolerance. Based on a comprehensive review of research in relevant fields, we carefully present the following provisional guidelines for oral rehydration therapy in burn patients. It is critical to emphasize that, despite these guidelines being intended to inform clinical practice, they should be applied with caution due to the lack of robust clinical evidence. Implementation should either be cautious, considering the specifics of the patient’s condition, or conducted under the supervision of healthcare professionals. Additionally, these guidelines should be dynamically adjusted in response to the unique circumstances and evolving condition of each patient: ① Initiation timing: Start as soon as possible, and the ideal start time is usually within 6 h after injury. ② Rate of application: Employing a fractional administration approach, wherein small quantities of approximately 150–250 millilitres are provided for each instance and the initial fluid rate of oral rehydration can be simplified to 100 mL/kg/24 h. ③ Composition combination: In addition to essential salts and glucose, the oral rehydration solution can incorporate various anti-inflammatory and cellular protection constituents such as pyruvate, vitamins, teprenone or glutamine.

Determinants of respectful maternity care among women who gave childbirth in Southern Ethiopia.

Having a good provision of respectful maternity care (RMC) to a woman who gives childbirth is a crucial component of maternal health care to result in positive maternal and neonatal outcomes. Disrespect and lack of women-centered care in birth discourage a woman from seeking healthcare during childbirth contributing to poor healthcare-seeking behaviour and dissatisfaction with the maternity service. The current study aimed to assess key determinants of RMC during childbirth at selected public health facilities of the Gofa zone, Southern Ethiopia. A cross-sectional study design was conducted from March to April 2021 among 390 women who gave birth in eight randomly selected public health facilities of Gofa zone, Southern Ethiopia. The level of RMC was measured using structured exit interview items. A structured-interviewer-administered questionnaire was used to collect data and then entered into Epi-data version 4.6 and exported to SPSS version 25 for further analysis. Bivariate and multivariate logistic regression analyses were used to identify determinants of RMC among women. A total of 390 women responded to the exit interview making a response rate of 100%. The mean (± SD) age of the 390 women was 27.9 (± 4.85) years. The overall prevalence of women who received RMC was 40.5%, 95% CI (36-45%). Two hundred and ninety-seven (76.2%; n = 297/390) women had antenatal care (ANC) attendance in the index pregnancy. A woman who had planned pregnancy (AOR = 1.72, CI: 1.04, 2.85), planned to deliver in a health facility (AOR = 1.68, CI: 1.00, 2.81), presence of familial support (AOR = 2.04, CI: 1.20, 3.48), and had information about service availability (AOR = 4.44, CI: 2.09, 9.42) were associated with RMC among women. The provision of respectful maternity care in the study area was low when compared with local studies. Planned pregnancy, plan to deliver in a health facility, family support, and presence of information about service availability were factors associated with RMC among women. More attention should be given to training and supportive supervision of health care professionals on respectful maternity care and its standards to increase service uptake and make service more women-centred.

Nutritional and lifestyle procedures to reduce symptoms associated with dysbiosis in women

The main objective of this research is to evaluate the impact of food and nutritional education strategies on symptoms associated with intestinal dysbiosis in women. For the methodological search, a qualitative research approach was conducted, of the integrative literature review type. Data collection took place in scientific databases: LILACS and PUBMED. The results obtained suggest that food and nutritional education plays a crucial role in modulating the intestinal microbiota. Nutritional education strategies can provide women with information about how to choose foods rich in fiber, prebiotics and probiotics, which promote intestinal health. Nutritional guidance can help women avoid processed foods high in sugar and saturated fat, which are known to harm the microbiota. However, adopting a balanced and healthy diet, under the supervision of healthcare professionals, can be an effective tool in improving symptoms associated with intestinal dysbiosis in women.

Quality of care as an individual concept: Proposition of a three-level concept for clinical practice

BackgroundQuality in health care is a complex framework with many components. The word “quality” is used in different official settings and different contexts (public health, certification, patient safety). On individual and team levels, the perception of quality is heterogenous, and the term is often used beyond the theoretical framework. Therefore, it remains a challenge to describe the perceived quality of care in the clinical setting. The aim of this paper is to present a simple concept that can be used to visually define the perceived quality of care for the individual health care professional. Methods/conceptAn experience-based concept that uses different levels of “quality of care” individually to guide the supervision of health care professionals (residents) and quality goal setting in teams is presented, with the assumption that the ambition of any health care professional is to provide excellence in care. Three perceived levels of quality of care are defined, described, and visualized, namely, a) security, b) comfort, and c) perfection. The “comfort level” defines a sustainable level of care where the optimal balance between good patient care and resource use is achieved. Excellence of care is located between the comfort and the perfection level. The practical application of this proposed concept is described in three settings, namely, 1) the threshold for asking advice from the supervisor (resident physicians), 2) in supervision/coaching discussions between residents and supervisors, and 3) in the analysis of perceived quality of care and goals setting within the team. ConclusionA simplified, purpose-built but well-defined concept to visually depict the perception of quality of care by clinicians can be useful in clinical practice, for the supervision of residents and for team dynamics.

Intrapartum respectful maternity care practices and its barriers in Eastern India.

Respectful maternal care (RMC) is increasingly recognized globally as critical to improving the quality of maternity care as women deserve respectful and dignified care. Numerous women face disrespectful maternal care during labor and delivery, especially in low- and middle-income countries, which dissuades them from seeking institutional care. Women, the consumers of care, are better positioned to report on the level of respectful care they receive. Health care workers' perspectives on barriers to delivering respective maternity care are seldom explored. Thus, this study aims to assess the levels of respectful maternity care and its barriers. This cross-sectional study assesses the level of RMC and its barriers in the labor room of tertiary care hospital in Odisha among 246 women selected by consecutive sampling technique by a questionnaire. More than one-third of women reported good RMC. Although women rated high in domains of environment, resources, dignified care, and non-discrimination, non-consented care and non-confidential care were poorly rated. Barriers that adversely affect the delivery of RMC perceived by health care workers were lack of resources, staffing, uncooperative mother, communication issues, privacy issues, lack of policies, workload, and language problems. There was a significant association of RMC with age, education, occupation, and income. In contrast, residence, marital status, number of children, antenatal visit, type of institute of antenatal care, mode of delivery, and gender of health care provider were not associated with RMC. Given the above findings, we recommend vigorous efforts to improve the institutional policies, resources, training, and supervision of health care professionals on women's rights during childbirth to strengthen the quality of care for positive birth experiences.

Smartphone-Assisted High-Intensity Interval Training in Inflammatory Rheumatic Disease Patients: Randomized Controlled Trial.

BackgroundPatients with inflammatory rheumatic diseases (IRDs) experience disease-related barriers to physical training. Compared with the general population, IRD patients are reported to have reduced maximal oxygen uptake (VO2max) and physical activity levels. Supervised high-intensity interval training (HIIT) is documented to counteract the reduced VO2max and poor cardiovascular health associated with IRDs. However, supervised HIIT is resource demanding.ObjectiveThis study sought to investigate if self-administered 4×4-min HIIT guided by a smartphone app (Myworkout GO) could yield similar HIIT-induced effects as standard 4×4-min HIIT performed under the guidance and supervision of health care professionals. The effects studied were on VO2max and health-related quality of life (HRQoL).MethodsForty patients (33 female patients, mean age 48 years, SD 12 years; 7 male patients, mean age 52 years, SD 11 years) diagnosed with rheumatoid arthritis, spondyloarthritis, or systemic lupus erythematosus were randomized to a supervised group (SG) or an app group (AG). Both groups were instructed to perform 4×4-min intervals with a rate of perceived exertion of 16 to 17, corresponding to 85% to 95% of the maximal heart rate, twice a week for 10 weeks. Treadmill VO2max and HRQoL measured using RAND-36 were assessed before and after the exercise period.ResultsVO2max increased (P<.001) in both groups after 10 weeks of HIIT, with improvements of 3.6 (SD 1.3) mL/kg/min in the SG and 3.7 (SD 1.5) mL/kg/min in the AG. This was accompanied by increases in oxygen pulse in both groups (P<.001), with no between-group differences apparent for either measure. Improvements in the HRQoL dimensions of bodily pain, vitality, and social functioning were observed for both groups (P<.001 to P=.04). Again, no between-group differences were detected.ConclusionsHigh-intensity 4×4-min interval training increased VO2max and HRQoL, contributing to patients’ reduced cardiovascular disease risk, improved health and performance, and enhanced quality of life. Similar improvements were observed following HIIT when IRD patients were guided using perceived exertion by health care professionals or the training was self-administered and guided by the app Myworkout GO. Utilization of the app may help reduce the cost of HIIT as a treatment strategy in this patient population.Trial RegistrationClinicalTrials.gov NCT04649528; https://clinicaltrials.gov/ct2/show/NCT04649528

Analyses of posts written in online eating disorder and depression/anxiety moderated communities: Emotional and informational communication before and during the COVID-19 outbreak

IntroductionModerated online health communities (OHCs) are digital platforms that provide a means for patients with similar medical conditions to communicate with each other under the supervision of healthcare professionals. AimsTo examine the impact of the COVID-19 outbreak on content and type of posts published in two moderated OHCs – eating disorders and depression/anxiety – by comparing categorizations of posts written before vs. after the lockdown, and about vs. not about the pandemic. MethodsPosts were retrieved from Camoni, the first Israeli medical social network (January-June 2017, March-May 2020). A total of 1475 posts were analyzed. Of them, 802 posts were written before and 680 were written during the first lockdown. Posts were divided into two main categories: informational and emotional, and into fourteen subcategories. ResultsBefore the pandemic, the eating disorders OHC was characterized as primarily emotional (emotional: 66.7%, informational: 45.4%) and the depression/anxiety OHC as primarily informational (emotional: 49.8%, informational: 65.8%) (χ2 = 31.6, p < 0.001). During the lockdown, there was a transition in the eating disorders community, from primarily emotional to primarily informational communication (emotional: 46.1%, informational: 71.7%) (χ2 = 30.3, p < 0.001). In both OHCs, only about one in six posts written during the lockdown was related to the pandemic. There were only minimal differences in subcategorization of posts written before vs. after the outbreak (e.g., searching for medical information was more common during the pandemic: χ2 = 40.9, p < 0.001), as well as about vs. not about the pandemic (e.g., sharing negative emotions was more common when writing about the pandemic: χ2 = 4.1, p = 0.43). ConclusionDuring the first lockdown, people with eating disorders have increased their use of OHCs as sources of informational (as opposed to emotional) support, but the overall impact of the pandemic on the content of posts written in the examined OHCs was minimal, suggesting that OHCs have not changed their function as a valuable means of providing emotional and informational support for people with mental difficulties.

Patients' Informational Needs for Pharmacotherapy and Health Literacy

Health literacy is defined as the ability to obtain, evaluate, and scrutinize health information and make appropriate decisions and actions. The spread of the Internet means that medical and drug information is becoming increasingly accessible to patients. However, there is also a large amount of inappropriate and biased medical- and drug-related information on the Internet. Therefore, patients require a high level of health literacy to ensure the effectiveness and safety of pharmacotherapy. In particular, outpatients need a high level of health literacy because they use their own medications without the supervision of healthcare professionals. In this article, I discuss the situation of health literacy and access to pharmaceutical information on the Internet in Japan. Furthermore, issues related to providing drug information to specific populations are explained using the example of chronic kidney disease. It is essential for all pharmaceutical information stakeholders to work together to solve these problems.

Falsas dietas y dietas falsas

Globally, 1.9 billion adults are overweight, 650 million of which are obese, which in turn impacts both health and economy. Treating obesity involves strategies such as physical activity and dietary planning, always under the supervision of healthcare professionals. Recent decades have brought many fad diets. They originated at the beginning of the twentieth century and can lead to health problems among their users. A practical way to detect them is that they promise rapid weight loss (more than 1 kg per week), they are allegedly effortless, impose excessive energy restrictions, and exclude food or nutrients from the diet.

The effects of participation in an individualized exercise program under the supervision of health care professionals on cancer-related fatigue.

208 Background: A majority of (80–100%) of patients with cancer report cancer-related fatigue. Physical activity has shown to be an effective intervention for cancer-related fatigue. The cancer rehabilitation team at Aurora Health Care’s Aurora Medical Center Grafton initiated the Exercise for Cancer Recovery Program (ECRP) in order to have a greater impact on the quality of life of their patients. ECRP was an individualized exercise program taking place in a group setting with other cancer survivors under the supervision of healthcare professionals. The program was open to patients with all types and stages of cancer, including patients in active treatment as well as those who completed treatment. The aim of the study was to determine if participation in ECRP reduces cancer-related fatigue. Methods: Upon referral and/or clearance from the patient’s oncologist/advanced practitioner, the patient was evaluated by a physical therapist and placed on an individualized exercise program. ECRP ran twice per week for an hour. Patients followed and filled out an exercise log. During each session, the supervising health care professionals circulated throughout the class, providing individual guidance as appropriate to ensure safe participation and motivation. Baseline data on fatigue was obtained for each patient upon the initial session and monthly thereafter using the Brief Fatigue Inventory Outcome Measurement tool (BFI) over a 12-month period dating from January to December 2017. Twenty-seven patients participated in ECRP. Not all patients attended all exercise sessions or completed BFI every month. The minimum fatigue score was determined and compared with the initial score utilizing a paired t-test and signed rank test. Results: Data was obtained and analyzed utilizing a paired t-test and a signed rank test to evaluate the significance of BFI scores obtained between the initial and minimum score. There was a significant reduction in the Total Brief Fatigue score (P-value &lt; 0.001). Conclusions: An exercise program resulted in a significant reduction in cancer-related fatigue with improved patient outcomes and patient satisfaction.

Evaluation of lung cancer awareness among pharmacy students in Malaysia: a cross-sectional study

Event Abstract Back to Event Evaluation of lung cancer awareness among pharmacy students in Malaysia: a cross-sectional study Sohail Ahmad1*, Muhammad Qamar1, Wong Y. Zhi1 and Nurul I. Hassan Bashri1 1 Faculty of Pharmacy, Mahsa University, Malaysia Background Cigarette smoking at an early age and the increasing trend of using e-cigarettes and vaping devices are potential risk factors for developing lung cancer among Malaysians. It accounts for 19.8% of all cancer mortality and is the third most common cancer in Malaysia. This study was conducted to assess the awareness of lung cancer among pharmacy students in Malaysia. Methods This cross-sectional study recruited a total of 225 pharmacy students enrolled at three private universities situated in Selangor, Malaysia. Post-approval from Cancer Research UK, a validated Cancer Awareness Measure (CAM) was used. CAM consisted of five main sections: socio-demographic data (n=6), level of confidence (n=1), lung cancer age (n=1), warning signs (n=14), and risk factors (n=9) of lung cancer. The data were extracted from completed questionnaires and analyzed descriptively and inferentially using SPSS® version 22. Results Majority of the enrolled students were females (75.5%), and Malay (40.8%). The descriptive analyses of correct responses suggested that the students possessed a high level of awareness regarding warning signs (n=139, 61.7%) and risk factors (n=145, 64.4%) of lung cancer. Chi-square test showed that the age categories exhibited statistically significant associations with warning signs, χ2 (4)=14.256, p=0.007, as well as with risk factors, χ2 (4)=13.431, p=0.010. In addition, educational level, χ2 (4)=11.396, p=0.022, and smoking status, χ2 (8)=22.251, p=0.044, showed statistically significant associations with risk factors. The students’ score of warning signs and risk factors were positively correlated as suggested by Spearman's correlation (r=0.42, p=0.001). Conclusion The pharmacy students in Malaysia possess high level of lung cancer awareness. Pharmacy students therefore can contribute actively in community-based lung cancer awareness campaigns after adequate training and under the supervision of healthcare professionals. Acknowledgements This research is partially funded by the research grant awarded by Research Management Centre (RMC), MAHSA University, Selangor, Malaysia. Keywords: lung cancer, Malaysian, Pharmacy, Awareness, Students Conference: International Conference on Drug Discovery and Translational Medicine 2018 (ICDDTM '18) “Seizing Opportunities and Addressing Challenges of Precision Medicine”, Putrajaya, Malaysia, 3 Dec - 5 Feb, 2019. Presentation Type: Oral Presentation Topic: Cancer Citation: Ahmad S, Qamar M, Zhi WY and Hassan Bashri NI (2019). Evaluation of lung cancer awareness among pharmacy students in Malaysia: a cross-sectional study. Front. Pharmacol. Conference Abstract: International Conference on Drug Discovery and Translational Medicine 2018 (ICDDTM '18) “Seizing Opportunities and Addressing Challenges of Precision Medicine”. doi: 10.3389/conf.fphar.2018.63.00016 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 21 Oct 2018; Published Online: 17 Jan 2019. * Correspondence: Dr. Sohail Ahmad, Faculty of Pharmacy, Mahsa University, Bandar Saujana Putra, Selangor, 42610, Malaysia, sohail@mahsa.edu.my Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Sohail Ahmad Muhammad Qamar Wong Y Zhi Nurul I Hassan Bashri Google Sohail Ahmad Muhammad Qamar Wong Y Zhi Nurul I Hassan Bashri Google Scholar Sohail Ahmad Muhammad Qamar Wong Y Zhi Nurul I Hassan Bashri PubMed Sohail Ahmad Muhammad Qamar Wong Y Zhi Nurul I Hassan Bashri Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

A Preceptoria na Formação Médica e Multiprofissional com Ênfase na Atenção Primária – Análise das Publicações Brasileiras

A mudança do conceito de saúde e a introdução de outro modelo de Atenção produziram transformações na formação em saúde e exigiram que os alunos participassem dos serviços de saúde com a presença de profissionais sob a forma de preceptoria. Objetivo Analisar quais conceitos e atividades da preceptoria são apresentados pelas publicações brasileiras em saúde, entre os anos de 2002 e 2012, que tratam da preceptoria médica e multiprofissional. Metodologia Revisão de literatura das experiências brasileiras publicadas nas bases bibliográficas Lilacs, Medline, SciELO, Wholis e Portal Capes, utilizando como descritores “formação” e “preceptoria”. Para a análise, selecionaram-se os temas: conceito de preceptor/preceptoria; atividades, características e formação do preceptor; relação preceptor-aluno-serviço; condições de trabalho. Resultados Os termos preceptoria e preceptor são frequentemente utilizados no âmbito da formação em saúde, porém ainda carecem de definição consistente. As atividades e características do preceptor são heterogêneas. A preceptoria traz uma dimensão docente/pedagógica, poucas vezes presente nos processos formativos dos profissionais. Conclusão O perfil e as atividades do preceptor devem ser pactuados previamente nos programas dos cursos. Pensar a formação do preceptor é fundamental para garantir a transformação da Educação em Saúde.

Hepatotoxicity of green tea: an update.

Green tea (GT), obtained from the leaves of Camellia sinensis (L.) Kuntze (Fam. Theaceae), is largely used for its potential health benefits such as reduction in risk of cardiovascular diseases and weight loss. Nevertheless, it is suspected to induce liver damage. Present work reviews the hepatic adverse reactions associated with GT-based herbal supplements, published by the end of 2008 to March 2015. A systematic research was carried out on PubMed, MedlinePlus, Scopus and Google Scholar databases, without any language restriction. Moreover, some accessible databases on pharmacovigilance or phytovigilance were consulted. The causality assessment was performed using the CIOMS/RUCAM score. Nineteen cases of hepatotoxicity related to the consumption of herbal products containing GT were identified. The hepatic reactions involved mostly women (16/19); the kind of liver damage was generally classified as hepatocellular (16/19). The causality assessment between consumption of herbal preparation and hepatic reaction resulted as probable in eight cases and as possible in eleven cases. In seven cases, patients used preparations containing only GT, while twelve reactions involved patients who took multicomponent preparations (MC). The reactions induced by GT had a generally long latency (179.1±58.95days), and the outcome was always resolution, with recovery time of 64.6±17.78days. On the contrary, liver injury associated with MC had a shorter latency (44.7±13.85days) and was more serious in four cases that required liver transplantation and, when resolution occurred, the recovery time was longer (118.9±38.79). MC preparations contained numerous other components, many of which are suspected to induce liver damage, so it is difficult to ascribe the toxicity to one specific component, e.g., GT. Present data confirm a certain safety concern with GT, even if the number of hepatic reactions reported is low considering the great extent of use of this supplement. The mechanism of GT hepatotoxicity remains unclear, but factors related to the patient are becoming predominant. A major safety concern exists when GT is associated with other ingredients that can interact between them and with GT, enhancing the risk of liver damage. Patients should be discouraged from using herbal or dietary supplements containing complex mixtures and should be encouraged to use herbal and dietary supplement possibly under supervision of healthcare professionals.

The relation between Internet and social media use and the demographic and clinical parameters, quality of life, depression, cognitive function and sleep quality in hemodialysis patients: Social media and hemodialysis

ObjectiveThere are very few studies in the literature investigating the Internet use in hemodialysis (HD) patients. However, no study examined the relationship between Internet and social media use and quality of life, depression, cognitive function and sleep problems in HD patients. MethodsThe study is cross-sectional in design. All patients underwent history taking; physical examination; laboratory analysis and quality of life (by a short form of the Medical Outcomes Study), depression (by the Beck Depression Inventory), cognitive function (by the Standardized Mini Mental State Examination) and sleep problems (by the Pittsburgh Sleep Quality Index) evaluation. ResultsIn total, 134 HD patients (male/female: 73/61, age: 53.0±13.4 years) were included. Patients with mail, Facebook and Twitter accounts were younger, were less depressive, had better quality of life, had higher cognitive function and were more educated compared to patients who did not have these accounts. Patients with Internet-based research about their disease were less depressive, had better quality of life and sleep quality, had higher cognitive function and were more educated compared to patients who did not have Internet-based research. ConclusionInternet and social media use was closely related with quality of life, depression, cognitive function and education in HD patients. Studies are needed on whether Internet use under the supervision of health care professionals will improve clinical outcomes, adherence, quality of life, depression and decision making in HD patients.

Oral Chemotherapy & Biotherapy: Effective Care and Support for Patients

Background: Oral anti-cancer medications are increasingly a part of standard chemotherapy regimens. Clinicians and patients alike overwhelmingly prefer oral chemotherapy to traditional intravenous chemotherapy. However, the side effect profiles of oral chemotherapy agents are often just as severe as IV chemotherapy medications that are given under the close supervision of health-care professionals. This leaves a significant ‘care gap’ for those taking oral chemotherapy as the development of evidence-based care standards has not kept pace with the increasing use of these medications. Purpose: The purpose of this study is to explore current practice to support patients taking oral chemotherapy at the BC Cancer Agency and to make specific recommendations for future practice based on current literature. Methods: An electronic literature review utilizing the databases PubMed, CINAHL, and the Cochrane Library resulted in 140 identified peer-reviewed journal articles, of which 31 were deemed relevant and retrieved. Additionally, a qualitative cross sectional survey was administered to the regional nursing and pharmacy leaders of the six (6) Regional BC Cancer Agency Centers to gain understanding of current practice. Findings: Models of care identified in the literature for patients receiving oral chemotherapy and biotherapy include: Nurse/Pharmacy led clinics, Automated Voice System Response, and Home Care Nursing. Inconsistent practice within nursing and pharmacy was identified across the Regional BC Cancer Centers. Recommendations based on findings include: Provision of patient/family centered education, increased support to patients throughout their first cycle of oral chemotherapy, and development of consistent protocols for nursing and pharmacy across the BC Cancer Agency.

Parenting and the parallel processes in parents’ counseling supervision for eating-related problems

This paper presents an integrative model for supervising counselors of parents who face eating-related problems in their families. The model is grounded in the theory of parallel processes which occur during the supervision of health-care professionals as well as the counseling of parents and patients. The aim of this model is to conceptualize components and processes in the supervision space, in order to: (a) create a nurturing environment for health-care facilitators, parents and children, (b) better understand the complex and difficult nature of parenting, the challenge counselors face, and the skills and practices used in parenting and in counseling, and (c) better own practices and oppose the judgment that often dominates in counseling and supervision. This paper reflects upon the tradition of supervision and offers a comprehensive view of this process, including its challenges, skills and practices.

Safety of biologics approved for treating rheumatoid arthritis: analysis of spontaneous reports of adverse events

Despite the effectiveness of biologics approved for the treatment of rheumatoid arthritis, they have been associated with serious adverse events (AEs). Biologics are used under close supervision of health care professionals. In Portugal, they are legally required to report AEs occurring during the treatment. This study aims at investigating post-marketing safety monitoring data of biologics in Portugal by comparing the frequency of spontaneously reported adverse events between 2009 and 2011 with the frequency of such events in the summary of the product characteristics of each biologic. Sales data for biologics were obtained from IMS Health and converted into defined daily doses/1,000 inhabitants/day in order to estimate a proportion of the population treated. The frequency of AEs was estimated as the percentage of patients in which an AE may have occurred. The use of each biologic was estimated for adalimumab at 1,439 patients/year, etanercept 1,944 patients/year, and infliximab 3,211 patients/year. A total of 992 AEs were reported: 207 for adalimumab, 199 for etanercept, and 586 for infliximab. Of the 515 different spontaneously reported AEs, 194 were included for comparisons with the SPCs. Of those, 31 (16 %) were similarly frequent, and 163 (84.0 %) occurred less frequently compared with SPCs' data. These results suggest an insufficient post-marketing safety monitoring of biologics in Portugal.

Education and supervision of health care professionals to initiate, implement and improve management of obesity

The objective of this study was to explore whether there were differences in organisational setting and professional intervention between health professionals who, after 1 year of education, and ongoing supervision for all together 30 months, started obesity treatment and those who did not. Furthermore to analyse what factors facilitate the start of obesity treatment. One hundred and seventy-one health professionals from different parts of Sweden were included in the education. One hundred and thirty-five health professionals remained in the study for up to 2.5 years. Eighty-seven subjects started the obesity treatment program, whereas 48 subjects had no possibility to start treatment. Significantly more of those who started the behavioural treatment program had previous theoretical education and clinical experience of obesity. They also, to a greater degree, had a go-ahead from the management and support from physicians, colleagues and were more likely to be part of a team or had a colleague to work with. In addition, they could find the time to organise and plan the treatment. Supervision had a significant positive influence on starting up the treatment program. Education, working organization, a structural behavioural treatment program, seems to be significant factors in facilitating and increasing the likelihood for a start.

Use of survey information to develop a hospital-based medication teaching program

As the volume of prescribed medications and complexity of regimen continue to rise, medication instruction is imperative, particularly for patients with chronic illness who must care for themselves without direct supervision of health care professionals. However, as hospital acuity levels increase and lengths of stay decrease, limited opportunity exists to adequately prepare hospitalized patients who are to be discharged with new prescriptions. Hospital-based medication teaching programs must be designed so that they encourage patient-professional interaction, yet also conserve nursing staff time. In this project, members of a hospital-based, interdisciplinary committee used survey information to develop a basic medication instruction program that emphasized ‘need to know’ content. The program was designed to involve patients and also to encourage them to seek additional information from other providers. Potential for successful implementation was enhanced by participation of nurse managers who developed the pilot implementation procedure.