Use In Healthcare Practice Research Articles

Nursing theories applied to clinical nursing practice

After a brief description of twointermediate theories, transition theory developed by Afaf Ibrahim Meleis and uncertainty management theory in healthcare by Merle H. Mishel, the article illustrates their concrete use in healthcare practice. To this end, two clinical situations in pediatrics are presented, for each of which the needs of the patient, his or her family and environment are identified, followed by proposals for nursing interventions based on these theories.

Behavior, Risk Perception and Misinformation Monitoring Tool: Adaptation of the WHO Approach to the Ukrainian Context

Risk communication is a process aimed at supporting stakeholders in identifying threats, assessing vulnerabilities and promoting collective resilience. According to WHO recommendations, one of the priority directions for improvement of Ukraine’s emergency response capabilities is the forming and/or implementation of a system for collecting and analyzing information on risk perception, behavior and misinformation, problems and fears of society. The objective: to determine the validity and reliability of the developed Behavior, Risk Perception and Misinformation Monitoring Tool, which was created on the basis of WHO Europe’s Behavioral Insights tool. Materials and methods. The analyzed cohort of 56 adults living in different regions of Ukraine differ in gender, level of education, and field of activity. At the initial stage (T1), risk perception, behavior and misinformation were assessed. A repeat survey (T2) was conducted after 17 days to determine the reliability of the proposed Tool. Results. The Tool demonstrated adequate or high reliability in most of the proposed questions (ICC ≥ 0.6). Some questions that did not meet the established reliability criteria (ISS < 0.4) were excluded from the final version of the questionnaire. The shortened version of the questionnaire contains 131 questions. Conclusions. Given that in each block of questions, most of them were found to be reliable, and the deletions did not affect the structure and main purpose of the questionnaire, the Behavior, Risk Perception and Misinformation Monitoring Tool has potential for use in health care practice as a means of assessing behavioral risk perception and misinformation of the adult population. Systemic monitoring of behavioral variables is an important component of building Ukraine’s emergency response capabilities, which becomes especially important in wartime.

Awareness of medical students about the role of artificial intelligence in health care: A survey-based cross-sectional study

Background: Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially by computers. In the recent past, the utility of AI has been tested and proven in many fields like health care, education, finance, defense, etc. AI has received so much attention these days and is described as the new electricity and the fourth industrial revolution. It is anticipated that AI’s role will be crucial and imminent soon in different fields, including the health sector. The medical graduates need to update their knowledge and keep pace with the new developments in technology. Given this, our study was designed to evaluate the awareness and perception of medical students regarding the basic concepts of AI and its implications in health care. Aim and Objective: The aim and objective of the study are to assess the knowledge and perceptions of medical students about AI at a tertiary care teaching hospital. Materials and Methods: The study was a questionnaire-based, cross-sectional study. A prevalidated, self-made questionnaire was distributed to 264 medical students of all professional years through Google Forms. The student’s knowledge, opinions, and perceptions of AI were evaluated. The analysis of the collected data was done with an Excel sheet and using descriptive statistical measures such as mean and percentages. Results: Our study revealed that the majority of the students (79.16%) were under the impression that AI decreases errors in clinical practice. 86% of participants agreed that AI aids doctors in making accurate decisions in the diagnosis and treatment of different conditions. Around 72% of the students said that AI guides the patient to choose the right medical care. Onethird of the participants thought that AI hampers the relationship between patient and doctor by breaking trust between them. A few subsets of participants expressed concerns over ethical issues, confidentiality, empathy, and sympathy, which are considered to be the pillars of medical practice. Conclusions: Our study concluded that medical students at Mamatha Academy of Medical Sciences, Hyderabad, have positive perceptions and good awareness about AI and its use in health-care practice, but they still need a better understanding of AI.

(How) ChatGPT-Artificial Intelligence Thinks It Can Help/Harm Physiatry.

ChatGPT is a chatbot that is based on the generative pretrained transformer architecture as an artificial inteligence-based large language model. Its widespread use in healthcare practice, research, and education seems to be (increasingly) inevitable. Also considering the relevant limitations regarding privacy, ethics, bias, legal, and validity, in this article, its use as a supplement (for sure not as a substitute for physicians) is discussed in light of the recent literature. Particularly, the "opinion" of ChatGPT about how it can help/harm physiatry is exemplified.

Innovation in healthcare: leadership perceptions about the innovation characteristics of artificial intelligence—a qualitative interview study with healthcare leaders in Sweden

BackgroundDespite the extensive hopes and expectations for value creation resulting from the implementation of artificial intelligence (AI) applications in healthcare, research has predominantly been technology-centric rather than focused on the many changes that are required in clinical practice for the technology to be successfully implemented. The importance of leaders in the successful implementation of innovations in healthcare is well recognised, yet their perspectives on the specific innovation characteristics of AI are still unknown. The aim of this study was therefore to explore the perceptions of leaders in healthcare concerning the innovation characteristics of AI intended to be implemented into their organisation.MethodsThe study had a deductive qualitative design, using constructs from the innovation domain in the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted with 26 leaders in healthcare.ResultsParticipants perceived that AI could provide relative advantages when it came to care management, supporting clinical decisions, and the early detection of disease and risk of disease. The development of AI in the organisation itself was perceived as the main current innovation source. The evidence base behind AI technology was questioned, in relation to its transparency, potential quality improvement, and safety risks. Although the participants acknowledged AI to be superior to human action in terms of effectiveness and precision in some situations, they also expressed uncertainty about the adaptability and trialability of AI. Complexities such as the characteristics of the technology, the lack of conceptual consensus about AI, and the need for a variety of implementation strategies to accomplish transformative change in practice were identified, as were uncertainties about the costs involved in AI implementation.ConclusionHealthcare leaders not only saw potential in the technology and its use in practice, but also felt that AI’s opacity limits its evidence strength and that complexities in relation to AI itself and its implementation influence its current use in healthcare practice. More research is needed based on actual experiences using AI applications in real-world situations and their impact on clinical practice. New theories, models, and frameworks may need to be developed to meet challenges related to the implementation of AI in healthcare.

Сравнительный анализ физического развития детей г. Самара и г. Нижний Новгород

Analysis of physical development in children and adolescents is an integral to the monitoring of child population. Health status of children and adolescents is an essential criterion of societal welfare. Numerous studies of physical development in children indicate the heterogenous nature of growth and develpmental processes in children living in various regions of Russia. The study was aimed to perform the comparative analysis of physical development between children aged 15–17 living in Samara (a total of 714 children were examined, among them 368 boys and 346 girls) and children of the same age group living in Nizhny Novgorod (a total of 689 children, among them 351 boys and 338 girls). In school students aged 16–17, significant differences in the mean height were revealed: adolescents living in Samara were taller than those living in Nizhny Novgorod (p = 0.001). The same trend was observed in girls of the same age group. Comparative analysis showed that girls aged 15–17 living in Samara were significantly taller (p < 0.001) than girls who lived in Nizhny Novgorod. Assessment of body weight showed that the weight of boys aged 15–16 who lived in Samara was significantly higher compared to boys living in Nizhny Novgorod (p = 0.009). No significant differences were revealed between the groups of 17‑year‑old boys and the groups of girls aged 15–17 (р = 0.7). The findings on the differences in the anthropometric indicators of children living in Samara and Nizhny Novgorod justify the need for periodic development and use in healthcare practice of the regional standards for assessment of physical development in children and adolescents.

The Importance of Direct Patient Reporting of Adverse Drug Reactions in the Safety Monitoring Process.

All medicinal products authorized in the European Union are subjects of constant drug-safety monitoring processes. It is organized in a pharmacovigilance system that is designed to protect human health and life by the detection, analysis and prevention of adverse drug reactions (ADRs) and other drug-related problems. The main role of the aforementioned system is to collect and analyze adverse drug reaction reports. Legislation introduced several years ago allowed patients, their legal representatives and caregivers to report adverse drug reactions, which caused them to be an additional source of safety data. This paper presents the analysis of EudraVigilance data related to adverse drug reactions provided by patients, their representatives, as well as those obtained from healthcare professionals related to medicines which belong to M01A anti-inflammatory and antirheumatic products, a non-steroid group. The objective of the study was to identify the changes in the number and structure of adverse reaction reporting after the introduction of pharmacovigilance (PV) obligations in EU. A review of scientific literature was also conducted to assess the differences in adverse reactions reported by patients or their representatives and by healthcare professionals. We also identified other factors which, according to literature review, influenced the number of adverse reaction reports provided by patients. Analysis of data collected from the EudraVigilance showed that from 2011 to 2013 the number of reports made by patients and their caregivers increased by approx. 24 percentage points, and then, from 2014, it constituted around 30% of the total of reported reactions every year, so patient reporting is an important part of pharmacovigilance system and a source of drugs’ safety information throughout their use in healthcare practice. Additionally, there was no interrelationship between the seriousness of reported adverse reactions and the overall number of patient reports when compared to reports form healthcare professionals.

Прогнозування тяжкості розладів унаслідок уживання алкоголю у хворих залежно від рівня психосоціального стресу і стану гепатобіліарної системи у світлі концепції інтегрованої діагностики й терапії наркопатології

Розробляли спосіб визначення і прогнозування тяжкості розладів, що виникають унаслідок уживання алкоголю, у хворих залежно від рівня психосоціального стресу і стану гепатобіліарної системи у світлі концепції інтегрованої діагностики й терапії наркопатології для використання його лікарями первинної ланки медико-санітарної допомоги. При розробці моделі виділено три основні групи факторів, які, за отриманими даними, мали вплив на формування тяжкості розладів унаслідок уживання алкоголю: вираженість адиктивної симптоматики (за AUDIT), рівень випробовуваного пацієнтами стресового навантаження (за тестом Л. Рідера) та стан гепатобіліарної системи (за коефіцієнтом де Рітіса). Створено модель, яка математично описує співвідношення різних факторів у формуванні тяжкості розладів, що розвиваються внаслідок уживання алкоголю, і дає можливість кількісно оцінити ймовірнісний стан у конкретного хворого на розлади внаслідок уживання алкоголю. Показано, що запропонована модель характеризується високою детермінантністю і придатна для застосування у практиці охорони здоров’я для прогнозування тяжкості розладів унаслідок уживання алкоголю у хворих на алкогольну залежність.

The French Society of Internal Medicine's Top-5 List of Recommendations: a National Web-Based Survey.

The international project "Choosing Wisely" aims to target unnecessary and potentially harmful examinations and treatments. To define the French Internal Medicine Top-5 list. Based on a review of existing Top-5 lists and personal experience, a working group of the French National Society of Internal Medicine selected 27 diagnostic and therapeutic procedures. They were submitted through a national web-based survey to French internists who rated from 1 to 5 the perceived frequency, uselessness, and risk of each procedure. A composite score was calculated as the unweighted addition of the three scores. Four hundred thirty internists answered the web-based survey (14% of all French internists including residents). All the French regions and status of the profession were represented. For the 27 submitted procedures, the mean score (± SD) was 3.25 (± 0.48) for frequency, 3.10 (± 0.43) for uselessness, and 2.63 (± 0.84) for risk. The Top-5 list obtained with the composite score was as follows: 1. Do not prescribe long-term treatment with proton pump inhibitors without regular reevaluation of the indication 2. Do not administer preventive treatments (e.g., for dyslipidemia, hypertension…) in elderly people with dementia when potential risks outweigh the benefits 3. Do not administer hypnotic medications as first-line treatment for insomnia 4. Do not treat with an anticoagulant for more than 3months a patient with a first venous thromboembolism occurring in the setting of a major transient risk factor 5. Do not screen for Lyme disease without an exposure history or related clinical examination findings We found that the composite score was strongly correlated to the risk score (rs= 0.88, p< 10-5) and not to the frequency (rs= 0.06, p= 0.75) or uselessness score (rs= 0.17, p= 0.38). This Top-5 list provides an opportunity to discuss appropriate use of health care practices in internal medicine.

Efficiency of immunomodulatory therapy in the complex treatment of patients with combined craniofacial injuries

Background: Our aim is to study the effectiveness of immunomodulatory therapy with Polyoxidonium in the complex treatment of patients with combined craniofacial injuries. Methods: In accordance with the intended purpose of this study, we conducted a comprehensive immunological examination of patients with combined craniofacial injuries in the dynamics of treatment with the drug authorized for use in healthcare practice: Polyoxidonium. In total 22 patients with combined craniofacial injuries in the complex therapy received Polyoxidonium at a dosage level of 6[Formula: see text]mg/m once for 5 days. Results: We conducted a comprehensive immunological study of the clinical course of the post-traumatic period in patients with combined craniofacial injuries which showed that the immunomodulatory therapy with Polyoxidonium during the complex treatment has a high clinical and immunological efficacy. Conclusions: Thus, in patients with combined craniofacial injuries, there is an immunodeficiency state involving both cellular immunity, manifested by a decrease in the level of T-lymphocytes, T-helpers, NK-cells and B-lymphocytes, and decrease of immunoglobulin production. The use of Polyoxidonium immunomodulator in complex therapy in patients with combined craniofacial injuries helped in improving the condition of patients in a shorter period of time and in preventing the development of purulent-inflammatory complications due to the positive dynamics of cellular and humoral immunity.

Predicting long-term sickness absence among employees with frequent sickness absence

PurposeFrequent absentees are at risk of long-term sickness absence (SA). The aim of the study is to develop prediction models for long-term SA among frequent absentees.MethodsData were obtained from 53,833 workers who participated in occupational health surveys in the period 2010–2013; 4204 of them were frequent absentees (i.e., employees with ≥ 3 SA spells in the year prior to the survey). The survey data of the frequent absentees were used to develop two prediction models: model 1 including job demands and job resources and model 2 including burnout and work engagement. Discrimination between frequent absentees with and without long-term SA during follow-up was assessed with the area under the receiver operating characteristic curve (AUC); (AUC) ≥ 0.75 was considered useful for practice.ResultsA total of 3563 employees had complete data for analyses and 685 (19%) of them had long-term SA during 1-year follow-up. The final model 1 included age, gender, education, marital status, prior long-term SA, work pace, role clarity and learning opportunities. Discrimination between frequent absentees with and without long-term SA was significant (AUC 0.623; 95% CI 0.601–0.646), but not useful for practice. Model 2 showed comparable discrimination (AUC 0.624; 95% CI 0.596–0.651) with age, gender, education, marital status, prior long-term SA, burnout and work engagement as predictor variables. Differentiating by gender or sickness absence cause did not result in better discrimination.ConclusionsBoth prediction models discriminated significantly between frequent absentees with and without long-term SA during 1-year follow-up, but have to be further developed for use in healthcare practice.

From Linear to Complicated to Complex Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation".

Attention to collaborative approaches to encouraging evidence use in healthcare practice are gaining traction. The inherent complexities in collaborative and networked approaches to knowledge translation (KT) have been embraced by Kitson and colleagues in their complexity network model. In this commentary, the potential of complexity as presented by Kitson et al within their model is considered. The utility of such a model will be contingent upon how easy users find it to understand and apply to their challenge, and doing so in a way that is useful to not only help with explanation, but also with prediction.

Master student's application of evidence-based knowledge and skills in Swedish healthcare practice.

To investigate the application of evidence-based knowledge and skills in everyday healthcare practice among healthcare personnel attending a course in evidence-based practice (EBP) at the master's level. In this cross-sectional study, an evaluation of the use of instrumental, conceptual and persuasive research was performed among students attending a master's course in EBP at Lund University. Seven questions from the validated questionnaire in the Longitudinal Analysis of Nursing Education project were used. The questionnaire was distributed among 21 students at the first lecture in the course (the group before the course). Students who had participated in the course 1 (n = 15) and 2 (n = 13) years earlier received the questionnaire by ordinary mail (the group after the course). The current study revealed that the majority of the students used research in their daily healthcare practice. However, the extent and type of use varied. There were differences in research use between the 'before' and 'after' groups. More specifically, the students in the group responding after the course were significantly more prone to use research in practice than the students responding before the course (P = 0.01 and 0.04). An EBP course offered to master's degree students provides enhancement of evidence-based knowledge and skills, and stimulates research use in healthcare practice.

Psychometric Assessment of the Child Surgery Worries Questionnaire Among Portuguese Children

Worries are common in surgical patients, especially in children. The present study analyzed the factor structure and the psychometric properties of a Portuguese version of the Child Surgery Worries Questionnaire (CSWQ-P) in a Portuguese sample of 490 children. Exploratory factor analysis, conducted via principal axis factoring with oblimin rotation, provided evidence for a four-factor structure of the 21 item questionnaire. A confirmatory factor analysis was also conducted, showing the good fit of this solution. The CSWQ-P proved to have one more subscale than the original Spanish version CSWQ. Correlations with the children's trait anxiety provided evidence of convergent validity for the CSWQ-P. Females also scored higher on worries than males on all subscales. Psychometric properties of this revised version of the CSWQ provided support for use with young children, and indicate the CSWQ-P has value for use in healthcare practice and in clinical research.

Reconsidering healthcare evidence as dynamic and distributed: the role of information and cognition.

The basic thrust of evidence-based healthcare is that current best evidence should be used explicitly and judiciously for diagnosis, management, and other activities in healthcare settings. For this to be possible, researchers, practitioners, and other stakeholders must have a clear and accurate conceptualization of what constitutes 'evidence' in healthcare environments, and the manner in which it is used in decision-making and other activities. Currently, the dominant conceptualization of evidence is that of a body of information that can be retrieved by stakeholders for use in healthcare practice. The aim of this article is to critically examine the concept of evidence, particularly in light of recent models of human cognition and information use in decision-making and other cognitive activities. In this theoretical article, we employ both analytical and synthetic methods to critically examine the concepts under investigation. Key concepts, such as evidence and information, and the essential relationships between them are analyzed from the vantage point of cognitive science, information science, and other relevant disciplines to explicate a conceptualization of evidence that moves past static and objectivist accounts. We demonstrate that evidence is fundamentally information that takes various forms-i.e., artifacts, mental structures, or communication processes. Specific forms and manifestations of evidence can thus be described in the context of information use in dynamic information environments. Furthermore, evidence-based healthcare activities are shown to be fundamentally cognitive in nature. For any given evidence-based healthcare activity, its quality and outcome can be understood in the context of how different sources of evidence are coordinated within a distributed cognitive system. In this sense, evidence based health care activity becomes more a matter of understanding the movement of information and knowledge within a distributed and dynamic cognitive system than mere access to or translation of a ready-at-hand resource. The conceptualization of evidence presented in this article has a number of implications for evidence-based healthcare-in terms of where attention is focused, the direction of future research efforts, how evidence generation, use, and practice are conceptualized and discussed, and how healthcare technologies are designed and evaluated. Furthermore, the conceptualization presented in this article has implications for the manner in which evidence 'hierarchies' are developed. Such hierarchies do not provide a complete picture of evidence and the way it is used in healthcare activities. Understanding the dynamic nature of evidence and its role in distributed cognitive activities may lead to more robust and multi-faceted taxonomies, frameworks, and hierarchies related to evidence-based healthcare.

Características y uso del documento de voluntades anticipadas en un hospital terciario

ObjectiveTo evaluate the characeristics of patients who provide written advance directives and their use in healthcare practice. MethodologyObservational, descriptive, retrospective study of all written advance directives registered at a university hospital between 2001-2011. The clinical-demographic characteristics of the patients at the time they provided the documents was studied, as was as the later use of the documents through an electronic medical history analysis. ResultsA total of 130 advance directive documents were registered. At the time of their provision, the average patient age was 61 years; some 64% were diagnosed with a neoplastic illness; 73% were completely independent (Barthel), and 36.4% presented no comorbidities (Charlson). The women were slightly older than the men (63 vs. 60, P=0.17), and they were more likely to provide advance directives (61.5% vs. 31.5%, P=0.01) than men; the womens’ illnesses were less relevant (P=0.001), and the women presented less comorbidity (P=0.01). A total of 361 medical acts were reviewed (193 hospital admissions and 168 emergency visits). At the end of the study, 74 patients were alive (57%), 37 had died (28%), and in 19 cases (15%), their evolution was lost. Of those who died, 13 (35.1%) were functionally incapacitated in the terminal phase of their illness, and in 9 (69%), the advance directives were applied in the final phase of their illness. ConclusionsThe number of registered advance directives is low; they do not interfere in the care process, and the documents are considered in the final decisions of life.

Nursing diagnoses and outcomes related to the circulatory-system terms (ICNP®) represented in an ontology

The aim of the present study was to develop titles of Nursing Diagnoses and Outcomes (ND/NO) through the relationship between the terms of the Focus axis, limited to the Circulatory System Process, and the terms of other ICNP® axes and to integrate these terms into an ontology. Titles were developed linking 17 terms of the focus axis, which were evaluated by expert nurses in five Brazilian cities. Titles whose use concordance was above 0.80 were included in the ontology. In total, 89 titles for ND/NO were supported in the literature, and 19 were not supported; 37 were assessed as eligible for use in healthcare practice and were included in the ontology. The construction of ND/NO titles based on the ICNP® and using a formal representation of knowledge is a task that requires deepening concepts used for nursing and adequate classification revisions. The elaborated titles will facilitate the composition of diagnostics that are more consistent with practice.

Diagnósticos e resultados de enfermagem relacionados aos termos do sistema circulatório - CIPE® representados em uma ontologia

The aim of the present study was to develop titles of Nursing Diagnoses and Outcomes (ND/NO) through the relationship between the terms of the Focus axis, limited to the Circulatory System Process, and the terms of other ICNP® axes and to integrate these terms into an ontology. Titles were developed linking 17 terms of the focus axis, which were evaluated by expert nurses in five Brazilian cities. Titles whose use concordance was above 0.80 were included in the ontology. In total, 89 titles for ND/NO were supported in the literature, and 19 were not supported; 37 were assessed as eligible for use in healthcare practice and were included in the ontology. The construction of ND/NO titles based on the ICNP® and using a formal representation of knowledge is a task that requires deepening concepts used for nursing and adequate classification revisions. The elaborated titles will facilitate the composition of diagnostics that are more consistent with practice.

Myofeedback training and intensive muscular strength training to decrease pain and improve work ability among female workers on long-term sick leave with neck pain: a randomized controlled trial

The theoretical framework is that muscle tension in the neck is related to insufficient muscular rest and is a risk factor for chronic pain and reduced work ability. Promoting muscle strength and muscle rest may increase work ability and reduce neck pain.ObjectivesTo test whether myofeedback training or intensive strength training leads to decreased pain and increased work ability in women on long-term sick leave.MethodsThis is a randomized controlled trial of two 1-month interventions with myofeedback or muscular strength training in the home environment. Female human service organization workers (n = 60) on long-term (>60 days) sick leave and with chronic neck pain were followed with self-reported and laboratory-observed data of health, pain, muscular activation, and work ability, at baseline, immediately after the intervention and 3 months after baseline.ResultsFor both intervention groups, pain was lowered over time compared with the control group. Decreased pain and muscular activity was associated with increased self-rated work ability and with laboratory-observed work ability at 3-month follow-up. Decreased pain was also associated with increased self-rated work ability at 1-month follow-up. Muscular strength training was associated with increased self-rated work ability and mental health. Myofeedback was associated with increased observed work ability and self- rated vitality.ConclusionsThe two interventions showed positive results, suggesting that they could be developed for use in health care practice to address pain and work ability. The intensive muscular strength training program, which is both easy to conduct at home and easy to coach, was associated with increased work ability.

Action research in health-care practice: Nature, present concerns and future possibilities

This paper begins by defining what is meant by action research and locates it as a form of a new paradigm of research. Next it describes some present-day concerns about its use in health-care practice and then goes on to describe a vision of research policy and practice which suggests that action research may have a greater role to play in the next millennium. In conclusion, a cautious and pragmatic approach to the use of action research is advocated which is based on rigorous, systematic and visible methods of data collection, analysis and verification of findings.