Health Care Providers (health + care_provider)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Health Care Providers

  • other health care provider
  • primary health care provider

  • Selected Abstracts

    Improving Child Protection in the Emergency Department: A Systematic Review of Professional Interventions for Health Care Providers

    Amanda S. Newton PhD
    Abstract Objectives:, This systematic review evaluated the effectiveness of professional and organizational interventions aimed at improving medical processes, such as documentation or clinical assessments by health care providers, in the care of pediatric emergency department (ED) patients where abuse was suspected. Methods:, A search of electronic databases, references, key journals, and conference proceedings was conducted and primary authors were contacted. Studies whose purpose was to evaluate a strategy aimed at improving ED clinical care of suspected abuse were included. Study methodologic quality was assessed by two independent reviewers. One reviewer extracted the data, and a second checked for completeness and accuracy. Results:, Six studies met the inclusion criteria: one randomized controlled trial (RCT), one quasi-RCT, and four observational studies. Study quality ranged from modest (observational studies) to good (trials). Variation in study interventions and outcomes limited between-study comparisons. The quasi-RCT supported self-instructional education kits as a means to improve physician knowledge for both physical abuse (mean standard deviation [SD] pretest score = 13.12 2.36; mean SD posttest score = 18.16 1.64) and sexual abuse (mean SD pretest score = 10.81 3.20; mean SD posttest score = 18.45 1.79). Modest-quality observational studies evaluated reminder systems for physician documentation with similar results across studies. Compared to standard practice, chart checklists paired with an educational program increased physician consideration of nonaccidental burns in burn cases (59% increase), documentation of time of injury (36% increase), and documentation of consistency (53% increase) and compatibility (55% increase) of reported histories. Decisional flow charts for suspected physical abuse also increased documentation of nonaccidental physical injury (69.5% increase; p < 0.0001) and had a similar significant effect as checklists on increasing documentation of history consistency and compatibility (69.5 and 70.0% increases, respectively; p < 0.0001) when compared to standard practice. No improvements were noted in these studies for documentation of consultations or current status with child protective services. The introduction of a specialized team and crisis center to standardize practice had little effect on physician documentation, but did increase documentation of child protective services involvement (22.7% increase; p < 0.005) and discharge status (23.7% increase; p < 0.02). Referral to social services increased in one study following the introduction of a chart checklist (8.6% increase; p = 0.018). A recently conducted multisite RCT did not support observational findings, reporting no significant effect of educational sessions and/or a chart checklist on ED practices. Conclusions:, The small number of studies identified in this review highlights the need for future quality studies that address care of a vulnerable clinical population. While moderate-quality observational studies suggest that education and reminder systems increase clinical knowledge and documentation, these findings are not supported by a multisite randomized trial. The limited theoretical base for conceptualizing change in health care providers and the influence of the ED environment on clinical practice are limitations to this current evidence base. ACADEMIC EMERGENCY MEDICINE 2010; 17:117,125 2010 by the Society for Academic Emergency Medicine [source]

    Web-based Resources for Health Care Providers and Women Following Pregnancy Loss

    Pamela A. Geller
    Experiencing perinatal loss can leave women and families feeling distressed, overwhelmed, and with many questions, while health care providers often lack time and may not be prepared to provide all the answers. This paper highlights the rationale for use and benefits of the Internet with this population and outlines an effort to review and select reliable Internet resources containing valid and substantial content specific to pregnancy loss. A summary table is included for distribution to women and providers. JOGNN, 35, 523,532; 2006. DOI: 10.1111/J.1552-6909.2006.00065.x [source]

    Psychosocial Aspects of Pain: A Handbook for Health Care Providers

    M Craigie Dr
    No abstract is available for this article. [source]

    Clinical Practice Characteristics and Preconception Counseling Strategies of Health Care Providers Who Recommend Alcohol Abstinence During Pregnancy

    ALCOHOLISM, Issue 11 2004
    Suzanne C. Tough
    Objective: National initiatives on fetal alcohol syndrome in Canada and the United States aimed at prevention, identification, and treatment of individuals who are affected by alcohol exposure in utero recommend that women abstain from consuming alcohol during pregnancy. Health care providers are key educators regarding appropriate alcohol use. The objective of this study was to describe characteristics of physicians who recommend alcohol abstinence during pregnancy with regard to knowledge of fetal alcohol syndrome and preconception counseling strategies. Methods: A survey was mailed to Canadian physicians and midwives between 2001 and 2002. Participants consisted of a national random sample of 1090 Canadian obstetricians and gynecologists, midwives, and family physicians who were current members of provincial and national professional organizations. The main outcome measure was questionnaire responses to knowledge, prevention, and diagnosis of issues related to alcohol use during pregnancy. Results: Response rates ranged from 31.1% among family physicians to 63.5% among midwives. Overall, 91.2% of providers recommended abstinence from alcohol during pregnancy. These providers were significantly more likely to believe that there is sufficient information about alcohol use and that clients were interested in discussing alcohol (p < 0.05). They were also significantly more likely to discuss depression, personal alcohol use, partner's use of alcohol, and family history of alcohol misuse with women of childbearing age (p < 0.05). Once a patient became pregnant, fewer practice differences were noted, although those who recommended alcohol abstinence were significantly more likely to take clinical action when pregnant patients were consuming moderate amounts of alcohol (p < 0.05). Conclusions: It is encouraging that almost 90% of Canadian health care providers recommend abstinence from alcohol during pregnancy. However, differences in clinical practice exist between providers who recommend alcohol abstinence during pregnancy as compared with those who recommend a "glass in moderation." [source]

    Attitudes and Intentions of Future Health Care Providers Toward Abortion Provision

    Solmaz Shotorbani
    CONTEXT: Induced abortion is one of the most common procedures performed among women in the United States. However, 87% of all counties had no abortion provider in 2000, and little is known about the attitudes and intentions of future health care providers, including advanced clinical practitioners, regarding abortion provision. METHODS: During March 2002, first- and second-year students in health sciences programs (i.e., medicine, physician assistant and nursing) at the University of Washington were anonymously surveyed. Univariate, bivariate and multi-variate analyses were used to determine students' attitudes and intentions regarding provision of abortion services. RESULTS: Of the 312 students who completed the survey, 70% supported the availability of legal abortion under any circumstances. Thirty-one percent intended to provide medical abortion in their practice, and 18% planned to offer surgical abortion. Fifty-two percent of all respondents agreed that advanced clinical practitioners should be able to provide medical abortion, and 37% agreed that they should be able to provide surgical abortion services; however, greater proportions of advanced clinical practitioners (45,83%) than of medical students (21,43%) expressed such support. Sixty-four percent of all respondents were willing to attend a program whose curriculum requires abortion training. CONCLUSIONS: Although it may not be possible to require abortion training for every future health care provider, making abortion a standard part of clinical training would provide opportunities for future physicians and advanced clinical practitioners, and would likely ameliorate the abortion provider shortage. [source]

    Sexuality in children and adolescents with disabilities

    Nancy Murphy MD
    This review presents a discussion of the sexual development of children and adolescents with disabilities, described in the framework of body structure and function, individual activities, and societal perspectives presented in the World Health Organization's International Classification of Functioning, Disability and Health. Issues of sexual development, gynecological care and contraception, sexual functioning, societal barriers, sexual victimization, and sexuality education are presented. Overall, adolescents with disabilities seem to be participating in sexual relationships without adequate knowledge and skills to keep them healthy, safe, and satisfied. Although their sexual development may be hindered both by functional limitations and by intentional or unintentional societal barriers, the formal and informal opportunities for teenagers with disabilities to develop into sexually expressive and fulfilled persons do exist. Health care providers are urged to increase their awareness of this unmet need and to implement strategies that promote the physical, emotional, social, and psychosexual independence of children, teenagers, and young adults with disabilities. [source]

    Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management,

    HEPATOLOGY, Issue 1 2009
    Raj Vuppalanchi
    Nonalcoholic fatty liver disease (NAFLD) is among the most common causes of chronic liver disease in the western world. It is now recognized that these patients have myriad of important co-morbidities (e.g., diabetes, hypothyroidism and metabolic syndrome). The workup of patients with suspected NAFLD should consist of excluding competing etiologies and systemic evaluation of metabolic comorbidities. NAFLD is histologically categorized into steatosis and steatohepatitis, two states with fairly dichotomous natural history. While significant progress has been made in terms of noninvasively predicting advanced fibrosis, insufficient progress has been made in predicting steatohepatitis. Currently, liver biopsy remains the gold standard for the histological stratification of NAFLD. While sustained weight loss can be effective to treat NASH, it is often difficult to achieve. Foregut bariatric surgery can be quite effective in improving hepatic histology in selected patients without liver failure or significant portal hypertension. Thiazolidinediones have shown promise and the results from the ongoing, large multicenter study should become available soon. Large multicenter studies of CB, receptor anatagonists are also underway but their results will not be available for several years. Several recent studies have highlighted that cardiovascular disease is the single most important cause of morbidity and mortality in this patient population. Conclusion: Health care providers should not only focus on liver disease but also concentrate on aggressively modifying and treating their cardiovascular risk factors. (HEPATOLOGY 2009;49:306-317.) [source]

    Help-seeking among Korean American women with urinary incontinence

    Youngmi Kang
    ABSTRACT Background: Despite the availability of effective treatments, many women manage their urinary incontinence (UI) silently rather than seeking professional help. Delays in seeking help in effectively managing UI can lead to a worsening of the incontinence and in overall quality of life. Aims: The aim of this study was to explore the help-seeking behaviour (HSB) among Korean American women with UI. The following research question guied this study: is there any difference in HSB for UI according to severity of UI among Korean American woment with UI?. Methods: 149 community-dwelling Korean American women who are age 30 years and older and self-identified as being incontinent were invited to particpate in the study. Data collection was conducted in 12 Korean religious organizations. This study uses a correlation descriptive design by means of interviews. The HSB scale was used to measure the propensity ot help-seeking. Results: This study showed that the propensity of seeking help among Korean American women was lower than that of general population. It indicated that Korean women cope urinary symptoms nonmedical measures rather seeking professional help. The severity of UI is associated with help-seeking among Korean American women with UI. Conclusions: Health care providers need to be aware of low rates of seeking care among Korean women for this problem, and the need for further education in this area. [source]

    Are Maternal Cortisol Levels Related to Preterm Birth?

    Carmen Giurgescu
    ABSTRACT Objective: To examine the evidence related to the relationship between maternal cortisol levels and preterm birth. Data Sources: A search of Medline, PubMed, and Cumulative Index of Nursing and Allied Health Literature was conducted using the keywords preterm birth, preterm delivery, premature birth, and cortisol. Study Selection: Fifteen studies published in English were selected based on the inclusion criteria. There were no limitations on the dates of publication. Data Extraction: The data extracted were related to the gestational age at collection of biological samples, time of day at collection, and differences in cortisol levels between preterm and full-term groups. Data Synthesis: The majority of the studies suggested that maternal cortisol levels are related to preterm birth. Women with higher levels of cortisol had higher risk of having a preterm birth. Conclusions: Researchers can use the findings of this review to develop future studies that examine the relationship between cortisol levels and preterm birth. Health care providers need to assess pregnant women's stress levels more closely and provide appropriate referrals and treatment to ensure that any actions that may possibly lower stress are being taken to reduce the likelihood of preterm birth. [source]

    The FDA Recommendations on Fish Intake During Pregnancy

    Emily C. Evans MSN
    The U.S. Food and Drug Administration recommends that pregnant women, women of childbearing age, and young children avoid eating shark, swordfish, mackerel, and tilefish. These fish often harbor high levels of methylmercury, a potent human neurotoxin. Methylmercury readily crosses the placenta and has the potential to significantly damage the fetal nervous system. Health care providers are responsible for educating women about the hazards of methylmercury and the Food and Drug Administration recommendation. [source]

    Clinical Practice Characteristics and Preconception Counseling Strategies of Health Care Providers Who Recommend Alcohol Abstinence During Pregnancy

    ALCOHOLISM, Issue 11 2004
    Suzanne C. Tough
    Objective: National initiatives on fetal alcohol syndrome in Canada and the United States aimed at prevention, identification, and treatment of individuals who are affected by alcohol exposure in utero recommend that women abstain from consuming alcohol during pregnancy. Health care providers are key educators regarding appropriate alcohol use. The objective of this study was to describe characteristics of physicians who recommend alcohol abstinence during pregnancy with regard to knowledge of fetal alcohol syndrome and preconception counseling strategies. Methods: A survey was mailed to Canadian physicians and midwives between 2001 and 2002. Participants consisted of a national random sample of 1090 Canadian obstetricians and gynecologists, midwives, and family physicians who were current members of provincial and national professional organizations. The main outcome measure was questionnaire responses to knowledge, prevention, and diagnosis of issues related to alcohol use during pregnancy. Results: Response rates ranged from 31.1% among family physicians to 63.5% among midwives. Overall, 91.2% of providers recommended abstinence from alcohol during pregnancy. These providers were significantly more likely to believe that there is sufficient information about alcohol use and that clients were interested in discussing alcohol (p < 0.05). They were also significantly more likely to discuss depression, personal alcohol use, partner's use of alcohol, and family history of alcohol misuse with women of childbearing age (p < 0.05). Once a patient became pregnant, fewer practice differences were noted, although those who recommended alcohol abstinence were significantly more likely to take clinical action when pregnant patients were consuming moderate amounts of alcohol (p < 0.05). Conclusions: It is encouraging that almost 90% of Canadian health care providers recommend abstinence from alcohol during pregnancy. However, differences in clinical practice exist between providers who recommend alcohol abstinence during pregnancy as compared with those who recommend a "glass in moderation." [source]

    Reiter's Syndrome (Reactive Arthritis) and Travelers' Diarrhea

    DTM&H, Johnnie A. Yates MD
    Reiter's syndrome [also called reactive arthritis (ReA)] is the triad of arthritis, urethritis, and conjunctivitis. Two cases of Reiter's syndrome triggered by travelers' diarrhea are presented. Health care providers should suspect ReA in travelers with joint symptoms and antecedent diarrheal disease. [source]

    The mind-body connection in elderly

    Oksoo Kim rn
    Depression is an illness affecting mind and body. Depression in people aged 65 years and older is a major public health problem. Because many older people are unaware that they need treatment for depression, as depression in the elderly is insidious. The consequences of undiagnosed depression can be fatal, as depression is a leading cause of suicide among elders. Late-life depression is particularly tricky in that the relationship between depression, disability and illness is very difficult to disentangle. Specific symptoms and signs of depression may impair some functions and not others. Medical disorders accompanying geriatric depression can cause disability, independent of the depressive syndrome or in synergy with it. There is growing evidence that treating depression in patients with a chronic physical condition may improve their medical condition, reduce the degree of pain, increase activity and lessen disability, enhance their quality of life and increase their ability to follow their treatment plan. Health care providers, elderly and their family should be aware of geriatric depression. [source]

    Compliance in Pain Rehabilitation: Patient and Provider Perspectives

    PAIN MEDICINE, Issue 1 2004
    Michael E. Robinson PhD
    ABSTRACT Objective. To identify potential predictors and correlates of compliance and to examine differences between patient and provider perspectives on compliance. Patients. One hundred eighty-four patients (84 men and 96 women) were recruited from a chronic pain treatment program for this telephone follow-up study. Results. Health care providers (HCPs) reported making more recommendations than patients reported hearing. Patients rated themselves as more compliant than did HCPs. Overall compliance rates at a >6-month follow-up were 89% from the patients' perspective and 70% from the HCPs' perspective. HCPs rated compliance specific to psychological care as more related to positive outcomes than did patients. Participants' pain and anxiety ratings at a >6-month follow-up and satisfaction with treatment were significantly associated with patients' compliance ratings. For HCP-rated compliance, only HCPs' perceived benefit and interference from compliance were associated. Conclusion. Results suggest important disparities between HCPs and patients on remembered recommendations, levels of compliance, and health-related importance of complying with recommendations. [source]

    Interest in services among prostate cancer patients receiving androgen deprivation therapy

    PSYCHO-ONCOLOGY, Issue 8 2004
    Pamela J. Shapiro
    Treatment side effects and decreased quality of life associated with androgen deprivation therapy (ADT) suggest the need for supportive services for prostate cancer (PC) patients receiving ADT. Nonetheless, uptake of services is low, suggesting that PC patients' preferences are not being addressed. We examined interest in supportive services and predictors of interest among 118 PC patients receiving ADT. Overall interest in services was associated with lower quality of life (p=0.01). The majority of participants expressed interest in informational services (70%), with a minority (22%) expressing interest in psychosocial services. Interest in psychosocial services was associated with younger age (p=0.02), and shorter duration of ADT (p<0.04), but was unrelated to psychological distress or social support. Although most men (68%) reported that they would prefer not to take medication for depression, 75% would do so if advised by their physician. Overall, results suggest that PC patients on ADT prefer individualized informational support. Substantial interest (61%) in Oncolink, an internet-based informational resource, suggests the Internet may provide an acceptable mode of service delivery. Health care providers should consider integrating increased informational support into routine care and, more generally, consider patient preferences in prioritizing and designing support services. Copyright 2003 John Wiley & Sons, Ltd. [source]

    Factors associated with health-related quality of life among low-compliant asthmatic adults in Korea,

    Ja Yun Choi
    Abstract This cross-sectional descriptive study was conducted to identify the factors associated with health-related quality of life (HRQoL) in low-compliant Korean adults with asthma. The sample consisted of 178 patients referred by a physician to the education clinic at a University hospital in Korea. Stepwise multiple regression analysis revealed that previous hospital admissions, recent asthma-related symptoms within the previous week, lower peak expiratory flow rate, and lower level of asthma knowledge were independently associated with lower HRQoL and accounted for 46% of the total variance. Health care providers should focus on these factors to increase perceptions of HRQoL among low-compliant patients. Interventional strategies need to be developed to emphasize the importance of compliance to the self-monitoring regimen and management protocols. 2008 Wiley Periodicals, Inc. Res Nurs Health 32:140,147, 2009 [source]

    Tobacco Screening Multicomponent Quality Improvement Network Program: Beyond Education

    Sharon Kimmel PhD
    Abstract Objectives:, Due to the addictive nature of the disease and interrelated societal influences on the behavior of tobacco use, repeated interventions are often required before people successfully stop using tobacco. Our objective was to implement a multicomponent clinical intervention initiative enabling health care providers to effectively screen for tobacco use. We also sought to describe changes in emergency medicine providers' documentation of cessation advice to tobacco users. Methods:, The intervention was conducted at three emergency departments (EDs) and four clinics at a community-based teaching hospital and health network. Health care providers with the opportunity to identify and counsel tobacco-using patients in ambulatory health care settings were the study population. The authors initiated a quality improvement initiative for tobacco screening that employed a multicomponent strategy to facilitate systemic changes that support 100% tobacco use identification, documentation, and counseling. Baseline, posteducation, and post,wrap-around documented screening rates were compared within each site across the intervention. Cumulative ED baseline, posteducation, and post,wrap-around rates of provider advice to tobacco users were compared across the intervention. Percentage of possible available gain was calculated in consideration of a 100% ceiling effect. Statistical analysis was performed using SPSS and MetStat. Descriptive statistics and Pearson's chi-square cell frequency were used to analyze and compare sites. Fisher's exact test was used to compare those tests with a chi-square cell frequency of five or less. The statistical tests used for pre-/postintervention percentage comparisons by site had power between 80% and 90%, detecting differences of 10% and 20% or more at a 0.05 level of significance. Results:, Significant increases in posteducation screening rates for all ED sites complemented significant increases in ED post,wrap-around intervention screening rates. Significant increases in ED provider documented cessation advice were also noted. Conclusions:, This initiative successfully changed tobacco screening behavior of health care providers at all sites. It was particularly successful in the ED, typically an environment less likely to be conducive to preventive health interventions. [source]

    Antibiotic Prescriptions Are Associated with Increased Patient Satisfaction With Emergency Department Visits for Acute Respiratory Tract Infections

    Cordelia R. Stearns
    Abstract Objectives:, Health care providers cite patient satisfaction as a common reason for prescribing antibiotics for viral acute upper respiratory infections (URIs), even though quality performance measures emphasize nonantibiotic treatment for these conditions. In a secondary analysis of a cluster-randomized trial to test a combined patient and physician educational intervention to reduce antibiotic prescribing for URIs, the authors examined whether satisfaction is greater among patients diagnosed with URIs who are prescribed antibiotics in emergency department (ED) settings. Methods:, This was a follow-up telephone survey of 959 patients who received care for acute respiratory infections at any of eight Veterans Administration (VA) hospital EDs or eight location-matched non-VA hospital EDs around the United States. Patients reported their satisfaction with the amount of time spent in the ED, the explanation of treatment, the provider treatment, and overall satisfaction on a five-point Likert scale. The primary measure of effect was the association between antibiotic prescription and visit satisfaction, adjusted for patient and visit characteristics. Results:, Antibiotic treatment was significantly associated with increased overall visit satisfaction in non-VA EDs (adjusted odds ratio [OR] = 1.97, 95% confidence interval [CI] = 1.23 to 3.17), but not VA EDs (adjusted OR = 1.13, 95% CI = 0.81 to 1.58). Patients managed in non-VA EDs who received antibiotics were also significantly more likely to be satisfied with the explanation of treatment and the manner in which they were treated by the provider. Conclusions:, Antibiotic prescriptions are associated with increased overall patient satisfaction in non-VA, but not VA, ED visits for URIs. Continued efforts to reduce unnecessary prescriptions in these settings must address ways to maintain patient satisfaction and still reduce antibiotic prescriptions. [source]

    Partner violence prevalence among women attending a Maori health provider clinic

    Jane Koziol-McLain
    Abstract Objective: To determine partner violence rates among women attending a general practice in Aotearoa, New Zealand. Methods: This descriptive study was conducted in a hauora (Maori health provider general practice clinic) in one South Auckland community. Non-acute, English-speaking women who entered the huaora during 30 randomly selected clinic sessions in a five-week period in 2003 were eligible to participate. Research assistants (RAs) verbally administered a structured, brief questionnaire that included a partner violence screen (past 12 months), assessment of high danger risk, and lifetime prevalence. Of 148 women approached, 109 participated. Participants generally self-identified as Maori (74%) or New Zealand European (18%) and ranged in age from 17 to 82 years (mean 38.8). Results: Twenty-three per cent (95% CI 15,31) of women screened positive for partner violence. Among the 25 women who screened positive, six (24%) had one or more high danger risk factors and 24 (96%) reported one or more children living in the household. Seventy-eight per cent (95% CI 70,86) of women reported a history of partner violence. Conclusions: In this sample of mostly Maori women, direct partner violence questioning in a general practice setting yielded a high disclosure rate. Three out of four women disclosed violence by a partner; nearly one out of four disclosed violence by a partner in the past year. Implications: Healthcare providers have the opportunity to identify and provide services to women and their children experiencing partner violence. Health care providers and the health care system also have a responsibility to join with the community in calling for non-tolerance of family violence. [source]


    BIOETHICS, Issue 7 2010
    ABSTRACT The goal of this paper is both modest and ambitious. The modest goal is to show that intercountry adoption should be considered by ethicists and healthcare providers. The more ambitious goal is to introduce the many ethical issues that intercountry adoption raises. Intercountry adoption is an alternative to medical, assisted reproduction option such as in vitro fertilization (IVF), intracytoplasmic sperm injection, third party egg and sperm donation and surrogacy. Health care providers working with assisted reproduction are in a unique position to introduce their clients to intercountry adoption; however, providers should only do so if intercountry adoption is ethically equal or superior to the alternatives. This paper first presents a brief history of intercountry adoption. The second section compares intercountry adoption with medical alternatives. The third section examines the unique ethical challenges that are not shared by other medical alternatives. The final section concludes that it is simplistic for a healthcare provider to promote intercountry adoption unconditionally; however, in situation where intercountry adoption is practiced conscientiously it poses no greater ethical concern than several medical alternatives. This conclusion is preliminary and is intended as a start for further discussion. [source]

    13 Knowledge Translation Shift

    Rawle Seupaul
    Health care providers have demonstrated difficulty in adopting the latest information into their clinical practice patterns. This gap in "Knowledge Translation" (KT) is currently under broad discussion within the medical community and was the focus of SAEM's Consensus Conference in 2007. In an effort to bridge this gap, we implemented a novel "KT shift" for our PGY-2 residents. PGY-2 emergency medicine (EM) residents are required to work a nine hour KT shift during their scheduled EM rotation at one of two large urban training emergency departments (EDs). This shift has reduced patient responsibilities to allow for the development of clinical queries that are answered by searching for the best evidence to be applied to patient care. This process is summarized on a "KT Shift Log" that records the PICO question, databases searched, and level of evidence found to answer clinical questions. KT shift log sheets and search strategies are reviewed by EM faculty with expertise in evidence-based medicine and KT principles. We believe that the implementation of a KT shift will improve residents' ability to obtain high quality evidence to answer real-time clinical questions. This may serve as an important measure in closing the knowledge to practice gap. [source]

    Surge Capacity for Health Care Systems: Early Detection, Methodologies, and Process

    Peter L. Estacio PhD
    Excessive demand on hospital services from large-scale emergencies is something that every emergency department health care provider and hospital administrator knows could happen at any time. Nowhere in this country have we recently faced a disaster of the magnitude of concern we now face involving agents of mass destruction or social disruption, especially those in the area of infectious diseases and radiological materials. The war on terrorism is not a conventional war, and terrorists may use any means of convenience to carry out their objectives in an unpredictable time line. Have we adequately prepared for the potentially excessive surge in demand for medical services that a large-scale event could bring to our medical care system? Are our emergency departments ready for such events? Surveillance systems, such as BioWatch, BioSense, the National Biosurveillance Integration System, and the countermeasure program BioShield, offer hope that we will be able to meet these new challenges. [source]

    Application of activity-based costing (ABC) for a Peruvian NGO healthcare provider

    Dr. Hugh Waters
    Abstract This article describes the application of activity-based costing (ABC) to calculate the unit costs of the services for a health care provider in Peru. While traditional costing allocates overhead and indirect costs in proportion to production volume or to direct costs, ABC assigns costs through activities within an organization. ABC uses personnel interviews to determine principal activities and the distribution of individual's time among these activities. Indirect costs are linked to services through time allocation and other tracing methods, and the result is a more accurate estimate of unit costs. The study concludes that applying ABC in a developing country setting is feasible, yielding results that are directly applicable to pricing and management. ABC determines costs for individual clinics, departments and services according to the activities that originate these costs, showing where an organization spends its money. With this information, it is possible to identify services that are generating extra revenue and those operating at a loss, and to calculate cross subsidies across services. ABC also highlights areas in the health care process where efficiency improvements are possible. Conclusions about the ultimate impact of the methodology are not drawn here, since the study was not repeated and changes in utilization patterns and the addition of new clinics affected applicability of the results. A potential constraint to implementing ABC is the availability and organization of cost information. Applying ABC efficiently requires information to be readily available, by cost category and department, since the greatest benefits of ABC come from frequent, systematic application of the methodology in order to monitor efficiency and provide feedback for management. The article concludes with a discussion of the potential applications of ABC in the health sector in developing countries. Copyright 2001 John Wiley & Sons, Ltd. [source]

    The influence of education on the interpretation of pharmaceutical pictograms for communicating medicine instructions

    Ros Dowse senior lecturer
    Objective To assess the influence of formal education on the interpretation of pharmaceutical pictograms. Method A total of 46 pictograms were used: 23 were extracted directly from the USP-DI, and 23 with corresponding meanings were designed in accordance with the local culture (local pictograms). One hundred and thirty Xhosa respondents, who ranged from having no formal education to tertiary level education, were interviewed with the aid of an interpreter. Demographic data were collected, a literacy test was conducted and respondents were tested for their interpretation of all 46 pictograms. Preference for either the USP-DI or the local pictogram was determined. Setting Respondents were interviewed in primary health care clinics, a variety of work settings or in their homes in Grahamstown, South Africa. Key findings Standard of education had a significant influence on the interpretation of 24 of the 46 pictograms. Generally, significant differences in interpretation were apparent between those with only primary school education and those who had completed at least some senior school education (P < 0.05). The group with tertiary education was significantly better than the other groups (P < 0.05). Only 15 of the 46 pictograms met the American National Standards Institute (ANSI) 85% correct criterion. Conclusion Interpretation was dependent on education and the development of visual literacy skills, but potential for misinterpretation in all educational groups was noted. These results suggest that pictograms should only be used as a communication aid in combination with text or verbal information from the health care provider. [source]

    Prostate cancer in London: is the triadic clinical encounter the standard?

    Amanda Euesden Hughes
    Abstract It has been reported that men with prostate cancer in London were less satisfied with the service they received than patients with other cancers. Studies from the USA have looked at the experience of the prostate cancer couple. It has been established that the cancer couple have information needs and that when a clinical encounter is triadic in nature, these needs are more likely to be met and information is more likely to be retained. The aim of this study was to examine the clinic attendance patterns of men in London with prostate cancer (n = 200). A comparison group of women in London with breast cancer was identified (n = 200). Direct observation of the groups was performed, accompanied/unaccompanied (triadic/dyadic) attendance was recorded and demographic data were extracted from the clinical notes. Forty-one percent (81) of the women experienced their clinical encounter as a triad compared with 24% (48) of the prostate group who experienced their clinical encounter as a dyad between themselves and their health care provider (p < 0.05). In the first year of diagnosis, men with prostate cancer were more likely to experience a triadic encounter, but this was more evenly distributed throughout the cancer journey for women with breast cancer. There did not appear to be a correlation with marriage and triadic encounters for either group. Men with prostate cancer in this tertiary referral centre in London are less likely to experience a triadic clinical encounter than women with breast cancer. Further work is needed to establish a relationship between unmet informational needs of the prostate cancer couple and the high level of dissatisfaction in the prostate cancer population in London, but the nature of the dyadic encounter may play a part in this. [source]

    Evaluation of the impact of restructuring wound management practices in a community care provider in Niagara, Canada

    Theresa Hurd
    Abstract The burden of chronic wounds is substantial, and this burden is set to increase as the population ages. The challenge for community health services is significant. Wound care is labour intensive, and demand for services is set to increase at a time when the availability of nursing resources is likely to be severely limited. In March 2005, the Niagara community health care provider implemented a radical reorganisation of wound management practices designed to ensure that available resources, particularly nurse time, were being used in the most efficient way. An evaluation of the impact of the reorganisation has shown improvements in clinical practice and better patient outcomes. The use of traditional wound care products reduced from 75% in 2005 to 20% in 2007 in line with best practice recommendations, and frequency of daily dressing changes reduced from 48% in 2005 to 15% in 2007. In a comparison of patients treated in 2005 and 2006, average time to healing was 515 weeks in 2005 compared with 209 weeks in 2006. Total treatment cost was lower in 2006 by $10 700 (75%) per patient. Overall, improvements in wound management practice led to a net saving of $38 million in the Niagara wound care budget. [source]

    Bisphosphonate-Associated Osteonecrosis of the Jaw: Report of a Task Force of the American Society for Bone and Mineral Research,,

    Sundeep Khosla (Chair)
    Abstract ONJ has been increasingly suspected to be a potential complication of bisphosphonate therapy in recent years. Thus, the ASBMR leadership appointed a multidisciplinary task force to address key questions related to case definition, epidemiology, risk factors, diagnostic imaging, clinical management, and future areas for research related to the disorder. This report summarizes the findings and recommendations of the task force. Introduction: The increasing recognition that use of bisphosphonates may be associated with osteonecrosis of the jaw (ONJ) led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address a number of key questions related to this disorder. Materials and Methods: A multidisciplinary expert group reviewed all pertinent published data on bisphosphonate-associated ONJ. Food and Drug Administration drug adverse event reports were also reviewed. Results and Conclusions: A case definition was developed so that subsequent studies could report on the same condition. The task force defined ONJ as the presence of exposed bone in the maxillofacial region that did not heal within 8 wk after identification by a health care provider. Based on review of both published and unpublished data, the risk of ONJ associated with oral bisphosphonate therapy for osteoporosis seems to be low, estimated between 1 in 10,000 and <1 in 100,000 patient-treatment years. However, the task force recognized that information on incidence of ONJ is rapidly evolving and that the true incidence may be higher. The risk of ONJ in patients with cancer treated with high doses of intravenous bisphosphonates is clearly higher, in the range of 1,10 per 100 patients (depending on duration of therapy). In the future, improved diagnostic imaging modalities, such as optical coherence tomography or MRI combined with contrast agents and the manipulation of image planes, may identify patients at preclinical or early stages of the disease. Management is largely supportive. A research agenda aimed at filling the considerable gaps in knowledge regarding this disorder was also outlined. [source]

    The Danish version of the questionnaire on pain communication: preliminary validation in cancer patients

    Background: The modified version of the patients' Perceived Involvement in Care Scale (M-PICS) is a tool designed to assess cancer patients' perceptions of patient,health care provider pain communication process. The objective of this study was to examine the psychometric properties of the shortened Danish version of the M-PICS (SDM-PICS). Methods: The validated English version of the M-PICS was translated into Danish following the repeated back-translation procedure. Cancer patients were recruited for the study from specialized pain management facilities. Results: Thirty-three patients responded to the SDM-PICS, Danish Barriers Questionnaire II, Hospital Anxiety and Depression Scale, and Brief Pain Inventory Pain Severity Scale. A factor analysis of the SDM-PICS resulted in two factors: Factor one, patient information, consisted of four items assessing the extent to which the patient shared information with his/her health care provider, and Factor two, health care provider information, consisted of four items measuring the degree to which a health care provider was perceived as the one who shares information. Two separate items addressed the perceived level of information exchange between the patient and the health care provider. The SDM-PICS total had an internal consistency of 0.88. The SDM-PICS scores were positively related to pain relief and inversely related to the measures of cognitive pain management barriers, anxiety, and reported pain levels. Conclusion: The SDM-PICS seems to be a reliable and valid measure of perceived patient,health care provider communication in the context of cancer pain. [source]

    Modifying Women's Risk for Cardiovascular Disease

    Kathleen M. McCauley
    Objective:, To present current recommendations for cardiovascular disease risk reduction in women. Data Sources:, Medline databases were searched from 1990 to 2006 using keywords women and cardiovascular risk, hypertension, cholesterol, and hormone replacement therapy, as well as Web sites from scientific associations such as the American Heart Association, American College of Cardiology, Agency for Health Research and Quality, and the Centers for Disease Control for relevant scientific statements and guidelines. Study Selection:, Randomized controlled trials, particularly those that have influenced current practice recommendations, scientific statements, and clinical practice guidelines were selected. Data Extraction and Synthesis:, Factors contributing to women's particular risk and current practice recommendations. Conclusions:, Current research has clarified the importance of regular exercise (at least 30 minutes/day most days of the week); abstinence from smoking; a diet focused on whole grains, fruits, vegetables, and low-fat protein sources; and maintenance of normal weight. This lifestyle combined with a partnership with a health care provider to maintain a normal blood pressure (115/75 mm Hg) and optimal lipoproteins through pharmacotherapy when indicated can prevent 82% of cardiovascular disease events in women. JOGNN, 36, 116-124; 2007. DOI: 10.1111/J.1552-6909.2007.00125.x [source]

    Reproductive Options for Individuals at Risk for Transmission of a Genetic Disorder

    Shirley L. Jones RNC
    The basis of human growth and development has long been considered to be one of the great mysteries of science and mankind. The portal to understanding this mystery was achieved by the Human Genome Project and Celera Genomics in 2001, with their joint announcement of the sequencing of 99% of the human genome map. Current reproductive options, however, remain restricted to the prevention of transmitting an at-risk gene or genes, but do not include treatment or cure. It is anticipated that this state of "halfway technology" will continue for years to come. As such, the scientific and ethical issues associated with each of these reproductive options will continue to affect the decision making of at-risk individuals. As the omnipresent health care provider, nurses have a duty to know and disseminate accurate and current information about reproductive options for individuals at risk for transmission of a genetic disorder. Nurses also have a duty to advocate for and ensure the privacy and confidentiality of genetic information. [source]