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Selected AbstractsInterobserver agreement in neonatal seizure identificationEPILEPSIA, Issue 9 2009Aileen Malone Summary Objectives:, Accurate diagnosis of neonatal seizures is critically important and is often made clinically, without EEG (electroencephalography) monitoring. This observational study aimed to determine the accuracy and interobserver reliability of healthcare professionals in distinguishing clinically manifested seizures from other neonatal movements, when presented with clinical histories and digital video recordings only. Methods:, Twenty digital video recordings of paroxysmal movements in term and preterm infants were selected from a video-EEG database. The movements were categorized as seizure and nonseizure using EEG. Health care professionals (n = 137) from eight neonatal intensive care units (NICUs) were shown the video recordings with additional relevant clinical data, excluding EEG findings. The observers were asked to indicate which movements they considered to be seizure or nonseizure. A multirater Kappa statistic was used to assess agreement between observers and with the true diagnosis. Results:, Twenty video clips (11 seizure, 9 nonseizure) were evaluated by 91 doctors and 46 other professionals. The average number of correctly identified events was 10/20. Clonic seizures were correctly identified most frequently (range 36.5,95.6% of observers). Subtle seizures were poorly identified (range 20.4,49.6% of observers). The interobserver agreement (Kappa) for doctors and other health care professionals was poor at 0.21 and 0.29, respectively. Agreement with the correct diagnosis was also poor at 0.09 for doctors and ,0.02 for other healthcare professionals. Discussion:, It is often impossible to accurately differentiate between seizure-related and nonseizure movements in infants using clinical evaluation alone. In addition, doctors do not have a higher capacity for discriminating between neonatal paroxysmal events than other health care professionals. Until reliable continuous neurologic monitoring of newborn babies is available, it is likely that some babies with seizures will remain undetected and others with nonseizure movements will continue to be treated with potentially harmful anticonvulsants. [source] The Diabetes Continuity of Care Scale: the development and initial evaluation of a questionnaire that measures continuity of care from the patient perspective,HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2004Lisa R. Dolovich PharmD MSc Abstract The purpose of the present study was to develop and pilot test a questionnaire to assess continuity of care from the perspective of patients with diabetes. Seven patient and two healthcare-provider focus groups were conducted. These focus groups generated 777 potential items. This number was reduced to 56 items after item reduction, face validity testing and readability analysis, and to 47 items after a preliminary factor analysis. Readability was assessed as requiring 7,8 years of schooling. Sixty adult patients with diabetes completed the draft Diabetes Continuity of Care Scale (DCCS) at a single point in time to assess the validity of the instrument. Patients completed the draft DCCS again 2 weeks later to assess test,retest reliability. A provisional factor analysis and grouping according to clinical sense yielded five domains: access and getting care, care by doctor, care by other healthcare professionals, communication between healthcare professionals, and self-care. The internal consistency (Cronbach's alpha) for the whole scale was 0.89. The test,retest reliability was r = 0.73. The DCCS total score was moderately correlated with some of the measures used to establish construct validity. The DCCS could differentiate between patients who did and did not achieve specific process and clinical indicators of good diabetes care (e.g. Hba1c tested within 6 months). The development of the DCCS was centred on the patient's perspective and revealed that the patient perspective regarding continuity of care extends beyond the concept of seeing one doctor. Initial testing of this instrument demonstrates that it has promise as a reliable and valid measure in this area. [source] Management of systemic lupus erythematosus in the coming decade: potentials and challengesINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 4 2006Hiok Hee CHNG Abstract The management of systemic lupus erythematosus (SLE) has improved in the past 50 years, but there is still a 3,5-fold increased mortality compared to the general population, with major organ failure due to active disease, infection and cardiovascular disease as the major challenges for the coming decade. Research advances at cellular, molecular and genetic levels enhance our understanding of the immunopathogenic mechanisms of SLE, leading to the development of drugs targeting specific sites of immune dysregulation , with therapies directed at cytokines, B- and T-cells, and their interactions showing promise. Advances are expected in the field of haematopoietic stem cell transplant (HSCT) as a therapeutic option for a subset of patients. Furthermore, some non-traditional immunomodulating therapies like statins, leflunomide and tacrolimus may prove useful as alternative or adjunct treatment in some patients. A better understanding of how current immunosuppressants act at the cellular and molecular level should guide the re-evaluation of the indications, doses and duration of therapy in clinical trials using these agents, many of which have not been subjected to proper double-blinded placebo-controlled studies. Research on triggers of SLE onset and flare of activity continues to yield information helpful in prevention. The evidence on the impact of psychosocial and economic factors on the outcome of SLE is overwhelming and the rheumatology community should enlist the assistance of other healthcare professionals, patient advocates and local health authorities to address these issues pertinent to good patient care and outcome. [source] Parents' Concerns About Issues Related to Their Children's Genetic ConditionsJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2008Agatha M. Gallo PURPOSE.,The purpose of this analysis was to examine parents' (N = 142) concerns about issues (i.e., privacy of information, insurance, healthcare costs, employment, school) related to their children's genetic conditions. DESIGN AND METHODS.,Using a series of matrices, thematic analysis was conducted focusing on parents' concerns. RESULTS.,Parents were less concerned with privacy and more concerned with insurance, healthcare costs, employment, and school issues. PRACTICE IMPLICATIONS.,Nurses and other healthcare professionals need to give parents the opportunity to discuss their concerns and to assist parents with strategies and resources to meet the needs of their children and families. [source] The nature of advocacy vs. paternalism in nursing: clarifying the ,thin line'JOURNAL OF ADVANCED NURSING, Issue 8 2009Meg Zomorodi Abstract Title.,The nature of advocacy vs. paternalism in nursing: clarifying the ,thin line'. Aim., This paper is an exploration of the concepts of advocacy and paternalism in nursing and discusses the thin line between the two. Background., Nurses are involved in care more than any other healthcare professionals and they play a central role in advocating for patients and families. It is difficult to obtain a clear definition of advocacy, yet the concepts of advocacy and paternalism must be compared, contrasted, and discussed extensively. In many situations, only a thin line distinguishes advocacy from paternalism. Data sources., A literature search was conducted using PubMed and CINAHL databases (2000,2008) as well as a library catalogue for texts. Discussion., Four case stories were described in order to discuss the ,thin line' between advocacy and paternalism and develop communication strategies to eliminate ambiguity. Weighing the ethical principles of beneficence and autonomy helps to clarify advocacy and paternalism and provides an avenue for discussion among nurses practicing in a variety of settings. Implications for nursing., Advocacy and paternalism should be discussed at interdisciplinary rounds, and taken into consideration when making patient care decisions. It is difficult to clarify advocacy vs. paternalism, but strategies such as knowing the patient, clarifying information, and educating all involved are initial steps in distinguishing advocacy from paternalism. Conclusion., Truly ,knowing' patients, their life experiences, values, beliefs and wishes can help clarify the ,thin line' and gain a grasp of these difficult to distinguish theoretical concepts. [source] End-of-Life Decision-Making, Decisional Conflict, and Enhanced Information: Race EffectsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2008Rebecca S. Allen PhD OBJECTIVES: To examine the effect of enhanced information regarding the risks, benefits, and life-sustaining treatment alternatives on hypothetical medical decisions and decisional conflict in older, community-dwelling Caucasian and African-American adults. DESIGN: Two-group (enhanced information; no information) between-subjects design. SETTING: Community-based dwellings, two assisted living facilities, and one senior citizen center. PARTICIPANTS: Seventy-eight adults (aged 74.5±7.18) with a mean Telephone Interview for Cognitive Status,Modified (TICS-m) score of 31.5±4.7 were recruited through personal contacts and informational talks held at the recruitment sites. MEASUREMENTS: Measures included the Life Support Preferences/Predictions Questionnaire,modified (LSPQ-m); the Decisional Conflict Scale; and enhanced information, including detailed descriptions of life-sustaining treatment options for each LSPQ-m illness scenario, risks of the treatment, benefits of the treatment, and alternatives for each treatment (called medical information stimuli). RESULTS: Enhanced information (e.g., medical information stimuli) reduced decisional conflict (P=.049, d=0.47) for hypothetical life-sustaining treatment decisions. A mixed analysis of variance with group and race as between-subjects variables and illness and treatment as within-subjects variables revealed significant main effects of race, illness, and treatment, as well as a significant race-by-illness-by-group interaction (Wilk's lambda=0.923, F(2, 73)=3.05, P=.05, partial ,2=0.08). Enhanced information produced different patterns of desire for life-sustaining treatments in African Americans and Caucasians. CONCLUSION: Physicians and other healthcare professionals can reduce decisional conflict in patients by providing enhanced information regarding treatment risks, benefits, and alternatives. Such decision aids may provide new information or knowledge and thus reduce desire for treatment in African Americans. [source] Caring for Older Americans: The Future of Geriatric MedicineJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue S6 2005American Geriatrics Society Core Writing Group of the Task Force on the Future of Geriatric Medicine In response to the needs and demands of an aging population, geriatric medicine has grown rapidly during the past 3 decades. The discipline has defined its core values as well as the knowledge base and clinical skills needed to improve the health, functioning, and well-being of older persons and to provide appropriate palliative care. Geriatric medicine has developed new models of care, advanced the treatment of common geriatric conditions, and advocated for the health and health care of older persons. Nevertheless, at the beginning of the 21st century, the health care of older persons is at a crossroads. Despite the substantial progress that geriatric medicine has made, much more remains to be done to meet the healthcare needs of our aging population. The clinical, educational, and research approaches of the 20th century are unable to keep pace and require major revisions. Maintaining the status quo will mean falling further and further behind. The healthcare delivery and financing systems need fundamental redesign to improve quality and eliminate waste. The American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has identified five goals aimed at optimizing the health of older persons: ,,To ensure that every older person receives high-quality, patient-centered health care ,,To expand the geriatrics knowledge base ,,To increase the number of healthcare professionals who employ the principles of geriatric medicine in caring for older persons ,,To recruit physicians and other healthcare professionals into careers in geriatric medicine ,,To unite professional and lay groups in the effort to influence public policy to continually improve the health and health care of seniors Geriatric medicine cannot accomplish these goals alone. Accordingly, the Task Force has articulated a set of recommendations primarily aimed at the government, organizations, agencies, foundations, and other partners whose collaboration will be essential in accomplishing these goals. The vision described in this document and the accompanying recommendations are only the broad outline of an agenda for the future. Geriatric medicine, through its professional organizations and its partners, will need to mobilize resources to identify and implement the specific steps that will make the vision a reality. Doing so will require broad participation, consensus building, creativity, and perseverance. The consequences of inaction will be profound. The combination of a burgeoning number of older persons and an inadequately prepared, poorly organized physician workforce is a recipe for expensive, fragmented health care that does not meet the needs of our older population. By virtue of their unique skills and advocacy for the health of older persons, geriatricians can be key leaders of change to achieve the goals of geriatric medicine and optimize the health of our aging population. Nevertheless, the goals of geriatric medicine will be accomplished only if geriatricians and their partners work in a system that is designed to provide high-quality, efficient care and recognizes the value of geriatrics. [source] Review: the legal duty of care for nurses and other health professionalsJOURNAL OF CLINICAL NURSING, Issue 22 2009Andy Young Aims and objectives., To explore the nature and extent of the legal duty of care in relation to contemporary healthcare practice. Background., The paper seeks to re-frame and update the legal duty of care for clinical nursing practice in the 21st century, taking into account collaborative and partnership working in healthcare practice. Design., Doctrinal legal ,approach'. Method., ,Black letter' legal research methodology used for data collection and analysis. Literature search using Westlaw and LexisNexis database(s) to identify recent common law decisions. Results., There has been a perceptible doctrinal shift away from paternalism and toward patient empowerment and autonomy in the last decade. This has implications for nurses and other healthcare professionals in terms of consenting patients and acting reasonably to ensure quality patient care. Conclusions., A number of experienced nurses are currently assuming extended roles and some are completing medical tasks, traditionally allocated to doctors. These specialist practitioners must remember that additional responsibility invariably means increased professional risk and accountability. Therefore, it is essential that those engaging in advanced nursing practice, fully understand the nature and reach of their professional duty of care and the significance of statutory and common law developments. Relevance to clinical practice., Nurses and other healthcare professionals must update their clinical skills and practice within a legal framework and to certain standards. The cases cited and discussed are relevant to all branches of nursing and indeed to all health professions. [source] Nurses' perception of disaster: implications for disaster nursing curriculumJOURNAL OF CLINICAL NURSING, Issue 22 2009Fung WM Olivia Aims and objectives., The aims of the study were to identify nurses' perception of disaster, whether they considered some of the events that have occurred in Hong Kong to be disasters and the types of disastrous events that they considered likely in Hong Kong. Background., The frequent occurrence of disasters has caused concern internationally. When disaster strikes, the demands on nursing staff are much higher than those on other healthcare professionals. There is little understanding of the concept of disaster among nurses in Hong Kong. Design., This was a descriptive study. A questionnaire was used to explore nurses' perception of disaster. Method., The questionnaire was distributed to all registered nurses studying in a master's degree programme in a university in Hong Kong. Findings., Only 123 out of the 164 respondents (75%) gave a description of disaster in the open-ended question. Sixty-one per cent of them described unfortunate events with large numbers of victims as disasters. The ,Lan Kwai Fong tragedy , stampede caused by over-crowdedness' (90·9%) and the severe acute respiratory syndrome outbreak (89·6%) were commonly referred to as disasters in Hong Kong. Fires in tall buildings (61·6%), infectious disease outbreaks (61%) and stampedes caused by overcrowding (48·8%) were rated as the events most likely to happen in Hong Kong. Conclusion., Understanding how nurses perceive disaster and the likelihood of disastrous events is the initial step for disaster planning and the development of a disaster nursing curriculum in Hong Kong. Relevance to clinical practice., All nurses around the world should be equipped with knowledge and skills for disaster care. This study provides information and implications for related research and the development of a disaster nursing curriculum to meet the global demand for disaster preparedness. [source] Consumer perspectives in adolescent ward designJOURNAL OF CLINICAL NURSING, Issue 5 2005Alison Hutton MN Aims., The aim of the study was to gain an understanding of the environment and facilities that adolescents require in a purpose-built adolescent ward. Background., People who are hospitalized have limited control over their care and environment. The experience of hospitalization is also considered a highly stressful event. It is essential that patients have an opportunity to participate in the planning and design of ward environments in order to reduce their stress and better accommodate their treatment needs. Methods., An interpretative qualitative design was used. Seven chronically ill adolescents were asked to design their own ward in order to obtain consumer input about what the perceived necessary facilities for adolescent wards. Findings., The adolescents provided clear information about the facilities that should be incorporated into an adolescent ward to maintain their privacy and independence. Further research needs to be conducted seeking consumer input, especially if it can enhance the stay of adolescent patients while they are hospitalized. Relevance to clinical practice., Adolescent voice is more often than not represented by nurses, or other healthcare professionals in the patients' best interest. This practice acts on the assumption that the adult knows best and/or that adolescents are unable to articulate their own needs. Adolescent consumers contribute worthwhile recommendations to how a ward is run providing insight about their needs in the ward environment. [source] Pharmacist prescribing in the UK , a literature review of current practice and researchJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2007A. P. Tonna MRPharmS MSc Abstract Objective:, To review the research literature to date on pharmacist prescribing in the United Kingdom (UK) and to explore the main areas of care and practice settings including any benefits and limitations. Findings:, There are two models of pharmacist prescribing in the UK: pharma\cist supplementary prescribing (SP) introduced in 2003, involving a voluntary partnership between the responsible independent prescriber (a physician or a dentist), the supplementary prescriber and the patient, to implement an agreed patient-specific clinical management plan; and pharmacist independent prescribing (IP) introduced in 2006, responsible for the assessment and consequent management, including prescribing of both undiagnosed and diagnosed conditions. There have been narrative reports of pharmacist SP in different health care settings including primary care, community pharmacies, secondary care and at the primary/secondary care interface; published research within these areas of care is conflicting as to which setting is more suitable for pharmacist prescribing. Initial research reports that almost 50% of pharmacist supplementary prescribers self-reported prescribing with both benefits of and barriers to implementing SP. Research involving other healthcare professionals has indicated that encroachment of traditional roles is likely to occur because of the advent of pharmacist prescribing. A small-scale study has concluded that patients are likely to accept pharmacist prescribing favourably, with another study showing pharmacist prescribing leading to improved adherence to guidelines. There is no published research yet available about practices involving pharmacist IP. Discussion:, Most of the literature focuses on pharmacists' perceptions of SP, with little information referring to other stakeholders, including patients. There is also limited published research focusing on clinical and economic outcomes of pharmacist SP. Conclusion:, This is a rapidly changing aspect of pharmacy practice in the UK, particularly with the more recent introduction of pharmacist IP. It is likely that this area of research will expand rapidly over the coming years. [source] Breast-Cancer-Related Lymphedema: Information, Symptoms, and Risk-Reduction BehaviorsJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2008Mei R. Fu Purpose: To explore the effect of providing lymphedema information on breast cancer survivors' symptoms and practice of risk-reduction behaviors. Design: A cross-sectional design was used to obtain data from 136 breast-cancer survivors in New York City from August 2006 to May 2007. Descriptive statistics, t tests, chi-square tests, and correlations were calculated. Methods: Data were collected using a demographic and medical information interview tool, two questions regarding status of receiving lymphedema information, the Lymphedema and Breast Cancer Questionnaire, and Lymphedema Risk-Reduction Behavior Checklist. Findings: Fifty-seven percent of the participants reported that they received lymphedema information. On average, participants had three lymphedema-related symptoms. Only 18% of participants were free of symptoms. Participants who received information reported significantly fewer symptoms (t=3.03; p<0.00) and practicing more risk-reduction behaviors (t=2.42; p=0.01). Conclusions: Providing lymphedema information has an effect on symptom reduction and more risk-reduction behaviors being practiced among breast cancer survivors. Clinical Relevance: In clinical practice, nurses and other healthcare professionals could consider taking the initiative to provide adequate and accurate information and engage breast-cancer survivors in supportive dialogues concerning lymphedema risk-reduction. [source] Narrative Research: A Viable Methodology for Clinical NursingNURSING FORUM, Issue 1 2004Janine A. Overcash PhD TOPIC Narrative research provides a reasonable methodology for gathering rich, multidimensional data in the clinical setting. PURPOSE To familiarize nurses with the concept of narrative research, review pertinent narrative research literature, and identify some ways this methodology can be integrated into clinical nursing. SOURCES A review of published literature from psychology, sociology, anthropology, and nursing, with citations from women with breast cancer. CONCLUSIONS Narrative research can make a valid contribution to nursing science in language familiar to nurses and other healthcare professionals. [source] Tracheal intubation and alternative airway management devices used by healthcare professionals with different level of pre-existing skills: a manikin study,ANAESTHESIA, Issue 5 2009B. M. Wahlen Summary The classic Laryngeal Mask Airway (cLMAÔ), ProSeal Laryngeal Mask Airway (PLMAÔ), Intubating Laryngeal Mask AirwayÔ (ILMAÔ), Combitube (CTÔ), Laryngeal Tube (LTÔ) and tracheal intubation (TI) were compared in a manikin study. Nurses, anaesthetic nurses, paramedics, physicians and anaesthetists inserted the devices three times in a randomised sequence. Time taken for successful insertion, success rates and ease of insertion were evaluated. Anaesthetists performed tracheal intubation significantly faster than other healthcare professionals (p < 0.05). Insertion times for the cLMA, PLMA, LT and CT were not significantly different between the groups. Insertion of the CT, ILMA and TI was associated with a significant learning effect in all groups. This was not observed with the cLMA, PLMA or LT. All non-anaesthetists were able to insert the cLMA, PLMA and LT within two attempts with a > 90% success rate on the first attempt. The ILMA and TI were the only devices where more than one subject experienced some difficulty in insertion. The cLMA, PLMA and LT should be evaluated for use in situations where only limited airway training is possible. [source] Parents' use and views of the national standard Personal Child Health Record: a survey in two primary care trustsCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 6 2007S. Walton Abstract Background The Personal Child Health Record (PCHR) is a booklet given to parents in the UK, following the birth of a child, to be used as the main record of their growth, development and uptake of preventative health services. The national standard PCHR has been available since April 2004. The aim of this survey was to explore parental views of the ,new' PCHR, their experiences in receiving it, and its subsequent use, focusing on specific issues of current debate among health professionals. Methods A parental questionnaire (n = 89) was administered in July 2004, in 10 child health clinics located in two primary care trusts; one in central London and the other in Buckinghamshire. Results Nearly all parents (98%) reported that they used the PCHR as a record of their child's health and development and 92% reported that they ,always' took it with them when seeing healthcare staff about their child. Some parents (22%) indicated that they had not been given a satisfactory explanation as to how to use the PCHR, at the time it was issued to them. Parents reported that health visitors were more likely than other health professionals to use the PCHR both to obtain information about their child and to record information. The majority of respondents (78%) were happy for the level of maternal education to be documented in their child's PCHR. Conclusions Parents used, appreciated and liked the design of the national standard PCHR. Health visitors and primary care staff used the PCHR more than secondary care staff. The potential benefits of the PCHR will only be maximized if other healthcare professionals respond by using it. [source] | ||||||||||