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Karera A, Musili T, Kalondo L. Radiographers' insights on the impact of their potential role in image interpretation within a low resource setting. Radiography (Lond) 2024; 30:1099-1105. [PMID: 38776819 DOI: 10.1016/j.radi.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION The global shortage of radiologists has led to a growing concern in medical imaging, prompting the exploration of strategies, such as including radiographers in image interpretation, to mitigate this challenge. However, in low-resource settings, progress in adopting similar approaches has been limited. This study aimed to explore radiographers' perceptions regarding the impact of their potential role in image interpretation within a low-resource setting. METHODS The study used a qualitative descriptive design and was conducted at two public referral hospitals. Radiographers with at least one year of experience were purposively sampled and interviewed using a semi-structured interview guide after consenting. Data saturation determined the sample size, and content analysis was applied for data analysis. RESULTS Two themes emerged from fourteen interviews conducted with two male and twelve female radiographers. Theme one revealed the potential for enhanced healthcare delivery through improved diagnostic support, bridging radiologist shortages, career development and fulfilment as positive outcomes of role extension. Theme two revealed possible implementation hurdles including radiographer resistance and reluctance, limited training, lack of professional trust, and legal and ethical challenges. CONCLUSION Radiographers perceived their potential participation positively, envisioning enhanced healthcare delivery, however, possible challenges like resistance and reluctance of radiographers, limited training, and legal/ethical issues pose hurdles. Addressing these challenges through tailored interventions, including formal education could facilitate successful implementation. Further studies are recommended to explore radiographers' competencies, providing empirical evidence for sustaining and expanding this role extension. IMPLICATION FOR PRACTICE The study further supports the integration of radiographers into image interpretation with the potential to enhance healthcare delivery, however, implementation challenges in low-resource settings require careful consideration.
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Affiliation(s)
- A Karera
- Department of Radiography, School of Allied Health Sciences, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P.O Box 13301 Windhoek, Namibia.
| | - T Musili
- Department of Radiography, School of Allied Health Sciences, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P.O Box 13301 Windhoek, Namibia.
| | - L Kalondo
- Department of Radiography, School of Allied Health Sciences, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P.O Box 13301 Windhoek, Namibia.
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Clark JF. Medicine, emotience, and reason. Philos Ethics Humanit Med 2024; 19:5. [PMID: 38594714 PMCID: PMC11005265 DOI: 10.1186/s13010-024-00154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
Medicine is faced with a number of intractable modern challenges that can be understood in terms of hyper-intellectualization; a compassion crisis, burnout, dehumanization, and lost meaning. These challenges have roots in medical philosophy and indeed general Western philosophy by way of the historic exclusion of human emotion from human reason. The resolution of these medical challenges first requires a novel philosophic schema of human knowledge and reason that incorporates the balanced interaction of human intellect and human emotion. This schema of necessity requires a novel extension of dual-process theory into epistemology in terms of both intellect and emotion each generating a distinct natural kind of knowledge independent of the other as well as how these two forms of mental process together construct human reason. Such a novel philosophic schema is here proposed. This scheme is then applied to the practice of medicine with examples of practical applications with the goal of reformulating medical practice in a more knowledgable, balanced, and healthy way. This schema's expanded epistemology becomes the philosophic foundation for more fully incorporating the humanities in medicine.
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Affiliation(s)
- John F Clark
- UCSF, Natividad Medical Center Family Medicine Residency Program, 1441 Constitution Blvd., Salinas, CA, 93906, USA.
- UCSF Medical School, 533 Parnassus Ave., San Francisco, CA, 94143, USA.
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Goodwin RL, Black AC, Nathaniel TI. Integrating basic, clinical, and health system science in a medical neuroscience course of an integrated pre-clerkship curriculum. ANATOMICAL SCIENCES EDUCATION 2024; 17:263-273. [PMID: 37772635 DOI: 10.1002/ase.2343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/03/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
Basic science, clinical science, and health system science (HSS) have become three pillars of integration upon which modern, post-Flexner, medical education is now based. Because of this new approach to curricular integration in a clinical presentation curruculum, medical training is now placed in the context of healthcare delivery. This study described the design, implementation, and assessment of an integrated teaching strategy, including the effect on students' performance in a medical neuroscience course's summative and formative examinations of an integrated clinical presentation curriculum. The integrated teaching of basic science content, clinical case discussion, and HSS was performed in the first year of an allopathic integrated pre-clerkship curriculum. The two cohorts were from two different years, spring 2018 and 2019. The acceptance of the integrated teaching strategy by medical students was above 80% in all categories that were assessed, including enhancing the integrated experience in learning basic and clinical science materials in the context of HSS; understanding of the learning lessons; facilitation of self-directed learning; provision of a better learning environment; and a holistic understanding of materials including the relevance of HSS issues in the discussion of neurological cases in the medical career of the students. More than 90% of the students scored ≥70% in summative questions mapped to the four learning objectives of the integrated teaching session. The objectives are the correlation of structure to specific functions (94.0 ± 0.21), clinical anatomical features of the nervous system (95.0 ± 0.27), cross-sectional features of the nervous system (96.0 ± 0.31), and the effect of lesions on the structure and functional pathways of the nervous system (97.0 ± 0.34). This result was significantly higher when compared to students' performance in the non-integrated teaching cohort (p < 0.05). Formative assessments (F(7,159) = 92.52, p < 0.001) were significantly different between the two groups. When medical students were evaluated using the same questions for formative assessment, they performed better in the integrated teaching cohort (*p < 0.05) compared to the non-integrated teaching cohort (**p < 0.05).
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Affiliation(s)
- Richard L Goodwin
- Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, South Carolina, USA
| | - Asa C Black
- Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, South Carolina, USA
| | - Thomas I Nathaniel
- Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, South Carolina, USA
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Morris S, Geraghty S, Sundin D. Consensus-based recommendations for the care of women with a breech presenting fetus. Midwifery 2024; 130:103916. [PMID: 38241800 DOI: 10.1016/j.midw.2024.103916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 10/31/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To establish consensus related to aspects of breech presentation and care. DESIGN A multinational, three round e-Delphi study. PARTICIPANTS A panel of 15 midwives, four obstetricians and an academic with knowledge and/or experience of caring for women with a breech presenting fetus. METHODS An initial survey of 45 open-ended questions. Answers were coded and amalgamated to form 448 statements in the second round and three additional statements in the third round. Panellists were asked to provide their level of agreement for each statement using a 5-point Likert scale. Consensus was deemed met if 70% of panellists responded with strongly agree to somewhat agree, or strongly disagree to somewhat disagree after the second round. FINDINGS Results led to the development of a consensus-based care pathway for women with a breech presenting fetus and a skills development framework for clinicians. KEY CONCLUSIONS A cultural shift is beginning to occur through the provision of physiological breech workshops offered by various organisations and may result in greater access to skilled and experienced clinicians for women desiring a vaginal breech birth, ultimately improving the safety of breech birth. IMPLICATIONS FOR PRACTICES The care pathway and skills development framework can be used by services wishing to make changes to their current practices related to breech presentation and increase the level of skill in their workforce.
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Affiliation(s)
- Sara Morris
- Lecturer at Edith Cowan University, Clinical Nurse Midwife at King Edward Memorial Hospital, Western Australia.
| | - Sadie Geraghty
- Head of Midwifery at Notre Dame University, Western Australia
| | - Deborah Sundin
- Senior Lecturer at Edith Cowan University, Western Australia
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Ekeleme N, Yusuf A, Kastner M, Waite K, Montesanti S, Atherton H, Salvalaggio G, Langford L, Sediqzadah S, Ziegler C, Do Amaral T, Melamed OC, Selby P, Kelly M, Anderson E, O'Neill B. Guidelines and recommendations about virtual mental health services from high-income countries: a rapid review. BMJ Open 2024; 14:e079244. [PMID: 38388504 PMCID: PMC10884256 DOI: 10.1136/bmjopen-2023-079244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES This study reviewed existing recommendations for virtual mental healthcare services through the quadruple aim framework to create a set of recommendations on virtual healthcare delivery to guide the development of Canadian policies on virtual mental health services. DESIGN We conducted a systematic rapid review with qualitative content analysis of data from included manuscripts. The quadruple aim framework, consisting of improving patient experience and provider satisfaction, reducing costs and enhancing population health, was used to analyse and organise findings. METHODS Searches were conducted using seven databases from 1 January 2010 to 22 July 2022. We used qualitative content analysis to generate themes. RESULTS The search yielded 40 articles. Most articles (85%) discussed enhancing patient experiences, 55% addressed provider experiences and population health, and 25% focused on cost reduction. Identified themes included: screen patients for appropriateness of virtual care; obtain emergency contact details; communicate transparently with patients; improve marginalised patients' access to care; support health equity for all patients; determine the cost-effectiveness of virtual care; inform patients of insurance coverage for virtual care services; increase provider training for virtual care and set professional boundaries between providers and patients. CONCLUSIONS This rapid review identified important considerations that can be used to advance virtual care policy to support people living with mental health conditions in a high-income country.
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Affiliation(s)
- Ngozichukwuka Ekeleme
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Abban Yusuf
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Monika Kastner
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Karen Waite
- Population Health and Value-based Health Systems, Ontario Health, Toronto, Ontario, Canada
| | | | | | | | - Lucie Langford
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Saadia Sediqzadah
- Department of Psychiatry, Unity Health Toronto, Toronto, Ontario, Canada
| | - Carolyn Ziegler
- Health Sciences Library, Unity Health Toronto, Toronto, Ontario, Canada
| | - Tamara Do Amaral
- Population Health and Value-based Health Systems, Ontario Health, Toronto, Ontario, Canada
| | - Osnat C Melamed
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Selby
- Addiction Programs, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Martina Kelly
- Department of Family Medicine, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | | | - Braden O'Neill
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Gomes Souza L, Bouba DA, Corôa RDC, Dofara SG, Robitaille V, Blanchette V, Kastner K, Bergeron F, Guay-Bélanger S, Izumi SS, Totten AM, Archambault P, Légaré F. The Impact of Advance Care Planning on Healthcare Professionals' Well-being: A Systematic Review. J Pain Symptom Manage 2024; 67:173-187. [PMID: 37827454 DOI: 10.1016/j.jpainsymman.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 10/14/2023]
Abstract
CONTEXT Advance care planning (ACP) improves care for patients with chronic illnesses and reduces family stress. However, the impact of ACP interventions on healthcare professionals' well-being remains unknown. OBJECTIVE To systematically review the literature evaluating the impact of ACP interventions on healthcare professionals' well-being. METHODS We followed the Joanna Briggs Institute methodology for systematic reviews and registered the protocol in PROSPERO (CRD42022346354). We included primary studies in all languages that assessed the well-being of healthcare professionals in ACP interventions. We excluded any studies on ACP in psychiatric care and in palliative care that did not address goals of care. Searches were conducted on April 4, 2022, and March 6, 2023 in Embase, CINAHL, Web of Science, and PubMed. We used the Mixed Methods Appraisal Tool for quality analysis. We present results as a narrative synthesis because of their heterogeneity. RESULTS We included 21 articles published in English between 1997 and 2021 with 17 published after 2019. All were conducted in high-income countries, and they involved a total of 1278 participants. Three reported an interprofessional intervention and two included patient partners. Studies had significant methodological flaws but most reported that ACP had a possible positive impact on healthcare professionals' well-being. CONCLUSION This review is the first to explore the impact of ACP interventions on healthcare professionals' well-being. ACP interventions appear to have a positive impact, but high-quality studies are scarce. Further research is needed, particularly using more rigorous and systematic methods to implement interventions and report results.
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Affiliation(s)
- Lucas Gomes Souza
- Department of Social and Preventive Medicine (L.G.S., D.A.B.), Faculty of Medicine, Université Laval, Québec, Canada, and VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Dalil Asmaou Bouba
- Department of Social and Preventive Medicine (L.G.S., D.A.B.), Faculty of Medicine, Université Laval, Québec, Canada, and VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Roberta de Carvalho Corôa
- Department of Family Medicine and Emergency Medicine (R.C.C.), VITAM, Centre de recherche en santé durable, Unité de soutien au système de santé apprenant, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Suélène Georgina Dofara
- VITAM, Centre de recherche en santé durable (S.G.B., S.G.D.), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Vincent Robitaille
- Faculty of Medicine, Université Laval (V.R.), VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine (V.B.), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | | | - Sabrina Guay-Bélanger
- VITAM, Centre de recherche en santé durable (S.G.B., S.G.D.), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | | | - Annette M Totten
- Department of Medical Informatics and Clinical Epidemiology (A.M.T.), School of Medicine, Oregon Health & Science University, Portland, OR
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine (P.A.), Faculty of Medicine, Université Laval, VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Québec, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine (F.L.), Faculty of Medicine, Université Laval, VITAM, Centre de recherche en santé durable, Researcher, Centre de recherche du CHU de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada.
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Zipp JS, Mete M, Miller KE, Knauff AE, Beaty DL, Kverno KS, Shaya EK. Assessment of a Unit-Level Acuity Tool in Inpatient Psychiatry. J Psychosoc Nurs Ment Health Serv 2024; 62:13-18. [PMID: 37379120 DOI: 10.3928/02793695-20230623-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Assessing acuity is deemed essential to staffing in intensive care nursing; however, it has not received sufficient attention in inpatient psychiatry, where acuity can fluctuate greatly within shifts. Staffing and admission decisions rely on the accuracy of this information. The current mixed methods study surveyed nurses from two hospitals within the same hospital system: one using an acuity tool and one naïve to acuity tools. The survey was followed by a focus group on the specific factors influencing acuity and nurses' assessment of needs. Results suggest that the current tool is not satisfactory for nurses who use it to help with staffing or admission decisions and it is not user-friendly. Most nurses from both hospitals indicated they would prefer an electronic version with automated features reflecting up-to-date patient and unit acuity that would assist in interprofessional collaborative admissions decisions and staffing. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 13-18.].
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Grady C, Chan-Nguyen S, Mathies D, Alam N. Family physicians partnering for system change: a multiple-case study of Ontario Health Teams in development. BMC Health Serv Res 2023; 23:1113. [PMID: 37848926 PMCID: PMC10583319 DOI: 10.1186/s12913-023-10070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 09/25/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND The Ontario Health Team (OHT) model is a form of integrated care that seeks to provide coordinated delivery of care to communities across Ontario, Canada. Primary care is positioned at the heart of the OHT model, yet physician participation and representation has been severely challenged at planning and governance tables. The purpose of this multiple case study is to examine (1) processes and structures to enable family physician participation in OHTs and (2) describe challenges to family physician participation. METHODS We chose a qualitative, exploratory multiple-case study approach following Yin's design and methods. The study took place between June and December 2021.We conducted semi-structured interviews with OHT stakeholders in four communities and carried out an analysis of internal and external documents to contextualize interview findings. Thematic analysis was applied within case and between cases. RESULTS Four OHTs participated in this study with thirty-nine participants (17 family physicians; 22 other stakeholders). Over 60 documents were analyzed. Within-case analysis found that structures and processes should be formalized and established to facilitate physician participation. Skepticism, burnout, heavy workload, and the COVID-19 pandemic were challenges to participation. Between-case analysis found that participation varied. Face-to-face communication processes were favoured in all cases and history of collaboration facilitated relationship-building. All cases faced similar challenges to physician participation despite regional differences. CONCLUSIONS The implementation of OHTs demonstrates that integrated care models can address critical health system issues through a collective approach. Physician participation is vital to the development of an OHT, however, recognition of their challenges (skepticism, burnout, COVID-19 pandemic) to participating must be acknowledged first. To ensure that models like OHTs thrive, physicians must be meaningfully engaged in various aspects and levels of governance and delivery.
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Affiliation(s)
- Colleen Grady
- Centre for Studies in Primary Care, Department of Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 3G2, Canada.
| | - Sophy Chan-Nguyen
- Centre for Studies in Primary Care, Department of Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 3G2, Canada
| | - David Mathies
- Muskoka and Area Ontario Health Team, Muskoka, ON, Canada
| | - Nadia Alam
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Asthana S, Prime S. The role of digital transformation in addressing health inequalities in coastal communities: barriers and enablers. FRONTIERS IN HEALTH SERVICES 2023; 3:1225757. [PMID: 37711604 PMCID: PMC10498291 DOI: 10.3389/frhs.2023.1225757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Abstract
Healthcare systems worldwide are striving for the "quadruple aim" of better population health and well-being, improved experience of care, healthcare team well-being (including that of carers) and lower system costs. By shifting the balance of care from reactive to preventive by facilitating the integration of data between patients and clinicians to support prevention, early diagnosis and care at home, many technological solutions exist to support this ambition. Yet few have been mainstreamed in the NHS. This is particularly the case in English coastal areas which, despite having a substantially higher burden of physical and mental health conditions and poorer health outcomes, also experience inequalities with respect to digital maturity. In this paper, we suggest ways in which digital health technologies (DHTs) can support a greater shift towards prevention; discuss barriers to digital transformation in coastal communities; and highlight ways in which central, regional and local bodes can enable transformation. Given a real risk that variations in digital maturity may be exacerbating coastal health inequalities, we call on health and care policy leaders and service managers to understands the potential benefits of a digital future and the risks of failing to address the digital divide.
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Affiliation(s)
- Sheena Asthana
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
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Whiting A, Poolman AE, Misra A, Gordon JE, Angstman KB. Comparison of Ambulatory Quality Measures Between Shared Practice Panels and Independent Practice Panels. Mayo Clin Proc Innov Qual Outcomes 2023; 7:256-261. [PMID: 37388418 PMCID: PMC10300043 DOI: 10.1016/j.mayocpiqo.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Objective To assess for differences in patient care outcomes in the primary care setting for patients assigned to an independent practice panel (IPP) or a shared practice panel (SPP). Patients and Methods We retrospectively reviewed the electronic health records of patients of 2 Mayo Clinic family medicine primary care clinics from January 1, 2019 to December 31, 2019. Patients were assigned to either an IPP (physician or advanced practice provider [APP]) or an SPP (physician and ≥1 APP). We assessed 6 measures of quality care and compared them between IPP and SPP groups: diabetes optimal care, hypertension control, depression remission at 6 months, breast cancer screening, cervical cancer screening, and colon cancer screening. Results The study included 114,438 patients assigned to 140 family medicine panels during the study period: 87 IPPs and 53 SPPs. The IPP clinicians showed improved quality metrics compared with the SPP clinicians for the percentage of assigned patients achieving depression remission (16.6% vs 11.1%; P<.01). The SPP clinicians showed improved quality metrics compared with that of the IPP clinicians for the percentage of patients with cervical cancer screening (79.1% vs 74.2%; P<.01). The mean percentage of the panels achieving optimal diabetes control, hypertension control, colon cancer screening, and breast cancer screening were not significantly different between IPP and SPP panels. Conclusion This study shows a considerable improvement in depression remission among IPP panels and in cervical cancer screening rates among SPP panels. This information may help to inform primary care team configuration.
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Affiliation(s)
- Adria Whiting
- Department of Family Medicine, Mayo Clinic Health System, Southwest Minnesota Region, Fairmont, MN
| | - April E. Poolman
- Department of Family Medicine, Mayo Clinic Health System, Southwest Minnesota Region, Fairmont, MN
| | - Artika Misra
- Department of Family Medicine, Mayo Clinic Health System, Southwest Minnesota Region, Mankato, MN
| | - Joel E. Gordon
- Department of Family Medicine and Community Health Madison, University of Wisconsin, Madison
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Kapu A, Rodgers J. Supporting Advanced Practice Nurses to Work at the Top of Their License: A Partnership With Nurse Executives. J Nurs Adm 2023; 53:365-366. [PMID: 37463259 DOI: 10.1097/nna.0000000000001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
This month's column highlights the value of nurse executive leaders in leveraging their experience, role, and partnership in empowering advanced practice RNs to work at the top of their education, clinical training, and license, optimizing the triple aim, even quadruple aim, in healthcare.
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Affiliation(s)
- April Kapu
- Author Affiliations: Associate Dean (Dr Kapu), Clinical and Community Partnerships, Vanderbilt University School of Nursing, Nashville, Tennessee; Past President (Dr Kapu), American Association of Nurse Practitioners, Austin, Texas; and Vice President of Advanced Practice/Associate Chief Nursing Officer (Dr Rodgers), University of Colorado Hospital; and Assistant Clinical Professor (Dr Rodgers), Pulmonary/Critical Care Medicine, University of Colorado School of Medicine, Aurora
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Wami SD, Fasika S, Donnelly C, Gelaye KA, Pullatayil A, Miller J. Characteristics of interprofessional rehabilitation programs for patients with chronic low back pain evaluated in the literature: a scoping review protocol. Syst Rev 2023; 12:105. [PMID: 37386618 PMCID: PMC10308723 DOI: 10.1186/s13643-023-02275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 06/18/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Interprofessional rehabilitation programs have demonstrated effectiveness at improving health-related quality of life, function, work abilities, and reducing pain, for patients with chronic low back pain (CLBP). However, the characteristics of interprofessional rehabilitation programs vary widely across studies. Therefore, clarifying and describing key characteristics of interprofessional rehabilitation programs for patients with CLBP will be valuable for future intervention design and implementation. This scoping review aims to identify and describe the key characteristics of interprofessional rehabilitation programs for patients with CLBP. METHODS Our scoping review will follow the framework developed by Arksey and O'Malley, further enhanced by Levac et al. and the Joanna Briggs Institute (JBI). Electronic databases, including MEDLINE, EMBASE, CINAHL, PsycINFO, SCOPUS, PubMed, Web of Science, and Cochrane Library, will be searched to identify relevant published studies. Our scoping review will consider all primary source peer-reviewed published articles that evaluated interprofessional rehabilitation programs for adults with CLBP from all countries and any therapeutic settings. The Covidence software will be used to remove duplicates, article screening, record the step-by-step selection process, and data extraction. The analysis will involve a descriptive numerical summary and narrative analysis. Data will be presented in graphical and tabular format based on the nature of the data. DISCUSSION This scoping review is expected to provide a source of evidence for developing and implementing interprofessional rehabilitation programs in new settings or contexts. As such, this review will guide future research and provide key information to health professionals, researchers and policymakers interested in designing and implementing evidence and theory-informed interprofessional rehabilitation programs for patients with CLBP. TRIAL REGISTRATION https://osf.io/rquxv .
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Affiliation(s)
- Sintayehu Daba Wami
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Solomon Fasika
- Department of Physiotherapy, School of Medicine, University of Gondar, Gondar, Ethiopia
| | | | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | | | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
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Rangachari P. The Untapped Potential of the Quadruple Aim of Primary Care to Foster a Culture of Health. Int J Gen Med 2023; 16:2237-2243. [PMID: 37293519 PMCID: PMC10246710 DOI: 10.2147/ijgm.s416367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
In 2015, the Robert Wood Johnson Foundation introduced the Culture of Health (CoH) action model to inform its grantmaking decisions in the United States. The essential principles of this model fall into four action dimensions: 1) making health a shared value, 2) fostering cross-sector collaboration, 3) creating more equitable communities, and 4) transforming healthcare systems. Although considerable success has been achieved since introduction of the CoH model, the pace of progress has been slower on the fourth dimension, since work in this area involves shifting mindsets from the acute care paradigm to one that focuses on prevention, by addressing the "upstream factors", including social and behavioral determinants impacting health. Moreover, despite its academic prominence, the CoH model remains restricted to the research realm, with limited translation to practice. By comparison, the Quadruple Aim (QA) is a four-dimensional framework that has been successfully translated into primary healthcare practice. Introduced in 2008, the QA entails the adoption of four principles in delivering healthcare: 1) improved patient experience, 2) population health, 3) lower costs, and 4) care team well-being, to achieve value in healthcare. The four principles of the QA could be viewed as analogous to the four principles of the CoH, given the inherent synergies in the underlying philosophy of the two frameworks. It is also noteworthy that both healthcare leadership (physician champions) and legislative reform had significant roles to play in the successful translation of the QA into mainstream practice. This in turn suggests that the primary healthcare system has potential to play an instrumental role in accelerating the pace of progress towards a culture of health by extending the scope of influence of the QA. This paper explores the inherent synergies between the QA and CoH models, and the untapped potential of the QA to foster a culture of health in the United States.
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Affiliation(s)
- Pavani Rangachari
- Department of Population Health and Leadership, School of Health Sciences, University of New Haven, West Haven, CT, 06516, USA
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14
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Ansah JP, Chiu CT. Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. Front Public Health 2023; 10:1082183. [PMID: 36711415 PMCID: PMC9881650 DOI: 10.3389/fpubh.2022.1082183] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction As the United States population ages, the adult population with chronic diseases is expected to increase. Exploring credible, evidence-based projections of the future burden of chronic diseases is fundamental to understanding the likely impact of established and emerging interventions on the incidence and prevalence of chronic disease. Projections of chronic disease often involve cross-sectional data that fails to account for the transition of individuals across different health states. Thus, this research aims to address this gap by projecting the number of adult Americans with chronic disease based on empirically estimated age, gender, and race-specific transition rates across predetermined health states. Methods We developed a multi-state population model that disaggregates the adult population in the United States into three health states, i.e., (a) healthy, (b) one chronic condition, and (c) multimorbidity. Data from the 1998 to 2018 Health and Retirement Study was used to estimate age, gender, and race-specific transition rates across the three health states, as input to the multi-state population model to project future chronic disease burden. Results The number of people in the United States aged 50 years and older will increase by 61.11% from 137.25 million in 2020 to 221.13 million in 2050. Of the population 50 years and older, the number with at least one chronic disease is estimated to increase by 99.5% from 71.522 million in 2020 to 142.66 million by 2050. At the same time, those with multimorbidity are projected to increase 91.16% from 7.8304 million in 2020 to 14.968 million in 2050. By race by 2050, 64.6% of non-Hispanic whites will likely have one or more chronic conditions, while for non-Hispanic black, 61.47%, and Hispanic and other races 64.5%. Conclusion The evidence-based projections provide the foundation for policymakers to explore the impact of interventions on targeted population groups and plan for the health workforce required to provide adequate care for current and future individuals with chronic diseases.
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Affiliation(s)
- John P. Ansah
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, United States,*Correspondence: John P. Ansah ✉
| | - Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, New Taipei, Taiwan,Chi-Tsun Chiu ✉
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15
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Bullock WM, Gadsden J. Turning baby steps into big leaps: shifting paradigms in fast-track joint replacement surgery. Anaesthesia 2023; 78:14-16. [PMID: 36308017 DOI: 10.1111/anae.15903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Affiliation(s)
- W M Bullock
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - J Gadsden
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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16
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Timofeyev Y, Dremova O, Jakovljevic M. The impact of transparency constraints on the efficiency of the Russian healthcare system: systematic literature review. J Med Econ 2023; 26:95-109. [PMID: 36537319 DOI: 10.1080/13696998.2022.2160608] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is an ongoing debate among researchers and policy-makers on how to make transparency a powerful tool of healthcare systems. This study addresses how the availability and accessibility of information about medical services to the general population affects healthcare outcomes in Russia. A systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviewing and Meta-Analysis (PRISMA) guidelines. Transparency indicators of health facilities used in the world's most efficient healthcare systems are also reviewed. Although the increase of transparency in the Russian healthcare system is considered as a tool for improving its efficiency, very little has been done to improve the actual level of transparency. The existing institutional specifics of the Russian healthcare system impose serious restrictions on acceptable levels of transparency. In the reviewed empirical Russian studies, transparency is often viewed simplistically as either information available on the websites of medical organizations or issues related to the amount of accessible indicators of compulsory medical statistical reporting. The novelty of this study consists in (a) reviewing the most recent studies on the topic and (b) including studies in Russian in the analysis. We elaborate on general and specific policy implications for improving transparency-driven outcomes in the Russian healthcare system.
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Affiliation(s)
| | | | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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17
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Corneliusson L, Pesonen T, Ruotsalainen S, Sulander J, Noro A, Sinervo T. Managers' Perspectives of Quality of Care in Service Housing and Home Care Services: A Qualitative Study. Gerontol Geriatr Med 2022; 8:23337214221142938. [PMID: 36601086 PMCID: PMC9806402 DOI: 10.1177/23337214221142938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to illuminate facilitators and barriers to the quality of care in service housing and home care services, as described by managers. In total, 17 service housing and home care service front-line managers participated in this study. The interviews were conducted in Finland during October 2021 using semi-structured interviews. Qualitative content analysis was used to analyze the data. Described facilitators to the quality of care included: staff dedication and motivation, a positive psycho-social working environment, sufficient staffing, coaching management, and optimized tasks. Described barriers included: increased efficiency demands, staffing challenges, inefficient division of labor, conflicts within the working community, and disruptions due to COVID-19. The results suggest that recruiting and retaining sufficient dedicated and motivated staff is paramount to ensuring quality of care from the managerial perspective, and it seems changes in the working culture may support quality of care in a cost-efficient way.
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Affiliation(s)
- Laura Corneliusson
- Finnish Institute for Health and
Welfare, Helsinki, Finland,Laura Corneliusson, Finnish Institute for
Health and Welfare, Mannerheimintie 166, PL 30, Helsinki 00271, Finland.
| | - Tiina Pesonen
- Finnish Institute for Health and
Welfare, Helsinki, Finland
| | | | | | - Anja Noro
- Finnish Institute for Health and
Welfare, Helsinki, Finland
| | - Timo Sinervo
- Finnish Institute for Health and
Welfare, Helsinki, Finland
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18
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Joyce C, Markossian TW, Nikolaides J, Ramsey E, Thompson HM, Rojas JC, Sharma B, Dligach D, Oguss MK, Cooper RS, Afshar M. The Evaluation of a Clinical Decision Support Tool Using Natural Language Processing to Screen Hospitalized Adults for Unhealthy Substance Use: Protocol for a Quasi-Experimental Design. JMIR Res Protoc 2022; 11:e42971. [PMID: 36534461 PMCID: PMC9808720 DOI: 10.2196/42971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Automated and data-driven methods for screening using natural language processing (NLP) and machine learning may replace resource-intensive manual approaches in the usual care of patients hospitalized with conditions related to unhealthy substance use. The rigorous evaluation of tools that use artificial intelligence (AI) is necessary to demonstrate effectiveness before system-wide implementation. An NLP tool to use routinely collected data in the electronic health record was previously validated for diagnostic accuracy in a retrospective study for screening unhealthy substance use. Our next step is a noninferiority design incorporated into a research protocol for clinical implementation with prospective evaluation of clinical effectiveness in a large health system. OBJECTIVE This study aims to provide a study protocol to evaluate health outcomes and the costs and benefits of an AI-driven automated screener compared to manual human screening for unhealthy substance use. METHODS A pre-post design is proposed to evaluate 12 months of manual screening followed by 12 months of automated screening across surgical and medical wards at a single medical center. The preintervention period consists of usual care with manual screening by nurses and social workers and referrals to a multidisciplinary Substance Use Intervention Team (SUIT). Facilitated by a NLP pipeline in the postintervention period, clinical notes from the first 24 hours of hospitalization will be processed and scored by a machine learning model, and the SUIT will be similarly alerted to patients who flagged positive for substance misuse. Flowsheets within the electronic health record have been updated to capture rates of interventions for the primary outcome (brief intervention/motivational interviewing, medication-assisted treatment, naloxone dispensing, and referral to outpatient care). Effectiveness in terms of patient outcomes will be determined by noninferior rates of interventions (primary outcome), as well as rates of readmission within 6 months, average time to consult, and discharge rates against medical advice (secondary outcomes) in the postintervention period by a SUIT compared to the preintervention period. A separate analysis will be performed to assess the costs and benefits to the health system by using automated screening. Changes from the pre- to postintervention period will be assessed in covariate-adjusted generalized linear mixed-effects models. RESULTS The study will begin in September 2022. Monthly data monitoring and Data Safety Monitoring Board reporting are scheduled every 6 months throughout the study period. We anticipate reporting final results by June 2025. CONCLUSIONS The use of augmented intelligence for clinical decision support is growing with an increasing number of AI tools. We provide a research protocol for prospective evaluation of an automated NLP system for screening unhealthy substance use using a noninferiority design to demonstrate comprehensive screening that may be as effective as manual screening but less costly via automated solutions. TRIAL REGISTRATION ClinicalTrials.gov NCT03833804; https://clinicaltrials.gov/ct2/show/NCT03833804. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42971.
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Affiliation(s)
- Cara Joyce
- Department of Computer Science, Loyola University Chicago, Chicago, IL, United States
| | - Talar W Markossian
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | - Jenna Nikolaides
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Elisabeth Ramsey
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Hale M Thompson
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Juan C Rojas
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Brihat Sharma
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Dmitriy Dligach
- Department of Computer Science, Loyola University Chicago, Chicago, IL, United States
| | - Madeline K Oguss
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Richard S Cooper
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | - Majid Afshar
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States
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19
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Assael LA. Residency Education in Oral and Maxillofacial Surgery: A New Curriculum Framework. Oral Maxillofac Surg Clin North Am 2022; 34:537-544. [PMID: 36229387 PMCID: PMC9549297 DOI: 10.1016/j.coms.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Residency education in oral and maxillofacial surgery (OMS) exists in an environment of transformation unlike anything seen in the past. Changes in American society accelerated by the COVID-19 pandemic are impacting all of health-care education and demand a comprehensive response by OMS programs and in standards for education. The oral health in America report of the National Institutes of Health and actions of the American Council on Graduate Medical Education provides a new framework for structuring and adapting OMS programs. These include incorporating the Quadruple Aims and ACGME core competencies into OMS education. The evolution of clinical education is being adapted to changes in technology and the American higher education environment. A changing workforce and practice model combined with today's technology revolution are being incorporated into OMS residency education.
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Affiliation(s)
- Leon A Assael
- Department of Restorative and Preventive Dentistry, University of California San Francisco; University of Minnesota; Oral and Maxillofacial Surgery, Oregon Health & Science University.
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20
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Chada BV. The systems engineering approach to quality improvement in the NHS. Future Healthc J 2022; 9:330-332. [PMID: 36561829 PMCID: PMC9761458 DOI: 10.7861/fhj.2022-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Bharadwaj V Chada
- AHarvard Medical School, Boston, USA,Address for correspondence: Dr Bharadwaj V Chada, Center for Primary Care, Harvard Medical School, 2nd Floor, 635 Huntington Avenue, Boston, MA 02115, USA. Twitter: @bharadwajchada
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21
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Pridgeon M, Proudlove N. Getting going on time: reducing neurophysiology set-up times in order to contribute to improving surgery start and finish times. BMJ Open Qual 2022; 11:bmjoq-2021-001808. [PMID: 35863774 PMCID: PMC9310250 DOI: 10.1136/bmjoq-2021-001808] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 07/11/2022] [Indexed: 12/11/2022] Open
Abstract
At the Walton Centre we conduct a relatively large number of complex and lengthy elective (booked) spinal operations. Recently, we have had a particular problem with half or more of these sessions finishing late, resulting in staff discontent and greater use of on-call staff. These operations require patient monitoring by neurophysiology clinical scientists. Before the surgeon can start the operation, in-theatre neurophysiological measurements are required to establish a baseline. We reasoned that reducing this set-up time would reduce the risk of surgery starting late, and so the whole session finishing later than expected. In this project we redesigned the neurophysiology parts of in-theatre patient preparation. We conducted five Plan-Do-Study-Act cycles over 3 months, reducing the duration of pre-surgery preparation from a mean of 70 min to around 50 min. We saw improvements in surgical start times and session finish times (both earlier by roughly comparable amounts). The ultimately impact is that we saw on-time session finishes improve from around 50% to 100%. Following this project, we have managed to sustain the changes and the improved performance. The most impactful change was to conduct in-theatre neurophysiology patient preparation simultaneously with anaesthesia, rather than waiting for this to finish; when we performed this with a pair of clinical scientists, we were able to complete neurophysiology patient preparation by the time the anaesthetist was finished, therefore not introducing delays to the start of surgery. A final change was to remove a superfluous preparatory patient-baseline measurement. This is a very challenging and complex environment, with powerful stakeholders and many factors and unpredictable events affecting sessions. Nevertheless, we have shown that we can make improvements within our span of influence that improve the wider process. While using pairs of staff requires greater resource, we found the benefit to be worthwhile.
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Affiliation(s)
- Michael Pridgeon
- Neurophysiology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Nathan Proudlove
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
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22
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Loutfy M, Kennedy VL, Riazi S, Lena S, Kazemi M, Bawden J, Wright V, Richardson L, Mills S, Belsito L, Mukerji G, Bhatia S, Gupta M, Barrett C, Martin D. Development and assessment of a hospital-led, community-partnering COVID-19 testing and prevention program for homeless and congregate living services in Toronto, Canada: a descriptive feasibility study. CMAJ Open 2022; 10:E483-E490. [PMID: 35672043 PMCID: PMC9177196 DOI: 10.9778/cmajo.20210105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Outbreaks of SARS-CoV-2 in shelters and congregate living settings are a major concern because of overcrowding and because resident populations are often at high risk for infection. The objective of this study was to describe the development, implementation and assessment of the COVID-19 Community Response Team, a program that enabled Women's College Hospital in Toronto, Ontario, to work in partnership with shelters and congregate living settings to prevent outbreaks. METHODS The Community Response Team, associated with Women's College Hospital, an academic ambulatory hospital, carried out mobile testing for SARS-CoV-2, supported outbreak management and prevention through ongoing onsite partnership with medical staff, and conducted infection prevention and control (IPC) training to shelter staff. We conducted a descriptive analysis of the sites supported by the program between Apr. 20, 2020, and Aug. 15, 2020. We also assessed the program's feasibility (number of completed needs assessments, mobile testing events and IPC training events, and median time from referral to service delivery), adoption (number of nasopharyngeal swabs, number of pre- and post-program outbreaks and IPC uptake) and acceptability or satisfaction. RESULTS The Community Response Team supported 32 sites. Of those, 30 completed an intake needs assessment, 24 completed mobile testing for SARS-CoV-2 and 15 received IPC support. Mobile testing resulted in the collection of 1566 nasopharyngeal swabs, of which 64 were positive for SARS-CoV-2 infection. Three sites had confirmed outbreaks. The median time from referral to needs assessment was 4 days (interquartile range [IQR] 1-13 days), and the median time to the testing day was 9 days (IQR 1-49 days). The median time from referral to IPC staff training was 14 days (IQR 4-79 days), and 100% of respondents reported being pleased or very pleased with the training. During the follow-up period, the 3 facilities with outbreaks overcame those outbreaks. Three sites supported by the Community Response Team had further single cases, but no site reported subsequent or secondary outbreaks. INTERPRETATION The Community Response Team program led to the transfer of IPC knowledge, allowed for the management and prevention of SARS-CoV-2 outbreaks, and demonstrated feasibility. Collaborative supports between hospitals and the community housing sector may serve as models for ongoing system integration beyond the COVID-19 pandemic.
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Affiliation(s)
- Mona Loutfy
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont.
| | - V Logan Kennedy
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Sheila Riazi
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Suvendrini Lena
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Mina Kazemi
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Jessica Bawden
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Vanessa Wright
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Lisa Richardson
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Selena Mills
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Laura Belsito
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Geetha Mukerji
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Sacha Bhatia
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Meenakshi Gupta
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Cristina Barrett
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Danielle Martin
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
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Hidalgo T. Perspectives: Thoughts on rural health. J Res Nurs 2022; 26:593-596. [PMID: 35265166 DOI: 10.1177/17449871211043726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Therese Hidalgo
- Clinical Educator, Assistant Professor Emeritus, University of New Mexico College of Nursing, 1 University Blvd, Albuquerque, NM, USA
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Residency Education as a Catalyst for Quality Amidst the Shifting Climate of Health Care. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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