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Terry D, Hills D, Bradley C, Govan L. Nurse-led clinics in primary health care: A scoping review of contemporary definitions, implementation enablers and barriers and their health impact. J Clin Nurs 2024; 33:1724-1738. [PMID: 38284475 DOI: 10.1111/jocn.17003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/11/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
AIMS To define nurse-led clinics in primary health care, identify barriers and enablers that influence their successful implementation, and understand what impact they have on patient and population health outcomes. BACKGROUND Nurse-led clinics definitions remain inconsistent. There is limited understanding regarding what enablers and barriers impact successful nurse-led clinic implementation and their impact on patient health care. DESIGN Scoping review using narrative synthesis. METHODS PubMed, MEDLINE, Web of Science, Scopus, CINAHL and PsycINFO were searched to identify nurse-led clinic definitions and models of care between 2000 and 2023. Screening and selection of studies were based on eligibility criteria and methodological quality assessment. Narrative synthesis enabled to communicate the phenomena of interest and follows the PRISMA for Scoping Reviews (PRISMA-ScR) checklist. RESULTS Among the 36 identified studies, key principles of what constitutes nurse-led clinics were articulated providing a robust definition. Nurse-led clinics are, in most cases, commensurate with standard care, however, they provide more time with patients leading to greater satisfaction. Enablers highlight nurse-led clinic success is achieved through champions, partners, systems, and clear processes, while barriers encompass key risk points and sustainability considerations. CONCLUSION The review highlights several fundamental elements are central to nurse-led clinic success and are highly recommended when developing interventional nurse-led strategies. Nurse-led clinics within primary health care seek to address health care through community driven, health professional and policy supported strategies. Overall, a robust and contemporary definition of nurse-led care and the clinics in which they operate is provided. RELEVANCE TO CLINICAL PRACTICE The comprehensive definition, clear mediators of success and the health impact of nurse-led clinics provide a clear framework to effectively build greater capacity among nursing services within primary health care. This, in addition, highlights the need for good health care policy to ensure sustainability. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Daniel Terry
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Queensland, Australia
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Victoria, Australia
| | - Danny Hills
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Victoria, Australia
- Australian Primary Health Care Nurses Association, Melbourne, Victoria, Australia
| | - Cressida Bradley
- Australian Primary Health Care Nurses Association, Melbourne, Victoria, Australia
| | - Linda Govan
- Australian Primary Health Care Nurses Association, Melbourne, Victoria, Australia
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Ito M, Tajika A, Toyomoto R, Imai H, Sakata M, Honda Y, Kishimoto S, Fukuda M, Horinouchi N, Sahker E, Furukawa TA. The short and long-term efficacy of nurse-led interventions for improving blood pressure control in people with hypertension in primary care settings: a systematic review and meta-analysis. BMC Prim Care 2024; 25:143. [PMID: 38678180 DOI: 10.1186/s12875-024-02380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Previous systematic reviews suggest that nurse-led interventions improve short-term blood pressure (BP) control for people with hypertension. However, the long-term effects, adverse events, and appropriate target BP level are unclear. This study aimed to evaluate the long-term efficacy and safety of nurse-led interventions. METHODS We conducted a systematic review and meta-analysis. We searched the Cochrane Central Register of Controlled Trials, PubMed, and CINAHL, as well as three Japanese article databases, as relevant randomized controlled trials from the oldest possible to March 2021. This search was conducted on 17 April 2021. We did an update search on 17 October 2023. We included studies on adults aged 18 years or older with hypertension. The treatments of interest were community-based nurse-led BP control interventions in addition to primary physician-provided care as usual. The comparator was usual care only. Primary outcomes were long-term achievement of BP control goals and serious adverse events (range: 27 weeks to 3 years). Secondary outcomes were short-term achievement of BP control goals and serious adverse events (range: 4 to 26 weeks), change of systolic and diastolic BP from baseline, medication adherence, incidence of hypertensive complications, and total mortality. RESULTS We included 35 studies. Nurse-led interventions improved long-term BP control (RR 1.10, 95%CI 1.03 to 1.18). However, no significant differences were found in the short-term effects of nurse-led intervention compared to usual care about BP targets. Little information on serious adverse events was available. There was no difference in mortality at both terms between the two groups. Establishing the appropriate target BP from the extant trials was impossible. CONCLUSIONS Nurse-led interventions may be more effective than usual care for achieving BP control at long-term follow-up. It is important to continue lifestyle modification for people with hypertension. We must pay attention to adverse events, and more studies examining appropriate BP targets are needed. Nurse-led care represents an important complement to primary physician-led usual care.
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Affiliation(s)
- Masami Ito
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Aran Tajika
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Rie Toyomoto
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Hissei Imai
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Masatsugu Sakata
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Yukiko Honda
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Social Medicine, National Centre for Child Health and Development, Tokyo, Japan
| | - Sanae Kishimoto
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Memori Fukuda
- Department of Health Informatics, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Noboru Horinouchi
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
- Department of General Medicine, Oita University Faculty of Medicine, Oita, Japan
| | - Ethan Sahker
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
- Population Health and Policy Research Unit, Medical Education Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
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Rasmussen C, Larsen JW, Christensen HM, Larsen MB, Thomsen AM, Leishmann T, Kragh J, Nielsen GL. Optimising gout treatment: insights from a nurse-led cohort study. RMD Open 2024; 10:e004179. [PMID: 38663881 PMCID: PMC11043733 DOI: 10.1136/rmdopen-2024-004179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES Currently, gout management, particularly urate-lowering therapy (ULT), is often suboptimal. Nurses successfully manage various diseases including gout. As gout prevalence is rising, and rheumatologists and general practitioners face shortages, a new approach is imperative. This real-life prospective cohort study evaluated the effectiveness of nurse-led care employing a treat-to-target strategy for gout management over a 2-year period. METHODS All consecutively confirmed gout patients were included. The nurse-led clinic provided a structured treatment plan with consultations, patient leaflets, telephone contacts and laboratory monitoring. After a year of nurse-led care, patients transitioned to continued care in general practice. Follow-up data were complete through registries. The primary outcome was achieving target p-urate levels (<0.36 mmol/L) at 2 years after diagnosis. Secondary outcomes included treatment continuation and achievement of target p-urate levels in specific subgroups. The results were compared with patients diagnosed in the same clinic but followed up in 'usual care'. RESULTS In the nurse-led group (n=114), 83% achieved target p-urate levels and ULT was continued by 98%. This trend persisted across various patient subgroups. Only 44% of patients in usual care achieved target p-urate and with insufficient doses of allopurinol . Nurse-led care involved an average of two visits and three telephone contacts over 336 days. The 2-year mortality rate was 15%. CONCLUSIONS Nurse-led gout care, employing a targeted approach, was associated with a very high uptake of and adherence to ULT. The encouraging results were not achieved in usual care although a direct comparison might be influenced by selection bias.
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Affiliation(s)
- Claus Rasmussen
- Department of Rheumatology, North Denmark Regional Hospital, Hjorring, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Monica Bak Larsen
- Department of Rheumatology, North Denmark Regional Hospital, Hjorring, Denmark
| | - Anna Marie Thomsen
- Department of Rheumatology, North Denmark Regional Hospital, Hjorring, Denmark
| | - Tinna Leishmann
- Department of Rheumatology, North Denmark Regional Hospital, Hjorring, Denmark
| | - Jette Kragh
- Department of Rheumatology, North Denmark Regional Hospital, Hjorring, Denmark
| | - Gunnar Lauge Nielsen
- Clinical Medicine, Aalborg Universitet, Aalborg, Denmark
- Department of Internal Medicine, Farsø Outpatient Clinic, Aalborg University Hospital, Aalborg Universitetshospital, Aalborg, Denmark
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Wong AKC, Kwok VWY, Wong FKY, Tong DWK, Yuen BMK, Fong CS, Chan ST, Li WC, Zhou S, Lee AYL. Improving post-acute stroke follow-up care by adopting telecare consultations in a nurse-led clinic: Study protocol of a hybrid implementation-effectiveness trial. J Adv Nurs 2024; 80:1222-1231. [PMID: 37950400 DOI: 10.1111/jan.15960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
AIM To evaluate the clinical effectiveness and implementation strategies of telecare consultations in post-stroke nurse-led clinics. BACKGROUND Telecare consultations could be an alternative to conventional in-person consultations and improve continuity of care for stroke survivors following their discharge from hospital. Previous studies utilizing telecare consultations only focused on testing their clinical effectiveness on stroke survivors; the appropriateness and feasibility of adopting this new delivery modality in a real-world setting were not examined. DESIGN A Type II hybrid effectiveness-implementation design will be adopted. METHODS Eligible stroke survivor participants will be randomly assigned to the intervention group (telecare consultation) or control group (usual in-person clinic consultation). Both groups will receive the same nursing intervention but delivered through different channels. The Reach, Effectiveness, Adoption, Implementation, Maintenance framework will be used to evaluate the clinical effectiveness and implementation outcomes. The primary outcome is the non-inferiority of the degree of disability between the two groups at 3 months into the intervention and at 3 months post-intervention. The paper complies with the SPIRIT guidelines for study protocols adapted for designing and reporting parallel group randomized trials. CONCLUSION The findings of this study will provide key insights into the processes for implementing and adopting telecare consultations into long-term services for post-stroke patients. IMPACT This study contributes to the translation of telecare consultations for stroke survivors into real-life settings. If effective, this program may provide guidance for expanding telecare consultations to other post-stroke nurse-led clinics or to patients with other chronic diseases. TRIAL REGISTRATION This study has been registered at clinicaltrials.gov (identifier: NCT05183672). Registered on 10 January 2022.
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Affiliation(s)
| | | | | | - Danny Wah Kun Tong
- Hospital Authority Head Office, Hospital Authority Building, Homantin, Hong Kong
| | | | - Ching Sing Fong
- Queen Elizabeth Hospital, Hospital Authority, Homantin, Hong Kong
| | - Shun Tim Chan
- Queen Elizabeth Hospital, Hospital Authority, Homantin, Hong Kong
| | - Wah Chun Li
- Queen Elizabeth Hospital, Hospital Authority, Homantin, Hong Kong
| | - Shiyi Zhou
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
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Dhar A, Needham J, Gibb M, Coyne E. The client and family experience of attending a nurse-led clinic for chronic wounds. Aust J Prim Health 2024; 30:NULL. [PMID: 37925745 DOI: 10.1071/py23081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/10/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The quality of life for individuals with chronic wounds is diminished due to poor health-related outcomes and the financial burden of wound care. The literature has shown nurse-led wound care to have a positive impact on wound healing and psychosocial wellbeing. However, there is minimal research investigating the lived experience of attending a nurse-led clinic for chronic wounds. The purpose of this study was to explore the client and family experience of attending a nurse-led clinic for chronic wounds. METHODS Qualitative descriptive study. Semi-structured telephone interviews were transcribed verbatim and thematic analysis was undertaken. RESULTS Twelve clients and two family members participated, and the average length of interviews was 20min. Three main themes emerged: (1) expecting and managing pain; (2) receiving expert advice and reflecting on previous care; and (3) managing the cost of care. There was an emphasis on the impact of chronic wounds on pain and the ability to complete the activities of daily living. Expert advice, client satisfaction and physical accessibility were highlighted as benefits of the clinic. Cost and minimal client education were identified as challenges of the clinic. CONCLUSIONS The findings demonstrated that chronic wounds have a significant impact on the client and family attending the nurse-led clinic. Comprehensive pain assessment, improved social support, better client education and cost-effective care is required to optimise the experience for people attending the nurse-led clinic.
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Affiliation(s)
- Anusuya Dhar
- Griffith University, School of Nursing and Midwifery, Logan campus, Meadowbrook, Qld 4131, Australia
| | - Judith Needham
- Griffith University, School of Nursing and Midwifery, Logan campus, Meadowbrook, Qld 4131, Australia
| | - Michelle Gibb
- Wound Specialist Services Pty Ltd, Brisbane, Qld 4000, Australia
| | - Elisabeth Coyne
- Griffith University, School of Nursing and Midwifery, Logan campus, Meadowbrook, Qld 4131, Australia
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Xia W, Wang Y, Wu X, Yang X. Current practices and challenges in application of trauma-informed care for accidentally injured patients: An exploratory qualitative study. Nurs Open 2024; 11:e2046. [PMID: 38268294 PMCID: PMC10701293 DOI: 10.1002/nop2.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/09/2023] [Accepted: 10/19/2023] [Indexed: 01/26/2024] Open
Abstract
AIM To explore the Chinese nurses' current practices and challenges to trauma-informed care (TIC) for accidentally injured patients, which can provide the way forward of improvement in the future. DESIGN A qualitative study. METHODS Sixteen Chinese nurses who had experience working with accidentally injured patients were invited into the semi-structured interviews. Following each interview, the dialogue was transcribed verbatim. Subsequently, we analysed the data in accordance with the principles of thematic analysis. RESULTS Four common themes emerged from the analysis: (a) Awareness of patients' psychological trauma; (b) Recognition of psychological trauma; (c) Response to psychological trauma; (d) Perceived barriers to implementing TIC. This research indicated an urgent need for interventions in the future, such as TIC education and training, time constraints, heavy workload, emotional exhaustion and mood self-regulation, giving policy incentives, strengthening leadership support and internal cooperation. Identifying those factors of TIC practice among accidentally injured patients helps promote TIC development in hospitals.
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Affiliation(s)
- Weiping Xia
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of MedicineTongji UniversityShanghaiChina
- United Family hospitalShanghaiChina
| | - Yanbo Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of MedicineTongji UniversityShanghaiChina
- Division of Medical humanities and Behavioral Sciences, School of MedicineTongji UniversityShanghaiChina
| | - Xiaoning Wu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of MedicineTongji UniversityShanghaiChina
| | - Xiaojie Yang
- Department of OrthopedicsJiangyin Hospital Affiliated to Nantong UniversityJiang YinChina
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Mitchell E, Reynolds SS, Mower-Wade D, Raser-Schramm J, Granger BB. Implementation of an Advanced Practice Registered Nurse-Led Clinic to Improve Follow-up Care for Post-Ischemic Stroke Patients. J Neurosci Nurs 2022; 54:193-198. [PMID: 35852972 DOI: 10.1097/jnn.0000000000000670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT BACKGROUND: Ischemic stroke continues to be a leading cause of serious disability within the United States, affecting 795 000 people annually. Approximately 12% to 21% of post-ischemic stroke patients will be readmitted to the hospital within 30 days of discharge. Studies suggest that implementation of a follow-up appointment within 7 to 14 days of discharge improves 30-day readmission rates; however, implementation of these guidelines is uncommon, and follow-up visits within the recommended window are not often achieved. The purpose of this project was to evaluate the impact of an advanced practice registered nurse (APRN)-led stroke clinic on follow-up care for post-ischemic stroke patients. The aims were to improve time to follow-up visit and reduce 30-day unplanned readmissions. METHODS: A pre/post intervention design was used to evaluate the impact of a process to access the APRN-led stroke clinic. The intervention included a scheduling process redesign, and subsequent APRN and scheduler education. RESULTS: The time to clinic follow-up preintervention averaged 116.9 days, which significantly reduced to 33.6 days post intervention, P = .0001. Unplanned readmissions within 30 days declined from 11.5% to 9.9%; however, it was not statistically significant, P = .149. Age was not statistically different between preintervention and postintervention groups, P = .092, and other demographics were similar between the groups. CONCLUSION: An APRN-led clinic can improve follow-up care and may reduce unplanned 30-day readmissions for post-ischemic stroke patients. Further work is needed to determine the impact of alternative approaches such as telehealth.
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Ramachandran J, Lawn S, Tang MSS, Pati A, Wigg L, Wundke R, McCormick R, Muller K, Kaambwa B, Woodman R, Wigg A. Nurse Led Clinics; a Novel Model of Care for Compensated Liver Cirrhosis: A Qualitative Analysis. Gastroenterol Nurs 2022; 45:29-42. [PMID: 34369404 DOI: 10.1097/sga.0000000000000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/26/2021] [Indexed: 11/27/2022] Open
Abstract
A nurse-led cirrhosis clinic model for management of stable, compensated cirrhotic patients is practised in our unit since 2013, wherein these patients are reviewed every six months by specialist nurses in community clinics under remote supervision of hepatologists. We evaluated the experiences of patients and healthcare providers involved in the model to understand the acceptability, strengths, and limitations of the model and obtain suggestions to improve. A qualitative design using in-depth interviews was employed, followed by thematic analysis of eight patients, one attending physician both nurse and hospital clinics, four hepatologists, and three experienced specialist nurses running the nurse-led cirrhosis clinic. Patients expressed satisfaction and a good understanding of the nurse-led cirrhosis clinic, preferring it to hospital clinics for better accessibility and the unique nurse-patient relationship. Upskilling and provision of professional care in a holistic manner were appreciated by specialist nurses. The hepatologists expressed confidence and satisfaction, although they acknowledged the difference between the medical training of specialist nurses and hepatologists. The greater availability of hospital clinic time for sick patients was welcomed. Increased specialist nurse staffing, regular forums to promote specialist nurse learning, and formalization of the referral process were suggested. No adverse experiences were reported by patients or staff. The nurse-led cirrhosis clinic model for compensated liver cirrhosis was well received by patients, hepatologists, and specialist nurses. Wider implementation of the model could be considered after further investigations in other settings.
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Affiliation(s)
- Jeyamani Ramachandran
- Jeyamani Ramachandran, PhD, MD, MBBS, DM, FRACP, is Consultant Hepatologist, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Sharon Lawn, PhD, is Professor, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Matilda Swee Sun Tang, MBBS, is an intern, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Anuradha Pati, SACE, is Second-Year Medical Student, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Luisa Wigg, IBDP, is Second-Year Medical Student, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Rachel Wundke, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Rosemary Mccormick, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Kate Muller, PhD, FRACP, is Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Billingsley Kaambwa, PhD, is Associate Professor and Head of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Richard Woodman, PhD, is Professor, Department of Biostatistics and Epidemiology, Flinders University, Bedford Park, South Australia
- Alan Wigg, PhD, FRACP, is Professor and Head, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Sharon Lawn
- Jeyamani Ramachandran, PhD, MD, MBBS, DM, FRACP, is Consultant Hepatologist, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Sharon Lawn, PhD, is Professor, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Matilda Swee Sun Tang, MBBS, is an intern, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Anuradha Pati, SACE, is Second-Year Medical Student, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Luisa Wigg, IBDP, is Second-Year Medical Student, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Rachel Wundke, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Rosemary Mccormick, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Kate Muller, PhD, FRACP, is Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Billingsley Kaambwa, PhD, is Associate Professor and Head of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Richard Woodman, PhD, is Professor, Department of Biostatistics and Epidemiology, Flinders University, Bedford Park, South Australia
- Alan Wigg, PhD, FRACP, is Professor and Head, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Matilda Swee Sun Tang
- Jeyamani Ramachandran, PhD, MD, MBBS, DM, FRACP, is Consultant Hepatologist, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Sharon Lawn, PhD, is Professor, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Matilda Swee Sun Tang, MBBS, is an intern, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Anuradha Pati, SACE, is Second-Year Medical Student, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Luisa Wigg, IBDP, is Second-Year Medical Student, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Rachel Wundke, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Rosemary Mccormick, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Kate Muller, PhD, FRACP, is Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Billingsley Kaambwa, PhD, is Associate Professor and Head of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Richard Woodman, PhD, is Professor, Department of Biostatistics and Epidemiology, Flinders University, Bedford Park, South Australia
- Alan Wigg, PhD, FRACP, is Professor and Head, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Anuradha Pati
- Jeyamani Ramachandran, PhD, MD, MBBS, DM, FRACP, is Consultant Hepatologist, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Sharon Lawn, PhD, is Professor, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Matilda Swee Sun Tang, MBBS, is an intern, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Anuradha Pati, SACE, is Second-Year Medical Student, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Luisa Wigg, IBDP, is Second-Year Medical Student, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Rachel Wundke, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Rosemary Mccormick, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Kate Muller, PhD, FRACP, is Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Billingsley Kaambwa, PhD, is Associate Professor and Head of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Richard Woodman, PhD, is Professor, Department of Biostatistics and Epidemiology, Flinders University, Bedford Park, South Australia
- Alan Wigg, PhD, FRACP, is Professor and Head, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Luisa Wigg
- Jeyamani Ramachandran, PhD, MD, MBBS, DM, FRACP, is Consultant Hepatologist, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Sharon Lawn, PhD, is Professor, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Matilda Swee Sun Tang, MBBS, is an intern, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Anuradha Pati, SACE, is Second-Year Medical Student, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Luisa Wigg, IBDP, is Second-Year Medical Student, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Rachel Wundke, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Rosemary Mccormick, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Kate Muller, PhD, FRACP, is Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Billingsley Kaambwa, PhD, is Associate Professor and Head of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Richard Woodman, PhD, is Professor, Department of Biostatistics and Epidemiology, Flinders University, Bedford Park, South Australia
- Alan Wigg, PhD, FRACP, is Professor and Head, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Rachel Wundke
- Jeyamani Ramachandran, PhD, MD, MBBS, DM, FRACP, is Consultant Hepatologist, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Sharon Lawn, PhD, is Professor, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Matilda Swee Sun Tang, MBBS, is an intern, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Anuradha Pati, SACE, is Second-Year Medical Student, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Luisa Wigg, IBDP, is Second-Year Medical Student, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Rachel Wundke, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Rosemary Mccormick, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Kate Muller, PhD, FRACP, is Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Billingsley Kaambwa, PhD, is Associate Professor and Head of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Richard Woodman, PhD, is Professor, Department of Biostatistics and Epidemiology, Flinders University, Bedford Park, South Australia
- Alan Wigg, PhD, FRACP, is Professor and Head, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Rosemary McCormick
- Jeyamani Ramachandran, PhD, MD, MBBS, DM, FRACP, is Consultant Hepatologist, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Sharon Lawn, PhD, is Professor, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Matilda Swee Sun Tang, MBBS, is an intern, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Anuradha Pati, SACE, is Second-Year Medical Student, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Luisa Wigg, IBDP, is Second-Year Medical Student, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Rachel Wundke, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Rosemary Mccormick, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Kate Muller, PhD, FRACP, is Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Billingsley Kaambwa, PhD, is Associate Professor and Head of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Richard Woodman, PhD, is Professor, Department of Biostatistics and Epidemiology, Flinders University, Bedford Park, South Australia
- Alan Wigg, PhD, FRACP, is Professor and Head, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Kate Muller
- Jeyamani Ramachandran, PhD, MD, MBBS, DM, FRACP, is Consultant Hepatologist, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Sharon Lawn, PhD, is Professor, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Matilda Swee Sun Tang, MBBS, is an intern, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Anuradha Pati, SACE, is Second-Year Medical Student, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Luisa Wigg, IBDP, is Second-Year Medical Student, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Rachel Wundke, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Rosemary Mccormick, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Kate Muller, PhD, FRACP, is Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Billingsley Kaambwa, PhD, is Associate Professor and Head of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Richard Woodman, PhD, is Professor, Department of Biostatistics and Epidemiology, Flinders University, Bedford Park, South Australia
- Alan Wigg, PhD, FRACP, is Professor and Head, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Billingsley Kaambwa
- Jeyamani Ramachandran, PhD, MD, MBBS, DM, FRACP, is Consultant Hepatologist, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Sharon Lawn, PhD, is Professor, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Matilda Swee Sun Tang, MBBS, is an intern, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Anuradha Pati, SACE, is Second-Year Medical Student, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Luisa Wigg, IBDP, is Second-Year Medical Student, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Rachel Wundke, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Rosemary Mccormick, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Kate Muller, PhD, FRACP, is Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Billingsley Kaambwa, PhD, is Associate Professor and Head of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Richard Woodman, PhD, is Professor, Department of Biostatistics and Epidemiology, Flinders University, Bedford Park, South Australia
- Alan Wigg, PhD, FRACP, is Professor and Head, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Richard Woodman
- Jeyamani Ramachandran, PhD, MD, MBBS, DM, FRACP, is Consultant Hepatologist, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Sharon Lawn, PhD, is Professor, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Matilda Swee Sun Tang, MBBS, is an intern, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Anuradha Pati, SACE, is Second-Year Medical Student, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Luisa Wigg, IBDP, is Second-Year Medical Student, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Rachel Wundke, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Rosemary Mccormick, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Kate Muller, PhD, FRACP, is Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Billingsley Kaambwa, PhD, is Associate Professor and Head of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Richard Woodman, PhD, is Professor, Department of Biostatistics and Epidemiology, Flinders University, Bedford Park, South Australia
- Alan Wigg, PhD, FRACP, is Professor and Head, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Alan Wigg
- Jeyamani Ramachandran, PhD, MD, MBBS, DM, FRACP, is Consultant Hepatologist, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Sharon Lawn, PhD, is Professor, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Matilda Swee Sun Tang, MBBS, is an intern, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Anuradha Pati, SACE, is Second-Year Medical Student, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Luisa Wigg, IBDP, is Second-Year Medical Student, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Rachel Wundke, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Rosemary Mccormick, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Kate Muller, PhD, FRACP, is Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Billingsley Kaambwa, PhD, is Associate Professor and Head of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Richard Woodman, PhD, is Professor, Department of Biostatistics and Epidemiology, Flinders University, Bedford Park, South Australia
- Alan Wigg, PhD, FRACP, is Professor and Head, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Nyamathi A, Salem BE, Shin SS, Jones AA, Garfin DR, Yadav K, Chang AH, White K, Morisky D. Effect of a Nurse-Led Community Health Worker Intervention on Latent Tuberculosis Medication Completion Among Homeless Adults. Nurs Res 2021; 70:433-442. [PMID: 34380979 PMCID: PMC8563379 DOI: 10.1097/nnr.0000000000000545] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tuberculosis (TB) disproportionately affects marginalized and impoverished homeless adults. Although active TB can be prevented by treating latent TB infection (LTBI), individual factors, such as high prevalence of depression and anxiety, drug and alcohol use, and unstable housing, lead to poor LTBI treatment adherence and completion among homeless adults. OBJECTIVES We hypothesized that the delivery of a tailored nurse-led, community health worker (RN/CHW) program across the LTBI continuum of care (e.g., screening, diagnosis, and treatment) that delivers 3HP treatment (3HP: rifapentine plus isoniazid) for homeless adults (e.g., sheltered and unsheltered) and is tailored to their health and social service needs will overcome existing treatment completion barriers. We also hypothesized that mental health symptoms (e.g., depression and anxiety), drug use score, and problematic alcohol use will decline over time among clients receiving this treatment. METHODS We assessed the effect of delivering a theoretically guided, RN/CHW-based, single-arm study among eligible LTBI-positive homeless adults (N = 50) on completion of a weekly, directly observed, 12-dose 3HP LTBI treatment in Central City East (Skid Row). Completing 3HP treatment was compared to the only known historical, clinic-based control that obtained 65% completion among homeless adults. Secondary outcomes included drug and alcohol use, depression, and anxiety. RESULTS The RN/CHW program achieved a 91.8% 3HP treatment completion rate among homeless adults. Younger homeless adults (<50 years old) were less likely to complete 3HP treatment compared to those who were older. Neither drug use, depression, nor anxiety was associated with 3HP treatment completion. Decrease in anxiety was observed at 3 months, but not at 6 months, compared to baseline. DISCUSSION To our knowledge, the pilot study is the first to evaluate an effective RN/CHW-delivered, community-based intervention, which can reduce the burden of active TB for homeless adults.
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Rosenfeld P, Glassman K, Vetter M, Smith B. A comparative study of PhD and DNP nurses in an integrated health care system. Nurs Outlook 2021; 70:145-153. [PMID: 34489097 DOI: 10.1016/j.outlook.2021.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/16/2021] [Accepted: 07/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND A vast literature exists on doctorally-prepared RNs in academia, but little is known about those in practice settings. PURPOSE The purpose of this study was to explore demographic, educational, and employment characteristics, as well as practice patterns and professional accomplishments of doctorally-prepared RNs in one practice setting. METHODS Survey of approximately 100 doctorally-prepared RNs in an integrated health system were surveyed. DISCUSSION Doctors of Nursing Practice (DNPs) outnumber PhDs three to one in the institution. Several statistically significant differences exist between them: DNPs are younger and most likely hold advanced practice nursing positions; PhDs are 10 years older and more likely hold administrative or leadership positions. Little evidence exists that neither nurses nor administrators understand the skills and knowledge that doctorally-prepared RNs bring to the organization. This is particularly true for DNPs who predominantly hold clinical positions also held by master's-prepared RNs. CONCLUSION Advocates for continued growth of DNPs in academia and practice should partner more closely to clarify the skills and talents that doctorally-prepared nurses bring to clinical settings.
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Affiliation(s)
- Peri Rosenfeld
- Departments of Nursing, NYU Langone Health, New York, NY.
| | | | | | - Beverly Smith
- Departments of Nursing, NYU Langone Health, New York, NY
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11
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Schondelmeyer AC, Bettencourt AP, Xiao R, Beidas RS, Wolk CB, Landrigan CP, Brady PW, Brent CR, Parthasarathy P, Kern-Goldberger AS, Sergay N, Lee V, Russell CJ, Prasto J, Zaman S, McQuistion K, Lucey K, Solomon C, Garcia M, Bonafide CP. Evaluation of an Educational Outreach and Audit and Feedback Program to Reduce Continuous Pulse Oximetry Use in Hospitalized Infants With Stable Bronchiolitis: A Nonrandomized Clinical Trial. JAMA Netw Open 2021; 4:e2122826. [PMID: 34473258 PMCID: PMC8414187 DOI: 10.1001/jamanetworkopen.2021.22826] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE National guidelines recommend against continuous pulse oximetry use for hospitalized children with bronchiolitis who are not receiving supplemental oxygen, yet guideline-discordant use remains high. OBJECTIVES To evaluate deimplementation outcomes of educational outreach and audit and feedback strategies aiming to reduce guideline-discordant continuous pulse oximetry use in children hospitalized with bronchiolitis who are not receiving supplemental oxygen. DESIGN, SETTING, AND PARTICIPANTS A nonrandomized clinical single-group deimplementation trial was conducted in 14 non-intensive care units in 5 freestanding children's hospitals and 1 community hospital from December 1, 2019, through March 14, 2020, among 847 nurses and physicians caring for hospitalized children with bronchiolitis who were not receiving supplemental oxygen. INTERVENTIONS Educational outreach focused on communicating details of the existing guidelines and evidence. Audit and feedback strategies included 2 formats: (1) weekly aggregate data feedback to multidisciplinary teams with review of unit-level and hospital-level use of continuous pulse oximetry, and (2) real-time 1:1 feedback to clinicians when guideline-discordant continuous pulse oximetry use was discovered during in-person data audits. MAIN OUTCOMES AND MEASURES Clinician ratings of acceptability, appropriateness, feasibility, and perceived safety were assessed using a questionnaire. Guideline-discordant continuous pulse oximetry use in hospitalized children was measured using direct observation of a convenience sample of patients with bronchiolitis who were not receiving supplemental oxygen. RESULTS A total of 847 of 1193 eligible clinicians (695 women [82.1%]) responded to a Likert scale-based questionnaire (71% response rate). Most respondents rated the deimplementation strategies of education and audit and feedback as acceptable (education, 435 of 474 [92%]; audit and feedback, 615 of 664 [93%]), appropriate (education, 457 of 474 [96%]; audit and feedback, 622 of 664 [94%]), feasible (education, 424 of 474 [89%]; audit and feedback, 557 of 664 [84%]), and safe (803 of 847 [95%]). Sites collected 1051 audit observations (range, 47-403 per site) on 709 unique patient admissions (range, 31-251 per site) during a 3.5-month period of continuous pulse oximetry use in children with bronchiolitis not receiving supplemental oxygen, which were compared with 579 observations (range, 57-154 per site) from the same hospitals during the baseline 4-month period (prior season) to determine whether the strategies were associated with a reduction in use. Sites conducted 148 in-person educational outreach and aggregate data feedback sessions and provided real-time 1:1 feedback 171 of 236 times (72% of the time when guideline-discordant monitoring was identified). Adjusted for age, gestational age, time since weaning from supplemental oxygen, and other characteristics, guideline-discordant continuous pulse oximetry use decreased from 53% (95% CI, 49%-57%) to 23% (95% CI, 20%-25%) (P < .001) during the intervention period. There were no adverse events attributable to reduced monitoring. CONCLUSIONS AND RELEVANCE In this nonrandomized clinical trial, educational outreach and audit and feedback deimplementation strategies for guideline-discordant continuous pulse oximetry use among hospitalized children with bronchiolitis who were not receiving supplemental oxygen were positively associated with clinician perceptions of feasibility, acceptability, appropriateness, and safety. Evaluating the sustainability of deimplementation beyond the intervention period is an essential next step. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04178941.
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Affiliation(s)
- Amanda C. Schondelmeyer
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Amanda P. Bettencourt
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor
| | - Rui Xiao
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Rinad S. Beidas
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia
| | - Christopher P. Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Division of Sleep and Circadian Disorders, Departments of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Sleep and Circadian Disorders, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Patrick W. Brady
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Canita R. Brent
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Padmavathy Parthasarathy
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Andrew S. Kern-Goldberger
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nathaniel Sergay
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Pediatric Residency Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Vivian Lee
- Division of Hospital Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles
| | - Christopher J. Russell
- Division of Hospital Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles
| | - Julianne Prasto
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of Pediatrics, Children’s Hospital of Philadelphia Pediatric Care and Penn Medicine Princeton Medical Center, Philadelphia, Pennsylvania
| | - Sarah Zaman
- Department of Pediatrics, University of Washington School of Medicine, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - Kaitlyn McQuistion
- University of Washington Pediatric Residency Program, Department of Pediatrics, University of Washington, Seattle
| | - Kate Lucey
- Division of Hospital Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Courtney Solomon
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas
- Division of Pediatric Hospital Medicine, Children’s Health Dallas, Texas
| | - Mayra Garcia
- Division of General and Thoracic Surgery, Children’s Health Dallas, Dallas, Texas
| | - Christopher P. Bonafide
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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12
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Callan V, Eshkevari L, Finder S, Jeter L, May S, Schirle L, Stulce J, Hoyem RL, Everson M. Impact of COVID-19 Pandemic on Certified Registered Nurse Anesthetist Practice. AANA J 2021; 89:334-340. [PMID: 34342571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic prompted profound shifts in the delivery of critical healthcare services. A mixed-methods study was conducted to explore the impact of the pandemic on Certified Registered Nurse Anesthetist (CRNA) practice. The quantitative component involved a survey of CRNAs during the initial period of the pandemic to determine changes in practice and any relationship to removal of state and federal barriers. Approximately 16% of 2,202 responding CRNAs reported practice expansion beyond their normal responsibilities, primarily outside the operating room and involving tracheal intubation, ventilator management, arterial line placement, and central line placement. CRNAs were more likely to experience an expansion of practice in states affected by removal of regulatory barriers. However, respondents also reported missed opportunities to use the full expertise of CRNAs because of state and institutional restrictions. Findings from the qualitative component of this study are reported in a separate article.
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Affiliation(s)
- Vicki Callan
- is an associate professor at Webster University in St Louis, Missouri, and the director of clinical education for the Department of Nurse Anesthesia.
| | - Ladan Eshkevari
- is an associate professor at Georgetown University in Washington, DC, and program director of the Doctorate of Nurse Anesthesia Practice program
| | | | - Leslie Jeter
- is an instructor at the Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, and a practicing CRNA in Georgia
| | | | - Lori Schirle
- is an assistant professor of research at Vanderbilt University School of Nursing in Nashville, Tennessee
| | - Jill Stulce
- is an associate professor at Webster University in St Louis, Missouri, and program director for the Department of Nurse Anesthesia
| | - Ruby L Hoyem
- is a research associate for the Research and Quality Division of the American Association of Nurse Anesthesiology in Park Ridge, Illinois
| | - Marjorie Everson
- is a limited faculty member of The Johns Hopkins University DNP Nurse Anesthesia Track and a clinician at Benefis Hospital, Great Falls, Montana
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13
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McLachlan A, Aldridge C, Morgan M, Lund M, Gabriel R, Malez V. An NP-led pilot telehealth programme to facilitate guideline-directed medical therapy for heart failure with reduced ejection fraction during the COVID-19 pandemic. N Z Med J 2021; 134:77-88. [PMID: 34239147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIMS Heart failure with reduced ejection fraction (HFrEF) is associated with poor outcomes. While several medications are beneficial, achieving optimal guideline-directed medical therapy (GDMT) is challenging. COVID-19 created a need to explore new ways to deliver care. METHODS Fifty consecutive patients were taught to identify fluid congestion and monitor their vital signs using BP monitors and electronic scales with NP-led telephone support. Quantitative data were collected and a patient experience interview was performed. RESULTS The majority (76%) of the cohort (male, 76%; Māori/Pacific, 58%) had a new diagnosis of HFrEF, with 90% having severe left ventricular (LV) dysfunction. There were 216 contacts (129 (60%) by telephone), which eliminated travelling, (time saved, 2.12 hours per patient), petrol costs ($58.17 per patient), traffic pollution (607 Kg of CO2) and time off work. Most (75%) received contact within two weeks and 75% were optimally titrated within two months. Improvements in systolic BP (SBP) (124mmHg to 116mmHg), pulse (78 bpm to 70 bpm) and N-terminal pro-brain natriuretic peptide (NT-proBNP) (292 to 65) were identified. Of the 43 patients who had a follow-up transthoracic echocardiogram (TTE), 33 (77%) showed important improvement in left ventricular ejection fraction (LVEF). CONCLUSIONS Patients found the process acceptable and experienced rapid titration with less need for clinic review with titration rates comparable with most real-world reports.
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Zeleke S, Kassaw A, Eshetie Y. Non-pharmacological pain management practice and barriers among nurses working in Debre Tabor Comprehensive Specialized Hospital, Ethiopia. PLoS One 2021; 16:e0253086. [PMID: 34129616 PMCID: PMC8205171 DOI: 10.1371/journal.pone.0253086] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pain is an unpleasant sensory and emotional experience associated with or resembling that actual or potential tissue damage. Different study findings show that about 55% to 78.6% of inpatients experience moderate-to-severe pain. Nurses are one of the health professional who may hear of pain suffered by the patients and who can manage patient suffering by themselves. Therefore, their correct skill is very important in non- pharmacology and pharmacology pain management methods. OBJECTIVE To assess non-pharmacological pain management practice and barriers among nurses working in Debre Tabor Comprehensive Specialized Hospital, Ethiopia. METHODS Data were collected using structured observational check list with interviewer administered questionnaires that measure nurses' practice on non-pharmacological pain management. Data were entered using Epi Data version 3.1 and analyzed using SPSS (Stastical Package for Social Sciences) version 23. Bivariable and multivariable analysis were conducted to examine the association between independent and outcome variables. RESULTS A total of 169 nurses participated in the study, with a response rate of 100%. Among the study participants 94 (55.6%) were females, and the mean age of nurses were 34.9(SD = 5.7) years. Only 44(26%) of nurses had good practice on non- pharmacology pain management methods. About 130(77.55%), 125(74.0%), and 123(72.8%) of nurses reported that inadequate cooperation of physicians, multiple responsibilities of nurses and insufficient number of nurses per patient ratio as barriers for practice of non -pharmacology pain management respectively. CONCLUSION Majority of nurses didn't apply non-pharmacological pain management practices for their patients in pain and the overall practice level of nurses was very poor. The major identified obstacle factors for the poor practice of non-pharmacological pain management methods were nurses' fatigue, inadequate cooperation of physicians, heavy workload, multiple responsibilities of nurses, and insufficient number of nurses per patient ratio and unfavorable attitude of nurse on non-pharmacology pain management. Even if nurses experiences different challenges, they shall use non-pharmacological pain management methods complementary to pharmacological treatment of pain as they are low cost and safe. And also boosting nurse's attitude towards the effect of non-pharmacological pain management methods is crucial.
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Affiliation(s)
- Shegaw Zeleke
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Departments of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yeshambaw Eshetie
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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15
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Porter I, Davey A, Gangannagaripalli J, Evans J, Bramwell C, Evans P, Gibbons C, Valderas JM. Integrating Patient Reported Outcome Measures (PROMs) into routine nurse-led primary care for patients with multimorbidity: a feasibility and acceptability study. Health Qual Life Outcomes 2021; 19:133. [PMID: 33902607 PMCID: PMC8074460 DOI: 10.1186/s12955-021-01748-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The use of Patient Reported Outcome Measures (PROMS) in clinical practice has the potential to promote patient-centred care and improve patients' quality of life. Individualized PROMs may be particularly helpful in identifying, prioritizing and monitoring health problems of patients with multimorbidity. We aimed to develop an intervention centred around PROMs feedback as part of Primary Care annual reviews for patients with multimorbidity and evaluate its feasibility and acceptability. METHODS We developed a nurse-oriented intervention including (a) training of nurses on PROMs; (b) administration to patients with multimorbidity of individualized and standardized PROMS; and (c) feedback to both patients and nurses of PROMs scores and interpretation guidance. We then tailored the intervention to patients with two or more highly prevalent conditions (asthma, COPD, diabetes, heart failure, depression, and hip/knee osteoarthritis) and designed a non-controlled feasibility and acceptability evaluation in a convenience sample of primary care practices (5). PROMs were administered and scores fed back immediately ahead of scheduled annual reviews with nurses. Patients and nurses rated the acceptability of the intervention using with a brief survey including optional free comments. Thematic analysis of qualitative interviews with a sample of participating patients (10) and nurses (4) and of survey free comments was conducted for further in-depth evaluation of acceptability. Feasibility was estimated based on rates of participation and completion. RESULTS Out of 68 recruited patients (mean age 70; 47% female), 68 completed the PROMs (100%), received feedback (100%) and confirmed nurse awareness of their scores (100%). Most patients (83%) "agreed"/"strongly agreed" that the PROMs feedback had been useful, a view supported by nurses in 89% of reviews. Thematic analysis of rich qualitative data on PROMS administration, feedback and role in annual reviews indicated that both patients and nurses perceived the intervention as acceptable and promising, emphasizing its comprehensiveness and patient-centredness. CONCLUSIONS We have developed and tested an intervention focusing on routine PROM assessment of patients with multimorbidity in Primary Care. Preliminary findings support its feasibility and a high degree of acceptability from both patients and nurses. The next step is to conduct a full-scale trial for evaluating the effectiveness of the proposed intervention.
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Affiliation(s)
- Ian Porter
- Health Services and Policy Research, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Magdalen Campus, Smeall Building, Room JS02, Exeter, EX1 2LU, UK.
| | - Antoinette Davey
- Health Services and Policy Research, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Magdalen Campus, Smeall Building, Room JS02, Exeter, EX1 2LU, UK
| | | | - Jonathan Evans
- Health Services and Policy Research, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Magdalen Campus, Smeall Building, Room JS02, Exeter, EX1 2LU, UK
| | - Charlotte Bramwell
- Health Services and Policy Research, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Magdalen Campus, Smeall Building, Room JS02, Exeter, EX1 2LU, UK
| | - Philip Evans
- Health Services and Policy Research, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Magdalen Campus, Smeall Building, Room JS02, Exeter, EX1 2LU, UK
- NIHR Clinical Research Network, England, UK
| | - Chris Gibbons
- Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose M Valderas
- Health Services and Policy Research, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Magdalen Campus, Smeall Building, Room JS02, Exeter, EX1 2LU, UK
- St Leonard's Practice, Exeter, UK
- NIHR PenARC, University of Exeter, Exeter, UK
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Abstract
Catherine is an advanced nurse practitioner working in a large general practice in the North of England. Today she is running a travel clinic. Because of the immense changes brought about by COVID-19 the world is struggling to regain a degree of normality and the possibility of travel to distant places is liberating to many. More than ever medical advice about safety precautions are necessary. Marc and Emma are consulting Catherine about a projected holiday abroad.
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Affiliation(s)
- Ghislaine Young
- c/o La revue de l'infirmière, 65, rue Camille-Desmoulins, 92442 Issy-les-Moulineaux cedex, France.
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Mysore P, Khinkar RM, McLaughlin D, Desai S, McMahon GM, Ulbricht C, Mendu ML. Improving hepatitis B vaccination rates for advanced chronic kidney disease patients: a quality improvement initiative. Clin Exp Nephrol 2021; 25:501-508. [PMID: 33411114 PMCID: PMC7788540 DOI: 10.1007/s10157-020-02013-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
Introduction Chronic kidney disease (CKD) patients are vulnerable to hepatitis B, and immunization prior to end stage kidney disease is recommended to optimize seroconversion. Our institution undertook a process improvement approach to increase hepatitis B vaccination in stage 4 and 5 CKD patients. Methods Four strategies were utilized such as: (1) Electronic health record (EHR)-based CKD registry to identify patients, (2) EHR-based physician/nurse reminders, (3) a co-located nurse appointment for vaccine administration, and (4) information sharing and provider awareness effort. The CKD registry was utilized to identify patients with stage 4 or 5 CKD, with at least two clinic visits in the prior 2 years, who had not received the hepatitis B vaccine or did not have serologic evidence of immunity. Target monthly vaccination rate was set at 75%, based on clinic leadership, nephrologist, and nurse consensus. Results A total of 239 patients were included in the study period, from November 2018 to January 2019 (observation period) and from February 2019 to September 2019 (intervention period). Monthly vaccination rate improved from 48% in November 2018 to the target rate of 75% by the end of the intervention (August and September 2019). There was a statistically significant increase from the rate of vaccination at a unique patient level in the first month of the baseline period, compared to the last month of the intervention period (51 vs. 75% p = 0.03). Conclusions Utilizing a nurse-led approach to hepatitis B vaccination, coupled with EHR-based tools, along with continuous monitoring of performance, helped to improve hepatitis B vaccination among CKD stage 4 and 5 patients. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-020-02013-4.
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Affiliation(s)
- Priyanka Mysore
- Department of Nephrology, Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada
| | - Roaa M Khinkar
- Department of Clinical Pharmacy, College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
- Department of Quality and Safety, Brigham and Women's Hospital, Harvard Medical School, One Brigham Circle, Second Floor, Office No. BC-2-WS 34, 1620 Tremont Street, Boston, MA, 02120, USA.
| | - Donna McLaughlin
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sonali Desai
- Department of Quality and Safety, Brigham and Women's Hospital, Harvard Medical School, One Brigham Circle, Second Floor, Office No. BC-2-WS 34, 1620 Tremont Street, Boston, MA, 02120, USA
- Rheumatology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gearoid M McMahon
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Catherine Ulbricht
- Department of Quality and Safety, Brigham and Women's Hospital, Harvard Medical School, One Brigham Circle, Second Floor, Office No. BC-2-WS 34, 1620 Tremont Street, Boston, MA, 02120, USA
| | - Mallika L Mendu
- Department of Quality and Safety, Brigham and Women's Hospital, Harvard Medical School, One Brigham Circle, Second Floor, Office No. BC-2-WS 34, 1620 Tremont Street, Boston, MA, 02120, USA
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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18
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Abstract
BACKGROUND Nurse practitioners (NPs) have been regulated primary care providers in British Columbia since 2005; however, many practices and contributions of NPs, especially those in northern or rural regions, remain unarticulated in primary health care. The objective of this study was to evaluate NP practices in the context of providing primary health care in northern BC. METHODS This was a qualitative-dominant mixed-methods study. We recruited NP participants working in northern BC; recruitment and data collection occurred between April and June 2018. Participants completed the validated 28-item Primary Health Care Engagement (PHCE) Scale to assess their perceptions of their workplace with 8 attributes of primary health care (quality improvement, community participation, patient-centred care, accessibility, intersectoral team, interdisciplinary collaboration, continuity and population orientation). We also interviewed NPs about their everyday practice. Transcribed data from the interviews were analyzed interpretively. RESULTS In total, 13 of 30 (43%) eligible NPs participated in the survey and interview. The PHCE Scale results showed that all NPs perceived their workplaces to be highly engaged in patient-centred care, but none reported their workplaces as accessible. Interview data were organized into 5 headings which described how NPs see patients who are medically and socially complex, address inequities in access, practice collaboratively, address local service gaps and improve patient abilities to access care. INTERPRETATION In interprofessional primary health care teams, NPs are key members and attend to both direct patient care and broader social conditions affecting health. Nurse practitioners can help accelerate advancements to deliver responsive community-based primary health care.
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Affiliation(s)
- Erin C Wilson
- School of Nursing (Wilson), University of Northern British Columbia; Northern Health (Wilson, Pammett, Bourque), Prince George, BC; Faculty of Pharmaceutical Sciences (Pammett), University of British Columbia, Vancouver, BC; BC Cancer Centre for the North (McKenzie), Prince George, BC
| | - Robert Pammett
- School of Nursing (Wilson), University of Northern British Columbia; Northern Health (Wilson, Pammett, Bourque), Prince George, BC; Faculty of Pharmaceutical Sciences (Pammett), University of British Columbia, Vancouver, BC; BC Cancer Centre for the North (McKenzie), Prince George, BC
| | - Farah McKenzie
- School of Nursing (Wilson), University of Northern British Columbia; Northern Health (Wilson, Pammett, Bourque), Prince George, BC; Faculty of Pharmaceutical Sciences (Pammett), University of British Columbia, Vancouver, BC; BC Cancer Centre for the North (McKenzie), Prince George, BC
| | - Helen Bourque
- School of Nursing (Wilson), University of Northern British Columbia; Northern Health (Wilson, Pammett, Bourque), Prince George, BC; Faculty of Pharmaceutical Sciences (Pammett), University of British Columbia, Vancouver, BC; BC Cancer Centre for the North (McKenzie), Prince George, BC
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Abstract
ABSTRACT In this latest article in the AJN series Back to Basics-developed to improve nurses' understanding and application of common laboratory diagnostic tests-the author delineates the meaning and function of complete blood count components, highlighting the important pathophysiological evidence they provide and using composite patient scenarios to assist nurses in recognizing findings that can inform their plan of care and produce the best patient outcomes.
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Affiliation(s)
- Lydia A Bertschi
- Lydia A. Bertschi is an assistant professor at Illinois Wesleyan University School of Nursing in Bloomington. Contact author: . The author and planners have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the author is available at www.ajnonline.com
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Song C, Li X, Ning X, Song S. Nursing case management for people with hypertension: A randomized controlled trial protocol. Medicine (Baltimore) 2020; 99:e23850. [PMID: 33350776 PMCID: PMC7769350 DOI: 10.1097/md.0000000000023850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore the effect of management of nursing case on blood pressure control in hypertension patients. METHOD This is a randomized controlled study which will be carried out from May 2021 to May 2022. The experiment was granted through the Research Ethics Committee of the People's Hospital of Chengyang District (03982808). Our research includes 200 patients. Patients who meet the following conditions will be included in this experiment: the patients aged 18 to 60 years; the patients had the diagnosis of hypertension; and the urban residents. While patients with the following conditions will be excluded: having renal failure, liver failure, heart and respiratory failure; and known pregnancy. Primary result is blood pressure, while secondary results are treatment compliance, waist circumference, body mass index (BMI), type and number of antihypertensive agents used, and the existence of metabolic and cardiovascular comorbidities. RESULTS Table 1 shows the clinical outcomes between the two groups. CONCLUSION Nursing case management is effective to improve the prognosis of hypertension patients.
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Jin L, Pan R, Huang L, Zhang H, Jiang M, Zhao H. Family nursing with the assistance of network improves clinical outcome and life quality in patients underwent coronary artery bypass grafting: A consolidated standards of reporting trials-compliant randomized controlled trial. Medicine (Baltimore) 2020; 99:e23488. [PMID: 33327282 PMCID: PMC7738076 DOI: 10.1097/md.0000000000023488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Family nursing with the assistance of network (FNAN) improves nurses' practice and provides family/community-oriented nursing care. This study aimed to explore the effects of FNAN on the clinical outcome and life quality of coronary atherosclerotic heart disease (CHD) patients underwent coronary artery bypass grafting (CABG). TRIAL DESIGN This study is a randomized, placebo-controlled and double-blind trial. METHODS One-hundred and twelve patients underwent CABG were randomly divided into control group (CG, routine family nursing care) and experimental group (EG, FNAN) and the allocation ratio was 1:1. The situation of anxiety and depression were analyzed using the Hamilton Anxiety Scale (HAMA) scale and Hamilton Depression Scale (HAMD). Sleep quality was measured by using Pittsburgh Sleep Quality Index (PSQI). Lung function parameters were measured, including minute ventilation (MVV), partial pressure of oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), oxygen saturation measurement by pulse oximetry (SpO2), forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). Life quality was measured by using Chronic Obstructive Pulmonary Disease Assessment Test (CAT). RESULTS After a 3-month intervention, 10 and 6 patients were lost in the CG and EG groups, respectively. The scores of HAMA, HAMD, PSQI and CAT were reduced in the EG group when compared with the CG group (P < .05). The values of MVV, PaO2, SpO2, FEV1 and FVC in the EG group was higher than those in the CG group whereas the levels of PaCO2 in the EG group was lower than those in the CG group (P < .05). PSQI score had a strong relationship with the values of MVV, PaO2, PaCO2, SpO2, FEV1, and FVC. CONCLUSION FNAN improves the clinical outcome and life quality in the patients underwent CABG.
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Burklow CM, Jones MS, Allen DT, Cherry SE, Jackson TJ, Dethridge KL, McClellan VH. A Nurse-Led Population-Based Health Education Project to Improve Infant Care Knowledge for an Old Order Mennonite Community. Nurs Womens Health 2020; 24:446-452. [PMID: 33147440 DOI: 10.1016/j.nwh.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/09/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
Population health is changing the focus of nursing practice as nurses are challenged to focus on health promotion and education for communities rather than limiting their practice to restorative care for individual acute care patients. This new focus is necessary to improve knowledge of maternal and infant health among vulnerable populations. One particularly vulnerable population is members of Old Order Mennonite communities, who frequently rely on self-trained local midwives in the community for home births and home remedies when caring for their infants. Providing evidence-based education to members of this isolated population can be a challenge because they do not typically access information outside of the community. The purpose of this article is to share the process of developing, publishing, and disseminating a culturally sensitive infant care manual for an Old Order Mennonite community using a community-based participatory model and to highlight the impact nursing outreach can have on improving health knowledge.
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Tsumura H, Broome ME, Taki M. Advancing Nurses' Role to Address Issues Facing Japanese Anesthesia Practice. AANA J 2020; 88:453-458. [PMID: 33218380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Japan is challenged with unique social problems because of its declining birthrate and rapidly aging population. By the year 2025, all of Japan's baby boomers will be 75 years or older, making Japan a "superaging" society. Japanese healthcare expenditures are rapidly climbing because of the need for increasingly complex medical-surgical treatments for this aging population. In addition, a major shortage of anesthesiologists has produced serious threats to patient safety, as well as to quality and timeliness of surgical care. In an attempt to meet the demand for anesthesia services and to ensure access and quality care, the Japanese Ministry of Health, Labor and Welfare has identified a potential role for nurses as anesthesia practitioners, as an innovative solution. Nurse and physician educators in Japan have begun educating and training nurses in the practice of anesthesia; however, nationally recognized licensure or certification does not yet exist for graduates of these programs. The purpose of this article is to review the unique challenges facing Japan's anesthesia practice and to make recommendations about the potential introduction of nurse anesthetists in Japan.
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Affiliation(s)
- Hideyo Tsumura
- is a PhD student at Duke University School of Nursing, Durham, North Carolina.
| | - Marion E Broome
- is the dean and vice-chancellor for nursing affairs, School of Nursing, Duke University, Durham, North Carolina
| | - Mai Taki
- is the director of the Health Education and Guidance Department, Rakuwakai Healthcare Center, Kyoto, Japan
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Roschkov S, Chik CL. A Nurse Practitioner-Led Multidisciplinary Diabetes Clinic for Adult Patients Discharged From Hospital. Can J Diabetes 2020; 45:566-570. [PMID: 33388273 DOI: 10.1016/j.jcjd.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES In this study, we evaluated the feasibility of a nurse practitioner-led outpatient clinic (NPC) to facilitate the safe transition of patients with diabetes receiving insulin therapy between hospital and the community. METHODS An NPC was set up to manage patients who had diabetes education in hospital and who were discharged on insulin. In addition to patient demographics and admission diagnosis, days seen postdischarge, duration of follow up, diabetes interventions and discharge care plan were recorded. For quality improvement, patients were asked to complete a questionnaire at the time of discharge from the NPC. RESULTS Within a 12-month period, 71 patients with diabetes attended the NPC 3 to 21 days after discharge and they were followed for 1 to 98 days. Thirteen patients required management of hypoglycemia and 56 patients had adjustment of medications to basal/prandial insulin or switched to oral antihyperglycemic agents. Fifty-four patients were returned to the care of their family physicians and 18 patients required a referral to a diabetes specialist. A postclinic questionnaire indicated that the clinic enabled patients to improve management of their diabetes. However, communication of the diabetes management plan to the family physician was an identified concern. CONCLUSIONS An NPC clinic can provide timely management and is a viable option to ensure safe transition of patients with diabetes from hospital back to their family physicians.
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Affiliation(s)
- Sylvia Roschkov
- Division of Endocrinology & Metabolism, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Constance L Chik
- Division of Endocrinology & Metabolism, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Maltinsky W, Swanson V. Behavior change in diabetes practitioners: An intervention using motivation, action planning and prompts. Patient Educ Couns 2020; 103:2312-2319. [PMID: 32402490 DOI: 10.1016/j.pec.2020.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES It is important for health professionals to have behavior change skills to empower people to manage long-term-conditions. Theoretically derived, competency-based training can be particularly effective where it considers reflective and automatic routes to behavior change. The aim of this study was to develop, deliver and evaluate a motivational, action and prompting behavior change skills intervention for diabetes health practitioners in Scotland, UK. METHODS This was a longitudinal intervention study. A 2-day intervention was delivered to 99 health professionals. Participants set behavioral goals to change practice, completing action and coping plans post-training. Motivation and plan quality were evaluated in relation to goal achievement at 6-week follow-up. RESULTS Post-training, practitioners could develop high quality work-related action and coping plans, which they were motivated to enact. Although under half responded at follow-up, most reported successful goal achievement. There was no difference in plan quality for goal achievers, non-achievers and non-responders. Barriers and facilitators of behavior change included institutional, service-user and individual factors. CONCLUSIONS The intervention successfully used planning to implement participants' behaviour change goals. PRACTICE IMPLICATIONS Planning interventions are helpful to support clinicians to change their practice to help people self-manage diabetes care but may not fit demands of day-to-day clinical practice.
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Affiliation(s)
- Wendy Maltinsky
- Centre for Health and Behaviour Change, Psychology Division, University of Stirling, Stirling FK9 4LA, United Kingdom.
| | - Vivien Swanson
- Centre for Health and Behaviour Change, Psychology Division, University of Stirling, Stirling FK9 4LA, United Kingdom
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Key J, Hoare K. Nurse prescribing in New Zealand-the difference in levels of prescribing explained. N Z Med J 2020; 133:111-118. [PMID: 33119574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article discusses the three types of nurse prescriber currently registered in New Zealand (nurse practitioners, registered nurse prescribers (RNP) in primary health and specialty teams and registered nurse prescribers (RNPCH) in community health). It also provides an overview of the evolution of each group, as well as a summary of the current legislation, prescribing restrictions and models of supervision required for each type of prescriber.
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Affiliation(s)
- Jane Key
- Senior Lecturer/Nurse Practitioner, School of Nursing, College of Health, Massey University/Waitemata DHB, Auckland
| | - Karen Hoare
- Associate Professor/Nurse Practitioner School of Nursing, College of Health, Massey University/Greenstone Family Clinic, Auckland
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Yapa HM, De Neve JW, Chetty T, Herbst C, Post FA, Jiamsakul A, Geldsetzer P, Harling G, Dhlomo-Mphatswe W, Moshabela M, Matthews P, Ogbuoji O, Tanser F, Gareta D, Herbst K, Pillay D, Wyke S, Bärnighausen T. The impact of continuous quality improvement on coverage of antenatal HIV care tests in rural South Africa: Results of a stepped-wedge cluster-randomised controlled implementation trial. PLoS Med 2020; 17:e1003150. [PMID: 33027246 PMCID: PMC7540892 DOI: 10.1371/journal.pmed.1003150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 06/25/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Evidence for the effectiveness of continuous quality improvement (CQI) in resource-poor settings is very limited. We aimed to establish the effects of CQI on quality of antenatal HIV care in primary care clinics in rural South Africa. METHODS AND FINDINGS We conducted a stepped-wedge cluster-randomised controlled trial (RCT) comparing CQI to usual standard of antenatal care (ANC) in 7 nurse-led, public-sector primary care clinics-combined into 6 clusters-over 8 steps and 19 months. Clusters randomly switched from comparator to intervention on pre-specified dates until all had rolled over to the CQI intervention. Investigators and clusters were blinded to randomisation until 2 weeks prior to each step. The intervention was delivered by trained CQI mentors and included standard CQI tools (process maps, fishbone diagrams, run charts, Plan-Do-Study-Act [PDSA] cycles, and action learning sessions). CQI mentors worked with health workers, including nurses and HIV lay counsellors. The mentors used the standard CQI tools flexibly, tailored to local clinic needs. Health workers were the direct recipients of the intervention, whereas the ultimate beneficiaries were pregnant women attending ANC. Our 2 registered primary endpoints were viral load (VL) monitoring (which is critical for elimination of mother-to-child transmission of HIV [eMTCT] and the health of pregnant women living with HIV) and repeat HIV testing (which is necessary to identify and treat women who seroconvert during pregnancy). All pregnant women who attended their first antenatal visit at one of the 7 study clinics and were ≥18 years old at delivery were eligible for endpoint assessment. We performed intention-to-treat (ITT) analyses using modified Poisson generalised linear mixed effects models. We estimated effect sizes with time-step fixed effects and clinic random effects (Model 1). In separate models, we added a nested random clinic-time step interaction term (Model 2) or individual random effects (Model 3). Between 15 July 2015 and 30 January 2017, 2,160 participants with 13,212 ANC visits (intervention n = 6,877, control n = 6,335) were eligible for ITT analysis. No adverse events were reported. Median age at first booking was 25 years (interquartile range [IQR] 21 to 30), and median parity was 1 (IQR 0 to 2). HIV prevalence was 47% (95% CI 42% to 53%). In Model 1, CQI significantly increased VL monitoring (relative risk [RR] 1.38, 95% CI 1.21 to 1.57, p < 0.001) but did not improve repeat HIV testing (RR 1.00, 95% CI 0.88 to 1.13, p = 0.958). These results remained essentially the same in both Model 2 and Model 3. Limitations of our study include that we did not establish impact beyond the duration of the relatively short study period of 19 months, and that transition steps may have been too short to achieve the full potential impact of the CQI intervention. CONCLUSIONS We found that CQI can be effective at increasing quality of primary care in rural Africa. Policy makers should consider CQI as a routine intervention to boost quality of primary care in rural African communities. Implementation research should accompany future CQI use to elucidate mechanisms of action and to identify factors supporting long-term success. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov under registration number NCT02626351.
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Affiliation(s)
- H. Manisha Yapa
- The Kirby Institute, University of New South Wales Sydney, NSW, Australia
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- * E-mail:
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Terusha Chetty
- Health systems Research Unit, South African Medical Research Council, Durban, South Africa
| | - Carina Herbst
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Frank A. Post
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Awachana Jiamsakul
- The Kirby Institute, University of New South Wales Sydney, NSW, Australia
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Guy Harling
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Wendy Dhlomo-Mphatswe
- School of Clinical Medicine, Discipline of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa
| | - Mosa Moshabela
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Philippa Matthews
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- Islington GP Federation, London, United Kingdom
| | - Osondu Ogbuoji
- Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Frank Tanser
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, United Kingdom
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Dickman Gareta
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Deenan Pillay
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Sally Wyke
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- Institute for Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Till Bärnighausen
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute for Global Health, University College London, London, United Kingdom
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Guilamo-Ramos V, Benzekri A, Thimm-Kaiser M, Abram M, Hagan H. Participation of the nursing workforce to address COVID-19 among people who use alcohol, tobacco, and drugs. Int J Drug Policy 2020; 83:102831. [PMID: 32654929 PMCID: PMC7332926 DOI: 10.1016/j.drugpo.2020.102831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, New York University, 15 Washington Place, New York, NY, USA; Adolescent AIDS Program, Children's Hospital at Montefiore Medical Center, 3514 Wayne Avenue, Bronx, NY, USA; Center for Drug Use and HIV Research, New York University, 665 Broadway, New York, NY, USA; U.S. Presidential Advisory Council on HIV/AIDS, Washington, DC, USA.
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, New York University, 15 Washington Place, New York, NY, USA
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, New York University, 15 Washington Place, New York, NY, USA; City University of New York, School of Public Health and Health Policy, New York, NY, USA
| | - Marissa Abram
- College of Nursing and Public Health, Adelphi University, 1 South Avenue, Garden City, NY, USA; Pulse Center for Patient Safety Education and Advocacy, PO Box 353, Wantagh, NY, USA
| | - Holly Hagan
- Center for Drug Use and HIV Research, New York University, 665 Broadway, New York, NY, USA; College of Global Public Health, New York University, 665 Broadway, New York, NY, USA
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Planning for the post-COVID-19 pandemic future: Considerations for NP education and practice. Nurse Pract 2020; 45:5. [PMID: 32639277 DOI: 10.1097/01.NPR.0000681808.78887.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Belnap BH, Anderson A, Abebe KZ, Ramani R, Muldoon MF, Karp JF, Rollman BL. Blended Collaborative Care to Treat Heart Failure and Comorbid Depression: Rationale and Study Design of the Hopeful Heart Trial. Psychosom Med 2020; 81:495-505. [PMID: 31083056 PMCID: PMC6602832 DOI: 10.1097/psy.0000000000000706] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Despite numerous improvements in care, morbidity from heart failure (HF) has remained essentially unchanged in recent years. One potential reason is that depression, which is comorbid in approximately 40% of hospitalized HF patients and associated with adverse HF outcomes, often goes unrecognized and untreated. The Hopeful Heart Trial is the first study to evaluate whether a widely generalizable telephone-delivered collaborative care program for treating depression in HF patients improves clinical outcomes. METHODS The Hopeful Heart Trial aimed to enroll 750 patients with reduced ejection fraction (HFrEF) (ejection fraction ≤ 45%) including the following: (A) 625 patients who screened positive for depression both during their hospitalization (Patient Health Questionnaire [PHQ-2]) and two weeks following discharge (PHQ-9 ≥ 10); and (B) 125 non-depressed control patients (PHQ-2(-)/PHQ-9 < 5). We randomized depressed patients to either their primary care physician's "usual care" (UC) or to one of two nurse-delivered 12-month collaborative care programs for (a) depression and HFrEF ("blended") or (b) HrEFF alone (enhanced UC). Our co-primary hypotheses will test whether "blended" care can improve mental health-related quality of life versus UC and versus enhanced UC, respectively, on the Mental Component Summary of the Short-Form 12 Health Survey. Secondary hypotheses will evaluate the effectiveness of our interventions on mood, functional status, hospital readmissions, deaths, provision of evidence-based care for HFrEF, and treatment costs. RESULTS Not applicable. CONCLUSIONS The Hopeful Heart Trial will determine whether "blended" collaborative care for depression and HFrEF is more effective at improving patient-relevant outcomes than collaborative care for HFrEF alone or doctors' UC for HFrEF. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02044211.
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Affiliation(s)
- Bea Herbeck Belnap
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
| | - Amy Anderson
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kaleab Z. Abebe
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Clinical Trials & Data Coordination, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ravi Ramani
- Cardiovascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mathew F. Muldoon
- Cardiovascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jordan F. Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Bruce L. Rollman
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Patel S, Achana F, Carnes D, Eldridge S, Ellard DR, Griffiths F, Haywood K, Hee SW, Mistry D, Mistry H, Nichols VP, Petrou S, Pincus T, Potter R, Sandhu HK, Stewart K, Taylor S, Underwood M, Matharu M. Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: a randomised controlled trial protocol (CHESS). BMJ Open 2020; 10:e033520. [PMID: 32284387 PMCID: PMC7200026 DOI: 10.1136/bmjopen-2019-033520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic headaches are poorly diagnosed and managed and can be exacerbated by medication overuse. There is insufficient evidence on the non-pharmacological approaches to helping people living with chronic headaches. METHODS AND ANALYSIS Chronic Headache Education and Self-management Study is a pragmatic randomised controlled trial to test the effectiveness and cost-effectiveness of a self-management education support programme on top of usual care for patients with chronic headaches against a control of usual care and relaxation. The intervention is a 2-day group course based on education, personal reflection and a cognitive behavioural approach, plus a nurse-led one-to-one consultation and follow-up over 8 weeks. We aim to recruit 689 participants (356 to the intervention arm and 333 to the control) from primary care and self-referral in London and the Midlands. The trial is powered to show a difference of 2.0 points on the Headache Impact Test, a patient-reported outcome measure at 12 months post randomisation. Secondary outcomes include health related quality of life, self-efficacy, social activation and engagement, anxiety and depression and healthcare utilisation. Outcomes are being measured at 4, 8 and 12 months. Cost-effectiveness will be expressed in terms of incremental cost per quality-adjusted life year gained. ETHICS AND DISSEMINATION This trial will provide data on effectiveness and cost-effectiveness of a self-management support programme for chronic headaches. The results will inform commissioning of services and clinical practice. North West - Greater Manchester East Research Ethics Committee have approved the trial. The current protocol version is 3.6 date 7 March 2019. TRIAL REGISTRATION NUMBER ISRCTN79708100.
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Affiliation(s)
- Shilpa Patel
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Felix Achana
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - David R Ellard
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Kirstie Haywood
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Siew Wan Hee
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dipesh Mistry
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Hema Mistry
- Warwick Medical School, Warwick Evidence, University of Warwick, Coventry, UK
| | - Vivien P Nichols
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Rachel Potter
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Kimberley Stewart
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Stephanie Taylor
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Martin Underwood
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Manjit Matharu
- University College London Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
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Abstract
Surgical site infections (SSIs) are some of the most common and costly health care-associated infections. Although the rate of SSIs has declined significantly in the past decade, patient safety remains at risk. Perioperative nurses employ a variety of evidence-based best practices to prevent SSIs and facilitate a safe surgical experience for their patients, including hand hygiene, preoperative patient skin antisepsis, and antimicrobial irrigation. This article explores the causes of SSIs, such as modifiable and nonmodifiable patient factors and preoperative, intraoperative, and postoperative procedural factors, and discusses some of the specific recommended strategies related to the prevention of SSIs that perioperative nurses can initiate in their workplace.
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Cieslak JR, Rice AN, Gadsden JC, Vacchiano CA. Does Ultrasonographic Measurement of Gastric Content Influence Airway Management Decisions? AANA J 2020; 88:107-113. [PMID: 32234201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The presence of gastric content before induction of general anesthesia is the primary modifiable risk factor in the prevention of pulmonary aspiration. The purpose of this project was to determine if ultrasonography could be routinely used to measure gastric content and assign aspiration risk in patients undergoing general anesthesia. Preoperative gastric ultrasonography was performed in a convenience sample of 100 patients. A group of Certified Registered Nurse Anesthetists, anesthesia residents, and anesthesiologists were asked their plan for airway management before and after receiving the results of the patients' gastric ultrasonogram, to determine if the scan would alter the plan. In 14% of patients scanned, solid gastric content was observed, 7% had clear liquids present, and 79% had an empty stomach. Of the patients with clear liquids present, 3 had substantial (> 100 mL) gastric content despite following fasting guidelines. Overall, there was a 9% change in airway management from standard induction: 6% changed to modified rapid sequence intubation (no ventilation, no cricoid pressure), and 3% changed to rapid sequence intubation with cricoid pressure. The number of changes to the airway management plan and identification of several patients with substantial gastric content demonstrate the value of preoperative gastric ultrasonography in airway management decision making.
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Affiliation(s)
- Jamie R Cieslak
- was a student at Duke University School of Nursing, Durham, North Carolina, at the time of writing this article and is now a CRNA at Northwestern Memorial Hospital in Chicago
| | - Andi N Rice
- is a consulting associate for the Duke University Nurse Anesthesia Program. Andi has practiced as a CRNA in academic institutions, community hospitals, and outpatient and office-based practices since 2012
| | - Jeffrey C Gadsden
- is an associate professor of anesthesiology; chief of Division of Orthopedics, Plastics, and Regional Anesthesiology; and director of Regional Anesthesiology and Acute Pain Medicine Fellowship at Duke University Hospital, Durham, North Carolina
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McMurray R, Becker L, Olsen KF, McMurray M. Airway Management for Deep Sedation: Current Practice, Limitations, and Needs as Identified by Clinical Observation and Survey Results. AANA J 2020; 88:123-129. [PMID: 32234203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Using deep sedation, adjunct airway devices such as oral or nasal airways are frequently required to maintain airway patency. Traditional oral airways (TOAs, made of rigid plastic) or nasal airways (made of pliable materials) can be associated with adverse effects, contributing to a trend of anesthesia providers placing nasal airways orally. A clinical observational study and an electronic provider survey were conducted to examine this emerging practice. The observation study objective was to investigate reported postoperative sore throat occurrence associated with use of either a nontraditional airway (nasal airway used orally) or TOA in deep sedation procedures (N = 243). Patients receiving nontraditional airways reported significantly less postoperative sore throat than those receiving TOAs (17% vs 40%, respectively; P < .001). These results prompted a broader exploration into airway practices of anesthesia providers via an electronic survey. Most respondents (n = 293) reported adverse effects, including gagging/coughing on insertion, oral cavity injury, and bleeding with TOAs. More than half (52.8%) reported using nasal airways orally. These results suggest a clinical void in current airway management options for deep sedation. Providers indicated the need for airway devices that provide a patent airway while mitigating adverse effects associated with commonly used airways.
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Affiliation(s)
- Roxanne McMurray
- is an assistant program director, Nurse Anesthesia specialty, and a clinical assistant professor at the University of Minnesota School of Nursing in Minneapolis, Minnesota, and is a staff anesthetist with Community Anesthesia Professionals, a department of Minnesota Gastroenterology PA in St Paul, Minnesota
| | - Logan Becker
- is a staff anesthetist for Glencoe Regional Health Services in Glencoe, Minnesota. He is also affiliate faculty at the University of Minnesota School of Nursing
| | - Kelley Frost Olsen
- is a staff anesthetist for Sanford Bemidji Medical Center in Bemidji, Minnesota
| | - Megan McMurray
- is a current resident at Southern Illinois University in Springfield, Illinois
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Affiliation(s)
- Ian Peate
- Editor in Chief, British Journal of Nursing
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de Gouveia Belinelo P, Nielsen A, Goddard B, Platt L, Da Silva Sena CR, Robinson PD, Whitehead B, Hilton J, Gulliver T, Roddick L, Pearce K, Murphy VE, Gibson PG, Collison A, Mattes J. Clinical and lung function outcomes in a cohort of children with severe asthma. BMC Pulm Med 2020; 20:66. [PMID: 32188435 PMCID: PMC7081619 DOI: 10.1186/s12890-020-1101-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 02/28/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Uncontrolled severe asthma in children is burdensome and challenging to manage. This study aims to describe outcomes in children with uncontrolled severe asthma managed in a nurse-led severe asthma clinic (SAC). METHODS This retrospective analysis uses data collected from children referred by a paediatric respiratory specialist to a nurse-led SAC for uncontrolled severe asthma between 2014 and 2019. The pre-clinical assessments included a home visit to assess modifiable factors that could be addressed to improve control. A comprehensive lung function analysis was conducted at each visit. Interventions were personalised and included biologic agents. Statistical analysis was performed using nonparametric, two-tailed Mann-Whitney U-test, the parametric Student's t-test, or analysis of variance (ANOVA) as appropriate. RESULTS Twenty-three children with a median age of 12 years were seen once, and 16 were followed up. Compared to a non-asthmatic (NA) and asthmatic (A) age-matched cohort, children with severe asthma (SA) had a lower FEV1, and FVC% predicted before and after bronchodilator inhalation, and a higher mean Lung Clearance Index [LCI] (10.5 [SA] versus 7.3 [NA] versus 7.6 [A], p = 0.003). Almost 80% of children with SA had an abnormal LCI, and 48% had a reduced FEV1% at the first SAC visit. Asthma control and FEV1% predicted significantly improved at a follow-up visit, while LCI remained abnormal in the majority of children (83%). CONCLUSION Over time, many children with severe asthma showed improved clinical outcomes and lung function while lung ventilation inhomogeneities persisted. Future appropriately controlled studies are required to determine if a nurse-led multidisciplinary SAC is associated with better outcomes.
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Affiliation(s)
- Patricia de Gouveia Belinelo
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Aleisha Nielsen
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Bernadette Goddard
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Lauren Platt
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Carla Rebeca Da Silva Sena
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Bruce Whitehead
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Jodi Hilton
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Tanya Gulliver
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Laurence Roddick
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Kasey Pearce
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Vanessa E Murphy
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
| | - Peter G Gibson
- Priority Research Centre Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
- Respiratory & Sleep Medicine Department, John Hunter Hospital, Newcastle, Australia
| | - Adam Collison
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
| | - Joerg Mattes
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia.
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia.
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Li XX, Du XW, Song W, Lu C, Hao WN. Effect of continuous nursing care based on the IKAP theory on the quality of life of patients with chronic obstructive pulmonary disease: A randomized controlled study. Medicine (Baltimore) 2020; 99:e19543. [PMID: 32176107 PMCID: PMC7440075 DOI: 10.1097/md.0000000000019543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore the effect of continuous nursing care based on the Information, Knowledge, Attitude, and Practice (IKAP) theory on the quality of life of patients with chronic obstructive pulmonary disease (COPD). METHODS This study is a randomized control trial. COPD patients attending the Affiliated Hospital of Inner Mongolia Medical University, China between July 1 and October 31, 2017 were eligible. Following random assignment of participants to either the intervention group or control group, 70 patients (35 in each group) were included in the final sample. The intervention group received nursing care based on the Information, Knowledge, Attitude, and Practice theory, while the control group received standard nursing care. Data were collected before the intervention, 1 month after the intervention, and three months after the intervention. The St. George's Respiratory Questionnaire (SGRQ) was used to measure quality of life. RESULTS Three months after the intervention, there were significant differences in the total SGRQ score (20.29 ± 10.03 vs 30.14 ± 12.52) and in the three SGRQ dimensions between the intervention group and the control group (P < .05). A repeated-measures analysis of variance showed that the total SGRQ score and the scores for impact and symptoms had a significant time effect (P < .001), that the total SGRQ score and the score for symptoms had a significant interaction effect (P < .05), and that the impact dimension had a significant group effect (P = .042). Pairwise comparisons of the data for the intervention group showed that there were significant differences between the pre-intervention and 1 month after intervention scores as well as between pre-intervention and three months after intervention, for the total SGRQ scores and the scores for impact and symptoms(P < .001). In terms of the impact dimension, there was a significant difference in the intervention group between 1 month after intervention and 3 months after intervention (P = .016). CONCLUSION Continuous nursing care based on Information, Knowledge, Attitude, and Practice theory improved quality of scores at 3 months after intervention among COPD patients. Given limitations of the study, future large-scale studies are needed to validate our results.
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Affiliation(s)
- Xin-Xia Li
- Department of Nursing, Affiliated Hospital of Inner Mongolia Medical University, Hohhot
| | - Xue-Wei Du
- School of nursing, Inner Mongolia Medical University, Hohhot
| | - Wen Song
- School of nursing, Inner Mongolia Medical University, Hohhot
| | - Chang Lu
- School of nursing, Inner Mongolia Medical University, Hohhot
| | - Wen-Nv Hao
- Emergency Department, Affiliated Hospital of Inner Mongolia medical university, Hohhot, Inner Mongolia Autonomous Region, China
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Boninger ML, Davison J, Saxon S. How Nurse Practitioners Spend their Time in Nursing Facilities: Revisited 20 Years Later. J Am Geriatr Soc 2020; 68:892-894. [PMID: 32037521 DOI: 10.1111/jgs.16368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/16/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Michael L Boninger
- UPMC Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Clinical and Translational Science Institute, Pittsburgh, Pennsylvania
| | - Jennifer Davison
- UPMC Senior Communities within the UPMC Geriatric Division, UPMC Palliative and Supportive Institute, Pittsburgh, Pennsylvania
| | - Susan Saxon
- UPMC Palliative and Supportive Institute, UPMC Home Care Management Services, UPMC Advanced Practice Providers, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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Akiboye F, Adderley NJ, Martin J, Gokhale K, Rudge GM, Marshall TP, Rajendran R, Nirantharakumar K, Rayman G. Impact of the Diabetes Inpatient Care and Education (DICE) project on length of stay and mortality. Diabet Med 2020; 37:277-285. [PMID: 31265148 DOI: 10.1111/dme.14062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 01/09/2023]
Abstract
AIM To determine whether the Diabetes Inpatient Care and Education (DICE) programme, a whole-systems approach to managing inpatient diabetes, reduces length of stay, in-hospital mortality and readmissions. RESEARCH DESIGN AND METHODS Diabetes Inpatient Care and Education initiatives included identification of all diabetes admissions, a novel DICE care-pathway, an online system for prioritizing referrals, use of web-linked glucose meters, an enhanced diabetes team, and novel diabetes training for doctors. Patient administration system data were extracted for people admitted to Ipswich Hospital from January 2008 to June 2016. Logistic regression was used to compare binary outcomes (mortality, 30-day readmissions) 6 months before and after the intervention; generalized estimating equations were used to compare lengths of stay. Interrupted time series analysis was performed over the full 7.5-year period to account for secular trends. RESULTS Before-and-after analysis revealed a significant reduction in lengths of stay for people with and without diabetes: relative ratios 0.89 (95% CI 0.83, 0.97) and 0.93 (95% CI 0.90, 0.96), respectively; however, in interrupted time series analysis the change in long-term trend for length of stay following the intervention was significant only for people with diabetes (P=0.017 vs P=0.48). Odds ratios for mortality were 0.63 (0.48, 0.82) and 0.81 (0.70, 0.93) in people with and without diabetes, respectively; however, the change in trend was not significant in people with diabetes, while there was an apparent increase in those without diabetes. There was no significant change in 30-day readmissions, but interrupted time series analysis showed a rising trend in both groups. CONCLUSION The DICE programme was associated with a shorter length of stay in inpatients with diabetes beyond that observed in people without diabetes.
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Affiliation(s)
- F Akiboye
- Diabetes Research Unit, Ipswich Hospital NHS Trust, Ipswich, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - N J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - G M Rudge
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - T P Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R Rajendran
- Diabetes Research Unit, Ipswich Hospital NHS Trust, Ipswich, UK
| | - K Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - G Rayman
- Diabetes Research Unit, Ipswich Hospital NHS Trust, Ipswich, UK
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Eberly LA, Rusingiza E, Park PH, Ngoga G, Dusabeyezu S, Mutabazi F, Gahamanyi C, Ntaganda E, Kwan GF, Bukhman G. 10-Year Heart Failure Outcomes From Nurse-Driven Clinics in Rural Sub-Saharan Africa. J Am Coll Cardiol 2020; 73:977-980. [PMID: 30819366 DOI: 10.1016/j.jacc.2018.12.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 11/17/2022]
Abstract
Nurse-led delivery care models have the potential to address the significant burden of heart failure in sub-Saharan Africa. Starting in 2006, the Rwandan Ministry of Health, supported by Inshuti Mu Buzima (Partners In Health-Rwanda), decentralized heart failure diagnosis and care delivery in the context of advanced nurse-led integrated noncommunicable clinics at rural district hospitals. Here, the authors describe the first medium-term survival outcomes from the district level in rural sub-Saharan Africa based on their 10-year experience providing care in rural Rwanda. Kaplan-Meier methods were used to determine median time to event for: 1) composite event of known death from any cause, lost to follow-up, or transfer to estimate worst-case mortality; and 2) known death only. Five-year event-free rates were 41.7% for the composite outcome and 64.3% for known death. While death rates are encouraging, efforts to reduce loss to follow-up are needed.
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Affiliation(s)
- Lauren A Eberly
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emmanuel Rusingiza
- Department of Pediatrics, Pediatric Cardiology Unit, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Paul H Park
- Partners in Health, Boston, Massachusetts; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | - Gene F Kwan
- Partners in Health, Boston, Massachusetts; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Section of Cardiology, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Gene Bukhman
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Partners in Health, Boston, Massachusetts; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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Mane A. Double Gloving and Infection Control. AANA J 2020; 88:2-3. [PMID: 32008610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Science and Clinical Potpourri for Your Life and Your Practice. AANA J 2020; 88:9-10. [PMID: 32008612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Ylönen M, Viljamaa J, Isoaho H, Junttila K, Leino-Kilpi H, Suhonen R. Congruence between perceived and theoretical knowledge before and after an internet-based continuing education program about venous leg ulcer nursing care. Nurse Educ Today 2019; 83:104195. [PMID: 31734538 DOI: 10.1016/j.nedt.2019.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/13/2019] [Accepted: 08/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Previous research has revealed nurses' knowledge gaps in venous leg ulcer (VLU) nursing care, and continuing education is needed. The closer nurses' perceived knowledge is to their evidence-based theoretical knowledge, the better possibilities they have to conduct evidence-based VLU nursing care. OBJECTIVES To assess the congruence between nurses' perceived and theoretical knowledge about VLU nursing care before and after an internet-based education about VLU nursing care (eVLU). DESIGN Quasi-experimental study with intervention and comparison groups and pre- and post-measurements. SETTING Home health care in two Finnish municipalities. PARTICIPANTS Nurses (n = 946) working in home health care were invited to participate. In the intervention group, 239 nurses and 229 nurses in the comparison group met the inclusion criteria, and they were all recruited to the study. METHOD Nurses were divided into intervention and comparison groups with lottery between the municipalities. Nurses in both groups took care of patients with VLU according to their organizations' instructions. In addition to this, nurses in the intervention group received a 6-week eVLU while those in the comparison group did not. Data were collected with a questionnaire about perceived and theoretical knowledge before education, at six weeks, and at 10 weeks. The percentages of congruence were calculated at every measurement point, and the McNemar test was used to detect statistical significance of changes between measurements. RESULTS The increase of congruence was more often statistically significant in the intervention group than in the comparison group. CONCLUSION The results support the hypothesis that the congruence between perceived and theoretical knowledge will be higher among nurses receiving eVLU. Because of the low participation and drop-outs, the results should be interpreted with caution.
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Affiliation(s)
- Minna Ylönen
- Department of Nursing Science, University of Turku, Finland.
| | - Jaakko Viljamaa
- Department of Vascular Surgery, Turku University Hospital, Finland.
| | | | | | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Finland; Turku University Hospital, Turku, Finland.
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Finland; Turku University Hospital, Welfare Division, Turku, Finland.
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Abstract
BACKGROUND Intermittent fetal monitoring (IFM) is a recommended strategy for intrapartum fetal heart rate assessment in low-risk pregnancies; however, this "high touch, low tech" approach is underutilized. OBJECTIVE The aim of the study was to examine the relationships between labor and delivery nurses' intellectual capital and their perceptions of barriers to research utilization in the work setting. METHODS A cross-sectional correlational design using data derived from a larger study of labor and delivery nurses (N = 248) was used. Covell's theory of nursing intellectual capital was used as the conceptual and analytic framework to examine labor and delivery nurses' intellectual capital and their perceived barriers to research utilization. RESULTS Nurses who receive paid time off from their employer to attend conferences (p < .01) and nurses who do not report nurse-to-patient ratios as a problem in providing IFM (p < .01) perceive fewer barriers to research utilization. DISCUSSION Time, especially available time, has an effect on labor and delivery nurses' attitude toward IFM and their perceptions of barriers to research utilization.
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Affiliation(s)
- Lisa Heelan-Fancher
- Lisa Heelan-Fancher, PhD, FNP-BC, CNE, is Assistant Professor, University of Massachusetts Boston College of Nursing and Health Sciences. Emily J. Jones, PhD, RNC-Ob, is Associate Professor, University of Massachusetts Boston College of Nursing and Health Sciences. Joyce K. Edmonds, PhD, MPH, RN, is Associate Professor, Boston College Cornell School of Nursing, Chestnut Hill, Massachusetts
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Young DL, Seltzer J, Glover M, Outten C, Lavezza A, Mantheiy E, Parker AM, Needham DM. Identifying Barriers to Nurse-Facilitated Patient Mobility in the Intensive Care Unit. Am J Crit Care 2019; 27:186-193. [PMID: 29716904 DOI: 10.4037/ajcc2018368] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Nurse-facilitated mobility of patients in the intensive care unit can improve outcomes. However, a gap exists between research findings and their implementation as part of routine clinical practice. Such a gap is often attributed, in part, to the barrier of lack of time. The Translating Evidence Into Practice model provides a framework for research implementation, including recommendations for identifying barriers to implementation via direct observation of clinical care. OBJECTIVES To report on design, implementation, and outcomes of an approach to identify and understand lack of time as a barrier to nurse-facilitated mobility in the intensive care unit. METHODS An interprofessional team designed the observational process and evaluated the resulting data by using qualitative content analysis. RESULTS During three 4-hour observations of 2 nurses and 1 nursing technician, 194 distinct tasks were performed (ie, events). A total of 4 categories of nurses' work were identified: patient care (47% of observation time), provider communication (25%), documentation (18%), and down time (10%). In addition, 3 types of potential mobility events were identified: in bed, edge of bed, and out of bed. The 194 observed events included 34 instances (18%) of potential mobility events that could be implemented: in bed (53%), edge of bed (6%), and out of bed (41%). CONCLUSIONS Nurses have limited time for additional clinical activities but may miss potentially important opportunities for facilitating patient mobility during existing patient care. The proposed method is feasible and helpful in empirically investigating barriers to nurse-facilitated patient mobility in the intensive care unit.
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Affiliation(s)
- Daniel L Young
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Jason Seltzer
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Mary Glover
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Caroline Outten
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Annette Lavezza
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Earl Mantheiy
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Ann M Parker
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Dale M Needham
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University.
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DePrez B, Schreeder C, Davidson S. Implementation of chlorhexidine gluconate bathing to reduce HAIs. Nurs Manag (Harrow) 2019; 50:13-17. [PMID: 31688541 DOI: 10.1097/01.numa.0000602824.95678.0a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A nurse leader-led evidence-based practice change.
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Affiliation(s)
- Bernadette DePrez
- At the University of Tennessee at Chattanooga School of Nursing, Bernadette DePrez is an assistant professor and DNP nursing administration systems coordinator; Carolyn Schreeder is an adjunct professor, DNP nursing administration; and Susan Davidson is a professor and gateway program coordinator
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Shrapnel S, Dent E, Nicholson C. A nurse-led model of care within an emergency department reduces representation rates for frail aged care residents. Aging Clin Exp Res 2019; 31:1695-1698. [PMID: 30617858 DOI: 10.1007/s40520-018-1101-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/13/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hospital Emergency Departments (EDs) experience high presentation rates from older adults residing in Aged Care Facilities (ACFs), yet very few intervention studies have addressed the care needs of this population group. We designed and implemented a nurse-led model of care for older adults from ACFs, and determined its impact on patient outcomes. METHODS This 12-month pre-post intervention study was conducted during 2013-2014, with follow-up during 2015-2016. Participants included all older adults presenting from ACFs to the ED of Mater Hospital Brisbane (MHB), Australia. Frailty status was determined using the Clinical Frailty Scale (CFS). RESULTS All participants were frail (n = 1130), with 19% severely frail, 55% very-severely frail, and 26% terminally ill. The intervention resulted in several improvements in patient outcomes, including significant reductions in ward admissions and 28-day representation rates. CONCLUSION Significant improvements can be achieved by integration of an acute frail older person service into an ED.
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Affiliation(s)
- Sophie Shrapnel
- Mater/UQ Centre for Integrated Care and Innovation, Mater Health Services, Level 2 Aubigny Place, Raymond Tce, South Brisbane, QLD, 4101, Australia.
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.
| | - Elsa Dent
- Mater/UQ Centre for Integrated Care and Innovation, Mater Health Services, Level 2 Aubigny Place, Raymond Tce, South Brisbane, QLD, 4101, Australia
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
- Torrens University of Australia, Brisbane, QLD, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Caroline Nicholson
- Mater/UQ Centre for Integrated Care and Innovation, Mater Health Services, Level 2 Aubigny Place, Raymond Tce, South Brisbane, QLD, 4101, Australia
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
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Dyer A, Kirby M, White ID, Cooper AM. Management of erectile dysfunction after prostate cancer treatment: cross-sectional surveys of the perceptions and experiences of patients and healthcare professionals in the UK. BMJ Open 2019; 9:e030856. [PMID: 31585974 PMCID: PMC6797309 DOI: 10.1136/bmjopen-2019-030856] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Erectile dysfunction (ED) is known to be a common consequence of radical treatment for prostate cancer (PCa) but is often under-reported and undertreated. This study aimed to explore how ED in patients with PCa is managed in real-life clinical practice, from the perspective of patients and healthcare professionals (HCPs). DESIGN AND SETTING This is a UK-wide cross-sectional survey of men with ED after treatment for PCa which covered assessment and discussion of erectile function, provision of supportive care and satisfaction with management. Parallel surveys of primary and secondary HCPs were also conducted. RESULTS Responses were received from 546 men with ED after PCa treatment, 167 primary (general practitioners and practice nurses) and 94 secondary care HCPs (urologists and urology clinical nurse specialists). Survey findings revealed inadequate management of ED in primary care, particularly underprescribing of effective management options. A fifth of men (21%) were not offered any ED management, and a similar proportion (23%) were not satisfied with the way HCPs addressed their ED concerns. There was poor communication between HCPs and men, including failure to initiate discussions about ED and/or involve partners, with 12% of men not told that ED was a risk factor of PCa treatment. These issues seemed to reflect poor access to effective ED management or services and lack of primary HCP confidence in managing ED, as well as confusion over the roles and responsibilities among both HCPs and men. CONCLUSIONS This study confirms the need for better support for men from HCPs and more tailored and timely access to effective ED management after treatment for PCa. A clearly defined pathway is required for the discussion and management of ED, starting from the planning stage of PCa treatment. Improved adherence to ED management guidelines and better education and training for primary care HCPs are areas of priority.
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Affiliation(s)
- Amy Dyer
- Knowledge Team, Prostate Cancer UK, London, UK
| | - Mike Kirby
- The Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
- The Prostate Centre, London, UK
| | - Isabel D White
- Department of Pastoral and Psychological Care, Royal Marsden NHS Foundation Trust, London, UK
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Abstract
Ambulatory chemotherapy offers many advantages from supporting a closer to home treatment approach to lowering the cost of care. Ambulatory devices such as elastomeric pumps can deliver prolonged infusions of a variety of chemotherapy agents. Elastomeric pumps are preferred by the patients, as they get them connected at the hospital or cancer centres, then go back home where they can have visits from the district nursing team. This minimises disruption to carers and families. Despite all the advantages, experiments carried out by the authors and others in the literature showed that the performance of these pumps varied depending on the temperature and/or viscosity of the diluent. Interestingly, a two-phase study that was carried out to observe and evaluate patients receiving ambulatory chemotherapy concluded that in 50% of the observed cases the infusion pump did not finish on time. This disrupted the patients' treatment schedule and, in some cases, resulted in sub-therapeutic dosing.
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Affiliation(s)
| | - Dahlia Salman
- Post-doctoral Research Associate, Department of Chemisty, Loughborough University
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Abstract
The aim of deprescribing in end-of-life care is to improve the patient's quality of life by reducing their drug burden. It is essential to engage the patients and enable them to make choices about medications by discussing their preferences and implement a pharmacy management plan. Withdrawing medications during the end stages of life is extremely complex because the period of care varies substantially. The aim of this article is to address polypharmacy within end-of-life care. It will review which medications should be stopped by examining the non-essential and essential drugs. The intention is to encourage an approach to care which provides an equal balance between treatment and patient expectation.
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Affiliation(s)
- Emma Gardner
- Community Nurse Practitioner, Dorset HealthCare NHS, University NHS Foundation Trust Westminster Memorial Hospital, Dorset
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