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Ambulatory nursing

Brian Chan, Samuel T Edwards, Meg Devoe, Richard Gil, Matthew Mitchell, Honora Englander, Christina Nicolaidis, Devan Kansagara, Somnath Saha, P Todd Korthuis
BACKGROUND: Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. We present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research...
December 14, 2018: Addiction Science & Clinical Practice
Marie-Thérèse Lussier, Fatoumata Binta Diallo, Pierre Pluye, Roland Grad, Andréa Lessard, Caroline Rhéaume, Michel Labrecque
OBJECTIVE: To draw a portrait of drug sample distribution and to assess the concordance between drug samples distributed and the medical problems encountered in the ambulatory primary health care setting. DESIGN: Descriptive cross-sectional survey. A self-administered questionnaire was distributed to all health care professionals (HCPs) in family medicine teaching units (FMTUs) that kept drug samples between February and December 2013. Dispensers were defined as HCPs reporting the use of drug samples...
December 2018: Canadian Family Physician Médecin de Famille Canadien
Maria do Livramento Saraiva Lucoveis, Mônica Antar Gamba, Maria Angela Boccara de Paula, Ana Beatriz Pinto da Silva Morita
OBJECTIVE: To classify the level of risk for foot ulcers in people with diabetes mellitus and identify their main predictive risk factors. METHOD: Exploratory, descriptive study, in which patients were assessed in a municipal ambulatory of São Paulo through nursing consultation, following the guidelines of the International Consensus on the Diabetic Foot. Data were descriptively analyzed. RESULTS: The analyzed population was composed of 50 longevous and retired people, with household income of up to two minimum wages, with dermato-neurofunctional risk factors and unfavorable clinical indicators, and 66% had Risk 1; 16% Risk 2; 6% Risk 3 and 12% Risk 4...
November 2018: Revista Brasileira de Enfermagem
Ryan Brown, Alix Carter, Judah Goldstein, Jan L Jensen, Andrew H Travers
Introduction Hospitalization due to ambulatory care sensitive conditions (ACSC) is often used as a proxy measure for access to primary care. The prevalence of ACSC has not been measured in the prehospital setting. Emergency medical services (EMS) are being used by patients who lack access to primary care for ACSC. Many novel models of care have been implemented within Canada and internationally, utilizing paramedics to ease the burden of poor primary care access. Recently, a mobile care team (MCT) consisting of a paramedic/nurse configuration has been deployed in the community of New Waterford, Nova Scotia...
September 26, 2018: Curēus
Bradley R Fulton, Elizabeth A Sternke, Louis Ayala, Donald L Malott
The purpose of this research was to develop a psychometrically sound survey for use with the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Services (OAS CAHPS) survey. Both an exploratory pilot and a confirmatory pilot were conducted in hospital outpatient departments and freestanding ambulatory surgery centers eligible for participation in the OAS CAHPS program. Analyses indicated an internally consistent and valid 18-item survey with 6 measures, including Access, Moving Through the Visit, Nurses, Anesthesiologist, Doctor, and Coordinated Care...
January 2019: Journal of Ambulatory Care Management
Diana Kurch-Bek, Christian Gallowitz, Bernhard Tenckhoff, Leonie Sundmacher
BACKGROUND: Vaccination is one of the most important and effective preventive measures against seasonal influenza. The German Standing Committee on Vaccination (STIKO) recommends influenza vaccination for specific groups of patients, including those in protective facilities and nursing or special care homes ("bPA-facilities"). The defined aim of the European Commission (EC) is vaccination coverage of 75% or higher among the elderly. In Germany, vaccination rates in bPA-facilities are currently based on surveys in limited samples of patients...
November 29, 2018: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
Rachel Wong, William Carroll, Astha Muttreja, Victor Garcia, Erin Taub, Alice Fernan
Objective: Chronic pain and opioid management are challenging in primary care, especially for trainees with discontinuous ambulatory schedules and less practice experience. The study objective was to improve adherence to quality metrics and office visit utilization in a resident clinic. Design: Before-after quality improvement intervention over two Plan-Do-Study-Act cycles. Setting. Suburban, university-affiliated Internal Medicine resident clinic. Methods: During the 2015-2017 academic years, two sequential interventions were implemented: 1) use of electronic pain and opioid management templates and workflow redesign routing opioid renewals through a registered nurse (RN); 2) RN previsit planning and daily nurse-physician huddles before patient visits...
November 23, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Solène Guilloteau, Thierry Lobbedez, Sonia Guillouët, Christian Verger, Maxence Ficheux, Antoine Lanot, Clémence Béchade
BACKGROUND: Patients on peritoneal dialysis (PD) can be assisted by a nurse or a family member and treated either by automated PD (APD) or continuous ambulatory PD (CAPD). The aim of this study was to evaluate the effect of PD modality and type of assistance on the risk of transfer to haemodialysis (HD) and on the peritonitis risk in assisted PD patients. METHOD: This was a retrospective study based on data from the French Language PD Registry. All adults starting assisted PD in France between 2006 and 2015 were included...
November 21, 2018: American Journal of Nephrology
Mélanie Lelubre, Olivier Clerc, Marielle Grosjean, Karim Amighi, Carine De Vriese, Olivier Bugnon, Marie-Paule Schneider
BACKGROUND: An interprofessional medication adherence program (IMAP) for chronic patients was developed and successfully implemented in the community pharmacy of the Department of ambulatory care and community medicine (Lausanne, Switzerland). This study assesses the capacity of a physician and a nurse at the infectious diseases service of a public hospital and of community pharmacists in the Neuchâtel area (Switzerland) to implement the IMAP in their practice. METHODS: Mixed method, prospective, observational study...
November 20, 2018: BMC Health Services Research
Meri Kankaanpää, Marika Holma-Eriksson, Sami Kapanen, Merja Heitto, Sari Bergström, Leila Muukkonen, Veli-Pekka Harjola
BACKGROUND: In this study, we hypothesized that point of care testing (POCT) would reduce length of stay (LOS) in emergency department (ED) when compared to central laboratory testing and be a factor in patient discharge destination. METHODS: A single centre observational study was performed in ED non-ambulatory patients. Blood testing was performed either with POC instruments for blood gases and chemistry panel, full blood count, and CRP, or at central laboratory, or as a combination of both...
November 19, 2018: BMC Emergency Medicine
Lisa M Blackburn, Kathy Burns, Elizabeth DiGiannantoni, Karen Meade, Colleen O'Leary, Rita Stiles
BACKGROUND: Thorough, consistent pain assessment and reassessment are critical to guide and evaluate interventions designed to improve pain. OBJECTIVES: Based on a literature review about functional pain assessment, clinicians selected and then implemented the Defense and Veterans Pain Rating Scale (DVPRS) as a pain assessment instrument option in a comprehensive cancer center. METHODS: The DVPRS was added as a pain assessment instrument in clinical oncology practice...
December 1, 2018: Clinical Journal of Oncology Nursing
Scott Pugel, John L Stallworth, Leslie B Pugh, Carlee Terrell, Zuwere Bailey, Thomas Gramling, Helen Ward
BACKGROUND: Scant evidence exists of effective Choosing Wisely® initiatives, which are intended to reduce the use of unnecessary care. In 2013 substantial variations existed at Kaiser Permanente Georgia in the frequency of nonbeneficial services in ambulatory care. A Choosing Wisely campaign was implemented across 25 medical offices serving approximately 300,000 members. METHODS: The initiative was designed to reduce the use of complete blood counts (CBCs) and electrocardiograms (EKGs) as routine screening tests in physical examination visits, age-inappropriate dual-energy x-ray absorptiometry (DEXA) scans, and imaging for uncomplicated headache...
December 2018: Joint Commission Journal on Quality and Patient Safety
Sameh Mosaed, Ryka Vahidi, Ken Y Lin
Most operating rooms around the world play music, both during the surgeries and in between cases. We investigated whether music tempo (fast or slow) can affect the operating room preparation time in between surgeries (turnover time) in an ambulatory outpatient surgical centre setting. We compiled two playlists, one with fast upbeat tempo and the other with slow relaxing tempo. Each of the playlists was played throughout the workday in the operating room for one week with the same surgeon and nursing staff. The turnover times for each case were analysed...
November 12, 2018: Journal of Perioperative Practice
Caroline V Coburn, Deena Gilland, Katherine Stahl
For a new ambulatory care nursing course in an undergraduate baccalaureate program, a standardized patient simulation was created to support the clinical component of the course. The goals were for students to enhance their critical thinking skills, apply the nursing process to an ambulatory setting, apply learned skills to the non-acute care setting, and increase their confidence. The simulation format included three stations: skills refresher, telehealth, and clinic. Volunteers from faculty, clinical preceptors, and nursing management acted as clients for the mock clinical settings...
November 7, 2018: Nursing Education Perspectives
Marcos Antonio Martínez García, Martha Socorrro Fernández Rosales, Eduardo López Domínguez, Yesenia Hernández Velázquez, Saúl Domínguez Isidro
There are two million people with chronic kidney disease (CKD) worldwide. In Mexico, it is estimated that by 2025, there will be 212 thousand CKD cases. Among the renal replacement treatments, peritoneal dialysis (PD) exists either in the continuous ambulatory (CAPD) or automated (APD) mode, which requires continuous monitoring and strict control. Thus, several software systems have been proposed to perform reliable remote monitoring of patients using PD but also to achieve the goal with effectiveness, efficiency and satisfaction; i...
2018: PloS One
Carina C E G Pernot, Ineke Zwiers, Arina J Ten Cate-Hoek, Cees H A Wittens
OBJECTIVE: To explore the need for an extended diagnostic workup in patients with venous leg ulcers (VLUs) and to establish the prevalence of the underlying causes of VLU. METHOD: This retrospective cohort study analysed data from patients with VLU. The visual analogue scale (VAS) was used for pain assessment. The ankle-brachial index (ABI) was measured to exclude patients with arterial pathology. A duplex was performed. All patients received a wound treatment plan and ambulatory compression therapy...
November 2, 2018: Journal of Wound Care
Jordan W Tompkins, Selam Mequanint, Douglas Edward Barre, Meghan Fournie, Michael E Green, Anthony J Hanley, Mariam Naqshbandi Hayward, Merrick Zwarenstein, Stewart B Harris
BACKGROUND: There is a significant deficiency of national health information for Indigenous peoples in Canada. This manuscript describes the Community Profile Survey (CPS), a community-based, national-level survey designed to identify and describe existing healthcare delivery, funding models, and diabetes specific infrastructure and programs in Indigenous communities. METHODS: The CPS was developed collaboratively through FORGE AHEAD and the First Nations and Inuit Health Branch of Health Canada...
November 1, 2018: BMC Health Services Research
Julia Menichetti, Giuliana Pitacco, Guendalina Graffigna
AIMS AND OBJECTIVES: This study aimed to explore: (a) the usual patient education in different care services of an integrated-care organization, (b) the healthcare professionals' experiences with adding a patient engagement support intervention called PHEinAction in the patient education practice, and (c) the co-designed activities to assist the implementation. BACKGROUND: Including individual support for engaging patients in care into patient education practice is a key effort of integrated-care organizations...
October 26, 2018: Journal of Clinical Nursing
Tyler M Bauer, Adam P Johnson, Katerina Dukleska, Johanna Beck, Myles S Dworkin, Kamini Patel, Scott W Cowan, Geno J Merli
Hospital-acquired venous thromboembolism (VTE) affects morbidity and mortality and increases health care costs. Poor adherence to recommended prophylaxis may be a potential cause of ongoing events. This study aims to identify institutional adherence rates and barriers to optimal VTE prophylaxis. The authors performed patient and nurse interviews and a concurrent review of clinical documentation, utilizing a cloud-based, HIPAA-compliant tool, on a convenience sample of hospitalized patients. Adherence and agreement between different assessment modalities were calculated...
October 26, 2018: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Amanda Featherstone
This article explores the development of an ambulatory community service that demonstrates multidisciplinary working to meet the diverse needs of frail older people and their carers. The service comprises advanced nurse practitioners, a pharmacist, a community navigator, consultants, occupational therapists, physiotherapists, a nurse, rehabilitation assistants, a healthcare assistant and an administrator. This multidisciplinary team (MDT) serves adults with complex medical and rehabilitation needs who are being discharged from hospital, staying in bedded rehabilitation units or living at home by offering assessments, investigations and rehabilitation, where appropriate closer to home...
October 25, 2018: Nursing Older People
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