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critical care practitioner

Sandra Grace, Roger Engel, Ian Jalsion
The Australian chiropractic and osteopathic professions underwent a period of significant transformation between 1960 and 2000. This resulted in an improvement in the views held by the medical profession towards the two professions. However, a recent survey of Australian general practitioners (GPs) reported that a number of GPs still hold negative views towards chiropractors and osteopaths. This paper examines these views from the perspective of critical realism and explores the generative mechanisms that can influence the willingness of health practitioners to collaborate over patient care...
2018: Evidence-based Complementary and Alternative Medicine: ECAM
Jee Young Joo, Diane L Huber
Case management is a cost-effective strategy for coordinating chronic illness care. However, research showing how case management affects health care is mixed. This study systematically synthesizes and critically evaluates evidence in systematic reviews of health care utilization outcomes from case management interventions for the care of chronic illnesses. Results are synthesized from seven English language systematic reviews published between January 1990 and June 2017. Hospital readmissions, length of hospital stay, institutionalization, emergency department visits, and hospitals/primary care visits were all identified as health care utilization outcomes of case management interventions...
March 1, 2018: Western Journal of Nursing Research
Kristen M Brown, Shawna S Mudd, Elizabeth A Hunt, Julianne S Perretta, Nicole A Shilkofski, J Wesley Diddle, Gregory Yurasek, Melania Bembea, Jordan Duval-Arnould, Kristen Nelson McMillan
OBJECTIVES: Assess the effect of a simulation "boot camp" on the ability of pediatric nurse practitioners to identify and treat a low cardiac output state in postoperative patients with congenital heart disease. Additionally, assess the pediatric nurse practitioners' confidence and satisfaction with simulation training. DESIGN: Prospective pre/post interventional pilot study. SETTING: University simulation center. SUBJECTS: Thirty acute care pediatric nurse practitioners from 13 academic medical centers in North America...
March 10, 2018: Pediatric Critical Care Medicine
Anne L Donovan, J Matthew Aldrich, A Kendall Gross, Denise M Barchas, Kevin C Thornton, Hildy M Schell-Chaple, Michael A Gropper, Angela K M Lipshutz
OBJECTIVES: We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. DATA SOURCES: Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives...
March 7, 2018: Critical Care Medicine
Walter A Boyle, David J Murray, Mary Beth Beyatte, Justin G Knittel, Paul W Kerby, Julie Woodhouse, John R Boulet
OBJECTIVES: Develop a standardized simulation method to assess clinical skills of ICU providers. DESIGN: Simulation assessment. SETTING: Simulation laboratory. SUBJECTS: Residents, Critical Care Medicine fellows, acute care nurse practitioner students. INTERVENTIONS: Performance scoring in scenarios from multiple Critical Care Medicine competency domains. MEASUREMENTS AND MAIN RESULTS: Three-hundred eighty-four performances by 48 participants were scored using checklists (% correct) and holistic "global" ratings (1 [unprepared] to 9 [expert])...
March 7, 2018: Critical Care Medicine
Lu Yang, Wenbo Peng, Jon Adams, David William Sibbritt
INTRODUCTION: Emerging evidence has shown that traditional Chinese medicine (TCM) has a positive effect on arthritis. This research provides the first critical, systematic examination of TCM practitioners' perceptions of TCM use for people with arthritis. METHODS: An online survey was distributed to all TCM professionals including acupuncturists and Chinese herbal medicine practitioners registered with the Practitioner Research and Collaborate Initiative (PRACI) practitioner database...
March 8, 2018: Acupuncture in Medicine: Journal of the British Medical Acupuncture Society
Michelle Boltz, Norma G Cuellar, Casey Cole, Brent Pistorese
Introduction Since 2010, more than 75 rural hospitals have closed in the USA and more than one-third are at risk of closure due to lower patient volumes, lower funding levels, decreased hospital revenue and lower physician employment pools. Telemedicine can provide new models of care delivery that maintain quality and reduce cost of healthcare in rural populations. The purpose of this project was to evaluate a cross-organizational pilot program by comparing a NP/telemedicine physician hospitalist programme with a traditional physician hospitalist model to assess effects on length of patient stay, mortality rates, readmission rate, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings of provider communication, and total hospital costs...
January 1, 2018: Journal of Telemedicine and Telecare
Jasmin Dvorah Korbl, Benjamin Andrew Wood, Nathan Tobias Harvey
Certain diagnoses in dermatopathology have significant implications for patient management and on occasion appropriate clinical care may be facilitated by a phone call from the reporting dermatopathologist to the referring doctor. Whether this is appropriate depends on a number of factors. The concept of 'critical diagnoses' is now well established in surgical pathology, having evolved from critical value policies in clinical pathology and haematology. However, only limited attempts have been made to assess perceptions among different clinical groups...
February 26, 2018: Pathology
Giorgio Bert, Enrico Morello, Silvana Quadrino
Forty years have passed since the publication of the "Patients' Rights Charter" (included in a separate section at the end of the work: "Patients' rights: a critical guide to understanding and usage of civil hospital facilities"), but it still remains remarkably topical. We here provide an analysis of the original Charter (1975) taking into consideration the changes that have occurred in sensitivity to gender, cultural as well as socioeconomic differences, the right to body privacy and to continuity of care, the key role of general practitioners, the reciprocal relations in the information and decision-making processes with shared diagnostic and therapeutic pathways and active patient participation, which mandates that adequate education in communication and care strategies be provided to all caregivers...
February 2018: Recenti Progressi in Medicina
Tracy Kim, Farhad Yeroshalmi, Keith S Margulis, Victor Badner, Kenneth Rivlin
Congenital hypofibrinogenemia is a rare coagulation disorder characterized by a deficiency in fibrinogen protein, which is critical to the normal coagulation process. This hematological disorder can go undiagnosed until an event leads to prolonged bleeding. The purposes of this report were to describe an incidental diagnosis of congenital hypofibrinogenemia after a dental procedure, discuss the importance of recognizing coagulopathies on the delivery of dental care, examine the multi-disciplinary clinical management of prolonged bleeding after a dental procedure, and evaluate the challenges health care practitioners may encounter when obtaining a thorough medical history...
January 1, 2018: Pediatric Dentistry
Raymond E Fancher
Presents an obituary for John Chynoweth Burhham, who died May 12, 2017. An acknowledged "historian's historian," Burnham's critically acclaimed books and articles dealt prominently with American psychoanalysis, as well as other varied topics including accident proneness, health care in America, bad habits, and the question of "how superstition won and science lost." In his first major book, the 1967 Psychoanalysis and American Medicine, 1894-1918. Burnham approached his controversial subject not from the standpoint of practitioner or partisan, but rather that of an impartial historian placing psychoanalysis within the larger context of American culture and history...
February 2018: American Psychologist
Alistair Appleby, Philip Wilson, John Swinton
Guidance for medical staff reminds employees of the responsibility to deliver spiritual care in its broadest sense, respecting the dignity, humanity, individuality and diversity of the people whose cultures, faiths and beliefs coexist in society. This is no small or simple task, and although GPs (family practitioners) have been encouraged to deliver spiritual care, we suggest this is proving to be challenging and needs further careful debate. This literature review critiques and analyses existing studies and points to four categories of attitude to spiritual care, and two related but distinct concepts of spirituality in use by GPs...
February 23, 2018: Journal of Religion and Health
Shobhana Nagraj, Juliet Harrison, Lawrence Hill, Lesley Bowker, Susanne Lindqvist
BACKGROUND: Collaborative practice between paramedics and medical staff is essential for ensuring the safe handover of patients. Handover of care is a critical time in the patient journey, when effective communication and collaborative practice are central to promoting patient safety and to avoiding medical error. To encourage effective collaboration between paramedic and medical students, an innovative, practice-based simulation exercise, known as interprofessional clinical skills (ICS) was developed at the University of East Anglia, UK...
February 23, 2018: Clinical Teacher
Anna Fernández, Juan M Mendive, Sonia Conejo-Cerón, Patricia Moreno-Peral, Michael King, Irwin Nazareth, Carlos Martín-Pérez, Carmen Fernández-Alonso, Antonina Rodríguez-Bayón, Jose Maria Aiarzaguena, Carmen Montón-Franco, Antoni Serrano-Blanco, Inmaculada Ibañez-Casas, Emiliano Rodríguez-Sánchez, Luis Salvador-Carulla, Paola Bully Garay, María Isabel Ballesta-Rodríguez, Pilar LaFuente, María Del Mar Muñoz-García, Pilar Mínguez-Gonzalo, Luz Araujo, Diego Palao, María Cruz Gómez, Fernando Zubiaga, Desirée Navas-Campaña, Jose Manuel Aranda-Regules, Alberto Rodriguez-Morejón, Juan de Dios Luna, Juan Ángel Bellón
BACKGROUND: Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care...
February 23, 2018: BMC Medicine
Lingsheng Li, Judith E Nelson, Laura C Hanson, Christopher E Cox, Shannon S Carson, Emily J Chai, Kristine L Keller, James A Tulsky, Marion Danis
OBJECTIVES: Family members commonly make medical decision for patients with chronic critical illness. This study examines how family members approach this decision-making role in real time. DESIGN: Qualitative analysis of interviews with family members in the intervention arm of a randomized controlled communication trial. SETTINGS: Medical ICUs at four U.S. hospitals. PARTICIPANTS: Family members of patients with chronic critical illness (adults mechanically ventilated for ≥ 7 d and expected to remain ventilated and survive for ≥ 72 hr) who participated in the active arm of a communication intervention study...
February 16, 2018: Critical Care Medicine
Adrian Vk Wong, Nitin Arora, Olusegun Olusanya, Ben Sharif, Robert M Lundin, A Dhadda, S Clarke, R Siviter, M Argent, Gavin Denton, Anna Dennis, Angela Day, Tamas Szakmany
Background: Central venous catheters are inserted ubiquitously in critical care and have roles in drug administration, fluid management and renal replacement therapy. They are also associated with numerous complications. The true number of central venous catheters inserted per year and the proportion of them associated with complications are unknown in the UK. Methods: We performed a prospective audit at five hospitals, as a feasibility pilot for a larger, nationwide audit...
February 2018: Journal of the Intensive Care Society
Edward J Schenck, Kevin C Ma, Santosh B Murthy, Augustine M K Choi
OBJECTIVES: Sterile and infectious critical illnesses often result in vasoplegic shock and a robust systemic inflammatory response that are similar in presentation. The innate immune system is at the center of the response to both infectious and traumatic insults. Damage-associated molecular patterns are small molecules that are released from stressed or dying cells. Damage-associated molecular patterns activate pattern recognition receptors and coordinate the leading edge of the innate immune response...
February 13, 2018: Critical Care Medicine
Molly Frances Battistelli, Sara Magnusson, M Antonia Biggs, Lori Freedman
CONTEXT: Access to abortion care in the United States varies according to multiple factors, including location, state regulation and provider availability. In 2013, California enacted a law that authorized nurse practitioners (NPs), certified nurse-midwives (CNMs) and physician assistants (PAs) to provide first-trimester aspiration abortions; little is known about organizations' experiences in implementing this policy change. METHODS: Beginning 10 and 24 months after implementation of the new law, semistructured interviews were conducted with 20 administrators whose five organizations trained and employed NPs, CNMs and PAs as providers of aspiration abortions...
February 14, 2018: Perspectives on Sexual and Reproductive Health
Toby Helliwell, Sara Muller, Samantha L Hider, James A Prior, Jane C Richardson, Christian D Mallen
BACKGROUND: In the UK, general practitioners (GPs) are usually the first medical contact for patients with suspected giant cell arteritis (GCA). While rare, it is critical not to miss, as delayed treatment can lead to significant complications including permanent visual loss. To date, little is known about the approach and challenges to diagnosis and management of GCA by GPs. OBJECTIVE: To investigate the diagnosis and management of patients with suspected GCA in UK general practice...
February 3, 2018: BMJ Open
J P Cruz, F Alshammari, R F D Felicilda-Reynaldo
AIM: This study aimed to investigate the predictors of Saudi nursing students' attitudes towards the environment and sustainability in health care. BACKGROUND: With rising temperature and decreasing annual rainfall, Saudi Arabia is threatened by the harmful effects of climate change on its population. In response to these threats, the Ministry of Health adapted sustainable development and environmental preservation in their National E-Health strategy. INTRODUCTION: To implement these policies successfully, healthcare practitioners should be educated on how climate change could impact human health negatively...
February 9, 2018: International Nursing Review
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