Practice Patterns Contributing to Positive Patient Outcomes by Nurse Practitioners

Purpose: The purpose of this study was to identify NP practice patterns most important for positive patient outcomes. Data Sources: A convenience sample (n = 93) of Nurse Practitioners attending the 2005 California Association for Nurse Practitioners Conference (N = 535) completed the survey. Conclusions: The most important practice patterns identified were associated with patient-centered care. When analyzed with years in practice, patient-centered practice patterns continued to be the most important. This study suggests that patient-centered practice patterns are most important to positive patient outcomes for NPs. Implications for practice: Identifying the practice patterns that are most important to positive patient outcomes creates a distinct picture of the quality of care that is unique to nursing. As the role of NP continues to expand and be defined, these practice patterns will provide evidence of the unique quality of care given by the NP profession

The Spiral of Risk: Health Care Provision to Incarcerated Women

By law, prisoners in the United States have a fundamental right to receive adequate health care. However, most prisoners in this nation face numerous obstacles when attempting to receive quality health services. This is especially true for incarcerated women, who suffer from physical and mental health disorders at rates higher than incarcerated men, yet receive fewer targeted services. The state of California leads the nation in the number of women it incarcerates, second only to Texas. The vast majority of these women are in custody for nonviolent, drug-related offenses, and few receive adequate health care.Female offenders commonly face a wide range of serious health problems including substance abuse, infectious disease, mental illness, hypertension, asthma, and diabetes. Their health problems typically predate their involvement in the justice system, are often exacerbated while they are imprisoned, and continue to deteriorate after release. Furthermore, the majority of women in custody are racial and ethnic minorities, who receive inadequate or inappropriate health services that fail to be culturally competent.This paper presents the results of an intensive investigation of the health care delivery system for women imprisoned in California. We characterize the current system for providing health care to incarcerated women in California and address gaps in current service provision and cultural competency. We conclude by outlining a strategy to improve quality and access of holistic health care within the system and during transition back into the community

Exploring the factors affecting the motivation for learning from the perspective of public health students: A qualitative study

Objective. Despite the significant role of motivation in achieving success among public health students, students often do not demonstrate adequate motivation for learning and education. This study was performed to determine factors affecting the motivation for learning from the perspective of public health students via content analysis approach. Methods. This qualitative study was conducted at Kurdistan University of Medical Sciences in Sanandaj, Iran in 2017. 15 students were included in the study by using purposive sampling. Data were collected through personal interviews, group discussions, and field notes, and they were analyzed through conventional content analysis. Several parameters were taken into account to support the accuracy and the strength of the data: acceptability, confirmability, and transferability. Results. Five categories were derived from the data analysis, including “University Policy”, “Health Status”, “Teacher’s Role”, “Student-Related Factors” and “University Facilities”. Attention to the health status and its priority in the opinion of people, authorities, and educational system were the most important factors involved in the students’ motivation for learning. Conclusions. To increase motivation for learning, students have diverse needs that should be met. Attention to the components of motivation for learning not only enhances academic achievement but also promotes the formation of health behaviors in the society

Transforming Front Line Child Welfare Practice: The Impacts of Institutional Settings on Services, Employment Environments, Children, and Families, NON-RETROSPECTIVE TECHNICAL REPORT: Accessible Program and Agency Based Program Parent Survey Results from Case Opening and Follow Up

Outcomes of accessible and central service models are assessed in this non-retrospective technical report using three criteria: (1) impacts on parent, child and family functioning; (2) impacts on system functioning (e.g. child placements, court involvements); and (3) impacts on parent and community attitudes towards child protection organizations

Willingness to Pay for Community Health Fund Card in Mtwara Rural District,Tanzania

\ud The Ministry of Health in Tanzania has established a new programme in the primary health care service. CHF is a district-level prepayment scheme targeted at the rural population.CHF starts in 1995 on a pilot basis in one district and in 2003 has to be implemented in all districts. Mtwara Rural District is in the implantation stage. This study was proposed for assisting the district in pricing the health service and developing recommendations for the process of CHF implementation. It is focused primarily on the willingness of the population to pay for a CHF card.Price is not the only factor related to willingness to join the CHF. Complex human behavior,choices and motivation can also determine it. The result of the survey have drawn up the demand curve and constructed the chart of expected revenues from CHF card. Next stage was estimating the health Facility costs in order to find out the amount of funds to be collected. The CHF card rates proposed are based in maximizing the population under the health care system and covering the HF costs. The questionnaire prepared for the survey includes a section to know the opinion of respondents about the quality of care provided by MoH health facilities. According to the data obtained, the study proposed to establish the Tanzania national drug programme(Indent System),before CHF. Indent System changes the drug supply system and might improve the health quality. Experiences in Africa countries are also reviewed. This section contents the constraints identifies in other studies about different systems of payment. Evidence demonstrates the dangers associated with charging clients at the point of use of health service. Almost invariably payment systems have the affect of dissuading the poor from ccessing this services. Exemption mechanisms attempting to mitigate this impact have not tended to work. The experiences suggests querying some issues about CHF. The study is addressed to two audiences , MRD and MSF. This factor made complex drawing up the document. It was prepared with a view to: Pricing the health care services ,Developing recommendations for the CHF implementation in MRD and Providing qualitative information about the side effects of payment systems in the health care sector.\u

Extended scope of nursing practice: a multicentre randomised controlled trial of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery

Aim/ Principal Research Question:1) To determine whether pre-operative assessment carried out by an appropriately trained nurse (ATN) is equivalent in quality to that carried out by a pre-registration house officer (PRHO).2) To assess whether pre-assessments carried out by ATNs and PRHOs are equivalent in terms of cost.3) To determine whether assessments carried out by ATNs are acceptable to patients.4) To investigate the quality of communication between senior medical staff and ATNs.Factors of Interest:The extended role of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery.Methods:The study design was principally a prospective randomised equivalence trial but was accompanied by additional qualitative assessment of patient and staff perceptions, and an economic evaluation.The intervention consisted of a pre-operative assessment carried out by either an ATN or a PRHO. Of the patients who completed the study with a full evaluation, 926 patients were randomised to the PRHO arm of the trial and 948 to the ATN arm. Three ATNs took part in the study, one from each centre, together with a total of 87 PRHOs.Immediately following the initial assessment of a patient by a PRHO or an ATN, one of a number of clinical research fellows, all specialist registrars in anaesthetics, repeated the assessment and recorded it on a study form, together with a list of investigations required. The clinical research fellow then evaluated the competency of the initial assessor by comparing the quality of their assessment with their own. Any deficiencies in ordering of investigations and referral to other specialities were met in order to maximise patient care.Sample groups:All patients attending at one site for assessment prior to general anaesthetic for elective general, vascular, urological or breast surgery were potentially included in the study. Of 1907 patients who were randomised, 1874 completed the study with a full evaluation.The study was carried out at four NHS hospitals, three of which were teaching hospitals, in three NHS Trusts in Southampton, Sheffield and Doncaster.Outcome measures:Three areas of ATN and PRHO performance were judged separately, history taking, examination and ordering of tests, and each was graded into one of four categories, the most important of which was under-assessment, which would possibly have affected peri-operative management. In the case of ordering of tests, it was possible to have both over- and under-assessed a patient on different tests.Findings:The pre-operative assessments carried out by the ATNs were essentially equivalent to those performed by the PRHOs in terms of under-assessment that might possibly have affected peri-operative management, although there was variation between the ATNs in terms of the quality of history taking. This may be related to the low number of patients seen at one study site.PRHOs ordered significantly more unnecessary tests than the ATNs. The substitution of ATNs for PRHOs was calculated to be cost neutral.The results of the qualitative assessment showed that the use of ATNs for pre-operative assessment was acceptable to patients; however, there was no evidence that communication between senior medical staff and those carrying out pre-operative assessments was improved by their introduction.Conclusions:This study demonstrated no reason to inhibit the development of fully nurse-led pre-operative assessment, provided that the nurses are appropriately trained and maintain sufficient workload to retain skills.Implications for Further Research:Further research is needed in the following areas:1) the extent and type of training needed for nurses undertaking the pre-operative assessment role2) the use, costs and benefits of routine pre-operative testing.<br/

Study protocol; thyroid hormone replacement for untreated older adults with subclinical hypothyroidism - a randomised placebo controlled trial (TRUST)

Background: Subclinical hypothyroidism (SCH) is a common condition in elderly people, defined as elevated serum thyroid-stimulating hormone (TSH) with normal circulating free thyroxine (fT4). Evidence is lacking about the effect of thyroid hormone treatment. We describe the protocol of a large randomised controlled trial (RCT) of Levothyroxine treatment for SCH. Methods: Participants are community-dwelling subjects aged ≥65 years with SCH, diagnosed by elevated TSH levels (≥4.6 and ≤19.9 mU/L) on a minimum of two measures ≥ three months apart, with fT4 levels within laboratory reference range. The study is a randomised double-blind placebo-controlled parallel group trial, starting with levothyroxine 50 micrograms daily (25 micrograms in subjects &lt;50Kg body weight or known coronary heart disease) with titration of dose in the active treatment group according to TSH level, and a mock titration in the placebo group. The primary outcomes are changes in two domains (hypothyroid symptoms and fatigue / vitality) on the thyroid-related quality of life questionnaire (ThyPRO) at one year. The study has 80% power (at p = 0.025, 2-tailed) to detect a change with levothyroxine treatment of 3.0% on the hypothyroid scale and 4.1% on the fatigue / vitality scale with a total target sample size of 750 patients. Secondary outcomes include general health-related quality of life (EuroQol), fatal and non-fatal cardiovascular events, handgrip strength, executive cognitive function (Letter Digit Coding Test), basic and instrumental activities of daily living, haemoglobin, blood pressure, weight, body mass index and waist circumference. Patients are monitored for specific adverse events of interest including incident atrial fibrillation, heart failure and bone fracture. Discussion: This large multicentre RCT of levothyroxine treatment of subclinical hypothyroidism is powered to detect clinically relevant change in symptoms / quality of life and is likely to be highly influential in guiding treatment of this common condition. Trial registration: Clinicaltrials.gov NCT01660126; registered 8th June 2012

Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a 'Rapid Assessment Protocol for Insulin Access'

BACKGROUND: In order to improve the health of people with Type 1 diabetes in developing countries, a clear analysis of the constraints to insulin access and diabetes care is needed. We developed a Rapid Assessment Protocol for Insulin Access, comprising a series of questionnaires as well as a protocol for the gathering of other data through site visits, discussions, and document reviews. METHODS: The Rapid Assessment Protocol for Insulin Access draws on the principles of Rapid Assessment Protocols which have been developed and implemented in several different areas. This protocol was adapted through a thorough literature review on diabetes, chronic condition management and medicine supply in developing countries. A visit to three countries in sub-Saharan Africa and meetings with different experts in the field of diabetes helped refine the questionnaires. Following the development of the questionnaires these were tested with various people familiar with diabetes and/or healthcare in developing countries. The Protocol was piloted in Mozambique then refined and had two further iterations in Zambia and Mali. Translations of questionnaires were made into local languages when necessary, with back translation to ensure precision. RESULTS: In each country the protocol was implemented in 3 areas – the capital city, a large urban centre and a predominantly rural area and their respective surroundings. Interviews were carried out by local teams trained on how to use the tool. Data was then collected and entered into a database for analysis. CONCLUSION: The Rapid Assessment Protocol for Insulin Access was developed to provide a situational analysis of Type 1 diabetes, in order to make recommendations to the national Ministries of Health and Diabetes Associations. It provided valuable information on patients' access to insulin, syringes, monitoring and care. It was thus able to sketch a picture of the health care system with regards to its ability to care for people with diabetes. In all countries where this tool was used the involvement of local stakeholders resulted in the process acting as a catalyst in bringing diabetes to the attention of the health authorities

A comparison of the EQ-5D and the SF-6D across seven patient groups

As the number of preference-based instruments grows, it becomes increasingly important to compare different preference-based measures of health in order to inform an important debate on the choice of instrument. This paper presents a comparison of two of them, the EQ-5D and the SF-6D (recently developed from the SF-36) across seven patient/population groups (chronic obstructive airways disease, osteoarthritis, irritable bowel syndrome, lower back pain, leg ulcers, post menopausal women and elderly). The mean SF-6D index value was found to exceed the EQ-5D by 0.045 and the intraclass correlation coefficient between them was 0.51. Whilst this convergence lends some support for the validity of these measures, the modest difference at the aggregate level masks more significant differences in agreement across the patient groups and over severity of illness, with the SF-6D having a smaller range and lower variance in values. There is evidence for floor effects in the SF-6D and ceiling effects in the EQ-5D. These discrepancies arise from differences in their health state classifications and the methods used to value them. Further research is required to fully understand the respective roles of the descriptive systems and the valuation methods and to examine the implications for estimates of the impact of health care interventions