Building Evidence-Based Nursing Practice Capacity in a Large Statewide Health System

Integration of evidence-based practice (EBP) into the culture of a healthcare organization is essential to provide safe patient care and promote a thriving culture for the nurses within the healthcare organization. Collaboration and utilization of both clinical and academic experts facilitate the removal of barriers to EBP. This article describes the successful partnership between a healthcare system and school of nursing in executing a 3-phased multimodal approach to an EBP training program

A People-Centered Approach to Improving Interprofessional Communication in Health Care

poster abstractAs part of the objectives stated under the Interprofessional Collaborative Practices (IPCP) Model funded through a grant with the Health Resources and Services Administration and Indiana University School of Nursing, it was necessary to better understand the challenges around interprofessional communication across a hospital unit. To carry out this objective, research consultants from Collabo Creative, a design research company, partnered with the Renal Metabolic (B5C5) unit at IU Health Methodist. The main purpose for connecting design researchers with B5C5 was to assist the unit in utilizing a people-centered design approach in order to: 1) understand the current context of interprofessional collaboration and communication, 2) frame pertinent communication design challenges; and 3) develop solutions to improve interprofessional collaboration and communication across the B5C5 unit. Resulting from the 8-month research engagement, Collabo Creative and B5C5 identified four core challenges to interprofessional communication that appear to be relevant to other hospital units in addition to B5C5. These challenges include: 1) patient handoff of information; 2) doctor and patient two-way communication; 3) employee tensions as a result of PCA training; and 4) night-shift inclusion in plan of care. This poster will describe the people-centered design approach and methods that were used to engage B5C5, along with key findings and newly developed interprofessional communication tools resulting from the research project

CADMIUM GEOCHEMISTRY OF SOILS AND WILLOW IN A METAMORPHIC BEDROCK TERRAIN AND ITS POSSIBLE RELATION TO MOOSE HEALTH, SEWARD PENINSULA, ALASKA

The regional geochemistry of soil and willow over Paleozoic metamorphic rocks in the Seward Peninsula, Alaska is potentially high in cadmium (Cd), and willow, a preferred browse of moose, bioaccumulates Cd. Local moose show clinical signs of tooth wear and breakage and have been declining in population for unknown reasons. Willow leaves (all variants of Salix pulchra) and A-, B-, and C-horizon soils were sampled near 2 mining prospects suspected to be high in Cd. Although Al, Cd, Co, Cu, Fe, Mo, Ni, Pb, and Zn were examined, our focus in this exploratory study was on the level of Cd in the 3 soil horizons and willow between and within the 2 prospects and their vicinity. We used an unbalanced, one-way, hierarchical analysis of variance (ANOVA) to investigate the geochemistry of soils and willow at various distance scales across the 2 prospect areas that were separated by ~80 km; sites within a location were approximately 0.5 km apart and replicate samples were separated by ~0.05 km. Cd concentration was significantly different in willow between and within sites, and within sites for all soil horizons. Specifically, this exploratory study identified highly elevated levels of Cd in willow growing over Paleozoic bedrock in the Seward Peninsula at both prospects and over the Paleozoic geologic unit in general. Potential negative effects for moose are discussed

Implementation of an electronic medical record in family practice: a case study

Background Electronic medical records (EMRs) have the potential to foster a safer, more effective and more efficient healthcare system. However, their implementation in primary care practice remains a challenge. Objective This study aims at exploring factors that have influenced the successful implementation of an EMR system in a family medicine group (FMG) in the Province of Qu_bec, Canada. Methods A case study approach was selected to get a deep understanding of the phenomenon in its context. The case was chosen on the basis that it was the first FMG in Qu_bec to implement a full EMR used by all clinicians. Fifteen semi-structured interviews were conducted with key informants. Results Factors that have influenced the success of the EMR implementation were classified under three broad themes: a project leader who combined the roles of clinical, technology and knowledge champion; an organisation that was open to and supportive of change; and an evidence-based implementation strategy tailored to the local context and adoption pace. Conclusions This study underscores the importance of a champion for successful EMR implementation. It proposes a set of roles and characteristics that could be found in a champion as well as other elements for a successful EMR implementation strategy

Increased density and periosteal expansion of the tibia in young adult men following short-term arduous training

Purpose: Few human studies have reported early structural adaptations of bone to weight-bearing exercise, which provide a greater contribution to improved bone strength than increased density. This prospective study examined site- and regional-specific adaptations of the tibia during arduous training in a cohort of male military (infantry) recruits to better understand how bone responds in vivo to mechanical loading. Methods: Tibial bone density and geometry were measured in 90 British Army male recruits (ages 21 + 3 y, height 1.78 ± 0.06 m, body mass 73.9 + 9.8 kg) in weeks 1 (Baseline) and 10 of initial military training. Scans were performed at the 4%, 14%, 38% and 66% sites, measured from the distal end plate, using pQCT (XCT2000L, Stratec Pforzheim, Germany). Customised software (BAMPack, L-3 ATI) was used to examine whole bone cross-section and regional sectors. T-tests determined significant differences between time points (P<0.05). Results: Bone density of trabecular and cortical compartments increased significantly at all measured sites. Bone geometry (cortical area and thickness) and bone strength (i, MMi and BSI) at the diaphyseal sites (38 and 66%) were also significantly higher in week 10. Regional changes in density and geometry were largely observed in the anterior, medial-anterior and anterior-posterior sectors. Calf muscle density and area (66% site) increased significantly at week 10 (P<0.01). Conclusions: In vivo mechanical loading improves bone strength of the human tibia by increased density and periosteal expansion, which varies by site and region of the bone. These changes may occur in response to the nature and distribution of forces originating from bending, torsional and shear stresses of military training. These improvements are observed early in training when the osteogenic stimulus is sufficient, which may be close to the fracture threshold in some individuals

Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?

BACKGROUND: Telehealth, as other information and communication technologies (ICTs) introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. METHODS: A qualitative field study was conducted in four remote regions of Quebec (Canada) to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. RESULTS: According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and managers also highlighted the importance of considering telehealth within the broader organisation of health care services in remote and rural regions. CONCLUSION: This study identified core elements that should be considered when implementing telehealth applications with the purpose of supporting medical practice in rural and remote regions. Decision-makers need to be aware of the specific conditions that could influence telehealth integration into clinical practices and health care organisations. Thus, strategies addressing the identified conditions for telehealth success would facilitate the optimal implementation of this technology

Synthèse et caractérisation de composés supramoléculaires peptidiques

Ce mémoire se divise en deux parties. La première décrit le désign et la synthèse de récepteurs moléculaires peptidiques chiraux comportant deux éthers couronne sur une même chaîne peptidique. La seconde partie relate le désign, la synthèse et la caractérisation d'un canal ionique artificiel constitué d'un support peptidique et d'éthers couronne comme sites ionophores. Par la suite, on présente les résultats relatifs à des études des propriétés conformationnelles de ce canal ionique ainsi que les résultats des études de conductivité ionique

Of mothers and death: from procreation to creation

National audienc

Les mères et la mort: réalités et représentations

National audienc