Administration of post-operative analgesia

Pain is one of the major problems encountered by patients who have undergone surgery. The relief of pain is an important part of their treatment, and is both a nursing and a medical responsibility. Analgesics, both narcotic and non-narcotic, are usually prescribed by doctors on a pro re nata, or ‘as needed\u27 basis. The responsibility for administration lies with the nurses, and they choose the type and quantity of drug to be given. Research into the area of pain relief has shown that both nurses and doctors need further education in the judicious use of analgesics, particularly narcotics. This study was conducted on 27 patients on two orthopaedic wards in a public hospital. Using the patients\u27 drug charts and information obtained from nurses, the relationship between the type of drug (narcotic and non-narcotic) and quantity of analgesics administered post-operatively, and several environmental and patient related variables was investigated. The study tested whether any statistically significant correlations exist between the variables (gender of the patient, age of the patient, the nurses\u27 perception of the severity of injury, the person initiating the analgesia, time lapsed from surgery, and the shift the nurse is working) and the type and quantity of analgesia administered. It was hypothesised that positive correlations would be found for all the variables. Results showed no relationship between the age or gender of the patient and analgesia administered. A negative correlation was found between the nurses\u27 perception of the severity of the patient\u27s injury and the quantity of analgesia given. There was no difference between the quantity or type of analgesia administered during different shifts. A pattern of administration was found for the first 48 hours post-operatively. Results also showed a significant correlation between the person initiating the administration of analgesic and the type of analgesic given. From these findings it was recommended that further investigation of the correlations be done using a larger population from different wards and social background. Education of both nurses and patients is essential for pain management. Some ways in which this can be improved are by using pain measurement instruments to enhance nurses 1 assessment skills, incorporating pain management skills into both basic and in service education for nurses, and implementing a \u27pain management nurse specialist’ to educate patients pre-operatively and serve as a resource person for nursing staff

Perceptions of hypertension treatment among patients with and without diabetes

<p>Abstract</p> <p>Background</p> <p>Despite the availability of a wide selection of effective antihypertensive treatments and the existence of clear treatment guidelines, many patients with hypertension do not have controlled blood pressure. We conducted a qualitative study to explore beliefs and perceptions regarding hypertension and gain an understanding of barriers to treatment among patients with and without diabetes.</p> <p>Methods</p> <p>Ten focus groups were held for patients with hypertension in three age ranges, with and without diabetes. The topic guides for the groups were: What will determine your future health status? What do you understand by "raised blood pressure"? How should one go about treating raised blood pressure?</p> <p>Results</p> <p>People with hypertension tend to see hypertension not as a disease but as a risk factor for myocardial infarction or stroke. They do not view it as a continuous, degenerative process of damage to the vascular system, but rather as a binary risk process, within which you can either be a winner (not become ill) or a loser. This makes non-adherence to treatment a gamble with a potential positive outcome. Patients with diabetes are more likely to accept hypertension as a chronic illness with minor impact on their routine, and less important than their diabetes. Most participants overestimated the effect of stress as a causative factor believing that a reduction in levels of stress is the most important treatment modality. Many believe they "know their bodies" and are able to control their blood pressure. Patients without diabetes were most likely to adopt a treatment which is a compromise between their physician's suggestions and their own understanding of hypertension.</p> <p>Conclusion</p> <p>Patient denial and non-adherence to hypertension treatment is a prevalent phenomenon reflecting a conscious choice made by the patient, based on his knowledge and perceptions regarding the medical condition and its treatment. There is a need to change perception of hypertension from a gamble to a disease process. Changing the message from the existing one of "silent killer" to one that depicts hypertension as a manageable disease process may have the potential to significantly increase adherence rates.</p

Is the patient activation measure associated with adherence to colonoscopy after a positive fecal occult blood test result?

Abstract Background Colorectal cancer (CRC) is a major cause of morbidity and mortality worldwide, but these can be reduced significantly with population screening using annual fecal occult blood tests (FOBT)A positive FOBT requires timely follow-up with colonoscopy to maximize screening benefits.. Several barriers to follow-up have been identified, with patient health behaviors and choices comprising a significant part of these. The Patient Activation Measure (PAM) assesses knowledge, skills, beliefs, and confidence in managing health. Increased patient activation is related to positive health outcomes. The aim of this study is to examine the association between patient empowerment, as reflected in the PAM, and follow-up colonoscopy within 90 days of a positive FOBT result. Methods This case-control study included 429 patients with a positive FOBT, 174 who had a colonoscopy within 90 days, and 255 who did not.. Participants completed a PAM telephone questionnaire (Cronbach’s α = 0.785). We used both univariate and multivariate analyses to examine the effect of the PAM score as on the likelihood of undergoing colonoscopy, after adjusting for the independent variables. Results In this study we did not find a significant association between PAM and adherence to colonoscopy, using both univariate and multivariate analyses (p = .334 and p = .697, whether PAM was defined as a continuous or as categorical, respectively). Conclusions This study was the first to examine the association between patient empowerment, as reflected in the patient activation measure, and adherence to colonoscopy after a positive FOBT. The findings did not support such an association. Further examination is required to clarify the relation between patient empowerment and activation and personal healthcare in general, and in the Israeli population in particular. Future policy should include specific, technical interventions to improve FOBT follow-up among all groups, until the patient-related barriers are better understood. Trial registration ClinicalTrials.gov Identifier: NCT02534142 https://clinicaltrials.gov/ct2/show/NCT0253414

“Clean Air for Babies” App: A smoking cessation mobile app based on Cognitive Behavioral Therapy combined with personal counseling to help expectant mothers quit smoking.

Introduction Approximately 5%-10% of pregnant women smoke worldwide, placing their unborn babies under risk of complicated medical conditions. To date, common smoking cessation treatments have shown to be less adequate for smoking expectant mothers since the safety of anti-smoking medications during pregnancy has not yet been clearly proven, and current behavioral interventions available today fail to meet the intense emotional needs of this population. Our company, Mind Innovations, develops and integrates digital health solutions. Our aim is to reduce perinatal smoking by developing a clinical-based solution tailored specifically to the expectant mother that consists of three modules: (1) CBT-based mobile app, (2) 6-week personal counseling program, and (3) Patient Relationship Management (PRM) tool. We expect this will fill the gap where other solutions fall short by better addressing this population’s unique needs. Methods Mind Innovations collaborated with Meuhedet Health Provider, Israel to develop, implement, and recruit patients for this program. We created an 18-hour clinical training course designed to qualify experienced counselors for running a 6-week personal counseling program that prepares the perinatal smoker towards her quit date aided by our PRM. We developed a CBT-based app that provides motivation, knowledge, and training for preparing patients to succeed in meeting their quit date and preventing relapses Results We used questionnaires to evaluate our counselor training course. Results show satisfaction was very high (Mean=9.81/10 ;sd=0.48), and knowledge and skills increased from 5.93 to 8.86 (on a scale of 1-10, paired t-test ; p<0.001). The intervention program’s results will be published soon. Conclusions Counselor training has proved successful. Our mobile intervention program is undergoing research. Funding The project was funded by Global Bridges organization for Meuedet Health provider, Israel, and developed by Mind Innovations, a company specializing in developing digital health solutions

Clean air for babies: an integrated support system and app designed to increase perinatal smoking cessation

Aim and Objective Approximately 10% of pregnant Israeli women smoke. To date smoking cessation programs across Israel consist mainly of group interventions, but these have shown to be less effective during pregnancy due to the demand for intensive and immediate support. Smoking cessation during pregnancy is further complicated, as smoking while pregnant leads to feelings of guilt and shame. Such anxiety has been shown to lead to mood shifts and in some cases depression. Meuhedet is the third largest healthcare provider in Israel with over 1.2M members, many relatively young, with 30,000 births annually. One of our major concerns is perinatal smoking. We are currently developing an integrated support program consisting of two modules: a unique counsellor training program and a 6-week active intervention program, including use of a specialized app. We have already completed the counselor training program and are currently running the 6-week intervention program. We have partnered up with MindInnovations.co—a company focused on creating innovations in therapeutic care—in order to create the CBT-based app. The app provides motivation, knowledge, and skills by tracking progress, assigning tasks, and providing participants with a clear pathway towards their quit date. Methods Our counselor training program gave smoking cessation counselors practical clinical tools for delivering extensive emotional support to expectant mothers. This program integrated theoretical background with practical protocols to attend the patients’ intense emotional needs, based on current psychological theories (CBT, Narrative Therapy, Motivational Interviewing, Stages of Change and Mindset Theory). This was conducted over a 36-hour course to a group of experienced smoking cessation counselors. Our perinatal smoking intervention program is ongoing, and the app is in its final stages of development. Results Thirty-six smoking cessation counselors completed the training course. We used questionnaires to evaluate knowledge and skills pre-and post-intervention, and participant satisfaction. Satisfaction was very high (Mean=9.81/10 ;sd=0.48) with high correlation between all items. Most participants responded that the materials were new to them (2.21/4 on a scale of 1-4, with 1 being “highly agree”). Knowledge and skills increased from 5.93 to 8.86 (on a scale of 1-10, paired t-test; p<0.001). We are enthusiastic to report on the intervention program, as well as the app, in the coming months. Conclusions Our advanced training module for experienced counselors significantly increased their skills and met their expectations. Treatment commences at this period of time. Our presentation focuses on our consultation training module and our overall program, including our smoking cessation app. Funding The project is being funded by the Global Bridges organization

Countrywide Computer Alerts to Community Physicians Improve Potassium Testing in Patients Receiving Diuretics

More than 20% of approximately 35,000 patients filling a diuretic prescription had no potassium blood test recorded within the previous year. A laboratory reporting system used throughout Israel by Maccabi Healthcare Services physicians was modified to provide physician alerts regarding potassium testing. The physicians were experienced users of a computerized medical record (CMR) that provided online laboratory test results. A nightly batch file checked pharmacy diuretic purchases against the patient's potassium blood test status. On-screen computer-generated reminders were sent to physicians of patients lacking a recent potassium test. Reminders to clinicians increased potassium testing by 9.8% (p < 0.001). Physician age and gender played a small part in predicting compliance to the alert, but specialty and practice size did not. The time delay between the date a reminder was sent and the potassium test date decreased steadily during the intervention. The success of this reminder system encourages expansion to include more drug–laboratory interactions. Furthermore, direct alerts to patients at multiple organization/patient contact points are planned

Bridging the gap: challenging attitudes towards smoking in pregnancy among healthcare professionals

Background Clean Air for Babies is a Global Bridges project to reduce smoking in pregnancy in a healthcare organization, 'Meuhedet', with 1.2M members. One aim is empowering health professionals to provide brief smoking cessation interventions. In this study we assessed the effectiveness of an education program for nurses and ultrasound technicians. Methods The program consists of 8 hours, and includes smoking and ETS effects during pregnancy, practical tools and behavioral interventions. Evaluation includes before and after questionnaires based on Global Bridges tools, and focus groups. We are at the initial stage of analysis. We will conduct another round of questionnaires 3 months post intervention. Results We conducted 6 courses for 120 maternal health nurses and 60 technicians. Qualitative analysis demonstrates ambivalence regarding ability to intervene (“This will damage the therapeutic space”) and identification with smokers (“I have seen how difficult it is to stop, my husband became unbearable.”). A second theme was hesitance in approaching Muslim or Jewish-Orthodox spouses due to gender-based hierarchies in the cultural context (“In our culture it is hard for the women to tell a man what to do…"). A common theme among technicians was insecurity regarding their role in smoking cessation. We completed analysis of 29 nurses´ questionnaires pre and immediately post intervention. Using paired-t-test analysis we found a significant improvement in the level of knowledge (mean knowledge items 3.27 to 4.38 on a scale of 5, p< 0.001). No difference was found in self efficacy or reported behavior. Conclusions Initial results indicate that it is possible to identify specific barriers among caregivers that create resistance to smoking cessation interventions. Addressing them creates an opportunity for real organizational change. The improvement in knowledge is indicative of the appropriateness of the training sessions. We expect that improvement in self efficacy and reported behavior at the 3 month evaluation

Longitudinal Adherence to Diabetes Quality Indicators and Cardiac Disease: A Nationwide Population‐Based Historical Cohort Study of Patients With Pharmacologically Treated Diabetes

Background Evidence of the cardiovascular benefits of adherence to quality indicators in diabetes care over a period of years is lacking. Methods and Results We conducted a population‐based, historical cohort study of 105 656 people aged 45 to 80 with pharmacologically treated diabetes and who were free of cardiac disease in 2010. Data were retrieved from electronic medical records of the 4 Israeli health maintenance organizations. The association between level of adherence to national quality indicators (2006–2010: adherence assessment) and incidence of cardiac outcome; ischemic heart disease or heart failure (2011–2016: outcome assessment) was estimated using Cox proportional hazards models. During 529 551 person‐years of follow‐up, 19 246 patients experienced cardiac disease. An inverse dose–response association between the level of adherence and risk of cardiac morbidity was shown for most of the quality indicators. The associations were modified by age, with stronger associations among younger patients (<65 years). Low adherence to low‐density lipoprotein cholesterol testing (≤2 years) during the first 5 years was associated with 41% increased risk of cardiac morbidity among younger patients. Patients who had uncontrolled low‐density lipoprotein cholesterol in all first 5 years had hazard ratios of 1.60 (95% CI, 1.49–1.72) and 1.23 (95% CI, 1.14–1.32), among patients aged <65 and ≥65 years, respectively, compared with those who achieved target level. Patients who failed to achieve target levels of glycated hemoglobin or blood pressure had an increased risk (hazard ratios, 1.50–1.69) for cardiac outcomes. Conclusions Longitudinal adherence to quality indicators in diabetes care is associated with reduced risk of cardiac morbidity. Implementation of programs that measure and enhance quality of care may improve the health outcomes of people with diabetes