Patient Roles within Interprofessional Collaborative Patient-Centred Care Teams: The Patient and Health Care Provider Perspectives

With current rapid expansions to medical knowledge and technology and rising chronicity of diseases, health care providers are increasingly called upon to work together within interprofessional teams to provide the most comprehensive care to their patients. Interprofessional teams have been depicted as enhancing patient health outcomes and increasing patient satisfaction with care, while decreasing health care spending and wait times for receiving care. However, there is little evidence on how to collaboratively include patients in these teams. The study’s purpose was to construct a framework on the conditions and processes required for patients to assume active participant roles in their care within primary care interprofessional teams. Charmaz’s Constructivist Grounded Theory approach was used. Ten patients and 10 health care providers from two Family Health Teams in Southwestern Ontario, Canada participated in individual semi-structured interviews to learn about their perspectives on patient roles in teams. Data collection and analysis including memoing, coding and constant comparative analysis were used to generate theoretical concepts of the framework. Member-checking interviews occurred to provide final feedback on the framework. The framework entitled: “Patients on Interprofessional Teams in Primary Care: A Framework for Teamwork” presents three main concepts: (1) patient roles; (2) processes; and (3) conditions. The patient roles concept comprises three sub-concepts with each having two categories/descriptors: (1) expert of own health – expressive and advisor; (2) (co)decision-maker – active voice and trusting; and (3) self-manager – advocate and evaluator of care. The processes concept presents five sub-concepts: (1) explain; (2) identify; (3) educate; (4) build; and (5) collaborate. The conditions concept outlines four sub-concepts: (1) flexibility; (2) time; (3) willingness; and (4) readiness. This study presents a comprehensive framework for patient-health care provider interactions within primary care interprofessional teams, including dimensions of and more clarity about three types of roles patients can assume within these teams. This study also offers an understanding of the conditions and processes health care providers adopt in practice towards patient inclusion on these teams. Further research should utilize this framework to continue to build knowledge of patient roles on interprofessional teams within a multitude of health care settings and populations

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Poem written for special issue called "Learning from one another in medical encounters."</p

Nursing transfer of accountability at the bedside: partnering with patients to pilot a new initiative in Ontario community hospitals

The transfer of accountability (TOA) for a patient from one nurse to another at change of shift is an important opportunity to exchange essential patient care information, as well as to enhance the safety and quality of patient care. This study was undertaken to explore nurses’, patients’ and family members’ perceptions associated with the implementation of bedside nurse to nurse TOA. Focus groups were conducted pre-implementation (two with nurses and two with patients and family members) and post-implementation (six with nurses and two with patients and family members). The focus groups were audio-recorded, transcribed and analysed using directed content analysis. Findings were divided into positive outcomes and challenges to bedside nurse to nurse TOA. Positive outcomes included increased patient safety, more informed patients more consistent use of whiteboards in the patient rooms, better engagement with family via the whiteboard and increased family involvement, confirmation of information between nurses, increased accountability between nurses, and personal introduction/icebreaker of the new nurse. The inclusion of the Patient Partners on the project team was a key success factor for the project. Challenges included a perception of lengthened time required for TOA and increased workload, lack of privacy and potential breaches of confidentiality, patient fear and lack of comprehension, lack of clarity in TOA processes, and inconsistent application of the procedures. Hospital administrators and nurse leaders can use these findings to anticipate and understand change associated with bedside TOA as seen by both nurses and patients/families

Improving a Culture of Knowledge Transfer in a School of Nursing

Introduction: A series of 19 unfunded knowledge transfer hands-on workshops were implemented (2017–2019) and delivered by 22 facilitators from disciplines of nursing, business, communication, plastic arts, engineering, and community studies. The purpose of this paper is to report on the post-appraisal of the workshops’ implementation; uncovering the attendees’ new ideas and reflections on the content; and the process of expanding knowledge for practice. Methods: The qualitative program evaluation approach, using the standards of utility, feasibility, accuracy, and propriety of a given program, inspired the design of the immediate appraisal of the workshops delivered within a Canadian school of nursing located in a major urban center. Workshop participants (n = 267) included undergraduate and graduate nursing students, contract instructors, and nurses holding administrative positions. Results: Workshops with high attendance included: (a) Structuring Effective Teaching-Learning Encounters in Healthcare Education and Practice; (b) Cancer Pain; (c) Fetal Health Surveillance; and (d) Nurses as Educators in the Clinical Setting. Concerns were raised by the attendees’ low attendance to the following workshops: (a) Mindfulness for Students; (b) Horizontal Violence; and (d) Self-Care for Nursing Students: Alleviating Anxiety. Workshops offered opportunities for attendees to reflect on content and process as related to their future incorporation of learned knowledge in their own education and practice. Conclusions: High engagement in hands-on exercises, spontaneous construction of context, and relaxed moments shared by the attendees indicate a promising culture of sharing and receiving knowledge. A culture of collective, pleasurable learning among attendees was effective in mobilizing powerful forms of nursing knowledge

Synthesis and Broad-Spectrum Antiviral Activity of Some Novel Benzo-Heterocyclic Amine Compounds

A series of novel unsaturated five-membered benzo-heterocyclic amine derivatives were synthesized and assayed to determine their in vitro broad-spectrum antiviral activities. The biological results showed that most of our synthesized compounds exhibited potent broad-spectrum antiviral activity. Notably, compounds 3f (IC50 = 3.21–5.06 μM) and 3g (IC50 = 0.71–34.87 μM) showed potent activity towards both RNA viruses (influenza A, HCV and Cox B3 virus) and a DNA virus (HBV) at low micromolar concentrations. An SAR study showed that electron-withdrawing substituents located on the aromatic or heteroaromatic ring favored antiviral activity towards RNA viruses

Non-invasive mechanical ventilation and mortality in elderly immunocompromised patients hospitalized with pneumonia: a retrospective cohort study

Christopher S. Johnson and Eric M. Mortensen are with the University of Texas Southwestern Medical Center and the VA North Texas Health Care System, Dallas VA Medical Center -- Christopher R. Frei and Antonio R. Anzueto are with the South Texas Veterans Health Care System and the University of Texas Health Science Center at San Antonio -- Christopher R. Frei is with the University of Texas at Austin, -- Mark L Metersky is with the University of Connecticut School of MedicineBackground: Mortality after pneumonia in immunocompromised patients is higher than for immunocompetent patients. The use of non-invasive mechanical ventilation for patients with severe pneumonia may provide beneficial outcomes while circumventing potential complications associated with invasive mechanical ventilation. The aim of our study was to determine if the use of non-invasive mechanical ventilation in elderly immunocompromised patients with pneumonia is associated with higher all-cause mortality. Methods: In this retrospective cohort study, data were obtained from the Department of Veterans Affairs administrative databases. We included veterans age ≥65 years who were immunocompromised and hospitalized due to pneumonia. Multilevel logistic regression analysis was used to determine the relationship between the use of invasive versus non-invasive mechanical ventilation and 30-day and 90-day mortality. Results: Of 1,946 patients in our cohort, 717 received non-invasive mechanical ventilation and 1,229 received invasive mechanical ventilation. There was no significant association between all-cause 30-day mortality and non-invasive versus invasive mechanical ventilation in our adjusted model (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.66-1.10). However, those patients who received non-invasive mechanical ventilation had decreased 90-day mortality (OR 0.66, 95% CI 0.52-0.84). Additionally, receipt of guideline-concordant antibiotics in our immunocompromised cohort was significantly associated with decreased odds of 30-day mortality (OR 0.31, 95% CI 0.24-0.39) and 90-day mortality (OR 0.41, 95% CI 0.31-0.53). Conclusions: Our findings suggest that physicians should consider the use of non-invasive mechanical ventilation, when appropriate, for elderly immunocompromised patients hospitalized with [email protected]

Impact of oral cyclophosphamide on health-related quality of life in patients with active scleroderma lung disease: Results from the scleroderma lung study

Objective To assess the impact of cyclophosphamide (CYC) on the health-related quality of life (HRQOL) of patients with scleroderma after 12 months of treatment. Methods One hundred fifty-eight subjects participated in the Scleroderma Lung Study, with 79 each randomized to CYC and placebo arms. The study evaluated the results of 3 measures of health status: the Short Form 36 (SF-36), the Health Assessment Questionnaire (HAQ) disability index (DI), and Mahler's dyspnea index, and the results of 1 preference-based measure, the SF-6D. The differences in the HRQOL between the 2 groups at 12 months were calculated using a linear mixed model. Responsiveness was evaluated using the effect size. The proportion of subjects in each treatment group whose scores improved at least as much as or more than the minimum clinically important difference (MCID) in HRQOL measures was assessed. Results After adjustment for baseline scores, differences in the HAQ DI, SF-36 role physical, general health, vitality, role emotional, mental health scales, and SF-36 mental component summary (MCS) score were statistically significant for CYC versus placebo ( P < 0.05). Effect sizes were negligible (<0.20) for all of the scales of the SF-36, HAQ DI, and SF-6D at 12 months. In contrast, a higher proportion of patients who received CYC achieved the MCID compared with placebo in the HAQ DI score (30.9% versus 14.8%), transitional dyspnea index score (46.4% versus 12.7%), SF-36 MCS score (33.3% versus 18.5%), and SF-6D score (21.3% versus 3.8%). Conclusion One year of treatment with CYC leads to an improvement in HRQOL in patients with scleroderma lung disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56039/1/22580_ftp.pd

Design of a prospective cohort study to assess ethnic inequalities in patient safety in hospital care using mixed methods

<p>Abstract</p> <p>Background</p> <p>While US studies show a higher risk of adverse events (AEs) for ethnic minorities in hospital care, in Europe ethnic inequalities in patient safety have never been analysed. Based on existing literature and exploratory research, our research group developed a conceptual model and empirical study to increase our understanding of the role ethnicity plays in patient safety. Our study is designed to (1) assess the risk of AEs for hospitalised patients of non-Western ethnic origin in comparison to ethnic Dutch patients; (2) analyse what patient-related determinants affect the risk of AEs; (3) explore the mechanisms of patient-provider interactions that may increase the risk of AEs; and (4) explore possible strategies to prevent inequalities in patient safety.</p> <p>Methods</p> <p>We are conducting a prospective mixed methods cohort study in four Dutch hospitals, which began in 2010 and is running until 2013. 2000 patients (1000 ethnic Dutch and 1000 of non-Western ethnic origin, ranging in age from 45-75 years) are included. Survey data are collected to capture patients’ explanatory variables (e.g., Dutch language proficiency, health literacy, socio-economic status (SES)-indicators, and religion) during hospital admission. After discharge, a two-stage medical record review using a standardized instrument is conducted by experienced reviewers to determine the incidence of AEs. Data will be analysed using multilevel multivariable logistic regression. Qualitative interviews with providers and patients will provide insight into the mechanisms of AEs and potential prevention strategies.</p> <p>Conclusion</p> <p>This study uses a robust study plan to quantify the risk difference of AEs between ethnic minority and Dutch patients in hospital care. In addition we are developing an in-depth description of the mechanisms of excess risk for some groups compared to others, while identifying opportunities for more equitable distributions of patient safety for all.</p