Caring for the Medically At-Risk Driver: Oregon's Safe Mobility Initiative--Resources for Health Care Professionals

This article outlines special issues related to being a nonheterosexual youth. Information is presented on the sexual development of homosexual youth and their unique challenges. Included are data about the average age of initial awareness and self-identification of gay, lesbian, bisexual, transgendered, and questioning youth. The average age of awareness of homosexual orientation is between 10 or 11 years, while the average for identifying or self-labeling is ages 13–15. This age range is consistent across studies. The special issues related to a unique sexual development, prejudices associated with being a nonheterosexually oriented youth, typical behavioral outcomes of dealing with discrimination, and major health concerns for this at-risk population are identified. Finally, implications for health care professionals working with these adolescents are outlined.

Download Full-text

Are Health Care Professionals Advising Patients With Diabetes or At Risk for Developing Diabetes to Exercise More?

Diabetes Care ◽

10.2337/diacare.29.03.06.dc05-2165 ◽

2006 ◽

Vol 29 (3) ◽

pp. 543-548 ◽

Cited By ~ 49

Author(s):

E. H. Morrato ◽

J. O. Hill ◽

H. R. Wyatt ◽

V. Ghushchyan ◽

P. W. Sullivan

Keyword(s):

Health Care ◽

At Risk ◽

Health Care Professionals ◽

Patients With Diabetes

Download Full-text

Implementation of a Digitally Enabled Care Pathway (Part 2): Qualitative Analysis of Experiences of Health Care Professionals

Journal of Medical Internet Research ◽

10.2196/13143 ◽

2019 ◽

Vol 21 (7) ◽

pp. e13143 ◽

Cited By ~ 4

Author(s):

Alistair Connell ◽

Georgia Black ◽

Hugh Montgomery ◽

Peter Martin ◽

Claire Nightingale ◽

...

Keyword(s):

Health Care ◽

At Risk ◽

Early Detection ◽

Real Time ◽

Health Care Professionals ◽

Care Pathway ◽

Digital Technologies ◽

Response Team ◽

Working Practices ◽

The Impact

Background One reason for the introduction of digital technologies into health care has been to try to improve safety and patient outcomes by providing real-time access to patient data and enhancing communication among health care professionals. However, the adoption of such technologies into clinical pathways has been less examined, and the impacts on users and the broader health system are poorly understood. We sought to address this by studying the impacts of introducing a digitally enabled care pathway for patients with acute kidney injury (AKI) at a tertiary referral hospital in the United Kingdom. A dedicated clinical response team—comprising existing nephrology and patient-at-risk and resuscitation teams—received AKI alerts in real time via Streams, a mobile app. Here, we present a qualitative evaluation of the experiences of users and other health care professionals whose work was affected by the implementation of the care pathway. Objective The aim of this study was to qualitatively evaluate the impact of mobile results viewing and automated alerting as part of a digitally enabled care pathway on the working practices of users and their interprofessional relationships. Methods A total of 19 semistructured interviews were conducted with members of the AKI response team and clinicians with whom they interacted across the hospital. Interviews were analyzed using inductive and deductive thematic analysis. Results The digitally enabled care pathway improved access to patient information and expedited early specialist care. Opportunities were identified for more constructive planning of end-of-life care due to the earlier detection and alerting of deterioration. However, the shift toward early detection also highlighted resource constraints and some clinical uncertainty about the value of intervening at this stage. The real-time availability of information altered communication flows within and between clinical teams and across professional groups. Conclusions Digital technologies allow early detection of adverse events and of patients at risk of deterioration, with the potential to improve outcomes. They may also increase the efficiency of health care professionals’ working practices. However, when planning and implementing digital information innovations in health care, the following factors should also be considered: the provision of clinical training to effectively manage early detection, resources to cope with additional workload, support to manage perceived information overload, and the optimization of algorithms to minimize unnecessary alerts.

Download Full-text

Fidelity to Patients

Conscience in Reproductive Health Care ◽

10.1093/oso/9780198732723.003.0006 ◽

2020 ◽

pp. 115-147

Author(s):

Carolyn McLeod

Keyword(s):

Health Care ◽

At Risk ◽

Reproductive Health ◽

Health Care Professionals ◽

Fiduciary Duty ◽

Conscientious Objector ◽

Reproductive Health Care ◽

Duty Of Loyalty

The central claims of Chapter 5 are that health care professionals who serve a gatekeeping role are fiduciaries for their patients (normatively speaking), they therefore have a fiduciary duty of loyalty to them, and this duty prohibits them from making typical conscientious refusals because doing so jeopardizes health interests of their patients. This chapter explains why this argument works even though typical objectors tend to view the fetus or embryo whose life is at risk as their second patient. At the same time, the author agrees that making a referral to a colleague who is willing and able to provide the offending service, rather than providing it oneself, can be a morally appropriate option for a conscientious objector. The chapter as a whole defends the approach to typical refusals of prioritizing patient interests, specifically for cases where the objector and patient have an existing fiduciary relationship. The author also extends her analysis to atypical refusals in reproductive health care.

Download Full-text

How to optimise anticoagulation for patients who are obese

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.0323 ◽

2020 ◽

Vol 81 (1) ◽

pp. 1-8

Author(s):

Haseem Raja ◽

Jecko Thachil

Keyword(s):

Health Care ◽

At Risk ◽

Health Care Professionals ◽

Number Of Patients ◽

Hospital Acquired

Management of anticoagulation has become a hot topic in the last decade. Health-care professionals are encountering increasing number of patients diagnosed with a thromboembolic episode, probably as a result of heightened awareness. In addition, the recognition that hospital-acquired thrombosis causes substantial mortality has led to an emphasis on appropriate thromboprophylaxis in all patients deemed at risk of thrombosis. However, the use of anticoagulants for both treatment and prophylaxis of thrombosis can pose a challenge in individuals who are obese. There are no detailed studies in this area and as such the dosing and monitoring of anticoagulants in these individuals can be problematic.

Download Full-text

Work-Related Asthma Among Certified Nurse Aides in Texas

Workplace Health & Safety ◽

10.1177/2165079920914322 ◽

2020 ◽

Vol 68 (10) ◽

pp. 491-500

Author(s):

Jenil Patel ◽

David Gimeno Ruiz de Porras ◽

Laura E. Mitchell ◽

Riddhi R. Patel ◽

Joy De Los Reyes ◽

...

Keyword(s):

Health Care ◽

At Risk ◽

Health Care Professionals ◽

Bronchial Hyperresponsiveness ◽

Surface Cleaning ◽

Cross Sectional ◽

Latex Glove ◽

Work Related ◽

Nurse Aides ◽

Certified Nurse Aides

Background: Although nurses are well described as being at risk of work-related asthma, certified nurse aides (CNAs) are understudied. Using a statewide registry in Texas, we measured prevalence and risk factors for work-related asthma and bronchial hyperresponsiveness (BHR) symptoms among CNAs. Methods: For this cross-sectional study, a questionnaire was mailed to a random sample of CNAs ( n = 2,114) identified through the Texas Department of Aging and Disability Services registry, working in health care during 2016–2017, to collect data on job history, asthma symptoms, and sociodemographics. Two outcomes were defined: (a) new-onset asthma (NOA) after entry into the health care field and (b) BHR-related symptoms. Job exposures to cleaning compounds and tasks were assigned using an externally coded CNA-specific job-exposure matrix. Logistic regression modeling was used to measure associations between cleaning exposures and the two asthma outcomes. Findings: The final sample consisted of 413 CNAs (response rate 21.6%). The prevalence of NOA and BHR symptoms were 3.6% and 26.9%, respectively. In adjusted models, elevated odds for BHR symptoms were observed for patient care cleaning (odds ratio [OR] = 1.71, 95% confidence interval [CI] = [0.45, 6.51]), instrument cleaning (OR = 1.33, 95% CI = [0.66, 2.68]), building-surface cleaning (OR = 1.39, 95% CI = [0.35, 5.60]), exposure to glutaraldehyde/orthophthalaldehyde (OR = 1.33, 95% CI = [0.66, 2.68]), and latex glove use during 1992–2000 (OR = 1.62, 95% CI = [0.84, 3.12]). There were too few NOA cases to warrant meaningful regression analysis. Conclusion/Application to Practice: Although not statistically significant, we observed elevated odds of BHR symptoms among nurse aides, associated with cleaning exposures, suggesting this is an at-risk group of health care professionals for work-related respiratory disease, meriting further study.

Download Full-text

Development and psychometric study of a simple instrument to assess patient communication and comprehension skills: the AsCkS

Family Practice ◽

10.1093/fampra/cmz087 ◽

2019 ◽

Vol 37 (4) ◽

pp. 568-573

Author(s):

Luis González-De Paz ◽

Pablo Gálvez-Henández ◽

María Dolores Navarro-Rubio

Keyword(s):

Health Care ◽

At Risk ◽

Psychometric Properties ◽

Health Care Professionals ◽

Convergent Validity ◽

Associated Factors ◽

Goodness Of Fit ◽

Patient Activation ◽

Good Reliability ◽

Comprehension Skills

Abstract Background Instruments to examine patients’ communication skills are impractical for daily clinical practice in primary health care, and it is assumed that health care professionals are always aware of the communication and comprehension status of patients. Objective To design and examine the psychometric properties of a new questionnaire (AsCkS) to screen patients’ risk of low communication and comprehension skills. Methods Designing the new questionnaire involved: (i) a content validity study to generate a set of items, (ii) administration of a questionnaire in a sample of patients and (iii) study of the psychometric properties using a Rasch probabilistic model. The test probability function was used to detect patients at risk of having low communication and comprehension skills, and the associated factors were studied using multivariate logistic regression. Results Five items were generated and 369 patients screened. In the Rasch analysis, one item was removed due to a lack of goodness-of-fit (Outfit = 3.64). The final set of four items showed good reliability (person separation index = 0.90). Convergent validity was moderate for the health literacy construct (r = 0.53) and low for the patient activation (r = 0.38): 77 patients (20.86%) were at risk of having low communication and comprehension skills. After adjustment, the associated factors were age (p < 0.001) and lower educational level (p < 0.001). Conclusion The AsCkS is a reliable and valid instrument and may be used to detect patients requiring a greater effort by the physician to communicate health care messages.

Download Full-text

Hepatitis E Virus Immunoglobulin G Antibodies in Different Populations in Campinas, Brazil

Clinical and Diagnostic Laboratory Immunology ◽

10.1128/cdli.7.5.813-816.2000 ◽

2000 ◽

Vol 7 (5) ◽

pp. 813-816 ◽

Cited By ~ 16

Author(s):

Neiva S. L. Gonçales ◽

João Renato R. Pinho ◽

Regina C. Moreira ◽

Cláudia P. Saraceni ◽

Ângela M. M. Spina ◽

...

Keyword(s):

Health Care ◽

At Risk ◽

Hiv Infection ◽

Low Socioeconomic Status ◽

Health Care Professionals ◽

Hepatitis E Virus ◽

Blood Donors ◽

Hepatitis E ◽

University Hospital ◽

Southeastern Brazil

ABSTRACT The seroprevalence of anti-hepatitis E virus (HEV) antibodies was investigated by enzyme immunoassay in 205 volunteer blood donors, 214 women who attended a center for anonymous testing for human immunodeficiency virus (HIV) infection, and 170 hospital employees in Campinas, a city in southeastern Brazil. The prevalence of anti-HEV antibodies ranged from 2.6% (3 of 117) in health care professionals to 17.7% (38 of 214) in women who considered themselves at risk for HIV. The prevalence of anti-HEV antibodies in health care professionals was not significantly different from that in healthy blood donors (3.0%, 5 of 165) and blood donors with raised alanine aminotransferase levels (7.5%, 3 of 40). The prevalence of anti-HEV antibodies (13.2%, 7 of 53) in cleaning service workers at a University hospital was similar to that among women at risk for HIV infection. These results suggest that HEV is circulating in southeastern Brazil and that low socioeconomic status is an important risk factor for HEV infection in this region.

Download Full-text

Outpatient follow-up of high-risk babies at Lapa Specialized Rehabilitation Center (SRC)

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.993 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

I Stoever ◽

A Alpius ◽

C S Stoever ◽

S E Dias ◽

R S Soares

Keyword(s):

Health Care ◽

At Risk ◽

High Risk ◽

Health Services ◽

Health Care Professionals ◽

Social Inclusion ◽

Early Years ◽

Care Plan ◽

Innovative Technology ◽

Care Network

Abstract Background The Brazilian Ministry of Health has published, in 2012, the MS/GM Ordinance No. 793/12, establishing a Disability Care Network in order to extend access to people with temporary or permanent disabilities (progressive or stable, intermittent or continuous), to qualify the service care, to articulate and integrate the health services (from basic to specialized and hospital care) in such a way to guarantee an integrality care for these disabled people. The State and Municipal Health Departments of São Paulo have legitimized the guidelines with promotion, protection, prevention, monitoring, treatment and rehabilitation actions, providing, according to the principle of equity, greater emphasis on families with greater difficulty of access to health services due to issues of social vulnerability. Child health care is an essential task for health promotion, prevention of illness and identification of neuropsychomotor developmental delays by monitoring child development in the early years of life. As a consequence of low referral of high-risk babies to the Outpatient Care Plan established by SRC Lapa, the following consequences are expected: increase in children with physical, sensory, intellectual, social, emotional, speech and/or language disabilities. Objective To qualify the referral of high-risk babies to capacitate primary health care professionals (PHC) to identify them. Methods matrix support and permanent education meetings for PHC professionals in the Lapa region. Results After the proposed intervention, there was a significant increase in the number of at-risk infants referred to the outpatient clinic. Conclusions An integral and articulated care between the services of basic and specialized care of the Health Care Network made it possible to achieve greater functionality for children who presented some disability, thus allowing a future with more autonomy and social inclusion. Key message Prevention of diseases of at-risk babies an innovative technology in developing countries.

Download Full-text