scholarly journals Evidence-based care in high- and low-risk groups following whiplash injury: a multi-centre inception cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Alexandra Griffin ◽  
Jagnoor Jagnoor ◽  
Mohit Arora ◽  
Ian D. Cameron ◽  
Annette Kifley ◽  
...  
Keyword(s):  
Therapeutic Relationship ◽  
Health Care Providers ◽  
Neck Disability Index ◽  
Risk Groups ◽  
Risk Identification ◽  
Baseline Risk ◽  
Evidence Based ◽  
Care Providers ◽  
Post Injury ◽  
Evidence Based Care

Abstract Background Studies aimed at improving the provision of evidence-based care (EBC) for the management of acute whiplash injuries have been largely successful. However, whether EBC is broadly provided and whether delivery of EBC varies based on risk of non-recovery, is uncertain. Receiving EBC should improve recovery, though this relationship has yet to be established. Further, mitigating the effect of EBC is the relationship with the practitioner, a phenomenon poorly understood in WAD. This study aimed to determine the proportion of individuals with whiplash, at differing baseline risk levels, receiving EBC. This study also aimed to determine whether receiving EBC and the therapeutic relationship were associated with recovery at 3 months post injury. Methods Participants with acute whiplash were recruited from public hospital emergency departments, private physiotherapy practices, and State Insurance Regulatory Authority (SIRA) databases. Participants completed questionnaires at baseline (demographics, risk of non-recovery) and 3-months (treatment received, risk identification, therapeutic relationship) post injury. Primary health care providers (HCPs) treating these participants also completed questionnaires at 3-months. Recovery was defined as neck disability index ≤4/50 and global perceived effect of ≥4/5. Results Two-hundred and twenty-eight people with acute whiplash, and 53 primary care practitioners were recruited. The majority of the cohort reported receiving EBC, with correct application of the Canadian C-spine rule (74%), and provision of active treatments (e.g. 89% receiving advice) high. Non-recommended (passive) treatments were also received by a large proportion of the cohort (e.g. 50% receiving massage). The therapeutic relationship was associated with higher odds of recovery, which was potentially clinically significant (OR 1.34, 95% CI 1.18–1.62). EBC was not significantly associated with recovery. Conclusions Guideline-based knowledge and practice has largely been retained from previous implementation strategies. However, recommendations for routine risk identification and tailored management, and reduction in the provision of passive treatment have not. The therapeutic relationship was identified as one of several important predictors of recovery, suggesting that clinicians must develop rapport and understanding with their patients to improve the likelihood of recovery.

Promoting Women’s Participation in Maternity Care in Lebanon

2015 ◽  
Vol 5 (3) ◽  
pp. 166-176 ◽  
Author(s):  
Tamar Kabakian-Khasholian ◽  
Rawan Shayboub ◽  
Mona Kanaan ◽  
Ziyad Mahfoud ◽  
Faysal El Kak
Keyword(s):  
Best Practices ◽  
Communication Skills ◽  
Health Care Providers ◽  
Maternity Care ◽  
Controlled Trial ◽  
Effective Communication ◽  
Evidence Based ◽  
Care Providers ◽  
Cluster Randomized ◽  
Evidence Based Care

This study examined the effect of providing evidence-based information to women and enabling them to use effective communication skills on requesting changes in maternity care. A cluster randomized controlled trial was conducted where pregnant women, from 65 private obstetric clinics, were recruited from 2 regions in Lebanon. The intervention consisted of 2 prenatal sessions on evidence-based care and effective communication skills. Women in the intervention arm were more likely to request not to have an enema (odds ratio [OR] = 5.57; confidence interval [CI] = 2.44–12.71), to request keeping their infants for prolonged time in their room (OR= 2.1; CI = 1.43–3.09), and to actually being able to keep their infants in their rooms for longer periods (OR= 2.39; CI = 1.13–5.04), compared to women in the control arm. Knowledge on best practices was significantly improved. Informing women about best practices and enhancing communication skills with providers of care can facilitate change in the provision of health services. More consideration needs to be given to the commitment of health care providers and senior staff within hospitals to ensure the scaling up of such interventions.

scholarly journals Epidemiological Characteristics of Carrying Viral Hepatitis B Antigen in the Population of the Nišava District

2014 ◽  
Vol 31 (2) ◽  
pp. 121-128
Author(s):  
Marina Kostić ◽  
Biljana Kocić ◽  
Nataša Rančić
Keyword(s):  
Hepatitis B ◽  
Health Care Providers ◽  
Urban Areas ◽  
Drug Users ◽  
Risk Groups ◽  
Epidemiological Surveillance ◽  
Annual Reports ◽  
Care Providers ◽  
Upward Trend ◽  
Epidemiological Characteristics

Summary The aim of this paper was to determine the trend of diseases and epidemiological characteristics of viral antigen carrying of hepatitis B for better implementation of prevention and control of the disease activity. The annual reports, reports of diseases - deaths from infectious diseases, epidemiological survey of the Public Health Institute (IPH) Niš were used as the material. The period from 2002 to 2011 in the Nišava District was considered. A descriptive method was used. HBsAg carrying shows an upward trend (y=15+3.27 x). Most carriers are males (57.27%), live in urban areas (98.16/ 100.000 population), average age 41.92 years old ±SD 18.59, pensioners (22.42%). 54.05% are nephrology patients (almost all retirees under the age of 60 years old). Only 15.76% were hospitalized. The data on the vaccination status are insufficient. In 5.45%, co-infection with hepatitis C virus was found. 63.33% belong to the group of patients for whom there were no data on the mode of transmission. Hemodialysis patients make 16.67%, blood donors 9.39%, 6.36% pregnant women and injecting drug users 1.21%. The upward trend of carrying, the presence of all known risk groups in the population of carrying in the Nišava District points to the need for improved epidemiological surveillance, strict application of protective measures, conducting of statutory vaccination of all categories of people exposed to particular risk of infection as well as continuing education on preventive measures of both population and health care providers.

scholarly journals “What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anh Ly ◽  
Roger Zemek ◽  
Bruce Wright ◽  
Jennifer Zwicker ◽  
Kathryn Schneider ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Clinical Pathways ◽  
Theoretical Domains Framework ◽  
Local Context ◽  
Emergency Department Physician ◽  
Evidence Based ◽  
Care Providers ◽  
Structured Interviews ◽  
Pediatric Concussion

Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

Translating Evidence-Based Interventions Into Practice

2011 ◽  
Vol 12 (6_suppl_1) ◽  
pp. 9S-19S ◽  
Author(s):  
Meera Viswanathan ◽  
Linda Lux ◽  
Kathleen N. Lohr ◽  
Tammeka Swinson Evans ◽  
Lucia Rojas Smith ◽  
...  
Keyword(s):  
Health Care Providers ◽  
System Integration ◽  
Pediatric Asthma ◽  
Evidence Based ◽  
Extensive Literature ◽  
Care Providers ◽  
Planning Period ◽  
Community Based ◽  
Asthma Morbidity ◽  
Effective Interventions

Pediatric asthma is a multifactorial disease, requiring complex, interrelated interventions addressing children, families, schools, and communities. The Merck Childhood Asthma Network, Inc. (MCAN) is a nonprofit organization that provides support to translate evidence-based interventions from research to practice. MCAN developed the rationale and vision for the program through a phased approach, including an extensive literature review, stakeholder engagement, and evaluation of funding gaps. The analysis pointed to the need to identify pediatric asthma interventions implemented in urban U.S. settings that have demonstrated efficacy and materials for replication and to translate the interventions into wider practice. In addition to this overall MCAN objective, specific goals included service and system integration through linkages among health care providers, schools, community-based organizations, patients, parents, and other caregivers. MCAN selected sites based on demonstrated ability to implement effective interventions and to address multiple contexts of pediatric asthma prevention and management. Selected MCAN program sites were mature institutions or organizations with significant infrastructure, existing funding, and the ability to provide services without requiring a lengthy planning period. Program sites were located in communities with high asthma morbidity and intended to integrate new elements into existing programs to create comprehensive care approaches.

scholarly journals A Study Protocol for Increasing Access to Smoking Cessation Treatments for Low-Income Minority Smokers

2021 ◽  
Vol 9 ◽  
Author(s):  
Alicia K. Matthews ◽  
Karriem S. Watson ◽  
Cherdsak Duang ◽  
Alana Steffen ◽  
Robert Winn
Keyword(s):  
Health Care ◽  
Smoking Cessation ◽  
Health Care Providers ◽  
Low Income ◽  
Access To Health Care ◽  
Social Determinant ◽  
Evidence Based ◽  
Patient Portal ◽  
Care Providers ◽  
Access To Health

Background: Smoking rates among low-income patients are double those of the general population. Access to health care is an essential social determinant of health. Federally qualified health care centers (FQHC) are government-supported and community-based centers to increase access to health care for non-insured and underinsured patients. However, barriers to implementation impact adherence and sustainability of evidence-based smoking cessation within FQHC settings. To address this implementation barrier, our multi-disciplinary team proposes Mi QUIT CARE (Mile Square QUITCommunity-Access-Referral-Expansion) to establish the acceptability, feasibility, and capacity of an FQHC system to deliver an evidence-based and multi-level intervention to increase patient engagement with a state tobacco quitline.Methods: A mixed-method approach, rooted in an implementation science framework of RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance), will be used in this hybrid effectiveness-implementation design. We aim to evaluate the efficacy of a novel delivery system (patient portal) for increasing access to smoking cessation treatment. In preparation for a future randomized clinical trial of Mi QUIT CARE, we will conduct the following developmental research: (1) Examine the burden of tobacco among patient populations served by our partner FQHC, (2) Evaluate among FQHC patients and health care providers, knowledge, attitudes, barriers, and facilitators related to smoking cessation and our intervention components, (3) Evaluate the use of tailored communication strategies and patient navigation to increase patient portal uptake among patients, and (4) To test the acceptability, feasibility, and capacity of the partner FQHC to deliver Mi QUIT CARE.Discussion: This study provides a model for developing and implementing smoking and other health promotion interventions for low-income patients delivered via patient health portals. If successful, the intervention has important implications for addressing a critical social determinant of cancer and other tobacco-related morbidities.Trial Registration: U.S. National Institutes of Health Clinical Trials, NCT04827420, https://clinicaltrials.gov/ct2/show/NCT04827420.

scholarly journals Faktor-Faktor yang Mempengaruhi Self-care Behavior pada Klien dengan Hipertensi di Komunitas

2020 ◽  
Vol 11 ◽  
pp. 37
Author(s):  
Wimar Anugrah Romadhon ◽  
Bernadetta Germia Aridamayanti ◽  
Anggi Hanafiah Syanif ◽  
Gevi Melliya Sari
Keyword(s):  
Health Care Providers ◽  
Self Efficacy ◽  
Self Care ◽  
Google Scholar ◽  
Evidence Based ◽  
Care Providers ◽  
Inclusion Criteria ◽  
Salt Diet ◽  
Low Salt ◽  
Care Behavior

Background: self-care behavior is an important thing that needs to be considered by clients with hypertension which consists of several components, namely the use of drugs, low-salt diet, physical activity, smoking, weight management and alcohol consumption. Purpose: to show the factors that influence self-care behavior in clients with hypertension. Method: the database used to identify suitable articles obtained from Scopus, ProQuest and Google Scholar, limited to the last 5 years of publication from 2014 to 2019, English, and fulltext articles. The literature review used the keyword "Self-care behavior, Hypertension". In searching articles used "AND". Only 12 articles met the inclusion criteria. This review was from 12 of these articles. Results: self-care behavior in hypertensive clients were influenced by several factors, namely family support, self-efficacy, knowledge, and spirituality. Conclusion: factors related to self-care behavior and pathways can help health care providers develop and design evidence-based interventions for clients with hypertension. Recommendation: Community nurses understand the factors that influence self-care behavior in hypertensive clients in the community so they are able to provide appropriate nursing care. Keywords: factors of self-care behavior; hypertension; community ABSTRAK Latar belakang: self-care behavior merupakan hal penting yang perlu diperhatikan oleh klien dengan hipertensi yang terdiri dari beberapa komponen yaitu penggunaan obat-obatan, diet rendah garam, aktifitas fisik, merokok, manajemen berat badan dan konsumsi alkohol. Tujuan: untuk melihat adanya faktor-faktor yang mempengaruhi self-care behavior pada klien dengan hipertensi. Metode: database digunakan untuk mengidentifikasi artikel yang sesuai diperoleh dari Scopus, ProQuest dan Google Scholar terbatas untuk publikasi 5 tahun terakhir dari 2014 hingga 2019, bahasa inggris, dan fulltex article. Tinjauan literatur menggunakan kata kunci “factors of self-care behavior, Hypertension”. Dalam pencarian artikel menggunakan "AND". Hanya 12 artikel yang memenuhi kriteria inklusi. Ulasan ini berasal dari 12 artikel tersebut. Hasil: self-care behavior pada klien hipertensi dipengaruhi oleh beberapa faktor yaitu dukungan keluarga, self-efficacy, faktor personal, dan spiritualitas. Simpulan: faktor-faktor yang terkait dengan self-care behavior dan jalurnya dapat membantu penyedia layanan kesehatan mengembangkan dan mendesain intervensi bebasis bukti pada klien dengan hipertensi. Saran: Perawat komunitas memahami faktor-faktor yang mempengaruhi self-care behavior pada klien hipertensi di komunitas sehingga mampu memberikan asuhan keperawatan yang tepat. Kata kunci: factors of self-care behavior; hypertension; community

Infection risk and prophylaxis in patients with lymphoid cancer

Blood ◽  
2021 ◽  
Author(s):  
Nancy Law ◽  
Randy A. Taplitz
Keyword(s):  
Risk Factors ◽  
Health Care Providers ◽  
Treatment Approach ◽  
Antimicrobial Prophylaxis ◽  
Cancer Therapeutics ◽  
Infection Risk ◽  
Evidence Based ◽  
Care Providers ◽  
Additional Risk ◽  
Common Cause

Infections are a common cause of morbidity and mortality in patients with lymphoid cancer. With evolving cancer therapeutics, including new targeted and immunotherapies, clinicians need to be aware of additional risk factors and infections that may arise in patients treated with these agents. This "How I Treat" article will highlight fundamental issues including risk factors for infection, infectious diseases screenings and antimicrobial prophylaxis recommendations in patients with lymphoid cancers. We present 4 scenarios of patients with lymphoid cancers with varied infections and describe a treatment approach based on a combination of evidence-based data and experience, as there are limitations in objective infection data especially with newer agents. The goal of this discussion is to provide a framework for institutions and health care providers to develop their own approach in preventing and treating infections in patients with lymphoid cancer.

Depression in Medical Patients

2017 ◽  
pp. 146-159
Author(s):  
Myrna M. Weissman ◽  
John C. Markowitz ◽  
Gerald L. Klerman
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care Providers ◽  
Health Personnel ◽  
Time Constraints ◽  
Depression Treatment ◽  
Evidence Based ◽  
Medical Patients ◽  
Care Providers ◽  
Different Levels

Depression treatment that is coordinated with care for comorbid chronic conditions improves control of both the depression and the chronic medical disease. Interpersonal counseling (IPC) and briefer forms of IPT for depression have been introduced in medical practice and primary care to accommodate providers’ time constraints and different levels of training of mental health care providers. IPC is best used with patients who have low levels of depressive symptoms, or distress, and where more highly trained therapists are not available but health personnel are interested in providing counseling. There is high interest in developing briefer approaches for depression treatment in medical patients, a wealth of evidence-based choices, and much work to be done. A case example is given of a college student with comorbid depression and diabetes.

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