Kidney Disease, Race, and GFR Estimation

Assessment of GFR is central to clinical practice, research, and public health. Current Kidney Disease Improving Global Outcomes guidelines recommend measurement of serum creatinine to estimate GFR as the initial step in GFR evaluation. Serum creatinine is influenced by creatinine metabolism as well as GFR; hence, all equations to estimate GFR from serum creatinine include surrogates for muscle mass, such as age, sex, race, height, or weight. The guideline-recommended equation in adults (the 2009 Chronic Kidney Disease Epidemiology Collaboration creatinine equation) includes a term for race (specified as black versus nonblack), which improves the accuracy of GFR estimation by accounting for differences in non-GFR determinants of serum creatinine by race in the study populations used to develop the equation. In that study, blacks had a 16% higher average measured GFR compared with nonblacks with the same age, sex, and serum creatinine. The reasons for this difference are only partly understood, and the use of race in GFR estimation has limitations. Some have proposed eliminating the race coefficient, but this would induce a systematic underestimation of measured GFR in blacks, with potential unintended consequences at the individual and population levels. We propose a more cautious approach that maintains and improves accuracy of GFR estimates and avoids disadvantaging any racial group. We suggest full disclosure of use of race in GFR estimation, accommodation of those who decline to identify their race, and shared decision making between health care providers and patients. We also suggest mindful use of cystatin C as a confirmatory test as well as clearance measurements. It would be preferable to avoid specification of race in GFR estimation if there was a superior, evidence-based substitute. The goal of future research should be to develop more accurate methods for GFR estimation that do not require use of race or other demographic characteristics.

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First, Do No Harm: Understanding Primary Care Providers’ Perception of Risks Associated With Discussing Weight With Pediatric Patients

Global Pediatric Health ◽

10.1177/2333794x211040979 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110409

Author(s):

Katie A. Loth ◽

Jocelyn Lebow ◽

Marc James Abrigo Uy ◽

Samantha M. Ngaw ◽

Dianne Neumark-Sztainer ◽

...

Keyword(s):

Primary Care ◽

Health Care Providers ◽

Pediatric Patients ◽

Primary Care Providers ◽

Unintended Consequences ◽

Future Research ◽

Care Providers ◽

Perceived Risks ◽

Negative Impacts ◽

Pediatric Weight Management

Many health care providers struggle with if- and how-to discuss weight with their pediatric patients. This study used one-on-one interviews with primary care providers (n = 20) to better understand their: (1) perception of risks associated with talking about weight with pediatric patients, (2) commitment to adhering to best practices of pediatric weight management, and (3) approaches to mitigate perceived risks. Providers felt concerned that discussing weight with children during clinic visits may have unintended negative impacts. Despite perceived risks, providers continued regular BMI screening and weight-focused conversations, but took care with regard to language and approach with the goal of mitigating perceived risks. Findings suggest that pediatric primary care providers perceive that engaging in weight-related discussions with their patients has the potential to lead to negative, unintended consequences. Future research is needed to understand if weight-focused conversations should be avoided altogether or if there are approaches that can effectively mitigate risks.

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Acceptance of the HPV Vaccine in a Multiethnic Sample of Latinx Mothers

Qualitative Health Research ◽

10.1177/1049732320980697 ◽

2021 ◽

Vol 31 (3) ◽

pp. 472-483

Author(s):

Ana Cristina Lindsay ◽

Madelyne J. Valdez ◽

Denisse Delgado ◽

Emily Restrepo ◽

Yessica M. Guzmán ◽

...

Keyword(s):

Health Care Providers ◽

Thematic Analysis ◽

Hpv Vaccine ◽

Female Adolescents ◽

Future Research ◽

Care Providers ◽

Foreign Born ◽

Structured Interviews ◽

Direct Benefits ◽

Multiethnic Sample

This descriptive qualitative study explored Latinx mothers’ acceptance of the human papillomavirus (HPV) vaccine for their adolescent children. Data were collected through individual, semi-structured interviews and analyzed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Twenty-two ( n = 22), mostly foreign-born, Latinx mothers of male and female adolescents participated in the study. Three main themes and nine subthemes emerged from the analyses. Findings identified the need for increased efforts to raise awareness and knowledge among Latinx mothers of the direct benefits of the HPV vaccine for sons, including stressing prevention of HPV-associated cancers in males. Findings also underscore the need for improved health care providers’ communication and recommendation of the HPV vaccine for Latinx adolescent males. Future research should intervene upon the study’s findings to address barriers that remain and affect Latinx mothers’ acceptance and uptake of the HPV vaccine for their children, in particular their sons.

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Ways that nurse practitioner students self-explain during diagnostic reasoning

Diagnosis ◽

10.1515/dx-2020-0136 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Leah Burt ◽

Susan Corbridge ◽

Colleen Corte ◽

Laurie Quinn ◽

Lorna Finnegan ◽

...

Keyword(s):

Problem Solving ◽

Health Care Providers ◽

Nurse Practitioner ◽

Descriptive Analysis ◽

Diagnostic Errors ◽

Diagnostic Reasoning ◽

Knowledge Structures ◽

Future Research ◽

Biological Knowledge ◽

Care Providers

Abstract Objectives An important step in mitigating the burden of diagnostic errors is strengthening diagnostic reasoning among health care providers. A promising way forward is through self-explanation, the purposeful technique of generating self-directed explanations to process novel information while problem-solving. Self-explanation actively improves knowledge structures within learners’ memories, facilitating problem-solving accuracy and acquisition of knowledge. When students self-explain, they make sense of information in a variety of unique ways, ranging from simple restatements to multidimensional thoughts. Successful problem-solvers frequently use specific, high-quality self-explanation types. The unique types of self-explanation present among nurse practitioner (NP) student diagnosticians have yet to be explored. This study explores the question: How do NP students self-explain during diagnostic reasoning? Methods Thirty-seven Family NP students enrolled in the Doctor of Nursing Practice program at a large, Midwestern U.S. university diagnosed three written case studies while self-explaining. Dual methodology content analyses facilitated both deductive and qualitative descriptive analysis. Results Categories emerged describing the unique ways that NP student diagnosticians self-explain. Nine categories of inference self-explanations included clinical and biological foci. Eight categories of non-inference self-explanations monitored students’ understanding of clinical data and reflect shallow information processing. Conclusions Findings extend the understanding of self-explanation use during diagnostic reasoning by affording a glimpse into fine-grained knowledge structures of NP students. NP students apply both clinical and biological knowledge, actively improving immature knowledge structures. Future research should examine relationships between categories of self-explanation and markers of diagnostic success, a step in developing prompted self-explanation learning interventions.

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Accuracy of State-Level Surveillance during Emerging Outbreaks of Respiratory Viruses: A Model-Based Assessment

Medical Decision Making ◽

10.1177/0272989x211022276 ◽

2021 ◽

pp. 0272989X2110222

Author(s):

Yuwen Gu ◽

Elise DeDoncker ◽

Richard VanEnk ◽

Rajib Paul ◽

Susan Peters ◽

...

Keyword(s):

Growth Rate ◽

Data Collection ◽

Disease Progression ◽

Health Care Providers ◽

Growth Rates ◽

State Level ◽

Future Research ◽

Care Providers ◽

State Surveillance ◽

First Come First Serve

It is long perceived that the more data collection, the more knowledge emerges about the real disease progression. During emergencies like the H1N1 and the severe acute respiratory syndrome coronavirus 2 pandemics, public health surveillance requested increased testing to address the exacerbated demand. However, it is currently unknown how accurately surveillance portrays disease progression through incidence and confirmed case trends. State surveillance, unlike commercial testing, can process specimens based on the upcoming demand (e.g., with testing restrictions). Hence, proper assessment of accuracy may lead to improvements for a robust infrastructure. Using the H1N1 pandemic experience, we developed a simulation that models the true unobserved influenza incidence trend in the State of Michigan, as well as trends observed at different data collection points of the surveillance system. We calculated the growth rate, or speed at which each trend increases during the pandemic growth phase, and we performed statistical experiments to assess the biases (or differences) between growth rates of unobserved and observed trends. We highlight the following results: 1) emergency-driven high-risk perception increases reporting, which leads to reduction of biases in the growth rates; 2) the best predicted growth rates are those estimated from the trend of specimens submitted to the surveillance point that receives reports from a variety of health care providers; and 3) under several criteria to queue specimens for viral subtyping with limited capacity, the best-performing criterion was to queue first-come, first-serve restricted to specimens with higher hospitalization risk. Under this criterion, the lab released capacity to subtype specimens for each day in the trend, which reduced the growth rate bias the most compared to other queuing criteria. Future research should investigate additional restrictions to the queue.

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Exploring the Social Networks’ Use in the Health-Care Industry: A Multi-Level Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147295 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7295

Author(s):

Tommasina Pianese ◽

Patrizia Belfiore

Keyword(s):

Health Care ◽

Social Networks ◽

Health Care Providers ◽

Health Care Industry ◽

Future Research ◽

Great Level ◽

Care Providers ◽

Care Industry ◽

Multi Level ◽

Video And Audio

The application of social networks in the health domain has become increasingly prevalent. They are web-based technologies which bring together a group of people and health-care providers having in common health-related interests, who share text, image, video and audio contents and interact with each other. This explains the increasing amount of attention paid to this topic by researchers who have investigated a variety of issues dealing with the specific applications in the health-care industry. The aim of this study is to systematize this fragmented body of literature, and provide a comprehensive and multi-level overview of the studies that has been carried out to date on social network uses in healthcare, taking into account the great level of diversity that characterizes this industry. To this end, we conduct a scoping review enabling to identify the major research streams, whose aggregate knowledge are discussed according to three levels of analysis that reflect the viewpoints of the major actors using social networks for health-care purposes, i.e., governments, health-care providers (including health-care organizations and professionals) and social networks’ users (including ill patients and general public). We conclude by proposing directions for future research.

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Commentary on “Diabetes and people with learning disabilities: issues for policy, practice and education”

Tizard Learning Disability Review ◽

10.1108/tldr-11-2019-0035 ◽

2020 ◽

Vol 25 (1) ◽

pp. 35-39 ◽

Cited By ~ 1

Author(s):

Brianne Redquest ◽

Yona Lunsky

Keyword(s):

Health Care ◽

Learning Disabilities ◽

Health Care Providers ◽

Diabetes Care ◽

Future Research ◽

Care Providers ◽

Family Carers ◽

Content Type ◽

Policy Practice

Purpose There has been an increase in research exploring the area of intellectual and developmental disabilities (IDD) and diabetes. Despite being described as instrumental to diabetes care for people with IDD, the role and experiences of family carers, such as parents and siblings, are often neglected in this research. However, it is clear that family carers do not feel that they have sufficient knowledge about diabetes. The purpose of this commentary is to extend the content from “Diabetes and people with learning disabilities: Issues for policy, practice, and education (Maine et al., 2020)” and discuss how family carers can feel better supported when caring for someone with IDD and diabetes. Design/methodology/approach This commentary discusses specific efforts such as STOP diabetes, DESMOND-ID and OK-diabetes for people with IDD including family carers. Encouragement is given for health care providers to recommend such programmes to people with IDD and their family carers. It is also suggested that health care providers involve family carers in diabetes care planning and implementation for people with IDD. Findings It is hoped that if changes are made to current diabetes practices and more research with family carers is conducted, diabetes prevention and management for people with IDD will be more successful and family carers can feel more confident in providing support to their loved ones. Originality/value Research exploring the role of family carers in diabetes care for people with IDD and diabetes is very limited. This commentary makes recommendations to help family carers feel better supported in their role. It also provides areas for future research.

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A Scoping Review and Content Analysis of Common Depressive Symptoms of Young People

The Journal of School Nursing ◽

10.1177/10598405211012680 ◽

2021 ◽

pp. 105984052110126

Author(s):

Jia-Wen Guo ◽

Brooks R. Keeshin ◽

Mike Conway ◽

Wendy W. Chapman ◽

Katherine A. Sward

Keyword(s):

Content Analysis ◽

Depressive Symptoms ◽

Young People ◽

Health Care Providers ◽

Scoping Review ◽

School Nurses ◽

Future Research ◽

Depression Symptom ◽

Care Providers ◽

Five Dimensions

School nurses are the most accessible health care providers for many young people including adolescents and young adults. Early identification of depression results in improved outcomes, but little information is available comprehensively describing depressive symptoms specific to this population. The aim of this study was to develop a taxonomy of depressive symptoms that were manifested and described by young people based on a scoping review and content analysis. Twenty-five journal articles that included narrative descriptions of depressive symptoms in young people were included. A total of 60 depressive symptoms were identified and categorized into five dimensions: behavioral ( n = 8), cognitive ( n = 14), emotional ( n = 15), interpersonal ( n = 13), and somatic ( n = 10). This comprehensive depression symptom taxonomy can help school nurses to identify young people who may experience depression and will support future research to better screen for depression.

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VoIP for Telerehabilitation: A Pilot Usability Study for HIPAA Compliance

International Journal of Telerehabilitation ◽

10.5195/ijt.2012.6096 ◽

2012 ◽

Vol 4 (1) ◽

pp. 33-36 ◽

Cited By ~ 3

Author(s):

Valerie R. Watzlaf ◽

Briana Ondich

Keyword(s):

Health Care Providers ◽

Future Research ◽

Software Systems ◽

Usability Study ◽

Care Providers ◽

Privacy And Security ◽

Related Services ◽

Security Applications ◽

Health Related ◽

Hipaa Compliance

Consumer-based, free Voice and video over the Internet Protocol (VoIP) software systems such as Skype and others are used by health care providers to deliver telerehabilitation and other health-related services to clients. Privacy and security applications as well as HIPAA compliance within these protocols have been questioned by practitioners, health information managers, and other healthcare entities. This pilot usability study examined whether four respondents who used the top three, free consumer-based, VoIP software systems perceived these VoIP technologies to be private, secure, and HIPAA compliant; most did not. While the pilot study limitations include the number of respondents and systems assessed, the protocol can be applied to future research and replicated for instructional purposes. Recommendations are provided for VoIP companies, providers, and users.

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Reducing the Risk of Harm from Medication Errors in Children

Health Services Insights ◽

10.4137/hsi.s10454 ◽

2013 ◽

Vol 6 ◽

pp. HSI.S10454 ◽

Cited By ~ 10

Author(s):

Daniel R. Neuspiel ◽

Melissa M. Taylor

Keyword(s):

Medication Errors ◽

Health Care Providers ◽

Adverse Drug Events ◽

Chronic Illnesses ◽

Future Research ◽

Care Providers ◽

Pediatric Age Group ◽

Improvement Interventions ◽

Communication Ability ◽

Quality Improvement Interventions

Medication errors affect the pediatric age group in all settings: outpatient, inpatient, emergency department, and at home. Children may be at special risk due to size and physiologic variability, limited communication ability, and treatment by nonpediatric health care providers. Those with chronic illnesses and on multiple medications may be at higher risk of experiencing adverse drug events. Some strategies that have been employed to reduce harm from pediatric medication errors include e-prescribing and computerized provider order entry with decision support, medication reconciliation, barcode systems, clinical pharmacists in medical settings, medical staff training, package changes to reduce look-alike/sound-alike confusion, standardization of labeling and measurement devices for home administration, and quality improvement interventions to promote nonpunitive reporting of medication errors coupled with changes in systems and cultures. Future research is needed to measure the effectiveness of these preventive strategies.

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Workplace Fatigue Within Summer Camp: Perspectives From Camp Health Care Providers and Directors

Journal of Experiential Education ◽

10.1177/1053825919869367 ◽

2019 ◽

Vol 43 (1) ◽

pp. 71-87

Author(s):

Alexsandra Dubin ◽

Barry A. Garst ◽

Tracey Gaslin ◽

Beth E. Schultz

Keyword(s):

Health Care ◽

Health Care Providers ◽

Employee Performance ◽

Summer Camps ◽

Future Research ◽

Care Providers ◽

Frontline Staff ◽

Analysis Process ◽

Starting Point ◽

Negative Impacts

Background: Summer camps engage millions of youth in enrichment opportunities during the summertime while employing a substantial young adult workforce to provide high-quality programs and services to camp participants. Workplace fatigue has been implicated in camp-related injury and illness events, yet few studies have targeted fatigue among camp employees. Purpose: This study aimed to better understand how fatigue impacted employee performance as well as strategies for reducing the negative impacts of fatigue within camp settings. Methodology/Approach: Focus groups were conducted with camp health care providers and directors, and their responses were analyzed using directed content analysis. The analysis process was guided by sensitizing concepts from the literature. Findings/Conclusions: Emergent themes suggested that camp-related fatigue is conceptualized as a construct of time, types, and causes; is a distinct experience leading to setting-specific outcomes; is managed using administrative and peer supports; and is sometimes perceived in positive ways. Implications: This exploratory study highlighted the unique challenges associated with working in a camp setting and the potential development of fatigue as a starting point informing future research. It suggests that future research should include a broader study population, including frontline staff, as well as possible quantitative measures.

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