scholarly journals Patient willingness to be seen by a physician associate in Ireland

2018 ◽  
Vol 4 (2) ◽  
pp. 41 ◽  
Author(s):  
Pauline Joyce ◽  
Richard Arnett ◽  
Arnold Hill ◽  
Roderick S. Hooker
Keyword(s):  
Patient Preference ◽  
Medical Condition ◽  
Wait Time ◽  
Mixed Methods Study ◽  
Medical Provider ◽  
Specific Patient ◽  
Trade Off ◽  
Knowing That ◽  
The Mean ◽  
Gender Specific

Background: The physician associate (PA) role was piloted in Dublin, Ireland between 2015 and 2017. However, the concept of a PA and the acceptance of their role in Ireland had not been explored.Objective: To investigate the willingness of Irish citizens to be seen by a PA based on medical scenarios in a typical clinical setting.Design: A mixed methods study was undertaken. A preference survey, with three medical scenarios, gave participants a choice to be treated by a PA or a doctor, with two time trade-off options offered. Responses were supported with qualitative text. Four hundred people were invited to participate as surrogate patients.Setting and participants: In 2017 a total of 270 respondents took part in the study (67.5%) in two hospitals (one private and one public) in Dublin. The mean age was 60; male (n = 142) and female (n = 128) respondents.Findings: In total, 95% of the respondents chose to see a PA over a doctor based on the scenarios presented and a wait time of 30 minutes. Wait time, trust, competency and the severity or seriousness of the medical condition were categorized into three themes for choosing the PA over the doctor. The “surrogate patient” decisions made by this sample were influenced by knowing that the PA is supervised and can check decisions with his/her supervizing physician.Conclusion: These findings are consistent with studies carried out in other countries where willingness to be seen by a PA is neither age nor gender specific. Patient preference seems to concur around the importance of trust and confidence in the medical provider.

scholarly journals Willingness of medical students to refer patients to a physician associate or a doctor based on clinical scenarios when time is a trade-off

2020 ◽  
Vol 7 (1) ◽  
pp. 1
Author(s):  
Pauline Joyce ◽  
Saifullah Syed ◽  
Richard Arnett ◽  
Seamus Sreenan ◽  
Roderick S Hooker
Keyword(s):  
Medical Students ◽  
Nurse Practitioners ◽  
Online Survey ◽  
Medical Condition ◽  
Wait Time ◽  
Trade Off ◽  
Logistic Regression Models ◽  
Graduate Entry ◽  
Clinical Scenarios ◽  
Willingness To Refer

Background: The Physician Associate (PA) role was introduced in Ireland in 2015 in an effort to bolster medical services. From the perspective of the patient and staff they have been well received. However, the attitude of medical students about PAs is not known.Objective: To investigate the willingness of medical students to refer patients to a PA or a doctor.Methods: A quantitative study was undertaken using an online survey with a sample of 1,909 undergraduate and graduate entry medical students. Based on three outpatient scenarios, they were asked, in their role as future intern (PGY1), to choose a referral to a PA or a doctor, with six time trade-off options offered. Year of study, country of residence and working or treatment experience with PAs and Nurse Practitioners were recorded. Descriptive statistics, and logistic regression models were used.Results: In 2019, in Dublin, 177 medical students took part in the survey. Those surveyed were international and domestic nationals. Overall the PA option was chosen where the patient’s wait time was shorter and the clinical condition was perceived more serious. The doctor option was selected more readily when the wait time difference was less significant. Respondents from countries with established PA roles may have had experience to choose PAs than naïve ones.Conclusion: This study confirms that medical students’ willingness to refer a patient is influenced by familiarity with the PA role and severity of the medical condition. In addition wait time is a primary motivator for selecting the PA over doctor option. These findings suggest a need to improve communication about the PA role among Irish medical students.

(Preprint)

2018 ◽  
Author(s):  
Natalia Banasik ◽  
Dariusz Jemielniak ◽  
Wojciech P?dzich
Keyword(s):  
Medical Condition ◽  
Extended Period ◽  
Well Being ◽  
Marginal Effect ◽  
Life Duration ◽  
Significant Difference ◽  
The Mean ◽  
Academic Teachers ◽  
Length Of Life ◽  
The Impact

BACKGROUND There have been mixed results of the studies checking whether prayers do actually extend the life duration of the people prayed for. Most studies on the topic included a small number of prayers and most of them focused on people already struggling with a medical condition. Intercessory prayer’s influence on health is of scholarly interest, yet it is unclear if its effect may be dependent on the number of prayers for a named individual received per annum. OBJECTIVE We sought to examine if there is a noticeable increased longevity effect of intercessory prayer for a named individual’s well-being, if he receives a very high number of prayers per annum for an extended period. METHODS We retrieved and conducted a statistical analysis of the data about the length of life for 857 Roman Catholic bishops, 500 Catholic priests, and 3038 male academics from the US, France, Italy, Poland, Brazil, and Mexico. We obtained information for these individuals who died between 1988 and 2018 from Wikidata, and conducted an observational cohort study. Bishops were chosen for the study, as they receive millions of individual prayers for well being, according to conservative estimates. RESULTS There was a main effect for occupation F(2, 4391) = 4.07, p = .017, ηp 2 = .002, with pairwise comparisons indicating significant differences between the mean life duration of bishops (M=30489) and of priests (M=29894), but none between the academic teachers (M=30147) and either of the other groups. A comparison analysis between bishops from the largest and the smallest dioceses showed no significant difference t(67.31)=1.61, p = .11. Our main outcome measure is covariance of the mean length of life in each of the categories: bishops, priests, academic teachers, controlled for nationality. CONCLUSIONS The first analysis proved that bishops live longer than priests, but due to a marginal effect size this result should be treated with caution. No difference was found between the mean length of life of bishops from the largest and the smallest dioceses. We found no difference between bishops and male academics. These results show that the impact of intercessory prayers on longevity is not observable.

Nitrogen use efficiency: does a trade-off exist between the N productivity and the mean residence time within species?

2008 ◽  
Vol 56 (3) ◽  
pp. 272 ◽  
Author(s):  
Zhi Y. Yuan ◽  
Han Y. H. Chen ◽  
Ling H. Li
Keyword(s):  
Residence Time ◽  
Nitrogen Use Efficiency ◽  
Mean Residence Time ◽  
Negative Relationship ◽  
Controlled Experiments ◽  
Nitrogen Use ◽  
Trade Off ◽  
N Supply ◽  
Use Efficiency ◽  
The Mean

Nitrogen use efficiency (NUE) can be divided into two components, i.e. N productivity (A) and the mean residence time (MRT). Controlled experiments indicate that there is not a trade-off between A and MRT within species, but this theory has not been well tested in field conditions. Here, we studied the A, MRT and NUE of Stipa krylovii Roshev. in a grassland over 4 years of N fertilisation experimentation. The three parameters (A, MRT and NUE) were significantly related to soil N supply and there was a negative relationship between A and MRT within this species (r = –0.775, P < 0.05), i.e. plants with higher A had lower MRT. Our results showed a trade-off between A and MRT within this Stipa species and this observed trade-off was attributed to different responses of A and MRT to soil fertility.

Management of intended durotomy in minimally invasive intradural spine surgery

2014 ◽  
Vol 21 (2) ◽  
pp. 279-285 ◽  
Author(s):  
Lee A. Tan ◽  
Ippei Takagi ◽  
David Straus ◽  
John E. O'Toole
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Length Of Hospital Stay ◽  
Bed Rest ◽  
Tubular Retractor ◽  
Specific Patient ◽  
Dural Closure ◽  
Estimated Blood Loss ◽  
The Mean ◽  
Operative Notes

Object Minimally invasive surgery (MIS) has been increasingly used for the treatment of various intradural spinal pathologies in recent years. Although MIS techniques allow for successful treatment of intradural pathology, primary dural closure in MIS can be technically challenging due to a limited surgical corridor through the tubular retractor system. The authors describe their experience with 23 consecutive patients from a single institution who underwent MIS for intradural pathologies, along with a review of pertinent literature. Methods A retrospective review of a prospectively collected surgical database was performed to identify patients who underwent MIS for intradural spinal pathologies between November 2006 and July 2013. Patient demographics, preoperative records, operative notes, and postoperative records were reviewed. Primary outcomes include operative duration, estimated blood loss, length of bed rest, length of hospital stay, and postoperative complications, which were recorded prospectively. Results Twenty-three patients who had undergone MIS for intradural spinal pathologies during the study period were identified. Fifteen patients (65.2%) were female and 8 (34.8%) were male. The mean age at surgery was 54.4 years (range 30–74 years). Surgical pathologies included neoplastic (17 patients), congenital (3 patients), vascular (2 patients), and degenerative (1 patient). The most common spinal region treated was lumbar (11 patients), followed by thoracic (9 patients), cervical (2 patients), and sacral (1 patient). The mean operative time was 161.1 minutes, and the mean estimated blood loss was 107.2 ml. All patients were allowed full activity less than 24 hours after surgery. The median length of stay was 78.2 hours. Primary sutured dural closure was achieved using specialized MIS instruments with adjuvant fibrin sealant in all cases. The rate of postoperative headache, nausea, vomiting, and diplopia was 0%. No case of cutaneous CSF fistula or symptomatic pseudomeningocele was identified at follow-up, and no patient required revision surgery. Conclusions Primary dural closure with early mobilization is an effective strategy with excellent clinical outcomes in the use of MIS techniques for intradural spinal pathology. Prolonged bed rest after successful primary dural closure appears unnecessary, and the need for watertight dural closure should not prevent the use of MIS techniques in this specific patient population.

To Check the Knowledge of Hypertension amongst Undergraduate Physiotherapy Students

2021 ◽  
Vol 6 (2) ◽  
pp. 299-301
Author(s):  
Radha Parekh ◽  
Hardini Prajapati
Keyword(s):  
Salt Intake ◽  
Sedentary Lifestyle ◽  
Medical Condition ◽  
Knowledge Assessment ◽  
Main Emphasis ◽  
The Mean ◽  
Hypertension Knowledge ◽  
Physiotherapy Students ◽  
Assessment Questionnaire

Aim: To check the knowledge of hypertension amongst undergraduate physiotherapy students. Background: Hypertension is considered to be a serious medical condition that significantly increases the risk of heart, brain, kidney and other diseases. It is also called the “silent killer”. Sedentary lifestyle, obesity, excessive salt intake, consumption of tobacco are risk factors of hypertension. Hypertension is present in the curriculum of the 4 year long bachelor of physiotherapy course where main emphasis on this topic is usually in the last year of the course. Methodology: 125 students filled a hypertension knowledge assessment questionnaire. The mean result obtained was 12.8 from an 18 point questionnaire. Conclusion: The study concludes that there is moderate knowledge of hypertension amongst undergraduate physiotherapy students. Clinical Significance: Knowledge of hypertension is needed in physiotherapy students to help prescribe a proper exercise regime for patients suffering from hypertension and also help them improve their quality of life. Physiotherapist can also play a major role in preventing hypertension. Keywords: Hypertension, knowledge, undergraduate physiotherapy students.

Abstract WP399: Reduced Cost and Decreased Length of Stay Associated with Acute Ischemic Stroke Care Provided by Nurse Practitioners: A Single Primary Stroke Center Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Leah Roering ◽  
Michelle Peterson ◽  
Muhammad Shah Miran ◽  
Melissa Freese ◽  
Kenneth Shea ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Nurse Practitioners ◽  
Acute Care Hospital ◽  
Stroke Care ◽  
Care Hospital ◽  
Medical Provider ◽  
The Mean ◽  
Stroke Center

Background: Nurse practitioner (NP) have a wider role in modern stroke centers providing quality evidence based care to patients in both in and outpatient settings for acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients. We studied the outcome measures, length of stay (LOS) and cost before and after implementation of nurse practitioners as the primary medical provider in a community based stroke center. Methods: St Cloud hospital is acute care hospital with dedicated stroke service responsible for workup and management of all patients admitted with AIS and TIA. From March 2014-March 2015, all patients were primarily managed by stroke neurologists with or without support of NP, representing physician driven arm. From June 2015-March 2016 all non-critical patients were managed primarily by NP, representing the NP driven arm of care. For this analysis, we excluded all patients with subarachnoid hemorrhage or intracerebral hemorrhage. Using ICD codes, we abstracted LOS and hospitalization cost for all patients, and compared between two arms. Results: A total of 822 patients were included in physician arm and 336 in NP arm. The mean age was 72±14 years for both arms, and 54.4% were male in physician arm and 57.4% were male in NP arm. The mean total LOS for the physician arm was 3.1 ±3.3 days while 2.9±3.6 for NP arm (p=0.6). The total cost for physician arm was $11,286.70 ±$10,920.90 while the NP arm was $10,277.30± $10,142.30 (p=0.1). Conclusion: There is a trend towards lower cost and length of stay with implementation of NP as primary stroke provider for patients admitted with acute ischemic stroke.

scholarly journals Analysis of CNV in the Genomes of the Marrow Cells of the Patients with AML Revealed That High Numbers of Aberrations Associate with Better Survival and Deletions with the Aberrant Expression of CD19 in the Leukemic Blasts

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5164-5164
Author(s):  
Emilia Jaskula ◽  
Janusz Lange ◽  
Monika Mordak-Domagala ◽  
Mariola Sedzimirska ◽  
Marta Lemieszewska ◽  
...  
Keyword(s):  
Chromatin Structure ◽  
Bone Marrow Cells ◽  
Conflicts Of Interest ◽  
Hidden Markov ◽  
Aberrant Expression ◽  
Knowing That ◽  
Segmentation Algorithms ◽  
The Mean ◽  
Cd19 Expression ◽  
Marrow Cells

In our previous study (Jaskula et al., Blood 2017 130:1420) we reported that the number of CNVs within the KANSL1 gene was associated with the phenotype of AML. In the present study we looked at the presence of CNV across the whole genome. One hundred and twenty seven AML patients (diagnosed according to the FAB/WHO criteria, F/M=62/65, age median: 57, range: 21 - 84 years) were included to the present study. The patients were genetically analysed including GTG karyotyping and/or FISH for X or Y deletion, inv (3), -5/5q-, -7/7q-,+8, MLL, RUNX1, PML/RARA or RARA, inv(16). In all patients the microarray analysis of the bone marrow cells having blasts cells (median value 56%) at diagnosis Agilent - Catalog Agilent Cancer CGH+SNP 180K (74 patients) or Roche - WG Catalog NimbleGene 12x270K (53 patients) microarrays were employed and the results were analysed with the use the Partek software employing the Partek Hidden Markov Model (HMM) and segmentation algorithms. Results: The number of CNV in M0 AML marrow cells was significantly lower (median: 0 aberration), as compared to secondary to MDS AML (median: 4.5 aberrations, p=0.006). Patients with AML subtypes from M1 to M6 had higher number of CNV amplifications (median: 2) as compared to the patients with minimally differentiated blasts (M0, median: 0 amplifications, p=0.030). Knowing that (i) changes in the chromatin structure may be associated with the CNV prevalence within the genome (Gheldof et al., PLoS One. 2013 Nov 12;8(11):e79973) and (ii) the aberrant expression of CD19 in AML blasts results from the chromatin structure variations (Walter et al., Oncogene. 2010 May 20;29(20):2927-37) we looked at the presence of association between the numbers of CNV and the presence of the aberrant CD19 expression in the leukemic blasts. It appeared that 11 AML patients having aberrant expression of CD19 (within whom 4 had t(8:21)) had more frequently CNV deletions than those lacking this aberrant expression (median: 2 vs 1 deletions, p=0.018, HMM algorithm). Having the survival curves of the patients plotted accordingly to the high and low numbers of CNV, the situation is more complex and shows that: the patients having higher numbers of CNV aberrations (exceeding the mean of the whole group +SD) enjoyed better survival (20% vs 11%, p=0.090) when segmentation algorithm was employed. HMM analysis also suggested that the higher values of CNV (amplifications, exceeding the mean of the whole group +SD) was associated with better 5-year survival as compared to those with low numbers (42% vs 20%, ns). The aberrant expression of CD19 analysis was associated with higher numbers of deletions (see above) and with better 5-year survival than those lacking this aberrant expression (45% vs 20%, p=0.064). In conclusion, the prevalence of CNV within the genome shapes the phenotype of the leukemia and facilitates the survival. Disclosures No relevant conflicts of interest to declare.

scholarly journals Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology (Preprint)

2021 ◽  
Author(s):  
Alex Mariakakis ◽  
Ravi Karkar ◽  
Shwetak N Patel ◽  
Julie A Kientz ◽  
James Fogarty ◽  
...  
Keyword(s):  
Case Studies ◽  
Medical Condition ◽  
Early Stage ◽  
Health Belief ◽  
Wait Time ◽  
Health Behavior Change ◽  
Survey Instrument ◽  
Evaluation Methodology ◽  
Extrinsic Factors ◽  
Health Concept

BACKGROUND Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable evidence that can contribute to our broader understanding of HITs. OBJECTIVE In this research, we aim to develop and demonstrate a variation of vignette testing that supports developers and designers in evaluating early-stage HIT designs while generating usable evidence for the broader research community. METHODS We proposed a method called <i>health concept surveying</i> for untangling the causal relationships that people develop around conceptual HITs. In health concept surveying, investigators gather reactions to design concepts through a scenario-based survey instrument. As the investigator manipulates characteristics related to their HIT, the survey instrument also measures proximal cognitive factors according to a health behavior change model to project how HIT design decisions may affect the adoption and acceptability of an HIT. Responses to the survey instrument were analyzed using path analysis to untangle the causal effects of these factors on the outcome variables. RESULTS We demonstrated health concept surveying in 3 case studies of sensor-based health-screening apps. Our first study (N=54) showed that a wait time incentive could influence more people to go see a dermatologist after a positive test for skin cancer. Our second study (N=54), evaluating a similar application design, showed that although visual explanations of algorithmic decisions could increase participant trust in negative test results, the trust would not have been enough to affect people’s decision-making. Our third study (N=263) showed that people might prioritize test specificity or sensitivity depending on the nature of the medical condition. CONCLUSIONS Beyond the findings from our 3 case studies, our research uses the framing of the Health Belief Model to elicit and understand the intrinsic and extrinsic factors that may affect the adoption and acceptability of an HIT without having to build a working prototype. We have made our survey instrument publicly available so that others can leverage it for their own investigations.

scholarly journals Do DJIA Firms Reflect Stationary Debt Ratios?

Economies ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 76
Author(s):  
Feng-Li Lin
Keyword(s):  
Capital Structure ◽  
Stationary Processes ◽  
Debt Ratio ◽  
Pecking Order ◽  
Trade Off ◽  
Listed Firms ◽  
Growth Opportunity ◽  
Dow Jones Industrial Average ◽  
The Mean ◽  
The Stability

To form optimum firm capital structure strategies to face unanticipated economic events, firm managers should understand the stability of a firm’s capital structure. The aim of this research was to study whether the debt ratio is stationary in listed firms on the Dow Jones Industrial Average (DJIA). Two vital capital structure concepts regarding pecking order and trade-off theory are fairly contradictory. Using opposing theoretical contexts, the Sequential Panel Selection Method apparently categorizes which and how many series are stationary processes in the panel. This method was used to test the mean reverting properties of the 25 companies listed on Dow Jones Industrial Average between 2001 and 2017 in this study, which is expected to fill the current gap in the literature. The overall results show that stationary debt ratios exist in 10 of the 25 studied firms, supporting the trade-off theory. Moreover, the 10 firms utilizing trade-off theory are affected by firm size, profitability, growth opportunity, and dividend payout ratio. These results provide vital information for firms to certify strategies to optimize capital structure.

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