Saturday multidisciplinary hemodialysis access clinics to enhance patient care

Fragmentation of outpatient care is a substantial barrier to creation and maintenance of hemodialysis access. To improve patient accessibility, satisfaction, and multidisciplinary provider communication, we created a monthly Saturday multidisciplinary vascular surgery and interventional nephrology access clinic at a tertiary care hospital in a major urban area for the complicated hemodialysis patient population. The study included patients presenting for new access creation as well as those who had previously undergone access surgery. Staffing included two to three interventional nephrologists, two to three vascular surgeons, one medical assistant, one research assistant, and one practice assistant. Patient satisfaction and perception of the clinic was measured using surveys during six of the monthly Saturday hemodialysis clinics. A total of 675 patient encounters were completed (18.2 average/clinic ±6.3 standard deviation) from August 2016 to August 2019. All patients were seen by both disciplines. The average no-show rate was 19.9% throughout the study period. Patient satisfaction in all measures was consistently high with the Saturday clinic. Providers were also assayed, and they generally valued the real-time, multidisciplinary care plan generation, and its subsequent efficient execution. Saturday multidisciplinary hemodialysis access clinics offer high provider and patient satisfaction and streamlined patient care. However, no-show rates remain relatively high for this challenging patient population.

Smoking cessation advice after cervical screening: a qualitative interview study of acceptability in Dutch primary care

BackgroundCervical cancer screening in general practice could be a routine and opportune moment to advise females who smoke to stop smoking.AimThe aims of this study were to investigate the attitudes of females who smoke to receiving advice about stopping smoking after cervical screening and to identify factors associated with the acceptability of this advice.Design and settingThis qualitative interview study was conducted with Dutch females who smoked, had undergone cervical screening, and were aged 30 to 60 years. Interviews were performed between December 2016 and September 2017.MethodIn this study 15 participants were interviewed and transcripts were analysed using thematic analysis.ResultsFemales who smoke were ambivalent (positive or sceptical) about being advised to stop smoking after they had undergone cervical screening. An explanation of why smoking behaviour is addressed by the practice assistant performing the smear, and making females feel at ease during the smear test, were found to be factors that might influence acceptability of such advice. Although a personal and non-judgemental approach to discussing smoking was considered essential, participants expressed different preferences regarding the form and content of cessation support. This was reflected by the variations in knowledge about smoking cessation support, previous experiences of cessation attempts, and received cessation advice or support.ConclusionStudy participants had mixed opinions about being given advice about smoking cessation after their cervical smear test and differed in their preferences for the type of support for smoking cessation. An interactive approach might improve how well a smoking cessation intervention is received by females who smoke and cater to their individual needs and preferences.

A best space for assisted wheelchair users

Introduction Occupational therapists lack manual-handling sensitive tools to assist individual adaptation specifications for assisted wheelchair users, for example, corridor-room turns for extra-long wheelchairs. Method Engineering-based methods identified an experimental set-up. This provided a useful representation of possible manoeuvres in five tasks and proposed a turn difficulty order. Experienced wheelchair assistants ( n = 22) selected their maximum comfortable wheelchair weight for each turn. Results Some participants (3/22) were insensitive to turning-space but all other participants (19/22) chose their lowest maximum comfortable weight for the tightest turning-space and 17/19 chose their highest weights for space permitting a slow turn. Mean percentage weight increased by 30% from tight to slow turning-space. Results are statistically significant and clinically important. Experimental set-up was similar to assisting in confined spaces; participants were experienced in working in spacious environments and had recent manual-handling training so results are supported by good manual-handling practice. Assistant-size impact on easiest (highest weight) turning-space is small. Results are applicable to all floor coverings and wheelchair sizes but not to self-propelling wheelchair users. Results are incorporated into a tool, demonstrated by case study. Conclusion Tool-use specifies a best adaptation.

IMPROVING EFFI CIENCY MANUFACTURING PRACTICE «ASSISTANT DENTIST »

<p>Industrial practice – an integral and very important part of the preparation of a dentist. Optimization of production practices among students is an actual problem of modern educational process. The paper presents an analysis of the organization and results of the manufacturing practice «physician assistant dental surgeon» at the faculty of the Ural State Medical University, highlighted the main directions of improving its effectiveness. </p>