The Use of Information Technology in the Construction of a Nursing Communication Platform System

In order to effectively connect patient care information and reduce the amount of administrative work, a nursing care communication platform can effectively achieve 1. Real-time display of patient information while protecting patient privacy; 2. Integration of hospital information system, with individualized medical care team information; 3. Accurate and timely delivery of need for patient report; 4. Increase of interaction between the patient’s family and staff and breakthrough from the limit of paper-based health education information.

Medication Overuse Headache in a Patient with Myasthenia Gravis: a Case Report on Successful Intervention by an Acupuncturist

In this case of medication overuse headache in a patient with myasthenia gravis, an acupuncturist identified the use of an over-the-counter analgesic that was not revealed to the attending physician. This case highlights the potential role of an acupuncturist as part of the medical care team involved in headache management.

Molecular and Neural Mechanism of Dysphagia Due to Cancer

Cancer is one of the most common causes of death worldwide. Along with the advances in diagnostic technology achieved through industry–academia partnerships, the survival rate of cancer patients has improved dramatically through treatments that include surgery, radiation therapy, and pharmacotherapy. This has increased the population of cancer “survivors” and made cancer survivorship an important part of life for patients. The senses of taste and smell during swallowing and cachexia play important roles in dysphagia associated with nutritional disorders in cancer patients. Cancerous lesions in the brain can cause dysphagia. Taste and smell disorders that contribute to swallowing can worsen or develop because of pharmacotherapy or radiation therapy; metabolic or central nervous system damage due to cachexia, sarcopenia, or inflammation can also cause dysphagia. As the causes of eating disorders in cancer patients are complex and involve multiple factors, cancer patients require a multifaceted and long-term approach by the medical care team.

“It is you, me on the team together, and my child”: Attending, resident, and patient family perspectives on patient ownership

Introduction Patient ownership is an important element of physicians’ professional responsibility, but important gaps remain in our understanding of this concept. We sought to develop a theory of patient ownership by studying it in continuity clinics from the perspective of residents, attending physicians, and patients. Methods Using constructivist grounded theory, we conducted 27 semi-structured interviews of attending physicians, residents, and patient families within two pediatric continuity clinics to examine definitions, expectations, and experiences of patient ownership from March–August 2019. We constructed themes using constant comparative analysis and developed a theory describing patient ownership that takes into account a diversity of perspectives. Results Patient ownership was described as a bi-directional, relational commitment between patient/family and physician that includes affective and behavioral components. The experience of patient ownership was promoted by continuity of care and constrained by logistical and other systems-based factors. The physician was seen as part of a medical care team that included clinic staff and patient families. Physicians adjusted expectations surrounding patient ownership for residents based on scheduling limitations. Discussion Our theory of patient ownership portrays the patient/family as an active participant in the patient–physician relationship, rather than a passive recipient of care. While specific expectations and tasks will vary based on the practice setting, our findings reframe the way in which patient ownership can be viewed and studied in the future by attending to a diversity of perspectives.

Relationship of Humidity and Atmospheric Pressure With the Risk of Out-of-hospital Cardiac Arrest

Introduction: Climate change, which affects human health, is one of the most important public health concerns. Few studies have examined the effects of humidity and atmospheric pressure as risk factors on the cardiac system and Out-of-hospital Cardiac Arrest. Objective: This study aimed to determine the relationship between climatic variables (humidity and atmospheric pressure) with Out-of-hospital Cardiac Arrest , and its outcome over 3 years (2016-2018). Materials and Methods: This is an ecological time-series study. Participants were 392 patients with Out-of-hospital Cardiac Arrest referred to Hospital in Rasht City, Iran from 2016 to 2018. Meteorological data and information related to Out-of-hospital Cardiac Arrest and its consequences were collected from reliable resources and were analyzed in R software. Results: Low humidity increased the relative risk of Out-of-hospital Cardiac Arrest (OR=1.54, 95%CI: 1.001-2.69, P=0.001) and failed cardiopulmonary resuscitation (OR=1.76, 95% CI; 1.006-3.79, P=0.001). Higher atmospheric pressure was associated with increased risk of Out-of-hospital Cardiac Arrest (OR=1.16, 95%CI; 1.001-1.78, P=0.001) and unsuccessful cardiopulmonary resuscitation (OR=1.039, 95% CI; 1.005-1.91, P=0.001). Conclusion: Decreased humidity and increased atmospheric pressure are associated with an increased number of Out-of-hospital Cardiac Arrest cases and failure of cardiopulmonary resuscitation. Informing people with cardiovascular disease to avoid such weather conditions, as well as preparing the medical care team and designing early warning systems, can reduce the adverse effects of climate change on the heart.

Ethical Challenges of Pediatric Cancer Care: Interviews With Nurses in Saudi Arabia

Despite rapid and successful development in pediatric cancer treatment, many ethical challenges remain. These challenges have been, and continue to be, the subject of much research, but few qualitative studies have explored the views of nurses, especially in the Middle East. This study, therefore, seeks to fill a knowledge gap in this area and to better understand the concerns of nurses—particularly those in Saudi Arabia and the Middle East. Face-to-face, in-depth interviews were conducted with 17 male and female nurses working in pediatric units at 2 hospitals in Saudi Arabia to explore their views on the ethical challenges in caring for children with cancer. All interviews were recorded and transcribed, then line-by-line encoded, merged, and categorized into themes. Our results show that pediatric cancer is perceived as being “different” from other diseases, and from cancer in adults. Nurses are an integral part of the medical care team and are aware of the importance of their role, as well as the special relationships that they develop with the children. Consent is mandatory and necessary and can be signed by any parent. Assent is important when children become able to give it. Pediatric cancer is seen as a different disease by nurses for various reasons. Their roles and relationships with children and families pose many challenges. Though parental consent and child assent are essential, nurses’ collaboration is important for shared decision-making. Our study paves the way for broader studies to understand the concerns of nurses and other health-care providers about treating children with pediatric cancer.

THE FL-REACH PROJECT: TRANSLATING AN EBP FOR AN OUTPATIENT CLINICAL SETTING TO REACH DIVERSE COMMUNITY MEMBERS

With more than 500,000 patients with Alzheimer’s disease, constituting nearly 10% of all cases in the US, the state of Florida spends an estimated $20 billion per year on care and treatment related to this disease. The Florida State Plan on Aging reported that 75% of informal caregivers felt that early education and training should be a high priority for the state, and that difficult behaviors and limited knowledge about dementias were among the most significant challenges that they faced. The REACH II intervention is the gold-standard for evidence-based practices that address burden, well-being, and skills training for dementia caregivers. This presentation describes the partnership of a Memory Disorder Clinic (MDC) team and two university-based researchers working to embed a modified REACH protocol into an outpatient clinic. Critical streamlined components and new material designed to innovations since the REACH trials. The FL-REACH protocol is significantly shorter, adds a structured assessment for both patient and family needs, expands to include advanced care planning and grief modules, and intentionally builds linkages to the medical care team, with a focus on outreach to diverse families. This manualized intervention is offered to families of patients diagnosed through the MDC, thus capitalizing on the rapport and trust that is built, and providing in-house opportunities to engage diverse populations with a program grounded in the evidence base. This intervention provides critical foundational training for families that will bridge to seamless team coordination in the future.

Characteristics of Future Models of Integrated Outpatient Care

Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we described how patients and their families (or caregivers) can work with members of the medical care team to achieve these twin goals of maintaining—and perhaps improving—high-quality care and minimizing costs. We described how increased self-management enables patients and their families/caregivers to provide electronic patient-reported outcomes (i.e., symptoms, events) (ePROs), as frequently as the patient or the medical care team consider appropriate. These capabilities also allow ongoing assessments of physiological measurements/phenomena (mHealth). Remote surveillance of these communications allows longer intervals between (fewer) patient visits to the medical-care team, when this is appropriate, or earlier interventions, when it is appropriate. Systems are now available that alert medical care providers to situations when interventions might be needed.

The Management of Newly Diagnosed HIV in a Sudanese Refugee in Canada: Commentary and Review of Literature

Background: Human Immunodeficiency Virus (HIV) prevalence rates in refugee camps are inconclusive in current literature, with some studies highlighting the increased risk of transmission due to poor living conditions and lower levels of education. With the increasing number of refugees from HIV endemic countries, it is important to assess the programs established to support patients upon arrival. Refugees have been reported to have a lower health literacy and face disease-related stigmatization, which must be overcome for the lifelong treatment of HIV. </P><P> Case Presentation: 31-year-old female arrived in Canada as a refugee from Sudan with her 5 children in July of 2017. She was diagnosed with HIV and severe dental carries during her initial medical evaluation and referred to our centre. A lack of social support has resulted in severe psychological stress. The first being stigmatization which has led to her not disclosing the diagnosis to anyone outside her medical care team. Her level of knowledge about HIV is consistent with literature reporting that despite HIV prevention programs in refugee camps, compliance with risk reduction behaviors, especially in females, is low. Lastly, her major concern relates to the cost of living and supporting her children. Conclusion: Assessment of current HIV programs is necessary to recognize and resolve gaps in the system. Focusing on programs which increase both risk reduction behaviors in refugee camps and integration of refugees in a new healthcare system can facilitate an easier transition for patients and aid in the quest for global 90-90-90 targets for HIV.

Forgotten, silent, and overruled: Hearing the voice of the nursing home patient

As the population ages, more Americans are moving into nursing homes/long-term care facilities. Per Accreditation Council for Graduate Medical Education 2017 guidelines, family medicine residents are required to gain experience and competence working in long-term care facilities; however, this unique environment poses several challenges for residents to hear the wishes of their patients over the demands of the patient’s medical care team and family members. Also, many patients in long-term care facilities have sensory impairments (e.g., poor eyesight, deafness) and/or cognitive deficits (e.g., dementia). One solution for hearing the patient’s voice over the demands of medical professionals and family members is to train physicians on how to overcome communication barriers with their patients. This article will discuss solution-focused approaches to reducing the barriers of sensory and cognitive impairments through the use of adaptive communication behaviors and adaptive equipment. Ways to improve communication between physicians, nursing-home staff, and patients’ family in order to improve the care patients receive in long-term care facilities will also be addressed. These recommendations are designed to assist with reducing physician frustration, increasing each patient’s input in medical decision-making, and improving communication across the patient care team.