Creating Standardized Tools for the Pharmacist-Led Assessment and Pharmacologic Management of Adult Canadians Wishing to Quit Smoking: A Consensus-Based Approach

Tobacco use continues to be recognized as the single most preventable cause of death worldwide. As the gatekeepers of and experts on pharmacotherapy, pharmacists play a vital role in facilitating smoking cessation. While existing frameworks have enabled pharmacists to provide smoking cessation services in Canada for many years, the way in which they are delivered vary considerably across the nation. The purpose of this initiative was to create standardized tools for the pharmacists providing cessation services to ensure all Canadians wishing to stop smoking have equal access to consistent, evidence-based care. An iterative process using repeated rounds of voting was employed to establish consensus among key opinion leaders on the most important items to include in tools for the pharmacist-led assessment and pharmacologic management of Canadian adults wishing to stop smoking. The results were used to create eight standardized documents for national use by pharmacists: a readiness to quit assessment tool, a patient consent form, a patient assessment form for past users of tobacco and/or tobacco-like products, a patient assessment form for current users of tobacco and/or tobacco-like products, a treatment algorithm, a treatment plan summary form, a prescribing documentation form, and a follow-up & monitoring documentation form. Although not described in detail in these documents, other strategies for smoking cessation (e.g., non-pharmacologic strategies (including quitting “cold turkey” and behavioural interventions), harm reduction strategies, etc.) should be considered when pharmacotherapy is inappropriate or undesired; care should be individualized based on a patient’s previous experiences and current motivation. No single approach to treatment is endorsed by the authors. The consensus-based approach described here provides a suggested framework for harmonizing the pharmacist-led management of other ailments to optimize patient care.

Development and pilot implementation of a standardised trauma documentation form to inform a national trauma registry in a low-resource setting: lessons from Tanzania

ObjectivesTrauma registries are an integral part of a well-organised trauma system. Tanzania, like many low and middle-income countries, does not have a trauma registry. We describe the development, structure, implementation and impact of a context appropriate standardised trauma form based on the adaptation of the WHO Data Set for Injury (DSI), for clinical documentation and use in a national trauma registry.SettingOur study was conducted in emergency units of five regional referral hospitals in Tanzania.ProceduresMixed methods participatory action research was employed. After an assessment of baseline trauma documentation, we conducted semi-structured interviews with a purposefully selected sample of 33 healthcare providers from all participating hospitals to understand, develop, pilot and implement a standardised trauma form. We compared the number and types of variables captured before and after the form was implemented.OutcomesChange in proportion of variables of DSI captured after implementation of a standardised trauma documentation form.ResultsPiloting and feedback informed the development of a context appropriate standardised trauma documentation paper form with carbonless copy that could be used as both the clinical chart and data capture. Among 721 patients (seen by 21 clinicians) during the initial 30-day pilot, overall variable capture was 86.4% of required variables. After modifications of the form and training of healthcare providers, the form was implemented for 7 months, during which the capture improved to 96.3% among 6302 patients (seen by 31 clinicians). The providers reported the form was user-friendly, resulted in less time documenting, and served as a guide to managing trauma patients.ConclusionsThe development and implementation of a contextually appropriate, standardised trauma form were successful, yielding increased capture rates of injury variables. This system will facilitate expansion of the trauma registry across the country and inform similar initiatives in Sub-Saharan Africa.

Moral Guidance Models of Students in SMK Ma'arif 1 Kebumen

<em>Adolescence is the golden period for the students. Therefore, the school as an institution of public education to foster in terms of cognitive, psychomotor and affective must be able to see the symptoms change in adolescence all want to know and want to try. The purpose of this study is to describe and learn about moral guidance models in SMK ma'arif 1 Kebumen. The method used in this research is observation, interview and documentation. Form of business that is done school in Moral guidance in SMK ma'arif 1 Kebumen is with a wide variety of activities such as the application of An-Nahdiyah, that is all the action that is rooted in the permission of ahlu sunnah wal jama'ah and extracurricular activities. So it can be concluded, moral guidance, moral and ethics students should continue to be made in istikomah to be the media in shaping the character and morals of students in SMK ma'arif 1 Kebumen.</em>

Barriers to Physical Assessment: Registered Nurses in Mainland China

The authors focus on discussing the barriers in the use of physical assessment skills by RNs (Registered Nurses) in mainland China. This study was a multicenter, cross-sectional survey conducted in 6 cities with 1,115 RNs in mainland China. The results indicated that 15.36% of the skills were used regularly, where general and skin condition assessment skills are used most frequently. Lack of training and a unified documentation form were the top two barriers RNs faced. In conclusion, RNs are not performing assessment skills with required proficiency in mainland China and still need managerial attention in continuing education.

Gambaran Risiko Gangguan Jiwa pada Korban Bencana Alam Gempa di Lombok Nusa Tenggara Barat

Background: Earthquake is known as a disaster causing considerable health problems requiring immediate post trauma rehabilitation. Prominent health problem emerging after a disaster is psychiatric and mental health problem.Purpose: The study aimed to identify mental health risk and other significant problems growing among the victim’s post-earthquake in Lombok, West Nusa Tenggara, Indonesia.Method: Mix method approach, which was used throughout the study, is a strategy to obtain the data from the disaster victims of 88 people in Lombok. This study collected the data using Psychiatric and Mental Health Disorder Detection Questionnaire and symptom documentation form after practicing Mindfulness Spiritual. Results: The result showed that victims experienced neurosis symptom (85,2%), psychotic symptom (25,9%), PTSD symptom (64,7%) and 13 people did not experience mental health disorder risk. The qualitative study result showed that the earthquake victims grievance was afraid and feeling anxiety to enter the house due to earthquake incident, family relationship and economy problems, ghost issue and numerous diseases.Conclusion: Earthquake lead to psychiatric and mental health disorder and problems including mental health, economy, spiritual and physic aspects among people in Lombok, West Nusa Tenggara. It is essential for the future research to conduct a research about the description of mental health disorder after practicing mindfulness spiritual and planning the intervention that had been agreed by the respondent.

Schmerztherapie nach thoraxchirurgischen Eingriffen

The treatment of pain after thoracic surgery is a challenge and takes place in the individual clinics mostly according to clinic internal standards. It exists no currently valid S3 guideline for the treatment of acute perioperative and posttraumatic pain. For an effective pain treatment as well individual pain experience as the pain intensity of the various thoracic surgical procedures must be considered. Regular pain assessment with appropriate methods and their documentation form the basis for adequate and adapted pain therapy.There are a number of different pain therapy methods, non-medicamentous and drug-based methods, whose effectiveness is described in the literature partially different. For the treatment of acute postoperative pain after thoracic surgery, mainly drug-related procedures are used, except for physiotherapy as a non-medicamentous method. Increasingly, alternative procedures for the peridural catheter as a therapeutic gold standard in the treatment of pain after thoracic surgery are used. Their application can be integrated into a therapeutic algorithm.

Addressing the risk of infertility in young women with breast cancer (BC): A quality improvement (QI) intervention.

72 Background: Many young women with early BC require systemic therapy (ST) which can result in ovarian damage leading to infertility. Fertility preservation (FP) can be performed prior to ST, however uptake is low. Data suggest oncology providers do not routinely discuss the risk of treatment related infertility (TRI) or FP with young women with BC. Methods: We created a QI protocol to ensure providers address fertility needs of young women with early BC. Non-pregnant women age 18-44 years with stage I-III BC who have not initiated ST are identified by screening clinic schedules. Clinicians are asked to follow a QI protocol requiring assessment of patients’ childbearing potential (CBP), risk for TRI and fertility goals (FG). If appropriate, FP is discussed and consultation with a fertility specialist arranged. A clinical team member completes a provider documentation form (PDF) summarizing the QI protocol steps accomplished. Results: Since implementation of the QI protocol, there have been 80 eligible women (mean age 38.6). At least one PDF was completed for 56 (70%), with the majority completed by breast surgeons. Among those with a completed PDF, 48 (86%) were of CBP, all but one of whom planned ST associated with a risk of infertility. According to the PDF, the risk of TRI was discussed in 34 (72%) while FG were assessed in 44 (94%), with 8 (18%) desiring fertility and 8 (18%) undecided about FG. Discussion of FP by the provider and/or a fertility specialist was documented in the PDF for 85% of those who desired fertility or who were undecided. In comparison to the PDF, discussion of FG was recorded in provider notes in 36 (45%) women with documentation in both provider notes and the PDF for 29 (36%). Provider notes documented discussion of FG in 94% of the women who desired fertility or who were undecided according to the PDF. Conclusions: Implementation of a QI protocol with required documentation ensures providers address fertility needs of young women with BC. Providers do not discuss the risk of TRI as frequently as assessing FG. Efforts are ongoing to increase completion rate of our PDF and to incorporate it into the electronic medical record. Follow-up regarding ST and uptake of FP in our cohort is ongoing.