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ABSTRACT: The physician associate/assistant (PA) profession was introduced into the Republic of Ireland following a 2-year pilot project with the Irish Department of Health between 2015 and 2017. Four PAs from North America were recruited into four designated surgical services at a large teaching hospital in Dublin. To date, the PA numbers are small in Ireland, with one university, in Dublin, running the program and 61 graduates working mostly in the hospital setting, with a small number in primary care. The cautious introduction of PAs partly is due to a delay in follow-up from the Department of Health after the pilot project and in the university's decision to increase the student intake slowly to ensure all graduates secure employment.
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Emprego , Assistentes Médicos , Humanos , Irlanda , Projetos Piloto , Estudantes , Assistentes Médicos/educaçãoRESUMO
COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been shown to cause multisystemic damage. We undertook a systematic literature review and comprehensive analysis of a total of 55 articles on arterial and venous thromboembolism in COVID-19 and articles on previous pandemics with respect to thromboembolism and compared the similarities and differences between them. The presence of thrombosis in multiple organ systems points to thromboembolism being an integral component in the pathogenesis of this disease. Thromboembolism is likely to be the main player in the morbidity and mortality of COVID -19 in which the pulmonary system is most severely affected. We also hypothesize that D-dimer values could be used as an early marker for prognostication of disease as it has been seen to be raised even in the pre-symptomatic stage. This further strengthens the notion that thromboembolism prevention is necessary. We also examined literature on the neurovascular and cardiovascular systems, as the manifestation of thromboembolic phenomenon in these two systems varied, suggesting different pathophysiology of damage. Further research into the role of thromboembolism in COVID-19 is important to advance the understanding of the virus, its effects and to tailor treatment accordingly to prevent further casualties from this pandemic.
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Arteriopatias Oclusivas/etiologia , COVID-19/complicações , Transtornos Cerebrovasculares/etiologia , Embolia Pulmonar/etiologia , Tromboembolia Venosa/etiologia , Trombose Venosa/etiologia , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/mortalidade , Arteriopatias Oclusivas/prevenção & controle , COVID-19/diagnóstico , COVID-19/mortalidade , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/mortalidade , Transtornos Cerebrovasculares/prevenção & controle , Fibrinolíticos/uso terapêutico , Humanos , Prognóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Embolia Pulmonar/prevenção & controle , Medição de Risco , Fatores de Risco , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/mortalidade , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/diagnóstico , Trombose Venosa/mortalidade , Trombose Venosa/prevenção & controle , Tratamento Farmacológico da COVID-19RESUMO
BACKGROUND: Pressure ulcers, which are a localised injury to the skin, or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful, expensive to manage and have a negative impact on quality of life. While individual patient safety and quality care stem largely from direct healthcare practitioner-patient interactions, each practitioner-patient wound-care contact may be constrained or enhanced by healthcare organisation of services. Research is needed to demonstrate clearly the effect of different provider-orientated approaches to pressure ulcer prevention and treatment. OBJECTIVES: To assess the effects of different provider-orientated interventions targeted at the organisation of health services, on the prevention and treatment of pressure ulcers. SEARCH METHODS: In April 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: Randomised controlled trials (RCTs), cluster-RCTs, non-RCTs, controlled before-and-after studies and interrupted time series, which enrolled people at risk of, or people with existing pressure ulcers, were eligible for inclusion in the review. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, risk of bias assessment, data extraction and GRADE assessment of the certainty of evidence. MAIN RESULTS: The search yielded a total of 3172 citations and, following screening and application of the inclusion and exclusion criteria, we deemed four studies eligible for inclusion. These studies reported the primary outcome of pressure ulcer incidence or pressure ulcer healing, or both.One controlled before-and-after study explored the impact of transmural care (a care model that provided activities to support patients and their family/partners and activities to promote continuity of care), among 62 participants with spinal cord injury. It is unclear whether transmural care leads to a difference in pressure ulcer incidence compared with usual care (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.53 to 1.64; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).One RCT explored the impact of hospital-in-the-home care, among 100 older adults. It is unclear whether hospital-in-the-home care leads to a difference in pressure ulcer incidence risk compared with hospital admission (RR 0.32, 95% CI 0.03 to 2.98; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).A third study (cluster-randomised stepped-wedge trial), explored the impact of being cared for by enhanced multidisciplinary teams (EMDT), among 161 long-term-care residents. The analyses of the primary outcome used measurements of 201 pressure ulcers from 119 residents. It is unclear if EMDT reduces the pressure ulcer incidence rate compared with usual care (hazard ratio (HR) 1.12, 95% CI 0.74 to 1.68; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear whether there is a difference in the number of wounds healed (RR 1.69, 95% CI 1.00 to 2.87; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear whether there is a difference in the reduction in surface area, with and without EMDT, (healing rate 1.006; 95% CI 0.99 to 1.03; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear if EMDT leads to a difference in time to complete healing (HR 1.48, 95% CI 0.79 to 2.78, very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).The final study (quasi-experimental cluster trial), explored the impact of multidisciplinary wound care among 176 nursing home residents. It is unclear whether there is a difference in the number of pressure ulcers healed between multidisciplinary care, or usual care (RR 1.18, 95% CI 0.98 to 1.42; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear if this type of care leads to a difference in time to complete healing compared with usual care (HR 1.73, 95% CI 1.20 to 2.50; very low-certainty evidence; downgraded twice for very serious study limitations and twice for very serious imprecision).In all studies the certainty of the evidence is very low due to high risk of bias and imprecision. We downgraded the evidence due to study limitations, which included selection and attrition bias, and sample size. Secondary outcomes, such as adverse events were not reported in all studies. Where they were reported it was unclear if there was a difference as the certainty of evidence was very low. AUTHORS' CONCLUSIONS: Evidence for the impact of organisation of health services for preventing and treating pressure ulcers remains unclear. Overall, GRADE assessments of the evidence resulted in judgements of very low-certainty evidence. The studies were at high risk of bias, and outcome measures were imprecise due to wide confidence intervals and small sample sizes, meaning that additional research is required to confirm these results. The secondary outcomes reported varied across the studies and some were not reported. We judged the evidence from those that were reported (including adverse events), to be of very low certainty.
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Administração de Serviços de Saúde , Úlcera por Pressão/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Controlados Antes e Depois , Serviços Hospitalares de Assistência Domiciliar , Hospitalização , Humanos , Incidência , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Úlcera por Pressão/epidemiologia , Úlcera por Pressão/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Traumatismos da Medula Espinal/complicações , CicatrizaçãoRESUMO
BACKGROUND: Interprofessional health care teams are increasingly utilized in health care organizations. Although there is support for their capacity to solve complex problems, there is also evidence that such teams are not always successful. In an effort to understand the capacity of interprofessional teams to innovate successfully, we investigate the role of cognitive diversity to establish whether and how knowledge differences lead to innovation. PURPOSES: The aim of this study was to construct and investigate a model of team innovation predicted by cognitive diversity. In addition to investigating the direct impact of cognitive diversity in interprofessional health care teams, we develop a model incorporating mediated and moderated effects. In this study, we explore the role of debate as a mediating factor capable of explaining the impact of cognitive diversity on innovation. We further propose that the link between cognitive diversity and innovation through debate is contingent upon trans-specialist knowledge, knowledge shared by health care professionals, spanning specialist divides and enabling mutual understanding. METHODOLOGY: The hypotheses were investigated using a cross-sectional, correlational design. Survey data received from 75 interprofessional teams employed in an acute care setting, representing a 36% response rate, were used to investigate our model. FINDINGS: Analysis supports a significant relationship between cognitive diversity and debate, which is stronger when teams rate highly for trans-specialist knowledge. Results also support a positive relationship between debate and innovation and our full moderated mediated pathway. PRACTICE IMPLICATIONS: A range of strategies are indicated by our results to increase innovation in interprofessional teams. In particular, interventions such as interprofessional education and training, which have been shown to facilitate the development of shared language and meaning, are recommended by our findings.
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Conhecimentos, Atitudes e Prática em Saúde , Comunicação Interdisciplinar , Relações Interprofissionais , Estudos Transversais , Difusão de Inovações , Feminino , Humanos , Masculino , Equipe de Assistência ao Paciente/organização & administração , Inquéritos e QuestionáriosRESUMO
PURPOSE: The aim of this study was to measure the effectiveness of introducing a full five-day practice management (PM) training workshop based on selected Accreditation Council for Graduate Medical Education (ACGME) competencies; professionalism, interpersonal and communication skills, practice-based learning and improvement (PBLI), and system-based practice. METHODS: The study used pre-post study design. A total of 39 family medicine residents in Qatar were included in this study. The outcomes of interest were the level of change in the selected ACGME competencies. Pre- vs. post-workshop scores as well as change in scores of quarterly formative assessment were analysed using paired T-test. RESULTS: The overall improvement in post-programme scores compared to pre-programme scores was 9.8% (p-value < 0.001). The PGY1 Group showed the most significant improvement with a score difference of 18.6% (p-value < 0.001). In self-assessment of skills, the main improvement was in writing objectives and time management skills (p-value < 0.001). The residents showed greater improvements in scores related to communication skills specifically in communicating effectively with patients (p-value = 0.032) as well as in specified skills among system-based practices; specifically in effectively using health resources (p-value < 0.001) and in co-ordinating patient care (p-value < 0.001). CONCLUSION: Implementing a full five-days PM training workshop had resulted in moderate improvements in residents' score in selected ACGME competencies. A longer study on whether the effects of the programme on residents' sustained performance and applicability in practice is required.
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Educação de Pós-Graduação em Medicina/organização & administração , Medicina de Família e Comunidade/educação , Internato e Residência/métodos , Administração da Prática Médica , Adulto , Feminino , Humanos , Masculino , Assistência ao Paciente , Relações Médico-Paciente , Catar , Autoavaliação (Psicologia) , Gerenciamento do Tempo , RedaçãoRESUMO
BACKGROUND: Team Objective Structured Bedside Assessment (TOSBA) is a learning approach in which a team of medical students undertake a set of structured clinical tasks with real patients in order to reach a diagnosis and formulate a management plan and receive immediate feedback on their performance from a facilitator. TOSBA was introduced as formative assessment to an 8-week undergraduate teaching programme in Obstetrics and Gynaecology (O&G) in 2013/14. Each student completed 5 TOSBA sessions during the rotation. The aim of the study was to evaluate TOSBA as a teaching method to provide formative assessment for medical students during their clinical rotation. The research questions were: Does TOSBA improve clinical, communication and/or reasoning skills? Does TOSBA provide quality feedback? METHODS: A prospective cohort study was conducted over a full academic year (2013/14). The study used 2 methods to evaluate TOSBA as a teaching method to provide formative assessment: (1) an online survey of TOSBA at the end of the rotation and (2) a comparison of the student performance in TOSBA with their performance in the final summative examination. RESULTS: During the 2013/14 academic year, 157 students completed the O&G programme and the final summative examination . Each student completed the required 5 TOSBA tasks. The response rate to the student survey was 68 % (n = 107/157). Students reported that TOSBA was a beneficial learning experience with a positive impact on clinical, communication and reasoning skills. Students rated the quality of feedback provided by TOSBA as high. Students identified the observation of the performance and feedback of other students within their TOSBA team as key features. High achieving students performed well in both TOSBA and summative assessments. The majority of students who performed poorly in TOSBA subsequently passed the summative assessments (n = 20/21, 95 %). Conversely, the majority of students who failed the summative assessments had satisfactory scores in TOSBA (n = 6/7, 86 %). CONCLUSIONS: TOSBA has a positive impact on the clinical, communication and reasoning skills of medical students through the provision of high-quality feedback. The use of structured pre-defined tasks, the observation of the performance and feedback of other students and the use of real patients are key elements of TOSBA. Avoiding student complacency and providing accurate feedback from TOSBA are on-going challenges.
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Educação de Graduação em Medicina/métodos , Ginecologia/educação , Obstetrícia/educação , Adulto , Competência Clínica/normas , Educação de Graduação em Medicina/normas , Retroalimentação , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/terapia , Humanos , Masculino , Estudantes de Medicina , Inquéritos e Questionários , Ensino , Adulto JovemRESUMO
BACKGROUND: In the Republic of Ireland, the employment of physician associates (PAs) is growing. Following a pilot project in a hospital setting, PAs are now employed across primary and secondary care in public and private sectors. Most of the Irish PA graduates are working in hospital settings. AIMS: The aim of the study was to explore factors which supported or inhibited the employment of PAs in Irish hospital settings and the perceived supports or challenges for potential employers in recruiting PAs. METHODS: An online survey gathered data via human resources departments of public and private hospitals, with a 25% response rate. RESULTS: Similar to previous studies, the barriers included the lack of recognition and regulation of the role and the small number of PAs to fill available posts. Enablers, which influenced the employment of PAs, included improving workflow, continuity of care and helping to address junior doctors' working hours. CONCLUSIONS: Our data suggests that there is a keen interest and willingness to employ PAs and there is great potential to expand the role in Irish healthcare. However, there are some key issues around funding and recognition to be addressed at government level for this profession to highlight its worth.
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Assistentes Médicos , Médicos , Humanos , Irlanda , Projetos Piloto , EmpregoRESUMO
PURPOSE: This case study emerged from the necessity to reschedule an in-person long case examination to an online platform for physician assistant students' final clinical examination during COVID-19 restrictions. The aim of this study was to evaluate the experiences of students and examiners for a high stakes' clinical examination online. METHODS: This was an evaluation research study using the Context, Input, Process, Product model, which provided a framework to establish the effectiveness and/or success of an online format for a high stakes' clinical examination. All students and examiners were invited to take part in virtual interviews. RESULTS: The results suggest that both students (n = 5) and examiners (n = 7) agree that, although the stress of a face-to-face examination was lessened for the student, this was balanced by a new stressor of potential Internet problems. All agreed that a virtual setting for a high stakes' assessment is not transferable, with both groups citing the lack of opportunities to "read the patient" and "showcase their physical examination skills" as challenging. CONCLUSION: Our study suggests that, in the context of balancing the risks of the pandemic with graduating health care professionals, the online clinical examination format met the required assessment criteria. Recommendations suggest that the long case could be planned so that students and patients are in the same setting to perform a physical examination, confirming the finding that questions on "how to" examine a patient are no substitute for "doing."
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COVID-19 , Assistentes Médicos , Estudantes de Medicina , Humanos , Competência Clínica , Assistentes Médicos/educação , Estudantes , Exame Físico , Avaliação Educacional/métodosRESUMO
AIM: The aim of the present study was to evaluate approaches to learning of healthcare professionals in a postgraduate management programme. BACKGROUND: The study was carried out in a higher education institution. METHODS: An evaluation research study of an inter-professional healthcare group was carried out with students (insider stakeholders), their lecturers and an external examiner (external stakeholders). All three perspectives are presented here. Data were collected by interview, document analysis and reflection. RESULTS: The present study focused on the domain of learning as doing, as a major theme of the study, drawing variances between nurses and other healthcare professionals. The study highlights the importance of exploring approaches to learning from a pluralistic stance. CONCLUSIONS: There is a risk of adopting a narrow approach to education if management programmes are overly influenced by the immediate needs of application of knowledge to practice. Education is influenced by the needs of the students themselves in coming to the programme to acquire knowledge and skills for application to practice. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses undertaking management programmes need to be facilitated to cope with the conflicting demands of completing tasks on the job, engaging deeply with learning from these demands and becoming empowered to develop professionally and personally.
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Atitude do Pessoal de Saúde , Educação de Pós-Graduação em Enfermagem/métodos , Aprendizagem , Enfermeiros Administradores/educação , Educação de Pós-Graduação em Enfermagem/organização & administração , Humanos , Enfermeiros Administradores/psicologia , Pesquisa em Educação em Enfermagem , Pesquisa em Avaliação de Enfermagem , Pesquisa Metodológica em Enfermagem , Objetivos OrganizacionaisRESUMO
AIM: This paper reports on the implementation of a competency assessment tool for registered general agency nurses working in an acute paediatric setting, using a change management framework. BACKGROUND: The increased number of registered general agency nurses working in an acute children's hospital alerted concerns around their competency in working with children. These concerns were initially raised via informal complaints about 'near misses', parental dissatisfaction, perceived competency weaknesses and rising cost associated with their use. METHOD: [Young's (2009) Journal of Organisational Change, 22, 524-548] nine-stage change framework was used to guide the implementation of the competency assessment tool within a paediatric acute care setting. IMPLICATIONS FOR NURSING MANAGEMENT: The ongoing success of the initiative, from a nurse manager's perspective, relies on structured communication with the agency provider before employing competent agency nurses. Sustainability of the change will depend on nurse managers' persistence in attending the concerns of those resisting the change while simultaneously supporting those championing the change. These key communication and supporting roles highlight the pivotal role held by nurse managers, as gate keepers, in safe-guarding children while in hospital. Leadership qualities of nurse managers will also be challenged in continuing to manage and drive the change where resistance might prevail.
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Competência Clínica/normas , Serviços Contratados/normas , Pesquisas sobre Atenção à Saúde/normas , Hospitais Pediátricos/normas , Liderança , Pesquisa em Avaliação de Enfermagem/normas , Enfermagem Pediátrica/normas , Doença Aguda , Grupos Focais , Humanos , Supervisão de Enfermagem/normasRESUMO
PURPOSE: The purpose of this paper is to report on a study that explores healthcare professionals' experiences of the implementation of integrated care pathways (ICPs). DESIGN/METHODOLOGY/APPROACH: This study used a phenomenological research approach with a purposive sample of ten multi-disciplinary healthcare professionals across two acute hospitals in Ireland. Data were collected via semi-structured interviews and analysed using Colazzi's framework. FINDINGS: The findings of the study are presented under four themes: buy-in from all disciplines, multidisciplinary communication, service-user involvement, and audit of ICPs. These themes emanated from the questions asked at interview. RESEARCH LIMITATIONS/IMPLICATIONS: The limitations of the study include the small sample size and the use of two different interviewers across the sites. The inexperience of the interviewers is acknowledged as a limitation as the probing of some questions could have been improved. In addition the themes of the findings were predetermined by the use of the interview guide. PRACTICAL IMPLICATIONS: Changes in existing institutional structures and cultures are required when introducing ICPs. It is necessary for senior management in organisations to lead by example. They also need to identify where support can be offered, such as in the provision of an ICP facilitator, education sessions in relation to ICPs and the development of strategies to improve multi-disciplinary buy-in and participation. ORIGINALITY/VALUE: The findings of this study respond to a gap in the literature in Ireland on the experiences of healthcare professionals who have implemented ICPs. Key findings of the study are the perception that the doctor is pivotal in driving the implementation of ICPs, yet the doctor was not always interested in this responsibility.
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Atenção à Saúde/organização & administração , Pessoal de Saúde , Integração de Sistemas , Humanos , Comunicação Interdisciplinar , Irlanda , Cultura Organizacional , Participação do PacienteRESUMO
ABSTRACT: Investing time in mastering the feedback process is an important skill for all faculty. With physician assistant (PA) programs growing rapidly worldwide, faculty need to devote time to the education theory behind the feedback process. Within the clinical area, feedback is an everyday occurrence for PAs. However, ensuring that the process of giving feedback reaps dividends, ie, closes the feedback loop and ensures that learning and change of behavior have occurred, requires an understanding of what theories and models have already been tested with students. This article focuses on key principles of providing feedback and uses an example of a model of feedback, which highlights the challenges. An application to practice of the principles and model used as examples is provided, with a focus on self and peer feedback.
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Assistentes Médicos , Docentes , Retroalimentação , Humanos , Aprendizagem , Grupo Associado , Assistentes Médicos/educaçãoRESUMO
The role of physician assistant/associate (PA) has expanded from its inception in the United States over 50 years ago, to European countries including Ireland. While there is an increasing body of evidence exploring the role and training of PAs in clinical settings, there is a scarcity of research exploring PA students' perspectives in relation to their experience of anatomy dissection, or how these experiences may contribute to the development of their core professional identity. Students in the first two cohorts of PA Program at the Royal College of Surgeons in Ireland program were invited to interviews which solicited them to reflect and report on their own experiences of anatomical dissection during their course. Participants' responses were analyzed using a thematic inductive approach; common themes and patterns were organized into a hierarchical structure, which generated the final framework of themes. Ten participants took part in the study; only one had previous personal experience of dissection, while two further participants had some familiarity with prosected specimens. The first theme concerned the participants' expectation of anatomical dissection, with sub-themes of preconceptions, smell, and emotions. The second theme involves discussion of coping strategies that the participants used, including talking, viewing the cadaver as their first patient, and naming (or not naming) the cadaver. The third theme includes how the participants' talked about respect and compassion in the dissection room, development of team working skills, and awareness of bereavement and organ donation. A number of recommendations were also made for the experience and orientation of future students in such a program.
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Anatomia , Educação de Graduação em Medicina , Médicos , Estudantes de Medicina , Anatomia/educação , Cadáver , Currículo , Dissecação , HumanosRESUMO
AIM: The aim of this case study was to explore if observing leaders in the context of their day-to-day work can provide an insight into how they lead in particular circumstances. BACKGROUND: The study was carried out in a small organization which was set up 5 years ago. METHODS: A case study methodology was used. Data were collected by field notes of non-participant and participant observations. Follow-up interviews were transcribed and analysed to contextualize the observations. A reflective diary was used by the researcher to add to the richness of the data. RESULTS: The data demonstrates how the leader responded in key circumstances during scheduled meetings with staff, interactions in the office and during coffee time. These responses are linked to literature on leadership in the areas of power, personal development, coaching and delegation. CONCLUSIONS: The findings suggest that observing a leader in the context of their day-to-day work can provide evidence to validate what leaders do in particular circumstances. IMPLICATIONS FOR NURSING MANAGEMENT: The implications of the findings for nursing management are the opportunities to use observation as a tool to understand what managers/leaders do, how they manage or lead and why others respond as they do, and with what outcomes.
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Liderança , Poder Psicológico , Humanos , Irlanda , Observação , Estudos de Casos OrganizacionaisRESUMO
INTRODUCTION: Self-efficacy is positively associated with medication understanding and use self-efficacy (MUSE) among post-stroke patients. It is also closely related to knowledge, belief, and perception, which vary among people from different socioeconomic backgrounds and cultures. As interventions using video and peer stories have emerged to be successful on behavior modification, this study aimed to explore the effectiveness of video narratives incorporated with Health Belief constructs on MUSE and its associated factors among patients with stroke at a local setting. METHODS: A randomized controlled trial (RCT) for 12 months was carried out on patients diagnosed with stroke at Hospital Kuala Lumpur, Malaysia. The RCT recruited up to 216 eligible patients who were requested to return for two more follow-ups within six months. Consented patients were randomized to either standard care or intervention with video narratives. The control of potential confounding factors was ensured, as well as unbiased treatment review with prescribed medications, only obtained onsite. RESULTS AND DISCUSSION: A repeated measure of MUSE mean score differences at T0 (baseline), T2 (6th month) and T4 (12th month) for antithrombotic, antihypertensive, and all medication categories indicated significant within and between groups differences in the intervention group (p<0.05). Moreover, this impact was reflected upon continuous blood pressure (BP) monitoring compared to the control group (F (1214) =5.23, p=0.023, Æ2=0.024). Though BP measure differences were non-significant between the groups (p=0.552), repeated measure analysis displayed significant mean differences between intervention and control group on BP control over time (F (1.344, 287.55) =8.54, P<0.001, Æ2=0.038). Similarly, the intervention's positive impact was also present with similar trends for knowledge, illness perception, and the belief about medicine. Though significant differences (p<0.05) of all outcome measures gradually decreased between T2 and T4 in the intervention group; nevertheless, these positive findings confirmed that personalized video narratives were able to motivate and influence MUSE and its associated factors among post-stroke patients. The significant improvement in medication-taking self-efficacy and the sustenance of BP monitoring habits among patients in the intervention group strengthened our conceptual framework's practicality.
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BACKGROUND: A large number of stroke survivors worldwide suffer from moderate to severe disability. In Malaysia, long-term uncontrolled stroke risk factors lead to unforeseen rates of recurrent stroke and a growing incidence of stroke occurrence across ages, predominantly among the elderly population. This situation has motivated research efforts focused on tapping into patient education, especially related to patient self-efficacy of understanding and taking medication appropriately. Video narratives integrated with health belief model constructs have demonstrated potential impacts as an aide to patient education efforts. OBJECTIVE: The aim of this study was to investigate the feasibility and acceptability of study procedures based on a randomized controlled trial protocol of a video narratives intervention among poststroke patients. We also aimed to obtain preliminary findings of video narratives related to medication understanding and use self-efficacy (MUSE) and blood pressure control. METHODS: A parallel group randomized controlled trial including a control group (without video viewing) and an intervention group (with video viewing) was conducted by researchers at a neurology outpatient clinic on poststroke patients (N=54). Baseline data included patients' sociodemographic characteristics, medical information, and all outcome measures. Measurements of MUSE and blood pressure following the trial were taken during a 3-month follow-up period. Feasibility of the trial was assessed based on recruitment and study completion rates along with patients' feedback on the burden of the study procedures and outcome measures. Acceptability of the trial was analyzed qualitatively. Statistical analysis was applied to ascertain the preliminary results of video narratives. RESULTS: The recruitment rate was 60 out of 117 patients (51.3%). Nevertheless, the dropout rate of 10% was within the acceptable range. Patients were aged between 21 and 74 years. Nearly 50 of the patients (>85%) had adequate health literacy and exposure to stroke education. Most of the patients (>80%) were diagnosed with ischemic stroke, whereby the majority had primary hypertension. The technicalities of randomization and patient approach were carried out with minimal challenge and adequate patient satisfaction. The video contents received good responses with respect to comprehension and simplicity. Moreover, an in-depth phone interview with 8 patients indicated that the video narratives were considered to be useful and inspiring. These findings paralleled the preliminary findings of significant improvement within groups in MUSE (P=.001) and systolic blood pressure control (P=.04). CONCLUSIONS: The queries and feedback from each phase in this study have been acknowledged and will be taken forward in the full trial. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN 12618000174280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373554.
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AIM: The aim of this paper is to present findings of a case study on organisational effectiveness in an education setting and draw similarities with a healthcare setting, focusing on the school principal and nurse leader. BACKGROUND: The study was carried out in a primary school setting and focuses on a principal (as leader). The school, which will be named St Senan's for the case study, is a typical tall structure, has a staff of 30 (teachers and special needs' assistants) and a student number of 117. METHODS: A case study methodology was used. Data was collected by interviewing the principal, two teachers, two students and a parent, in this order. In addition, a Parents' Council meeting was observed and document analysis was carried out on measurements which reflected some critical success factors for the school. RESULTS: Interviews from students and teachers in addition to observation notes indicate that the principal's leadership impacts on organisational effectiveness in the school. CONCLUSIONS: The findings are located in the context of education with similarities being drawn from nursing. It is how the leader leads in the context of the organisation setting which is paramount. In other words it is not possible to take a set of general critical success factors for a school or healthcare setting and apply these widely. The paper concludes by proposing the use of a quality framework to contextualise the findings of the case and promote further discussion in the context of nurse leaders. IMPLICATIONS: The paper suggests that comparisons can be made between school principals and nurse leaders.
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Educação em Enfermagem , Eficiência Organizacional , Liderança , Enfermeiros Administradores , Humanos , Modelos Organizacionais , Reorganização de Recursos HumanosRESUMO
Miller Fischer syndrome (MFS) is a variant of Guillain-Barré syndrome first described in 1956 and is characterised by the clinical triad of ophthalmoplegia, ataxia and areflexia. However, since its discovery, forme fruste and overlapping syndrome have been described. A forme fruste of MFS implies an attenuated form where not all of the clinical triad are present. In this report, a case of MFS is highlighted that was mistakenly treated as posterior circulation stroke, as well as the challenges faced in reaching the correct diagnosis and hence the appropriate treatment.
Assuntos
Ataxia/etiologia , Imunoglobulinas Intravenosas/administração & dosagem , Síndrome de Miller Fisher/diagnóstico , Oftalmoplegia/etiologia , Reflexo Anormal , Adulto , Ataxia/diagnóstico , Seguimentos , Humanos , Masculino , Síndrome de Miller Fisher/tratamento farmacológico , Oftalmoplegia/diagnóstico , Doenças Raras , Recuperação de Função FisiológicaRESUMO
BACKGROUND: The debilitating effects of recurrent stroke among aging patients have urged researchers to explore medication adherence among these patients. Video narratives built upon Health Belief Model (HBM) constructs have displayed potential impact on medication adherence, adding an advantage to patient education efforts. However, its effect on medication understanding and use self-efficacy have not been tested. OBJECTIVE: The researchers believed that culturally sensitive video narratives, which catered to a specific niche, would reveal a personalized impact on medication adherence. Therefore, this study aimed to develop and validate video narratives for this purpose. METHODS: This study adapted the Delphi method to develop a consensus on the video scripts' contents based on learning outcomes and HBM constructs. The panel of experts comprised 8 members representing professional stroke disease experts and experienced poststroke patients in Malaysia. The Delphi method involved 3 rounds of discussions. Once the consensus among members was achieved, the researchers drafted the initial scripts in English, which were then back translated to the Malay language. A total of 10 bilingual patients, within the study's inclusion criteria, screened the scripts for comprehension. Subsequently, a neurologist and poststroke patient narrated the scripts in both languages as they were filmed, to add to the realism of the narratives. Then, the video narratives underwent a few cycles of editing after some feedback on video engagement by the bilingual patients. Few statistical analyses were applied to confirm the validity and reliability of the video narratives. RESULTS: Initially, the researchers proposed 8 learning outcomes and 9 questions based on HBM constructs for the video scripts' content. However, following Delphi rounds 1 to 3, a few statements were omitted and rephrased. The Kendall coefficient of concordance, W, was about 0.7 (P<.001) for both learning outcomes and questions which indicated good agreement between members. Each statement's Cronbach alpha was above .8 with SD values within a range below 1.5 that confirmed satisfactory content and construct validity. Approximately 75% (6/8) of members agreed that all chosen statements were relevant and suitable for video script content development. Similarly, more than 80% (8/10) of patients scored video engagement above average, intraclass correlation coefficient was above 0.7, whereas its Kendall W was about 0.7 with significance (P<.001), which indicated average agreement that the video narratives perceived realism. CONCLUSIONS: The Delphi method was proven to be helpful in conducting discussions systematically and providing precise content for the development of video narratives, whereas the Video Engagement Scale was an appropriate measurement of video realism and emotions, which the researchers believed could positively impact medication understanding and use self-efficacy among patients with stroke. A feasibility and acceptability study in an actual stroke care center is needed. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000174280; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=373554&isReview=true.
RESUMO
BACKGROUND AND AIM: Evidence-based prescribing practices for stroke-preventive medication have benefited stroke survivors; however, medication-nonadherence rates remain high. Medication understanding and use self-efficacy (MUSE) has shown great importance in medication-taking behavior, but its relationship with medication nonadherence in stroke-preventive regimens lacks exploration. The aim of this study was to determine the prevalence of MUSE and its association with nonadherence causes and other potential factors among stroke survivors in Malaysia. METHODS: This cross-sectional study was conducted among 282 stroke patients who provided informed consent and were in follow-up at the Neurology Outpatient Department of Hospital Kuala Lumpur, Malaysia. The study employed a data-collection form that gathered information on sociodemographics, clinical treatment, outcome measures on MUSE, and medication-nonadherence reasons. RESULTS: The prevalence of poor medication understanding and use self-efficacy among stroke patients was 46.5%, of which 29.1% had poor "learning about medication" self-efficacy, while 36.2% lacked self-efficacy in taking medication. Beliefs about medicine (74.02%) was the commonest reason for medication nonadherence, followed by medication-management issues (44.8%). In the multivariate model, independent variables significantly associated with MUSE were health literacy (AOR 0.2, 95% CI 0.069-0.581; P=0.003), medication-management issues (AOR 0.073, 95% CI 0.020-0.266; P<0.001), multiple-medication issues (AOR 0.28, 95% CI 0.085-0.925; P=0.037), beliefs about medicine (AOR 0.131, 95% CI 0.032-0.542; P=0.005), and forgetfulness/convenience issues (AOR 0.173, 95% CI 0.050-0.600; P=0.006). CONCLUSION: The relatively poor learning about medication and medication-taking self-efficacy in this study was highly associated with health literacy and modifiable behavioral issues related to nonadherence, such as medication management, beliefs about medicine, and forgetfulness/convenience. Further research ought to explore these underlying reasons using vigorous techniques to enhance medication understanding and use self-efficacy among stroke survivors to determine cause-effect relationships.