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1.
J Adv Nurs ; 78(2): 523-531, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34730841

RESUMO

AIM: To compare the satisfaction of patients managed by independent nurse prescribers with that of patients managed by nurses using PGDs with respect to experience of the consultation and information received about the medication. DESIGN: Survey. METHODS: Patients receiving medications from nurses in five urban sexual health services in the United Kingdom completed validated questionnaires immediately after the consultation, September 2015-August 2016. Scores of independent nurse prescribers and nurses using patient group directions were compared about consultation experience (5 items) Satisfaction with Information about Medicines (SIMS 16 items scale). RESULTS: Of 808 patients receiving medications, 393 (48.6%) received questionnaires and 380 were returned (independent nurse prescribers 180 of 198, 90.9%; patient group directions 173 of 195, 88.7%). Patients in both groups reported high levels of satisfaction. About the consultation experience, patients found nurses friendly/ approachable (>99%), instilling confidence and trust (>99%) and explaining reasons for medications clearly (97%). Satisfaction with medication information: Of 348 (92%) respondents completing SIMS, the overall mean score was 13.4 of maximum 16 (no difference between groups, t-test, p = .63). CONCLUSIONS: Patients were highly satisfied with nurse consultations and information around medications regardless of whether they were managed by independent nurse prescribers or nurses using patient group directions. IMPACT: Findings provide evidence in support of autonomous provision of medications by nurses in sexual health clinics.


Assuntos
Papel do Profissional de Enfermagem , Satisfação do Paciente , Prescrições de Medicamentos , Humanos , Encaminhamento e Consulta , Inquéritos e Questionários
2.
J Adv Nurs ; 78(1): 239-251, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34652029

RESUMO

BACKGROUND: Local services in the United Kingdom National Health Service enable autonomous provision of medication by nurses, supporting individual nurses to gain prescribing qualifications or by introducing local patient group directions. AIM: To compare nurse prescribing and patient group directions about clinic processes, patients' experiences, and costs from the perspectives of providers, nurses, and patients. DESIGN: Mixed methods, comparative case study in five urban sexual health services in the United Kingdom. METHODS: Data were collected from nurse prescribers, patient group direction users and their patients July 2015 to December 2016. Nurse questionnaires explored training (funding and methods). Nurses recorded consultation durations and support from other professionals in clinical diaries. Patient notes were reviewed to explore medication provision, appropriateness and safety; errors were judged by an expert panel. Patients completed satisfaction questionnaires about consultations and information about medications. RESULTS: Twenty-eight nurse prescribers and 67 patient group directions users took part; records of 1682 consultations were reviewed, with 1357 medications prescribed and 98.5% therapeutically appropriate. Most medication decisions were deemed safe (96.0% nurse prescribers, 98.7% patient group directions, Fisher's Exact Test p = .55). Errors were predominantly minor (55.6% nurse prescribers, 62.4% patient group directions) and related to documentation omissions (78.0%); no patients were harmed. Consultation durations and unplanned re-consultations were similar for both groups. Nurse prescribers sought assistance from colleagues less frequently (chi-squared = 46.748, df = 1, p < .001) but spent longer discussing cases. Nurse prescribing training required more resources from providers and nurses, compared with patient group directions. Nurse prescribers were on higher salary bands. Patient satisfaction was high in both groups (>96%). CONCLUSIONS: Nurse medication provision by both nurse prescribers and patient group direction users is safe and associated with high patient satisfaction; effects on clinic processes and costs are similar. Undertaking the prescribing qualification involves independent study but may bring longer-term career progression to nurses.


Assuntos
Saúde Sexual , Instituições de Assistência Ambulatorial , Prescrições de Medicamentos , Humanos , Papel do Profissional de Enfermagem , Encaminhamento e Consulta , Medicina Estatal
3.
Phytopathology ; 112(2): 261-270, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34261341

RESUMO

Exotic diseases and pests of trees have caused continental-scale disturbances in forest ecosystems and industries, and their invasions are considered largely unpredictable. We tested the concept of preinvasion assessment of not yet invasive organisms, which enables empirical risk assessment of potential invasion and impact. Our example assesses fungi associated with Old World bark and ambrosia beetles and their potential to impact North American trees. We selected 55 Asian and European scolytine beetle species using host use, economic, and regulatory criteria. We isolated 111 of their most consistent fungal associates and tested their effect on four important southeastern American pine and oak species. Our test dataset found no highly virulent pathogens that should be classified as an imminent threat. Twenty-two fungal species were minor pathogens, which may require context-dependent response for their vectors at North American borders, while most of the tested fungi displayed no significant impact. Our results are significant in three ways; they ease the concerns over multiple overseas fungus vectors suspected of heightened potential risk, they provide a basis for the focus on the prevention of introduction and establishment of species that may be of consequence, and they demonstrate that preinvasion assessment, if scaled up, can support practical risk assessment of exotic pathogens.


Assuntos
Besouros , Árvores , Animais , Besouros/microbiologia , Besouros/fisiologia , Ecossistema , Fungos/fisiologia , Casca de Planta , Doenças das Plantas/microbiologia , Árvores/microbiologia
4.
Int J Nurs Stud ; 107: 103590, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446018

RESUMO

BACKGROUND: United Kingdom legislation allows nurses to autonomously provide medications as independent nurse prescribers or using patient group directions. Evidence of medication safety and appropriateness is limited. We compared nurse prescribers and patient group direction users in terms of prevalence, types and severity of medication provision errors. METHODS: Objectives: Compare safety and appropriateness of medication provision between nurse prescribers and patient group direction users. DESIGN: MIXED METHODS: clinical notes review and nurse-patient consultation observations. SETTING: Five United Kingdom sexual health services. SELECTION CRITERIA: 'Clinical notes review' included a random selection of nurse-patient consultations July-December 2015, 743 consultations managed by nurse prescribers and 939 consultations by patient group direction users. 'Observation study' involved 15 nurse prescriber and 15 patient group direction user nurse-patient medication consultations. Patients aged under 16 or non-English speaking were excluded. MEASUREMENTS: Medication safety/appropriateness was compared between nurse prescribers and patient group direction users. Medication provision errors were categorised and assigned severity ratings. The Medication Appropriateness Index and the Prescribing Framework were used to assess medication provision. RESULTS: Of 1682 clinical notes (nurse prescribers=743, 44%; patient group directions=939, 56%), 879 involved the provision of 1357 medications (nurse prescribers=399, 54%; patient group directions=480, 51%). The overall error rate was 8.5% (1844 errors from a potential 21,738 errors), predominantly related to documentation omissions. Nurse prescribers were more likely to make an error compared to patient group directions users (error rates 9% versus 8%, respectively; p=0.001); most were 'minor' (nurse prescribers=489, 56%; patient group directions=602, 62%). Both nurse prescribers and patient group direction users made safe medication decisions (n=1640 of 1682 patient care episodes, 98%); however, patient group directions users worked outside patient group directions restrictions in 39 (8%) of consultations. In 101 consultations, medication was indicated but not documented as offered/provided. From 30 observed consultations assessed against the Prescribing Framework, nurse prescribers' and patient group directions users' clinical practice were comparable (maximum score 46: nurse prescribers=44.7; patient group direction=45.4, p=0.41). CONCLUSION: Sexual health nurse prescribers and patient group direction users provided safe and therapeutically appropriate medication. Improvements in clinical documentation are recommended. Moreover, patient group directions users should be encouraged to adhere to patient group directions' governance restrictions, such as through regular training, audits and staff updates.


Assuntos
Prescrições de Medicamentos/enfermagem , Autonomia Profissional , Saúde Sexual/normas , Adulto , Prescrições de Medicamentos/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Segurança do Paciente/normas , Segurança do Paciente/estatística & dados numéricos , Padrões de Prática em Enfermagem/normas , Padrões de Prática em Enfermagem/estatística & dados numéricos , Reino Unido
5.
Int Emerg Nurs ; 22(1): 10-7, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23648174

RESUMO

AIM: To explore nurse prescribing in an emergency department using patient group directions versus independent nurse prescribing. BACKGROUND: Patient group directions allow restricted access to medication in unselected patients using pre-set criteria. Independent nurse prescribing is a flexible method of medication provision. Limited data exists on the application of either method in clinical practice. METHODS: Exploration of patient group directions and independent nurse prescribing application in an emergency department using 617 nurse practitioners' clinical notes; 235 and 382 respectively. Patient attendances from 01/07/2009 to 30/06/2010 were randomly sampled. Prescribing frequency; range of medications and diagnoses; independent episode completion and prescribing safety was explored. RESULTS: Statistical difference exists in prescribing frequency between the independent nurse prescribers (51.6%, n = 197) and patient group directions (32.3%, n = 76). Appropriate medication given by 99.7% (n = 381) of independent nurse prescribers, with 1 contraindicated drug provided. The limitations of patient group directions was highlighted in 11.8% (n = 9) of cases, however all drugs given were appropriate for the diagnosis. No statistical difference in independent episode completion. CONCLUSIONS: Nurses provide appropriate medication in an emergency department. Patients being managed by nurse prescribers were more likely to receive medication. Further investigation is required to justify this.


Assuntos
Prescrições de Medicamentos/enfermagem , Enfermagem em Emergência , Profissionais de Enfermagem , Padrões de Prática em Enfermagem/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Autonomia Profissional , Reprodutibilidade dos Testes , Estudos Retrospectivos
6.
J Adv Nurs ; 69(3): 535-45, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22551089

RESUMO

AIM: This article is a report of a study to explore the application and safety of non-medical prescribing in an accident and emergency and sexual health department. Background. Since 1 May 2006 non-medical prescribers in the UK have had prescribing powers comparable with doctors. Evidence suggests that nurses give safe, competent, autonomous care packages in their scope of practice but despite the perceived benefits there is limited evidence detailing how it is specifically applied in practice. DESIGN: Cross-sectional comparative design. METHODS: The study explored non-medical prescribing in accident and emergency and sexual health retrospectively reviewing 764 nurse prescribers' case notes. For intra-department comparison 490 case notes from those who could not prescribe were included. Patient attendances from 1 July 2009-30 June 2010 were randomly sampled. Prescribing frequency, range of medications and diagnoses, independent episode completion, and prescribing safety was recorded. RESULTS/FINDINGS: Over 53·5% (n = 409) of prescribers' patients required medication, with 99·8% (n = 568) being clinically appropriate. Analgesia was most commonly prescribed in accident and emergency (31%, n = 85) and antibiotics in sexual health (55%, n = 162). Intra-department comparison of independent episode completion had statistically significant results using the chi-square test in sexual health, but not in accident and emergency. The use of patient group directions in accident and emergency explains this difference. Safe prescribing practice was evident in 99·4% of cases, with a lack of documentation (n = 2) and a contraindicated prescription (n = 1) identified. CONCLUSION: Nurses having access to medication facilitate safe, appropriate, and independent prescribing practice. Further research is advised in this area.


Assuntos
Prescrições de Medicamentos/enfermagem , Serviços Médicos de Emergência/organização & administração , Profissionais de Enfermagem , Padrões de Prática em Enfermagem/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Autonomia Profissional , Saúde Reprodutiva , Estudos Retrospectivos , Adulto Jovem
7.
Cardiovasc Eng ; 9(2): 49-55, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19466542

RESUMO

The search for a load-independent index of myocardial contractility has been a focus for nearly 100 years. Nearly all of the parameters developed have yielded insight into cardiac function but their clinical utility has been limited. A new index, dsigma*/dt (max), has been proposed to be useful in the clinic. This parameter is expressed as the maximum time rate of change of the pressure normalized circumferential wall stress (sigma* = sigma ( theta )/P, where sigma ( theta ) is circumferential wall stress and P is pressure) for a thick walled sphere model of the left ventricle (LV). This definition for a contractility index renders dsigma*/dt (max) dependent only on LV wall volume (V (m)) and maximum time rate of change of the ventricular volume, dV/dt (max). The index dsigma*/dt (max) has been studied in patients with echocardiogram-derived volume, but up until this point its characteristics in canines have remained unknown. Validating this index in the canine will allow for a more intensive and wide-range investigation of the index that is not available with humans. The purpose of this study was to validate dsigma*/dt (max) as a load-independent measure of contractility in the canine heart with the hope that it was a noninvasive assessment of contractile function. To assess the load independence of dsigma*/dt (max), the index was estimated over a range of preloads (end diastolic volume, EDV) during a vena caval occlusion (VCO). The study was conducted in five canines under various pacing modes [right atrial (RA), right ventricular (RV), left ventricular (LV), and biventricular (BV)] at rates of 90 or 100, and 160 bpm. The animals' ventricular volume measurements were assessed by conductance catheter, calibrated with echocardiography. A 50 Hz filter was applied to the volume signal before differentiation to obtain dV/dt (max). Echocardiography was used to calculate left ventricle mass and V (m). In eight of ten cases, dsigma*/dt (max) was significantly correlated with decreasing EDV (p < 0.05). There was also a significant correlation between dsigma*/dt (max) and dP/dt (max). With a strong correlation between the values of dsigma*/dt (max), dP/dt (max), and EDV in all five subjects, dsigma*/dt (max) is not load independent in the canine heart when preload is altered by a VCO. Further evaluation of this index is required to delineate the situations where dsigma*/dt (max) can be accurately applied.


Assuntos
Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Modelos Cardiovasculares , Contração Miocárdica/fisiologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Animais , Simulação por Computador , Cães
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