"We must know whether we want to change the world to experience it with the same sensorial system like the one we already possess, or whether we’d rather modify our body, the somatic filter through which it passes."
LINK
Objectives: To understand healthcare professionals' experiences and perceptions of nurses' potential or ideal roles in pharmaceutical care (PC). Design: Qualitative study conducted through semi-structured in-depth interviews. Setting: Between December 2018 and October 2019, interviews were conducted with healthcare professionals of 14 European countries in four healthcare settings: hospitals, community care, mental health and long-term residential care. Participants: In each country, pharmacists, physicians and nurses in each of the four settings were interviewed. Participants were selected on the basis that they were key informants with broad knowledge and experience of PC. Data collection and analysis: All interviews were conducted face to face. Each country conducted an initial thematic analysis. Consensus was reached through a face-to-face discussion of all 14 national leads. Results: 340 interviews were completed. Several tasks were described within four potential nursing responsibilities, that came up as the analysis themes, being: 1) monitoring therapeutic/adverse effects of medicines, 2) monitoring medicines adherence, 3) decision making on medicines, including prescribing 4) providing patient education/information. Nurses' autonomy varied across Europe, from none to limited to a few tasks and emergencies to a broad range of tasks and responsibilities. Intended level of autonomy depended on medicine types and level of education. Some changes are needed before nursing roles can be optimised and implemented in practice. Lack of time, shortage of nurses, absence of legal frameworks and limited education and knowledge are main threats to European nurses actualising their ideal role in PC. Conclusions: European nurses have an active role in PC. Respondents reported positive impacts on care quality and patient outcomes when nurses assumed PC responsibilities. Healthcare professionals expect nurses to report observations and assessments. This key patient information should be shared and addressed by the interprofessional team. The study evidences the need of a unique and consensus-based PC framework across Europe.
LINK
Clear role descriptions promote the quality of interprofessional collaboration. Currently, it is unclear to what extent healthcare professionals consider pharmaceutical care (PC) activities to be nurses’ responsibility in order to obtain best care quality. This study aimed to create and evaluate a framework describing potential nursing tasks in PC and to investigate nurses’ level of responsibility. A framework of PC tasks and contextual factors was developed based on literature review and previous DeMoPhaC project results. Tasks and context were cross-sectionally evaluated using an online survey in 14 European countries. A total of 923 nurses, 240 physicians and 199 pharmacists responded. The majority would consider nurses responsible for tasks within: medication self-management (86–97%), patient education (85–96%), medication safety (83–95%), monitoring adherence (82–97%), care coordination (82–95%), and drug monitoring (78–96%). The most prevalent level of responsibility was ‘with shared responsibility’. Prescription management tasks were considered to be nurses’ responsibility by 48–81% of the professionals. All contextual factors were indicated as being relevant for nurses’ role in PC by at least 74% of the participants. No task nor contextual factor was removed from the framework after evaluation. This framework can be used to enable healthcare professionals to openly discuss allocation of specific (shared) responsibilities and tasks.
DOCUMENT
Treatment guidelines difer signifcantly, not only between Europe and North America but also among European countries [1–4]. Reasons for these diferences include antimicrobial resistance patterns, accessibility to and reimbursement policies for medicines, and culturally and historically determined prescribing attitudes. The European Association of Clinical Pharmacology and Therapeutics’ Education Working Group has launched several initiatives to improve and harmonize European pharmacotherapy education, but international diferences have proven to be a major barrier to these eforts [5–7]. While we have taken steps to chart these diferences [6, 8], it will probably not be possible to fully resolve them. Rather than viewing these diferences as a barrier, we should perhaps see them as an opportunity for intercultural learning by providing students and teachers a valuable lesson in the context-dependent nature of prescribing medication and the diferent interpretations of evidence-based medicine. Here, we extend our experience with interprofessional student-run clinics [9, 10], to report on our first experiences with the “International and Interprofessional Student-run Clinic.” We organized three successful video meetings with medical and pharmacy students of the Amsterdam UMC, location VU University (the Netherlands), and the University of Bologna (Italy). During these meetings, one of the students presented a real-life case of a patient on polypharmacy. Then, in a 45-min session, the students split into smaller groups (break-out rooms) to review the patient’s medication, using the prescribing optimization method and STOPP/ START criteria [11, 12]. The teachers rotated between the diferent rooms and assisted the students when necessary. Teachers and students reconvened for 60 min for debriefng, with students presenting their fndings and suggestions to revise the medication list and teachers stimulating discussion and indicating how they would alter the medication list. Participation was voluntary, and the meetings were held in the evenings to accommodate students in clinical rotations. Third-to-fnal-year medical and pharmacy students participated in the three meetings (n=17, n=20, n=12, respectively). They reported learning a lot from each other, gaining an international and interprofessional perspective. Moreover, they learned to always consider the patient’s perspective, that evidence-based medicine is context-dependent, and that guidelines should be adapted to the patient’s situation.
MULTIFILE
Background: Nurses play an important role in pharmaceutical care. They are involved in: detecting clinical change; communicating/discussing pharmacotherapy with patients, their advocates, and other healthcare professionals; proposing and implementing medication-related interventions; and ensuring follow-up of patients and medication regimens. To date, a framework of nurses' competences on knowledge, skills, and attitudes as to interprofessional pharmaceutical care tasks is missing. Objectives: To reach agreement with experts about nurses' competences for tasks in interprofessional pharmaceutical care. Methods: A two-phase study starting with a scoping review followed by five Delphi rounds was performed. Competences extracted from the literature were assessed by an expert panel on relevance by using the RAND/UCLA method. The experts (n = 22) involved were healthcare professionals, nurse researchers, and educators from 14 European countries with a specific interest in nurses' roles in interprofessional pharmaceutical care. Descriptive statistics supported the data analysis. Results: The expert panel reached consensus on the relevance of 60 competences for 22 nursing tasks. Forty-one competences were related to 15 generic nursing tasks and 33 competences were related to seven specific nursing tasks. Conclusions: This study resulted in a competence framework for competency-based nurse education. Future research should focus on imbedding these competences in nurse education. A structured instrument should be developed to assess students' readiness to achieve competence in interprofessional pharmaceutical care in clinical practice.
DOCUMENT
Routine immunization (RI) of children is the most effective and timely public health intervention for decreasing child mortality rates around the globe. Pakistan being a low-and-middle-income-country (LMIC) has one of the highest child mortality rates in the world occurring mainly due to vaccine-preventable diseases (VPDs). For improving RI coverage, a critical need is to establish potential RI defaulters at an early stage, so that appropriate interventions can be targeted towards such population who are identified to be at risk of missing on their scheduled vaccine uptakes. In this paper, a machine learning (ML) based predictive model has been proposed to predict defaulting and non-defaulting children on upcoming immunization visits and examine the effect of its underlying contributing factors. The predictive model uses data obtained from Paigham-e-Sehat study having immunization records of 3,113 children. The design of predictive model is based on obtaining optimal results across accuracy, specificity, and sensitivity, to ensure model outcomes remain practically relevant to the problem addressed. Further optimization of predictive model is obtained through selection of significant features and removing data bias. Nine machine learning algorithms were applied for prediction of defaulting children for the next immunization visit. The results showed that the random forest model achieves the optimal accuracy of 81.9% with 83.6% sensitivity and 80.3% specificity. The main determinants of vaccination coverage were found to be vaccine coverage at birth, parental education, and socio-economic conditions of the defaulting group. This information can assist relevant policy makers to take proactive and effective measures for developing evidence based targeted and timely interventions for defaulting children.
MULTIFILE
Due to a lack of transparency in both algorithm and validation methodology, it is diffcult for researchers and clinicians to select the appropriate tracker for their application. The aim of this work is to transparently present an adjustable physical activity classification algorithm that discriminates between dynamic, standing, and sedentary behavior. By means of easily adjustable parameters, the algorithm performance can be optimized for applications using different target populations and locations for tracker wear. Concerning an elderly target population with a tracker worn on the upper leg, the algorithm is optimized and validated under simulated free-living conditions. The fixed activity protocol (FAP) is performed by 20 participants; the simulated free-living protocol (SFP) involves another 20. Data segmentation window size and amount of physical activity threshold are optimized. The sensor orientation threshold does not vary. The validation of the algorithm is performed on 10 participants who perform the FAP and on 10 participants who perform the SFP. Percentage error (PE) and absolute percentage error (APE) are used to assess the algorithm performance. Standing and sedentary behavior are classified within acceptable limits (+/- 10% error) both under fixed and simulated free-living conditions. Dynamic behavior is within acceptable limits under fixed conditions but has some limitations under simulated free-living conditions. We propose that this approach should be adopted by developers of activity trackers to facilitate the activity tracker selection process for researchers and clinicians. Furthermore, we are convinced that the adjustable algorithm potentially could contribute to the fast realization of new applications.
DOCUMENT
OBJECTIVE: To evaluate if using surface neuromuscular electrical stimulation (NMES) for paralyzed lower-limb muscles results in an increase in energy expenditure and if the number of activated muscles and duty cycle affect the potential increase.DESIGN: Cross-sectional study.RESULTS: Energy expenditure during all NMES protocols was significantly higher than the condition without NMES (1.2 ± 0.2 kcal/min), with the highest increase (+ 51%; +0.7 kcal/min, 95% CI: 0.3 - 1.2) for the protocol with more muscles activated and the duty cycle with a shorter rest period. A significant decrease in muscle contraction size during NMES was found with a longer stimulation time, more muscles activated or the duty cycle with a shorter rest period.CONCLUSION: Using NMES for paralyzed lower-limb muscles can significantly increase the energy expenditure compared to sitting without NMES with the highest increase for the protocol with more muscles activated and the duty cycle with a shorter rest period. Muscle fatigue occurred significantly with the more intense NMES protocols which might cause a lower energy expenditure in a longer protocol. Future studies should further optimize the NMES parameters and investigate the long-term effects of NMES on weight management in people with SCI.
DOCUMENT
Severe mental illness (SMI) imposes a significant burden on individuals, resulting in long-lasting symptoms, lower social functioning and impaired physical health. Physical activity (PA) interventions can improve both mental and physical health and care workers can serve as healthy role models. Yet, individuals with SMI face barriers to PA participation. This study evaluated the effects of Muva, and assessed if mental health worker’s (MHW) characteristics were associated with clients’ change in social functioning. Muva, an intervention package primarily created to increase PA of people with SMI, places a special focus on MHWs as they might play a key role in overcoming barriers. Other PA barrier-decreasing elements of Muva were a serious game app, lifestyle education, and optimization of the medication regime. Method: This study is a pragmatic stepped wedge cluster controlled trial. Controls received care as usual. Mixedeffects linear regressions were performed to assess changes in the primary outcome social functioning, and secondary outcomes quality of life, psychiatric symptoms, PA, body mass index, waist circumference, and blood pressure. Results: 84 people with SMI were included in three intervention clusters, and 38 people with SMI in the control cluster. Compared to the control condition, there was significant clinical improvement of social functioning in interpersonal communication (p=<0.01) and independent competence (p=<0.01) in people receiving Muva. These outcomes were not associated with MHW’s characteristics. There were no changes in the other outcome measures. Conclusions: Muva improved social functioning in people with SMI compared to care as usual.
DOCUMENT
Abstract Aims The involvement of an inter-professional healthcare student team in the review of medications used by geriatric patients could not only provide patients with optimized therapy but also provide students with a valuable inter-professional learning experience. We describe and evaluate the clinical and learning outcomes of an inter-professional student-run mediation review program (ISP). Subject and method A variable team consisting of students in medicine, pharmacy, master advanced nursing practice, and master physician assistant reviewed the medication lists of patients attending a specialized geriatric outpatient clinic. Results During 32 outpatient visits, 188 medications were reviewed. The students identified 14 medication-related problems, of which 4 were not recognized by healthcare professionals. The ISP team advised 95 medication changes, of which 68 (71.6%) were directly implemented. Students evaluated this pilot program positively and considered it educational (median score 4 out of 5) and thought it would contribute to their future inter-professional relationships. Conclusion An inter-professional team of healthcare students is an innovative healthcare improvement for (academic) hospitals to increase medication safety. Most formulated advices were directly incorporated in daily practice and could prevent future medication-related harm. The ISP also offers students a first opportunity to work in an inter-professional manner and get insight into the perspectives and qualities of their future colleagues.
MULTIFILE
