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Diabetes Research and Clinical Practice Aug 2020This study explores the General Practice (GP) experience of Gestational Diabetes Mellitus (GDM). Much has been written about patient perspectives, yet little is known... (Review)
Review
AIM
This study explores the General Practice (GP) experience of Gestational Diabetes Mellitus (GDM). Much has been written about patient perspectives, yet little is known about the GP perspective at initial diagnosis and management. GDM is increasingly managed in the secondary and tertiary sector, the confidence of GPs and their role in ongoing care has not been examined. Given GDM's poor follow up rates, all aspects of the patient journey warrant close examination.
METHODS
Through purposive and snowball sampling, we conducted semi-structured interviews with GPs in Brisbane, Australia between April and October 2018. Data collection, until saturation, and analysis were concurrent, and the Leximancer analysis tool assisted with content analysis and suggestion of themes.
RESULTS
Dominant themes include uncertainty/urgency and feeling under-utilised. GPs have a pragmatic approach in the face of uncertainty, and adopt one of several strategies to meet patient needs. A key issue that may impact on long term follow up and high quality GP-patient relationships is concern about the patient being 'taken away' by the hospital. Communication with the hospital is generally perceived as poor.
CONCLUSIONS
The experience of GPs in the initial diagnosis and management of GDM may assist in improving GDM follow up.
Topics: Adult; Australia; Continuity of Patient Care; Diabetes, Gestational; Female; Follow-Up Studies; General Practice; General Practitioners; Guideline Adherence; Humans; Male; Middle Aged; Postpartum Period; Practice Patterns, Physicians'; Pregnancy; Prenatal Care; Primary Health Care; Referral and Consultation
PubMed: 32615279
DOI: 10.1016/j.diabres.2020.108290 -
Journal of the American Association of... Jun 2019The purpose of this case study is to examine the role of the nurse practitioner in the management and treatment of a 35-year-old female patient diagnosed with several...
The purpose of this case study is to examine the role of the nurse practitioner in the management and treatment of a 35-year-old female patient diagnosed with several conditions, including fibromyalgia posttraumatic stress disorder, anxiety, and depression. Fibromyalgia is a chronic, nonprogressive rheumatic condition with cardinal symptoms of widespread pain and fatigue; it affects more than 5 million people in the United States. This case study examines the nurse practitioner's role in managing fibromyalgia. Benzodiazepines and opioids may be prescribed for treatment of symptoms but prove ineffective, thus contributing to dependency issues. Controversy exists over classification of fibromyalgia as a rheumatologic condition versus a mental health disorder. Fibromyalgia frequently is accompanied by anxiety and depression, making this illness difficult to diagnose and treat.
Topics: Adult; Anxiety; Depression; Female; Fibromyalgia; Humans; Nurse Practitioners; Practice Patterns, Nurses'; Stress Disorders, Post-Traumatic; Treatment Outcome
PubMed: 30829972
DOI: 10.1097/JXX.0000000000000178 -
International Journal of Clinical... Aug 2019Background In Germany, no validated measure and model of pharmacist-physician collaboration existed. Objectives To provide evidence for the factor structure of the...
Background In Germany, no validated measure and model of pharmacist-physician collaboration existed. Objectives To provide evidence for the factor structure of the previously validated Frequency of Inter-professional Collaboration Instrument and the Attitudes Toward Collaboration Instrument in measuring attitudes toward and frequency of collaboration from the general practitioner's perspective in the context of primary care in Germany; to develop an explanatory model which illustrates factors influencing collaboration. Setting The study was conducted in the primary health care sector in Mecklenburg-Western Pomerania, Germany with a cohort of general practitioners. Method The two measures were translated into German and the survey was administered to 1438 practitioners. Exploratory factor analysis was used to assess the structure of the instruments. Structural equation modelling was used to determine how demographic variables and attitudes influence collaborative behaviour. Main outcome measure Outcome measure comprised frequency of and attitudes toward collaboration among German general practitioners and an explanatory model of practitioner-pharmacist collaboration. Results A response rate of 35.9% was achieved. Exploratory factor analysis revealed one factor for the instrument measuring attitudes and two factors for frequency. The factors were interpreted as 'Communication and Collaboration' and 'Pharmacist medication management'. The significant demographic predictors of collaboration were age, population of the surgery's location, distance to the pharmacy, specialty. Conclusion The results provide evidence for the factor structure of both measures in measuring attitudes toward and frequency of collaboration. A model of collaboration in which behaviour and extent of collaboration are directly influenced by individual and context characteristics is supported.
Topics: Adult; Attitude of Health Personnel; Factor Analysis, Statistical; Female; General Practitioners; Germany; Humans; Interdisciplinary Communication; Intersectoral Collaboration; Male; Middle Aged; Models, Structural; Pharmacists; Primary Health Care; Young Adult
PubMed: 31140161
DOI: 10.1007/s11096-019-00851-1 -
Pediatric Critical Care Medicine : a... Aug 2018To describe physicians' and nurse practitioners' perceptions of the national and local PICU physician and other provider supply in institutions that employ PICU nurse...
OBJECTIVES
To describe physicians' and nurse practitioners' perceptions of the national and local PICU physician and other provider supply in institutions that employ PICU nurse practitioners, assess for differences in perceptions of supply, and evaluate the intent of institutions to hire additional nurse practitioners to work in PICUs.
DESIGN
National, quantitative, cross-sectional descriptive study via a postal mail survey from October 2016 to January 2017.
SETTING
Institutions (n = 140) identified in the 2015 American Hospital Association Annual Survey with a PICU who employ PICU nurse practitioners.
SUBJECTS
PICU physician medical directors and nurse practitioners.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
There were 119 respondents, representing 93 institutions. Responses were received from 60 PICU medical directors (43%) and 59 lead nurse practitioners (42%). More than half (58%) of all respondents reported the national supply of PICU physicians is less than demand and 61% reported the local supply of PICU providers (physicians in all stages of training, nurse practitioners, and physician assistants) is less than demand. Of the respondents from institutions that self-reported a local provider shortage (n = 54), three fourths (78%) reported plans to increase the number of PICU nurse practitioners in the next 3 years and 40% were likely to expand the nurse practitioner's role in patient care.
CONCLUSIONS
Most PICU medical directors and lead nurse practitioners in institutions that employ PICU nurse practitioners perceived that national and local supply of providers to be less than the demand. Nurse practitioners are employed in PICUs as part of interdisciplinary models of care being used to address provider demand. The demand for more PICU nurse practitioners with expanded roles in care delivery was reported. Further evaluation of models of care and provider roles in care delivery can contribute to aligning provider supply with demand for care delivery.
Topics: Adult; Cross-Sectional Studies; Female; Health Facility Size; Humans; Intensive Care Units, Pediatric; Male; Middle Aged; Nurse Practitioners; Patient Care Team; Pediatrics; Surveys and Questionnaires; United States
PubMed: 29923939
DOI: 10.1097/PCC.0000000000001587 -
BMJ Open Jan 2023The degree awarding gap indicates that racially minoritised higher education students receive lower degree classifications relative to their white peers. While the...
OBJECTIVE
The degree awarding gap indicates that racially minoritised higher education students receive lower degree classifications relative to their white peers. While the reasons for this are complex, research suggests that educator and practitioner attitudes and behaviour towards racially minoritised students are a significant contributing factor. This preregistered study evaluates the effectiveness of unconscious racial bias training (URBT) to enhance National Health Service senior practitioner's recognition of how racial inequalities negatively impact racially minoritised students.
DESIGN
A mixed-methods study with a pretest and post-test design was conducted in the higher education and healthcare practice environment.
METHODS
Forty-nine NHS senior practitioners completed a 4-hour URBT workshop with activities focusing on activating stereotypes, exploring differences between unconscious and implicit bias, discussing the development of bias, and reflecting on student experiences of prejudice, harassment and discrimination. They completed pre- and post- quantitative measures that assessed the effectiveness of URBT and changes in racial competency, awareness and perceptions of unconscious racial bias. Qualitative measures explored the usefulness and perceived applications of URBT, and a 1-month follow-up assessed further how it had been applied within practice.
RESULTS
Participants reported positive evaluations of URBT, higher perceived racial competency, awareness and perceptions of racial bias (ps<0.001, dz>0.35). After 1 month, key themes from qualitative responses suggested that participants had increased self-awareness and were exploring how to set up mentoring and working groups, change recruitment and progression processes, and diversify the taught curriculum.
CONCLUSIONS
URBT may be one effective strategy to enhance awareness and encourage reflections of racial bias. We discuss how reducing racial inequalities requires a multifaceted approach that affords upfront conversations about systemic racism, implements effective initiatives, policies and procedures, and engages in continuous evaluation.
Topics: Humans; Racism; State Medicine; Curriculum; Racial Groups; Students
PubMed: 36669838
DOI: 10.1136/bmjopen-2022-068819 -
Research in Nursing & Health Jun 2021The engagement of frontline practitioners in the production of research-derived knowledge is often advocated. Doing so can address perceived gaps between what is known...
The engagement of frontline practitioners in the production of research-derived knowledge is often advocated. Doing so can address perceived gaps between what is known from research and what happens in clinical practice. Engagement practices span a continuum, from co-production approaches underpinned by principles of equality and power sharing to those which can minimalize practitioners' contributions to the knowledge production process. We observed a conceptual gap in published healthcare literature that labels or defines practitioners' meaningful contribution to the research process. We, therefore, aimed to develop the concept of "Researcher Practitioner Engagement" in the context of academically initiated healthcare research in the professions of nursing, midwifery, occupational therapy, physiotherapy, and speech and language therapy. Guided by Schwartz-Barcott et al.'s hybrid model of concept development, published examples were analyzed to establish the attributes, antecedents, and consequences of this type of engagement. Academic researchers (n = 17) and frontline practitioners (n = 8) with relevant experience took part in online focus groups to confirm, eliminate, or elaborate on these proposed concept components. Combined analysis of theoretical and focus group data showed that the essence of this form of engagement is that practitioners' clinical knowledge is valued from a study's formative stages. The practitioner's clinical perspectives inform problem-solving and decision-making in study activities and enhance the professional and practice relevance of a study. The conceptual model produced from the study findings forms a basis to guide engagement practices, future concept testing, and empirical evaluation of engagement practices.
Topics: Cooperative Behavior; Decision Making; Focus Groups; Health Personnel; Health Services Research; Humans; Internet; Problem Solving; Research Personnel
PubMed: 33774826
DOI: 10.1002/nur.22128 -
Research in Psychotherapy (Milano) Dec 2020Although many separate aspects of the psychotherapy relationship have been studied, including empathy, working alliance, and self-disclosure, a metaphorical approach has...
Although many separate aspects of the psychotherapy relationship have been studied, including empathy, working alliance, and self-disclosure, a metaphorical approach has the potential to generate a more holistic perspective of this phenomenon. Hence, the goal of this study was to explore the nature of the psychotherapy relationship from the psychotherapists' perspective using a metaphorical approach. In an online survey, a sample of N=373 Czech psychotherapists and counselors rated a set of relational metaphors in terms of how accurately they depicted their roles in their relationships with their clients. The single most endorsed metaphor for the practitioner's role was a guide. Furthermore, the principal component analysis identified three relational components, namely, Mentor, Resource Supplier, and Remedy Distributor. The associations among these components and multiple practitioners' variables, including demographic and practice-related variables and theoretical orientation, were explored. These three components represent general dimensions of the psychotherapy relationship that cut across various theoretical orientations and, thus, define psychotherapy relationships in a general sense.
PubMed: 33585293
DOI: 10.4081/ripppo.2020.468 -
Science & Justice : Journal of the... Nov 2017In the debate as to whether forensic practitioners should assess and report the precision of the strength of evidence statements that they report to the courts, I remain...
In the debate as to whether forensic practitioners should assess and report the precision of the strength of evidence statements that they report to the courts, I remain unconvinced by proponents of the position that only a subjectivist concept of probability is legitimate. I consider this position counterproductive for the goal of having forensic practitioners implement, and courts not only accept but demand, logically correct and scientifically valid evaluation of forensic evidence. In considering what would be the best approach for evaluating strength of evidence, I suggest that the desiderata be (1) to maximise empirically demonstrable performance; (2) to maximise objectivity in the sense of maximising transparency and replicability, and minimising the potential for cognitive bias; and (3) to constrain and make overt the forensic practitioner's subjective-judgement based decisions so that the appropriateness of those decisions can be debated before the judge in an admissibility hearing and/or before the trier of fact at trial. All approaches require the forensic practitioner to use subjective judgement, but constraining subjective judgement to decisions relating to selection of hypotheses, properties to measure, training and test data to use, and statistical modelling procedures to use - decisions which are remote from the output stage of the analysis - will substantially reduce the potential for cognitive bias. Adopting procedures based on relevant data, quantitative measurements, and statistical models, and directly reporting the output of the statistical models will also maximise transparency and replicability. A procedure which calculates a Bayes factor on the basis of relevant sample data and reference priors is no less objective than a frequentist calculation of a likelihood ratio on the same data. In general, a Bayes factor calculated using uninformative or reference priors will be closer to a value of 1 than a frequentist best estimate likelihood ratio. The bound closest to 1 based on a frequentist best estimate likelihood ratio and an assessment of its precision will also, by definition, be closer to a value of 1 than the frequentist best estimate likelihood ratio. From a practical perspective, both procedures shrink the strength of evidence value towards the neutral value of 1. A single-value Bayes factor or likelihood ratio may be easier for the courts to handle than a distribution. I therefore propose as a potential practical solution, the use of procedures which account for imprecision by shrinking the calculated Bayes factor or likelihood ratio towards 1, the choice of the particular procedure being based on empirical demonstration of performance.
PubMed: 29173462
DOI: 10.1016/j.scijus.2017.08.004 -
Engaging people experiencing communication disability in stroke rehabilitation: a qualitative study.International Journal of Language &... Sep 2018Engagement is commonly considered important in stroke rehabilitation, with some arguing it is essential for positive patient outcomes. An emerging body of research...
BACKGROUND
Engagement is commonly considered important in stroke rehabilitation, with some arguing it is essential for positive patient outcomes. An emerging body of research indicates the practitioner influences engagement through their ways of relating, communicating and working with the patient. People experiencing communication disability may face particular challenges with engagement as a practitioner's communication and interactional patterns may limit their ability to engage.
AIMS
To understand how rehabilitation practitioners worked to engage people experiencing communication disability throughout the course of rehabilitation.
METHODS & PROCEDURES
A qualitative study using the Voice Centred Relational Approach. Longitudinal observational and interview data were gathered from 28 practitioners and three people experiencing communication disability in inpatient and community stroke rehabilitation services. Data were analyzed using the Listening Guide.
OUTCOMES & RESULTS
Engagement was a relational practice on the part of the rehabilitation practitioner. It was underpinned by a relational philosophy and characterized by three core processes: embedding relational work throughout rehabilitation; getting to know the patient and working in ways valued by the patient; and communicating using relational dialogue and supported conversation. Practitioners wove these together with their technical, disciplinary-based work and rehabilitation tasks.
CONCLUSIONS & IMPLICATIONS
Patient engagement was constructed through relationships and strongly influenced by the practitioners' way of thinking about and enacting practice, challenging the idea that engagement is solely an intrinsic patient state and behaviour. The findings raise questions about which aspects of rehabilitation work and communication are most valuable when working to engage people experiencing communication disability. Viewing engagement as a relational practice and understanding the different ways this is enacted may support practitioners to reflect on their understandings of engagement, their patient's engagement, their ways of working, and the frames and philosophies that surround and influence their practice.
Topics: Aged; Attitude of Health Personnel; Female; Health Personnel; Humans; Language Disorders; Male; Middle Aged; Patient Care Team; Patient Participation; Professional-Patient Relations; Qualitative Research; Stroke; Stroke Rehabilitation
PubMed: 30003629
DOI: 10.1111/1460-6984.12409 -
Physiotherapy Sep 2022As yet, the benefit of the Fit Note has not been convincingly demonstrated, although a limited body of research suggests that provision of fitness for work advice and...
Primary care first contact practitioner's (FCP) challenges and learning and development needs in providing fitness for work and sickness absence certification: consensus development.
BACKGROUND
As yet, the benefit of the Fit Note has not been convincingly demonstrated, although a limited body of research suggests that provision of fitness for work advice and sickness absence certification may be improved with training and case-specific direction. The role of certifying sickness absence in the UK has traditionally been conducted by General Practitioners, but this role has now been extended to First Contact Practitioner (FCP) Physiotherapists in primary care. Therefore, FCPs may offer an ideal solution to the current challenges faced within primary care for those with a musculoskeletal (MSK) condition at risk of sickness absence from their work environment.
OBJECTIVES
The main aim of this study was to identify the challenges and key learning and development needs of FCPs in response to providing Occupational Health (OH) information in the form of fitness for work advice and sickness certification for patients with MSK conditions within primary care.
DESIGN
Consensus was generated using an online modified version of the Nominal Group Technique (NGT) method. A priori consensus threshold of 60% was used in the voting stage.
PARTICIPANTS
NGT participants included clinicians with experience in managing MSK conditions in primary care within the FCP model of care. All participants generated, voted, and ranked the items using an online platform.
CONCLUSIONS
This research adds new evidence regarding the challenges and learning and development needs identified by a group of FCPs working within primary care in consideration of sickness absence certification and fitness for work advice. The items highlighted provide evidence to complement Health Education England's FCP A Roadmap to Practice educational pathway and informs on professional development needs in this area.
Topics: Certification; Consensus; General Practitioners; Humans; Musculoskeletal Diseases; Primary Health Care; Sick Leave
PubMed: 35576802
DOI: 10.1016/j.physio.2022.02.001