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Bioresource Technology Oct 2012The application of membrane bioreactors (MBRs) for municipal wastewater treatment has increased dramatically over the last decade. From a practitioner's perspective,... (Review)
Review
The application of membrane bioreactors (MBRs) for municipal wastewater treatment has increased dramatically over the last decade. From a practitioner's perspective, design practice has evolved over five "generations" in the areas of biological process optimization, separating process design from equipment supply, and reliability/redundancy thereby facilitating "large" MBRs (e.g. 150,000 m(3)/day). MBR advantages and disadvantages, and process design to accommodate biological nutrient removal, high mixed liquor suspended solids concentrations, operation and maintenance, peak flows, and procurement are reviewed from the design practitioner's perspective. Finally, four knowledge areas are identified as important to practitioners meriting further research and development: (i) membrane design and performance such as improving peak flow characteristics and decreasing operating costs; (ii) process design and performance such as managing the fluid properties of the biological solids, disinfection, and microcontaminant removal; (iii) facility design such as equipment standardization and decreasing mechanical complexity; and (iv) sustainability such as anaerobic MBRs.
Topics: Bioreactors; Cities; Membranes, Artificial; Waste Disposal, Fluid; Wastewater; Water Purification
PubMed: 22704189
DOI: 10.1016/j.biortech.2012.05.014 -
The Nurse Practitioner Mar 1996Being good at what you do is not enough. Despite strong evidence that the nurse practitioner delivers cost-efficient and outcome-based care, few consumers really... (Review)
Review
Being good at what you do is not enough. Despite strong evidence that the nurse practitioner delivers cost-efficient and outcome-based care, few consumers really understand the nurse practitioner's scope of practice. With the current rapidly changing status of health care, the nurse practitioner is presented with many opportunities. Strategies that ensure survival and growth are critical to longevity. Marketing strategies can offer solutions to these challenges. The 4 P's of marketing are discussed as an approach to promote the role of the nurse practitioner.
Topics: Advertising; Economic Competition; Fees and Charges; Marketing of Health Services; Nurse Practitioners
PubMed: 8710255
DOI: No ID Found -
Nephrology Nursing Journal : Journal of... 2023Hyponatremia affects patients in various settings. Nurse practitioners often face challenges in the evaluation and treatment of hyponatremia, due to the existence in the...
Hyponatremia affects patients in various settings. Nurse practitioners often face challenges in the evaluation and treatment of hyponatremia, due to the existence in the literature of different clinical guidelines and various schematic models. This article describes a systematic approach to diagnosing hyponatremia.
Topics: Humans; Hyponatremia; Nephrology; Nurse Practitioners
PubMed: 36961075
DOI: No ID Found -
Health Economics Oct 2019This paper investigates the impact of legislative changes allowing nurse practitioners to prescribe schedule II controlled substances independently. We find that this...
This paper investigates the impact of legislative changes allowing nurse practitioners to prescribe schedule II controlled substances independently. We find that this legal environment is associated with an increase in treatment admissions for opioid misuse and a decrease in opioid related mortality only when Mandatory Prescription Drugs Monitoring Programs are in place.
Topics: Analgesics, Opioid; Drug Overdose; Drug Prescriptions; Female; Humans; Male; Middle Aged; Nurse Practitioners; Professional Autonomy; Scope of Practice
PubMed: 31243861
DOI: 10.1002/hec.3922 -
Therapeutische Umschau. Revue... 2018Nephrological diagnostics with the general practitioner's toolbox Abstract. Kidney diseases are often asymptomatic or present nonspecifically and are frequently... (Review)
Review
Nephrological diagnostics with the general practitioner's toolbox Abstract. Kidney diseases are often asymptomatic or present nonspecifically and are frequently diagnosed by chance as part of a laboratory check up. In newly diagnosed renal failure, the physician should determine the dynamics (acute versus chronic) and identify the cause of the renal dysfunction based on history and additional tests. This is crucial to identify treatable kidney diseases and to provide patients with the adequate therapy. The identification of the underlying disease and determination of its severity are necessary to estimate the renal and cardiovascular prognosis. Finally, the degree of renal insufficiency is important for dose adjustment of renally eliminated drugs and assessment of possible complications of renal failure. Most general practitioners have the necessary diagnostic tools at their disposal to carry out the above assessments and decide when a specialist nephrological referral is advisable. To diagnose and stage renal failure, serum creatinine must be measured and the glomerular filtration rate (GFR) estimated. The second pillar is the examination of urine (proteinuria, albuminuria, urine sediment). Depending on the findings, further laboratory tests may be useful. Renal ultrasound is the primary imaging method in patients with acute and chronic renal failure. In this article, the above mentioned methods are described in more detail and their potential pitfalls are discussed.
Topics: Albuminuria; Creatinine; General Practitioners; Glomerular Filtration Rate; Humans; Kidney Diseases; Kidney Function Tests
PubMed: 30880620
DOI: 10.1024/0040-5930/a001006 -
Nursing Inquiry Jun 2008Acute care nurse practitioner roles have been introduced in many countries. The acute care nurse practitioner provides nursing and medical care to meet the complex needs... (Review)
Review
Acute care nurse practitioner roles have been introduced in many countries. The acute care nurse practitioner provides nursing and medical care to meet the complex needs of patients and their families using a holistic, health-centred approach. There are many pressures to adopt a performance framework and execute activities and tasks. Little time may be left to explore domains of advanced practice nursing and develop other forms of knowledge. The primary objective of praxis is to integrate theory, practice and art, and facilitate the recognition and valuing of different types of knowledge through reflection. With this framework, the acute care nurse practitioner assumes the role of clinician and researcher. Praxis can be used to develop the acute care nurse practitioner role as an advanced practice nursing role. A praxis framework permeates all aspects of the acute care nurse practitioner's practice. Praxis influences how relationships are structured with patients, families and colleagues in the work setting. Decision-makers at different levels need to recognize the contribution of praxis in the full development of the acute care nurse practitioner role. Different strategies can be used by educators to assist students and practitioners to develop a praxis framework.
Topics: Acute Disease; Case Management; Decision Making, Organizational; Evidence-Based Medicine; Health Services Needs and Demand; Holistic Health; Humans; Knowledge; Models, Nursing; Nurse Anesthetists; Nurse Clinicians; Nurse Midwives; Nurse Practitioners; Nurse's Role; Nursing Evaluation Research; Primary Health Care; Professional Autonomy; Quality of Health Care; Thinking
PubMed: 18476854
DOI: 10.1111/j.1440-1800.2008.00404.x -
Monash Bioethics Review Oct 2021Medical practice has always involved at least three roles, three complimentary identities. Practitioners have been at once clinicians dedicated to a patient's care,...
Medical practice has always involved at least three roles, three complimentary identities. Practitioners have been at once clinicians dedicated to a patient's care, members of a professional organization promoting medicine, and informed citizens engaged in public debates on health issues. Beginning in the 1970s, a series of social and technological changes affected, and in many cases restricted, the practitioner's ability to function equally in these three identities. While others have discussed the changing realities of medical practice in recent decades, none have commented on their effect on their effect on rights of practitioners as citizens. Here several cases begin an analysis of the manner in which those changes have limited the physician's right to act conscientiously and speak publicly in the face of organizational agendas and political priorities.
Topics: Humans; Medicine
PubMed: 34913156
DOI: 10.1007/s40592-021-00143-3 -
Journal of Ultrasonography Mar 2016Ultrasound, which is a safe and non-invasive diagnostic modality that uses more and more advanced imaging techniques, has become the first-choice examination in various... (Review)
Review
UNLABELLED
Ultrasound, which is a safe and non-invasive diagnostic modality that uses more and more advanced imaging techniques, has become the first-choice examination in various diseases. It is more and more often used in the general practitioner's office to supplement physical examination and interview.
AIM
The aim of this paper is to review the Polish medical literature pertaining to the usage of ultrasound imaging in general practice as well as to present advantages, disadvantages and utility associated with conducting ultrasound examinations by general practitioners based on selected publications.
MATERIAL AND METHODS
The analysis involved 15 articles found in Polish medical literature published in 1994-2013 in 9 medical journals. These publications were obtained using various data bases, such as Polish Medical Bibliography, Google Scholar as well as websites of "Lekarz Rodzinny" and "Ultrasonografia."
RESULTS
Of 15 available publications, 5 papers present the usage of ultrasound imaging by a primary care physician for general purposes, 4 discuss the usage of abdominal scans, 3 - imaging of the neck and lymph nodes, 1 - lungs, and 2 discuss its usage for specific disease entities. In over 70% of the papers, the financial aspect associated with the usage of this modality in general practice is mentioned. More than a half of the publications draw attention to the possibility of using point-of-care ultrasound examinations. Advantages of ultrasonography most often mentioned by the authors include: good effects of screening, safety, short duration and low cost. The authors of eight publications also indicate disadvantages associated with ultrasound imaging used by a general practitioner.
CONCLUSIONS
In the Polish literature, there are relatively few papers on the role of ultrasonography in the office of a primary care physician. This modality is more and more often becoming a tool that helps primary care physicians to establish diagnoses, accelerates the initiation of treatment and directs the further diagnostic process.
PubMed: 27104005
DOI: 10.15557/JoU.2016.0008 -
Birth (Berkeley, Calif.) Dec 2023Screening and treatment initiation for perinatal psychiatric conditions is a recommended competency in OB/GYN practitioners, yet perinatal psychiatry is rapidly...
INTRODUCTION
Screening and treatment initiation for perinatal psychiatric conditions is a recommended competency in OB/GYN practitioners, yet perinatal psychiatry is rapidly evolving. Practitioner-to-psychiatrist consultation programs have the potential to improve the management of psychiatric conditions in perinatal women. This study describes utilization of a statewide perinatal psychiatric consultation service by OB/GYN practitioners through examination of the volume, responsivity, content and outcomes of clinical inquiries, and satisfaction.
METHODS
This quality improvement study describes the 460 telephone or e-mail consultations requested by OB/GYN practitioners over 2 years and housed within a REDCap database. Data include the characteristics of consult users, month-over-month and total utilization, the patient's perinatal status, the reason for contact, current symptoms and medications, and the consulting psychiatrist recommendations. Practitioner satisfaction with consultation is also described.
RESULTS
After completion of triage, the psychiatrist returned the practitioner's call ≤5 min in 59% of consultations. The most common inquiries were for pregnant (64%) women for depressive (51%) or anxiety (46%) symptoms with 47% of inquiries reporting the patient was currently taking a psychiatric medication. Had consultation not been available, referral to mental health (41%) or starting a medication (15%) were most often reported.
CONCLUSIONS
This perinatal psychiatric consultation service rapidly and effectively met the needs of practitioners practicing in OB/GYN settings across a state having a critical psychiatry shortage and varying urban and rural geography. Future recommendations include the assessment of direct patient outcomes, practitioner skill attainment, and long-term cost savings of this perinatal psychiatric consultation model.
Topics: Pregnancy; Female; Humans; Male; Mental Health; Referral and Consultation; Anxiety; Personal Satisfaction
PubMed: 36939290
DOI: 10.1111/birt.12722 -
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