-
European Child & Adolescent Psychiatry Sep 2019We aimed to explore the levels of agreement about the diagnoses of Autistic Spectrum Conditions between the referrer, CAMHS practitioner and a research diagnosis, as...
The agreement between the referrer, practitioner and research diagnosis of autistic spectrum conditions among children attending child and adolescent mental health services.
We aimed to explore the levels of agreement about the diagnoses of Autistic Spectrum Conditions between the referrer, CAMHS practitioner and a research diagnosis, as well as the stability of the practitioner's diagnosis over time in a secondary analysis of data from 302 children attending two Child and Adolescent Mental Health Services over two years. Kappa coefficient was used to assess the agreement between the referrer and research diagnosis. Kendall's tau b coefficient was used to assess the agreement between the practitioner and the research diagnosis assigned using the Development and Well-Being Assessment, as well as the agreement between the referrer's indication of presenting problems and the practitioner diagnosis. Diagnostic stability was explored in children with and without a research diagnosis of Autistic Spectrum Condition. There was a moderate level of agreement between the referrer and research diagnosis (Kappa = 0.51) and between practitioner's and research diagnosis (Kendall's tau = 0.60) at baseline, which reduced over the subsequent two years. Agreement between the referrer and practitioner's diagnosis at baseline was fair (Kendall's tau = 0.36).The greatest diagnostic instability occurred among children who practitioners considered to have possible Autistic Spectrum Conditions but who did not meet research diagnostic criteria. Further studies could explore the approaches used by practitioners to reach diagnoses and the impact these may have on diagnostic stability in Autistic Spectrum Conditions. Standardised assessment using a clinically rated diagnostic framework has a potential role as an adjunct to standard clinical care and might be particularly useful where practitioners are uncertain.
Topics: Autistic Disorder; Child; Child, Preschool; Female; Humans; Male; Mental Health Services
PubMed: 30778764
DOI: 10.1007/s00787-019-01290-z -
Indian Journal of Psychiatry Apr 2019The Mental Healthcare Act (MHCA) 2017, after parliamentary approval in 2017, came into effect from May 29, 2018. It is rights-based and empowers the patients to make... (Review)
Review
The Mental Healthcare Act (MHCA) 2017, after parliamentary approval in 2017, came into effect from May 29, 2018. It is rights-based and empowers the patients to make their own choices unless they become incapacitous due to mental illness. There is much emphasis on the protection of human rights of persons with mental illness. The act provides a framework and regulation on how a person with mental illness should be treated. The experts, on multiple occasions, have debated on whether the act is a boon or a bane for the practitioners in India. The MHCA 2017 brings about more impetus on documentation, unlike the previous acts. With the act in place, clear documentation with reasons for decisions made and care given are important for good practice. Although this may potentially raise the cost of care, this will ensure a safer practice of psychiatry and will prove beneficial for the patients and the psychiatrists. To comply with the provisions of the act, one will have to modify the manner in which one carries out the day-to-day practice. Regular training through workshops is required to understand the practical implications of different provisions of the act. Furthermore, regular peer group meetings may give a sense of support and an opportunity to learn from one another and help find solutions to difficult aspects. Overall, following this and adapting to the new act may bring uniformity in practice. This article aims to explore ways to leverage the MHCA 2017 from the practitioner's perspective.
PubMed: 31040452
DOI: 10.4103/psychiatry.IndianJPsychiatry_98_19 -
Journal of the Advanced Practitioner in... Apr 2023The advent of precision medicine targeting oncogenic mutations and other alterations has led to a paradigm shift in the treatment of many solid tumors and hematologic... (Review)
Review
The advent of precision medicine targeting oncogenic mutations and other alterations has led to a paradigm shift in the treatment of many solid tumors and hematologic malignancies. For many of these agents, predictive biomarker testing is necessary to determine the presence of such alterations in order to select patients who are most likely to respond, and to avoid the use of ineffective and potentially harmful alternative therapy. Recent technological advances such as next-generation sequencing have facilitated the identification of targetable biomarkers in patients with cancer and thus help inform treatment decisions. Moreover, new molecular-guided therapies and associated predictive biomarkers continue to be discovered. For some cancer therapeutics, regulatory approval requires the use of a companion diagnostic to ensure proper patient selection. Advanced practitioners therefore need to be aware of current biomarker testing guidelines regarding who should be tested, how and when to test, and how these results can guide treatment decisions using molecular-based therapies. They should also recognize and address potential barriers and disparities in biomarker testing to ensure equitable care for all patients, and assist in educating patients and colleagues alike on the importance of testing and integration into clinical practice to enhance outcomes.
PubMed: 37206903
DOI: 10.6004/jadpro.2023.14.3.18 -
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 -
Frontiers in Psychology 2021This paper introduces a model that explains psychosocial development by embedding the developmental concept of rough-and-tumble play (RTP) into the contextual settings...
This paper introduces a model that explains psychosocial development by embedding the developmental concept of rough-and-tumble play (RTP) into the contextual settings of martial arts (MA). Current sport-for-change literature relies on theories that address contextual factors surrounding sport but agrees that sport in itself does not facilitate developmental outcomes. In contemporary times where western societies invest substantial resources in sport programs for their psychosocial contribution, this becomes problematic. If the contextual factors surrounding sport are exclusively what produce developmental outcomes, what is the rationale for investing resources in specifically? We challenge this idea and argue that although contextual factors are important to any social phenomena, the developmental outcomes from sport can also be traced to the corporeal domain in sport. To date, we have lacked the theoretical lenses to articulate this. The developmental concept of RTP emphasizes how "play fighting" between consenting parties stimulates psychosocial growth through its demand for self-regulation and control when "play fighting" with peers. In short, RTP demands that individuals maintain a self-regulated mode of fighting and is contingent on a give-and-take relationship to maintain enjoyment. RTP can thus foster empathy and prosocial behavior and has strong social bonding implications. However, such play can also escalate. A fitting setting to be considered as moderated RTP is MA because of its resemblance to RTP, and its inherent philosophical features, which emphasizes self-regulation, empathy, and prosocial behavior. This paper outlines what constitutes high-quality RTP in a MA context and how this relates to developmental outcomes. By doing so, we present a practitioner's framework in which practitioners, social workers, and physical educators can explain how MA, and not merely contextual factors, contributes toward developmental outcomes. In a time where sport is becoming increasingly politicized and used as a social intervention, it too becomes imperative to account for why , and in this case, MA, is suitable to such ends.
PubMed: 34659040
DOI: 10.3389/fpsyg.2021.731000 -
Journal of the Advanced Practitioner in... 2018Lung cancer screening with low-dose computed tomography of the chest is now a service covered by the Centers for Medicare and Medicaid Services and most private... (Review)
Review
Lung cancer screening with low-dose computed tomography of the chest is now a service covered by the Centers for Medicare and Medicaid Services and most private insurers. However, providers may experience many barriers that could prevent them from offering lung cancer screening to eligible patients. Advanced practitioners are uniquely positioned to provide lung cancer screening within a formal screening program. Our nurse practitioner-led lung cancer screening program was developed to address these barriers, and to provide evidence-based access to care for a high-risk patient population.
PubMed: 31086688
DOI: No ID Found -
The South African Journal of... 2023One in three women in South Africa suffer from urinary incontinence. Effective management is influenced by patients help-seeking behaviour and services offered by...
BACKGROUND
One in three women in South Africa suffer from urinary incontinence. Effective management is influenced by patients help-seeking behaviour and services offered by healthcare professionals within the healthcare system. Current practice towards urinary incontinence management in South Africa is unknown.
OBJECTIVES
Our study aimed to describe and compare urinary incontinence practice and knowledge of nurses and physicians (practitioners) working in primary healthcare settings, measured against the NICE 2013 guideline and explore attitudes and beliefs towards urinary incontinence management.
METHOD
Cross-sectional study using a self-designed online questionnaire. All primary healthcare practitioners in the Western Cape were eligible for the study. Stratified random and snowball sampling was used. Data was analysed in consultation with a statistician using SPSS.
RESULTS
Fifty-six completed questionnaires were analysed. Practitioners had an overall knowledge score of 66.7% and practice score of 68.9% compared to NICE 2013 guidelines. A lack of knowledge regarding urinary incontinence screening, following up on patients and conducting bladder diaries were noted. Pelvic floor muscle training and bladder training education was recognised as initial management but only 14.8% of practitioners referred patients to physiotherapy. Half of the sample reported being uncomfortable with urinary incontinence, although the majority wanted to learn more about urinary incontinence.
CONCLUSION
The knowledge and practices of practitioners working at a primary healthcare level in the Western Cape are not congruent with NICE 2013 guidelines.
CLINICAL IMPLICATIONS
Data can be used to inform intervention planning to address urinary incontinence management at a primary healthcare level in the Western Cape.
PubMed: 37415853
DOI: 10.4102/sajp.v79i1.1860 -
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 -
JMIR Human Factors Feb 2022Visual expertise refers to advanced visual skills demonstrated when performing domain-specific visual tasks. Prior research has emphasized the fact that medical experts...
BACKGROUND
Visual expertise refers to advanced visual skills demonstrated when performing domain-specific visual tasks. Prior research has emphasized the fact that medical experts rely on such perceptual pattern-recognition skills when interpreting medical images, particularly in the field of electrocardiogram (ECG) interpretation. Analyzing and modeling cardiology practitioners' visual behavior across different levels of expertise in the health care sector is crucial. Namely, understanding such acquirable visual skills may help train less experienced clinicians to interpret ECGs accurately.
OBJECTIVE
This study aims to quantify and analyze through the use of eye-tracking technology differences in the visual behavior and methodological practices for different expertise levels of cardiology practitioners such as medical students, cardiology nurses, technicians, fellows, and consultants when interpreting several types of ECGs.
METHODS
A total of 63 participants with different levels of clinical expertise took part in an eye-tracking study that consisted of interpreting 10 ECGs with different cardiac abnormalities. A counterbalanced within-subjects design was used with one independent variable consisting of the expertise level of the cardiology practitioners and two dependent variables of eye-tracking metrics (fixations count and fixation revisitations). The eye movements data revealed by specific visual behaviors were analyzed according to the accuracy of interpretation and the frequency with which interpreters visited different parts/leads on a standard 12-lead ECG. In addition, the median and SD in the IQR for the fixations count and the mean and SD for the ECG lead revisitations were calculated.
RESULTS
Accuracy of interpretation ranged between 98% among consultants, 87% among fellows, 70% among technicians, 63% among nurses, and finally 52% among medical students. The results of the eye fixations count, and eye fixation revisitations indicate that the less experienced cardiology practitioners need to interpret several ECG leads more carefully before making any decision. However, more experienced cardiology practitioners rely on their skills to recognize the visual signal patterns of different cardiac abnormalities, providing an accurate ECG interpretation.
CONCLUSIONS
The results show that visual expertise for ECG interpretation is linked to the practitioner's role within the health care system and the number of years of practical experience interpreting ECGs. Cardiology practitioners focus on different ECG leads and different waveform abnormalities according to their role in the health care sector and their expertise levels.
PubMed: 35138258
DOI: 10.2196/34058 -
Diabetes Therapy : Research, Treatment... Mar 2020To develop an evidence-based expert group opinion on the role of insulin motivation to overcome insulin distress during different stages of insulin therapy and to... (Review)
Review
AIM
To develop an evidence-based expert group opinion on the role of insulin motivation to overcome insulin distress during different stages of insulin therapy and to propose a practitioner's toolkit for insulin motivation in the management of diabetes mellitus (DM).
BACKGROUND
Insulin distress, an emotional response of the patient to the suggested use of insulin, acts as a major barrier to insulin therapy in the management of DM. Addressing patient-, physician- and drug-related factors is important to overcome insulin distress. Strengthening of communication between physicians and patients with diabetes and enhancing the patients' coping skills are prerequisites to create a sense of comfort with the use of insulin. Insulin motivation is key to achieving targeted goals in diabetes care. A group of endocrinologists came together at an international meeting held in India to develop tool kits that would aid a practitioner in implementing insulin motivation strategies at different stages of the journey through insulin therapy, including pre-initiation, initiation, titration and intensification. During the meeting, emphasis was placed on the challenges and limitations faced by both physicians and patients with diabetes during each stage of the journey through insulinization.
REVIEW RESULTS
After review of evidence and discussions, the expert group provided recommendations on strategies for improved insulin acceptance, empowering behavior change in patients with DM, approaches for motivating patients to initiate and maintain insulin therapy and best practices for insulin motivation at the pre-initiation, initiation, titration and intensification stages of insulin therapy.
CONCLUSIONS
In the management of DM, bringing in positive behavioral change by motivating the patient to improve treatment adherence helps overcome insulin distress and achieve treatment goals.
PubMed: 31981212
DOI: 10.1007/s13300-020-00764-7