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1.
Transition to practice experiences for new primary care nurse practitioners (NPs) is of interest, particularly considering the lack of requirements and options for formal training programs. The purpose of this article is to describe new primary care NPs’ experience and perceived needs of transitioning to practice. New Nebraska NPs were surveyed. The main findings include increased confidence and perceived preparedness after 3 months of practice, as well as challenges and helpful supportive services for transitioning to practice. Additional information on the transition to practice experience was provided and supports developing a formal program.  相似文献   
2.
Sharing new medical information that is perceived as seriously effecting people’s lives, i.e., breaking bad news (BBN) is important in caring for patients and relatives and is challenging for healthcare professionals. Optimal BBN requires incorporation and implementation of multiple professional competencies acquired gradually throughout years of training. The BBN encounter has implications for all participants: the patient, family members, their close social environments, and the deliverer of the news. Due to these implications and the accountability involved, medical schools invest educational resources in helping medical students develop this competency.The current paper summarizes literature, research, and teaching experiences while suggesting practical guidelines for designing and teaching a BBN course to undergraduate students.The following principles lie behind the recommendations: stepwise spiral continuity of exposure to and teaching of communication skills in various contexts while focusing on BBN in the advanced clinical years; relating the developing skills to broader humanistic studies; enhancing awareness of self-perspectives and beliefs regarding BBN; connecting to patients’ and family members experiences and needs; providing a BBN protocol and opportunities for structured experiential learning followed by reflection and feedback; using observation and reflection to address gaps between theory and real-life practice; and creating continuity of learning about BBN through undergraduate, graduate, and continuing medical education. Applying this learning process can help enhance the management of these difficult conversations to improve patients’ care during these difficult, life-changing encounters, and physicians’ well-being.  相似文献   
3.
《Journal of endodontics》2022,48(1):102-108
IntroductionThe first outbreak of coronavirus disease 2019 (COVID-19) in the United States resulted in a nationwide closure of dental offices that created an oral health crisis. The aim of this observational study was to analyze and compare the characteristics of patients who visited 2 private endodontics offices from March 16 to May 31, 2020, compared with the same period in 2019.MethodsDemographic, diagnostic, and procedural data of 1520 (693 in 2020 and 827 in 2019) patient visits were collected. Bivariate and multiple logistic regression analyses were used to assess the impact of the COVID-19 outbreak on patient-related variables.ResultsBivariate analyses showed that the number of patient visits decreased in April and May 2020 (P < .0001). In 2020, patients’ self-reported pain level was higher, they were more frequently diagnosed with pulp necrosis and acute apical abscess, and they received more incisions for drainage (P < .05). Multiple logistic regression analyses showed that the COVID-19 outbreak was associated with less visits for older patients (>49.5 years) (odds ratio [OR] = 0.720; 95% confidence interval [CI], 0.573–0.906), more patients with kidney diseases (OR = 2.690; 95% CI, 1.143–6.331), higher levels of pain on percussion (OR = 2.277; 95% CI, 1.718–3.016), less cases with previously initiated treatment (OR = 0.242; 95% CI, 0.080–0.731), less periapical diagnoses of asymptomatic apical periodontitis (OR = 0.510; 95% CI, 0.306–0.849), and a higher number of nonsurgical root canal treatments (OR = 2.073; 95% CI, 1.397–3.074) and apicoectomies (OR = 2.799; 95% CI, 1.367-5.729).ConclusionsThese findings show that the public health burden of endodontic infections was more intense during the initial outbreak of COVID-19.  相似文献   
4.
Minimally invasive approaches are increasingly being applied in surgeries and have recently been used in living donor hepatectomy. We have developed a safe and reproducible method for minimally invasive living donor liver transplantation, which consists of pure laparoscopic explant hepatectomy and pure laparoscopic implantation of the graft, which was inserted through a suprapubic incision. Pure laparoscopic explant hepatectomy without liver fragmentation was performed in a 60-year-old man with alcoholic liver cirrhosis and hepatocellular carcinoma. The explanted liver was retrieved through a suprapubic incision. A modified right liver graft, procured from his 24-year-old son using the pure laparoscopic method, was inserted through a suprapubic incision, and implantation was performed intracorporeally throughout the procedure. The time required to remove the liver was 369 min, and the total operative time was 960 min. No complications occurred during or after the surgery. The patient recovered well, and his hospital stay was of 11 days. Pure laparoscopic living donor liver transplantation from explant hepatectomy to implantation was performed successfully. It is a feasible procedure when performed by a highly experienced surgeon and transplantation team. Further studies with larger sample sizes are needed to confirm its safety and feasibility.

  相似文献   

5.
An essential role of critical care advanced practice providers—advanced practice registered nurses and physician assistants—is to have knowledge and competency to make accurate and efficient decisions. The ability to manage clinical scenarios involving medically deteriorating patients requires higher-order cognitive thinking and leadership skills that are challenging to extrapolate in traditional interviews. In critical care, advanced practice providers must make rapid clinical assessments and implement appropriate medical interventions to deter progression of life-threatening illnesses. Adding clinical simulation to the traditional interview allows interviewers to evaluate applicants’ crisis resource management skills, leadership, and clinical competency.  相似文献   
6.
Upper limb lympedema is a frequent consequence of breast cancer treatment. The International Society of Lymphology recommends physical therapy for lymphedema management. This treatment includes a combination of manual lymphatic drainage and high-compression bandaging. Actually, the effectiveness of manual lymphatic drainage remains an area of controversy, especially because of the many different techniques called “manual lymphatic drainage” since 1930. The purpose of this review was to emphasise the efficacy of these different techniques according to physiological data and evidence-based practice. To improve the manual lymphatic drainage efficiency, the pressure, sometimes important, should be tailored to each edema and the techniques had to consider altered lymphatic drainage patterns. The methods used by physical therapist in the studies should be specified for higher lightness.

Résumé
Le lymphœdème du membre supérieur est une séquelle du traitement des cancers du sein. Le traitement physique des lymphœdèmes est recommandé par la Société internationale de lymphologie. Il associe drainage lymphatique manuel et bandages de décongestion. Le drainage lymphatique manuel a fait l’objet de critiques quant à son effi- cacité. Or depuis son invention dans les années 1930, de très nombreuses techniques s’intitulent « drainage lymphatique manuel ». Les auteurs distinguent l’efficacité de ces différentes techniques en fonction des données de la physiologie lymphatique et de la démonstration de ses effets basée sur les faits. Pour améliorer son efficacité, le drainage lymphatique manuel doit être appliqué sur l’œdème avec une pression adaptée à la consistance de l’œdème, parfois élevée. Les manœuvres doivent prendre en considération les trajets remaniés des collecteurs lymphatiques. Les études qui l’utilisent doivent décrire la technique utilisée.  相似文献   
7.
目的:探讨儿科临床药师针对儿童患者及家长进行创新药学服务的实践及思考。方法:通过开展儿科专科药学门诊、床旁用药教育、社区儿童用药宣教和线上服务等创新药学服务项目,探讨儿科专科临床药师在药学转型发展中的作用。结果:37.4%的儿科药学门诊患者来自医师转诊,可实现临床医师和药师在专业知识上的互补,充分发挥专科临床药师的作用。床旁用药教育、社区儿童用药宣教和线上服务等项目的开展,不仅提升大众对安全合理用药和临床药师的认识,而且可引导需要咨询复杂专科用药问题的患儿家长到药学门诊挂号咨询。结论:儿科临床药师开展面向儿童及家长的创新药学服务,可促进儿童安全合理用药,提升药师职业形象及大众的信任度,为医院药学服务转型发展提供参考。  相似文献   
8.
In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FENO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis.  相似文献   
9.
目的 开展养老机构志愿者预立医疗照护计划培训并评价其效果。方法 应用基于Bloom目标教学理论构建的养老机构志愿者预立医疗照护计划培训内容,结合《预立医疗照护计划》知识教育手册、《我的五个愿望》手册、案例视频等教具,通过角色扮演、案例讨论等方式对53名养老机构志愿者进行培训。培训前后使用养老机构志愿者预立医疗照护计划知信行及自我效能问卷对志愿者进行调查,根据志愿者角色扮演表现评价其预立医疗照护计划沟通技能。结果 培训前后志愿者预立医疗照护计划认知、态度、行为意愿及自我效能差异有统计学意义(P<0.05,P<0.01),培训后75.47%志愿者预立医疗照护计划沟通技能达合格及以上水平。结论 预立医疗照护计划培训能改善养老机构志愿者的预立医疗照护计划知信行及自我效能感,培养其预立医疗照护计划沟通能力。  相似文献   
10.
Many patients with terminal cancer wish to die at home and general practitioners in the United Kingdom have a critical role in providing this care. However, it has been suggested general practitioners lack confidence in end-of-life care. It is important to explore with general practitioners their experience and perspectives including feelings of confidence delivering end-of-life care to people with cancer. The aim of this study was to explore general practitioners experiences of providing end-of-life care for people with cancer in the home setting and their perceptions of confidence in this role as well as understanding implications this has on policy design. A qualitative study design was employed using semi-structured interviews and analysed using thematic analysis. Nineteen general practitioners from London were purposively sampled from eight general practices and a primary care university department in 2018–2019, supplemented with snowballing methods. Five main themes were constructed: (a) the subjective nature of defining palliative and end-of-life care; (b) importance of communication and managing expectations; (c) complexity in prescribing; (d) challenging nature of delivering end-of-life care; (e) the unclear role of primary care in palliative care. General practitioners viewed end-of-life care as challenging; specific difficulties surrounded communication and prescribing. These challenges coupled with a poorly defined role created a spread in perceived confidence. Experience and exposure were seen as enabling confidence. Specialist palliative care service expansion had important implications on deskilling of essential competencies and reducing confidence levels in general practitioners. This feeds into a complex cycle of causation, leading to further delegation of care.  相似文献   
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