Understanding Hispanic Patient Satisfaction with Telehealth During COVID-19

BackgroundRecent studies have described the use of telehealth for pediatric surgical care during the COVID-19 pandemic. We aimed to evaluate equity in telehealth use by comparing rates of utilization and satisfaction with pediatric surgical telemedicine among Hispanic patients.MethodsWe conducted a retrospective cohort study of patients seen by a surgical subspecialty provider in the outpatient setting at a quaternary pediatric hospital between April 1 and June 30, 2020. Patients evaluated in the same three-month period in 2019 were analyzed as a historic control. Differences in Family Experience Survey (FES) responses based on race and ethnicity and preferred language of care were assessed using univariable and multivariable generalized linear modeling.ResultsThe pandemic cohort included fewer patients of Hispanic ethnicity and fewer Spanish-speakers. After controlling for visit type, comparison of Spanish-speaking and English-speaking patients revealed that Spanish-speaking families had significantly lower scores for FES items that evaluated healthcare provider explaining (IRR 0.74, 95% CI: 0.61–0.90), listening (IRR 0.76, 95% CI: 0.63–0.92), and time spent with the family (IRR 0.73, 95% CI: 0.60–0.89). There were no differences in FES responses based on insurance status or degree of medical complexity.ConclusionsTelehealth services were less commonly used among Hispanic and Spanish-speaking patients. Language may differentially affect family satisfaction with healthcare and telehealth solutions. Strategies to mitigate these inequities are needed and may include strengthening interpreter services and providing language-concordant care.Level of evidenceLevel IV.     

Nurses’ experiences of guideline implementation: a focus group study

Aims. The aim of the study was to address the following questions: What kind of experiences do primary care nurses have of guideline implementation? What do nurses think are the most important factors affecting the adoption of guidelines? Background. The implementation of clinical guidelines seems to be dependent on multiple context‐specific factors. This study sets out to explore the experiences of primary care nurses concerning guideline implementation. Design. Qualitative interview. Methods. Data were generated by four focus group interviews involving nurses working in out‐patient services in primary health centres in Finland. Purposive sampling was used to select health centres. Inductive content analysis was used to identify themes emerging from the data. Results. Four main groups of factors were identified from the analysis of data: (i) factors related to the organisation, (ii) factors related to nurses, (iii) factors related to the anticipated consequences and (iv) factors related to the patient group. Nurses’ awareness and acceptance of guidelines and the anticipated positive consequences facilitate the implementation of guidelines. Organisational support, especially the adapting of guidelines to local circumstances, seems to be crucial for successful implementation. Conclusions. Clinical guidelines can be promising tools in enhancing evidence‐based nursing practice, as nurses see them as practical work tools in patient care and so are willing to adopt them. However, support from management and physicians is needed to ensure the successful implementation of guidelines into nursing practices. Relevance to clinical practice. Based on the findings of this study and previous knowledge of guideline implementation some practical recommendations are suggested. Select the most relevant guidelines to clinical practice, organise the adaptation of guidelines to local circumstances, inform all practitioners involved in treatment and give clear instructions for the adoption of the guidelines.     

Long-term motor practice induces practice-dependent modulation of movement-related cortical potentials (MRCP) preceding a self-paced non-dominant handgrip movement in kendo players

Effects of long-term motor practice on movement-related brain activities were investigated by measuring from the scalp, movement-related cortical potentials (MRCP) associated with self-paced right (dominant) and left (non-dominant) brisk handgrip movements with a 20% maximal voluntary contraction (MVC) in 8 elite kendo players (kendo group) and 8 healthy young adults (control group). The kendo players had engaged in regular practice since childhood. Three components of MRCP were obtained from all subjects. These components relating to the preparation (Bereitschaftspotential: BP and negative slope: NS′) and initiation (motor potential: MP) of the movements were compared between the two groups. The BP onset time for a non-dominant handgrip task was significantly earlier in the control group than in the kendo group. Moreover, BP onset time appeared significantly earlier preceding the non-dominant handgrip task as compared with the dominant one only in the control group. Furthermore, MP amplitudes in the kendo group were significantly larger than in the control group. These findings suggest that long-term motor practice affects brain activities, leading to practice-dependent modulations in the cortical areas involved in the preparation and initiation of self-paced non-dominant handgrip movements in kendo players.     

British Association of Critical Care Nurses position statement on prescribing in critical care

Background: Nurses in the UK are now one group of non-medical staff who can prescribe. This practice is evolving for critical care nursing staff who care for critically ill patients during their stay in hospital through ward and outpatient follow-up after admission to critical care.
Aim: The purposes of this paper were to present existing information regarding prescribing to support nurses in critical care currently prescribing and to inform those who are intending to prescribe.
Methods: To develop the position statement, a search of the literature was conducted using key databases. To ascertain the current level and type of prescribing in critical care, a short questionnaire was sent by email to British Association of Critical Care Nursing members, and the results of this are presented in Appendix A.
Outcomes/Results: Evidence was found in relation to the history, context in critical care, educational requirements and issues of consent related to non-medical prescribing.
Conclusions: The position statement is based upon evidence from the literature, National Health Service policy and the Nursing and Midwifery Council regulations. It takes account of the critical care patient pathway before, during and after an admission to critical care.     

How Well Do Guidelines Incorporate Evidence on Patient Preferences?

BACKGROUND  Clinical practice guidelines (CPG) are meant to consider important values such as patient preferences. OBJECTIVE  To assess how well clinical practice guidelines (CPGs) integrate evidence on patient preferences compared with that on treatment effectiveness. DESIGN  A cross-sectional review of a listing in 2006 of CPGs judged to be the best in their fields by an external joint government and medical association body. STUDY SELECTION  Exclusion criterion was unavailability in electronic format. Sixty-five of 71 listed CPGs met selection criteria. MEASUREMENTS  Two instruments originally constructed to evaluate the overall quality of CPGs were adapted to specifically assess the quality of integrating information on patient preference vs. treatment effectiveness. Counts of words and references in each CPG associated with patient preferences vs. treatment effectiveness were performed. Two reviewers independently assessed each CPG. MAIN RESULTS  Based on our adapted instruments, CPGs scored significantly higher (p < 0.001) on the quality of integrating treatment effectiveness compared with patient preferences evidence (mean instrument one scores on a scale of 0.25 to 1.00: 0.65 vs. 0.43; mean instrument two scores on a scale of 0 to 1: 0.58 vs. 0.18). The average percentage of the total word count dedicated to treatment effectiveness was 24.2% compared with 4.6% for patient preferences. The average percentage of references citing treatment effectiveness evidence was 36.6% compared with 6.0% for patient preferences. CONCLUSION  High quality CPGs poorly integrate evidence on patient preferences. Barriers to incorporating preference evidence into CPGs should be addressed. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Using the caring dimensions inventory as an indicator of person‐centred nursing

Aims. This paper reports findings from a large‐scale quasi‐experimental study that used a measure of caring as a means of evaluating person‐centred nursing and aims to illustrate the synergy between the concepts of caring and person‐centredness. Background. Evidence would suggest that effective person‐centred nursing requires the formation of therapeutic relationships between professionals, patients and others significant to them in their lives and that these relationships are built on mutual trust, understanding and a sharing of collective knowledge. This correlates with the conceptualisation of caring that is underpinned by humanistic nursing theories. Design. A pretest post‐test design was used in this study to evaluate the effect of person‐centred nursing on a range of outcomes, one of which was nurses’ and patients’ perception of caring. Methods. The Person‐Centred Nursing Index was the main data collection tool. The Caring Dimension Inventory and Nursing Dimensions Inventory, were component parts of the Person‐Centred Nursing Index and were used to measure nurses’ and patients’ perceptions of caring. The Person‐Centred Nursing Index was administered at five points in time over a two‐year intervention period. Results. Nurses had a clear idea of what constituted caring in nursing, identifying statements that were reflective of person‐centredness, which was consistent over time. This was in contrast to patients, whose perceptions were more variable, highlighting incongruencies that have important implications for developing person‐centred practice. Conclusion. The findings confirm the Caring Dimension Inventory/Nursing Dimensions Inventory as an instrument that can be used as an indicator of person‐centred practice. Furthermore, the findings highlight the potential of such instruments to generate data on aspects of nursing practice that are traditionally hard to measure. Relevance to clinical practice. The findings would suggest that nurses need to be aware of patients’ perceptions of caring and use this to influence changes in practice, where the prime goal is to promote person‐centredness.     

Comparative studies on the ocular and dermal irritation potential of surfactants.

Comparative studies on the irritation potential of 18 surfactants were performed using the same stock solution of surfactant for each study. The ocular irritation potential of surfactants was studied using the red blood cell test (RBC), the hen's egg test-chorioallantoic membrane (HET-CAM) and the Skinethic ocular tissue model. The skin irritation potential was assessed based on data obtained from human studies using a 24h epicutaneous patch test (ECT) and a soap chamber test (SCT). The same pH and active substance (AS) content for all surfactants tested was used depending on the test conducted. In general, clusters of substances with varying irritation potential were identified similarly by most tests. These results show that when using standardized test conditions in which pH and % AS are the same for each surfactant tested, there is a good correlation between the in vitro ocular irritation assays themselves as well as between the dermal and ocular irritation assays. In particular the RBC test seems to be not only highly predictive for ocular irritation (H(50)/DI) but also for dermal irritation and changes in barrier function (DI) induced by surfactants.     

Toxicological assessment of a particulate yeast (1,3/1,6)-beta-D-glucan in rats.

This study investigates the toxicity of WGP 3-6, a yeast-derived beta-glucan ingredient, during single-dose acute and sub-chronic toxicity studies in rats. For the acute study, Fisher-344 rats were administered WGP 3-6 via gavage at a dose of 2000 mg/kg body weight, and any evidence of toxicity was monitored over a 14-day period. WGP 3-6 was well tolerated, indicating that the LD(50) value is greater than 2000 mg/kg body weight. For the sub-chronic study, Fisher-344 rats (10/sex/group) were randomly allocated to receive daily gavage treatment with WGP 3-6 at doses of 0, 2, 33.3, or 100 mg/kg body weight. Control and high-dose satellite recovery groups of each sex also were included. Full toxicological monitoring and endpoint investigations were performed throughout and upon completion of the study. No negative effects on animal weights or food consumption attributable to WGP 3-6 were evident at any dose. In addition, no mortality, clinical pathology, functional/behavioral, microscopic, or gross observations indicating toxicity were observed. Sporadic changes in some biochemical and hematological parameters were observed; however, since the effects were within the physiological ranges in historical controls, were not dose-responsive, or were not observed in both sexes, they were determined to be of no toxicological significance. In conclusion, no adverse or toxic effects were observed after subchronic oral administration of 2, 33.3, or 100mg/kg body weight/day of WGP 3-6 in Fisher-344 rats, and therefore, a no observed adverse effect level (NOAEL) of 100 mg/kg body weight/day, the highest dose tested, was determined.