Introduction: Adolescent idiopathic scoliosis (AIS) is a deformity that affects the spine in three dimensions. Even though AIS patients are usually asymptomatic, AIS negatively impacts them, ...affecting their quality of life and restricting their social life. There are many treatment options but no gold standard. Visceral manipulation (VM) is widely used in osteopathic practice for the treatment of several conditions, but it is little known among the medical community. To the best of our knowledge, there are no scientific studies reporting VM as a treatment alternative for AIS.
Case Presentation: The case was a 14-year-old girl with AIS (baseline Cobb angle of 38.9° in the lumbar spine and 32.3°in the thoracic spine). Although the patient had no physical symptoms, she was recommended for surgery to correct the deformity. The osteopathic assessment indicated that the uterus and pericardium where the main anatomical structures creating tension. Two VM sessions were conducted with a month-and-a-half interval between sessions. The follow-up X-ray revealed a Cobb angle of 32.1° in the lumbar curvature and 34.3° in the thoracic curvature. The results were perceived as an improvement by the patient and her parents. No adverse events or complications were reported.
Discussion: After two session of visceral osteopathic treatment, this document reports a 6.8° Cobb angle reduction of the primary curve in a patient with AIS, with the thoracic curvature becoming the major curve.
Solo and Small Practices: A Vital, Diverse Part of Primary Care Liaw, Winston R., MD, MPH; Jetty, Anuradha, MPH; Petterson, Stephen M., PhD ...
Annals of family medicine,
2016, 2016 Jan-Feb, 2016-01-01, 20160101, Letnik:
14, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Abstract Purpose Solo and small practices are facing growing pressure to consolidate. Our objectives were to determine (1) the percentage of family physicians in solo and small practices, and (2) the ...characteristics of and services provided by these practices. Methods A total of 10,888 family physicians seeking certification through the American Board of Family Medicine in 2013 completed a demographic survey. Their practices were split into categories by size: solo, small (2 to 5 providers), medium (6 to 20 providers), and large (more than 20 providers). We also determined the rurality of the county where the physicians practiced. We developed 2 logistic regression models: one assessed predictors of practicing in a solo or small practice, while the other was restricted to solo and small practices and assessed predictors of practicing in a solo practice. Results More than one-half of respondents worked in solo or small practices. Small practices were the largest group (36%) and were the most likely to be located in a rural setting (20%). The likelihood of having a care coordinator and medical home certification increased with practice size. Physicians were more likely to be practicing in small or solo practices (vs medium-sized or large ones) if they were African American or Hispanic, had been working for more than 30 years, and worked in rural areas. Physicians were more likely to be practicing in small practices (vs solo ones) if they worked in highly rural areas. Conclusions Family physicians in solo and small practices comprised the majority among all family physicians seeking board certification and were more likely to work in rural geographies. Extension programs and community health teams have the potential to support transformation within these practices.
Managing a small burn Antrum, John Henry George; Galloway, Jennifer Eleanor; Anwar, Mohammad Umair ...
BMJ (Online),
10/2022, Letnik:
379
Journal Article
"The Future of Nursing" explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to ...advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles--including limits on nurses' scope of practice--should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing. The following are appended: (1) Methods and Information Sources; (2) Committee Biographical Sketches; (3) Highlights from the Forums on the Future of Nursing; (4) APRN Consensus Model; (5) Undergraduate Nursing Education; (6) Health Care System Reform and the Nursing Workforce: Matching Nursing Practice and Skills to Future Needs, Not Past Demands; (7) Transformational Models of Nursing Across Different Care Settings; (8) Federal Options for Maximizing the Value of Advanced Practice Nurses in Providing Quality, Cost-Effective Health Care; (9) The Future of Nursing Education; and (10) International Models of Nursing. An index is also included. (Individual chapters contain references.) The content of this document was prepared by the Committee on the Robert Wood Johnson Foundation, Initiative on the Future of Nursing at the Institute of Medicine.
Nurses make up the largest segment of the health care profession, with 3 million registered nurses in the United States. Nurses work in a wide variety of settings, including hospitals, public health ...centers, schools, and homes, and provide a continuum of services, including direct patient care, health promotion, patient education, and coordination of care. They serve in leadership roles, are researchers, and work to improve health care policy. As the health care system undergoes transformation due in part to the Affordable Care Act (ACA), the nursing profession is making a wide-reaching impact by providing and affecting quality, patient-centered, accessible, and affordable care.
In 2010, the Institute of Medicine (IOM) released the report The Future of Nursing: Leading Change, Advancing Health , which made a series of recommendations pertaining to roles for nurses in the new health care landscape. This current report assesses progress made by the Robert Wood Johnson Foundation/AARP Future of Nursing: Campaign for Action and others in implementing the recommendations from the 2010 report and identifies areas that should be emphasized over the next 5 years to make further progress toward these goals.
Background
The high levels of healthcare worker shortage is recognised as a severe impediment to increasing patients' access to antiretroviral therapy. This is particularly of concern where the ...burden of disease is greatest and the access to trained doctors is limited.This review aims to better inform HIV care programmes that are currently underway, and those planned, by assessing if task‐shifting care from doctors to non‐doctors provides both high quality and safe care for all patients requiring antiretroviral treatment.
Objectives
To evaluate the quality of initiation and maintenance of HIV/AIDS care in models that task shift care from doctors to non‐doctors.
Search methods
We conducted a comprehensive search to identify all relevant studies regardless of language or publication status (published, unpublished, in press, and in progress) from 1 January 1996 to 28 March 2014, with major HIV/AIDS conferences searched 23 May 2014. We had also contacted relevant organizations and researchers. Key words included MeSH terms and free‐text terms relevant to 'task shifting', 'skill mix', 'integration of tasks', 'service delivery' and 'health services accessibility'.
Selection criteria
We included controlled trials (randomised or non‐randomised), controlled‐before and after studies, and cohort studies (prospective or retrospective) comparing doctor‐led antiretroviral therapy delivery to delivery that included another cadre of health worker other than a doctor, for initiating treatment, continuing treatment, or both, in HIV infected patients.
Data collection and analysis
Two authors independently screened titles, s and descriptor terms of the results of the electronic search and applied our eligibility criteria using a standardized eligibility form to full texts of potentially eligible or uncertain s. Two reviewers independently extracted data on standardized data extraction forms. Where possible, data were pooled using random effects meta‐analysis. We assessed evidence quality with GRADE methodology.
Main results
Ten studies met our inclusion criteria, all of which were conducted in Africa. Of these four were randomised controlled trials while the remaining six were cohort studies.
From the trial data, when nurses initiated and provided follow‐up HIV therapy, there was high quality evidence of no difference in death at one year, unadjusted risk ratio was 0.96 (95% CI 0.82 to 1.12), one trial, cluster adjusted n = 2770. There was moderate quality evidence of lower rates of losses to follow‐up at one year, relative risk of 0.73 (95% CI 0.55 to 0.97). From the cohort data, there was low quality evidence that there may be an increased risk of death in the task shifting group, relative risk 1.23 (95% CI 1.14 to 1.33, two cohorts, n = 39 160) and very low quality data reporting no difference in patients lost to follow‐up between groups, relative risk 0.30 (95% CI 0.05 to 1.94).
From the trial data, when doctors initiated therapy and nurses provided follow‐up, there was moderate quality evidence that there is probably no difference in death compared with doctor‐led care at one year, relative risk of 0.89 (95% CI 0.59 to 1.32), two trials, cluster adjusted n = 4332. There was moderate quality evidence that there is probably no difference in the numbers of patients lost to follow‐up at one year, relative risk 1.27 (95% CI 0.92 to 1.77), P = 0.15. From the cohort data, there is very low quality data that death at one year may be lower in the task shifting group, relative risk 0.19 (95% CI 0.05 to 0.78), one cohort, n = 2772, and very low quality evidence that loss to follow‐up was reduced, relative risk 0.34 (95% CI 0.18 to 0.66).
From the trial data, for maintenance therapy delivered in the community there was moderate quality evidence that there is probably no difference in mortality when doctors deliver care in the hospital or specially trained field workers provide home‐based maintenance care and antiretroviral therapy at one year, relative risk 1.0 (95% CI 0.62 to 1.62), 1 trial, cluster adjusted n = 559. There is moderate quality evidence from this trial that losses to follow‐up are probably no different at one year, relative risk 0.52 (0.12 to 2.3), P = 0.39. The cohort studies did not report on one year follow‐up for these outcomes.
Across the studies that reported on virological and immunological outcomes, there was no clear evidence of difference whether a doctor or nurse or clinical officer delivered therapy. Three studies report on costs to patients, indicating a reduction in travel costs to treatment facilities where task shifting was occurring closer to patients homes. There is conflicting evidence regarding the relative cost to the health system, as implementation of the strategy may increase costs. The two studies reporting the patient and staff perceptions of the quality of care, report good acceptability of the service by patients, and general acceptance by doctors of the shifting of roles. One trial reported on the time to initiation of antiretroviral therapy, finding no clear evidence of a difference between groups. The same trial reports on new diagnosis of tuberculosis which favours nurse initiation of HIV care for increasing the numbers of diagnoses of tuberculosis made.
Authors' conclusions
Our review found moderate quality evidence that shifting responsibility from doctors to adequately trained and supported nurses or community health workers for managing HIV patients probably does not decrease the quality of care and, in the case of nurse initiated care, may decrease the numbers of patients lost to follow‐up.
Abstract Purpose Ultrasound examinations are currently being implemented in general practice. This study aimed to systematically review the literature on the training in and use of point-of-care ...ultrasound (POCUS) by general practitioners. Methods We followed the Cochrane guidelines for conduct and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. We searched the databases MEDLINE (via PubMed), EMBASE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials using the key words ultrasonography and general practice in combination and using thesaurus terms. Two reviewers independently screened articles for inclusion, extracted data, and assessed the quality of included studies using an established checklist. Results We included in our review a total of 51 full-text articles. POCUS was applied for a variety of purposes, with the majority of scans focused on abdominal and obstetric indications. The length of training programs varied from 2 to 320 hours. Competence in some types of focused ultrasound scans could be attained with only few hours of training. Focused POCUS scans were reported to have a higher diagnostic accuracy and be associated with less harm than more comprehensive scans or screening scans. The included studies were of a low quality, however, mainly because of issues with design and reporting. Conclusions POCUS has the potential to be an important tool for the general practitioner and may possibly reduce health care costs. Future research should aim to assess the quality of ultrasound scans in broader groups of general practitioners, further explore how these clinicians should be trained, and evaluate the clinical course of patients who undergo scanning by general practitioners.
Aims
The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for ...Australian general practice nurses.
Background
Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting.
Design
Concurrent mixed methods design.
Methods
Data collection was conducted during 2013–2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts.
Findings
Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard.
Conclusion
The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses’ practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance.
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