Engaging Patients in Integrated Behavioral Health and Primary Care: A Technology-Based System to Facilitate Behavioral Health Screening for Patients in Rural and Underserved Areas

xloma.fota13 shared this article with you from Inoreader Engaging Patients in Integrated Behavioral Health and Primary Care: A Technology-Based System to Facilitate Behavioral Health Screening for Patients in Rural and Underserved Areas Via Computers Informatics Nursing - Current Issue Integrating behavioral health into primary care can increase patient access to treatments for behavioral health disorders, especially in rural areas. The first step of integrated care implementations is the need to identify at-risk patients and effectively communicate patient screening results to the care team. The use of technology can facilitate patient screening and incorporate screening data into electronic health records. This paper describes the development of a tablet-based screening system to facilitate behavioral health integration in a rural primary care clinic, discusses the preliminary impact of digital screening on workflows, and provides recommendations for the use of technology for screening. A tablet-based assessment was developed to screen patients for behavioral health concerns and was implemented within a rural primary care clinic. The system was created using the Visual Signature Capture system, which integrates directly with the electronic health record. Following the initial assessment, patients are screened as frequently as every 30 days with a mini-screen assessment, consisting of multiple screening tools for mental health and substance use. The tablet-based screening system had a positive impact on clinician workflows and the overall effectiveness of clinic operations. This system supports providers in addressing the behavioral health needs of patients that often go unrecognized in primary care. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Agent-Based Modeling Simulation of Nurse Medication Administration Errors

xloma.fota13 shared this article with you from Inoreader Agent-Based Modeling Simulation of Nurse Medication Administration Errors Via Computers Informatics Nursing - Current Issue It has been 20 years since the National Academy of Medicine released its report, "To Err Is Human," which shocked the healthcare community on the pervasiveness of medical error. While errors in medication administration are a significant contributor to medical error, research seeking to understand the complex systems nature and occurrence of medication administration error is limited. Computer modeling is increasingly being used in the healthcare industry to assess the impact of changes made to healthcare processes. The objective of the study is to evaluate the use of agent-based modeling, a type of computer modeling th at allows the simulation of virtual individuals and their behavior, to simulate nurse performance in the medication administration process. The model explores the effect of Just-in-Time information, as an intervention, on the occurrence of medication error. The model demonstrated significant utility in understanding the interplay of the system elements of the nurse medication administration process. Therefore this approach, using systems-level computer simulation such as agent-based models, can help administrators understand the effects of changes to the medication administration process as they work to reduce errors and increase performance. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Byzantine Role of Big Data Application in Nursing Science: A Systematic Review

xloma.fota13 shared this article with you from Inoreader The Byzantine Role of Big Data Application in Nursing Science: A Systematic Review Via Computers Informatics Nursing - Current Issue Big data have the potential to determine enhanced decision-making process and to personalize the approach of delivering care when applied in nursing science. So far, the literature on this topic is still not synthesized for the period between 2014 and 2018. Thus, this systematic review aimed to identify and synthesize the most recent evidence on big data application in nursing research. The systematic search was undertaken for the evidence published from January 2014 to May 2018, and the outputs were formatted using the PRISMA Flow Diagram, whereas the quality appraisal was addressed by recommendations consistent with the Critical Appraisal Skills Program. Twelve studies on big data in nursing were included and divided into two themes: the majority of the studies aimed to determine prediction assessment, while only four studies were related to the impact of big data applications to support clinical practice. This review tracks the recent state of knowledge on big data applications in nursing science, revealing the potential for nursing engagement in big data science, even if currently limited to some fields. Big data applications in nursing might have a tremendous potential impact, but are currently underused in research and clinical practice. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Using a Systems Engineering Approach to Design an Interactive Mobile Health Application for Improving Asthma Self-management

xloma.fota13 shared this article with you from Inoreader Using a Systems Engineering Approach to Design an Interactive Mobile Health Application for Improving Asthma Self-management Via Computers Informatics Nursing - Current Issue Mobile health applications are in demand. According to the Grand Review Research group, there were US $12.4 billion in mobile health app sales in 2018. Increasingly, providers are seeking new ways to engage their pediatric patients. One approach is through mobile health apps. Nearly 10 000 mobile health apps target youth and teens, especially for children with conditions that require complex treatment and self-management. One such chronic illness is asthma. Children with asthma who lack social support are particularly vulnerable to exacerbations because they often are not focused on self-care. For this reason, succ essful asthma programs for children engage family members, encouraging them to play an active role on the healthcare team. The Just-in-Time Asthma Self-management Intervention is unique in several ways compared to other asthma management mobile applications. The app uses gold standard, evidence-based asthma care practices and extends the support infrastructure beyond family and healthcare providers to engage the child, their peers, and school personnel. Further, the app was built using a systems engineering approach. This article reviews the basis for developing an asthma care mobile application including the conceptual framework supporting a systems model, how the Just-in-Time Asthma Self-management Intervention is unique, and how it was built using a systems engineering design. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hygiene bei der HNO-Untersuchung: Fluoreszenzstudie mit Übersicht der aktuellen Empfehlungen

xloma.fota13 shared this article with you from Inoreader Hygiene bei der HNO-Untersuchung: Fluoreszenzstudie mit Übersicht der aktuellen Empfehlungen Via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1408-7046 Steigende normative Ansprüche an Patientensicherheit und Maßnahmen der Qualitätssicherung, aber auch die Problematik multiresistenter Keime und von Erregern mit hohem Ansteckungspotenzial verstärken die Notwendigkeit hygienisch korrekten Arbeitens.In dieser Studie sollten hygienisch relevante potenzielle Kontaminationsquellen bei der HNO-Untersuchung identifiziert und mögliche Verbesserungsstrategien untersucht werden.Von 5 Untersuchern mit unterschiedlicher Berufserfahrung, deren Handschuhe vor der Untersuchung mit Fluoreszenzlotion benetzt wurden, wurde eine komplette HNO-Untersuchung durchgeführt. Kontaminierungen insbesondere an der Untersuchungseinheit und am Instrumentarium wurden identifiziert. Das potenzielle Risiko einer Übertragung von Erregern auf Folgepatienten wurde mittels eines eigens entwickelten Scores bewertet. Verschiedene Strategien zur Reduzierung identifizierter Kontaminationsmöglichkeiten wurden erarbeitet und gedanklich durchgespielt.Der Score der Untersucher war mit im Mittel 87,4 Punkten (±3,6) sehr hoch. Die Umsetzung von einzelnen Hygienemaßnahmen im Untersuchungsablauf würde zu einer deutlichen Erniedrigung des Scores und damit einer Verbesserung der Hygiene führen: kein Händeschütteln (81,8), zusätzlich Patientenstuhldesinfektion (79,8), Desinfektion wichtiger Flächen (69,8), Bereitstellen von Standardinstrumenten (60,2) oder aller Instrumente (32,2), Desinfektion aller relevanten Flächen und Bereitstellen aller Instrumente (7,4).Die Ergebnisse zeigen sehr deutlich, dass eine HNO-Untersuchung aus Sicht der Hygiene einen komplexen Vorgang darstellt. Für einen verlässlichen Schutz vor möglichen Übertragungsereignissen ist deshalb eine strukturierte Bündelung von Hygienemaßnahmen notwendig. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Skin-Reducing Mastectomy with Immediate Prepectoral Reconstruction: Surgical, Aesthetic, and Patient-Reported Outcomes with and without Dermal Matrices

xloma.fota13 shared this article with you from Inoreader Skin-Reducing Mastectomy with Immediate Prepectoral Reconstruction: Surgical, Aesthetic, and Patient-Reported Outcomes with and without Dermal Matrices Via Plastic and Reconstructive Surgery - Published Ahead-of-Print Background: Prepectoral breast reconstruction is being increasingly popularized, largely because of technical advances. Patients with ptotic breasts and active cancer require mastectomies through a mastopexy excision pattern to achieve proper pocket control in a prepectoral single-stage operation. This article presents a single-surgeon experience with direct-to-implant, prepectoral reconstruction following skin-reducing mastectomies. Methods: A retrospective chart review identified all patients undergoing prepectoral, direct-to-implant breast reconstruction following Wise-pattern mastopexy from June of 2016 to June of 2018. Surgical and aesthetic outcomes, including capsular contracture and revision surgery, were measured. The BREAST-Q was administered preoperatively, 6 months postoperatively, and 1 year postoperatively. Results: Eighty-four patients (121 breasts) were included. A widely based inframammary fold adipodermal flap was used in all cases, with acellular dermal matrix used in 77 breasts (63.3 percent), free nipple grafts in 42 breasts (34.7 percent), and postmastectomy radiation therapy in 31 breasts (26.5 percent). Operative complications included nipple-areola complex necrosis in six (5.1 percent), hematoma in four (3.4 percent), seroma in four (3.4 percent), implant exposure in three (2.6 percent), and infection in one (0.9 percent). Minor complications included cellulitis in five (6.0 percent) and minor wound issues in five (4.3 percent). In aesthetic outcomes, only two nonirradiated breasts experienced a grade 3 to 4 or grade 4 capsular contracture requiring capsulectomy. Rippling was visible in four breasts (3.4 percent). The BREAST-Q showed good satisfaction with the technique, with no significant differences between nipple-areola complex techniques. Conclusions: This cohort represents the largest single-surgeon, Wise-pattern, direct-to-implant prepectoral database in the literature. This report showed that surgical and aesthetic complications did not differ in terms of acellular dermal matrix use. This technique has shown, through patient-reported outcomes, to yield good patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Perforator-Based Intercostal Artery Muscle Flap: A Novel Approach for the Treatment of Tracheoesophageal or Bronchoesophageal Fistulas

xloma.fota13 shared this article with you from Inoreader Perforator-Based Intercostal Artery Muscle Flap: A Novel Approach for the Treatment of Tracheoesophageal or Bronchoesophageal Fistulas Via Plastic and Reconstructive Surgery - Published Ahead-of-Print Summary: Postoperative tracheoesophageal or bronchoesophageal fistulas represent a major surgical challenge. The authors report the description of an original perforator-based intercostal artery muscle flap, aiming to cover all types of intrathoracic fistulas, from any location, in difficult cases such as postoperative fistulas after esophagectomy in an irradiated field. Between June of 2016 and January of 2019, eight male patients were treated with a perforator-based intercostal artery muscle flap. All had previous surgery for esophageal cancer and developed a tracheoesophageal or bronchoesophageal fistula during the perioperative course. The mean patient age was 55.9 ± 8.8 years. All patients received neoadjuvant chemotherapy and seven received neoadjuvant radiation therapy. A perforator-based intercostal artery muscle flap, with a mean skin paddle size of 9.86 × 5 cm, was harvested. The median operative time was 426.50 minutes. The tracheoesophageal or bronchoesophageal fistula was succe ssfully and definitively occluded in three patients; two patients experienced recurrence; and one patient underwent reoperation. At 1 year, five patients were alive (62.5 percent), and among them, three (37.5 percent) were free from any intrathoracic complications. Three patients died, because of massive digestive bleeding, mesenteric ischemia, and multiorgan failure, respectively. The perforator-based intercostal artery muscle flap, like the Taylor flap in abdominoperineal reconstruction, could become a workhorse flap for all intrathoracic reconstructions, as it can always be harvested, even if a previous thoracotomy has ruined most of the options. This surgical technique, easily feasible, reliable, and reproducible, became our first option for all postoperative tracheoesophageal or bronchoesophageal fistula patients during the postoperative course following esophagectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.