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Background: Nurse practitioner (NP) autonomy is often misunderstood and misconstrued. These misconceptions cause a confusing interplay of words that impedes advocating for policy change and ultimately hinders the profession. Objective: To develop a clear definition of NP autonomy to describe the professional role. Data sources: Walker and Avant's method of concept analysis was used to undertake a concept analysis of NP autonomy. The terms used to search for possible uses and definitions of NP autonomy in electronic databases included NP, autonomy, and concept analysis. In addition, the websites for nursing organizations, Google, Google Scholar, and the Merriam-Webster dictionary were searched and included in this analysis. This search yielded 29 articles, consisting of literature reviews, meta-synthesis, position papers, and qualitative and quantitative studies. Conclusions: Nurse practitioner autonomy should be defined as the NP's use of their experience, clinical judgment, and responsibility to practice without restriction in professional collaboration with other health care professionals. Autonomy allows NPs to practice to the maximum extent of their advanced education, participate in productive and voluntarily collaborations, and continue to positively influence health care discrepancies throughout the United States. Implications for practice: This concept analysis provides a clear definition of NP autonomy. In addition, it explains the difference between the concepts of NP autonomy and full practice authority. Clear definitions of the concepts of NP autonomy and full practice authority will be beneficial in advocating and advancing policy on behalf of NPs. [ABSTRACT FROM AUTHOR]

Background Establishing healthy eating habits early affects lifelong dietary intake, which has implications for many health outcomes. With children spending time in early care and education (ECE) programs, teachers establish the daytime meal environment through their feeding practices. Objective We aimed to determine the effect of a teacher-focused intervention to increase responsive feeding practices in 2 interventions, 1 focused exclusively on the teacher's feeding practices and the other focused on both the teacher's feeding practices and a nutrition classroom curriculum, in ECE teachers in a Native American (NA) community in Oklahoma. Methods Nine tribally affiliated ECE programs were randomly assigned to 1 of 2 interventions: 1) a 1.5-h teacher-focused responsive feeding practice training (TEACHER; n  = 4) and 2) TEACHER plus an additional 3-h training to implement a 15-wk classroom nutrition curriculum (TEACHER + CLASS; n  = 5). Feeding practice observations were conducted during lunch at 1 table in 1 classroom for 2- to 5-y-olds at each program before and 1 mo after the intervention. The Mealtime Observation in Child Care (MOCC) organizes teacher behaviors into 8 subsections. Descriptive statistics and the Shapiro–Wilk test for normality were calculated. Paired t tests were calculated to determine change in each group. Results A mean ± SD of 5.2 ± 2.0 (total n  = 47) children and 1.7 ± 0.5 (total n  = 14) teachers/center were observed at baseline, and 5.6 ± 1.7 (total n  = 50) children and 1.7 ± 0.7 teachers (total n  = 14) were observed/center postintervention. Total MOCC scores (max possible = 10) improved for TEACHER (6.1 ± 0.9 compared with 7.5 ± 0.3, t  = 4.12, P  = 0.026) but not for TEACHER + CLASS (6.5 ± 0.8 compared with 6.4 ± 1.0, t  = −0.11, P  = 0.915). No other changes were observed. Conclusions Teacher intervention–only programs demonstrated improvements in responsive feeding practices, whereas the programs receiving teacher and classroom training did not. Greater burden likely decreased capacity to make changes in multiple domains. We demonstrated the ability to implement interventions in NA ECE. Further research with larger communities is necessary. This trial was registered at clinicaltrials.gov as NCT03251950. [ABSTRACT FROM AUTHOR]

Caesarean section (CS) rates have risen worldwide in the past two decades, particularly in middle and high-income countries. In addition to changing maternal and health system factors, there is growing evidence that provider factors may contribute to rising unnecessary caesareans. The aim of this review was to assess the evidence for the association between individual provider characteristics, attitudes towards CS and decision-making for CS. A search was conducted in May 2018 in PubMed and Web of Science with 23 papers included in our final review. Our results show that higher anxiety scores and more favourable opinions of CS were associated with increased likelihood of performing CS. These findings highlight a need for appropriate interventions to target provider attitudes towards CS to reduce unnecessary procedures. [ABSTRACT FROM AUTHOR]

Objective A number of studies have documented the benefits of neuropsychological evaluation as a tool for understanding brain-behavior relationships in various childhood disorders; however, little is known about the process by which children are referred for neuropsychological evaluation. From a systems perspective, it is important to understand whether there are identifiable referral patterns, and if so, how being aware of such patterns could shape the behavior of providers making those referrals. We aim to examine child characteristics that influence referral for neuropsychological evaluation. Methods Retrospective chart review of 773 children who received neuropsychological evaluation and were diagnosed with autism, attention-deficit/hyperactivity disorder, and/or anxiety was completed. Children were divided into groups based on referral source (professional or caregiver) and compared on demographic, behavioral, and medical characteristics. Results Overall, professionals were more likely than caregivers to refer children for neuropsychological evaluation. Though standardized measures suggested children referred by professionals and caregivers were similar, their clinical presentation appears to be different (i.e. those referred by professionals had more comorbidities and were more likely to be prescribed psychotropic medication than those referred by caregivers). Also, children with public insurance were more likely to be referred by a professional than by their caregiver. Conclusions Findings highlight the important role of professionals in identifying "at-risk" children and supporting families through the process of receiving further evaluation when indicated. This information can be used to create a more efficient system for evaluating children and developing treatment plans, providing neuropsychologists with direct information to share with referral sources. [ABSTRACT FROM AUTHOR]

HIV medical care providers need a wide range of evidence-based clinical information resources to manage their patients' health. We determined whether providers' choice of information sources for HIV care and treatment are associated with their demographic and medical practice characteristics. Data used for this study were obtained from a probability sample of HIV medical care providers in 13 outpatient HIV facilities in Houston/Harris County, Texas, surveyed between June and September 2009. The mean number of information sources used by HIV medical care providers for HIV care and treatment was 5.83 (95% confidence interval: 4.90–6.75). Antiretroviral therapy guidelines (95.6%), medical journals and textbooks (82.6%), and Internet sources (69.5%) were ranked first, second, and third as sources of clinical information. At least one of the providers' demographic or medical practice characteristics was significantly (p ⩽ 0.05) associated with six of the clinical information sources. Integration of these information resources into clinicians' workflow may enhance efficiency of HIV care and treatment and facilitate improved patients' care and health outcomes. [ABSTRACT FROM AUTHOR]

Cultural competency in lesbian, gay, bisexual, transgender, and queer (LGBTQ) health care has been found to be lacking within various medical specialties, but no studies have compared competency among primary care providers. The authors compared 127 primary care providers' cultural competency regarding LGBTQ health using a survey that assessed providers' attitudes, practices, and knowledge. Overall, 78.0% of respondents agreed that they were comfortable treating LGBTQ patients. Yet many providers did not feel well informed on specific LGBTQ health needs (70.1%), on clinical management of LGBTQ care (74.8%), nor on referring patients with LGBTQ issues (78.7%). Overall accuracy on LGBTQ knowledge questions was 51.0%. This study revealed a lack of cultural competency and much need for improvement as primary care providers endorsed negative attitudes, biases, inconsistencies in clinical practice, and deficiencies in medical knowledge in specialty-specific ways. There is a need for greater LGBTQ-specific education to increase providers' comfortability and competency in the needs, management, and referrals within LGBTQ health care. [ABSTRACT FROM AUTHOR]

Warfarin dosing algorithms have proven beneficial in increasing time within therapeutic range (TTR) and decreasing adverse events associated with out-of-range international normalized ratios (INRs). Despite widespread availability, providers' utilization and perceptions of warfarin algorithms in real-world practice are unclear. Identifying perceptions and barriers to algorithm use may help attempts to improve warfarin therapy management. Anticoagulation providers' utilization and perceptions of warfarin dosing algorithms were assessed via a nationwide electronic survey. Of the 246 providers who completed the survey, 82% were pharmacists, and 69% had over five years' experience dosing warfarin. Warfarin dosing algorithms were deemed beneficial by 84% of respondents and 72% currently use a warfarin dosing algorithm in their practice at least occasionally. Pharmacists were least likely of anticoagulation providers to use algorithms, although this was not statistically significant (p = 0.12). Algorithm utilization also decreased as years of warfarin dosing experience increased, with the highest rate of usage noted in the first year of dosing warfarin. The most common reason providers gave for discontinuing algorithm use was that they no longer felt it was needed. In this study, clinic patient volume did not appear to be associated with algorithm utilization. Warfarin dosing algorithms are frequently used among anticoagulation providers, especially those new to dosing warfarin, but use is frequently not sustained over the long-term. Education on the continued benefits of warfarin dosing algorithms could increase long-term utilization, potentially improving patient outcomes. • Most providers generally find warfarin dosing algorithms beneficial. • Three out of 4 providers use a warfarin dosing algorithm in their current practice. • Warfarin algorithm utilization declines as years of experience increases. • Warfarin dosing algorithms restricting clinical judgement is a barrier to use. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to understand patient-, provider- and system-level factors associated with long-acting reversible contraception (LARC) use among women Veterans and with receipt of LARC methods within the Veterans Affairs (VA) system.Study Design: We analyzed data from a national telephone-based survey of 2302 women ages 18-44 receiving primary care in VA. Multivariable regression was used to examine adjusted associations of participant-reported patient-, provider- and facility-level factors with LARC use and within-VA receipt of LARC among women Veterans.Results: Among 987 women Veterans at risk of unintended pregnancy, 294 (30%) reported using LARC, 65% of whom had received their method within VA. Higher LARC use was observed among women who were multiparous vs. nulliparous [adjusted odds ratio (aOR)=1.52; 95% confidence interval (CI)=1.04-2.22] and did not desire future pregnancies (aOR=1.88; 95% CI=1.31-2.68). Although overall LARC uptake was not associated with any provider- or facility-level factors, receipt of these methods within VA was associated with receiving both general and gender-specific health care by a single provider (aOR=2.81; 95% CI=1.20-6.61) and with receiving care within a women's health clinic (aOR=2.54; 95% CI=1.17-5.50).Conclusions: While patient-level factors were more strongly correlated with use of LARC, provider- and system-level factors influence whether women received these methods within VA.Implications: This study of patient-, provider- and system-level correlates of LARC use in VA, the country's largest integrated healthcare system, highlights that women Veterans share similar patient-level factors associated with LARC use as the general population and that continuity with providers and comprehensive women's health services can facilitate LARC access. [ABSTRACT FROM AUTHOR]

As health care becomes increasingly patient centered, organizations strive to improve patients' ratings of satisfaction with care. Communication with nurses and providers drives overall satisfaction, yet little evidence exists to guide them in ensuring effective communication in the emergency department. A semistructured interview guide based on the Hospital Consumer Assessment of Healthcare Providers survey was used to elicit qualitative data from 30 patients seen in the emergency department and fast track regarding communication with nurses and providers. Data were analyzed using content analysis methodology. Two types of overarching themes emerged. Foundational themes include behaviors that convey courtesy and respect and are required for participants to view their interactions with nurses and providers as positive. Interactive themes describe humanistic ways in which nurses and providers conveyed courtesy and respect, reassurance through careful listening, attentiveness, and explaining things in an understandable way. The findings underscore existing evidence regarding patients' perceptions of being treated with courtesy and respect via nurses' and providers' use of positive verbal phrasing and nonverbal body language. They reveal new insights into the importance of specific communication behaviors used by nurses and providers during interactions. Treating patients as individuals amidst a fast-paced care environment, proactively recognizing and responding to patients' fears and concerns, and explaining information clearly to ensure understanding were critical. [ABSTRACT FROM AUTHOR]

In recent years, as a result of changes in the social and demographic structure of our country, new forms of social intervention, trying to integrate and support the welfare state, have been spreading by mobilizing non-public resources. In addition to representing a new response to the social needs of the individuals, in some cases these types of measures have favored the creation of new employment and new professional figures in the social sphere. A concrete example comes from company-based and occupational welfare that, although not uniformly, is growing at a fast pace in Italy. The increasing importance of this phenomenon has led to the creation of a real market made up of consulting companies, service companies and, above all, provider companies. In order to capture ongoing dynamics of this market, also in terms of employment, this contribution intends to focus first and foremost on these latter subjects. [ABSTRACT FROM AUTHOR]

The attitude of the agricultural producer in the central area of Sinaloa (Mexico) was evaluated in the face of technology transfer, to generate strategies that facilitate technological innovation in agriculture. A questionnaire was used for the producers, who were selected using the method of batch sampling of quality control (LQAS), conforming five lots, applying 19 questionnaires in each. It was found that most of the producers use the new technology once applied by other producers that had positive results, they resort mainly to the supplier to solve a technical problem, the farmer does not mean things that do not affect him immediately, but when considers that his interests are affected directly and immediately, his attitude is different. It is does not care about the meetings on technology transfer because he does not know the usefulness of them, the behavior of the farmer is influenced by the opinions of family members and suppliers, the main source of information on agricultural technology is the supplier of inputs, but also they are informed through the friend or relative, as well as; through demonstrations on technological developments and agricultural exhibitions. [ABSTRACT FROM AUTHOR]

Acute health care interventions for residents of skilled nursing facilities (SNFs) are often unwarranted, unwanted, and/or harmful. We describe a provider-focused care model to reduce unwarranted or unwanted acute health care utilization. Assess the capability of the Reducing Avoidable Facility Transfers (RAFT) model to reduce unwanted and unwarranted acute health care utilization among residents in 3 rural SNFs between January 1, 2016 and June 30, 2017. Prospective cohort, pre/post study. Three rural SNFs in collaboration with a geriatric practice in a tertiary academic medical center. Post-acute care (PAC) and long-term care (LTC) residents of 3 rural SNFs. RAFT includes the following components: (1) a small team of providers who manage longitudinal care and after hours call; (2) elicitation of advance care plans and preferences regarding acute care; (3) standardized communication process engaging the provider at the identification of an acute care event; (4) a biweekly case review of all emergency department (ED) transfers. ED and hospital utilization. RAFT demonstrated a 35% reduction in monthly ED transfers and a 30.5% reduction in monthly hospitalizations. These reductions were greatest for LTC residents. The RAFT approach substantially reduced unwarranted ED and hospital utilization in this study. Results support replication and evaluation in a larger, more diverse setting and population. [ABSTRACT FROM AUTHOR]

The huge amount of exchanged data in the internet between entities and the quick development of edge computing has increased users frustration about the future generations. We expect a future where transactions will be based on clouds and virtual machines, gathered from sensors and IoT devices and processed by different artificial intelligence algorithms or agents. The speed and backlash change in the world has driven researchers to work on privacy and security for entities' information and transactions. Different concepts arise and still in their early stage as digital identity, self sovereign identity, global unique identifier and identity of things (IDoT). Therefore, motivated by the recent explosion of interest around Blockchains, we examine whether they make a good fit for the Identity Internet of Things (IDoT) sector. Blockchain a major distributed peer-to-peer network where non-trusting members can interact together without a need for a trusted third party, it actually make available many advantages to providers and consumers and solve data protection features lifelong a transaction existing. As being immutable, transparent and trustful platform the Blockchain allows managing identities and privacy of its nodes information. Our contribution is a new architecture eventually using a public Blockchain and creating a smart identity wallet. It contains standard node data and will also integrate proactive data behavior and the reactive one. The main target is to protect users from sybil attack at early stage. We will define a new digital wallet based on entities behavior in order to prevent 51% attack and Sybil attack [ABSTRACT FROM AUTHOR]

On May 15, 2018, the Federal Drug Administration amended the approval of preexposure prophylaxis (PrEP) to include minors (>35 kgs). Adolescent providers are now in need of access to a comprehensive education curriculum on the administration of PrEP to adolescents. This paper outlines such a curriculum with the goal of reaching adolescent providers unfamiliar with PrEP assessment, administration, and monitoring. A comprehensive adolescent PrEP curriculum was designed using a literature review. An expert panel of seven reviewed the curriculum for content validity. A pilot implementation of the curriculum was conducted with staff from eight school-based health clinics located in Upper Manhattan and the Bronx. A formal content-validated curriculum was established providing adolescent health care providers with the tools needed to administer PrEP in their clinical setting. Clinical providers can access our curriculum to aid in their administration of PrEP to an adolescent population. [ABSTRACT FROM AUTHOR]

Despite a plurality of paternal forms available to men, certain enactments of fathering remain immobile. In South Africa the 'father as provider' discourse, which establishes the legitimate father as one who provides financially for his family, continues to be regarded as the primary mark of a good father. Using photo-elicitation interviews to interrogate the persistence of this discourse, this paper examines how adolescents from two low-resourced South African communities construct fathering. Using a critical intersectional discursive framework, the analysis focuses on how gender, race, class and culture are implicated in the reproduction of the 'father as provider' discourse. Participants' constructions suggest that the father's duty to provide is intensified within marginalised contexts. Central to participants' reproductions of the 'father as provider' discourse was a neoliberal conception of 'freedom of choice'. The paper concludes that South Africa's post-apartheid reliance on discourses around liberal democracy has cast the low-income father's ability to fulfil the provider role as a conscious choice. While the father is made responsible for his failure to provide, broader structural oppressions are in turn rendered largely invisible by such discourse. [ABSTRACT FROM AUTHOR]

Background Complicated grief, a syndrome of persistent grief diagnosed >6 months following the loss of someone close is expected to be included in the 11th revision of the International Classification of Diseases as a new diagnosis called prolonged grief disorder. Complicated grief is associated with impaired functioning and health comorbidity and does not respond to treatments for depression. Individuals may seek help in primary care where providers need to be familiar with the syndrome. Objective This study examines the acceptability, feasibility and outcome of a screening programme for complicated grief among diverse adults receiving behavioural health services in integrated primary care. Methods Behavioural health providers (n = 14) administered the Brief Grief Questionnaire and the Inventory of Complicated Grief during routine assessment and completed an acceptability survey. Descriptive statistics described rates of complicated grief symptoms and sample demographics, health and service use. Results Most providers (71%) reported the Brief Grief Questionnaire to be a moderate to very useful assessment instrument and the Inventory of Complicated Grief moderate to very useful for developing a treatment plan (57%). Of the 2425 patients screened, 1015 reported a loss over 6 months ago. Of these 1015, 28% (n = 282) screened positive on the Brief Grief Questionnaire and 22% (n = 228) endorsed symptoms of complicated grief (Inventory of Complicated Grief score ≥25), considered at high risk for needing clinical care. Conclusions A screening programme for identifying complicated grief was acceptable to providers, feasible to implement and useful in identifying complicated grief in integrated primary care clinics. [ABSTRACT FROM AUTHOR]

Background: Mechanical thrombectomy (MT) for ischemic stroke can be performed under local anesthesia (LA), conscious sedation (CS), or general anesthesia (GA). The need for monitoring by anesthesia providers may be resource intensive. We sought to determine differences in outcomes of MT when sedation is performed by an anesthesia team compared to sedation-trained providers. Methods: We performed a retrospective analysis on patients who were screened by a pre-hospital stroke severity screening tool and underwent MT at two stroke centers. Baseline characteristics, time metrics, sedatives, peri-procedural intubation, complications, and outcomes were recorded. Good outcome was defined as modified Rankin score of ≤2. Results: We analyzed 104 patients (sedation-trained provider = 63, anesthesia team = 41) between July 2015 and December 2017. In the sedation-trained provider group, four patients required intervention by an anesthesia team. There were no differences in patients receiving LA (sedation-trained provider 24% vs. anesthesia team 27% p = 0.82), CS (70 vs. 63%, p = 0.53), or GA (6 vs. 10%, p = 0.71) between groups. Sedation-trained providers were more likely to use only one drug during the procedure (62 vs. 34%, p = 0.009). The rate of procedural complications (9.5 vs. 4.5%, p = 0.48), good outcome (56 vs. 39%, p = 0.11), and mortality (22 vs. 24%, p = 0.82) was similar between groups. Sedation by provider type did not predict functional outcome or mortality at 3 months. Conclusions: Sedation-trained providers are capable of delivering appropriate sedation without compromising patient safety. The use of "as needed" anesthesia teams for MT may have considerable effect on resource allocation and cost. [ABSTRACT FROM AUTHOR]

The article presents the author's views on the need to support mental health care providers after their patients died of drug overdose. The experience of an adult psychiatry resident of handling a 26-year-old who was stabilized on buprenorphine and was found dead by his parents from an apparent overdose, is cited. Topics include the common emotions experienced by providers, the barriers to accessing treatment for opioid use disorder, and the need to prepare providers for drug overdose death.

Content centric network (CCN) is a robust and uncomplicated communication paradigm. It introduces built-in features, such as data authenticity, in-networking caching, mobility, flow balance methods, and multi-cast data delivery. Data packet flooding is a hot research issue due to the broadcast nature of the CCN-based wireless multimedia sensor networks (WMSNs). To mitigate this problem, in this paper, we have proposed a novel protocol, named packet diffusion-limited protocol for CCN-based WMSNs for smart cities. Extensive evaluation of the proposed protocol is performed by using ndnSIM that is based on NS-3 simulator. Simulation results show that proposed protocol not only limits flooding of Data packets as well as speeds up content download time by using a shortest path.

Payment for environmental services (PES) to mangrove forest is judged appropriate for applied in Jailolo Sub-district of West Halmahera District as a protection of mangrove ecosystems. This is due to the high utilization of mangrove environment services. If not managed properly can potentially threaten the preservation of mangrove forests. Benefits that have been perceived by the public such as a water source, pond, travel, as well as the protection of coastal areas. These benefits must be preserved for the future availability of environmental services namely through the payment of the services already provided the commonly named as payment for environmental services (PES). PES is also very supported by West Halmahera District Regulation No. 4 of 2012 year and constitution No. 32 of 2009 year about the protection and environmental management. Basically, PES is a scheme that aims to restore and protect the availability of goods and environmental services sustainable. Therefore, PES initiation for mangrove forest economy preservation in Jailolo Sub-district needs to be studied. This research aims to: 1) Identify environmental services of mangrove forest ecosystems that are potential for PES; 2) Examines the perceptions of the public service providers (providers) towards the implementation of the plan; and 3) How much willingness to accept (WTA) community as a providers of environmental services (providers) if PES is applied. The research results showed that the service potentially initiated PES are sea-water intrusion regulating service and the cultural service of mangrove tourism. For perception and public participation, environmental service providers about the mangrove environment services were judged to be sufficient for determining PES plan assignment, where communities want to participate if the maintenance costs were IDR3.350,00/trees/year

On 11–12 September 2015, the fourth annual Cologne Consensus Conference (CCC) was held in Cologne, Germany. The 2-day educational event was organised by the European Cardiology Section Foundation (ECSF) and the European Board for Accreditation in Cardiology (EBAC), a specialty continuing medical education–continuing professional development (CME—CPD) accreditation board of the European Union of Medical Specialists (UEMS). The conference was again planned in cooperation with an impressive group of international organisations and faculty members representing leading European and North American institutions. Each year, the CCC is organised around a specific topic area. For the conference's fourth iteration, the providers in accredited CME/CPD were the focus. The CCC 2015 set out to share ideas, discuss concepts, and increase collaborations amongst the various groups. This report provides a summary of the presentations and discussions from the educational event.

This article has been retracted: please see INNOVATIONS in pharmacy retraction policy (https://pubs.lib.umn.edu/index.php/innovations/policies). This article has been retracted by the Editor and Publisher due to the inappropriate use of previously published work. Ambulatory care pharmacy practice is defined as the provision of integrated, accessible healthcare services by pharmacists who are accountable for addressing medication needs, developing sustained partnerships with patients, and practicing in the context of family and community. This is accomplished through direct patient care and medication management for ambulatory patients, long-term relationships, coordination of care, patient advocacy, wellness and health promotion, triage and referral, and patient education and self-management. The ambulatory care pharmacists may work in both an institutional and community-based clinic involved in direct care of a diverse patient population. A variety of specialty clinics are available for allergy and immunology, pulmonology, endocrinology, cardiology, nephrology, neurology, behavioral health, and infectious disease. Such services for this population may exist as a primary care clinic or an independent specialty clinic, typically in a PCMH, which is instrumental in coordinating care between various providers. Once a practice site is identified, it is important to establish a strong, trusting, and mutually beneficial relationship with the various decision-makers (e.g., administrators, providers) involved with the clinic. If pharmacy services are currently in existence, the pharmacy director may be able to identify and initially contact the appropriate person. If another pharmacist is providing clinical services, this person would be a resource to help determine areas for expansion of patient care and to whom to direct the proposed business plan. Additional individuals to consider as an initial point of contact include the clinic manager, clinic medical director, or administrative assistant to either of these persons. If the clinic setting is affiliated with a medical school, it may be necessary to contact the Department of Family Medicine head. Article Type: Commentary

High levels of HIV and unwanted pregnancies have renewed interest in sexual and reproductive health (SRH) services integration. A district-based model for integrating SRH and HIV services was developed and implemented in a district hospital and six feeder clinics in eThekwini District, South Africa. A cross-sectional survey was conducted before and after implementation of this model and explored training and SRH service integration. Forty-six providers participated in baseline, and 44 in an endline survey. Data were descriptively analysed using SPSS. Overall, training undertaken did not change between baseline and endline. The proportion of providers performing HIV testing when providing other SRH services, and those counselling on family planning during HIV counselling and testing and STI services increased at endline. The proportion offering family planning counselling to HIV infected and antenatal clients decreased at endline. Overall, service integration improved modestly after integration model implementation, which could impact positively on uptake of SRH services.

Patient experience is emerging as a key differentiating factor in patients’ choice of healthcare system. Many healthcare organizations are attempting to improve their patient experience by data-driven, patient-centered initiatives. This involves engaging all staff along all the contact points of a patient’s journey in healthcare. Perhaps, the physicians or care providers are most important link in this chain but also the most challenging to engage in improvement efforts. Most healthcare organizations have some training or workshops to educate providers on communication skills and other tools to enhance patient experience. However, there seems to a paucity of a standardized approach or a roadmap to put together a robust physician or care provider coaching or improvement partnership program with patient experience (PX) staff. There seems to be several gaps in this process. The current article attempts to develop broad guidelines and suggest a roadmap to address these gaps. The article also suggests general templates for PX staff to use in conducting these improvement work with providers and suggestions for developing a standard physician observation or shadowing template for consistency. The article has woven several commonly used tools like motivational interviewing, change management (ADKAR model), and several communication tools to suggest a detailed blue print for provider patient experience improvement partnership.

The article is concerned with conceptualization of substance, distinguishing characteristics and motives of the implementation of tolling operations in conditions of the European integration. The study, based on the systematization and analysis of existing scientific approaches to definition of essence of tolling and tolling operations, has disclosed the dominating poli-positionality and ambiguity in this area. Economical autonomy of tolling operations has been determined, their difference from the operations with customerfurnished raw materials has been allocated, substance and characteristics of tolling operations has been conceptually grounded, motives of their implementation for both the customer and the provider has been systematized. It is proved that implementation of tolling operations will address the pivotal financial, production and staffing problems of domestic enterprises and ensure their progressive development in conditions of the European integration. Prospect of further research is developing a conceptual framework for management of tolling operations, which will provide targeted exposure of management system on the controlled system, which is directly involved in the implementation of tolling operations, with a view to enhancing the efficiency of tolling process

In the spring of 2015, the European Board for Accreditation in Cardiology (EBAC) collaborated with International CME/CPD Consulting to design and administer a survey to approximately 1,171 professionals active in the field of European CME/CPD, with a focus on cardiology. With a nearly 5% response rate, the results herewith are non-representative, but do express current behaviours and attitudes of those active in European accredited CME/CPD.

Background: Health care is highly complex and can be both emotionally and physically challenging. This can lead health care workers to develop compassion fatigue and burnout (BO), which can negatively affect their well-being and patient care. Higher levels of resilience can potentially prevent compassion fatigue and BO. Strategies that enhance resilience include gratitude, exercise, and mindfulness., Objective: The purpose of this study was to determine if a 3-week daily resiliency practice, prompted via a gratitude, exercise, and mindfulness smartphone app, impacted the professional quality of life, physical activity, and happiness level of health care workers in a newborn intensive care unit setting., Methods: In total, 65 participants from a level III newborn intensive care unit at a regional hospital in the western United States completed this study. The Professional Quality of Life Scale, Physical Activity Vital Sign, and Subjective Happiness Score instruments were used to evaluate the effects of the mobile health (mHealth) intervention. Further, 2-tailed dependent paired t tests were used to evaluate participant pre- and postintervention instrument scores. Multiple imputation was used to predict scores of participants who practiced an intervention but did not complete the 3 instruments post intervention., Results: Dependent t tests using the original data showed that participants, as a whole, significantly improved in BO (t 35 =2.30, P=.03), secondary trauma stress (STS; t 35 =2.11, P=.04), and happiness (t 35 =-3.72, P<.001) scores. Compassion satisfaction (CS; t 35 =-1.94, P=.06) and exercise (t 35 =-1.71, P=.10) were trending toward, but did not reach, significance. Using the original data, only the gratitude intervention group experienced significant improvements (CS, BO, and happiness), likely due to the higher number of participants in this group. Analysis using imputed data showed that participants, as a whole, had significant improvements in all areas: CS (t 64 =-4.08, P<.001), BO (t 64 =3.39, P=.001), STS (t 64 =4.08, P<.001), exercise (t 64 =-3.19, P=.002), and happiness (t 64 =-3.99, P<.001). Looking at the intervention groups separately using imputed data, the gratitude group had significant improvements in CS, BO, STS, and happiness; the exercise group had significant improvements in STS and exercise; and the mindfulness group had significant improvements in CS and happiness., Conclusions: Phone app delivery of resilience-enhancing interventions is a potentially effective intervention model for health care workers. Potential barriers to mHealth strategies are the technical issues that can occur with this type of intervention. Additional longitudinal and experimental studies with larger sample sizes need to be completed to better evaluate this modality., (©Neil E Peterson, Michael Thomas, Stacie Hunsaker, Tevin Stewart, Claire J Collett. Originally published in JMIR Nursing (https://nursing.jmir.org), 16.02.2024.)

Background: As care shifts from institutional to community settings, family caregivers are providing increasing support to older adults, including complex medical/nursing care. In the mid-late pandemic, technology advancements such as use of online patient portals present opportunities for communication and care delivery. This study aims to assess the association between caregiver medical/nursing tasks or patient portal use with contact, communication, and training of caregivers by healthcare providers., Methods: We conducted a cross-sectional analysis of caregiver data from the 2021 National Study of Caregiving (NSOC), linked to the National Health and Aging Trends Study (NHATS). NHATS is nationally-representative, annual survey of Medicare enrollees; NSOC surveys family/unpaid caregivers of NHATS participants. Logistic regression tested association between whether the caregiver does medical/nursing tasks or uses an online patient portal to contact the medical team (independent variables), and communication with or training by the medical team (dependent variables)., Results: Participants were 1590 caregivers of living, community-dwelling older adults. More than half (54%) reported no contact with the care recipient's medical team in the past year. Caregivers who did medical/nursing tasks (OR = 3.10; 95% CI: 2.16, 4.46) or who used patient portals (OR = 3.28; 95% CI: 1.96, 5.51) had higher odds of contacting the older adult's medical team. Thirty percent of caregivers stated communication was either not at all or just a little helpful. Sixty-seven percent reported that providers rarely asked if they needed help managing the older adult's treatments. Just 6% of caregivers reported receiving any caregiver training in the last year., Conclusions: Both medical/nursing tasks and online patient portal use were independently associated with contact with health providers. Overall contact, communication, and training were limited or of variable value. Despite recent policy changes and technology advancement, there is still a need for improved integration of caregivers into health teams with ongoing assessment of their needs., (© 2023 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Background: Providers caring for adolescents and young adults with HIV (AYA-HIV) mostly base their adherence counseling during clinical encounters on clinical judgment and expectations of patients' medication adherence. There is currently no data on provider predictions of viral suppression for AYA-HIV. We aimed to assess the accuracy of provider predictions of patients' viral suppression status compared to viral load results., Methods: Providers caring for AYA-HIV were asked to predict the likelihood of viral suppression of patients before a clinical encounter and give reasons for their predictions. Provider predictions were compared to actual viral load measurements of patients. Patient data were abstracted from electronic health records. The final analysis included 9 providers, 28 patients, and 34 observations of paired provider predictions and viral load results., Results: Provider prediction accuracy of viral suppression was low (59%, Cohen's Kappa = 0.16). Provider predictions of lack of viral suppression were based on nonadherence to medications, new patient status, or structural vulnerabilities (e.g., unstable housing). Anticipated viral suppression was based on medication adherence, history of viral suppression, and the presence of family or other social forms of support., Conclusions: Providers have difficulty accurately predicting viral suppression among AYA-HIV and may base their counseling on incorrect assumptions. Rapid point-of-care viral load testing may provide opportunities to improve counseling provided during the clinical encounter., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Patient-centered care (PCC) improves HIV adherence and retention, though lack of consensus on its conceptualization and understanding how it is interpreted has hindered implementation. Methods: We recruited 20 HIV providers at Ryan White Programs in FL for in-depth interviews. Thematic analysis identified core consistencies pertaining to: 1) provider perceptions, 2) current practices promoting PCC. Results: Provider perceptions of PCC emerged under four domains: 1) holistic, 2) individualized care, 3) respect for comfort and security, and 4) patient engagement and partnership. PCC practices occurred at multiple levels: 1) individual psychosocial and logistical support, 2) interpersonal support within patient-provider relationships through respectful communication and active engagement, and 3) institutional practices including feedback mechanisms, service integration, patient convenience, and diverse staffing. Conclusions: Our findings highlight the central tenets of PCC as respectful, holistic, individualized, and engaging care. We offer an HIV-adapted framework of PCC as a multilevel construct to guide future intervention., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.