A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Currently few studies have investigated the accuracy of using transcutaneous bilirubinometry after phototherapy especially in the outpatient setting. The purpose of this study was to evaluate the accuracy of transcutaneous bilirubin measurements (TCB) after phototherapy for neonates with jaundice. At the Maricopa Integrated Health System, neonates who undergo phototherapy for hyperbilirubinemia come in for outpatient follow‐up at the Comprehensive Health Center following their discharge. For those neonates, current protocol calls for serum bilirubin (TSB) to be measured to properly monitor bilirubin levels, however transcutaneous measurements were made and recorded as well. In this study, we compared the values of total serum bilirubin and transcutaneous bilirubin in jaundiced neonates who underwent phototherapy. From October 2013‐April 2015, a total 67 healthy infants were seen in the Pediatric Clinic who had received phototherapy in our hospital, only 36 (54%) of those met minimum data criteria to be included in the study. The absolute difference between mean serum bilirubin and transcutaneous bilirubinometry in healthy outpatient newborns who received inpatient phototherapy was 0.4 and is clinically insignificant. The average time from hospital discharge to return to clinic was 47 hours. We conclude that for the outpatient physician, transcutaneous bilirubinometry can be used following phototherapy, which facilitates faster, more convenient, and painless follow‐up visits.

Thesis (M.S.)--Boston University

Introduktion: Att någon gång drabbas av psykisk ohälsa blir allt vanligare, därför är betydelsen av forskning inom området stor. Sjuksköterskor med sin specifika omvårdnadskompetens utgör den största personalgruppen inom psykiatrisk öppenvård men sjuksköterskans roll inom psykiatrisk öppenvård är begränsat beskriven i vetenskaplig litteratur. Detta innefattar aspekter kring sjuksköterskans egen roll samt i relation till andra yrkesgrupper inom psykiatrisk öppenvård. Syfte: Att beskriva sjuksköterskans upplevelse av sin egen roll inom psykiatrisk öppenvård samt upplevelsen av interaktionen med andra yrkesgrupper i sitt arbete. Metod: Studien var en deskriptiv intervjustudie med kvalitativ ansats. Sju sjuksköterskor arbetandes i psykiatrisk öppenvård inkluderades i studien. Data insamlades genom semistrukturerade intervjuer och analyserades sedan med kvalitativ innehållsanalys. Resultat: Sammanlagt skapades 25 kategorier: positiva respektive negativa aspekter i arbetet som sjuksköterska inom öppenpsykiatri, samarbete mellan de olika yrkeskategorierna i teamet, bemötande och uppskattning för sjuksköterskans kompetens samt sjuksköterskans bidragande kompetens i vården av patienten. Slutsats: Sjuksköterskans upplevelse inom psykiatrisk öppenvård är komplex och visar bland annat på känslor av hög arbetsbelastning, en odefinierad roll i interprofessionellt samarbete samt både undervärdering och uppskattning för sin kompetens. Uttryck för ett bidragande omvårdnadsperspektiv samt en bredare syn på patienten i vården visar dock på tydliga uppfattningar om sin kompetens som sjuksköterska. Allt detta är relaterat till flera faktorer såsom organisation, arbetskollegor samt den egna uppfattningen om sin yrkesroll i arbetet. / Introduction: At some point suffer from mental illness is becoming more common, therefore, research in the field is of great importance. Nurses with their specific nursing skills form the largest staff group in psychiatric outpatient care, but the nurse's role in psychiatric outpatient care is limited as described in scientific literature. This includes aspects of the nurse's own role and in relation to other professions in psychiatric outpatient care. Aim: To describe the nurse's perception of their role in psychiatric outpatient care, and the experience of interaction with other professionals in their work. Method: The study was a qualitative, descriptive interview study. Seven nurses working in psychiatric outpatient care were enrolled in the study. Data were collected through semi-structured interviews and analyzed with qualitative content analysis. Results: A total of 25 categories concerning positive and negative aspects of work as a nurse in outpatient psychiatric care, collaboration between the professions in the team, treatment and appreciation to the nurse's competence and nurses contributory expertise in caring of the patient were created. Conclusion: Nurse's experiences in psychiatric outpatient care are complex and show feelings of heavy workload, an undefined role in inter-professional collaboration and both under-valuation and appreciation of their skills. Though, expression of a contributory caring perspective and a broader view of the patient show views oft the nurse's competence. All this can be related to several factors such as organization, work colleagues and their own perception of their professional role in their work.

No description available.

Univerzita Karlova v Praze 1. léka ská fakulta Studijní program: Specializace v léka ství Studijní obor: Adiktologie Bc. Kate ina Sklená ová Francová ístup zam ený na lov ka (PCA) v psychoterapii závislostí: teoretická východiska, aplika ní možnosti a kompatibilita se sou asným systémem ambulantní pé e a jeho praxí. Person centred approach in psychotherapy of addiction: theoretical background, application possibilities and compatibility with the current system of outpatient care and practice. Diplomová práce Vedoucí práce: PhDr. Monika Nevoralová Praha, 2013 Abstrakt diplomové práce: Východiska: Mezi základní charakteristiky p ístupu zam eného na lov ka (PCA) ve vztahu klient- terapeut pat í mimo jiné pojmy bezpodmíne né p ijetí, empatie a autenticita. V minulosti se tento psychoterapeutický sm r nazýval nedirektivním. Dnes je tento název p ekonán pro jeho redukující edur ení, nicmén pojem nedirektivita by se dal ozna it jako další z jeho p ízna ných rys . Sou asný systém lé by a rehabilitace závislých v psychiatrických lé ebnách, terapeutických komunitách i ambulantních typech lé by je založen na kontrole, režimu, vedení, tvorb terapeutického plánu a jiných, zejména kognitivn -behaviorálních metod, které jsou v sou asné adiktologii "dominantní". Nabízí se proto otázka, zda PCA m že najít v adiktologii...

To suffer from bipolar disorder can cause significant distress. Bipolar disorder causes severe shifts in mood. The person can, apart from having a normal mood, experience depressive episodes or a highly elevated mood – hypomania or mania. Psychoeducation as a complement to medicine treatment can help persons manage their disorder and reduce severe changes in mood. Little is known about psychoeducation programs in the country as a whole. Knowledge about these programs can be useful for evaluation and can contribute to valuable insights. The aim of this study was to survey the setup and content of psychoeducation programs for people with bipolar disorder in outpatient care in the country. To accomplish this a cross-sectional study was made through a web-based questionnaire sent to staff involved in outpatient psychoeducation. The Swedish National Quality Register for Bipolar Disorder – BipoläR contributed with contact information to the outpatient clinics. All 234 clinics involved were linked to BipoläR, 56 answers were returned resulting in the following information: Most of the psychoeducation programs were group-based. The major part used programs designed by themselves. Nurses were the most frequently staff involved. The mean amount of time for education delivery was 12 hours. The psychoeducation content was rich in important aspects related to the disorder. The programs were delivered through lectures and discussion. The conclusion of this study was the emphasis on group-based programs developed at the clinics, the quality content of programs and the possible need for more evidence-based programs. / Bipolär sjukdom kan vara svår att leva med då den medför stora variationer i personens sinnesstämning. Ett sätt att underlätta kan vara medverkan i patientutbildningsprogram som tillägg till medicinsk behandling. Detta kan bidra till ökad förståelse för sjukdomen och dess individuella uttryck och därmed göra den mer hanterbar. På flera öppenvårdsmottagningar för personer med bipolär sjukdom runt om i Sverige bedrivs patientutbildning. Någon sammanhållen beskrivning av utbildningarna finns inte. I samråd med personal hos Nationellt kvalitetsregister för personer med bipolär affektiv sjukdom (BipoläR) bedömdes dessa utbildningar vara intressanta att undersöka. Forskning har påvisat att patientutbildningsprogram har positiva effekter för att motverka depression, hypomani och mani vid bipolär sjukdom. Programmen kan se olika ut men utbildning i grupp verkar generellt ge bättre utfall än individuell utbildning. Det är oklart hur utbildningarna i landet ser ut och vi har därför valt att i denna studie kartlägga upplägg och innehåll i dessa utbildningar. Specialistsjuksköterskan i psykiatrisk vård ansvarar bland annat för att stödja patienter och deras anhöriga till lärande och beslutsfattande genom undervisning. Patientutbildning för personer med bipolär sjukdom ligger inom psykiatrisjuksköterskans kompetensområde och sjuksköterskan kan vara en lämplig förmedlare av sådan utbildning. En kartläggning av patientutbildningsprogrammen kan utgöra grund för utvärdering och därmed bidra till utveckling av det psykiatriska vårdandet. Syftet med denna undersökning var att kartlägga upplägg och innehåll i patientutbildningar för personer med bipolär sjukdom inom den psykiatriska öppenvården runt om i landet. Detta gjordes via en webbenkätundersökning riktad till personal involverade i patientutbildning på öppenvårdsmottagningar anslutna till BipoläR. Resultatet visade att de flesta utbildningar var grupputbildningar. Största delen av mottagningarna använde sig av egenutformade utbildningsprogram. Sjuksköterskor var den personalkategori som oftast gav patientutbildning, följt av läkare och psykologer. Utbildningarna hade ett medelvärde på 12 timmars utbildningstid. Erfarenhetsutbytet i utbildningarna sågs som ett värdefullt inslag. Studiens slutsatser var att enkätsvaren tyder på att det i landet fanns en övervikt av gruppbaserade utbildningsprogram för personer med bipolär sjukdom. De flesta mottagningar utformade sina egna program. Utbildningarna var innehållsmässigt rika på viktiga ämnen relaterade till olika aspekter av bipolär sjukdom. De verkade i genomsnitt även vara tidsmässigt tillräckligt långa för att kunna förmedla sitt innehåll. Sjuksköterskor var den personalkategori som oftast var involverad i patientutbildningarna och kunde därmed ge ett betydande bidrag i dessa. Det kan vara värdefullt med en tydligare evidensbas i utbildningarna.

Several studies show that the clinical reality in psychiatric care does not correspond to the demand of consumer participation from a variety of policy documents that has been produced recently. Studies also show that there is a lot to do in improving, patients with sever mental illness, becoming more involved in their own care. The nurse has a central role in this work. The Norwegian nursing theorist Jan-Kåre Hummelvolls holistic, existentialistic model for psychiatric nursing were used as theoretical ground. The aim of this study was to examine how nurses in psychiatric outpatient units, caring for patients with psychotic disorders, experiences consumer participation. Qualitative phenomenological method was used. Semi-structured interviews with six nurses caring for patients suffering from psychotic disorders in outpatient units were conducted. The interviews were recorded and transcript by the author and then analyzed using qualitative content analyze. Two themes were identified: To follow the road chosen by the patient and When consumer participation risks failing. The result of this study shows that there are several factors that influences nurses job to involve patients in their care. The interviews also showed that there were areas where consumer participation was more problematic. To share a decision with the patient is a way to improve consumer participation. Shared decision making is a complicated process where the nurse needs support to succeed. In pharmacological issues nurses must continue working with consumer participation.

Analysis of drug-related problems in general practitioners office II. Author: Šárka Sperottová Supervisor of the thesis: PharmDr. Martin Doseděl, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Background: A Drug-Related Problem - DRP - is according to Pharmaceutical Care Network Europe - PCNE - an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. We can encounter DRP in every general practitioner's - GPs - office all around the world. But with proper cooperation between practitioners and pharmacists we could reduce the number of problems. That would be big benefit for patients and health system as well. This thesis is focused on anticoagulant drugs, mainly on DOAC group - direct oral anticoagulants - and their DRP in it's theoretical part. Practical part of thesis is analysis of DRP in GPs office itself. Aim: Theoretical part - describe the process of haemostasis and the possibilities of influencing this process by drugs. Discuss DRP of anticoagulants, especially oral anticoagulants and heparins. Practical part - identify and describe DRP. Sort them by PCNE Classification for DRP V5.01. Analyse and describe the most frequent drug-related problems occurring in general...

Bakgrund: Ungefär en tredjedel av Sveriges befolkning uppskattas leva med långvarig smärta. Smärta är en komplex och subjektiv upplevelse som är svår att bevisa, och bedömningen av smärta utgår därmed från patientens upplevelse. Målet med behandling av långvarig smärta är att patienten ska leva ett så bra liv som möjligt trots smärtan, och innefattar olika behandlingsmetoder anpassat efter patienten som individ. Därmed är sjuksköterskans kärnkompetens personcentrerad vård en essentiell byggsten i vårdandet av långvarig smärta. Kunskap om patienters erfarenheter av att vårdas för långvarig smärta kan vägleda sjuksköterskor i omvårdnadsarbetet och möjliggöra personcentrerad vård. Syfte: Syftet med litteraturstudien var att belysa patienters erfarenheter av att vårdas för långvarig smärta i öppenvården. Metod: Litteraturstudie baserad på 11 studier med kvalitativ studiedesign genomfördes. Databassökningen utfördes i databaserna PubMed och CINAHL. Avgränsning av tillgänglig litteratur gjordes med hjälp av inklusions- och exklusionskriterier och relevanta studier kvalitetsgranskades utifrån SBU:s granskningsmall för kvalitativ forskningsmetodik. För att bearbeta data och identifiera teman utfördes en innehållsanalys. Resultat: Innehållsanalysen gav upphov till två teman: Påverkan av vårdpersonalens bemötande och Hantering av smärta samt sju subteman: Behovet av att bli betraktad som en unik person, Betydelsen av att vara involverad i sin vård, Kommunikationens betydelse, Känslan av att inte bli trodd, Betydelsen av att få en diagnos, Vikten av stöd från medpatienter och Att försöka acceptera smärtan. Konklusion: Långvarig smärta påverkar patientens fysiska, psykiska och emotionella välbefinnande. Vårdpersonalen bör bemöta patienterna med empati och eftersträva ett partnerskap med patienten. Det beskrevs som viktigt för patienterna att bli involverade i sin vård och att ses som en unik person. Att få en bekräftelse på att smärtan inte var inbillad och att bli trodd i sitt tillstånd gjorde att patienterna kunde acceptera smärtan och lära sig hantera den. / Background: About a third of Sweden's population is estimated to live with long- term pain. Pain is a complex and subjective experience that is difficult to prove, and the assessment of pain is thus based on the patient's experience. The goal of treating long-term pain is for the patient to live as good a life as possible despite the pain and includes different treatment methods adapted to the patient as an individual. Thus, the nurse's core competence person-centered care is an essential building block in the care of long-term pain. Knowledge of patients' experiences of being cared for for long-term pain can guide nurses in the nursing work and enable person-centered care. Aim: The aim of the literature review was to illustrate patients' experiences of being cared for for long-term pain in outpatient care. Method: Literature study based on 11 studies with qualitative study design was conducted. The information search was performed in the databases PubMed and CINAHL. Delimitation of available literature was done with the help of inclusion and exclusion criteria and relevant studies were quality reviewed based on SBU's review template for qualitative research methodology. To process data and identify themes, a content analysis was performed. Results: The content analysis resulted in two themes: Influence of health care providers' attitudes and Management of pain and seven sub-themes: The need to be considered a unique person, The importance of being involved in their care, The importance of communication, The feeling of not being believed, The importance of getting a diagnosis, The importance of support from fellow patients and Trying to accept the pain. Conclusion: Long-term pain affects the patient's physical, mental and emotional well-being. The care staff should treat the patients with empathy and strive for a partnership with the patient. It was described as important for patients to be involved in their care and to be seen as a unique person. Getting a confirmation that the pain was not imagined and being believed in their condition allowed the patients to accept the pain and learn to deal with it.

The electronic health record (EHR) is an important part of the effort to improve health care and reduce costs in the United States. Primary care providers, among the largest group of caregivers in the nation, often experience difficulty with implementation and utilization of EHRs. Efforts to enhance the provider's effectiveness in the use of the EHR should result in improved patient outcomes as well as decreasing the overall cost of health care. Guided by the diffusion of innovation theory, this project was initiated to develop a plan for improved usage of the EHR in a primary care setting. A survey and observations were used to better understand how the providers and staff were using the EHR. Observations and a survey of 11 participants were completed. The observations utilizing a mock patient revealed issues related to the usability of screen information, information availability, and user preference for documentation. The mock patient scenario took 25-35 minutes, on average, to complete. All participants stated they had stayed late to input information on actual clinic patients or to clarify their documentation. The same 11 participants completed the Primary Care Information Project (PCIP) Post-Electronic Health Record Implementation: Survey of Providers responses. Descriptive statistics were used to analyze the results. Most participants indicated that the screen font was difficult to read (72.7%), they had difficulty using the EHR (72.8%) and were not satisfied with its use (63.6%). The project recommendations include working with the vendor to improve information access and ongoing training. Improvements to the EHR should support social change by improving access to information at the point of care, enhancing quality treatment and improving patient care outcomes.