Symptom Management Theory (SMT) developed at UCSF explains the interaction between symptom experience, management strategies, and outcomes. The theory has potential to improve outcomes and lower costs of chronic disease management with telemonitoring by allowing remote communication between patients and providers about symptoms and management strategies. Modifications may be needed to account for the telemonitoring context and communication changes.
Dr. Harold Freeman founded the first patient navigation program in 1990 to help reduce barriers to care for low-income cancer patients. A study he conducted between 1995-2000 found that the five-year cancer survival rate increased to 70% for low-income patients who received help from patient navigators, compared to only 39% in an earlier study without navigators. Research has shown that patient navigators increase patient compliance, decrease delays in care, and can increase patient satisfaction scores by explaining treatment plans and helping patients overcome barriers to care. While start-up costs may be high initially, patient navigators ultimately save health systems money by reducing unnecessary emergency room visits and improving health outcomes.
This randomized clinical trial tested an intervention using interactive voice response (IVR) technology to provide tailored behavioral support to improve statin medication adherence. The trial involved 497 patients from a large health plan who were randomized to an experimental group receiving up to 3 tailored IVR calls and printed materials, or a control group receiving a single generic IVR call and generic printed materials. The primary outcome was 6-month statin adherence based on pharmacy claims. Patients in the experimental group had significantly higher adherence (70.4%) than controls (60.7%), suggesting tailored behavioral support using IVR can effectively improve statin medication adherence.
Running head: TELE HEALTHCARE 1
TELE HEALTHCARE 6
Tele Healthcare
Name
Institution
Tele Healthcare
Approximately over 50 years of telehealth development has seen tackling of numerous medical conditions through the utilization of different types of technologies. Tele healthcare has been associated with a wide variety of outcomes in the healthcare. Despite the fact that it as shown great promise in the modern times, it has also triggered a number of challenges for interpretation and technical issues that are linked to the lack of technological expertise among the healthcare practitioners. For instance, then challenges that exist in defining such terms as telehealth is a reflection of the broader difficulties when it comes to the interpretation of the complex interplay that exists between clinical output, patient involvement, service designs and technology. Despite these significant challenges whose impacts in the healthcare delivery is great, the significance of telehealth practices cannot be overlooked in terms of the patient outcomes and efficiency of healthcare delivery. Tele healthcare has enhanced information sharing between patients and doctors even those who are located in the remote areas. It has made it possible to monitor the progress of patients within and outside the facilities devoid of the need to have physical meetings. The benefits of tele healthcare outweigh its pitfalls hence it is important that is integrated into medical practices to optimize patient outcomes.
Tele healthcare is depicted as personalized healthcare that is delivered over a long distance such that data is transferred from the patients to the professionals and back. It has played a key role in enhancing feedback from the patients to the professionals for the interest of evidence-based decision making and treatment. For instance, the significance of telehealth can be evident among the inpatients with severe long-term conditions such as diabetes and long-term asthma. It has played a key role in reducing hospital admissions without increasing mortality.
Advantages of Tele Healthcare
There are numerous advantages of tele healthcare. To start with is that it is powered by technology. Technological advancement in the modern times has made it easy for various organizational operations. Technological advancement has been adopted across all spheres of life and healthcare is not an exemption. Creating a balance between healthcare practices and technology is a key requirement when it comes to the medical operations and practices (Dorsey & Topol, 2016). The case of the importance of tele healthcare can be witnessed in electronic health records whereby a medical professional admits the patient and their data is keyed in the system. This data is required in the en ...
Telehealth and Geriatrics How telehealth improves medicati.docxAASTHA76
Telehealth and Geriatrics:
How telehealth improves medication management
and patient safety in the geriatric patient
Avrakham Rubinov
Adelphi University
College of Nursing and Public Health
December 3rd, 2018
What is Geriatrics?
Geriatrics is a subspecialty of internal medicine and primary care that was named in 1909 by Ignatz Leo Nascher.
Geriatrics is that specialty of medicine that addresses the health needs of the elderly.
Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J., & Ten Have, T. (2012).
2
Telemedicine is a highly effective
and necessary tool in geriatrics.
The global population of elderly people is increasing at a remarkable rate,
This is expected to continue for some time.
Older patients require more care.
The current model of care delivery indicated costs are expected to rise.
Telemedicine is a great opportunity for medical practice to evolve to cost effective and new levels of engagement with patients
Chang, W., Homer, M., & Rossi, M. (2018).
3
Geriatics, HIT and Patient Safety
CONCERNS:
SOLUTIONS:
Patient safety is a concern.
Telehealth: Difficult to monitor conditions in a patient’s home.
Safety risks such as falls and inability to get in and out of the tub or shower.
Fewer In-Person Consultations
Doctors worry about technical problems associated with telemedicine. poor broadband connections could lead to “possible patient mismanagement.”
Many physicians and patients alike still like a “personal touch,” and not all procedures – even simple checkups – can be performed digitally.
Difficult to monitor depression or other emotional issues.
Health information technology (HIT) is the future of improving care and outcomes for older adults.
There is a growing program of research. HIT are solutions to improving the safety, quality and efficiency of care.
Gerontological nurse scientists are at the forefront of advancing this work.
Electronic health records (EHRs)and telehealth will blend care of older adults.
Multimedia/advanced directives from HIT provided to patients recovering from critical illness have increased the intent to sign an advanced directive by 25 times
Liu, L., Stroulia, E., Nikolaidis, I., Miguel-Cruz, A., Rincon, A. R. (2016).
4
The HITECH Act resulted growth in the development and implementation of the EHR.
The impact of an integrated EHR in 29 Kaiser Permanente hospitals was significant on process and outcome indicators for patient falls and hospital acquired pressure ulcers and other measures of patient safety.
The EHR system was associated with improved documentation of falls/pressure ulcers and significant improvements for pressure ulcer risk assessment documentation.
Bowles, K. H., Dykes, P., & Demiris, G. (2015).
5
NICHE
(Nurses Improving Care for Healthsystem Elders)
NICHE builds decision support within the workflow of nurses caring for old.
Running head ROLE OF DESCRIPTIVE EPIDEMIOLOGY IN NURSING SCIENCE .docxtodd521
Running head: ROLE OF DESCRIPTIVE EPIDEMIOLOGY IN NURSING SCIENCE 1
ROLE OF DESCRIPTIVE EPIDEMIOLOGY IN NURSING SCIENCE 8
Role of Descriptive Epidemiology in Nursing Science
Steve Akinbehinje
DNP/825- Population Management
May 22, 2019
Descriptive Epidemiology
According to Naito (2014), “descriptive epidemiology is the epidemiological studies with much of the activities being in the descriptive component rather than the analytical component”. From the analytical epidemiology prospective, descriptive epidemiology deals with the reporting and identification of patterns and frequency of disease process in a population. In descriptive epidemiology, “the focus is on the occurrence of the diseases which is described through temporal trends and geographical comparisons” (Cassone & Mody, 2015). Descriptive epidemiology is therefore at the realm of evidence-based pyramid, they dictate an influence that is strong in the approach of epidemiology. Prevalence and incidence data of disease are relevant in today’s healthcare setting and research.
Relationship of Descriptive Epidemiology in Nursing Science
Unarguably, descriptive epidemiology centers on distribution and frequency of the health-related exposure or health outcome. “The analysis of who is affected by health outcome and how common it is showing prevalence as well as incidence” (Kim & Hooper, 2014). Person, place, and time can describe the aspect of people affected. An example in the explanation of the description of the distribution of health outcome with elements such as geography, population and time. “These aspects are crucial in nursing science as they provide a guideline which will be employed in the provision of quality care to outcome” (Montoya, Cassone & Mody, 2016). Subsequently, better understanding of disease severity is increased which enhance the development of prevention and management strategies. Whenever there is an improvement in healthcare outcome, the process that allows understanding of the changes that resulted in attaining the improvement is made possible through descriptive epidemiology.
Role of Descriptive Epidemiology in Nursing Science
Health data source and disease surveillance system are used to gather information when monitoring disease and health trends, and they are organized in such a way that enables the data to be systematically analyzed by descriptive epidemiology. Thus, the discrepancies in the frequency of the disease can be better understood over a given time (Fazel, Geddes & Kushel, 2014). Moreover, better understanding of disease variation of individuals in the basis of personal traits such as place and time is made possible thereby making the process of planning resources to address healthcare issues of the population easier. “The hypothesis that are used in making of the determinants about health and diseases are generated from the descriptive epidemiology” (Karimi et al., 2014). Most importantly, generating hypothesis is an initial s.
This document discusses the use of telemedicine for patients with chronic respiratory diseases. It begins by defining telemedicine and outlining the various types of telemedicine interventions that can be used, including telephone counseling, remote monitoring of symptoms and biometrics, store-and-forward of medical images/data, and video consultations with specialists. It then reviews evidence that telemedicine can help manage chronic conditions through improved care coordination, self-management support, and remote monitoring to reduce exacerbations and hospitalizations. Key types of telemedicine systems and interventions discussed for respiratory diseases include forced spirometry, CT imaging support, and integrated care programs led by nurses.
2
Annotated Bibliography
3164 words
Rough Draft on Infection Control
by
Submitted to
Semester
Date
Contact
Address
Phone
Email
Infection Control
1
Introduction of the Paper
Background
According to various reports by the Centers for Disease Control and Prevention, a significant number of lives are lost each passing year due to the spread of infections in hospitals that could otherwise have been prevented (Alp & Damani, 2015). Therefore, effort geared towards understanding infection control plays a significant role in reducing the otherwise unnecessary loss of lives. Infection control entails the power to directly prevent or determine the spread of infections with the aim of avoiding it (Berríos-Torres, et al., 2017). Indeed, the pathological state resulting from the invasion of the body by pathogenic microorganisms has far-reaching consequences. While so much has been done to prevent its spread, there is still a lot more to be done. This research paper intends to focus on Healthcare-associated Infections and how it can be prevented if not eliminated altogether.
Statement of the Problem
Healthcare-Associated Infections are a common occurrence in the modern healthcare setting resulting in huge financial losses and loss of lives. According to the Office of Disease Prevention and Healthcare Promotion (ODPHP), these are infections that patients contract while receiving treatment in a medical facility. Percival, Suleman, Vuotto & Donelli, (2015) pointed out that its prevalence is as a result of the employment of invasive devices and procedures meant to treat patients and to help them recover. While most of them are accidental in nature, they still remain to be seen as accidents that could have been prevented. The US government, through the establishment of Healthy People 2020 and the U.S. Department of Health and Human Services (HHS) have taken a lead role in spreading the news on infection control. To that effect, recent research reveals that there could be a 70% reduction in infections by implementing existing prevention practices. This translates to a financial benefit estimated to be $31.5 billion in medical cost savings (ODPHP, 2019). Understanding these prevention measures should, therefore, be a priority to all healthcare practitioners. That is why this research study intends to shade more light on nosocomial infections. These are infections that occur within 48 hours upon admission into a hospital. They can also occur in three days of discharge or 30 days of operation. They affect one in every 10 patients admitted in a hospital (Khan, Baig & Mehboob, 2017; Suleyman, & Alangaden, 2016).
Rationale for addressing the issue
Addressing this issue is important to the health sector from a political, social as well as environmental perspective. As a matter of fact, its impact will be on a short term, interim basis and long term basis. Politically, health has always been a major subject of concern as it is used by voters to determi.
The document discusses the Medicare Inpatient Prospective Payment System (IPPS) which determines payment to hospitals based on Diagnosis Related Groups (DRGs). The IPPS was implemented in 1983 based on a Yale study from the 1970s. DRGs classify patients into groups based on diagnoses, treatment, age, resource use, and length of stay. There are now over 750 Medicare Severity DRGs (MS-DRGs) used to more precisely classify hospital stays and facilitate payment. The IPPS system puts the cost risk on hospitals by setting prospective payment rates based on average costs rather than actual costs.
Dr. Harold Freeman founded the first patient navigation program in 1990 to help reduce barriers to care for low-income cancer patients. A study he conducted between 1995-2000 found that the five-year cancer survival rate increased to 70% for low-income patients who received help from patient navigators, compared to only 39% in an earlier study without navigators. Research has shown that patient navigators increase patient compliance, decrease delays in care, and can increase patient satisfaction scores by explaining treatment plans and helping patients overcome barriers to care. While start-up costs may be high initially, patient navigators ultimately save health systems money by reducing unnecessary emergency room visits and improving health outcomes.
This randomized clinical trial tested an intervention using interactive voice response (IVR) technology to provide tailored behavioral support to improve statin medication adherence. The trial involved 497 patients from a large health plan who were randomized to an experimental group receiving up to 3 tailored IVR calls and printed materials, or a control group receiving a single generic IVR call and generic printed materials. The primary outcome was 6-month statin adherence based on pharmacy claims. Patients in the experimental group had significantly higher adherence (70.4%) than controls (60.7%), suggesting tailored behavioral support using IVR can effectively improve statin medication adherence.
Running head: TELE HEALTHCARE 1
TELE HEALTHCARE 6
Tele Healthcare
Name
Institution
Tele Healthcare
Approximately over 50 years of telehealth development has seen tackling of numerous medical conditions through the utilization of different types of technologies. Tele healthcare has been associated with a wide variety of outcomes in the healthcare. Despite the fact that it as shown great promise in the modern times, it has also triggered a number of challenges for interpretation and technical issues that are linked to the lack of technological expertise among the healthcare practitioners. For instance, then challenges that exist in defining such terms as telehealth is a reflection of the broader difficulties when it comes to the interpretation of the complex interplay that exists between clinical output, patient involvement, service designs and technology. Despite these significant challenges whose impacts in the healthcare delivery is great, the significance of telehealth practices cannot be overlooked in terms of the patient outcomes and efficiency of healthcare delivery. Tele healthcare has enhanced information sharing between patients and doctors even those who are located in the remote areas. It has made it possible to monitor the progress of patients within and outside the facilities devoid of the need to have physical meetings. The benefits of tele healthcare outweigh its pitfalls hence it is important that is integrated into medical practices to optimize patient outcomes.
Tele healthcare is depicted as personalized healthcare that is delivered over a long distance such that data is transferred from the patients to the professionals and back. It has played a key role in enhancing feedback from the patients to the professionals for the interest of evidence-based decision making and treatment. For instance, the significance of telehealth can be evident among the inpatients with severe long-term conditions such as diabetes and long-term asthma. It has played a key role in reducing hospital admissions without increasing mortality.
Advantages of Tele Healthcare
There are numerous advantages of tele healthcare. To start with is that it is powered by technology. Technological advancement in the modern times has made it easy for various organizational operations. Technological advancement has been adopted across all spheres of life and healthcare is not an exemption. Creating a balance between healthcare practices and technology is a key requirement when it comes to the medical operations and practices (Dorsey & Topol, 2016). The case of the importance of tele healthcare can be witnessed in electronic health records whereby a medical professional admits the patient and their data is keyed in the system. This data is required in the en ...
Telehealth and Geriatrics How telehealth improves medicati.docxAASTHA76
Telehealth and Geriatrics:
How telehealth improves medication management
and patient safety in the geriatric patient
Avrakham Rubinov
Adelphi University
College of Nursing and Public Health
December 3rd, 2018
What is Geriatrics?
Geriatrics is a subspecialty of internal medicine and primary care that was named in 1909 by Ignatz Leo Nascher.
Geriatrics is that specialty of medicine that addresses the health needs of the elderly.
Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J., & Ten Have, T. (2012).
2
Telemedicine is a highly effective
and necessary tool in geriatrics.
The global population of elderly people is increasing at a remarkable rate,
This is expected to continue for some time.
Older patients require more care.
The current model of care delivery indicated costs are expected to rise.
Telemedicine is a great opportunity for medical practice to evolve to cost effective and new levels of engagement with patients
Chang, W., Homer, M., & Rossi, M. (2018).
3
Geriatics, HIT and Patient Safety
CONCERNS:
SOLUTIONS:
Patient safety is a concern.
Telehealth: Difficult to monitor conditions in a patient’s home.
Safety risks such as falls and inability to get in and out of the tub or shower.
Fewer In-Person Consultations
Doctors worry about technical problems associated with telemedicine. poor broadband connections could lead to “possible patient mismanagement.”
Many physicians and patients alike still like a “personal touch,” and not all procedures – even simple checkups – can be performed digitally.
Difficult to monitor depression or other emotional issues.
Health information technology (HIT) is the future of improving care and outcomes for older adults.
There is a growing program of research. HIT are solutions to improving the safety, quality and efficiency of care.
Gerontological nurse scientists are at the forefront of advancing this work.
Electronic health records (EHRs)and telehealth will blend care of older adults.
Multimedia/advanced directives from HIT provided to patients recovering from critical illness have increased the intent to sign an advanced directive by 25 times
Liu, L., Stroulia, E., Nikolaidis, I., Miguel-Cruz, A., Rincon, A. R. (2016).
4
The HITECH Act resulted growth in the development and implementation of the EHR.
The impact of an integrated EHR in 29 Kaiser Permanente hospitals was significant on process and outcome indicators for patient falls and hospital acquired pressure ulcers and other measures of patient safety.
The EHR system was associated with improved documentation of falls/pressure ulcers and significant improvements for pressure ulcer risk assessment documentation.
Bowles, K. H., Dykes, P., & Demiris, G. (2015).
5
NICHE
(Nurses Improving Care for Healthsystem Elders)
NICHE builds decision support within the workflow of nurses caring for old.
Running head ROLE OF DESCRIPTIVE EPIDEMIOLOGY IN NURSING SCIENCE .docxtodd521
Running head: ROLE OF DESCRIPTIVE EPIDEMIOLOGY IN NURSING SCIENCE 1
ROLE OF DESCRIPTIVE EPIDEMIOLOGY IN NURSING SCIENCE 8
Role of Descriptive Epidemiology in Nursing Science
Steve Akinbehinje
DNP/825- Population Management
May 22, 2019
Descriptive Epidemiology
According to Naito (2014), “descriptive epidemiology is the epidemiological studies with much of the activities being in the descriptive component rather than the analytical component”. From the analytical epidemiology prospective, descriptive epidemiology deals with the reporting and identification of patterns and frequency of disease process in a population. In descriptive epidemiology, “the focus is on the occurrence of the diseases which is described through temporal trends and geographical comparisons” (Cassone & Mody, 2015). Descriptive epidemiology is therefore at the realm of evidence-based pyramid, they dictate an influence that is strong in the approach of epidemiology. Prevalence and incidence data of disease are relevant in today’s healthcare setting and research.
Relationship of Descriptive Epidemiology in Nursing Science
Unarguably, descriptive epidemiology centers on distribution and frequency of the health-related exposure or health outcome. “The analysis of who is affected by health outcome and how common it is showing prevalence as well as incidence” (Kim & Hooper, 2014). Person, place, and time can describe the aspect of people affected. An example in the explanation of the description of the distribution of health outcome with elements such as geography, population and time. “These aspects are crucial in nursing science as they provide a guideline which will be employed in the provision of quality care to outcome” (Montoya, Cassone & Mody, 2016). Subsequently, better understanding of disease severity is increased which enhance the development of prevention and management strategies. Whenever there is an improvement in healthcare outcome, the process that allows understanding of the changes that resulted in attaining the improvement is made possible through descriptive epidemiology.
Role of Descriptive Epidemiology in Nursing Science
Health data source and disease surveillance system are used to gather information when monitoring disease and health trends, and they are organized in such a way that enables the data to be systematically analyzed by descriptive epidemiology. Thus, the discrepancies in the frequency of the disease can be better understood over a given time (Fazel, Geddes & Kushel, 2014). Moreover, better understanding of disease variation of individuals in the basis of personal traits such as place and time is made possible thereby making the process of planning resources to address healthcare issues of the population easier. “The hypothesis that are used in making of the determinants about health and diseases are generated from the descriptive epidemiology” (Karimi et al., 2014). Most importantly, generating hypothesis is an initial s.
This document discusses the use of telemedicine for patients with chronic respiratory diseases. It begins by defining telemedicine and outlining the various types of telemedicine interventions that can be used, including telephone counseling, remote monitoring of symptoms and biometrics, store-and-forward of medical images/data, and video consultations with specialists. It then reviews evidence that telemedicine can help manage chronic conditions through improved care coordination, self-management support, and remote monitoring to reduce exacerbations and hospitalizations. Key types of telemedicine systems and interventions discussed for respiratory diseases include forced spirometry, CT imaging support, and integrated care programs led by nurses.
2
Annotated Bibliography
3164 words
Rough Draft on Infection Control
by
Submitted to
Semester
Date
Contact
Address
Phone
Email
Infection Control
1
Introduction of the Paper
Background
According to various reports by the Centers for Disease Control and Prevention, a significant number of lives are lost each passing year due to the spread of infections in hospitals that could otherwise have been prevented (Alp & Damani, 2015). Therefore, effort geared towards understanding infection control plays a significant role in reducing the otherwise unnecessary loss of lives. Infection control entails the power to directly prevent or determine the spread of infections with the aim of avoiding it (Berríos-Torres, et al., 2017). Indeed, the pathological state resulting from the invasion of the body by pathogenic microorganisms has far-reaching consequences. While so much has been done to prevent its spread, there is still a lot more to be done. This research paper intends to focus on Healthcare-associated Infections and how it can be prevented if not eliminated altogether.
Statement of the Problem
Healthcare-Associated Infections are a common occurrence in the modern healthcare setting resulting in huge financial losses and loss of lives. According to the Office of Disease Prevention and Healthcare Promotion (ODPHP), these are infections that patients contract while receiving treatment in a medical facility. Percival, Suleman, Vuotto & Donelli, (2015) pointed out that its prevalence is as a result of the employment of invasive devices and procedures meant to treat patients and to help them recover. While most of them are accidental in nature, they still remain to be seen as accidents that could have been prevented. The US government, through the establishment of Healthy People 2020 and the U.S. Department of Health and Human Services (HHS) have taken a lead role in spreading the news on infection control. To that effect, recent research reveals that there could be a 70% reduction in infections by implementing existing prevention practices. This translates to a financial benefit estimated to be $31.5 billion in medical cost savings (ODPHP, 2019). Understanding these prevention measures should, therefore, be a priority to all healthcare practitioners. That is why this research study intends to shade more light on nosocomial infections. These are infections that occur within 48 hours upon admission into a hospital. They can also occur in three days of discharge or 30 days of operation. They affect one in every 10 patients admitted in a hospital (Khan, Baig & Mehboob, 2017; Suleyman, & Alangaden, 2016).
Rationale for addressing the issue
Addressing this issue is important to the health sector from a political, social as well as environmental perspective. As a matter of fact, its impact will be on a short term, interim basis and long term basis. Politically, health has always been a major subject of concern as it is used by voters to determi.
The document discusses the Medicare Inpatient Prospective Payment System (IPPS) which determines payment to hospitals based on Diagnosis Related Groups (DRGs). The IPPS was implemented in 1983 based on a Yale study from the 1970s. DRGs classify patients into groups based on diagnoses, treatment, age, resource use, and length of stay. There are now over 750 Medicare Severity DRGs (MS-DRGs) used to more precisely classify hospital stays and facilitate payment. The IPPS system puts the cost risk on hospitals by setting prospective payment rates based on average costs rather than actual costs.
The Use of Health Information Technology to Improve Care and .docxpelise1
The Use of Health Information Technology to Improve Care and
Outcomes for Older Adults
Kathryn H. Bowles, PhD, FAAN, FACMI,
van Ameringen Professor in Nursing Excellence, Director of the Center for Integrative Science in
Aging, University of Pennsylvania School of Nursing, Philadelphia, PA
Patricia Dykes, PhD, FAAN, FACMI, and
Senior Nurse Scientist, Director of the Center for Patient Safety Research and Practice; Director
of the Center for Nursing Excellence, Brigham and Women’s Hospital, Boston, MA
George Demiris, PhD, FACMI
Alumni Endowed Professor in Nursing; Professor in Biomedical and Health Informatics, School of
Medicine; Director, Clinical Informatics and Patient Centered Technologies; Graduate Program
Director, Biomedical and Health Informatics University of Washington, Seattle, Washington
Introduction
Using health information technology (HIT) to improve care and outcomes for older adults is
a growing program of research propelled by recent transformative policies such as the
Health Information Technology for Economic and Clinical Health (HITECH) Act
(Blumenthal, 2010; Institute of Medicine, 2011) and the Institute of Medicine report, "The
Future of Nursing: Leading Change, Advancing Health." (Institute of Medicine, 2010). Both
documents call for the implementation of electronic health records (EHR) and HIT solutions
to improve the safety, quality and efficiency of care. Several nurse scientists are at the
forefront of advancing this work, particularly using electronic health records, decision
support and telehealth. This commentary highlights examples of recent research (2010–
2014) led by nurse scientists using HIT to improve patient safety, and the quality and
efficiency of patient care. We also discuss future opportunities for Gerontological nurse
scientists interested in blending the care of older adults and HIT and suggest strategies to
increase our capacity to engage in such innovative research.
Using the EHR to improve outcomes for older adults
Recent incentives provided by the HITECH Act have resulted in rapid growth in the
development and implementation of the EHR. Nurse led studies are beginning to
demonstrate that effective use of the EHR can improve outcomes of relevance to older
adults such as pressure ulcers and falls. Dowding and colleagues evaluated the impact of an
integrated EHR in 29 Kaiser Permanente hospitals on process and outcome indicators for
patient falls and hospital acquired pressure ulcers (Dowding, Turley, & Garrido, 2012).
They found that the EHR system was associated with improved documentation of both fall
and pressure ulcer risk assessments and statistically significant improvements for pressure
ulcer risk assessment documentation. They demonstrated that improved documentation
using the EHR was associated with a 13% decrease in hospital acquired pressure ulcer rates.
HHS Public Access
Author manuscript
Res Gerontol Nurs. Author manuscript; avai.
Health policy plan. 2007-lönnroth-156-66Reaksmey Pe
This study assessed the impact of a social franchise model for tuberculosis (TB) care delivered through private general practitioners (GPs) in Myanmar. The key findings were:
1) The franchisees contributed around 20% of newly diagnosed smear-positive TB cases notified to the national TB program, helping to improve case detection.
2) Lower socioeconomic groups represented 68% of TB patients accessing care through the franchise, indicating it helped reach the poor.
3) The treatment success rate for new smear-positive cases through the franchise was 84%, close to the WHO target of 85% and similar to the national program rate.
4) While overall costs of TB care were high for poor patients, comprising on
Rehabilitation for and Stroke Patients.docxwrite22
This document discusses a proposed change to address the high prevalence of pressure ulcers among hospitalized post-surgical and stroke patients. It proposes implementing a multifaceted educational intervention for nurses to enhance their knowledge and confidence in caring for patients with or at risk of pressure ulcers. This is aimed to reduce ulcer incidence by improving nursing care. The effectiveness will be measured by decreased pressure ulcer cases, deaths, and readmissions post-implementation. However, reluctance to change and lack of funding could hinder the plan.
NURS 438 Trends And Issues In Nursing And Health Systems.docxstirlingvwriters
This document discusses trends and issues related to medical errors in nursing and health systems. It outlines several common causes of medical errors, including communication problems, inadequate information flow, and technical errors. Communication issues between nurses and patients can lead to medication errors, while inadequate discharge instructions and a lack of information for patients post-hospitalization can also result in errors. Technical failures of medical equipment during procedures have caused patient injuries and deaths. Reducing these types of errors will help improve safety and outcomes in healthcare.
Nearly half of American adults have chronic illnesses, which account for 80% of healthcare spending. Congestive heart failure (CHF) is a costly chronic disease to treat. The document discusses how telehealth programs that monitor CHF patients daily using devices have improved health outcomes and lowered costs. It provides evidence that telehealth can effectively manage CHF through remote monitoring, reducing emergency visits and hospitalizations while improving health.
Observational research can impact clinical decision making for cancer treatment by providing real-world evidence to complement randomized controlled trials, which have limitations. Observational studies capture long-term outcomes of various treatments in everyday practice. However, their findings are more susceptible to bias. To strengthen observational research, standards are needed for electronic health data collection and reporting, while prioritizing patient privacy and rigorous methodologies. With these improvements, observational data can better inform estimates of cancer progression and treatment effects.
Factors associated to adherence to DR-TB treatment in Georgia, Policy Brief (...Ina Charkviani
Tuberculosis (TB) is a widely spread disease globally that causes millions of people’s death worldwide. Treatment for TB is complex and usually involves taking several antibiotics at once for a long time (sometimes up to two years). Considering the severity of the treatment regimen, it becomes hard for the patients to adhere and complete proposed treatment and particularly for those who are infected with drug-resistant strain of TB. Poor adherence to treatment remains significant problem that prevents countries from obtaining high treatment success rates that is essential for health systems to control the epidemic and decrease spread of the disease. A new study from Georgia looks at adherence to treatment factors among drug resistant TB (DR-TB) patients and provides evidence that may help policy-makers develop effective strategies for improving treatment outcomes among DR-TB patients. The study findings might be helpful for other countries in the region where TB burden is also high.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
NURS 521 Nursing Informatics And Technology.docxstirlingvwriters
This document discusses the application of clinical information systems in nursing. It reviews 4 peer-reviewed articles on this topic. The articles found that clinical information systems can help reduce medical errors, improve care quality by enhancing workflow and access to patient information, and engage patients more in their care when interactive technology is used. However, challenges remain around data integration across healthcare systems and technical, human, and organizational constraints. The document concludes that clinical information systems provide opportunities to improve care but must be effectively implemented and upgraded so nurses can benefit from these technologies.
Running head INFECTION PREVENTION1INFECTION PREVENTION.docxjeanettehully
Running head: INFECTION PREVENTION 1
INFECTION PREVENTION 15
Phase # 2 Infection Prevention
Literature Review
Healthcare acquired infections constitute a major public health issue and it is affecting millions of people on a yearly basis. The approximation from the recent studies is showing more than 5 percent of the hospitalized patients are exposed to nosocomial infections. Many studies further show that the surgical site infections are the common infections associated with nosocomial infections and it is contributing to about 30 percent of all healthcare acquired infections cases.
Study by Ayed et al (2015) shows that healthcare providers are continuously exposed to pathogens which are sometimes severe and lethal. Nurses specifically are more exposed to different infections during the course of providing healthcare services to the patients. This study indicates that it is therefore crucial for nurses to possess sound knowledge as well as strict adherence to the infection control practices. Updating the acquaintance and the practices of nurses through involvement in ongoing in-service educational programs and putting more focus on the role of the current evidence-based practices of infection prevention in the continuous training is important. Provision of the training to the newly recruited nurses regarding the infection control frequently as well as replicating the study through observation checklist is necessary in assessing the level of practice (Imad, Ayed, Faeda, & Lubna, 2015).
Study by Desta et al (2018) reveals that working experience is a stronger predictor of the knowledge in relation to the prevention of the infection. In this study, the goal was to the relationship between the acquaintance, practice and connected aspects of infection prevention among healthcare employees. Education level is a key determinant to the level of experience when it comes to the control or the prevention of infections. According to this study, it is clear that healthcare providers with advanced experience as well as advanced age are significantly linked with the knowledge. This is basically based on the fact that as healthcare providers are getting older, they are more likely to have advance knowledge due to their experiences as well as having worked with their seniors (Desta, Ayenew, Sitotaw, Tegegne, Dires, & Getie, 2018).
Teshager et al (2015) also studies the knowledge, practices, and the related aspects towards the reduction or prevention of the surgical site infections among nurses who were employed in Amhara Regional State Referral healthcare facilities, in the Northwest Ethiopia. This study looked at some of the factors linked with the knowledge of the nurses regarding the preventi ...
Introduction Healthcare system is considered one of the busiest.pdfbkbk37
The document discusses the application of clinical information systems in nursing. It reviews 4 peer-reviewed articles on the topic. The articles found that clinical information systems can improve workflow and reduce medical errors. However, challenges remain around data integration and sharing patient data across healthcare systems. The document concludes that clinical systems provide opportunities to improve care if effectively implemented and regularly updated to support nurses.
Remote Patient Monitoring (RPM) is becoming an essential part of future healthcare. Read this guide, to learn more about remote patient monitoring. Click here :https://bluestartelehealth.com/
Levels of Utilization and Socio - Economic Factors Influencing Adherence to U...inventionjournals
This document analyzes levels of utilization and socio-economic factors influencing adherence to antiretroviral therapy (ART) among people living with HIV/AIDS in Dodoma Municipality and Kongwa District, Tanzania. The study found that ART usage rates ranged from 100% at some facilities to 40% at others. Common reasons for dropping out of ART programs included side effects like vomiting (25.1%) and frequent sickness (19.9%), as well as lack of employment support (66.7%) and lack of confidentiality (50%). The document concludes that improving adherence requires addressing side effects, providing income assistance, and ensuring confidentiality in HIV services.
Signature Essay Peer Review WorksheetFor this assignment, your o.docxmaoanderton
Signature Essay Peer Review Worksheet
For this assignment, your objective is to provide high-level feedback to one of your fellow classmates that will help to improve her or his final essay. Please completely fill out each question in this worksheet to help your fellow student.
Name of the student whose essay youreviewed:
Your Name:
First,in three to five sentences, summarize the overall argument addressed in this essay as well as how well you think this draft meets the assignment requirements listed in the Signature Assignment Instructions.
Next, answer each of the following questions using complete sentences, addressing each question in its entirety, and providing specific examples when possible.
Remember that you can give both positive and negative answers to help highlight the best aspects of the essay and those areas that need revision.
Content-Specific QuestionsCan you identify the main argument being discussed?Can you identify the thesis statement? Does it address the main points that the writer will be making in the essay?At any point in the essay, can you identify the author’s opinion on the controversy? If so, can you address where the bias is revealed?Are the arguments for both sides equally addressed?
OrganizationHow effectively does the introduction engage the reader while providing an overview of the main argument? Can you identify the topic sentences for each body paragraph? Be sure to list any body paragraphs that do not appear to have topic sentences.Does the paper effectively use transitions? Be sure to point out any areas where a topic shift occurs that seems to be abrupt.Is the conclusion effective? Does it summarize the main points and bring the discussion to a logical and satisfying ending?
Format
Does the essay use appropriate APA formatting, including double-spacing, Times New Roman, 12-point font, 1" margins, and appropriate paragraph indentations? Can you identify any areas where outside sources appear to be used without including in-text citations? Provide specific examples here. When in-text citations are used, do they follow APA formatting?Does the essay include the required eight sources?Can you identify any issues with the reference page? If so, please provide specific examples,
Grammar and MechanicsDoes the writer use proper grammar, punctuation, and spelling? If not, please provide examples of errors in need of correction.Is the writing clear and comprehensible throughout the draft? If not, please provide examples in need of improvement.
Three strengths of this version of this essay are:
Three aspects of this essay to work on before final submission are:
Running head: TELE HEALTHCARE 1
Tele Healthcare
5
Tele Healthcare
Enrique Cateriano
Written Communications II
Jennifer Haber
West Coast U.
This document discusses creating a market for personalized whole genome sequencing to develop patient-centric healthcare. It begins by outlining how genome sequencing costs have dropped significantly since 2003, enabling more widespread genomic data collection. However, genome sequencing has provided little direct economic benefit due to a lack of defined markets or networks to deliver personalized care. The document then discusses how whole genome sequencing could shift healthcare towards a preventative, personalized, participatory model focused on wellness rather than disease. However, information asymmetries and technical limitations have prevented this vision. The document argues that creating a patient-centric model where individuals own their genomic data could help address these issues and promote innovative healthcare solutions through disruptive approaches like whole genome sequencing.
Patient Reported Outcomes (PRO) - Challenge and potential solutions.
Why and how can medical device and pharmaceutical companies, as well as the entire healthcare sector, leverage patient engagement with next-generation ePRO solutions?
Discover our white paper...
Research paper 2020 of assessment of Financial Toxicity in Tunisian cancer patient using Compressive Score of Financial Toxicity. Journal Club Presentation. Its include FT in North Africa Population.
The document discusses clinical decision support systems (CDSS) which are electronic tools that assist clinicians in making clinical decisions for patients. CDSS helps clinicians focus more on interacting with patients by providing clinical guidelines, recommendations, and diagnostic and prescribing support. While these systems can help with continuity of care, implementing them can also lead to confusion and lack of communication if not done properly. The aim is to compare the design and implementation of CDSS to assess diagnostic accuracy before and after its use in patient care.
roles are largely complete when they hand an investigation.docxwrite4
This document outlines the responsibilities of investigators at different phases of a criminal investigation from initial response to a crime scene through trial preparation. It provides guidance to complete an assignment detailing the steps, procedures, best practices, legal obligations and potential pitfalls at each phase, including: processing the initial crime scene; gathering information and interviewing witnesses during the investigation; identifying, locating, apprehending and interrogating suspects; assembling the final report and presenting the case to prosecutors; and preparing evidence and testimony for prosecution and trial. The assignment criteria include describing responsibilities at each phase, examining relevant procedures, analyzing strategies, and citing references.
The military plays an important role in responding to domestic disasters by providing personnel, equipment, and logistical support. During 9/11 and Hurricane Katrina, fighter jets patrolled cities and the National Guard and Coast Guard conducted large-scale rescue operations. While the military is effective at disaster response, there are also debates around federalizing the National Guard, authorizing deadly force, and declaring martial law during relief efforts.
The Use of Health Information Technology to Improve Care and .docxpelise1
The Use of Health Information Technology to Improve Care and
Outcomes for Older Adults
Kathryn H. Bowles, PhD, FAAN, FACMI,
van Ameringen Professor in Nursing Excellence, Director of the Center for Integrative Science in
Aging, University of Pennsylvania School of Nursing, Philadelphia, PA
Patricia Dykes, PhD, FAAN, FACMI, and
Senior Nurse Scientist, Director of the Center for Patient Safety Research and Practice; Director
of the Center for Nursing Excellence, Brigham and Women’s Hospital, Boston, MA
George Demiris, PhD, FACMI
Alumni Endowed Professor in Nursing; Professor in Biomedical and Health Informatics, School of
Medicine; Director, Clinical Informatics and Patient Centered Technologies; Graduate Program
Director, Biomedical and Health Informatics University of Washington, Seattle, Washington
Introduction
Using health information technology (HIT) to improve care and outcomes for older adults is
a growing program of research propelled by recent transformative policies such as the
Health Information Technology for Economic and Clinical Health (HITECH) Act
(Blumenthal, 2010; Institute of Medicine, 2011) and the Institute of Medicine report, "The
Future of Nursing: Leading Change, Advancing Health." (Institute of Medicine, 2010). Both
documents call for the implementation of electronic health records (EHR) and HIT solutions
to improve the safety, quality and efficiency of care. Several nurse scientists are at the
forefront of advancing this work, particularly using electronic health records, decision
support and telehealth. This commentary highlights examples of recent research (2010–
2014) led by nurse scientists using HIT to improve patient safety, and the quality and
efficiency of patient care. We also discuss future opportunities for Gerontological nurse
scientists interested in blending the care of older adults and HIT and suggest strategies to
increase our capacity to engage in such innovative research.
Using the EHR to improve outcomes for older adults
Recent incentives provided by the HITECH Act have resulted in rapid growth in the
development and implementation of the EHR. Nurse led studies are beginning to
demonstrate that effective use of the EHR can improve outcomes of relevance to older
adults such as pressure ulcers and falls. Dowding and colleagues evaluated the impact of an
integrated EHR in 29 Kaiser Permanente hospitals on process and outcome indicators for
patient falls and hospital acquired pressure ulcers (Dowding, Turley, & Garrido, 2012).
They found that the EHR system was associated with improved documentation of both fall
and pressure ulcer risk assessments and statistically significant improvements for pressure
ulcer risk assessment documentation. They demonstrated that improved documentation
using the EHR was associated with a 13% decrease in hospital acquired pressure ulcer rates.
HHS Public Access
Author manuscript
Res Gerontol Nurs. Author manuscript; avai.
Health policy plan. 2007-lönnroth-156-66Reaksmey Pe
This study assessed the impact of a social franchise model for tuberculosis (TB) care delivered through private general practitioners (GPs) in Myanmar. The key findings were:
1) The franchisees contributed around 20% of newly diagnosed smear-positive TB cases notified to the national TB program, helping to improve case detection.
2) Lower socioeconomic groups represented 68% of TB patients accessing care through the franchise, indicating it helped reach the poor.
3) The treatment success rate for new smear-positive cases through the franchise was 84%, close to the WHO target of 85% and similar to the national program rate.
4) While overall costs of TB care were high for poor patients, comprising on
Rehabilitation for and Stroke Patients.docxwrite22
This document discusses a proposed change to address the high prevalence of pressure ulcers among hospitalized post-surgical and stroke patients. It proposes implementing a multifaceted educational intervention for nurses to enhance their knowledge and confidence in caring for patients with or at risk of pressure ulcers. This is aimed to reduce ulcer incidence by improving nursing care. The effectiveness will be measured by decreased pressure ulcer cases, deaths, and readmissions post-implementation. However, reluctance to change and lack of funding could hinder the plan.
NURS 438 Trends And Issues In Nursing And Health Systems.docxstirlingvwriters
This document discusses trends and issues related to medical errors in nursing and health systems. It outlines several common causes of medical errors, including communication problems, inadequate information flow, and technical errors. Communication issues between nurses and patients can lead to medication errors, while inadequate discharge instructions and a lack of information for patients post-hospitalization can also result in errors. Technical failures of medical equipment during procedures have caused patient injuries and deaths. Reducing these types of errors will help improve safety and outcomes in healthcare.
Nearly half of American adults have chronic illnesses, which account for 80% of healthcare spending. Congestive heart failure (CHF) is a costly chronic disease to treat. The document discusses how telehealth programs that monitor CHF patients daily using devices have improved health outcomes and lowered costs. It provides evidence that telehealth can effectively manage CHF through remote monitoring, reducing emergency visits and hospitalizations while improving health.
Observational research can impact clinical decision making for cancer treatment by providing real-world evidence to complement randomized controlled trials, which have limitations. Observational studies capture long-term outcomes of various treatments in everyday practice. However, their findings are more susceptible to bias. To strengthen observational research, standards are needed for electronic health data collection and reporting, while prioritizing patient privacy and rigorous methodologies. With these improvements, observational data can better inform estimates of cancer progression and treatment effects.
Factors associated to adherence to DR-TB treatment in Georgia, Policy Brief (...Ina Charkviani
Tuberculosis (TB) is a widely spread disease globally that causes millions of people’s death worldwide. Treatment for TB is complex and usually involves taking several antibiotics at once for a long time (sometimes up to two years). Considering the severity of the treatment regimen, it becomes hard for the patients to adhere and complete proposed treatment and particularly for those who are infected with drug-resistant strain of TB. Poor adherence to treatment remains significant problem that prevents countries from obtaining high treatment success rates that is essential for health systems to control the epidemic and decrease spread of the disease. A new study from Georgia looks at adherence to treatment factors among drug resistant TB (DR-TB) patients and provides evidence that may help policy-makers develop effective strategies for improving treatment outcomes among DR-TB patients. The study findings might be helpful for other countries in the region where TB burden is also high.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
NURS 521 Nursing Informatics And Technology.docxstirlingvwriters
This document discusses the application of clinical information systems in nursing. It reviews 4 peer-reviewed articles on this topic. The articles found that clinical information systems can help reduce medical errors, improve care quality by enhancing workflow and access to patient information, and engage patients more in their care when interactive technology is used. However, challenges remain around data integration across healthcare systems and technical, human, and organizational constraints. The document concludes that clinical information systems provide opportunities to improve care but must be effectively implemented and upgraded so nurses can benefit from these technologies.
Running head INFECTION PREVENTION1INFECTION PREVENTION.docxjeanettehully
Running head: INFECTION PREVENTION 1
INFECTION PREVENTION 15
Phase # 2 Infection Prevention
Literature Review
Healthcare acquired infections constitute a major public health issue and it is affecting millions of people on a yearly basis. The approximation from the recent studies is showing more than 5 percent of the hospitalized patients are exposed to nosocomial infections. Many studies further show that the surgical site infections are the common infections associated with nosocomial infections and it is contributing to about 30 percent of all healthcare acquired infections cases.
Study by Ayed et al (2015) shows that healthcare providers are continuously exposed to pathogens which are sometimes severe and lethal. Nurses specifically are more exposed to different infections during the course of providing healthcare services to the patients. This study indicates that it is therefore crucial for nurses to possess sound knowledge as well as strict adherence to the infection control practices. Updating the acquaintance and the practices of nurses through involvement in ongoing in-service educational programs and putting more focus on the role of the current evidence-based practices of infection prevention in the continuous training is important. Provision of the training to the newly recruited nurses regarding the infection control frequently as well as replicating the study through observation checklist is necessary in assessing the level of practice (Imad, Ayed, Faeda, & Lubna, 2015).
Study by Desta et al (2018) reveals that working experience is a stronger predictor of the knowledge in relation to the prevention of the infection. In this study, the goal was to the relationship between the acquaintance, practice and connected aspects of infection prevention among healthcare employees. Education level is a key determinant to the level of experience when it comes to the control or the prevention of infections. According to this study, it is clear that healthcare providers with advanced experience as well as advanced age are significantly linked with the knowledge. This is basically based on the fact that as healthcare providers are getting older, they are more likely to have advance knowledge due to their experiences as well as having worked with their seniors (Desta, Ayenew, Sitotaw, Tegegne, Dires, & Getie, 2018).
Teshager et al (2015) also studies the knowledge, practices, and the related aspects towards the reduction or prevention of the surgical site infections among nurses who were employed in Amhara Regional State Referral healthcare facilities, in the Northwest Ethiopia. This study looked at some of the factors linked with the knowledge of the nurses regarding the preventi ...
Introduction Healthcare system is considered one of the busiest.pdfbkbk37
The document discusses the application of clinical information systems in nursing. It reviews 4 peer-reviewed articles on the topic. The articles found that clinical information systems can improve workflow and reduce medical errors. However, challenges remain around data integration and sharing patient data across healthcare systems. The document concludes that clinical systems provide opportunities to improve care if effectively implemented and regularly updated to support nurses.
Remote Patient Monitoring (RPM) is becoming an essential part of future healthcare. Read this guide, to learn more about remote patient monitoring. Click here :https://bluestartelehealth.com/
Levels of Utilization and Socio - Economic Factors Influencing Adherence to U...inventionjournals
This document analyzes levels of utilization and socio-economic factors influencing adherence to antiretroviral therapy (ART) among people living with HIV/AIDS in Dodoma Municipality and Kongwa District, Tanzania. The study found that ART usage rates ranged from 100% at some facilities to 40% at others. Common reasons for dropping out of ART programs included side effects like vomiting (25.1%) and frequent sickness (19.9%), as well as lack of employment support (66.7%) and lack of confidentiality (50%). The document concludes that improving adherence requires addressing side effects, providing income assistance, and ensuring confidentiality in HIV services.
Signature Essay Peer Review WorksheetFor this assignment, your o.docxmaoanderton
Signature Essay Peer Review Worksheet
For this assignment, your objective is to provide high-level feedback to one of your fellow classmates that will help to improve her or his final essay. Please completely fill out each question in this worksheet to help your fellow student.
Name of the student whose essay youreviewed:
Your Name:
First,in three to five sentences, summarize the overall argument addressed in this essay as well as how well you think this draft meets the assignment requirements listed in the Signature Assignment Instructions.
Next, answer each of the following questions using complete sentences, addressing each question in its entirety, and providing specific examples when possible.
Remember that you can give both positive and negative answers to help highlight the best aspects of the essay and those areas that need revision.
Content-Specific QuestionsCan you identify the main argument being discussed?Can you identify the thesis statement? Does it address the main points that the writer will be making in the essay?At any point in the essay, can you identify the author’s opinion on the controversy? If so, can you address where the bias is revealed?Are the arguments for both sides equally addressed?
OrganizationHow effectively does the introduction engage the reader while providing an overview of the main argument? Can you identify the topic sentences for each body paragraph? Be sure to list any body paragraphs that do not appear to have topic sentences.Does the paper effectively use transitions? Be sure to point out any areas where a topic shift occurs that seems to be abrupt.Is the conclusion effective? Does it summarize the main points and bring the discussion to a logical and satisfying ending?
Format
Does the essay use appropriate APA formatting, including double-spacing, Times New Roman, 12-point font, 1" margins, and appropriate paragraph indentations? Can you identify any areas where outside sources appear to be used without including in-text citations? Provide specific examples here. When in-text citations are used, do they follow APA formatting?Does the essay include the required eight sources?Can you identify any issues with the reference page? If so, please provide specific examples,
Grammar and MechanicsDoes the writer use proper grammar, punctuation, and spelling? If not, please provide examples of errors in need of correction.Is the writing clear and comprehensible throughout the draft? If not, please provide examples in need of improvement.
Three strengths of this version of this essay are:
Three aspects of this essay to work on before final submission are:
Running head: TELE HEALTHCARE 1
Tele Healthcare
5
Tele Healthcare
Enrique Cateriano
Written Communications II
Jennifer Haber
West Coast U.
This document discusses creating a market for personalized whole genome sequencing to develop patient-centric healthcare. It begins by outlining how genome sequencing costs have dropped significantly since 2003, enabling more widespread genomic data collection. However, genome sequencing has provided little direct economic benefit due to a lack of defined markets or networks to deliver personalized care. The document then discusses how whole genome sequencing could shift healthcare towards a preventative, personalized, participatory model focused on wellness rather than disease. However, information asymmetries and technical limitations have prevented this vision. The document argues that creating a patient-centric model where individuals own their genomic data could help address these issues and promote innovative healthcare solutions through disruptive approaches like whole genome sequencing.
Patient Reported Outcomes (PRO) - Challenge and potential solutions.
Why and how can medical device and pharmaceutical companies, as well as the entire healthcare sector, leverage patient engagement with next-generation ePRO solutions?
Discover our white paper...
Research paper 2020 of assessment of Financial Toxicity in Tunisian cancer patient using Compressive Score of Financial Toxicity. Journal Club Presentation. Its include FT in North Africa Population.
The document discusses clinical decision support systems (CDSS) which are electronic tools that assist clinicians in making clinical decisions for patients. CDSS helps clinicians focus more on interacting with patients by providing clinical guidelines, recommendations, and diagnostic and prescribing support. While these systems can help with continuity of care, implementing them can also lead to confusion and lack of communication if not done properly. The aim is to compare the design and implementation of CDSS to assess diagnostic accuracy before and after its use in patient care.
Similar to Complete Medical Theories Disc.docx (20)
roles are largely complete when they hand an investigation.docxwrite4
This document outlines the responsibilities of investigators at different phases of a criminal investigation from initial response to a crime scene through trial preparation. It provides guidance to complete an assignment detailing the steps, procedures, best practices, legal obligations and potential pitfalls at each phase, including: processing the initial crime scene; gathering information and interviewing witnesses during the investigation; identifying, locating, apprehending and interrogating suspects; assembling the final report and presenting the case to prosecutors; and preparing evidence and testimony for prosecution and trial. The assignment criteria include describing responsibilities at each phase, examining relevant procedures, analyzing strategies, and citing references.
The military plays an important role in responding to domestic disasters by providing personnel, equipment, and logistical support. During 9/11 and Hurricane Katrina, fighter jets patrolled cities and the National Guard and Coast Guard conducted large-scale rescue operations. While the military is effective at disaster response, there are also debates around federalizing the National Guard, authorizing deadly force, and declaring martial law during relief efforts.
Role of telemedinine in disease preventions.docxwrite4
Telemedicine can play an important role in preventive medicine by allowing medical professionals to monitor patients remotely, collect health data over time, and intervene early if signs of disease emerge. However, the source material did not include a full research article describing a study on this topic. It only listed keywords and did not provide details on goals, methods, findings or impact. More information would be needed to fully evaluate telemedicine's role in prevention.
Digital tools like social media are increasingly used to influence public opinion, not just for advertising but also for legal and illegal political purposes. Researchers are asked to demonstrate an independent and mature analysis of how influence campaigns operate online, the tools and techniques they employ, their effectiveness, and how to counter them, discussing at what point such practices could go too far in western democracies.
The document provides instructions for a speech on the role of private security. The speech should:
1) Welcome the audience and introduce the purpose of discussing a security director's responsibilities.
2) Identify current challenges for security directors and possible solutions.
3) Discuss a director's roles in loss prevention, investigation, administration, and management.
4) Identify the critical skills needed for a director to succeed.
5) Discuss why internal and external relationships are important to meet security objectives and provide examples.
6) Conclude by summarizing and opening to questions.
Robbie a 12 year old is hospitalized for multiple.docxwrite4
Robbie, a 12-year-old boy, is hospitalized with terminal multiple myeloma. His mother rarely visits and does not engage with him when she does. Robbie's father refuses to acknowledge Robbie's terminal condition and demands further treatment. When Robbie asks the nurse if he is dying, the nurse must determine the most ethical way to respond while considering medical facts, the parents' wishes, and Robbie's right to know.
Robbins Network Services (RNS) is a company that provides network services. An audit plan is being created for RNS to analyze its business environment and determine what internal controls may be needed. The memo will evaluate RNS's internal controls by describing its major financial transactions, evaluating its highest business risks and supporting controls for the industry, and addressing ethical issues and current events that could impact financial audits.
The document provides guidance for writing a close reading analysis of a text excerpt from Robinson Crusoe. It advises analyzing specific quotes in detail over multiple sentences rather than a brief interpretation. For example, it suggests explaining the language techniques used in a quote that describes Crusoe's relationship with Friday, and analyzing how the quote reveals Crusoe's desire to control Friday despite using the metaphor of a parent-child relationship. The purpose of this close analysis is to provide concrete evidence and make insightful observations about the text that may not be obvious at first reading.
The document provides instructions for writing a literary analysis paper on the short story "The Rocking Horse Winner" by D.H. Lawrence. It prompts the reader to develop a three-part thesis question and use it to structure a three-part outline answering the question, with each part supported by evidence from the text. The outline should then be used to guide research finding additional sources to further support each part of the outline. Finally, the document instructs the writer to develop a rough draft and final draft of the paper following MLA formatting guidelines.
Rodrigo Diaz, known as El Cid, decided while in exile to remain loyal to King Alfonso and serve him if called upon, though he was willing to contradict the king if he felt Alfonso was wrong. The document asks if Rodrigo was right to maintain his loyalty to Alfonso over many years despite any mistreatment, or if he should have withdrawn support sooner given the king's imperfections.
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Nursing's role in decision making for selecting information systems is an important issue. Nurses should be involved in the decision making process to select systems that support the delivery of quality patient care and meet nursing workflow needs. Research shows nurse input is valuable for choosing systems that align with nursing practice and improve patient outcomes.
Samantha Chanel De Vera Posted Date Apr.docxwrite4
Weaning from mechanical ventilation should be considered when the disease prompting intubation has improved and daily screening for weaning potential is performed. Studies show most intubated patients should have scheduled spontaneous breathing trials following daily sedation breaks. For SBT, the patient must be alert, able to follow commands and breathe spontaneously, with stable oxygenation and hemodynamics before extubation. Daily SBT involves at least 30-120 minutes of breathing without ventilator support using an open breathing circuit or minimal pressure support. A successful SBT is when the patient can breathe without distress and their vital signs remain stable.
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Mr. Jackson presented with abdominal pain and other symptoms. Differential diagnoses included appendicitis, urinary calculus, and bowel perforation. Laboratory tests showed elevated white blood cells. A CT scan showed an enlarged cecum with a small fluid collection, consistent with acute appendicitis. This led to a diagnosis of appendicitis, ruling out the other differentials.
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The document discusses Lenin and Trotsky's visions for the Russian Revolution. It asks the reader to write a paper answering whether Lenin and Trotsky envisioned the revolution as a national or international project, and to what extent they framed it as a Russian enterprise versus a worldwide endeavor. The reader is instructed to support their response with evidence from assigned texts by Lenin and Trotsky addressing themes of exploitation, emancipation, and imperialism, and to properly cite any direct quotes or indirect references using author and page number.
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The document provides instructions for a paper assignment on the architectural history of the Ka'ba in Mecca, Saudi Arabia. Students are asked to write a 6 page paper that includes: an introduction, basic facts and history of the building, analysis of precedents and influences, 2 pages of original diagrams, and a conclusion. In addition to the written component, students must include 4 pages of existing images and 2 pages of original diagrams. They are expected to find at least 10 scholarly sources to cite and the final paper should be approximately 14 pages total. The goals of the assignment are to develop research, analysis, graphic, and writing skills related to architectural subjects.
The document discusses the tension between privacy rights and national security in the digital age. It notes that while civil liberties are highly valued, they sometimes conflict with safety concerns. New technologies now record people's activities more through cameras, smartphones, and other means. The assignment asks readers to analyze privacy versus security by addressing questions about which part of the Constitution protects privacy rights, whether those protections still apply today, and how courts have balanced privacy and security when national security issues arise.
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Richard Rodriguez, an immigrant writer, has received criticism from some immigrant activists. Two passages from his work convey attitudes that may explain this backlash. Specifically, his tone and ideas suggest perspectives on immigration that immigrant activists oppose.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
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International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
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An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
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Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
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In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Your Skill Boost Masterclass: Strategies for Effective Upskilling
Complete Medical Theories Disc.docx
1. Complete Medical Theories Disc (WALDEN)
Erin Christine Shankel, DNP, RN, FNP-BC and Linda G. Wofford, DNP, RN, CPNP Abstract:
Symptom Management Theory, developed by faculty at the University of California, San
Francisco, is a middle-range nursing theory which explains the interaction between
symptom experience, symptom management strategies, and outcomes. Successful
integration of the model into the emerging field of telemonitoring has the potential to
improve outcomes and lower costs associated with the management of chronic diseases.
Modifications to the model related to communication, feedback, and adherence may make it
more suitable for this application. Key Words: chronic disease, nursing theory, symptom
management theory, symptom assessment, telemedicine Symptom Management Theory as
a Clinical Practice Model for Symptom Telemonitoring in Chronic Disease A s chronic
disease and life expectancy continue to increase simultaneously, management of chronic
conditions will become increasingly burdensome in terms of both manpower and financial
costs. Now more than ever, creative strategies for the management of chronic diseases are
needed. The field of telemedicine is growing rapidly, and clinical practice models must
evolve to guide and support development of chronic disease management initiatives. The
aim of this article is to discuss the potential of Symptom Management Theory (SMT)
(Humphreys et al., 2014) to improve outcomes and lower costs associated with the
management of chronic diseases. The financial burden of chronic disease is staggering.
Currently, the percentage of U.S. dollars spent on chronic conditions is about 75% among
the general population (Harris & Wallace, 2012) and is closer to 95% among those over age
65 (Centers for Disease Control and Prevention, 2013) Among older adults, the percentage
who report having one or more chronic diseases rose more than 5% between 1998 and
2008, and that trend will likely continue (Dall et al., 2013). Furthermore, by 2050 the
number of Americans over 65 is expected to more than double to 89 million, compared to
40.5 million in 2010 (Dall et al., 2013). This growing population of older and sicker patients
is projected to lead to a 25% increase in health care Burden of Chronic Disease
expenditures by 2030 (Centers for Disease Control The prevalence of chronic diseases such
as osteoar- and Prevention, 2013). thritis, asthma, chronic obstructive pulmonary disease
The U.S. is ill-equipped to handle the financial [COPD], heart disease, hypertension,
depression, and burden of increasing medical costs, but the healthcare diabetes is on the
rise. Approximately half of all Ameri- field also lacks the manpower (Dall et al., 2013).
Lowcans have been diagnosed with at least one chronic er-cost methods of preventing and
managing chronic disease, and one in four has multiple chronic diseases conditions can be
2. found in lower-acuity settings, such (Ward, Schiller, & Goodman, 2014). The reason for as
primary care. However, fewer and fewer physicians this rapid increase is multifactorial. On
one hand, poor are choosing to go into primary care, and even increaslifestyle choices
abound. On the other hand, advances ing numbers of other clinicians (such as nurse practiin
medicine are contributing to greater life expectantioners [NPs] and physician assistants
[PAs]) cannot cies, giving genetic predispositions for disease more make up the gap. In the
U.S. only 35% of physicians time to come to fruition. are primary care providers (PCPs),
compared to 50% in other industrialized countries (Bodenheimer, et al., The Journal of
Theory Construction & Testing – 31 – Volume 20, Number 1 2009). Of note, most of these
countries with higher percentages of PCPs have better outcomes, lower costs, and better
access to care than what is seen in the U.S. Bodenheimer et al. (2009) suggest that there are
three ways that increased demand for low cost, lowacuity management of chronic diseases
can be met: specialty care, primary care, or multidisciplinary teams. Their extensive
research examined differences in the way chronic diseases are managed in specialty and
primary care settings. In the first scenario, specialists are uniquely equipped to manage
individual conditions, but they are more likely than generalists to order expensive
diagnostic tests unnecessarily (Bellinger et al., 2010). There are also well-documented
disparities in access to specialty care, especially among those living in rural areas and/or
with low incomes (Bellinger et al., 2010). If number of PCPs continue to dwindle, many
patients may be forced to seek routine care in specialty settings, thereby promoting a
steeper increase in medical expenditures and health disparities. Reliance on specialists
alone would reduce coordination of care and emphasis on health promotion typically found
in primary care (Bellinger et al., 2010). The second scenario, in which primary care fills the
gap, is more ideal but, as previously mentioned, current workforce trends do not suggest
this will be feasible. The third scenario would use a multidisciplinary team – made up of
physicians, NPs, PAs, registered nurses, pharmacists, and community health workers – to
address the needs of patients with chronic conditions. According to Friedman et al. (2014),
this option has potential to ease disease burden, improve outcomes, and reduce costs, but
successful implementation will require significant changes to the current health care
system. For instance, one of the most weighty barriers to implementation of team-based
care is reforming deeply held beliefs about traditional physician role and identity. Changes
required to convert the traditional healthcare system to a team-based system are
meritorious, but they will take time. A fourth option may exist. Telemonitoring, a field in
which technology is used to provide remote health care, could allow specialists, primary
care providers, and multidisciplinary teams to more efficiently manage symptoms of
chronic disease. Because collaborative management of chronic diseases places much of the
onus on patients to perform adequate self-care between visits (Estes, 2008), remote
communication with providers is sometimes necessary. For example, a patient who has
asthma might see his NP every six months for routine evaluation, but within that interval he
will likely experience recurring and remitting respiratory symptoms related to many
factors, including oral health (Estes, 2010). Telemonitoring can provide a method by which
patients’ self-care strategies are guided by interactive communication with providers,
allowing patients like this one to receive immediate input about appropriate management
3. options. The Journal of Theory Construction & Testing Telemedicine and Telemonitoring of
Chronic Diseases Telemonitoring is a subset of telemedicine. Telemedicine is defined as “the
use of medical information exchanged from one site to another via electronic
communications to improve a patient’s clinical health status” (American Telemedicine
Association, n.d.). The field is relatively new and much has yet to be discovered, but
emerging research shows great potential. A 2015 review of literature (American
Telemedicine Association, 2015) shows that high quality, cost-effective care can be
delivered through telemedicine while also achieving high rates of patient satisfaction. While
telemedicine is a term that can broadly be used to describe any sort of direct patient care
(including diagnosis, treatment, or consultation) that occurs via technology for patients at a
distance, telemonitoring is understood more narrowly as using telecommunication
technologies to remotely monitor data about patient status (Pare, Jaana, & Sicotte, 2007).
Both objective and subjective data can be telemonitored. Objective data, like blood glucose
readings, vital signs, and weight, are easily measured by patients from home and
transmitted via phone, SMS messages, Smartphone applications, or computer. Similarly,
subjective symptoms can be tracked and transmitted from patients to health care providers.
Because symptoms are the most common reason patients seek healthcare (Lee &
Miaskowski, n.d.), an acceptable alternative method of managing symptoms might eliminate
the need for some of these costly visits. Telemonitoring could potentially provide guided
self-management of symptoms, thereby reducing unnecessary resource utilization. The full
implications of symptom telemonitoring are not yet known, but so far it appears that
“remote patient monitoring that tracks vital signs of patients with chronic diseases is
offering more-frequent contact between the patient and the primary care provider,
providing earlier detection of potential problems, and allowing real-time alerts, resulting in
a proactive, affordable option for bestpractice health care” (Schwartz & Britton, 2011, p.
216). Telemonitoring has the potential to offer patients a more active and immediate role in
managing their health. When a patient experiences symptoms—for example, wheezing—
telemonitoring permits him to share those symptoms with his provider in real time. The
role of the provider is to suggest symptom management strategies (e.g., a nebulizer
treatment), and the role of the patient is to then implement the recommended strategies as
he sees fit. Continued telemonitoring can help providers evaluate ongoing symptom status
outcomes, such as reductions in coughing or wheezing. These steps – communication of a
symptom experience, recommendation of symptom management strategies, and evaluation
of outcomes – make up the three conceptual domains of SMT. This pro- – 32 – Volume 20,
Number 1 cess of experiencing and reporting symptoms, seeking management, and
evaluating outcomes is familiar, as it frequently happens in traditional face-to-face patient
encounters. Telemonitoring, however, changes the timing and context of these steps, and
may alter the way SMT is understood. Overview of SMT Most published telemonitoring
interventions do not use any documented behavioral change theories, clinical guidelines, or
assessment tools to inform their design (Al-Durra, Torio, & Cafazzo, 2015). Many articles
that do include theoretical frameworks use theories such as the Transtheoretical Model,
which focus on patient motivation and behavior (Battaglia, Benson, Cook, & Prochazka,
2013; Finkelstein & Cha, 2009; Tabak, et al., 2012). While these articles are helpful in
4. understanding the diffusion and adoption of telemonitoring systems, there is a paucity of
clinical practice models and theoretical frameworks addressing adherence and
communication with telemonitoring. SMT (Dodd et al., 2001; Humphreys et al., 2008;
Humphreys et al., 2014) may be useful in filling this gap. SMT (Dodd et al., 2001;
Humphreys et al., 2008; Humphreys et al., 2014) was originally introduced by the nursing
faculty at University of California, San Fransisco (UCSF) in 1994, was updated in 2001, and
again in 2008. (See Figure 1.) The model development was a collaborative effort,
incorporating the expertise of faculty with diverse experience in managing symptoms of
chronic diseases such as heart disease, diabetes, cancer, COPD, and chronic pain. It is a
deductive, middle range theory describing three simultaneously interactive factors within
the domain of nursing care (Humphreys et al., 2008). These three main factors are symptom
experience, symptom management strategies, and symptom status outcomes (See Figure 1).
Each of these domains is connected to the others with bidirectional arrows, symbolizing the
mutual interaction of each factor with both of the other factors. Additionally, a broken
bidirectional arrow between symptom management strategies and outcomes labeled
“adherence” exists to show the risk of nonadherence that occurs at this stage. The model
has been described extensively elsewhere (Humphreys et al., 2014), but this article will
briefly summarize the essential points. The commonly acknowledged starting point of the
model is the symptom experience component. Here the patient perceives, evaluates, and
responds to symptoms. Examples could include wheezing, as used in a previous example, or
a multitude of other symptoms, such as anxiety, headache, joint pain, or insomnia. Figure 1.
Symptom Management Model. Reprinted from “Advancing the Science of Symptom
Management,” by M. Dodd, S. Janson, N. Facione, J. Faucett, E. S. Froelicher, J. Humphreys, K.
Lee, C. Miaskowski, K. Puntillo, S. Rankin, and D. Taylor, 2001, Journal of Advanced Nursing,
33(5), 668-676. Copyright 2001 by Blackwell Science Ltd. Reprinted with permission. The
Journal of Theory Construction & Testing – 33 – Volume 20, Number 1 Figure 2. Newcomb’s
Spiral Symptom Management Model. Environment Person Health Symptom experience
communication Symptom management adherence Outcomes feedback Reprinted from
“Using Symptom Management Theory to Explain How Nurse Practitioners Care for Children
with Asthma,” by P. Newcomb, 2010. Journal of Theory Construction & Testing, 14(2), 40-
44. While patients’ perceptions are extremely valuable, the meanings patients assign to
their symptoms occasionally lead to ill-timed or inappropriate symptom management
strategies. For instance, a person who is wheezing may not perceive his symptoms as severe
enough to seek treatment until the wheezing is so acute that it becomes necessary to go to
the emergency room. Janson and Becker (1998) described this phenomenon in an article
showing that, among patients with asthma, two of the most common reasons that patients
delay seeking care during an acute exacerbation are the concepts of “minimization” and
“uncertainty”. Minimization refers to under-recognition of an asthma episode’s severity,
while uncertainty refers to a patient’s ambiguity about how to interpret a symptom’s
meaning or what to do about it. Because patients suffering from chronic condition often
deal with recurring and remitting symptoms for long stretches of time between health care
visits, patients are left to interpret their symptoms through the lens of their own lay
knowledge and past experience. Not surprisingly, this interpretation affects how and when
5. they progress to the next phase of the model, symptom management strategies. During the
second stage of symptom management strategies, an intervention may be performed.
According to Humphreys et al. (2014), the goal of The Journal of Theory Construction &
Testing Symptom experience symptom management is to “avert, delay, or minimize the
symptom experience” (p. 144). However, because patients may delay seeking advice and
treatment due to issues like minimization or uncertainty, the invasiveness, risk, cost, and
potential success of the symptom management strategy varies accordingly. Using the
example of asthma, if a patient delays seeking treatment for early signs of an exacerbation,
what could have been managed conservatively through increased inhaled corticosteroid
doses often progresses to a need for oral corticosteroids, emergency room visits, and
hospitalizations. Authors of the model agree that more research is needed regarding how to
deal with the issue of timeliness of patient-initiated strategies (Dodd et al., 2001). Dodd et
al. (2001) assert that the type of intervention should be specific to the symptom and should
be guided by current evidence within the field. This expectation is problematic in patients
who have chronic diseases because they may be using symptom management strategies
that are not evidence-based. Patients rely on information from their health care providers,
and from family, friends, media, and the internet (Humphreys et al., 2014), especially when
communication with providers does not occur between visits. There is increasing emphasis
placed on shifting the responsibility for chronic disease symptom – 34 – Volume 20,
Number 1 management to the individual patient (Humphreys et al., 2014), rightly affirming
value of the patient’s own lived experience and self-knowledge. However, aligning the
patient’s experience and self-awareness with the provider’s medical knowledge can only
strengthen the accuracy of the patient’s interpretation of his symptom experience.This
partnership between patient and provider can improve the efficacy of symptom
management strategies. Multiple studies have shown that this type of collaboration, known
as “informed self-monitoring” improves health outcomes (Janson & Becker, 1998; Janson et
al. 2003, 2010, 2009). During stage three of the model, the symptom experience and
symptom management strategies lead to symptom status outcomes, which can then go on to
subsequently influence future symptom experience and, in turn, symptom management
strategies. Outcomes can include quality of life, self-care, morbidity and comorbidy,
mortality, functional status, emotional status, and direct and indirect costs (Dodd et al.,
2001). For patients with chronic diseases, symptom experiences and evidence-based
symptom management strategies may not immediately or obviously result in improved
symptom status outcomes. For example, it may not be obvious to the hypertensive patient
that daily adherence to prescribed medication is associated with gradual improvement in
such blood pressure-related symptoms as headaches or blurred vision. Unless strategies are
employed to assist patients to make these connections, positive symptom management
strategies producing gradual clinical improvements may not be reinforced. Newcomb’s
Modifications to the SMT Model Newcomb (2010) suggested an alteration to the SMT model
in which communication and feedback were explicitly described as conceptual links
between the model components symptom experience, symptom management strategies,
and symptom status outcomes. (See Figure 2.) Communication, positioned between
symptom experience and symptom management strategies in the model, emphasizes the
6. bidirectional exchange of information between a patient’s experience of symptoms and his
attempts at symptom management, which may involve the patient’s health care provider
and/or family members. For example, Newcomb (2010) used this communication concept
to explain the unique ways children and parents collaborate first to perceive and interpret
asthma symptoms and then to respond. However, competing demands and limited access to
care can negatively impact the patient’s likelihood of initiating communication with
providers, and unfortunatly, in an outpatient setting, unscheduled communication relies
upon the patient or parents taking initiative. The UCSF faculty who developed the model
agree that “providers must establish and maintain good patient-provider communication if
they are to understand their patient’s symptom perception, The Journal of Theory
Construction & Testing accept symptom experience, and implement management
strategies” (Humphreys et al., 2014, p. 155). Newcomb’s modified model makes the
communication concept more explicit. The second concept Newcomb (2010) adds to the
original SMT model is feedback. Feedback explains how patients evaluate the efficacy of
their symptom management strategies in terms of their resulting health outcomes.
Feedback refers to the patient’s receipt of information concerning whatever disease process
is underlying the symptoms of interest, and this information can help the patient notice
connections between the symptom experience and outcomes. For example, if a patient with
uncontrolled asthma was prescribed a new daily controller medication and then returned to
the clinic two weeks later stating, “I don’t think it makes much difference. I think I’m going
to stop using it”, he could benefit from feedback. Appropriate feedback might include a
comparison of a symptom survey completed during the current visit compared to one
completed two weeks ago. If self-reported scores improved during the two-week interval,
that information could inform the patient of gradual changes in his symptom experience
that he may not have noticed on his own. Access to feedback can help patients make
informed decisions about adherence, which can subsequently affect outcomes. When
selfmanagement strategies result in improved symptom status outcomes, the successful
strategies are likely to be repeated. As already discussed, some outcomes may not be
immediately noticeable to patients with chronic diseases, which causes a breakdown in the
SMT model at the point of feedback. Application of the SMT Model to Telemonitoring
Telmonitoring technologies such as electronic logs, text messaging, and interactive
SmartPhone apps can empower patients to track their symptoms, receive immediate
feedback, and manage their chronic disease symptoms more effectively. Because of this
cyclical process, the SMT model, which has been useful in a multitude of other clinical
settings, shows promise within the field of telemonitoring. The model has gained particular
acceptance in a few pockets of clinical practice such as oncology (Baggott, Cooper, Marina,
Matthay, & Miaskowski, 2012; Cherwin, 2012; Steel et al., 2010) and cardiology (DeVon,
Ryan, Rankin, & Cooper, 2010; Hwang, Ahn, & Jeong, 2012; Jurgens et al., 2009; McSweeney,
Cleves, Zhao, Lefler, & Yang, 2010; Riegel et al., 2010). Health professionals within the
disciplines of cancer and cardiac care may gradually become familiar with the theory
through reading current literature relevant to their specialty. Likewise, those blazing trails
in the field of telemonitoring must be exposed to SMT through reading about successful
applications to their practice. – 35 – Volume 20, Number 1 Usefulness of SMT in the
7. emerging field of telemonitoring has been explicitly addressed in only one article. In 2009,
SMT was used as the framework for studying the effect of telehealth intervention on
physical activity and functioning in patients who had recently undergone coronary artery
bypass surgery (Barnason, Zimmerman, & Schulz). The intervention was a 6-week symptom
management tool that was connected to the participants’ telephones. Participants
responded to assessment questions, and received management strategies based on their
reported symptoms. In this way, the patients’ symptom perceptions were immediately
addressed by electronic symptom telemonitoring devices), with an expectation of
improving outcomes related to activity and functioning. Comparing the telemonitoring
group with the usual care group yeilded a significant main effect (F[1,209]= 4.66, p