V O L U M E 3 4 , N U M B E R 4 , F A L L 2 0 1 6 187
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Nurse Practitioner Perceptions of a Diabetes Risk Assessment Tool in the Retail Clinic Setting Kristen L. Marjama, JoAnn S. Oliver, and Jennifer Hayes
Diabetes is the seventh leading cause of death in the United States, burdening society with
high costs for treatment and placing increased demand on the health care system (1). According to the 2014 National Diabetes Statistics Report, an estimated 29.1 million people in the United States have diabetes, and 8.1 million of them are undiagnosed (2). The lack of screening for early identification of patients at risk for type 2 diabetes is a significant clin- ical problem. Health care providers (HCPs) need to be aware of the in- creasing diabetes burden and to pri- oritize the screening of patients who may be at risk. Screening for risk can aid in both efforts to prevent the development of diabetes and early management of the disease to reduce complications. Clinical trials have demonstrated that type 2 diabetes can be delayed or prevented through life- style modification or pharmacother- apy for people at increased risk (3).
In order to reduce risk for those at risk of developing diabetes, screen- ing is a priority that will raise patient
awareness. Many patients are not aware of their risk for type 2 dia- betes until they receive a confirmed diagnosis from their HCP. There are numerous health care settings in which screenings can be imple- mented, including but not limited to primary care practices, urgent care centers, hospital emergency depart- ments, and retail health clinics.
Retail clinics are located in retail supermarket and pharmacy chains to provide high-quality, affordable, and easily accessible health care services for communities. A true measure of quality in retail clinics is their degree of adherence to several measures iden- tified in the Healthcare Effectiveness Data and Information Set (4). Services in this type of setting may include treatment of acute episodic conditions, physical examinations, vaccinations, health screenings, and prevention and management of chronic conditions (5). Retail clinics provide services to patients with or without insurance or a primary care “home.†Patients’ visits to a retail clinic afford the opportunity to assess
■IN BRIEF This article describes a study to gain insight into the utility and perceived feasibility of the American Diabetes Association’s Diabetes Risk Test (DRT) implemented by nurse practitioners (NPs) in the retail clinic setting. The DRT is intended for those without a known risk for diabetes. Researchers invited 1,097 NPs working in the retail clinics of a nationwide company to participate voluntarily in an online questionnaire. Of the 248 NPs who sent in complete responses, 114 (46%) indicated that they used the DRT in the clinic. Overall mean responses from these NPs indicated that they perceive the DRT as a feasible tool in the retail cli.
This document discusses approaches to personalizing quality measurement in healthcare. It outlines three fundamental approaches:
1) Integrating patient-reported outcome and experience measures (PROMs and PREMs) into clinical workflow to better capture patients' health status and perspectives.
2) Encouraging patients' and clinicians' joint generation of medical records, such as through the OpenNotes project, to improve patient engagement, communication, and safety reporting.
3) Measuring decision quality through shared decision making between clinicians and patients to respect patient autonomy and better account for individual risk-benefit preferences in medical decisions. The document argues for rapidly adopting these personalized approaches and incentivizing their use through payment reform.
Clinical practice guidelines and quality metrics often emphasize effectiveness over patient-centered care. In this article, the authors offer three approaches to personalizing quality measurement to ensure patient preferences and values guide all clinical decisions.
Learning from marketing rapid development of medication messages that engage...LydiaKGreen
The document describes a study that partnered healthcare researchers with advertising professionals to develop advertising-style messages to encourage patients with chronic kidney disease to discuss medication options with their doctors. They aimed to assess the feasibility of this partnership approach and test whether the messages would be acceptable and effective. The teams created 11 initial messages, tested them with patients and doctors via surveys, refined 5 messages, and conducted focus groups to identify the 3 most persuasive messages. Focus group feedback suggested the approach could be acceptable if used to support patient-provider relationships and had an evidence base, and that messages were more motivating if they elicited personal identification and clear understanding.
Patient-centered pharmacovigilance represents a pivotal shift in the landscape of healthcare, emphasizing the active involvement of patients in the monitoring and reporting of adverse drug reactions. Unlike traditional pharmacovigilance, which primarily relies on healthcare professionals to identify and document adverse events, this approach recognizes patients as critical stakeholders in ensuring medication safety. By empowering patients to share their experiences, concerns, and observations regarding medication effects, whether positive or negative, healthcare systems can gain a comprehensive understanding of drug safety and efficacy in real-world settings. Patient-centered pharmacovigilance fosters a collaborative partnership between patients, healthcare providers, and regulatory agencies, promoting transparency, accountability, and ultimately, better patient outcomes. Through increased patient engagement and the utilization of patient-reported data, this approach enables healthcare systems to identify potential safety issues earlier, tailor treatment strategies to individual needs, and enhance overall drug safety surveillance efforts.
My talk at the Scientific Research Day of Medical colleges, UQU
5 March 2019
where I presented my publication (Patient-Centered Pharmacovigilance: A review)
The document discusses efforts by the US Department of Health and Human Services (HHS) to address the growing challenges posed by multiple chronic conditions. HHS released a 2010 strategic framework with 4 goals: 1) foster health system changes like accountable care organizations and medical homes, 2) empower individuals through self-management programs, 3) equip clinicians with guidelines and training, and 4) enhance research. Since then, HHS has made progress in areas like expanding self-management programs, testing new care models, establishing payments for non-face-to-face care management, and increasing focus on comorbidities in clinical trials and guidelines. However, more accelerated efforts are still needed across all goals to better meet the needs of the growing multiple
This document discusses regulatory inefficiencies surrounding companion diagnostics and laboratory developed tests (LDTs) in the United States. It uses the case study of Genentech's drug MPDL3280A and its companion diagnostic to show that the FDA thoroughly regulates companion diagnostics but provides no oversight of clinical validity for LDTs. This allows multiple competing diagnostic tests to be used without proof of efficacy. The document also compares healthcare systems and technology assessment processes in the US, UK, and France to illustrate decentralized decision making in the US compared to centralized bodies in other countries.
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 document discusses approaches to personalizing quality measurement in healthcare. It outlines three fundamental approaches:
1) Integrating patient-reported outcome and experience measures (PROMs and PREMs) into clinical workflow to better capture patients' health status and perspectives.
2) Encouraging patients' and clinicians' joint generation of medical records, such as through the OpenNotes project, to improve patient engagement, communication, and safety reporting.
3) Measuring decision quality through shared decision making between clinicians and patients to respect patient autonomy and better account for individual risk-benefit preferences in medical decisions. The document argues for rapidly adopting these personalized approaches and incentivizing their use through payment reform.
Clinical practice guidelines and quality metrics often emphasize effectiveness over patient-centered care. In this article, the authors offer three approaches to personalizing quality measurement to ensure patient preferences and values guide all clinical decisions.
Learning from marketing rapid development of medication messages that engage...LydiaKGreen
The document describes a study that partnered healthcare researchers with advertising professionals to develop advertising-style messages to encourage patients with chronic kidney disease to discuss medication options with their doctors. They aimed to assess the feasibility of this partnership approach and test whether the messages would be acceptable and effective. The teams created 11 initial messages, tested them with patients and doctors via surveys, refined 5 messages, and conducted focus groups to identify the 3 most persuasive messages. Focus group feedback suggested the approach could be acceptable if used to support patient-provider relationships and had an evidence base, and that messages were more motivating if they elicited personal identification and clear understanding.
Patient-centered pharmacovigilance represents a pivotal shift in the landscape of healthcare, emphasizing the active involvement of patients in the monitoring and reporting of adverse drug reactions. Unlike traditional pharmacovigilance, which primarily relies on healthcare professionals to identify and document adverse events, this approach recognizes patients as critical stakeholders in ensuring medication safety. By empowering patients to share their experiences, concerns, and observations regarding medication effects, whether positive or negative, healthcare systems can gain a comprehensive understanding of drug safety and efficacy in real-world settings. Patient-centered pharmacovigilance fosters a collaborative partnership between patients, healthcare providers, and regulatory agencies, promoting transparency, accountability, and ultimately, better patient outcomes. Through increased patient engagement and the utilization of patient-reported data, this approach enables healthcare systems to identify potential safety issues earlier, tailor treatment strategies to individual needs, and enhance overall drug safety surveillance efforts.
My talk at the Scientific Research Day of Medical colleges, UQU
5 March 2019
where I presented my publication (Patient-Centered Pharmacovigilance: A review)
The document discusses efforts by the US Department of Health and Human Services (HHS) to address the growing challenges posed by multiple chronic conditions. HHS released a 2010 strategic framework with 4 goals: 1) foster health system changes like accountable care organizations and medical homes, 2) empower individuals through self-management programs, 3) equip clinicians with guidelines and training, and 4) enhance research. Since then, HHS has made progress in areas like expanding self-management programs, testing new care models, establishing payments for non-face-to-face care management, and increasing focus on comorbidities in clinical trials and guidelines. However, more accelerated efforts are still needed across all goals to better meet the needs of the growing multiple
This document discusses regulatory inefficiencies surrounding companion diagnostics and laboratory developed tests (LDTs) in the United States. It uses the case study of Genentech's drug MPDL3280A and its companion diagnostic to show that the FDA thoroughly regulates companion diagnostics but provides no oversight of clinical validity for LDTs. This allows multiple competing diagnostic tests to be used without proof of efficacy. The document also compares healthcare systems and technology assessment processes in the US, UK, and France to illustrate decentralized decision making in the US compared to centralized bodies in other countries.
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.
Predicting Patient Interest and Participation in Clinical TrialsNassim Azzi, MBA
- A meta-analysis of survey data from over 21,000 patients with chronic conditions found several key factors that influence patient interest and participation in clinical trials.
- Health condition, age, gender, dissatisfaction with current treatment, patient-physician engagement, concerns about costs, and awareness of new treatments in development were significant predictors of interest in clinical trials.
- Additionally, having previously participated in a clinical trial, especially for one's own health condition, was a strong indicator that a patient would be willing to participate in future clinical research if eligible.
The document discusses diagnostic error in healthcare. It begins by noting that inaccurate diagnoses, incorrect treatments, and lack of diagnoses contribute to unnecessary costs, inefficiency, and patient dissatisfaction. Improving diagnostic accuracy can help achieve quality, control costs, and increase patient satisfaction. The document then discusses:
- The high incidence of diagnostic errors, which result in tens of thousands of deaths per year and enormous financial tolls.
- Evidence that diagnostic errors commonly cause patient harm and occur across primary care, inpatient, and outpatient settings.
- An innovative solution of independent virtual second opinions to address diagnostic errors by improving accuracy and ensuring appropriate treatment.
A study on drug utilisation evaluation of Bronchodilators using defined daily...Dr. Afreen Nasir
Conference proceeding: Nasir A. A study on drug utilisation evaluation of Bronchodilators using a defined daily dose method. Pharmacy Education Journal [Internet]. 2023 Aug;23(5):23–24. Available from: https://doi.org/10.46542/pe.2023.235.138
1) A meta-analysis of survey data from over 21,000 patients with chronic conditions found several key factors that influence patient interest and participation in clinical trials.
2) Health condition, age, gender, treatment satisfaction, awareness of new treatments, and the patient-physician relationship were found to impact a patient's likelihood of interest in clinical trials.
3) In addition to interest, prior clinical trial participation, health condition, treatment satisfaction, and concerns about cost also predicted a patient's actual likelihood of enrolling in future clinical trials if eligible.
Impact of Telephone-Based Chronic Disease Program on Medical Expenditures_Pop...David Cook
1) The study evaluated the impact of a telephone-based chronic disease management program on medical expenditures using claims data from over 126,000 health plan members, comparing expenditures of those enrolled in the program to those not enrolled.
2) A random effects regression model controlling for risk factors found that participation in the program was associated with average annual savings of $1,158 per member.
3) Savings increased the longer members participated in the program, supporting the cost-effectiveness of telephone-based chronic disease self-management in reducing healthcare expenditures.
The document discusses a report from the NGA that acknowledges pharmacists' scope of practice is restricted by state laws and encourages classifying pharmacists as health care providers to maximize pharmacy services. It summarizes that the report encourages states and private entities to expand what pharmacist services are covered by insurance, state employee health plans, health information exchanges, and Medicaid to allow pharmacists to practice at the full extent of their training.
This study evaluated a comprehensive diabetes management program within a managed care organization that included risk stratification of patients and social marketing approaches. Over 12 months, the program resulted in improved glycemic control as measured by an increase in the number of patients in the low-risk HbA1c category. The majority of high-risk patients had changes made to their treatment regimens. Other clinical measures like blood pressure and LDL cholesterol also improved. Patients and providers reported greater satisfaction with the program. The risk stratification and intervention approach was successful in initiating recommended treatment changes and improving diabetes outcomes and satisfaction.
This document discusses opportunities to empower patients and reduce demand on the UK National Health Service (NHS) through patient education. It identifies four key areas along the patient journey that could be improved: 1) healthcare education; 2) healthcare information; 3) healthcare provision; and 4) healthcare involvement. It then provides seven recommendations to better empower patients in these areas, such as providing compulsory health education in schools, regulating health information online through an NHS accreditation system, training non-traditional community healthcare experts, and creating mobile apps and tools to help patients manage their conditions. The overall aim is to improve health literacy and help patients better navigate the healthcare system, with the goal of reducing unnecessary demand on NHS services.
Polypharmacy resource_JAN 15_NINA BARNETTZeshan Ahmed
This document provides resources to support the management of polypharmacy and deprescribing. It begins with an overview of key terms such as polypharmacy, oligopharmacy, and deprescribing. It then discusses the increase in polypharmacy among older adults and some of the risks associated with inappropriate polypharmacy. The document is structured to provide background information on polypharmacy, tools and initiatives to support practice, and references. It aims to assist healthcare professionals with medication reviews and decisions around deprescribing for patients taking multiple medications.
This study compared information on medication use and drug-related problems (DRPs) obtained via a patient questionnaire versus a patient interview. 97 patients aged 65+ years with polypharmacy or geriatric problems completed the questionnaire and were then interviewed. There was 87.6% agreement between the questionnaire and interview for reported medications. More medications and DRPs were reported in interviews than questionnaires. Agreement on complete medication lists was 45.4% of patients. Vulnerable patients with many chronic diseases or medications showed lower agreement. The questionnaire provided reasonably similar but not identical information as interviews and may be suitable for medication reviews in most patients.
The document discusses health literacy as it relates to medication and the use and delivery of healthcare. It analyzes reports from the National Academies of Sciences on these topics. For medication, it describes progress made in standardizing drug labels but notes more is needed. It also discusses using technology like apps and electronic records to promote health literacy. For healthcare delivery, it highlights the importance of health literacy in reducing complexity and disparities. While policies have helped, stronger communication skills are still required. The document proposes a case study on screening for low health literacy using the Newest Vital Sign assessment tool to test hypotheses about time and cost constraints.
This paper examines the opportunities and benefits of using apps to help manage diabetes, as well as limitations and concerns. Apps can help patients track key areas of care, enable personalized self-management through data sharing with providers, and provide decision support. However, many apps focus only on parts of care and few use evidence-based practices or offer comprehensive education. After analyzing the top diabetes apps against criteria for effective features, the author concludes that Diabetes App is currently the best option due to its coverage of important data areas and education. Overall, apps show promise for improving outcomes but development needs to address gaps versus clinical guidelines.
Real world Evidence and Precision medicine bridging the gapClinosolIndia
Real-world evidence and precision medicine represent complementary forces reshaping the healthcare landscape. The synergy between these realms offers a pathway to more personalized, effective, and patient-centered care. As technology, data analytics, and collaborative initiatives advance, the integration of real-world evidence into precision medicine practices holds the promise of revolutionizing how healthcare is delivered, ensuring that treatments are not only scientifically sound but also tailored to the unique characteristics and experiences of individual patients.
Patient engagement in clinical trials Martin Kelly
The document discusses improving patient engagement in clinical trials through digital methods. Only 2-5% of cancer patients currently participate in clinical trials. The top 3 solutions identified to engage patients were: 1) a clinical trial finder for patients to inform them of available trials, 2) virtual clinical trials conducted entirely online, and 3) tools to personalize clinical trials to individual patient needs/preferences. The document reviews several companies providing these types of solutions and proposes an experiment partnering with a CRO to test if a digital intervention increases patient enrollment and retention in a clinical trial compared to a control group without a digital intervention.
The AHSN Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing Problematic Polypharmacy in Haringey Care Homes, can be viewed here.
For more information about the polypharmacy programme, please visit https://www.ahsnnetwork.com/programmes/medicines/polypharmacy/
This policy brief discusses strategies to increase patient engagement in their own healthcare. It outlines three key areas: improving health literacy, promoting shared decision-making, and supporting self-management of chronic conditions. Effective interventions include providing tailored written and online health information, training healthcare professionals in communication skills, using decision aids and question prompts, and delivering self-management education programs. Governments need a coherent strategy targeting multiple levels to inform and empower patients in their care.
The document discusses strategies to increase patient engagement in their own healthcare. It outlines three key areas: improving health literacy, promoting shared decision-making, and supporting self-management of chronic conditions. Effective interventions include providing tailored written and online health information, training healthcare professionals in communication skills, using decision aids and question prompts, and delivering self-management education programs. Governments need a coherent strategy targeting multiple levels to inform and empower patients in their care.
Population health management real time state-of-health analysispscisolutions
To lower health costs, physician networks and medical homes must employ a closed loop population management program that focus on patient SOH stratification, chronic disease management, care coordination and incentive management. This approach will enable them to consistently reduce ER and inpatient admissions, which are the greatest expenditures in health care today.
The Combined Predictive Model final report describes a new predictive model that was developed using data from multiple sources, including inpatient, outpatient, emergency room, and primary care records. This model segments patients into risk levels and can help the NHS target interventions appropriately based on patients' predicted risk levels. It improves on previous models by identifying a broader range of at-risk patients and allowing for stratified approaches along the continuum of care. The report concludes the model can help design long term condition programs that match intervention intensity to patients' needs.
Unit VII Assignment IntroductionThe Nature vs- Nurture debate is a lon.docxkdennis3
Unit VII Assignment
Introduction
The Nature vs. Nurture debate is a long-standing controversy over whether human behavior is primarily determined by genetics (Nature) or by environmental factors (Nurture). The proponents of the nature vs. nurture argument for serial killers would contend that these individuals are born with particular tendencies or traits that cause them to commit horrible deeds. Lack of empathy, impulsivity and a propensity for violent action are a few of these predispositions. The argument put out by the opponents of the idea is that serial killers have innate traits and features that predispose them to crime. This encompasses a lack of compassion, guilt, and fear of the repercussions. This argument is particularly pertinent when considering the actions of serial killers, as some specialists argue that they are predisposed to violence from birth. Others, on the other hand, contend that environmental variables, including a traumatic upbringing, can contribute to developing aggressive impulses. The arguments in favor of nature are the genetic similarities among serial killers and the fact that some serial killers have a family history of mental illness. They would also emphasize that some serial killers have a history of mental illness, which genetic causes may bring on. Additionally, proponents of the "nature" camp would contend that even if serial killers are exposed to certain environmental variables, like a lack of parental supervision or violent media, these elements do not sufficiently explain serial killer behavior. The opposite viewpoint asserts that some serial killers have a hereditary propensity for aggression and violence, which increases their likelihood of becoming serial murderers. According to the Con side, a person's surroundings and upbringing can influence their development and conduct, but they do not necessarily turn them into serial killers. However, it might also intensify already present inclinations or trigger the emergence of certain antisocial behaviors. Genetics or environment alone cannot explain a serial killer's motivation, but a combination of the two may be able to. Serial killers are distinct individuals, moulded by their remarkable experiences, circumstances, and mindsets beyond a few basic qualities.
The Literature Review
The contentious argument regarding the causes of serial killers' behavior—their nature or nurture—will be examined in this literature review. The numerous hypotheses underlying the emergence of serial killers will be examined, along with the arguments for and against each hypothesis. It will also consider how these theories might affect society and law enforcement. This review will also discuss how comprehending this controversy might improve crime prevention measures. Ultimately, this analysis will summarize the numerous hypotheses and viewpoints concerning the controversy over the nature versus nurture factors in serial killers.
A brief look at the histological persp.
Unit VI Project Government Funding1Unit VI Project Government Fundin.docxkdennis3
Unit VI Project – Government Funding
Unit VI Project – Government Funding
Unit VI Project – Government Funding
The government of the United States is involved in different types of programs for society's well-being. One government funding program to help small businesses is the United States small business administration. If a person has a small business that is engaged in scientific development and research, then a person can qualify for a government grant under small business technology transfer and small business innovation research. The program has not filed for bankruptcy yet, and it’s been helping many new businesses establish their position in the industry (Marks, 2022).
After COVID-19, the government has been proposing new schemes and grants for small businesses 7nder the American Rescue Plan Act. In 2022, the government announced that it would distribute more than $10 billion to each state. In 2020, the government spent around $76 billion. While in 2021, the government spent approximately $41 billion. This shows that government spending on small businesses has increased over the last three years (Milano, 2013). The analysis shows that federal agencies get funding for small business from Congress called budgetary resources. Agencies are required to spend these budgetary resources bases on the promise, also known as an obligation. In 2022, the government had $21.24 billion in award obligations for small businesses, the number of transactions that happened was around 1.25 million, and the niner of new awards was estimated to be 352,676.
The analysis shows that COVID-19 greatly impacted small and medium enterprises. To help small businesses, the government support programs played a critical role in managing the crisis. There are multiple programs to help support small companies, such as the Pay Protection Program, with 5.2 million loans for small businesses. The SBA economic injury disaster loan program added around 3.6 million for small business loans valued at more than 91 billion dollars (SBA, 2022).
Small businesses play a significant role in the economy of the countries, or it can be said that it act as the backbone of the community. So, by funding small business activities, the government of the United States has also benefited through business activities in the SME sector. The entire idea was to help small businesses by giving them an investment in hand, which would not have been possible through traditional lenders. The impact on the government funding for small companies is also beneficial for the government because of local tax income, employment tax, and property tax. More businesses in the United States economy boost the government's tax income (Marks, 2022). So, it can be said that the government of the United States recognizes the importance of small businesses and helping them after COVID-19 lockdowns to ethically source taxes from them.
The biggest challenge to helping small businesses after COVID-19 is the war in Ukraine.
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Predicting Patient Interest and Participation in Clinical TrialsNassim Azzi, MBA
- A meta-analysis of survey data from over 21,000 patients with chronic conditions found several key factors that influence patient interest and participation in clinical trials.
- Health condition, age, gender, dissatisfaction with current treatment, patient-physician engagement, concerns about costs, and awareness of new treatments in development were significant predictors of interest in clinical trials.
- Additionally, having previously participated in a clinical trial, especially for one's own health condition, was a strong indicator that a patient would be willing to participate in future clinical research if eligible.
The document discusses diagnostic error in healthcare. It begins by noting that inaccurate diagnoses, incorrect treatments, and lack of diagnoses contribute to unnecessary costs, inefficiency, and patient dissatisfaction. Improving diagnostic accuracy can help achieve quality, control costs, and increase patient satisfaction. The document then discusses:
- The high incidence of diagnostic errors, which result in tens of thousands of deaths per year and enormous financial tolls.
- Evidence that diagnostic errors commonly cause patient harm and occur across primary care, inpatient, and outpatient settings.
- An innovative solution of independent virtual second opinions to address diagnostic errors by improving accuracy and ensuring appropriate treatment.
A study on drug utilisation evaluation of Bronchodilators using defined daily...Dr. Afreen Nasir
Conference proceeding: Nasir A. A study on drug utilisation evaluation of Bronchodilators using a defined daily dose method. Pharmacy Education Journal [Internet]. 2023 Aug;23(5):23–24. Available from: https://doi.org/10.46542/pe.2023.235.138
1) A meta-analysis of survey data from over 21,000 patients with chronic conditions found several key factors that influence patient interest and participation in clinical trials.
2) Health condition, age, gender, treatment satisfaction, awareness of new treatments, and the patient-physician relationship were found to impact a patient's likelihood of interest in clinical trials.
3) In addition to interest, prior clinical trial participation, health condition, treatment satisfaction, and concerns about cost also predicted a patient's actual likelihood of enrolling in future clinical trials if eligible.
Impact of Telephone-Based Chronic Disease Program on Medical Expenditures_Pop...David Cook
1) The study evaluated the impact of a telephone-based chronic disease management program on medical expenditures using claims data from over 126,000 health plan members, comparing expenditures of those enrolled in the program to those not enrolled.
2) A random effects regression model controlling for risk factors found that participation in the program was associated with average annual savings of $1,158 per member.
3) Savings increased the longer members participated in the program, supporting the cost-effectiveness of telephone-based chronic disease self-management in reducing healthcare expenditures.
The document discusses a report from the NGA that acknowledges pharmacists' scope of practice is restricted by state laws and encourages classifying pharmacists as health care providers to maximize pharmacy services. It summarizes that the report encourages states and private entities to expand what pharmacist services are covered by insurance, state employee health plans, health information exchanges, and Medicaid to allow pharmacists to practice at the full extent of their training.
This study evaluated a comprehensive diabetes management program within a managed care organization that included risk stratification of patients and social marketing approaches. Over 12 months, the program resulted in improved glycemic control as measured by an increase in the number of patients in the low-risk HbA1c category. The majority of high-risk patients had changes made to their treatment regimens. Other clinical measures like blood pressure and LDL cholesterol also improved. Patients and providers reported greater satisfaction with the program. The risk stratification and intervention approach was successful in initiating recommended treatment changes and improving diabetes outcomes and satisfaction.
This document discusses opportunities to empower patients and reduce demand on the UK National Health Service (NHS) through patient education. It identifies four key areas along the patient journey that could be improved: 1) healthcare education; 2) healthcare information; 3) healthcare provision; and 4) healthcare involvement. It then provides seven recommendations to better empower patients in these areas, such as providing compulsory health education in schools, regulating health information online through an NHS accreditation system, training non-traditional community healthcare experts, and creating mobile apps and tools to help patients manage their conditions. The overall aim is to improve health literacy and help patients better navigate the healthcare system, with the goal of reducing unnecessary demand on NHS services.
Polypharmacy resource_JAN 15_NINA BARNETTZeshan Ahmed
This document provides resources to support the management of polypharmacy and deprescribing. It begins with an overview of key terms such as polypharmacy, oligopharmacy, and deprescribing. It then discusses the increase in polypharmacy among older adults and some of the risks associated with inappropriate polypharmacy. The document is structured to provide background information on polypharmacy, tools and initiatives to support practice, and references. It aims to assist healthcare professionals with medication reviews and decisions around deprescribing for patients taking multiple medications.
This study compared information on medication use and drug-related problems (DRPs) obtained via a patient questionnaire versus a patient interview. 97 patients aged 65+ years with polypharmacy or geriatric problems completed the questionnaire and were then interviewed. There was 87.6% agreement between the questionnaire and interview for reported medications. More medications and DRPs were reported in interviews than questionnaires. Agreement on complete medication lists was 45.4% of patients. Vulnerable patients with many chronic diseases or medications showed lower agreement. The questionnaire provided reasonably similar but not identical information as interviews and may be suitable for medication reviews in most patients.
The document discusses health literacy as it relates to medication and the use and delivery of healthcare. It analyzes reports from the National Academies of Sciences on these topics. For medication, it describes progress made in standardizing drug labels but notes more is needed. It also discusses using technology like apps and electronic records to promote health literacy. For healthcare delivery, it highlights the importance of health literacy in reducing complexity and disparities. While policies have helped, stronger communication skills are still required. The document proposes a case study on screening for low health literacy using the Newest Vital Sign assessment tool to test hypotheses about time and cost constraints.
This paper examines the opportunities and benefits of using apps to help manage diabetes, as well as limitations and concerns. Apps can help patients track key areas of care, enable personalized self-management through data sharing with providers, and provide decision support. However, many apps focus only on parts of care and few use evidence-based practices or offer comprehensive education. After analyzing the top diabetes apps against criteria for effective features, the author concludes that Diabetes App is currently the best option due to its coverage of important data areas and education. Overall, apps show promise for improving outcomes but development needs to address gaps versus clinical guidelines.
Real world Evidence and Precision medicine bridging the gapClinosolIndia
Real-world evidence and precision medicine represent complementary forces reshaping the healthcare landscape. The synergy between these realms offers a pathway to more personalized, effective, and patient-centered care. As technology, data analytics, and collaborative initiatives advance, the integration of real-world evidence into precision medicine practices holds the promise of revolutionizing how healthcare is delivered, ensuring that treatments are not only scientifically sound but also tailored to the unique characteristics and experiences of individual patients.
Patient engagement in clinical trials Martin Kelly
The document discusses improving patient engagement in clinical trials through digital methods. Only 2-5% of cancer patients currently participate in clinical trials. The top 3 solutions identified to engage patients were: 1) a clinical trial finder for patients to inform them of available trials, 2) virtual clinical trials conducted entirely online, and 3) tools to personalize clinical trials to individual patient needs/preferences. The document reviews several companies providing these types of solutions and proposes an experiment partnering with a CRO to test if a digital intervention increases patient enrollment and retention in a clinical trial compared to a control group without a digital intervention.
The AHSN Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing Problematic Polypharmacy in Haringey Care Homes, can be viewed here.
For more information about the polypharmacy programme, please visit https://www.ahsnnetwork.com/programmes/medicines/polypharmacy/
This policy brief discusses strategies to increase patient engagement in their own healthcare. It outlines three key areas: improving health literacy, promoting shared decision-making, and supporting self-management of chronic conditions. Effective interventions include providing tailored written and online health information, training healthcare professionals in communication skills, using decision aids and question prompts, and delivering self-management education programs. Governments need a coherent strategy targeting multiple levels to inform and empower patients in their care.
The document discusses strategies to increase patient engagement in their own healthcare. It outlines three key areas: improving health literacy, promoting shared decision-making, and supporting self-management of chronic conditions. Effective interventions include providing tailored written and online health information, training healthcare professionals in communication skills, using decision aids and question prompts, and delivering self-management education programs. Governments need a coherent strategy targeting multiple levels to inform and empower patients in their care.
Population health management real time state-of-health analysispscisolutions
To lower health costs, physician networks and medical homes must employ a closed loop population management program that focus on patient SOH stratification, chronic disease management, care coordination and incentive management. This approach will enable them to consistently reduce ER and inpatient admissions, which are the greatest expenditures in health care today.
The Combined Predictive Model final report describes a new predictive model that was developed using data from multiple sources, including inpatient, outpatient, emergency room, and primary care records. This model segments patients into risk levels and can help the NHS target interventions appropriately based on patients' predicted risk levels. It improves on previous models by identifying a broader range of at-risk patients and allowing for stratified approaches along the continuum of care. The report concludes the model can help design long term condition programs that match intervention intensity to patients' needs.
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Unit VII Assignment IntroductionThe Nature vs- Nurture debate is a lon.docxkdennis3
Unit VII Assignment
Introduction
The Nature vs. Nurture debate is a long-standing controversy over whether human behavior is primarily determined by genetics (Nature) or by environmental factors (Nurture). The proponents of the nature vs. nurture argument for serial killers would contend that these individuals are born with particular tendencies or traits that cause them to commit horrible deeds. Lack of empathy, impulsivity and a propensity for violent action are a few of these predispositions. The argument put out by the opponents of the idea is that serial killers have innate traits and features that predispose them to crime. This encompasses a lack of compassion, guilt, and fear of the repercussions. This argument is particularly pertinent when considering the actions of serial killers, as some specialists argue that they are predisposed to violence from birth. Others, on the other hand, contend that environmental variables, including a traumatic upbringing, can contribute to developing aggressive impulses. The arguments in favor of nature are the genetic similarities among serial killers and the fact that some serial killers have a family history of mental illness. They would also emphasize that some serial killers have a history of mental illness, which genetic causes may bring on. Additionally, proponents of the "nature" camp would contend that even if serial killers are exposed to certain environmental variables, like a lack of parental supervision or violent media, these elements do not sufficiently explain serial killer behavior. The opposite viewpoint asserts that some serial killers have a hereditary propensity for aggression and violence, which increases their likelihood of becoming serial murderers. According to the Con side, a person's surroundings and upbringing can influence their development and conduct, but they do not necessarily turn them into serial killers. However, it might also intensify already present inclinations or trigger the emergence of certain antisocial behaviors. Genetics or environment alone cannot explain a serial killer's motivation, but a combination of the two may be able to. Serial killers are distinct individuals, moulded by their remarkable experiences, circumstances, and mindsets beyond a few basic qualities.
The Literature Review
The contentious argument regarding the causes of serial killers' behavior—their nature or nurture—will be examined in this literature review. The numerous hypotheses underlying the emergence of serial killers will be examined, along with the arguments for and against each hypothesis. It will also consider how these theories might affect society and law enforcement. This review will also discuss how comprehending this controversy might improve crime prevention measures. Ultimately, this analysis will summarize the numerous hypotheses and viewpoints concerning the controversy over the nature versus nurture factors in serial killers.
A brief look at the histological persp.
Unit VI Project Government Funding1Unit VI Project Government Fundin.docxkdennis3
Unit VI Project – Government Funding
Unit VI Project – Government Funding
Unit VI Project – Government Funding
The government of the United States is involved in different types of programs for society's well-being. One government funding program to help small businesses is the United States small business administration. If a person has a small business that is engaged in scientific development and research, then a person can qualify for a government grant under small business technology transfer and small business innovation research. The program has not filed for bankruptcy yet, and it’s been helping many new businesses establish their position in the industry (Marks, 2022).
After COVID-19, the government has been proposing new schemes and grants for small businesses 7nder the American Rescue Plan Act. In 2022, the government announced that it would distribute more than $10 billion to each state. In 2020, the government spent around $76 billion. While in 2021, the government spent approximately $41 billion. This shows that government spending on small businesses has increased over the last three years (Milano, 2013). The analysis shows that federal agencies get funding for small business from Congress called budgetary resources. Agencies are required to spend these budgetary resources bases on the promise, also known as an obligation. In 2022, the government had $21.24 billion in award obligations for small businesses, the number of transactions that happened was around 1.25 million, and the niner of new awards was estimated to be 352,676.
The analysis shows that COVID-19 greatly impacted small and medium enterprises. To help small businesses, the government support programs played a critical role in managing the crisis. There are multiple programs to help support small companies, such as the Pay Protection Program, with 5.2 million loans for small businesses. The SBA economic injury disaster loan program added around 3.6 million for small business loans valued at more than 91 billion dollars (SBA, 2022).
Small businesses play a significant role in the economy of the countries, or it can be said that it act as the backbone of the community. So, by funding small business activities, the government of the United States has also benefited through business activities in the SME sector. The entire idea was to help small businesses by giving them an investment in hand, which would not have been possible through traditional lenders. The impact on the government funding for small companies is also beneficial for the government because of local tax income, employment tax, and property tax. More businesses in the United States economy boost the government's tax income (Marks, 2022). So, it can be said that the government of the United States recognizes the importance of small businesses and helping them after COVID-19 lockdowns to ethically source taxes from them.
The biggest challenge to helping small businesses after COVID-19 is the war in Ukraine.
Which (if any) of Aquinass Five Ways of demonstrating Gods existence a.docxkdennis3
Which (if any) of Aquinas’s Five Ways of demonstrating God’s existence are/is convincing? Is there a God? Explain each of Aquinas’s Ways in your answer.
What are the causes of human quarrel according to Hobbes and how are they remedied? Is he right about human nature?
Answer in at least 500 words
.
When conducting testing on a system the common approaches are-Unit Tes.docxkdennis3
When conducting testing on a system the common approaches are:
Unit Testing (Testing of individual units or modules)
Integrative Systems Testing (Testing the entire system as one)
Debugging (Correcting systems problems).
For your assigned option, prepare a plan for testing a system. Students are encouraged to use scholarly resources from the internet as well as the recommended resources for this week.
Option 2:
For this option, your system testing is based upon the new software system for release of information for a health information management department.
.
What type of music- Where does the music come from-Who created this mu.docxkdennis3
What type of music? Where does the music come from?
Who created this music? Was this music used for a particular purpose?
Who are the typical types of performers (singers, types of instruments, etc.)?
Are there particular characteristics about melody, rhythms, lyric content that are "required" for this type of music?
Please provide a representative musical selection--if it is vocal music, please include the lyrics and a translation, if necessary.
.
When conducting testing on a system the common approaches are-Unit Tes (1).docxkdennis3
When conducting testing on a system the common approaches are:
Unit Testing (Testing of individual units or modules)
Integrative Systems Testing (Testing the entire system as one)
Debugging (Correcting systems problems).
For your assigned option, prepare a plan for testing a system. Students are encouraged to use scholarly resources from the internet as well as the recommended resources for this week.
Option 2:
For this option, your system testing is based upon the new software system for release of information for a health information management department.
.
What were the major causes of the American Civil War-Describe elements.docxkdennis3
What were the major causes of the American Civil War?
Describe elements of Reconstruction in America. What were the legacies and consequences of this period?
What was significant about the Compromise of 1850?
Describe Feminism and Abolitionism in the 19th Century. How did the two merge into one another?
2questions
2pages each
double space
.
What strategies can staff nurses use to share evidence that could impa.docxkdennis3
What strategies can staff nurses use to share evidence that could impact health policy decisions?
Submission Instructions:
Your initial post should be at least 600 words, formatted and cited in current APA style with support from at least 3 academic sources
Online Materials & Resources
Research and Policy
Download Research and Policy
Ivey, J. (2018). Research and policy.
Pediatric Nursing
, 44(3), 141–146.
Nurse Guide to Social Media
Download Nurse Guide to Social Media
A nurse’s guide to the use of social media. (2020).
Missouri State Board of Nursing Newsletter
, 22(3), 8–9.
Oncology Research
Download Oncology Research
Sherner, T. (2016). How oncology nursing research impacts healthcare policy.
ONS Connect
, 31(3), 16.
.
What would our society be like if we suddenly developed a foolproof me.docxkdennis3
What would our society be like if we suddenly developed a foolproof method of determining at birth a person’s probability of becoming a criminal in the future?
Explain your reasoning.
Be sure to respond to at least one of your classmates’ posts.
.
What is motivational interviewing (MI)-What is the righting reflex- Wh.docxkdennis3
What is motivational interviewing (MI)?
What is the righting reflex? What are two examples of the righting reflex?
What is client discord and how is it different from resistance?
What is the spirit of MI? Briefly describe each domain.
What are the four processes of MI?
What are reflections? What are two types of reflections?
What are the core skills used in MI?
What is change talk and why is it important?
.
Unit 1 AssignmentAttached Files-Due- Midnight SundayAs the new Chief I.docxkdennis3
Unit 1 Assignment
Attached Files:
Due: Midnight
Sunday
As the new Chief Information Security Officer (CISO) for PostCyberSolutions (PCS) LLC you are developing a Security Program Plan for the Executive Board approval.Based on your research for Unit 1:
Develop the PCS security program charter for the corporate network and satellite offices.
Clearly state the CISOs vision including elements of a strong security program.
Include information regarding some of the regulations or laws that influence the direction of your security program.
Identify the key roles and responsibilities of the various company stakeholders.
The requirements for your assignment are:
1-2 page APA paper excluding title and reference pages
Provide at least two references and in-text citations in APA format
College level writing
Refer to the attached document for the grading rubric.
.
What is being done to fight child pornography and child exploitationon.docxkdennis3
What is being done to fight child pornography and child exploitation online?
How have existing practices in storing individuals’ personal information facilitated identity theft?
Can a universal definition cyberterrorism be created?  In what ways can cyberterrorism be combated?
What is intellectual property and why should it be protected?
Choose one cybercrime (it does not have to be included in this chapter). Make up a scenario including this cybercrime or use an existing case (if you choose the latter, make sure to cite your case). As an investigator, which evidence of this crime should you look for when conducting your investigation? Why?
.
What does it mean to be the director of an early childhood program- It.docxkdennis3
What does it mean to be the director of an early childhood program?
It is a lot more than just completing the required paperwork.  the center  director Alison Boucher reviews how she manages her day to ensure the health,  safety, and nurturing of the students, families, and staff in her care.   What are characteristics of  successful directors
and
the techniques you can utilize to manage a child care center center.
List the six systems crucial to the success of a child development center that the director must oversee.
summarize three characteristics of a successful director.
.
What branch of government should have control over issues of national.docxkdennis3
What branch of government should have control over issues of national security (e.g., sending troops into combat, air strikes, covert operations, etc.)? Support your answer with references to the constitutional text and history, the opinions of our Founders, Supreme Court cases, and relevant Biblical principles. Primary posts should be 250-350 words.
.
What are the benefits of constructing an abstract and a capstone poste.docxkdennis3
What are the benefits of constructing an abstract and a capstone poster with regard to dissemination of research findings?
Expectations
Length: A minimum of 250 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last 5 year
.
What are some of the challenges of implementing the Whole School- Whol.docxkdennis3
What are some of the challenges of implementing the Whole School, Whole Community, Whole Child framework? What is the role of stakeholders (i.e., parents, teachers, administrators, etc.) in the debate concerning the role of school health programming in today’s educational environment?
.
Week 7 ProjectAssignment Due December 12 at 11-59 PMLeadershipSupport.docxkdennis3
Week 7 Project
Assignment
Due December 12 at 11:59 PM
Leadership
Supporting Lecture:
Review the following lecture:
Leadership
THIS WEEK'SÂ project is to
write
a
section
of your final capstone paper that
deals
with
leadership
around your health issue. This can serve as a final piece of the CONCLUSION section for your final paper.
What kinds of leaders are needed to address the issue in the future? This includes community member leaders, organization leaders, government leaders, health agency leaders, nonprofit leaders, and others. How do leadership theories relate to leadership around your issue?
Create a 2-3 page report discussing the issues above. Use at least 5 reputable sources (the text, South University library resources, government websites, peer-reviewed research articles) that you cite in the text and at the end in APA format.
Submission Details
Name your document SU_PHE4200_W7_A2_LastName_FirstInitial.doc.
Submit your document to the
Submissions Area
by
the due date assigned.
Support your responses with examples.
Cite any sources in APA format.
.
Week 6 ProjectAssignment Due December 5 at 11-59 PMChallenges and Opp.docxkdennis3
Week 6 Project
Assignment
Due December 5 at 11:59 PM
Challenges and Opportunities moving into the Future: Resources and Stakeholders
Supporting Lecture:
Review the following lecture:
Major Public Health Advancements
THIS WEEK'S
project is to
write
the
CONCLUSION
section of your final capstone paper. In this section, you will describe challenges and opportunities related to your health issue, moving into the future. You will highlight additional resources that are needed to address the issue, and stakeholders who need to be involved in the process.
Create a 3-4 page report discussing the issues above. Use at least five (5 ) reputable sources (the text, South University library resources, government websites, peer-reviewed research articles) that you cite in the text and at the end in APA format.
Submission Details
Name your document SU_PHE4200_W6_A2_LastName_FirstInitial.doc.
Submit your document to the
Submissions Area
by
the due date assigned.
Support your responses with examples.
Cite any sources in APA format.
.
Week 1 - Unconscious BiasOur biases can be dangerous- even deadly as.docxkdennis3
Week 1 - Unconscious Bias
Our biases can be dangerous, even deadly — as we've seen in the cases of Michael Brown in Ferguson, Missouri, and Eric Garner, in Staten Island, New York. Diversity advocate VernÄ Myers looks closely at some of the subconscious attitudes we hold toward out-groups.
Instructions:
View the How to Overcome our Biases? Walk Boldly Toward Them video.
Take the Implicit Association Test (IAT).
Post your reaction to the IAT results.
Do you agree or disagree? Why? Why not?
.
Week 1 Lecture The Nature of Business ResearchBusiness researc.docxkdennis3
Week 1 Lecture
The Nature of Business Research
Business research covers a wide range of phenomena. For managers, the purpose of research is to provide knowledge regarding the organization, the market, the economy, or another area of uncertainty. A financial manager may ask, “Will the environment for long-term financing be better two years from now?†A personnel manager may ask, “What kind of training is necessary for production employees?†or “What is the reason for the company’s high employee turnover?†A marketing manager may ask, “How can I monitor my retail sales and retail trade activities?†Each of these questions requires information about how the environment, employees, customers, or the economy will respond to executives’ decisions. Research is one of the principal tools for answering these practical questions.
Business research is the application of the scientific method in searching for the truth about business phenomena. These activities include defining business opportunities and problems, generating and evaluating alternative courses of action, and monitoring employee and organizational performance. Business research is more than conducting surveys.6 This process includes idea and theory development, problem definition, searching for and collecting information, analyzing data, and communicating the findings and their implications.
Applied business research is conducted to address a specific business decision for a specific firm or organization. The opening vignette describes a situation in which ESPN used applied research to decide how to best create knowledge of its sports fans and their preferences. Basic business research (sometimes referred to as pure research) is conducted without a specific decision in mind, and it usually does not address the needs of a specific organization.
All research, whether basic or applied, involves the scientific method. The scientific method is the way researchers go about using knowledge and evidence to reach objective conclusions about the real world. The scientific method is the same in social sciences, such as business, as in physical sciences, such as physics. In this case, it is the way we come to understand business phenomena.
A firm can be production-oriented. A production-oriented firm prioritizes the efficiency and effectiveness of production processes in making decisions. Here, research providing input from workers, engineers, finance, and accounting becomes important as the firm seeks to drive costs down. Production-oriented firms are usually very large firms manufacturing products in very large quantities. The third orientation is marketing- oriented, which focuses more on how the firm provides value to customers than on the physical product or production process. With a marketing-oriented organization the majority of research focuses on the customer. Research addressing consumer desires, beliefs, and attitudes becomes essential.
Diagnosing Opportunities: After a.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
-------------------------------------------------------------------------------
Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
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Slideshare: http://www.slideshare.net/PECBCERTIFICATION
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
The chapter Lifelines of National Economy in Class 10 Geography focuses on the various modes of transportation and communication that play a vital role in the economic development of a country. These lifelines are crucial for the movement of goods, services, and people, thereby connecting different regions and promoting economic activities.
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.
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
V O L U M E 3 4 - N U M B E R 4 - F A L L 2 0 1 6 187FEATURE ART.docx
1. V O L U M E 3 4 , N U M B E R 4 , F A L L 2 0 1 6 187
F E
A T
U R
E A
R T
IC L
E
Nurse Practitioner Perceptions of a Diabetes Risk Assessment Tool in the Retail Clinic Setting
Kristen L. Marjama, JoAnn S. Oliver, and Jennifer Hayes
Diabetes is the seventh leading cause of death in the United States, burdening society with
high costs for treatment and placing increased demand on the health care system (1). According
to the 2014 National Diabetes Statistics Report, an estimated 29.1 million people in the United
States have diabetes, and 8.1 million of them are undiagnosed (2). The lack of screening for early
identification of patients at risk for type 2 diabetes is a significant clin- ical problem. Health care
providers (HCPs) need to be aware of the in- creasing diabetes burden and to pri- oritize the
screening of patients who may be at risk. Screening for risk can aid in both efforts to prevent the
development of diabetes and early management of the disease to reduce complications. Clinical
trials have demonstrated that type 2 diabetes can be delayed or prevented through life- style
modification or pharmacother- apy for people at increased risk (3).
In order to reduce risk for those at risk of developing diabetes, screen- ing is a priority that will
raise patient
awareness. Many patients are not aware of their risk for type 2 dia- betes until they receive a
confirmed diagnosis from their HCP. There are numerous health care settings in which
screenings can be imple- mented, including but not limited to primary care practices, urgent care
centers, hospital emergency depart- ments, and retail health clinics.
Retail clinics are located in retail supermarket and pharmacy chains to provide high-quality,
affordable, and easily accessible health care services for communities. A true measure of quality
in retail clinics is their degree of adherence to several measures iden- tified in the Healthcare
Effectiveness Data and Information Set (4). Services in this type of setting may include treatment
of acute episodic conditions, physical examinations, vaccinations, health screenings, and
prevention and management of chronic conditions (5). Retail clinics provide services to patients
3. increased 41%, from $176 million to $245 million (8). Thus, it has become increasingly
important to identify individuals who would benefit from interventions aimed at preventing the
development of diabetes.
The Problem HCPs play a major role in improving the quality of health care and thus increasing
the value of services pro- vided (9). Such quality improvement occurs primarily at the level of
inter- action between HCPs and patients. Providers need evidence-based tools and resources to
aid them in initiating important conversations and provid- ing high-quality care to every patient.
However, studies have identified barriers to HCPs’ use of type 2 dia- betes risk assessment
tools. These barriers include attitudes about avail- able tools, the impracticality of their
use, and a lack of reimbursement for administering them (10). A diabe- tes risk assessment tool
that can be completed by patients while they are waiting to be seen at a clinic could be an
effective way to screen all patients. A tool that is easy for patients to use and understand can play
a major role in increasing patients’ awareness of their risk for diabetes.
One Solution Dealing with the demands of the di- abetes epidemic requires health care
organizations to develop innovative, coordinated approaches to prevention and care (11). Several
health care or- ganizations operate retail clinics. This study was implemented with NPs em-
ployed by one national retail clinic organization. Primary prevention and health promotion,
discussed at every clinic encounter regardless of the rea- son for the visit, can be successful at
reducing disease occurrence and im- proving health (12). Currently, there is no evidence in the
literature regard- ing the use and feasibility of a diabe- tes risk assessment tool in the retail clinic
setting. Understanding the per- ceptions of a diabetes risk assessment tool used by NPs in the
retail clinic setting will provide a framework to assist in the development of a diabe- tes
screening program. Assessing NPs’ perceptions of this intervention also may lead to
increased or continued use of the risk assessment tool and identify factors that are negatively in-
fluencing its continued use. The re- sults may encourage other retail clinic organizations to adopt
the use of a di- abetes risk assessment tool in practice.
The American Diabetes Associa- tion (ADA) and the U.S. Preventive Services Task Force
(USPSTF) have established guidelines for detecting prediabetes and type 2 diabetes for the
purposes of prevention and early intervention. A study comparing these guidelines found that the
ADA guidelines detected 38.9% more cases of prediabetes and 24.3% more cases of type 2
diabetes than the USPSTF guidelines (13). ADA recommends
the Diabetes Risk Test (DRT) as a tool for assessing patients’ risk for type 2 diabetes (14).
The DRT is currently used in the retail clinic organization selected for this study. This diabetes
risk assessment tool has also been adopted by the National Institutes of Health/CDC National
Diabetes Education Program (15). Since 20 November 2014, the retail organization involved in
this study has encouraged having patients complete the DRT in its retail clinic waiting rooms.
The DRT is a one-page form con- taining seven questions regarding patients’ age, sex,
history of gesta- tional diabetes, family history of diabetes, history of hypertension, physical
activity, and weight (14). Patients are instructed to add up the scores based on their answers to
4. determine whether they are at risk for type 2 diabetes. Those whose scores indicate that they are
at risk are encouraged to participate in a diabe- tes screening visit at the retail clinic.
This study examined how NPs in this retail clinic setting perceive the merit of the DRT in terms
of adding value to screening for type 2 diabe- tes and whether NPs perceive that it initiates,
complements, and improves risk-related conversations between patients and providers. The study
also assessed how NPs perceive patients’ use of and satisfaction with the DRT. The DRT
was made available for use as a resource 5 months before the ini- tiation of this study.
Methods An online questionnaire to assess NPs’ use and perceptions of the DRT was
developed using Survey Monkey, a Web-based survey tool (16). Retail clinics in 26 markets
were selected for this project, and 1,097 NPs were invited to participate. All NPs in the selected
markets were sent an email message describing the purpose of the study, the time required for
participa- tion, and an Internet link they could open to complete the questionnaire. NPs’
participation was voluntary,
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consent was obtained from all partic- ipants, and all survey responses were anonymous. NPs
could withdraw from completing the survey at any point without any consequences.
The questionnaire consisted of 15 items. The first three gathered demographic information,
including practice location, years of clinical experience as an NP, and average number of patients
seen per day. The fourth asked whether the NP had used or was currently using the DRT. If the
answer was no, the partici- pant was not asked to complete the remaining 11 items, and the
survey was considered complete. Participants who had used or were currently using the DRT
5. proceeded through the remaining items, which assessed their perceptions of use of the DRT
(Table 1).
The survey items were developed to assess perceptions of the feasibility and value of a risk
assessment tool (17). Several concepts were used to measure feasibility, including per- ceptions
of patient use, provider approach, and patient-provider inter- action. For each item, respondents
used a 5-point Likert scale (Strongly Disagree, Disagree, Neutral, Agree, or Strongly Agree) to
indicate the degree to which they agreed with the given statement.
Participants completed surveys from 15 April 2015 through 29 April 2015. Of the 1,097 NPs
who were invited to participate, 258 returned responses. Ten responses contained no data and
were therefore deleted, leaving 248 responses for analysis (response rate of 22.61%).
SPSS Statistics version 22 com- puter software (IBM, Armonk, N.Y.) was used for descriptive
and inferen- tial statistical analyses. All variables were examined for accuracy of data entry.
Mean responses to each question were examined to facili- tate discussion of the results; mean
responses are a good indicator of the aggregate direction toward the two ends of the scale for
each question. With responses restricted to a 5-point
Likert scale, a mean response value of 3 is the midpoint value of the scale and implies a neutral
stance. A mean response of <3 implies that responses were in the “disagree― direction, and
a mean of >3 indicates that responses were in the “agree― direction. For analysis, a Pearson
correlation coef- ficient was used to determine the presence of a correlation between variables.
Results Of the 248 responses available for analysis, the highest response rates came from
Chicago, Ill., with 27 re- sponses (10.89%); Atlanta, Ga., with 26 responses (10.48%); and
Orlando, Fla., with 23 responses (9.27%). A to- tal of 243 participants indicated that they were
NPs. Of these, 80 (32.92%) had 0–5 years of clinical experience, 65 (26.75%) had 6–10
years, 41 (16.87%) had 11–15 years, and 57 (23.46%) had ≥15 years of experience (Figure
1). Of the 246 participants who responded to the question about the number of patients they see
on average each day at their retail clinic, 163 (66.26%) reported seeing 11–20 patients per day,
57 (23.17%) report- ed seeing 0–10 patients, 24 (9.76%) reported seeing 21–30 patients, and
2 (0.81%) reported seeing ≥31 patients per day.
Of the 248 respondents who reported on their use of the DRT in their retail clinic, 134 (54.03%)
indi- cated that they did not use the DRT, whereas 114 participants (45.97%) reported that they
did. Of the 114 participants who did use the DRT, 106 provided responses to the 11 perception
questions regarding the feasibility of DRT use in their retail clinic setting. The majority of those
106 respondents were NPs with 1–5 years of experience (34.9%) who reported seeing 11–20
patients per day (61.3%).
Descriptive statistical analysis was performed (Table 2). The lowest mean response to any of the
11 survey items was for item 8 (“Contributes to the number of repeat visits to the retail
clinic―). The mean score of 3.0000 for that item indicates that participants overall were
neutral on this issue. The meaningful measure for this item was the percentage of respon- dents
strongly agreeing/agreeing (22.6%) versus those strongly dis- agreeing/disagreeing (23.6%).
6. Mean responses to each of the 11 perception items ranged from those indicating “neutral―
to those indicating “agree.― The highest mean response (3.8868) was for item 3 (“Does
not take long for patients to complete―). Again, the meaningful measure for this item
TABLE 1. Items on Perception of Feasibility From my clinical perspective, the Diabetes Risk
Test:
1. Is readily accepted by patients for completion
2. Helps patients easily understand if they are at risk for diabetes
3. Does not take long for patients to complete
4. Initiates more patient-to-provider conversation regarding diabetes
5. Complements my approach to discussing risk for diabetes with patients
6. Improves my approach to discussing risk for diabetes with patients
7. Increases patient desire to participate in the diabetes screening service at the retail clinic
8. Contributes to the number of repeat visits to the retail clinic
9. Saves time in tailoring the discussion with patients with identified risk factors
10. Improves the quality of the diabetes screening service offered at the retail clinic
11. Increases patient satisfaction with care provided
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was the percentage of respondents strongly agreeing/agreeing (81.1%) versus those strongly
disagreeing/ disagreeing (5.7%). To assess overall feasibility of DRT use in the retail clinic
setting, the overall mean of all 11 individual mean responses was cal- culated to be 3.6046,
which indicates that responses overall were in the “agree― direction. Correlation of the 11
perception items of feasibility was significant at the 0.01 level according
to the Pearson correlation coefficient (Table 3).
7. Discussion Assessing the use of the DRT and evaluating NPs’ perceptions of the feasibility
of its use can be essential in determining whether this screening tool for type 2 diabetes has value
in guiding the current or future health care approach for utilization with pa- tients and facilitating
patient-provider communication. In the setting stud-
ied here, utilization of the DRT was recommended but not mandated, and the majority of NPs
(54.03%) indicated that they did not use the DRT. However, the overall mean of responses to the
perception items from NPs who have used the DRT indicates that these NPs agree that using a
diabetes risk assessment tool in the retail clinic setting is feasible. There was only one neutral
response, and it was on the DRT’s contribution
TABLE 2. Mean and Proportion Responses to Items on Perception (n = 106) Item Mean
Standard Deviation Strongly Agree/ Agree
(%) Strongly Disagree/
Disagree (%)
1 3.4057 0.91317 52.8 17.9
2 3.8208 0.77824 76.4 5.7
3 3.8868 0.73447 81.1 5.7
4 3.8774 0.77709 79.2 6.6
5 3.8396 0.73208 76.4 4.7
6 3.7547 0.77842 70.8 6.6
7 3.3868 0.83462 43.4 11.3
8 3.0000 0.81650 22.6 23.6
9 3.5283 0.83046 60.4 13.2
10 3.6604 0.74177 67.9 7.5
11 3.4906 0.67957 52.8 5.7
Overall mean of individual means for
all 11 items: 3.6046
■FIGURE 1. Overall responses in each market by respondents’ years of experience (n =
243).
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to the number of repeat patient visits to the retail clinic. Because the DRT was made available to
patients waiting to be seen for a separate reason, more research is needed to determine the
number of patients who may return based on the use of the DRT.
Although this study looked at NPs in the retail clinic setting, there are patients in the waiting
areas of all health care settings. The DRT is not geared toward a particular setting, but rather
toward patients in general. Thus, all health care settings could use a risk assessment tool to
screen patients who may not be aware of their potential risk for diabetes. Implementation and uti-
lization of such a tool can be a key component in proactively screening patients and providing
high-quality, evidence-based care.
Limitations A limitation in this study was the small sample size. The low response rate of
22.16% (248 completed ques- tionnaires from 1,097 NPs invited to participate) may be
attributable to sev- eral factors. Some of the invited NPs were in management or educator roles
with limited opportunities for direct patient care. It is possible that they did not see patients
during the timeframe of the study. Some invited NPs are per-diem employees with a require-
ment to work only one or two shifts per month and may not have received the emailed invitation
during the 2-week timeframe, or some potential participants may have been on paid time off or a
leave of absence. Finally, one market included in the study does not evaluate and treat chronic
condi- tions, which may have led to lower utilization of a screening tool for a chronic condition.
This market was included because it met the criteria of being staffed by NPs and had imple-
mented the DRT as a resource.
9. Another limitation is that feasibil- ity of use can be interpreted in several ways. Concepts used to
define feasi- bility in this study included patients’ acceptance of the DRT, its ease of
understanding by patients, the time it took patients to complete the DRT, whether the DRT
initiated conver- sation between patients and an NP, whether the DRT complemented or
improved the approach of NP, whether its use led to an increase in diabetes screening services or
repeat visits, and whether its use saved time, improved the quality of care, or increased patient
satisfaction. Further research is needed to translate feasi- bility into implementation.
Conclusion To address the demands of the dia- betes epidemic, health care organi-
zations need to focus on risk factor awareness. Evaluating NPs’ use and perceptions of the
feasibility of a dia- betes risk assessment tool are import- ant in determining whether such a tool
adds value in the retail clinic set- ting. In this study, NPs who used the DRT agreed that the use
of this tool is feasible in their setting. However, less than half of respondents reported having
used the DRT, and increased utilization is needed.
Using a diabetes risk assessment tool can be a quick, efficient way to increase patient screening,
com- plement HCPs’ approach, and help to initiate conversations between patients and
providers. This in turn may have an impact on the early identification of individuals with dia-
betes and improve the quality of care offered to these patients. The more we can do as a health
care community to identify risk factors for diabetes, the better our chances of preventing disease
and improving the health and wellness of our patients.
Additional research is needed to understand the barriers to utilization of a diabetes risk
assessment tool, examine the use of such tools to effi- ciently identify patients with type 2
diabetes, and explore the feasibility of using the DRT or similar tools in other health care
settings.
TABLE 3. Pearson Correlation Coefficient of 11 Perception Items of Feasibility (n = 106) 1 2 3
4 5 6 7 8 9 10 11
1 1.0
2 0.438** 1.0
3 0.325** 0.331** 1.0
4 0.406** 0.436** 0.443** 1.0
5 0.469** 0.517** 0.533** 0.735** 1.0
6 0.436** 0.556** 0.467** 0.548** 0.816** 1.0
7 0.592** 0.357** 0.259** 0.456** 0.508** 0.426** 1.0
8 0.524** 0.345** 0.206* 0.360** 0.462** 0.405** 0.615** 1.0
10. 9 0.318** 0.546** 0.349** 0.308** 0.532** 0.571** 0.403** 0.478** 1.0
10 0.402** 0.438** 0.313** 0.638** 0.583** 0.531** 0.522** 0.456** 0.449** 1.0
11 0.505** 0.384** 0.303** 0.494** 0.581** 0.536** 0.603** 0.463** 0.465** 0.541** 1.0
**Correlation is significant at the 0.01 level (two-tailed). *Correlation is significant at the 0.05
level (two-tailed).
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Acknowledgments The authors thank the NPs who partici- pated in this study. The authors take
full responsibility for the content of this article and participated in all stages of manuscript
development and approval of the article for publication.
Duality of Interest No potential conflicts of interest relevant to this article were reported.
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