Objective: A pharmacist and physician collaborative practice intervention to improve the initial dosing of vancomycin was implemented with the goal of decreasing the number of subtherapeutic first troughs and increasi...Objective: A pharmacist and physician collaborative practice intervention to improve the initial dosing of vancomycin was implemented with the goal of decreasing the number of subtherapeutic first troughs and increasing the number of therapeutic troughs. Methods: Using the best available evidence, a nomogram was created to determine the initial vancomycin dose. The nomogram utilized actual bodyweight and glomerular filtration rate (eGFR) estimated with the MDRD4 equation. The dose was based on the 2009 ASHP/IDSA/SIDP guidelines, which recommended 15 - 20 mg/kg every 8 - 12 hours. Providers ordered “vancomycin IV dosed per pharmacy”. Results: The pre- (n = 75) and post-intervention (n = 108) cohorts had similar age, gender distribution, weight, and eGFR. The median total daily vancomycin dose was similar in pre- and post-intervention groups (2000 mg), although the median first trough was higher following the intervention (13.0 vs. 14.8 mcg/ml, p = 0.03). Following the intervention, the proportion of first troughs under 10 mcg/ml decreased (32% to 13%, p = 0.003), while the proportion of troughs in the 10 - 20 mcg/ml therapeutic range increased (50.7% vs. 69.4%, p = 0.01). There was no difference in the proportion of troughs over 20 mcg/ml (17.3% vs. 17.6%, p = 0.96). Conclusions: A multi-disciplinary intervention utilizing a nomogram-based pharmacy collaborative practice model significantly improves the proportion of therapeutic initial vancomycin troughs and decreases the number of subtherapeutic troughs by half.展开更多
Aims: Research the process of organizational change to understand how interventions such as appearance care can be integrated into daily practice. Background: Typical treatment of breast cancer is surgery, often follo...Aims: Research the process of organizational change to understand how interventions such as appearance care can be integrated into daily practice. Background: Typical treatment of breast cancer is surgery, often followed by chemotherapy. Associated aesthetic ramifications, including hair loss, frequently cause patient distress. Methods: We conducted face-to-face semi-structured hour-long recorded interviews with three nurses. We then analyzed the developmental process according to the core competencies for interprofessional collaborative practice using the thematic content analysis. Results: Nurses worked with interdisciplinary team members with mutual respect and shared values such as concern for patients’ quality of life. Nurses used knowledge of appearance-related side effects combined with beautician-provided coping skills. Intervention involved responsible communication with other health professionals and patients in a team approach. Nurses promoted the developmental process and became program facilitators. Conclusion: This group-intervention program, facilitated by nurses, was integrated into daily practice. Implications for nursing management: Research partnerships between academics, clinical nurses, nurse managers, and beauticians can improve the integration of interventions in routine practice and increase awareness of patients’ needs.展开更多
The purpose of this study was to identify factors that enhance and hinder interdisciplinary collaborative practice (ICP) among doctors and nurses at the Nnamdi Azikiwe teaching hospital, Nnewi, southeast Nigeria. The ...The purpose of this study was to identify factors that enhance and hinder interdisciplinary collaborative practice (ICP) among doctors and nurses at the Nnamdi Azikiwe teaching hospital, Nnewi, southeast Nigeria. The study was a cross-sectional descriptive survey and the quantitative method of data collection was employed. The population was all doctors irrespective of area of specialty and all nurses employed and working in the hospital as at the time of study. Proportionate stratified and convenience sampling methods were used to select study participants according to their categories. Using validated structured questionnaire, data were collected from 110 doctors and 95 nurses in the teaching hospital on their perception on ICP and factors that enhance/hinder ICP. Data were analyzed using both descriptive and inferential statistics. Specifically, frequencies, percentages, standard deviation and graphic presentation were used for descriptive analysis of scores while the unpaired t test of mean score using Graph Pad Prism, Version 5.30 was used to determine the influence of profession, gender, and years of experience on perception of ICP at 0.05 level of significance. The study found that both doctors and nurses have positive perception on ICP. Their years of experience have significant influence on their perception. Clear individual roles and good working relationships enhance ICP while giving priority to professional status rather than expertise was seen as a prominent hindrance to ICP. The study recommends collaborative continuing education for doctors and nurses to enhance ICP in patient care. In addition, the inclusion of interdisciplinary collaborative practice programmme into the curriculum of medical and nursing students (where it does not exist) would go a long way to strengthen ICP and decrease hindrances when they graduate.展开更多
The aim of this article is to strengthen and improve the collaboration between professional agents of a service that manages one of the technical processes acting on a given territory by synchronizing the spatio-tempo...The aim of this article is to strengthen and improve the collaboration between professional agents of a service that manages one of the technical processes acting on a given territory by synchronizing the spatio-temporal dimensions including all agents assembled for the task. This proposal was tested in the Lamkansa neighborhood in Casablanca, Morocco. The employed approach is based GIS resources and on systemic analysis of communication present in a territory. We were inspired by several methodological developments that carried multi-actor processes in land use planning. We focused our work on strengthening the collaboration between professionals, field agents and office agents, in the process of design and monitoring the liquid sanitation system. The device is based on geolocation and synchronous feedback of topological, geographical, and multimedia data related to the liquid sanitation network. Thanks to a geo-collaborative, participative, and motivating logic, we reduced the management costs of the network and made it faster and more efficient by equally mobilizing another type of non-specialized actors (the inhabitants). This device uses spatial and temporal dimensions to consolidate collaborative work tools through ICT and GIS technologies that thematize and exchange information collected in the field. Furthermore, this device raises great interest as it entails the concept of integration of several actors in a geo-collaborative mode while combining geomatics with communication and information sciences.展开更多
文摘Objective: A pharmacist and physician collaborative practice intervention to improve the initial dosing of vancomycin was implemented with the goal of decreasing the number of subtherapeutic first troughs and increasing the number of therapeutic troughs. Methods: Using the best available evidence, a nomogram was created to determine the initial vancomycin dose. The nomogram utilized actual bodyweight and glomerular filtration rate (eGFR) estimated with the MDRD4 equation. The dose was based on the 2009 ASHP/IDSA/SIDP guidelines, which recommended 15 - 20 mg/kg every 8 - 12 hours. Providers ordered “vancomycin IV dosed per pharmacy”. Results: The pre- (n = 75) and post-intervention (n = 108) cohorts had similar age, gender distribution, weight, and eGFR. The median total daily vancomycin dose was similar in pre- and post-intervention groups (2000 mg), although the median first trough was higher following the intervention (13.0 vs. 14.8 mcg/ml, p = 0.03). Following the intervention, the proportion of first troughs under 10 mcg/ml decreased (32% to 13%, p = 0.003), while the proportion of troughs in the 10 - 20 mcg/ml therapeutic range increased (50.7% vs. 69.4%, p = 0.01). There was no difference in the proportion of troughs over 20 mcg/ml (17.3% vs. 17.6%, p = 0.96). Conclusions: A multi-disciplinary intervention utilizing a nomogram-based pharmacy collaborative practice model significantly improves the proportion of therapeutic initial vancomycin troughs and decreases the number of subtherapeutic troughs by half.
文摘Aims: Research the process of organizational change to understand how interventions such as appearance care can be integrated into daily practice. Background: Typical treatment of breast cancer is surgery, often followed by chemotherapy. Associated aesthetic ramifications, including hair loss, frequently cause patient distress. Methods: We conducted face-to-face semi-structured hour-long recorded interviews with three nurses. We then analyzed the developmental process according to the core competencies for interprofessional collaborative practice using the thematic content analysis. Results: Nurses worked with interdisciplinary team members with mutual respect and shared values such as concern for patients’ quality of life. Nurses used knowledge of appearance-related side effects combined with beautician-provided coping skills. Intervention involved responsible communication with other health professionals and patients in a team approach. Nurses promoted the developmental process and became program facilitators. Conclusion: This group-intervention program, facilitated by nurses, was integrated into daily practice. Implications for nursing management: Research partnerships between academics, clinical nurses, nurse managers, and beauticians can improve the integration of interventions in routine practice and increase awareness of patients’ needs.
文摘The purpose of this study was to identify factors that enhance and hinder interdisciplinary collaborative practice (ICP) among doctors and nurses at the Nnamdi Azikiwe teaching hospital, Nnewi, southeast Nigeria. The study was a cross-sectional descriptive survey and the quantitative method of data collection was employed. The population was all doctors irrespective of area of specialty and all nurses employed and working in the hospital as at the time of study. Proportionate stratified and convenience sampling methods were used to select study participants according to their categories. Using validated structured questionnaire, data were collected from 110 doctors and 95 nurses in the teaching hospital on their perception on ICP and factors that enhance/hinder ICP. Data were analyzed using both descriptive and inferential statistics. Specifically, frequencies, percentages, standard deviation and graphic presentation were used for descriptive analysis of scores while the unpaired t test of mean score using Graph Pad Prism, Version 5.30 was used to determine the influence of profession, gender, and years of experience on perception of ICP at 0.05 level of significance. The study found that both doctors and nurses have positive perception on ICP. Their years of experience have significant influence on their perception. Clear individual roles and good working relationships enhance ICP while giving priority to professional status rather than expertise was seen as a prominent hindrance to ICP. The study recommends collaborative continuing education for doctors and nurses to enhance ICP in patient care. In addition, the inclusion of interdisciplinary collaborative practice programmme into the curriculum of medical and nursing students (where it does not exist) would go a long way to strengthen ICP and decrease hindrances when they graduate.
文摘The aim of this article is to strengthen and improve the collaboration between professional agents of a service that manages one of the technical processes acting on a given territory by synchronizing the spatio-temporal dimensions including all agents assembled for the task. This proposal was tested in the Lamkansa neighborhood in Casablanca, Morocco. The employed approach is based GIS resources and on systemic analysis of communication present in a territory. We were inspired by several methodological developments that carried multi-actor processes in land use planning. We focused our work on strengthening the collaboration between professionals, field agents and office agents, in the process of design and monitoring the liquid sanitation system. The device is based on geolocation and synchronous feedback of topological, geographical, and multimedia data related to the liquid sanitation network. Thanks to a geo-collaborative, participative, and motivating logic, we reduced the management costs of the network and made it faster and more efficient by equally mobilizing another type of non-specialized actors (the inhabitants). This device uses spatial and temporal dimensions to consolidate collaborative work tools through ICT and GIS technologies that thematize and exchange information collected in the field. Furthermore, this device raises great interest as it entails the concept of integration of several actors in a geo-collaborative mode while combining geomatics with communication and information sciences.
