scholarly journals A Retrospective Review of Patient Records and Factors Associated with Decisions Made by Community Nurse-Paramedics’ in Finland

2021 ◽  
Vol 11 (3) ◽  
pp. 690-701
Author(s):  
Tuija Rasku ◽  
Mika Helminen ◽  
Marja Kaunonen ◽  
Elizabeth Thyer ◽  
Eija Paavilainen ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Care ◽  
Elderly Care ◽  
Patient Records ◽  
Hospital District ◽  
Factors Associated ◽  
Community Paramedicine ◽  
General Weakness ◽  
The Impact ◽  
At Home

Community paramedicine (CP) has extended the role of paramedics and the main goal is to provide non-emergency care, which reduces the visits to emergency departments. The aim of this study was to describe the Finnish CP and examine the factors that were involved in CNPs’ decision-making processes. The study was based on data from 450 consecutive CP patient records from three hospital districts. A more detailed analysis was carried out on 339 cases in patients’ homes and elderly care homes, and the data analysis included multivariate logistic regression to examine the impact of variables on the CNPs’ decisions. These patients’ most common health issues were general weakness (15.9%) and fever (10.6%), and over half (58.7%) could remain at home after the CP visit. There were five independent factors associated with the CNPs’ decisions of the patient’s care continuum: the hospital district, if the patient could walk, whether the troponin test was performed, a physician was consulted, and the nature of the task. CP units played a valuable role in non-emergency care. Understanding the factors associated with CNP decision-making can increase the safety and effectiveness of reducing hospital visits, by providing patient care at home, or in elderly care facilities.

Using an App to monitor postoperative pain at home in pediatric patients

2021 ◽  
pp. 136749352091931
Author(s):  
Emanuela Tiozzo ◽  
Valentina Biagioli ◽  
Matilde Brancaccio ◽  
Riccardo Ricci ◽  
Anna Marchetti ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Health Professionals ◽  
Pediatric Patients ◽  
Pain Scale ◽  
Factors Associated ◽  
Prospective Comparative Study ◽  
Paper And Pencil ◽  
The Impact ◽  
At Home

A prospective comparative study was conducted in 487 pediatric patients (69% male, mean age = 6.4 ± 4.0) to evaluate (a) the incidence, intensity, and characteristics of pain in pediatric patients at home during the first 24 hours and 5 days after surgery and (b) the factors associated with higher pain intensity, including the impact of an application (App) compared to the paper-and-pencil approach. Postoperative pain was assessed by patients or their parents at home using the ‘Bambino Gesù’ Children’s Hospital (Ospedale Pediatrico Bambino Gesù, OPBG) tool for participants aged 4–17 years or the Faces, Legs, Arms, Cry, and Consolability scale for participants less than four years old. Participants were assigned to two groups: those who used the paper-and-pencil version of the pain scale and those who used the App. Overall, 209 of the 472 (44%) participants reported pain during the first 24 hours, and 92 of the 420 (22%) reported pain between one and five days after surgery. Higher pain intensity scores were associated with being in the App group, directly assessing own pain, and using the OPBG tool. The App was effective in facilitating pain assessment. Health professionals could empower pediatric patients and their parents in assessing pain at home through a dedicated App.

scholarly journals Can This Patient Be Discharged Home? Factors Associated With At-Home Death Among Patients With Cancer

2011 ◽  
Vol 29 (9) ◽  
pp. 1159-1167 ◽  
Author(s):  
Alberto Alonso-Babarro ◽  
Eduardo Bruera ◽  
María Varela-Cerdeira ◽  
María Jesús Boya-Cristia ◽  
Rosario Madero ◽  
...  
Keyword(s):  
Social Support ◽  
Decision Making ◽  
Perceived Social Support ◽  
Acute Care Hospital ◽  
Place Of Death ◽  
Care Hospital ◽  
Home Death ◽  
Factors Associated ◽  
Decision Making Model ◽  
At Home

Purpose The purpose of this study was to identify factors associated with at-home death among patients with advanced cancer and create a decision-making model for discharging patients from an acute-care hospital. Patients and Methods We conducted an observational cohort study to identify the association between place of death and the clinical and demographic characteristics of patients with advanced cancer who received care from a palliative home care team (PHCT) and of their primary caregivers. We used logistic regression analysis to identify the predictors of at-home death. Results We identified 380 patients who met the study inclusion criteria; of these, 245 patients (64%) died at home, 72 (19%) died in an acute-care hospital, 60 (16%) died in a palliative care unit, and three (1%) died in a nursing home. Median follow-up was 48 days. We included the 16 variables that were significant in univariate analysis in our decision-making model. Five variables predictive of at-home death were retained in the multivariate analysis: caregiver's preferred place of death, patients' preferred place of death, caregiver's perceived social support, number of hospital admission days, and number of PHCT visits. A subsequent reduced model including only those variables that were known at the time of discharge (caregivers' preferred place of death, patients' preferred place of death, and caregivers' perceived social support) had a sensitivity of 96% and a specificity of 81% in predicting place of death. Conclusion Asking a few simple patient- and family-centered questions may help to inform the decision regarding the best place for end-of-life care and death.

scholarly journals The Impact of Trust, Satisfaction, and Perceived Quality on Preference for Setting of Future Care Among Veterans With PTSD

2019 ◽  
Vol 184 (11-12) ◽  
pp. e708-e714
Author(s):  
Elizabeth Haro ◽  
Michael Mader ◽  
Polly H Noël ◽  
Hector Garcia ◽  
Dawne Vogt ◽  
...  
Keyword(s):  
Decision Making ◽  
Care Setting ◽  
Network Capacity ◽  
Perceived Quality ◽  
Cross Sectional ◽  
Improvement Project ◽  
Factors Associated ◽  
Institutional Review ◽  
Future Care ◽  
The Impact

Abstract Introduction Among US veterans, posttraumatic stress disorder (PTSD) is a high-prevalence condition; more than a million veterans of all combat eras are service-connected for this condition. Research on factors driving veterans’ decision-making regarding preferred setting for PTSD care has been limited. The purpose of this study was to understand factors associated with preferences for setting of future PTSD care among veterans service-connected for PTSD. Materials and Methods We conducted a cross-sectional mailed survey among veterans with service connection for PTSD in Texas and Vermont identified from the Veterans Services Network Corporate Mini Master File (VETSNET). Survey items were intended to elucidate PTSD healthcare decision-making and queried utilization, perceived need for care, and satisfaction and preferences for VA, community, and/or military setting for receipt of future PTSD care. Logistic regression was used to identify factors associated with preference for care setting. UT Health San Antonio’s Institutional Review Board determined this quality improvement project to be non-research. Results Veterans (n = 2,327) were surveyed with an overall response rate of 37.1%. Most veterans (72.4%) identified VA as a preferred site for their future PTSD care; a substantial, but smaller, number of veterans identified being interested in receiving care in community (39.9%) and military (12.7%) settings. Factors associated with preferences for future care setting included demographics (e.g., ethnicity, income), availability of healthcare coverage, prior experiences of care, and attitudes related to perceived quality of care and trust in VA. Conclusions These findings suggest that it is important to retain foundational mental health services within VA, as well as to continue to invest in building provider and network capacity in community settings, to ensure alignment with veteran preferences for care setting.

Non-medical prescribing by paramedics in emergency, urgent and critical care

2021 ◽  
Vol 13 (5) ◽  
pp. 184-188
Author(s):  
Adam Bedson
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Critical Care ◽  
Empirical Evidence ◽  
Emergency Care ◽  
Patient Records ◽  
Medical Support ◽  
Controlled Drugs ◽  
Prehospital Emergency ◽  
Advanced Paramedics

This article considers some of the unique considerations and challenges that are associated with non-medical prescribing in the context of paramedic emergency care. In contrast to primary care, advanced paramedics practicing in emergency settings are more likely to encounter patients who require an immediate supply or administration of medication and access to a range of controlled drugs. Furthermore, access to medical support for prescribing decision-making, restrictions on the prescribing of controlled drugs and potential challenges in obtaining access to patient records, may also impact non-medical prescribing in these settings. Currently, very little empirical evidence has been published on the topic of non-medical prescribing in paramedic practice. Further research is required to understand whether the anticipated benefits are being realised for patients and NHS services. This is particularly the case in the context of prehospital emergency, urgent and critical care settings.

scholarly journals The impact of digital interventions to support parents caring for acutely ill children at home and factors that affect their use: systematic review protocol (Preprint)

2021 ◽  
Author(s):  
Madison Milne-Ives ◽  
Sarah Neill ◽  
Natasha Bayes ◽  
Mitch Blair ◽  
Jane Blewitt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Systematic Reviews ◽  
Parental Knowledge ◽  
Urgent Care ◽  
Systematic Review Protocol ◽  
Digital Interventions ◽  
Review Protocol ◽  
The Impact ◽  
At Home

BACKGROUND Emergency and urgent care healthcare services are overburdened and the use of these services by acutely ill infants and children is increasing. A large proportion of these visits could be sufficiently addressed by other healthcare professionals. Uncertainty about the severity of a child’s symptoms is one of many factors that play a role in parents’ decisions to take their children to emergency services, demonstrating the need for improved support for health literacy. Digital interventions are a potential tool to improve support for parents’ information, knowledge and decision-making around acute childhood illness. However, existing systematic reviews related to this topic need to be updated and expanded to provide a contemporary review of the impact, usability, and limitations of these solutions. OBJECTIVE The purpose of this systematic review protocol is to present the method for an evaluation of the impact, usability, and limitations of different types of digital interventions to support parents caring for acutely ill children at home. METHODS The review will be structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and Population, Intervention, Comparator, and Outcome (PICO) frameworks. Five databases will be systematically searched for studies published in English during and after 2014: Medline, EMBASE, CINAHL, APA PsycNet, and Web of Science. Two reviewers will independently screen references’ titles and abstracts, select studies for inclusion based on the eligibility criteria, and extract the data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer if necessary. Risk of bias of all studies will be assessed using the Mixed-Methods Appraisal Tool (MMAT) and a descriptive analysis will be used to evaluate the outcomes reported. RESULTS The systematic review will commence during 2021. CONCLUSIONS This systematic review will summarize the impact, usability, and limitations of digital interventions for parents with acutely ill children. It will provide an overview of the field, identify reported impacts on health and behavioural outcomes; parental knowledge, satisfaction, and decision making; and the factors that affect use to help inform the development of more effective and sustainable interventions.

scholarly journals Explaining prosecution outcomes for cryptocurrency-based financial crimes

2022 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Arianna Trozze ◽  
Toby Davies ◽  
Bennett Kleinberg
Keyword(s):  
Decision Making ◽  
Regression Models ◽  
Design Methodology ◽  
Financial Crime ◽  
Content Type ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Financial Crimes ◽  
The Usa ◽  
The Impact

Purpose Cryptocurrencies have been used to commit various offences, but enforcement efforts remain underdeveloped relative to the value of these crimes. This paper aims to examine factors associated with outcomes of US-based cryptocurrency financial crime prosecutions. Design/methodology/approach The authors studied the 37 resolved cryptocurrency-based financial crime cases in the USA to date, exploring the impact of offence, defendant and evidence characteristics on the mode of disposition and penalties. The authors used bivariate analyses and logistic regression models to determine relationships among these variables. Findings The presence of individual defendants only (rather than a corporate defendant or combination thereof) and the use of only a cryptocurrency other than Bitcoin in committing a crime each made a case less likely to be resolved by dismissal, trial or summary or default judgement. Originality/value This paper is the first to examine variables contributing to financial crime prosecution outcomes and has implications for prosecutorial decision-making, resource allocation and the prevention and detection of financial offences involving cryptocurrencies.

Quota Women Are Threatening to Men

2017 ◽  
Vol 76 (3) ◽  
pp. 107-116 ◽  
Author(s):  
Klea Faniko ◽  
Till Burckhardt ◽  
Oriane Sarrasin ◽  
Fabio Lorenzi-Cioldi ◽  
Siri Øyslebø Sørensen ◽  
...  
Keyword(s):  
Decision Making ◽  
Organizational Performance ◽  
Gender Stereotypes ◽  
Perceived Threat ◽  
Preferential Treatment ◽  
Public Sector Employees ◽  
Different Types ◽  
Low Levels ◽  
Women In Decision Making ◽  
The Impact

Abstract. Two studies carried out among Albanian public-sector employees examined the impact of different types of affirmative action policies (AAPs) on (counter)stereotypical perceptions of women in decision-making positions. Study 1 (N = 178) revealed that participants – especially women – perceived women in decision-making positions as more masculine (i.e., agentic) than feminine (i.e., communal). Study 2 (N = 239) showed that different types of AA had different effects on the attribution of gender stereotypes to AAP beneficiaries: Women benefiting from a quota policy were perceived as being more communal than agentic, while those benefiting from weak preferential treatment were perceived as being more agentic than communal. Furthermore, we examined how the belief that AAPs threaten men’s access to decision-making positions influenced the attribution of these traits to AAP beneficiaries. The results showed that men who reported high levels of perceived threat, as compared to men who reported low levels of perceived threat, attributed more communal than agentic traits to the beneficiaries of quotas. These findings suggest that AAPs may have created a backlash against its beneficiaries by emphasizing gender-stereotypical or counterstereotypical traits. Thus, the framing of AAPs, for instance, as a matter of enhancing organizational performance, in the process of policy making and implementation, may be a crucial tool to countering potential backlash.

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