Search Results (352)

Background: Health care work contributes significantly to greenhouse gas emissions. Primary health care is community-based and focused on wellness and disease prevention. Within primary health care, pharmacists are most frequently the stewards of medicines, supplies, and other tangible products that contribute to carbon footprints. Pharmacists are in a unique position to help adapt to and mitigate climate change-related issues. Objective: To examine pharmacists’ perspectives on climate adaptation and mitigation strategies in primary health care delivery in interprofessional settings. Methods: Semi-structured qualitative interviews with primary care pharmacists were undertaken. Constant-comparative data analysis was used to code and categorize findings. The COREQ system was applied to ensure rigor and quality of research. Results: A total of 21 primary care pharmacists participated in this research. Several core themes emerged as follows: (a) universal agreement that climate change is real and primary health care needs to evolve rapidly to address it; (b) recognition that primary health care is time-pressured and resource constrained so successful solutions need to be pragmatic and work within realities of practice; (c) identification of actionable priorities with high potential for mitigation impact; and (d) mobilization of a coalition to develop system-wide initiatives that could be implemented in primary health care. Conclusions: Collaborative approaches and those that focus on the implementation of regulatory requirements were identified as being most productive in this setting. Full article

Background/Objectives: Dizziness is a symptom of many disorders across a wide range of etiologies. If dizzy patients are seen for vestibular evaluation with an audiologist and no vestibular reason for the patient’s dizziness is found, the medical referral pathway can become convoluted. This can leave patients feeling discouraged and unable to manage their symptoms. Clinically symptomatic chronic respiratory alkalosis (CSCRA) is an acid–base disorder that typically presents with dizziness but is unfamiliar to practitioners in vestibular and balance care settings. Methods: In a retrospective chart review deemed exempt by the Mayo Clinic Institutional Review Board, 74 patients at Mayo Clinic Arizona were included. All had consultations with both Audiology and Aerospace Medicine to assess their dizzy symptoms. Results: After completing vestibular testing, arterial blood gas (ABG) testing, and a functional test developed at Mayo Clinic Arizona called the Capnic Challenge test, 40% of patients were found to have CSCRA contributing to their dizzy symptoms. Many of these patients also had common comorbidities of CSCRA, like postural orthostatic tachycardia syndrome (POTS), migraines, and sleep apnea. Fewer than one-fourth of these patients had measurable vestibulopathies causing their dizziness. Half of the patients referred by the vestibular audiologist to Aerospace Medicine had a diagnosis of CSCRA. Conclusions: Assessment for CSCRA should be considered as a next step for patients presenting with dizziness without a vestibular component. Being aware of the prevalence of CSCRA and its comorbidities may help balance providers offer quality interprofessional referrals and improve patient quality of life. Full article

This pre–post study aimed to determine whether interprofessional education (IPE) combining online and in-person instruction enhanced medical students’ empathy. The IPE program was conducted during the academic years 2022 and 2023 for medical (n = 240) and other healthcare students. Subjects discussed a case scenario involving a patient with chronic myeloid leukemia, sharing their ideas within their team and with other teams. The medical students’ empathy was assessed before and after the IPE program using the Japanese version of the Jefferson Scale of Empathy for Health Professions Students (JSE-HPS). Medical students provided written responses to the question, “What do you think is necessary for the care of patients with cancer, besides medical skills and knowledge?” Empathy-related terms were identified using frequency and co-occurrence analyses. The frequencies before and after the IPE were compared. The median JSE-HPS score rose from 98.0 to 114.0 (p < 0.001, Wilcoxon signed-rank test). The frequency of words categorized as demonstrating empathy increased from 37.9% to 52.9% after the IPE (p < 0.01, chi-square test). Our hybrid IPE program enhanced medical students’ empathy, which was supported by both quantitative and qualitative methods. Full article

Background/Objectives: Reasons for long-term stays in intensive care units (ICUs) include various critical conditions, prolonged weaning with post-extubation dysphagia (PED), as well as the mere presence of a tracheal cannula. In an interprofessional QM project, medicine, nursing, physiotherapy, speech and language therapy (SLT), and occupational therapy work together to reduce the length of stay (LOS) in ICUs. SLT focuses on tracheal cannula management (TCM) and PED. The primary aim of SLT is fast and safe decannulation and thereby the reduction in LOS. Methods: Two SOPs for dealing with PED patients and for structured TCM were developed for this purpose and were both implemented in a postoperative ICU, together with a SLT staff increase. To compare the effects on the intervention group (IG, n = 54), a historical control (HC, n = 58) group was created through a retrospective data analysis. We screened all patients from ICU (n = 5605), including those with tracheostomy, and analyzed them during their ICU stay. Results: Clinically relevant results were observed for the mean time in days of tracheostomy in those who could be decannulated (HC = 43.43, IG = 23.8; d = 0.99) and, even more importantly, for LOS in days (HC = 33.41, IG = 23.8; d = 0.48). Conclusions: The integration of SLT in ICU care is feasible and helps to reduce the time to decannulation and LOS. Full article

Introduction: During pharmaceutical care, community pharmacists play a crucial role by carrying out interventions aimed at preventing, detecting, and resolving drug-related problems (DRPs) and negative outcomes associated with medication (NOM), simultaneously enhancing patients’ knowledge about their treatments. The chronic use of Benzodiazepines (BZDs) is known to be associated with risks such as tolerance, dependence, and cognitive impairment. Furthermore, the combined use of BZDs with other medications or alcohol may expose patients to significant drug interactions. Objectives: This study aimed to characterize and describe the clinical profile of patients using BZDs, to evaluate the extent of polypharmacy and potential drug interactions, to investigate their level of knowledge regarding BZD treatment, and ultimately, to propose evidence-based interventions from the community pharmacy to contribute to improving patient safety and minimizing risks associated with BZD use. Method: A cross-sectional, descriptive study was conducted in a single community pharmacy in Gran Canaria (Canary Islands, Spain). The study population comprised 125 adult patients with active BZD prescriptions. Data collection was performed through pharmacist–patient structured interviews using a questionnaire that included sociodemographic, clinical, and BZD knowledge variables. Results: Lormetazepam and alprazolam were the BZDs most frequently prescribed and dispensed. Potential drug interactions with other medications were detected in 38.4% of BZD users. Notably, 61.5% of patients using BZDs also reported the concurrent use of opioid analgesics, with tramadol being the most common opioid (48.1% of BZD users were also treated with tramadol). Statistically significant differences were observed between patients with and without BZD and other drug interactions in several adverse outcome variables, including the risk of falls (p = 0.003), cognitive impairment (p = 0.047), and urinary incontinence (p = 0.016). Existing BZD dependence is detected in 25% and 22.1% of cases, respectively. Patients’ knowledge of their BZD treatment revealed critical gaps, which are identified as a challenge and a clear opportunity for intervention through pharmaceutical care services. Conclusions: The findings underscore the essential and proactive role of community pharmacists in identifying and managing drug interactions, as well as in supporting deprescribing strategies through collaborative and interprofessional care models. Full article

Background: ECHO Pain is a health professions education model that uses telehealth technology to connect specialists in academic centres to healthcare professionals who work in the community to disseminate best practice knowledge and foster interprofessional collaboration to support real patient cases. Methods: This paper summarizes 10 years of ECHO Pain implementation and evaluation in Ontario. We reviewed participants’ demographics, characteristics of cases presented in ECHO sessions, and the research output of this ECHO Pain program. Results: From June 2014 to June 2024, there were 529 sessions, 1527 healthcare professionals from urban and rural regions attended ECHO, and 25,898 h of continuing medical education credits were provided. We published 11 papers in peer-reviewed scientific journals using qualitative and quantitative research methods. Conclusions: ECHO Pain has been implemented and sustained in Ontario for 10 years, with demonstrated interprofessional education and an ongoing community of practice to discuss chronic pain cases. ECHO Pain is filling a significant gap in health professions education related to chronic pain in Ontario, especially for primary care professionals living in rural, remote, and underserved areas. Full article

Introduction: Advancements in diabetes technology have transformed diabetes management, yet technology implementation remains inconsistent due to barriers at both the clinician and patient levels. Team-based collaborative care offers a promising strategy to bridge these gaps. Framework: The Practical, Robust Implementation and Sustainability Model (PRISM), which incorporates the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework, was applied to identify clinician and patient-level barriers to technology implementation and guide development of team-based strategies for improvement. Application of this framework is illustrated through a rural primary care clinic implementing a remote patient monitoring program. Results: Analysis across RE-AIM domains identified team-based, interprofessional strategies for enhancing technology implementation and sustainability. Recommended strategies include structured onboarding and digital literacy support for both patients and clinicians, clear delineation of team roles and intentional integration of workflows, continuous quality improvement through feedback and huddles, and sustained organizational and policy support that ensures security, reimbursement, and equitable access. Conclusions: Application of the PRISM framework to improve diabetes technology implementation allows for translation of technological innovation into meaningful outcomes. Full article

Background: In South Africa, diabetic foot complications (DFC) often present for the first time at the primary healthcare (PHC) level, where nurses are central to diabetes management and prevention. Despite their key role, there are limited data on nurses’ experiences in managing DFC, particularly in resource-constrained primary healthcare (PHC) settings. This study’s objective was to explore and describe nurses’ experiences in managing DFC at the PHC level, with the aim of informing future interventions and policy development. Methods: A descriptive phenomenological study was conducted with 21 PHC nurses working in community healthcare centres to explore their experiences in managing DFC within PHC facilities. Results: Five key themes emerged: limited knowledge, time and workload constraints, lack of referral feedback, need for targeted training, and resource constraints. These reflect systemic and practical barriers that hinder effective care and contribute to inconsistent patient outcomes. Nurses are vital to early detection and intervention but face structural challenges that limit their capacity to deliver optimal care. Conclusions: Nurses encounter significant challenges when implementing routine diabetic foot screening at the primary healthcare level. These challenges include limited training, inadequate resources, and poor interprofessional collaboration. To overcome these barriers, targeted capacity-building initiatives, improved referral and communication pathways, and the provision of essential tools and support are needed. Additionally, integrating podiatrists into primary healthcare teams and establishing multidisciplinary foot care services are crucial steps to enhance care quality and reduce complications in resource-limited settings. Full article

Objective: This study aims to validate a referral model for specialised nursing consultation in the treatment of patients with complex wounds. Methods: A sequential mixed-methods design was used. First, a focus group with national wound care experts was conducted to identify and discuss potential referral indicators based on current clinical practice and the existing literature. The preliminary criteria were then evaluated and refined through a two-round Delphi survey involving a multidisciplinary panel of specialists. Consensus was defined as ≥70% agreement among participants. Results: Fourteen referral criteria achieved expert consensus, with several, such as the need for advanced therapies, multidisciplinary management, and the presence of peripheral vascular disease, reaching over 90% agreement. The most frequently prioritised indicators for referral included wound complexity (exposure of fascia or surgical material, presence of non-viable tissue, or associated vascular pathology) and the need for innovative advanced therapies (e.g., negative-pressure wound therapy, topical oxygen therapy). Conclusions: This validated set of referral criteria offers a structured, evidence-informed tool to support timely and appropriate referral to specialised nursing consultation, enhancing consistency, quality, and efficiency in wound management. Beyond clinical utility, these criteria may serve as a foundation for national referral policies, interprofessional collaboration, and future digital decision-support systems aimed at optimising complex wound care. Full article

Objectives: This systematic review and meta-analysis evaluated differences in job satisfaction scores between nurses and physicians, examining variation by (a) care setting (hospital, emergency department, outpatient, mixed), and (b) time period (pre-COVID, during COVID, post-COVID). Methods: We systematically searched PubMed, Scopus, ScienceDirect, Web of Science, and CINAHL for studies published between January 2020 and July 2025. Eligible studies reported mean and standard deviation values for job satisfaction among physicians and nurses in healthcare settings across the specified timeframes. Studies were excluded if they assessed other types of satisfaction or combined data across COVID periods. Pooled standardized mean difference (SMD) was calculated using random-effects models in R. Results: Before COVID-19, the SMD was −2.40 (95% CI −8.05 to 3.26; I² = 98%). During the pandemic, the estimate was 1.39 (95% CI −0.57 to 3.35; I² = 91.5%), and post-pandemic, it remained small (SMD = 0.29; 95% CI −1.63 to 2.22; I² = 95.8%). Emergency care during COVID showed a significant advantage for physicians (SMD = 0.29; 95% CI 0.05 to 0.52; I² = 0%). Post-COVID, mixed settings slightly favored physicians (SMD = 0.06), while primary care favored nurses (SMD = −0.30); subgroup differences were significant. Conclusions: The findings reveal that job satisfaction is not solely determined by professional role but is significantly influenced by temporal and contextual factors. Job satisfaction is shaped more by temporal and contextual factors than by professional role. While no consistent differences were observed pre-pandemic, emergency care favored physicians during COVID, and post-pandemic trends showed modest advantages for nurses in primary care and physicians in mixed settings. Due to the methodological limitations of this meta-analysis, including high heterogeneity, reliance on cross-sectional data, and very low/low certainty of evidence, these results should be interpreted with caution. Full article

Background/Objective: Worldwide, ~45% of hypertensives remain undiagnosed, and ~26% are adequately controlled. The active involvement of all healthcare professionals in diagnosing hypertension at primary health care units (PHCUs) is linked to better blood pressure (BP) control. There is currently no research examining the potential role of senior medical students in the diagnosis of hypertension. This study aimed to evaluate the contribution of final-year medical students’ active participation in the diagnosis of hypertension. The study also examined the prevalence and control of hypertension among health service users in Greek PHCUs. Methods: This is a cross-sectional convenience sample study. During clinical placement in PHC, sixth-year medical students received systematic training and performed BP measurements, according to the guidelines, in private, well-organized spaces. Adult patients and visitors were enlisted for BP measurements. The BP readings were provided to the participants so they could discuss any concerns about their BP with their physician. Statistical analysis was performed with SPSS. Categorical variables are presented as frequencies. Continuous variables were assessed for normality and, based on their distribution, are expressed as mean ± standard deviation or median (interquartile range). Appropriate tests were performed for the comparisons across groups (chi-square for the categorical variables, and two-sample t-test or Mann–Whitney test for continuous variables). A p-value < 0.05 was considered statistically significant. Results: In the present study, 124 medical students performed BP measurements in 68 PHCUs. BP was measured in 704 individuals, aged 61 (IQR: 48.0–73.0) years old; 58.8% were female, 68.3% of whom were patients. The prevalence of hypertension was 56.7%. The control rate was 44.9% (BP < 140 and 90 mmHg among all hypertensives), and the control rate under treatment was 61.0% (BP < 140 and 90 mmHg among treated hypertensives). The involvement of medical students contributed positively, increasing the diagnosis of hypertension in individuals who might not have their BP measured in routine clinical practice. Ninety-nine newly diagnosed hypertensives were detected. Students identified 220 uncontrolled hypertensives and 112 uncontrolled under-treated patients, who were then referred to the consultant physicians. Conclusions: Students played a critical role in diagnosing hypertension and identifying newly diagnosed hypertensive patients. Embracing interprofessional care in the diagnosis and management of hypertension is essential for achieving better outcomes for our patients. Engaging medical students in BP measurements is a practical and feasible approach to improve hypertension diagnosis and control, taking into consideration the increased workload of PHC physicians. While this action has important medical education implications, the impact on the knowledge level of medical students was not evaluated. Limitations of this study include the assessment of BP in one visit without home BP measurements or a second visit, lack of follow-up of newly diagnosed hypertensives, and the low average number of BP measurements per student. Full article

Background/Objectives: Interprofessional training wards (ITWs) are effective in fostering interprofessional collaboration during undergraduate medical training. Ensuring safety is particularly crucial for vulnerable patient groups. We developed a safety concept for the pediatric cardiology ITW, enabling nursing trainees and final-year medical students to independently care for children with congenital heart defects (CHDs). This study aims to evaluate whether our safety concept allows the inclusion of patients with CHDs in the care provided by our ITW. It also seeks to evaluate patient feedback, including their perception of safety, and to investigate whether there is a correlation between the input and the severity of the heart defect. Methods: From 2020 to 2023, 16 ITW blocks were evaluated, each lasting 3–4 weeks. The three-stage safety concept includes patient selection, emergency prevention and emergency training. CHD severity in treated patients was recorded, and experiences were assessed via parent/patient questionnaires. Results: Between August 2020 and November 2023, 183 patients with mild (n = 52), moderate (n = 28), and severe (n = 103) CHDs were treated. The severity of CHDs was generally higher compared to other pediatric cardiology wards in Germany. There was no significant difference between the severity of CHDs of the patient treated by the ITW and those treated on the regular ward. Of 140 completed questionnaires, 99% of respondents would recommend the program. Overall impressions ranged from “very good” (81%) to “good” (19%), with a high sense of safety reported. Positive free-text comments highlighted the team’s competence and friendliness. Conclusions: The safety concept enabled the successful treatment of patients across all CHD severities, providing a transferable model for safe, interprofessional care in ITWs. Full article

Background: The nursing practice environment is a critical determinant of healthcare quality, patient safety, and nurse well-being. Military healthcare settings present unique challenges, including rigid hierarchical structures, deployment rotations, and resource constraints, which may significantly affect the nursing practice. This scoping review mapped the available scientific evidence on the nursing practice environment in military healthcare institutions and identified its influencing factors. Methods: Following JBI methodology, a scoping review was conducted according to the PCC framework: nurses (Population), the nursing practice environment (Concept), and military healthcare settings (Context). Papers in English, Portuguese, or Spanish were included without date restrictions. Searches were performed in 4 databases (September 2025) and data selections were conducted independently by two reviewers. Results: Eleven studies (2010–2025), mainly from the United States, met the inclusion criteria. Thematic analysis revealed three main components influencing the nursing practice environment: structural (leadership, professional development, staffing), relational (collaboration, conflict management), and outcome-related (well-being, retention, patient safety). Favourable environments were associated with higher satisfaction, retention, and reduced burnout. Conversely, unfavorable environments, often influenced by rank hierarchy, deployment rotations, and organizational rigidity, were linked to turnover intention, moral distress, and compromised patient outcomes. Conclusions: Evidence from the included studies indicates that adaptive leadership, interprofessional collaboration, professional development and staffing adequacy are recurrent factors associated with nurses’ satisfaction, retention, and perceived quality of care. Hierarchy structures, deployments, and mobility also appear to influence the specific characteristics of military nursing practice environments. Full article

Background/Objectives: Older patients with cancer are predisposed to malnutrition, contributing to adverse postoperative outcomes, high complication rates, and poor prognosis, warranting dietary support from nurses. Practices and factors related to such support remain unexplored. We examined factors associated with discharge-oriented dietary support for older patients with cancer. Methods: This cross-sectional study involved registered nurses working in wards and was conducted using a self-report questionnaire between September 2024 and February 2025 at two regional core cancer Japanese hospitals. The survey included the Ward Nurses’ Discharge-Oriented Dietary Support Scale for Older Adult Patients (NDODSS), items assessing nurses’ perceived difficulty with cancer care, patient assessment, interprofessional collaboration, and their interest in, perceived importance of, and difficulty with dietary support. Data were analyzed using t-test, Pearson correlation, and multiple regression analysis. Results: Overall, 134 nurses, with an average of 6.8 years of cancer nursing experience, were included. The total mean scores for NDODSS, assessment of healthy eating behavior, adjustment of the living environment, and continual frailty assessment were 68.6 (11.8), 28.4 (4.9), 18.2 (4.7), and 22.0 (4.2), respectively. Multiple regression analysis showed that NDODSS was significantly associated with difficulty providing dietary support (β = −0.127, p = 0.043), physical assessment of cancer patients (β = 0.282, p < 0.001), social assessment (β = 0.207, p = 0.003), and consultation with other professionals (β = 0.205, p = 0.010). Conclusions: Dietary support for older patients with cancer requires a multidisciplinary approach, including cancer symptom assessment, social factor evaluation and sharing dietary support-related challenges. Full article

Background: The growing burden of chronic illnesses calls for integrated and sustainable models of Primary Healthcare (PHC) that emphasize health promotion and patient-centered care. Interprofessional collaboration between General Practitioners (GPs) and Family and Community Nurses (FCNs) is a strategic approach to enhancing continuity of care and supporting individuals in adopting healthy behaviors across the trajectory of chronic conditions. This study aims to explore the experiences and perspectives of GPs and FCNs in Italy, with the goal of identifying the barriers, enablers, and transformative dynamics that can inform future PHC models. Methods: A qualitative study was conducted with four focus groups with 21 participants (8 GPs and 13 FCNs) from three Italian regions, carried out between March and November 2023. Data were analyzed using Reflexive Thematic Analysis (RTA) following Braun and Clarke’s framework. Ethical approval was obtained from the University of Parma (Protocol No. 0266537—21 October 2022). Results: Four themes and sixteen subthemes were identified: (1) barriers to effective collaboration (role ambiguity, limited time, structural misalignments); (2) facilitators of collaboration (openness, mutual recognition, shared goals); (3) team-building processes (phases of trust development, shared values, reflective problem-solving); and (4) transformation of work practices (improved patient outcomes, flexible methodologies, integrated care strategies). Conclusions: Interprofessional collaboration between GPs and FCNs enhances the capacity of PHC to address the complex needs of people with chronic conditions. Aligning relational, organizational, and structural factors is essential for sustainable, health-promoting care models. Tailored training, protected time, and shared spaces are critical to foster teamwork, promote patient empowerment, and ensure continuity of care in chronic illness management. Full article