Journal of the American Association of Nurse Practitioners最新文献

Abstract: The COVID-19 pandemic has led to a rapidly shifting health care environment, with frequent changes to best practices, which can lead to knowledge and practice gaps among health care providers, including nurse practitioners (NPs). The purpose of this paper was to describe a continuing education (CE) program developed to address COVID-19 knowledge gaps and to report on the changes in knowledge, competence, and confidence following program completion. The CE program was a 2.5 to 2.67 contact hour webinar delivered in July 2020, October 2020, and February 2021. Content included COVID-19 prevention, diagnosis, and management and was updated before the second and third webinars. Changes in content and webinar audience participation in the question and answer portion were reflected in the CE credit awarded. Preactivity and postactivity knowledge, competence, and confidence levels were assessed among activity completers. Changes between the preactivity and postactivity evaluation were compared. A total of 2,901 learners were included in the analysis, of whom 91.6% were NPs. Overall, baseline knowledge of COVID-19 transmission, diagnosis, and treatment was low. Substantial improvements in knowledge, competence, and confidence were reported from baseline to postactivity evaluation, with increases of 47-73% overall. Furthermore, learner confidence in identifying patients at risk for severe COVID-19 and counseling patients on prevention and transmission significantly increased. Despite plans to implement strategies to improve COVID-19 management, several barriers to uptake were identified. The rapid development of a COVID-19 CE program resulted in substantial gains in NP knowledge related to prevention, diagnosis, and management, with possible implications for nearly 68,000 patient encounters per month.

Background: Antibiotic overprescribing for acute respiratory tract infections (ARTIs) commonly occurs and can lead to higher medical costs, antibiotic resistance, and health complications. Inappropriate prescribing of antibiotics for ARTIs has been shown to occur more frequently in urgent care than other outpatient settings. It is not clear whether antibiotic overprescribing varies between virtual and in-person urgent care.

Objectives: Summarize published primary scientific literature on antibiotic prescribing patterns for ARTIs among adults in virtual urgent care settings.

Data sources: We conducted a systematic review to compare antibiotic prescribing for ARTIs between virtual and in-person urgent care. Our review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We assessed risk of bias using the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) assessment tool. We summarized study results from seven included retrospective cohort studies.

Conclusions: Antibiotic prescribing frequency may be similar between virtual urgent care and in-person care for adult patients treated for ARTIs. However, variability existed in intervention characteristics, settings, and outcome measures. Additional studies are needed to better understand the conditions in which virtual care may be most effective.

Implications for practice: Evidence suggests that giving providers direct access to evidence-based guidelines and electronic health records within the virtual visit may support diagnosis and management. Furthermore, practices that use telemedicine platforms for virtual urgent care visits should consider how to potentially improve diagnosis and management of conditions through the use of home-based point-of-care testing or accessory "e-tools."

Abstract: Noninvasive prenatal screening using cell-free DNA involves analysis of a sample of maternal blood for DNA fragments of fetal chromosomes from the fetal-placental unit to detect common chromosome abnormalities, trisomy 21, trisomy 13, trisomy 18, and sex chromosomes as early as 10 weeks' gestation when the fetal fraction is usually more than 4%. It is the most sensitive and specific prenatal screening option for these conditions. Because it is a screening test, false-positive and false-negative results can occur. Positive screen results necessitate further evaluation for diagnosis to confirm a medical condition, before critical decisions regarding pregnancy are made. Professional organizations provide clinical recommendations to providers regarding prescreen and postscreen counseling and management of results.

Background: There are unique challenges presented during the transition from pediatric to adult health care for adolescents with chronic medical conditions, and many do not transition smoothly. Although there is little research on how mobile applications can influence the transition process specifically, research shows technology, in general, can be advantageous to the transition process for adolescents. Ample literature exists on how adolescents are avid users of technology.

Local problem: The Children's Medical Services program in a large urban county in the southern United States lacked an efficient system for transitioning the care of children with special needs to the adult health care setting.

Methods: Qualitative semistructured interviews and pre-post tests were conducted with 23 adolescent participants with chronic medical conditions. Multiple choice questions elicited information from four categories: knowledge of medical condition, organization/health care system navigation, identified adult health care provider, and awareness of available resources.

Interventions: A novel website and smartphone application designed to aid adolescents and young adults during transition were developed.

Results: Gain scores from pre-post tests showed an increase in all 4 sections of the survey: knowledge of medical condition-21% increase, organization/health care system navigation-15.3% increase, identified health care provider-32% increase, and awareness of available resources-19.3% increase. All 23 adolescent participants reported that the application would be useful for managing their health information.

Conclusions: Smartphone applications can be helpful for adolescents in their transition into adult health care. Such applications also have potential to increase confidence and independence in managing health care needs.