Health care utilization following “digi-physical” assessment compared to physical assessment for infectious symptoms in primary care

Background The use of chat-based digital visits (eVisits) to assess infectious symptoms in primary care is rapidly increasing. The “digi-physical” model of care uses eVisits as the first line of assessment while assuming a certain proportion of patients will inevitably need to be further assessed through urgent physical examination within 48 h. It is unclear to what extent this approach can mitigate physical visits compared to assessing patients directly using office visits. Methods This pre-COVID-19-pandemic observational study followed up “digi-physical” eVisit patients (n = 1188) compared to office visit patients (n = 599) with respiratory or urinary symptoms. Index visits occurred between March 30th 2016 and March 29th 2019. The primary outcome was subsequent physical visits to physicians within two weeks using registry data from Skåne county, Sweden (Region Skånes Vårddatabas, RSVD). Results No significant differences in subsequent physical visits within two weeks (excluding the first 48 h) were noted following “digi-physical” care compared to office visits (179 (18.0%) vs. 102 (17.6%), P = .854). As part of the “digital-physical” concept, a significantly larger proportion of eVisit patients had a physical visit within 48 h compared to corresponding office visit patients (191 (16.1%) vs. 19 (3.2%), P < .001), with 150 (78.5%) of these eVisit patients recommended some form of follow-up by the eVisit physician. Conclusions Most eVisit patients (68.9%) with respiratory and urinary symptoms have no subsequent physical visits. Beyond an unavoidable portion of patients requiring urgent physical examination within 48 h, “digi-physical” management of respiratory and urinary symptoms results in comparable subsequent health care utilization compared to office visits. eVisit providers may need to optimize use of resources to minimize the proportion of patients being assessed both digitally and physically within 48 h as part of the “digi-physical” concept. Trial registration Clinicaltrials.gov identifier: NCT03474887.

Combined Methods for Physical and Mental Workload

This chapter presents information about the methods that combine physical and mental workload/fatigue during ergonomic evaluation. The methods were identified through a systematic literature review. The search criteria were done through a literature search in databases like SciFinder, SciELO, ScienceDirect, etc. As result, the following methods are described: Global Load Scale, Multivariate Workload Assessment, Subjective Fatigue Symptoms Test, Fatigue Assessment Scale, Scale of Recovery for Exhaustion of Occupational Fatigue, Scale of Estimated Fatigue-Energy Points, Swedish Occupational Fatigue Inventory, NASA-TLX, Combined Cognitive and Physical Assessment, Laboratory Method of Economics and Sociology of Work, OWL Method, Ergonomic Checklist Method, RENAULT Method, Joyce Method, NERPA Method, ARBAN Method, and MAPFRE Method. As a conclusion, it is possible to affirm that there are some evaluation methods that provide better elements for an accurate evaluation, and others lack basic elements, which causes an incomplete/not accurate evaluation.

Improving Student Pharmacists' Learning Through the Use of Pediatric Simulation

OBJECTIVE The purpose of this study was to assess the effect of low-fidelity simulation on students' confidence, knowledge, and skills in pediatric physical assessments, and to compare students' interest ratings of topics and effectiveness of learning activities between students' who experienced simulation and those who did not. METHODS Within a pediatric elective, a vital signs and physical assessment activity was re-designed to incorporate a low-fidelity heart and breath sounds simulator. Students rated their confidence in completing 9 different physical assessment skills before and after the activity and assessment. Students' perspectives of the activity were also assessed. Course evaluation surveys were compared with prior course offerings (without simulation) to determine a change in students' interest ratings of the topic and effectiveness of learning activities. The Wilcoxon signed rank test, thematic analysis, and descriptive statistics were used to analyze outcomes. RESULTS All 106 second professional year students in the elective completed the pre- and post-simulation surveys and course evaluations for 3 offerings. Students' post-simulation average confidence scores increased statistically on all 9 skills compared with pre-simulation scores. All students agreed or strongly agreed “the lecture and simulation activity done in class helped me overcome challenges I had with learning the skill.” Students (98%) successfully demonstrated competency on the formal assessment. Compared with previous course offerings, students reported higher interest ratings in the topics and instruction effectiveness when simulation was incorporated into the activity. CONCLUSIONS Low-fidelity simulation is an effective teaching and learning approach to increase students' confidence, knowledge, and interest in pediatric vital signs and physical assessment.

Knowledge of Nurses Regarding Respiratory Physical Assessment in Tertiary Hospital Lahore, Pakistan

In health care setting nursing practices depends on knowledge. Knowledgeable nurses express their expertise in critical care units. Specialty in critical care units required respiratory knowledge regarding physical assessment. Furthermore nursing profession has been viewed central point for client care. The rapid changes in healthcare setting that increased demand of trained, experienced nurses in health care setting. The knowledge about anatomy and physiology regarding respiratory assessment necessary in the field of auscultating expertise like respiratory system that gives the chance of early diagnosis, assess the clients need and client health problem to implement the nursing process. Study Design: Descriptive Cross Sectional Study design was applied. Settings: Data was collected through convenient sampling method from ICU department of tertiary Hospital Lahore. Study Participants: 36 female nurses within the age range 24 to 39 years were included in this research. Results: The knowledge of ICU Nurses regarding anatomy of respiratory above 50% but knowledge regarding physical assessment less than 50%. Furthermore less knowledge among nurses about respiratory physical assessment in clinical practices. Keywords: Physical Assessment, Nurses application, Respiratory Knowledge, Practices