No abstract

Realistic simulations of interactions around social determinants of health with adolescent standardized patients demonstrated the need to increase trainee practice in asking sensitive questions, as well as in devising appropriate follow-up responses, and in improving trainee familiarity with local resource referrals. Policy: Policymakers and credentialing boards should promote creation of more dynamic curricular programming that incorporates social determinants of health considerations to ensure that future health care trainees are adept and consistent in their screening and response to unmet social needs. Research: Our preliminary study should be expanded to better understand how explicit integration of social determinants of health into simulation experiences across a range of disciplines and types of trainees can help improve clinical practitioners' abilities to meaningfully integrate social determinants frameworks into their clinical interactions.

Four small populations of American chameleons (Anolis carolinensis) were tested to

The increase in nurse practitioners (NPs) in ambulatory medical and surgical specialty settings has prompted inquiry into their role and contribution to patient care. We explored the role and contribution of NPs in ambulatory specialty care through their activities outside of direct care and billable visits (referred to as service value activities), and how NPs perceive these activities enhance quality and efficiency of care, for both patients and the health care institution. This qualitative thematic analysis examined interviews from 16 NPs at a large academic medical center about their role and contribution to patient care quality and departmental efficiency beyond billable visits. Five categories of NP contribution were identified: promoting patient care continuity, promoting departmental continuity, promoting institutional historical and insider knowledge, addressing time-sensitive issues, and participating in leadership and quality improvement activities. As the role of NPs in specialty care grows and health care systems emphasize quality of care, it is appropriate to explore the quality- and efficiency-enhancing activities NPs perform in specialty care beyond direct patient care.

A435sub-locations in Kenya where hundred community health workers were trained on community based referral and counter referral model and issued with referral tools. Each was assigned 25 households, instructed to regularly visit them in order to identify sick persons counsel and refer them to link hospitals. One hundred villages comprising 2209 households with a population of 11,000 people were covered where the counter referral model was implemented. Results: Three hundred and twenty two sick persons were identified, counseled and referred to the two link health facilities by one hundred community health workers who covered one hundred villages. It was further shown that 82% (263/322) arrived in the referral health facilities with referral slips on the same day, 5% (15/322) second day, 6% (20/322) third day and over while 7% (24/322) did not arrive in the hospitals. ConClusions: It was observed that community health workers regularly visited households. This observation is consistent with findings of previous similar studies. Only about less than a third of all the referrals did not arrive the link referral hospital the first day. It is therefore concluded that community health workers are a critical link between the households and primary health care facilities. They are likely to identify common illnesses during routine household visitation, counsel and refer sick persons to health facilities for care.objeCtives: A core outcome set (COS) is a standardised set of outcomes which should be measured and reported, as a minimum, in all effectiveness trials for a specific health area. This will allow results to be compared, contrasted and combined as appropriate, as well as ensuring that all trials contribute usable information. The aim of this review was to identify studies which sought to determine which outcomes or domains to measure in all clinical trials in a specific condition, and to describe the methodological techniques used in these studies. Methods: We developed a multi-faceted search strategy for electronic databases (MEDLINE, SCOPUS, and Cochrane Methodology Register). We included studies which sought to determine which outcomes/domains to measure in all clinical trials in a specific condition. Results: 198 studies (250 reports) were included in the review. Studies covered various areas of health, most commonly cancer, rheumatology, neurology, heart and circulation, and dentistry and oral health. A variety of methods have been used to develop COS, including semi-structured discussion, unstructured group discussion, the Delphi Technique, Consensus Development Conference, surveys and Nominal Group Technique. The most common groups involved were clinical experts and non-clinical research experts. Thirty-one (16%) studies reported that the public had been involved in the process. The geographic locations of participants were predominantly North America (n= 164; 83%) and Europe (n= 150; 76%). ConClusions: This review has brought together the existing research in a single place. COS will increase the efficienc...