Perceptions of the effectiveness of Advanced Practice Nurses on a neurosurgery unit in a Canadian Tertiary Care Centre:A pre-and-post implementation design

Objectives:A framework for the advanced practice nurse(APN)role was developed in our Canadian Tertiary Care Centre,delineating five domains of advanced nursing practice:clinical practice,consultation,research,education and leadership.The goal of this study was to evaluate perceptions of the effectiveness of the implementation of an innovative APN role on an in-patient Neurosurgery unit.Methods:A pre-and-post implementation design,incorporating both qualitative and quantitative data,was utilized.An innovative APN role was implemented within the Neurosurgery program focusing on the clinical domain and required the successful candidates to be NP prepared.This APN role was designed to improve patient flow,documentation,communication and patient and staff satisfaction.Three primary outcomes were measured:pre-implementation questionnaire(nurses),post-implementation questionnaire(nurses and residents)and number of pages to the on-call resident.Results:Survey scores by nurses and residents indicated improvement across all aspects studied.Average scores increased from 1.1 to 2.6,reflecting an overall statistically significant increase.The number of pages to the on-call resident also showed a decrease.Conclusion:Perceptions of patient care delivery and professional collaboration improved following implementation of the APN role.Responses indicated that APNs significantly impacted patient care and improved nurses and residents'job satisfaction.

Status of Equities in Prenatal Care Utilization and Changing Patterns among Women in China

Objective To assess the extent and relative changes of the equities in prenatal care utilization among women with different educational attainment in some areas of China. Methods Data were collected in 13 counties/cities covered by Perinatal Health Care Surveillance System established by Institute of Reproductive and Child Health, Peking University. The study population consisted of 103 704 women who delivered single live births in 1994 and 2000. Chi-square and multiple Logistic regression were employed to compare the administrative rates and relative risks. Concentration index was used to assess the relative changes of equities in prenatal care utilization. SPSS 11.5 and Microsoft Excel 2003 were used for analysis. Results The total systematic management rate was 22.1% in 1994 and 57.4% in 2000. The concentration index was -0.046 in 1994 and 0.066 in 2000. In northern areas, the concentration index increased from 0.015 in 1994 to 0.295 in 2000, while it increased from -0.015 in 1994 to 0.062 in 2000 in southern areas. In rural areas, the concentration index increased from O. 002 in 1994 to 0.026 in 2000, while it decreased from 0.042 in 1994 to 0.019 in 2000 in urban areas. Conclusion Inequities in prenatal care utilization in 2000 become more obvious than in 1994, especially in northern areas. More attention should be paid to solve the inequities.

mHealth as a health system strengthening tool in China

Over the past 70 years,there was a rapid epidemiological transition in disease burden in China,from infectious disease to non-communicable diseases(NCDs),which requires long-term prevention and management.Rapid growth in mobile phone use,internet connectivity and digital health technology,presents new opportunities for improvement in NCD healthcare delivery and population-based outcomes.Although there were a growing number of research to evaluate the feasibility and effectiveness of the mobile health(mHealth)interventions for NCD management,the extent to which mHealth contributes towards the health system strengthening in China remains unknown.In this paper,we provided a high-level overview of mHealth in China and its role for Chinese health system strengthening.We conclude with several recommendations for the future of mHealth research in China based on existing evidence identified.

A paradigm shift in models of oral health care:An example and a call to action

The consequences of oral disease are wide-ranging and can have a major impact on an indi-vidual’s and that person’s family’s quality of life.A range of factors interact to determine a person’s oral and general health.Such factors can be biological,social,economic,political,cultural,or environmental,in addition to knowledge,attitudes and behaviors.Traditional models of oral health care,however,have generally ignored these factors and instead have focused on the treatment and management of existing pathology(tertiary prevention/downstream approach).This has had no effect on the rate of hospitalization or the inequitable distribution of dental diseases.To reduce the prevalence and severity of oral diseases at the individual and population levels,holistic evidence-informed prevention-based health-promoting models of care that focus on upstream determinants of health are required.The Oral Health Program at North Richmond Community Health in the state of Victoria,Australia,has developed an innovative model of oral health care based on the follow-ing principles:health promotion,disease prevention,risk-based access to care,client-and family-centered care,team-based provision of care,multidisciplinary care,and innovation.Evaluation of this approach is currently being conducted to study the sustainability of such a model under the current public dental service funding model.

The questionnaire on autonomic regulation： a useful concept for integrative medicine？

The concept of autonomic regulation （aR） reflects the relevance of the function of different autonomic systems for health, aR can be captured by questionnaires. We differentiate between a trait or constitutional aR questionnaire version including 12 （short-version） or 18 items, respectively, with three subscales （orthostatic-circulatory, rest/activity and digestive regulation）, and an 18-item state aR questionnaire on the preceding week with four subscales （rest/activity, orthostatic-circulatory, thermo- and digestive regulation）. The validated questionnaires show satisfying to good reliability and robust validity with clear construct validity. In this article, we summarized the actually available literature on aR and the use of aR questionnaires in clinical and observational studies. We described the relationship of high aR with health and in case of low aR or loss of regulation with disease and functional disorder in the three （four） different subscales and functional systems, such as rest/activity, orthostatic-circulatory or digestive regulation （thermoregulation） with the consecutive therapeutJc need. Finally, we gave perspectives of its further application in clinical research.