Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reform of emergency service provision. The findings suggest that further high quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in evidence based health service planning.
To determine whether transplacental transmission could explain overwintering of bluetongue virus in the United Kingdom, we studied calves born to dams naturally infected during pregnancy in 2007–08. Approximately 33% were infected transplacentally; some had compromised health. In all infected calves, viral load decreased after birth; no evidence of persistent infection was found.
Problem: To establish greater understanding into nurse practitioners and their value within healthcare. Hypothesis: Value in healthcare, when used as a tool of healthcare economics, is a marker for effective service recognition. Value cannot be determined without understanding, the lack of descriptive properties about Australian nurse practitioners contributes to the gap in understanding the value of the nurse practitioner service. Design: In this preliminary study we tested a concurrent triangulation design comprising of a three-part on-line questionnaire eliciting participating clinician's views of their nurse practitioner role. Setting: Nurse practitioners from one rural and one metropolitan Local Health District of New South Wales, Australia were surveyed. Thirty-five surveys were distributed to practitioners with an overall response rate of 77.5% (n=27). Results: Data analysis reveals that nurse practitioners primarily perceive they address healthcare access gaps. Most nurse practitioners reported it was easy to maintain their practice whilst reporting they found it difficult to attend education and consequently expand their practice. Nurse practitioners opinions were mixed when reporting the level of support from their employers. Conclusion: Nurse practitioners perceive their roles exist to meet shortfalls in health service delivery. Nurse practitioners identified the need for specialist nurse practitioner education and perceived varying support for their roles. Results qualify a more informed value judgement of the nurse practitioner role.
Risk stratification tools for patients presenting to rural EDs with undifferentiated chest pain enable early definitive treatment in high-risk patients. This systematic review compares the most commonly used risk stratification tools used to predict the risk of major adverse cardiac event (MACE) for patients presenting to rural EDs with chest pain. A comprehensive search of MEDLINE and Embase for studies published between January 2011 and January 2015 was undertaken. Study quality was assessed using QUADAS-2 criteria and the PRISMA guidelines.Eleven studies using eight risk stratification tools met the inclusion criteria. The percentage of MACE in the patients stratified as suitable for discharge, and the percentage of patients whose scores would have recommended admission that did not experience a MACE event were used as comparisons. Using the findings of a survey of emergency physicians that found a 1% MACE rate acceptable in discharged patients, the EDACS-ADP was considered the best performer. EDACS-ADP had one of the lowest rates of MACE in those discharged (3/1148, 0.3%) and discharged one of the highest percentage of patients (44.5%). Only the GRACE tool discharged more patients (69% - all patients with scores <100) but had a MACE rate of 0.3% in discharged patients. The HFA/CSANZ guidelines achieved zero cases of MACE but discharged only 1.3% of patients.EDACS-ADP can potentially increase diagnostic efficiency of patients presenting at ED with chest pain. Further assessment of tool in a rural context is recommended.
The emergency nurse practitioner is now a well established and respected member of the healthcare team. Evaluation of the role has focused on patient safety, effectiveness and quality of care outcomes. Comparisons of the role continue to focus on cost, with findings based on incomplete and almost impossible to define, recognition of contribution to service delivery by paralleled practitioners. Currently there is no clear definition as to how nurse practitioners contribute to value in health service delivery. Robust and rigorous research needs to be commissioned taking into consideration the unique hybrid nature of the emergency nurse practitioner role and focusing on the value they contribute to health care delivery.
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