Abstract Objectives Expiratory radiographs are sometimes performed in addition to inspiratory radiographs when a diagnosis of pneumothorax is suspected. There is little published evidence to support this practice and most studies suggest the additional radiograph does not confer any benefit in terms of increased sensitivity. The present study is the first to assess if specialist emergency physicians are more likely to detect a pneumothorax on an inspiratory radiograph compared to an expiratory radiograph. Methods Across two urban district EDs 103 paired radiographs positive for pneumothorax and 112 negative controls were identified for inclusion in the study. These were reviewed by three specialist emergency physicians who rated them as either positive or negative for pneumothorax. Results The mean sensitivity for the three reviewers was 84.8% (95% CI 82.0–87.5) for the inspiratory radiographs and 91.9% (95% CI 88.2–95.6) for the expiratory radiographs, a mean absolute difference of 7.1% (95% CI 2.2–12.1, P = 0.025) in favour of expiratory radiographs. Conclusions When reviewed by emergency physicians the present study found expiratory radiographs confer an increase in sensitivity for the diagnosis of pneumothorax compared with inspiratory radiographs. In certain patients where the clinical suspicion for pneumothorax is high performing an expiratory radiograph may increase the likelihood of the diagnosis being made in the ED.
Research continues to show significant gaps in nursing graduates' preparedness in digital health.The aim of this study was to explore nursing students' self-perceived nursing informatics competency and preparedness in digital health, describe learning opportunities available, and identify perceived learning barriers and facilitators to developing informatics competency.A sequential mixed-methods design, using a cross-sectional survey and interviews, was used. Senior undergraduate students (n = 221) in BScN programs in a Western Canadian Province participated.Participants self-reported being somewhat competent in nursing informatics. Three themes were identified: struggling to make sense of informatics nursing practice; learning experiences; and preparedness for future practice.Addressing inconsistencies in informatics education is an urgent priority so that nursing graduates are competent upon joining the workforce. Implications for nursing education, practice, and policy are discussed.
In order that graduates have the ability to access, manage, and apply up-to-date information (Scollin, Healey-Walsh, Kafel, Mehta, & Callahan, 2007) and make evidence-informed decisions, nurse educators must integrate informatics and information management tools within the nursing curriculum (Canadian Association of Schools of Nursing, 2012; Hebda & Calderone, 2010; National League for Nursing, 2008). Nurse experts have recommended that pre-licensure nurses use smart information technologies to enable them to provide informed, safe, and competent patient care (TIGER, 2009). Smart technologies, such as handheld devices, improve access to clinical information and drug dosage calculations (Farrell & Rose, 2008; White et al., 2005). Such devices, including smartphones, iPods, and tablets, can house current, reliable, digital resources and textbooks. Current studies suggest that, with handheld devices, nursing students search for information more frequently, make fewer medication errors (Koeniger-Donohue, 2008), and report more positive attitudes and lower stress when acquiring clinical information (Jamieson et al., 2009). Students in one small, local study highly recommended adoption of Nursing Central [TM] (NC) as an information support software system for clinical learning (Jamieson et al., 2009). However, more knowledge about student perspectives on the usability and usefulness of specific information-support software and technologies is required before adoption of this learning resource. METHOD This pilot study evaluated the perspectives of nursing students who used NC in a clinical practice rotation. NC, a software program developed by Unbound(r) Medicine (Charlottesville, VA) specifically for nurses, enables the download and searching of electronic quick reference guides (Taber's Medical Dictionary, Davis's Drug Guide for Nurses, Davis's Comprehensive Handbook of Laboratory and Diagnostic Tests, Davis's Diseases and Disorders, and Handbook of Nursing Diagnosis) to a handheld device. NC also enables Medline search capability and download of journal Table of Contents alerts. For a trial period, Unbound Medicine donated NC software licenses for interested students and waived the annual individual software fee of US$159. Fourth-year students were oriented to NC in the classroom while third-year students received orientation in the clinical setting before use during a clinical rotation. While the third-year students completed their clinical rotation with a clinical instructor who also used NC, the fourth-year students used NC independently in their final preceptored placement. One hundred fifty students (third-year, 70; fourth year, 80) from a four-year baccalaureate nursing program were invited to participate in the pilot study. Students were eligible if they had an appropriate handheld device or smartphone and, for third-year students, if their clinical instructor also used NC. From this population, 80 nursing students requested an NC licence from Unbound Medicine, and 65 students downloaded software programs. Recruitment for the study began after courses were completed, course grades were received, and ethics approval was provided by the university ethics committee. The study explanation and online survey link (Askitonline.com) were emailed to participants; all study data were anonymous. The survey consisted of 25 Likert items with scores ranging from 1 (do not agree) to 5 (strongly agree), with one item rating of overall helpfulness and three textboxes designed to measure NC user-friendliness, information support, and resource quality for clinical learning. RESULTS A total of 31 students completed the online survey (third year, n = 16; fourth-year, n = 15). Their average age was 25.86 years, with ages ranging from 20 to 43 years. Quantitative Findings The rating of overall helpfulness of NC as a resource during the clinical rotation was high (M = 4. …
Abstract Objective EDs are necessary for urgent health concerns; however, many physical ED visits could be better treated in alternate settings. The present study aimed to describe the feasibility, acceptability and effectiveness of a Virtual ED to reduce unnecessary physical ED presentations at a large tertiary health service in Australia. Methods This observational study using the RE‐AIM framework (Reach, Efficacy, Adoption, Implementation and Maintenance) evaluated the feasibility of a Virtual ED using routinely collected health service data and process‐evaluation to assess intervention fidelity and adherence between April 2020 and 31 March 2022. The primary outcome for the present study was the feasibility of the Virtual ED model of care. Results The Virtual ED received 2080 direct calls for patients with a mean age of 50.3 years, with 70.4% managed in the Virtual ED alone and 29.6% referred for physical ED presentation. Of the 2080 direct referrals, 95.8% were potentially avoidable ED presentations. Of those referred, 28.3% required an admission. Of calls managed entirely by Virtual ED, 18 (1.2%) unexpectedly required a hospital admission within 48 h. General practitioner respondents rated the Virtual ED service as helpful to very helpful. The service had an average of 212 referrals per month, with a 65.2% average growth rate. The Virtual ED service was considered helpful and clinically appropriate, with a high level of ED avoidance. Conclusion The Virtual ED prevented 70% of community triaged patients from presenting to the physical ED, with good uptake from all referrers, supporting the use of virtual care pathways in emergency care management.
While much progress has been achieved in advancing nursing informatics capacity in Canada, more work is needed to keep pace with the 21st century technological revolution. Nursing programs and educators are at the forefront of this change, and are key to ensuring successful integration of digital health and informatics in nursing education and practice.
This article demonstrates how community renewable energy (RE) can lead the Yukon towards energy resilience. As shown in other areas of Canada and abroad, community RE delivery through social economy businesses can be a bridge between government programs and provision of renewable technologies to communities. Through identifying the opportunities and barriers in the Yukon, this study demonstrates that social enterprise delivery of community RE will create energy resilience in Yukon communities, while empowering their residents. From the themes of the role of the state, community connection, Yukon cultural influence, technical considerations, and social enterprise start-up, a framework emerged for social enterprise delivery of community RE in the Yukon. This implementation framework, entitled “EmPower the Yukon,” is comprised of factors important for success and includes starting small, harnessing the power of government, finding community champions, working with community development corporations, and leading with both the heart and mind. The research has shown that empowering Yukoners to become involved in the transition to energy resilience is the best way to ensure successful social enterprise delivery of renewable energy projects.
'/%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h10080v5040H0z'/%3e%3cpath stroke='%23fff' stroke-width='.6' d='m0 0 6 3m0-3L0 3' clip-path='url(%23b)' transform='scale(840)'/%3e%3cpath stroke='%23e4002b' stroke-width='.4' d='m0 0 6 3m0-3L0 3' clip-path='url(%23c)' transform='scale(840)'/%3e%3cpath stroke='%23fff' stroke-width='840' d='M2520 0v2520M0 1260h5040'/%3e%3cpath stroke='%23e4002b' stroke-width='504' d='M2520 0v2520M0 1260h5040'/%3e%3cg fill='%23fff'%3e%3cuse xlink:href='%23d' x='2520' y='3780'/%3e%3cuse xlink:href='%23a' x='7560' y='4200'/%3e%3cuse xlink:href='%23a' x='6300' y='2205'/%3e%3cuse xlink:href='%23a' x='7560' y='840'/%3e%3cuse xlink:href='%23a' x='8680' y='1869'/%3e%3cuse xlink:href='%23e' x='8064' y='2730'/%3e%3c/g%3e%3c/svg%3e)
