Activity

The setting up of an advanced practice nursing activity to monitor patients with severe or very severe pneumonia associated with Severe Acute Respiratory Syndrome Coronavirus 2, is a reponse to the population’s new health care needs and a massive influx of patients. The skills of the advanced practice nurse are mobilised in this context in order to carry out prevention missions and screening for potential sequelae which could lead to chronic respiratory failure.The first advanced practice nurses in psychiatry and mental health are being deployed across the country. Such is the case at Paris XV psychiatric university hospital, which is working to gradually integrate an advanced practice nurse into medico-psychological centres to work with patients with schizophrenia. The role also comprises time devoted to research and teaching.The French association of advanced practice nurses (anfipa) is actively participating in setting up advanced practice across the country. Colleges are places of interaction and work for advanced practice nurses and students. Highlighting missions of this college enables us to create places of discussion and exchanges in the field, and to take part in the rollout of this new profession.Le système de santé français reste à ce jour encore trop médico-centré Une véritable révolution doit s’opérer afin de le faire évoluer, nécessitant de revoir nos schémas de pensée habituels et d’intégrer les évolutions technologiques telles que l’intelligence artificielle D’autres acteurs peuvent y contribuer, comme les infirmiers en pratique avancée, grâce à une formation solide et une volonté politique forte.While being integrated into a public health policy which is extending their role, advanced practice nurses should operate within a discipline-specific approach, which takes account of their professional identity and ensures their added value for the health care system. Conceptual models of nursing care and other nursing theories are there to guide their practice and enable them to stay focused on their specific discipline.The concept of advanced practice nursing and the way it has been adapted to the French context are still poorly understood. It is however rooted in a long history and is based on well-established international notions. After a phase of structuring, advanced practice nurses are now being deployed across the country, with their missions, their association and their own union. Two years after the first graduations, challenges remain but the future is promising.In a healthcare facility, the way in which health professionals envisage quality can explain the different levels of investment observed. Documentary research into the representations of quality among caregivers identified the human and regulatory dimensions which influence their engagement. It opens up prospects for the involvement of lead nurses for quality, trained in encouraging a change of perspectives and the appropriation of a quality culture.

Clinicians often encounter defective restorations and are faced with the difficult decision of whether to repair the existing restoration or replace it.

An electronic survey on repairing or replacing defective restorations was developed to assess how clinicians are making these decisions and the technical aspects considered when making a repair. E-mails containing the survey link were sent to the American Dental Association Clinical Evaluators (ACE) Panel on August 14, 2019, and the survey remained open for 2 weeks. Nonrespondents were sent reminders 1 week after deployment.

Approximately 4 of every 5 respondents repair defective restorations. Z-DEVD-FMK The top 3 conditions for making these repairs were noncarious marginal defects (87%), partial loss or fracture of the restoration (79%), and crown margin repair due to carious lesions (73%). Among respondents who repair defective restorations, almost all repair direct resin composite (98%), whereas approximately one-third do not repair the other restorative materials (that is, amalgam, glass ionomer, and fractured indirect all-ceramic crowns). Resin composite is used most often to repair resin direct composite restorations, and likewise, glass ionomer is used most often to repair glass ionomer restorations. Only 54% of respondents use amalgam to repair amalgam restorations. Surface treatments varied among the 3 available restorations types.

Many dentists are actively making restoration repairs, but choosing clinical scenarios to make these repairs is material dependent.

The repair of defective restorations is an acceptable and more conservative alternative than restoration replacement, and its success depends on proper case selection, material, and technique.

The repair of defective restorations is an acceptable and more conservative alternative than restoration replacement, and its success depends on proper case selection, material, and technique.

The integration of medical and dental care in the dental setting offers a unique opportunity to close medical care gaps, such as providing immunizations and laboratory-based tests, compared with traditional nonintegrated settings.

We used a matched cohort study design among patients 65 years or older (n= 2,578) with an index dental visit to the Kaiser Permanente Northwest medical-dental integration (MDI) program from June 1, 2018, through December 31, 2019. MDI patients were matched 11 to non-MDI controls (n= 2,578) on 14 characteristics. The Kaiser Permanente Northwest MDI program focuses on closing 23 preventive (for example, flu vaccines) and disease management care gaps (for example, glycated hemoglobin testing) within the dental setting. The closure of all care gaps (yes versus no) was the outcome for the analysis. Multivariable logistic regression was used to evaluate the association between exposure to the MDI program and level of office integration (least, moderate, and most integration) with closure of care gaps. All data were obtained through Kaiser Permanente Northwest’s electronic health record.

MDI patients had significantly higher odds (odds ratio [OR],1.46, 95% confidence interval [CI],1.29 to 1.65) of closing all medical care gaps than non-MDI patients. Greater MDI integration was associated with significantly higher odds of gap closure compared with non-MDI (least integration OR,1.18, 95% CI,1.02 to 1.37; moderate integration OR,1.70, 95% CI, 1.36 to 2.12; most integration OR, 2.08, 95% CI, 1.73 to 2.50).

Patients receiving dental care in an MDI program had higher odds of closing medical care gaps compared with similar patients receiving dental care in a non-MDI program.

MDI is effective at facilitating delivery of preventive and disease management medical services.

MDI is effective at facilitating delivery of preventive and disease management medical services.