Caseload Data Research Articles

Burnout and compassion fatigue among Exercise Physiologists in mental healthcare.

Burnout and compassion fatigue (CF) are common among mental health practitioners. Accredited Exercise Physiologists (AEPs) provide clinical services to individuals experiencing mental illness, increasing their likelihood of experiencing burnout and CF. To examine the prevalence of burnout and CF among AEPs working with people experiencing mental illness. An anonymous online cross-sectional survey of AEPs working with people experiencing mental illness was distributed via the Exercise and Sports Science Australia Mental Health Special Interest Group Facebook page between July and November 2019. In addition to demographics and caseload data, respondents completed the Professional Quality of Life scale and Oldenburg Burnout Inventory (OLBI). Results are reported using descriptive statistics. Sixty-two AEPs (68%, n = 42 female) completed the survey. Most (n = 53, 86%) reported delivering services to consumers with severe mental health conditions. Less than half (n = 27, 44%) reported working in a dedicated mental health facility. Moderate levels of burnout and CF were experienced by 60% and 30% of respondents, respectively. The prevalence of moderate burnout and CF symptoms in AEPs is comparable with other mental health professionals. Strategies to preserve psychological well-being such as enhancing mental health training for undergraduates and formalized supervision structures discussed.

Navigating Government Disability Programs across Canada

Effective and accessible disability programs are essential to supporting Canadians with disabilities and achieving Canada’s commitment to the United Nations Convention on the Rights of Persons with Disabilities. The limited availability of centralized data on disability programs in Canada makes it difficult to understand, let alone evaluate, existing programs. To address this issue, we used government publications to create a database that compiles expenditure data, caseload data, and information about disability programs for each Canadian province from fiscal year 1999/00 to 2017/18, where available. We discuss the value of these data by presenting preliminary analyses. We also detail limitations associated with our database and highlight areas for future study.

Retrospective analysis of epidemic thunderstorm asthma in children in Yulin, northwest China.

An epidemic of thunderstorm asthma in pediatric patients occurred in Yulin, a northwest city of China, on 11 September 2018. We described the epidemic and retrospectively analyzed the demographic and clinical aspects of the involved children. The caseload data of patients were collected from the hospital information system in Yulin Pediatric Hospital. The detailed document of hospitalized children with thunderstorm asthma was sourced from the medical records. The mean number of daily visits to emergency/outpatient department and the daily admission to hospital were 2.7 and 16 times, respectively, than on the other days of September. A gender prominence of males was observed in both emergency/outpatient and inpatient department. Among the 51 hospitalized children with detailed medical records, 56% of them had never experienced or were diagnosed with asthma and 25% had confirmed diagnosis of asthma. Sixty-seven percent had a history of allergic rhinitis during August and September. Seventy-six percent of the hospitalized children presented as moderate asthma. Ninety-four percent of the pediatric patients had positive IgE against mugwort pollen and 78% were monosensitized to pollen. Thunderstorm asthma can affect children, especially who has allergic rhinitis or asthma without preventive management. Mugwort is also an aeroallergen in thunderstorm asthma attacks. Thunderstorm can induce asthma attacks in children with allergic rhinitis owing to mugwort and aggravate symptoms in children with confirmed diagnosis of asthma. Children with mugwort allergy are susceptible to thunderstorm asthma and a preponderance of boys was observed. Better identification of allergic children to mugwort, giving suitable protective measures during thunderstorm and standard therapy to existing allergic situation could be a benefit for children at risk of thunderstorm asthma.

Challenges in the Australasian neurosurgery training program: who should be trained and where should they train?

Neurosurgical training poses particular challenges in Australia and New Zealand, given the large landmass, small population, and widely separated, often small, neurosurgical units. Such factors have necessitated a move away from autonomous, single-institution-based training to the selection of trainees by a centralized binational process. The success of this system is based on rigorous standardized evaluation of candidates' academic achievements, anatomical knowledge, references, and interview performance. Similarly, the accreditation of hospitals to train successful candidates has been standardized. The authors review the evolution of trainee selection and the accreditation of training posts in Australia and New Zealand. The records of the Neurosurgical Society of Australasia Surgical Education and Training Board were reviewed for documents pertaining to the selection of neurosurgical trainees and the accreditation of training posts. Application records and referee scores from 2014 to the present were reviewed to encompass process changes, in particular the change from written referee reports to standardized interviews of referees. Surgical logbook case numbers for 23 trainees completing training in 2016, 2017, and 2018 were collated and presented in an aggregated, de-identified form as a measure of adherence to accreditation standards. Written evaluations of the training experience were also sought from two trainees reflecting on the selection process, the quality of training posts, and training limitations. While a time-consuming process, the method of obtaining referee reports by interview has resulted in a wider spread of scores, more able to separate high- and low-scoring applicants than other components of the selection process. Review of the training post accreditation records for the last 2 years showed that adherence to standards has resulted in loss of accreditation for one unit and shortened periods of review for units with more minor deficiencies. Two applications for accreditation have been denied. Examination of caseload data showed that trainees more than fulfill minimum requirements in accredited training posts, confirming the robust nature of this aspect of unit accreditation. A key factor determining the success of neurosurgical training in Australia and New Zealand has been a willingness to evolve selection and other processes to overcome challenges as they become apparent. According to available analyses, the revised referee process and strict accreditation standards appear effective. The benefits and challenges of the current training system are discussed in the context of a paucity of international literature.

The Impact of Breast Care Nurses: An Evaluation of the McGrath Foundation's Breast Care Nurse Initiative

Objective:Over the four years to 30 June, 2017 the McGrath Foundation's Second Federal Government Breast Care Nurse (BCN) Initiative funded 57 McGrath BCNs (MBCNs) to deliver better continuity of care and provide specialized support to those diagnosed with and undergoing treatment for breast cancer. This article summarizes the findings generated through a mixed-method evaluation of the program's appropriateness, effectiveness, and efficiency.Methods:The evaluation comprised surveys and semi-structured interviews with patients, multidisciplinary clinicians and MBCNs. The research also drew on secondary materials, including MBCN activity and patient caseload data, a review of existing programs and costing information.Results:The evaluation generated evidence that access to an MBCN results in an improved experience for patients and clinicians, and that these impacts are more profound when MBCNs come into contact with their patients at the time of diagnosis. The economic modeling component of the evaluation revealed that there are cost savings to the health system when breast cancer patients have early access to an MBCN (through reduced health service utilization). The net saving produced by the program was estimated to be worth $6,323,257 per year, or $1,527 per new breast cancer patient seen. Stakeholders indicated that the MBCN model of care could be evolved to respond to emerging trends in breast cancer care pathways, such as a greater role in survivorship.Conclusion:This research advances the current understanding of the impact of BCNs on different levels of the health system and holds relevance for health-care funders, providers, and policy-makers. The evaluation demonstrates that access to an MBCN results in an improved experience for patients and clinicians, along with savings to the health system (through reduced health service utilization). The evaluation also shows that these impacts are more profound when MBCNs come into contact with their patients at the time of diagnosis.

Nasojejunal tube feeding in children: knowledge and practice

Nasojejunal tubes (NJ) are used in small numbers of children outside of neonatal and paediatric intensive care units. There is limited evidence on which to base practice aside from insertion techniques. Ongoing care and management is largely based on historical practice and extrapolation from nasogastric tube practice. This paper presents the historical caseload data for 36 babies and children over a five year period. The children ranged from 0 to 13 years of age, and 95% were less than 2 years old. They had a median of 4 tubes each (range 1 - 46). The paper presents data from two surveys of health professionals that demonstrate a lack of consistency in practice. There are concerns about ongoing position checks and about the radiation burden in these children. Local practice is described that aims to reduce dependence on x-ray procedures and to stimulate debate. Finally, an argument is made for a better evidence base for future practice.

Debundling Accountability: Prosecutor and Public Defender Elections in Florida

I explore the impact of public defender and prosecutor elections using caseload data from Florida. While most states within the U.S. use popular elections to select and retain prosecutors, public defenders are typically appointed positions. Florida is novel in that for both positions popular, partisan elections are used to select the office's leader. I first document important distortions in pre-trial case handling. A public defender re-election is associated with an increase in the proportion of cases resolved via plea bargaining, while prosecutor re-elections are associated with less plea bargaining. At the trial phase, I present evidence that public defender re-elections are associated with a decrease in the proportion of jury trials that result in a conviction, while a prosecutor re-election coincides with an increase in the conviction rate. The results are consistent with voters holding both of these elected officials accountable for doing their job. Public defenders are able to obtain plea bargains at a higher rate and secure acquittals for their clients when up for re-election. Prosecutors do not plea bargain as much and win at trial when up for re-election.

Interchangeability of counts of cases and hours of cases for quantifying a hospital's change in workload among four-week periods of 1 year

Study objectiveRecent studies have made longitudinal assessments of case counts using State (e.g., United States) and Provincial (e.g., Canada) databases. Such databases rarely include either operating room (OR) or anesthesia times and, even when duration data are available, there are major statistical limitations to their use. We evaluated how to forecast short-term changes in OR caseload and workload (hours) and how to decide whether changes are outliers (e.g., significant, abrupt decline in anesthetics). DesignObservational cohort study. SettingLarge teaching hospital. Measurements35 years of annual anesthesia caseload data. Annual data were used without regard to where or when in the year each case was performed, thereby matching public use files. Changes in caseload or hours among four-week periods were examined within individual year-long periods using 159 consecutive four-week periods from the same hospital. Main resultsSeries of 12 four-week periods of the hours of cases performed on workdays lacked trend or correlation among periods for 49 of 50 series and followed normal distributions for 50 of 50 series. These criteria also were satisfied for 50 of 50 series based on counts of cases. The Pearson r = 0.999 between hours of anesthetics and cases. ConclusionsFor purposes of time series analysis of total workload at a hospital within 1-year, hours of cases and counts of cases are interchangeable. Simple control chart methods of detecting sudden changes in workload or caseload, based simply on the sample mean and standard deviation from the preceding year, are appropriate.

Too Much of a Good Thing? Assessing Access to Civil Justice in Russia

Belying the public perception of widespread distrust of the courts, Russians have been flocking to the courts in recent years. Judges and court officials consistently complain about the resulting burden. The official caseload data confirm that judges are handling an extraordinary number of cases. This paper explores whether this open door policy makes sense. The procedural codes governing the Russian courts reflect a conscious choice to make it as easy as possible for Russian individuals and companies to gain access to the courts. Courts are a unique institutional resource. Ideally, access to courts should be limited to cases in which there is a genuine dispute that has proven resistant to the parties' efforts to resolve on their own. The author's field work suggests that both the courts of general jurisdiction and the arbitrazh courts are being flooded by simple cases in which the results are a foregone conclusion. Yet judicial resources are expended in an effort to give these parties their day in court. The Russian judicial system now finds itself at a cross-road. Its policy of increasing the capacity of the system (through building new courthouses and adding more judges) to accommodate the increased caseload has reached the limit of its usefulness and feasibility. The author lays out alternative policy options, including diverting empty cases to mediation, empowering judges to discipline lawyers when they fail to live up to their responsibilities, reenforcing the power of judges to dismiss cases when the parties show up empty-handed or fail to show up at all, and creating alternative institutions to handle the empty cases.

Regional Anesthesia and Pain Medicine: US Anesthesiology Resident Training-The Year 2015.

The Anesthesiology Review Committee of the Accreditation Council for Graduate Medical Education sets core requirements for residency program accreditation. We periodically report and analyze the US anesthesiology residents' training experience in regional anesthesia and pain medicine. Resident caseload, procedure, and pain medicine evaluation data were aggregated for the resident cohort who graduated in 2015. These data were analyzed for present-day experience and compared with previous reports from years 1980, 1990, and 2000 graduates. Data were available for 1631 residents who graduated from 129 training programs. Regional anesthesia as a portion of the overall anesthesiology residents' training experience remains unchanged since 1990. The distribution of regional anesthesia training has shifted from neuraxial to peripheral blocks. All residents at the 10th percentile and above achieved the benchmark for spinal, epidural, and peripheral nerve block anesthetics and for new pain evaluations. The focus of US anesthesiology resident training in regional anesthesia and pain medicine has changed over the past 15 years by shifting from neuraxial to peripheral nerve block techniques. Previous training deficits have resolved for spinal anesthesia and peripheral nerve block. Procedural experience in pain medicine overwhelmingly involves epidural and facet injections.

Delivery of electroconvulsive therapy in Canada: a first national survey report on usage, treatment practice, and facilities.

The aims of this study were to document electroconvulsive therapy use in Canada with respect to treatment facilities and caseloads based on a survey of practice (Canadian Electroconvulsive Therapy Survey/Enquete Canadienne Sur Les Electrochocs-CANECTS/ECANEC) and to consider these findings in the context of guideline recommendations. All 1273 registered hospitals in Canada were contacted, and 175 sites were identified as providing electroconvulsive therapy; these sites were invited to complete a comprehensive questionnaire. The survey period was calendar year 2006 or fiscal year 2006/2007. National usage rates were estimated from the responses. Sixty-one percent of the sites completed the questionnaire; a further 10% provided caseload data. Seventy were identified as general; 31, as university teaching; and 21, as provincial psychiatric/other single specialty (psychiatric) hospitals. Caseload volumes ranged from a mean of fewer than 2 to greater than 30 treatments per week. Estimated national usage during the 1-year survey period was 7340 to 8083 patients (2.32-2.56 per 10,000 population) and 66,791 to 67,424 treatments (2.11-2.13 per 1000 population). The diagnostic indications, admission status, and protocols for course end points are described. The usage rates are in keeping with earlier Canadian data and with those from other jurisdictions. The difficulty obtaining caseload data from individual hospitals is indicative of the need for standardized data collection to support both clinical research and quality assurance. The wide variation in protocols for number of treatments per course indicates a need for better informed clinical guidelines. The broad range of caseload volumes suggests the need to review the economies of scale in the field.

Costs of postabortion care in public sector health facilities in Malawi: a cross-sectional survey.

BackgroundHealth systems could obtain substantial cost savings by providing safe abortion care rather than providing expensive treatment for complications of unsafely performed abortions. This study estimates current health system costs of treating unsafe abortion complications and compares these findings with newly-projected costs for providing safe abortion in Malawi.MethodsWe conducted in-depth surveys of medications, supplies, and time spent by clinical personnel dedicated to postabortion care (PAC) for three treatment categories (simple, severe non-surgical, and severe surgical complications) and three uterine evacuation (UE) procedure types (manual vacuum aspiration (MVA), dilation and curettage (D&C) and misoprostol-alone) at 15 purposively-selected public health facilities. Per-case treatment costs were calculated and applied to national, annual PAC caseload data.ResultsThe median cost per D&C case ($63) was 29 % higher than MVA treatment ($49). Costs to treat severe non-surgical complications ($63) were almost five times higher than those of a simple PAC case ($13). Severe surgical complications were especially costly to treat at $128. PAC treatment in public facilities cost an estimated $314,000 annually. Transition to safe, legal abortion would yield an estimated cost reduction of 20 %-30 %.ConclusionsThe method of UE and severity of complications have a large impact on overall costs. With a liberalized abortion law and implementation of induced abortion services with WHO-recommended UE methods, current PAC costs to the health system could markedly decrease.

Association of assisted reproductive technology (ART) treatment and parental infertility diagnosis with autism in ART-conceived children

STUDY QUESTION Are assisted reproductive technology (ART) treatment factors or infertility diagnoses associated with autism among ART-conceived children? SUMMARY ANSWER Our study suggests that the incidence of autism diagnosis in ART-conceived children during the first 5 years of life was higher when intracytoplasmic sperm injection (ICSI) was used compared with conventional IVF, and lower when parents had unexplained infertility (among singletons) or tubal factor infertility (among multiples) compared with other types of infertility. WHAT IS KNOWN ALREADY Some studies found an increased risk of autism among ART-conceived infants compared with spontaneously-conceived infants. However, few studies, and none in the USA, have examined the associations between types of ART procedures and parental infertility diagnoses with autism among ART-conceived children. STUDY DESIGN, SIZE, DURATION Population-based retrospective cohort study using linkages between National ART Surveillance System (NASS) data for 1996-2006, California Birth Certificate data for 1997-2006, and California Department of Developmental Services (DDS) Autism Caseload data for 1997-2011. PARTICIPANTS/MATERIALS, SETTING, METHODS All live born ART-conceived infants born in California in 1997-2006 (n = 42 383) with 5-year observation period were included in the study. We assessed the annual incidence of autism diagnosis documented in DDS, which includes information on the vast majority of persons with autism in California, and the association of autism diagnosis with ART treatment factors and infertility diagnoses. MAIN RESULTS AND THE ROLE OF CHANCE Among ART-conceived singletons born in California between 1997 and 2006, the incidence of autism diagnosis remained at ∼0.8% (P for trend 0.19) and was lower with parental diagnosis of unexplained infertility (adjusted hazard risk ratio [aHRR]; 95% confidence interval: 0.38; 0.15-0.94) and higher when ICSI was used (aHRR 1.65; 1.08-2.52), when compared with cases without these patient and treatment characteristics. Among ART-conceived multiples, the incidence of autism diagnosis between 1997 and 2006 remained at ∼1.2% (P for trend 0.93) and was lower with parental diagnosis of tubal factor infertility (aHRR 0.56; 0.35-0.90) and higher when ICSI was used (aHRR 1.71; 1.10-2.66). LIMITATIONS, REASONS FOR CAUTION Study limitations include imperfect data linkages, lack of data on embryo quality and possible underestimation of autism diagnosis cases. Limitations of the observational study design could affect the analysis by the possibility of residual confounders. Since information about ICSI use was missing for most frozen/thawed embryo transfer cycles, our findings of association of ICSI use and autism diagnosis can only be generalizable to fresh embryo transfer cycles. WIDER IMPLICATIONS OF THE FINDINGS Our study provides additional evidence of the association between some types of ART procedures with autism diagnosis. Additional research is required to explain the increased risk of autism diagnosis with ICSI use, as well as studies on the effectiveness and safety of ICSI.

Military Otolaryngology Resident Case Numbers and Board Passing Rates during the Afghanistan and Iraq Wars

During the wars in Iraq and Afghanistan, the US military has continued to train medical residents despite concern that postgraduate medical education at military training facilities has suffered. This study compares the experience of otolaryngology residents at military programs with the experience of their civilian counterparts. Retrospective review. Academic military medical centers. Resident caseload data and board examination passing rates were requested from each of the 6 Department of Defense otolaryngology residency programs for 2001 to 2010. The American Board of Otolaryngology and the Accreditation Council for Graduate Medical Education provided the national averages for resident caseload. National board passing rates from 2004 to 2010 were also obtained. Two-sample t tests were used to compare the pooled caseloads from the military programs with the national averages. Board passing rates were compared with a test of proportions. Data were available for all but one military program. Regarding total cases, only 2001 and 2003 showed a significant difference (P < .05), with military residents completing more cases in those years. For individual case categories, the military averages were higher in Otology (299.6 vs 261.2, P = .033) and Plastics/Reconstruction (248.1 vs 149.2, P = .003). Only the Head & Neck category significantly favored the national average over the military (278.3 and 226.0, P = .039). The first-time board passing rates were identical between the groups (93%). Our results suggest that the military otolaryngology residency programs are equal in terms of caseload and board passing rates compared with civilian programs over this time period.

Case-load simulation using home telemonitoring data of heart failure patients to assess the impact of new sensor technologies and alerting algorithms on the decision making of healthcare professionals

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Military Otolaryngology Resident Case Numbers and Board Passing Rates from 2001‐2010

Objectives: 1) Compare the caseloads of graduates from military otolaryngology residency programs to the national averages for the years 2001-2010. 2) Measure residency outcomes by comparing the board exam pass rates of military otolaryngology graduates to their civilian complement. Methods: Resident caseload data and board exam passing rates were requested from each of the Department of Defense Otolaryngology residency programs for the years 2001-2010. The American Board of Otolaryngology and the Accreditation Council for Graduate Medical Education provided the national averages for resident caseload for these years, as well as national passing rates on the certifying board exam. The pooled numbers from the military programs were then compared to the national averages for total cases, cases in defined categories, and board passing rates. Results: Data were available for all but one military otolaryngology residency program. Regarding total cases, only the years 2001 and 2003 showed a significant difference (p&lt;0.05), with military residents completing more cases in those years. For the 10 year averages in individual categories, the military residents reported more cases in otology (299.6 vs. 261.2, p=0.009) and plastics/reconstruction (248.1 vs. 149.2, p=0.0003). No category showed a significant difference in 10 year average favoring the national average over the military. Military residents demonstrated a first-time board exam pass rate identical to the national average (93%). Conclusions: The results suggest that as a whole, the military otolaryngology residency programs are keeping pace with their civilian counterparts in resident education. Resident caseload has not been compromised by the war effort.

Too Much of a Good Thing? Assessing Access to Civil Justice in Russia

Kathryn Hendley argues that easy access to the civil courts in Russia is a deliberate policy choice aimed at countering the popular image of courts as hopelessly corrupt and incompetent that is propagated by the media. Judicial officials present judges as heroically struggling to cope with the deluge of cases in a timely fashion. Relying on field work and analysis of caseload data, Hendley shows that the burden on trial-level Russian judges has been exaggerated for effect. She documents the procedural mechanisms available to facilitate rapid turnaround of simple cases. She argues that the flood of cases could easily be stanched by increasing filing fees, but that judicial officials cling to the open door policy as a way of proving the value of the courts. Rather than discouraging the demand for courts, they prefer to tinker with the supply side of the equation.

Surgical Care during Humanitarian Crises: A Systematic Review of Published Surgical Caseload Data from Foreign Medical Teams

Humanitarian surgery is often organized and delivered with short notice and limited time for developing unique strategies for providing care. While some surgical pathologies can be anticipated by the nature of the crisis, the role of foreign medical teams in treating the existing and unmet burden of surgical disease during crises is unclear. The purpose of this study was to examine published data from crises during the years 1990 through 2011 to understand the role of foreign medical teams in providing surgical care in these settings. A literature search was completed using PubMed, MEDLINE, and EMBASE databases to locate relevant manuscripts published in peer-reviewed journals. A qualitative review of the surgical activities reported in the studies was performed. Of 185 papers where humanitarian surgical care was provided by a foreign medical team, only 11 articles met inclusion criteria. The reporting of surgical activities varied significantly, and pooled statistical analysis was not possible. The quality of reporting was notably poor, and produced neither reliable estimates of the pattern of surgical consultations nor data on the epidemiology of the burden of surgical diseases. The qualitative trend analysis revealed that the most frequent procedures were related to soft tissue or orthopedic surgery. Procedures such as caesarean sections, hernia repairs, and appendectomies also were common. As length of deployment increased, the surgical caseload became more reflective of the existing, unmet burden of surgical disease. This review suggests that where foreign medical teams are indicated and requested, multidisciplinary surgical teams capable of providing a range of emergency and essential surgical, and rehabilitation services are required. Standardization of data collection and reporting tools for surgical care are needed to improve the reporting of surgical epidemiology in crisis-affected populations.

Assessing the Role of the Justice-of-the-Peace Courts in the Russian Judicial System

Justice-of-the-peace courts (JP courts) have been in operation for ten years in Russia. The article assesses the extent to which they have fulfilled the original policy goals of diverting mundane cases away from the raionnye (district) courts and making the legal system more accessible to ordinary citizens. Policy makers have repeatedly tinkered with their jurisdictional parameters in order to find a proper dividing point between the JP courts and the district courts. The caseload data document that the JP courts now handle almost all first-instance administrative cases, as well as about three-quarters of all civil cases. Their role in criminal justice is more constrained. Their success in processing huge numbers of cases is facilitated by the use of “judicial orders” (sudebnye prikazy) in many civil cases, and by the use of a type of plea bargaining (osoboe proizvodstvo) in criminal cases. Each of these procedural mechanisms obviates the need for a full hearing on the merits.

Explaining the Use of Russian Courts

Russians' lack of trust in courts as an institution has been repeatedly documented through public opinion polling. Yet the caseload data show a steady increase in the use of courts by both individuals and firms in Russia. The paper investigates this puzzle through an analysis of survey data. The existing literature assumes that the lack of legitimacy of courts in Russia forestalls use. While confirming the societal disdain for courts, the analysis reveals that this attitude has little effect on behavior. Instead, the use of the courts is driven by a complicated mix of need and capacity. Two publicly-available datasets were used: the EBRD-World Bank Business Environment & Enterprise Performance Survey and the Russian Longitudinal Monitoring Survey, RLMS-HSE.