Clinical Care Processes Research Articles

Clustering clinical and health care processes using a novel measure of dissimilarity for variable-length sequences of ordinal states.

Clinical and health care processes are often summarised through sequences of ordinal data describing patient's state over time. Identifying patterns in these sequences can provide valuable insights into patient progression trajectories for the purposes of clinical monitoring and quality assurance. However, both the variation in the length of each sequence and the ordinal nature of observable states present challenges to pattern identification. In this paper, we address these challenges by presenting a novel measure of dissimilarity for comparing two or more variable-length ordinal sequences that can be used in conjunction with conventional clustering methods to identify patterns in patient progression trajectories. We provide practical guidance on how this can be achieved, and demonstrate it in the context of identifying patterns in post-stoke recovery trajectories.

Towards standardisation of evidence-based clinical care process specifications.

There is a strong push towards standardisation of treatment approaches, care processes and documentation of clinical practice. However, confusion persists regarding terminology and description of many clinical care process specifications which this research seeks to resolve by developing a taxonomic characterisation of clinical care process specifications. Literature on clinical care process specifications was analysed, creating the starting point for identifying common characteristics and how each is constructed and used in the clinical setting. A taxonomy for clinical care process specifications is presented. The De Bleser approach to limited clinical care process specifications characterisation was extended and each clinical care process specification is successfully characterised in terms of purpose, core elements and relationship to the other clinical care process specification types. A case study on the diagnosis and treatment of Type 2 Diabetes in the United Kingdom was used to evaluate the taxonomy and demonstrate how the characterisation framework applies. Standardising clinical care process specifications ensures that the format and content are consistent with expectations, can be read more quickly and high-quality information can be recorded about the patient. Standardisation also enables computer interpretability, which is important in integrating Learning Health Systems into the modern clinical environment. The approach presented allows terminologies for clinical care process specifications that were widely used interchangeably to be easily distinguished, thus, eliminating the existing confusion.

Integrating trastuzumab biosimilars and HER2-directed therapies into HER2-positive breast cancer management.

The approval of the humanized monoclonal antibody trastuzumab in 1998 changed the trajectory of treatment and subsequent outcomes for patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer and is now the standard of care in the neoadjuvant, adjuvant, and metastatic settings. However, as with most biologic drugs, trastuzumab comes with a relatively high price tag compared with traditional cytotoxic chemotherapy and contributes to healthcare budgets. Three engineered products related to trastuzumab-2 antibody-drug conjugates, ado-trastuzumab emtansine and fam-trastuzumab deruxtecan-nxki, as well as the subcutaneous trastuzumab/hyaluronidase-have since been approved and have expanded the treatment options for this patient population. The approval of 5 trastuzumab biosimilars as of the end of 2019 holds the promise of considerable cost savings, but challenges to integrating their use into patient care must be addressed. Barriers to their use, including physician uncertainty to switch patients from the reference drug to the therapeutic biosimilar and patients' lack of understanding about biosimilars, are common in the United States. It is also important that all stakeholders, including managed care professionals, pharmacists, and practice administrators, understand how to incorporate trastuzumab biosimilars into formulary discussions, clinical care plans and processes, and educational initiatives for healthcare providers and patients.

Utilizing the Huddle for Meaningful Conversations about Goals of Care and Advance Directives

Oftentimes, the conversations that are needed the most to understand patient care goals, especially in the context of serious illness or end of life, are often not talked about. Patients’ goals of care and advance directives tend to happen too late or are avoided. Early discussions about goals of care are associated with better quality of life, can avoid non-beneficial medical care, and more importantly, improve family outcomes. At our hospital in rural Missouri, we proactively communicate goals of care in our regular clinical care processes. Our multidisciplinary huddle is a good opportunity to incorporate goals of care and improve outcomes. This is a time to identify emerging events and potential geriatric-related issues, express concern, discuss discharge, and coordinate difficult conversations. By implementing huddle, we removed barriers by equipping participants with details and tools to have crucial conversations and update treatment plan with the cohesive group to derive 1 common shared patient goal. We use the opportunity of the huddle to identify patients who are high risk for readmission or may need to be transitioned to skilled nursing. Furthermore, huddle is an opportunity to align team members on patient specific advance directive wishes that impact medical decision making processes. The objective is to improve the frequency of discussions of goals of care and advance directives by incorporating it into the inpatient huddle.

Building the Bridge to Quality: An Urgent Call to Integrate Quality Improvement and Patient Safety Education With Clinical Care.

Current models of quality improvement and patient safety (QIPS) education are not fully integrated with clinical care delivery, representing a major impediment toward achieving widespread QIPS competency among health professions learners and practitioners. The Royal College of Physicians and Surgeons of Canada organized a 2-day consensus conference in Niagara Falls, Ontario, Canada, called Building the Bridge to Quality, in September 2016. Its goal was to convene an international group of educational and health system leaders, educators, frontline clinicians, learners, and patients to engage in a consensus-building process and generate a list of actionable strategies that individuals and organizations can use to better integrate QIPS education with clinical care.Four strategic directions emerged: prioritize the integration of QIPS education and clinical care, build structures and implement processes to integrate QIPS education and clinical care, build capacity for QIPS education at multiple levels, and align educational and patient outcomes to improve quality and patient safety. Individuals and organizations can refer to the specific tactics associated with the 4 strategic directions to create a road map of targeted actions most relevant to their organizational starting point.To achieve widespread change, collaborative efforts and alignment of intrinsic and extrinsic motivators are needed on an international scale to shift the culture of educational and clinical environments and build bridges that connect training programs and clinical environments, align educational and health system priorities, and improve both learning and care, with the ultimate goal of achieving improved outcomes and experiences for patients, their families, and communities.

Examining the financial and quality performance effects of group purchasing organizations.

Hospitals frequently enter into group purchasing organizations (GPOs) to manage supply costs, yet there is mixed evidence regarding the benefit for hospitals to participate in a GPO. However, the role of GPOs on hospital operations has expanded into dimensions of quality that have not been previously examined. The aim of this study was to examine the effect of hospital participation in a GPO, as well as GPO network characteristics, on both financial and quality performance outcomes. Data from multiple secondary sources regarding hospital and GPO characteristics were used to create an unbalanced panel of hospitals from 2012 to 2015. This data set was then aggregated to the GPO network level to address questions related to network characteristics, including concentration, bed size, geographic scope, and focus. We evaluated three hospital-level outcomes: supply expense, clinical processes of care score, and patient experience score. The mean of each outcome among all hospitals in a GPO in a given year was used for analyses at the network level. We used fixed and random effect models to assess the effect of hospital characteristics and network characteristics on three measures of financial and quality performance. We found no difference between GPO and non-GPO hospitals for any of the outcomes. However, analyses at the network level revealed network characteristics, including concentration, size, and scope, that affected both supply expense and patient experience scores, but not clinical processes of care. These results indicate that GPO participation may be motivated for reasons beyond cost and quality performance impacts. Hospitals and GPOs should consider network characteristics, such as the concentration and geographical dispersion of the GPO network. Alternatively, GPOs may seek to develop homogeneously sized networks dispersed locally in order to best deliver both financial and quality benefits to their members.

An Interdisciplinary Review of Surgical Data Recording Technology Features and Legal Considerations.

Surgical data recording technology has great promise to generate patient safety and quality data that can be utilized to potentially reduce medical errors. Variations of these systems aim to improve surgical technique, develop better training simulation, and promote adverse event investigation similar to the aims of black box technology utilized in other industries. However, many unknowns remain for surgical data recording utilization in operating rooms and clinical settings in the United States. This includes the need to appropriately design systems so they collect meaningful and useful data that can be discussed by surgical team members in an open and safe environment to optimize clinical care processes. In order to better understand the clinical and regulatory environment for surgical data recording systems, we conducted an interdisciplinary review to identify key technology approaches, and assess legal and regulatory implications associated with this potentially disruptive technology. We found technology ranging from audio and visual data, to systems utilizing mobile applications, and kinematic data capture. The data collected present legal questions over ownership of information and privacy, along with regulatory issues at the federal and state levels. The benefits of these data should be balanced with the need to develop appropriate policies and regulations that protect the interests of both clinicians and patients in order to encourage further innovation and better realize the potential of surgical data recording technology to improve clinical decision making and patient safety outcomes.

Abstract 190: Does Gender Matter? Addressing the Question of Gender Superiority in Resuscitation Leadership

Introduction: Effective team leadership is linked to better patient care during resuscitations. Several studies suggest a relationship between team leader gender and the quality of resuscitation leadership and clinical care. However, these studies have been either (1) retrospective investigations that do not capture clinical care processes or (2) simulation-based research involving novice medical student subjects. The objective of this study is to compare the quality of team leadership and clinical care between male- and female-led trauma resuscitation teams. Hypothesis: We hypothesize that team leader gender is not associated with differences in trauma team leadership and clinical care Methods: We performed a secondary analysis of prospectively acquired data by analyzing video recordings of trauma resuscitations at a Level 1 trauma center. Subjects (n=60) included 2 nd and 3 rd year emergency medicine and surgery residents functioning in the team leader role. Two video recorded observations for each participant (n=120) were coded for team leadership and clinical care by two sets of raters balanced with regard to gender and blinded to study hypothesis. Duplicate coding was performed on 10% of the observations. We analyzed data using random coefficient modeling (RCM), controlling for patient injury severity score and subject postgraduate training year. Results: We found no significant difference between men and women on team leadership behavior (p=.43; Men: M=7.63, SE = 0.54; Women: M = 8.67, SE = 0.74) nor on clinical care (p=.39; Men: M = 62.32, SE = 1.50; Women: M = 64.87, SE = 2.57). Effect sizes were modest in favor of women and nonsignificant for both team leadership behavior ( d = .26) and clinical care ( d =.21). Conclusion: Our prospective evaluation of team leadership quality and clinical care during trauma resuscitations does not support a male performance advantage, contradicting previous simulation-based work. Focusing on effective team leadership behaviors, not inherent traits and leadership styles, will allow resuscitation leaders to optimize their individual and team performance, irrespective of gender. Further work is needed to develop training and cognitive aids capable of supporting team leadership during complex resuscitative care.

Web Exclusive. Annals for Hospitalists Inpatient Notes - Reaching for Higher Value in Health Care by Bringing Together Clinicians and Researchers-The Michigan Program on Value Enhancement.

Web Exclusives19 November 2019Annals for Hospitalists Inpatient Notes - Reaching for Higher Value in Health Care by Bringing Together Clinicians and Researchers—The Michigan Program on Value EnhancementGeoffrey D. Barnes, MD, MSc and Eve A. Kerr, MD, MPHGeoffrey D. Barnes, MD, MScMichigan Program on Value Enhancement, Michigan Medicine Quality Department and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan (G.D.B., E.A.K.)Search for more papers by this author and Eve A. Kerr, MD, MPHMichigan Program on Value Enhancement, Michigan Medicine Quality Department and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan (G.D.B., E.A.K.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2980 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Hospitalists frequently serve as clinical leaders of quality improvement (QI) projects. Their first-hand knowledge of clinical care processes and breadth of clinical expertise make them perfectly suited for these roles. In many health systems, these clinical QI leads are paired with QI staff or “performance improvement coaches” who have process expertise in one or more QI methodologies (e.g., Lean).However, even with a clinician-QI staff partnership, many well-intentioned QI projects are limited by suboptimal design and analysis. Hospitalists who work in this space should consider collaborating with health services researchers who can assist with rigorous preintervention assessments, innovative intervention design, ...

LAGOS: learning health systems and how they can integrate with patient care

ProblemLearning health systems (LHS) are an underexplored concept. How LHS will operate in clinical practice is not well understood. This paper investigates the relationships between LHS, clinical care process specifications...

CN21 - Development of core indicators of non-specialist palliative care in hospitals: An international modified Delphi study

BackgroundHealthcare providers working in acute care hospitals have significant exposure to cancer patients with palliative care needs, and for the majority of patients these reflect non-specialist rather than specialist palliative care needs. Embedding non-specialist palliative care in acute hospital-based care is challenging. The aim of this paper is to present a core set of indicators for the provision of non-specialist palliative care in hospitals which was determined using a Delphi consensus process. MethodsPreliminary indicators derived from a concept analysis and systematic review were subjected to a three round modified Delphi study, whereby a multidisciplinary expert panel of key stakeholders appraised (rated) each preliminary indicator on its ‘importance’ to non-specialist palliative care provision in hospitals. Stakeholders were also offered an opportunity to add ‘new’ indicators as they considered relevant. Consensus was defined whereby 70%, or more, of the participants across stakeholder groups agreed that an indicator was ‘core’ to non-specialist palliative care provision in the hospital setting. ResultsA total of 92 experts (74% response rate) representing the views of patients, clinicians and researchers, from twelve countries participated in the final round. This study resulted in 32 core indicators of hospital based non-specialist palliative care, categorised into 5 structural indicators (relating to infrastructure and governance), 21 organisational indicators (relating to clinical care processes) and 6 staff indicators (relating to training and support for healthcare providers). ConclusionsThis study presents the first guidance for clinical practice, policy and research related to non-specialist palliative care provision in hospitals, based on evidence and International consensus from all key stakeholder groups. These indicators provide a means to assess, review, and communicate the core elements of non-specialist palliative care in hospitals, thereby setting a benchmark for changes in policy and practice. Legal entity responsible for the studyThe authors. FundingHealth Research Board. DisclosureAll authors have declared no conflicts of interest.

326 Implementation of Patient Navigators Reveals Barriers to and Increases Uptake of Colonoscopy After Positive Fecal Immunochemical Tests

INTRODUCTION: Patients with abnormal fecal immunochemical test (FIT) results require diagnostic colonoscopy to reduce mortality from colorectal cancer (CRC). Barriers to follow-up are multifactorial and include patient-, provider-, and system-level factors. Patient navigators (PN) can be effective in improving follow-up by helping patients overcome these barriers. We aimed to assess the impact of PN on clinical care processes required for colonoscopy completion after positive FIT in a large, academic health care system. METHODS: We included all UCLA Health outpatients with an abnormal FIT result between 12/1/2016 and 12/01/2018 without documentation of a colonoscopy. Two PN underwent training with a gastroenterologist and quality officer. For all FIT positive patients, PN 1) conducted a chart review to confirm lack of colonoscopy completion, 2) contacted the primary care provider when there was an inappropriate reason for lack of colonoscopy, and 3) called patients to review FIT results, encourage follow-up, address barriers, and schedule a colonoscopy. Intervention endpoints were 1) colonoscopy completion, 2) patient refusal, 3) provider felt colonoscopy inappropriate, and 4) patient left the health system. We determined the proportion of patients that reached each endpoint at 4 months and reasons providers reported that colonoscopy was not indicated after positive FIT. RESULTS: Our cohort included 131 subjects. Mean age was 62.8 (±7.3), 50.3% were female, and 49.6% were White. In all, 87 (66.4%) reached an intervention endpoint at 4 months (Figure 1). Twenty-seven (31.0%) received diagnostic follow-up: 12 (44.5%) had colonoscopy, 3 (11.1%) had CT colonography, 1 (3.7%) had sigmoidoscopy, and 11 (40.7%) reported colonoscopies outside the health system. Primary care providers that were contacted by the PN often did not feel colonoscopy was indicated (25, 19.1%), and many (10, 40.0%) cited recent colonoscopy (Table 1). There were 19 (21.8%) patients that refused follow-up colonoscopy. CONCLUSION: PN was effective in increasing diagnostic follow-up after positive FIT and revealed persistent challenges to appropriate resolution of positive FIT. Future efforts will improve provider education about appropriate use of FIT and evaluate if PN can improve timely diagnostic follow-up when tracking positive FIT patients prospectively.

Conditions and ethical challenges that could influence the implementation of technologies in nursing homes: A qualitative study

To explore the conditions that may influence the implementation of an interactive mobile application (app) and an intelligent videomonitoring system (IVS) in nursing homes (NHs) and the ethical challenges of their use. There is a lack of knowledge about implementing technologies in NHs and the ethical challenges that might arise. In past studies, nursing care teams expressed the need for technologies offering clinical support. Technologies like an IVS and an app could prove useful in NHs to prevent and manage falls and responsive behaviours. An exploratory qualitative study was conducted with care managers, family caregivers and formal caregivers in five NHs. Each participant was shown a presentation of a potential app and a short video on an IVS. It was followed by an individual semi-structured interview. A conventional contentanalysis was performed. Potential users found it would be possible to implement these technologies in NHs even if resistance could be expected. To facilitate adoption and achieve clinical benefits, the implementation of technologies should be pilot-tested, and coaching activities should be planned. Ethical risks were considered already present in NHs even without technologies, for example, risks to privacy. Strategies were proposed, for instance, to adapt the code of ethics and procedures. Some potential prejudices about the interest and abilities of older staff, nurses' aides, and family caregivers to use technology were identified. Through rigorous and ethical implementation, technologies supporting clinical care processes could benefit older people living in NHs, as well as their relatives and the staff. Various strategies are proposed to successfully implement technologies. Effort should be made to avoid prejudices during implementation, and procedures should be adapted to mitigate possible ethical challenges.

PENGARUH KUALITAS PELAYANAN TERHADAP KEPUASAN PELANGGAN DARI SUDUT PANDANG PASIEN DAN PENDAMPING PASIEN ( STUDI KASUS DI RS MEDISTRA, JAKARTA)

Along with the increasingly competitive business environment and changes in the living standards, people have changed their mindset in choosing and making judgment of hospital services. The change of paradigm requires hospitals to maintain quality of services to service users in order to achieve organization's goals. Therefore a study is conducted to determine the effect of the hospital service quality on satisfaction from the perspective of patient and their attendants. In collecting the data, the authors distribute the questionnaires in RS Medistra Jakarta on February 4 to March 5, 2013. Questionnaire was distributed to 123 patients and 123 attendants by using non-probability sampling, which is judgmental sampling. Data were analyzed using SPSS version 17 by Regression testing method.The results showed that simultaneously and partially there is an influence of Infrastructure, Quality Personnel, Process of clinical care, Administrative procedures, safety indicator, Image Hospital, Social responsibility, trustworthiness of the hospital on Customer Satisfaction from the perspectives of patient and their attendants.

Improving long-lasting insecticidal nets use in Kayange community of north-western Burundi: a pilot study exploring the use of quality improvement methodologies in low-resource community settings

Quality improvement (QI) approaches have demonstrated a lot of promise in improving clinical care processes, both in high-resource and low-resource settings. However, most examples of QI initiatives in healthcare in...

Best practices: Incorporating pharmacy technicians and other support personnel into the clinical pharmacist's process of care

JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACYVolume 2, Issue 5 p. 602-602 ERRATUMFree Access Best practices: Incorporating pharmacy technicians and other support personnel into the clinical pharmacist's process of care This article corrects the following: Best practices: Incorporating pharmacy technicians and other support personnel into the clinical pharmacist's process of care Jill S. Borchert Pharm.D., FCCP, Jennifer Phillips Pharm.D., FCCP, Melissa L. Thompson Bastin Pharm.D., Angela Livingood Pharm.D., Rebecca Andersen Pharm.D., Cynthia Brasher Pharm.D., M.S., David Bright Pharm.D., Bassem Fahmi-Armanious Pharm.D., MBA, Mary-Haston Leary Pharm.D., M.S., James C. Lee Pharm.D., Volume 2Issue 1Journal of the American College of Clinical Pharmacy pages: 74-81 First Published online: July 23, 2018 First published: 11 July 2019 https://doi.org/10.1002/jac5.1162AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In Borchert et al.1 the Conflict of Interest statement was not published. Here is the Conflict of Interest statement: The authors declare no conflicts of interest. The Journal of American College of Clinical Pharmacy has made changes to its policy to ensure Conflict of Interest statements are correctly captured moving forward. We apologize for this error. REFERENCE 1Borchert JS, Phillips J, Thompson Bastin ML, et al. Best practices: Incorporating pharmacy technicians and other support personnel into the clinical pharmacist's process of care. J Am Coll Clin Pharm. 2018; 2: 74– 81. https://doi.org/10.1002/jac5.1029. Volume2, Issue5October 2019Pages 602-602 ReferencesRelatedInformation

Fast-track program of elective joint replacement in hip and knee\u2014patients\u2019 experiences of the clinical pathway and care process

BackgroundThe clinical pathway and care program in elective total hip and knee replacement (THR/TKR) has, during the last decade, undergone considerable changes in many countries influenced by the concept of fast-track surgery, resulting in a very short hospital stay. Studies into patients’ experiences of the entire fast-track program, from decision-making regarding surgery until recovery 3 months after surgery, are lacking. The aim of the study was to increase the knowledge about patients’ experiences of the clinical pathway and care in a fast-track program of elective THR/TKR in order to identify factors that may influence recovery and clinical outcome.MethodsA qualitative research design was chosen with data collected from interviews 3 months after surgery and analyzed using an inductive content analysis method. In total, 24 patients from three hospitals with a fast-track care program were included in the study: 14 women and 10 men, 13 with THR and 11 with TKR. The mean age was 65 years (range 44–85).ResultsThe analysis identified three chronological phases in the clinical pathway: preparation, hospital stay for surgery, and recovery. In the preparation phase, patients’ experiences and involvement in the planning of the operation were highlighted. The need to know the risks and expectations of recovery and outcome were also central, although there was great diversity in needs for information and involvement. In the hospital stay for the surgery phase, there were mainly positive experiences regarding admission, early mobilization, and early discharge. Experiences about the recovery phase focused on management of daily life, rehabilitation program, and recovery. Rehabilitation involved uncertainty as to whether or not the progress was normal. The recovery phase was also filled with questions about unfulfilled expectations. Regardless of the different phases, we found the importance of a person-centered care to be a pervasive theme.ConclusionOur study supports the view that a person-centered approach, from surgery decision until recovery, is an important element in optimizing care in a THR and TKR fast-track care program. More focus on the period after hospital discharge may improve recovery, patient satisfaction, and functional outcome.

Health service accreditation stimulating change in clinical care and human resource management processes: A study of 311 Australian hospitals

ObjectiveThis study aimed to establish whether longitudinal participation in an accreditation program is translated into improvement in continuity of quality patient care and human resource management (HRM) processes outcomes. Materials and methodsThis was a secondary data analysis of accreditation panel data from acute hospitals participating in the Australian Council on Healthcare Standards’ Evaluation and Quality Improvement Program (EQuIP). EQuIP criteria data from 311 hospitals were collected by external surveyors across 2003–2006 (Time 1) and 2007–2010 (Time 2). Mandatory accreditation criteria ratings at Time 1 were used to determine hospital performance group membership (1 = below moderate, 2 = moderate, 3 = above moderate). Analysis was undertaken of ratings across continuity of quality patient care and HRM process criteria, at Time 1 and 2. ResultsContinuity of quality patient care and HRM processes improved across time in the three performance groups. Lower performing hospitals improved at a greater rate than moderate and higher performing hospitals. The groupings and performance order did not change over time. ConclusionsAn accreditation program is an external driver that facilitates continual and systemic quality improvement changes to sub-systems with an organisation.

MINDFULNESS-BASED ART PSYCHOTHERAPY GROUP FOR OLDER ADULTS USING DIGITAL TOOLS

Introduction Art therapy is effective for older adults by stimulating cognitive processes, helping to externalize and express emotions, and creating the potential for meaningful activity. Mindfulness has been shown to improve working memory and focus, and enhance integration of verbal and nonverbal processing. Phototherapy involves taking, viewing, manipulating, and interpreting photographs as a therapeutic process. Because of its relatively easy accessibility, spontaneity, and the ability to easily correct errors, phototherapy is an especially approachable form of art therapy compared to painting or drawing. The explosion of digital tools for phototherapy in the past 5 years offers the capability to maximize the potential of this modality by facilitating combination of both mindfulness and phototherapy for exponential treatment impact. In this study we report preliminary findings from a digital phototherapy-based mindfulness group in the SAGE program within the Division of Geriatric Psychiatry at McLean. The primary objective of this study was to assess the feasibility and qualitative effectiveness of a mindfulness-based phototherapy group for older adults experiencing anxiety and depression. Methods This was an observational pilot study of a 13-week group of 4 older women. Each session was 60 minutes long, which was later expanded to 75 minutes to allow times for mindfulness exercises and group sharing. Each participant learned how to take pictures and use the MyMoments, Union, Fuse, & Collage apps on their iPhone and iPad. Effectiveness was evaluated both qualitatively and quantitatively, by collecting unstructured participant feedback at Week 13 and administering the Rosenburg Self-Esteem Scale (RSES) and the Day to Day Experiences Scale at baseline and Week 13. Results We demonstrated that an approach combining digital phototherapy with mindfulness is feasible and possible to implement in a group of older adults. We also demonstrated the feasibility of teaching this cohort the use of apps for phototherapy in a group setting. While we did not conduct quantitative analysis of intervention efficacy, we noted 3 out of 4 patients scored higher on the Day to Day Experiences Scale at Week 13 compared to baseline; in addition, on the RSES at Week 13, participants endorsed statements indicative of higher self-esteem compared to baseline. Qualitative feedback indicated that participants felt a sense of mastery and continued interest in both mindfulness and phototherapy practices. Conclusions Our preliminary study points to the vast potential of incorporating technologies to accelerate and expand the process of art therapies such as phototherapy. Our findings bear replication and quantitative validation but point to the possibility of improving self-esteem and mindfulness skills in older adults. They may also serve as a model of how to incorporate digital tools into the process of clinical care in group and individual settings. This research was funded by This study was supported by the McLean Hospital Division of Geriatric Psychiatry.

The Chinese version of attitudes towards guidelines scale: validity and reliability assessment

BackgroundThe use of guidelines has shown to improve clinical practice process and structure of health care, but health care providers don’t always use and keep up-to-date with the new clinical practice guidelines. Nurses’ attitudes towards guidelines have shown to be the most frequently identified factor affecting their actual use of clinical practice guidelines, but no instruments for measuring it are available in China. There are scales validated in the western countries, but there is no information about their validity in Chinese health care. The purpose of this study is to test the validity and reliability of Chinese Attitudes towards guidelines - scale for nurses.MethodsThe study was conducted from April to July 2017. The Attitudes towards guidelines scale was translated into Chinese with forward-backward translation method and a questionnaire survey was conducted. Eight hundred randomly selected nurses (final N = 768) from Geriatrics, Internal medical and Rehabilitation departments of 16 hospitals were drawn in Sichuan province, China. Construct validity was evaluated by exploratory and confirmatory factor analysis, and reliability was assessed by test-retest reliability (represented by intra class correlation) and internal consistency (expressed by Cronbach’s coefficients). The test-retest reliability was examined with a sample of 32 clinical nurses who filled out the questionnaire 14 days after the first survey.ResultsExploratory factor analysis supported a four-factor model for the Chinese version of the scale. Confirmatory factor analysis indicated that the hypothetical four-factor model fitted the data relatively well. The intra class correlation coefficient was 0.85 (95%CI, 0.68–0.93) and the Cronbach’s alpha values for the four subscales ranged from 0.645 to 0.912.ConclusionsThe results support the acceptable level of validity and reliability of the Chinese version of Attitudes towards guidelines scale, which can be used to assess nurses’ attitudes towards guidelines in China. Future testing for the Chinese version of Attitudes towards guidelines scale needs to be carried out to see whether these results are generalizable to other professionals and occupational groups and to be used to revise attitudes towards specific guidelines in China.