Design-the Design Research Articles

Implementing diversity, equity, and inclusion modules into a nursing trends and issues course: A quality improvement project

BackgroundThe American Association of Colleges of Nursing (AACN) supports integrating diversity, equity, and inclusivity (DEI) into nursing curricula to aid in preparing students to administer competent care for diverse patient populations. AACN highlights equitable healthcare as the overarching goal and catalyst for improving patient health, reducing health disparities, and addressing social determinants of health. AimThe aim is to plan, implement, and evaluate diversity, equity, and inclusion modules in a nursing trends and issues course. DesignThe design is a quality improvement project using the PDSA cycle as a framework. ResultsStudents strongly agree that incorporating DEI modules into the course promotes learning. Nursing faculty acknowledge that more revisions are needed to the course modules to address and compare learning gaps in DEI between nursing cohorts for next semester. ConclusionIncorporating DEI in nursing curricula may demand the application of strategies and structure for students learning. With a lack of faculty experience on DEI topics, this process may require effective interventions to address the learning needs of students.

Teaching global interdependence to health professions students during the Anthropocene epoch: Findings from documentary analysis of an interprofessional education course

Aim(s)To examine the effects of new course material that incorporated the Anthropocene and The Centers for Disease Control's (CDC) 'Climate Effects on Health' framework into an IPE course to enhance students' understanding global interdependence. BackgroundTeaching global interdependence with a suitable framework and relevant content in an introductory Interprofessional Education course in undergraduate programs is challenging when these early learners who do not have significant clinical experience. Therefore, it is necessary to adapt these courses to provide a framework that all students can relate to regardless of previous experience. DesignThe design for this study was qualitative document analysis. MethodThe required introductory IPE course was for students on the programs offered by the College of Health Sciences and the School of Nursing. Students (n = 142) from seven health professions programs, including athletic training (n=9), nursing (n=70), nutrition and dietetics (n=8), occupational therapy (n=15), physical therapy (n=31), radiation therapy (n=2) and magnetic resonance imaging and pre-professional students from other majors (n=5) were enrolled in this IPE course. The study used data derived from the final reflections submitted by the students. The CQI analysis focused on students enrolled in a dedicated interprofessional course related to health professions. ResultsWays interprofessional teams can address global challenges like the Anthropocene, climate-related illnesses and severe weather events were revealed in student responses. Three themes that emerged from the student responses included: public health collaborations, holistic health promotion and policy advocacy. ConclusionIncorporating the concept of Anthropocene and the 'Climate Effects on Health' framework into an IPE course can be a promising approach to shaping students' perception and enhancing their knowledge about global interdependence. By doing so, students can gain a deeper understanding of how human activities have an impact on the climate and ecology of the planet and how severe weather can lead to various health problems.

Reducing No-Show Appointments in Preanesthesia Screening

PurposePreanesthesia screening is critical to evaluate the patient’s medical and surgical history prior to any procedure or surgery to assess for risks and to optimize outcomes during the perioperative period. Missed appointments impede the ability to identify comorbidities, perform cardiac testing, review laboratory results and current medications. No-shows also result in a waste of clinical resources and impacts the schedules of Advance Practice Providers (APPs). The purpose of this quality improvement project was to decrease the number of missed appointments in the outpatient preanesthesia and surgical screening clinic and the impact on provider satisfaction. DesignThe design of this quality improvement project was pre and post design. Automated and live phone calls reminders were provided for patients scheduled in the outpatient preanesthesia. Data was collected to compare missed appointment rates from a 3-month period prior to the project implementation and a 3-month period afterwards. MethodsPre-data collection included the number of no-shows in the EHR system from the previous 3 months. Participants included all adult patients who are scheduled for a pre-anesthesia surgical screening appointment. Provider satisfaction was assessed using a 5-question survey, pre and post innovation. FindingsReminder systems had a statistically significant impact on reducing the number of no-shows in the preanesthesia and surgical screening clinic (PASS). No significant impact was shown in provider satisfaction. ConclusionImplementation of a reminder system can help to reduce no show rates in clinics. Patient no-shows overload the health system by reducing the productivity of providers and waste resources including use of clinic staff, longer wait times for other patients, and the timing providers put into chart preparation.

Academic performance, emotional intelligence, and academic burnout: A cross-sectional study of a mediational effect in nursing students

BackgroundCourse failure arises as the ultimate result of students' declining academic performance in the face of high course demands. It can eventually lead to dropout and academic dissatisfaction. Emotional intelligence may play an essential role in decreasing the emotional effects of stress, such as academic burnout in nursing students. However, emotional intelligence is conceptualized multidimensionally, and each of its attributes may have a different impact on burnout reduction. ObjectiveTo explore the dimensions of emotional intelligence that may mediate the association between academic performance (course failure) and academic burnout in nursing students. DesignThe design was cross-sectional, with survey-based data collection. SettingsEducational setting, undergraduate nursing students at a private university in Metropolitan Lima, Peru. Participants154 students (77.3 % female) with a mean age of 25.9 years. MethodsA multiple mediation strategy was used, using the Wong-Law Emotional Intelligence Scale. Four emotional intelligence attributes (self-emotional appraisal, others' emotional appraisal, use of emotion, and regulation of emotion) were evaluated in the relationship of failed courses (dichotomous variable: yes/no) and academic burnout (single item based on physical and emotional exhaustion). The structural equation modeling framework was used. ResultsCourse failure (academic performance) positively affects academic burnout. Regulation of emotion is the only dimension of emotional intelligence mediating between course failure and academic burnout. The proportion of the mediating effect was 0.315, while the rest was around zero. Statistically significant gender differences were detected concerning burnout, with men scoring moderately higher than women. ConclusionsThe results indicate that the regulation of emotion may have a relevant role in reducing burnout compared to other emotional intelligence attributes. These regulatory skills are important for developing health care and positive patient relationships. Interventions focused on the regulatory characteristics of emotions and distinguishing different attributes of emotional intelligence while exploring its mediating effect should be strengthened. These implications are linked to the growing call to include EI in university education.

Prevalence of missed nursing care and its association with work experience: A cross-sectional survey

BackgroundNurses faced with multiple demands in hospitals are often compelled to prioritize nursing care. Knowledge of missed nursing care provides insight into whether necessary nursing care is delivered, what is missed, and the reasons for missed nursing care. This insight is essential to support evidence-based policy and practice to improve patient care, enhance nursing practice, and optimize the work environment. Research on factors influencing missed nursing care is imperative to implement targeted strategies. However, studies investigating work experience as a predictor are inconclusive, and no identified studies have examined how nurses’ work experience is associated with different elements of missed nursing care. ObjectivesTo investigate the prevalence and reasons for missed nursing care and whether nurses' work experience was associated with missed nursing care. DesignThe design was cross‐sectional, using the Danish version of the MISSCARE survey. SettingThe study was conducted at a public Danish university hospital with 1,150 beds and approximately 10,350 employees. ParticipantsAcross 34 surgical, medical, and mixed bed wards for adults, 1,241 nurses were invited by email to respond anonymously to the Danish MISSCARE survey. Of these nurses, 50.3% responded, and 42.6% fully completed the questionnaire. MethodsA total score mean and a mean score were calculated and then compared between experience (≤5 years/>5 years) in a linear regression model adjusting for unequally distributed variables. ResultsMore than two thirds of the nurses reported that emotional support, patient bathing, ambulation, mouth care, interdisciplinary conferences, documentation, and assessing effectiveness of medication were frequently missed elements of nursing care. The most significant reasons for missed nursing care were an inadequate number of nurses, an unexpected rise in patient volume, urgent patient situations, heavy admission, and discharge activity. Nurses with work experience of less than 5 years reported more missed nursing care, especially within fundamental care. ConclusionsNursing elements to avoid potentially critical situations and nursing related to treatment observations were rarely missed, while nursing care elements visible only to the patient and the nurse were most often missed. By increasing transparency and explicitness within nursing care, the results enable critical evaluation of prioritization of nursing care elements. The number of staff not balancing the number and acuity of patients was the main reason for missed nursing care. The perception of missed nursing care was most pronounced in less experienced nurses. The study contributes to the global research community to achieve a broader understanding of missed nursing care. Tweetable abstractNursing to avoid potentially critical situations and treatment observations are prioritized over fundamental care, perceived mainly by less experienced nurses.

PATHFINDER-CHD: prospective registry on adults with congenital heart disease, abnormal ventricular function, and/or heart failure as a foundation for establishing rehabilitative, prehabilitative, preventive, and health-promoting measures: rationale, aims, design and methods

BackgroundAdults with congenital heart defects (ACHD) globally constitute a notably medically underserved patient population. Despite therapeutic advancements, these individuals often confront substantial physical and psychosocial residua or sequelae, requiring specialized, integrative cardiological care throughout their lifespan. Heart failure (HF) is a critical challenge in this population, markedly impacting morbidity and mortality.AimsThe primary aim of this study is to establish a comprehensive, prospective registry to enhance understanding and management of HF in ACHD. Named PATHFINDER-CHD, this registry aims to establish foundational data for treatment strategies as well as the development of rehabilitative, prehabilitative, preventive, and health-promoting interventions, ultimately aiming to mitigate the elevated morbidity and mortality rates associated with congenital heart defects (CHD).MethodsThis multicenter survey will be conducted across various German university facilities with expertise in ACHD. Data collection will encompass real-world treatment scenarios and clinical trajectories in ACHD with manifest HF or at risk for its development, including those undergoing medical or interventional cardiac therapies, cardiac surgery, inclusive of pacemaker or ICD implantation, resynchronization therapy, assist devices, and those on solid organ transplantation.DesignThe study adopts an observational, exploratory design, prospectively gathering data from participating centers, with a focus on patient management and outcomes. The study is non-confirmatory, aiming to accumulate a broad spectrum of data to inform future hypotheses and studies.ProcessesRegular follow-ups will be conducted, systematically collecting data during routine clinical visits or hospital admissions, encompassing alterations in therapy or CHD-related complications, with visit schedules tailored to individual clinical needs.AssessmentsBaseline assessments and regular follow-ups will entail comprehensive assessments of medical history, ongoing treatments, and outcomes, with a focus on HF symptoms, cardiac function, and overall health status.Discussion of the designThe design of the PATHFINDER-CHD Registry is tailored to capture a wide range of data, prioritizing real-world HF management in ACHD. Its prospective nature facilitates longitudinal data acquisition, pivotal for comprehending for disease progression and treatment impacts.ConclusionThe PATHFINDER-CHD Registry is poised to offer valuable insights into HF management in ACHD, bridging current knowledge gaps, enhancing patient care, and shaping future research endeavors in this domain.

Assessing the Quality of Postoperative Recovery: A Guide for Making Adjustments in Anesthesia Delivery

PurposeThe purpose of this project was to develop a plan and then implement a process for improving anesthesia delivery at a surgery center in the Southeast United States over a 2-month period. DesignThe design of the project was based on utilization of the instrument QoR-15 (Quality of recovery - 15 item questionnaire). This tool is a valid and reliable instrument for the measurement of postoperative outcomes. The QoR-15 includes 15 questions that can each be scored on a 10-point scale. MethodsMethods included a literature search, collecting pre-assessment data, making phone calls to patients utilizing QoR-15 tool, analyzing data, presenting findings to stakeholders, creating a plan of future anesthesia care adjustments. FindingsThe results revealed the following outcome data: a total of 183 postoperative phone calls were successfully performed. The calls were completed on the first postoperative day during the months of July and August 2021. There were 459 total cases during this 2-month period with 113 successful patient contacts (24.6 % successful contact rate). Mean scores of the QoR-15 data for the total population were above 9 for all 15 items. The data was then analyzed according to surgical specialty. The category of moderate pain scores in patients from the General and Ophthalmology surgical specialties were 7.9 and 7.8 respectively. General surgery patients also had one of the highest scores in severe pain with a mean of 8.7. ConclusionsIn conclusion, the leadership team at the ASC received a formal presentation of the results and recommendations for future adjustments that could be potentially implemented in anesthesia care. The benefits of regional anesthesia were suggested to help achieve better patient pain outcomes in both the General and Ophthalmologic surgical populations.

Trends in liver cancer mortality in China from 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019

ObjectiveWe aimed to examine trends in overall mortality rates for liver cancer and those within subgroups according to sex, age, aetiological factors and modifiable risk factors in China from 1990...

Using Structured Observations to Evaluate the Effects of a Personalized Music Intervention on Agitated Behaviors and Mood in Nursing Home Residents With Dementia: Results From an Embedded, Pragmatic Randomized Controlled Trial

ObjectiveThe objective of this research was to determine if a personalized music intervention reduced the frequency of agitated behaviors as measured by structured observations of nursing home (NH) residents with dementia. DesignThe design was a parallel, cluster-randomized, controlled trial. SettingThe setting was 54 NH (27 intervention, 27 control) from four geographically-diverse, multifacility NH corporations. ParticipantsThe participants were 976 NH residents (483 intervention, 493 control) with Alzheimer's disease or related dementias (66% with moderate to severe symptoms); average age 80.3 years (SD: 12.3) and 25.1% were Black. InterventionThe intervention was individuals’ preferred music delivered via a personalized music device. MeasurementThe measurement tool was the Agitated Behavior Mapping Instrument, which captures the frequency of 13 agitated behaviors and five mood states during 3-minute observations. ResultsThe results show that no verbally agitated behaviors were reported in a higher proportion of observations among residents in NHs randomized to receive the intervention compared to similar residents in NHs randomized to usual care (marginal interaction effect (MIE): 0.061, 95% CI: 0.028–0.061). Residents in NHs randomized to receive the intervention were also more likely to be observed experiencing pleasure compared to residents in usual care NHs (MIE: 0.038; 95% CI: 0.008–0.073)). There was no significant effect of the intervention on physically agitated behaviors, anger, fear, alertness, or sadness. ConclusionsThe conclusions are that personalized music may be effective at reducing verbally-agitated behaviors. Using structured observations to measure behaviors may avoid biases of staff-reported measures.

Investigation of the relationship between cultural sensitivity and effectiveness levels among nursing students

AimThe aim of this study is to investigate the relationship between cultural sensitivity and effectiveness levels among nursing students. BackgroundThe world is changing and globalizing, and societies are becoming increasingly multicultural. Therefore, nurses, who play an important role in health service delivery, are expected to be competent in interacting with patients from different cultures and to develop cultural sensitivity during their education. DesignThe design of this study is a prospective descriptive study. MethodsThe research was conducted with 284 nursing students in the faculty of nursing at a university in Ankara. The data collection process of this study was conducted at the end of the spring semester of the 2019–2020 academic year between 20 and 30 June 2020. The Sociodemographic Characteristics Form, Intercultural Sensitivity Scale, and Intercultural Effectiveness Scale were used to collect data. Descriptive statistics, parametric and nonparametric tests were used for data analysis. ResultsThe mean age of the students was 20.80 ± 1.64, and 82% of the students were female. The mean scores on the Intercultural Sensitivity and Intercultural Effectiveness Scales were 92.56 ± 11.98 and 53.87 ± 6.28, respectively. A positive, moderate, and statistically significant correlation was found between the scores on the two scales. In the study, it was determined that females have higher cultural sensitivity and cultural effectiveness level than males, and students who could not understand and speak English have lower cultural sensitivity and cultural effectiveness level than students who could understand and speak English. ConclusionIn this study, it was evaluated that the nursing students had high cultural sensitivity and moderate cultural effectiveness levels, and cultural sensitivity levels were found to increase in line with cultural effectiveness levels. It is recommended to review the educational curricula to improve cultural communication competence and organize programs to improve English speaking and conduct more studies examining the cultural effectiveness of students.

The associations between body composition and vital capacity index of medical students in Shenyang of China: a cross-sectional survey

ObjectivesThis study aimed to examine the associations between body composition and vital capacity index (VCI) among medical students of Shenyang, China.Study designThe design of this study is a cross-sectional study.MethodsParticipants were 2063 individuals (17–25 years) from a medical college in Shenyang, who participated in this survey from April to May 2017. Height, weight, fat mass (FM), fat free mass (FFM), protein mass (PM), total body water (TBW), mineral mass (MM), vital capacity were measured, then BMI and VCI were calculated. Stepwise multiple linear regression analysis was used to evaluate the effect of body composition on VCI of participants in different genders. In addition, subgroup analysis was carried out according to BMI levels.ResultsMale students showed significantly higher height, weight, BMI, FFM, PM, TBW, MM, VC, and VCI, but lower FM in comparison with female students. Stepwise multiple linear regression analysis showed that in both sexes FM was negatively correlated with VCI which represents pulmonary function (r < 0; P < 0.001). After dividing the whole participants by BMI, further correlation analysis showed FM was positively correlated with VCI only for male subgroups with BMI < 18.5 (r > 0; P = 0.050).ConclusionOverall, FM is highly negatively correlated with the VCI of Chinese medical students of both genders. However, there was a positive correlation between FM and VCI among low-weight male students.

Inhaled corticosteroids do not affect the antibody titer against the SARS-CoV-2 spike protein in BNT162b2 mRNA vaccinated patients

ObjectivesOral corticosteroids reduce the antibody titer of the BNT162b2 mRNA vaccine against SARS-CoV-2. To date, the effect of inhaled corticosteroids on antibody titers is unknown.Study designThe design of this study is retrospective study.MethodsWe analyzed the relationship between the clinical features and total antibody titers against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein in 320 subjects who had never been infected with Coronavirus disease 2019 (COVID-19) and were vaccinated the second time with the BNT162b2 mRNA vaccine between October 1 to December 28, 2021.ResultsOf the 320 subjects, 205 were treated with inhaled corticosteroids. The median antibody titer of patients treated with inhaled corticosteroids was 572 U/mL, which was significantly higher than that of patients treated without inhaled corticosteroids (454U/mL, P = 0.00258). The median antibody titers of smokers, men, and patients aged 65 years and over, were 315.5 U/mL, 385 U/mL, and 425.5 U/mL, respectively. These results are significantly lower than those of patients who never smoked, women, and patients aged less than 64 years (582 U/mL [P < 0.0001], 682.5 U/mL [P < 0.0001], and 717 U/mL [P < 0.0001], respectively). The multivariate analysis revealed that females and age were independent antibody titer-reducing factors (P = 0.0001 and P < 0.0001, respectively).ConclusionsThe use of inhaled corticosteroids did not reduce the antibody titer against SARS-CoV-2 spike protein. Clinicians should continue treatment with inhaled corticosteroids if indicated.

Improving PACU Throughput Using an Electronic Dashboard: A Quality Improvement Initiative

PurposePatients boarding in a 14-bed postanesthesia care unit (PACU) impacted throughput in a large university hospital in West Virginia. The PACU and operating room (OR) boarder rate in 2019 was 12% (n = 1241) and 5% (n = 503), respectively. The purpose of this initiative was to improve PACU throughput by developing an efficient and evidence-based handoff communication process between the PACU and the medical-surgical floors. DesignThe design of the project was evidence-based quality improvement. MethodsAn interprofessional team created a nursing patient dashboard in the electronic medical record to be used during handoff communication between the PACU and medical-surgical floor nurses. The dashboard displayed real-time vital signs, patient history, medications, and laboratory results. When the patient met Aldrete score requirements for transfer, PACU nurses notified the floor that the patient was ready for transfer. After allowing 20 minutes for the floor nurse to view the dashboard, the PACU nurse and floor nurse spoke on the phone to discuss any outstanding questions. PACU and OR boarder rates were obtained from the electronic medical record 12 months before and after implementing the nursing patient dashboard. User feedback was gathered via plan-do-study-act cycles, posters, and interviews. FindingsThe electronic dashboard was a successful strategy to improve handoff communication between the PACU and receiving units. The dashboard was accepted by the staff with 70% (n = 24) of the comments being positive. A significant decrease in the number of PACU (χ2(1, n = 20,608) =122.63, P < .00001) and OR boarding (χ2 (1, n = 20,283) =14.55, P = .000136) of patients was found in the C-year compared to 2019. For patients who were boarded in the PACU, no significant difference in PACU delay duration was found (t(11) =1.49, P = .149) with the mean in 2019 of 166.96 (SD = 68.38) and the C-Year mean 132.84 (SD = 39.74). For patients who boarded in the OR, there was a significant difference (t(11) =15.590162, P <.00001) between groups for average duration of boarding with the mean in 2019 of 19.06 minutes (SD = 3.72) compared to 1.62 (SD = 1.1) in C-year. However, in July 2020 the PACU intermittently opened 2 flexible beds when the PACU was full, suggesting that OR boarding was not a reliable measure, but PACU boarding remained an accurate measure. ConclusionsThe findings of this evidence-based quality improvement project demonstrated the usefulness of an electronic dashboard tool combined with verbal report to improve patient throughput by decreasing the number of patients boarding in the PACU.

Effect of application time of 38% silver diamine fluoride solution on arresting early childhood caries in preschool children: a randomised double-blinded controlled trial protocol

BackgroundTo study the caries lesion activity response to topical 38% silver diamine fluoride (SDF) therapy with increasing treatment application time.Methods/designThe design is a stratified-randomised, double-blind, active-controlled, parallel-group clinical trial with nine treatment arms. The trial will involve recruiting at least 414 3- to 5-year-old kindergarten children with caries, who will receive approximately 0.004 mL of 38% SDF (the typical amount applied per the manufacturer’s instructions) to treat each caries lesion. The children will be stratified by caries status, randomised by blocks, and allocated to nine groups of SDF application times: 3, 5, 10, 15, 30, 45, 60, 120, and 180 s. The outcome measure is caries lesion activity (active/arrest) at the tooth-surface level at 6 months post-initial treatment. A calibrated dentist will conduct the blinded clinical examinations at baseline and at the 6-month follow-up. In addition, the parents will be surveyed to examine the effects of the moderating variables, such as oral hygiene, on caries lesion activity. The hypothesis is that a monotonically increasing trend can be found between the SDF application time and the proportion of caries lesions that are arrested. The Cochran-Armitage test for trends in proportions, corrected for clustering within children, will be used to determine the relationship between the exposure to SDF (the SDF application time) and the response (proportion of lesions arrested) in children, taking into consideration the effect of the moderating variables as well as the nesting of multiple caries lesions within an individual child. An EC 80 analysis (an 80% maximal concentration) will be used to determine the exposure (the SDF application time) for 80% caries lesion arrest. Bootstrap methods will be used for clustered data and will be resampled by clustering to determine the 95% confidence interval.DiscussionThis study will help with determining the optimal application time for SDF treatment. It will provide an evidence-based protocol for the use of SDF to arrest tooth decay in the primary teeth of young children. The results will inform an evidence-based SDF protocol to arrest caries, which affects 573 million children with tooth decay worldwide.Trial registrationClinicalTrials.gov NCT04655430. Registered on 7th December 2020.

Predicting the trend of infectious diseases using grey self-memory system model: a case study of the incidence of tuberculosis

ObjectivesThe prediction and early warning of infectious diseases is an important work in the field of public health. This study constructed the grey self-memory system model to predict the incidence trend of infectious diseases affected by many uncertain factors. Study designThe design of this study is a combination of the prediction method and empirical analysis. MethodsBy organically coupling the self-memory algorithm with the mean GM(1,1) model, the tuberculosis incidence statistics of China from 2004 to 2018 were selected for prediction analysis. Meanwhile, by comparing with the other traditional prediction methods, three representative accuracy check indexes (MSE, AME, MAPE) were conducting for error analysis. ResultsOwing to the multiple time-points initial fields, which replace the single time-points, the limitation of the traditional grey prediction model, which is sensitive to the initial value, is overcome in the self–memory equation. Consequently, compared with the mean GM model and other statistical methods, the grey self-memory model shows significant forecasting advantages, and its single-step rolling prediction accuracy is superior to other prediction methods. Therefore, the incidence of tuberculosis in China in the next year can be predicted as 55.30 (unit: 1/105). ConclusionsThe grey self-memory system model can closely capture the individual random fluctuation in the whole evolution trend of the uncertain system. It is appropriate for predicting the future incidence trend of infectious diseases and is worth popularizing to other similar public health prediction problems.

First and second cycle nursing students' perceptions of the clinical learning environment in acute care settings - A comparative crossectional study using the CLES+T scale

BackgroundResearch has shown that the clinical learning environment can both facilitate and hinder students' learning. Students' perceptions need to be evaluated, preferably using nationally and internationally validated instruments. In Sweden, there is a lack of research about students' evaluation in acute care settings and from the perspectives of different levels of students. ObjectivesThe aim was to explore and compare perceptions of the clinical learning environment of first- and second-cycle nursing students in an acute care setting using the Clinical Learning Environment, Supervision and Nurse Teacher scale (CLES+T). DesignThe design involves cross-sectional data collection with comparisons between groups. Setting and participantsData were collected from a convenience sample of first- and second-cycle students at the end of their clinical placements in an acute care setting at a university hospital. MethodsA paper version and a web version of the culturally adapted version of CLES+T was filled out by the students. An independent t-test was used to explore the differences between CLES+T scores and distribution methods and educational level. Internal consistency was evaluated using Cronbach's alpha. ResultsOverall, the students (N = 179) were satisfied with the clinical learning environment. There was no significant difference in the total score (m = 4.31, SD = 0.63) between first- and second-cycle students except for the subscale of “Premises of nursing on the ward” and the individual items “The ward's nursing philosophy was clearly defined” and “Patients received individual nursing care”, showing that the first-cycle students were more satisfied compared to the second-cycle students. The scale demonstrated high internal consistency (α = 0.97 vs. 0.96) for the paper survey and the web survey, respectively. ConclusionsOur findings provide initial support for the CLES+T as a useful instrument to evaluate the clinical learning environment at different levels of education and in different contexts regardless of distribution method.

COMmunity PARticipation through Education (COMPARE): effectiveness of supported education for students with mental health problems, a mixed methods study \u2013 study protocol for a randomized controlled trial

BackgroundThe onset of mental health problems generally occurs between the ages of 16 and 23 – the years in which young people follow post-secondary education, which is a major channel in our society to prepare for a career and enhance life goals. Several studies have shown that students with mental health problems have a higher chance of early school leaving. Supported Education services have been developed to support students with mental health problems to remain at school. The current project aims to study the effect of an individually tailored Supported Education intervention on remaining at school, study success, and satisfaction of students with mental health problems studying at an institute for intermediate vocational education and a university of applied sciences in the Netherlands.Methods/designThe design combines quantitative research (Randomized Controlled Trial; RCT) with qualitative research (monitoring, interviews, focus groups). One hundred students with mental health problems recruited from the two educational institutes will be randomly allocated to either the intervention or control condition. The students in the intervention condition receive the Supported Education intervention given by a Supported Education specialist, the students in the active control condition receive support as usual plus advice from a trained staff member on potential supportive resources regarding studying with mental health problems. The primary outcome ‘remaining at school’, and the secondary outcome ‘study success’ will be determined using data from the school’s administration. The secondary outcome ‘student satisfaction’ and other variables that will be studied in a more exploratory way, such as self-efficacy and study skills, will be determined through online questionnaires at baseline, at 6 and at 12 months follow-up. Focus groups and interviews with the students and Supported Education specialists will be carried out to complement the trial.DiscussionThis RCT is the first to assess the effect of Supported Education on remaining at school, next to study success and student satisfaction among students with mental health problems. The use of a mixed-methods design will result in a thorough evaluation of the effect of the intervention. Issues regarding the influx and possible attrition of students in the follow-up are discussed.Trial registrationThe study was registered with Trialregister.nl, no. NL8349, date registered: February 4th 2020. Register name: Community participation through education. Effectiveness of Supported Education for youth with mental health problems, a mixed methods study – Study protocol for a Randomized Controlled Trial.Protocol Version: 3, date: May 28th, 2021.

Ophiolitic outcrops, naturally occurring asbestos exposure and mortality risk from malignant mesothelioma in Calabria (Southern Italy)

ObjectivesNaturally occurring asbestos from ophiolitic outcrops can pose a health risk to the resident population. Some studies have documented this risk of exposure in many areas around the world. The aim of the study is to estimate the possible impact on health caused by asbestos outcrops present in some areas of Calabria, a region of southern Italy. Study designThe design of the study is observational and uses routinely collected data on employment, compensations and mortality. MethodsData from archives of mortality in the period 2005–2015 were selected. Standardized mortality ratio (SMR) for malignant mesothelioma (MM) by municipalities of residence with reference to the regional population was estimated assuming a Poisson distribution of the data. Administrative archives of companies' employment records and occupational disease compensation data were used to exclude occupational origin cases. ResultsA total of 163 cases of MM were identified. Statistically significant excess risks (P-value <0.05) were observed for several municipalities, some of which were located in areas where asbestos outcrops had previously been identified. Significant SMRs vary between 44.0 and 5.2. The mean age at death in the areas at risk of ophiolitic outcrops ranges from 65.4 to 77.1 years, and the gender ratio (male/female) ranges from 0.66 to 1.3. ConclusionsMonitoring of areas most involved in the risk of environmental contamination from ophiolitic outcrops is highly suggested. Full implementation of the local MM surveillance system is strongly encouraged. Further investigations are recommended to specifically identify the cause of exposure and confirm the hypothesis of a causal association with asbestos naturally occurring in these risk areas.

Hepatitis C treatment uptake among patients who have received methadone substitution treatment in the Republic of Georgia

ObjectivesThere is a dearth of research on hepatitis C virus (HCV) treatment uptake among people who inject drugs (PWIDs) and receive methadone substitution treatment (MST) in Eastern Europe and Central Asia countries. This study contributed to addressing that gap. We examined and identified factors that may affect HCV treatment uptake among PWID who received MST in the Republic of Georgia. Study designThe design of the study is retrospective cohort study. MethodsWe conducted HCV care cascade analysis by matching the data from the web-based national hepatitis C program registry (ELIM C) and the MST treatment database between January 1, 2015, and December 31, 2018. Using the World Health Organization's (WHO) Consensus HCV cascade of care (CoC) global instrument, we assessed the progress made toward the country's 2020 and WHO's 2030 hepatitis C elimination targets for the subpopulation of MST patients. ResultsOverall, 10,498 individuals have been dispensed methadone during the study period. A total of 6828 MST beneficiaries had HCV screening, of whom 5843 (85.6%) tested positive; 5476 (93.7%) were tested for HCV viremia, and 5275 (96.3%) were confirmed with chronic HCV infection. More than 75% (n = 4000) of HCV-infected MST patients initiated HCV treatment, and 3772 (94.3%) completed the treatment. Of those eligible for sustained virologic response assessment, 71.0% (2641/3715) were evaluated, and the reported cure rate was 96.1% (2537). The study found the odds of patients starting HCV treatment differed by the type of facility they were screened at and whether they were registered as PWID at the screening sites. The patients screened at centers with integrated HCV treatment services had higher treatment uptake rates than those screened at other centers. ConclusionsAs the cumulative HCV treatment uptake and cure rates among MST patients with HCV infection are high (75.8% and 96.1%, respectively), the MST patients might become the first microelimination target population in which hepatitis C elimination will be achieved in Georgia. The study found the type of screening facility and whether MST patients registered themselves as PWID or not had significant effects on MST patients starting HCV treatment. At the same time, the study did not find gender and age to be significant predictors of MST patients starting HCV treatment. MST patients used different types of health facilities to get screened for HIV. Many of them did not register themselves as PWID when screened for HIV. The existence of only a few harm reduction sites with integrated HCV treatment services, a high level of stigma, and the criminalization of drug use might have incentivized MST patients to self-navigate across the HCV care continuum with the rest of the population. The implementation of focused, harm reduction, integrated HCV treatment with good peer and professional adherence support at treatment sites could help reach the hepatitis C elimination goals among MST patients.

Incidence and mortality of cervical cancer in French Guiana: Temporal and spatial trends

ObjectivesCervical cancer is the second most frequent cancer among women in French Guiana. The objective was to review a decade of cervical cancer data, and to study spatial and temporal trends. Study designThe design was retrospective and descriptive. MethodsThe cancer registry of French Guiana compiled exhaustive data on cervical cancer throughout French Guiana between 2005 and 2015. Age-standardized incidence and mortality were computed and mapped to identify priority areas. ResultsWith 232 new cases recorded in French Guiana between 2005 and 2014 (23 annual cases), cervical cancer ranked 5th among all incident cancers (11%) and was the 2nd most frequent cancer in women (12% of cancers among women). The standardized incidence rate over the period 2005–2014 was 23.8 cases of cervical cancer per 100 000 woman-years. Between 2005-2009 and 2010–2014 the incidence of cervical cancer decreased from 26.26 cases per 100 000 to 22.66 cases per 100 000 and the mortality rate from cervical cancer decreased from 6 deaths per 100 000 to 3.2 deaths per 100 000.Within French Guiana, the standardized incidence rates were very heterogenous with the highest rates in remote areas. The standardized death rate from cervical cancer over the 2005–2014 decade was 4.4 cases per 100 000 woman-years. ConclusionsThe present results suggest there has been progress in French Guiana, but there are still areas where screening is challenging and should be expanded. The recent authorization of HPV testing is an opportunity that could help health professionals achieve this goal. HPV vaccination –with a nonavalent vaccine—is also an important public health endeavor that could alleviate the burden of cervical cancer among the cohorts of women benefitting from it.