Diverse Group Of Clinicians Research Articles

Extremity War Injury Symposium 2024: Sports Medicine and Medical Readiness Section Summary

Collaboration between military and civilian investigators is necessary to develop strategies for optimizing treatments to diminish the sequelae of non–battle-related musculoskeletal injuries, which are highly prevalent among servicemembers. The 2024 Extremity War Injuries Symposium provided a forum whereby a diverse group of clinicians and researchers could develop strategies for optimizing treatments and diminishing the sequelae of conditions that are highly prevalent among active individuals. Key points were as follows: 1. The value of collaborations between military and civilian investigators cannot be overemphasized. These synergies can leverage the capabilities of established infrastructures in order to answer important questions pertaining to short-term outcomes—for example, warrior readiness of anterior cruciate ligament reconstructions among servicemembers and long-term posttraumatic osteoarthritis (PTOA) outcomes among civilian cohorts. 2. Current and future prospective trials will inform future treatment decisions related to multiligamentous knee injuries and glenohumeral instability. 3. Novel approaches to addressing PTOA in the acute postinjury period will need longitudinal surveillance to measure their impact on improving clinical outcomes and diminishing residual functional deficits.

Designing for community engagement: user-friendly refugee wellness center planning process and concept, a health design case study

BackgroundRefugee and immigrant populations have diverse cultural factors that affect their access to health care and must be considered when building a new clinical space. Health design thinking can help a clinical team evaluate and consolidate these factors while maintaining close contact with architects, patients’ community leaders, and hospital or institutional leadership. A diverse group of clinicians, medical students, community leaders and architects planned a clinic devoted to refugee and immigrant health, a first-of-its-kind for South Philadelphia.MethodsThe planning process and concept design of this wellness center is presented as a design case study to demonstrate how principles and methods of human-centered design were used to create a community clinic. Design thinking begins with empathizing with the end users’ experiences before moving to ideation and prototyping of a solution. These steps were accomplished through focus groups, a design workshop, and iterations of the center’s plan.ResultsFocus groups were thematically analyzed and generated two themes of access and resources and seven subthemes that informed the design workshop. A final floor plan of the wellness center was selected, incorporating priorities of all stakeholders and addressing issues of disease prevention, social determinants of health, and lifestyle-related illness that were relevant to the patient population.ConclusionsDesign thinking methods are useful for health care organizations that must adapt to the needs of diverse stakeholders and especially populations that are underserved or displaced. While much has been written on the theory and stages of design thinking, this study is novel in describing this methodology from the beginning to the end of the process of planning a clinical space with input from the patient population. This study thus serves as a proof of concept of the application of design thinking in planning clinical spaces.

The Best RX is Better UX: Redesigning, Migrating, and Usability Testing a Hospital Library Website

ABSTRACT The John S. Marietta Library team provides onsite services as part of a collaborative agreement between the UNT Health Science Center and JPS Health Network. The team was tasked with migrating the hospital library website to a new content management system (CMS) in Summer 2021. The migration project provided an opportunity to reimagine the look and feel of the website and conduct usability testing to improve user experience (UX). Conducting thorough usability testing with a diverse group of clinicians and staff provided valuable insights regarding the search behavior and needs of this unique patron population.

45. Antimicrobial Stewardship for Urinary Tract Infection in Three Emergency Departments Across a Health System

BackgroundBroad spectrum antibiotics are often prescribed to patients presenting to the emergency department (ED) for evaluation of urinary tract infection and pyelonephritis (UTI). We evaluated the effect of a target-specific antibiogram, education, and feedback on UTI diagnosis and antibiotic prescribing in this setting.MethodsWe created a urine-specific antibiogram from patients seen and treated without admission at three ED locations (one academic and two community hospitals). We then provided a treatment algorithm and supplemental educational content to ED providers in November 2019. Educational content highlighted appropriate diagnosis, antibiotic selection, and treatment duration for UTI. Adult encounters with appropriate ICD-9/10 codes within twelve months prior to content delivery comprised the preintervention cohort. The postintervention cohort consisted of adult visits following educational intervention until April 17, 2020. During the postintervention phase (November 2019 to April 2020), summary data regarding UTI diagnoses and guideline-concordant prescriptions were fed back routinely to ED providers through email. Guideline-concordant prescriptions were defined as those adhering to first or second-line therapy in the treatment algorithm. The proportion of prescriptions meeting this definition fulfilled the primary outcome. An interrupted time series analysis measured changes in guideline concordance.ResultsData from 6,713 distinct encounters were analyzed across the three sites. While guideline concordant prescribing increased following intervention at all locations (30.9% to 38.8%, 48.1% to 49.1%, and 48.2% to 59.6%), these increases were not statistically significant (Figures 1, 2, and 3). The proportion of all ED encounters with a UTI diagnosis did not differ following the intervention. Interestingly, guideline concordance was greater in the academic ED, compared to the community hospitals. ConclusionAlthough guideline concordant prescribing for UTI increased in all three ED settings with education and email correspondence feedback, these results were not statistically significant. A variety of methods may be required to realize improved antibiotic prescribing across a diverse group of clinicians.DisclosuresRebekah W. Moehring, MD, MPH, Agency for Healthcare Quality and Research (Grant/Research Support)Centers for Disease Control and Prevention (Grant/Research Support)

The role of facilitator training in intervention delivery: Preparing clinicians to deliver AFFIRMative group cognitive behavioral therapy to sexual and gender minority youth

Cognitive behavioral therapy (CBT) promotes sexual and mental health risk reduction. Tailored affirmative approaches, where facilitators validate participants’ lived experiences, can bolster CBT’s potential to improve coping and mood, especially for sexual and gender minority youth (SGMY). Specialized training better prepares clinicians to deliver affirmative CBT and contributes to implementation fidelity. This paper describes a standardized facilitator training for clinicians to deliver an affirmative CBT group intervention to SGMY. The AFFIRM training consists of fourteen hours of didactic and simulation-based learning. Study participants (n = 129) represented diverse professional, sexual, gender, and ethnoracial identities with a particular focus on community-based practitioners. To evaluate training effectiveness, The Affirmative CBT Facilitator Competence Scale (ACCS; 7-items, α = 0.922), designed for this study was completed by participants. Paired sample t-tests showed a significant difference between pre (M = 18.14, SD = 5.90) and post training scores (M = 25.97, SD = 6.34); t(128) = −16.21, p < .001). Thematic analysis of qualitative feedback identified two major themes strengthened ability to affirm SGMY identities and increased competence to deliver AFFIRM. The training increased the skills of a diverse group of clinicians to facilitate affirmative CBT to SGMY.

Emergency clinician perceptions of occupational stressors and coping strategies: A multi-site study

BackgroundResearch exploring multi-disciplinary emergency department (ED) clinicians’ perceptions of their working environment is limited, although exposure to occupational stressors is frequent. This study describes ED clinicians’ perceptions of their working environment, occupational stressors and their use of coping strategies. MethodsA cross-sectional descriptive study was conducted in 2017 at two Australian public hospital EDs. Nursing and medical staff completed a print-based survey of 100 items, which included three scales and a demographic questionnaire. Responses were analysed using descriptive statistics and regression analysis. ResultsDoctors and nurses (n = 241) completed the survey (response rate 45%). Workload featured as a major factor in perception of the working environment and was a frequently occurring stressor. Death or sexual abuse of a child was the highest rated stressor, despite relative infrequency of exposure. When coping strategies were adjusted for sex, female respondents were more likely to use negative strategies such as blaming themselves (Odds Ratio, OR 4 [1.6–9.7]; p < 0.01) and less likely to use positive strategies such as exercise (OR 0.2 [0.1–0.6]; p < 0.01). ConclusionsWhile stressors were similarly rated among the diverse group of clinicians, the ways in which they reported coping varied. Further research is required to facilitate design of staff support strategies.

Can We Improve Thyroid Fine-needle Aspiration Cytology Adequacy in a Low-volume Thyroid Center?

Introduction: Thyroid cancer is the most common endocrine malignancy, and has shown an increase in incidence in recent decades. Fine-needle aspiration cytology (FNAC) is the mainstay of assessment of thyroid nodules and diagnosis of malignancy. Several reports have suggested that ultrasound (US)-guided FNAC has many advantages over palpation-guided biopsy. Methods: Comparison of results of thyroid nodule FNACs in a low volume thyroid center (Northumbria Health Care NHS Foundation Trust) performed by a diverse group of clinicians and radiologists involved in the management of thyroid nodules over 18 months, between October 2008 and April 2010, identified retrospectively from pathology records, with the results of surgeon-performed US (SUS) -guided FNACs performed by a single operator (SRA) recorded prospectively over 17 months between July 2013 and November 2014. Results: The study included 185 FNA, with 104 FNAC being undertaken between October 2008 and April 2010 compared to 81 FNAC between July 2013 and November 2014. There was a statistically significant reduction of non-diagnostic rates in the second period: 23/81 (28%) versus 51/104 (49%) (Fisher’s exact, p=0.0063), non-neoplastic (Thy2) scores remained comparable: 28/81 (35%) versus 32/104 (31%), there were more Thy3 results: 21/81 (26%) versus 15/104 (14%), while the proportion of neoplastic results in the SUS-FNAC group increased: 8/81 (10%) versus 6/104 (6%). Also, time to diagnostic FNAC was significantly shorter in the SUS-FNAC group: 24.2 ± 4.5 versus 54.9 ± 11.4 days (p=0.01, unpaired t-test). Conclusion: SUS-guided FNAC for thyroid nodules is a safe and simple technique. This study demonstrates that it leads to improved patient care by reducing inadequacy rate and time to diagnosis in a low-volume thyroid center.

Lost without translation: Selective Control Assessment of the Lower Extremity (SCALE) in German.

This commentary is on the original article by Balzer et al. on pages 167–172 of this issue. As clinicians and scientists, translation is an important concept. We translate the meaning of words to students, patients, and families. We have been challenged to translate scientific evidence into practice. When publishing consensus definitions, classifications, evaluations, and outcomes, English language nuances across countries and continents must be considered. During meetings of the Taskforce on Childhood Motor Disorders,1 we spent hours deliberating the optimal words to define various motor impairments, including reduced selective motor control and obtaining consensus among a diverse group of clinicians and researchers – not an easy task. In developing content validity for Selective Control Assessment of the Lower Extremity (SCALE),2 we learned that facilitating plantar flexion by coaching a child to move as if they were pushing on a ‘gas pedal’ was not logical in a country that uses ‘petrol’. Balzer et al.3 translated the English version of SCALE into German for use in the clinical environment. Although, I cannot directly evaluate this translation, the methods used instill confidence in their findings. International guidelines for translation of clinical measures were followed.4 The authors assessed the validity and reliability of the translated version for children with spastic cerebral palsy for which SCALE was designed. The original published SCALE validation results were supported and expanded. Additional validation was performed using the Fugl-Meyer Assessment, which includes evaluation of isolated joint motion. Some limitations were noted. The concentration of participants in Gross Motor Function Classification System level I limits the generalization of their results to children with lower mobility levels. Additionally, this study demonstrated the reliability of scoring but did not address the reliability of administration as all tests were scored from videotaped assessments. Hopefully, the German version of SCALE will fully translate into the clinical environment. As the American Academy for Cerebral Palsy and Developmental Medicine, European Academy of Childhood Disability, and the Australasian Academy of Cerebral Palsy and Developmental Medicine move toward an international alliance that supports clinicians in developing countries, translation must consider not only the meaning of the words but also the values present in diverse cultures.

Evidence-Based Practice of Anesthesiology (Third Edition)

Evidence-Based Practice of Anesthesiology (Third Edition) is a wonderful update to the previous edition published four years ago. Dr. Lee Fleisher has made significant improvements to this invaluable resource text by updating existing topics with the most recent evidence, adding new relevant topics, and removing some of the more irrelevant subjects. Your purchase price for this textbook includes electronic online access, which comprises the ability to access the text on any internet-ready device, perform keyword searches, and reference links to PubMed abstracts. This 72-chapter 585-page paperback textbook is well organized, consisting of ten sections that represent the major domains of anesthesia, including perioperative preparation and management, regional anesthesia, and cardiovascular management. Each section is subdivided further into a series of topics that are addressed with a question (e.g., Chapter 14: ‘‘When Should Pulmonary Function Tests Be Performed Preoperatively?’’). The authors of the chapters are a diverse group of clinicians with extensive international representation and expertise. Chapter 1: ‘‘Evidence-Based Practice Parameters: The Approach of the American Society of Anesthesiologists’’ points the book in the right direction by outlining the framework for making evidence-based decisions from inception, identifying sources of evidence (literatureand opinion-based), evaluating and summarizing the literature, and providing advice for dissemination of new evidence. This approach provides the backdrop for the remaining 71 chapters. Chapters 2-72 are structured in a consistent manner such that every chapter begins with an introduction summarizing the relevance of the topic. In most chapters, the introduction is followed by an options section, where applicable, an evidence section that summarizes the current state of knowledge, an areas of uncertainty section, and guidelines. Lastly, each chapter ends with a table of authors’ recommendations which summarize the pertinent information. The section on areas of uncertainty is particularly enjoyable reading; it is especially thought provoking and, for my part, stimulates clinical investigation. Although this is an excellent resource on the whole, there are several aspects that could be improved. The textbook is largely comprised of text and tables, and the number of figures is limited, which may not appeal to all styles of learning. Moreover, apart from the vibrant purple book sleeve, the remainder of the publication is monotonous black and white, lacking much visual appeal. Nevertheless, the online access overcomes much of this limitation with the text. Other minor areas for improvement would include moving the table of author’s recommendations to the beginning of each chapter for ease of access and adding review questions to help solidify learning. In summary, this is a must-have textbook for everyone who practices anesthesiology – from residents embarking on their career to established practitioners wanting a concise reference to keep their practice up to date.

Navigating the transition from pediatric to adult eating disorder programs: Perspectives of service providers

This study aims to conduct qualitative research on the perspectives of service providers regarding the transition process from pediatric to adult specialized eating disorder tertiary care programs. Two focus groups with a diverse group of clinicians in pediatric and adult eating disorder programs and five qualitative interviews with clinicians in the community were conducted. Three themes were identified as challenges during the transition process: (1) illness related factors (ambivalence and denial); (2) the interruption of normative adolescent developmental processes by the illness; and, (3) the impact of decreased parental involvement in the adult compared to pediatric eating disorder programs. These themes were compared with empirical evidence on other chronic mental or physical health concerns for the purpose of identifying ways to facilitate a more successful service transition for young adults with anorexia nervosa. Future research and clinical implications are delineated.

From swampy lowlands to giddy heights

PurposeThe purpose of this case study is to describe the design and delivery of a leadership programme for a diverse group of clinicians and middle managers within a British mental health organisation.Design/methodology/approachThis paper shows how the course was co‐designed between managers, clinicians and higher education, specifically to meet the needs of individuals, teams and the organisation. The authors' thoughts and impressions are presented based on their experience of developing and facilitating this program. Particular attention focuses on notions of leadership, adult learning and organisational change and how these influenced the design of the course. Furthermore, consideration is given to aligning the programme to the organisational culture and strategic plan.FindingsDrawing on Kolb's experiential learning cycle, a process map for the learning journey emerged which shows how the participants were able to critically blend theory with experience and practice. Using a three‐dimensional model developed by Boydell and Leary (2000) of implementation, improvement and innovation, performance outcomes were identified and placed within a taxonomy of learning. This enabled a more specific and sophisticated approach to eliciting the learning that has taken place. Furthermore, this framework provides an approach to identifying future learning and development needs.Originality/valueThis paper offers the theory and narrative for our approach to designing and delivering a leadership course, reflecting on the impact of the course and the achievements for course participants and the organisation. Given the criticisms that such courses do not make explicit their theories of management and leadership practice nor the educational processes that underpin their design and development, we seek to redress this. Not only do we combine emerging leadership theory with cultural and organisational development needs, relevant methods of adult education were also chosen in order to optimise learning and performance development.

Evaluating practice-based learning specific to the community matron role

Since the inception of the community matron role in 2004 there has been much debate about the exact nature of the role in primary and secondary care. How to effectively skill-up and educate a diverse group of clinicians has been a hot topic. This study involved a small focus group of community matrons in training. The qualitative themes extracted from this work are reported on and suggest that practice-based learning is both valuable and efficacious.

Outcome Analysis for Treatment in 100 Patients with Deep Vein Thrombosis

The treatment of acute deep vein thrombosis has been the subject of much research aimed at delineat ing the safest and most effective approach to diagnosis and treatment. Studies regarding long-term treatment have been limited by the narrow scope of laboratory and clinical analyses of many patients. In this study of 100 patients with a history of deep vein thrombosis, treated on an outpatient basis by a diverse group of clinicians, follow-up data were retrieved in order to determine the outcomes of various approaches to acute and long-term care. Among individuals followed for &gt; 1 year, in only two patients (2%) was death attributable to a thrombotic event related to the etiology of the first episode of deep vein thrombosis. Most deceased patients succumbed to unrelated causes (11%). Among the 77 survivors, most (52%) received long-term antiplatelet therapy. All individ uals with a plasma coagulation defect, whether inherited or acquired, received anticoagulation with either heparin or warfarin. Since the long-term clinical outcome of most patients with deep vein thrombosis is dependent upon the underlying factor predisposing to thrombosis, the most important treatment decision is to select the therapy most likely to provide benefit without causing hemorrhage. An tiplatelet therapy, heparin, or warfarin may be chosen as appropriate for the individual patient.