Healthcare Foundation Research Articles

The presence of psychological trauma symptoms in resuscitation providers and an exploration of debriefing practices

IntroductionWitnessing traumatic experiences can cause post-traumatic stress disorder (PTSD). The true impact on healthcare staff of attending in-hospital cardiac arrests (IHCAs) has not been studied. This cross-sectional study examined cardiac arrest debriefing practices and the burden of attending IHCAs on nursing and medical staff. MethodsA 33-item questionnaire-survey was sent to 517 doctors (of all grades), nurses and health-care assistants (HCAs) working in the emergency department, the acute medical unit and the intensive care unit of a district general hospital between April and August 2018. There were three sections: demographics; cardiac arrest and debriefing practices; trauma-screening questionnaire (TSQ). ResultsThe response rate was 414/517 (80.1%); 312/414 (75.4%) were involved with IHCAs. Out of 1463 arrests, 258 (17.6%) were debriefed. Twenty-nine of 302 (9.6%) staff screened positively for PTSD. Healthcare assistants and Foundation Year 1 doctors had higher TSQ scores than nurses or more senior doctors (p = 0.02, p = 0.02, respectively). Debriefing was not associated with PTSD risk (p = 0.98). Only 8/67 (11.9%) of resuscitation leaders had prior debriefing training. ConclusionsNearly 10% of acute care staff screened positively for PTSD as a result of attending an IHCA, with junior staff being most at risk of developing trauma symptoms. Very few debriefs occurred, possibly because of a lack of debrief training amongst cardiac arrest team leaders. More support is required for acute care nursing and medical staff following an IHCA.

191-LB: Artesunate Treatment Improves Hyperglycemia in a Rodent Model of Gestational Glucose Intolerance without Increasing Beta-Cell Mass

Gestational diabetes (GDM) has been associated with a failure to adequately increase maternal β-cell mass (BCM) during pregnancy. The anti-malarial drugs, artemisinins, have been shown to improve glucose homeostasis in rodent models of diabetes by increasing BCM. Our objective was to reverse BCM deficiency and impaired glucose tolerance in a mouse model of GDM using the artemisinin artesunate. In order to produce glucose intolerance in pregnancy, female mice (F0) were fed a low protein (8%, LP) diet during gestation and lactation, and offspring weaned onto control (20%, C) diet. At 6-10 weeks age female offspring (F1) were time-mated and given C diet throughout pregnancy. Artesunate was administered via drinking water from gestational day (GD) 0.5-6.5. We previously found glucose intolerance, mimicking aspects of GDM, in LP-exposed offspring at GD18 when compared to animals fed a C diet. Thus, glucose tolerance tests (GTT) were performed at GD18 or for non-pregnant age-matched animals. Subsequently, pancreata were removed for fluorescence immunohistochemistry to assess histology. Artesunate-treated LP females had a lower area under the curve during a GTT (389.9±52.3mmol/L*min) compared to non-treated LP females at GD18 (726.6±56.9mmol/L*min, p<0.01). Furthermore, artesunate-treated LP females had improved glucose homeostasis at 5min (9.1 vs. 18.9mmol/L), 15min (11.6 vs. 20.9mmol/L) and 30min (10.2 vs. 19.2mmol/L) during the GTT compared to non-treated LP females at GD18 (p<0.05). There were no significant differences in BCM, alpha-cell mass, or mean islet size between LP and artesunate-treated LP females at GD18. The results show that artesunate-treated LP pregnant females had significantly improved glucose homeostasis compared to untreated LP mice at GD18. However, the improved glucose tolerance was not associated with increased BCM or changes in endocrine pancreas morphology. Disclosure S. Szlapinski: None. D.J. Hill: None. Funding St. Joseph's Health Care Foundation; Ontario Graduate Scholarship

What Are We Really Talking About? An Organizing Framework for Types of Consultation and Their Implications for Physician Communication.

Consultation amongst providers is a foundation of modern health care and one of the most frequent means of interdisciplinary communication. Accordingly, clear and efficient communication between providers and across medical specialties during consultation is essential to patient care and a collegial work environment. Traditionally, consultation requests are felt to require a clear question that falls within the purview of the consultant's expertise. However, this narrow constraint is often lacking in the real-world clinical environment and may in fact be detrimental to physician communication and patient care. In this Perspective, the authors propose an organizing framework of seven specific consultation types, which apply broadly across disciplines: ideal, obligatory, procedural, S.O.S., confirmatory, inappropriate, and curbside. The authors describe what factors define each type and the benefits and pitfalls of each. The proposed framework may help providers have more productive, efficient, and collegial conversations about patient care, which may facilitate improved work satisfaction and an enhanced learning environment.

A Summary from the Institute for Clinical and Economic Review's New England Comparative Effectiveness Public Advisory Council.

Funding for this summary was contributed by the Laura and John Arnold Foundation, Blue Shield of California, and California Health Care Foundation to the Institute for Clinical and Economic Review (ICER), an independent organization that evaluates the evidence on the value of health care interventions. ICER's annual policy summit is supported by dues from Aetna, AHIP Anthem, Blue Shield of California, CVS Caremark, Express Scripts, Harvard Pilgrim Health Care, Cambia Health Solutions, United Healthcare, Kaiser Permanente, Premera Blue Cross, AstraZeneca, Genentech, GlaxoSmithKline, Johnson & Johnson, Merck, National Pharmaceutical Council, Prime Therapeutics, Sanofi, Spark Therapeutics, Health Care Service Corporation, Editas, Alnylam, Regeneron, Mallinkrodt, Biogen, HealthPartners, and Novartis. Otuonye, Kumar, and Pearson are ICER employees. Banken received consulting fees from ICER for work on this report.

10 Years of INTERACT: The Push for Better SNF Care

10 Years of INTERACT: The Push for Better SNF Care

The Effectiveness and Value of Biologic Therapies for the Treatment of Uncontrolled Asthma.

Funding for this summary was contributed by the Laura and John Arnold Foundation, Blue Shield of California, and California Health Care Foundation to the Institute for Clinical and Economic Review (ICER), an independent organization that evaluates the evidence on the value of health care interventions. ICER's annual policy summit is supported by dues from Aetna, AHIP, Anthem, Blue Shield of California, CVS Caremark, Express Scripts, Harvard Pilgrim Health Care, Cambia Health Solutions, United Healthcare, Kaiser Permanente, Premera Blue Cross, AstraZeneca, Genentech, GlaxoSmithKline, Johnson & Johnson, Merck, National Pharmaceutical Council, Prime Therapeutics, Sanofi, Spark Therapeutics, Health Care Service Corporation, Editas, Alnylam, Regeneron, Mallinkrodt, Biogen, HealthPartners, and Novartis. Synnott, Kumar, Adair, Rind, and Pearson are employees of ICER, which provided grants to the University of California, San Francisco, and the University of Colorado to perform work for these analyses. Tice and Walsh are employed by the University of California, San Francisco, and Campbell and Whittington are employed by the University of Colorado.

Can We Develop Sustainable and Sharable Cost-Effectiveness Models for Value Assessment in the U.S. Health Care System?

There is currently a movement to make economic models more transparent, with some arguing for completely open-source models. However, increasing model transparency raises several logistical challenges, including ownership and funding. This article outlines recent experience and approaches to some of the logistical hurdles that must be overcome in pursuit of more transparent economic models. The Institute for Clinical and Economic Review (ICER) has recently completed a pilot transparency initiative that made drafts of executable economic models available to involved drug manufacturers during the review process. By directly viewing and interacting with models' structures, inputs, key assumptions, and results, stakeholders were better equipped to provide valuable feedback as part of the health technology assessments. This experience, along with feedback received from the modeling collaborators and relevant manufacturers during this pilot, have helped determine ICER's approach to sharing economic models associated with ongoing and future evidence reviews. This process has been expanded to all assessments going forward, making it the standard approach to model transparency. DISCLOSURES: No outside funding supported the writing of this article. Both authors are employees of the Institute for Clinical and Economic Review (ICER), which is an an independent organization that evaluates the evidence on the value of health care interventions. ICER receives grant funding from the California Healthcare Foundation, Laura and John Arnold Foundation, and New England States Consortium Systems Organization. ICER's annual policy summit is supported by dues from Aetna, AHIP, Allergan, Alnylam, Anthem, AstraZeneca, Biogen, Blue Shield of California, Cambia Health Services, CVS Caremark, Editas, Express Scripts, Genentech, GlaxoSmithKline, Harvard Pilgrim Health Care, Health Care Service Corporation, Health Partners, Johnson & Johnson, Kaiser Permanente, LEO, Mallinckrodt, Merck, National Pharmaceutical Council, Novartis, Premera, Prime Therapeutics, Regeneron, Sanofi, Spark Therapeutics, and United Healthcare.

Days at Home after Surgery: An Integrated and Efficient Outcome Measure for Clinical Trials and Quality Assurance

BackgroundSurgical audit, sometimes including public reporting, is an important foundation of high quality health care. We aimed to assess the validity of a novel outcome metric, days at home up to 30 days after surgery, as a surgical outcome measure in clinical trials and quality assurance. MethodsThis was a multicentre, registry-based cohort study. We used prospectively collected hospital and national healthcare registry data obtained from patients aged 18 years or older undergoing a broad range of surgeries in Sweden over a 10-year period. The association between days at home up to 30 days after surgery and patient (older age, poorer physical status, comorbidity) and surgical (elective or non-elective, complexity, duration) risk factors, process of care outcomes (re-admissions, discharge destination), clinical outcomes (major complications, 30-day mortality) and death up to 1 year after surgery were measured. FindingsFrom January, 2005, to December, 2014, we obtained demographic and perioperative data on 636,885 patients from 21 Swedish hospitals. Mortality at 30 days and one year was 1.8% and 7.3%, respectively. The median (IQR) days at home up to 30 days after surgery was 27 (23–29), being significantly lower among high-risk patients, those recovering from more complex surgical procedures, and suffering serious postoperative complications (all p < 0.0001). Patients with 8 days or less at home up to 30 days after surgery had a nearly 7-fold higher risk of death up to 1 year postoperatively when compared with those with 29 or 30 days at home (adjusted HR 6.78 [95% CI: 6.44–7.13]). InterpretationDays at home up to 30 days after surgery is a valid, easy to measure patient-centred outcome metric. It is highly sensitive to changes in surgical risk and impact of complications, and has prognostic importance; it is therefore a valuable endpoint for perioperative clinical trials and quality assurance. FundingSwedish National Research Council Medicine and Stockholm County Council ALF-project grant (LE), and the Australian National Health and Medical Research Council (PM).

Biological Effects of Licochalcones.

Medicinal plants and their natural bioactive molecules, are evaluated as the foundation for health preservation and care of humanity. The licorice root, known as "Radix Glycyrrhizae", is a perennial plant that comes from Mediterranean countries, central to southern Russia, Asia, Turkey, Iraq and Iran. The licorice root has been used in traditional Chinese medicines for centuries and has been defined as "the progenitor of herbs". The name 'Licorice' is derived from the ancient Greek word Glukurrhiza, meaning 'sweet root'. It consists of approximately 30 species, however, the most common ones consist of Glycyrrhiza glabra L., Glycyrrhiza uralensis Fisch and Glycyrrhiza Inflata. In addition, the licorice root contains chalcones, which are a part of an important class of natural products and are precursors of flavonoids. Chemically, chalcones are composed of two aromatic rings associated with α, β-unsaturated α-carbon ketone, representing the prima nucleus of the structure. They have been classified, according to chemical structures, in Licochalcone A, B, C, D, E, F and G. This review aims to highlight all the in vitro and in vivo studies that have been conducted on the licochalcones, extracted from Glycyrrhiza species. The main effects are as follows: anti-inflammatory, antioxidant, anticancer, antimicrobial, antiviral, antiallergic, antidiabetic, hepatotoxic and osteogenic. It is important to implement the introduction of biologically active natural molecules from the bench (research) to the bedside (clinical practice). However, in the future, it is required to conduct additional studies to validate these biological effects.

Financial Cost of Insecure Attachment in At-Risk Young People

Background: Effective clinical practice and social policy require understanding sources of economic costs of poor mental health in young people. A potent risk-indicator of high lifetime health, social and economic costs is adolescent antisocial behaviour, characterised psychiatrically as Oppositional Defiant Disorder and Conduct Disorder. Over the lifespan, such youth cost society ten times more than their well-adjusted peers, estimated on average at £260,000 extra each and more in severe cases. An insecure attachment pattern is related to sub-optimal care-giving and is common in at-risk youth, who are more distrustful of adults and authority-figures, yet little is known about its economic consequences. Objectives: To determine whether already early in adolescence, cost differences are emerging associated with attachment insecurity in at-risk youth, after accounting for antisocial behaviour, IQ, and socio-economic status. Methods: Sample: 174 young people followed-up aged 9-17 years (mean 12.1, sd 1.8): 85 recruited with moderate antisocial behaviour (80th percentile) from a school screen when younger; 89 clinically referred with very high antisocial behaviour (98th percentile) when younger. Measures: costs by detailed health economic interview; attachment security to mother and father from interview; diagnostic interviews for oppositional and conduct problems; self-reported delinquent behaviour. Findings: Costs were greater for youth insecurely attached to their mothers (secure £6,743 per year, insecure £10,199, p =0.001) and more so to fathers (secure £1,353, insecure £13,978, p <0.001). These differences remained significant (mother p=0.019, father p<0.001) after adjusting for confounders, notably family income and education, intelligence and antisocial behaviour severity. Interpretation: Attachment insecurity is a significant predictor of public cost in at-risk youth, even after accounting for covariates. Adolescent attachment security is influenced by caregiving quality earlier in childhood, therefore these findings add support to the case for early parenting interventions to improve child outcomes and reduce the financial burden on society. Funding Statement: This study was supported by grant 1206/2491 from The Healthcare Foundation. Declaration of Interests: Drs Scott and O’Connor received a grant from The Healthcare Foundation to carry out the work. They have no other interests, and the other authors have no interests to declare Ethics Approval Statement: The study was approved by the research ethics committee of King’s College London (Reference 242/03), and written informed consent was obtained from parents and youths.

The Effectiveness and Value of Lanadelumab and C1 Esterase Inhibitors for Prophylaxis of Hereditary Angioedema Attacks.

Funding for this summary was contributed by the Laura and John Arnold Foundation, Blue Shield of California, and California Health Care Foundation to the Institute for Clinical and Economic Review (ICER), an independent organization that evaluates the evidence on the value of health care interventions. ICER's annual policy summit is supported by dues from Aetna, AHIP Anthem, Blue Shield of California, CVS Caremark, Express Scripts, Harvard Pilgrim Health Care, Cambia Health Solutions, United Healthcare, Kaiser Permanente, Premera Blue Cross, AstraZeneca, Genentech, GlaxoSmithKline, Johnson & Johnson, Merck, National Pharmaceutical Council, Prime Therapeutics, Sanofi, Spark Therapeutics, Health Care Service Corporation, Editas, Alnylam, Regeneron, Mallinkrodt, Biogen, HealthPartners, and Novartis. Agboola, Dreitlein, and Pearson are ICER employees. Lin reports personal fees from ICER, during the conduct of this study, and grants from the National Institutes of Health and the California Department of Insurance, outside the submitted work. Carlson and Lubinga report grants from ICER, during the conduct of this study.

Accelerating reforms of primary health care towards universal health coverage in Sri Lanka.

Since the late 1920s, the Sri Lankan health system has been based on a firm foundation of primary health care, and it has been recognized internationally as a highly successful low-cost model. However, rethinking the future health-care model has been essential, owing to the country having one of the fastest ageing populations in the world, coupled with a high premature mortality from noncommunicable diseases. To sustain past gains and meet new challenges, several models centred on an expanded primary health-care system have been trialled and refined in the past decade. Primary health care was identified as a key priority in the National Health Strategic Master Plan 2016-2025, and in 2018 the Cabinet approved the Policy on healthcare delivery for universal health coverage. This policy introduces the "shared care cluster" system, whereby an apex specialist institution serves the local primary care referral institutions. The catchment population is divided into populations of approximately 5000, for which one family doctor is responsible. Strengthening and retaining human resources at these primary-level curative institutions will be essential, especially in rural locations. Also critical will be initiatives to orient the population's health-seeking behaviours. Sustained political commitment, an effective communication strategy, a tailored health workforce policy, performance monitoring and evaluation, coordination mechanisms, and changes in administrative and financial regulations are some of the future factors that will be critical to realizing the full potential of primary health care and accelerating universal health coverage in Sri Lanka.

&lt;inline-formula&gt; &lt;tex-math notation="LaTeX"&gt;$iCLAS$ &lt;/tex-math&gt; &lt;/inline-formula&gt;: An Improved Certificateless Aggregate Signature Scheme for Healthcare Wireless Sensor Networks

As the world’s population gradually enters the aging stage, the smart healthcare demand has become extremely urgent and incomparably important. Healthcare wireless sensor networks (HWSNs) is one of the foundations of smart healthcare. Medical information is extremely sensitive information. However, HWSNs uses a common communication channel and is vulnerable to various types of security attacks. Therefore, ensuring the communication and data security of HWSNs and protecting patient privacy are the basis of smart healthcare. After analyzing the deficiencies of a certificateless aggregation signature scheme for HWSNs, an improved certificateless aggregation signature scheme (called iCLAS) is proposed in this paper. We present rigorous security proof that shows iCLAS can resist all kinds of security attacks and can ensure patient privacy protection. The detailed performance comparisons show iCLAS has clear advantages in computation and communication cost.

The Effectiveness and Value of Patisiran and Inotersen for Hereditary Transthyretin Amyloidosis.

Funding for this summary was contributed by the Laura and John Arnold Foundation, Blue Shield of California, and California Health Care Foundation to the Institute for Clinical and Economic Review (ICER), an independent organization that evaluates the evidence on the value of health care interventions. ICER's annual policy summit is supported by dues from Aetna, AHIP, Anthem, Blue Shield of California, CVS Caremark, Express Scripts, Harvard Pilgrim Health Care, Cambia Health Solutions, United Healthcare, Kaiser Permanente, Premera Blue Cross, AstraZeneca, Genentech, GlaxoSmithKline, Johnson & Johnson, Merck, National Pharmaceutical Council, Prime Therapeutics, Sanofi, Spark Therapeutics, Health Care Service Corporation, Editas, Alnylam, Regeneron, Mallinkrodt, Biogen, HealthPartners, and Novartis. Mickle, Dreitlein, and Pearson are ICER employees. Lasser, Cipriano, and Hoch have nothing to disclose.

Assessing the Value of Sarilumab Monotherapy for Adults with Moderately to Severely Active Rheumatoid Arthritis: A Cost-Effectiveness Analysis.

Rheumatoid arthritis is associated with a societal burden greater than $39 billion annually. Novel treatments, known as targeted immune modulators (TIMs), are expensive but effective, producing improvements in response rates compared with conventional disease-modifying antirheumatic drugs (cDMARDs). Sarilumab, a TIM approved in 2017, shows superior improvements compared with cDMARDs and produced significantly greater likelihood of achieving response and improvement in the Health Assessment Questionnaire Disability Index than adalimumab monotherapy. Although sarilumab monotherapy has shown improvements over cDMARDs and the TIM market leader adalimumab, treatment with sarilumab is costly, with an annual wholesale acquisition cost of $39,000. To estimate the lifetime cost-effectiveness of starting treatment with sarilumab monotherapy for adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to cDMARDs. A sequential treatment cohort model followed a hypothetical cohort from initiation of sarilumab monotherapy until death. The model allowed patients to switch therapies up to 3 times due to effectiveness or adverse events. The first switch was to a TIM within the same treatment category; the second switch was to a TIM within a different treatment category; and the third switch was to a cDMARD. Sarilumab monotherapy was compared with a cDMARD (methotrexate) and the TIM market leader (adalimumab monotherapy). Key risk and benefit evidence came from clinical studies and network meta-analyses of data on radiographic progression and response. We used a lifetime time horizon and the U.S. health sector payer perspective assuming therapy net pricing. We also incorporated loss of productivity to reflect a restricted societal perspective. Over a lifetime time horizon, a treatment pathway starting with sarilumab resulted in 17.16 life-years and 13.66 quality-adjusted life-years (QALYs). Treatment pathways starting with the cDMARD resulted in 16.54 life-years and 11.77 QALYs; treatment pathways starting with adalimumab resulted in 17.05 life-years and 13.35 QALYs. Total costs for sarilumab ($492,000 for payer perspective, $634,000 for societal perspective) were less than total costs for adalimumab ($536,000 for payer perspective, $689,000 for societal perspective) but higher than total costs for the cDMARD ($63,000 for payer perspective, $272,000 for societal perspective). When compared with cDMARD therapy, sarilumab resulted in a cost-effectiveness estimate of $227,000 per QALY gained from the payer perspective and $191,000 per QALYs gained from the societal perspective. When compared with adalimumab, sarilumab was dominant from both perspectives. Sarilumab resulted in better health outcomes than conventional therapy alone. However, its additional cost with assumed class-level net prices led to cost-effectiveness estimates above commonly cited thresholds. When compared with the market leader, sarilumab achieved favorable value. This evaluation informs stakeholders of the value of sarilumab and its alternatives to promote high value practices in health care. Funding for this research was contributed by the Institute for Clinical and Economic Review (ICER). Ollendorf, Chapman, Kumar, Synnott, and Agboola are employees of ICER, an independent organization that evaluates the evidence on the value of health care interventions, which is funded by grants from the Laura and John Arnold Foundation, Blue Shield of California Foundation, and the California HealthCare Foundation. The organization's annual policy summit is supported by dues from Aetna, AHIP, Anthem, Blue Shield of California, CVS Caremark, Express Scripts, Harvard Pilgrim Health Care, Omeda Rx, United Healthcare, Kaiser Permanente, Premera Blue Cross, AstraZeneca, Genentech, GlaxoSmithKline, Johnson & Johnson, Merck, National Pharmaceutical Council, Takeda, Pfizer, Novartis, Lilly, and Humana. This work is an extension of an analysis presented at the New England Comparative Effectiveness Public Advisory Council on March 24, 2017, where the authors received public feedback on the analysis, results, and effect of a value assessment for targeted immune modulators. At the time of presentation, sarilumab was still an investigational product; therefore, a price was not known, so cost-effectiveness estimates were not generated. Since the presentation of that material, additional evidence for sarilumab has become available. The additional evidence has been incorporated into this analysis to present cost-effectiveness estimates for sarilumab.

The syllabus and the casualty ward

A 1974 study of 'Doctor-Patient Communication Skills', led by Christopher Candlin, can tell us about the intellectual background of studies of professional communication and the ways theoretical frameworks are adapted to the actualities of collaboration with a funder and day-to-day work in an institutional environment. The funder was a healthcare foundation, and the aim of the study was to develop a syllabus for teaching communication to doctors coming from overseas. The study involved observation of more than 200 consultations in a casualty ward. Findings were framed in terms of a set of functions and the possible transitions between these functions, and these would guide the kinds of linguistic actions to be taught. But within this narrow and now dated framework, the team also raised a number of wider questions that are still relevant today: the idea of the consultation as a unit, networks of medical professionals, the use of frames, attention to multimodality as 'transmediation' and the crucial role of time constraints.

The Concept of Patient-Oriented Model of Organization of Medical Care

The efficient and rational support of quality om medical care rendering is an important aspect of the system of organization of health care functioning. The study considers the development of concept of patient-oriented model of medical care rendering and also system analysis of main parameters of the model. The study was based on the analysis of publications and normative legislative documents of Minzdrav of Russia and the Federal Foundation of mandatory medical insurance, control boards of health care and territorial Foundations of mandatory medical insurance, subjects of the Russian Federation. The comprehensive analysis resulted in formulation of main parameters and propositions of the patient-oriented model. The concept of related model of organization of medical care rendering to population was presented too. The implementation of the proposed concept in case of its appropriate implementation will favor amelioration of clinical outcomes, increasing of satisfaction and compliance of patients, that will permit to optimize organization of medical care rendering.

Paving the Way for A Normal Life: A Qualitative Study of Coping Strategies Among Iranian Divorced Women

ABSTRACTRegarding the devastating aftermath of divorce among Iranian divorced women, which is mainly affected by sociocultural factors, this qualitative study was conducted to explore their applied strategies in reorganizing their lives. Data collection started through deep unstructured interviews followed by semistructured interviews with 18 divorced women who were chosen by purposive sampling from mental health clinics, social work centers, or available cases. Gathered data were analyzed using the qualitative content analysis method. Two main themes—behaviors of self-preservation and abstinence and struggling for balance—emerged. Subcategories were concealing the divorce, feminine self-restriction, avoidance behaviors, replacement of losses, seeking support, role development, handling the tensions, and defending oneself against the divorce failure. This study provides comprehensive knowledge of how Iranian divorced women reregulate their lives and also highlights their unique and culture-based coping strategies. Therefore, it provides specialists with a context-specific foundation for mental health care and enables them to intervene more effectively.

Pennsylvania university awarded grants for nursing BH education

Pittsburgh‐based Carlow University has received two grants totaling $130,000 that will be used to develop and implement behavioral health experiential activities for its graduate and undergraduate nursing programs, according to a press release from the university. Carlow University will use these grants to enhance the preparation of nurses to meet the behavioral health needs of their patients. “Rather than offer a separate behavioral health class in isolation, Carlow decided that a more holistic approach would be to offer integrated content throughout the undergraduate and graduate nursing programs,” said Lynn George, Ph.D., RN, CNE, dean of the College of Health and Wellness at Carlow. The grants — $100,000 from the Jewish Healthcare Foundation and $30,000 from the Fine Foundation — will be used to provide a blend of classroom education, simulated interviews with patients and case studies to prepare Carlow family nurse practitioner (FNP) graduate students and pre‐licensure bachelor's of science in nursing students training to effectively care for patients with behavioral health challenges. The Fine Foundation grant is specifically targeted toward the FNP program and will focus on women's health, as well as behavioral health.

Vending machines in commercial sex venues to increase HIV self-testing among men who have sex with men.

Commercial sex venues (CSV), bathhouses and sex clubs, have a long history of serving a high-risk population. In those facilities, patrons engage in multiple sexual encounters and often in high-risk sexual behaviors. Designing prevention interventions specifically for CSVs could be an effective way to increase testing and control HIV transmission. In collaboration with the AIDS Healthcare Foundation (AHF), our team distributed free HIV self-test kits using vending machines located at two CSVs in Los Angeles, California. Test kit dispensing rate was monitored remotely. Patrons receiving a test kit were surveyed regarding their testing experience, test result and follow up. Linkage to care was offered to participants. During 18 months, 1,398 kits were dispensed. The survey was completed by 110 patrons (response rate =7.9%). Among those who reported that they used the test kit (n=96), 17 (17.7%) participants reported a first-time reactive HIV result. At the time of the survey, six participants with reactive results reported seeking confirmatory testing and linkage to care and four had initiated treatment. Two participants requested linkage-to-care assistance. Participants reported valuing the privacy and convenience of the vending machine but were skeptical on the accuracy of their result. The startup cost, including the purchase of two vending machines, was $10,000 and the recurring cost (monitoring, test kits, personnel) was $33.81 per kit vended. While survey response was low, our results demonstrate that an intervention using vending machines and HIV self-test kits in CSVs was acceptable, feasible, used by the CSV patrons and can help identify new HIV cases.