Clinical Health Settings Research Articles

Pharmacists in clozapine clinics improving physical health monitoring.

IntroductionPeople living with schizophrenia have a higher rate of comorbid physical health diseases and compared with the general population die earlier due to these diseases. A pharmacist working in an outpatient mental health clinic setting could assist with the management of physical health disease for this population. The aim of this study was to investigate whether having a pharmacist in a community clozapine clinic would improve adherence to physical health monitoring and whether this would have a positive effect on these physical health outcomes.MethodsThis retrospective observational study compared patient data from 2 clozapine clinics; one where a pharmacist engaged in medication reviews and management of medication side effects, and another that did not have a pharmacist. The rates of physical health monitoring and the changes from baseline of physical health outcomes (weight, BMI, BP, HbA1c, and lipids) were compared after the first pharmacist intervention (medication review).ResultsThe pharmacist clinic had statistically higher rates of metabolic and ECG monitoring (glucose 48% vs 11%, P < .001; lipids 61% vs 7.1%, P < .001; ECG 15% vs 0%, P = .001). Positive trends in weight were identified in the pharmacist-group, although this failed to reach statistical significance.DiscussionThis study shows that pharmacists providing regular medication reviews improves physical health monitoring for patients receiving clozapine.

MP58-18 REAL WORLD APPLICATION AND EXPERIENCE OF A PROSTATE SPECIFIC ANTIGEN (PSA) MACHINE LEARNING MODEL IN A SCREENING POPULATION

You have accessJournal of UrologyCME1 May 2022MP58-18 REAL WORLD APPLICATION AND EXPERIENCE OF A PROSTATE SPECIFIC ANTIGEN (PSA) MACHINE LEARNING MODEL IN A SCREENING POPULATION Marlon Perera, Lewis Smith, Peter Swindle, Anthony Costello, and Elliot Smith Marlon PereraMarlon Perera More articles by this author , Lewis SmithLewis Smith More articles by this author , Peter SwindlePeter Swindle More articles by this author , Anthony CostelloAnthony Costello More articles by this author , and Elliot SmithElliot Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Machine learning algorithms may be beneficial in the setting of prostate cancer screening. Our group has developed one such algorithm based on PSA, age, free:PSA and other variables based on the data sets from the Prostate, Lung, Colorectal and Ovarian Cancer and PCPT trials. Limited data exists examining the effect of machine learning algorithms on prostate cancer diagnosis prospectively. We aimed to report our early experience using this algorithm in prostate cancer screening on an Australian cohort. METHODS: 1223 men without previous history of prostate cancer were tested using an AI clinical decision support tool in a digital health clinical setting. Clinicians assessed demographic factors as well as PSA, Free-PSA, Prostate Health Index and MRI results alongside an AI based clinical decision support tool. Men determined to be high risk were referred for urologic assessment and potential biopsy. When results were discordant with guidelines but flagged by AI the case was reviewed by a second clinician. The results of those men who underwent biopsy were collected and compared to statistics in a recent publication from the Australian Prostate Cancer Outcomes Registry. RESULTS: Of the 1223 men tested prospectively, 49 were referred to a urologist on the basis of their clinical parameters and AI risk score. These men underwent MRI which was then assessed. Of those that underwent MRI 26 continued to a prostate biopsy. Of the 26 biopsies completed 19 were found to have prostate cancer, 17 of the 19 (89%) cancers were found to be Gleason 7 or above on surgical histopathology. This is above a recently published rate of 74%. The median PSA at diagnosis was 2.3 µg/L, lower than the published median of 7.3 µg/L. No biopsied men were found to have metastatic disease compared to a published rate of 7%. Overall initial results show early detection of clinically significant disease with a reduced rate of biopsies in low risk men. CONCLUSIONS: Our machine learning model appears to reduce the need for biopsy and reduces the diagnosis of low-risk prostate cancer. Further, we highlight that PSA at the time of diagnosis was considerably lower than comparable screening cohorts. We provide a proof-of-principal highlighting the utility of machine-learning algorithms for prostate cancer screening in a real-world population. Source of Funding: MP is funded by a Fulbright scholarship through the Australian-America Fulbright Association © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e999 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marlon Perera More articles by this author Lewis Smith More articles by this author Peter Swindle More articles by this author Anthony Costello More articles by this author Elliot Smith More articles by this author Expand All Advertisement PDF DownloadLoading ...

Development of nutrition screening guideline content for use by healthcare staffs in older adults in health clinic setting: A scoping review

Introduction: Malnutrition, specifically undernutrition, in community-dwelling older adults reduces their well-being and predisposes to diseases. Therefore, timely malnutrition identification through nutrition screening is needed to identify at risk and malnourished patients. This study aimed to develop the content of nutrition screening guideline to facilitate healthcare staffs in health clinics to administer a validated nutrition screening tool specifically for older adults. Methods: A scoping review was conducted electronically using SCOPUS, PubMed, ProQuest Health &amp; Medical Complete, and Cochrane databases. The systematic search was performed up to 31st December 2021. Search terms were created for identification of eligible and related articles. Inclusion and exclusion criteria were determined for the systematic search. The search was limited to English and Malay languages, and full text articles with no limitation of years. All data were extracted and analysed, guided by the PRISMA extension for scoping reviews (PRISMA-ScR). Results: From 728 identified articles, 18 articles were included in the analysis. Identified information for the guideline content were: introduction, aims and objectives, definition of malnutrition, prevalence of malnutrition, implementation of nutrition screening, guidance on administering items in validated tools, and guidance on anthropometric measurements. Meanwhile, format and flow charts from established guidelines served as references for the guideline development process. Conclusion: Appropriate content to develop a nutrition screening guideline has been identified based on this review. Development of a guideline based on this content can facilitate healthcare staffs to perform timely nutrition screening in older adults.

Collaborative identification and prioritisation of mental health nursing care process metrics and indicators: a Delphi consensus study

BackgroundThe Irish Office of Nursing & Midwifery Services Director (ONMSD) commissioned the development an updated suite of mental health nursing metrics and indicators for implementation in Irish mental health clinical settings. While measuring care processes does offer the potential to improve care quality, the choice of which mental health nursing metrics to measure presents a significant challenge, both in Ireland and internationally. The provision of safe and high-quality mental health nursing care stems from nurses’ expertise, skills and overall capacity to provide recovery focused care across a range of health care settings. Accordingly, efforts to measure what mental health nurses do depends on the identification of those care processes that contribute to mental health nursing practice. This paper reports on the identification, development and prioritisation of a national suite of Quality Care Metrics (QCM), along with their associated indicators, for mental health nursing care processes in Ireland.MethodsThe study was undertaken over four phases; i) a systematic literature review to identify mental health care process metrics and their associated indicators of measurement; ii) a two-round, online Delphi survey of mental health nurses to develop consensus on the suit of mental health nursing care process metrics; iii) a two-round online Delphi survey of mental health nurses to develop consensus on the indicators to be used to measure the agreed metrics; and iv) a face-to-face consensus meeting with mental health nurses and service user representatives to develop consensus on the final suite of metrics and indicators.ResultsFollowing these four phases 9 metrics and their 71 associated indicators were agreed for inclusion in the final suite of Mental Health Nursing QCM. These metrics are applicable across the life span and the range of mental health nursing health care settings.ConclusionThe development of this suite of Mental Health Nursing QCM and their indicators represents an opportunity for the measurement of safe and high-quality mental health nursing care for application in Ireland and internationally. This initial development of metrics and indicators should be followed by a rigorous baseline review of QCM uptake and implementation amongst mental health nurses as part of an ongoing evaluation.

The Impact of Pet Ownership on Healthcare-Seeking Behavior in Individuals Experiencing Homelessness

ABSTRACT The objective of this research was to understand the effect of pet ownership on healthcare-seeking behavior among persons experiencing homelessness with animals. Mixed-method, semi-structured interviews were conducted with 44 people experiencing homelessness with animals in Seattle, Washington to collect stories of barriers and facilitators due to animal ownership, health-seeking behaviors for themselves and their animals, and self-assessed health status and health conditions of the owners and their pets. The interviews also explored the ways in which the participants would like to receive healthcare services for themselves and their animals. Quantitative results showed that the medical care sourced for pets exceeded that for the owner’s own health, with 86% of participants seeking healthcare for themselves within the past year and 93% of participants seeking veterinary care for their pet within the past year. Results also displayed self-described health of the animal faring better than that of the owner, with 47% of participants reported being “Healthy” or “Very healthy” compared with 90% of pets being reported as the same. Themes emerging from the qualitative research included that persons experiencing homelessness with animals place a high value on the health and welfare of their pets, that the animals can pose a barrier to traditional health services and access to overall services, and that the owner’s need for animal companionship and support is high. These findings suggest that utilizing the human–animal bond and creating integrated (human and animal), interprofessional health services using a One Health approach for unhoused populations owning pets can reduce barriers to services and improve both human and animal health. In an integrated health clinic setting, the owner may seek care for their animal but stay for the human healthcare.

Identifying facilitators, barriers, and strategies to implement social determinants of health screening, referral, and follow-up in the US: a scoping review protocol.

This review will assess the literature exploring facilitators, barriers, and strategies for the implementation of social determinants of health and social needs screening, referral to community resources, and follow-up in clinical settings and clinical training curricula in the United States. Social determinants of health and social needs are a central cause of health inequity and poor health outcomes in the United States. Existing research primarily focuses on theoretical implications of social determinants of health on health outcomes, with a growing secondary focus on the development of screening tools that identify patients' specific unmet social needs. However, summative research has not yet focused on the barriers, facilitators, and strategies relating to the implementation of social determinants of health and social need screenings into routine clinical care. This scoping review aims to examine literature on the implementation of social determinants of health and social needs screening in clinical settings and clinical training curricula while also identifying gaps that require further exploration. This review will include relevant studies examining the facilitators, barriers, and strategies for the implementation of social determinants of health and social needs screening, referral, and follow-up as they relate to human subjects. The literature must be in English from 2010 and focus on United States clinical health settings and curricula. We will search PubMed, CINAHL, and Embase databases for relevant articles. Two independent reviewers will screen abstracts for eligibility. Data will be extracted from eligible articles and results will be presented in narrative and tabular format in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

A communal intervention for military moral injury

The Moral Injury Group (MIG) at the Corporal Michael J. Crescenz (Philadelphia) VA Medical Center (CMCVAMC) is an example of collaborative care between chaplains and psychologists that engages religious, academic, and not-for-profit communities, as well as the media and other organizations external to the healthcare context. The intervention is primarily informed by a unique conceptualization: the moral injury (MI) of individual veterans is rooted in the unfair distribution of appropriate moral pain and best addressed through communal intervention that facilitates broader moral engagement and responsibility. MI is a public health issue that arises from the unfair distribution of appropriate moral pain and is sourced by the sedimentary layers of structural violence in US institutions related to war, and US war-culture. Preventing veteran suicide and promoting public health requires a larger social analysis and more broad-based, collective and collaborative understanding of, and response to, US war-culture, extending responsibility for MI care and prevention beyond individual veterans in health care institutions and clinical settings to US society.

Closing the Gaps in Patients’ Data Protection Rights: A Glance Into the Future with a Dutch Case Study

This article discusses the legislative framework of data protection and health law in today’s world where the individual has become an active player in governing his health. The individual’s protection within the traditional treatment relationship between the care provider and the care receiver is subject to substantial changes amidst technological and health innovations. The traditional, clinical health setting is complemented with actors from a non-clinical background, such as commercial companies that provide healthcare deliverables. New mechanisms for data protection and safeguarding data subject’s rights are required. The European Health Data Space Regulation is a good starting point, since it enables individuals to obtain a copy of their health data, to share and rectify these. However, we observe three gaps in the individual’s data protection and his position vis-à-vis commercial companies, i.e. in the domain of legislation, governance and in the interaction between the care provider and care receiver. The individual plays a role as a patient, but also as an individual with a particular lifestyle who uses wearables and buys commercial DNA tests. The individual’s monitoring of his own health with devices does not necessarily fall within the scope of existing European and national legislation on data protection and health. Keywords: European Health Data Space | fundamental rights | individual and informational self-determination | technological innovations

The Effectiveness of Mindfulness-Based Cognitive Therapy in Primary Care and the Role of Depression Severity and Treatment Attendance

ObjectivesEvidence suggests the efficacy of mindfulness-based cognitive therapy (MBCT) to prevent depression relapse and decrease depressive symptoms during the acute phase. However, the effectiveness of MBCT in real-world heterogeneous samples treated in clinical health settings, including primary care, has received little attention. This study had two aims: (1) to evaluate the effectiveness of MBCT delivered in primary care considering pre-treatment depression scores and (2) to explore the role of participants’ characteristics on symptom improvement.MethodsData were obtained from 433 individuals who received MBCT. Participants completed the Personality Inventory for ICD-11 (PiCD) pretreatment and the Beck Depression Inventory (BDI-II) pre- and post-treatment.ResultsSixty percent presented moderate-to-severe depression according to scores on the BDI-II, 18.1% presented mild depression, and 21.7% were in the non-depressed range. The severity of pre-treatment depressive symptoms was associated with outcomes. Most individuals who lacked depressive symptoms at baseline remained in the non-clinical range after the treatment. Those in the severe group benefited the most from the intervention, since 35.6% were considered recovered. Rates of deterioration ranged from 2.1 to 2.7%, depending on the depression-baseline scores. Depression severity at the entrance, attendance, and age, but not personality traits, appear to be related to symptom improvement.ConclusionsAccording to our results, MBCT can be effectively and safely delivered in primary care.

70.4 UTILIZING SCREENING, BRIEF INTERVENTION, AND REFERRAL TO EVALUATION FOR SUBSTANCE USE (SBIRE) IN THE ADOLESCENT OUTPATIENT MENTAL HEALTH SETTING

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based method to identify patients with substance use disorders and help refer them to treatment. SBIRT can be carried out in a variety of ambulatory and primary care outpatient settings. Referral to treatment, the last arm, is designed to allow clinicians to connect patients to services that can appropriately help them. However, it is often difficult to use and underutilized in these settings. Screening, Brief Intervention, and Referral for Brief Consultative Evaluation (SBIRE) may be a more effective approach to help connect patients with treatment. In this program, the audience will understand current gaps in clinical care in the outpatient setting and review how SBIRE can be applied to help patients receive appropriate care. Scott Krakower, DO, will review current approaches and limitations to managing patients with dual diagnosis in an outpatient child and adolescent psychiatry clinic. He will also briefly discuss ways in which the SBIRE model may be adapted for implementation in this setting to enhance substance treatment engagement among youth referrals. Dr. Krakower will specifically identify training, procedures, and components of existing clinical operations that would need to be modified or adapted to improve substance screening and treatment engagement in an outpatient child and adolescent mental health clinic. SBIRE is a practical and effective approach that can be adapted in pediatric outpatient mental health clinical settings to identify and engage substance-involved youth in earlier or more timely treatment intervention.

Perceived benefits and limitations of using patient-reported outcome measures in clinical practice with individual patients: a systematic review of qualitative studies.

Patient-reported outcome measures (PROMs) are increasingly used in clinical settings to inform individual patient care. In-depth understanding of end-users' experiences may help identify factors that promote or hinder their use in clinical decision-making. We aimed to examine stakeholder perceptions of the utility of using PROMs in clinical practice based on real-life experience. Systematic review searching Medline, Embase and PsychINFO from inception to May 2021. Qualitative studies examining patients' and/or clinicians' experiences of using PROMs in clinical settings were included. Study screening and data extraction were performed by two independent reviewers. Qualitative data from included studies was analysed thematically. Of 2388 abstracts retrieved, 52 articles reporting 50 studies met eligibility. Five key benefits were identified: (1) promotes active patient involvement (enables goal setting and discussion of sensitive topics); (2) enhances the focus of consultations (prioritizes patient needs); (3) improves quality of care (enables tailored, holistic care and prompts action); (4) enables standardized monitoring of patient outcomes; and (5) enhances the patient-clinician relationship (provides reassurance). Perceived limitations included the capacity of PROMs to shift the focus of consultations; inaccurately estimate problems; raise unrealistic expectations for care; inhibit patient-clinician interaction; lack clinically meaningful information; and not be suitable for all patients. Both patients and clinicians reported benefits of using PROMs across diverse health conditions and clinical settings, but also highlighted several limitations. These limitations shed some light on why PROM use may not always improve patient outcomes and provide considerations for the design and implementation of future PROM initiatives.

National multi-stakeholder meetings: a tool to support development of integrated policies and practices for testing and prevention of HIV, viral hepatitis, TB and STIs

BackgroundCountry level policies and practices of testing and care for HIV, viral hepatitis and sexually transmitted infections are lagging behind European recommendations on integration across diseases. Building on previous experiences and evidence, the INTEGRATE Joint Action arranged four national stakeholder meetings. The aim was to foster cross-disciplinary and cross-disease collaborations at national level as a vehicle for strengthened integration of testing and care services. This article presents the methodology and discusses main outcomes and recommendations of these meetings.MethodsLocal partners in Croatia, Italy, Lithuania and Poland oversaw the planning, agenda development and identification of key persons to invite to ensure that meetings addressed main challenges and issues of the respective countries. Invited national stakeholders represented policy and public health institutions, clinical settings, testing sites and community organisations. National experts and experts from other European countries were invited as speakers and facilitators. Main topic discussed was how to increase integration across HIV, viral hepatitis and sexually transmitted infections in testing and care policies and practice; tuberculosis was also addressed in Lithuania and Italy.ResultsThe agendas reflected national contexts and the meetings provided a forum to engage stakeholders knowledgeable of the national prevention, testing and care systems in interaction with international experts who shared experiences of the steps needed to achieve integration in policies and practice. The evaluations showed that participants found meetings relevant, important and beneficial for furthering integration. Of the respondents 78% agreed or strongly agreed that there was a good representation of relevant national stakeholders, and 78% that decision/action points were made on how to move the agenda forward. The importance of securing participation from high level national policy makers was highlighted. Outcomes were nationally tailored recommendations on integrated policies and strategies, diversification of testing strategies, stigma and discrimination, key populations, cost effectiveness, surveillance and funding.ConclusionsShifting from single to multi-disease approaches require collaboration among a broad range of actors and national multi-stakeholder meetings have proven excellent to kick-start this. Face-to-face meetings of key stakeholders represent a unique opportunity to share cross-sectoral perspectives and experiences, identify gaps in national policies and practices and agree on required next steps.

Targeting Culture Criteria to Maximize Culture Positivity of Neisseria gonorrhoeae in 3 Sexual Health Clinic Settings.

Although most gonorrhea (GC) cases in the United States are detected using nucleic acid amplification tests (NAATs), isolation of Neisseria gonorrhoeae (NG) using culture specimens is needed for antibiotic susceptibility testing (AST). We present data on NAATs and cultures collected before and during the Centers for Disease Control and Prevention demonstration project (Strengthening the US Response to Resistant Gonorrhea [SURRG]) to describe a process to define culture criteria for NG isolation for surveillance of NG with reduced susceptibility. For sexually transmitted infection clinics in New York City, NY; San Francisco, CA; and Milwaukee, WI, we calculated NAAT positivity by anatomic site in 2016 (pre-SURRG) across 3 groups: (1) sex partners of persons with GC, (2) patients with symptoms (e.g., urethral or cervical discharge), (3) patients who had tested positive and were returning for GC treatment and compared it with positivity among all other patients. We then examined SURRG-period NAAT positivity among patients from whom a culture was or was not collected, and culture positivity, by specimen site and jurisdiction. Pre-SURRG, NAAT positivity across the 3 select groups was at least twice that of patients who did not meet any criteria. SURRG-period NAAT positivity was higher among patients from whom a culture was also collected. Overall culture positivity was relatively high (New York City, 34.8%; San Francisco, 26.7%; Milwaukee, 24.8%); the proportion of specimens tested varied widely (range, 5.7%-26.5%) by jurisdiction. Evaluation of NAAT data can inform the establishment of criteria for culture collection for AST. Routine evaluation and quality improvement activities related to culture collection/isolation techniques could increase NG isolation for AST.

A Behavior-Analytic Perspective on Interprofessional Collaboration

Collaborative service delivery models have gained considerable popularity in health care, education, and clinical settings. Despite the unique opportunity that this new popularity provides for the dissemination of applied behavior analysis, the majority of practicing behavior analysts have received little or no formal professional development on how to participate in teams with nonbehavioral colleagues. The purpose of this article is to elucidate the larger movement toward collaborative service delivery with an emphasis on interprofessionalism. The four core competency domains presented by the Interprofessional Education Collaborative (IPEC) Framework are interpreted through a behavior-analytic lens. This article is an initial attempt to operationalize constructs commonly associated with interprofessional educational and collaborative practices including (but not limited to) cultural sensitivity and responsiveness, cultural humility and reciprocity, empathy, and compassion.

Decreasing Chlamydial Reinfections in a Female Urban Population.

Chlamydia is the most reported bacterial sexually transmitted infection (STI). The rates of chlamydia rose by 19% between 2011 and 2018. The STI National Strategic Plan (2021-2025), encourages coordinated solutions to address STIs and reduce disparities in disadvantaged populations. We implemented institutional policy changes, clinical decision support, including a Best Practice Advisory, and defaulted SmartSet with provider and patient education for women's health clinics at a large county health system. The advisory prompted providers to follow best practices when treating Chlamydia trachomatis infections. New C. trachomatis diagnosis cohorts were compared preintervention and postintervention for 6-month reinfection rates and patient and expedited partner treatment (EPT) practices. Five hundred and nineteen women were included in the final analysis. Six-month chlamydia reinfection was lower in the postintervention cohort after adjusting for age (12.3% [26/211] vs 6.5% [20/308], P = 0.02). There was an increase in directly observed therapy of primary patients (17.5% [37/211] vs 77.3% [238/308], P < 0.001), an increase in EPT prescriptions written (4.3% [9/211] vs 79.5% [245/308], P < 0.0001), and a decrease of partners referred out for treatment (61.6% [130/211] vs 5.2% [16/308], P < 0.001) when compared with the control group. The majority of EPT was patient-delivered partner therapy postintervention (3.3% [7/211] vs 69.2% [213/308], P < 0.001). A multifaceted, streamlined approach was effective in changing provider practices in the treatment of C. trachomatis. Increased rates of directly observed therapy for primary patient treatment and increased rates of patient-delivered partner therapy were observed postimplementation in addition to lower 6-month reinfection rates in a public women's health clinic setting.

Freely Generated Word Responses Analyzed With Artificial Intelligence Predict Self-Reported Symptoms of Depression, Anxiety, and Worry.

BackgroundQuestion-based computational language assessments (QCLA) of mental health, based on self-reported and freely generated word responses and analyzed with artificial intelligence, is a potential complement to rating scales for identifying mental health issues. This study aimed to examine to what extent this method captures items related to the primary and secondary symptoms associated with Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). We investigated whether the word responses that participants generated contained information of all, or some, of the criteria that define MDD and GAD using symptom-based rating scales that are commonly used in clinical research and practices.MethodParticipants (N = 411) described their mental health with freely generated words and rating scales relating to depression and worry/anxiety. Word responses were quantified and analyzed using natural language processing and machine learning.ResultsThe QCLA correlated significantly with the individual items connected to the DSM-5 diagnostic criteria of MDD (PHQ-9; Pearson’s r = 0.30–0.60, p < 0.001) and GAD (GAD-7; Pearson’s r = 0.41–0.52, p < 0.001; PSWQ-8; Spearman’s r = 0.52–0.63, p < 0.001) for respective rating scales. Items measuring primary criteria (cognitive and emotional aspects) yielded higher predictability than secondary criteria (behavioral aspects).ConclusionTogether these results suggest that QCLA may be able to complement rating scales in measuring mental health in clinical settings. The approach carries the potential to personalize assessments and contributes to the ongoing discussion regarding the diagnostic heterogeneity of depression.

Barriers to Using Telehealth During a Pandemic Versus In-Person Appointments to Conduct Nutrition Assessments in a Community Health Clinic Setting

Abstract Objectives Barriers to healthcare among undocumented immigrants include fear of deportation, national policies excluding patients from receiving healthcare, and resource constraints, such as a lack of financial assets and transportation. The pandemic has exacerbated these barriers for community health clinic patients at St. Mary's Health Clinics (SMHC). Nutrition assessments are pivotal in providing holistic healthcare at SMHC, as high rates of food insecurity and chronic diseases exist, in addition to a unified need for education on culturally appropriate food selections for long-term health. The primary objective was to assess the barriers for SMHC patients when conducting nutrition assessments via telehealth versus an in-person clinic. Methods SMHC registered nurses (RN) triaged patients in need of nutrition assessment based on recent laboratory results or patient requests. The schedule was coordinated between RN, registered dietitian (RD), interpreter, and patient; the interpreter connected the patient to the telehealth appointment by providing call-in details or merging phone calls. The appointment was conducted via a secure virtual platform where phone or computer access was granted to all parties. Perception of barriers to telehealth were recorded by RD. Results Pre-pandemic, 6–8 nutrition assessments were conducted in-person monthly. Between the initiation of telehealth in July and December of 2020, 62 telehealth appointments were conducted, averaging 12.4 appointments per month. As a result of telehealth, the barrier of transportation to appointments was eliminated, nutrition assessment volume increased by 1.5–2 times, flexibility in appointment scheduling times increased, and the risk of spreading illness decreased. Challenges of telehealth were the inability to conduct nutrition-focused physical examinations, the presence of distractions in patient and/or provider home environments, increased coordination of care across the interprofessional team, and miscommunication/technology issues with the telehealth platform. Conclusions Telehealth has reduced some of the barriers to conducting nutrition assessments and has allowed for accessibility to a wider patient population, however, additional challenges unique to telehealth during the global pandemic were present. Funding Sources GHR Foundation Grant

Pain Assessment Tool With Electrodermal Activity for Postoperative Patients: Method Validation Study.

BackgroundAccurate, objective pain assessment is required in the health care domain and clinical settings for appropriate pain management. Automated, objective pain detection from physiological data in patients provides valuable information to hospital staff and caregivers to better manage pain, particularly for patients who are unable to self-report. Galvanic skin response (GSR) is one of the physiologic signals that refers to the changes in sweat gland activity, which can identify features of emotional states and anxiety induced by varying pain levels. This study used different statistical features extracted from GSR data collected from postoperative patients to detect their pain intensity. To the best of our knowledge, this is the first work building pain models using postoperative adult patients instead of healthy subjects.ObjectiveThe goal of this study was to present an automatic pain assessment tool using GSR signals to predict different pain intensities in noncommunicative, postoperative patients.MethodsThe study was designed to collect biomedical data from postoperative patients reporting moderate to high pain levels. We recruited 25 participants aged 23-89 years. First, a transcutaneous electrical nerve stimulation (TENS) unit was employed to obtain patients' baseline data. In the second part, the Empatica E4 wristband was worn by patients while they were performing low-intensity activities. Patient self-report based on the numeric rating scale (NRS) was used to record pain intensities that were correlated with objectively measured data. The labels were down-sampled from 11 pain levels to 5 different pain intensities, including the baseline. We used 2 different machine learning algorithms to construct the models. The mean decrease impurity method was used to find the top important features for pain prediction and improve the accuracy. We compared our results with a previously published research study to estimate the true performance of our models.ResultsFour different binary classification models were constructed using each machine learning algorithm to classify the baseline and other pain intensities (Baseline [BL] vs Pain Level [PL] 1, BL vs PL2, BL vs PL3, and BL vs PL4). Our models achieved higher accuracy for the first 3 pain models than the BioVid paper approach despite the challenges in analyzing real patient data. For BL vs PL1, BL vs PL2, and BL vs PL4, the highest prediction accuracies were achieved when using a random forest classifier (86.0, 70.0, and 61.5, respectively). For BL vs PL3, we achieved an accuracy of 72.1 using a k-nearest-neighbor classifier.ConclusionsWe are the first to propose and validate a pain assessment tool to predict different pain levels in real postoperative adult patients using GSR signals. We also exploited feature selection algorithms to find the top important features related to different pain intensities.International Registered Report Identifier (IRRID)RR2-10.2196/17783

Change Mechanisms in Brief Interpersonal Psychotherapy for Women With Perinatal Depression: Qualitative Study.

Brief interpersonal psychotherapy (IPT-B) has been shown to be effective in treating perinatal depression and in preventing depressive relapse among socioeconomically disadvantaged women. Yet, it is unclear how IPT-B alleviates depression. Previous research has suggested four possible change mechanisms derived from IPT's interpersonal model: decreasing interpersonal stress, facilitating emotional processing, improving interpersonal skills, and enhancing social support. This study explored how women who received IPT-B or enhanced maternity support services (MSS-Plus) evaluated their respective experiences. A qualitative study was conducted with 16 women who had been recruited from public health clinics to participate in a larger, randomized controlled trial of women with major depression or dysthymia and who had been assigned to receive IPT-B or MSS-Plus. The sample was 63% non-Hispanic White, had an average age of 31.6 years, and was balanced in intervention group assignment, posttraumatic stress disorder status, and depression improvement. Telephone interviews included semistructured, open-ended questions eliciting participants' experiences with depression treatment. Predetermined, conceptually derived codes were based on the four postulated IPT change mechanisms. Thematic coded excerpts were collected and discussed. Excerpts lent support to the role of IPT-B in helping women decrease their interpersonal stress; identify, reflect on, and regulate their emotions; and improve their social skills. Evidence for increasing social support was mixed but highlighted the importance of the therapeutic relationship. Including qualitative findings into training in public health and other clinical settings will help illuminate the role of the provider in facilitating the change mechanisms that may lead to improved mental health among clients.

Tracking the impact of nursing informatics

Tracking the impact of nursing informatics