Health Professional Schools Research Articles

Determinants of Substance Use Among High School Students in Jordan.

Substance use is becoming a global health problem that concerns health professionals and decision makers. Studies showed that teens are at higher risk for substance use. the purpose of this study was to examine the prediction power of the selected sociodemographic and psychological factors on substance use among high school students in Jordan. Specific aims were; 1) to explore substance use among high school students in Jordan, and 2) to examine the prediction power of sociodemographic and psychological factors on substance use among high school students in Jordan. This is a predictive cross-sectional study where data was collected using self-administered questionnaires from a convenience sample of 1497 high school students in the central district of Jordan. Students who reported that they have never used stimulant agent were 91.5%, tranquilizer sedative 87.2%, hypnotic agent 85.8% and antidepressant agent 94.5%, while those never used nicotine were 81.7%. Coping efficacy (crude OR = 1.07, CI 95% = 1.03 - 1.12), psychological distress (crude OR = 1.07, CI 95% = 1.03 - 1.11), and perceived social support from family (crude OR = 1.20, CI 95% = 0.95 - 1.24) were significantly associated with substance use. While perceived social support from friends was not. High school students are at risk for the use of various forms of substances and mainly the over counter ones. Legitimate rules of screening and using substance prevention programs at high schools considering the psychological factors is a priority for school health professionals and policy makers.

Using innovative models in transition to practice and Master's Entry programs to teach ambulatory and primary care nursing.

With advancements in health care and changes in reimbursement that contribute to shorter hospitalizations, health care delivery is increasingly shifting to other settings to include skilled nursing, home care, and outpatient areas. There is a well-documented shortage of hospital-based capacity for clinical placements in California. The need for clinical placements is creating an opportunity to utilize ambulatory care settings as innovative alternative learning experiences for prelicensure nursing students. Care coordination, health coaching, and population health management are examples of skills useful for all RNs that ambulatory care settings offer as learning experiences for nursing students. The skills and knowledge students gain in ambulatory care are valuable for a wide range of employment settings. Additionally, these alternative settings provide faculty other clinical placement options since acute care placements are difficult to secure and sustain. The University of San Francisco (USF), School of Nursing and Health Professions (SONHP) developed two educational models to prepare nurses for complex disease management. One was a post-graduate new RN program that focused on outpatient/ambulatory care, the Transition to Practice Program (TTP). The other was a prelicensure Master's-Entry Master's of Science in Nursing (ME-MSN) program that has an ambulatory and acute care pathway.

Twelve tips for rapidly migrating to online learning during the COVID-19 pandemic.

This article was migrated. The article was marked as recommended. The COVID-19 pandemic has resulted in a massive adaptation in health professions education, with a shift from in-person learning activities to a sudden heavy reliance on internet-mediated education. Some health professions schools will have already had considerable educational technology and cultural infrastructure in place, making such a shift more of a different emphasis in provision. For others, this shift will have been a considerable dislocation for both educators and learners in the provision of education. To aid educators make this shift effectively, this 12 Tips article presents a compendium of key principles and practical recommendations that apply to the modalities that make up online learning. The emphasis is on design features that can be rapidly implemented and optimised for the current pandemic. Where applicable, we have pointed out how these short-term shifts can also be beneficial for the long-term integration of educational technology into the organisations' infrastructure. The need for adaptability on the part of educators and learners is an important over-arching theme. By demonstrating these core values of the health professions school in a time of crisis, the manner in which the shift to online learning is carried out sends its own important message to novice health professionals who are in the process of developing their professional identities as learners and as clinicians.

Suicidal ideation and associated factors among high school adolescents.

ABSTRACTOBJECTIVE To analyze the prevalence of suicidal ideation and its associated factors in school adolescents.METHODS Cross-sectional school-based study with 674 students from public and private schools in Teresina, Piauí, in 2016. Bivariate analysis was performed with the chi-square test and multiple analysis by the Poisson regression model to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI).RESULTS The study participants were mostly female (56.7%), black (77.4%), who lived with their parents (85%), whose mothers had schooling greater than or equal to 8 years of schooling (68.8%), with family income greater than a minimum wage (58.3%), practitioners of some religion (86.8%) and coming from public school (64.7%). The prevalence of suicidal ideation was 7.9%. Higher frequency of suicidal ideation was reported among female students (10.2%). Suicidal ideation was statistically associated with students who reported not living with their parents (adjusted PR = 2.27; 95%CI 1.26–4.10; p < 0.05) and those who reported having suffered sexual violence by other students, teachers or school staff (adjusted PR = 3.40; 95%CI 1.80–6.44; p < 0.05), among which the prevalence of suicidal ideation was more than three times that observed among those who did not mention this type of violence.CONCLUSION The prevalence of suicidal ideation in school adolescents was associated with female students, who did not live with parents and have been victim of sexual violence at school. We recommend advising the school community and health professionals to identify signs of suicidal behavior, especially in those with suspicion or proof of the occurrence of sexual violence at school.

Behavioural and socio-ecological factors that influence access and utilisation of health services by young people living in rural KwaZulu-Natal, South Africa: Implications for intervention.

Young people's health service utilisation (the number accessing a facility) has been the focus of guidelines and health systems strengthening policies. This is due to young people being at an increased health risk because of inequitable access and utilisation of health services, which is more pronounced in rural settings with limited service availability. This is a major concern as globally, youth constitute a considerable and increasing part of the population in Sub-Saharan Africa. The objective of this paper is to present a comprehensive approach for the exploration of health service utilisation by young people in rural KwaZulu-Natal, South Africa. We examined barriers and facilitators conceptualised by the constructs of the Theory of Planned Behaviour, framed within a socio-ecological model. Data were collected in January to June 2017 from two sites using in-depth interviews, spiral transect walks and community mapping with young people (aged 10 to 24 years), primary care health providers, school health professionals, community stakeholders and young people's parents. Socio-ecological and behavioural factors influenced young people's intention to use services. Barriers included perceived negative attitudes of health providers and perceived poor staff competencies. Facilitators included an appreciation of receiving health education and assumed improved health. At social and community levels, normative beliefs hindered young people from utilising services as they feared stigmatisation and gossip. At a public policy level, structural elements had a disempowering effect as the physical layout of the clinics hindered utilisation, limited resources influenced staffing, and facility opening times were not convenient for school goers. We suggest that to fully appreciate the complexity of health service utilisation, it is necessary to not only consider factors and processes relevant to the individual, but also acknowledge and act upon, the disjuncture between community level cultural values, norms and national policies.

Restructuring the inpatient advanced pharmacy practice experience to reduce the risk of contracting coronavirus disease 2019: Lessons from Saudi Arabia.

IntroductionOn March 11, 2020, the World Health Organization announced the rapidly spreading epidemic of the coronavirus disease 2019 (COVID‐19) pandemic. Almost all countries started to take proactive precautionary measures to reduce the risk of contracting the virus. The education sector, including pharmacy education, has been drastically impacted by this pandemic. During the outbreak, many hospitals instructed the health profession's schools to restrict or prevent the presence of their students and interns in their hospitals in an effort to limit the spread of the virus.ObjectivesConstraining the presence of interns in the affiliated hospital has impacted the integrity of delivering the learning outcomes of each clinical rotation. In this paper, we present the experience of four faculty preceptors in restructuring the advanced pharmacy practice experience in different clinical settings, including critical care, infectious diseases, cardiology, and internal medicine, in order to reduce the risk of contracting COVID‐19 at a large academic medical institution in Saudi Arabia.ConclusionWe believe that this experience could provide guidance and insights for other pharmacy schools dealing with this issue during this global pandemic.

The Vanderbilt Program in Interprofessional Learning: Sustaining a Longitudinal, Clinical Experience That Aligns Practice With Education.

Designing and sustaining a longitudinal, clinic-based interprofessional learning experience is logistically challenging, which has limited the educational opportunities available in health professions schools. The authors discuss the Vanderbilt Program in Interprofessional Learning (VPIL), which addresses some of the challenges facing clinic-based interprofessional experiences. VPIL places first- and second-year students from 4 professional degree programs (medicine, nursing, pharmacy, social work) in Nashville, Tennessee, on teams where they work and learn together in authentic clinical environments over a 2-year period. The program was implemented in 2010 and includes 3 components: a summer immersion experience, seminar-based classroom and simulation sessions, and a weekly clinical experience. Students also complete a capstone quality improvement project. VPIL administrators have set up structures at the institutional, clinic, faculty, and student levels that have contributed to the sustainability of the program. Between 2010 and 2019, VPIL admitted 398 students who participated on 91 clinical teams. In addition, 55 clinical preceptors and 12 core faculty trained students for future collaborative practice. The program has received consistently high ratings from students, who have produced 69 quality improvement projects at their clinics. These projects have addressed aspects of the care delivery process and produced durable materials, showing that the program has contributed to important innovations in the health system. VPIL faculty continue to improve the curriculum and administrative structures and work to expand the program to reach a wider variety of health professions students. Going forward, lessons from the program could assist educators in creating opportunities for students to learn interprofessionally and deliver high value health care in increasingly complex delivery systems.

Educational Approach in Integrated Pharmacotherapy Cardiology Course: Emphasizing Pharmacology in Clinical Cases

Curricular models that merge biomedical and/or pharmaceutical sciences with clinical sciences are being increasingly employed across schools of pharmacy and other health professions with the goal to promote integrative learning among students. Integrated Pharmacotherapy (IP): Cardiology is one of 12 courses in the IP series taught in the Doctor of Pharmacy program at St. Louis College of Pharmacy designed to prepare student pharmacists to care for patients by integrating pathophysiology, pharmacology, medicinal chemistry and therapeutics. About 25% of the didactic course content is taught by pharmacology faculty with main emphasis on basic pharmacology of drugs in clinical use for cardiovascular disorders.To incorporate pharmacology content and develop knowledge and skills that can be applied in therapeutic decision making, we included pharmacology concepts in patient cases prepared by clinical faculty. To aid in creating and grading these integrated cases, a faculty‐developed patient case rubric was used. This rubric included a descriptor titled “scientific‐guided appropriateness” where a student was expected to evaluate appropriateness of given drug regimens and justify them based on drug’s mechanism of action. This rubric was introduced during the first course offering in Fall 2017.Prior to completing integrated patient cases, students had opportunities to solidify their understanding during group learning sessions focused on pharmacology content. However, despite good performance on these sessions with class averages above 80%, class average for scientific‐guided appropriateness section on 10 integrated case vignettes included in four IP: Cardiology course exams was only 68.4±14.5%. Many student answers pointed to the lack of clear understanding of the information expected in this segment and, after clarification, performance appeared to improve towards the end of the course.To increase student understanding of the expectations regarding the case‐related pharmacology content, we introduced targeted questions within the patient case in the following course offering (Fall 2018). For example, we asked students to describe the mechanism of antihypertensive effect of drug X or describe pharmacogenetic factors affecting response to drug Y. Class performance on pharmacology content‐related targeted questions improved to 78.7±10.7% in Fall 2018. We observed about 10% increase in average grade, but due to larger standard deviation in Fall 2017 cohort resulting from higher scores in the latter part of the semester, the difference was not statistically significant. Nevertheless, student answers to targeted questions showed significant qualitative improvement in Fall 2018, and appeared to be a better indicator of their knowledge and understanding.We plan to continue using targeted questions for science content in integrated cases in IP: Cardiology class. In addition to providing direction to students, these questions enable us to expand the range of topics that relate back to pharmacology content relevant for clinical case management. Similar approaches are used in some IP courses and we plan to expand it to patient cases given in other IP courses which should help us achieve meaningful integration across the entire series.

Creating Educator Scholar Leaders – Effectiveness of Robust Curriculum Development of a New PhD Program in Anatomy Education.

INTRODUCTIONThere is a current deficit in the number of high quality anatomy educators. This shortage has developed as well‐experienced anatomists move into administrative roles or retire and health profession schools expand course offerings and open new campuses. Curricular hour reductions, new technological innovations, and a focus on improved board performances forces anatomists to accomplish more with less. Although many anatomists make education a keystone in their careers, few PhD programs in anatomy provide formalized training in educational practice. AIM. To evaluate the effectiveness of a new PhD program in Anatomy Education designed to graduate educational‐scholar‐leaders as educational specialists.METHODSApplying Kern’s six step approach to curriculum development in medical education, we successfully merged the strengths existing educational programs at LECOM to create a new PhD program in Anatomy Education.RESULTSA new curriculum was planned, implemented, and evaluated. Program strengths include emphasis on the practice of teaching skills, educational research/scholarship, leadership, while developing robust knowledge in the anatomical sciences. Evidence of effectiveness of the innovative and unique curriculum includes, the number of applications, successful obtainment of accreditation, credit hours devoted to educational training, current evidence‐based dissertation research projects in anatomy education, institutional support of the program, and current PhD student evaluations.CONCLUSIONThis program has a strong commitment to producing a unique breed of new anatomists as education specialists who have the knowledge, skills and behaviors needed to lead health professions education development and research, thereby enhancing academic programs, improving health care outcomes, and strengthening the anatomical profession.

Social Mission Metrics: Developing a Survey to Guide Health Professions Schools

The social mission, which is focused on advancing social justice and health equity, has gained recognition as an important aspect of health professions education. However, there is currently no established method to measure a school's commitment to these activities. In this Perspective, the authors describe the development of a new tool to measure the social mission at dental, medical, and nursing schools across the United States, and they reflect on the implications of using this tool to deepen discussions around the social mission and strengthen progress toward health equity.From 2016 to 2019, the authors created and field tested the online social mission metrics survey for health professions schools to identify their level of engagement in social mission activities, track that level over time, and compare their progress with that of other schools. The survey measures a school's social mission values, programs, and activities across 6 domains and 18 activity areas. The authors also developed a scoring system based on stakeholder priorities, which they used to provide customized, confidential feedback to the schools that participated in the field tests.Going forward, the authors recommend that schools complete the survey every 3 to 5 years to track their social mission over time, and they plan to expand the survey process to additional dental, medical, and nursing schools as well as to schools in other health professions. The social mission metrics survey is meant to be a useful tool for improving the level and quality of social mission engagement at health professions schools, with the goal of improving the awareness, skills, and commitment of health professionals to health equity.

Addressing Human Trafficking Through Nurse Leadership:: Application of AONL Competencies

Human trafficking is a multibillion dollar industry and a public health crisis that is present in every country and every state in the United States. Victims and survivors of forced labor and commercial sex exploitation suffer physical, emotional, and psychological traumas that have long-lasting effects. They access the health care system for treatment, often going unrecognized by providers or clinicians. Nurse executives, through the application of the American Organization of Nursing Leadership (AONL) Nurse Executive Competencies, are uniquely qualified to lead efforts to combat trafficking through advocacy, by serving as catalysts for change, and by influencing nursing practice across the care continuum. Human trafficking is a multibillion dollar industry and a public health crisis that is present in every country and every state in the United States. Victims and survivors of forced labor and commercial sex exploitation suffer physical, emotional, and psychological traumas that have long-lasting effects. They access the health care system for treatment, often going unrecognized by providers or clinicians. Nurse executives, through the application of the American Organization of Nursing Leadership (AONL) Nurse Executive Competencies, are uniquely qualified to lead efforts to combat trafficking through advocacy, by serving as catalysts for change, and by influencing nursing practice across the care continuum. Connie A. Clemmons-Brown, MBA, RN, CENP, is currently the system senior vice president for Patient Care Services for CommonSpirit Health, headquartered in Chicago, Illinois, and a doctor of nursing practice–executive leadership student at the University of San Francisco School of Nursing and Health Professions in San Francisco, California. She can be reached at [email protected] .

Addressing LGBTQ Student Bullying in Massachusetts Schools: Perspectives of LGBTQ Students and School Health Professionals.

Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) youth face disparities in bullying victimization are associated with higher rates of physical injury, psychological distress, and even suicide. Innovative strategies to address bullying victimization are needed to prevent adverse physical and mental health outcomes, including those engaging school health professionals (SHPs; school nurses, psychologists). This mixed-methods study sought to identify factors that facilitate or impede SHPs' reporting and responding to LGBTQ bullying in Massachusetts from the perspectives of LGBTQ students and SHPs. Between August 2017 and July 2018, asynchronous online focus group discussions and a brief survey were conducted separately for 28 LGBTQ students and 19 SHPs in Massachusetts (9-12 participants per group; n = 47 enrolled). Focus groups probed on bullying experiences. Rapid qualitative inquiry was used for thematic coding of facilitators and barriers to address LGBTQ student bullying described by youth and SHPs. Facilitators and barriers largely coalesced around the social ecological model. Youth and SHPs identified factors at multiple levels of the social ecological model: (1) individual (knowledge, skills, attitudes); (2) interpersonal (trust and follow-through, confidentiality and fear of being "outed," close relationships, champion SHPs); and (3) structural (school buy-in, time, reporting and protocols, staff roles, resources, and school culture of inclusivity). LGBTQ students expressed a need for an intersectional lens for SHPs when addressing LGBTQ student bullying. Interventions that help SHPs overcome multilevel barriers and leverage facilitators are needed. Consideration of intersectionality will better equip SHPs to support LGBTQ students and address disparities in LGBTQ student bullying that confer health risks.

When an Omitted Curriculum Becomes A Hidden Curriculum: Let's Teach to Promote Health Equity.

Omitting topics such as the social determinants of health and the relationship between discrimination and allostatic load on individuals and communities conveys an implicit message about the health and health outcomes of people of color. Th is is an example of a hidden curriculum in health professions schools. Th is qualitative study includes the insights of 54 medical or nursing students belonging to groups underrepresented in the health professions. Th e students came from three academic health institutions and were asked about microaggressions they may have experienced as students. Th e data highlight participants' perceptions of curricular deficits and a hidden curriculum and indicate the need for curriculum reform in schools of nursing and schools of medicine.

Is sleep duration associated with self-reported overall health, screen time, and nighttime texting among adolescents?

ObjectivesWe aimed to investigate whether sleep duration is associated with self-reported overall health, screen time, and nighttime texting among Swedish adolescents.MethodsThis was a cross-sectional survey of students (n = 1518) aged 13 to 15 years (50.7% girls) in southern Sweden.ResultsFewer than 8 hours sleep duration before a school day was reported by 31% of students. The median time spent watching television and/or at the computer was 3 hours, and 43% of students reported texting at night one or more times per week. Sleeping fewer than 8 hours was significantly associated with poorer self-reported overall health, often being tired at school, increased screen time, and a habit of nighttime texting.ConclusionsShort sleep duration (<8 hours) was associated with poor self-reported health, increased screen time, and nighttime texting among respondents. These results provide information for parents, educators, and school health professionals to encourage young people to adopt healthy screen habits and sleep hygiene.

Learning and Teaching Together to Advance Evidence-Based Clinical Education: A Faculty Learning Community.

Clinical teaching is a cornerstone of health sciences education; it is also the most challenging aspect. The University of Pittsburgh Schools of Dental Medicine, Nursing, and Pharmacy developed a new evidence-based interprofessional course framed as a faculty learning community (FLC) around the principles of learning in a clinical environment. The aim of this study was to assess the overall effectiveness of this two-semester FLC at four health professions schools in academic year 2014-15. The assessment included anonymous participant surveys in each session and an anonymous end-of-course survey. Thirty-five faculty members from dental, health and rehabilitation sciences, nursing, and pharmacy enrolled in the FLC, with six to 32 enrollees attending each session. All attendees at each session completed the session evaluation surveys, but the attendance rate at each session ranged from 17.1% to 91.4%. Sixteen participants (46%) completed the end-of-course survey. The results showed overall positive responses to the FLC and changes in the participants' self-reported knowledge. Session surveys showed that the participants found the FLC topics helpful and appreciated the opportunity to learn from each other and the interprofessional nature of the FLC. Responses to the end-of-course survey were in alignment with the individual session surveys and cited specific benefits as being the content, teaching materials, and structured discussions. In additional feedback, participants reported interest to continue as a cohort and to extend the peer-support system beyond the FLC. This outcomes assessment of the first round of the FLC confirmed that this cohort-based faculty development in an interprofessional setting was well received by its participants. Their feedback provided valuable insights for changes to future offerings.

Influence of Future Prescribers' Personal and Clinical Experiences With Opioids on Plans to Treat Patients With Opioid Use Disorder.

Recreational use of opioids is a growing problem in the United States, particularly in the Midwest. Educators have called for inclusion of pain- and opioid-specific courses in health professional school curricula, yet more research is needed to address future prescribers' beliefs, experiences, and postgraduate plans related to opioids. To examine health professional students' perceived severity of the opioid crisis and opioid-related beliefs, experiences, and postgraduate plans. Using a descriptive, cross-sectional design, researchers evaluated health professional students from 3 academic programs (nurse practitioner [NP], physician assistant [PA], and doctor of osteopathic medicine [DO]) using a 25-item survey that assessed perceived opioid crisis severity and opioid-related beliefs, experiences, and postgraduate plans. Demographics of respondents were assessed using descriptive statistics and frequencies. Responses were compared between academic programs with 1-way analysis of variance or Kruskal-Wallis tests, and relationships between students' experiences and postgraduate plans were assessed. A total of 491 students (mean [SD] age, 27.2 [5.4] years; 62.7% female; 68.2% DO students) participated in the survey (response rate, 40.4%). The opioid crisis was perceived to be severely impacting the health care system (mean [SD] score, 79.7 [16.8] out of 100), and most respondents (415 [84.5%]) reported that opioid use affected their communities. Clinical experience varied by program, with NP students (75 [81.5%]) reporting the most experience treating acute overdose. Most respondents (317 [64.6%]) agreed that their postgraduate practice would involve caring for patients addicted to opioids; however, only 232 students (47.3%) felt confident in their ability to treat patients with addiction. Experiences managing acute overdose and handling drug-seeking behavior were positively associated with a belief that postgraduate work would involve working with patients with addiction (U=38,275.5, Z=5.92, P<.001; U=25,346.0, Z=4.94, P<.001) and confidence in treating patients with opioid addictions (U=36,806.5, Z=4.96, P<.001; U=23,765.5, Z=3.66, P<.001). Although health professional students had similar beliefs and perceptions regarding the opioid crisis, there were notable differences between academic programs. Students with clinical opioid experiences were more likely to plan on working with patients addicted to opioids and be confident in treating these patients. Thus, the inclusion of experiential learning in the medical curricula may be beneficial for both students and their future patients.

Advancing Nutrition Education, Training, and Research for Medical Students, Residents, Fellows, Attending Physicians, and Other Clinicians: Building Competencies and Interdisciplinary Coordination

Nutrition plays an important role in health promotion and disease prevention and treatment across the lifespan. Physicians and other healthcare professionals are expected to counsel patients about nutrition, but recent surveys report minimal to no improvements in medical nutrition education in US medical schools. A workshop sponsored by the National Heart, Lung, and Blood Institute addressed this gap in knowledge by convening experts in clinical and academic health professional schools. Representatives from the National Board of Medical Examiners, the Accreditation Council for Graduate Medical Education, the Liaison Committee on Medical Education, and the American Society for Nutrition provided relevant presentations. Reported is an overview of lessons learned from nutrition education efforts in medical schools and health professional schools including interprofessional domains and competency-based nutrition education. Proposed is a framework for coordinating activities of various entities using a public-private partnership platform. Recommendations for nutrition research and accreditation are provided.

Effectiveness of a Short Education Series to Reduce Anxiety for Health Professions Graduate Students: A Pilot Study

Abstract. In college and graduate programs across the United States, educators have become aware that the psychological well-being of the current generation of students (often referred to as “Millennials”) needs to be an important area of focus. In 2007, 50.7% of American college students met the clinical criteria for a depressive or anxiety disorder. In the 2010 American College Health Survey, 48% of college and university respondents felt overwhelming anxiety at least once in the preceding year. These data make it clear that there is a need for effective interventions to help students reduce the emotional distress they experience. This pilot study examined the effects of an educational intervention on anxiety in graduate students. The intervention included cognitive behavioral therapy (CBT) and mindfulness training, in addition to education about lifestyle health behaviors and study habits. First year graduate students in the UT Southwestern School of Health Professions were recruited for the pilot study. The study design included 4 educational sessions to provide education/training in CBT, mindfulness, lifestyle, and study habits. Subjects completed outcome measures before and after the intervention including the Depression Anxiety Stress Scale-21 (DASS-21) and a survey about subjects' behaviors in the domains targeted in the study. Results indicated a decrease in student distress in DASS-21 overall and individual subtest scores. The results suggest that a comprehensive intervention was successful in impacting the depression, anxiety, and overall stress levels of the involved students.

The development and psychometric evaluation of a new instrument to market healthy breakfast and snacks among adolescents.

The consumption of non-nutritious snacks instead of a proper breakfast is becoming more widespread among adolescents. It is expected that using the 4P (product, price, place, promotion) strategies of the social marketing (SM) model can help to better identify factors affecting healthy breakfast and snack consumption. The objective of this study was to develop and evaluate the psychometric properties of the Healthy Breakfast and Snack Consumption Scale (HBSCS) using the SM model. This was a cross-sectional descriptive study that was conducted in 2017. First, a scale was developed using the results of a qualitative research based on the SM model. Then, its face, content and construct validities as well as its reliability were assessed. Construct validity was evaluated via exploratory factor analysis conducted on a random sample of 300 high school pupils selected from five girls' schools located in Isfahan, Iran, using the multistage cluster sampling method. Exploratory factor analysis was performed using the methods of principle components extraction and varimax rotation with eigenvalues greater than 1. A four-factor structure that explained 61.73% of the total variance of the HBSCS included healthy breakfast and snack preferences, readiness to pay the price, place preferences and communication channel preferences. Items with an impact score of less than 1.5 were removed. Additionally, items with content validity ratio values of less than 0.62 and content validity index values of less than 0.79 were deleted. The Kaiser-Meyer-Olkin measure value was 0.74 [chi-squared (χ2) = 2353.622; p-value < 0.001]. The Cronbach's α values of the scale and its four dimensions were 0.71 and 0.56-0.72, respectively. This scale has acceptable validity and reliability. School authorities and health professionals can use this scale to screen adolescents at risk of consuming unhealthy foods and snacks. Besides, the scale might be used as a framework for assessing, implementing and promoting healthy eating behaviors among pupils.

Towards Patient Safety: Evaluation of Care Transitions Training Needs Among Key Providers Involved in Patient Care Transitions.

Significant morbidity, mortality, and increased healthcare costs of up to 20.1 billion dollars annually occur as a result of poorly executed patient care transitions. The critical role of providers in ensuring patient safety at discharge requires provider knowledge of required care transitions processes to ensure optimal execution of transitions of care. The present study was designed to determine provider perception of their care transitions training, curriculum content, and self-identified care transitions knowledge gaps. A cross-sectional survey was conducted among key healthcare providers at the Grady Memorial Hospital, a 953 bed urban safety net hospital. Of these, 131 participants completed the surveys including 73 internal medicine residents, 51 nurses, and 7 social workers. Among participants, 13% reported that they had never had any formal training on care transitions. Of these, 88.2% were medical residents, while 11.8% were bedside nurses. Among participants who had received care transitions training, only 40% received their training prior to graduation. Healthcare providers across disciplines were least exposed to training on discharge settings of care, determining the most appropriate next level of care for patients at discharge, and communication and coordination with post-acute care facilities. Providers made recommendations regarding topics they considered important to be included in care transitions training. Defining the full discharge process and responsibilities of various healthcare providers were topics recommended by most providers as important to be included in care transitions training. This study has highlighted the extent of exposure to formal care transitions training among providers from multiple disciplines involved in various aspects of discharge care. It has demonstrated a paucity of formal care transitions training at the health professional school level. It has also highlighted self-identified care transitions training needs and will form a foundation for design of care transitions curricula for a broad range of healthcare professionals.