Intervention Staff Research Articles

Supporting older people experiencing homelessness and memory problems in hostels: Learning from an ethnographic study.

Older people with memory problems living in temporary hostel accommodation have longer stays and higher care needs than those without memory problems. In this ethnographic study, we aimed to elucidate how staff currently support older hostel residents with memory problems, what contextual factors determine support given and, what facilitates positive and meaningful outcomes for staff and residents. We conducted interviews and participant observations with older people (≥50 years) experiencing memory problems and homelessness (interviews n=17, observations n=13), hostel staff and managers (interviews n=15, observations n=20) from seven residential facilities (six hostels and one care home), and health and social care practitioners (interviews n=17, observations n=7), from September 2021-December 2022 in London, England. We analyzed thematically from a critical realist position. We identified four overarching themes: (1) Compensatory strategies and routines, (2) hostels are not homes, (3) meeting challenging interactions with compassion, and (4) facilitating opportunities for meaningful interactions. Social interactions for people with memory problems were restricted and, although sheltered by living in hostels, this did not equate to safety or provide opportunities for positive interactions. Staff worked hard to connect with older residents with memory problems, in resource and time-poor contexts, often left to provide care beyond their roles in contexts of unmet need. Our ethnographic account has informed co-design of a support intervention for hostel staff working with older people with memory problems, alongside recommendations for policy and practice.

Team Time as a wellbeing intervention for NHS staff: a qualitative evaluation of implementation during the COVID-19 pandemic

BackgroundSupport for NHS staff was vital during the COVID-19 pandemic and Team Time was developed as an adaptation of Schwartz Rounds™ – a well-evidenced, facilitated group intervention. Building on the existing evidence base for Schwartz Rounds implementation, this study aims to understand the key factors associated with Team Time implementation and sustainability in this context.MethodsTwenty semi-structured interviews were conducted within 10 NHS acute, community and mental health organisations that ran Team Time during the pandemic: six with no prior experience of Schwartz Rounds and four that ran Schwartz Rounds prior to the pandemic. Additionally, three Team Time mentors who provided support to these organisations were also interviewed. Data analysis was underpinned by the Consolidated Framework for Implementation Research (CFIR). Data were analysed thematically, and key implementation factors were mapped onto CFIR constructs using the Framework method to explore patterns.ResultsImplementation of Team Time was challenging in organisations that did not run Schwartz Rounds previously. Facilitating factors included having incentives in the outer setting (wider context of the organisation), the adaptability of the intervention, and wide ownership across the organisation. However, barriers to implementation were the perception that the intervention was complex and resource intensive and an unsupportive organisational culture and communication difficulties which hindered engagement. In those organisations which already ran Schwartz Rounds the burden of setting up the organisational infrastructure for Team Time was smaller and the implementation climate more supportive.ConclusionsSimilar to Schwartz Rounds, Team Time needed broad and sustained organisational support for implementation to become embedded in organisations and deliver benefits. Implementing it as an entirely new and stand-alone online intervention during the pandemic was challenging. Team Time should therefore be considered as an addition to Schwartz Rounds and as part of a long-term organisational investment in staff psychological wellbeing, not as a short-term intervention in a period of crisis.

Tunable and real-time automatic interventional x-ray collimation from semi-supervised deep feature extraction.

The use of endovascular procedures is becoming increasingly popular across multiple clinical domains. These procedures are generally performed under image guidance using an interventional c-arm x-ray system. Radiation exposure to both patients and interventional staff due to use of fluoroscopy is a health and occupational concern, but modifications to the interventional workflow to address radiation may come at the cost of procedure time orquality. Interventional x-ray collimation is a crucial task for improving image quality as well as reducing radiation exposure to both patients and operators who work in the x-ray domain. However, collimation is heavily underutilized due to its cumbersome nature and the difficulty of manually manipulating multiple parameters during fast-paced interventional procedures. Additionally, the widely varying collimation preferences of interventionalists across different procedure types, procedure phases, and anatomies makes the standardizing of collimation challenging for radiation technologist supportstaff. Automating collimation has the potential to bridge this gap, freeing up mental bandwidth for interventionalists and technologists and improving outcomes for patients. Here, we propose a tunable algorithm for automatic collimation based on a region-of-interest optimizer driven by a combination of image, system, device, and radiation based features and we illustrate its efficacy across varying personal preferences. Critically, we devise a method with a simple and easily understandable mapping between algorithm parameters and practicaloutcomes. We show a real-time implementation of this algorithm using deep feature extraction by a convolutional neural network and evaluate its performance in a custom dataset of simulated fluoroscopy and recorded fluoroscopy from clinical radial access procedures. We evaluate the effects of a practically implemented mixed supervision training strategy on model performance and show potential for radiation reduction in simulation. An uncertainty analysis indicates that the algorithm is robust to noise and anatomical variation across our clinical dataset. Clinical acceptability and quality is evaluated through a reader study with expert neuro-interventional radiologists, with participants indicating 100% clinical acceptability, high quality ratings, and improved radiation protection over their typicalpractice. The algorithm's modular design ensured that users' collimation requirements were met without disruption to the interventional workflow or procedure time, while exhibiting strong potential to reduce radiation risk to patients and operators. Evaluation in more varied clinical settings could support translation of this technology into theclinic.

Implementing INTERACT in Veterans Health Administration Community Living Centers: A pragmatic randomized trial.

Hospital transfers from VA Community Living Centers (CLCs) are common. The objective of this study was to evaluate the effect of introducing the Intervention to Reduce Acute Care Transfers (INTERACT) program into VA CLCs. Cluster randomized trial involving 16 pair-matched VA CLCs. Intervention CLC nursing staff were trained in the use of INTERACT tools designed to identify early signs of a clinical change in condition and improve communication and documentation. One tool was embedded into the VA Electronic Medical Record. Intervention staff were supported by bi-weekly calls over 18 months to reinforce INTERACT tool use. The primary outcome for intent-to-treat analyses was the rate of all-cause hospitalizations per 1000 person days. Secondary outcomes, assessed through structured record reviews and algorithms, were intervention CLCs change in 1) potentially inappropriate transfer decisions and 2) potentially preventable transfers. CLC staff implementation and engagement in INTERACT were documented. Only five of the eight intervention CLCs substantially engaged in the intervention. Using a negative-binomial regression with random effects, adjusting for month, intervention, and the interaction of time and the intervention, we observed no statistically significant difference between intervention and control facilities in all-cause hospitalizations. This was confirmed with matched resident-level, as-treated, analyses among residents in the five engaged CLCs and their matched controls. Structured implicit review of intervention CLC's medical records revealed low rates of inappropriate transfer decisions both before and after the intervention. Introducing INTERACT into volunteer VA CLCs did not reduce the rates of all-cause hospitalizations. In both the pre- and post-intervention periods, all-cause hospitalization rates were relatively higher, and inappropriate transfers lower in VA CLCs than commonly observed in community NHs. Low rates of potentially inappropriate transfers and higher nurse and physician staffing in CLCs may explain why INTERACT was not implemented as fully as planned.

Implementation strategies to support recovery support workers serving criminal legal involved people who use drugs

IntroductionRecovery support workers (RSWs) who provide social support interventions for people who use drugs (PWUD) often face challenges that can jeopardize the well-being, efficacy and sustainability of this essential workforce. To date, little has been reported on the types of implementation strategies used to support RSWs. We describe and evaluate a multifaceted implementation strategy package to support Reducing Opioid Mortality in Illinois (ROMI), a paired peer recovery coach and case manager (PRC-CM) intervention for PWUD with recent criminal-legal involvement in urban and rural settings. MethodsROMI utilized a remote, hub and spoke-administered multifaceted implementation strategy package to support PRCs-CMs to deliver evidence-based services to PWUD with criminal-legal involvement. The core strategies included: (a) comprehensive training; (b) individual clinical supervision; (c) group consultation; and (d) centralized technical assistance. We evaluated the implementation strategy package using a mixed-methods design including qualitative interviews with the intervention staff to explore their experiences with each strategy component, as well as a quantitative coding of topics discussed during supervision and group consultation meetings to estimate prioritization of issues and balance of topics between strategy type. ResultsBetween January 2019 and January 2024, the study interviewed 8 PRC-CMs and quantitatively coded 568 sessions (79 group consultations and 489 individual supervisory) for discussion themes. The hub-and-spoke model allowed for centralized access to highly skilled supervisory staff as well as knowledge sharing across geographically remote teams. The therapeutic space to process feelings and emotional support provided during individual supervision was noted to be an essential resource by PRC-CMs. Group consultation facilitated camaraderie, mutual support and continual learning through dynamic and responsive trainings. Frustrations around resource limitations and systemic barriers facing their clients remained a dominant concern for PRCs-CMs, and was incompletely addressed by the technical assistance strategy. ConclusionUnderstanding the practical components and individual strengths of the implementation strategies required to support the implementers of complex interventions such as social support and navigation for PWUD with criminal-legal involvement elucidates the organizational and professional capacities that may be required for real world implementation. Trial registrationNCT04925427

Reducing the Number of Intrusive Memories of Work-Related Traumatic Events in Frontline Health Care Staff During the COVID-19 Pandemic: Case Series.

Frontline health care staff are frequently exposed to traumatic events as part of their work. Although this study commenced before the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many health care staff members report intrusive memories of such events, which can elicit distress, affect functioning, and be associated with posttraumatic stress disorder symptoms in the long term. We need evidence-based interventions that are brief, preventative, nonstigmatizing, suitable for the working lives of frontline health care staff, and effective for repeated trauma exposure. A brief, guided imagery-competing task intervention involving a trauma reminder cue and Tetris gameplay may hold promise in this regard, given evidence that it can prevent and reduce the number of intrusive memories following trauma across various settings. This case series aims to investigate the impact of a brief imagery-competing task intervention on the number of intrusive memories, general functioning, and symptoms of posttraumatic stress, anxiety, and depression, and examine the feasibility and acceptability of the intervention for UK National Health Service frontline health care staff. The intervention was delivered with guidance from a clinical psychologist. We recruited 12 clinical staff from the UK National Health Service, specifically from emergency departments, the intensive care unit, and the ambulance service. We evaluated the intervention using an AB single-case experimental design, where the baseline (A) was the monitoring-only phase and the postintervention (B) period was the time after the intervention was first administered. Methods were adapted once the COVID-19 pandemic began. There was a decrease (59%) in the mean number of intrusive memories per day from baseline (mean 1.29, SD 0.94) to postintervention (mean 0.54, SD 0.51). There was a statistically significant reduction in the number of intrusive memories from baseline to postintervention, as shown by an aggregated omnibus analysis with a small effect size (τ-U=-0.38; P<.001). Depression, anxiety, and posttraumatic stress symptoms all significantly reduced from preintervention to postintervention. Participants also reported improvements in functioning based on both quantitative and qualitative measures. The intervention was feasible to deliver and rated as acceptable by participants. These preliminary findings suggest that this brief therapist-guided imagery-competing task intervention offers a potential approach to mitigating the impact of work-related traumatic events in frontline health care staff, both during a pandemic and beyond. Randomized controlled trials will be an important next step.

Disruptions and adaptations of an urban nutrition intervention delivering essential services for women and children during a major health system crisis in Dhaka, Bangladesh.

Systematic crises may disrupt well-designed nutrition interventions. Continuing services requires understanding the intervention paths that have been disrupted and adapting as crises permit. Alive & Thrive developed an intervention to integrate nutrition services into urban antenatal care services in Dhaka, which started at the onset of COVID-19 and encountered extraordinary disruption of services. We investigated the disruptions and adaptations that occurred to continue the delivery of services for women and children and elucidated how the intervention team made those adaptations. We examined the intervention components planned and those implemented annotating the disruptions and adaptations. Subsequently, we detailed the intervention paths (capacity building, supportive supervision, demand generation, counselling services, and reporting, data management and performance review). We sorted out processes at the system, organizational, service delivery and individual levels on how the intervention team made the adaptations. Disruptions included decreased client load and demand for services, attrition of providers and intervention staff, key intervention activities becoming unfeasible and clients and providers facing challenges affecting utilization and provision of services. Adaptations included incorporating new guidance for the continuity of services, managing workforce turnover and incorporating remote modalities for all intervention components. The intervention adapted to continue by incorporating hybrid modalities including both original activities that were feasible and adapted activities. Amidst health system crises, the adapted intervention was successfully delivered. This knowledge of how to identify disruptions and adapt interventions during major crises is critical as Bangladesh and other countries face new threats (conflict, climate, economic downturns, inequities and epidemics).

Well-being interventions for emergency department staff: ‘necessary’ but ‘inadequate’ – a phenomenographic study

IntroductionStress and burnout are prevalent among emergency department (ED) staff in the UK. The concept of well-being interventions for ED staff is a growing area of interest and research worldwide....

Radiation Exposure to the Brains of Interventional Radiology Staff: A Phantom Study.

Numerous papers report the occurrence of head and neck tumors in interventional radiology (IR) physicians. Recently, appropriate dosimetry and protection have become much more important. To accomplish these, first, we should accurately understand how the brain is exposed. We assessed the dose distribution of the head and clarified the relationship between head exposure and brain dose. We used eight radiophotoluminescence dosimeters (RPLDs), two at the surface of the eyes and six inside the phantom head. We conducted measurements with three kinds of irradiation fields: one irradiated the whole head, the second irradiated the brain region, and the third irradiated the soft tissue of the face. The cranial bone reduced the brain dose to less than half the skin dose: about 48% at the front and less than 9% at the back of the brain. Due to the brain exposure, the soft tissues were slightly exposed to the scatter radiation from the cranial bone. We revealed the dose distribution of the head and the influence of the scatter radiation from the cranial bone and the soft tissues of the face. There are two kinds of scatter radiation: from the cranial bone to the soft tissue of the face, and from the soft tissue to the brain. Although the influence of these sources of scatter radiation is not significant, the relationship between brain exposure and the occurrence of head and neck tumors is still unclear. Therefore, some IR physicians should keep this in mind if they receive high levels of exposure in their daily practice.

Knowledge and practices of interventional radiology staff regarding radiation protection

Interventional radiology (IR) has become a widespread medical imaging technique, offering minimally invasive treatment options. However, IR procedures can expose patients and staff to substantial radiation risks, necessitating enhanced radiation protection practices. This study aimed to survey the knowledge and practices of interventional radiology staff regarding radiation protection. A cross-sectional study with a descriptive aim, based on a questionnaire was done. The study subjects were all healthcare personnel of all specialties having practiced in interventional radiology between 2019 and 2022 at the University Hospital Center of Rabat. The statistical processing was carried out using Microsoft Excel 2013® and the IBM SPSS Statistical program version 20 (IBM Inc. NY, USA). The results indicated that 59.4% of participants had not received any specific training in radiation protection, and 45% were unaware of the radiation-induced risks associated with interventional radiology procedures. Regarding safety practices, 75% of participants maintained a distance of at least 1 meter from the x-ray source, while only 6% used the lowest possible exposure settings. Concerning the use of radiation protection devices, 87.5% of participants wore a lead apron, 75% used a thyroid shield, 6.3% wore lead glasses, and 37.5% utilized suspended mobile screens, whereas 12.5% did not use any radiation protection devices. Additionally, 84% of participants wore their personal dosimeter, though not consistently. The knowledge and practices of most interventional radiology personnel are inadequate for effective radiation protection. Regular, ongoing training in radiation safety is essential to improve adherence to protection standards and enhance overall safety in clinical practice.

A-016 Can You Believe Your Troponin? Using Laboratory Automation and Programmed Rules to Reduce Non-Repeatable False Positive Troponin Results

Abstract Background Cardiac troponin is currently the standard biomarker for evaluating patients with suspected acute coronary syndrome. Like all immunoassays, troponin testing is susceptible to non-repeatable positive results. Because this can cause a clinical challenge, we assessed our false positive rate by manipulating the timing and conditions of repeat troponin testing. Methods A prospective observational study established the repeatability failure (RF) rate in three scenarios, where a suspicious initial result prompts a repeat test. Protocol 1: We programed our middleware (Remisol, Beckman Coulter) to route the specimen to online storage after initial testing. After a 120-minute delay, the specimen was automatically retrieved from storage and tested again. Protocol 2: We programmed DxI 800 systems (Beckman Coulter) to aspirate a specimen reserve volume sufficient for two test replicates simultaneously. Protocol 3: We restricted repeat testing to 18-50 ng/L where the majority of RF occurred. To analyze RF in 4 and 18 ng/L interval (limit of reporting and URL, respectively), an absolute 3.5 ng/L bias was considered an RF. For specimens &amp;gt;18 ng/L, a difference of ±4.0 SD difference between replicates with a CV of 7% was a RF, equating to a relative difference of 28% (Method 1). Method 2 used a relative difference of 35% for RF. Method 3 defined RF as a critical difference of z×√2×SDanalytical where z=3.5 and SD=1.8 for results &amp;lt;19 ng/L and SD for results ≥19 ng/L were calculated from a fixed 7% CV for each result. A z-value of 3.5 represents a probability of 0.0005 (5 in 10,000). Results Using Protocol 1, RF rate was significantly higher in delayed repeat testing (1.6%, CI 1.5-1.8, n=23,525) compared to immediate repeat testing (0.4%, CI 0.4-0.5, n=14,880, p&amp;lt;0.0001) in two-tailed analysis. Because the first result was more commonly larger than the second (77.7% v. 52.2%, respectively), one-tailed analysis was used and found RF in delayed repeat testing was 0.9% (CI 0.8-1.0) v. immediate repeat testing (0.4%, CI 0.3-0.4, p&amp;lt;0.0001). A similar percentage of results were found in the 18-50 ng/L range in delayed testing (88.6%) v. immediate repeat (86.8%). Protocol 2 (with one-tailed analysis) yielded similar RF rates: 0.8%, CI 0.8-1.0 v. 0.3%, CI 0.3-0.4, delayed and immediate repeat testing, respectively. Protocol 3 yielded RF rate of 0.6%, CI 0.5-0.7 v. 0.2%, CI 0.2-0.3, delayed and immediate repeat testing, respectively, with all p-values &amp;lt;0.0001. Conclusions By programming auto-repeating hsTnI testing only in the 18-50 ng/L range, we found &amp;gt;80% of specimens with potential RF results could be retested using either the delayed- or immediate-repeat protocols. This suggests automated protocols could repeat testing with potential RFs without staff intervention or increasing container movement on the automation line. Reagent usage because of repeat testing could be conserved by limiting repeat testing to specimens most likely to create provider confusion. Rules to automate selected retesting of hsTnI in testing systems and/or middleware can enhance quality of results without human intervention and subsequent burden on staff, reduce reagent waste and enhance provider decision making in a critical population.

Effect of the i2TransHealth e-health intervention on psychological distress among transgender and gender diverse adults from remote areas in Germany: a randomised controlled trial

Transgender and gender diverse (TGD) people in remote areas face challenges accessing health-care services, including mental health care and gender-affirming medical treatment, which can be associated with psychological distress. In this study, we aimed to evaluate the effectiveness of a 4-month TGD-informed e-health intervention to improve psychological distress among TGD people from remote areas in northern Germany. In a randomised controlled trial done at a single centre in Germany, adults (aged ≥18 years) who met criteria for gender incongruence or gender dysphoria and who lived at least 50 km outside of Hamburg in one of the northern German federal states were recruited and randomly assigned (1:1) to i2TransHealth intervention or a wait list control group. Randomisation was performed with the use of a computer-based code. Due to the nature of the intervention, study participants and clinical staff were aware of treatment allocation, but researchers responsible for data analysis were masked to allocation groups. Study participants in the intervention group (service users) started the i2TransHealth intervention immediately after completing the baseline survey after enrolment. Participants assigned to the control group waited 4 months before they were able to access i2TransHealth services or regular care. The primary outcome was difference in the Brief Symptom Inventory (BSI)-18 summary score between baseline and 4 months, assessed using a linear model analysis. The primary outcome was assessed in the intention-to-treat (ITT) population, which included all randomly assigned participants. The trial was registered with ClinicalTrials.gov, NCT04290286. Between May 12, 2020, and May 2, 2022, 177 TGD people were assessed for eligibility, of whom 174 were included in the ITT population (n=90 in the intervention group, n=84 in the control group). Six participants did not provide data for the primary outcome at 4 months, and thus 168 people were included in the analysis population (88 participants in the intervention group and 80 participants in the control group). At 4 months, in the intervention group, the adjusted mean change in BSI-18 from baseline was -0·65 (95% CI -2·25 to 0·96; p=0·43) compared with 2·34 (0·65 to 4·02; p=0·0069) in the control group. Linear model analysis identified a significant difference at 4 months between the groups with regard to change in BSI-18 summary scores from baseline (between-group difference -2·98 [95% CI -5·31 to -0·65]; p=0·012). Adverse events were rare: there were two suicide attempts and one participant was admitted to hospital in the intervention group, and in the control group, there was one case of self-harm and one case of self-harm followed by hospital admission. The intervention was clinically significant in averting worsening psychological distress in service users, outperforming the wait list control group. These findings support the effectiveness of e-health services in TGD health care, specifically for people from remote areas. Innovation Committee at the Federal Joint Committee. For the German translation of the abstract see Supplementary Materials section.

Blinatumomab infusion interruptions in pediatric patients rarely lead to readmission.

Blinatumomab is a bispecific T-cell engager administered as a 28-day continuous infusion. Infusions can be associated with interruptions requiring support from clinical staff, but the frequency of interventions with outpatient blinatumomab has not been characterized. This study is a single-center, retrospective review of patients who received blinatumomab between December 3, 2014 and October 31, 2021 to determine frequency and type of interventions. Forty patients received blinatumomab for 69 cycles. Clinical staff intervention was required in 31 (45%) cycles, only six (8.7%) cycles needed readmission. Management of outpatient blinatumomab infusions requires education and training of clinical staff and caregivers to quickly troubleshoot interruptions.

An In-depth Analysis of the Adverse Effects of Ionizing Radiation Exposure on Cardiac Catheterization Staffs.

Diagnostic and interventional angiograms are instrumental in the multidisciplinary approach to CAD management, enabling accurate diagnosis and effective targeted treatments that significantly enhance patient care and cardiovascular outcomes. However, cath lab staff, including interventional cardiologists, is consistently exposed to ionizing radiation, which poses inherent health risks. Radiation exposure in the cath lab primarily results from the use of fluoroscopy and cineangiography during diagnostic and interventional procedures. Understanding these risks and implementing effective radiation protection measurements are imperative to ensure the well-being of healthcare professionals while delivering high-quality cardiac care. Prolonged and repeated exposure can lead to both deterministic and stochastic effects. Deterministic effects, such as skin erythema and tissue damage, are more likely to occur at high radiation doses. Interventional cardiologists and staff may experience these effects when safety measures are not rigorously followed. In fact, while ionizing radiation is essential in the practice of radiation cardiology ward, cath lab staff faces inherent risks from radiation exposure. Stochastic effects, on the other hand, are characterized by a probabilistic relationship between radiation exposure and the likelihood of harm. These effects include the increased risk of cancer, particularly for those with long-term exposure. Interventional cardiologists, due to their frequent presence in the cath lab, face a higher lifetime cumulative radiation dose, potentially elevating their cancer risk. Protective measures, including the use of lead aprons, thyroid shields, and radiation monitoring devices, play a crucial role in reducing radiation exposure for cath lab personnel. Adherence to strict dose optimization protocols, such as minimizing fluoroscopy time and maximizing distance from the radiation source, is also essential in mitigating these risks. Ongoing research and advancements in radiation safety technology are essential in further for minimizing the adverse effects of ionizing radiation in the cath lab.

Investigating innovations in outpatient services: a mixed-methods rapid evaluation.

Within outpatient services, a broad range of innovations are being pursued to better manage care and reduce unnecessary appointments. One of the least-studied innovations is Patient-Initiated Follow-Up, which allows patients to book appointments if and when they need them, rather than follow a standard schedule. To use routine national hospital data to identify innovations in outpatient services implemented, in recent years, within the National Health Service in England. To carry out a rapid mixed-methods evaluation of the implementation and impact of Patient-Initiated Follow-Up. The project was carried out in four sequential workstreams: (1) a rapid scoping review of outpatient innovations; (2) the application of indicator saturation methodology for scanning national patient-level data to identify potentially successful local interventions; (3) interviews with hospitals identified in workstream 2; and (4) a rapid mixed-methods evaluation of Patient-Initiated Follow-Up. The evaluation of Patient-Initiated Follow-Up comprised an evidence review, interviews with 36 clinical and operational staff at 5 National Health Service acute trusts, a workshop with staff from 13 National Health Service acute trusts, interviews with four patients, analysis of national and local data, and development of an evaluation guide. Using indicator saturation, we identified nine services with notable changes in follow-up to first attendance ratios. Of three sites interviewed, two queried the data findings and one attributed the change to a clinical assessment service. Models of Patient-Initiated Follow-Up varied widely between hospital and clinical specialty, with a significant degree of variation in the approach to patient selection, patient monitoring and discharge. The success of implementation was dependent on several factors, for example, clinical condition, staff capacity and information technology systems. From the analysis of national data, we found evidence of an association between greater use of Patient-Initiated Follow-Up and a lower frequency of outpatient attendance within 15 out of 29 specialties and higher frequency of outpatient attendance within 7 specialties. Four specialties had less frequent emergency department visits associated with increasing Patient-Initiated Follow-Up rates. Patient-Initiated Follow-Up was viewed by staff and the few patients we interviewed as a positive intervention, although there was varied impact on individual staff roles and workload. It is important that sites and services undertake their own evaluations of Patient-Initiated Follow-Up. To this end we have developed an evaluation guide to support trusts with data collection and methods. The Patient-Initiated Follow-Up evaluation was affected by a lack of patient-level data showing who is on a Patient-Initiated Follow-Up pathway. Engagement with local services was also challenging, given the pressures facing sites and staff. Patient recruitment was low, which affected the ability to understand experiences of patients directly. The study provides useful insights into the evolving national outpatient transformation policy and for local practice. Patient-Initiated Follow-Up is often perceived as a positive intervention for staff and patients, but the impact on individual outcomes, health inequalities, wider patient experience, workload and capacity is still uncertain. Further research should include patient-level analysis to determine clinical outcomes for individual patients on Patient-Initiated Follow-Up and health inequalities, and more extensive investigation of patient experiences. This study is registered with the Research Registry (UIN: researchregistry8864). This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/138/17) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 38. See the NIHR Funding and Awards website for further award information.

Electronic Newsletters as a Professional Development Tool for Rural Educators

Rural educators need access to evidence-based instructional practices and technologies that meet the needs of our communities. Difficulty accessing quality professional development due to geographic isolation, limited access to specialists, cost constraints, staffing shortages, lack of access to resources and technology, and less time to participate in meaningful professional development are common barriers facing rural teachers. One way to disseminate evidence-based practices is through an electronic newsletter. This article shares how a behavior analyst developed an online newsletter to build relationships, offer resources, highlight staff achievement, provide instruction, and model evidence-based behavior interventions for school staff.

The experience of gerotranscendence in the Indian context

ABSTRACT The theory of gerotranscendence embodies the positive behavioral and psychological changes experienced by people in their later years, including a change in their worldview and a newer understanding of the fundamental existential questions relating to the self, life, and death. Despite its wide-ranging implications for geriatric caregiving and counseling, there is a dearth of research on the experience of gerotranscendence among older people living in India. Accordingly, the present study used a concurrent triangulation mixed-methods design to explore the recognition of gerotranscendental changes among older Indians. We conducted individual interviews (N = 39) and a quantitative survey (N = 219) using the Gerotranscendence Scale – Further Revised (Cozort, 2008). Our findings provide evidence of the experience of gerotranscendence among older adults in India, with the cosmic dimension being the most well-recognized aspect of gerotranscendence. The present findings support the idea that many amongst the older population experience gerotranscendence, and it encourages ongoing efforts to challenge common stereotypes about purpose in life, disengagement, and self-transcendence in old age. These results have implications for geriatric nursing staff, caring professionals, geriatric counsellors, family caregivers, and future intervention studies on gerotranscendence in India.

Assessing the Clinical Effectiveness of an Exergame-Based Exercise Training Program Using Ring Fit Adventure to Prevent and Postpone Frailty and Sarcopenia Among Older Adults in Rural Long-Term Care Facilities: Randomized Controlled Trial.

Frailty and sarcopenia are geriatric syndromes of increasing concern and are associated with adverse health outcomes. They are more prevalent among long-term care facility (LTCF) users than among community dwellers. Exercise, especially multicomponent and progressive resistance training, is essential for managing these conditions. However, LTCFs, particularly in rural areas, face challenges in implementing structured exercise programs due to health care professional shortages. Moreover, older adults often become bored with repetitive exercise training and may lose interest over time. The Nintendo Switch Ring Fit Adventure (RFA) exergame is a novel exergame that combines resistance, aerobic, and balance exercises and offers a potential solution by boosting motivation in an immersive manner and reducing staff intervention needs. We aimed to evaluate the clinical effectiveness of an exergame-based exercise training program delivered via RFA (exergame-RFA) in improving muscle mass and functional performance among older adult LTCF users. This was a randomized controlled trial conducted from August 2022 to September 2023 and involved older adult LTCF users (aged ≥60 y) in rural southern Taiwan. Participants were randomized into an intervention group (exergame-RFA plus standard care) or a control group (standard care alone). The intervention, conducted seated with arm fit skills and trunk control exercises using the RFA, lasted 30 minutes twice weekly over 12 weeks. The primary outcomes measured were the Study of Osteoporotic Fractures index (serving as an indicator of frailty status) and the diagnostic criteria for sarcopenia (appendicular skeletal muscle mass index, handgrip strength, and gait speed). The secondary outcomes included functional performance (box and block test as well as maximum voluntary isometric contraction of the dominant upper extremity), muscle condition (muscle thickness measured using ultrasonography), activities of daily living (Kihon checklist), health-related quality of life (Short Form Health Survey-36), and cognitive function (brain health test). We used an intention-to-treat analysis, incorporating a simple imputation technique in statistical analysis. A mixed ANOVA, with time as a within-participant factor and intervention as a between-participant factor, was used to compare the training effects on outcomes. We recruited 96 individuals, of whom 60 (62%) underwent randomization. Of these 60 participants, 55 (92%) completed the study. Significant group×time interactions were observed in the intervention group in all primary outcomes (all P<.001, except P=.01 for handgrip strength) and most secondary outcomes, including maximum voluntary isometric contraction of the biceps (P=.004) and triceps brachii (P<.001) muscles, biceps muscle thickness measured using ultrasonography (P<.001), box and block test (P<.001), Kihon checklist (physical function: P=.01, mood status: P=.003, and total: P=.003), and brain health test (P<.001). The exergame-RFA intervention significantly improved muscle mass, strength, and functional performance among older adult users of rural LTCFs, offering a novel approach to addressing frailty and sarcopenia. ClinicalTrials.gov NCT05360667; https://clinicaltrials.gov/study/NCT05360667. RR2-10.3389/fmed.2022.1071409.

Job burnout and anxiety among medical staff: A latent profile and moderated mediation analysis

BackgroundDue to work pressure, work intensity, and the impact of emergencies such as the epidemic, job burnout and mental health problems among medical staff have become increasingly prominent. ObjectivesOur study aims to characterize the patterns of burnout in Chinese medical staff, explore the profile differences on anxiety and self-esteem, examine whether the differences in these profiles on anxiety were mediated by self-esteem, and investigate whether this mediating process was moderated by positive coping styles among medical staff. MethodsData were collected from 602 medical staff in China by a convenient sampling method. A latent profile and moderated mediation analysis were performed. ResultsLatent profile analysis on three burnout dimensions [emotional exhaustion, cynicism, and professional efficacy] indicated two burnout profiles: low burnout (82.47% of the sample) and high burnout (17.53%). Medical staff with a low burnout profile had lower levels of emotional exhaustion and cynicism than those with a high burnout profile. It was also determined that self-esteem mediates burnout and anxiety in both high- and low-burnout medical staff. The moderating role of positive coping styles was also identified (β = 0.30, 95%CI: 0.058–0.550). ConclusionsThe identification of two distinct burnout patterns (low burnout and high burnout) provides clinical administrators with clear goals for individualizing support and interventions for medical staff with different levels of burnout. Furthermore, attention should be given to self-esteem and positive coping styles, as they act as potential mediators and moderators of medical staff's mental health problems.

Occupational health risk recognition, evaluation, and management of radiation workers in Gansu province, China

ObjectiveIn order to protect the health of radiation workers, scientific management of radiation workplace protection is implemented, and occupational health risks of radiation workplaces in Gansu Province, China are identified and evaluated through monitoring. MethodsThe basic situation of occupational health management of radiological workers in 1366 radiological diagnosis and treatment institutions was investigated, and 596 monitoring hospitals were selected for occupational health monitoring. Using a 2-IN∗2-in NaI (Tl) scintillation spectrometer and its supporting software, internal thyroid irradiation monitoring was performed. Fifty-one underground workers in a deep mine iron mine were selected to monitor the effect of high radon exposure. Results11 (6%) monitored hospital interventional radiology staff detected lead outside the aprons between 5 mSv and 20 mSv during a single monitoring period; In nuclear medicine, radiation monitoring in the thyroid detected 3(15%) people with doses between 5 mSv and 20msv.The chromosome aberration rate and Detection rate of posterior pole subcapsular opacification of interventional radiation group and nuclear medicine group was higher than that of conventional radiation group, and the difference between interventional radiation group and conventional medicine group was statistically significant. Abnormal detection of tumor markers in serum after sustained radon exposure accounted for 39.2% of NSE(neuron-specific enolase), 22.5% of SCC(squamous cell carcinoma associated antigen), and 5.9% of CyFRA21-1(cytokeratin 19 fragment), respectively, chest low-dose CT showed plaque and stripe shadow in 21 cases (41.2%) and nodules in 16 cases (31.4%). ConclusionIndividual dose monitoring found that radiation workers engaged in interventional radiology were exposed to higher doses and had higher occupational risks. The results of occupational health examination show that there is a certain degree of radiation injury in interventional radiology and nuclear medicine workers. Nuclear medicine radiation monitoring results show that some workplaces have radioactive contamination. The radon exposure of deep mine miners has a higher occupational risk of lung cancer caused by high radon.The analysis of chromosome aberration is an important index of occupational health monitoring of radiation workers.