Low Comfort Level Research Articles

Polish Emergency Dispatchers During a COVID-19 Pandemic - Burnout Syndrome, Perceived Stress, and Self-Efficacy. Effects of Multidimensional Path Analysis.

International research has demonstrated that emergency call operators face unique risks to their mental health, in particular job stress, and occupational burnout syndrome. There is already wide knowledge about the relationship between stress, burnout and employee personal resources, which has practical application in preventing mental health. However, more research into the subtle relationships between variables is needed. The aim of the study was to check the moderation effect of differences in the intensity of latent variables on the relationship between perceived stress, self-efficacy and professional burnout. The participants were 546 call-takers and dispatchers from 14 public-safety answering point in Poland aged between 19 and 65 years. The Link Burnout Questionnaire, the 10-item Perceived Stress Scale, the Generalized Self-Efficacy Scale, and an independent questionnaire were used to gather information. The method of path analysis was used. The study confirmed the existence of negative relationships between perceived stress (assessment of the current situation) and self-efficacy (a personal trait). Taking into account the moderating effect of latent variable: psychological comfort revealed a hidden relationship between stress and burnout. The stress-burnout relationship occurred only among participants with low level of psychological comfort, so it was not a proportional relationship. In the case of participants with a high level of second latent variable: power-to-affect, the hypothesis that a high level of this variable should weaken the relationship between stress and burnout was not confirmed. The level of latent variables did not affect the self-efficacy relationship with occupational burnout. Taking into account the differences in the intensity of latent variables showed their moderating effect, which often turned out to be different from the assumed one and obtained in the research of other authors. This allowed to discover the relationships that might otherwise have been overlooked and not included in burnout prevention. The results showed a high level of occupational burnout in the ECD’s group during the COVID-19 pandemic: 32% of the responders reported emotional exhaustion, 53% loss of professional effectiveness.

Palliative Care Training for Pediatric Hematology/Oncology Fellows: a Canadian Perspective.

Children with cancer experience suffering, particularly at the end of life. Pediatric hematology/oncology (PHO) fellows need dedicated palliative care (PC) training in order to adequately manage this suffering. Our objectives wereto understand (1) the PC training needs of Canadian PHO fellows and (2) experiences in providing PC, from the perspectives of fellows and their training program directors (PDs) and to describe (1)our experience in enhancing our institutional PC curriculum and (2)the preliminary evaluation of this curriculum. Electronic surveys were sent to all Canadian PHO fellows and PDs. Fellows participating in our curriculum were also sent post-course surveys. All 9/9 of the PDs and 63% (29/46) of the fellows completed our pre-course surveys. The majority of survey participants agreed that PHO fellows require dedicated PC training. All programs provided some PC education, but 45% of programs offered 3 or fewer hours of training per year. Only 55% (5/9) of the PDs believed that their trainees had adequate PC skills on completion of training. Fellows perceived a range of PC skills to be important but expressed low levels of comfort across these skills. Many fellows had experienced distress as a result of managing PC clinical situations, and many cited a lack of training as contributing to their distress. Despite increasing awareness of the importance of PC education for PHO fellows, this subject does not receive adequate attention in training curricula. The introduction of a Canadian national curriculum may improve the provision of PC training in education programs.

Development of a simulation-based curriculum for Pediatric prehospital skills: a mixed-methods needs assessment

BackgroundThe assessment and treatment of pediatric patients in the out-of-hospital environment often presents unique difficulties and stress for EMS practitioners.ObjectiveUse a mixed-methods approach to assess the current experience of EMS practitioners caring for critically ill and injured children, and the potential role of a simulation-based curriculum to improve pediatric prehospital skills.MethodsData were obtained from three sources in a single, urban EMS system: a retrospective review of local pediatric EMS encounters over one year; survey data of EMS practitioners’ comfort with pediatric skills using a 7-point Likert scale; and qualitative data from focus groups with EMS practitioners assessing their experiences with pediatric patients and their preferred training modalities.Results2.1% of pediatric prehospital encounters were considered “critical,” the highest acuity level. A total of 136 of approximately 858 prehospital providers responded to the quantitative survey; 34.4% of all respondents either somewhat disagree (16.4%), disagree (10.2%), or strongly disagree (7.8%) with the statement: “I feel comfortable taking care of a critically ill pediatric patient.” Forty-seven providers participated in focus groups that resulted in twelve major themes under three domains. Specific themes included challenges in medication dosing, communication, and airway management. Participants expressed a desire for more repetition and reinforcement of these skills, and they were receptive to the use of high-fidelity simulation as a training modality.ConclusionsCritically ill pediatric prehospital encounters are rare. Over one third of EMS practitioners expressed a low comfort level in managing critically ill children. High-fidelity simulation may be an effective means to improve the comfort and skills of prehospital providers.

Problems and prospects of personality formation and development in the context of social well-being

The goal of the article is to empirically establish the problems and determine the prospects of formation and development of personality in the context of social well-being. The empirical study surveyed 120 students and students, 118 adults, and 112 seniors. The age of the respondents ranged from 14 to 70 years old. Psychodiagnosis was carried out through cooperation with educational institutions, social protection institutions and with the help of social networks. Respondents were from: Khmelnitsky, Rivne, Zhytomyr, Kyiv, Cherkasy, Vinnitsa, Ternopil, Poltava, Kherson, Odessa regions. Respondents were pupils, students, teachers, medics, trade and service workers, ICT specialists, and pensioners. The main problems of personality formation and development in the context of social well-being are: disregard of altruistic, cognitive, existential life meanings by the younger generation; prevalence of hedonistic beginning over high-spiritual; increased attention to obtaining status and power; consideration of self-realization and status outside the cognitive sphere; low adaptability in society, poorly expressed acceptance of others and self-acceptance, low level of emotional comfort.

The effect of immunosuppression therapy on activities of daily living and comfort level after liver transplantation

ObjectivesThis study was carried out to investigate the effect of immunosuppression therapy on activities of daily living and comfort level after liver transplantation. Materials and methodsThis study was conducted in a descriptive and correlational type with the participation of 148 liver transplant patients hospitalized in the liver transplant center of a university hospital. Personal Information Form, Katz Activities of Daily Living Scale and General Comfort Questionnaire were used in data collection. The data analysis was performed with IBM SPSS (Statistical Package for the Social Sciences) Statistics 25. ResultsAccording to the results obtained from the study, it was determined that 31.1% of the patients were 58 years old and over, 20.9% of them were between 48‐ and 57 years old, and 81.8% of them were male. It was found that 61.5% of the patients were between the 11th and 21st days after transplantation and 26.4% of them were given oxygen with a non-invasive catheter. It was determined that the patients were semi-independent in activities of daily living and had a moderate comfort level. ConclusionsIt is not always possible for liver transplant patients to effectively deal with their condition. The low comfort level and quality of life of patients who have undergone liver transplantation should be noticed, and social, economic and psychological support should be provided.

CIM-based modeling and simulating technology roadmap for maintaining and managing Chinese rural traditional residential dwellings

Due to the lack of scientific construction standards and management systems, the Chinese rural traditional residential dwellings always have problems, such as low comfort level, poor safety, and large energy consumption. City Intelligent Modeling (CIM) is a three-dimensional digital city information model constructed by integrating multi-source heterogeneous data based on Building Information Modeling (BIM), Geographic Information System (GIS), Internet of Things (IoT), and other technologies. Compared with urban areas, rural residential regions have far smaller volume and simpler elements so that CIM has great feasibility in carrying out rural areas' maintenance and management. This paper introduces a CIM-based “4 M” (Modeling - Monitoring - Mining – Management) technology roadmap to build a dynamic three-dimensional visualized maintenance and management platform, which can maintain the rural traditional residential dwellings with less intervention, high efficiency, and high accuracy. This proposed platform has already been applied in a historic town in Fujian province and succeeded to early warning several potential hazards with acceptable data prediction deviation. A new concept, “Community intelligent modeling”, is put forward since this platform is not only suitable for rural traditional residential dwellings but also for other small communities. In addition, for the further optimization of rural residential regions, this simulation platform could act as a bridge between buildings and digital environment analysis software.

Spatio-Temporal Evolution and Prediction of Tourism Comprehensive Climate Comfort in Henan Province, China

The tourism comprehensive climate comfort index (TCCI) was used to evaluate the tourism climate comfort in Henan Province in the last 61 years, and its future development trend is predicted. The results showed that the temporal variation of the TCCI had a “double peak” type (monthly variation), and an overall comfort improvement trend (interannual variation). The change of tourism climate comfort days was similar to the change of the index, especially in the months with a low comfort level. In space, the distribution of the TCCI gradually increased from northeast to southwest, and the area with a high comfort level also increased over time. Meanwhile, it also showed the spatial distribution of months with a low comfort level, which provides reliable information for tourists to use when choosing tourist destinations across all periods of the year. The TCCI was classified by hierarchical classification, and principal components were extracted to explore the main climate factors controlling different types of TCCIs and the relationship between them, and large-scale atmospheric–oceanic variability. According to the temporal change trend and correlation, the long-term change trend of tourism climate comfort was predicted, which will provide a scientific basis for tourism planners to choose tourist destinations.

Real‐Time Virtual Naloxone Training for Fourth Year Medical Students

Introduction: Between 1999-2018, almost 450,000 deaths have been attributed to opioid overdose. Co-prescription of Naloxone with opioids, as well as implementation of Naloxone education and training, may substantially decrease morbidity and mortality related to opioid abuse. Nevertheless, resident physicians report low levels of comfort in prescribing Naloxone and difficulty discussing this topic with patients even when it directly relates to their care. Study Objective & Hypothesis: We designed and implemented a virtual Naloxone training session for fourth-year medical students to prepare them for encounters with patients suffering from opioid overdose. We hypothesized that students participating in the session would report increased confidence in prescribing and using Naloxone. Methods: All fourth-year medical students at Florida International University Herbert Wertheim College of Medicine (HWCOM, CO 2021, n=113) were offered participation in a voluntary, virtual Naloxone training session as well as access to a free Naloxone trainer kit. Of the 30 students who agreed to participate, 28 picked up their training kits, and 19 students participated in the session. Prior to the session, students completed a short voluntary pre-session confidence survey. The session was conducted virtually via Zoom and consisted of an interactive PowerPoint presentation, an instructional video illustrating the use of the Naloxone kit, and an interactive real-time simulated patient case. Students asked questions throughout and explanations and feedback were provided as necessary. Knowledge acquisition, confidence, and learner satisfaction were assessed through a voluntary post-session survey. Results: All participants (n=19) completed the pre-session survey and 94.7% of participants (n=18) completed the post-session survey. On a 5-point Likert scale (1-Strongly Agree through 5-Strongly Disagree) mean pre-session confidence in assessing a patient with potential overdose was found to be 3.4 (SD 0.49), mean confidence in the proper delivery of Naloxone was 4.0 (SD 0.94), and mean confidence in the ability to continue management of a patient treated with Naloxone was 3.9 (SD 0.64). Post-session agreement with the statement, “The workshop increased my ability to recognize, treat, and manage an opioid overdose” was found to be 1.1 (SD 0.29). 63% of participants (n=12) provided additional qualitative feedback. Conclusion: The implemented intervention improved student knowledge and confidence in the assessment and pharmacologic management of patients suffering from opioid overdose.

Breast Density Notification: A Systematic Review of the Impact on Primary Care Practitioners.

Background: In the last decade, there has been an unprecedented amount of advocacy and attention surrounding the issue of breast density (BD) in relation to mammography screening. It is largely unknown what impact notifying women of their BD has had on clinical practice for PCPs. This systematic review aimed to synthesize evidence from existing studies to understand the impact of BD notification on primary care practitioners' (PCPs) knowledge, attitudes, and practice implications. Methods: Empirical studies were identified through relevant database searches (database inception to May 2020). Two authors evaluated the eligibility of studies, extracted and crosschecked data, and assessed the risk of bias. Results were synthesized in a narrative form. Results: Six studies of the 232 titles identified and screened were included. All studies were undertaken in the United States, with five conducted postlegislation in their respective states, and one study conducted in states that were both prelegislation and postlegislation. Five studies were quantitative, including four cross-sectional surveys, and one study was qualitative. Findings consistently demonstrated PCPs' overall lack of knowledge about BD, low level of comfort in discussing and managing patients in relation to dense breasts, and limited consensus on the most appropriate approach for managing women with dense breasts, particularly in relation to supplemental screening. Conclusions: This review highlights important gaps in PCPs' understanding of BD and confidence in having discussions with women about the implications of dense breasts. It identifies the need for high-quality research and the development of evidence-based guidelines to better support PCPs.

Adults with autism spectrum disorder show atypical patterns of thoughts and feelings during rest.

Mind wandering constitutes a major part of everyday experience and is inherently related to how we feel and identify ourselves. Thus, probing the character and content of thoughts and feelings experienced during mind-wandering episodes could lead to a better understanding of the human mind in health and disease. How mind wandering and spontaneous thought processes are affected in disorders such as autism is poorly understood. Here, we used the eyes-closed rest condition to stimulate mind wandering and quantified the subjective experiences using the Amsterdam Resting-State Questionnaire—which quantifies subjective psychological states of resting-state cognition across 10 domains—in 88 adults with autism spectrum disorder and 90 controls. We observed an atypical pattern of both thoughts and feelings in the autism spectrum disorder cohort, specifically in the domains of Theory of Mind, Comfort, and Discontinuity of Mind. We propose that the use of the Amsterdam Resting-State Questionnaire as a standardized cognitive instrument could advance our understanding of thoughts and feelings in autism spectrum disorder as well as in a wide variety of other brain disorders and how these may change due to therapeutic interventions.Lay abstractEveryone knows the feeling of letting one’s mind wander freely in a quiet moment. The thoughts and feelings experienced in those moments have been shown to influence our well-being—and vice versa. In this study, we looked at which thoughts and feelings are being experienced by adults with autism spectrum disorder and compared them to adults without autism spectrum disorder. In total, 88 adults with autism spectrum disorder and 90 adults without autism spectrum disorder were asked to rest for 5 min with their eyes closed and let their mind wander. Directly after, they filled in the Amsterdam Resting-State Questionnaire, which probes what participants were feeling and thinking during the period of rest. We found that adults with autism spectrum disorder tend to think less about others, felt less comfortable, and had more disrupted thoughts during the rest compared to adults without autism spectrum disorder. Interestingly, autism spectrum disorder participants reporting lower levels of comfort during the rest also reported more autism spectrum disorder symptoms, specifically in social behaviors and skills, attention switching, and imagination. We propose to use the eyes-closed rest condition in combination with the Amsterdam Resting-State Questionnaire more widely to shed light on aberrant thoughts and feelings in brain disorders and to study the effect of therapeutic interventions.

Inservice Music Educators’ Perceived Comfort for Teaching and Performing on Secondary Band Instruments

I surveyed inservice instrumental music educators ( N = 96) to determine their comfort level for teaching and performing on secondary band instruments. Research questions included the following: (a) How comfortable do inservice music educators feel teaching and performing on secondary instruments? (b) Does grade level affect educators’ comfort levels? (c) Does the educators’ primary instrument family relate to their perceived comfort level for teaching and playing on secondary instruments? and (d) Does the format of instrument classes during preparation programs influence educators’ comfort for teaching and playing secondary instruments? Participants reported moderate comfort on most instruments, with brass being most comfortable. Participants indicating woodwind as a primary instrument reported an overall higher comfort level for teaching and performing on brass instruments, whereas low comfort levels on double reeds. High school educators felt least comfortable teaching and performing on secondary instruments. Participants who took Split-Families and Semester-Families preservice classes felt more comfortable performing on secondary instruments versus those who took Individual-Instrument courses.

ОБОСНОВАНИЕ МЕТОДИКИ АНАЛИЗА КОМФОРТА И БЕЗОПАСНОСТИ ПРИ ПЕРЕВОЗКАХ ПАССАЖИРОВ ЗА СЧЕТ УМЕНЬШЕНИЯ ВИБРАЦИОННОЙ НАГРУЖЕННОСТИ КУЗОВА ПАССАЖИРСКОГО ВАГОНА

The purpose of the work is to increase comfort and safety of railway passenger transportation, at the expense of passenger car body vibration load decrease. The analysis of the investigations carried out and dedicated to the definition of rigidity property impact upon the level of passenger comfort and traffic safety has shown that the first mode of vertical bending impacts considerably upon car body dynamic behavior. The analysis of vibration load impact upon passenger car body was carried out in accordance with Dumitriu’s technique. As apposed to the investigations carried out earlier in the paper the data on car metal structure acceleration are obtained through the methods of mathematical modeling based on solid and finite element models. 
 On the basis of the data obtained and natural running tests there was created and verified a particularized lamellar finite-element model of a car body with the aid of which there were obtained values of vertical and horizontal accelerations of a car body metal structure. The analysis of the results obtained has shown that within the frequency range of 8.9. – 20 Hz there are observed acceleration surges which are among the most sensitive ones in terms of the impact upon man and transport comfort support. 
 At the frequencies obtained there was carried out a passenger comfort investigation with the aid of which it was defined that at the frequency of car body own bending oscillations of 8.9 Hz – a comfort index is above 4 units that shows a low comfort level. 
 A frequency of 8.9 Hz corresponds to a vertical bending mode which is the most significant mode of car body deformation in terms of passenger comfort support. With regard to this in the works there was offered a number of efficient measures for strengthening car body structure bearing capacity with the goal of its bending rigidity increase which provides an installation of a supplementary bearing partition in the mid-section of a car body, and also the introduction of auxiliary longitudinal elements in a frame supporting design. For the effectiveness assessment of measures offered there was carried out re-investigation according to the technique described. As a result of the computation it was defined that the design measures offered allowed increasing a frequency value of own bending vibration of car body metal structure up to 11.7 Hz. 
 The analysis of the results obtained allowed drawing a conclusion of the effectiveness of design solutions offered on car body vibration load decrease.

Determination of Anxiety and Comfort Levels of Patients Who Underwent Fiberoptic Bronchoscopy: A Cross-sectional Study

Objective: The aim of this study was to determine the anxiety and comfort levels of outpatients who underwent fiberoptic bronchoscopy. Method: This cross-sectional study was performed between January-December 2018 in a bronchoscopy unit of a Training and Research Hospital in Ankara. A total of 173 patients who underwent bronchoscopy for the first time were included in the study by purposeful sampling method. The data were obtained by using ”Personal Information Form”, “State Trait Anxiety Inventory (STAI-I)” and Perianesthesia Comfort Scale (PACS)”. The Personal Information Form and the STAI-I were filled out before the bronchoscopy and the PACS after the bronchoscopy procedures by face-to-face interviews. Results: Study population with a mean age of 54.68±16.64 years consisted mostly (72.8%) of male patients. In the present study, mean STAI-I, and PACS scores of the patients were 43.51±5.67, and 5.20±0.43 points, respectively. Mean STAI-I scores of female, and male participants were 41.93±5.73 and 44.06±5.56 points, respectively with a statistically significant intergroup difference (p=0.03). The PACS scores of female, and male participants were 4.99±0.57 and 5.24±0.37 points, respectively with a statistically significant intergroup difference (p=0.001). After the procedure, choking, cough and sore throat were the most common symptoms. Conclusion: It was determined that patients who underwent bronchoscopy had generally experienced anxiety but their comfort was good. Male patients had more anxiety, but female patients had lower levels of comfort. To reduce the level of anxiety due to bronchoscopy; nursing interventions should be planned according to the individual characteristics of the patients

Assessment of community pharmacists' communication and comfort levels when interacting with Deaf and hard of hearing patients.

Background:Deaf and hard of hearing patients who use sign language face considerable communication barriers while accessing pharmacy services. Low comfort-levels between community pharmacists and Deaf and hard of hearing patients result in poor interactions and increase patient safety risks.Objective:1) To examine the way community pharmacists interact with Deaf and hard of hearing patients in Malaysia, and their level of comfort in such interactions. 2) To examine how comfort-levels vary by the preferred communication methods, resources and employer support.Methods:This cross-sectional study was conducted among registered community pharmacists practicing in Malaysia. Questionnaire items included comfort-levels of community pharmacists when interacting with Deaf and hard of hearing patients, used and preferred communication methods, necessary resources, and perceived employer’s level of support. Based on the list of registered pharmacies, the questionnaire with a pre-paid return envelope was mailed out while pharmacies close to the university were approached in person. This questionnaire was distributed online using Google Form. Comparisons between comfort-levels and study parameters were analyzed using independent t-tests and ANOVA.Results:A total of 297 community pharmacists responded (response rate 29.2%). Higher comfort-levels were reported in those who had received between 1 to 5 prescriptions as compared to those who did not receive prescriptions from Deaf and hard of hearing patients (MD= -0.257, SD=0.104, p=0.042). More than 80% used written information and only 3.4% had used the services of a qualified sign language interpreter throughout their community pharmacist career. Significantly lower comfort-levels (p=0.0004) were reported in community pharmacists who perceived training in sign language as a necessity to interact with Deaf and hard of hearing patients (M=3.6, SD=0.9) versus those who were not interested in sign language training (M=3.8, SD=0.6).Conclusions:The results suggest that community pharmacists were neither extremely comfortable nor averse when interacting with Deaf and hard of hearing patients. The lack of significant findings in terms of comfort-levels may indicate other potential drivers for their choice of communication method when interacting with Deaf and hard of hearing patients.

Medical Student Comfort With Procedural Skills Performance Based on Elective Experience and Career Interest.

IntroductionDespite increased efforts, studies suggest that exposure to procedural skills in undergraduate medical training is insufficient. As medical students have low self-reported competence in many skills, a significant concern is that medical students are underprepared for a clerkship. Furthermore, pre-clerkship electives selected based on student career interests can provide students with additional skills learning opportunities. The impact of career interest and elective choice on student comfort with procedural skills is unclear. This study examines the relationship between student procedural skills comfort, career interest, and elective choices.Materials and methodsAn evidence-based questionnaire was synthesized following a literature search using PubMed, Embase, and Google Scholar. Surveys were completed by second-year medical students. A Likert scale was used to evaluate students’ exposure, comfort, and motivation to learn common procedural skills. Descriptive, Pearson’s chi-square and Spearman’s rho correlation coefficient analyses were performed to evaluate the relationship between career interests, elective exposure, and procedural skills.ResultsMedical students (>60%) reported poor comfort levels for most skills, despite >80% of students displaying high motivation to learn. Elective choice impacted student comfort levels as students who completed electives in anesthesiology were more comfortable with performing intubation (23% vs 10%, p = 0.026) and IV insertion (38% vs 13%, p = 0.002). Those with surgical career interests were less comfortable performing Foley catheter insertion in males (7% vs 5%, p = 0.033) and in females (7% vs 5%, p = 0.008).ConclusionsThis study supports that medical students feel low levels of comfort with performing procedural skills despite high motivation for learning. Comfort was influenced by both career interest and elective experience. Programs aiming to increase students’ comfort levels in performing procedural skills should adapt curricula toward increasing early exposure to these skills.

Internal thermal environment and futureproofing of a newly built, naturally ventilated UK school

Research indicates that school children have lower comfort levels than adults and this exacerbates the challenge of tackling the risks of summer overheating in schools without resorting to air conditioning. UN SDG 13 calls for climate action to strengthen the resilience of our cities and reduce the impact of climate change. In this work, a modern, naturally ventilated school in Southampton, UK was used to evaluate single, “hard”, passive retrofit measures and “soft”, building management solutions that could increase the wellbeing of students and reduce current and future demand for cooling. The school was selected as it represents the current standardised design guidance for schools released in 2012 by the Department of Education (DfE). The research presents air temperature observations collected during the summer of 2015. Dynamic thermal modelling was undertaken to evaluate passive retrofit and “soft” solutions to reduce the overheating risk. The model was validated with temperature data collected from the school classrooms. The results indicate that (a) such school buildings have high likelihood of overheating, based on children’s comfort temperatures and (b) passive retrofits focused on shading and ventilation could help to reduce the classroom temperature when required. It is recommended that “soft” adaptive solutions will prove effective to reduce future air conditioning demand, but this will require a radical change in established practices. Achieving the UN Sustainable Development Goals by 2030 will require to rethink and redesign urban living and city infrastructures.

Assessing comfort level of organ donation competencies among pediatric intensivists in Saudi Arabia: a national survey

BackgroundAs increasing the number of organ donations presents a global challenge, Saudi Arabia is no different. Intensivists can play a major role in maximizing the organ donation process and minimize the challenges. The purpose of this study was to investigate Saudi pediatric intensivists’ comfort and importance levels of organ donation competencies.MethodsWe conducted a cross-sectional survey whose sampling frame included 100 pediatric intensivists. The pediatrician intensivists were identified through an updated list provided by the Saudi Critical Care Society. We assessed 14 competencies categorized into four domains: the general donation, donation after brain death (DBD), neurological determination of death, and medicolegal, religious, and ethical domains. Then we investigated the association between these competencies and physicians’ characteristics.ResultsWith a response rate of 76%, we found that 40–60% of the surveyed pediatric intensivists rated their comfort in 6 out of 14 competencies as high or very high. There was a statistically significant gap in the intensivists’ rating of 10 competencies (i.e., high importance but low comfort levels). Ordinal regression showed that comfort levels with the general donation, neurological determination of death, and medicolegal, religious, and ethical domains were higher in intensivists who were frequently involved with DBD than those who had never been exposed.ConclusionsPediatric intensivists expressed low comfort levels to organ donation competencies that are essential for maximizing donation rates. Adapting mandatory comprehensive donation education programs and dedicated physician specialists may be beneficial in critical care units aiming to increase donation rates.

Implementing Transit Oriented Development Principles in Designing Light Rail Transit Station in Bandung

The density of transportation in Bandung has been increased every year which causes many problems and one of them is congestion. The low level of security, comfort, and long trip are the main factors of people preferring private vehicles over public transportation as a driving option. The form of public transportation that becomes a solution for Bandung city is Light Rail Transit (LRT) with the concept of transit-oriented development (TOD). TOD is an urban design in aiming to reduce mobility by integrating the role of mixed-use. This study using several variables that combined the theory of Cervero (1997) and ITDP (2014): walk, cycle, connect, transit, and design. The importance of applying TOD’s principle is interconnecting between transportation and various infrastructure in the selected area, such as commercial, office, residence, etc. The implementation of the TOD principle in LRT station design is adjusted to the characteristics and policies of selected area. The result gathered from this study is the design of supporting facilities of transit area that meets TOD principles by ITDP in a way to aim walkable city for Bandung better urban mobility. Keywords: connectivity; LRT; TOD; transportation.

Vascularized composite allotransplantation: Knowledge and attitudes of a national sample of organ procurement organization professionals.

With the emergence of vascularized composite allografts (VCAs) for transplantation, donation professionals' ability to obtain authorization for these anatomical gifts has become paramount for its continued practice. Our national study examines the experience of organ procurement organization (OPO) professionals responsible for presenting the opportunity to donate VCAs to families of deceased donor-eligible patients. Semi-structured telephone interviews conducted with 157 OPO staff assessed experience with VCA discussions, VCA knowledge, and comfort, confidence, and feeling prepared with discussions about different VCA types. Standard procedures were used to code and analyze the qualitative data and summarize the quantitative data. Most respondents (70.1%) never held a VCA donation discussion, but those with experience reported overall low levels of knowledge, comfort, and confidence talking with families about VCA. Although 44.4% of the sample had VCA-related training, many felt unprepared, with most (75.0%) stating the training was insufficient. Participants without experience indicated even lower ratings of the aforementioned constructs. Findings support extant work demonstrating that no standardized procedures exist for VCA donation discussions; however, donation professionals are willing to adopt new VCA-related skills. This report concludes that sustained and content-specific training will elevate donation professionals' ability to augment the supply of VCAs available for transplantation.

Postoperative Analgesia Protocol: A Resident-Led Effort to Standardize Opioid Prescribing Patterns.

The combined impact of variable surgeon prescribing preferences and low resident prescribing comfort level can lead to significant disparity in opioid prescribing patterns for the same surgery in the same academic surgical practice. We report the results of a resident led initiative to standardize postoperative prescription practices within the Department of Otolaryngology at a single tertiary-care academic hospital in order to reduce overall opioid distribution. Retrospective cohort study. Following approval by the Institutional Review Board, performed a retrospective review of 12 months before (July 2016-June 2017) and after (July 2017-June 2018) implementation of the Postoperative Analgesia Protocol, which included all adults undergoing tonsillectomy, septoplasty, thyroidectomy, parathyroidectomy, tympanoplasty, middle ear exploration, stapedectomy, and ossicular chain reconstruction. Seven hundred and thirty eight procedures met inclusion criteria. Following implementation, total morphine milligram equivalents decreased by 26% (P < .0001). The number of patients requiring opioid refills decreased by 49%, and morphine milligram equivalents received as refills decreased by 16% (P < .001). Thyroid and parathyroid surgery had the greatest reduction in morphine milligram equivalents prescribed (84%, P < .001), followed by septoplasty (30%, P = .001) and tonsillectomy (18%, P < .001). The number of patients receiving refills of opioid medications decreased for all procedures (tonsillectomy 54%; septoplasty 67%; thyroid/parathyroid surgery 80%, middle ear surgery 100%). While every patient and surgery must be treated individually, this study demonstrates that a resident led standardization of pain control regimes can result in significant reductions in total quantity of opioids prescribed. IV Laryngoscope, 131:982-988, 2021.