Ongoing Service Research Articles

Accessibility and utilization of family planning services in Nigeria during the coronavirus disease-2019 pandemic

Background: Family planning services are an important aspect of reproductive health as it helps in the improvement of maternal health. During the coronavirus disease-2019 (COVID-19) pandemic, several measures were taken by the Nigerian government to control the virus, which included restriction of movements including curfews and lockdown. Aim: This article is a review of the impact of the COVID-19 pandemic on the accessibility of family planning services in Nigeria. Materials and Methods: This is a narrative review of articles related to the accessibility of family planning services during the COVID-19 pandemic. The literature search was done using Medline, Google Scholar, and PubMed. The keywords used for searching for the literature were COVID-19 and family planning services in Nigeria. The literature search review was done from June 2020 to November 2021. Results: The study found both supply- and demand-side service disruptions. There was a disruption in the supply chain management system, affecting the production and distribution of family planning commodities. The demand-side issues were because of the lockdown measures on health seeking behaviour, absence, and increased cost of transportation. Conclusion: Accessing and utilizing various contraceptive methods were disrupted by the COVID-19 pandemic. This is due to several factors including the restriction of movements put in place by the Nigerian government to control the pandemic. The improvement of the use of various pregnancy preventive strategies has the potential to reduce poverty. It is imperative to develop adaptive systems to provide ongoing contraceptive services, by implementing innovations to sustain demand and supply of family planning services during pandemics.

Parent perceptions of a group telepractice communication intervention for autism

Estimates suggest that one in 59 children receive a diagnosis of autism and that early intervention can be effective if applied consistently and intensively. Parent implemented intervention can increase intervention consistency and intensity however, availability of providers, geographical factors, time constraints, and parental stress levels can all act as barriers to service access. Limitations in understanding elements that support family engagement can also impact participation in intervention. Telepractice can increase availability of intervention services and decrease the time and costs associated with face-to-face delivery. Research focused on children with autism has shown that telepractice is acceptable to parents. Despite positive findings for telepractice services with individual clients, limited research has been conducted on telepractice services for parent groups; parent perceptions and preferences regarding intervention; and service delivery methods. This research aimed to investigate parent perceptions of a group intervention programme for autism; the telepractice approach; parent and child outcomes; and parental stress. The purpose of the investigation was to build an understanding of parent's intervention preferences to inform future service offerings, increase choice, and support participation. Eleven parents of preschool children with autism participated in a telepractice delivered group training programme called Hanen More Than Words (HMTW). The intervention is traditionally delivered face to face and teaches strategies to facilitate social-communication development in young children.Quantitative and qualitative measures were used to evaluate parent perceptions of the telepractice HMTW intervention. Data were collected via the Parenting Stress Index, HMTW programme evaluation forms, and online parent survey.Quantitative data was analysed using descriptive statistics. Pre- and post-intervention comparisons of parenting stress were conducted using paired T-Tests. Open comment field responses were analysed qualitatively using a directed content analysis. Parents reported high levels of satisfaction with telepractice delivered HMTW across intervention and post programme evaluations. Interactive learning opportunities, group participation, video coaching, individualisation of service, and programme facilitation were identified as key supports to learning.Parents perceived increased insight into the interaction, learning, and behaviour of themselves and their children. They reported positive changes in strategy implementation and confidence. Parents also perceived improvements in their children's communication, responsiveness, interaction, and play following intervention. Parental stress measurements from pre- to post intervention, were not significantly different. Telepractice may reduce service barriers and improve access, particularly with the efficiency of a group delivery approach. Utilising technology to deliver group intervention was acceptable to parents and perceived to have positive outcomes for both parent and child. Further investigation into parent perceptions of intervention types and delivery approaches, could facilitate a broader understanding of family needs with respect to service access and engagement. Expansion of telepractice offerings can increase efficiencies and service choice for families and providers. Limitations in service availability and barriers to service access and engagement, confirm the importance of pursuing ongoing service improvements and evaluating the preferences of service users. Development of standardised tools to measure and compare parent perceptions across intervention types and service delivery approaches would be beneficial.

Factors inhibiting effective organisational performance management: insights from the South African public sector

Despite a quarter of a century of democracy, the South African government continues facing civil unrest relating to poor delivery of public goods and services. To address this deficiency, the South African government adopted organisational performance management (OPM), as a tool to improve strategic management and operational performance. Despite this directive, service delivery does not appear to have improved, as evidenced by ongoing service delivery protests. The study therefore aims to determine the factors inhibiting the effective implementation of OPM, accordingly impairing service delivery. The study which adopts a multiphase mixed methods research approach, utilises both quantitative and qualitative data collected through surveys, interviews and focus groups, as well as from a content analysis of pertinent documents and records. Non-alignment between planning and budgeting, focusing on outcomes rather than impacts, the adoption of a compliance-driven orientation rather than focusing on effective organisational performance, inadequate stakeholder management, poor technical skills, and a lack of effective consequence management were identified amongst the factors inhibiting OPM and effective service delivery.

Short-Term Hip Fracture Outcomes during the COVID-19 Pandemic.

Introduction Despite many significant changes as a result of the coronavirus disease 2019 (COVID-19) pandemic, and reductions in overall trauma workload, patients with fragility hip fractures continued to present to hospital. As we plan for ongoing service provision during future waves of the pandemic, valuable lessons can be learned from patients that have been treated surgically during the “first wave.” Methods All patients admitted to our center (a busy District General Hospital in London, United Kingdom) with a hip fracture during a 13-week period representing the initial rise (“United Kingdom first wave”) in COVID-19 cases, from February 17 th to May 17 th , 2020 (study group) were compared with hip fracture patients from the equivalent 13-week period in February to May 2019 (control group). The primary outcome was 30-day mortality, and additional information was collected in terms of length of stay (LOS), SARS-CoV-2 antigen testing, and cause of death. Results During the COVID-19 study period, 69 patients were admitted with a hip fracture, compared with 70 patients in the control group ( p = 0.949). There was no significant difference in 30-day mortality between the two groups (5.8 vs. 7.1%, p = 0.747). Mean LOS was shorter in the COVID-19 period compared with the control group (11.6 vs. 19.6 days, p <0.001, effect size 0.572). Forty-six patients (66.7%) had a SARS-CoV-2 antigen swab test, as testing was not available in the early period, and 10 patients (14.5%) tested positive. None of the patients, who presented before the antigen testing was available, had clinical suspicion of COVID-19 retrospectively. Two “COVID-19 positive” patients (20%) died within 30 days of admission.Conclusion We report reassuring short-term results demonstrating no statistically significant difference in the 30-day mortality rate of hip fracture patients admitted during the United Kingdom's first wave of the COVID-19 pandemic compared to the equivalent period in the previous year. Hip fracture incidence remained stable, and LOS was reduced, likely due to recent departmental changes as well as a drive to discharge patients quickly during the pandemic. We agree with existing reports that elderly hip fracture patients with COVID-19 have a higher risk of perioperative mortality, however, our results suggest that overall mortality for the whole hip fracture population was similar to the previous year, in which deaths were more commonly attributed to respiratory infections associated with other pathogens. Further work may be needed to evaluate the outcomes during subsequent waves of the pandemic as mutations in the virus and conditions may affect outcomes.

Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design.

BackgroundTreating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined.ObjectiveThis study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns.MethodsAdolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality.ResultsParticipants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language.ConclusionsThe novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes.

Determinants of Internet Financial Reporting Quality

Abstract. Introduction. Internet Financial Reporting (IFR) is a requirement for companies to provide high-quality financial reports and technology as a corporate responsibility to the principles of good corporate governance and to demonstrate that management have adopted those principles. As a result, it is important to ascertain the aspects that may affect the quality of IFR. This study uses secondary data from annual reports that will be listed on the Indonesian Stock Exchange (IDX) in 2020, as well as each company's official website. The study sampled 66 property, real estate, and building construction firms that were listed on the IDX. Eviews 20 were used to test this research hypothesis. Purpose. The purpose of this study is to determine the relationship of company size, age, audit committee composition, public shareholding, and auditor quality on the quality of IFR for property, real estate, and building construction companies listed on the IDX in 2020. Results. The findings indicated that company size, company age, and public shareholding all influenced IFR quality, but that audit committee and auditor quality had no effect. Simultaneously, company size, company age, the composition of the audit committee, public shareholding, and the quality of the auditor all influence the quality of IFR. Conclusions. IFR is important in times and circumstances like these, when the high number of COVID-19 cases necessitates that all activities be conducted via internet information technology. IFR is one of the mandatory methods for companies to submit annual financial reports to investors, as required by Law 40 of 2007 on provisions for reporting ongoing business activities and Financial Services Authority Regulation 8/ POJK.4/2015 on issuers' or public companies' websites. Given our constraints, it is advised that future researchers analyze additional organizations using a larger sample size and a longer time of observation, as well as conducting observations and interviews with the companies under study.

USABILITY APLIKASI ANDROID HONDA e-Care DENGAN USE QUESTIONNAIRE DAN IMPORTANCE PERFORMANCE ANALYSIS (IPA)

Honda Pondok Pinang, which is located on Jl. Ciputat Raya No.80 Pondok Pinang, South Jakarta, in customer service using an android application called HONDA e-Care. HONDA e-Care is very helpful in making it easier for consumers to access Honda service services. Customers can book services at Honda dealers online, get notifications of periodic maintenance schedules, and search for the nearest dealer from a location that can be seen on a digital map by first accessing the Honda e-Care application. But consumers often also face problems, such as when booking a service, but the ongoing booking service does not appear. Until now, no one has conducted research on the quality of the Honda e-Care application. This study aims to measure the extent of the usability of the HONDA e-Care android application and provide suggestions for developing the HONDA e-Care application in the future. Based on the gap analysis, it was found that in general the HONDA e-Care android application on the Honda Pondok Pinang was not satisfied with the quality of the current applications. Based on the IPA analysis, the priority scale for improving the quality of the HONDA e-Care android application can be mapped where quadrant I is the highest priority scale according to the user's perspective, namely: [2], [5], [7], [8] and [9]. These four items must be upgraded immediately by the manager to meet user expectations.

Neurological features in infants with congenital heart disease.

To report neurological examination findings at 5 to 12 months of age in infants with congenital heart disease (CHD) and to identify predictors of abnormal neurological examination. This retrospective observational study included infants who required cardiac surgery at less than 3 months of age and underwent a standard neurological examination from a neurologist in the cardiac neurodevelopmental outpatient clinic between age 5 months and 12 months. Predictors for abnormal neurological examination (concerns on structured developmental history, demographic factors, medical history, and newborn neurodevelopmental assessment) were considered for multivariate regression. The sample included 127 infants (mean age 7mo 2wks), who underwent first cardiac surgery at 7 days (4-49 interquartile range [IQR]) of age and were seen for a neurological examination in the cardiac neurodevelopmental clinic. Neurological abnormalities were common; 88% of infants had an abnormal neurological examination in at least one domain assessed. The most common abnormalities were abnormal axial (48%) and extremity (44%) tone, mostly hypotonia. Abnormal neurological examination was associated with concerns on the concurrent structured developmental history, genetic condition, extracardiac anomaly, longer length of stay, more than one cardiac surgery, ongoing early intervention services, and abnormalities on newborn neurodevelopmental assessment. Neurological examination abnormalities are common in infants with CHD after infant heart surgery, supporting the need for early and ongoing therapeutic developmental services and adherence to American Heart Association recommendations for developmental follow-up for children with CHD. What this paper adds Neurological examination abnormalities are common in infants who undergo open-heart surgery. Medical complications in infancy increase risk for neurological abnormalities. Family-reported concerns on structured developmental history may predict abnormal neurological examination at 5 to 12 months of age. Abnormal newborn neurodevelopmental assessment may predict abnormal neurological examination at 5 to 12 months of age.

Experiences of nurses diagnosed with COVID-19 in Turkey: A qualitative study.

This study examined the experiences of nurses diagnosed with COVID-19 under the guidance of Meleis' Transitions Theory. Nurses, who make up the majority of healthcare professionals, are struggling with COVID-19, a silent war, on the front lines at the cost of their lives. The pandemic has deeply affected nurses' lives, and hundreds of nurses around the world have been diagnosed with COVID-19 and died. A descriptive qualitative approach was used in this study. Data were collected from 18 nurses who experienced COVID-19 symptoms, with a semistructured interview form prepared based on Meleis' Transitions Theory concepts. Interview transcripts were analyzed using a thematic analysis technique. The Consolidated Criteria for Reporting Qualitative Research checklist was used in the study. The six themes that emerged in the data analysis were emotions experienced when nurses tested positive for COVID-19, emotions experienced during the quarantine process, posttraumatic growth, methods of coping with COVID-19, nursing care after COVID-19 treatment, and metaphors about COVID-19. This study showed that being diagnosed with COVID-19 caused nurses to have both positive (posttraumatic growth, empathic and psychosocial nursing care) and negative experiences (fear of death, stigma, etc.). They tried to cope with adverse situations due to COVID-19 by obtaining social support, thinking positively, and engaging in domestic activities. To reduce COVID-19-related physical and psychological symptoms, appropriate policies should be developed for effective and rapid nursing workforce planning, extending the time allocated for postdiagnosis treatment, updating infection control and prevention guides, training nurses, and providing ongoing psychosocial counseling services that nurses can access.

STEP-HI Study: A Multimodal Intervention of Exercise and Testosterone Therapy: Design and Real-World Challenges

Hip fractures are common among older women and can have a devastating impact on their ability to remain independent. Many women who were high functioning before the hip fracture do not return to their pre-fracture level of function, have persistent weakness and mobility impairments, and may require ongoing supportive services. Age-associated androgen deficiency may contribute to deficits in muscle mass, strength and power that are common in older female hip fracture patients. The Starting a Testosterone and Exercise Program after Hip Injury (STEP-HI ) Study is a three-group, randomized, double-blinded, placebo-controlled Phase III clinical trial designed to evaluate a multi-modal intervention aimed at improving functional outcomes in older female hip fracture patients. 168 female hip fracture patients, age 65 yrs. and older are being recruited from 6 clinical sites in the USA. Participants are being assigned to one of three groups: supervised exercise (EX) plus 1% testosterone topical gel; EX plus placebo gel; or enhanced usual care. The primary outcome is six-minute walk distance. This symposium will present information related to key aspects of the design of the STEP-HI trial, including recruitment of a frail patient population during a period of injury recovery, the testosterone and exercise interventions and related fidelity procedures, and implementation challenges for this multi-modal intervention prior to and during the COVID-19 pandemic. In addition, the underlying mechanisms by which testosterone and exercise are expected to have a synergistic effect on muscle strength and function will be discussed.

Integrative medicine for mental health (INTEGRAL) - An ongoing health service research project comparing psychiatric routine care and integrative psychiatry

Integrative medicine for mental health (INTEGRAL) - An ongoing health service research project comparing psychiatric routine care and integrative psychiatry

Growing-Service Systems: New Business Models for Modular Urban-Vertical Farming

To secure sustainable and resilient food systems, new approaches, innovations, techniques, and processes are needed. In recent years, urban farming firms have been developing and experimenting with innovative approaches to expand their offerings and connect with consumers in new ways. New business models are being developed to provide functions and services instead of traditional products to meet demands from consumers, retailers, and users. As such, modular growing systems are increasing in popularity to provide fresh produce, visual appeal, transparency, and other tailor-made functions and services in so-called “growing-service systems” (GSS). Using GSS approaches, firms are developing and providing modular and small-scale farms in restaurants, residential spaces, supermarkets, and other commercial spaces, often including a large degree of automation and optimization of digital solutions to remotely control their operation. Using qualitative methods, the aim of this study is to explore and analyze the development of these novel GSS systems, highlighting different strategies, business models, motivations, and challenges. The results illustrate the divergence in approaches to GSSs for vertical farming. This includes different scales of modular units and varying business models for capturing value from the combination of products and services. All of the systems include varying degrees of automation and digitalized solutions to ensure the services are monitored, which is done to improve growing conditions and improve the experience for the users. Business-to-business systems are being developed as both market expansion and awareness-building strategies, where modular units are provided as a rental or subscription model that includes a number of services. Business-to-consumer systems are being introduced as an alternative for consumers, particularly in urban areas, to have greater control and access over growing their own fresh produce. The modules are purchased by consumers, which includes a number of ongoing services from the GSS firms. By categorizing and exploring these systems, this article offers novel insights and a first endeavor to distinguish these new GSS systems in the growing segment of urban agriculture, controlled-environment agriculture, and product-service system literature.

Assessment of Medical Service Pricing in China's Healthcare System: Challenges, Constraints, and Policy Recommendations.

Medical service pricing reform was considered as one of the focuses of China's remarkable health reform. This paper preliminarily assessed the roles of medical service pricing in the context of China's healthcare system. Specifically, we described the potential roles of medical service pricing in China and pointed out relevant challenges that emerged in practice as the result of reform-related activities. Multiple constraint factors that might have induced undesired outcomes were then recognized, including the excessive diversity and specialization of medical services, the price inelasticity of patients' demand, and the inadequate capability of both medical institutions and administrations. Finally, we provided policy recommendations to inform the ongoing medical service pricing reform in China from a long-term perspective.

41 Innovative solutions to support “Virtual First” pediatric endocrine care

Primary Subject areaEndocrinology and MetabolismBackgroundWith the onset of the SARS-CoV-2 pandemic, health care providers everywhere were forced to rapidly shift the way they deliver care. Within our community-based academic organization, there was variability in response to required changes among different clinical areas, with many clinics ramping down their services while they restructured. In our pediatric endocrinology clinic, we had built the infrastructure to support virtual care using a provincial platform as part of a pilot program for our diabetes population in the year preceding the pandemic. This experience set the stage for a swift pivot to virtual care. To ensure ongoing high quality consultation and follow-up services during the pandemic, our clinic required rapid restructuring to successfully and immediately shift completely to a sustainable “virtual first” approach in March 2020.ObjectivesIn the months following the onset of the SARS-CoV-2 pandemic, we sought to quickly develop and implement innovative strategies, using a quality improvement framework, to supplement virtual care and maintain high quality care delivery.Design/MethodsAs soon as physical distancing measures were implemented in March 2020, our multidisciplinary team held daily 30-minute meetings to troubleshoot, brainstorm, and strategize potential adaptations in care delivery to ensure we continued to meet patient and family needs with primarily virtual care. Barriers and problems were presented and prioritized, solutions proposed, then implemented with support of operation and e-health teams. Attention to educational needs for medical students, residents and fellows helped shape solutions.ResultsThe following innovative solutions were successfully implemented within three months:• a drive thru hemoglobin A1C clinic for patients with diabetes• a streamlined “low touch” Auxology Clinic to supplement virtual visits when body measurement, vital signs or physical exam assessment were required• pre-visit preparation instructions for patients and families• active promotion of patient portal enrolment• re-design of follow-up orders content to allow providers to accurately indicate suitability of virtual care alone or with support measures• a workflow to allow quick conversion from in-person to virtual visits to prevent cancellations related to isolation requirements• an educational framework to ensure level-appropriate exposure to and involvement in patient care for trainees• auto-faxing of medication and supplies• printer mapping and workflow for external lab requisitions• provider/staff scheduling and role re-assignment to facilitate minimal number of on-site staff• support of the team to adopt best practices for virtual visitsConclusionWhile virtual care delivery existed before the pandemic, it was rarely used outside of pilot projects, or only from necessity, when travel to a health care facility was not possible. Herein we provide an overview of an innovative, primarily virtual, care delivery model to satisfy patient and family needs in a pediatric endocrinology clinic in an academic centre. Many components of our model have (and can be) applied or adapted to support care delivery in other clinical areas. The people, processes, and digital health adaptations required to support a primarily virtual mode of care were critical to its success.

Changes on the Demand for Attention for a Mental Health Service During Social Isolation Measures

BackgroundMost of the countries in the world adopted isolation measures during the COVID-19 pandemic. According to Kola L. et. al (2021), “in most settings in low and middle-income countries (LMICs), ongoing in-person mental health services have been disrupted and patients with severe mental conditions and substance abuse disorders are often unable to obtain medications, attend to treatment centres, or receive social services”. The aim of this paper is to describe the effects of the COVID-19 pandemic on the demand for attention in a mental health service as reported by healthcare workers.MethodsA quantitative cross-sectional descriptive study was conducted and a survey designed by the Secretaría de Políticas Integrales sobre Drogas de la Nación Argentina was applied to a total of 29 healthcare workers of a mental health centre in the Province of Córdoba, Argentina, during the month of November, 2020.ResultsThe perception of healthcare workers towards the demand for attention shows that the 3 main reasons for consultation during the first three months of isolation measures were drug abuse (50%), request for treatment (10.3%), and order for medication (10.3%). During the three subsequent months, the reasons for consultation were drug abuse (62.1%), request for treatment (44.8%) and remote treatment modality (24.1%). Healthcare workers state that drug abuse consultations increased 65.5% and the self-inflicted violence consultations increased 44.8%.ConclusionsThe isolation measures generate a change in the demand for attention. There are differences between various phases of the isolation measures, where an increase in the drug abuse consultations and remote treatment modality could be observed.Key messages To develop predictability according to the variations in the demand for attention produced during public health crisis.To train healthcare workers in order to make interventions in public health crisis.

Student Perceptions and Adaptations to Quality Assurance of Education Services During the 2019 Corona Pandemic

This study examines student perceptions of the quality assurance of education services so that they can adapt during the Covid-19 pandemic. Using qualitative research methods positivistic approach. The research subjects were determined purposively, namely 53 students of sociology. The type of data collected is quantitative and qualitative, using closed and open questionnaires with google form facilities, supported by documents. Likert scale 1-5 as a means of measuring student perceptions with positive and negative criteria. Tangible, emphaty, responsibility, reliability, and assurance are indicators of Quality Assurance Education Services. While the adaptation process, goals, integration, and efforts to maintain the continuity of the relationship are indicators of adaptation. Data analysis was done descriptively. The results of the study prove that there are 47.17% of students who have a negative perception of the quality assurance of educational services, but no one thinks that it is not good, in fact the category is good (39,62%), even very good (37,74%), the lowest is quite good (22,64%). This assessment is good because the socialization process is perfect, carried out by all campus components related to the process of internationalization of institutional character and the integration of Islamic values that are being pursued, so that students are aware of the limitations of ongoing services. This is what makes students able to adapt to online learning models and administrative processes that are taking place in the era of the covid-19 pandemic.

Predicting Duration of Outpatient Physical Therapy Episodes for Individuals with Spinal Cord Injury Based on Locomotor Training Strategy

ObjectiveTo characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy. DesignObservational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services. SettingRehabilitation and community wellness facilities at 4 SCI Model Systems centers. ParticipantsEligibility criteria were SCI or dysfunction resulting in motor impairment and the use of physical therapy or community wellness programs for locomotor/gait training. We excluded those who did not complete training or who experienced a disruption in training greater than 45 days. Our sample included 62 participants in conventional therapy and 37 participants in robotic exoskeleton training. InterventionsOutpatient physical therapy or community wellness services for locomotor/gait training. Main Outcome MeasuresSCI characteristics (level and completeness of injury) and the duration of services from medical records. Self-reported perceptions of SCI consequences using the SCI-Functional Index for basic mobility and SCI-Quality of Life measurement system for bowel difficulties, bladder difficulties, and pain interference. ResultsAfter controlling for predictors, the duration of services for the conventional therapy group was an average of 63% longer than for the robotic exoskeleton group, however each visit was 50% shorter in total time. Men had an 11% longer duration of services than women had. Participants with complete injuries had a duration of services that was approximately 1.72 times longer than participants with incomplete injuries. Perceived improvement was larger in the conventional group. ConclusionsLocomotor/gait training strategies are distinctive for individuals with SCI using a robotic exoskeleton in a community wellness facility as episodes are shorter but individual sessions are longer. Participants’ preferences and the ability to pay for ongoing services may be critical factors associated with the duration of outpatient services.

Short report: Call to action for autism clinicians in response to anti-Black racism.

Anti-Black racism is a pervasive issue in the autism field that affects the autism service pathway, which ranges from identification of concerns to ongoing service navigation. In this short report, we provide a working model of the autism service pathway and highlight ways in which anti-Black racism affects all components of the pathway. We summarize the literature that demonstrates the effects of racism within autism assessment, treatment, and quality of care. We end with six recommendations for systemic change that clinicians can take: (1) including and amplifying Black autistic voices within their organization, (2) continuously learning about and acknowledging the ways in which their discipline perpetuates anti-Black racism, (3) recognizing that cultural humility is a lifelong process, (4) being mindful of the complex pathway that families must navigate to receive autism services, particularly when working with Black individuals, and (5) advocating for system-level changes within their organization and refining changes that are made.Lay abstractBlack autistic people experience anti-Black racism when interacting with service systems and the clinicians in those systems. In this article, we describe the various steps families take to get services and how anti-Black racism makes that process even harder. We discuss research that shows the negative effects of anti-Black racism in autism assessment, treatment, and quality of care. We then provide five recommendations that clinicians should follow to reduce anti-Black racism in the autism field: (1) find Black autistic people and listen to their opinions about your organization, (2) always keep learning about how your profession promotes anti-Black racism, (3) recognize that the process of a clinician learning to be culturally humble takes time and is never “complete,” (4) pay attention to all of the steps that families must take to receive autism services and how these steps are even harder for Black individuals, and (5) advocate for your organization to make systems-level changes in their policies and procedures.

MANAGEMENT GUIDANCE AND COUNSELING IN SCHOOL

Management of guidance and counseling in schools is an activity that is carried out within a certain period of time. In order for guidance and counseling services to be carried out effectively and efficiently, in its implementation, guidance and counseling management must be carried out properly. Changes that occur in the behavior of students at school certainly provide an illustration for BK teachers to carry out various service activities, where one form of service which is at the same time the spearhead of all guidance activities is counseling activities. The provision of ongoing guidance and counseling services to students shows that the counselor profession is dynamic. The ability of guidance and counseling teachers to anticipate and choose strategies in accordance with the demands of these needs and developments will be a powerful ammunition to be able to deal with the various dynamics and changes faced For this reason, an understanding of some of the roles of guidance and counseling teachers (counselors) needs to be considered well and the success in the implementation of guidance and counseling can be seen from how the counselor is able to manage each existing service so that the counselor at school can function properly according to the educational goals that have been planned. previously in the school environment.

The Impact of COVID-19 on Hospital Admissions in Croatia

Background: The COVID-19 pandemic disrupted hospital care, as hospitals had to deal with a highly infectious virus, while at the same time continuing to fulfill the ongoing health service needs of their communities. This study examines the direct effects of COVID-19 on the delivery of inpatient care in Croatia.Materials and Methods: The research is a retrospective, comparative analysis of the hospital admission rate across all Diagnosis Related Group (DRG) classes before and during the pandemic. It is based on DRG data from all non-specialized acute hospitals in Croatia, which account for 96% of national inpatient activity. The study also used COVID-19 data from the Croatian Institute of Public Health (CIPH).Results: The results show a 21% decrease in the total number of admissions [incident rate ratio (IRR) 0.8, p < 0.0001] across the hospital network during the pandemic in 2020, with the greatest drop occurring in April, when admissions plunged by 51%. The decrease in activity occurred in non-elective DRG classes such as cancers, stroke, major chest procedures, heart failure, and renal failure. Coinciding with this reduction however, there was a 37% increase (IRR 1.39, p < 0.0001) in case activity across six COVID-19 related DRG classes.Conclusions: The reduction in hospital inpatient activity during 2020, can be attributed to a number of factors such as lock-downs and quarantining, reorganization of hospital operations, the rationing of the medical workforce, and the reluctance of people to seek hospital care. Further research is needed to examine the consequences of disruption to hospital care in Croatia. Our recommendation is to invest multidisciplinary effort in reviewing response procedures to emergencies such as COVID-19 with the aim of minimizing their impact on other, and equally important community health care needs.