Resident Outcomes Research Articles

Local government perspectives on housing buyouts in New York after Hurricane Sandy

ABSTRACT Understanding government experience with hazard buyouts can enhance future efforts. We conducted a study of state and local government perspectives about buyouts after Hurricane Sandy in the New York area, including three jurisdictions that participated in buyouts and two that did not. Respondents differentiated outcomes for buyout participants, which they saw as financially beneficial, and outcomes for residents remaining, including limited open space and risk reduction benefits. The perceived benefits and drawbacks of buyouts were dependent on site and local government characteristics. Buyouts were seen as most appropriate as a last resort, in response to financial losses for homeowners. Increasing partnerships and opportunities for cross-jurisdictional learning, expanding time frames for buyout participation, and revisiting buyout costs and benefits over time could enhance buyout programmes.

Comparative safety and cardiovascular effectiveness of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in nursing homes.

Studies examining the safety and effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT2is) versus glucagon-like peptide-1 receptor agonists (GLP-1RAs) among community-dwelling adults may not generalize to nursing home (NH) residents, who are typically older and more multimorbid. We compared the safety and cardiovascular effectiveness of SGLT2is and GLP-1RAs among US NH residents. Eligible individuals were aged ≥66 years with type 2 diabetes mellitus and initiated an SGLT2i or GLP-1RA in an NH between 2013 and 2018. Safety outcomes included fall-related injuries, hypoglycaemia, diabetic ketoacidosis (DKA), urinary tract infection or genital infection, and acute kidney injury in the year following treatment initiation. Cardiovascular effectiveness outcomes included death, major adverse cardiovascular events and hospitalization for heart failure. Per-protocol adjusted hazard ratios (HR) were calculated using stabilized inverse probability of treatment and censoring weighted cause-specific hazard regression models accounting for 127 covariates. The study population included 7710 residents (31.08% SGLT2i, 68.92% GLP-1RA). Compared with GLP-1RA initiators, SGLT2i initiators had higher rates of DKA (HR 1.95, 95% confidence limits 1.27, 2.99) and death (HR 1.18, 95% confidence limits 1.02, 1.36). Rates of urinary tract infection or genital infection, acute kidney injury, major adverse cardiovascular events, and heart failure were also elevated, while rates of fall-related injuries and hypoglycaemia were reduced, but all estimates were imprecise and highly compatible with no difference. SGLT2is do not have superior, and may have inferior, effectiveness compared with GLP-1RAs for cardiovascular and mortality outcomes in NH residents. Residents initiating SGLT2is should be monitored closely for DKA.

Nursing Home Characteristics and Resident Quality of Care Outcomes: A Scoping Review

Nursing Home Characteristics and Resident Quality of Care Outcomes: A Scoping Review

FRAILTY REDUCTION VIA IMPLEMENTATION OF EXERCISE, NUTRITION AND DEPRESCRIBING (FRIEND) TRIAL: NOVEL IMPLEMENTATION OF THE ASIA-PACIFIC FRAILTY GUIDELINES IN AGED CARE

INTRODUCTION Virtually all adults in aged care are frail, contributing to falls, cognitive decline, hospitalisation, and mortality. polypharmacy, malnutrition, sedentariness, and sarcopenia are risk factors amenable to intervention. Asia-Pacific Frailty treatment guidelines recommend anabolic exercise, medication and dietary optimisation. However, no study has evaluated this best practice intervention in aged care. AIM: Evaluate institutional translation of best-practice frailty treatment in aged care residents. METHODS The Frailty Reduction via Implementation of Exercise, Nutritional support and Deprescribing (FRIEND) trial (ANZCTR#:ACTRN12622000926730p) is a 6-month translational trial evaluating resident outcomes, staff/caregiver knowledge and institutional translation in a Townsville aged care facility. Residents received high-intensity resistance and balance training, medication and nutrition optimisation co-implemented by investigators (AEP, geriatrician, pharmacist, nutritionist) and facility staff. Staff and caregivers completed comprehensive education modules and training. We report resident outcomes for Phase-one (6 months exercise with staggered implementation of medication/nutritional arms) in preparation for full implementation (Phase-two). RESULTS 29 residents (21 female, age:88.6±6.3yrs) were recruited. At baseline, residents were frail (FRAIL-NH;6.3±2.4/14), cognitively-impaired (MoCA;13.8±6.8/30), had low physical function/capacity (SPPB;4.9±3.1/12, 6MWT;222.2±104.4m) and numerous prescribed medications (15.5±5.9). Two residents died & one withdrew before intervention, and nine residents declined exercise intervention. Exercising residents’ adherence was 73.4±18.3% (28±7/38 sessions), with non-significant baseline differences compared to decliners (p>0.05). FRAIL-NH worsened significantly across the entire sample (0.93±1.87,p=.019), however this progression was attenuated in exercisers (0.71±1.83,p=0.35). Furthermore, clinically meaningful improvements in frailty (Fried phenotype;-0.73±1.09,p=.022), Leg press (median{IQR}:40.9%{26.5%)) and knee extension strength (median{IQR):61.9%(259%),p<0.001), 6MWD (35.4±45.8m,p=0.022;30m-MCID), Physical Function (SPPB;1.9±2.3,p=0.007;1-point MCID), and cognition (MoCA;1.31±3.4,p=.131;1.22-point MCID) were observed in exercisers. Only 1 minor exercise-related adverse event occurred. CONCLUSION Six months of AEP-led high-intensity exercise with preliminary, staggered implementation of medication and nutrition optimisation in aged care improved frailty and risk factors in residents. Phase-two results following 6-months of full, concurrent implementation of exercise, medication and nutrition arms are anticipated May, 2024.

Registered nurses’ confidence related to undertaking a leadership role in residential aged care: A clinical leadership self-assessment survey

BackgroundThe Australian Royal Commission emphasizes the importance of registered nurse leadership in providing safe, high-quality care to older adults in Residential aged care. Nurse leadership has important ramifications for effective multidisciplinary care as well as recruitment and retention of the aged care workforce. Registered nurse leadership plays a crucial role in enhancing resident outcomes in Residential aged care, however there are limited studies examining self-perceptions of confidence and competence of nurses running Residential aged care, particularly after hours. AimTo examine registered nurse leadership via self-reported confidence and competence in Residential aged care. MethodsA cross-sectional research design with ten facilities in Western Australia was used, including a survey tool that relied on the Clinical Leadership Competency Framework. Cronbach's alpha test was used to ascertain internal reliability and replicability. The Strengthening the Reporting of Observational studies in Epidemiology guidelines was used to guide the study. Inferential statistics were used for data analysis. Data collection occurred over a six-month period, involving registered nurses employed by a single Residential aged care provider in Perth, Western Australia. Participants rated their leadership confidence on a 5-point Likert-type scale ranging from 1 (never) to 5 (all the time). FindingsFrom a sample of 100 registered nurses working in aged care after-hours, 90% reported high levels of self-confidence. The survey results showed that those who have more than 10 years of experience reported highest confidence in managing services. Registered nurses over 50 years old self-reported highest confidence in personal qualities, managing, and improving service domains. DiscussionRegistered nurses run residential aged care, and this time of aged care reform provides an opportunity to examine associations between registered nurse leadership and resident outcomes and provide avenues for improvements in working environments and resident experiences. ConclusionThe findings have important implications for Residential aged care providers in establishing effective leadership mentoring programs to support registered nurses in improving their confidence and ability.

The impact of the COVID-19 pandemic, and care home closures on timing of mortality in residents of English LTCFs

Background In the UK, mortality incidence of residents in long-term care facilities (LTCFs) was high during the first two waves of the COVID-19 pandemic. Prior to the pandemic, mortality risk was greater amongst new LTCFs admissions compared to longer term residents. Following the re-opening of these facilities to new residents after the second wave of the pandemic, we hypothesised that this difference would be more pronounced. We aimed to establish whether this occurred by comparing mortality risk in new admissions with existing residents. Methods Data were accessed from the VIVALDI study, a prospective cohort study set up to investigate COVID-19 in English LTCFs. Residents aged over 65 were included and analysis performed over the Delta (16th May 2021-19th December 2021) and Omicron (19th December 2021-31st March 2022) waves of the pandemic. Classification into new and existing residents was based on presence in the LTCF before or after 24th April 2021. Mixed effects Cox regression models were used, with separate hazard ratios associated for existing vs new residents estimated for each calendar month. Results 11,532 residents were observed during the Delta wave and 9,801 during the Omicron wave. Mortality hazard ratios for existing care home residents compared to new care home residents stabilised after September 2021, following a period of reduced risk between May (HR: 0.23 95% CI: 0.11-0.47) and August (HR: 0.37, CI:0.29-0.47) 2021. No mortality displacement was observed in the Omicron wave. Conclusions Mortality rates amongst existing residents were lower than anticipated between May and August 2021 but increased and stabilised by September 2021, providing evidence for mortality displacement within this population. Improved monitoring of infection outcomes for LTCF residents that consider time since admission would help improve our understanding of the dynamics and composition of LTCF populations in non-pandemic periods.

Health insurance and subjective well-being: evidence from integrating medical insurance across urban and rural areas in China.

Health insurance coverage and the risk protection it provides may improve enrollees' subjective well-being (SWB), as demonstrated, e.g. by Oregon Medicaid's randomized expansion significantly improving enrollees' mental health and happiness. Yet little evidence from low- and middle-income countries documents the link between insurance coverage and SWB. We analyse individual-level data on a large natural experiment in China: the integration of the rural and urban resident health insurance programmes. This reform, expanded nationally since 2016, is recognized as a vital step towards attaining the goal of providing affordable and equitable basic healthcare in China, because integration raises the level of healthcare coverage for rural residents to that enjoyed by their urban counterparts. This study is the first to investigate the impact of urban-rural health insurance integration on the SWB of the Chinese population. Analysing 2011-18 data from the China Health and Retirement Longitudinal Study in a difference-in-difference framework with variation in the treatment timing, we find that the integration policy significantly improved the life satisfaction of rural residents, especially among low-income and elderly individuals. The positive impact of the integration on SWB appears to stem from the improvement of rural residents' mental health (decrease in depressive symptoms) and associated increases in some health behaviours, as well as a mild increase in outpatient care utilization and financial risk protection. There was no discernible impact of the integration on SWB among urban residents, suggesting that the reform reduced inequality in healthcare access and health outcomes for poorer rural residents without negative spillovers on their urban counterparts.

Perceived distributive fairness and public acceptance of a policy mandating on-site wastewater treatment and reuse

Throughout the world, climate change, rapid population growth, and urbanisation raise the need for reducing freshwater consumption. One solution are on-site systems that treat wastewater for non-potable reuse near its source of generation, for example within a building. Policies mandating their installation can effectively increase installation rates and have been implemented in several cities. Yet, such policies have the potential to impair distributive fairness in society and therefore also policy acceptance, because usually they cover only part of the population, which then has to carry most costs and risks. On the example of Bengaluru, India, where such a policy exists, this online study (N = 350) analysed whether policy acceptance can be explained by the perceived policy outcome for different groups of society (i.e. the distribution of the policy’s costs, risks, and benefits among these groups), and whether this relation is mediated by perceived fairness. We further investigated whether these relations differed between participants covered and those not covered by the policy, since being personally affected may influence perceptions. Specifically, the outcomes for the following six groups were included: 1) participants themselves, 2) people covered by the policy, 3) people with a low income who are covered by the policy, 4) people vulnerable to water insecurity who are covered by the policy, 5) all inhabitants of Bengaluru taken together, and 6) the environment and future generations. A moderated mediation analysis showed that higher acceptance of the policy was explained by a higher perceived fairness, which, in turn, was explained by a better perceived outcome of the policy for different groups of society. Covered and non-covered participants differed with regard to which groups of society they considered for evaluating fairness. While a better perceived outcome for residents covered by the policy (compared with the outcome for those not covered) explained perceived fairness among all participants, it explained acceptance only among participants not covered by the policy. Further, and only among participants covered by the policy, perceived fairness was additionally explained by better perceived outcomes for the environment and future generations, which also explained higher acceptance among covered participants. It is discussed whether in the specific context, collective considerations may be more relevant than self-centred considerations to the perception of fairness and acceptance of the policy.

Factors impacting community living outcomes among former long-term nursing home residents using the interdependence-Human Activity Assistive Technology (i-HAAT) model

ABSTRACT Despite an increased application of social theory in assistive technology (AT) outcomes research, there continues to be a gap in integrating AT conceptual models in research design, data analysis, and results interpretation. This paper merged two preexisting AT models, the Human Activity Assistive Technology model (HAAT) and the interdependence frame for AT into a novel framework, the interdependence-HAAT model (i-HAAT). This model was used to examine the outcomes of former long-term nursing home residents using AT. The model was also used as a framework to facilitate quantitative variable identification and categorization, emphasize the interconnectivity between domain variables, and explore the infrastructural supports necessary for the successful community reintegration of deinstitutionalized AT users. Meaningful integration of theory into practice is the essential next step in generating socially responsive research that addresses AT consumer needs and moves the field forward.

Post-fall outcomes of aged care residents that did not transfer to hospital following referral to a specialised hospital outreach service: A retrospective cohort study

BackgroundHospital outreach services aim to reduce the number of avoidable emergency department (ED) transfers of aged care residents and improve healthcare outcomes. While there are known benefits of such services, including avoiding the distress and discomfort that comes with the care transition, little is known about the outcomes of older people in residential aged care facilities who are referred to an outreach service and do not transfer to hospital after a fall. AimThe aim of this study was to describe the characteristics of residents who experienced a fall in an aged care facility and were referred to a hospital outreach service, and to report the health outcomes of those who did not transfer to hospital. MethodsA retrospective cohort study of health administrative data collected from 1st January 2019 to 31st May 2022 was undertaken. Clinical chart audits were conducted of aged care residents who avoided attending an ED following a fall but subsequently, within 30 days, died or presented to hospital. Descriptive statistics were used for analysis. FindingsMost residents who avoided the ED post fall (n = 370, 73%), did not present to hospital or die within 30 days. Of the cohort who presented to hospital within 30 days, the reasons included new symptoms, pain or medical imaging requirement. Of the residents who died (n = 42, 8%), most did not attend an ED within 30 days of the fall. DiscussionMost residents who were recommended not to transfer to an ED post fall by the hospital outreach service did not die or require transfer to hospital within 30 days. The residents who died had incurable progressive illness. Most of them who died were cared for in the aged care facility allowing the resident to die in a familiar environment being cared for by staff known to them. ConclusionThe results suggest that the hospital outreach service in this study was effective in most cases in supporting residents to avoid transfer to an ED post fall. Avoiding ED is not always appropriate.

Picking Apart a Program Evaluation Committee: A Multiple Case Study Characterizing Primary Care Residency Program Evaluation Committee Structure, Program Improvement, and Outcomes.

As of 2014, the Accreditation Council for Graduate Medical Education (ACGME) mandates initiating a Program Evaluation Committee (PEC) to guide ongoing program improvement.However, little guidance nor published reports exist about how individual PECs have undertaken this mandate. To explore how four primary care residency PECs configure their committees, review program goals and undertake program evaluation and improvement. We conducted a multiple case study between December 2022 and April 2023 of four purposively selected primary care residencies (e.g., family medicine, pediatrics, internal medicine). Data sources included semi-structured interviews with four PEC members per program and diverse program artifacts. Using a constructivist approach, we utilized qualitative coding to analyze participant interviews and content analysis for program artifacts. We then used coded transcripts and artifacts to construct logic models for each program guided by a systems theory lens. Results: Programs adapt their PEC structure, execution, and outcomes to meet short- and long-term needs based on organizational and program-unique factors such as size and local practices. They relied on multiple data sources and sought diverse stakeholder participationto complete program evaluation and improvement. Identified deficiencies were often categorized as internal versus external to delineate PEC responsibility, boundaries, and feasibility of interventions. The broad guidance provided by the ACGME for PEC configuration allows programs to adapt the committee based on individual needs. However, further instruction on program evaluation and organizational change principles would augment existing PEC efforts.

Experience real-time, health and biological outcoMes of personal recovery in PeOple With mEntal disorders in Residential facilities (EMPOWER): a cohort study

Introduction Deinstitutionalization has resulted in diverse mental health care models, influenced by local resources, funding, and cultural factors. In Italy, 127 Department of Mental Health (DMHs) provide care for individuals with mental disorders. People with severe mental disorders (SMD) live independently or in residential facilities (RFs). Approximately half of the Italian DMH budget is allocated to RFs, serving around 3.6% of people with SMD. Italian RFs prioritize personal recovery, empowering individuals with SMD to live fulfilling lives despite symptoms and psychosocial challenges. While personal recovery is known to improve well-being and cost-effectiveness, its implementation in Italian RFs remains incomplete. There is insufficient evidence regarding its impact on various outcomes for residents, including health, psychosocial, and biological factors.Objectives The EMPOWER Study aims to assess whether adding personal recovery to Treatment As Usual (TAU) in Italian RFs could improve functioning (primary outcome), health, biological status, productivity and interpersonal relationships (secondary outcomes) among patients receiving the personal recovery-oriented treatment, compared with TAU. Additionally, data will be collected from informal caregivers, mental health professionals, and concerning the recovery orientation of RFs.MethodsThis study employs a longitudinal cohort design, gathering data at baseline and six-month follow-up in Italian RFs. A cohort of residents over 18 y.o. who receive a personal recovery-oriented treatment, the Mental Health Recovery Star (N=20), is compared to a matched group of residents receiving the TAU (N=20). International standardized assessments collect patients’ data on functioning, psychopathology, need for care, quality of life (QoL), positivity, social network, service satisfaction, and patient stigma. Informal caregivers’ data includes burden, QoL, positivity, and service satisfaction. Mental health professionals’ data encompasses burnout, stress, stigma, positivity, and work satisfaction. The working alliance between professionals and patients is assessed. Clinical and biological exams (blood and saliva samples) are collected, along with actigraphy data on patients’ circadian rhythm and physical activities. Digital data through a mobile app captures psychopathology, productive activities, social network, using the Experience Sampling Method with questions defined with patients. Focus groups with patients, professionals, and informal caregivers are facilitated by an expert by experience. Recovery orientation of RFs is assessed.ResultsNot yet available.ConclusionsThis study aims to generate novel insight that could improve our treatment approaches for patients in residential facilities.Disclosure of InterestNone Declared

Preference Signaling in the Orthopaedic Surgery Match: Applicant and Residency Program Attitudes, Behaviors, and Outcomes.

The orthopaedic surgery match has experienced a consistent increase in both the number of applicants and applications submitted per applicant. Preference signaling was implemented during the 2022 to 2023 application cycle in part to curtail the rising application burden on both applicants and residency programs. Our aim was to explore the impact of the preference signaling system on applicant and residency program leader attitudes, behaviors, and outcomes. We distributed surveys to American Orthopaedic Association/Council of Orthopaedic Residency Directors member program leaders (program directors, assistant program directors, and program coordinators) and applicants registered for the Electronic Standardized Letter of Recommendation after Universal Interview Offer Day 2022 (Fall Survey) and Match Day 2023 (Spring Survey). The surveys contained multiple-choice and numeric response questions on attitudes, behaviors, and outcomes that were analyzed and reported as percentages and medians, respectively. Open-text responses were reviewed for dominant themes. One hundred program leaders and 378 applicants (47%) completed the Fall Survey, and 146 program leaders and 290 applicants (36%) completed the Spring Survey. A majority of applicants (71%) and program leadership (91%) support the continued use of signaling. Applicants reported a 16% reduction in the number of programs to which they applied. Program directors largely used signaling as a tool for screening applications (75%), with few programs using signaling in the ranking process (20%). Applicants reported that 81% of their interviews were from programs they signaled. Slightly more than half of programs (53%) reported filling their last slot at a higher rank order position than the average of the previous 5 years. Qualitative analysis suggests a need for more transparency in the use of signals, consideration of application and/or interview caps, and reconsideration of the other components of the application. Preference signaling in the orthopaedic surgery match was met with positive feedback and led to a reduction in the number of applications. Future research will examine the continued impact of preference signaling and assess alterations for optimizing the match process.

Promoting Nursing Home Success: A Business Model Supporting Frontline Staff Retention and Resident Outcomes

Promoting Nursing Home Success: A Business Model Supporting Frontline Staff Retention and Resident Outcomes

Impact of implementing the pain best practice guideline in a long-term care home using the knowledge-to-action framework

Introduction. Assessment and management of pain in older adults can be challenging, with persistent pain prevalence ranging from 25% to 80%, especially in long term care homes (LTCH), where most seniors are unable to verbalize their pain. This article describes the implementation of the Registered Nurses’ Association of Ontario (RNAO) Assessment and Management of Pain (Third Edition) best practice guideline (BPG) in a LTCH in Toronto, Canada. Methodology. Using mixed descriptive study methodology, this 391-bed home housing older adults over 80 years implemented the Pain guideline using the knowledge-to-action framework and audit procedures to evaluate the impact of implementing this guideline. Key implementation activities included educating residents, families, and staff about pain while integrating validated pain screening and assessment tools into practice. A mixed methods approach of qualitative and quantitative data was utilized to monitor improvements in clinical and organizational outcomes. Results. The impact of implementing Pain BPG is: improved utilization of pain assessment and management tools, reduced incidence of worsening pain, improved pain scores and improved resident quality of life. The structured and integrated, evidence-based approaches to pain assessment and management reflected that long-term care residents don’t have to live with pain regularly, which leads to a better quality of life and resident/family satisfaction. Discussion. In conjunction with the structured approach of the knowledge-to-action framework and the Pain BPG, the LTCH utilized tailored approaches to meet the needs of their resident population. Recognizing the unique needs of seniors in a residential setting, organizational structural facilitators, and barriers and cultural needs, the LTCH developed multi modal approaches based on a person and family centred approach. This evidence-based and resident focused approach was the key to the successful implementation and subsequent outcomes that were resultant. Conclusion. The systematic implementation of the RNAO pain BPG and the utilization of the knowledge-to-action framework was shown to improve resident outcomes, improve organizational processes and generate staff satisfaction. Participation and engagement of residents, their families and health professionals in the process was one of the greatest facilitators.

The Frailty Reduction via Implementation of Exercise, Nutrition, and Deprescribing (FRIEND) Trial: Study Protocol and Recruitment Results.

Virtually all adults in aged care facilities are frail, a condition which contributes to falls, cognitive decline, hospitalisation, and mortality. Polypharmacy, malnutrition, sedentariness, and sarcopenia are risk factors amenable to intervention. The Asia-Pacific Frailty Management Guidelines recommend anabolic exercise and the optimisation of medications and nutrition. However, no study has evaluated this best practice intervention triad in aged care. The Frailty Reduction via the Implementation of Exercise, Nutrition, and Deprescribing (FRIEND) Trial (ANZCTR No.ACTRN12622000926730p) is a staged 6-month translational trial evaluating resident outcomes, staff/caregiver knowledge, and institutional implementation in a Townsville aged care facility. Residents received high-intensity resistance exercise and balance training and medication and nutrition optimisation co-implemented by investigators (exercise physiologist, geriatrician, pharmacist, and nutritionist) and facility staff. Staff and caregivers completed comprehensive education modules and training. We report the trial protocol and recruitment results. 29 residents (21 female, age: 88.6 ± 6.3 years) were recruited. At baseline, the residents were frail (frailty scale nursing home (FRAIL-NH); 6.3 ± 2.4/14), cognitively impaired (Montreal Cognitive Assessment; 13.8 ± 6.8/30), functionally impaired (Short Physical Performance Battery; 4.9 ± 3.1/12, 6 min walk distance; 222.2 ± 104.4 m), and were prescribed numerous medications (15.5 ± 5.9). Two residents died and one withdrew before the intervention's commencement. Thirty family members and 19 staff (carers, allied health assistants, nurse managers, registered nurses, lifestyle-leisure officers, kitchen/hospitality staff, and senior leadership) were recruited to receive frailty education modules. The FRIEND trial is currently being implemented with results expected in mid-2024. This is the first trial to evaluate the implementation of the best practice frailty guidelines including anabolic exercise and medication/nutritional optimisation in residential aged care.

Opportunities and achievements — experiences of pharmacists as Foundation Residency Program residents — a qualitative study

AbstractBackgroundThe Australian Foundation Residency Program prepares new‐to‐hospital and early career pharmacists for extended roles and advanced pharmacy practice. An understanding of the outcomes residents perceive they achieve through completion of a residency and what supports them in their achievements is limited.AimTo explore pharmacists' experiences during their residency and what they perceive as its outcomes and their achievements.MethodFocus groups and interviews were conducted and recorded with 12 early career or new‐to‐hospital pharmacists who recently completed a residency program in an Australian hospital. Recordings were transcribed and analysed using inductive thematic analysis. Ethical approval was granted by the University of Queensland Human Research Ethics Committee (Reference no: 2021/HE001225) and the study conforms to the Australian Statement on Ethical Conduct in Human Research. Informed consent was obtained from all participants via the distribution of project information sheets and completion of written consent forms.ResultsFive distinct themes were generated from participants' discussions of their experiences and achievements throughout their residency. The outcomes and achievements they described included gaining the confidence to take on new and challenging roles as well as advancing their career by developing a deeper understanding of their role and potential in the healthcare system. Skill development was accelerated by the structure and assessment requirements of the residency program and by support from mentors, which positively influenced their attitudes towards feedback and competency assessments. Participants reflected on the differences between postgraduate university‐based learning and workplace‐based learning and saw benefits in both.ConclusionThe residency was reported to offer a structured and supportive training pathway for pharmacists in the early stages of their hospital pharmacy career. Completion of residency facilitates pharmacists' skill development and a deeper understanding of their roles. Dedicated and qualified mentorship and routine networking events between peers and past residents enhance these experiences and outcomes for residents.

The hidden struggle of overworked urology residents “the hour”: The overlooked burnout, a narrative review

AbstractBurnout is a growing concern across numerous professions and industries worldwide. It has increased for many people since the onset of COVID‐19 due to the stress, uncertainty, and changes brought on by the pandemic. Burnout is also a significant issue in the field of medicine, particularly urology, where residents face long working hours and high workloads, leading to physical and mental health problems, as well as limited opportunities for rest and rejuvenation. This alarming trend highlights the need for more effective measures to address burnout and promote employee well‐being and job satisfaction. A thorough search of electronic databases such as PubMed, Scopus, and Google Scholar was conducted to obtain pertinent articles using relevant keywords. Retrieved articles were screened for relevance, with duplicates and irrelevant articles excluded. Thematic and critical review analysis was conducted on chosen articles, identifying key themes and contributing factors related to burnout in urology residents. The hidden struggle of overworked urology residents and their overlooked burnout represents a complex issue that requires systemic change and individual‐level interventions. Organizations must prioritize employee well‐being by providing adequate support and resources for managing burnout. Additionally, promoting effective leadership practices that prioritize resident well‐being over any personal or institution recognitions or gains is crucial. These steps will improve the quality of care while mitigating negative outcomes for residents.

The Relationship Between Parental Support and Learning Outcomes For Social Studies Package B At SPNF SKB Bukittinggi City

The background to this research is the low social studies learning outcomes of residents studying package B. The aim of this research is to see a picture of the family environment of study residents, see a picture of social studies learning outcomes of residents studying package B, and see a picture of social studies learning outcomes of residents studying package B. The relationship between the family environment and Social Sciences learning results package B at SPNF SKB Bukittinggi City. This research uses a correlational quantitative approach. The population of this study was residents studying package b at SPNF SKB Bukittinggi City, totaling 45 people. Meanwhile, samples were taken from 60% of the population, namely 27 people, using a cluster random sampling technique. Data collection techniques using questionnaires. Data analysis techniques using percentage formulas and Spearman rank formulas. The research results show (1) the family environment is still not good, (2) student learning outcomes are still relatively low, (3) there is a relationship between the family environment and social studies learning outcomes package b, this relationship is declared significant because it is categorized as very strong. It is recommended that parents provide support in education in the family environment in order to optimize student learning outcomes. The SPNF SKB Institute is able to provide motivational support to learning residents and be creative in using learning media so that learning enthusiasm can increase among learning residents. Future researchers can identify characteristics or other variables that have not been examined in this research for further follow-up. Keywords: Family Environment, Learning Outcomes

Family Involvement Training for Staff and Family Caregivers: Case Report on Program Design and Mixed Methods Evaluation.

The COVID-19 pandemic underscored the imperative for meaningful family involvement in long-term care, aligning with policy and safety standards while enhancing outcomes for caregivers, residents, and staff. The objectives of this article are as follows: (1) a case study report on implementing a family involvement intervention designed to facilitate the formal and safe engagement of family caregivers in resident care and (2) the pilot evaluation of the intervention. We used Knapp's six-step implementation science model to guide and describe intervention development to provide insight for others planning family involvement projects. We employed sequential mixed methods, including surveys with quantitative and qualitative questions before and after program implementation for providers, and surveys and interviews with family caregivers a year after. We used the Mann-Whitney U test (p < 0.05) to assess differences in health providers' perceptions pre- and post-education. Families and staff perceived that the Family Involvement Program was important for improving the quality of care, residents' quality of life and family/staff relationships. Providers' perceptions of the program's positive impact on residents' quality of life (p = 0.020) and quality of care (p = 0.010), along with their satisfaction with working relationships with families (p = 0.039), improved significantly after the program. Qualitative data confirmed improvements in family-staff relationships. In conclusion, we documented the design of this family involvement initiative to encourage family caregivers and staff to work together in residents' care. Youville's Family Involvement Program gives families and family caregivers an explicit role as partners in long-term care. The mixed methods pilot evaluation documented improvements in staff and family relationships.