Resident Assessment Research Articles

Pediatric Residents’ Procedural Competency Requirements: A National Needs Assessment of Program Directors and Chief Residents

BackgroundThere is increased learner competition for a shrinking pool of procedural training opportunities and indications in pediatrics. This study aimed to describe pediatric residency program directors’ (PDs) and chief residents’ (CRs) perspectives about whether procedural requirements for pediatric residents should be reformed and individualized. MethodsThis was a survey-based, mixed methods study of PDs and CRs affiliated with the Association of Pediatric Program Directors (APPD). We used descriptive statistics to analyze demographics and perspectives, logistic regressions to examine individual and program factors, and thematic analysis for qualitative data. ResultsForty-seven percent (95/203) of PDs and 16% (64/392) of CRs responded, representing APPD membership across program setting, size, and region (average standard mean deviation 0.28). Ninety-one percent of PD respondents considered one or more of the current Accreditation Council for Graduate Medical Education (ACGME) required procedures nonessential; 74% favored individualizing procedural training. CR responses mirrored PD responses. Program size, setting, and access to procedural teams did not significantly associate with likelihood to favor individualization. ConclusionsThe majority of PD and CR respondents believe that current ACGME procedures should be reformed and individualized to future career goals. This change could allow maximization of limited time in residency in this era of decreased opportunity.

Integration of a dental hygienist into the interprofessional long-term care team.

To address poor oral health of residents in long-term care homes (LTCH), this study explored the process of integrating an educational resource and a dental hygienist on the interprofessional care team. This convergent mixed-methods study took place at a 472-bed LTCH in Toronto, Canada from February to August 2018. Nurses employed at the LTCH participated in the study. During the study period, a dental hygienist was integrated into an interprofessional LTCH team. Nurses completed an online eLearning module about using the Oral Health Assessment Tool (OHAT) when referring residents' oral health concerns to a. Pre/post knowledge quizzes, module feedback and satisfaction surveys were administered. A retrospective chart review examined OHAT use and compared nurse and dental hygienist oral health assessments. Two cycles of semi-structured interviews with five nurses explored experiences with the eLearning module, OHAT and integration of the dental hygienist into the team. Nurses scored well on the knowledge quizzes and reported comfort in using the OHAT to refer oral concerns to a dental hygienist; however, actual use was minimal. oral health issues were under-reported by nurses on the Resident Assessment Instrument-Minimum Data Set (RAI-MDS); the dental hygienist reported significantly more debris, teeth lost and carious teeth (all P < 0.0001). Qualitative analysis indicated that the nurses valued dental hygienist integration into the team. Using knowledge mobilisation practices, a new oral health referral tool was developed. This study highlights the feasibility and desirability of an oral health eLearning module, practical assessment tools and participation of a dental hygienist on the LTCH interprofessional care team.

Radiation safety assessments for radioactive concrete recycling workers and residents

Carried out was the assessment of the radiation safety for the recycling workers of the radioactive concrete generated from nuclear power plants and nearby residents. Decommissioning of a nuclear power plant with an electric output of 1000 MW generates approximately 500,000 tons of concrete waste. It is important to reduce the volume of concrete waste to reduce the costs of decommissioning projects. For this purpose, the low-level radioactive cement powder from bioshield concrete is recycled as a solidifying agent. The number of radioactive concrete waste drums to be disposed is reduced by extracting cement from the radioactive concrete and using it as a solidifying agent, rather than using cement from general industrial waste. Various exposure scenarios exist, and it is necessary to evaluate the radiation dose in each scenario. In this study, seven scenarios were selected and evaluated. The radioactive exposure to facility workers, nuclear power plant workers, and landfill management workers is within the annual dose limit, even if they work 2000 h per year. A loader can work close to the drum for 90–93 h per year, and a truck driver can drive 621 one-way trucks per year. Dose evaluations for road users and residents after landfill closure showed that both had values far below the dose limit for the public. Bioshield concrete recycling was confirmed to be radiologically safe in all scenarios if certain conditions were satisfied. Thus, this study showed that cement powder from bioshield concrete could be used safely without exceeding the radiation safety limits for workers and the public when recycling concrete.

FOSTERING PRACTICE CHANGE BY INTEGRATING INTERPROFESSIONAL EDUCATION IN A COMMUNITY HEALTH COLLABORATION

Abstract NJGWEP undertook an interprofessional community/public health initiative collaborating with Rutgers University School of Nursing-Camden, Stockton University, NJ Housing and Mortgage Finance Agency, and four affordable housing sites located in underserved communities, with a potential to reach approximately 600 older residents. An IPE curriculum delivered to faculty, students, and staff from multiple health professions disciplines prepares them for assessing residents with chronic health problems using the 4Ms framework (What Matters, Mind, Medications, Mobility), adding the Geriatric 5th M for multi-complexity. Using a Resident Health Risk Assessment (RHRA) to assess residents’ health/biopsychosocial needs by capturing critical information needed to support “aging in place,” students and staff develop person-centered plans of care that address maintenance of independence, health, and referral to needed services/supports to delay or prevent institutional placement. From 2019-2022, 84 students from multiple disciplines (i.e., nursing, social work, counseling, OT) participated in community-based rotations, completed 279 RHRAs, and developed 101 IPE case reviews and person-centered plans of care. Evaluating residents’ co-morbid conditions (Hypertension 46%, Diabetes Mellitus 42%, Mental Health 40%; 8.6 medications per/resident, 44% Mini-Cog &amp;lt; 3; 19% PHQ+, 51% + Falls Screen; 48% TUG&amp;gt;12; 58% ADL/IADL deficits) highlighted the 5th M, Multi-Complexity. IPE is a sustainable venue for training a health care workforce that acknowledges/values the person-centered approach and encourages learning the roles and responsibilities of other disciplines. Implementation of a customized database in 2022 facilitates longitudinal tracking of outcomes related to resident needs, referrals, interventions, access to services to support aging in place, and informs policy and practice change.

BUILDING CLINICAL JUDGMENT IN THE HEALTH CARE WORKFORCE BY ADDRESSING THE 4MS AND MULTICOMPLEXITY

Abstract Since 2019, NJGWEP, Rutgers School of Nursing-Camden and Fair Share Support Services, Inc. partnered in an affordable housing site in an underserved, disadvantaged community to support aging in place. Senior nursing students conduct Resident Health Risk Assessments (RHRAs) using the 4Ms framework to build assessment skills, sharpen clinical judgment, and address the Geriatric 5th M in a multi-complex resident population. Nursing students, working in teams with social service and community health workers, completed 92 RHRAs incorporating the 4Ms (What Matters, Mind, Medication, Mobility). On average, residents had &amp;gt; 3 risk factors related to the 4Ms (M=3.31); 25% +screen for depression, 25% +screen for cognitive impairment, 64% w/mobility deficits, 83% w/polypharmacy, and 80% on 1 or more high-risk medications. There were 53% w/diabetes, 65% w/hypertension and other biopsychosocial factors related to social determinants of health; 91% could be characterized as multi-complex (the Geriatric 5th M) and in need of services/supports to age in place. The 4Ms framework, with the addition of the 5th M, provides curricular structure for development of clinical judgment through focused assessment, analysis, flagging of key assessment data, prioritization of problems, and developing person-centered plans of care. Interprofessional (IP) case studies of increasing levels of difficulty experienced by affordable housing residents build cultural competence, foster development of critical thinking, clinical reasoning, and, when supplemented by weekly IP case reviews, facilitate shared decision-making and care planning. The process is further supported by a customized electronic database that permits monitoring person-centered recommendations and outcomes over time, gauging impact.

An exploration of status of chronic diseases and its influencing factors of older people in Chinese home care and long-term care facilities: a cross-sectional study.

As the population ages, the proportion of chronic diseases becomes more prevalent. This study aimed to investigate the current status of chronic diseases among the older people in home care (HC) and long-term care facilities (LTCFs) in China and to analyze its influencing factors. This cross-sectional study was conducted between 2021 and 2022. A multi-stage stratified random sampling and census sampling approach was used in this survey of the health of 389 older people in HC and 202 older people in LTCFs from Western Hunan, respectively. The following instruments were included in the survey "International Resident Assessment Instrument for Home Care (interRAI-HC)" and the "International Resident Assessment Instrument for Long-Term Care Facilities (interRAI-LTCF)." Univariate analysis was used to examine the prevalence of chronic diseases among older people with different characteristics. Data were analyzed by IBM SPSS version 25.0 software. A p-value of <0.05 was considered statistically significant. The survey results showed that the prevalence of chronic diseases among older people in HC was 73.26% (95% CI, 68.85-77.68), and the top five chronic diseases were hypertension (26.36%), bone and joint disease (23.36%), gastrointestinal and gallbladder disease (11.78%), heart disease (11.21%), and diabetes (8.97%). The prevalence of chronic diseases among older people in LTCFs was 77.23% (95% CI, 77.23-83.06), and the top five chronic diseases were hypertension (33.11%), bone and joint disease (13.25%), cerebrovascular disease (12.91%), diabetes (11.26%), and heart disease (10.26%). The results showed that long time spent alone, having sleep disorders, and self-rated health status significantly increased HC in older people with the prevalence of chronic diseases (p < 0.05). Having marital status, non-healthy BMI, having sleep disorder, walking with the use of assistive devices, and self-rated health status significantly increased older people in LTCFs with the prevalence of chronic diseases (p < 0.05). There are differences in the prevalence and distribution of chronic diseases among older people in two different aged care models in China, and there are various risk factors for chronic diseases. Therefore, chronic disease healthcare strategies should be tailored to two different aged care models for older people. Further summary found that older people in HC spend a lot of time alone and suffer from loneliness, which ultimately causes psychological disorders. Thus, psychological adaptation interventions are needed for older people in HC. Besides, older people in LTCFs lack social support from their families (divorced/widowed) and have activity disorders (walking with the use of assistive devices). Thus, social adaptation interventions are needed for older people in LTCFs. This study provides a theoretical basis for the distribution of healthcare and the prevention and treatment of chronic diseases in Chinese older people.

THE ASSOCIATION OF COVID-19 OUTBREAKS AND OTHER FACTORS WITH NURSING HOME RESIDENTS’ QUALITY OF LIFE

Abstract Nursing home (NH) residents’ Quality of life (QoL) is an important goal of care. However, it is understudied, particularly during the COVID-19 pandemic. Our objective was to examine whether COVID-19 outbreaks, care aide emotional exhaustion, and lack of resident access to geriatric professionals were associated with NH residents’ QoL. In this cross-sectional study (Jul-Dec 2021), we purposefully selected 9 NHs in Alberta, Canada based on their COVID-19 exposure (no or minor/short outbreaks vs repeated or extensive outbreaks). Using a validated questionnaire (DEMQOL-CH), we assessed dementia-specific QoL of 689 residents from 18 care units through video-based interviews with care aides. Independent variables included COVID-19 outbreak in the NH in the last 2 weeks (health authority records), proportion of care aides on a care unit with high emotional exhaustion scores (9-item short form Maslach Burnout Inventory), and resident access to geriatric professionals (validated facility survey). We ran mixed-effects regression models, adjusted for facility and care unit characteristics (validated facility and care unit surveys), and resident covariates (Resident Assessment Instrument – Minimum Data Set 2.0). COVID-19 outbreaks within two weeks of the data collection (β=0.189, 95% confidence interval [CI]: 0.058;0.320), higher proportions of emotionally exhausted care aides on a care unit (β=0.681, 95%CI: 0.246;1.115) and lack of access to geriatric professionals (β=0.216, 95%CI: 0.003;0.428) were significantly associated with poorer resident QoL. Policies aimed at reducing infection outbreaks, better supporting care staff, and increasing access to geriatric specialists, may help to mitigate negative effects of COVID-19 NH residents’ QoL.

ASSOCIATION OF ASSISTED LIVING HOMES PREPAREDNESS AND RESPONSES TO THE COVID-19 PANDEMIC WITH RESIDENT LONELINESS

Abstract Loneliness has been an ongoing problem among Assisted living (AL) residents and has worsened during the COVID-19 pandemic. Loneliness is associated with an increased risk of mental and physical illness, cognitive decline, suicidal behavior, and all-cause mortality. However, the impact of the pandemic on AL residents’ loneliness is poorly understood. We surveyed 42 AL homes in Alberta to understand whether resident characteristics and homes’ pandemic preparedness and response to the pandemic were associated with resident loneliness. The surveys reflected pandemic waves 1 (Mar-Jul 2020) and 2 (Nov 2020-Feb 2021) and were linked to Resident Assessment Instrument (RAI) records of residents who lived in these homes during these periods. Using generalized estimating equation models, we assessed whether resident characteristics, residents’ social relationships, and home preparedness for and responses to the pandemic were associated with resident loneliness (measured as present or absent based on RAI items). Our sample included 1,828 residents (wave 1: 890, wave 2: 938). Almost 13% of the residents reported loneliness (wave 1: 11.2%, wave 2: 14.2%). Depressive symptoms (odds ratio [OR]=2.73, 95% CI, 1.9-3.9) daily/excruciating pain (OR=1.97, 95% CI, 1.4-2.8), and cognitive impairment (OR=0.38, 95% CI, 0.2-0.6) were significantly associated with loneliness. Caregiver availability, hours of caregiver help, and home preparedness were not associated with loneliness, but more communication with caregivers (OR=2.19, 95% CI, 1.1-4.2) and same or improved staff morale (OR=0.61, 95% CI, 0.4-0.9) were. Improving staff morale and communication with caregivers is crucial in addressing resident loneliness.

ASSESSING REGULATORY STRINGENCY FOR LICENSED ASSISTED LIVING: A MULTIFACETED APPROACH

Abstract Regulations in long-term care settings aim to ensure quality and accessibility for residents. However, inadequate enforcement can limit their impact on the community. Simply increasing regulations does not always lead to improved care, as it may incentivize facilities to limit admissions. Regulatory stringency encompasses the scope, specificity, and enforcement of regulations. This study examines 10 dimensions of specificity related to medical care regulations in assisted living, focusing on scope and enforcement. We found that regulations related to staffing levels and resident assessments governed almost all assisted living communities, while medication review and administrator certification were the least commonly addressed. The “Residential Care Facilities” license with an “Alzheimer’s Dementia Care Unit” certification in Maine had the highest stringency score, though the “Assisted Living Program” license in the same state had one of the lowest. High regulatory specificity and scope scores were not always associated with high enforcement. For example, the “Assisted Living Center” license in South Dakota covered 100% of the scope’s dimensions and 75% of the provisions contributing to the specificity score, but had no regulatory enforcement for these rules. Findings suggest that a multifaceted approach to assessing regulatory stringency is crucial for policymakers and researchers to understand regulatory approaches across license types and states. Accounting for differences in licensure is also important for a broad view of regulatory stringency.

DO PUBLIC HOME CARE CLIENTS “LOSE OUT ON SERVICES” BECAUSE THEY HAVE A FAMILY CAREGIVER?

Abstract The public home care (PHC) system in Canada is heavily reliant on family caregivers to enable clients to stay in the community. When caregivers are present, there are concerns formal home care aide (HCA) services are less available. Using data from the Resident Assessment Instrument for Home Care (RAI-HC), we examined caregiver and client characteristics in relation to HCA service amounts. Our cohorts were individuals aged 60+ receiving an initial RAI-HC assessment in 2011-2013, and one subsequent assessment in two provincial jurisdictions: the Winnipeg Regional Health Authority (n=5,251) and Nova Scotia Health (n=5291). We measured weekly HCA hours and constructed a predictive model for hours of care controlling for client need. To identify the most underserved client population, we calculated the ratio between predicted to actual received hours of care ascertaining the lowest client quintile. In both jurisdictions, the odds of being underserviced were higher when the client co-resided or had a spouse. Clients living alone at initial intake were least likely to be underserved. Caregiver characteristics increasing the risk of being underserved in Winnipeg included providing IADLs/ADLs support, caring more than 14 hours per week and being unable to continue. Rurality increased risk of underservice in Nova Scotia. These findings contribute to the debate: is PHC a supplement or substitution for family care? PHC as a supplement to family care was more pronounced in Winnipeg and in rural Nova Scotia. Implications for greater equity across regions is explored using an Equity, Diversity and Inclusion lens.

COVID-19 AND THE CARE OF ASSISTED LIVING RESIDENTS: THE COVCARES PROGRAM OF RESEARCH

Abstract This presentation describes the goals, design and methods of the COVID-19 and the Care of Assisted living Residents (COVCARES) program of research. Our goals were to address critical knowledge gaps related to how COVID-19 impacted assisted living (AL) residents, family/friend caregivers, and homes, and to compare how outcomes differed between AL and nursing homes (NH). Partnering closely with provincial Alzheimer Societies, family caregiver advocates, and health policy decision makers, we conducted two interconnected studies: The first was a prospective cohort study, surveying family/friend caregivers of AL residents and directors of care of AL homes in the Canadian provinces of Alberta and British Columbia twice (10/2020–04/2021 and 07/2021–09/2021). 673 caregivers and 104 AL homes responded to our first survey. Of those, 386 caregivers and 78 AL homes submitted a second survey. The second was a population-based retrospective cohort study (01/2017–12/2021), using clinical and health administrative data of all AL and NH residents in Alberta. Data included Resident Assessment Instrument (RAI) records, acute care and emergency department admission data, prescription medications, data on COVID-19 infections, and vital statistics of 23,355 AL residents and 41,583 NH residents. Analyzing each of the aforementioned data sets individually, and linking family and facility surveys, as well as resident and facility survey data, we provide unique insights into the impacts of the COVID-19 pandemic on AL settings. The presentations in this symposium will share selected key findings from our program of research.

FEASIBILITY OF THE NUDGELTC CLINICAL DECISION SUPPORT APPLICATION

Abstract Long-term-care residents are at risk for under reporting of urinary tract infections due to insufficient point-of-care testing and indirect communication. Aim: Examine the feasibility of a Clinical Decision Support application (NudgeLTC) designed to guide Licensed Vocational Nurses (LVNs) in data collection to improve communication confidence and satisfaction between LVN and Primary Care Provider (PCP). Sample size: 4 LVNs and 4 PCPs across 10 events. Qualitative description of interview comments and NudgeLTC output documented data collection and communication between LVN and PCP within the app. Forced choice questions about resident signs, symptoms, and laboratory values guided LVN data collection. Information was collected and stored within NudgeLTC. A summary was relayed directly to the PCP and followed with a PCP response to the LVN. Questionnaires included visual analogue scales for confidence (LVNs M=81.6; PCPs M=100 [0 low, 100 high]), satisfaction (LVNs M=7.8; PCPs M=10 [0 low, 10 high]), and the Systems Usability Scale (LVNs M=85.4; PCPs M=100 [0 poor, 100 high]). The NudgeLTC summary included resident assessment, vital signs, and lab values. Particular signs and symptoms noted included indwelling catheter and confusion. Select Challenges: PCP received LVN message and data, but was unable to respond via app; LVN stated the app did not work as “expected.” Transmission issues occurred and were resolved. Asynchronous communication was valued and facilitated confidence in resident data. Difficulties with data collection may, in part, be due to discomfort with technology or infrequent use of electronic charting. Future studies should focus on improving point-of- care data collection.

The 5Cs: an assessment of residents' ability to communicate during virtual consultations.

The 5Cs: an assessment of residents' ability to communicate during virtual consultations.

Needs Assessment of Residents and Nurses for Interprofessional Cross-Cultural Curriculum.

Clinicians must learn to care for patients from different cultures. They must also work in teams for optimal outcomes. Few studies have analysed the intersection of cross-cultural care and interprofessional education. We completed a needs assessment to determine what paediatric residents and nurses view as essential cross-cultural components. We led a sequential mixed-methods study of residents and nurses at an urban tertiary care centre. We administered the 'Residency Training in Cross Cultural Care' instrument. Survey results informed focus group interview guide development. Thematic analysis of qualitative data was conducted following the five stages to qualitative research framework. Thirty-five residents (70%) and 46 nurses (66%) completed the survey. Five residents and six nurses attended a focus group. Five themes resulted: 1) lack of clinician diversity and cross-cultural training, 2) effective cross-cultural care not always delivered, 3) multiple challenges for delivery of effective cross-cultural care, 4) call to action for enhanced cross-cultural education and 5) different cross-cultural educational needs between nurses and residents. Residents and nurses conveyed that meaningful cross-cultural care education is imperative, lacking, and must offer skills to improve patient care. They call for a robust cross-cultural curriculum that is up to date and teaches about intersectionality. We have used this data to implement interprofessional interventions to meet their unique learning needs and enhance upstander skills by using facilitated discussions of techniques, case studies and role plays. Ultimately, teaching all clinicians to care for patients of other cultures may lead to more equitable care.

Specifics of employment in rural areas of Kazakhstan

The employment of rural population in rural regions is the object of close attention from the state. The goal is to identify trends in the structure of the sphere of labor relations in the context of the transition to a post-industrial society and technological modernization of the economy. To conduct the research, general scientific and special methods were used: abstraction, analysis, synthesis and logical cognition. The results—employment and unemployment—are closely related socio-economic categories that characterize labor market policy. Its comparative assessment of urban and rural residents for 2022 is given. The activities of small-scale commodity structures located in rural areas on a regional basis are analyzed. Conclusions - priority directions of agricultural policy have been identified. The negative impact of problems that hinder the growth of labor potential is shown. Modern agricultural labor does not receive proper positive development due to the dissatisfaction of rural workers with their activities, the low level of mechanization of agricultural production sectors, and the material disinterest of workers. Ways of assistance in employment are proposed: development of small forms of entrepreneurship, including expansion and increase in the profitability of personal subsidiary plots and peasant farms; training and retraining of young rural workers and specialists as the main factor determining the growth of their professional mobility and competitiveness. It is necessary to create conditions under which agricultural enterprises and farmers would have the opportunity to work profitably, update fixed assets and equipment, master innovative resource-saving technologies, increase and modernize jobs in the social sector, infrastructure (transportation, storage, marketing of products), housing and communal services, rural construction.

Reliability and validity of Urdu PARENTS for assessing non-technical skills of paediatric residents in a teaching hospital in Pakistan

PurposeThe primary objective of our study is twofold. First, we assessed nontechnical skills (NTSs), such as the cognitive, social, and personal skills of postgraduate residents (PGRs), from paediatric caregivers’ perspectives in a paediatric emergency department (PED) of a tertiary care hospital. Second, we evaluated the reliability and validity of the ‘Parents’ Assessment of Residents Enacting Non-Technical Skills’ (PARENTS) instrument in its Urdu-translated version, ensuring its applicability and accuracy in the Pakistani context.Materials and methodsThis mixed-method study used an instrument translation and validation design. We translated an existing instrument, PARENTS, into Urdu, the national language of Pakistan, and administered it to paediatric caregivers in the PED of a tertiary care hospital. We collected data from 471 paediatric caregivers and coded them for analysis in AMOS and SPSS.ResultsThe Urdu-translated version of the PARENTS demonstrated reliability and internal validity in our study. The findings from the assessment revealed that paediatric caregivers expressed satisfaction with the knowledge and skill of residents. However, there was comparatively lower satisfaction regarding the residents’ display of patience or empathy towards the children under their care.ConclusionThe study findings support the validity and reliability of the PARENTS as an effective instrument for assessing the NTS of PGRs from the perspective of paediatric caregivers. With its demonstrated efficacy, medical educators can utilize PARENTS to pinpoint specific areas that require attention regarding the NTS of PGRs, thus facilitating targeted interventions for enhanced patient care outcomes.

Exploring gender and thematic differences in qualitative assessments of internal medicine resident performance

IntroductionEvidence suggests gender disparities in medical education assessment, including differences in ratings of competency and narrative comments provided in resident performance assessments. This study explores how gender manifests within the content of qualitative assessments (i.e., narrative comments or performance feedback) of resident performance.MethodsQualitative content analysis was used to explore gender-based differences in narrative comments included in faculty assessments of resident performance during inpatient medicine rotations at six Internal Medicine residency programs, 2016–2017. A blinded, multi-analyst approach was employed to identify themes across comments. Patterns in themes with resident gender and post-graduate year (PGY) were explored, focusing on PGY2 and PGY3 when residents are serving in the team leader role.ResultsData included 3,383 evaluations with narrative comments of 385 men (55.2%) and 313 women residents (44.8%). There were thematic differences in narrative comments received by men and women residents and how these themes manifested within comments changed with training time. Compared to men, comments about women had a persistent relationship-orientation and emphasized confidence over training including as interns and in PGY2 and PGY3, when serving as team leader. The relationship-orientation was characterized not only by the residents’ communal attributes but also their interpersonal and communication skills, including efforts supporting others and establishing the tone for the team. Comments about women residents often highlighted confidence, including recommendations around behaviors that convey confidence in decision-making and team leadership.DiscussionThere were gender-based thematic differences in qualitative assessments. Comments about women resident team leaders highlight relationship building skills and urge confidence and actions that convey confidence as team leader. Persistent attention to communal skills suggests gendered expectations for women resident team leaders and a lost opportunity for well-rounded feedback to the disadvantage of women residents. These findings may inform interventions to promote equitable assessment, such as providing feedback across the competencies.

Tissue-specific distribution and bioaccumulation of perfluoroalkyl acids, isomers, alternatives, and precursors in citrus trees of contaminated fields: Implication for risk assessment

The ingestion of fruits containing perfluoroalkyl acids (PFAAs) presents potential hazards to human health. This study aimed to fill knowledge gaps concerning the tissue-specific distribution patterns and bioaccumulation behavior of PFAAs and their isomers, alternatives, and precursors (collectively as per-/polyfluoroalkyl substances, PFASs) within citrus trees growing in contaminated fields. It also assessed the potential contribution of precursor degradation to human exposure risk of PFASs. High concentrations of total target PFASs (∑PFASstarget, 92.45–7496.16 ng/g dw) and precursors measured through the total oxidizable precursor (TOP) assay (130.80–13979.21 ng/g dw) were found in citrus tree tissues, and short-chain PFASs constituted the primary components. The total PFASs concentrations followed the order of leaves > fruits > branches, bark > wood, and peel > pulp > seeds. The average contamination burden of peel (∑PFASstarget: 57.75%; precursors: 71.15%) was highest among fruit tissues. Bioaccumulation factors (BAFs) and translocation potentials of short-chain, branched, or carboxylate-based PFASs exceeded those of their relatively hydrophobic counterparts, while ether-based PFASs showed lower BAFs than similar PFAAs in above-ground tissues of citrus trees. In the risk assessment of residents consuming contaminated citruses, precursor degradation contributed approximately 36.07% to total PFASs exposure, and therefore should not be ignored.

Development and validation of risk of CPS decline (RCD): a new prediction tool for worsening cognitive performance among home care clients in Canada

BackgroundTo develop and validate a prediction tool, or nomogram, for the risk of a decline in cognitive performance based on the interRAI Cognitive Performance Scale (CPS).MethodsRetrospective, population-based, cohort study using Canadian Resident Assessment Instrument for Home Care (RAI-HC) data, collected between 2010 and 2018. Eligible home care clients, aged 18+, with at least two assessments were selected randomly for model derivation (75%) and validation (25%). All clients had a CPS score of zero (intact) or one (borderline intact) on intake into the home care program, out of a possible score of six. All individuals had to remain as home care recipients for the six months observation window in order to be included in the analysis. The primary outcome was any degree of worsening (i.e., increase) on the CPS score within six months. Using the derivation cohort, we developed a multivariable logistic regression model to predict the risk of a deterioration in the CPS score. Model performance was assessed on the validation cohort using discrimination and calibration plots.ResultsWe identified 39,292 eligible home care clients, with a median age of 79.0 years, 62.3% were female, 38.8% were married and 38.6% lived alone. On average, 30.3% experienced a worsening on the CPS score within the six-month window (i.e., a change from 0 or 1 to 2, 3, 4, 5, or 6). The final model had good discrimination (c-statistic of 0.65), with excellent calibration.ConclusionsThe model accurately predicted the risk of deterioration on the CPS score over six months among home care clients. This type of predictive model may provide useful information to support decisions for home care clinicians who use interRAI data internationally.

Characteristics of United States nursing homes with high percentages of stage 2-4 pressure injuries among high-risk nursing home residents with obesity.

Obesity rates in nursing homes (NHs) are increasing. Residents with obesity are at risk for poor outcomes such as pressure injuries (PIs) due to special care needs such as bariatric medical equipment and special protocols for skin care. PIs among resident populations is a sign of poor quality NH care. The purpose of this retrospective observational study was to identify characteristics of NHs with high rates of stage 2-4 PIs among their high-risk residents with obesity. Resident assessment data were aggregated to the NH level. NH structure and process of care and antecedent conditions of the residents and environment measures were used in bivariate comparisons and multivariate logistic regression models to identify associations with NHs having high rates of stage 2-4 PIs among high-risk residents with obesity. We identified three characteristics for which the effect on the odds was at least 10% for clinical significance - for-profit status, large facilities, and the hours of certified nursing assistants (CNAs) per patient day (HRPPD). This study identified several NH characteristics that are associated with higher risk for PIs, which can be targeted with evidence-based interventions to reduce the risk of these adverse safety events occurring.