Scheduling Conflicts Research Articles

Divergent rhythms of motherhood. Patterns of paid and unpaid work and domestic outsourcing among mothers in the United Kingdom and Western Germany

Objective: This article investigates class differences in mothers’ daily organization of paid and unpaid work, and how they are associated with domestic outsourcing in the United Kingdom and Western Germany. Background: Operating hours of schools and daycare facilities often conflict with long working hours in high-skilled jobs and nonstandard working hours in low-skilled jobs. However, little is known on whether advantaged mothers rely on domestic outsourcing to resolve such scheduling conflicts, and how disadvantaged mothers reconcile their daily care responsibilities with paid work, depending on the welfare state context. Method: The study uses sequence and cluster analyses on time-use data to identify typical patterns of paid and unpaid work (N=1,947). Regression models predict how these patterns differ by the mothers’ education and household income, and how they are associated with outsourcing housework and childcare. Results: In both contexts, disadvantaged mothers were more likely to have unpaid workdays rather than nonstandard workdays. However, British advantaged mothers were considerably more likely to outsource childcare to pursue standard workdays. By contrast, the pattern of partial workdays in the morning, combined with more unpaid work allocation, prevailed among Western German mothers. Conclusion: In the United Kingdom, more market-oriented as opposed to conservative family policies, stronger labor market deregulation, and more consistent policy incentives for domestic outsourcing seem more effective than in Western Germany in promoting advantaged mothers’ careers. However, this comes at the expense of greater class differences in how mothers organize their time.

Meeting Men Where they are: Motivators and Barriers to Accessing Health Services through a Men's Mobile Wellness Clinic, October 2019 to March 2020, Blantyre, Malawi.

In Malawi approximately, 88.3% people living with HIV are aware of their HIV status. Significant gaps are among men aged 15-34 years; only 72% know their HIV status. To reach men, Jhpiego, in collaboration with the Ministry of Health (MOH), implemented the Men's Mobile Wellness Clinic (MMWC) at workplace settings in Blantyre, Malawi between October 2019 and March 2020. We conducted a descriptive qualitative study to understand motivators and barriers to MMWC service uptake by employees and employers. Primary data was drawn from in-depth telephone interviews from four study populations: employers who accepted or declined to host the MMWC at their worksite, and employees who accessed or did not access the services. We performed a thematic analysis using Nvivo 12 software to identify patterns and themes across the dataset. Main reasons given for using the service among male employees were a desire to know their health status, availability of free health services at the workplace, and good quality services offered by MMWC staff, and support from their supervisor. Men who did not access services stated reasons such as work-clinic scheduling conflicts, lack of adequate promotion of the service, and miscommunication on the criteria about who should attend the MMWC. Employers who accepted to host the MMWC stated convenience and employee's rights to know their health status. Those who declined either stated that employees did not want the services or COVID-19 preventive measures by the MOH between October 2019 and March 2020 restricted participation. This study underscores the potential utility of MMWC services including HIV testing among men. The desire to know their health status, availability of free MMWC services at the workplace, good quality services offered by MMWC staff, and the endorsement of MMWC by supervisors were main motivators to access the MMWC services. Sensitizing supervisors and employees about the benefits of the MMWC services, strengthening demand creation, and clarifying eligibility are important to facilitate MMWC uptake among men in Malawi.

5066 Evolution And Evaluation Of A Longitudinal ECHO Program In Transgender Health

Abstract Disclosure: M.S. Rothman: None. A. Chippone: None. A. Clark: None. D. Saxon: None. D. Miller: None. K. Young: None. S.J. Iwamoto: None. Background: Providers often report a lack of training in the care of transgender and gender diverse(TGD) patients. Extension for Community Healthcare Outcomes(ECHO) programs have been developed around the world as a form of tele-mentoring. As gender-affirming care bans rise in the US, it is crucial for providers to have access to education in TGD patient health. ECHO Colorado(CO) launched “Comprehensive Care for Transgender Patients” in 2020 as an ongoing live monthly series for providers interested in improving care for TGD patients. Design/Methods: 40 sessions were held between 2/2020-9/2023. Topics spanned mental health, medical, and surgical care with didactic presentations followed by case discussions. Demographic data was collected at registration via Connect, an online portal, and evaluations were conducted quarterly using Qualtrics. Not all questions were required. Participants attending at least one session in the quarter were eligible to complete the survey. With multiple responses, the most recent survey was used in the analysis. Results: 257 individuals participated in at least one session. 164/255 (64.3%) respondents identified as clinical health care providers. The majority of the remainder identified as: behavior health professional(n=28), other(n=23) or health outreach/admin(n=17). Most participants (79.4%) practice in CO and the majority provide direct care for underserved populations. 110 attendees responded to at least one survey. 96% of all participants reported improved understanding of the subject matter. Of the prescribing providers, 80%(60/75) rated themselves as comfortable with continuing and 68%(51/75) were comfortable with initiating hormone therapy. In the most recent quarter, participants were asked to self-report levels of professional isolation before and after the series. 30%(8/27) reported feeling very or extremely isolated prior, while none(0/27) reported this since participating. Common barriers reported were obstacles to implementing care and scheduling conflicts preventing attendance. Conclusion: Participants with a variety of backgrounds are highly satisfied with this longitudinal program. ECHO learning may combat feelings of professional isolation. The majority of providers report comfort with initiating and providing hormone therapy, but future efforts should seek ways to improve comfort, competency and examine asynchronous educational opportunities. Interest from attendees outside of CO supports a need for a national collaborative of TGD focused ECHOs. Presentation: 6/1/2024

Enhancing Laboratory Sample Collection Efficiency through Laboratory Information Systems: Insights into Optimal Despatch Rider Management

Effective administration of dispatch riders is crucial for delivering reliable diagnoses and research results by enabling prompt and precise sample collection. Laboratory Information Systems (LIS) offers a solution to enhance the efficiency and organization of dispatch riders in laboratory settings. Thus, the main objective of this study is to provide insights and knowledge on the potential benefits of implementing LIS to optimize the management of dispatch riders and enhance the efficiency of sample collection. An analysis of previous research findings illustrates the varied benefits of using LIS in improving key performance indicators such as turnaround time, mistake rates, and coordination of dispatch riders. The LIS platform serves as a centralized system for managing and allocating sample collection jobs, minimizing scheduling conflicts, and optimizing dispatch rider routes. Real-time tracking capabilities enable laboratory management to monitor dispatch rider locations and sample collection progress, facilitating enhanced coordination and resource allocation. Furthermore, LIS-generated data analytics provide valuable insights into sample collection patterns, enabling proactive management strategies to mitigate potential bottlenecks. Integration of LIS into payroll systems allows for automated compensation calculation based on dispatch rider performance metrics, ensuring fair and transparent pay rates. Studies consistently demonstrate that adequate compensation positively impacts dispatch rider motivation and sample collection effectiveness. This study highlights the vital importance of LIS in enhancing dispatch rider administration for efficient sample collection operations. It provides insights for laboratory managers and policymakers to optimize the potential of LIS to improve operational performance, facilitate patient care, and advance research outcomes.

Evaluating Patient Perceptions of Pharmacist-Led Medication Therapy Management in Hypertension Management

Background: Hypertension is the primary contributor to cardiovascular diseases worldwide, it affects millions and needs effective management strategies. Pharmacist-led Medication Therapy Management (MTM) is essential in improving medication adherence and optimizing the treatment outcomes for patients suffering from hypertension. Objective: This study aims to evaluate patient perceptions of pharmacist-provided Medication Therapy Management (MTM) services for managing hypertension. Moreover, it evaluates to examine how these perceptions influence patient`s adherence to their prescribed treatment regimens. Methods: This cross-sectional observational study aimed at determining the patients' perceptions on the Medication Therapy Management (MTM) services they receive to control their hypertension. Data from 114 patients was obtained and their perceptions were recorded using the survey instruments. Patients below 20 years were excluded. The data was assessed using the SPSS 24th version. The p-value was ascertained by using the Chi-square test. Results: The study analyzed 114 hypertensive patients predominantly females (63.2%) aged 50 years or above (51.8%). The selection of patients was based on a convenience-stratified strategy. The p-value was ascertained by using the Chi-square test. The majority had been managing hypertension for over a year (88.8%), with 45.6% managing it for 1-5 years. Educational levels varied, and most participants resided in urban areas (75.4%). Awareness of hypertension management was high with 86% of patients recognizing MTM's positive influence on medication adherence. Despite these favorable outcomes, challenges such as medication costs and lifestyle changes were noted, highlighting the need for tailored interventions to improve patient adherence and health outcomes. Conclusion: In conclusion, most hypertensive patients understood how to manage their condition and found Medication Therapy Management (MTM) helpful. MTM improved their medication adherence, reduced side effects, and enhanced their understanding of the treatment, leading to better health outcomes. However, challenges such as medication costs, lifestyle changes, and scheduling conflicts made it harder for patients to fully follow MTM advice. Despite these challenges, MTM played an important role in effectively managing hypertension.

Enhancing Geometry Achievement in Pre-Service Mathematics Teachers: The Impact of a Scaffolded Flipped Classroom Using a Learning Management System

This study investigates the effectiveness of a flipped classroom approach integrated with scaffolding through a Learning Management System (LMS) in enhancing the geometry achievement of pre-service mathematics teachers. The study utilized an experimental post-test-only control group design involving 63 randomly selected pre-service mathematics teachers. The experimental group received instruction through a flipped classroom model supplemented with scaffolding and LMS support, while the control group experienced traditional teaching methods enhanced by scaffolding and LMS. Quantitative data were collected via a geometry essay test and analyzed using descriptive and inferential statistics, including t-tests. The results revealed that the experimental group significantly outperformed the control group in geometry achievement. Additionally, qualitative data from thematic analysis of semi-structured interviews indicated that the flipped classroom approach fostered improved comprehension, peer interaction, and active discussion, despite challenges such as varying levels of motivation and scheduling conflicts. The scaffolding provided was found to be an effective strategy in clarifying complex topics and enhancing student success. This study underscores the potential of integrating a flipped classroom with scaffolding and LMS to improve geometry achievement and overall instructional quality.

Development and implementation of an optimization model for the assignment of medical specialties in clinics: application of the Knapsack algorithm with a graphical interface in Python

This project presents the development and application of an optimization model designed to allocate medical specialties to clinics based on a predefined schedule. By employing the Knapsack algorithm in Python, the model aims to optimize resource utilization within a medical environment, ensuring that the distribution of services is both efficient and effective. The model incorporates critical constraints such as clinic capacity and patient service demand, which are essential for balancing resources across various specialties. Furthermore, the model addresses potential scheduling conflicts, ensuring that no overlaps occur among different specialty professionals assigned to the same clinic. The integration of these constraints ensures that the allocation process is not only optimal but also practical for real-world implementation. The results demonstrate the potential of this approach to enhance operational efficiency, minimize resource wastage, and improve patient care by strategically managing the availability of specialized medical services across clinics. This model serves as a robust framework for healthcare organizations aiming to improve their resource management strategies.

Analisis Kepuasan Pasien Terhadap Kualitas Pelayanan Rawat Jalan Rumah Sakit X Menggunakan Service Quality Metode Costumer Statisfaction Index (CSI) dan Importance Performance Analysis (IPA)

This study aims to evaluate the level of customer satisfaction with outpatient services at Hospital X and identify areas that require improvement. The results of data processing show that the customer satisfaction index (CSI) value obtained is 76.435%, which is included in the "Satisfied" category. However, there are still a number of patients who are dissatisfied with the services they receive, so efforts are needed to improve the quality of outpatient services. Meanwhile, the results of further analysis using the importance performance analysis (IPA) method reveal attributes that require special attention. The attributes are in Quadrant I of the Cartesian IPA diagram, which shows improvement priorities. Recommendations for improvement include adding facilities such as drinking water stations, children's play areas, and spare chairs for patients queuing. Apart from that, it is necessary to design standard operating procedures (SOP) that are in accordance with doctors' schedules to avoid schedule conflicts, as well as regular training regarding service excellence for medical personnel and hospital staff. The implementation of these recommendations is expected to increase patient satisfaction with outpatient services at Hospital X.

The Future of Speech Therapy for Autism: Bridging Technology and Personalized Care

Researchers have been working on autism since the 1980s [1]. Autism spectrum disorder (AUD) is a complex neurodevelopment condition that affects people's interaction with others, behavior, communication, and social interaction. Although autism may be a lifelong condition, appropriate support, services, and treatments can improve a person's symptoms and daily functioning. Individuals with autism often face challenges with speech and language development are prominent. Speech therapy (ST) plays a role in gaining control over verbal communication. An effective speech therapy can enhance the quality of life by addressing communication difficulties. Traditionally, the treatment of autism has a multidisciplinary approach that aims to address the diverse needs of individuals on the spectrum. Advancements in technology are revolutionizing the field by offering various possibilities for personalized care and improved outcomes. Healthcare professionals diagnose autism by assessing a person's development patterns and behaviors. Currently, speech therapy is delivered through face-to-face interactions with a trained therapist. Because parents of autistic children consistently identify language and social communication skills as a top priority. This approach has limitations, like scheduling conflicts, limited access to geographical constraints, and specialized care [2]. Telepractice platforms and virtual reality systems (VR), offer novel opportunities for accessible, personalized, and engaging therapy experiences. Telepractice is an online therapy service via technology-based platforms that allows long-distance interventions, breaking geographical barriers and expanding access to specialized care. Specifically, telepractice capitalized on communication practices such as video conferencing, and data tracking tools to facilitate effective communications and reduce barriers like distance. It is a very effective and low-cost method for conducting and completing online sessions for individuals with autism spectrum disorder [3]. The use of mobile technology in various countries become a necessity in the lives of people and also makes it a potential medium of intervention for people diagnosed with autism. It also enhances social skills, language development, and communication abilities. Virtual reality is an essential tool for healthcare intervention, offering realistic scenarios for practicing communication strategies and social interaction. Virtual reality interventions can lead to more stable and faster communication skills over time [4]. Advancements in artificial intelligence has enabled therapists to analyze data and identify patterns to meet the unique needs of each individual with autism. Technology is poised to facilitate collaboration and communication among individuals, and promote consistency across various settings. Researchers are involved in creating and training robots to interact with autistic children. We can empower individuals with autism to reach their full communication potential with the help of these latest technologies.

INNOVATIONS IN SCHOOL ROOM RESERVATION MANAGEMENT: TOWARDS SMART AND SUSTAINABLE SOLUTIONS

Abstract The efficient management of school room reservations is crucial for maximizing resource utilization and ensuring smooth operations within educational institutions. Traditional room reservation systems often suffer from inefficiencies, leading to underutilization of spaces, scheduling conflicts, and increased administrative burden. This research paper explores the development and implementation of smart and sustainable solutions for school room reservation management. The suggested approach makes use of contemporary technologies to expedite the classroom reservation process, giving teachers, administrators, and students effective means of scheduling and overseeing room reservations. The technology has significantly improved classroom utilization rates and overall operational efficiency in our institution, according to preliminary tests. The school room reservation system provides a scalable solution for improving the management of educational facilities by lowering scheduling conflicts, minimizing downtime between courses, and enabling better resource allocation. Future improvements could incorporate support for mobile platforms, integrate with current school management systems, and introduce new capabilities in response to user feedback and changing needs. In general, the establishment of this school room reservation system is a step toward the modernization of facilities management procedures in academic establishments, which will ultimately lead to the creation of a more efficient and cooperative learning environment. Index Term : Frontend development HTML, CSS, React, Backend NodeJS, Express, MongoDB

Capillary versus Venous Glucose for the Screening 1-Hour Glucose Tolerance Test for Gestational and Pregestational Diabetes

Purpose: This study aimed to assess for disparities between capillary blood glucose and plasma glucose for the O’Sullivan 1-hour glucose tests. Methodology: Subjects included were English-speaking, non-incarcerated, adult (>18 years old) pregnant patients who could give informed consent. Patients were approached at their outpatient obstetric office visits. After receiving written and verbal consent, patients were given a 50-g glucose load at the conclusion of their clinic visit. Strictly timed venous and capillary blood draws were performed at the outpatient labs. The venous and capillary blood samples were drawn within less than 5 minutes of each other and analyzed using select chemistry analyzers within less than one hour. Quality control measures, including recalibration, testing, and various quality control mechanisms, were reassessed every 24 hours. Data was tested for normal distribution with the Shapiro-Wilk test and Kolmogorov-Smirnov tests. Paired T-tests were used to compare the average difference between measurements in subjects on GraphPad. Results: One hundred patients had enrolled in the study, with ten dropping out soon after being consented. Patients were lost due to nausea and vomiting with the 50-gram glucose load (4 patients) and scheduling conflicts (6 patients). Demographics identified 84% as African American (76/90), average body mass index (BMI) being 35.4 kg/m2, and a mean age of 26. All data of the differences (capillary minus venous glucose) were found to be normally distributed. The capillary sample was significantly different from the venous sample, with the former being, on average 6.156 mg/dL higher than the latter (P 0.0008, CI 2.65 to 9.66). Subgroup analysis suggested significant differences in values among the multiparous patients (P 0.0014, CI -13.18 to -3.349), with capillary glucose being on average 8.26mg/dL higher. Similarly, patients with BMI < 30 mg/kg had significantly different sample values (P 0.0031, CI -18.75 to -4.25), with capillary glucose being 11.50 mg/dL higher on average. Patients with a gestational age of 24 weeks and beyond also had significantly different samples based on collection site (P 0.0023, CI 2.7 to 11.75), with capillary being on average 7.226 mg/dL higher. Patients with BMI 30.0 to 39.9 had no significant difference between capillary and venous glucose (P 0.2393, CI -8.72 to 2.25), with capillary being 3.24 mg/dL higher on average. Patients with BMI 40 or higher also showed no significant difference between venous and capillary glucose (P 0.1053, CI -10.11 to 1.030), with capillary glucose being on average 4.52 mg/dL higher. Nineteen (21%) patients failed their glucose test based on one or both samples. In 12 patients (13%), the two samples were in agreement for test failure. However, seven patients (7.8%) had discordant results where the glucose was less than 140 mg/dL for one sample and higher for the other. Furthermore, 4 of these patients passed by the venous sample and failed with the capillary, and the reverse in sample source occurred in 3 patients. None of the patients with discordant results failed their 3-hour confirmatory test. Discussion: All pregnant patients undergo gestational diabetes mellitus (GDM) screening, and those with diabetes risk factors such as obesity and a history of GDM undergo early diabetes screening. The two-step approach commonly used in the United States is a one-hour 50-gram oral glucose tolerance test (OGTT) using a venous plasma glucose sample. If a patient fails (glucose > 140 mg/dL), she undergoes a 3-hour OGTT. Other accepted cutoffs for the one-hour OGTT are 135 mg/dL and 130 mg/dL. Venous sampling has some factors which lead to inaccuracy, including ongoing glycolysis in samples and decreased concentration compared to capillary/arterial samples in postprandial patients. Capillary sampling can be inaccurate in patients with microvascular disease such as shock, COPD, and Raynaud’s disease. Our institution uses point-of-care testing (POCT) on capillary (finger-stick) using a glucometer with a 140 mg/dL cutoff. Studies are mixed in their endorsement of POCT for the diagnosis/screening of DM. This study suggests that capillary testing is more sensitive to hyperglycemia in postprandial patients and is more sensitive for non-obese, multiparous, and patients undergoing screening for gestational diabetes at 24 weeks GA and beyond. This study also suggests that if POCT/capillary testing is considered, the higher (140) cutoff may be the best. The findings do not show that there is a significant risk of missing diagnoses of GDM, but a higher incidence of needing 3-hour glucose tolerance testing due to its higher sensitivity.

Implementation of hematology oncology lecture series for nursing staff.

e21005 Background: Westchester Medical Center has an oncology unit that provides care for hundreds of patients annually. Inpatient cancer patients often have especially complex medical treatment plans that require interdisciplinary collaboration and specialized knowledge of oncologic conditions. There is a need to implement formal teaching tailored to nursing staff devoted to topics in hematology and oncology. Our goal was to develop a monthly lecture series for nursing that deepened their understanding of cancer treatments, enabling them to assess and monitor patients with greater expertise. Methods: Topics were chosen based on relevance and are listed in the table. Speakers included full-time faculty, fellows and residents, pharmacists, and medical students. Ten lectures were completed and scheduled approximately once monthly in the mornings just prior to sign out for nursing shift change. Nursing staff were asked to complete a set of questions prior to each lecture (Pre-Test) They were given the same set of questions after each lecture (Post-Test) to determine whether there was an improvement in understanding of the topic. Informational handouts were distributed at the end of each lecture to provide participants with a summary of key points. A survey administered at the conclusion of the lecture series was collected to assess attitudes towards the lectures. Results: Overall test scores improved after each lecture was given, as demonstrated in the table: Pre and Post Lecture Test Scores. Additionally, feedback regarding the lectures was positive. 100% agreed that they gained a better understanding of topics related to hematology oncology and 92% agreed that participation in these lectures has improved their ability to function collaboratively on interprofessional healthcare teams. Conclusions: A didactic lecture series is a valuable component of hematology oncology education for nursing staff and will improve quality of care of the oncology service. Some limitations of this lecture series concerned nursing staff scheduling conflicts and their availability for lecture attendance. Possible interventions in the future may include setting aside time dedicated for monthly lectures and scheduling lectures for afternoons to avoid conflicts with shift changes and morning rounds. Nevertheless, our findings highlight the value of continued education in empowering nursing staff to deliver quality care to hematology oncology patients.[Table: see text]

INNOVATIONS IN SCHOOL ROOM RESERVATION MANAGEMENT: TOWARDS SMART AND SUSTAINABLE SOLUTIONS

Abstract— In order to maximize resources and create an optimal atmosphere for learning, educational institutions must manage their facilities effectively. This essay describes the planning and execution of a system for reserving school rooms with the goal of increasing classroom usage. The suggested approach makes use of contemporary technologies to expedite the classroom reservation process, giving teachers, administrators, and students effective means of scheduling and overseeing room reservations. The technology has significantly improved classroom utilization rates and overall operational efficiency in our institution, according to preliminary tests. The school room reservation system provides a scalable solution for improving the management of educational facilities by lowering scheduling conflicts, minimizing downtime between courses, and enabling better resource allocation. Future improvements could incorporate support for mobile platforms, integrate with current school management systems, and introduce new capabilities in response to user feedback and changing needs. In general, the establishment of this school room reservation system is a step toward the modernization of facilities management procedures in academic establishments, which will ultimately lead to the creation of a more efficient and cooperative learning environment. Index Term: Frontend development HTML, CSS, React, Backend NodeJS, Express, MongoDB

Application of Round Robin in Scheduling in Web-Based Wedding Organizers

Wedding are cherished moments in the lives of couples. However, the complexity of wedding planning often poses challenges in arranging event schedules. To address this issue, this study aims to implement the Round Robin method for scheduling in a web-based Wedding Organizer. The Round Robin method is a scheduling algorithm that evenly allocates time for various necessary activities. In the context of a web-based Wedding Organizer, its implementation can optimize wedding activity scheduling by considering available time slots and avoiding scheduling conflicts among vendors. This research involves the development of a web-based application that employs the Round Robin method to organize the schedules of various vendors involved in weddings. The application offers convenience to couples-to-be and Wedding Organizers in viewing, organizing, and utilizing resources more effectively. With the application of the Round Robin method, it is anticipated that the operational efficiency of Wedding Organizers will improve, schedule conflicts will be mitigated, and the allocation of limited resources can be maximized. This study contributes to the advancement of a web-based Wedding Organizer scheduling.

Research on AGV scheduling and potential conflict resolution in port scenarios: based on improved genetic algorithm

In the research of Automated Guided Vehicle (AGV) scheduling, the most critical issues are the optimization of task allocation to AGVs and the handling of conflict scenarios. To address these challenges, we propose a scheme for AGV scheduling optimization and conflict resolution. To begin with, we introduce a novel improved genetic algorithm grounded on a combination strategy that re-encodes tasks into compound groupings, effectively simplifying large-scale integer programing problems into smaller, more manageable ones. Subsequently, the simplified problem is solved using an improved genetic algorithm. Test results validate that this method not only quickens the pace of finding solutions but also significantly improves the quality of those solutions. This is particularly evident when it comes to managing larger-scale optimization challenges. Furthermore, within AGV system conflict scenarios, this paper divides them into two primary categories: navigational conflicts and task quantity changes. For navigational conflicts, three resolution approaches are designed to address four different types of conflict situations: head-on, crossing, occupation, and chasing conflicts. Considering the fluctuations in task quantity, we developed strategies for rescheduling, non-rescheduling, and insertion rescheduling. Their performances were experimentally compared across various scales of scheduling problems, providing data support and theoretical basis for the selection of scheduling strategies in practical applications.

A qualitative evaluation of the pathway for eating disorders and autism developed from clinical experience (PEACE): clinicians' perspective.

The Pathway for Eating disorders and Autism developed from Clinical Experience (PEACE pathway) is a clinical pathway of adapted treatment for individuals with eating disorders and autism in the UK. This study aims to investigate multidisciplinary clinicians' views of the strengths and challenges of PEACE pathway adaptations, while identifying areas where further improvement is needed. Semi-structured interviews were conducted with 16 clinicians who worked on the PEACE pathway. Themes relevant to the benefits, challenges and areas of improvement were identified, and a thematic map was produced. PEACE Pathway brought clinical benefits such as improved understanding of patients' perspective, improved flexibility and individualisation in clinicians' approach, increased patient engagement, and provision of resources that are helpful to all patients with or without autism. Benefits to the service included increase in autism awareness, clinicians' confidence, and team collaboration. Challenges were also identified, including difficulties in incorporating autism adaptations into existing treatment protocol, implementing PEACE at different levels of care, staff schedule conflicts, and increased pressure to meet patients' needs. Overall, there is a need for systemic improvement in aftercare and community support for autism, more suitable autism screening tool, and more structured guidelines for making adaptations. PEACE Pathway has brought clinical and service benefits, while also bringing practical challenges rooted in the difficulty in distinguishing between autism and eating disorder in comorbid population. Future areas of improvement are highlighted for PEACE resources as well as in the national support system for autistic individuals.

Developing and evaluating an evidence-based practice research competency enhancement program for clinical nurses in Korea: a pilot study

BackgroundEvidence-based practice (EBP) is crucial for delivering high-quality healthcare and effective self-care. Enhancing clinical nurses’ research competencies through structured mentorship is key to the widespread application of EBP. This study evaluated a newly developed Research Competency Enhancement Program (RCEP), aimed at bolstering EBP among experienced nurses.MethodsConducted in a tertiary university hospital in Korea, this single-group study employed a pretest-post-test design and a mixed-methods approach. The RCEP involved 11 experienced clinical nurses in an 8-week intervention, featuring mentor-led workshops, interactive sessions, and resource-driven activities. Data were collected using the Evidence-Based Practice Beliefs Scale (EBPB), the Evidence-Based Practice Attitude Scale (EBPA), and the Research Practice Ability (RPA) tool, alongside qualitative feedback. These measures assessed the program’s feasibility, acceptability, and preliminary effectiveness.ResultsThe quantitative analysis indicated significant improvements in research competency post-intervention. Mean scores on the EBPB and RPA scales increased (Z = -2.53, p = .011; Z = -2.66, p = .008). Participants described the RCEP as inspirational and challenging, creating an environment conducive to research. Facilitators included mentor support and innovative learning tools, while barriers were internet connectivity and scheduling conflicts. Suggestions for improvement included more hands-on sessions, small team collaborations, and integration with academic institutions.ConclusionThe RCEP, facilitated by EBP mentors, significantly improved the research competencies and attitudes of clinical nurses towards EBP. The study underscores the importance of continual RCEP refinement, integrating structured, interactive, and collaborative elements to further empower nurses in evidence-based practice. The program shows promise in enhancing research competencies and fostering a commitment to EBP in clinical settings.

Peningkatan Perilaku Sosial Santri melalui Peran Wali Asuh di Pesantren

This study explores ways to improve students' social behavior through the role of foster guardians in Islamic boarding schools. This study uses qualitative research methods. The data sources are interviews with key informants, the heads and administrators of Islamic boarding schools, and observations. This research shows that Islamic boarding schools have unique methods for improving students' social behavior. The indicator is the active involvement of foster guardians in implementing the Islamic boarding school program. There are three types of programs implemented by foster guardians to improve the social behavior of students, including routine recitation, cleanliness pickets, and social service. The implementation of these three programs has supporting and inhibiting factors. Supporting factors for foster guardians to improve the social behavior of students, such as cooperation and discipline between foster guardians to help the administrators with their duties so that it is easier for their foster children to carry out Islamic boarding school activities. In contrast, inhibiting factors are lack of coordination, cooperation, and conflicts in the foster guardian's activity schedule.

Telemedicine Reduces Missed Appointments but Disparities Persist

IntroductionMissed appointments also known as “no-shows” adversely affect clinical outcomes, clinic efficiency, and quality of care and have been attributed to barriers such as work schedule conflicts and lack of transportation. The widespread telemedicine implementation and adoption that has occurred as a consequence of the COVID-19 pandemic has the potential to address these barriers and improve missed appointment rates. This study aims to analyze the relationship between telemedicine and missed appointments. MethodsThis retrospective cohort study used electronic health records data from a safety-net academic health center with federally qualified clinics (March 2020 to December 2022). Bivariate and multivariable generalized estimating equations were used to analyze the relationship between no-show and appointment type (in-person versus telemedicine appointment). Stratified adjusted regression analyses were used to calculate the average change in the marginal effect of telemedicine appointments on no-shows across covariates. The data was analyzed from 09/2023-10/2023. ResultsHispanic patients accounted for 60% of the 474,212 appointments, followed by non-Hispanic White (22.5%), Non-Hispanic Black (13.3%), Asian (2.7%), Native American (1%) and “other race/ethnicity” patients (0.6%). The no-show rate for telemedicine appointments was 12% compared to 25% for in-person appointments. Multivariable analysis showed that telemedicine appointment was associated with a decreased likelihood of no-show compared to in-person appointments (OR:0.40; 95% CI:0.40, 0.41). The average change in the marginal effect of telemedicine appointments on the reduction of no-shows across race/ethnicity was greatest for Native American and non-Hispanic Black patients. ConclusionsTelemedicine appointments were associated with decreased likelihood of no-shows and the protective effect of telemedicine appointments on missed appointments was greatest for underserved groups. Strategies to increase telemedicine uptake especially for underserved groups are critical.

Expectation, Attitude, and Barriers to Receiving Telehomecare Among Caregivers of Homebound or Bedridden Older Adults: Qualitative Study.

In recent years, telehomecare has become an increasingly important option for health care providers to deliver continuous care to their patients. This study aims to explore the expectations, attitudes, and barriers to telehomecare among caregivers of homebound or bedridden older adults. This qualitative study used semistructured interviews to explore caregivers' perspectives on telehomecare for homebound or bedridden older adults. The study adhered to the SRQR (Standards for Reporting Qualitative Research) guidelines. Participants were selected using convenience sampling from caregivers of homebound or bedridden older adults with experience in both in-person home visits and telehomecare services provided by the Department of Family Medicine at Chiang Mai University, in an urban area of Chiang Mai Province in Northern Thailand. Semistructured interviews were conducted. The interviews were audio recorded with participant consent and transcribed verbatim. The framework method was used, involving multiple readings of transcripts to facilitate familiarization and accuracy checking. The study used the technology acceptance model and comprehensive geriatric assessment as the analytical framework. The study included 20 caregivers of older adult patients. The patients were predominantly female (15/20, 75%), with an average age of 86.2 years. Of these patients, 40% (n=8) of patients were bedridden, and 60% (n=12) of patients were homebound. Caregivers expressed generally positive attitudes toward telehomecare. They considered it valuable for overall health assessment, despite recognizing certain limitations, particularly in physical assessments. Psychological assessments were perceived as equally effective. While in-person visits offered more extensive environmental assessments, caregivers found ways to make telehomecare effective. Telehomecare facilitated multidisciplinary care, enabling communication with specialists. Caregivers play a key role in care planning and adherence. Challenges included communication issues due to low volume, patient inattention, and faulty devices and internet signals. Some caregivers helped overcome these barriers. The loss of information was mitigated by modifying signaling equipment. Technology use was a challenge for some older adult caregivers. Despite these challenges, telehomecare offered advantages in remote communication and resolving scheduling conflicts. Caregivers varied in their preferences. Some preferred in-person visits for a broader view, while others favored telehomecare for its convenience. Some had no strong preference, appreciating both methods, while others considered the situation and patient conditions when choosing between them. Increased experience with telehomecare led to more confidence in its use. Caregivers have positive attitudes and high expectations for telehomecare services. Although there may be barriers to receiving care through this mode, caregivers have demonstrated the ability to overcome these challenges, which has strengthened their confidence in telehomecare. However, it is important to enhance the skills of caregivers and health care teams to overcome barriers and optimize the use of telehomecare.