Skilled Staff Research Articles

Technology-enhanced training for central venous catheter insertion training: a reflective essay

Abstract With the advancement of innovative technology, healthcare professionals stand to benefit from adjustments to procedural skills training/assessment introduced during the COVID-19 pandemic. In this essay, we reflect on the development of a virtual reality (VR)-based training programme to support medical and nursing staff in procedural skills for central venous catheter (CVC) insertion, related communication skills and situation awareness. The remote delivery was a direct response to the impact of the pandemic and is likely to remain as an educational strategy on our centre.

Burnout in Cybersecurity Incident Responders: Exploring the Factors that Light the Fire

As concerns about employee burnout and skilled staff shortages in cybersecurity grow, our study aims to better understand the contributing factors to burnout in this field. Utilizing a mixed-methods approach, we analyze self-reported job and personal characteristics, along with digital activity data from 35 incident responders, identifying several factors such as high workload, time pressure, and lack of support from management. Our findings reveal that over half of the participants experience burnout (N=19), which is linked to increased workload, limited control, poor teamwork, and inadequate recognition. Burned-out responders often work more than 40 hours per week, have poor sleep quality, and engage in more email activities, meetings, and after-hour collaborations. Through our research, we also identify coping strategies individuals use to mitigate these stressors. Based on our findings, we provide practical recommendations to help organizations better support their cybersecurity incident response teams. While our study acknowledges limitations and suggests future research directions, it contributes significantly to understanding the challenges faced by cybersecurity incident responders. Our insights offer a comprehensive understanding of burnout factors in this domain and have broader implications for other high-stress work environments consistent with the interdisciplinary nature of CSCW.

The Role of Human Factors in Maintaining Service Quality in Hospitals

The delivery of high-quality healthcare services is a multifaceted endeavor influenced by various factors, among which human factors play a pivotal role. This paper explores the significance of human factors in upholding service quality within hospital settings. Drawing upon interdisciplinary research from fields such as psychology, sociology, and healthcare management, it examines the intricate interplay between healthcare professionals, patients, and organizational structures. In today's healthcare landscape, where patient-centric care is increasingly emphasized, understanding the impact of human factors is paramount. One of the primary focuses is on patient satisfaction, which is not only influenced by clinical outcomes but also by the quality of interactions with healthcare providers. Effective communication between healthcare professionals and patients is essential for building trust, managing expectations, and ensuring informed decision-making. Moreover, the demeanor, empathy, and interpersonal skills of healthcare staff significantly contribute to patients' overall experience and satisfaction levels. Safety is another critical aspect of service quality in hospitals, and human factors play a central role in patient safety initiatives. Research has shown that the majority of adverse events in healthcare are attributable to human error, highlighting the importance of addressing factors such as fatigue, stress, and workload among healthcare professionals. Furthermore, teamwork and collaboration are vital for promoting a culture of safety, where healthcare providers work together cohesively to identify and mitigate risks, thereby enhancing patient outcomes and reducing preventable harm. Effective leadership within healthcare organizations is also instrumental in shaping service quality. Strong leadership sets the tone for organizational culture, values, and priorities, influencing the behavior and performance of healthcare staff. Leaders who prioritize patient-centered care, employee well-being, and continuous quality improvement foster an environment conducive to delivering high-quality services. To optimize service quality, hospitals must invest in staff training, development, and support programs. Ongoing education ensures that healthcare professionals stay abreast of the latest evidence-based practices, technological advancements, and regulatory requirements. Moreover, initiatives to promote staff well-being, such as employee assistance programs, work-life balance initiatives, and resilience training, are essential for preventing burnout and maintaining morale. In conclusion, human factors play a multifaceted role in maintaining service quality in hospitals, encompassing aspects such as communication, teamwork, leadership, and staff well-being. By recognizing the complexities of human interactions within healthcare systems and implementing targeted interventions, hospitals can enhance service delivery, improve patient outcomes, and cultivate a culture of excellence.

Auditory Learner

Auditory Learner

Diagnostic accuracy of DPP Fever Panel II Asia tests for tropical fever diagnosis.

Fever is the most frequent symptom in patients seeking care in South and Southeast Asia. The introduction of rapid diagnostic tests (RDTs) for malaria continues to drive patient management and care. Malaria-negative cases are commonly treated with antibiotics without confirmation of bacteraemia. Conventional laboratory tests for differential diagnosis require skilled staff and appropriate access to healthcare facilities. In addition, introducing single-disease RDTs instead of conventional laboratory tests remains costly. To overcome some of the delivery challenges of multiple separate tests, a multiplexed RDT with the capacity to diagnose a diverse range of tropical fevers would be a cost-effective solution. In this study, a multiplex lateral flow immunoassay (DPP Fever Panel II Assay) that can detect serum immunoglobulin M (IgM) and specific microbial antigens of common fever agents in Asia (Orientia tsutsugamushi, Rickettsia typhi, Leptospira spp., Burkholderia pseudomallei, Dengue virus, Chikungunya virus, and Zika virus), was evaluated. Whole blood (WB) and serum samples from 300 patients with undefined febrile illness (UFI) recruited in Vientiane, Laos PDR were tested using the DPP Fever Panel II, which consists of an Antibody panel and Antigen panel. To compare reader performance, results were recorded using two DPP readers, DPP Micro Reader (Micro Reader 1) and DPP Micro Reader Next Generation (Micro Reader 2). WB and serum samples were run on the same fever panel and read on both micro readers in order to compare results. ROC analysis and equal variance analysis were performed to inform the diagnostic validity of the test compared against the respective reference standards of each fever agent (S1 Table). Overall better AUC values were observed in whole blood results. No significant difference in AUC performance was observed when comparing whole blood and serum sample testing, except for when testing for R. typhi IgM (p = 0.04), Leptospira IgM (p = 0.02), and Dengue IgG (p = 0.03). Linear regression depicted R2 values had ~70% agreement across WB and serum samples, except when testing for leptospirosis and Zika, where the R2 values were 0.37 and 0.47, respectively. No significant difference was observed between the performance of Micro Reader 1 and Micro Reader 2, except when testing for the following pathogens: Zika IgM, Zika IgG, and B pseudomallei CPS Ag. These results demonstrate that the diagnostic accuracy of the DPP Fever Panel II is comparable to that of commonly used RDTs. The optimal cut-off would depend on the use of the test and the desired sensitivity and specificity. Further studies are required to authenticate the use of these cut-offs in other endemic regions. This multiplex RDT offers diagnostic benefits in areas with limited access to healthcare and has the potential to improve field testing capacities. This could improve tropical fever management and reduce the public health burden in endemic low-resource areas.

Views of assistant professors on digital transformation in otorhinolaryngology education : Current status and perspectives in undergraduate and advanced training

Digital transformation in curricular teaching in medicine comprises the use of digital teaching and learning formats as well as the transfer of digital skills for medical staff. Concepts of knowledge transfer and competency profiles also have to be adapted and transferred in advanced training due to necessary changes. The aim of this study was an evaluation of the current state of digital transformation in otorhinolaryngology teaching in undergraduate and advanced training at otorhinolaryngology departments of university medical centers in Germany. Aquestionnaire with nine questions on digital transformation was sent to the assistant professors of 37national university ENT departments. The anonymous survey was conducted online via the online platform SurveyMonkey®. Of the contacted assistant professors, 86.5% participated in the survey. Teaching sessions on digital skills for medical students are part of the curriculum in only 25% of ENT departments. Digital teaching formats are used by half of the departments in undergraduate training. Only 56.25% of the assistant professors receive support to realize the changes required by digital transformation. In 40.62% of departments, the issue of digital transformation is broached during advanced training, but only 28.12% use digital teaching methods to train junior doctors. Aspects of digital transformation are implemented mainly in undergraduate education, partly driven by the COVID19 pandemic. Overall, there is still considerable backlog in undergraduate and advanced training in ENT.

Peran Kepala Sekolah dalam Meningkatkan Mutu Sumber Daya Manusia

The purpose of this study is to explain and describe the role of the principal in improving the quality of human resources at Al-Ghafur Vocational High School in Sumenep. The research method used is qualitative through a case study. Data collection techniques include interviews, observations, and documentation. The results of the study show that the principal's strategy in improving the quality of human resources includes the design and development of a curriculum that meets the needs of students, with a primary focus on HR management. The goal is for all school members to have a high spirit to advance the educational institution. Other strategic steps include regular performance monitoring and evaluation, as well as staff training and skills development. The principal also strives to build good relationships with the community through meetings with students' guardians, social activities, and school events. As an educational manager, the principal focuses on improving HR quality through regular planning, organizing, directing, coordinating, and supervising. Factors such as effective leadership, a supportive organizational culture, clear policy implementation, technology development, and HR training also play important roles in improving HR quality.

“Prison Life Can Make You Go Crazy”: Insights Into the Situation for People With a Mental Illness in the Malawi Prison System

Little is known with regard to due process and forensic assessment capacities in Africa, where over one million are deprived of their liberty on any given day. A rapid situation assessment explored multi-stakeholder perspectives regarding the situation of people with a mental illness in the Malawi prison system. In-depth interviews were conducted with 10 regional professional stakeholders, 18 former prisoners, and five prison staff from two maximum-security prisons. Reflexive thematic analysis yielded five themes; occurrence of mental illness among people living in prison; prison environment exacerbating harm and levels of mental illness; security responses to the presence of psychiatric disorders; availability and coverage of specialist psychiatric and psychological care; and diversion, other non-custodial measures and continuity of care on release. Narratives highlight the substantial causal impact of the prison environment in amplifying existing and new mental illness, vulnerability and exploitation of people with a mental disorder. Malawi prisons are hampered by lack of specialist forensic capacity nationally; centralized mental health surveillance system; and insufficient skilled staff to conduct evidence-based screening and care. Security operations implement the use of pharmacological and physical restraint measures at times. Faith-based organizations play an important role in providing psychological and spiritual support. Release and reintegration require family involvement. A cross departmental intersectoral partnership response spanning government ministries, key civil society organizations, the Malawi Prison Inspectorate and Malawi Human Rights Commission is warranted. Recommendations include alleviation of prison congestion, prison staff capacity building and investment in forensic mental health services with adequate geographic coverage.

‘Sit down and thrash it out’: opportunities for expanding ethics consultation during conflict resolution in long-term care

Objective: To identify the frequency and nature of care conflict dilemmas that United States long-term care providers encounter, response strategies, and use of ethics resources to assist with dispute resolution. Design: An online cross-sectional survey was distributed to the Society for Post-Acute and Long-Term Care Medicine (AMDA). Results: Two-thirds of participants, primarily medical directors, have rejected surrogate instructions and 71% have managed family conflict. Conflict over treatment decisions and issues interpreting advance directives were frequently reported. Half of facilities lack a formal dispute mediation policy. Only five respondents have called an ethics consult for assistance. Conclusion: Ethically tense care conflicts commonly arise in long-term and post-acute care facilities. Few facility procedures incorporate ethics resources into actual practice. Recommendations are made to create actionable policy, increase access to ethics services, and support staff skill development in order to improve the end-of-life care experiences for patients, families, and care facility staff.

A post-COVID-19 assessment of resilience of nurses and paramedical workers in municipal hospitals of urban Pune, India.

To assess the resilience of primary healthcare workers (HCWs) by determining the factors associated with developing resilience post-coronavirus disease 2019 (COVID-19). A cross-sectional study in selected municipal hospitals. Connor-Davidson Resilience Scale was used to assess the resilience of the 245 HCWs, including the nurses and paramedics working in Pune Municipal Corporation (PMC) hospitals in Pune City. Data were analysed using the Chi-square test, one-way analysis of variance (ANOVA), independent-samples t-test and correlational analysis using the Statistical Package for the Social Sciences (SPSS) version 28. The mean resilience score of the HCWs in PMC hospitals post-COVID-19 was 75.09 (±9.25). The score for hardiness, optimism, resourcefulness and purpose was 20.15 (±3.87), 21.22 (±3.39), 17.24 (±2.76) and 16.40 (±2.17), respectively. Seven factors were significantly associated with the resilience of nurses and paramedics, namely age (P < 0.001), work experience (P < 0.001), monthly income (P < 0.001), having faced financial problems during COVID-19 (P < 0.001), hospital setting (P < 0.05), marital status (P < 0.01) and professional category (P < 0.001). In addition, 60% of the participants reported mental health issues due to routine workloads such as irritation/anger, frustration and tension/worry, fatigue and work-related stress, and sadness and anxiety. Suggestions for improvement were mainly increasing human resources, proper management, skilled staff, improved facilities and funding, and cooperation among staff. The resilience of primary HCWs in Pune post-COVID-19 was higher than HCWs in other countries assessed during COVID-19. Further, resilience was found more among nurses than paramedics. Modifiable factors affecting resilience must be addressed to improve the resilience of HCWs to build everyday resilience and strengthen health systems for public health emergencies.

Prevalence and Pattern of Morbidity, Febrile Illness, and Treatment-Seeking Behavior in a Tribal-Dominated District in Odisha, India: An Observational Study.

Background Tribal populations constitute a major portion of India's total population, especially in the eastern and northeastern states. We lack comprehensive information on the community burden of general morbidity and febrile illness in tribal population-dominated areas, which is quite essential for the microplanning of healthcare expenditure and implementation. This study aimed to provide evidence on the prevalence and pattern of general morbidity and febrile illness at the community level as well as the treatment-seeking behaviour in a tribal-dominated area. Methods The study was undertaken as an observational study in the community setting; looking into seasonal cross-sectional evidence on period prevalence (two weeks) of morbidity and qualitative/semiquantitative information on treatment-seeking behaviour of the selected community during 2012 and 2013. Result This study involved 5541, 5482, and 5638 individuals during the rainy season 2012,winter 2012-13, and rainy season 2013 seasons, respectively, from 25 tribal villages of Odisha, India. A period prevalence (two weeks) of overall morbidities was shown to be 27.28% and 28.9% during the rainy seasons of 2012 and 2013, respectively, of which 13% and 11.5%, respectively, were febrile, with low prevalence(6.44% overall morbidity and 1.81% febrile illness) in the winter of 2012-13. It indicated inadequacy in skills of the village-level health staff, monitoring of supplies/logistics, and population awareness for early reporting of fever to healthcare providers at the community level. Conclusion The evidence provided by the study would be helpful in making public health plans in tribal settings and also highlighted the opportunity to improve tribal health status through community awareness, especially in areas and populations with limited health access.

Strategies to implement evidence-informed decision making at the organizational level: a rapid systematic review

BackgroundAchievement of evidence-informed decision making (EIDM) requires the integration of evidence into all practice decisions by identifying and synthesizing evidence, then developing and executing plans to implement and evaluate changes to practice. This rapid systematic review synthesizes evidence for strategies for the implementation of EIDM across organizations, mapping facilitators and barriers to the COM-B (capability, opportunity, motivation, behaviour) model for behaviour change. The review was conducted to support leadership at organizations delivering public health services (health promotion, communicable disease prevention) to drive change toward evidence-informed public health.MethodsA systematic search was conducted in multiple databases and by reviewing publications of key authors. Articles that describe interventions to drive EIDM within teams, departments, or organizations were eligible for inclusion. For each included article, quality was assessed, and details of the intervention, setting, outcomes, facilitators and barriers were extracted. A convergent integrated approach was undertaken to analyze both quantitative and qualitative findings.ResultsThirty-seven articles are included. Studies were conducted in primary care, public health, social services, and occupational health settings. Strategies to implement EIDM included the establishment of Knowledge Broker-type roles, building the EIDM capacity of staff, and research or academic partnerships. Facilitators and barriers align with the COM-B model for behaviour change. Facilitators for capability include the development of staff knowledge and skill, establishing specialized roles, and knowledge sharing across the organization, though staff turnover and subsequent knowledge loss was a barrier to capability. For opportunity, facilitators include the development of processes or mechanisms to support new practices, forums for learning and skill development, and protected time, and barriers include competing priorities. Facilitators identified for motivation include supportive organizational culture, expectations for new practices to occur, recognition and positive reinforcement, and strong leadership support. Barriers include negative attitudes toward new practices, and lack of understanding and support from management.ConclusionThis review provides a comprehensive analysis of facilitators and barriers for the implementation of EIDM in organizations for public health, mapped to the COM-B model for behaviour change. The existing literature for strategies to support EIDM in public health illustrates several facilitators and barriers linked to realizing EIDM. Knowledge of these factors will help senior leadership develop and implement EIDM strategies tailored to their organization, leading to increased likelihood of implementation success.Review registrationPROSPERO CRD42022318994.

Development and preliminary validation of a MERS-CoV ELISA for serological testing of camels and alpacas

This study describes the development and preliminary validation of a new serological assay using MERS-CoV S1 protein in an indirect enzyme-linked immunosorbent assay (ELISA) format. This assay has the advantage of being able to test MERS-CoV serum samples in a PC2 laboratory without the need for a high-level biocontainment laboratory (PC3 or PC4), which requires highly trained and skilled staff and a high level of resources and equipment. Furthermore, this MERS-CoV S1 ELISA enables a larger number of samples to be tested quickly, with results obtained in approximately five hours. The MERS-CoV S1 ELISA demonstrated high analytical specificity, with no cross-reactivity observed in serum of animals infected with other viruses, including different coronaviruses. We tested 166 positive and 40 negative camel serum samples and have estimated the diagnostic sensitivity (DSe) to be 99.4% (95% CI: 96.7 – 100.0%) and diagnostic specificity (DSp) to be 100% (95% CI: 97.2%-100.0%) relative to the assigned serology results (ppNT and VNT) using a S/P ratio cut-off value of >0.58. The findings of this study showed that our MERS-CoV S1 ELISA was more sensitive than the commercial EUROIMMUN ELISA (Se 99.4% vs 84.9%) and comparable to the ppNT assay, and therefore could be used as a diagnostic aid in countries in the Middle East where MERS-CoV is endemic in dromedary camels. The assay reagents and protocol were easily adapted and transferred from an Australian laboratory to a laboratory in the University of Hong Kong. Thus, the results described here show that the MERS-CoV S1 ELISA represents a cheap, rapid, robust, and reliable assay to support surveillance of MERS-CoV in camels in endemic regions.

Online assessment in higher education during the COVID-19

The COVID-19 pandemic has accelerated the digital transformation of education, prompting universities worldwide to swiftly transition to online and blended learning environments. The adaptation process to online education varies depending on several factors, including the level of digitalization and technological penetration in each country, the availability of technologies at universities, and the digital skills of students and staff. Additionally, the specific field of knowledge influences the adaptation process, with differences observed between disciplines such as health sciences and humanities. In this study, we conduct an exploratory qualitative analysis on how universities have responded, specifically focusing on the coordinators of Master’s programs in Spain in the specific area of assessment. This unprecedented situation has forced educators and institutions to rethink their assessment strategies and adapt to a new educational landscape. The insights gained from this study could provide valuable guidance for future crises and contribute to the ongoing discourse on the role of digital technologies in education in general, and in assessment in particular.

Ultrasound-Guided Centrally Inserted Central Catheter (CICC) Placement in Newborns: A Safe Clinical Training Program in a Neonatal Intensive Care Unit.

Centrally inserted central catheters (CICCs) are increasingly used in neonatal care. CICCs have garnered attention and adoption owing to their advantageous features. Therefore, achieving clinical competence in ultrasound-guided CICC insertion in term and preterm infants is of paramount importance for neonatologists. A safe clinical training program should include theoretical teaching and clinical practice, simulation and supervised CICC insertions. We planned a training program for neonatologists for ultrasound-guided CICCs placement at our level III neonatal intensive care unit (NICU) in Modena, Italy. In this single-centre prospective observational study, we present the preliminary results of a 12-month training period. Two paediatric anaesthesiologists participated as trainers, and a multidisciplinary team was established for continuing education, consisting of neonatologists, nurses, and anaesthesiologists. We detail the features of our training program and present the modalities of CICC placement in newborns. The success rate of procedures was 100%. In 80.5% of cases, the insertion was obtained at the first ultrasound-guided venipuncture. No procedure-related complications occurred in neonates (median gestational age 36 weeks, IQR 26-40; median birth weight 1200 g, IQR 622-2930). Three of the six neonatologists (50%) who participated in the clinical training program have achieved good clinical competence. One of them has acquired the necessary skills to in turn supervise other colleagues. Our ongoing clinical training program was safe and effective. Conducting the program within the NICU contributes to the implementation of medical and nursing skills of the entire staff.

Sustainable Human Resources in the Tourism Industry in Indonesia: Employee Competence and Government Regulation

The present study investigates the dynamics of sustainable human resources (HR) practices in the Indonesian tourist sector, with a particular emphasis on staff skills and adherence to government rules. The study utilized a quantitative methodology, specifically utilizing Structural Equation Modeling with Partial Least Squares (SEM-PLS), to examine data gathered from 235 individuals who represented a varied range of industries. The findings showed strong positive correlations: employee capabilities and compliance with legal requirements are both positively impacted by sustainable HR practices. Furthermore, compliance with government rules is positively impacted by staff competencies. With a Root Mean Square Error of Approximation of 0.06 and a Goodness-of-Fit Index of 0.92, the model demonstrated a decent fit. These results provide important new understandings of the complex interactions that exist in the Indonesian tourism industry between employee capabilities, sustainable HR practices, and regulatory compliance.

Free for All

Periodic website redesign projects have become essential -- though often complex and costly -- measures that libraries take to ensure users’ ease of access to resources. Though administrators often enlist university web designers or even outside contractors to undertake these projects, librarians themselves can and should be at the center of any library website redesign. This is easier for libraries with employees who have considerable web development-related skills, but it is also within reach for libraries with smaller staff and limited web development skills. Indeed, free UX testing applications, basic office software, and open source or freely available CMSes such as Drupal make library website redesign projects both feasible and affordable. Generating buy-in and recruiting content editors to help build the new site are two vital measures for a successful redesign, as well as ongoing, post-launch maintenance. During our library website redesign, we leveraged both the communication of UX testing results and periodic peer training activities to create support, invite feedback or input, and recruit partners for content creation on the new site. As our site launched, we sustained the momentum of our peers’ involvement with the site by providing training materials, tech support, and targeted documentation. By combining freely available, user-friendly applications with a strategic, inclusive implementation process, even libraries with limited resources can successfully complete significant website redesign projects.

Providing Lesbian, Gay, Bisexual, Transgender, Nonbinary, and Queer Adolescents With Nurturance, Trustworthiness, and Safety: Protocol for Pilot Cluster Randomized Controlled Trial Design.

Sexual and gender minority youths (lesbian, gay, bisexual, transgender, nonbinary, and queer individuals) face elevated risks of substance use (eg, alcohol and tobacco) and mental health issues (eg, depressive symptoms and suicidality) compared to their cisgender heterosexual peers. These inequities are hypothesized to be reduced by building supportive high school environments via the training of school staff. An intervention that trains school staff to better understand and support sexual and gender minority youths and engage in positive bystander behaviors that protect them from bullying exposure may reduce disparities in drug and alcohol use among them. Experts, school staff, and sexual and gender minority youths developed Providing LGBTQ+ Adolescents with Nurturance, Trustworthiness, and Safety (PLANTS), a web-based intervention to train school staff on how to support, affirm, and protect sexual and gender minority youths. This paper describes the design of the PLANTS pilot trial primarily aimed at assessing its acceptability, usability, appropriateness, and feasibility. We hypothesize PLANTS will have high acceptability, usability, appropriateness, and feasibility as rated by the school staff. Secondary objectives focus on implementation, safety, and pre-post changes in high school staff outcomes, including self-efficacy and skills (eg, active-empathic listening and bullying intervention). Exploratory objectives focus on the impact of PLANTS on student health outcomes. In a 2-arm cluster randomized controlled trial, high schools in Massachusetts are allocated to PLANTS or an active comparator group (publicly available sexual and gender minority youths resources or training). High school staff complete pretest and posttest surveys containing validated scales. Primary outcomes are validated measures of acceptability, usability, appropriateness, and feasibility of the intervention completed by staff during posttest surveys. To test our primary hypotheses for each outcome, we will calculate means and 95% CIs and P values using 1-sample 2-sided t tests against a priori thresholds or benchmarks of success. Secondary outcomes include staff's active-empathetic listening skills, self-efficacy for working with sexual and gender minority youths, bystander intervention behaviors for bullying and cyberbullying, and self-efficacy for PLANTS' change objectives completed during pretest and posttest staff surveys. Staff can also complete a posttest interview guided by the Information-Motivation-Behavior model and Consolidated Framework for Implementation Research. Exploratory outcomes include student-level data collected via the 2021 and 2023 MetroWest Adolescent Health Surveys, a health behavior surveillance system in 30 Massachusetts schools. School enrollment began in May 2023 and participant enrollment began in June 2023. Data collection is expected to be completed by February 2024. This pilot trial will yield important information about the PLANTS intervention and provide necessary information to conduct a fully powered trial of the efficacy of PLANTS for reducing the deleterious health inequities experienced by sexual and gender minority youths. ClinicalTrials.gov NCT05897827; https://clinicaltrials.gov/study/NCT05897827. DERR1-10.2196/55210.

A Clinical Guide to Support the Implementation of Addiction Consult Services and the Value of Teaching and Technical Assistance.

People with substance use disorders (SUDs) are increasingly admitted to general hospitals; however, many hospital systems lack both formal structures and skilled staff to provide high-quality care for inpatients with SUDs. Inpatient addiction consult services (ACSs), which are increasingly being implemented around the country, are an evidence-based strategy to add focused care for people with SUDs into the general medical setting. In 2018, New York City Health + Hospitals (H + H) launched an ACS program called Consult for Addiction Care and Treatment in Hospitals in six hospitals, supported by a team of addiction consult experts to deliver teaching and technical assistance (TTA) for the Consult for Addiction Care and Treatment in Hospitals ACSs. This commentary describes the TTA, which included site visits, introductory educational lectures, case conferences, ad hoc support, implementation assistance, and the creation of an addiction care guide. Similar TTA services could be used in the future when hospitals or systems want to launch novel clinical programs.

Open Exploration and Reduction of Paediatric Supracondylar Humerus Fracture with Pink, Pulseless Hand in Resource-Limited Settings.

Background: Supracondylar humerus fractures (SHFs) are common paediatric injuries, with high risk of vascular compromise. Some patients present with a 'pink, pulseless hand', caused by occlusion of brachial artery flow but with collateral circulation preserving distal perfusion. Management of these patients remains controversial, especially when resources may be limited for prolonged hospitalisation and serial monitoring by skilled staff. The aim of this study is to present the intraoperative findings, surgical procedures done and outcomes at 6 weeks for patients with paediatric supracondylar fractures with a pink pulseless hand. Methods: We retrospectively identified 13 patients who presented to a public hospital between January 2019 and May 2023 with a displaced SHF and pink, pulseless hand. All patients underwent an open reduction with an anterior approach allowing for exploration, protection and repair of neurovascular structures. Distal flow was restored in the brachial artery either with topical lidocaine application, thrombectomy or artery reconstruction. Results: Out of 13 patients, all had intact median nerves and 10 had intact arteries (69%), of which seven were interposed at the fracture site and four were in vasospasm. Of the three patients with true arterial injury (23%), two had a crushed artery and one had thrombosis of the artery. Peripheral pulses were restored within an hour of fracture open reduction in all patients. At final follow-up, a mean 6 weeks postoperatively, all patients had recovered without neurovascular deficit, compartment syndrome or Volkmann ischemic contracture. Conclusions: In resource-limited settings, we recommend performing open exploration and reduction for patients with SHFs with pink, pulseless hand. This approach prevents iatrogenic neurovascular injury during closed reduction attempts, allows for immediate repair of a brachial artery injury and avoids unnecessary hospitalisation and serial monitoring. Level of Evidence: Level IV (Therapeutic).