Care Venues Research Articles

COVID-19 testing, incidence, and positivity trends among school age children during the academic years 2020–2022 in the State of Qatar: special focus on using CDC indicators for community transmission to evaluate school attendance policies and public health response

BackgroundThere exists a gap in our understanding of the age-dependent epidemiological dynamics of SARS-CoV-2 among school-age children in comparison to adults within the State of Qatar. Additionally, there has been limited assessment of the timely implementation of physical distancing interventions, notably national school closures, and their impact on infection trends.MethodsWe used the national database to capture all records of polymerase-chain-reaction (PCR) testing, and rapid antigen tests (RAT) conducted at all health care venues in Qatar and administered between August 26, 2020, and August 21, 2022, across all age groups (≥ 5 years old). Study participants under 18 years old were categorized into two age brackets: (5–11) and (12–17), aligning with the Primary and Preparatory/Secondary grade levels in Qatar, respectively. We assessed age group testing rates, incidence rates, and positivity rates in relation to adults. These epidemiological metrics were compared with the CDC’s thresholds for COVID-19 community transmission.ResultsThroughout the school years of 2020–2021 and 2021–2022, a total of 5,063,405 and 6,130,531 tests were respectively conducted. In the 2020–2021 school year, 89.6% of the tests were administered to adults, while 13.7% were conducted on children in the following year. The overall test positivity rates for the 2020–2021 and 2021–2022 school years were 5.8% and 8.1%, respectively. Adolescents underwent the fewest tests during the full study period compared to both adults and young children. Using the CDC indicators, we found that children and adolescents can significantly contribute to elevated infection rates, potentially driving community transmission upon relaxation of social restrictions.ConclusionIt is crucial to acknowledge the potential for higher transmission among youth and adolescents when formulating transmission control strategies and making decisions regarding school closures. Employing data-driven indicators and thresholds to monitor COVID-19 community levels is important for informing decision-making. These approaches also enable the prompt implementation of infection control transmission mitigation measures in future pandemics.

Screening for hepatitis C as part of an opioid stewardship quality improvement initiative: Identifying infected patients and analyzing linkage to care.

Screening patients with opioid use disorder (OUD) for HCV can potentially decrease morbidity and mortality if HCV-infected individuals are linked to care. We describe a quality improvement initiative focused on patients with OUD, incorporating an electronic health record decision-support tool for HCV screening across multiple health care venues, and examining the linkage to HCV care. Of 5829 patients with OUD, 4631 were tested for HCV (79.4%), (compared to a baseline of 8%) and 1614 (27.7%) tested positive. Two hundred and thirty patients had died at the study onset. Patients tested in the acute care and emergency department settings were more likely to test positive than those in the ambulatory setting (OR = 2.21 and 2.49, p < 0.001). Before patient outreach, 279 (18.2%) HCV-positive patients were linked to care. After patient outreach, 326 (23.0%) total patients were linked to care. Secondary end points included mortality and the number of patients who were HCV-positive who achieved a cure. The mortality rate in patients who were HCV-positive (12.2%) was higher than that in patients who were HCV-negative (7.4%) (OR = 1.72, p < 0.001) or untested patients (6.2%) (OR = 2.10, p<0.001). Of the 326 with successful linkage to care, 113 (34.7%) had a documented cure. An additional 55 (16.9%) patients had a possible cure, defined as direct acting antiviral ordered but no follow-up documented, known treatment in the absence of documented sustained viral response lab draw, or documentation of cure noted in outside medical records but unavailable laboratory results. A strategy utilizing electronic health record decision-support tools for testing patients with OUD for HCV was highly effective; however, linking patients with HCV to care was less successful.

P193: Participation of faith-based organizations in the secular health- and welfare- care system for the older people in Japan: evidence and challenges

Objective:Due to longevity, universal health coverage, declining population, and a stable society, it is estimated that the number of people with dementia will reach 10 million by the mid-21st century, accounting for 10% of the total population in Japan. To move toward a dementia-friendly community, it is essential to develop innovative and effective dementia care. However, human and economic resources are limited. Therefore, we focused on traditional Buddhist denominations that have organizations, educational systems, human resources, networks, and care venues. The fundamental question of this study is: Japanese Buddhism has created basis for mindfulness-based cognitive therapy, but is it also innovative in the care of older people?Methods:We looked for papers that 1) were written in a medical rather than a religious context, 2) were written in English, and 3) dealt with the care of the older people in Japan.Results:1) Institutional care workers’ need for Buddhist priests for helping anxiety of older residents was reported. 2) Effectiveness of community cafés for the family caregivers of people with dementia in the Buddhist temples were reported. 3) Potentials of monthly visit to bereaved families, Buddhist priests’ tradition, as the outreach of grief care was suggested. 4) Care workers’ own ideas about death after working in the landscape of dying and death was reported by the interview which used Buddhist priests as the interviewers.Conclusion:Participation of Buddhist priests as 1) spiritual cares for the residents in the institutions, 2) carers for the family carers in the community, 3) carers of the bereaved families in the outreach activity, and 4) carers for the care workers, were reported. However, robust evidence was not enough. From the standpoint of Japanese clinicians, there are too few papers compared to the actual contributions. More studies should be done which might also work as external monitoring. Traditional Buddhism in Japan has a closed membership system which is based on the family gravesite system and is generally not enthusiastic about propagation, which would also be compatible with a secular care system.

Racial Disparities in Breast Cancer Treatments and Adverse Events in the SEER-Medicare Data.

Despite lower incidence rates, African American (AA) patients have shorter survival from breast cancer (BC) than white (W) patients. Multiple factors contribute to decreased survival, including screening disparities, later presentation, and access to care. Disparities in adverse events (AEs) may contribute to delayed or incomplete treatment, earlier recurrence, and shortened survival. Here, we analyzed the SEER-Medicare dataset, which captures claims from a variety of venues, in order to determine whether the cancer care venues affect treatment and associated adverse events. We investigated a study population whose claims are included in the Outpatient files, consisting of hospital and healthcare facility venues, and a study population from the National Claims History (NCH) files, consisting of claims from physicians, office practices, and other non-institutional providers. We demonstrated statistically and substantively significant venue-specific differences in treatment rates, drugs administered, and AEs from treatments between AA and W patients. We showed that AA patients in the NCH dataset received lower rates of treatment, but patients in the Outpatient dataset received higher rates of treatment than W patients. The rates of recorded AEs per treatment were higher in the NCH setting than in the Outpatient setting in all patients. AEs were consistently higher in AA patients than in W patients. AA patients had higher comorbidity indices and were younger than W patients, but these variables did not appear to play roles in the AE differences. The frequency of specific anticancer drugs administered in cancer- and venue-specific circumstances and their associated AEs varied between AA and W patients. The higher AE rates were due to slightly higher frequencies in the administration of drugs with higher associated AE rates in AA patients than in W patients. Our investigations demonstrate significant differences in treatment rates and associated AEs between AA and W patients with BC, depending on the venues of care, likely contributing to differences in outcomes.

Identifying misconceptions and knowledge gaps in functional neurological disorders among emergency care providers

BackgroundFunctional Neurologic Disorders (FND) are a common but heterogeneous group of disabling conditions. The Emergency Department (ED) is an important venue for care and referral as it is often the first point of contact when patients with FND are faced with a crisis or exacerbation of symptoms. MethodsED providers (n = 273) practicing in the Cleveland Clinic Foundation Northeast Ohio network were invited to participate through secure web application electronic surveys. Data were collected on practice profiles, knowledge, attitudes, management of FND, and awareness of available resources for FND. ResultsSixty providers completed the survey (22% response rate; n = 50 ED physicians, 10 advanced care providers) with 95.0% (n = 57) reporting a lack of understanding about FND. The terms Psychogenic Nonepileptic Seizures and stress induced/stress related disease were used by 60.0% (n = 36) and 58.3% (n = 35) respectively. Ninety percent (n = 53) rated their experience with managing FND patients as at least more difficult. Eighty- five percent (n = 51) agreed with “rule out others” and 60% (n = 36) agreed with “caused by psych stress”. Eighty six percent (n = 50) believe that there is a difference between FND from malingering. Only one respondent was familiar with any FND resources and 79% (n = 47) reported the need for FND specific educational materials. ConclusionThis survey revealed major gaps in knowledge, inaccurate perceptions, and management that differs from the current standard of care among ED providers caring for patients with FND. Educational opportunities are needed to guide diagnosis and evidence-based treatment to optimize management of patients with FND.

Clinically stable covid-19 patients presenting to acute unscheduled episodic care venues have increased risk of hospitalization: secondary analysis of a randomized control trial

BackgroundAssessment for risks associated with acute stable COVID-19 is important to optimize clinical trial enrollment and target patients for scarce therapeutics. To assess whether healthcare system engagement location is an independent predictor of outcomes we performed a secondary analysis of the ACTIV-4B Outpatient Thrombosis Prevention trial.MethodsA secondary analysis of the ACTIV-4B trial that was conducted at 52 US sites between September 2020 and August 2021. Participants were enrolled through acute unscheduled episodic care (AUEC) enrollment location (emergency department, or urgent care clinic visit) compared to minimal contact (MC) enrollment (electronic contact from test center lists of positive patients).We report the primary composite outcome of cardiopulmonary hospitalizations, symptomatic venous thromboembolism, myocardial infarction, stroke, transient ischemic attack, systemic arterial thromboembolism, or death among stable outpatients stratified by enrollment setting, AUEC versus MC. A propensity score for AUEC enrollment was created, and Cox proportional hazards regression with inverse probability weighting (IPW) was used to compare the primary outcome by enrollment location.ResultsAmong the 657 ACTIV-4B patients randomized, 533 (81.1%) with known enrollment setting data were included in this analysis, 227 from AUEC settings and 306 from MC settings. In a multivariate logistic regression model, time from COVID test, age, Black race, Hispanic ethnicity, and body mass index were associated with AUEC enrollment. Irrespective of trial treatment allocation, patients enrolled at an AUEC setting were 10-times more likely to suffer from the adjudicated primary outcome, 7.9% vs. 0.7%; p < 0.001, compared with patients enrolled at a MC setting. Upon Cox regression analysis adjustment patients enrolled at an AUEC setting remained at significant risk of the primary composite outcome, HR 3.40 (95% CI 1.46, 7.94).ConclusionsPatients with clinically stable COVID-19 presenting to an AUEC enrollment setting represent a population at increased risk of arterial and venous thrombosis complications, hospitalization for cardiopulmonary events, or death, when adjusted for other risk factors, compared with patients enrolled at a MC setting. Future outpatient therapeutic trials and clinical therapeutic delivery programs of clinically stable COVID-19 patients may focus on inclusion of higher-risk patient populations from AUEC engagement locations.Trial RegistrationClinicalTrials.gov Identifier: NCT04498273.

HIV Services and Outcomes During the COVID-19 Pandemic - United States, 2019-2021.

Increasing HIV testing, preexposure prophylaxis (PrEP), and antiretroviral therapy (ART) are pillars of the federal Ending the HIV Epidemic in the U.S. (EHE) initiative, with a goal of decreasing new HIV infections by 90% by 2030.* In response to the COVID-19 pandemic, a national emergency was declared in the United States on March 13, 2020, resulting in the closure of nonessential businesses and most nonemergency health care venues; stay-at-home orders also limited movement within communities (1). As unemployment increased during the pandemic (2), many persons lost employer-sponsored health insurance (3). HIV testing and PrEP prescriptions declined early in the COVID-19 pandemic (4-6); however, the full impact of the pandemic on use of HIV prevention and care services and HIV outcomes is not known. To assess changes in these measures during 2019-2021, quarterly data from two large U.S. commercial laboratories, the IQVIA Real World Data - Longitudinal Prescription Database (IQVIA),† and the National HIV Surveillance System (NHSS)§ were analyzed. During quarter 1 (Q1)¶ 2020, a total of 2,471,614 HIV tests were performed, 190,955 persons were prescribed PrEP, and 8,438 persons received a diagnosis of HIV infection. Decreases were observed during quarter 2 (Q2), with 1,682,578 HIV tests performed (32% decrease), 179,280 persons prescribed PrEP (6% decrease), and 6,228 persons receiving an HIV diagnosis (26% decrease). Partial rebounds were observed during quarter 3 (Q3), with 2,325,554 HIV tests performed, 184,320 persons prescribed PrEP, and 7,905 persons receiving an HIV diagnosis. The proportion of persons linked to HIV care, the number who were prescribed ART, and proportion with a suppressed viral load test (<200 copies of HIV RNA per mL) among those tested were stable during the study period. During public health emergencies, delivery of HIV services outside of traditional clinical settings or that use nonclinical delivery models are needed to facilitate access to HIV testing, ART, and PrEP, as well as to support adherence to ART and PrEP medications.

Focus group study of factors relevant to treatment decisions and experiences among patients with symptomatic peripheral artery disease.

Clinical guidelines recommend shared decision-making for treatment of peripheral artery disease (PAD), which requires understanding of patient perspectives and preferences. We conducted a focus group study of patients with symptomatic PAD to identify factors important and relevant to treatment choices, and to characterize aspects of the health care process that contribute to positive vs negative experiences apart from the specific treatment(s) received. Participants were recruited from an academic medical center over 2years using a purposeful sampling approach based on a clinical diagnosis of symptomatic PAD (either claudication or chronic limb-threatening ischemia [CLTI]) confirmed by the abnormal ankle or toe brachial index. Focus groups were led by a nonphysician moderator, consisted of 5 to 12 participants, and were conducted separately for patients with CLTI and claudication. Audio recordings converted to verbatim transcripts were used for qualitative analysis. A total of 51 patients (26 with CLTI and 25 with claudication) were enrolled and participated in focus groups. Major themes identified related to treatment preferences and decisions included specific interventions under consideration, the chance of technical success versus failure, anticipated degree of symptom improvement, outcome durability, and risk.Major themes related to the process of care included decision-making input, provider communication and trust, the timeline from diagnosis to definitive treatment, and compartmentalized care (including different venues of care). The results provide insights into patient preferences, perspectives, and experiences related to PAD treatment. These observations can be used to inform patient-centered approaches to shared decision-making, communication, and assessment of PAD treatment outcomes.

Differences in Health Care Access, Utilization, and Experiences Among LGBTQ+ Subgroups in the Southern United States.

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals experience health inequities and barriers to accessing appropriate, affirming care. Little is known about differing health care experiences within the LGBTQ+ population, particularly among individuals living in underserved areas. This study explored health care experiences and utilization among LGBTQ+ subgroups: lesbian and gay cisgender individuals (n = 258), bisexual+ cisgender individuals (n = 71), and transgender and gender-diverse individuals (n = 80). Participants were recruited from a geographic region in South Carolina and Georgia and completed an online survey regarding negative health care experiences, barriers to care, and utilization of different health care venues and services. Results revealed significant differences between LGBTQ+ subgroups, with transgender and gender-diverse participants reporting more discriminatory experiences and greater barriers to care. Bisexual+ cisgender individuals also experienced some disparities compared with lesbian and gay cisgender individuals. Most participants endorsed a need for more competent providers. Findings and recommendations are considered within the context of the Southeastern United States for addressing access and utilization disparities among LGBTQ+ communities.

Multicentre randomised controlled trial of a group psychological intervention for postnatal depression in British mothers of South Asian origin (ROSHNI-2): study protocol

BackgroundIn the UK, postnatal depression is more common in British South Asian women than White Caucasion women. Cognitive–behavioural therapy (CBT) is recommended as a first-line treatment, but there is little evidence for the adaptation of CBT for postnatal depression to ensure its applicability to different ethnic groups.AimsTo evaluate the clinical and cost-effectiveness of a CBT-based positive health programme group intervention in British South Asian women with postnatal depression.MethodWe have designed a multicentre, two-arm, partially nested, randomised controlled trial with 4- and 12-month follow-up, comparing a 12-session group CBT-based intervention (positive health programme) plus treatment as usual with treatment as usual alone, for British South Asian women with postnatal depression. Participants will be recruited from primary care and appropriate community venues in areas of high South Asian density across the UK. It has been estimated that randomising 720 participants (360 into each group) will be sufficient to detect a clinically important difference between a 55% recovery rate in the intervention group and a 40% recovery rate in the treatment-as-usual group. An economic analysis will estimate the cost-effectiveness of the positive health programme. A qualitative process evaluation will explore barriers and enablers to study participation and examine the acceptability and impact of the programme from the perspective of British South Asian women and other key stakeholders.

COVID-19’s Disruptive Innovation: Accelerating the Academic Preparation of Professional Nurses’ Ambulatory and Telehealth Roles

The pandemic has enhanced professional nursing’s role in ambulatory and telehealth practice, and reinforced the academic preparation gap for practice-ready nurses in these specialties. Population health and community-focused care, fully leveraging ambulatory and telehealth practices, are the immerging venues of health care and a solution to health care equity and affordability. Accelerated academic reformation is pivotal to fundamentally prepare for the nursing’s essential post-pandemic role. An overview of key industry report recommendations, disruptive innovation exemplars in academic design for ambulatory and telehealth practice-ready graduates, and implications for nurse executives in leading this transformation are identified.

Child Sleep and Parent Depressive Symptoms.

Parent distress and child sleep problems have been associated in earlier research. The present study expands on past research on parent depressive symptoms and their child's sleep. This study examines the relation between parents who screen positive for depressive symptoms and their perception of their child's sleep. Three hundred sixty-nine English-speaking parents of children ages 3 to 5 years (n = 134) or 6 to 11 years (n = 235) met this study's inclusion criteria within the Southwestern Ohio Ambulatory Research Network (response rate 90%). The validated scales used were the RAND Depression Screener (DS), the Wisconsin Abbreviated Children's Sleep Habits Questionnaire (WCSHQ), and the Jenkins Sleep Questionnaire. Multiple logistic regression was used to determine adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for associations with the WCSHQ. In total, 74.3% of the study children were White, 82.4% of respondents were the child's mother, 75.1% had at least some college education, and 54.4% reported an annual income of <$50,000. In total, 54.4% of children were male and 53.8% had public health insurance. Approximately one-fourth of parents had a positive DS and nearly one-third reported sleep problems. Adjusting for child's age and other factors, we found that parents with a positive (vs negative) DS had AOR 2.42 (95% CI 1.38-4.24) for higher WCSHQ scores. Children ages 3 to 5 years (vs 6-11 years) had AOR 2.48 (95% CI 1.56-3.95) for higher WCSHQ scores. Parents with a positive DS were more likely to report sleep problems in their children after adjusting for the child's age. These findings from a diverse sample of US Midwestern families at primary care venues corroborate previous research.

Pediatric Emergency Department Challenges and Response to COVID-19.

Severe acute respiratory syndrome coronavirus 2, the virus causing the pandemic illness coronavirus disease 2019, was first detected in the United States in January 2020. As the illness spread across the country, all aspects and venues of health care were significantly impacted. This article explores the challenges and response of one children's emergency medicine division related to surge planning, personal protective equipment, screening, testing, staffing, and other operational challenges, and describes the impact and implications thus far. [Pediatr Ann. 2021;50(4):e172-e177.].

2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure).

2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure).

An Examination of Mental Health, Perceived Barriers, and Outreach Recommendations amongRural College Students

ABSTRACT Background: Mental health concerns for the collegial population are noted throughout the literature, with a recent focus on assessment, interventions and outreach.1 Concerns regarding individual resilience, barriers to seeking care and outreach opportunity venues have led careful consideration for further investigation of the rural college student. Purpose: The purpose of this research study was to examine the mental health issues and concerns, as well as the challenges related to accessing campus mental health services. Methods: A descriptive study was conducted to examine the self-reported mental health of currently enrolled students. Results: A campus wide survey confirmed that many students experience stressors that negatively impact their college experience. Study participants reported that their major sources of stress were financial strains and academic performance pressures, along with body image and food related issues to a lesser degree. Additionally, the students reported barriers to accessing mental health resources. Discussion: College students face a variety of stressors and mental health issues that threaten the quality of their lives and their ability to perform well academically. Translation to Health Education Practice: Institutions of higher education need to ensure that mental health and wellness resources are not only available to students, but readily accessible.

Mental Health Challenges and Needs among Sexual and Gender Minority People in Western Kenya.

Background: Sexual and gender minority (SGM) people in Kenya face pervasive socio-cultural and structural discrimination. Persistent stress stemming from anti-SGM stigma and prejudice may place SGM individuals at increased risk for negative mental health outcomes. This study explored experiences with violence (intimate partner violence and SGM-based violence), mental health outcomes (psychological distress, PTSD symptoms, and depressive symptoms), alcohol and other substance use, and prioritization of community needs among SGM adults in Western Kenya. Methods: This study was conducted by members of a collaborative research partnership between a U.S. academic institution and a Kenyan LGBTQ civil society organization (CSO). A convenience sample of 527 SGM adults (92.7% ages 18–34) was recruited from community venues to complete a cross-sectional survey either on paper or through an online secure platform. Results: For comparative analytic purposes, three sexual orientation and gender identity (SOGI) groups were created: (1) cisgender sexual minority women (SMW; 24.9%), (2) cisgender sexual minority men (SMM; 63.8%), and (3) gender minority individuals (GMI; 11.4%). Overall, 11.7% of participants reported clinically significant levels of psychological distress, 53.2% reported clinically significant levels of post-traumatic stress disorder (PTSD) symptoms, and 26.1% reported clinically significant levels of depressive symptoms. No statistically significant differences in clinical levels of these mental health concerns were detected across SOGI groups. Overall, 76.2% of participants reported ever using alcohol, 45.6% home brew, 43.5% tobacco, 39.1% marijuana, and 27.7% miraa or khat. Statistically significant SOGI group differences on potentially problematic substance use revealed that GMI participants were less likely to use alcohol and tobacco daily; and SMM participants were more likely to use marijuana daily. Lifetime intimate partner violence (IPV) was reported by 42.5% of participants, and lifetime SGM-based violence (SGMV) was reported by 43.4%. GMI participants were more likely than other SOGI groups to have experienced both IPV and SGMV. Participants who experienced SGMV had significantly higher rates of clinically significant depressive and PTSD symptoms. Conclusions: Despite current resilience demonstrated by SGM adults in Kenya, there is an urgent need to develop and deliver culturally appropriate mental health services for this population. Given the pervasiveness of anti-SGM violence, services should be provided using trauma-informed principles, and be sensitive to the lived experiences of SGM adults in Kenya. Community and policy levels interventions are needed to decrease SGM-based stigma and violence, increase SGM visibility and acceptance, and create safe and affirming venues for mental health care. Political prioritization of SGM mental health is needed for sustainable change.

The use of telehealth to increase mental health services access and promote medication adherence in rural locations.

Fifteen million residents living in rural locations in the United States struggle with mental illness, substance dependence, or comorbid conditions, and are not receiving adequate health care (CDC, 2017). Approximately 55% of the 3,075 rural communities in the United States lack psychiatric providers. A specialty mental health treatment facility in northeast Florida cannot meet the needs of the patients because of limited psychiatric-mental health nurse practitioner (PMHNP) on site. By design, patients are expected to be seen in the clinic every three months. A pilot project was initiated using telehealth as a venue for patient care as an alternative to a face-to-face consultation with a PMHNP. The project was implemented with adults diagnosed with schizophrenia, bipolar disorder, major depression, posttraumatic stress disorder, anxiety, and/or substance abuse. A 3-month pilot of telehealth consultations with a remote PMHNP tracking access, medication adherence at 30 and 60 days after the consultation, appointment follow-up, and patient satisfaction. Access increased from 4.86% to 10.19% following implementation of the telehealth model. Medication adherence was 82% at 30 days and 77.5% at 60 days, compared to a benchmark of 80%. In addition, 89% of patient responses indicated comfort with telehealth and a willingness to continue to see PMHNPs in this venue. Telehealth with PMHNPs was shown to be a viable option in rural locations to meet the needs of mental health and dual diagnosis patients. Because of this project, the facility increased to three remote PMHNPs in the telehealth role.

An Investigation of Work-Related Fatigue Levels and Related Factors among Emergency Nurses: A Primary Quantitative Study

One of the most frequent phenomena among shift workers, particularly nurses, is work-related fatigue. There is a necessary demand for research in the area concerning the relationship between socio-demographic factors, occupational variables and work-related fatigue among Arabic, including Jordanian nurses, given the lack of knowledge. This study targets evaluating the magnitude of the relationship between socio-demographic and occupational factors and work-related fatigue among Jordanian nurses who work in emergency care venues. A descriptive correlational study was used. A non-probability based convenient sampling technique was applied, capturing 220 emergency nurses in Jordan. Measures included socio-demographic data, Occupational variables and Fatigue Exhaustion/Recovery Scale (OFER 15). In comparison to chronic and inter-shift fatigue, acute work-related fatigue attained the highest average score (Mean = 61.63, SD +27.17). Acute fatigue had a significant but weak relationship with years of experience, age, marital status, income and shift-work had an imperative relationship with acute work-related fatigue. Further, the chronic fatigue and inter shift (recovery) were correlated with marital status, years of experience, income and shift-work. The findings of this study provided empirical data that would help develop procedures to diminish levels of work-related fatigue among Jordanian emergency nurses, which would enhance nurses and patients' positive health outcomes.

Transitions in Care: A Workshop to Help Residents and Fellows Provide Safe, Effective Handoffs for Acute Psychiatric Patients.

IntroductionFocused training in care transitions is an ACGME-required component of resident education. However, there are limited published curricular resources specific to trainees in psychiatry to help develop this crucial skill.MethodsWe developed a 90-minute interactive workshop on care transitions in psychiatry for general adult psychiatry residents (PGY 2-PGY 4), child and adolescent fellows, and consult-liaison fellows. Trainees collaborated in interdisciplinary teams to explore a vignette in which a patient moved through four different venues of care (outpatient, emergency department, inpatient medical, and inpatient psychiatric). Guiding questions prompted discussions of critical issues related to logistics and clinical communication for each transition between care environments.ResultsIn a postworkshop anonymous survey, 100% of trainee participants (n = 30) felt the workshop was successful in creating the opportunity to develop relationships with, and learn from, colleagues at other levels of psychiatry training. Ninety percent responded affirmatively that they were able to identify key elements of an effective handoff for an acute psychiatric patient. Eighty-three percent identified being able to describe logistical steps for transferring the care of patients between mental health services at their institution.DiscussionTrainee participants found the workshop beneficial for understanding the steps needed to transfer patients between levels of care safely, discussing and debating gray areas with peers and faculty, and developing interdisciplinary relationships within psychiatry. Faculty participants described an interest in using the workshop as a faculty development exercise. This workshop fills a critical gap in available curricula on transitions in care in psychiatry.

Big Data Analytics and Sensor-Enhanced Activity Management to Improve Effectiveness and Efficiency of Outpatient Medical Rehabilitation.

Numerous societal trends are compelling a transition from inpatient to outpatient venues of care for medical rehabilitation. While there are advantages to outpatient rehabilitation (e.g., lower cost, more relevant to home and community function), there are also challenges including lack of information about how patient progress observed in the outpatient clinic translates into improved functional performance at home. At present, outpatient providers must rely on patient-reported information about functional progress (or lack thereof) at home and in the community. Information and communication technologies (ICT) offer another option—data collected about the patient’s adherence, performance and progress made on home exercises could be used to help guide course corrections between clinic visits, enhancing effectiveness and efficiency of outpatient care. In this article, we describe our efforts to explore use of sensor-enhanced home exercise and big data analytics in medical rehabilitation. The goal of this work is to demonstrate how sensor-enhanced exercise can improve rehabilitation outcomes for patients with significant neurological impairment (e.g., from stroke, traumatic brain injury, and spinal cord injury). We provide an overview of big data analysis and explain how it may be used to optimize outpatient rehabilitation, creating a more efficient model of care. We describe our planned development efforts to build advanced analytic tools to guide home-based rehabilitation and our proposed randomized trial to evaluate effectiveness and implementation of this approach.