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Background. Nurses' high workload can result in depressive symptoms. However, the research has underexplored the internal and external variables, such as organisational support, career identity, and burnout, which may predict depressive symptoms among Chinese nurses via machine learning (ML). Aim. To predict nurses' depressive symptoms and identify the relevant factors by machine learning (ML) algorithms. Methods. A self-administered smartphone questionnaire was delivered to nurses to evaluate their depressive symptoms;1,431 questionnaires and 28 internal and external features were collected. In the training set, the use of maximum relevance minimum redundancy ranked the features' importance. Five ML algorithms were used to establish models to identify nurses' depressive symptoms using different feature subsets, and the area under the curve (AUC) determined the optimal feature subset. Demographic characteristics were added to the optimal feature subset to establish the combined models. Each model's performance was evaluated using the test set. Results. The prevalence rate of depressive symptoms among Chinese nurses was 31.86%. The optimal feature subset comprised of sleep disturbance, chronic fatigue, physical fatigue, exhaustion, and perceived organisation support. The five models based on the optimal feature subset had good prediction performance on the test set (AUC: 0.871–0.895 and accuracy: 0.798–0.815). After adding the significant demographic characteristics, the performance of the five combined models slightly improved;the AUC and accuracy increased to 0.904 and 0.826 on the test set, respectively. The logistic regression analysis results showed the best and most stable performance while the univariate analysis results showed that external and internal personal features (AUC: 0.739–0.841) were more effective than demographic characteristics (AUC: 0.572–0.588) for predicting nurses' depressive symptoms. Conclusions. ML could effectively predict nurses' depressive symptoms. Interventions to manage physical fatigue, sleep disorders, burnout, and organisational support may prevent depressive symptoms.
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Surveys are an important vehicle for advancing research on urban policy and governance. The introduction of online tools eased survey-based data collection, making it cheaper and easier to obtain data from key informants like local elected officials or public administrators. However, the utility of web-based survey administration may be diminishing. To investigate this dynamic and search for strategies to support survey research in urban studies, we perform a systematic review of survey research in urban policy and administration scholarship and conduct an original survey follow-up experiment. Our findings identify a clear downward trend in survey response rates that was accentuated during the COVID-19 pandemic. Results from our survey experiment show distinctly different costs per solicitation and per completed survey, depending on administration mode. These findings stimulate discussion on how scholars may continue to use surveys to generate high-quality, empirically rigorous research on urban affairs in light of recent trends. [ FROM AUTHOR] Copyright of Urban Affairs Review is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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BackgroundThe COVID-19 pandemic caused concerns whether patients with rheumatic musculoskeletal disease (RMD) treated with conventional (cs) or biologic (b) disease modifying drugs (DMARDs) and/or prednisolone exhibit an adequate immune response to the applied SARS-CoV2 vaccines.ObjectivesWe established the DECODIR study to assess and compare the efficacy of the SARS-CoV2 vaccines administered as part of the national vaccine roll-out: BNT162b2 vaccine (Pfizer/BioNTech) and mRNA-1273 vaccine (Moderna). The vaccines were offered as two doses four weeks apart;followed by a booster vaccination six months later. This national regimen included inflammatory rheumatic patients regardless of their respective anti-inflammatory treatment. We used patients' SARS-CoV2 IgG serum level as proxy for vaccination response (1).MethodsThe study was conducted as a longitudinal prospective cohort study. Patients with rheumatoid arthritis (RA), spondyloarthropathies (SpA) or psoriatic arthritis (PsA) receiving their outpatient treatment at the Danish Hospital for Rheumatic Diseases, Sonderborg, and monitored in the Danish DANBIO registry, were included.Blood samples, Disease activity and treatment information (cs/bDMARD, prednisolone) were collected at baseline (i.e. prior to vaccination), after six weeks, six and twelve months. SARS-CoV-2 IgG levels in serum were assessed by ELISA (Thermo-Fischer), and manufacturer's cut-off (>=10 EliA U/mL) selected as definition of sufficient IgG response. Antibody response was measured and compared at all four time points.Associations between antibody response, age, gender, disease (RA/PsA/SpA), treatment (none, cs/bDMARD or prednisolone) and disease activity were tested using proportional odds regression and bootstrapped tests of medians. Results were reported using mean, median (IqR) and bootstrapped 95% confidence interval (CI) of the median.ResultsA total of 243 patients were included at baseline and all were followed-up after six weeks;data from 233 patients were available at six months and for 229 patients at twelve months' follow-up. Those 229 patients had completed the national vaccination programme.The measurements performed 6 months after baseline demonstrated a per se decrease of IgG levels for the whole study population (median of 2.08 EliA U/mL at 6 months vs. 16 EliA U/mL at 6 weeks). The final measurements performed after twelve months demonstrated a significant increase of IgG levels. Thus, the completed vaccination programme, was followed by a significant increase in IgG levels (median of 100 EliA U/mL at twelve months vs. 16.5 EliA U/mL at six months, p < 0.001).Sufficient response rates were now recorded in all treatment scenarios, also in patients treated with prednisolone or combination of csDMARD and bDMARD. These two groups were at 6 months characterized by significant lower response rates, when compared with patients without any DMARD treatment.ConclusionCompleted vaccination programme defined as two doses plus booster vaccination resulted in a sufficient vaccination response as measured by IgG levels regardless of RA treatment.It is noteworthy that IgG levels increased markedly in patients treated with a combination of cs/bDMARD or oral prednisolone, who had low IgG levels (below manufacturer's cut-off >=10 EliA U/mL) after 6 months. Our results strongly support the efficacy of the complete vaccination programme including the 3rd booster vaccine in patients with inflammatory rheumatic diseases.Figure 1.Serum IgG-levels at baseline, 6 weeks, 6 months and 12 months;stratified by antirheumatic treatment. (Box plot showing median and interquartile range).[Figure omitted. See PDF]Reference[1]Schreiber K. et al. Reduced Humoral Response of SARS-CoV-2 Antibodies following Vaccination in Patients with Inflammatory Rheumatic Diseases— an Interim Report from a Danish Prospective Cohort Study. Vaccines 2022, 10(1), 35;https://doi.org/10.3390/vaccines10010035AcknowledgementsWe acknowledge all patients contributing to the DANBIO registry.The Danish Rheumatologic Biobank is a knowledged for handling and storage of biological material.Lab chieftechnician Charlotte Drachmann is acknowledged for her assistance.Disclosure of InterestsChristine Graversgaard: None declared, Karen Schreiber Speakers bureau: Lilly, UCB, Henning Jakobsen: None declared, Randi Petersen: None declared, Anders Bo Bojesen: None declared, Niels Steen Krogh: None declared, Bente Glintborg Grant/research support from: Pfizer, AbbVie, BMS, Sandoz, Merete Lund Hetland: None declared, Oliver Hendricks Speakers bureau: Pfizer, Lilly, Novartis.
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Ritlecitinib (Pfizer Inc) demonstrated efficacy in treating alopecia areata in patients aged 12 years and older with at least 50% scalp hair loss, according to results from a phase 2b/3 trial (NCT03732807) published in The Lancet. Of those randomly assigned, 104 patients discontinued treatment: 34 withdrew, 19 had adverse events (AEs), 12 were physician decided, 12 were discontinued due to lack of efficacy, 13 were lost to follow-up, 5 were moved to long-term study transfer, 4 discontinued due to pregnancies, 2 discontinued for protocol deviations, 1 declined follow-up due to COVID-19, 1 attended the last visit late due to COVID-19, and 1 was nonadherent. Between the placebo and the ritlecitinib 200 mg plus 50 mg group, the difference in response rate based on a SALT score of 20 or less was 29.1% (95% CI, 21.2-37.9;P < .0001). The difference in response rate based on a SALT score of 20 or less between placebo and ritlecitinib was 20.8% (95% CI, 13.7-29.2;P < .0001) for the 200 mg plus 30 mg group, 21.9% (95% CI, 14.7-30.2;P < .0001) for the 50 mg group, and 12.8% (95% CI, 6.7-20.4;P = .0002) for the 30 mg group.
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Objectives: This study assessed trends in tobacco use in students of the Third Faculty of Medicine of Charles University in the Czech Republic between academic years 2012/13 and 2019/2020. Methods: Two cross-sectional surveys designed to obtain information on smoking history, smoking status, tobacco products use, and cessation were conducted among 382 students of the 6-year Master's Study Programme (General Medicine) and the 3-year Bachelor's Study Programme (Public Health) in 2012/2013;and among 580 students of General Medicine and of the Bachelor's Study Programmes (Public Health, Dental Hygiene and Nursing) in 2019/2020. Results: Regular/daily smoking was reported by 4.4 ± 2.4% (with 95% CI) of General Medicine students and 4.8 ± 4.1% of Public Health students in 2012/2013, and 1.3 ± 1.1% of General Medicine students and 14.4 ± 4.8% of students of bachelor studies in 2019/2020. The share of regular and occasional smokers was higher among junior students in both academic years (23.9 ± 5.1% and 20.1 ± 4.7%, respectively) compared to senior students (23.6 ± 9.8% and 9.6 ± 5.7%). Cigarettes were the most common products used in both academic years (67.0 ± 4.7% and 45.5 ± 4.0%). There was a significant increase in proportion of students using more tobacco products in the course of the time (from 12.1 ± 3.1% to 53.7 ± 4.1%). The proportion of students who quitted smoking has risen from 11.4 ± 3.2% to 16.1 ± 3.0%. On the contrary, the proportion of students who started smoking has dropped from 15.9 ± 3.7% to 2.9 ± 1.4%. The proportion of non-smokers has risen from 57.6 ± 5.0% to 65.3 ± 3.9%. Conclusions: The study revealed some positive trends concerning tobacco use in students (decline in regular smokers among students of General Medicine, senior students, cigarette smokers, water pipe smokers;rise in non-smokers), but also negative ones (rise in regular smokers among students of Public Health, students who used more tobacco products).
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The economic and public health crisis caused by COVID-19 was devastating and disproportionately hurt Blacks and Hispanics and some other groups. Unemployment rates and other measures of material hardship were higher and increased more during the crisis among Blacks and Hispanics than among non-Hispanic Whites. Congress authorized a historic policy response, incorporating both targeted and universal supports, and expanding both the level and duration of benefits. This response yielded the remarkable result of an estimated decline in the Supplemental Poverty Measure between 2019 and 2020. We study administrative data to investigate the impact of the Supplemental Nutrition Assistance Program (SNAP) during the crisis. We find that participation in SNAP increased more in counties that experienced a larger employment shock. By contrast, the increase in total SNAP benefits was inversely related to the employment shock. The SNAP benefit increases were less generous to Black and Hispanic SNAP participants than to White.
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OBJECTIVES/GOALS: Methods for recruitment and retention of participants in research have been extensively discussed, but procedures to end studies in a way that is respectful to participants and keeps them engaged are seldom described. We relate the procedures to close a study focused on genomic DNA damage and DNA repair capacity in a longitudinal population sample. METHODS/STUDY POPULATION: Data collection, which included the provision of 30 ml blood sample along with a health status survey and anthropometric measurements, was discontinued earlier than anticipated during the fourth of a five-year Community Engaged Research (CEnR) study focused on residents of historically marginalized, low wealth communities. In collaboration with the project's Community Advisory Board, we devised a strategy to inform study participants of the study closure, which included: 1) attempts at one-on-one contact via phone, 2) provision of a study closure packet, 3) periodic mailing of study updates through study year five, 4) sustained interaction with participants through invitations to participate in additional research projects. RESULTS/ANTICIPATED RESULTS: Among 149 participants (65% female, 99% of African American descent), 106 (71%) have been reached by phone. The communication included: 1) expressions of gratitude for their participation;2) explanation of study findings to date;and 3) assurance that data analysis continued. Among those reached, 96% agreed to ongoing communication and 97% agreed to be contacted about future studies. We continue procedures to reach the remaining 43 participants. Over the study closure period, two qualitative studies offered opportunities for participants to join in focus groups (FG). The first one queried perceptions of community-based research. The response rate was 66% among 65 persons invited. The second study, focused on COVID-19 knowledge and invited 39 individuals with 24 scheduled to participate (62% response rate). DISCUSSION/SIGNIFICANCE: Translational research views the participant as an active partner. Study closure offers an opportunity to foster a long-lasting participant-research institution partnership, while also promoting participants' broad engagement and familiarity with research. Respectful research closure is an important step in CEnR.
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Researchers compared organ preservation rates - defined as alive, total mesorectal excision-free and having no evidence of disease in the pelvis - among 332 patients with rectal cancer (median age, 57 years;62.1% men) who underwent short-course (n = 76) vs. long-course (n = 256) chemoradiation total neoadjuvant therapy. Patient and tumor characteristics appeared similar between the groups, with no significant differences in high-risk features, and most patients (81.6%) had clinical stage III disease. Results showed 2-year OS rates of 95% with long-course vs. 92% with short-course chemoradiation, DFS rates of 78% vs. 70%, and distant recurrence rates of 20% vs. 21%. [...]researchers observed a 2-year organ preservation rate of 40% (95% CI, 35-47) with long-course vs. 29% (95% CI, 20-42) with short-course chemoradiation and, among those managed with a watch-and-wait approach, 88% (95% CI, 81-94) with long-course and 67% (95% CI, 51-87) with short-course chemoradiation.
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Objective. To assess the impact of the COVID-19 pandemic on pharmacy residency application/interview processes, match rate, and factors influencing match rankings at a single college of pharmacy Methods. In spring of 2020 and 2021, an anonymous survey of fourth-year pharmacy school (P4) residency applicants at one college of pharmacy was administered. Survey responses were compared to explore trends in showcase participation, number/type/geographic dispersion of applications submitted, interview invitations, grade point average (GPA), research experience, and match rate. A thematic analysis evaluated common factors influencing match rankings. Results. Responses were collected from 75 of 99 (75.8% response rate) residency-seeking students in 2020 and 79 of 94 (84.0% response rate) in 2021. Students in 2021 reported applying to a higher median number of programs, with no significant differences in mean reported number of interview invitations or match rate. The virtual American Society of Health-System Pharmacists (ASHP) Midyear Showcase led to a median reported savings of $1000 with no significant impact on perceived value. Virtual interviews led to a median reported savings of $430. Thematic analysis revealed feel/culture, location, and learning experience options as the most prevalent deciding factors for match rankings in both years. Conclusion. The pandemic led to an increase in the number of residency applications per student and yielded a net cost savings. There were no differences in number of interviews offered, match rate, or in deciding factors influencing match rankings. As the pandemic evolves, schools should maintain a flexible and dynamic approach to support students.
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Background: Various COVID-19 vaccines with proven safety and effectiveness are available now but vaccine hesitancy remains a public threat. COVID-19 vaccines uptake appears to have an essential role in the successful control of the COVID-19 pandemic. Objective: To examine predictors of COVID-19 vaccination uptake and reasons for decline of vaccination. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for this systematic review. We searched Medline, PubMed, Web of Science, Scopus, ProQuest, CINAHL, and a preprint service (medRxiv). We used the following key-words: vaccin·, COVID-19, and uptake. We included all types of studies (quantitative, qualitative, and mixed methods) reporting COVID-19 vaccination uptake. The review protocol was registered with PROSPERO (CRD42021267460). Results: Twelve studies met the inclusion and exclusion criteria. COVID-19 vaccination uptake ranged from 28.6% to 98% in the general population, while among healthcare workers ranged from 33.3% to 94.5%, and among patients ranged from 36% to 80%. The main predictors of COVID-19 vaccination uptake were male gender, white race, older age, higher socioeconomic status, higher self-perceived COVID-19 vulnerability, increased information about COVID-19 vaccines, and chronic illness. The most important reasons for decline of vaccination were concerns about the safety and effectiveness of vaccines, illness, medication, pregnancy, fertility, breastfeeding, religious reasons, ethical reasons, previous COVID-19 diagnosis, self-estimation that COVID-19 is not a severe disease, and limited knowledge about the vaccines. Conclusions: Several factors affect COVID-19 vaccination uptake, while various reasons affect people's decision to refuse to take a COVID-19 vaccine. These findings are essential to further enhance our understanding of COVID-19 vaccination uptake and design specific interventions. Given the high prevalence of COVID-19 vaccine hesitancy, our findings have major implications for the delivery of COVID-19 vaccination programmes in the public with special attention to people who are undecided or unlikely to take a COVID-19 vaccine.
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South African women remain vulnerable to gender-based violence, including femicide. Intimate Partner Violence (IPV) is a major and very complex public concern in the country currently. This makes IPV the most widespread method by which men perpetrate violence against women. It is not clear if women are empowered with IPV Information, Motivation and Behavior skills (IBM) to protect themselves against IPV occurrences. This article presents the developed PreCCL (prevention, community-based, corrective and law enforcement) strategies to empower women against intimate partner violence in Limpopo Province, South Africa. PreCCL strategies were developed based on qualitative and quantitative IBM (Information, Motivation and Behaviour) of IPV results as well as evidence-based information from the review of literature. Delphi technique was used to organize one stakeholder engagement meeting with a panel of 38 experts knowledgeable regarding Vhembe district IPV issues (namely managers from Vhembe Thohoyandou victim empowerment centre, members of the Executive council of the 6th administration of Limpopo provincial Legislatures, heads of departments or directors from the department of health, social development and community safety and security, chairperson of gender equity, TVEP managers, as well as women who were victims from Vhembe where the study was conducted, and chairperson of gender equity, disability women and children). The purpose of the stakeholder engagement meeting was consultation and buy-in of experts in the field regarding feasible and practical evidence-based intervention strategies for local communities. The setting for stakeholder engagement meeting was Vhembe District Tshifulanani at Munnandinnyi and Hadumasi the Victorious Community offices. However, due to COVID-19 regulations other stakeholders failed to attend, and the rating scales were emailed to them together with the PreCCL strategies. The participants were asked to rate the PreCCL strategies on a given Likert scale in terms of relevance, importance, potential effectiveness and recommendation for adoption. The 0.67 Cronbach Alpha reliability score of the Likert scale was found acceptable for this study. Of the 65 questionnaires sent out, only 38 were returned, which was 58.5% response rate. Data were analyzed quantitatively using SPSS. The strategies were rated relevant in addressing IPV in the district by most (n = 36;97,4%;Mean ± SD = 3.0 ± 0.7) of the stakeholder, whereby (n= 6;15.8%;Mean ± SD=3.8 ±1.2) strongly agreed and (n =30;78,9%) agreed. In terms of importance, most (n = 32;84.3%) of the respondents rated the strategies very important in addressing IPV in the communities. The strategies were rated potentially effective in addressing IPV by most (n =34;89.5%;Mean ± SD (3.2 ± 0.6) of the stakeholder. The majority (n = 34;89.6%) of the stakeholders recommended the adoption of the developed strategies in current state. Conclusion: PreCCL strategies to empower women against IPV occurrences, which were developed based on IBM qualitative and quantitative results as well as review of literature are considered relevant and potentially effective by stakeholder who recommend their adoption by the Department of Social Development, Limpopo Province.
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Introduction:A patient experience survey was undertaken as part of the role of the Macmillan Consultant Therapy Radiographer for the bone and brain metastases patients to inform future development of the service.Method:A questionnaire was developed and approved by the Trust's local Questionnaire, Interview and Survey Group to survey the experiences and satisfaction of the service including the informed consent process, radiotherapy appointments and overall experience and satisfaction. The survey used qualitative and quantitative methods, including Likert Scales and free comment boxes. The responses were analysed by counting the frequency of each response and identifying any themes in free text responses.Results:Most patients were satisfied with the consent process with 1/36 patients reporting a lack of understandable information and 4/36 wanting more side effect information. The option of plan and treat was a preference of 53% of patients due to travelling back and forth to the centre;however, only 6% stated that they wanted two separate appointments. Ninety-four percent of patients felt that they had complete confidence and trust in the professional who consented them and 86% did not feel fully involved in the decision-making process. Overall, the service was rated as 10/10 by 61% of patients (n = 36).Conclusions:The patients surveyed were satisfied with their experience of the Palliative Radiotherapy Service;however, it needs to be developed further to meet the needs and expectations of the service users.
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Within-semester shifts in course modality in response to pandemics, weather, or accommodation for travel and health are increasingly common and can interrupt student learning. We tracked temporary modality changes across 10 sections of "Introduction to American Government” to examine the extent to which instructors have tools to help students successfully navigate such changes and mitigate learning loss. We find that students rated instructors' handling of shifts well if they made course material engaging, communicated clearly, and effectively used technology. The analysis suggests that instructors can mitigate the impact of unplanned changes to modality on students' learning when there are three or fewer shifts during a semester.
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Aim 3: Attaining Pediatric Endocrinology Clinician SatisfactionPediatric endocrinology clinician and nurse feedback was collected before each pilot round of checklist distribution. Pediatric endocrinology clinicians and nurses were encouraged to give the project team their suggestions and potential topic additions for each of the transition checklists. Team members' feedback and input were highly valued and used during each checklist revision before the finalized versions were introduced. Moreover, it was believed that by maintaining staff involvement throughout the project, the team would be more inclined to want to use the checklists with their patients. Thus, their feedback was incorporated directly into the finalized checklists.Feedback was sought through a series of staff surveys throughout the project during the following times: before implementation of the transition checklists, during implementation, and after implementation. Effectiveness measurement occurred at multiple points of the project and of the patient encounter cycle. This was performed through surveys with Likert scales and free-text questions. These surveys occurred before project implementation, after a 4-week trial, and after another 4-week cycle.It is important to note that the first 2 staff surveys (ie, before implementation and during the implementation) asked a uniform set of questions, whereas the postimplementation survey asked unique, specific questions pertaining to each age-related checklist. These 3 sets of staff surveys were vital to assess staff feedback and to track areas of improvement. Staff were able to voice their areas of concern and provide recommendations for the checklists.ResultsResults were centered on staff perception of inclusivity, program usefulness, and effectiveness. Before and during implementation, a total of 3 rounds of staff surveys were completed. The first staff survey was administered during the week of January 5, 2020. A total of 17 staff surveys were distributed to the provider team. A response rate of 76% (13/17) was obtained.Regarding Aim 1, the majority of individuals surveyed (94%;16/17) strongly agreed that transition management should begin in middle adolescence, that it was important to the practice, and that the pediatric endocrinology clinic's current self-management and transition screening process was lacking. The majority of nurses and providers (77%;13/17) strongly agreed that there was ease of use with the checklist process. These positive results aligned with the first aim of the project—to assist pediatric endocrinology clinicians in assessing the responsibility of T1D care.Aim 2 of this project was to integrate evidence-based checklists into daily use. Prior to the start of implementation, staff strongly agreed that the checklists were easy to use (92%;12/13), and the majority of individuals surveyed (69%;9/13) agreed strongly that they would adopt the checklists as a standard of care. Throughout the project, time was the main issue that pediatric endocrinology clinicians expressed concern with checklist integration. Although most staff had no concerns for additional time requirements, over a quarter (31%;4/9) were unsure if the checklists would ultimately extend pediatric endocrinology clinic visits and provider schedules (see Figure 5).The second survey was administered the week of February 2, 2020, with a good response rate (86%;6/7). As evidenced in Figure 6, pediatric endocrinology clinic nurses showed increasing support for use of the checklists during the intake portion of the visit in February compared to preintervention data. After 1 month of a PDSA pilot, nurses also unanimously agreed that they would be willing to integrate the checklist model and transition education into their daily practice with patients.Aim 3 of this project was to attain pediatric endocrinology clinician satisfaction in a manageable and attainable new intake process. After an initial PDSA cycle, a second staff survey was slightly modified to only include nurse feedback;the nurses were the staf mem ers who were directly involved with the distribution, collection, and tracking of the transition checklists. There was also a decrease in staff perception as to whether it was useful for patients and whether the educational handouts were beneficial (see Figure 7).However, staff were split as to whether they believed both parents and adolescents thought the process was equally beneficial. As Figure 8 shows, nurses were satisfied with the level of parental support they had witnessed both during checklist administration and while providing education to teens and families. Over half of nurses (53%;7/13) felt that the same support existed among adolescent patients.DiscussionPediatric care providers, particularly nursing staff, have an integral role in helping adolescents with T1D transition to adult care. In outpatient settings, pediatric nurses proactively manage patients and outcomes in between follow-up visits. It is extremely important to attain the interest and involvement of pediatric nurses, advanced practice pediatric endocrinology clinicians, and physicians prior to starting a care management and transition program. Within the context of T1D, research has shown that young adults are not confident in their self-management and may also display higher levels of depression and risk-taking behaviors (Gutierrez-Colina et al 2020). A coordinated and enthusiastic team approach is necessary to approach care management for patients on physical, mental, and emotional levels.Involving pediatric endocrinology clinic care providers early and throughout the project may have contributed to sustained support for the implementation of the checklists. Staff were involved during every round of the checklist revisions in which their feedback and suggestions were continually welcomed. Nurses and NPs were shadowed prior to implementation to assess daily activities, pediatric endocrinology clinic flow, and the feasibility of integrating new duties into appointments and charting duties. New patient support and insulin pump classes, hosted by dual pediatric nurses and certified diabetes care and education specialists, were also attended to assess the responsibilities of pediatric endocrinology clinic staff. In consideration of the literature, involvement of providers was extremely important through the self-management evaluation (Garvey et al 2017). It was extremely important for our team to integrate interventions that were manageable and sustainable for nurses and providers. We sought approval from physicians, advanced practice providers, nurses, and the pediatric endocrinology clinic dietitian for every checklist and proposed educational intervention. Involving pediatric endocrinology clinic care providers early and throughout the project may have contributed to sustained support for the implementation of the checklists.A nurse champion was identified and assigned to help coordinate patient selection, distribution of checklists, and staff education. Having a champion was critical to implementation of the project, even when it was noted to cause additional time in patient intake. The champion spearheaded meetings with facility technology liaisons, which was helpful because the DNP students on the team were not employees of the health system. The nurse champion was a BSN-prepared certified diabetes educator, and her expertise supported the project both before and during COVID-19. This individual is expected to assist with the sustainability of the project.Nursing staff routinely provided feedback that the checklist process would need to be integrated into the electronic medical record (EMR) for it to be sustainable after the end of the trial period. While awaiting coordination with the facility's EMR team, the pediatric endocrinology clinic's medical assistants provided the checklist to patients and parents during the check-in process. Meetings occurred every Friday with nurses and a lead medical assistant to identify next week's patients who would need assessment of self-management and transition readiness. Patients were identi ied and mar ed with the date and time of appointment, provider name, and team nurse. At this preweekly screening, patients' health history was assessed to ensure the adolescent was an appropriate candidate for self-management discussion.Throughout the project, pediatric endocrinology clinical staff support and buy-in for the transition of care readiness checklists remained above average or high. For instance, it was found in the first survey that 92% of the staff strongly believed that transition of care management is important and relevant to their practice. Interdisciplinary coordination and buy-in of a transition of care program has been viewed as important to the success of transition (Pierce et al 2017). Perhaps a potential reason for such high, sustained pediatric endocrinology clinical support could be explained by the fact that the pediatric endocrinology clinic did not have any prior transition of care process in place. They were eager for us to begin working on a structured process for the staff and patients. Evaluation of the contextual setting and implementing evidence into practice assisted with implementation and continuing momentum on the project (Seers et al 2012).The final versions of the checklists support a developmentally appropriate and systematic process that can assist pediatric endocrinology clinics to prepare adolescents with T1D for a safe transition to adult care. Most children are diagnosed at a young age, and teaching is focused on parent understanding. Therefore, transition to adult care requires a comprehensive and logical approach to assess adolescent understanding. Starting with an independent environment in high school and the need to correctly count carbohydrates and dose insulin and progressing on to the ability to refill prescriptions anddeal with insurance questions is crucial. The final versions of the checklists support a developmentally appropriate and systematic process that can assist pediatric endocrinology clinics to prepare adolescents with T1D for a safe transition to adult care.LimitationsBarriers identified included the size of data collection during initial cycles, time needed for checklist completion, and integration into the EMR. A major limitation of our project was the small sample size of pediatric endocrinology clinical staff who were surveyed. A total of 17 clinical staff members, 16 of whom provided feedback during survey 1. Of the 7 nurses who were surveyed in surveys 2 and 3, 6 provided feedback during survey 2, and 7 provided feedback during survey 3. Another limitation is that the pediatric endocrinology clinical site for the project resides in a large, suburban area and cannot be assumed to be representative of the entire adolescent T1D population at large. Moreover, our data only come from a single pediatric endocrinology clinic.Another area where the data were not as persuasive compared to the pediatric endocrinology clinical staff support for the checklists was in terms of staff feedback involving the length of time required to complete the checklists. A resounding theme with staff was their concern with how much time would be added on to the intake process for patients. Due to the nature of the pediatric endocrinology clinic, nurses had approximately 5 to 10 minutes to room patients and prepare them for a visit with the provider. The initial rollout of the project consisted of patients being presented with the survey upon check in. If deficiencies in care management were identified, the nurse would provide education and an issue-specific handout. This handout had to be retrieved from the provider office, which added an extra 3 to 5 minutes of walking and coordination.Additionally, the decrease in the percentage who strongly disagreed could potentially be attributed to not having the checklists uploaded into the EMR. This action could decrease the amount of time that staff would need to chart on the patient's progress. We might expect more favorable responses for this category once a more finalized pediatric endocrinology clinical workflow process is established. How ver, this is largely reliant on when the checklists become uploaded by the health IT department into the EMR.Using paper checklists and handouts, rather than technology, was the largest impediment to our aims. During the phase of our project where we sought staff feedback, it would have been useful to engage with the facility's IT department early in the process. This would have assisted with concurrent project and EMR rollout, rather than initiating the project using hard copies of checklists and educational handouts. Integration of the project into daily use is intended to be done by using the EMR. The team expected to lay the groundwork for the aim in spring 2020 and create a plan with IT to facilitate a unique note within the EMR. Transition of the pediatric endocrinology clinic from regular to COVID-19 operations put this aim on hold. The next direction of this project is a nurse-led program to integrate the checklists as part of a routine template within the medical record. Using paper checklists and handouts, rather than technology, was the largest impediment to our aims.RecommendationsIt is important to note that while the use of checklists can be a helpful mechanism to track a patient's progression in their self-care and to prepare them to be able to self-manage their diabetes, it may not be the best format to use for all patients. Some patients may require multiple transitions of care strategies. We recommend a targeted approach to each patient's unique situation.We also recommend that the transition process begins earlier rather than later. Current literature supports assessing readiness of emerging adults with diabetes to transition to adult care at 15 years of age (Kamoun et al 2022). Our staff noted that adolescents are required to independently manage their diabetes when starting high school at 14 years of age. Therefore, we recommend starting the transition process as early as age 14 to begin assessing the patient's needs and self-care abilities. This is in contrast to many larger diabetes authorities, such as the American Diabetes Association (ADA), who largely recommend beginning the transition of care process approximately 1 year prior to transition. Our approach offers more time to prepare and home in on the important self-care skills.We further recommend that staff administer the transition of care checklists at least 1 to 2 times per year starting at age 14 until the transition. Because most patients are seen in the pediatric endocrinology clinic at least every 3 months for follow-up, we recommend incorporating the checklists into the routine 3-month visit workflow to maintain tight tracking of the patient's progression in their disease self-management.It is also important to keep in mind the practicality of integrating a checklist system into a busy pediatric endocrinology clinic day of approximately 10 to 15 patients per provider. Most pediatric endocrinology clinic visits are fairly short and may only last 15 to 30 minutes, making it at times seem cumbersome to administer the checklists. This is why we recommend continuing to have patients complete the checklist form while they are in the waiting area before their appointment and to supply them with the corresponding education at the end of the appointment should they feel unsure about a particular disease topic. This way, filling out the checklists would not impede the overall flow of the visit.
ABSTRACT
Quality of care continues to be of serious concern in the United States. Part of addressing this concern must include academic programs that produce students with an appreciation of quality management to take up positions in healthcare organizations. Moreover, healthcare organizations must ensure that quality and safety are front of mind for those they employ, especially those in management. This study presents an evaluation of student perception of their readiness to work as part of quality management teams and undertake quality management activities. Majority of the students surveyed agreed that they felt well prepared to participate on a healthcare quality management (QM) team, felt confident in their ability to participate in QM activities, and were extremely confident in their QM skills. Additionally, majority of the respondent indicated that "everyone" was responsible for ensuring quality in the healthcare organization. Healthcare organizations must invest in the professional development of their employees especially in quality management. This may prove to be beneficial to their patients and bottom line.
ABSTRACT
Background: During the COVID-19 pandemic, measures were taken to decrease viral spread by transitioning health care appointments to virtual mediums. This study evaluates the use of telemedicine within the Divisions of Colon and Rectal Surgery and Otolaryngology-Neurotology at a single academic institution during the COVID-19 pandemic. Study Design: An online survey modeled after the TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) was administered to gauge patient’s experience with Electronic Medical Record-based telemedicine visits. Results: Participants noticed several advantages of telemedicine visits over traditional in-office visits: shorter visits, saving money, and avoiding potential exposure during the pandemic. A total of 36% at least somewhat agreed that the quality of care was hindered by the lack of a physical examination;61.7% participants at least somewhat agreed that they prefer a face-to-face visit rather than telemedicine consultation. Most patients were satisfied with the care they received via telemedicine (Likert 6.19/7) and 95.8% would use telemedicine again. Participants self-reported an average saving of $108.70 when using telemedicine. When comparing the telemedicine cohort with the in-office control, the telemedicine patients noticed an improved ability to communicate with their physician in five out of eight domains of the MCCS. Conclusion: Surgical preoperative consultation, postoperative follow-up, and routine visits were conducted via telemedicine during the COVID-19 pandemic, representing a new direction for surgical appointments and consultations. This study shows that telehealth can provide satisfactory care and increases access to surgical care for patients when external factors prevent the traditional physician–patient interaction. With better-perceived communication via telemedicine appointments, patients may subjectively feel that they can express their symptoms and gather information from the doctor regarding their diagnosis more efficiently.
ABSTRACT
IntroductionThe COVID-19 pandemic affected medical students experience of clinical neurology. Outpatient clinics reverted to telephone or video consultations. We sought to assess the impact of this change via a survey of both students and consultant neurologists.MethodsAn online 14-part questionnaire using Likert scales and free text options was distributed to all Year 4 medical students and consultant neurologists via email.Results366 students received the survey and 39 responded (an 11% response rate). 41 consultants received the survey and 9 responded (a 22% response rate). 83% of consultants felt the student’s inter- action with the patient was affected by the telephone/video software. 29% of students strongly agreed and 36% agreed that technological barriers impacted their learning experience.The free text student feedback highlighted good practice. We developed best practice guidance which included use of video consultation software, student engagement and clinic debrief. This was distributed as digestible checklists for students and clinicians. The limitations of this survey are the small response rates of both consultant and student groups.ConclusionRemote consultations are likely to remain part of neurological practice. Ongoing evaluation of its effect on medical student education and specific guidance for educators is required.
ABSTRACT
ObjectivesHand signatures offer a more authentic personalisation, which carries over to a sense of trust, although are costly and time-consuming when considering large postal surveys. The objective of this study was to compare response rates when using either hand-signed or electronic-signed letters in a postal survey.Design and settingWe embedded this randomised controlled trial within a national cross-sectional postal survey of emergency physicians in Canada. The survey aimed to describe current practice patterns with respect to primary headache disorders.ParticipantsWe randomly sampled 500 emergency physicians listed in the Scott’s Canadian Medical Directory, 2019 edition.InterventionsUsing computer-generated random numbers, physicians were allocated to receiving either hand-signed (n=250) or electronic signed (n=250) letters. The initial mailout contained a US$5 Tim Hortons coffee card with the invitation letter. Four reminders were sent to non-responders every 3 weeks. The same type of signature was used for the initial invitation and subsequent reminders.OutcomeThe primary outcome was the survey response rate.ResultsAmong 500 physicians invited, 32 invitations were undeliverable. Among the remaining 468 physicians, 231 had been allocated to the hand-signed group and 237 to the electronic signed group. The response rate in the hand-signed group was 87 (37.7%) vs 97 (40.9%) in the electronic-signed group (absolute difference in proportions −3.3%, 95% CI −12.1% to 5.6%).ConclusionThere was no significant difference in physician response rate between hand-signed and e-signed cover letter and reminder letters. Electronic signatures should be used in future postal surveys among physicians to save on time and labour without impacting response rates.
ABSTRACT
Social networking has become an essential part of our day-to-day life;reaching a peak during the Covid-19 pandemic. Social media advertising and Social Networking Sites (SNS) provide information, reviews and feedback on branded products. The study investigates the impact of SNS on online purchase intention of branded products. It also investigates the mediatory role of brand attitude in online purchase intention of such products. A sample of 380 respondents from 18 metropolitan cities of India was taken, and 350 responses (92.1% response rate) were used for coding, analyzing and testing the hypothesis. SPSS 20 and AMOS 21 were used to analyze the collected data. The results showed that SNS affect the online purchase intention of branded products. Brand attitude has a partial mediating effect on online purchase intention. The study suggests that companies should keep vigilance on brand image, communication, feedback and reviews of their products on SNS. Negative communication or anti-branding of branded products on SNS affects the purchase intention of consumers negatively. It is very essential to strategically manage the negative communication and anti-branding.
ABSTRACT
COVID 19 pandemic has become one of the biggest disruptor of progressive business operations in this century. The term, 'business un-usual is no longer a fad but a reality. This current era has come to be known as the 'COVID 19 pandemic times'. It has come to be typified with reduced business operations, business closures, restructuring, refocusing and downright activation of business plans and protocols which are rarely employed, like business continuity plans, risk management plans and strategic contingency plans. The phenomenon has been experienced all over the world, however this paper is based on the United Arab Emirates, more specifically the small and medium sized enterprises in its two northern emirates, the emirates of Sharjah and Dubai. With a review of oil based economy, the two emirates have been on an economic diversification model and hence the growth impetus of service industry like tourism and hospitality and manufacturing. These have seen the springing up of many SMEs competing to fill up the emerging opportunities as a result of the economic diversification. The role of SMEs in the entire UAE cannot be underscored since they critically have become one of the pillars of the economy. This paper tested whether the combination of an organisational processes, its manpower and industry relevant government policy has any significant effect on the firm's sustainable financial performance. For the purposes of the research, 400 hundred units were chosen randomly, which are within the stipulated sample criterion, since as at the end of the last quarter of 2019, there were 400,000 SMEs registered and actively doing business in the UAE. The response rate was 95.75 percent. This high response rate may be attributed to that fact that the questionnaire was online and in both English and Arabic. Piloting of the questionnaire had been done earlier in different emirate called Ajman and the results showed high reliabilityand consistency of the instrument. The findings indicated that the variable under study have a significant effect on the firm's sustainable financial performance. The regression model adopted indicated that the predictor variables could explain 15 percent of the outcome. The research therefore concludes that, for a positive impact on an organisations' sustainable financial performance, the three dependent variables, which were organisational processes, the manpower of the organisation and governmental interventions through appropriate policy framework are necessary. The researchers further recommend that other factors which contribute to the sustainability of the financial performance, non-financial performance or the overall performance, within all the seven emirates of the UAE may also be studied.