A Hazardous Materials Educational Curriculum Improves Pediatric Emergency Department Staff Skills.

OBJECTIVE: Emergency department (ED) providers require competency in responding to hazardous materials (HAZMAT) events. The optimal strategies to teach HAZMAT response principles to ED providers and to ensure skill retention are not known. Our aim was to design, implement, and evaluate a multifaceted, interprofessional educational curriculum for pediatric ED staff to improve their skills, knowledge, and confidence in responding to a HAZMAT event. METHODS: In this longitudinal cohort study, we created and assessed a 3-hour educational curriculum comprised of didactics, skills stations, a tabletop exercise, and a simulated multivictim disaster. Learning objectives included critical aspects of pediatric HAZMAT incident response with an emphasis on donning personal protective equipment (PPE). The primary outcome was the number of HAZMAT PPE donning steps correctly completed within 10 minutes at pre- and postcurriculum assessments measured using a 32-item checklist. Secondary outcomes included skill retention at 3 months, change in knowledge assessed using multiple-choice questions, and change in participant confidence. RESULTS: Eighty-one of 84 participants (96%) completed the entire curriculum. Compared to the precurriculum assessment, participants completed more donning steps correctly after the intervention (mean increase = 58%, 95% confidence interval [CI] = 48%-70%). Relative to the baseline, more steps were also correctly completed at 3 months (mean increase = 49%, 95% CI = 38%-61%). Performance on multiple-choice knowledge questions and confidence in skills also significantly increased from the pre- to postcurriculum assessments. CONCLUSIONS: A newly developed HAZMAT educational curriculum improved skills-based performance, knowledge, and confidence in PPE and decontamination skills. Brief, multifaceted educational interventions for ED staff can effectively develop sustainable skills needed for uncommon emergency events.

Leisure-Time Physical Activity: Experiences of College Students With Disabilities.

College years are an experimental phase in young adulthood and can lay the foundation for lifelong behaviors. One type of behavior developed during these years is the use of leisure-time physical activity (LTPA). LTPA experiences of typical college students have been examined, but there is a lack of studies examining the experiences of students with disabilities. The purpose of this inquiry is to understand the experiences of college students with disabilities and their LTPA, with focus on factors that facilitate or create barriers to engagement. Grounded theory was used to understand LTPA with undergraduates with mobility or visual impairments. Results indicated a theme of culture of physical activity and disability as they received a message that engagement in LTPA was "unnecessary" or "heroic," which altered their LTPA experiences. Barriers to LTPA can be understood through a social relational lens to recognize the multidimensionality of barriers and facilitators to LTPA.

Health state utilities associated with attributes of treatments for hepatitis C.

BACKGROUND: Cost-utility analyses are frequently conducted to compare treatments for hepatitis C, which are often associated with complex regimens and serious adverse events. Thus, the purpose of this study was to estimate the utility associated with treatment administration and adverse events of hepatitis C treatments. DESIGN: Health states were drafted based on literature review and clinician interviews. General population participants in the UK valued the health states in time trade-off (TTO) interviews with 10- and 1-year time horizons. The 14 health states described hepatitis C with variations in treatment regimen and adverse events. RESULTS: A total of 182 participants completed interviews (50% female; mean age = 39.3 years). Utilities for health states describing treatment regimens without injections ranged from 0.80 (1 tablet) to 0.79 (7 tablets). Utilities for health states describing oral plus injectable regimens were 0.77 (7 tablets), 0.75 (12 tablets), and 0.71 (18 tablets). Addition of a weekly injection had a disutility of -0.02. A requirement to take medication with fatty food had a disutility of -0.04. Adverse events were associated with substantial disutilities: mild anemia, -0.12; severe anemia, -0.32; flu-like symptoms, -0.21; mild rash, -0.13; severe rash, -0.48; depression, -0.47. One-year TTO scores were similar to these 10-year values. CONCLUSIONS: Adverse events and greater treatment regimen complexity were associated with lower utility scores, suggesting a perceived decrease in quality of life beyond the impact of hepatitis C. The resulting utilities may be used in models estimating and comparing the value of treatments for hepatitis C.

Health state utilities associated with adult attention-deficit/hyperactivity disorder.

OBJECTIVES: With growing awareness of the importance of adult attention-deficit/hyperactivity disorder (ADHD) treatment, cost-effectiveness analyses, including utilities, are needed to compare the value of treatment options. Although utilities have been reported for childhood ADHD, little is known about utilities representing adult ADHD. Therefore, the purpose of this study was to estimate utilities associated with adult ADHD. METHODS: Health-state descriptions of adult ADHD were drafted based on literature review, interviews with four clinicians, and clinical trial data. Health states were revised based on a pilot study with 26 participants. Final health states were rated in time trade-off interviews with general population respondents in London and Edinburgh, UK. RESULTS: A total of 158 participants completed interviews (mean age =47.0 years; 49.4% female; Edinburgh =80 participants). Mean (standard deviation [SD]) utilities were 0.82 (0.17), 0.68 (0.28), and 0.67 (0.28) for health states describing treatment responders (health state A), nonresponders (health state B), and untreated patients (health state C), respectively. Most participants rated health state A as preferable to B (n=92; 58.2%) and C (n=97; 61.4%). The majority rated B and C as equal (n=125; 79.1%). Paired Student's t-tests found that A had a significantly greater mean utility than B (t=10.0; P<0.0001) and C (t=10.2; P<0.0001). CONCLUSION: The current study provides utilities that may be used in cost-utility models of treatment for adult ADHD. Results reflected clear differences between health states representing treatment responders and nonresponders/untreated patients. Current utilities were comparable to those previously reported for childhood ADHD.

Are treatment benefits in neuropathic pain reflected in the Self Assessment of Treatment questionnaire?

BACKGROUND/OBJECTIVE: The Self Assessment of Treatment (SAT) questionnaire was developed to reflect key patient reported outcomes of Neuropathic Pain (NP) treatments. This study aimed to understand how patients perceived the relevance and ease of understanding of the questions in the SAT and to recommend modifications based on patient and clinician interviews. METHODS: Semi-structured interviews were conducted with clinicians and NP patients to provide information regarding treatment attributes and the impact of pain. Patients were debriefed on the SAT, a 5-item scale evaluating pain, activity level, quality of life (QoL) and satisfaction with treatment (recommend treatment and undergo treatment again). The SAT has a recall period reflecting back to the start of treatment. The qualitative analysis software ATLAS.ti 5.0 was used to analyze patient transcripts. Changes to the SAT were integrated into the questionnaire for a second round of debriefing interviews. RESULTS: Three NP clinicians and 44 patients (20 painful diabetic neuropathy, 16 HIV-associated neuropathy and 8 post herpetic neuralgia) with a mean age of 60.3 (12.3) years and an even gender distribution were interviewed. Patient treatment experience included anticonvulsants (73%), antidepressants (34%), opioids (25%), and topical medications (41%). Pain descriptors and treatment attributes were similar across the three NP groups. Pain relief was judged the most important treatment attribute, followed by ability to undertake activities. Sleep improvement was another important attribute. Activity limitations and QOL were perceived as too broad and non-specific, and were split into 3 concepts each (activity limitations was split into self care, daily and physical activities and QOL was split into sleep, emotions, and social function). A 7-day recall period was introduced. The item stem and response options were made consistent, and a baseline and follow-up questionnaires were developed (except for the satisfaction items) to enable monitoring onset of treatment benefit and change over time. CONCLUSIONS: The content validity of the revised SAT was improved by the qualitative research, and NP treatment benefits are reflected in a more consistent fashion by the changes. Baseline and follow-up versions make it possible to perform assessments of change over time.

Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage.

BACKGROUND: Survivors of aneurysmal subarachnoid hemorrhage (SAH) are faced with a complicated recovery, which typically includes surgery, prolonged monitoring in the intensive care unit, and treatment focusing on the prevention of complications. OBJECTIVE: The purpose of this study was to determine the safety and feasibility of an early mobilization program for patients with aneurysmal SAH. DESIGN: This study was a retrospective analysis. METHODS: Twenty-five patients received early mobilization by a physical therapist or an occupational therapist, or both, which focused on functional training and therapeutic exercise in more progressively upright positions. Participation criteria focused on neurologic and physiologic stability prior to the initiation of early mobilization program sessions. RESULTS: Patients met the criteria for participation in 86.1% of the early mobilization program sessions attempted. Patients did not meet criteria for the following reasons: Lindegaard ratio >3.0 or middle cerebral artery (MCA) mean flow velocity (MFV) >120 cm/s (8.1%), mean arterial pressure (MAP) <80 mm Hg (1.8%), intracranial pressure (ICP) >15 mm Hg (1.8%), unable to open eyes in response to voice (0.9%), respiratory rate >40 breaths/min (0.6%), MAP >110 mm Hg (0.3%), and heart rate <40 bpm (0.3%). Adverse events occurred in 5.9% of early mobilization program sessions for the following reasons: MAP <70 mm Hg (3.1%) or >120 mm Hg (2.4%) and heart rate >130 bpm (0.3%). The 30-day mortality rate for all patients was 0%. Participation in the early mobilization program began a mean of 3.2 days (SD=1.3) after aneurysmal SAH, and patients received an average of 11.4 sessions (SD=4.3). Patients required a mean of 5.4 days (SD=4.2) to participate in out-of-bed activity and a mean of 10.7 days (SD=6.2) to walk ≥15.24 m (50 ft). CONCLUSIONS: The results of this study suggest that an early mobilization program for patients with aneurysmal SAH is safe and feasible.

Recreational planning: an important component of career counseling for people with disabilities.

Participation in recreational activities is a critical component of the career development process, providing opportunities for individuals to explore their interests and to develop work-related skills. Recreational participation also offers a healthy outlet for dealing with job-related and other life stressors. People with disabilities are often excluded from participation in recreational activities because of a multitude of barriers. This exclusion can seriously impede the career development of these individuals. This article explores the importance of recreational planning as part of the vocational rehabilitation process. The authors define inclusive recreation and discuss the implications of recreational planning in the various phases of rehabilitation.