ABSTRACT
Background: We implemented a multi-disciplinary process improvement intervention at our Comprehensive Stroke Center with speech/language pathologists to expedite oral medication delivery in stroke patients. Following a failed nursing dysphagia screen, trained neurology physicians screened dysphagia further to approve use of oral medications. We analyzed the safety and efficacy of this intervention. Methods: We analyzed retrospectively collected data for hospital course, timing of first screen, first oral medication use, and complications (e.g., aspiration pneumonia) in consecutive ischemic stroke patients (9/2019-07/2021). Patients were included if they passed a dysphagia assessment by physicians (Ph), nurses (RN), or speech/language pathologists (SLP). Arrival-to-dysphagia screen and arrival-to-antithrombotic were assessed using restricted mean survival time (RMST). Results: Of the 789 included patients, 673 were passed by RN, 104 by SLP, and 12 by Ph. Compared to patients passed by SLP, those passed by Ph were younger and had less severe deficits (P < .01 for both). Patients were screened more quickly by Ph than RN or SLP (median 38 vs 182 vs 1330-min post-arrival, P = .0001; 299-min RMST difference vs RN [95%CI 22-575, P = .03]; 470-min RMST difference vs SLP [95%CI 175-765, P = .002]). This translated to faster oral antithrombotic use for Ph-passed patients (138-min RMST difference vs RN [95%CI 59-216]; 332-min RMST difference vs SLP [95%CI 253-411]). No patients passed by Ph experienced aspiration pneumonia (0%). Conclusions: We safely conducted a physician-driven dysphagia screening paradigm which led to faster oral antithrombotic delivery without signal of patient harm. Physician availability to complete dysphagia screens in acute stroke patients was a limitation.
ABSTRACT
In the present study, we examined the ability of Self-Determination Theory's causality orientations to predict alcohol use and abstinence self-efficacy. We also provided suggestions for counselors supporting client and student autonomy in clinical practice. Objectives: This study sought to answer the following questions: (a) Does a person's causality orientation (autonomy, control, and impersonal) predict their alcohol use? (2) Does a person's causality orientation (autonomy, control, and impersonal) predict their temptation to use drugs and alcohol? (3) Does a person's causality orientation (autonomy, control, and impersonal) predict their confidence to use drugs and alcohol? Method: We utilized Amazon's Mechanical Turk (MTurk), a crowdsourced online labor market approach to collect data from a community sample. Results: The results suggest heightened impersonal orientation was predictive of increased alcohol use and increased temptation to use while control orientation was also predictive of increased temptation. Higher autonomous orientation was predictive of increased confidence to not use while impersonal and controlled were not. Conclusion: This study's findings underline the importance of SDT in substance use prevention, initiation, and treatment, and open the door to more empowering interventions. Through the intentional use of SDT, individuals may feel more empowered to set and achieve goals, feel a greater sense of control in their lives, strengthening their overall autonomy.
