scholarly journals Disaster Planning for Homeless Populations: Analysis and Recommendations for Communities

2020 ◽  
Vol 35 (3) ◽  
pp. 322-325 ◽  
Author(s):  
Stephen C. Morris
Keyword(s):  
Emergency Preparedness ◽  
Resource Constraints ◽  
Homeless People ◽  
Disaster Planning ◽  
The United States ◽  
Lessons Learned ◽  
Homeless Population ◽  
Special Populations ◽  
Population Classification ◽  
Mental And Physical Health

AbstractHomelessness is a growing problem, with perhaps greater than a 150 million homeless people globally. The global community has prioritized the problem, as eradicating homelessness is one of the United Nation’s sustainability goals of 2030. Homelessness is a variable entity with individual, population, cultural, and regional characteristics complicating emergency preparedness. Overall, there are many factors that make homeless individuals and populations more vulnerable to disasters. These include, but are not limited to: shelter concerns, transportation, acute and chronic financial and material resource constraints, mental and physical health concerns, violence, and substance abuse. As such, homeless population classification as a special or vulnerable population with regard to disaster planning is well-accepted. Much work has been done regarding best practices of accounting for and accommodating special populations in all aspects of disaster management. Utilizing what is understood of homeless populations and emergency management for special populations, a review of disaster planning with recommendations for communities was conducted. Much of the literature on this subject generates from urban homeless in the United States, but it is assumed that some lessons learned and guidance will be translatable to other communities and settings.

scholarly journals Electronic medical record implementation for a healthcare system caring for homeless people

JAMIA Open ◽  
2018 ◽  
Vol 2 (1) ◽  
pp. 89-98
Author(s):  
Gerald H Angoff ◽  
James J O’Connell ◽  
Jessie M Gaeta ◽  
Denise De Las Nueces ◽  
Michael Lawrence ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Resource Constraints ◽  
Management Strategies ◽  
Homeless People ◽  
Software Tools ◽  
Homeless Population ◽  
Successful Implementation ◽  
Training Environment ◽  
Workflow Analysis

Abstract Objective Electronic medical record (EMR) implementation at centers caring for homeless people is constrained by limited resources and the increased disease burden of the patient population. Few informatics articles address this issue. This report describes Boston Health Care for the Homeless Program’s migration to new EMR software without loss of unique care elements and processes. Materials and methods Workflows for clinical and operational functions were analyzed and modeled, focusing particularly on resource constraints and comorbidities. Workflows were optimized, standardized, and validated before go-live by user groups who provided design input. Software tools were configured to support optimized workflows. Customization was minimal. Training used the optimized configuration in a live training environment allowing users to learn and use the software before go-live. Results Implementation was rapidly accomplished over 6 months. Productivity was reduced at most minimally over the initial 3 months. During the first full year, quality indicator levels were maintained. Keys to success were completing before go-live workflow analysis, workflow mapping, building of documentation templates, creation of screen shot guides, role-based phased training, and standardization of processes. Change management strategies were valuable. The early availability of a configured training environment was essential. With this methodology, the software tools were chosen and workflows optimized that addressed the challenges unique to caring for homeless people. Conclusions Successful implementation of an EMR to care for homeless people was achieved through detailed workflow analysis, optimizing and standardizing workflows, configuring software, and initiating training all well before go-live. This approach was particularly suitable for a homeless population.

scholarly journals Designing a smoking cessation intervention for the unique needs of homeless persons: a community-based randomized clinical trial

2011 ◽  
Vol 8 (6) ◽  
pp. 744-754 ◽  
Author(s):  
Kate Goldade ◽  
Guy-Lucien Whembolua ◽  
Janet Thomas ◽  
Sara Eischen ◽  
Hongfei Guo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Smoking Cessation ◽  
Nicotine Patch ◽  
The United States ◽  
Homeless Persons ◽  
Lessons Learned ◽  
Community Advisory Board ◽  
Homeless Population ◽  
Community Based ◽  
Quit Smoking

Background Although smoking prevalence remains strikingly high in homeless populations (~70% and three times the US national average), smoking cessation studies usually exclude homeless persons. Novel evidence-based interventions are needed for this high-risk subpopulation of smokers. Purpose To describe the aims and design of a first-ever smoking cessation clinical trial in the homeless population. The study was a two-group randomized community-based trial that enrolled participants ( n = 430) residing across eight homeless shelters and transitional housing units in Minnesota. The study objective was to test the efficacy of motivational interviewing (MI) for enhancing adherence to nicotine replacement therapy (NRT; nicotine patch) and smoking cessation outcomes. Methods Participants were randomized to one of the two groups: active (8 weeks of NRT + 6 sessions of MI) or control (NRT + standard care). Participants attended six in-person assessment sessions and eight retention visits at a location of their choice over 6 months. Nicotine patch in 2-week doses was administered at four visits over the first 8 weeks of the 26-week trial. The primary outcome was cotinine-verified 7-day point-prevalence abstinence at 6 months. Secondary outcomes included adherence to nicotine patch assessed through direct observation and patch counts. Other outcomes included the mediating and/or moderating effects of comorbid psychiatric and substance abuse disorders. Results Lessons learned from the community-based cessation randomized trial for improving recruitment and retention in a mobile and vulnerable population included: (1) the importance of engaging the perspectives of shelter leadership by forming and convening a Community Advisory Board; (2) locating the study at the shelters for more visibility and easier access for participants; (3) minimizing exclusion criteria to allow enrollment of participants with stable psychiatric comorbid conditions; (4) delaying the baseline visit from the eligibility visit by a week to protect against attrition; and (5) regular and persistent calls to remind participants of upcoming appointments using cell phones and shelter-specific channels of communication. Limitations The study’s limitations include generalizability due to the sample drawn from a single Midwestern city in the United States. Since inclusion criteria encompassed willingness to use NRT patch, all participants were motivated and were ready to quit smoking at the time of enrollment in the study. Findings from the self-select group will be generalizable only to those motivated and ready to quit smoking. High incentives may limit the degree to which the intervention is replicable. Conclusions Lessons learned reflect the need to engage communities in the design and implementation of community-based clinical trials with vulnerable populations.

scholarly journals Disaster Planning for the Urban Homeless Population in the United States

2019 ◽  
Vol 34 (s1) ◽  
pp. s93-s93
Author(s):  
Stephen Morris ◽  
Emily Bartlett
Keyword(s):  
United States ◽  
Social Services ◽  
Health Care Services ◽  
Emergency Services ◽  
Census Data ◽  
Disaster Planning ◽  
The United States ◽  
Homeless Population ◽  
Care Services ◽  
Medical Services Utilization

Introduction:Homeless individuals may be dependent on social services for nutrition, shelter, and protection. These services are susceptible to disruption in disasters. Individuals are often frequent utilizers of emergency health care services, and an increase in emergency medical services utilization may be predictable. Disaster planners should anticipate and plan for the needs of these special populations.1Methods:A review of disaster planning in US cities with high rates of homelessness was conducted. Utilizing homelessness census data, the five cities with the largest homeless population were chosen for analysis. Publicly available disaster plans specifically targeting at homeless were identified. Planning for nutritional support, shelter, protection, and emergency healthcare utilization was identified.Results:Planning specifically addressing the needs of the homeless was variable. Planning items surrounding nutrition and shelter were identified, but those around protection and use of emergency services were more limited.Discussion:Recent disasters in the United States have demonstrated the increased vulnerability of populations with high utilization of emergency services during a disaster.2 Homelessness is common throughout the United States, and appear to be underrepresented at the city disaster planning level.3 Resources to assist planners are available, but increased adoption is indicated.

Role of Public Transportation in a Natural Disaster State of Emergency Declaration

2019 ◽  
Vol 2673 (5) ◽  
pp. 230-239 ◽  
Author(s):  
Jodi Godfrey ◽  
Gennaro Saliceto ◽  
Roberta Yegidis
Keyword(s):  
Public Transportation ◽  
Emergency Preparedness ◽  
Public Transit ◽  
The United States ◽  
Lessons Learned ◽  
Extreme Weather Events ◽  
The Public ◽  
The Status ◽  
Response And Recovery ◽  
Transit Agencies

Destructive natural disasters such as hurricanes or other extreme weather events challenge many industries, especially the public transit industry. The 2017 hurricane season proved to be tumultuous, with three major hurricanes devastating the United States in less than 2 months. The challenges faced in Florida, in response to Hurricane Irma, precipitated best practices and lessons learned related to monitoring and reporting the status of transportation infrastructure, identifying temporary alternative solutions, and coordinating and communicating with emergency operations centers, state departments of transportation, and individual transit agencies. Sharing the lessons learned from recent firsthand experiences will undoubtedly improve the public transit industry’s emergency preparedness, response, and recovery activities.

Characteristics of Physician Relocation Following Hurricane Katrina

2009 ◽  
Vol 95 (1) ◽  
pp. 6-12
Author(s):  
Kusuma Madamala ◽  
Claudia R. Campbell ◽  
Edbert B. Hsu ◽  
Yu-Hsiang Hsieh ◽  
James James
Keyword(s):  
Hurricane Katrina ◽  
Gulf Coast ◽  
General Medicine ◽  
The United States ◽  
Lessons Learned ◽  
Bivariate Analysis ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Factors Associated ◽  
The Impact

ABSTRACT Introduction: On Aug. 29, 2005, Hurricane Katrina made landfall along the Gulf Coast of the United States, resulting in the evacuation of more than 1.5 million people, including nearly 6000 physicians. This article examines the relocation patterns of physicians following the storm, determines the impact that the disaster had on their lives and practices, and identifies lessons learned. Methods: An Internet-based survey was conducted among licensed physicians reporting addresses within Federal Emergency Management Agency-designated disaster zones in Louisiana and Mississippi. Descriptive data analysis was used to describe respondent characteristics. Multivariate logistic regression was performed to identify the factors associated with physician nonreturn to original practice. For those remaining relocated out of state, bivariate analysis with x2 or Fisher exact test was used to determine factors associated with plans to return to original practice. Results: A total of 312 eligible responses were collected. Among disaster zone respondents, 85.6 percent lived in Louisiana and 14.4 percent resided in Mississippi before the hurricane struck. By spring 2006, 75.6 percent (n = 236) of the respondents had returned to their original homes, whereas 24.4 percent (n = 76) remained displaced. Factors associated with nonreturn to original employment included family or general medicine practice (OR 0.42, 95 percent CI 0.17–1.04; P = .059) and severe or complete damage to the workplace (OR 0.24, 95 percent CI 0.13–0.42; P < .001). Conclusions: A sizeable proportion of physicians remain displaced after Hurricane Katrina, along with a lasting decrease in the number of physicians serving in the areas affected by the disaster. Programs designed to address identified physician needs in the aftermath of the storm may give confidence to displaced physicians to return.

Winning the Argument and Moving the Fight: The Legacy of a Grassroots Humanitarian

Public Voices ◽  
2016 ◽  
Vol 14 (1) ◽  
pp. 115
Author(s):  
Mary Coleman
Keyword(s):  
Higher Education ◽  
United States ◽  
Winning Strategy ◽  
Supreme Court Decision ◽  
The United States ◽  
Colleges And Universities ◽  
Lessons Learned ◽  
The Political ◽  
Political Actors ◽  
Trade Offs

The author of this article argues that the two-decades-long litigation struggle was necessary to push the political actors in Mississippi into a more virtuous than vicious legal/political negotiation. The second and related argument, however, is that neither the 1992 United States Supreme Court decision in Fordice nor the negotiation provided an adequate riposte to plaintiffs’ claims. The author shows that their chief counsel for the first phase of the litigation wanted equality of opportunity for historically black colleges and universities (HBCUs), as did the plaintiffs. In the course of explicating the role of a legal grass-roots humanitarian, Coleman suggests lessons learned and trade-offs from that case/negotiation, describing the tradeoffs as part of the political vestiges of legal racism in black public higher education and the need to move HBCUs to a higher level of opportunity at a critical juncture in the life of tuition-dependent colleges and universities in the United States. Throughout the essay the following questions pose themselves: In thinking about the Road to Fordice and to political settlement, would the Justice Department lawyers and the plaintiffs’ lawyers connect at the point of their shared strength? Would the timing of the settlement benefit the plaintiffs and/or the State? Could plaintiffs’ lawyers hold together for the length of the case and move each piece of the case forward in a winning strategy? Who were plaintiffs’ opponents and what was their strategy? With these questions in mind, the author offers an analysis of how the campaign— political/legal arguments and political/legal remedies to remove the vestiges of de jure segregation in higher education—unfolded in Mississippi, with special emphasis on the initiating lawyer in Ayers v. Waller and Fordice, Isaiah Madison

scholarly journals The Global Limb Anatomic Staging System (GLASS) for CLTI: Improving Inter-Observer Agreement

2021 ◽  
Vol 10 (16) ◽  
pp. 3454
Author(s):  
Joep G. J. Wijnand ◽  
Devin Zarkowsky ◽  
Bian Wu ◽  
Steven T. W. van Haelst ◽  
Evert-Jan P. A. Vonken ◽  
...  
Keyword(s):  
Staging System ◽  
The United States ◽  
Lessons Learned ◽  
Observer Agreement ◽  
Lesion Length ◽  
Solid Base ◽  
Stepwise Approach ◽  
Additional Tool ◽  
Atherosclerotic Lesions ◽  
Stenosis Severity

Objective: The 2020 Global Vascular Guidelines aim at improving decision making in Chronic Limb-Threatening Ischemia (CLTI) by providing a framework for evidence-based revascularization. Herein, the Global Limb Anatomic Staging System (GLASS) serves to estimate the chance of success and patency of arterial pathway revascularization based on the extent and distribution of the atherosclerotic lesions. We report the preliminary feasibility results and observer variability of the GLASS. GLASS is a part of the new global guideline and posed as a promising additional tool for EBR strategies to predict the success of lower extremity arterial revascularization. This study reports on the consistency of GLASS scoring to maximize inter-observer agreement and facilitate its application. Methods: GLASS separately scores the femoropopliteal (FP) and infrapopliteal (IP) segment based on stenosis severity, lesion length and the extent of calcification within the target artery pathway (TAP). In our stepwise approach, we used two angiographic datasets. Each following step was based on the lessons learned from the previous step. The primary outcome was inter-observer agreement measured as Cohen’s Kappa, scored by two (step 1 + 2) and four (step 3) blinded and experienced observers, respectively. Steps 1 (n = 139) and 2 (n = 50) were executed within a dataset of a Dutch interventional RCT in CLTI. Step 3 (n = 100) was performed in randomly selected all-comer CLTI patients from two vascular centers in the United States. Results: In step 1, kappa values were 0.346 (FP) and 0.180 (IP). In step 2, applied in the same dataset, the use of other experienced observers and a provided TAP, resulted in similar low kappa values 0.406 (FP) and 0.089 (IP). Subsequently, in step 3, the formation of an altered stepwise approach using component scoring, such as separate scoring of calcification and adding a ruler to the images resulted in kappa values increasing to 0.796 (FP) and 0.730 (IP). Conclusion: This retrospective GLASS validation study revealed low inter-observer agreement for unconditioned scoring. A stepwise component scoring provides acceptable agreement and a solid base for further prospective validation studies to investigate how GLASS relates to treatment outcomes.

scholarly journals The COVID Army: Experiences from the Deployment of Non-Hospitalist Physician Volunteers during the 2020 COVID Pandemic

2021 ◽  
pp. 1-15
Author(s):  
Kevin Hauck ◽  
Katherine Hochman ◽  
Mark Pochapin ◽  
Sondra Zabar ◽  
Jeffrey A Wilhite ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Medical Center ◽  
The United States ◽  
Lessons Learned ◽  
Front Line ◽  
Clinical Leadership ◽  
Team Members ◽  
Medical Centers ◽  
Hospitalist Physician

Abstract Objective New York City was the epicenter of the outbreak of the 2020 COVID-19 pandemic in the United States. As a large, quaternary care medical center, NYU Langone Medical Center was one of many New York medical centers that experienced an unprecedented influx of patients during this time. Clinical leadership effectively identified, oriented, and rapidly deployed a “COVID Army”, consisting of non-hospitalist physicians, to meet the needs of this patient influx. We share feedback from our providers on our processes and offer specific recommendations for systems experiencing a similar influx in the current and future pandemics. Methods In order to assess the experiences and perceived readiness of these physicians (n=183), we distributed a 32-item survey between March and June of 2020. Thematic analyses and response rates were examined in order to develop results. Results Responses highlighted varying experiences and attitudes of our front-line physicians during an emerging pandemic. Thematic analyses revealed a series of lessons learned, including the need to: (1) provide orientations, (2) clarify roles/ workflow, (3) balance team workload, (4) keep teams updated on evolving policies, (5) make team members feel valued, and (6) ensure they have necessary tools available. Conclusions Lessons from our deployment and assessment are scalable at other institutions.

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