scholarly journals 710 Association of Social Isolation, Perceived Stress, and CPAP Use in Sleep Medicine Patients during the COVID-19 Pandemic

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A277-A277
Author(s):  
Sara Nowakowski ◽  
Emily Arentson-Lantz ◽  
Ahmad Debian ◽  
Manasa Kokanda ◽  
Fidaa Shaib
Keyword(s):  
Social Isolation ◽  
Perceived Stress ◽  
Online Survey ◽  
Clinical Care ◽  
Sleep Medicine ◽  
Stepwise Logistic Regression ◽  
Veterans Health ◽  
Health Administration ◽  
Medicine Clinic ◽  
Department Of Veteran Affairs

Abstract Introduction Due to the COVID-19 pandemic, many individuals are likely experiencing increased stress and social isolation. This study aimed to examine the effect of perceived stress and social isolation on self-reported continuous positive airway pressure (CPAP) use and treatment adherence among sleep medicine clinic patients during the pandemic. Methods Between June-November 2020, 81 sleep medicine clinic patients (54.8±15.9y, 44% male, 69% Caucasian) completed an online survey that included self-reported changes in CPAP use and using CPAP as advised; and PROMIS Social Isolation and Perceived Stress Scale (PSS). CPAP measures were categorized based on reported changes during the pandemic. Stepwise logistic regression was performed using SAS to determine if Social Isolation and PSS predicted change in CPAP measures. Results Among participants, 53% reported using CPAP. Out of those, 61% reported change, 16% reported no change, and 23% reported they do not know if there is a change in using CPAP as advised during the pandemic. Social Isolation predicted an increase in odds of CPAP use by a factor of 1.15 (p=0.024). PSS predicted a decrease in odds of using CPAP therapy as advised by a factor of 0.86 (p=0.049). Conclusion Increases in perceived stress predicted lower odds of utilizing CPAP as advised. Increases in self-reported social isolation predicted greater odds of CPAP use in sleep medicine clinic patients during the COVID-19 pandemic. Addressing stressors/coping and social isolation/support as part of routine clinical care in sleep medicine clinic patients is advised. Support (if any) This work is supported by National Institutes of Health Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413).

scholarly journals 711 Changes in Healthcare Visits and Sleep Medication Use in Sleep Medicine Patients during the COVID-19 Pandemic

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A277-A278
Author(s):  
Ahmad Debian ◽  
Emily Arentson-Lantz ◽  
Manasa Kokanda ◽  
Fidaa Shaib ◽  
Sara Nowakowski
Keyword(s):  
Health Care ◽  
Sleep Disturbance ◽  
Online Survey ◽  
Medication Use ◽  
Severity Index ◽  
Sleep Medicine ◽  
Veterans Health ◽  
Health Administration ◽  
Sleep Medication ◽  
Insomnia Severity

Abstract Introduction Patients may be experiencing increased stress and sleep disturbance due to healthcare changes during the COVID-19 pandemic. Healthcare changes may include telemedicine visits, delayed or canceled appointments and sleep studies. The purpose of this study was to assess the association between changes in healthcare and sleep medication use on sleep disturbance and insomnia severity. Methods Between June-November 2020, 81 sleep medicine clinic patients (54.8 ± 15.9 y, 44% male, 69% Caucasian) completed an online survey that included questions about COVID-19 (tested for coronavirus, test results, willingness to be vaccinated for COVID-19, changes in health care visits and sleep medications during the pandemic), PROMIS measures (Sleep Disturbance, Sleep-Related Impairments), and Insomnia Severity Index (ISI). Stepwise linear regression was performed using SAS to determine if changes in healthcare and sleep medications predicted poorer sleep. Results Among participants, 32% were tested for coronavirus, out of those 8% tested positive for COVID-19. 74% were willing to get vaccinated and 65% were willing to get their children vaccinated. 35% changed their healthcare office appointments to telephone visits, 54% changed to video visits; whereas 26% cancelled and 32% rescheduled their healthcare appointments. Changes in health care visits during the pandemic had a significant increase on ISI score (3.98 ± 1.66, p=0.019). Changes in sleep medication during the pandemic had significant effect on Sleep Disturbance (7.15 ± 2.51, p=0.005), Sleep-Related Impairments (8.69 ± 2.68, p=0.001) and ISI (6.04 ± 1.66, p=0.001) measures. Conclusion Sleep medicine patients who reported changes in sleep medication reported higher insomnia severity, sleep disturbance, and sleep-related impairments. Patients who reported changes in healthcare visits during the pandemic reported higher insomnia severity. Assessing sleep medication changes and preference for healthcare visit format is advised when treating sleep medicine patients during the pandemic. Support (if any) This work is supported by National Institutes of Health (NIH) Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413).

Communication and psychological safety in veterans health administration work environments

2014 ◽  
Vol 28 (6) ◽  
pp. 754-776 ◽  
Author(s):  
Nancy J. Yanchus ◽  
Ryan Derickson ◽  
Scott C. Moore ◽  
Daniele Bologna ◽  
Katerine Osatuke
Keyword(s):  
Health Care Providers ◽  
Care Delivery ◽  
Clinical Care ◽  
Psychological Safety ◽  
Veterans Health Administration ◽  
Employee Perceptions ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Content Type

Purpose – The purpose of this paper is to explore employee perceptions of communication in psychologically safe and unsafe clinical care environments. Design/methodology/approach – Clinical providers at the USA Veterans Health Administration were interviewed as part of planning organizational interventions. They discussed strengths, weaknesses, and desired changes in their workplaces. A subset of respondents also discussed workplace psychological safety (i.e. employee perceptions of being able to speak up or report errors without retaliation or ostracism – Edmondson, 1999). Two trained coders analysed the interview data using a grounded theory-based method. They excerpted passages that discussed job-related communication and summarized specific themes. Subsequent analyses compared frequencies of themes across workgroups defined as having psychologically safe vs unsafe climate based upon an independently administered employee survey. Findings – Perceptions of work-related communication differed across clinical provider groups with high vs low psychological safety. The differences in frequencies of communication-related themes across the compared groups matched the expected pattern of problem-laden communication characterizing psychologically unsafe workplaces. Originality/value – Previous research implied the existence of a connection between communication and psychological safety whereas this study offers substantive evidence of it. The paper summarized the differences in perceptions of communication in high vs low psychological safety environments drawing from qualitative data that reflected clinical providers’ direct experience on the job. The paper also illustrated the conclusions with multiple specific examples. The findings are informative to health care providers seeking to improve communication within care delivery teams.

Improving clinic utilization and workload capture for clinical pharmacy specialists

2020 ◽  
Vol 77 (7) ◽  
pp. 552-559
Author(s):  
Allison Steen ◽  
Jessica Bovio Franck
Keyword(s):  
Clinical Pharmacy ◽  
Clinical Care ◽  
Quality Care ◽  
Clinical Pharmacy Service ◽  
Quality Improvement Initiative ◽  
Pharmacy Services ◽  
Veterans Health ◽  
Health Administration ◽  
Post Intervention ◽  
Clinical Pharmacy Services

Abstract Purpose To assess a quality improvement initiative aimed at improving clinic utilization and encounter and intervention workload capture for clinical pharmacy specialists. This initiative aided in justification of clinical pharmacy services, identification of clinical areas for intervention, and incorporation of all modalities to appropriately document clinical care. Methods In order to objectively demonstrate clinical pharmacy service value to stakeholders, pharmacy administrators and clinical pharmacy specialists at the North Florida/South Georgia Veterans Health System performed clinic scheduling and profile reviews using data extracted from the Veterans Health Administration electronic health record and analytic software. Outpatient clinical pharmacy specialty practice areas were primarily investigated; the specialty areas included are as follows: cardiology, infectious disease, mental health, oncology, pain management/palliative care, and specialty clinics (a collection of medical and surgical subspecialties). The first intervention entailed completing a worksheet and assessing clinic utilization data. Then, an evaluation was performed to assess the number of encounters, clinical interventions, clinic modalities, and coding for each clinic. Next, a meeting was arranged with each like clinical pharmacy specialist practice group to discuss this collected data. During these meetings, the delineation of where workload was generated and the activities taking place in an average workday were discussed. Finally, clinics were adjusted to reflect appropriate clinic coding and mapping of the average workday. Metrics were evaluated pre intervention (October through December 2017) and post intervention (July through September 2018). Results After intervention, there were statistically significant increases in clinic utilization, total encounters completed, and total interventions recorded in the composite group of clinical pharmacy specialists. Conclusion The increases in clinic utilization, total encounters, and interventions observed for the clinical pharmacy specialists suggest the beneficial role of pharmacy administrators’ collaboration with clinical pharmacy specialists to improve workload capture and access to quality care, to justify clinical pharmacy services, and to identify opportunities for pharmacy clinical intervention.

scholarly journals 1180 The Use Of Natural Language Processing To Extract Data From Psg Sleep Study Reports Using National Vha Electronic Medical Record Data

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A450-A451
Author(s):  
S Nowakowski ◽  
J Razjouyan ◽  
A D Naik ◽  
R Agrawal ◽  
K Velamuri ◽  
...  
Keyword(s):  
Natural Language Processing ◽  
Language Processing ◽  
Veterans Health Administration ◽  
Free Text ◽  
Veterans Health ◽  
Health Administration ◽  
Rule Based ◽  
Veteran Affairs ◽  
Department Of Veteran Affairs ◽  
Sleep Parameters

Abstract Introduction In 2007, Congress asked the Department of Veteran Affairs to pay closer attention to the incidence of sleep disorders among veterans. We aimed to use natural language processing (NLP), a method that applies algorithms to understand the meaning and structure of sentences within Electronic Health Record (EHR) patient free-text notes, to identify the number of attended polysomnography (PSG) studies conducted in the Veterans Health Administration (VHA) and to evaluate the performance of NLP in extracting sleep data from the notes. Methods We identified 481,115 sleep studies using CPT code 95810 from 2000-19 in the national VHA. We used rule-based regular expression method (phrases: “sleep stage” and “arousal index”) to identify attended PSG reports in the patient free-text notes in the EHR, of which 69,847 records met the rule-based criteria. We randomly selected 178 notes to compare the accuracy of the algorithm in mining sleep parameters: total sleep time (TST), sleep efficiency (SE) and sleep onset latency (SOL) compared to human manual chart review. Results The number of documented PSG studies increased each year from 963 in 2000 to 14,209 in 2018. System performance of NLP compared to manually annotated reference standard in detecting sleep parameters was 83% for TST, 87% for SE, and 81% for SOL (accuracy benchmark ≥ 80%). Conclusion This study showed that NLP is a useful technique to mine EHR and extract data from patients’ free-text notes. Reasons that NLP is not 100% accurate included, the note authors used different phrasing (e.g., “recording duration”) which the NLP algorithm did not detect/extract or authors omitting sleep continuity variables from the notes. Nevertheless, this automated strategy to identify and extract sleep data can serve as an effective tool in large health care systems to be used for research and evaluation to improve sleep medicine patient care and outcomes. Support This material is based upon work supported in part by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Dr. Nowakowski is also supported by a National Institutes of Health (NIH) Grant (R01NR018342).

scholarly journals Characteristics of patients visiting naturopathic practitioners for maternal and reproductive health

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Steel ◽  
H Foley ◽  
J Schloss ◽  
R Redmond
Keyword(s):  
Reproductive Health ◽  
Postnatal Care ◽  
Online Survey ◽  
Clinical Care ◽  
World Health ◽  
Stepwise Logistic Regression ◽  
Health Issues ◽  
Health Concerns ◽  
Wide Range ◽  
The World

Abstract Background Naturopathy, recognised by the World Health Organisation as a European traditional medicine system, is practiced in every world region. Patients in countries where naturopathy is practiced visit a naturopathic practitioner for a range of health concerns including maternal and reproductive health; recognised as a global health priority area. This study aims to examine the characteristics of patients visiting naturopathic practitioners for their maternal and reproductive health concerns, and the clinical care provided by naturopathic practitioners to those patients. Methods An international cross-sectional survey of typical naturopathic practices and their associated patients, conducted in naturopathic clinics in 14 countries and 4 world regions. Naturopathic practitioners(n = 54) were invited to prospectively complete an online survey for up to 20 consecutive cases within the study period. Univariate relationships were examined through chi-square tests. Backwards stepwise logistic regression was employed to explore the characteristics most likely to be associated with individuals visiting a naturopath for maternal and reproductive health. Results Naturopathic practitioners provided data for 852 patients, with 43 (5.0%) visiting a naturopath for maternal and reproductive health concerns such as fertility (54.8%), pregnancy (26.2%), preconception health (11.9%), and lactation, breastfeeding or other postnatal care (7.1%). The regression analysis indicates the practitioners are more likely to prescribe acupuncture (OR 2.71, p<.001) and more likely to identify gynecological (OR 4.31, p<.001) or endocrine (OR 3.30, p=.01) systems as important in the management of the health of these patients. Conclusions Individuals are accessing naturopathic practitioners for maternal and reproductive health. An examination of the motivations influencing this population to access naturopathic care and the outcomes of this care is urgently needed. Key messages Naturopathic practitioners throughout the world are being visited for assistance with maternal and reproductive health issues including fertility, pregnancy, preconception and postnatal care. Naturopathic practitioners are prescribing acupuncture, as well as a wide range of other treatments, for maternal and reproductive health issues.

scholarly journals 707 Association of Self-Reported Anxiety, Informational Support, and Sleep in Sleep Medicine Patients during the COVID-19 Pandemic

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A276-A276
Author(s):  
Emily Arentson-Lantz ◽  
Ahmad Debian ◽  
Manasa Kokanda ◽  
Fidaa Shaib ◽  
Sara Nowakowski
Keyword(s):  
Sleep Disturbance ◽  
Sleep Medicine ◽  
Sunlight Exposure ◽  
Stressful Events ◽  
Accurate Information ◽  
Health Administration ◽  
Informational Support ◽  
Caffeine Consumption ◽  
Medicine Clinic ◽  
Insomnia Severity

Abstract Introduction Stressful events, such as the COVID-19 pandemic, can have a detrimental effect on sleep. It is important for practitioners to understand how their patients are affected by events to optimize their care. In this study we evaluated associations of anxiety and daily habits with self-reported sleep disturbance among sleep medicine clinic patients. Methods Between June-November 2020, 81 sleep medicine clinic patients (54.8±15.9 y, 44% male, 69% Caucasian) completed an online survey that included PROMIS measures (Sleep Disturbance, Sleep-Related Impairments, Informational Support, Emotional Distress-Anxiety) and Insomnia Severity Index (ISI). Patients were asked about changes in their daily habits (sunlight exposure, caffeine consumption). During the 5-month survey completion time window, the weekly average of positive COVID-19 cases in the Houston area was 2,914. Stepwise linear regression was performed using SAS to determine if self-reported anxiety and informational support predicted PROMIS Sleep Disturbance, PROMIS Sleep-Related Impairments and ISI. Results Anxiety had a significant effect on Sleep Disturbance (0.43 ± 0.11, p=0.0001), Sleep-Related Impairments (0.53 ± 0.12, p=0.0001) and ISI (0.28 ± 0.08, p=0.0004). Informational support had a significant inverse effect on Sleep Disturbance (-0.29 ± 0.10, p=0.0063), Sleep-Related Impairments (-0.26 ± 0.11, p=0.01) and ISI (-0.31 ± 0.08, p<0.0001) measures. Decreased sunlight exposure during the pandemic contributed to a significant increase in Sleep Disturbance scores (0.06 ± 0.03, p=0.045). Increased caffeine consumption during the pandemic had significant increase in ISI scores (16.3 ± 7.59, p=0.035). Conclusion Higher levels of anxiety and lower levels of informational support predicted greater insomnia severity, sleep disturbance, and sleep-related impairments in sleep medicine clinic patients during the COVID-19 pandemic. Decreased sunlight exposure and increased caffeine consumption also predicted greater sleep disturbance and insomnia severity, respectively. Addressing anxiety symptoms and access to accurate information during the pandemic is advised when treating sleep medicine clinic patients. Support (if any) This work is supported by National Institutes of Health (NIH) Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413).

scholarly journals The Primary Care Analytics Team: Integrating research and clinical care within the Veterans Health Administration Office of Primary Care

Healthcare ◽  
2021 ◽  
Vol 8 ◽  
pp. 100491
Author(s):  
Karin Nelson ◽  
Ashok Reddy ◽  
Susan E. Stockdale ◽  
Danielle Rose ◽  
Stephan Fihn ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Care ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration

scholarly journals Young Adults’ Cellphone Dependence, Stress, Depression and Self-Esteem

2019 ◽  
Vol 1 (2) ◽  
pp. p125
Author(s):  
Mikiyasu Hakoyama, Ph.D.
Keyword(s):  
Young Adults ◽  
Path Analysis ◽  
Social Isolation ◽  
Perceived Stress ◽  
Online Survey ◽  
Self Esteem ◽  
Men And Women ◽  
Communication Device

Cellphones have become an indispensable communication device, especially for young adults. Based on an online survey conducted in the Midwest, USA, the current study examined young adults’ (N = 1,659, M age = 19.38, SD = 1.71) use of cellphone and its influence on their psychosocial states. Almost 90% of the participants owned their first cellphone at age 14 or younger; 96.5% of the cellphone owners were smartphone users. Women spent significantly longer time for both voice calling and texting, were more cellphone dependent, stressed and depressed than men. Both men and women spent significantly more time for texting than voice calling. Path analysis revealed that the time spent for texting and the fear of social isolation for being a non-texting user predicted cellphone dependence, which subsequently predicted self-esteem; the latter relationship was mediated by the level of perceived stress and depression. Implications of the findings are discussed.

Sign in / Sign up

Export Citation Format

Share Document