Horizontal return to work coordination was more common in RTW programs than the recommended vertical coordination. The Rapid-RTW cohort study

Abstract Background In return-to-work (RTW) programs, coordinators are often provided in order to integrate services. However, models of coordinating services vary widely internationally, and across different programs, where one distinction is between vertical and horizontal integration (i.e. between levels/institutions, or within one service/level). The aim of this study was therefore to explore and describe if and how a coordinator was provided in RTW-programs, and whether the provision of a coordinator was associated with certain personal or intervention characteristics. Methods The study was designed as a cohort study following employees participating in a variety of Rapid-RTW-programs in Norway (n = 39). Employees (n = 494) answered a self-administered questionnaire, which was linked to register-data on diagnoses and sickness-absence. Employees who replied yes/no to the question “Did the program provide a person who tailored or coordinated your services?” were included in this analysis. Associations for being provided with a coordinator were tested in adjusted logistic regression models. Results Sixty-nine percent of the employees reported having a coordinator. These coordinators were mainly responsible for coordinating treatment within own programs (i.e. horizontal coordination, 68%). As expected, rehabilitation programs more often provided a coordinator compared to treatment programs (OR 3.87 95% CI 2.42–6.24). The odds for being provided with a coordinator were reduced for each additional year of age of the employee (OR 0.97, 95% CI 0.96–0.99). More professions were involved in programs that provided coordinators, also more contact with other stakeholders like leaders and social insurance services (NAV), but only contact with supervisor remained statistically significant in adjusted analysis (OR 1.69 95% CI 0.31–9.27). The programs with a coordinator more often provided adaptations at the workplace for the individual employee (OR 0.08 95% CI 0.01–0.60). However, these signs of vertical integration were only evident for a limited number of employees. Conclusion In this study, seven of ten employees reported to have a coordinator, which was associated with more professions and stakeholder involvement in the RTW-process. Most of these coordinators did not coordinate vertically between the service levels and types of intervention arenas for sick listed employees (i.e. workplace, social security, and health care services), as recommended in earlier research.

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The Beacon Collaborative: A Journey to Excellence

Critical Care Nurse ◽

10.4037/ccn2021956 ◽

2021 ◽

Vol 41 (5) ◽

pp. e17-e25

Author(s):

Deborah Hurley ◽

Sarah M. Gantz ◽

E. Kate Valcin ◽

Tara L. Sacco

Keyword(s):

Critical Care ◽

Care Delivery ◽

Care Service ◽

Stakeholder Involvement ◽

Service Level ◽

Lessons Learned ◽

Organizational Level ◽

Unit Level ◽

Individual Unit ◽

The Individual

Topic The development of the Critical Care Beacon Collaborative to achieve meaningful recognition. Clinical Relevance Recognizing nurses for contributions to their work environment and care delivery is important for their professional and personal fulfillment, job satisfaction, and retention; such recognition can occur at the individual, unit, or organizational level. The American Nurses Credentialing Center’s Magnet Recognition Program acknowledges nursing excellence at the organizational level. It would, however, be difficult for an organization to achieve Magnet designation without nursing excellence at the unit level. To recognize excellence at the unit level, the American Association of Critical-Care Nurses developed the Beacon Award in 2003. Objective To describe one academic medical center’s journey toward winning Beacon Awards across 8 units within the adult critical care service. Content Covered The Critical Care Beacon Collaborative resulted in a Beacon Award for each unit and important staff outcomes. This article describes the organization, the process before the Critical Care Beacon Collaborative convened and the desired state, and the methods used to achieve our goal. It also discusses unit- and service-level stakeholder involvement. The successes, lessons learned, sustainability, and growth of the Critical Care Beacon Collaborative are shared to assist readers who aspire to pursue a Beacon Award.

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The Development of Language-Training Programs for Postrubella Hearing-Impaired Children

Journal of Speech and Hearing Disorders ◽

10.1044/jshd.3801.15 ◽

1973 ◽

Vol 38 (1) ◽

pp. 15-24 ◽

Cited By ~ 2

Author(s):

Linda Lynch ◽

Annette Tobin

Keyword(s):

Hearing Impaired ◽

Treatment Programs ◽

Individual Treatment ◽

Target Behaviors ◽

Systematic Fashion ◽

Development Of Language ◽

The Individual ◽

Impaired Children ◽

Hearing Impaired Children

This paper presents the procedures developed and used in the individual treatment programs for a group of preschool, postrubella, hearing-impaired children. A case study illustrates the systematic fashion in which the clinician plans programs for each child on the basis of the child’s progress at any given time during the program. The clinician’s decisions are discussed relevant to (1) the choice of a mode(s) for the child and the teacher, (2) the basis for selecting specific target behaviors, (3) the progress of each program, and (4) the implications for future programming.

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A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

The American Surgeon ◽

10.1177/0003134820973384 ◽

2020 ◽

pp. 000313482097338

Author(s):

Elizabeth McCarthy ◽

Benjamin L. Gough ◽

Michael S. Johns ◽

Alexandra Hanlon ◽

Sachin Vaid ◽

...

Keyword(s):

Postoperative Recovery ◽

Logistic Regression Models ◽

Community Institution ◽

Physical Status Classification ◽

Estimated Blood Loss ◽

Comparative Review ◽

Significant Difference ◽

American Society ◽

The Individual ◽

American Society Of Anesthesiologists

Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

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Public Roads as Places of Interspecies Conflict: A Study of Horse-Human Interactions on UK Roads and Impacts on Equine Exercise

Animals ◽

10.3390/ani11041072 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1072

Author(s):

Danica Pollard ◽

Tamzin Furtado

Keyword(s):

Near Miss ◽

Online Questionnaire ◽

Near Misses ◽

Logistic Regression Models ◽

Emotional Management ◽

The Road ◽

Human Interactions ◽

Road Users ◽

Conflict Risk ◽

The Individual

Real or perceived traffic risk is a significant barrier to walking and cycling. To understand whether similar barriers influence equestrians, this study obtained exercise behaviours, road use and experiences of road-related incidents from UK equestrians (n = 6390) via an online questionnaire. Multivariable logistic regression models were used to identify factors associated with road use and experiencing a near-miss or injury-causing incident in the previous year. Content analysis identified themes around equestrians’ decisions not to use roads. Our results show that most equestrians (84%) use roads at least once weekly, and in the previous year, 67.7% had a near-miss and 6.1% an injury-causing incident. Road use differs regionally, with exercise type and off-road route availability. Road-using equestrians covered greater daily distances and were younger. However, younger equestrians were at higher risk of near-misses. Respondents’ decisions not to use roads were based on individualised risk assessments arising from: the road itself, perceptions of other road users, the individual horse and the handler’s own emotional management. Roads were perceived as extremely dangerous places with potentially high conflict risk. Injury-causing incidents were associated with increasing road-use anxiety or ceasing to use roads, the proximity of off-road routes, having a near-miss and type of road use. Targeted road-safety campaigns and improved off-road access would create safer equestrian spaces.

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Risk factors for mortality, ICU admission and bacteremia in patients suspected of sepsis at the Emergency department. A prospective cohort study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa594 ◽

2020 ◽

Author(s):

Valentino D’Onofrio ◽

Agnes Meersman ◽

Sara Vijgen ◽

Reinoud Cartuyvels ◽

Peter Messiaen ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Regression Models ◽

Serum Lactate ◽

Suspected Sepsis ◽

Logistic Regression Models ◽

Icu Admission ◽

Observational Cohort ◽

Independent Risk Factors ◽

Prediction Of Prognosis

Abstract Background There is a clear need for a better assessment of independent risk factors for in-hospital mortality, ICU admission, and bacteremia in patients presenting with suspected sepsis at the ED. Methods A prospective observational cohort study including 1690 patients was performed. Two multivariable logistic regression models were used to identify independent risk factors. Results SOFA score of ≥2 and serum lactate of ≥2mmol/L were associated with all outcomes. Other independent risk factors were individual SOFA variables and SIRS variables but varied per outcome. MAP<70 mmHg negatively impacted all outcomes. Conclusion These readily available measurements can help with early risk stratification and prediction of prognosis.

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Comparable Outcomes of Short-Course and Prolonged-Course Therapy in Selected Cases of Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Pooled Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/ciab201 ◽

2021 ◽

Author(s):

Louise Thorlacius-Ussing ◽

Håkon Sandholdt ◽

Jette Nissen ◽

Jon Rasmussen ◽

Robert Skov ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Clinical Outcomes ◽

Treatment Duration ◽

Cohort Analysis ◽

Antimicrobial Treatment ◽

Low Risk ◽

Logistic Regression Models ◽

Staphylococcus Aureus Bacteremia ◽

Short Course ◽

The Individual

Abstract Background The recommended duration of antimicrobial treatment for Staphylococcus aureus bacteremia (SAB) is a minimum of 14 days. We compared the clinical outcomes of patients receiving short-course (SC; 6–10 days), or prolonged-course (PC; 11–16 days) antibiotic therapy for low-risk methicillin-susceptible SAB (MS-SAB). Methods Adults with MS-SAB in 1995–2018 were included from 3 independent retrospective cohorts. Logistic regression models fitted with inverse probability of treatment weighting were used to assess the association between the primary outcome of 90-day mortality and treatment duration for the individual cohorts as well as a pooled cohort analysis. Results A total of 645, 219, and 141 patients with low-risk MS-SAB were included from cohorts I, II, and III. Median treatment duration in the 3 SC groups was 8 days (interquartile range [IQR], 7–10), 9 days (IQR, 8–10), and 8 days (IQR, 7–10). In the PC groups, patients received a median therapy of 14 days (IQR, 13–15), 14 days (IQR, 13–15), and 13 days (IQR, 12–15). No significant differences in 90-day mortality were observed between the SC and PC group in cohort I (odds ratio [OR], 0.85 [95% confidence interval {CI}, .49–1.41]), cohort II (OR, 1.24 [95% CI, .60–2.62]), or cohort III (OR, 1.15 [95% CI, .24–4.01]). This result was consistent in the pooled cohort analysis (OR, 1.05 [95% CI, .71–1.51]). Furthermore, duration of therapy was not associated with the risk of relapse. Conclusions In patients with low-risk MS-SAB, shorter courses of antimicrobial therapy yielded similar clinical outcomes as longer courses of therapy.

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Impairment in activities of daily living and readmission in older patients with heart failure: a cohort study

BMJ Open ◽

10.1136/bmjopen-2020-044416 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044416

Author(s):

Tan Van Nguyen ◽

Huyen Thanh Dang ◽

Mason Jenner Burns ◽

Hiep HH Dao ◽

Tu Ngoc Nguyen

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Activities Of Daily Living ◽

Daily Living ◽

Older Patients ◽

Tertiary Hospital ◽

Logistic Regression Models ◽

Hospitalised Patients ◽

Patients With Heart Failure ◽

The Impact

ObjectivesThis study aims to investigate the prevalence of impairment of activities of daily living (ADLs) in older patients with heart failure (HF), and to examine the impact of ADL impairment on readmission after discharge.Design and settingsA prospective cohort study was conducted in patients aged ≥65 years with HF admitted to a tertiary hospital in Vietnam from August 2016 to June 2017. Difficulties with six ADLs were assessed by a questionnaire. Participants were classified into two categories (with and without ADL impairment). The associations of ADL impairment with 3-month readmission were examined using logistic regression models.ResultsThere were 180 participants (mean age 80.6±8.2, 50% female) and 26.1% were classified as having ADL impairment. The most common impaired activity was bathing (21.1%), followed by transferring (20.0%), toileting (12.2%), dressing (8.9%), eating (3.3%), and continence (2.8%). During 3-month follow-up, 32.8% of the participants were readmitted to hospitals (55.3% in participants with ADL impairment, 24.8% in those without ADL impairment, p<0.001). ADL impairment significantly increased the risk of 3-month readmission (adjusted OR 2.75, 95% CI 1.25 to 6.05, p=0.01).ConclusionsIn summary, ADL impairment was common in older hospitalised patients with HF and was associated with increased readmission. These findings suggest further studies on ADL assessment and intervention during transition care for older patients with HF after discharge to prevent readmission.

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COVID-19 Inequalities: Individual and Area Socioeconomic Factors (Aragón, Spain)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126607 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6607

Author(s):

Isabel Aguilar-Palacio ◽

Lina Maldonado ◽

Sara Malo ◽

Raquel Sánchez-Recio ◽

Iván Marcos-Campos ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort ◽

Social Inequalities ◽

Deprivation Level ◽

Social Consequences ◽

Multilevel Analyses ◽

The Social ◽

The Individual ◽

The Impact ◽

Second Wave

It is essential to understand the impact of social inequalities on the risk of COVID-19 infection in order to mitigate the social consequences of the pandemic. With this aim, the objective of our study was to analyze the effect of socioeconomic inequalities, both at the individual and area of residence levels, on the probability of COVID-19 confirmed infection, and its variations across three pandemic waves. We conducted a retrospective cohort study and included data from all individuals tested for COVID-19 during the three waves of the pandemic, from March to December 2020 (357,989 individuals) in Aragón (Spain). We studied the effect of inequalities on the risk of having a COVID-19 confirmed diagnosis after being tested using multilevel analyses with two levels of aggregation: individuals and basic healthcare area of residence (deprivation level and type of zone). Inequalities in the risk of COVID-19 confirmed infection were observed at both the individual and area level. There was a predominance of low-paid employees living in deprived areas. Workers with low salaries, unemployed and people on minimum integration income or who no longer receive the unemployment allowance, had a higher probability of COVID-19 infection than workers with salaries ≥ €18,000 per year. Inequalities were greater in women and in the second wave. The deprivation level of areas of residence influenced the risk of COVID-19 infection, especially in the second wave. It is necessary to develop individual and area coordinated measures by areas in the control, diagnosis and treatment of the epidemic, in order to avoid an increase in the already existing inequalities.

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Factors associated with successful return to work in young heart failure and ischaemic heart disease patients following index hospital admission

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.312 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

HV Thakkar ◽

L Hollingsworth ◽

JA Enright ◽

S Sanderson ◽

RJ Macfadyen ◽

...

Keyword(s):

Heart Failure ◽

Return To Work ◽

Decompensated Heart Failure ◽

Individual Factors ◽

P Value ◽

Complex Interplay ◽

Coronary Syndrome ◽

Funding Sources ◽

Financial Benefits ◽

The Individual

Abstract Funding Acknowledgements Type of funding sources: None. Background Factors influencing return to remunerated work following an acute cardiac illness are poorly defined. We wished to compare the factors in our cohorts following first presentation of acute coronary syndrome(ACS) and decompensated heart failure(HF). Methods Prospectively identified subjects, aged 18-65years, from a rehabilitation population for ACS and HF during 2018-2019 underwent a survey. Results Of 133cases meeting inclusion criteria, 84 completed the survey(41 HF, 80% male, mean age 55years; 43 ACS, 86% male, mean age 57years). Socio-economic indexes for Areas(SIEFA) index were similar for HF(900) & ACS(909) groups, which represents 11th and 14th percentile for Australia respectively. Cardiovascular risk factors were similar except hypercholesterolemia(37% v 60%; p = 0.029) was more common in ACS. Many subjects did not continue beyond Yr12, (54% HF v 30% ACS; p = 0.029). A majority of ACS cases returned to work as compared with HF(70% v 44%; p = 0.017)(Figure). On multivariate analysis, male gender[p = 0.031;OR 13.71 (1.28-147.36)]; access to financial benefits[p < 0.001;OR 22.75 (4.31-119.99)] and a desire to return to work [p = 0.014;OR 12.1 (1.67-87.82)] were associated with successful return to work (Table). Limitations Our study has small numbers so will be difficult to generalise to a wider population. We do show a signal towards the complex interplay of the social and individual factors in determining return to work. Further larger studies are required to tease out the differences between the individual factors to help predict return to work in the Australian context. Conclusion Successful return to work for patients with first presentation of ACS or HF could not be reliably predicted. Patients with ACS returned to work more often than HF. In HF patients who do n to return to work, recurrent symptoms, individual motivation, social support and access to financial benefits have a complex interplay. Predictors of return to work Predictor P value OR (95% CI) Diagnosis (heart failure) 0.095 0.29 (0.07, 1.24) Gender (male) 0.031 13.71 (1.28, 147.36) Access to benefit (none) <0.001 22.75 (4.31, 119.99) Desire to RTW (yes) 0.014 12.1 (1.67, 87.82) Abstract Figure. Rates of return to work in the 2 groups

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Work-life balance predicted work ability two years later: a cohort study of employees in the Swedish energy and water sector

BMC Public Health ◽

10.1186/s12889-021-11235-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Erik Berglund ◽

Ingrid Anderzén ◽

Åsa Andersén ◽

Per Lindberg

Keyword(s):

Logistic Regression ◽

Cohort Study ◽

Work Ability ◽

Regression Models ◽

Work Life ◽

Personal Life ◽

Life Balance ◽

Logistic Regression Models ◽

Mental Demands ◽

Longitudinal Associations

Abstract Background Work-life balance (WLB) is the extent to which individual’s multiple life roles and demands carry over between each role. WLB can be divided into work interference with personal life (WIPL) and personal life interference with work (PLIW). This study aimed to investigate longitudinal associations between WIPL, PLIW and work ability outcomes. Methods In this cohort study, 224 employees in the energy and water sector in Sweden were followed-up over 2 years. Three questions derived from the Work Ability Index were used for measuring work ability outcome: current work ability compared with lifetime best; work ability regarding physical; and mental demands. Logistic regression models were used to analyse longitudinal associations between work ability and WIPL and WIPL respectively, controlling for workplace (company), position at work, experience of leadership quality, demographics, and work ability. Results Work ability compared to lifetime best were associated with WIPL in the adjusted logistic regression models (odds ratio (OR) 1.77, 95% confidence interval (CI) 1.15–2.73), and PLIW (OR 3.34, 95% CI 1.66–6.74). Work ability regarding physical demands was associated with WIPL (OR 1.60, 95% CI 1.07–2.40). Work ability regarding mental demands was associated with WIPL (OR 1.59, 95% CI 1.03–2.44) and PLIW (OR 2.88, 95% CI 1.31–6.32). Conclusion In this two-year longitudinal study, lower WIPL predicted good/excellent overall work ability compared with lifetime best, higher work ability regarding physical and mental demands, and lower PLIW predicted good/excellent overall work ability compared with lifetime best and higher work ability regarding and mental demands.

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