Fishing in Salty Waters: Poverty, Occupational Saline Exposure, and Women’s Health in the Indian Sundarban

Collecting wild tiger prawn seedlings, also known as prawn post-larvae (PL), from rivers and creeks is an important occupation for more than 100,000 poor women in India’s Sundarban estuarine delta. Prawn PL collecting requires many hours of immersion in saline river water. This paper uses a large household survey to explore the determinants of poor women’s engagement in this occupation and the health impacts. The results reveal high significance for two variables: (i) the opportunity wage, proxied by years of education and (ii) child-care demands, proxied by the household child-dependency ratio. Together, these variables are sufficient to distinguish between women who have no engagement with prawn PL collecting and those with many years of engagement. The probability of self-reported health problems is also significantly higher for women with more saline exposure from prawn PL collecting and whose drinking water is from tube wells with higher salinity.

Factors of Caregiving Resilience by Race-Ethnicity in a National Sample of Caregivers

Despite heavy burdens and responsibilities, some caregivers are more likely to cope better with their care responsibilities than others, and this could vary by cultural beliefs and norms on caregiving. This study examined contributing factors of resilience with three racial-ethnic groups (White, Blacks, Hispanic). A total of 2,652 caregivers were included from Round 7 of the National Study of Caregiving. Caregiving resilience was defined by higher levels of care demands and higher levels of psychological well-being. Five domains of contributing factors were included: socio-demographic characteristics, context of care, caregivers’ psychological attributes, informal and formal support. Multiple logistic regressions showed that caregivers with higher psychological attribute levels were more likely to be resilient in all three groups. However, unique predictors have also been observed by race-ethnic groups (e.g., Blacks using formal support were more resilient). These findings suggest the need for culturally specific programs to facilitate resilience among caregivers.

Fair prioritization of casualties in disaster triage: a qualitative study

Background Disasters may result in mass casualties and an imbalance between health care demands and supplies. This imbalance necessitates the prioritization of the victims based on the severity of their condition. Contributing factors and their effect on decision-making is a challenging issue in disaster triage. The present study seeks to address criteria for ethical decision-making in the prioritization of patients in disaster triage. Methods This conventional content analysis study was conducted in 2017. Subjects were selected from among Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis. Results Efficient and effective triage and priority-oriented triage were the main categories. These categories summarized a number of medical and nonmedical factors that should be considered in the prioritization of the victims in disaster triage. Conclusion A combination of measures should be considered to maximize the benefits of the prioritization of causalities in disasters. None of these measures alone would suffice to explain all aspects of ethical decision-making in disaster triage. Further investigations are needed to elaborate on these criteria in decision-making.

Adoption of telemedicine (Telemed) by medical oncologists/hematologists (mO/H) during the COVID-19 pandemic.

285 Background: The COVID-19 pandemic has dramatically impacted access to and delivery of healthcare in the U.S. At the height of the pandemic, many practices began initiating or increasing telemed visits to meet care demands in a quarantined environment. The objective of this descriptive study was to assess mO/H perceptions of benefits and barriers to current and post-pandemic use of telemed in oncology. Methods: Web-based surveys were fielded to mO/H before virtual meetings held between September and November 2020. Participants submitted their demographic information and responses to questions about pandemic impacts on their practice and patients. Responses were aggregated and analyzed using descriptive statistics. Results: A total of 259 mO/H across the U.S. completed the survey; 73% practice in a community setting; 44% identify as hospital employees. The participants spend a median of 90% of their working time in direct patient care, have a median of 18 years of clinical experience, and see a median of 20 patients per day on clinic days. Before the pandemic, 92% of the participants’ practices had telemed capabilities but of those, 77% were not utilizing telemed for any visits. During the pandemic, almost all the participants’ practices were offering telemed, with 97% reporting some patient visits being conducted via telemed. Most (78%) anticipate continuing to offer or conduct some patient visits via telemed. Two-thirds stated that up to 25% of their patient visits could be converted to telemed outside of a pandemic environment. The types of visits that most believe are suitable for telemed include reviewing test/lab results, routine surveillance of chronic conditions, and survivorship care visits. Most (60%) stated that their patients view telemed favorably. About half reported a positive overall experience with telemed, with 47% reporting a better-than-expected experience. Most (79%) estimated that pivoting to telemed equates to a revenue loss of up to 50% for that visit; 53% feel that telemed has had an overall negative financial impact on their practice. Two-thirds have experienced challenges getting reimbursed for telemed claims. The most common challenges with telemed reported were reluctance or inability of patients to participate in telemed (39%) and technology challenges (37%). The most common benefit of telemed reported was safety, i.e., less potential exposure to COVID-19 for providers and staff (65%). Conclusions: Telemed use was infrequent before the pandemic, but utilization has dramatically increased during the pandemic. Despite favorable experiences with telemed, mO/H expect telemed use to decline significantly post-pandemic. This prediction may be driven by the perceived loss of revenue when an in-person visit is converted to telemed visit. Further research is needed in identifying factors that may allow for the long-term adoption of telemed for appropriate patients.

Frailty for neurologists: a practical guide

Neurologists increasingly care for people with significant frailty in both clinic and ward settings. Such care demands a balanced approach to investigation, diagnosis and treatment, as well-intentioned actions can produce adverse effects. This article presents a practical approach to the identification and management of patients with frailty and neurological conditions. We address medicines optimisation, common causes of deterioration in those with frailty, communication, decisions about intensity of treatment, and shared decision-making including ethical aspects of withholding or withdrawing life-prolonging treatment, with a view to improving the experience both of people living with frailty and of the teams who care for them.

Broadening the scope of task shifting in the organisation of healthcare

Task shifting in healthcare has mainly been initiated and studied as a way to react to/or mitigate workforce shortages. Here, we define task shifting as the structural redistribution of tasks, usually including responsibilities and competencies between different professions. As such, task shifting is commonly focused on highly specialised and trained professionals who hand-over specific, standardised tasks to professionals with lower levels of education. It is expected that this type of task shifting will lead to efficiency and cost savings to healthcare organisations. Yet, there are more benefits to task shifting, in particular its contribution to integrated patient-centred quality of care and a tailored system that meets the changing care demands in society. Hence the importance to broaden the scope of task shifting, its goals, manifestations and how task shifting plays a role in addressing both the strengths and weaknesses in the healthcare system. In this focus piece, trends and conditions for task shifting and its (un)anticipated effects are discussed. We argue that, only when designed to face specific complexities at the workplace and taking into account the balance between specialists and generalists, task shifting may substantially contribute to enhanced quality of care that meets the changing needs of society.

Health Communication and Inter-professional Care in Context of Multimorbidity Management: Assessment of Health Professional Curricular Focus in India

To meet the long term care demands of chronic diseases as well as multimorbidity, healthcare providers from different disciplines need to work collaboratively in practice. This requires healthcare providers to be appropriately trained on delivery of inter-professional care (IPC) and health communication aspects during formative professional years. In this study, we have looked at the prevailing undergraduate and postgraduate healthcare professional curricula to understand the focus on health communication and on IPC for the delivery of multidisciplinary care for multimorbidity management. We observe that while there are exclusive courses on health communication being delivered at different levels, the focus on IPC is still in stages of infancy. The IPC component is just beginning to be woven into the health professional curricula through elements like competency-based curriculum, rotational posting, inter-departmental engagements. At the same time, the need to put curricular attention on multimorbidity is also highlighted here. There remains wider scope for strengthening learning on health communication and IPC among different disciplines within the curricula in the context of multimorbidity. We expect our findings to provide key inputs to academic planners and policy makers towards the introduction of adequate curricular components for addressing multimorbidity along with necessary prescriptions for health communication and IPC in India.

Developing an Approach to Quantify Nurse Workload and Quality of Care Using Discrete Event Simulation

Intensive workload for nurses due to high demands directly impacts the quality of care and nurses’ health. To better manage workload, it is necessary to understand the drivers of workload. This multidisciplinary research provides an adaptable nurse-focused approach to discrete event simulation (DES) modelling that can quantify the effects of changing technical design and operational policies in terms of nurse workload and quality of care. In the first phase of this research, a demonstrator model was developed that explored the impact of nurse-patient ratios. As the number of patients per nurse (nurse-patient ratio) increased, nurse workload increased, and the quality of care deteriorated. In the second phase of this research, the DES model tested the interaction of patient acuity and nurse-patient ratios. As the levels of patient acuity and number of patients per nurse increased, nurse workload increased, and quality of care deteriorated – a result that was not surprising but an ability to quantify this proactively, was conceived. In the third phase of this research, the DES model was validated by means of an external field validation study by adapting the model to a real-world unit. The DES model showed excellent consistency between modelling and real-world outcomes (Intraclass iv Correlation Coefficient = 0.85 to 0.99; Spearman Rank-order Correlation Coefficient = 0.78). The fourth phase of this research used the validated simulation model to test the design implication of geographical patient bed assignment. As nurses were assigned to patient beds further away from the center of the unit or spread further apart, nurse workload increased as the nurse had to walk more leading to a deterioration in the quality of care. The DES modelling capability showed that both aspects of assignment were important for patient bed assignment. The fifth phase of this research combined Digital Human Modelling (DHM) and DES to produce a time-trace of biomechanical load and peak biomechanical load (‘activity’) for a full shift of nursing work. As the nurse was assigned to beds further away from the center of the unit, the cumulative biomechanical load decreased as the nurse spent more time walking yielding a reduced biomechanical load in comparison to the task group ‘activity’. As patient acuity is increased, a decrease in L4/L5 moment is observed as the task duration and frequency of most care task increase. Due to increased care demands, nurses must now spend more time delivering care. Since the care demands are much higher than the current capability of nurses, quality of care is deteriorated. As number of patients per nurse, increased a ‘ceiling’ effect on biomechanical load can be observed as nurses do not have the time to attend to this extra demand for care. The use of this adaptable DES modeling approach can assist decision makers by providing quantifiable information on the potential impact of these decisions on nurse workload and quality of care. Thereby, assisting decision makers to create technical design and operational policies for hospital units that do not compromise patient safety and health of nurses. Keywords: Behavioural operations research; Discrete Event Simulation; Nurse Workload; Quality of care; Healthcare Ergonomics; Human Factors Engineering; Nurses; Healthcare policy