Barriers to implementation of pediatric emergency department interventions for parental tobacco use and dependence: a qualitative study using the theoretical domains framework

Background Pediatric emergency department (PED) and urgent care (UC) professionals can play a key role in delivering evidence-based guidelines to address parental tobacco use and child tobacco smoke exposure (TSE). Understanding PED/UC professionals’ perceptions regarding these guidelines is the first step in developing and implementing a TSE screening and counseling intervention in these settings. This study aimed to use the theoretical domains framework (TDF) to identify current screening and counseling behaviors of PED/UC professionals related to parental tobacco use and child TSE, and determine barriers and enablers that influence these behaviors. Methods Semi-structured, focused interviews were conducted with 29 actively practicing PED/UC clinical staff who worked at one large, Midwestern children’s hospital. The interview guide was informed by the TDF and included open-ended questions. Content analysis of interview transcripts was guided by the TDF. Nurses, physicians, and healthcare administrators were assessed overall and by group membership to ensure each group was represented based on their varying PED/UC roles. Results Fifty-one percent were nurses, 38% were physicians, and 11% were healthcare administrators. Most PED/UC professionals did not currently follow the guidelines, but perceived addressing parental tobacco use as part of their role. All 14 TDF domains were identified by nurses, physicians, and administrators in relation to counseling for parental tobacco use and child TSE. Domains with the most sub-themes were (1) knowledge: lack of knowledge about tobacco counseling, including implementing counseling, cessation resources/referrals, and thirdhand smoke; (2) beliefs about capabilities: not comfortable counseling parents, easier to discuss with parents who are receptive and to ask and advise when patients have a TSE-related complaint, and more likely to discuss if there were resources/referrals; and (3) environmental context and resources: barriers include lack of time, training, and resources and referral information to give to parents, and an enabler is using TSE-related complaints as a context to offer counseling. Conclusions Study findings provide a strong foundation for developing and implementing clinical practice guidelines regarding parental tobacco use and child TSE in the PED/UC setting. Future intervention development will address all TDF domains and test the implementation of the intervention in the PED/UC setting.

Correlations Between the Neurobehavioral Symptom Inventory and Other Commonly Used Questionnaires for Traumatic Brain Injury

ABSTRACT Objective To evaluate the correlations between the Neurobehavioral Symptom Inventory (NSI) and other questionnaires commonly administered within military traumatic brain injury clinics. Setting Military outpatient traumatic brain injury clinics. Participants In total, 15,428 active duty service members who completed 24,162 NSI questionnaires between March 2009 and May 2020. Design Observational retrospective analysis of questionnaires collected as part of standard clinical care. Main Measures NSI, Post-Traumatic Stress Disorder Checklist for DSM-5 and Military Version, Patient Health Questionnaire (PHQ), Generalized Anxiety Disorder, Headache Impact Test (HIT-6), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Activities-Specific Balance Confidence Scale (ABC), Dizziness Handicap Inventory (DHI), Alcohol Use Disorders Identification Test (AUDIT), and the World Health Organization Quality of Life Instrument-Abbreviated Version. Only questionnaires completed on the same date as the NSI were examined. Results The total NSI score was moderately to strongly correlated with all questionnaires except for the AUDIT. The strongest correlation was between the NSI Affective Score and the PHQ9 (r = 0.86). The NSI Vestibular Score was moderately correlated with the ABC (r = –0.55) and strongly correlated with the DHI (r = 0.77). At the item level, the HIT-6 showed strong correlation with NSI headache (r = 0.80), the ISI was strongly correlated with NSI difficulty sleeping (r = 0.63), and the ESS was moderately correlated with NSI fatigue (r = 0.39). Conclusion Clinicians and healthcare administrators can use the correlations reported in this study to determine if questionnaires add incremental value for their clinic as well as to make more informed decisions regarding which questionnaires to administer.

Organisational structural predictors of ambulance crashes: an analysis

Objective: This study investigated the association between three organisational structural factors—organisational type, organisation status (staffing model), and level of service—and ambulance crash rates. The null hypothesis was that there would be no difference in ambulance crash rates during response or transport between any of the three factors. Methods: A cross-sectional design with a sample drawn from the 2019 National Emergency Medical Services Information System dataset was used to examine the relationship between these systems-level factors and ambulance crashes. After applying inclusion criteria, a sample of 2207 cases was drawn and analysed using the χ2 test of association and multiple logistic regression. Results: There was a statistically significant but small association between level of service and ambulance crashes during transport, using the χ2 test of association (P<0.05). Emergency medical technician (EMT)-level services had lower crash rates and paramedic-level services had higher rates than expected. There was no statistically significant association between organisational type or organisational status and ambulance crashes during either the response or transport phase of an emergency medical service (EMS) call, using the χ2 test of association (P>0.05). Of the two logistic regression models performed, only EMT-level services had a statistically significant association with ambulance crashes during transport (P<0.05; OR 0.208 [0.050, 0.866]). Conclusion: The organisational structural factors examined in this study failed to explain most of the variance in ambulance crash rates. However, EMT-level services were associated with lower rates of ambulance crashes than paramedic level services. EMS healthcare administrators and researchers should continue to explore potentially modifiable factors to reduce the incidence of these events and promote positive social change by reducing the risk of injury to patients, EMS workers and the public at large.

Policy Paper on Decision Making in Intensive Care Units

Intensive Care Units (ICU) are units where vital support with advanced technology is given to critically ill patients and multidisciplinary approaches are frequently applied. As we all see during the pandemic, the ICU beds are limited in number; therefore, appropriate use of ICU beds is very important to give the necessary treatment to patients on time while spending the resources rationally and efficiently. Practices to be implemented for this purpose may cause conflicts between the patients, relatives of the patients, the society and the healthcare team. It is crucial to prevent these conflicts and to ensure that they are resolved properly when they arise. This policy paper prepared by Turkish Society of Clinical Microbiology and Infection (Klimik), Turkish Society of Intensive Care and Turkish Bioethics Association brings suggestions to physicians and healthcare administrators regarding the rational use of intensive care units. It is thought that it will become effective to the extent that it is supported by the professional organizations and medical associations operating in our country.

Assessment of healthcare professionals’ perceptions and attitudes towards the COVID-19 pandemic in Turkey

BACKGROUND: Determining the healthcare professionals’ perceptions and attitudes towards the COVID-19 pandemic will contribute to managing and struggling their efforts against COVID-19. OBJECTIVE: This study aimed to determine the perceptions and attitudes of healthcare professionals who are at the forefront in the fight against this pandemic. METHODS: In the study, the survey technique used as the data collection method and 216 participants agreed to participate. The questionnaire consisted of three sections. Reliability analysis and descriptive statistical methods used to analyze the data obtained using the SPSS package program. RESULTS: According to the study results, 80.4%of the participants perceive the probability of being infected with the COVID-19 to be very high, and 64%of them consider that the conditions are very favorable for them to be infected. More than half of them are afraid of being infected and believe that if they contract COVID-19, adverse effects may continue for a long time. Furthermore, almost all participants (96.20%) consider personal protective equipment beneficial and will protect them from the COVID-19 as a wise preventive measure. However, 82.30%of the participants stated that using personal protective equipment is uncomfortable, and 76.60%said it is challenging to take care of patients while using personal protective equipment. CONCLUSIONS: The current study results show that healthcare professionals are aware of how serious COVID-19 is, understand the importance of protective equipment in protection from COVID-19, and are seriously afraid of COVID-19. Given that the fears of healthcare professionals may have adverse effects on them, it is recommended that healthcare administrators take measures to comfort healthcare workers and ensure that they maintain their positive attitude towards COVID-19.

Prioritization of Indicators of the Quality of Care Provided to Older Adults with Frailty by Key Stakeholders from Five Canadian Provinces

Background: To meet the needs of older adults with frailty better, it is essential to understand which aspects of care are important from their perspective. We therefore sought to assess the importance of a set of quality indicators (QI) for monitoring outcomes in this population. Methods: In this mixed-method study, key stakeholders completed a survey on the importance of 36 QIs, and then explained their ratings in a semi-structured interview. Stakeholders included older adults with frailty and their caregivers, healthcare providers (HCPs), and healthcare administrators or policy/decision makers (DMs). We conducted descriptive statistical analyses of quantitative variables, and deductive thematic qualitative analyses of interview transcripts. Results: The 42 participants (8 older adults, 18 HCPs, and 16 DMs) rated six QIs as more important: increasing the patients’ quality of life; increasing healthcare staff skills; decreasing patients’ symptoms; decreasing family caregiver burden; increasing patients’ satisfaction with care; and increasing family doctor continuity of care.Conclusions: Key stakeholders prioritized QIs that focus on outcomes targeted to patients and caregivers, whereas the current healthcare systems generally focus on processes of care. Quality improvement initiatives should therefore take better account of aspects of care that are important for older adults with frailty, such as having a chance to express their individual goals of care, receiving quality communications from HCPs, or monitoring symptoms that they might not spontaneously describe. Our results point to the need for patient-centred care that is oriented toward quality of life for older adults with frailty.

Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting

BackgroundEarly access to diagnosis is crucial for effective management of any disease including tuberculosis (TB). We investigated the barriers and opportunities to maximise uptake and utilisation of molecular diagnostics in routine healthcare settings.MethodsUsing the implementation of WHO approved TB diagnostics, Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) and Line Probe Assay (LPA) as a benchmark, we evaluated the barriers and how they could be unlocked to maximise uptake and utilisation of molecular diagnostics.ResultsHealth officers representing 190 districts/counties participated in the survey across Kenya, Tanzania and Uganda. The survey findings were corroborated by 145 healthcare facility (HCF) audits and 11 policy-maker engagement workshops. Xpert MTB/RIF coverage was 66%, falling behind microscopy and clinical diagnosis by 33% and 1%, respectively. Stratified by HCF type, Xpert MTB/RIF implementation was 56%, 96% and 95% at district, regional and national referral hospital levels. LPA coverage was 4%, 3% below culture across the three countries. Out of 111 HCFs with Xpert MTB/RIF, 37 (33%) used it to full capacity, performing ≥8 tests per day of which 51% of these were level five (zonal consultant and national referral) HCFs. Likewise, 75% of LPA was available at level five HCFs. Underutilisation of Xpert MTB/RIF and LPA was mainly attributed to inadequate—utilities, 26% and human resource, 22%. Underfinancing was the main reason underlying failure to acquire molecular diagnostics. Second to underfinancing was lack of awareness with 33% healthcare administrators and 49% practitioners were unaware of LPA as TB diagnostic. Creation of a national health tax and decentralising its management was proposed by policy-makers as a booster of domestic financing needed to increase access to diagnostics.ConclusionOur findings suggest higher uptake and utilisation of molecular diagnostics at tertiary level HCFs contrary to the WHO recommendation. Country-led solutions are crucial for unlocking barriers to increase access to diagnostics.

Nature and scope of medical social work in healthcare setting in Pakistan

A sick person’s needs are hardly ever simple rather these are complicated and multifold which require several kinds of assistance, simultaneously. Medicine is the one while the Medical Social Work (MSW) is another way. Social Work discipline emerged in earlier 20th century but in Pakistan, it has been started in 1953. The role of Social Work in healthcare setting is exclusively unique. Social Workers as a part of multidisciplinary teams are dealing with the multidimensional issues of the patients. In Pakistan, the MSW seems failed to achieve a mature professional status and it is still blurred in terms of skills and services. The significance of Social Work services is vague to healthcare administrators and even healthcare professionals. The role of social workers in healthcare setting is limited. Continuous...

Turnover and Retention Strategies Among Mental Health Workers

BackgroundThe purpose of this study was to explore retention strategies that healthcare administrators use to retain mental health workers in community mental health clinics. The study was guided by the question What strategies do HCAs use to retain their MHWs with more than 2 years of experience? MethodsA qualitative case study analysis was performed. Interviews were conducted with six healthcare administrators at Fort Worth area community mental health clinics. Interviews were coded using thematic analysis. To increase the study’s reliability and validity, the interview guide was field checked by experts and member checking performed on interview transcripts.ResultsThe healthcare administrators identified six strategies for retention: providing good benefits packages, promoting worker health and wellness, providing competitive salaries, giving workers flexible scheduling options, incentivizing workers with rewards and positive reinforcement, and maintaining open communication channels.ConclusionsThe results from this study have positive implications for mental health workers, patients, and community mental health clinics. The strategies identified in this study can be implemented to increase worker satisfaction and reduce turnover. In doing so, patients will receive higher quality care and organizations will be more attractive to prospective employees.

Characteristics of the ideal hospitalist inpatient care program: perceptions of Canadian health system leaders

Background Despite the growing prevalence of hospitalist programs in Canada, it is not clear what program features are deemed desirable by administrative and medical leaders who oversee them. We aimed to understand perceptions of a wide range of healthcare administrators and frontline providers about the implementation and necessary characteristics of a hospitalist service. Methods We conducted semi-structured interviews with a range of administrators, medical leaders and frontline providers across three hospital sites operated by an integrated health system in British Columbia, Canada. Results Most interviewees identified the hospitalist model as the ideal inpatient care service line, but identified a number of challenges. Interviewees identified the necessary features of an ideal hospitalist service to include considerations for program design, care and non-clinical processes, and alignment between workload and physician staffing. They also identified continuity of care as an important challenge, and underlined the importance of communication as an important enabler of implementation of a new hospitalist service. Conclusions Most hospital administrators and frontline providers in our study believed the hospitalist model resulted in improvements in clinical processes and work environment.