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Madan, Atul K., Timothy C. Fabian, and David S. Tichansky. "Potential Financial Impact of First Assistant Billing by Surgical Residents." American Surgeon 73, no. 7 (July 2007): 652–57. http://dx.doi.org/10.1177/000313480707300703.
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General surgery residency involves a mixture of 1) education of residents and 2) service by residents. The service that residents provide is not directly reimbursed in our current healthcare system by private healthcare insurance companies. This investigation characterizes the amount of reimbursement a typical resident would be able to collect if residents were allowed to collect for their services as a first assistant. The case logs of residents who graduated over 2 years from our general surgery residency program were reviewed. Data from each resident's last 2 years (postgraduate years 4 and 5) were included in this study. Relative value units (RVUs) for each Current Procedural Terminology code were reviewed. Collections were calculated by multiplying the Medicare conversion factor of $36.7856/RVU, the corresponding RVU, and a “standard” collection rate of 16 per cent for first assistants. There were 13 general surgery residents. These residents provided first assistant help with 91,473 RVUs over 2 years. A total amount of $535,380 could have been collected on first assistant fees for the last 2 years of their residency. Each resident would have been able to collect an average at least $41,414 just for first assistant operative fees. Resident assistance in the operating room provides significant savings for private healthcare insurance companies each year by reducing the need for first assistants. The data demonstrate that private insurance companies receive a considerable amount of pro bono service from residents. Changes in the financing of the current healthcare system in the United States will require educators to examine other sources ( i.e., private insurance companies) for support of graduate medication education.
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Nishisaki, Akira, Aaron J. Donoghue, Shawn Colborn, Christine Watson, Andrew Meyer, Calvin A. Brown, Mark A. Helfaer, Ron M. Walls, and Vinay M. Nadkarni. "Effect of Just-in-time Simulation Training on Tracheal Intubation Procedure Safety in the Pediatric Intensive Care Unit." Anesthesiology 113, no. 1 (July 1, 2010): 214–23. http://dx.doi.org/10.1097/aln.0b013e3181e19bf2.
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Background Tracheal intubation-associated events (TIAEs) are common (20%) and life threatening (4%) in pediatric intensive care units. Physician trainees are required to learn tracheal intubation during intensive care unit rotations. The authors hypothesized that "just-in-time" simulation-based intubation refresher training would improve resident participation, success, and decrease TIAEs. Methods For 14 months, one of two on-call residents, nurses, and respiratory therapists received 20-min multidisciplinary simulation-based tracheal intubation training and 10-min resident skill refresher training at the beginning of their on-call period in addition to routine residency education. The rate of first attempt and overall success between refresher-trained and concurrent non-refresher-trained residents (controls) during the intervention phase was compared. The incidence of TIAEs between preintervention and intervention phase was also compared. Results Four hundred one consecutive primary orotracheal intubations were evaluated: 220 preintervention and 181 intervention. During intervention phase, neither first-attempt success nor overall success rate differed between refresher-trained residents versus concurrent non-refresher-trained residents: 20 of 40 (50%) versus 15 of 24 (62.5%), P = 0.44 and 23 of 40 (57.5%) versus 18 of 24 (75.0%), P = 0.19, respectively. The resident's first attempt and overall success rate did not differ between preintervention and intervention phases. The incidence of TIAE during preintervention and intervention phases was similar: 22.0% preintervention versus 19.9% intervention, P = 0.62, whereas resident participation increased from 20.9% preintervention to 35.4% intervention, P = 0.002. Resident participation continued to be associated with TIAE even after adjusting for the phase and difficult airway condition: odds ratio 2.22 (95% CI 1.28-3.87, P = 0.005). Conclusions Brief just-in-time multidisciplinary simulation-based intubation refresher training did not improve the resident's first attempt or overall tracheal intubation success.
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Helgesen, Ann Karin, Elsy Athlin, and Maria Larsson. "Relatives’ participation in everyday care in special care units for persons with dementia." Nursing Ethics 22, no. 4 (July 28, 2014): 404–16. http://dx.doi.org/10.1177/0969733014538886.
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Background: Research concerning relatives’ participation in the everyday care related to persons living in special care units for persons with dementia is limited. Research questions: To examine relatives’ participation in their near one’s everyday care, the level of burden experienced and important factors for participation, in this special context. Design: The study had a cross-sectional design, and data collection was carried out by means of a study-specific questionnaire. Participants and context: A total of 233 relatives from 23 different special care units participated. Ethical consideration: The study was approved by the Norwegian Social Science Data Services. Results: A great majority of relatives reported that they visited weekly and were the resident’s spokesperson, but seldom really participated in decisions concerning their everyday care. Participation was seldom reported as a burden. Discussion: This study indicated that relatives were able to make a difference to their near one’s everyday life and ensure quality of care based on their biographical expertise, intimate knowledge about and emotional bond with the resident. Since knowing the resident is a prerequisite for providing individualised care that is in line with the resident’s preferences, information concerning these issues is of utmost importance. Conclusion: This study prompts reflection about what it is to be a spokesperson and whether everyday care is neglected in this role. Even though relatives were satisfied with the care provided, half of them perceived their participation as crucial for the resident’s well-being. This indicated that relatives were able to offer important extras due to their biographical expertise, intimate knowledge about and emotional bond with the resident. Good routines securing that written information about the residents’ life history and preferences is available and used should be implemented in practice.
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Jackson, J. Benjamin, William P. Huntington, and Steven L. Frick. "Assessing the Value of Work Done by an Orthopedic Resident During Call." Journal of Graduate Medical Education 6, no. 3 (September 1, 2014): 567–70. http://dx.doi.org/10.4300/jgme-d-13-00370.1.
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Abstract Background Medicare funding for graduate medical education may be cut in the next federal budget. Objective We quantified the value of work that 1 orthopedic surgery resident performs on call and compare it to Medicare educational funding received by the hospital for each resident. Methods A single orthopedic resident's on-call emergency department and inpatient consults were collected during a 2-year call period at a large, tertiary, level-1 trauma center. Patient charts were reviewed; ICD-9 codes, evaluation and management, and procedural treatment were recorded. Codes were converted into work relative value units. The number of work relative value units was multiplied by the 2012 Medicare rate of $34.03 per relative value units to calculate the monetary value of resident work. Results Of 120 resident call shifts, 115 call sheets (95.8%) were available for review, and 1160 patients were seen (average = 10.09 consults/call). A total of 4688 work relative value units were generated (average = 40.76 per night), and the total dollar value generated was $159,561 ($1,387 per call) during the 2 years of call (average = $79,780 annually). Evaluation and management codes generated 2340 work relative value units, with a calculated dollar amount of $79,648, and procedural codes generated 2348 work relative value units, with a calculated dollar amount of $79,913. Conclusions Our institution estimated Medicare direct medical education support per resident at $40,000/y, and total funding was $130,000/resident. At our tertiary care institution, the unbilled work of 1 orthopedic resident on call amounts to more than 60% of Medicare direct medical education and indirect medical education funding annually.
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van Beek, Adriana P. A., Dinnus H. M. Frijters, Cordula Wagner, Peter P. Groenewegen, and Miel W. Ribbe. "Social engagement and depressive symptoms of elderly residents with dementia: a cross-sectional study of 37 long-term care units." International Psychogeriatrics 23, no. 4 (November 15, 2010): 625–33. http://dx.doi.org/10.1017/s1041610210002061.
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ABSTRACTBackground: Social engagement and depression are important outcomes for residents with dementia in long-term care. However, it is still largely unclear which differences in social engagement and depression exist in residents of various long-term care settings and how these differences may be explained. This study investigated the relationship between social engagement and depressive symptoms in long-term care dementia units, and studied whether differences in social engagement and depressive symptoms between units can be ascribed to the composition of the resident population or to differences in type of care setting.Methods: Thirty-seven long-term care units for residents with dementia in nursing- and residential homes in the Netherlands participated in the study. Social engagement and depressive symptoms were measured for 502 residents with the Minimum Data Set of the Resident Assessment Instrument. Results were analyzed using multilevel analysis.Results: Residents of psychogeriatric units in nursing homes experienced low social engagement. Depressive symptoms were most often found in residents of psychogeriatric units in residential homes. Multilevel analyses showed that social engagement and depressive symptoms correlated moderately on the level of the units. This correlation disappeared when the characteristics of residents were taken into account.Conclusions: Social engagement and depressive symptoms are influenced not only by individual characteristics but also by the type of care setting in which residents live. However, in this study social engagement and depressive symptoms were not strongly related to each other, implying that separate interventions are needed to improve both outcomes.
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Brühl, Albert, Katarina Planer, and Anja Hagel. "Variation of Care Time Between Nursing Units in Classification-Based Nurse-to-Resident Ratios: A Multilevel Analysis." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 55 (January 1, 2018): 004695801875524. http://dx.doi.org/10.1177/0046958018755242.
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A validity test was conducted to determine how care level–based nurse-to-resident ratios compare with actual daily care times per resident in Germany. Stability across different long-term care facilities was tested. Care level–based nurse-to-resident ratios were compared with the standard minimum nurse-to-resident ratios. Levels of care are determined by classification authorities in long-term care insurance programs and are used to distribute resources. Care levels are a powerful tool for classifying authorities in long-term care insurance. We used observer-based measurement of assignable direct and indirect care time in 68 nursing units for 2028 residents across 2 working days. Organizational data were collected at the end of the quarter in which the observation was made. Data were collected from January to March, 2012. We used a null multilevel model with random intercepts and multilevel models with fixed and random slopes to analyze data at both the organization and resident levels. A total of 14% of the variance in total care time per day was explained by membership in nursing units. The impact of care levels on care time differed significantly between nursing units. Forty percent of residents at the lowest care level received less than the standard minimum registered nursing time per day. For facilities that have been significantly disadvantaged in the current staffing system, a higher minimum standard will function more effectively than a complex classification system without scientific controls.
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Postman, Whitney Anne. "Computer-Mediated Cognitive-Communicative Intervention for Residents with Dementia in a Special Care Unit: An Exploratory Investigation." Perspectives of the ASHA Special Interest Groups 1, no. 15 (March 31, 2016): 68–78. http://dx.doi.org/10.1044/persp1.sig15.68.
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Residents of “lockdown” dementia units, also referred to as “Special Care Units” of skilled nursing facilities, constitute a population of rapidly escalating needs. These entail rising demands for speech-language pathology services to treat and manage symptoms of dementia. This article recounts an exploratory investigation of rehabilitation sessions with an elderly resident of a Special Care Unit, using a new computer-based program targeting cognitive-communicative capacities. Preliminary results suggest that this resident with moderate dementia achieved a higher degree of functional recovery and superior quality of life than would have been possible with more traditional therapeutic approaches alone. An iPad-based software platform was used to administer tasks to train attention, working memory, and executive functions. The resident demonstrated significant gains in task performance that were coupled with increased independence and safety, enhanced participation in non-computerized therapeutic tasks, adaptation to surroundings, and reduction of negative behaviors. The resident's improved cognitive-communicative performance was sufficient to warrant a transfer to a long-term care wing within the same facility. This proof of concept demonstration invites formulation of testable hypotheses, which should be pursued in future research on optimizing interventions for institutionalized people with dementia using leading-edge computerized therapies.
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Burnes, D., and M. Syed. "UNDERSTANDING HOW RESIDENT-TO-RESIDENT AGGRESSION IN LONG-TERM CARE DEMENTIA UNITS UNFOLDS." Innovation in Aging 2, suppl_1 (November 1, 2018): 727. http://dx.doi.org/10.1093/geroni/igy023.2685.
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Klosterman, Theresa, Rachel Meyers, Anita Siu, Pooja Shah, Katelin Kimler, Marc Sturgill, and Christine Robinson. "An Academic Multihealth System PGY2 Pediatric Pharmacy Residency Program." Journal of Pediatric Pharmacology and Therapeutics 20, no. 6 (November 1, 2015): 468–75. http://dx.doi.org/10.5863/1551-6776-20.6.468.
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We describe a novel multihealth system pediatric pharmacy residency program through the Ernest Mario School of Pharmacy at Rutgers University. Pediatric clinical pharmacy is a growing field that has seen an increase in demand for practitioners. Practice sites include freestanding children's hospitals, children's hospitals within adult hospitals, and pediatric units within adult hospitals. To accommodate a residency program in a region with no freestanding children's hospital, the pediatric faculty members at the Ernest Mario School of Pharmacy at Rutgers University developed a multihealth system postgraduate year 2 (PGY2) pediatric pharmacy residency program with 6 pediatric faculty members functioning as preceptors at their 5 respective practice sites. The multihealth system setup of the program provides the resident exposure to a multitude of patient populations, pediatric specialties, and pediatric pharmacy practices. In addition, the affiliation with Rutgers University allows an emphasis on academia with opportunities for the resident to lecture in small and large classrooms, facilitate discussion periods, assist with clinical laboratory classes, and precept pharmacy students. The resident has the unique opportunity to develop a research project with a large and diverse patient population owing to the multihealth system rotation sites. A multihealth system PGY2 residency in pediatric pharmacy provides the resident a well-rounded experience in pediatric clinical practice, research, and academia that will enhance the resident's ability to build his or her own pediatric pharmacy practice.
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Harris, John A., and Nicholas Castle. "LACK OF POLICIES, TRAINING, AND SPECIAL CARE UNITS FOR OBESITY CARE IN PENNSYLVANIA NURSING HOMES." Innovation in Aging 3, Supplement_1 (November 2019): S701. http://dx.doi.org/10.1093/geroni/igz038.2579.
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Abstract It is unclear how nursing homes in the U.S. prepare for the specific needs of residents with obesity at a population level in terms of equipment availability, policies, staff training, and special care units. Using a mail survey of Directors of Nursing (DON) to 420 Pennsylvania Nursing Homes in 2017 and 2018, we examined the reported presence of obesity-specific equipment availability, organizational policies, staff training, and special care units. We compared the presence of these adaptation approaches by whether the DON strongly agreed that obesity was a problem for resident and staff safety using χ2 tests. One hundred fifty-one surveys were returned and included in the analysis (response rate of 36%). 80.7% of respondents were, on average, very concerned when asked about 11 resident medical, functional, relational, and staff-related safety outcomes (e.g., pressure ulcers, hospital readmissions, social isolation, and staff injury). DONs reported reduced equipment availability in nursing homes for obesity-specific beds (66%), walkers (34%), bedside commodes (30%), and gowns (28%). The presence of obesity-specific organizational policies (44%), staff training (26%), and special care units (7%) was limited. DON strong agreement with obesity-related resident and staff safety issues was significantly associated with obesity-specific bed availability (p=0.04) but was not significantly associated with obesity-specific organizational policies (p=0.17), staff training (p=0.51), and special care units (p=0.09). Despite a high concern for resident and staff safety related to obesity care expressed by DONs, there is little appropriate nursing home organizational response as measured by policies, staff training or special care units.
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Tupper, Susan M., Heather Ward, and Jasneet Parmar. "Family Presence in Long-Term Care During the COVID-19 Pandemic: Call to Action for Policy, Practice, and Research." Canadian Geriatrics Journal 23, no. 4 (November 23, 2020): 335–39. http://dx.doi.org/10.5770/cgj.23.476.
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Family presence in long-term care (LTC) homes is crucial for meeting the health, psychosocial, and practical needs of residents. Initially during the COVID-19 pandemic, visitation restrictions essentially locked-out families as public health orders prioritized prevention of harm from spread of infection. Although telephone and technology-assisted communication with families was encouraged, many residents were unable to participate. The outcry from families on the injustice of disruption of family units and emerging reports of harms arising from prolonged restrictions highlight the need for provincial and organizational policies to recognize the impact of resident and family separation on well-being. In this commentary we describe family caregiving, review the impact of visitation restrictions on residents, families, and LTC staff, and provide a resident- and family-oriented perspective on policy implications that challenge the outdated notion that extreme restrictions to family presence protect resident health.
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Helgesen, Ann Karin, Maria Larsson, and Elsy Athlin. "Patient participation in special care units for persons with dementia." Nursing Ethics 21, no. 1 (June 21, 2013): 108–18. http://dx.doi.org/10.1177/0969733013486796.
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The aim of this study was to explore the experience of nursing personnel with respect to patient participation in special care units for persons with dementia in nursing homes, with focus on everyday life. The study has an explorative grounded theory design. Eleven nursing personnel were interviewed twice. Patient participation is regarded as being grounded in the idea that being master of one’s own life is essential to the dignity and self-esteem of all people. Patient participation was described at different levels as letting the resident make their own decisions, adjusting the choices, making decisions on behalf of the residents and forcing the residents. The educational level and commitment of the nursing personnel and how often they were on duty impacted the level that each person applied, as did the ability of the residents to make decisions, and organizational conditions, such as care culture, leadership and number of personnel.
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Starmer, Amy J., Lauren Destino, Catherine S. Yoon, and Christopher P. Landrigan. "Intern and Resident Workflow Patterns on Pediatric Inpatient Units." JAMA Pediatrics 169, no. 12 (December 1, 2015): 1175. http://dx.doi.org/10.1001/jamapediatrics.2015.2471.
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Almoosa, Khalid F., Linda M. Goldenhar, Jonathan Puchalski, Jun Ying, and Ralph J. Panos. "Critical Care Education During Internal Medicine Residency: A National Survey." Journal of Graduate Medical Education 2, no. 4 (December 1, 2010): 555–61. http://dx.doi.org/10.4300/jgme-d-10-00023.1.
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Abstract Background Current training practices and teaching methods for critical care medicine education during internal medicine residency have not been well described. This study explored critical care medicine education practices and environments for internal medicine residents in the United States. Methods A web-based survey recruited Pulmonary and Critical Care Medicine fellowship program directors involved with internal medicine residency programs at academic institutions in the United States. Results Of 127 accredited Pulmonary and Critical Care Medicine programs in 2007, 63 (50%) responded. Demographics of the intensive care units varied widely in size (7–52 beds), monthly admissions (25–300 patients), and presence of a “night float” (22%) or an admissions “cap” (34%). All programs used bedside teaching, and the majority used informal sessions (91%) or didactic lectures (75%). More time was spent on resident teaching in larger (≥20 bed) medical intensive care units, on weekdays, in programs with a night-float system, and in programs that suspended residents' primary care clinic duties during their intensive care unit rotation. Conclusions Although similar teaching methods were used within a wide range of training environments, there is no standardized approach to critical care medicine education for internal medicine residents. Some survey responses indicated a correlation with additional teaching time.
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Chang, Nai-Chung, Karim Khader, Molly Leecaster, Lindsay Visnovsky, Scott Fridkin, Morgan Katz, Philip Polgreen, et al. "Evaluation of Care Interactions Between Healthcare Personnel and Residents in Nursing Homes Across the United States." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s36—s38. http://dx.doi.org/10.1017/ice.2020.516.
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Background: Certain nursing home (NH) resident care tasks have a higher risk for multidrug-resistant organisms (MDRO) transfer to healthcare personnel (HCP), which can result in transmission to residents if HCPs fail to perform recommended infection prevention practices. However, data on HCP-resident interactions are limited and do not account for intrafacility practice variation. Understanding differences in interactions, by HCP role and unit, is important for informing MDRO prevention strategies in NHs. Methods: In 2019, we conducted serial intercept interviews; each HCP was interviewed 6–7 times for the duration of a unit’s dayshift at 20 NHs in 7 states. The next day, staff on a second unit within the facility were interviewed during the dayshift. HCP on 38 units were interviewed to identify healthcare personnel (HCP)–resident care patterns. All unit staff were eligible for interviews, including certified nursing assistants (CNAs), nurses, physical or occupational therapists, physicians, midlevel practitioners, and respiratory therapists. HCP were asked to list which residents they had cared for (within resident rooms or common areas) since the prior interview. Respondents selected from 14 care tasks. We classified units into 1 of 4 types: long-term, mixed, short stay or rehabilitation, or ventilator or skilled nursing. Interactions were classified based on the risk of HCP contamination after task performance. We compared proportions of interactions associated with each HCP role and performed clustered linear regression to determine the effect of unit type and HCP role on the number of unique task types performed per interaction. Results: Intercept-interviews described 7,050 interactions and 13,843 care tasks. Except in ventilator or skilled nursing units, CNAs have the greatest proportion of care interactions (interfacility range, 50%–60%) (Fig. 1). In ventilator and skilled nursing units, interactions are evenly shared between CNAs and nurses (43% and 47%, respectively). On average, CNAs in ventilator and skilled nursing units perform the most unique task types (2.5 task types per interaction, Fig. 2) compared to other unit types (P < .05). Compared to CNAs, most other HCP types had significantly fewer task types (0.6–1.4 task types per interaction, P < .001). Across all facilities, 45.6% of interactions included tasks that were higher-risk for HCP contamination (eg, transferring, wound and device care, Fig. 3). Conclusions: Focusing infection prevention education efforts on CNAs may be most efficient for preventing MDRO transmission within NH because CNAs have the most HCP–resident interactions and complete more tasks per visit. Studies of HCP-resident interactions are critical to improving understanding of transmission mechanisms as well as target MDRO prevention interventions.Funding: Centers for Disease Control and Prevention (grant no. U01CK000555-01-00)Disclosures: Scott Fridkin, consulting fee, vaccine industry (spouse)
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Blumenfeld Arens, Olivia, Katharina Fierz, and Franziska Zúñiga. "Elder Abuse in Nursing Homes: Do Special Care Units Make a Difference? A Secondary Data Analysis of the Swiss Nursing Homes Human Resources Project." Gerontology 63, no. 2 (October 22, 2016): 169–79. http://dx.doi.org/10.1159/000450787.
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Background: In special care units (SCUs) for residents with advanced dementia, both personnel and organizations are adapted to the needs of residents. However, whether these adaptations have a preventive effect on elder abuse has not yet been explored. Objective: To describe the prevalence of observed emotional abuse, neglect, and physical abuse in Swiss nursing homes, to compare SCUs with non-SCUs concerning the frequency of observed emotional abuse, neglect, and physical abuse, and to explore how resident-related characteristics, staff outcomes/characteristics, and organizational/environmental factors relate to observed elder abuse. Methods: This is a secondary data analysis of the Swiss Nursing Homes Human Resources Project (SHURP), a cross-sectional multicenter study. Data were collected from 2012 to 2013 and are based on observed rather than perpetrated elder abuse. We performed multilevel mixed-effects logistic regressions taking into account the hierarchical structure of the data with personnel nested within units and facilities. Results: Of 4,599 care workers in 400 units and 156 facilities, 50.8% observed emotional abuse, 23.7% neglect, and 1.4% physical abuse. There was no significant difference between SCUs and non-SCUs regarding observed emotional abuse and neglect. Higher scores for ‘workload' and sexual aggression towards care workers were associated with higher rates of emotional abuse and neglect. Verbal and physical resident aggression, however, were only associated with higher rates of emotional abuse. Negative associations were found between ‘teamwork and resident safety climate' and both forms of abuse. Conclusion: Improving teamwork and the safety climate and reducing work stressors might be promising points of intervention to reduce elder abuse. More specific research about elder abuse in SCUs and the interaction between work climate and elder abuse is required.
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Kanagalingam, J., A. Zainal, C. Georgalas, S. Paun, and N. S. Tolley. "The disinfection of flexible fibre-optic nasendoscopes out-of-hours: confidential telephone survey of ENT units in England." Journal of Laryngology & Otology 116, no. 10 (October 2002): 817–22. http://dx.doi.org/10.1258/00222150260293637.
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We present the results of a confidential telephone survey of ENT units in England on the disinfection of flexible fibre-optic nasendoscopes out-of-hours. The on-call residents of 124 units were contacted and questioned. In 35.1 per cent of units surveyed, the on-call resident was primarily responsible for cleaning the scopes after use. Only 46 per cent of these junior doctors had access to a chemical sterilant to allow for high-level disinfection of these scopes. Provision for disinfection of scopes was poorer in teaching hospitals and in units that served inner city populations. Only 12.1 per cent of Senior House Officers (SHOs) received any training in disinfection techniques and only 25.5 per cent of units kept a register of patients nasendoscoped out-of-hours for purposes of contact tracing.
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Holmes, Douglas, and Jeanne A. Teresi. "Relating personnel costs in special care units and in traditional care units to resident characteristics." Journal of Mental Health Policy and Economics 1, no. 1 (March 1998): 31–40. http://dx.doi.org/10.1002/(sici)1099-176x(199803)1:1<31::aid-mhp5>3.0.co;2-p.
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Garg, Rakesh, AnjuR Bhalotra, Nitesh Goel, Amit Pruthi, Poonam Bhadoria, and Raktima Anand. "Attitude of resident doctors towards intensive care units′ alarm settings." Indian Journal of Anaesthesia 54, no. 6 (2010): 522. http://dx.doi.org/10.4103/0019-5049.72640.
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Greenberg, William E., and Jonathan F. Borus. "Focused Opportunities for Resident Education on Today’s Inpatient Psychiatric Units." Harvard Review of Psychiatry 22, no. 3 (2014): 201–4. http://dx.doi.org/10.1097/hrp.0000000000000037.
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Gerber, B. S., S. J. Weiner, and P. S. Heckerling. "The “Resident’s Dilemma”?" Methods of Information in Medicine 45, no. 04 (2006): 455–61. http://dx.doi.org/10.1055/s-0038-1634104.
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Summary Objectives: Medical residents engage in formal and informal education interactions with fellow residents during the working day, and can choose whether to spend time and effort on such interactions. Time and effort spent on such interactions can bring learning and personal satisfaction to residents, but may also delay completion of clinical work. Methods: Using hypothetical cases, we assessed the values and strategies of internal medicine residents at one hospital for both cooperative and non-cooperative education interactions with fellow residents. We then used these data and cellular automata models of two-person games to simulate repeated interactions between residents, and to determine which strategies resulted in greatest accrued value. We conducted sensitivity analyses on several model parameters, to test the robustness of dominant strategies to model assumptions. Results: Twenty-nine of the 57 residents (50.9%) valued cooperation more than non-cooperation no matter what the other resident did during the current interaction. Similarly, thirty-six residents (63.2%) endorsed an unconditional always-cooperate strategy no matter what the other resident had done during their previous interaction. In simulations, an always-cooperate strategy accrued more value (776.42 value units) than an aggregate of strategies containing non-cooperation components (675.0 value units, p = 0.052). Only when the probability of strategy errors reached 50%, or when values were re-ordered to match those of a Prisoner's Dilemma, did non-cooperation-based strategies accrue the most value. Conclusions: Cooperation-based values and strategies were most frequent among our residents, and dominated in simulations of repeated education interactions between them.
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Chabanne, Delphine, Hugh Finn, Chandra Salgado-Kent, and Lars Bedjer. "Identification of a resident community of bottlenose dolphins (Tursiops aduncus) in the Swan Canning Riverpark, Western Australia, using behavioural information." Pacific Conservation Biology 18, no. 4 (2012): 247. http://dx.doi.org/10.1071/pc120247.
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Identifying appropriate management units is vital for wildlife management. Here we investigate one potential management unit — resident communities of bottlenose dolphins — using information from ranging, occupancy, and association patterns. We identify a resident community of Indo-Pacific bottlenose dolphins (Tursiops aduncus) in the Swan Canning Riverpark, Western Australia based on: ranging patterns, sighting rates, Lagged Identification Rates (LIR), and three measures of social affinity and structure (Simple Ratio Index, preferred dyadic association analyses, and Lagged Association Rates (LAR)). The analyses yielded an estimated ‘community size’ of 17–18 individuals (excluding calves). High seasonal sighting rates (> 0.75 sightings per season) and a long mean residence time (ca. nine years) indicated year-round residency. The model best-fitting the LIR (emigration and mortality) also supported this. The social structure of dolphins was species-typical, characterized by significant dyadic associations within agesex classes (permutation test; P < 0.001), stronger associations among adult males than among adult females (LAR males > LAR females), and temporally stable associations (LAR > null LAR). Constant companions or long-lasting association models best explained adult male and female LARs. While behavioural information identified a resident community in the Riverpark, genetic and demographic information is needed to assess its appropriateness as a management unit.
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Ostapenko, Alexander, Samantha McPeck, Shawn Liechty, and Daniel Kleiner. "Has COVID-19 Hurt Resident Education? A Network-Wide Resident Survey on Education and Experience During the Pandemic." Journal of Medical Education and Curricular Development 7 (January 2020): 238212052095969. http://dx.doi.org/10.1177/2382120520959695.
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Purpose: As the COVID-19 pandemic continues to evolve, the healthcare system has been forced to adapt in myriad ways. Residents have faced significant changes in work schedules, deployment to COVID-19 units, and alterations to didactics. This study aims to identify the effects of the COVID-19 pandemic on resident perception of their own education within the Nuvance Health Network. Methods: We conducted an observational study assessing resident perception of changes in education and lifestyle during the COVID-19 pandemic. A survey was developed to assess the quality and quantity of resident education during this time and administered anonymously to all residents within the healthcare network. Results: Eighty-four (68%) residents responded to the survey from 5 different specialties, including general surgery, internal medicine, obstetrics and gynecology, pathology, and radiology. The average change in hours per week performing clinical work was −6 hours (SD = 17; P = .003), in time studying was +0 hours (SD = 5; P = .96), in weekly didactics was −2 hours (SD = 3; P < .001), and in attending involvement was −1 hours (SD = 2; P < .001). Additionally, 32% of residents expressed concern that the pandemic has diminished their preparedness to become an attending, 13% expressed concern about completing graduation requirements, and 3% felt they would need an additional year of training. Conclusion: During the COVID-19 pandemic thus far, residents perceived that time spent on organized didactics/conferences decreased and that attending physicians are less involved in education. Furthermore, the majority of residents felt that the quality of didactic education diminished as a result of the pandemic. Surprisingly, while many residents expressed concerns about being prepared to become an attending, few were concerned about completing graduation requirements or needing an extra year of education. In light of these findings, it is critical to devote attention to the effects of the pandemic on residents’ professional trajectories and create innovative opportunities for improving education during this challenging time.
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Desbiens, R., M. G. Elleker, G. Goldsand, J. Max Findlay, H. Hugenholtz, D. Puddester, and B. Toyota. "Current Educational Issues in the Clinical Neurosciences." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 28, no. 4 (November 2001): 283–92. http://dx.doi.org/10.1017/s0317167100001499.
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Objective:Canadian training in the clinical neurosciences, neurology and neurosurgery, faces significant challenges. New balances are being set by residents, their associations and the Royal College of Physicians and Surgeons of Canada between clinical service, education and personal time. The nature of hospital-provided medical service has changed significantly over the past decade, impacting importantly on resident training. Finally, future manpower needs are of concern, especially in the field of neurosurgery, where it appears that soon more specialists will be trained than can be absorbed into the Canadian health care system.Methods:A special symposium on current challenges in clinical neuroscience training was held at the Canadian Congress of Neurological Sciences in June 2000. Representatives from the Canadian Association of Interns and Residents, the Royal College of Physicians and Surgeons of Canada and English and French neurology and neurosurgery training programs made presentations, which are summarized in this report.Results:Residency training has become less service-oriented, and this trend will continue. In order to manage the increasingly sophisticated hospital services of neurology and neurosurgery, resident-alternatives in the form of physician “moonlighters” or more permanent hospital-based clinicians or “hospitalists” will be necessary in order to operate major neuroclinical units. Health authorities and hospitals will need to recognize and assume this responsibility. As clinical experience diminishes during residency training, inevitably so will the concept of the fully competent “generalist” at the end of specialty training. Additional subspecialty training is being increasingly sought by graduates, particularly in neurosurgery.Conclusion:Training in neurology and neurosurgery, as in all medical specialties, has changed significantly in recent years and continues to change. Programs and hospitals need to adapt to these changes in order to ensure the production of fully qualified specialists in neurology and neurosurgery and the provision of optimal care to patients in clinical teaching units.
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Desbiens, R., M. G. Elleker, G. Goldsand, H. Hugenholtz, D. Puddester, B. Toyota, and J. Max Findlay. "Current Educational Issues in the Clinical Neurosciences." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 28, no. 4 (November 2001): 299–308. http://dx.doi.org/10.1017/s0317167100054032.
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Objective:Canadian training in the clinical neurosciences, neurology and neurosurgery, faces significant challenges. New balances are being set by residents, their associations and the Royal College of Physicians and Surgeons of Canada between clinical service, education and personal time. The nature of hospital-provided medical service has changed significantly over the past decade, impacting importantly on resident training. Finally, future manpower needs are of concern, especially in the field of neurosurgery, where it appears that soon more specialists will be trained than can be absorbed into the Canadian health care system.Methods:A special symposium on current challenges in clinical neuroscience training was held at the Canadian Congress of Neurological Sciences in June 2000. Representatives from the Canadian Association of Interns and Residents, the Royal College of Physicians and Surgeons of Canada and English and French neurology and neurosurgery training programs made presentations, which are summarized in this report.Results:Residency training has become less service-oriented, and this trend will continue. In order to manage the increasingly sophisticated hospital services of neurology and neurosurgery, resident-alternatives in the form of physician “moonlighters” or more permanent hospital-based clinicians or “hospitalists” will be necessary in order to operate major neuroclinical units. Health authorities and hospitals will need to recognize and assume this responsibility. As clinical experience diminishes during residency training, inevitably so will the concept of the fully competent “generalist” at the end of specialty training. Additional subspecialty training is being increasingly sought by graduates, particularly in neurosurgery.Conclusions:Training in neurology and neurosurgery, as in all medical specialties, has changed significantly in recent years and continues to change. Programs and hospitals need to adapt to these changes in order to ensure the production of fully qualified specialists in neurology and neurosurgery and the provision of optimal care to patients in clinical teaching units.
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Sloane, Philip D., C. Madeline Mitchell, John S. Preisser, Charles Phillips, Charlotte Commander, and Eileen Burker. "Environmental Correlates of Resident Agitation in Alzheimer's Disease Special Care Units." Journal of the American Geriatrics Society 46, no. 7 (July 1998): 862–69. http://dx.doi.org/10.1111/j.1532-5415.1998.tb02720.x.
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Sabri, Nessrine, Ning-Zi Sun, Beth-Ann Cummings, and Dev Jayaraman. "The Perceived Effect of Duty Hour Restrictions on Learning Opportunities in the Intensive Care Unit." Journal of Graduate Medical Education 7, no. 1 (March 1, 2015): 48–52. http://dx.doi.org/10.4300/jgme-d-14-00180.1.
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Abstract Background Many countries have reduced resident duty hours in an effort to promote patient safety and enhance resident quality of life. There are concerns that reducing duty hours may impact residents' learning opportunities. Objectives We (1) evaluated residents' perceptions of their current learning opportunities in a context of reduced duty hours, and (2) explored the perceived change in resident learning opportunities after call length was reduced from 24 continuous hours to 16 hours. Methods We conducted an anonymous, cross-sectional online survey of 240 first-, second-, and third-year residents rotating through 3 McGill University–affiliated intensive care units (ICUs) in Montreal, Quebec, Canada, between July 1, 2012, and June 30, 2013. The survey investigated residents' perceptions of learning opportunities in both the 24-hour and 16-hour systems. Results Of 240 residents, 168 (70%) completed the survey. Of these residents, 63 (38%) had been exposed to both 24-hour and 16-hour call schedules. The majority of respondents (83%) reported that didactic teaching sessions held by ICU staff physicians were useful. However, of the residents trained in both approaches to overnight call, 44% reported a reduction in learner attendance at didactic teaching sessions, 48% reported a reduction in attendance at midday hospital rounds, and 40% reported a perceived reduction in self-directed reading after the implementation of the new call schedule. Conclusions A substantial proportion of residents perceived a reduction in the attendance of instructor-directed and self-directed reading after the implementation of a 16-hour call schedule in the ICU.
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Pekkarinen, Laura, Timo Sinervo, Marko Elovainio, Anja Noro, Harriet Finne-Soveri, and Esko Leskinen. "Resident care needs and work stressors in special care units versus non-specialized long-term care units." Research in Nursing & Health 29, no. 5 (2006): 465–76. http://dx.doi.org/10.1002/nur.20157.
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Pineles, Lisa, Chris Petruccelli, Eli N. Perencevich, Mary-Claire Roghmann, Kalpana Gupta, Jose Cadena, Gio Baracco, et al. "The Impact of Isolation on Healthcare Worker Contact and Compliance With Infection Control Practices in Nursing Homes." Infection Control & Hospital Epidemiology 39, no. 6 (April 2, 2018): 683–87. http://dx.doi.org/10.1017/ice.2018.50.
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OBJECTIVETo directly observe healthcare workers in a nursing home setting to measure frequency and duration of resident contact and infection prevention behavior as a factor of isolation practiceDESIGNObservational studySETTING AND PARTICIPANTSHealthcare workers in 8 VA nursing homes in Florida, Maryland, Massachusetts, Michigan, Washington, and TexasMETHODSOver a 15-month period, trained research staff without clinical responsibilities on the units observed nursing home resident room activity for 15–30-minute intervals. Observers recorded time of entry and exit, isolation status, visitor type (staff, visitor, etc), hand hygiene, use of gloves and gowns, and activities performed in the room when visible.RESULTSA total of 999 hours of observation were conducted across 8 VA nursing homes during which 4,325 visits were observed. Residents in isolation received an average of 4.73 visits per hour of observation compared with 4.21 for nonisolation residents (P<.01), a 12.4% increase in visits for residents in isolation. Residents in isolation received an average of 3.53 resident care activities per hour of observation, compared with 2.46 for residents not in isolation (P<.01). For residents in isolation, compliance was 34% for gowns and 58% for gloves. Healthcare worker hand hygiene compliance was 45% versus 44% (P=.79) on entry and 66% versus 55% (P<.01) on exit for isolation and nonisolation rooms, respectively.CONCLUSIONSHealthcare workers visited residents in isolation more frequently, likely because they required greater assistance. Compliance with gowns and gloves for isolation was limited in the nursing home setting. Adherence to hand hygiene also was less than optimal, regardless of isolation status of residents.Infect Control Hosp Epidemiol 2018;39:683–687
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Raines, Alexander, Tabitha Garwe, Ademola Adeseye, Alejandro Ruiz-Elizalde, Warren Churchill, David Tuggle, Cameron Mantor, and Jason Lees. "The Effects of the Addition of a Pediatric Surgery Fellow on the Operative Experience of the General Surgery Resident." American Surgeon 81, no. 6 (June 2015): 610–13. http://dx.doi.org/10.1177/000313481508100626.
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Adding fellows to surgical departments with residency programs can affect resident education. Our specific aim was to evaluate the effect of adding a pediatric surgery (PS) fellow on the number of index PS cases logged by the general surgery (GS) residents. At a single institution with both PS and GS programs, we examined the number of logged cases for the fellows and residents over 10 years [5 years before (Time 1) and 5 years after (Time 2) the addition of a PS fellow]. Additionally, the procedure related relative value units (RVUs) recorded by the faculty were evaluated. The fellows averaged 752 and 703 cases during Times 1 and 2, respectively, decreasing by 49 ( P = 0.2303). The residents averaged 172 and 161 cases annually during Time 1 and Time 2, respectively, decreasing by 11 ( P = 0.7340). The total number of procedure related RVUs was 4627 and 6000 during Times 1 and 2, respectively. The number of cases logged by the PS fellows and GS residents decreased after the addition of a PS fellow; however, the decrease was not significant. Programs can reasonably add an additional PS fellow, but care should be taken especially in programs that are otherwise static in size.
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DiBiase, Lauren, Amy Powell, Maria Gergen, David J. Weber, Emily E. Sickbert-Bennett, and William A. Rutala. "1242. Quantitative Analysis of Microbial Burden on LTCF Environmental Surfaces." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S378. http://dx.doi.org/10.1093/ofid/ofy210.1075.
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Abstract Background There is a lack of data on environmental surface contamination in long-term care facilities (LTCF), despite multiple reports of outbreaks of multi-drug-resistant organisms in these settings. Therefore, we conducted a quantitative analysis of the microbial burden and prevalence of epidemiologically important pathogens (EIP) found on LTCF environmental surfaces. Methods Microbiological samples were collected using Rodac plates from resident rooms and common areas in five LTCFs. At each facility, five samples from up to 10 different available environmental surfaces were collected from a room of a resident reported to be colonized with EIP, as well as from a room of a resident reported to be non-colonized. In addition, five samples from up to 10 different environmental surfaces were collected from two common areas in the facility. EIPs were defined as MRSA, VRE, C. difficile and multi-drug-resistant Gram negative bacilli. Data were analyzed for each environmental site sampled in a resident room or common area based on total bacterial colony forming units (CFU), mean CFU per Rodac, total EIP by site, and mean EIP counts per Rodac. Results The below table summarizes total EIP recovered from environmental sites by reported EIP colonization status of the resident. Rooms of residents with reported colonization had much greater EIP counts per Rodac (8.32, 95% CI 8.05, 8.60) than rooms of non-colonized residents (0.78, 95% CI 0.70, 0.86). MRSA was the most common EIP recovered from Rodacs, followed by C. difficile. Very few EIPs were recovered from the common areas sampled at these LTCFs. Conclusion We found varying levels of CFU and EIP on environmental sites at LTCFs. Colonization status of a resident was a strong predictor of higher levels of EIP being recovered from his/her room. Disclosures All authors: No reported disclosures.
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Piedboeuf, Bruno, Robert Platt, Keith Barrington, Victoria Bizgu, Prakesh Shah, and Marc Beltempo. "Association of Resident Duty Hour Reform and Neonatal Outcomes of Very Preterm Infants." American Journal of Perinatology 34, no. 14 (June 5, 2017): 1396–404. http://dx.doi.org/10.1055/s-0037-1603687.
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Objective To assess the association of the 2011 Quebec provincial resident duty hour reform, which reduced the maximum consecutive hours worked by all residents from 24 to 16 hours, with neonatal outcomes. Study Design Retrospective observational study of 4,271 infants born between 23 and 32 weeks, admitted at five Quebec neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network (CNN) between 2008 and 2015 was conducted. Adjusted odds ratios (AORs) were calculated to compare mortality and the composite outcome of mortality or major morbidity before and after the implementation of the duty hour reform. Results The mortality rate was 8.4% (218/2,598) before the resident duty hour reform and 8.6% (182/2,123) after the reform (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 0.83–1.26). The composite outcome rate was 32% (830/2,598) before the duty hour reform and 29% (615/2,123) after the reform (OR = 0.87, 95% CI = 0.77–0.98). In the adjusted analyses, the resident call-hour reform was not associated with a significant change in mortality (AOR = 1.17, 95% CI = 0.91–1.50) or composite outcome (AOR = 0.87, 95% CI = 0.74–1.03). Conclusion Reducing residents' duty hours from 24 to 16 hours in Quebec was not associated with a difference in mortality or the composite outcome of very preterm infants.
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Molloy, Una, and Amanda Phelan. "292 Palliative Care for Older People in Residential Care: From the Inside Out." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.186.
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Abstract Background To enhance the quality of care of older people living and dying in nursing homes, it has been suggested that palliative care should be integrated into this care. This study aims to explore what palliative care means in the context of older person residential care. Methods Action research, using a co-operative inquiry (CI) approach was used. A total of 18 healthcare assistants (HCAs) and 16 registered nurses (RGNs) in two residential older person care units, participated. A reflection on deaths that occurred on the units over a six-month period N=23 took place. This facilitated reflection on care given to the residents and assisted in developing an understanding of how palliative care is understood and integrated into caring for residents. Results A number of actions took place. A debriefing group, acknowledging the importance of relationships and a sense of loss experienced by staff on the death of a resident, a group reflection on recognising dying and how this might impact on care a resident receives, and a healthcare assistant group which contributed to developing an understanding of the unique role HCA’s have in this context. Categories that evolved to describe palliative care include, communication, decision making, transitions in care, grief, relationships, experience and the importance of knowing a resident. Conclusion This study has illustrated that palliative care in older person care, is often aligned with dying. In general, end of life care and person-centred care were more commonly used terms. It was suggested that palliative care is an inherent part of this care. There is a need to value the expertise and experience of the nurses and healthcare assistants caring for older people living and dying in residential care. There is also a need to improve the interdisciplinary roles between older person care and specialist palliative care.
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Edwards, Nancy E., Alan M. Beck, and Eunjung Lim. "Influence of Aquariums on Resident Behavior and Staff Satisfaction in Dementia Units." Western Journal of Nursing Research 36, no. 10 (March 17, 2014): 1309–22. http://dx.doi.org/10.1177/0193945914526647.
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Cooper, Myra, Patsy Holly, and Simon Hampson. "A Specialist Unit for Difficult to Manage Patients: Preliminary Findings." Behavioural and Cognitive Psychotherapy 25, no. 1 (January 1997): 67–77. http://dx.doi.org/10.1017/s135246580001540x.
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Preliminary findings are reported from a specialist unit for difficult to manage patients (those patients who have severe behavioural problems in addition to a mental illness). Staff attitudes and residents' psychiatric and social needs were assessed after the unit had been open for just over a year. The effect on residents' behaviour and symptoms over the course of that year was also evaluated. Findings showed that staff attitudes were resident orientated and that interactions between staff and residents and of staff with each other were almost always positive. These findings compared favourably with data collected on three other continuing care units in the same Trust and with data from previously published studies. The Cardinal Needs Schedule, a recent adaptation of the MRC Needs for Care Assessment Schedule, appeared to be a useful way of identifying unmet needs of the residents and gaps in service provision. Over the course of the year, behaviour in one third of the residents improved sufficiently for them to be considered suitable for potential discharge into community based accommodation. Implications of the findings for specialist units for difficult to manage patients are discussed, together with suggestions for further research.
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Slaughter, Susan E., Jill M. Morrison-Koechl, Habib Chaudhury, Christina O. Lengyel, Natalie Carrier, and Heather H. Keller. "The association of eating challenges with energy intake is moderated by the mealtime environment in residential care homes." International Psychogeriatrics 32, no. 7 (January 9, 2020): 863–73. http://dx.doi.org/10.1017/s1041610219001959.
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ABSTRACTObjectives:Given the increased risk of malnutrition in residential care homes, we studied how specific aspects of the mealtime environment are associated with residents’ eating challenges and energy intake in general and dementia care units of these homes.Design:Cross-sectional study.Participants:624 residents and 82 dining rooms.Setting:32 residential care homes across Canada.Measurements:Eating challenges were measured using the Edinburgh Feeding Evaluation in Dementia Questionnaire (Ed-FED-q). Energy intake was estimated over nine meals. Physical, social, person-centered, functional, and homelike aspects of the mealtime environment were scored using standardized, valid measures. Effects of interactions between dining environment scores and eating challenges on daily energy intake were assessed using linear regression.Results:More eating challenges were associated with decreased energy intake on the general (β = −36.5, 95% confidence interval [CI] = −47.8, −25.2) and dementia care units (β = −19.9, 95% CI = −34.6, −5.2). Among residents living on general care units, the functional (β = 48.5, 95% CI = 1.8, 95.2) and physical (β = 56.9, 95% CI = 7.2, 106.7) environment scores were positively and directly associated with energy intake; the social and person-centered aspects of the mealtime environment moderated the relationship between eating challenges and energy intake.Conclusions:Resident eating challenges were significantly associated with energy intake on both dementia care and general care units; however on general care units, when adjusting for eating challenges, the functional and physical aspects of the environment also had a direct effect on energy intake. Furthermore, the social and person-centered aspects of the dining environment on general care units moderated the relationship between eating challenges and energy intake. Dementia care unit environments had no measurable effect on the association between resident eating challenges and energy intake.
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Backman, Annica, and Anders Sköldunger. "PERSON-CENTERED CARE RELATED TO RESOURCE USE, RESIDENT QUALITY OF LIFE, AND STAFF JOB STRAIN IN SWEDISH NURSING HOMES." Innovation in Aging 3, Supplement_1 (November 2019): S36. http://dx.doi.org/10.1093/geroni/igz038.141.
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Abstract A critical challenge facing aged care systems throughout the world is to meet the complex care needs of a growing population of older persons. Although person-centred care has been advocated as the “gold standard” and a key component of high quality of care, the significance of care utilization in person-centred units as well as the impact of person-centred care on resident quality of life and staff job strain in nursing home care is yet to be explored. Thus, the aim was to explore person-centred care and its association to resource use, resident quality of life and staff job strain. The study is based on a cross-sectional national survey and data on 4831 residents and 3605 staff were collected by staff in 2014, deriving from nursing homes in 35 Swedish municipalities. In this study, descriptive statistics and regression modelling were used to explore this association. The preliminary results showed that person-centred care was positively associated to resource use (i.e care hours) and resident quality of life in Swedish nursing homes, when controlling for resident age, gender and cognitive status. Person-centred care was negatively associated to staff perception of job strain. This indicates that person-centred care provision seem to increase resource use (i.e. slightly more care hours utilized) but also beneficially impact resident quality of life as well as alleviate care burden in terms job strain among staff.
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Fanucchi, Laura, Michelle Unterbrink, and Lia S. Logio. "(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency." Journal of Hospital Medicine 9, no. 2 (December 31, 2013): 120–22. http://dx.doi.org/10.1002/jhm.2143.
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Neuberg, Marijana, Danica Železnik, Tomislav Meštrović, Rosana Ribić, and Goran Kozina. "Is the burnout syndrome associated with elder mistreatment in nursing homes: results of a cross-sectional study among nurses." Archives of Industrial Hygiene and Toxicology 68, no. 3 (September 26, 2017): 190–97. http://dx.doi.org/10.1515/aiht-2017-68-2982.
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Abstract As this issue has not yet been addressed in Croatia, our aim was to explore the presence of the burnout syndrome in nurses and see how it is related to their perception of elder mistreatment in nursing homes and extended care units. The burnout syndrome was assessed in 171 nursing professionals with a standardised Maslach Burnout Inventory for Human Services Survey (MBI-HSS) for three dimensions: emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA). High EE was reported by 43.9 %, high DP by 22.2 %, and low PA by 39.8 % of the respondents. Their perception of elder abuse and neglect was investigated with two self-completion questionnaires. The answers suggest that elder mistreatment in Croatian nursing homes and extended care units is more common than expected: 55 % witnessed shouting at a resident in anger, 43 % insulting and swearing at a resident, 42 % force-feeding the resident, 39 % ignoring a resident when they called, and 38 % neglecting to turn or move a resident to prevent pressure sores. We also established associations between a number of questionnaire items on perceived abuse and neglect and the burnout syndrome dimensions and determined the items that predicted the type and level of burnout in our respondents. One way to avoid the pitfalls that lead to abuse and neglect is education in schools and at work. We believe our research could contribute to this end.
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Chochinov, Harvey Max, Beverley Cann, Katherine Cullihall, Linda Kristjanson, Mike Harlos, Susan E. McClement, Thomas F. Hack, and Tom Hassard. "Dignity therapy: A feasibility study of elders in long-term care." Palliative and Supportive Care 10, no. 1 (February 13, 2012): 3–15. http://dx.doi.org/10.1017/s1478951511000538.
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AbstractObjective:The purpose of this study was to assess the feasibility of dignity therapy for the frail elderly.Method:Participants were recruited from personal care units contained within a large rehabilitation and long-term care facility in Winnipeg, Manitoba. Two groups of participants were identified; residents who were cognitively able to directly take part in dignity therapy, and residents who, because of cognitive impairment, required that family member(s) take part in dignity therapy on their behalf. Qualitative and quantitative methods were applied in determining responses to dignity therapy from direct participants, proxy participants, and healthcare providers (HCPs).Results:Twelve cognitively intact residents completed dignity therapy; 11 cognitively impaired residents were represented in the study by way of family member proxies. The majority of cognitively intact residents found dignity therapy to be helpful; the majority of proxy participants indicated that dignity therapy would be helpful to them and their families. In both groups, HCPs reported the benefits of dignity therapy in terms of changing the way they perceived the resident, teaching them things about the resident they did not previously know; the vast majority indicated that they would recommend it for other residents and their families.Significance of results:This study introduces evidence that dignity therapy has a role to play among the frail elderly. It also suggests that whether residents take part directly or by way of family proxies, the acquired benefits—and the effects on healthcare staff—make this area one meriting further study.
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Paul, James T., Emily K. Rimmer, Carmen Morales, Graham Bay, Kiraninder Lamba, and Ryan Zarychanski. "Adverse Events Associated with Bone Marrow Biopsy In A Resident Training Program; First Do No Harm." Blood 118, no. 21 (November 18, 2011): 4775. http://dx.doi.org/10.1182/blood.v118.21.4775.4775.
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Abstract Abstract 4775 BACKGROUND: Bone marrow aspirates and biopsies are commonly performed to evaluate a variety of hematological abnormalities. Generally, it is regarded as a safe procedure; however, the complication rate is uncertain. Much of the data surrounding bone marrow complications derives from retrospective, voluntary reported data from the UK and is estimated to occur in 0.08 – 0.12% of procedures. Data also suggests that the quality of bone marrow specimens may vary with operator expertise. OBJECTIVES: In this report we present a case series of adverse events following bone marrow examinations performed by internal medical residents. In response to these procedural outcomes, we will outline a comprehensive quality improvement and quality assurance initiative designed to improve resident training, ensure patient safety, and enhance sample quality. CASE SERIES: Four cases of attempted bone marrow aspirate and biopsy on the Clinical Teaching Units (CTU) at the Health Science Centre from June 2010 to April 2011 were identified. All four procedures were performed by internal medicine residents at varying levels of training and were unsuccessful despite multiple attempts. In two of the cases the GIM attending was also unsuccessful in obtaining sample. Two cases of major bleeding occurred necessitating multiple units of red blood cells to be transfused and one patient required admission to the intensive care unit. In another case the patient was unable to ambulate for 3 days due to severe leg pain at the site of attempted biopsy. Improper landmarking for the procedure was common in all cases and confirmed with 3D computed axial tomographic rendering in 2 patients. INTERVENTION: In response to these patient adverse patient outcomes and with patient safety in mind, we decided that, until a more detailed plan could be developed, all bone marrow biopsies performed on the CTU will be supervised by an attending hematologist. With involvement from stakeholders in internal medicine, hematology and hematopathology, we developed a multifaceted quality improvement and assurance initiative. We designed an educational curriculum starting with an academic half day that would consist of an instructional video followed by a practical session in the Clinical Learning and Simulation Facility. This will allow residents to strengthen communication skills by obtaining informed consent and build important procedural skills through the use of simulators. Learning will be reinforced through resident rotations on the Hematology service that will include participation in a weekly bone marrow clinic. This clinic would allow residents an opportunity to perform a number of successive bone marrows in a controlled environment under the supervision of an attending hematologist. To evaluate resident performance and adverse events, a data collection instrument will be developed to monitor the success of these interventions for bone marrows completed on the CTUs. A credentialing process to ensure competency of resident training is being considered. ANCTICIPATED RESULTS: With the implementation of a multifaceted and comprehensive strategy we expect to improve resident training, ensure patient safety, and enhance sample quality resulting in less need for repeat procedures. Disclosures: No relevant conflicts of interest to declare.
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ZEIDEMANN, V., K. A. KAINER, and C. L. STAUDHAMMER. "Heterogeneity in NTFP quality, access and management shape benefit distribution in an Amazonian extractive reserve." Environmental Conservation 41, no. 3 (November 28, 2013): 242–52. http://dx.doi.org/10.1017/s0376892913000489.
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SUMMARYExtractive reserves are conservation units that are concurrently expected to sustain subsistence and cash economies of reserve residents, often through use of non-timber forest products (NTFPs). Brazil nut (Bertholletia excelsa) has been central to many Amazonian reserves and resident livelihoods therein, due to its basin-wide distribution, significance in global markets, and potential for sustainable use and forest conservation. Yet, do the benefits of this and other NTFPs extend to all extractive reserve residents? A livelihood survey, structured interviews, and Brazil nut inventories from 2008 to 2010, randomly sampling the widely dispersed households and corresponding forests across the three regions of Riozinho do Anfrísio Extractive Reserve (RDAER), revealed significant social and ecological heterogeneity among RDAER regions. There were differences in Brazil nut stand access, individual tree characteristics (including crown form and marginally, and fruit production), stand and tree management, multiple household characteristics that shape resident investment and dependence on NTFPs, and the contribution of Brazil nut to forest-based income. If Brazil nut and other NTFPs are to reconcile conservation and development in forest communities, then policies to regulate and promote NTFP use must integrate the socioecological heterogeneity inherent in these forest products and within reserve polygons.
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Sjögren, Karin, Marie Lindkvist, Per-Olof Sandman, Karin Zingmark, and David Edvardsson. "Person-centredness and its association with resident well-being in dementia care units." Journal of Advanced Nursing 69, no. 10 (January 21, 2013): 2196–206. http://dx.doi.org/10.1111/jan.12085.
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McKinley, D. F., and M. Fitzpatrick. "9 Evaluating Emergency Medicine Resident Productivity by Relative Value Units Versus Patients Seen." Annals of Emergency Medicine 60, no. 5 (November 2012): S166. http://dx.doi.org/10.1016/j.annemergmed.2012.07.032.
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Rende, Sevinc, and Dorothy J. Rosenberg. "Rebuilding multi-ethnic communities in post-conflict nations: returnee assessment of municipal services in Bosnia and Herzegovina." Journal of International and Comparative Social Policy 32, no. 3 (October 2016): 165–81. http://dx.doi.org/10.1080/21699763.2016.1175960.
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Local administrative units are crucial to the reconstruction of a sustainable multi-ethnic social consensus in fragile states. Using the delivery of public goods and social services in Bosnia and Herzegovina as our case study, we ask whether the level of heterogeneity in community composition has any effect on resident opinion of public services at the municipal level. We find that post-war residency status is not the only factor defining community-level heterogeneity and that evaluations of public services at the local level are not neutral to community composition.
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Cheung, Sai On, Brigitta Levina, and Yuhan Niu. "Concentration Analysis of New Private Residential Units Market in Hong Kong." Construction Economics and Building 17, no. 2 (June 23, 2017): 1–23. http://dx.doi.org/10.5130/ajceb.v17i2.5232.
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The new residential property price in Hong Kong has rocketed in the last decade and has ranked within the top three metropolitan cities in the world. Housing is a necessity for most people, high residential property price has its social ramification. The rocketing price seems not solely the result of the market. As such, this raised the issue of competition in this market. This study employs Concentration Ratio and Hirfindahl-Hirschman index to evaluate the market concentration of the New Private Resident Units Market in Hong Kong. Using the best information available in the public domains and applying universal thresholds, the New Private Resident Units Market in Hong Kong is considered moderately concentrated. It is noted that the big five listed developers in Hong Kong are collectively holding a dominant position of the potential supply. Moreover, the top three have comparable market shares thus suggesting no monopoly exists. It is also found that the substantial land banks held by the five big listed developers, amount to 60% of that owned by the Government. These developers will therefore retain their dominant market power in the future. Further study is recommended to examine whether the big developers have abused their market power.
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Clyne, Brian, Jessica L. Smith, and Anthony M. Napoli. "Influence of Clinical Experience and Productivity on Emergency Medicine Faculty Teaching Scores." Journal of Graduate Medical Education 4, no. 4 (December 1, 2012): 434–37. http://dx.doi.org/10.4300/jgme-d-11-00193.1.
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Abstract Background Commonly cited barriers to effective teaching in emergency medicine include lack of time, competing demands for patient care, and a lack of formal teaching experience. Teaching may be negatively affected by demands for increased clinical productivity, or positively influenced by clinical experience. Objective To examine the association between faculty teaching scores and clinical productivity, years of clinical experience, and amount of clinical contact with resident physicians. Methods We conducted a retrospective, observational study with existing data on full-time faculty at a high-volume, urban emergency medicine residency training program for academic year 2008–2009. Residents rated faculty on 9 domains of teaching, including willingness to teach, enthusiasm for teaching, medical knowledge, preparation, and communication. Clinical productivity data for relative value units per hour and number of patients per hour, years of clinical experience, and annual clinical hours were obtained from existing databases. Results For the 25 core faculty members included in the study, there was no relationship between faculty teaching scores and clinical productivity measures (relative value units per hour: r2 = 0.01, P = .96, patients per hour: r2 = 0.00, P = .76), or between teaching scores and total clinical hours with residents (r2 = 0.07, P = .19). There was a significant negative relationship between years of experience and teaching scores (r2 = 0.27, P < .01). Conclusions Our study demonstrated that teaching scores for core emergency medicine faculty did not correlate with clinical productivity or amount of clinical contact with residents. Teaching scores were inversely related to number of years of clinical experience, with more experienced faculty earning the lowest teaching scores. Further study is necessary to determine if there are clinical measures that identify good educators.
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Malaty, John, Maribeth Williams, and Peter J. Carek. "Impact of Providing Data on Family Medicine Practice Management Education." Family Medicine 52, no. 6 (June 5, 2020): 432–34. http://dx.doi.org/10.22454/fammed.2020.944284.
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Background and Objectives: Residents need to learn about practice management, including how to improve the quality of their patient care utilizing practice data. However, little is known about the effectiveness of providing practice data to residents. This study examined the effectiveness of utilizing resident practice management reports. Methods: We provided residents quarterly practice management reports with individual resident data on coding compliance (determined by manual chart review by a certified coder), clinical productivity (number of clinic sessions, visits per session, relative value units [RVUs] per visit, and RVUs per session), and patient quality outcomes (rates of diabetes mellitus control, diabetic nephropathy screening/management, hypertension control, influenza immunization, pneumococcal immunization, and colorectal cancer screening). We compared all data to national metrics. Quality outcome data was also provided by clinical team and with comparison to nonresidency departmental clinics. We surveyed residents before and after receiving these practice management reports to determine how they felt it prepared them for future practice (on a 9-point Likert scale). Results: There was significant improvement in the ability to implement clinic-based processes to improve patient care (6.5 vs 5.6; P=.04) and learning about clinical productivity/financial aspects of practicing family medicine (6.3 vs 5.4; P=.03). Other areas had trends of improvement, although not statistically significant. Conclusions: Providing residents with their clinic practice data, with reference to team practice data and national benchmarks further helps them learn and apply practice management, when superimposed on an existing infrastructure to teach practice management.
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Baggs, JG, MH Schmitt, AI Mushlin, DH Eldredge, D. Oakes, and AD Hutson. "Nurse-physician collaboration and satisfaction with the decision-making process in three critical care units." American Journal of Critical Care 6, no. 5 (September 1, 1997): 393–99. http://dx.doi.org/10.4037/ajcc1997.6.5.393.
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OBJECTIVE: To assess and compare levels of nurse-physician collaboration and satisfaction with the decision-making process as reported by critical care nurses, resident physicians (residents), and attending physicians (attendings) in making decisions to transfer individual patients out of the critical care unit, and to assess if satisfaction predicts nurse retention. DESIGN: Longitudinal descriptive correlational study using self-reporting instruments. SETTINGS: A university hospital's surgical ICU, a community teaching hospital's medical ICU, and a community hospital's mixed ICU. SUBJECTS: Eighty-one nurses, 23 residents, and 37 attendings from the surgical ICU; 44 nurses and 51 residents from the medical ICU; 25 nurses and 45 attendings from the community hospital's ICU, reporting on the transfers of 473, 465, and 494 patients, respectively. MAIN OUTCOME MEASURES: Healthcare providers' reported levels of collaboration and satisfaction with the decision-making process, the correlations between collaboration and satisfaction, and nurse retention. RESULTS: Nurses and physicians within sites (except attendings from the surgical ICU) reported similarly moderate amounts of collaboration, but nurses reported less satisfaction with decision making than did physicians in all sites. Collaboration was related to satisfaction with decision making for all providers, but more strongly for nurses. The strength of the relationship for nurses was similar in all sites. Nurses' satisfaction with decision making did not predict their retention. CONCLUSIONS: Collaboration between nurses and physicians is a more important component of satisfaction with decision making for nurses than for physicians. Any interventions to change the amount of collaboration in practice must take account of this difference.
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Miller, Anne, Matthew B. Weinger, Peter Buerhaus, and Mary S. Dietrich. "Care Coordination in Intensive Care Units: Communicating Across Information Spaces." Human Factors: The Journal of the Human Factors and Ergonomics Society 52, no. 2 (April 2010): 147–61. http://dx.doi.org/10.1177/0018720810369149.
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Objective: This study explores the interactions among phases of team coordination, patient-related information, decision-making levels, and role holders in intensive care units (ICUs). Background: The effects of communication improvement initiatives on adverse patient events or improved outcomes have been difficult to establish. Conceptual inconsistencies and methodological shortcomings suggest insufficient understanding about clinical communication and care coordination. Method: Data were collected by shadowing a charge nurse, fellow, resident, and nurse in each of eight ICUs and recording each of their conversations during 12 hrs (32 role holders during 350 hrs). Results: Hierarchical log linear analyses show statistically significant three-way interactions between the patient information, phases of team coordination, and decision levels, χ2( df = 75) = 212, p < .0001; between roles, phases of team coordination, and decision levels, χ2( df = 60) = 109, p < .0001; and between roles, patient information, and decision levels, χ2( df = 60) = 155, p < .0001. Differences among levels of the variables were evaluated with the use of standardized parameter estimates and 95% confidence intervals. Conclusion: ICU communication and care coordination involve complex decision structures and role interactions across two information spaces. Different role holders mediate vertical and lateral process flows with goals and directions representing an important conceptual transition. However, lateral isolation within decision levels (charge nurses) and information overload (residents) are potential communication and care coordination vulnerabilities. Results are consistent with and extend the findings of previous studies. Application: The profile of ICU communication and care coordination provides a systemic framework that may inform future interventions and research.