Resilience in the midst of chaos: Socioecological model applied to women with depressive symptoms and socioeconomic disadvantage.

Socioeconomic disadvantage is extremely common among women with depressive symptoms presenting for women's health care. While social stressors related to socioeconomic disadvantage can contribute to depression, health care tends to focus on patients' symptoms in isolation of context. Health care providers may be more effective by addressing issues related to socioeconomic disadvantage. It is imperative to identify common challenges related to socioeconomic disadvantage, as well as sources of resilience. In this qualitative study, we interviewed 20 women's health patients experiencing depressive symptoms and socioeconomic disadvantage about their views of their mental health, the impact of social stressors, and their resources and skills. A Consensual Qualitative Research approach was used to identify domains consisting of challenges and resiliencies. We applied the socioecological model when coding the data and identified cross-cutting themes of chaos and distress, as well as resilience. These findings suggest the importance of incorporating context in the health care of women with depression and socioeconomic disadvantage.

Interprofessional learning, impression management, and spontaneity in the acute healthcare setting.

Spontaneous learning is integral to definitions of interprofessional learning (IPL) because it has been suggested that spontaneous learning can be deeply connected with the work that people do in collaboration with colleagues via their professional networks. However, its nature and the processes involved are not well understood. Goffman's theory of impression management offers a useful theoretical framework to consider the way in which interaction in the workplace connects to spontaneous learning. This article explores the current literature to investigate the usefulness of this framework to better understand and identify spontaneous learning in the workplace. Aspects such as the connections between spontaneous learning occurring in formal and informal work activities, the spaces in which it occurs, and the influence of professional networking are considered. It is proposed that research directed to developing a better understanding of the nature of spontaneous learning in IPL will assist in connecting this learning to formal IPL curricula, enhancing IPL and patient outcomes.

A Comparative Effectiveness Trial of Two Patient-Centered Interventions for Women with Unmet Social Needs: Personalized Support for Progress and Enhanced Screening and Referral.

Background: Despite recent widespread acceptance that unmet social needs are critically relevant to health, limited guidance exists about how best to address them in the context of women's health care delivery. We aimed to evaluate two interventions: enhanced screening and referral (ESR), a screening intervention with facilitated referral and follow-up calls, and personalized support for progress (PSP), a community health worker intervention tailored to women's priorities. Materials and Methods: Women >18 years were screened for presence of elevated depressive symptoms in three women's health clinics serving primarily Medicaid-eligible patients. If eligible and interested, we enrolled and randomized women to ESR or PSP. Pre- and postintervention assessments were conducted. Primary outcomes were satisfaction, depression, and quality of life (QOL). Planned analyses of subgroup differences were also explored. Results: A total of 235 participants were randomized; 54% identified as African American, 19% as White, and 15% as Latina. Participant mean age was 30 years; 77% reported annual incomes below US $20,000/year; and 30% were pregnant at enrollment. Participants in both arms found the interventions satisfactory and improved for depression (p < 0.001). There were no differences between groups for the primary outcomes. Subgroups reporting greater improvement in QOL in PSP compared with ESR included participants who at baseline reported anxiety (p = 0.05), lack of access to depression treatment (p = 0.02), pain (p = 0.04), and intimate partner violence (p = 0.02). Conclusions: Clinics serving women with unmet social needs may benefit from offering PSP or ESR. Distinguishing how best to use these interventions in practice is the next step.

Exciting times for the Defence Medical Services.

The last dedicated military hospital in the UK, the Royal Hospital Haslar in Gosport, Hampshire, closed in May 2007. This was the final stage in a radical change in the delivery of health care for armed forces personnel. The change saw the opening of Ministry of Defence hospital units across the UK, which are fully integrated within the NHS (for example, the Royal Centre for Defence Medicine, located in Birmingham alongside the University Hospital Birmingham Foundation Trust).

Feasibility of population screening tests to establish a healthy ageing trajectory.

OBJECTIVES: There are no agreed comprehensive tests for age-related changes to physical, emotional, mental and social functioning. Research into declining function focuses on those 75 years and older and little is known about age-related changes in younger people. The aims of this project were (1) to ascertain a comprehensive test battery that could underpin community-based health screening programmes for people aged 40-75 years and pilot both (2) community-based recruitment and (3) the utility, acceptability, response burden and logistics. METHODS: A total of 11 databases were searched using a broad range of relevant terms. An identified comprehensive, recent, high-quality systematic review of screening instruments for detection of early functional decline for community-dwelling older people identified many relevant tools; however, not all body systems were addressed. Therefore, lower hierarchy papers identified in the rapid review were included and expert panel consultation was conducted before the final test battery was agreed. Broad networks were developed in one Australian city to aid pilot recruitment of community-dwellers 40-75 years. Recruitment and testing processes were validated using feasibility testing with 12 volunteers. RESULTS: The test battery captured (1) online self-reports of demographics, health status, sleep quality, distress, diet, physical activity, oral health, frailty and continence; and (2) objective tests of anthropometry; mobility; lung function; dexterity; flexibility, strength and stability; hearing; balance; cognition and memory; foot sensation; and reaction time. Recruitment and testing processes were found to be feasible. CONCLUSION: This screening approach may provide new knowledge on healthy ageing in younger people.

Osteopathic specialty board certification.

Specialty board certification, though voluntary, has become an indispensable designation for many osteopathic physicians. The authors report rates of osteopathic specialty board certification and recertification for osteopathic physicians. In the past year, osteopathic specialty boards have proposed conjoint examinations in hospice and palliative medicine as well as in sleep medicine. Plans for the addition of a new conjoint examination for undersea and hyperbaric medicine are also described. As the healthcare environment continues to evolve, the American Osteopathic Association, the Bureau of Osteopathic Specialists, and the 18 osteopathic specialty boards continue to adapt to meet the professional needs of osteopathic physicians.

The influence student placement experience can have on the employment choices of graduates: A paediatric nursing context.

This paper explores how the student placement experience may influence employment choices in the context of paediatric nursing. A qualitative research methodology was used. Data was collected using semi structured interviews at a tertiary teaching hospital. The sample group comprised of six newly qualified nurses who had completed their Bachelor of Nursing less than 12 months before the interview. They had completed at least one clinical placement at the site of data collection in their 2nd or 3rd year of undergraduate nursing studies. The main themes contributing to the student nurse experience within the context of paediatric nursing included the wish to work with children, a job being available, support during clinical placements and assistance with future career planning while on placement. The support experienced by student nurses during their clinical placement was seen to have a very positive influence on their future employment choices. Group de-briefing to support mutual understanding and sharing was seen to be a highly positive aspect of a clinical placement. Also how students were treated by clinical staff was a key factor that influenced future employment choices.

Using patient engagement in the design and rationale of a trial for women with depression in obstetrics and gynecology practices.

INTRODUCTION: Significant health disparities exist among socioeconomically disadvantaged women, who experience elevated rates of depression and increased risk for poor depression treatment engagement and outcomes. We aimed to use stakeholder input to develop innovative methods for a comparative effectiveness trial to address the needs of socioeconomically disadvantaged women with depression in women's health practices. METHODS: Using a community advisory board, focus groups, and individual patient input, we determined the feasibility and acceptability of an electronic psychosocial screening and referral tool; developed and finalized a prioritization tool for women with depression; and piloted the prioritization tool. Two intervention approaches, enhanced screening and referral using an electronic psychosocial screening, and mentoring using the prioritization tool, were developed as intervention options for socioeconomically disadvantaged women attending women's health practices. We describe the developmental steps and the final design for the comparative effectiveness trial evaluating both intervention approaches. CONCLUSIONS: Stakeholder input allowed us to develop an acceptable clinical trial of two patient-centered interventions with patient-driven outcomes.

Managing a breast sinus wound in the community: a care study.

The district nursing team had to manage a breast sinus wound which produced copious amounts of exudate and caused further problems because of its shape and position. Using a hydrofibre dressing the wound successfully healed without causing any problems with maceration to the surrounding skin. However, the nurses were unsure as to what was the correct amount of dressing to pack into the wound, and there are no specific guidelines on how tightly to pack wounds and this can influence the successful outcome of wound healing. In addition, this case showed the impact of the patient's altered body image as a result of her mastectomy.

Cancer rehabilitation: outcome evaluation of a strengthening and conditioning program.

BACKGROUND: Cancer treatments can lead to detriments in patients' health and declines in quality of life (QOL). Cancer rehabilitation programs may improve functional status, symptom control, and QOL. OBJECTIVE: The objective of this study was to determine if an outpatient, physical therapy-supervised Cancer Rehabilitation Strengthening and Conditioning (CRSC) program improved patients' conditioning level, functional status, QOL, and symptoms. METHODS: This was a prospective study of oncology patients participating in CRSC program. Measurements included conditioning level (6-minute walk test [SMWT], metabolic equivalent level, grip strength), functional status (Physical Component Summary of Short Form 36), QOL (Mental Component Summary of Short Form 36), and symptoms (M. D. Anderson Symptom Inventory). Paired t tests were conducted to determine significant changes between pre- and post-CRSC program measures, and regression methods identified predictors of change from baseline. RESULTS: One hundred fifteen patients with cancer were enrolled in the study; 75 patients completed pre- and post-CRSC program measures. Significant improvements were noted in SMWT by 186.4 ft, SMWT speed by 0.35 mph, treadmill time (3.5 minutes longer), metabolic equivalent level (by 0.87 units), QOL, symptom severity, symptom interference with daily life, fatigue, shortness of breath, and sadness. CONCLUSIONS: In a pretest-posttest design, significant improvements were noted in conditioning level, functional status, QOL, and symptoms. Greater improvements were noted in participants who were most deconditioned at baseline. IMPLICATIONS FOR PRACTICE: Further research should be conducted to provide additional support for CRSC programs. Cancer rehabilitation strengthening and condition programs may benefit patients across the continuum of care, including deconditioned patients.

Organisational culture and learning: a case study.

OBJECTIVES: To explore the impact organisational cultures have on the learning experience of student nurses and identify the influencing factors. METHODS: A case study approach was used. The single case being a Defence School of Health Care Studies (DSHCS) and the multiple units of analysis: student nurses, the lecturers and Student Standing Orders. An in depth three dimensional picture was achieved using multiple data collection methods: interview, survey, observation and document analysis. FINDINGS: The findings suggest that the DSHCS is perceived to be a sub-culture within a dominant civilian learning culture. Generally, the students and staff believed that the DSHCS is an excellent learning environment and that the defence students overall are high achievers. The common themes that appeared from the data were image, ethos, environment, discipline, support, welfare and a civilian versus military way of thinking. CONCLUSION: The learning experience of defence student nurses is very positive and enhanced by the positive learning culture of the civilian Higher Educational Institution. The factors influencing a positive learning experience that can be impacted by the overarching culture are discipline, image, ethos of adult learning, support and welfare.

AOA specialty board certification.

The authors details information related to the 2012 certification processing activity of the Bureau of Osteopathic Specialists, which oversees the work of the 18 specialty certifying boards of the American Osteopathic Association.

Osteopathic specialty board certification.

The Bureau of Osteopathic Specialists continually assesses the skills of osteopathic physician specialists in response to the growth of specialization in the osteopathic medical profession. Most recently, the Bureau has mandated that all osteopathic specialty certifying boards fully implement Osteopathic Continuous Certification no later than January 1, 2013. The authors discuss communication efforts related to this change, including a survey to assess physician needs in light of the new requirement. Also reported are rates of osteopathic specialty board certification and recertification for 2010.

American Osteopathic Association specialty board certification.

Specialty board certification is an important tool in recognizing physicians who take extra measures to establish their skills in any number of specialty areas. The American Osteopathic Association Bureau of Osteopathic Specialists, which oversees the 18 specialty certifying boards, continues to amend existing policies and implement new policies to improve the certification process. Among these policies, the authors describe new collaboration efforts, the development of the osteopathic continuous certification process, and revisions to board eligibility. An update on AOA certification awards, including certificates of added qualifications, is also provided.

Osteopathic specialty board certification.

Specialty board certification, though voluntary, has become an indispensable designation for many osteopathic physicians. The authors report rates of osteopathic specialty board certification and recertification. On the recommendation of the Bureau of Osteopathic Specialists--and as a result of recent action by the American Osteopathic Association Board of Trustees--a new osteopathic continuous certification model will be used by all 18 member boards. This model firmly establishes osteopathic specialty board certification as an ongoing process that helps to ensure patient health and safety by measuring and monitoring physician competence. In addition, time limits on board eligibility have been established for certification candidates. As the healthcare environment continues to evolve, the American Osteopathic Association, the Bureau of Osteopathic Specialists, and the 18 osteopathic specialty boards continue to adapt to meet the professional needs of osteopathic physicians.