The Effects of Oral Health Instruction, and the Use of a Battery-Operated Toothbrush on Oral Health of Persons with Serious Mental Illness: A Quasi-Experimental Study.

People with a diagnosis of serious mental illness (SMI) have a greater incidence of poorer oral health as compared to the general population. The aim of this quasi-experimental study was to determine the effect that a combination of the use of a battery-operated toothbrush and a related educational intervention may have on the oral health of individuals with serious mental illness. Key findings include that the battery-operated toothbrush resulted in a significant improvement in the mean change in gingival index, a common indicator of oral health. The study also found that oral home care instructions, smoking and level of negative symptoms did not have an effect on the mean change in plaque or gingival indices. This project suggests that the implementation of a relatively simple, cost effective measures such as a battery-operated toothbrush may have a positive impact on the oral health in this population.

Development of an interprofessional lean facilitator assessment scale.

High reliability is important for optimising quality and safety in healthcare organisations. Reliability efforts include interprofessional collaborative practice (IPCP) and Lean quality/process improvement strategies, which require skilful facilitation. Currently, no validated Lean facilitator assessment tool for interprofessional collaboration exists. This article describes the development and pilot evaluation of such a tool; the Interprofessional Lean Facilitator Assessment Scale (ILFAS), which measures both technical and 'soft' skills, which have not been measured in other instruments. The ILFAS was developed using methodologies and principles from Lean/Shingo, IPCP, metacognition research and Bloom's Taxonomy of Learning Domains. A panel of experts confirmed the initial face validity of the instrument. Researchers independently assessed five facilitators, during six Lean sessions. Analysis included quantitative evaluation of rater agreement. Overall inter-rater agreement of the assessment of facilitator performance was high (92%), and discrepancies in the agreement statistics were analysed. Face and content validity were further established, and usability was evaluated, through primary stakeholder post-pilot feedback, uncovering minor concerns, leading to tool revision. The ILFAS appears comprehensive in the assessment of facilitator knowledge, skills, abilities, and may be useful in the discrimination between facilitators of different skill levels. Further study is needed to explore instrument performance and validity.

More Evidence That the Healthcare Administrative Burden Is Real, Widespread and Has Serious Consequences Comment on "Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study".

Countries around the world have implemented programs to help monitor and enhance the quality of health services provided. Inherent in these programs and internal process improvement initiatives are an array of reporting requirements which often place a burden on clinicians and the organizations in which they function. Zegers and colleagues performed a mixed methods study on the perceived burden which these reporting requirements place on doctors, nurses, and other clinicians within three hospitals in the Netherlands. Like all studies, theirs has some minor limitations; most notably possible limits on generalizability from a limited sample. Nonetheless, their project makes a valuable contribution to the growing body of research which suggests that the burden has deleterious effects on clinicians and may well have an erosive impact on patient care.

Integrated primary care behavioral health services in college health: Results from a national survey of health center administrators.

OBJECTIVE: The present study investigates the organization of primary care behavioral health within student health centers and assesses the relationship between organizational structure and practice integration among physical and mental health services. Methods: We collaborated with the American College Health Association to distribute a 54 item survey to representatives of each ACHA member institution. Results: A total of 189 (26.3%) surveys were obtained and included 86 (46%) integrated (health/counseling) centers and 101 (54%) nonintegrated centers. Significant differences in levels of practice integration were noted between these two groups. Significant correlations were found between levels of practice integration and the presence of behavioral health staff. Conclusions: The organization and delivery of physical and behavioral healthcare services for students is considerably integrated and collaborative. Adding behavioral health clinicians to the primary care college health setting increases integrated care practice without embarking on full administrative integration of physical and mental health services.

Effect of pharmacist intervention on improving antidepressant medication adherence and depression symptomology: A systematic review and meta-analysis.

BACKGROUND: Depression is a widespread disease with effective pharmacological treatments, but low medication adherence. Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients. PURPOSE: The aim of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders. METHODS: A systematic review of controlled trials (both randomized and non-randomized) was conducted. Studies were obtained through a search of PubMed, Academic Search Premier, and Cochrane Library databases. Studies which included a pharmacist intervention to improve medication adherence in outpatients age 17 and above with a depressive disorder diagnosis and antidepressant treatment were included. Twelve publications met inclusion criteria, representing a total of 15,087 subjects: 1379 (9%) intervention and 13,708 (91%) control. RESULTS: The interventions in each selected publication included some level of in-person counseling and education to promote antidepressant adherence. The pooled odds ratio for medication adherence at 6 months was 2.50 (95% CI 1.62 to 3.86). There were no significant differences noted in subgroup meta-analyses except study location (US, Middle East or Europe) and setting. Only one of the identified studies reported statistically significant impacts of the pharmacist intervention on patient depression symptoms. CONCLUSIONS: The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms. Additional longitudinal research is recommended to investigate the multidimensional relationships between pharmacist interventions, patient adherence, and clinical outcomes. ARTICLE SYNOPSIS: Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients. The purpose of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders. A systematic review of randomized and non-randomized controlled trials was conducted of the twelve studies which met inclusion criteria. The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms.

Examining the Phenomenon of the Administrative Burden in Health Care, Allied Health, and Respiratory Care.

Documentation expectations for allied health professional appears to have changed dramatically in the past decade. The purpose of this essay is to discuss the literature related to clinician perceptions of these documentation expectations and changes in the workload attributable to such administrative duties, review the results of a recent pilot project surveying respiratory therapists' perception of documentation, and reflect upon the potential ramifications of excessive documentation. This commentary also discusses some recommendations for the future in terms of the design of documentation systems and the need for additional research to further explore this area.

Inspiratory muscle strength relative to disease severity in adults with stable cystic fibrosis.

BACKGROUND: Due to heterogeneity in pulmonary disease, current literature may misrepresent inspiratory muscle involvement in cystic fibrosis (CF). This study investigated inspiratory muscle strength (IMS) relative to disease severity in adults with CF. METHODS: Maximal inspiratory pressure (MIP) was assessed in 58 adults with stable CF grouped by disease severity (20 mild, 20 moderate, 18 severe) and compared to 20 controls. Relationships between MIP, lung function, dyspnea and anthropometrics were evaluated using multivariable linear models. RESULTS: MIP in cmH2O and %-predicted was decreased in advanced CF lung disease as compared to mild disease and healthy controls (p<0.05). Disease severity accounted for 24% of the variance in IMS after controlling for confounding variables (p<0.001). CONCLUSIONS: IMS is decreased in some adults with stable CF with moderate and severe pulmonary disease, and is related to dyspnea. Future studies should determine if decreased IMS contributes inefficient breathing patterns, respiratory pump dysfunction, and/or exercise intolerance in advanced CF.

Electronic screening of patients for predisposition to Clostridium difficile infection in a community hospital.

BACKGROUND: Clostridium difficile infection (CDI) continues to cause significant morbidity and mortality among hospitalized patients. Early diagnosis, contact precautions, and prompt therapy are crucial to the control of the disease and its spread. This study aims to develop an electronic screening tool to help identify patients who are at risk of CDI. METHODS: Six variables associated with CDI including antibiotic usage, age, and admission from another facility were identified. Logistic regression was used to weigh the variables, and then a predictive model was devised to help identify which patients may be at risk for developing CDI. A retrospective review of 29,453 records of hospitalizations was conducted including 274 cases of C difficile toxin positive patients to retrieve data for the model. RESULTS: The final model resulted in an area under the curve of 0.929, which suggests that the electronic screening tool will be an accurate predictor of predisposition to the disease. Model testing suggests a positive relationship between the total weight or score and the probability of developing the disease. CONCLUSION: An electronic screening tool may be an effective tool to assist in the accurate and timely identification of patients who may be predisposed to CDI during hospitalization.

Introducing medical students to the interdisciplinary health care team: piloting a case-based approach.

Medicine in the 21st century requires expanded multidisciplinary problem-solving in order to deliver cost-effective, quality health care, yet many medical schools still educate their students in relative isolation with little interaction or understanding of other health care professionals. To begin to address this issue, the University of Medicine and Dentistry of New Jersey (UMDNJ) School of Health Related Professions and School of Nursing were invited by the New Jersey Medical School to introduce medical students at the New Jersey Medical School to a cross-section of health professions they are likely to encounter. These health professions included medical imaging, dietetics-nutrition, laboratory technology, nursing, physical therapy, physician assistant, respiratory therapy and social work. During a 60-min educational session, a simulated case-based approach heightened medical school students' awareness of the function and value of interdisciplinary collaboration. Faculty from each of the eight disciplines gave a brief summary of their profession, including their scope-of-practice and academic requirements. At the end of the session, participants were given a brief 12-item survey to evaluate the experience. Though this was only a small, explorative project, survey results suggested that participants increased their understanding of other health professions, including when to refer to and collaborate with these professions. Feedback from this pilot project may be used to optimize future initiatives of this type.

Hospital accreditation and patient satisfaction: testing the relationship.

This article describes a study that examines the relationship between two principal measures of institutional healthcare quality: accreditation scores and independently measured patient-satisfaction ratings. This study involved a retrospective review and comparison of summative and selected categorical hospital accreditation scores from the Joint Commission on Accreditation of Healthcare Organizations and independently measured patient satisfaction ratings. A total of 41 acute care, 200-plus bed, not-for-profit hospitals in New Jersey and eastern Pennsylvania were included. Correlation and multiple-regression statistical methods were employed. The results revealed no relationship between these quality indicators on a summative level and no meaningful pattern categorical relationships. This finding suggests a disassociation between these two quality indicators, thus supporting the use of a balanced scorecard approach to hospital quality management. The study also revealed certain shortcomings in these two quality indicators, relating to insufficient score variability, which should be considered by those using such data to manage quality outcomes.