Impact of the COVID-19 pandemic on cytology practice: An international survey in the Asia-Pacific region.

BACKGROUND: The purpose of the current study was to examine the impact of coronavirus disease 2019 (COVID-19) on various aspects of cytology practice in the Asia-Pacific region. METHODS: An online questionnaire was distributed to cytopathology laboratories in 24 Asia-Pacific countries to explore the impact of restrictive measures on access to health care, use of general and personal protective equipment (PPE), and changes in cytology workflow and workload from February to April 2020. RESULTS: A total of 167 cytopathology laboratories from 24 countries responded to the survey; the majority reported that restrictive measures that limited the accessibility of health care services had been implemented in their cities and/or countries (80.8%) and their hospitals (83.8%). The respondents noted that COVID-19 had an impact on the cytologic workflow as well as the workload. Approximately one-half of the participants reported the implementation of new biosafety protocols (54.5%) as well as improvements in laboratory facilities (47.3%). Rearrangement or redeployment of the workforce was reported in 53.3% and 34.1% of laboratories, respectively. The majority of the respondents reported a significant reduction (>10%) in caseload associated with both gynecological (82.0%) and nongynecological specimens (78.4%). Most laboratories reported no significant change in the malignancy rates of both gynecological (67.7%) and nongynecological specimens (58.7%) compared with the same period in 2019. CONCLUSIONS: The results of the survey demonstrated that the COVID-19 pandemic resulted in a significant reduction in the number of cytology specimens examined along with the need to implement new biosafety protocols. These findings underscore the need for the worldwide standardization of biosafety protocols and cytology practice.

Economic and sociocultural impacts of fisheries closures in two fishing-dependent communities following the massive 2015 U.S. West Coast harmful algal bloom.

In the spring of 2015, a massive harmful algal bloom (HAB) of the toxin-producing diatom Pseudo-nitzschia occurred on the U.S. West Coast, resulting in the largest recorded outbreak of the toxin domoic acid and causing fisheries closures. Closures extended into 2016 and generated an economic shock for coastal fishing communities. This study examines the economic and sociocultural impacts of the Dungeness crab and razor clam fisheries closures on two fishing-dependent communities. Semi-structured interviews were conducted with 36 community members from two communities impacted by the event - Crescent City, California and Long Beach, Washington. Interviewees included those involved in the fishing, hospitality, and retail industries, local government officials, recreational harvesters, and others. Interviews probed aspects of resilience in economic, social, institutional, and physical domains, based on the contention that community resilience will influence the communities' ability to withstand HAB events. Dimensions of vulnerability were also explored, encompassing sensitivity of the communities to HAB events and their adaptive capacity. Common themes that emerged from the interview responses indicate that economic hardships extended beyond fishing-related operations and permeated through other sectors, particularly the hospitality industry. Significant barriers to accessing financial and employment assistance during extended fisheries closures were identified, particularly for fishers. Long-held traditions surrounding crab and shellfish harvest and consumption were disrupted, threatening the cultural identities of the affected communities. Community members expressed a desire for clearer, more thorough, and more rapid dissemination of information regarding the management of fisheries closures and the health risks associated with HAB toxins. The likelihood of intensifying HABs under climate change heightens the need for actions to increase the resilience of fishing communities to the economic and sociocultural impacts caused by HAB-related fisheries closures.

Nursing Practice, Research and Education in the West: The Best Is Yet to Come.

PURPOSE: This paper celebrates the 60th anniversary of the Western Institute of Nursing, the nursing organization representing 13 states in the Western United States, and envisions a preferred future for nursing practice, research, and education. BACKGROUND: Three landmark calls to action contribute to transforming nursing and healthcare: the Patient Protection and Affordable Care Act of 2010; the Institute of Medicine report Future of Nursing: Leading Change, Advancing Health; and the report Advancing Healthcare Transformation: A New Era for Academic Nursing. Challenges abound: U.S. healthcare remains expensive, with poorer outcomes than other developed countries; costs of higher education are high; our profession does not reflect the diversity of the population; and health disparities persist. Pressing health issues, such as increases in chronic disease and mental health conditions and substance abuse, coupled with aging of the population, pose new priorities for nursing and healthcare. DISCUSSION: Changes are needed in practice, research, and education. In practice, innovative, cocreated, evidence-based models of care can open new roles for registered nurses and advanced practice registered nurses who have knowledge, leadership, and team skills to improve quality and address system change. In research, data can provide a foundation for clinical practice and expand our knowledge base in symptom science, wellness, self-management, and end-of-life/palliative care, as well as behavioral health, to demonstrate the value of nursing care and reduce health disparities. In education, personalized, integrative, and technology-enabled teaching and learning can lead to creative and critical thinking/decision-making, ethical and culturally inclusive foundations for practice, ensure team and communication skills, quality and system improvements, and lifelong learning. CONCLUSION: The role of the Western Institute of Nursing is more relevant than ever as we collectively advance nursing, health, and healthcare through education, clinical practice, and research.

Inpatient Cost Assessment of Transjugular Intrahepatic Portosystemic Shunt in the USA from 2001 to 2012.

BACKGROUND: Despite widespread use of transjugular intrahepatic portosystemic shunt (TIPS) for treatment of portal hypertension, a paucity of nationwide data exists on predictors of the economic impact related to TIPS. AIMS: Using the National Inpatient Sample (NIS) database from 2001 to 2012, we aimed to evaluate factors contributing to hospital cost of patients admitted to US hospitals for TIPS. METHODS: Using the NIS, we identified a discharge-weighted national estimate of 61,004 TIPS procedures from 2001 to 2012. Through independent sample analysis, we determined profile factors related to increases in hospital costs. RESULTS: Of all TIPS cases, the mean charge adjusted for inflation to the year 2012 is $125,044 ± $160,115. The mean hospital cost adjusted for inflation is $44,901 ± $54,565. Comparing pre- and post-2005, mean charges and cost have increased considerably ($98,154 vs. $142,652, p < 0.001 and $41,656 vs. $46,453, p < 0.001, respectively). Patients transferred from a different hospital, weekend admissions, Asian/Pacific Islander patients, and hospitals in the Northeastern and Western region had higher cost. Number of diagnoses and number of procedures show positive correlations with hospital cost, with number of procedures exhibiting stronger relationships (Pearson 0.613). Comorbidity measures with highest increases in cost were pulmonary circulation disorders ($32,157 increase, p < 0.001). CONCLUSION: The cost of the TIPS procedure is gradually rising for hospitals. Alongside recent healthcare reform through the Affordable Care Act, measures to reduce the economic burden of TIPS are of increasing importance. Data from this study are intended to aid physicians and hospitals in identifying improvements that could reduce hospital costs.

A comparison of self-reported physical health and health conditions of American Indian/Alaskan Natives to other college students.

American Indian/Alaska Natives comprise a small portion of the general college student population, but often have the poorest health and wellness, as well as the highest dropout rates compared to any other race or ethnicity. Despite the well-documented issues this group faces in higher education, they are often ignored in studies due to their status as the minority within the minority, comprising only 0.8% of all college students in the US. This study examines the differences in college students' overall ratings of health across racial and ethnic groups, focusing specifically on the health and wellness of AI/AN students compared to their counterparts. This paper also investigates the physical health issues students experienced in the past 12 months and the health issues' impact on their academic achievement. Results showed that AI/AN students reported the lowest overall health ratings and the most health issues in the past year.

The trade-offs in field trauma triage: a multiregion assessment of accuracy metrics and volume shifts associated with different triage strategies.

BACKGROUND: National benchmarks for trauma triage sensitivity (≥95%) and specificity (≥50%) have not been rigorously evaluated across broad populations of injured patients. We evaluated the impact of different field triage schemes for identifying seriously injured patients across a range of sensitivity values. Impact metrics included specificity and number of undertriaged and overtriaged patients compared with current triage practices. METHODS: This was a retrospective cohort study of injured children and adults transported by 48 emergency medical service (EMS) agencies to 105 hospitals in 6 regions of the Western United States from 2006 through 2008. Hospital outcomes were probabilistically linked to EMS records through trauma registries, state discharge databases, and state emergency department databases. The primary outcome was an Injury Severity Score (ISS) of 16 or greater. We evaluated 40 field predictor variables, including 31 current field triage criteria, using classification and regression tree analysis and cross-validation to generate estimates for sensitivity and specificity. RESULTS: A total of 89,261 injured patients were evaluated and transported by EMS providers during the 3-year period, of whom 5,711 (6.4%) had ISS of 16 or greater. As the 95% sensitivity target for triage was approached (from the current value of 87.5%), decision tree complexity increased, specificity decreased (from 62.8% to 18.7%), and the number of triage-positive patients without serious injury doubled (67,927 vs. 31,104). Analyses restricted to children and older adults were similar. The most consistent modification to the current triage algorithm to increase sensitivity without a major decrease in specificity was altering the Glasgow Coma Scale (GCS) score cutoff point from 13 or less to 14 or less (sensitivity increase to 90.4%). CONCLUSION: Reaching the field triage sensitivity benchmark of 95% would require a large decrease in specificity (increase in overtriage). A 90% sensitivity target seems more realistic and may be obtainable by modest changes to the current triage algorithm.

Minority perceptions of Whites' motives for responding without prejudice: the perceived internal and external motivation to avoid prejudice scales.

Whites' nonprejudiced behavior toward racial/ethnic minorities can be attributionally ambiguous for perceivers, who may wonder whether the behavior was motivated by a genuine internal commitment to egalitarianism or was externally motivated by desires to avoid appearing prejudiced to others. This article reports the development of a scale that measures perceptions of Whites' internal and external motives for avoiding prejudice (Perceived Internal Motivation Scale/Perceived External Motivation Scale [PIMS/PEMS]) and tests of its internal, test-retest, discriminant, convergent, and predictive validity among ethnic minority perceivers. Minorities perceived Whites as having internal and external motives for nonprejudiced behavior that were theoretically consistent with but distinct from established measures of minority-group members' concerns in interracial interactions. Tests of the predictive validity of PIMS/PEMS showed that when a White evaluator praised the mediocre essay of a minority target, minorities who were high PEMS and low PIMS were most likely to regard the feedback as inauthentic and derogate the quality of the essay.

Temporal and regional trends in the prevalence of healthy lifestyle characteristics: United States, 1994-2007.

OBJECTIVES: We examined temporal and regional trends in the prevalence of health lifestyles in the United States. METHODS: We used 1994 to 2007 data from the Behavioral Risk Factor Surveillance System to assess 4 healthy lifestyle characteristics: having a healthy weight, not smoking, consuming fruits and vegetables, and engaging in physical activity. The concurrent presence of all 4 characteristics was defined as a healthy overall lifestyle. We used logistic regression to assess temporal and regional trends. RESULTS: The percentages of individuals who did not smoke (4% increase) and had a healthy weight (10% decrease) showed the strongest temporal changes from 1994 to 2007. There was little change in fruit and vegetable consumption or physical activity. The prevalence of healthy lifestyles increased minimally over time and varied modestly across regions; in 2007, percentages were higher in the Northeast (6%) and West (6%) than in the South (4%) and Midwest (4%). CONCLUSIONS: Because of the large increases in overweight and the declines in smoking, there was little net change in the prevalence of healthy lifestyles. Despite regional differences, the prevalence of healthy lifestyles across the United States remains very low.

Asian American college students' suicide ideation: a mixed-methods study.

The purpose of this mixed-methods study was to explore the phenomenon of suicide ideation among 293 Asian American college students. Guided by T. Joiner's (2005) interpersonal-psychological theory of suicidal behavior, the authors examined the relationships among perceived burdensomeness, thwarted belongingness, self-construals, and suicide ideation. Compared with thwarted belongingness, perceived burdensomeness was a more robust predictor of suicide ideation. However, thwarted belongingness moderated the positive association between perceived burdensomeness and suicide ideation. Furthermore, interdependent self-construal and independent self-construal both weakened the link between perceived burdensomeness and suicide ideation and between thwarted belongingness and suicide ideation. The authors also conducted a qualitative analysis of participants' open-ended responses about their perceptions of why Asian American college students might consider suicide. The authors identified a core phenomenon of unfulfilled expectations as well as 2 broad themes related to this core phenomenon: unfulfilled intrapersonal expectations and unfulfilled interpersonal expectations, comprising the subthemes of (a) family, (b) relationship, (c) cultural differences, and (d) racism. These findings are discussed in terms of implications for suicide-related clinical interventions and primary prevention efforts among Asian American college students.

Being cabezona: success strategies of Hispanic nursing students.

Hispanic registered nurses (RNs) are poorly represented in professional nursing, comprising only 1.7% of RNs despite representing 15% of the population of the United States. Furthermore, their numbers are actually decreasing in nursing at the same time the Hispanic population is experiencing serious health disparities. This descriptive, interpretive study explores strategies used by Hispanic nursing students to overcome obstacles from the perspectives of 13 currently enrolled students and recent graduates through focus groups and individual interviews. Successful students were highly motivated to succeed, while at the same time able to maintain strong cultural ties and family responsibilities, and used a strategy they called being cabezona(stubborn) in the face of numerous obstacles, including discrimination. Recommendations for nurse educators are presented, including the need for increased flexibility, mentoring support, and including curricular content about issues of privilege and oppression in nursing programs.

Journey or destination? Evaluating student learning about race, class, and privilege in health care.

The purpose of this research was to use narrative analysis to study final papers in a Social and Cultural Issues in Health Care course in order to understand how to improve nursing student learning about discrimination and oppression in health care. The study addressed two questions: a) What were the dimensions of diversity in the student population, including hidden dimensions such as social class and religion? b) How effectively did students analyze and synthesize course content on race, class, and privilege through autobiographical reflection and cognitive, attitudinal and applied learning? Dimensions of diversity were identified through narrative analysis of student autobiographical information. Four levels of learning emerged from a thematic narrative analysis of how students used personal autobiographical reflection and cognitive, affective, and applied learning to analyze and synthesize course content on race, class, and privilege in health care.This study makes a unique contribution to nursing educational research by exploring the use of narrative analysis in evaluating student learning about discrimination in health care.

Implementing strategic change in a health care system: the importance of leadership and change readiness.

BACKGROUND: Shifts in the environment can compel health care organizations to change their strategies. However strategic change frequently fails because individuals do not adopt the behaviors necessary to successfully implement the new strategy. PURPOSE: This study explores how three variables-agreement with new strategy, leaders' actions, and groups' general orientation toward change-can influence members of physician teams to take actions supporting a strategic shift aimed at improving patient satisfaction. METHODOLOGY: Physicians in 37 specialty departments in a large health care organization were surveyed regarding their support for a new customer service initiative, the actions of department leaders, and generalized norms supporting change. The results of the survey were linked to changes in patient satisfaction for the department. RESULTS: Normative support for the specific strategic change was directly related to increased patient satisfaction 1 year later. The interaction between norms supporting change readiness and the quality of leadership was positively related to change in patient satisfaction. PRACTICE IMPLICATIONS: Successfully implementing a strategic change often requires getting individuals to change their behaviors. Leaders can enhance the results of the change by working to develop general norms such as teamwork and tolerance for mistakes that increase general readiness for change with the group.

Effects of compensation method on physician behaviors.

OBJECTIVE: To examine physician and leader perceptions of the relationship between physician compensation and the productivity of physicians practicing in medical groups. STUDY DESIGN: Key informant interviews identified subjects' perceptions of factors influencing physician productivity and the behavioral effects of individual financial incentives. Interview transcripts were analyzed by a team of physicians, economists, and other researchers. STUDY POPULATION: Physicians, medical leaders, and group practice administrators (n = 114) representing 46 medical group practices in California, Oregon, Washington, and Wisconsin were interviewed. RESULTS: Five major themes emerged: (1) Most physicians reported that financial incentives did not substantially affect their own behavior, except for productivity. However, they suggested that specific compensation models do lead to certain seemingly undesirable physician behaviors. (2) By contrast, medical group leaders reported that financial incentives do affect a variety of physician behaviors. (3) Four productivity drivers emerged: financial incentives, demand-side factors, systems and infrastructure, and other individual or group attributes. (4) Physician compensation systems are evolving toward a blend of production-based and production-neutral incentives, plus new metrics aligned with the demands of managed care. (5) Culture, size, and specialty mix are significant determinants of group physician compensation systems. CONCLUSIONS: Compensation method is perceived to be a significant influence on physician productivity, particularly among group practice leaders. The changing context of medical practice represents another powerful "macro" lever on physician behavior.