Registered Nurses' Association of Ontario (RNAO) best practice guideline on the assessment and management of vascular access devices.

INTRODUCTION: Vascular access is the most common invasive procedure performed in health care. This fundamental procedure must be performed in a safe and effective manner. Vascular access devices (VADs) are often the source of infections and other complications, yet there is a lack of clear guidance on VADs for health providers across different settings. A Best Practice Guideline (BPG) was developed by the Registered Nurses' Association of Ontario (RNAO) to provide evidence-based recommendations on the assessment and management of VADs. METHODS: RNAO BPGs are based on systematic reviews of the literature following the GRADE approach. Experts on the topic of vascular access were selected to form a panel. Systematic reviews were conducted on six research areas: education, vascular access specialists, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. A search for relevant research studies published in English limited to January 2013 was applied to eight databases. All studies were independently assessed for eligibility and risk of bias by two reviewers based on predetermined inclusion and exclusion criteria. The GRADE approach was used to determine certainty of the evidence. RESULTS: Over 65,000 articles were screened related to the six priority research questions. Of these, 876 full-text publications were examined for relevance, with 174 articles designated to inform nine recommendations in the BPG on the subject areas of: comprehensive health teaching, practical education for health providers, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. In June 2021, the RNAO published the BPG on vascular access, which included the recommendations and other supporting resources. CONCLUSION: The vascular access BPG provides high quality guidance and updated recommendations, and can serve as a primary resource for health providers assessing and managing VADs.

Effects of wearing of metacarpal gloves on hand dexterity, function, and perceived comfort: A pilot study.

Metacarpal gloves are commonly used in heavy-duty industries such as mining and are typically thicker and bulkier than manufacturing or assembly industrial gloves. This pilot study investigates the impact of wearing metacarpal gloves on hand dexterity, functional capabilities, and perceived comfort. Four types of commercially available metacarpal gloves were selected for evaluation in a randomized controlled trial. Evaluations included turning and placing tests, also grip, pinch, and screwdriver tests, and rating of the perceived level of effort. Dexterity test results showed that metacarpal gloves significantly reduced the ability to perform motor tasks requiring coordination compared to bare hands. Hand functions such as gripping, pinching, and forearm rotations were not significantly affected. However, the perceived level of effort needed to complete those hand functions increased as the metacarpal glove's bulkiness increased. High levels of mechanical protection typically offered by metacarpal gloves can inversely affect hand dexterity and hand exertion.

Interdisciplinary Education Apartment Simulation (IDEAS) Project: An Interdisciplinary Simulation for Transitional Home Care.

Introduction: Home-based care (HBC) is a valuable tool to provide care to rural, medically underserved populations. By mitigating geographic and transportation barriers for vulnerable populations, HBC is a promising modality of health care delivery. Interprofessional education has become an integral part in undergraduate and professional curricula; however, applications of team-based training in HBC are often missing from curricula. When included, instruction in HBC often utilizes didactic instruction or laboratory experiences, which are discipline-specific and lack a focus on integration of team-based care. Methods: We implemented a standardized patient (SP) simulation of a posthospital discharge home visit using a team of learners from nursing, physical therapy (PT), occupational therapy (OT), dentistry, pharmacy, and medicine in a simulated home environment. Pre- and postsimulation competencies of interprofessional care were measured using the 20-item Interprofessional Collaborative Competency Attainment Survey (ICCAS). Results: Throughout the academic years of August 2018 - August 2020, 68 students from nursing, PT, OT, pharmacy, medicine, and dentistry completed a simulated home visit with an SP discharged from a hospital. For all 20 perceived abilities on the ICCAS, learners showed a statistically significant increase in postsurvey measurement. A modest to large (.31 ≤ r ≤ .94) effect size was observed in the majority of responses. Discussion: This SP simulation described a novel, interdisciplinary approach to incorporating HBC into interprofessional curricula.

Predicting Student Success on the National Board for Certification in Occupational Therapy® Examination.

IMPORTANCE: A predictive tool to support academic and practice outcomes for occupational therapy students is needed for use in advising students. OBJECTIVE: To determine whether characteristics of academic and professional behavior across cohorts could indicate the likelihood of student success in passing the National Board for Certification in Occupational Therapy® examination. DESIGN: Causal-comparative research. PARTICIPANTS: Master of occupational therapy students (N = 315; eight cohorts). MEASURES: Demographics, college entrance exams, grade point average, program benchmarks (i.e., specific course grades, fieldwork grades, Occupational Therapy Knowledge Exam scores), licensure exam. RESULTS: Baseline and in-program characteristics were used to determine success; for each unit increase in the success score, the odds of passing the exam were 4.11 (95% confidence interval [2.23, 7.60]). CONCLUSIONS AND RELEVANCE: Case studies that have used this success score suggest that additional resources and targeted interventions could be allocated to help students at highest risk of not passing the licensure exam. WHAT THIS ARTICLE ADDS: Using a predictive tool to support student success can enable more effective academic advising throughout an occupational therapy program and result in positive outcomes on the licensure exam.

Processing of Real-World, Dynamic Natural Stimuli in Autism is Linked to Corticobasal Function.

Many individuals with autism spectrum disorder (ASD) have been shown to perceive everyday sensory information differently compared to peers without autism. Research examining these sensory differences has primarily utilized nonnatural stimuli or natural stimuli using static photos with few having utilized dynamic, real-world nonverbal stimuli. Therefore, in this study, we used functional magnetic resonance imaging to characterize brain activation of individuals with high-functioning autism when viewing and listening to a video of a real-world scene (a person bouncing a ball) and anticipating the bounce. We investigated both multisensory and unisensory processing and hypothesized that individuals with ASD would show differential activation in (a) primary auditory and visual sensory cortical and association areas, and in (b) cortical and subcortical regions where auditory and visual information is integrated (e.g. temporal-parietal junction, pulvinar, superior colliculus). Contrary to our hypotheses, the whole-brain analysis revealed similar activation between the groups in these brain regions. However, compared to controls the ASD group showed significant hypoactivation in the left intraparietal sulcus and left putamen/globus pallidus. We theorize that this hypoactivation reflected underconnectivity for mediating spatiotemporal processing of the visual biological motion stimuli with the task demands of anticipating the timing of the bounce event. The paradigm thus may have tapped into a specific left-lateralized aberrant corticobasal circuit or loop involved in initiating or inhibiting motor responses. This was consistent with a dual "when versus where" psychophysical model of corticobasal function, which may reflect core differences in sensory processing of real-world, nonverbal natural stimuli in ASD. Autism Res 2020, 13: 539-549. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: To understand how individuals with autism perceive the real-world, using magnetic resonance imaging we examined brain activation in individuals with autism while watching a video of someone bouncing a basketball. Those with autism had similar activation to controls in auditory and visual sensory brain regions, but less activation in an area that processes information about body movements and in a region involved in modulating movements. These areas are important for understanding the actions of others and developing social skills.

Therapeutic nihilism of neurological diseases: A comparative qualitative study.

OBJECTIVE: The notion of therapeutic nihilism may lead to early removal of care based upon perceived poor prognosis. The goal of this study was to examine if differences for nihilism perspectives exist between professions and within professions at the different levels of experience and exposure to neurological conditions. METHOD: Survey methods was used to assess perception of care futility and therapeutic nihilism using six case-based scenarios followed by five questions regarding practitioner care choices and perspective. Participants were student and professional occupational and physical therapists, nurses, and doctors (n = 110). Thematic analysis was completed to determine influences on patient care. RESULTS: Six themes (quality of life, provider experience, prognosis/treatability, medical details, patient's age, and family/patient wishes) emerged that influenced treatment decisions across all participants. All provider groups reported prognosis and treatability as their number one factor for treatment decisions, then therapists mentioned QOL most, nurses cited age, and doctors said medical details. Differences between students and professionals were also apparent. DISCUSSION: The perceived ability of the patient to recover (prognosis/treatability) with medical care was the most commonly cited reason for aggressive measures, with quality of life, medical details, and patient age also representing strong themes across disciplines and level of training.

Barriers to Healthcare Participation in Persons With Disabilities in Appalachia: A Qualitative Pilot Study.

OBJECTIVES:: A study exploring facility-related barriers to healthcare participation (the level to which an individual is engaged or involved in their own healthcare activities from simply keeping appointments to following treatment regimens) in persons with disabilities in Appalachia from the perspectives of four stakeholder groups, (1) adults with disabilities, (2) caregivers of persons with disabilities, (3) advocates for persons with disabilities, and (4) providers who treat persons with disabilities. BACKGROUND:: Persons with disabilities potentially face additional barriers to healthcare participation than those without disabilities. Understanding and addressing the barriers to participation could assist in improving healthcare outcomes among the disabled population. METHODS:: A qualitative study was conducted involving scripted focus groups with four stakeholder groups with expertise/experience in disabilities. The objective was to assess perceptions of impacts of clinical design elements on healthcare participation. RESULTS:: Participants identified and characterized six major categories of facility- and nonfacility-related barriers they felt impacted healthcare participation, with priority differences reported between each group. CONCLUSIONS:: The healthcare facility is perhaps the most visible tool the provider has at his or her disposal to deliver effective healthcare. Understanding the interactions persons with different disabilities have with the physical facility and the messages, both intentional and unintentional, the state of the facility sends can provide useful insights into delivering more effective healthcare to this population.