Development and Testing of the RN Confidence in Evidence-Based Practice (RNcEBP) Survey: Assessing Evidence-Based Practice Culture.

Continual assessment of evidence-based culture is essential to inform growth in evidence-based practice (EBP). The RN Confidence in Evidence-Based Practice (RNcEBP) Survey was developed and tested over a 4-year period within a Magnet-designated organization. The primary aim of this institutional review board-approved study was to test reliability and validity of the workplace-focused RNcEBP Survey. The second aim of the electronic survey was to provide practical and concise assessment data to inform nursing professional development and support for EBP.

The Impact of Crisis Intervention Team Response, Dispatch Coding, and Location on the Outcomes of Police Encounters with Individuals with Mental Illnesses in Chicago.

The Crisis Intervention Team (CIT) model has been implemented in over 3,000 communities across the USA. Research to date has shown beneficial results in terms of officers' knowledge, attitudes, self-efficacy, stigma, and force preferences. This study aimed to broaden the lens on the implementation context of CIT to examine whether factors in the environment and response process affect how calls are resolved. This study focused on several factors-CIT response, call location, and upstream decisions to pre-identify calls as mental health-related-that may impact call outcomes. Our findings suggest that CIT response, dispatch coding, and the places where calls originate play a role in shaping outcomes. More research is needed to unpack the effects of this wider CIT implementation environment.

Lumbar Spine Surgery and What We Lost in the Era of the Coronavirus Pandemic: A Survey of the Lumbar Spine Research Society.

STUDY DESIGN: This was a survey of the surgeon members of the Lumbar Spine Research Society (LSRS). OBJECTIVE: The purpose of this study was to assess trends in surgical practice and patient management involving elective and emergency surgery in the early months of the coronavirus pandemic. SUMMARY OF BACKGROUND DATA: The novel coronavirus has radically disrupted medical care in the first half of 2020. Little data exists regarding the exact nature of its effect on spine care. METHODS: A 53-question survey was sent to the surgeon members of the LSRS. Respondents were contacted via email 3 times over a 2-week period in late April. Questions concentrated on surgical and clinical practice patterns before and after the pandemic. Other data included elective surgical schedules and volumes, as well as which emergency cases were being performed. Surgeons were asked about the status of coronavirus disease 2019 (COVID-19) virus testing. Circumstances for performing surgical intervention on patients with and without testing as well as patients testing positive were explored. RESULTS: A total of 43 completed surveys were returned of 174 sent to active surgeons in the LSRS (25%). Elective lumbar spine procedures decreased by 90% in the first 2 months of the pandemic, but emergency procedures did not change. Patients with "stable" lumbar disease had surgeries deferred indefinitely, even beyond 8 weeks if necessary. In-person outpatient visits became increasingly rare events, as telemedicine consultations accounted for 67% of all outpatient spine appointments. In total, 91% surgeons were under some type of confinement. Only 11% of surgeons tested for the coronavirus on all surgical patients. CONCLUSIONS: Elective lumbar surgery was significantly decreased in the first few months of the coronavirus pandemic, and much of outpatient spine surgery was practiced via telemedicine. Despite these constraints, spine surgeons performed emergency surgery when indicated, even when the COVID-19 status of patients was unknown. LEVEL OF EVIDENCE: Level IV.

A Community-Driven Probability Survey of Disadvantaged Populations in Chicago: Sinai Community Health Survey 2.0.

BACKGROUND: Community-level health data are needed to identify and prioritize the most pressing health issues at the local level. OBJECTIVES: To conduct a community-driven probability health survey of disadvantaged Chicago communities in 2015-2016. METHODS: A safety-net hospital completed questionnaire development and dissemination in close partnership with a Community Advisory Committee (CAC), so the data captured accurately reflected community priorities. LESSONS LEARNED: The final survey sample included 1,543 adult interviews and proxy reports for 394 children, well below our original recruitment goal. Although ideal for area probability sampling, face-to-face surveys are challenging given declining response rates. Nevertheless, these data provide representative community-level data that is otherwise unavailable. CONCLUSIONS: Hyper-local data are especially critical for diverse and segregated cities such as Chicago. Lessons learned can be applied to future community surveys done by hospital systems, health departments, and community advocates to maximize the usefulness of findings.

HIV sexual risk behaviors and multilevel determinants among male labor migrants from Tajikistan.

The purpose of this study was to investigate HIV risk behaviors and their multilevel determinants in male labor migrants from Tajikistan to Moscow. In Russia and Central Asia, where AIDS rates are amongst the world's highest, conditions in both sending and receiving countries pose serious challenges to HIV prevention. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method study. The quantitative results indicated that male labor migrants were at risk for HIV due to higher sexual behaviors including sexual relations with sex workers (92 %), multiple partnering in the past month (86 %), unprotected sex with sex workers (33 %), and reduced frequency of condom use while drinking alcohol (57 %). Multivariate tests indicated the multilevel factors that increased HIV sexual risks including: pre-migration factors (e.g. used sex workers in Tajikistan); migrant work and lifestyle factors (e.g. greater number of times visited Moscow); migrant sexual and relational factors (e.g. regular partner in Moscow); and migrant health and mental health factors (e.g. increased frequency of alcohol use). Qualitative findings from longitudinal ethnographic interviews and observations of a subset of 40 purposively sampled Tajik male migrants demonstrated how these multilevel pre-migration and migration factors account for HIV risk and protective behaviors in context. These findings underscore the seriousness of HIV risk for labor migrants and call both for multilevel approaches to prevention and for further study.

Trauma exposure, PTSD, and HIV sexual risk behaviors among labor migrants from Tajikistan.

Little is known about the role of trauma and PTSD symptoms in the context of migration-associated HIV risk behaviors. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method (quantitative and qualitative) study. The mean PC-PTSD score was 1.2 with one-quarter of migrants scoring at or above the cutoff of 3 indicating likely PTSD diagnosis. PC-PTSD score was directly correlated with both direct and indirect trauma exposure, but PC-PTSD score did not predict either HIV sexual risk behaviors or HIV protective behaviors. HIV sexual risk behavior was associated with higher indirect trauma exposure. PC-PTSD score was associated with some indicators of increased caution (e.g., more talking with partners about HIV and condoms; more use of condom when drinking). Qualitative findings were used to illustrate the differences between direct and indirect traumas in terms of HIV sexual risk. The study findings call for future efforts to address labor migrant's mental health needs and to integrate trauma dimensions into HIV prevention.

Morbidity associated with Pseudomonas aeruginosa bloodstream infections.

We sought to quantify patient morbidity throughout Pseudomonas aeruginosa bloodstream infection (PABSI) as a function of patient covariates. Individuals with PABSI were included in a retrospective, observational, cohort study. Morbidity was quantified by serial Sequential Organ Failure Assessment (SOFA) scores. Impact of active antimicrobial treatment was assessed as a function of changes in SOFA scores as the dependent variable. A total of 95 patients with PABSI were analyzed. Relative to baseline SOFA scores (day -2), scores after PABSI were increased by 37% on day 0 and 22% on day +2 but returned to baseline on day +7. Overall mortality was 37%, and mean length of hospital stay (postculture) was 16 days. Most patients were appropriately treated, with n = 83 (87%) receiving an active agent and n = 61 (64%) receiving >1 agent. As a result, an effect of therapy on morbidity was not observed. Advanced age and elevated baseline SOFA scores predicted increased in-hospital mortality (P = 0.01 and P < 0.001, respectively) and morbidity at day +2 (P < 0.05 and P < 0.05, respectively) and day +7 (P < 0.05 and P < 0.001, respectively). Neutropenia was also associated with increased morbidity at day +2 (P < 0.05). In treated PABSI, morbidity is highest the day of the diagnostic blood cultures and slowly returns to baseline over the subsequent 7 days. Age and baseline severity of illness are the strongest predictors of morbidity and mortality. Because neither of these factors are modifiable, efforts to minimize the negative impact of PABSI should focus on appropriate prevention and infection control efforts.

Quality-related activities in federally supported health centers: do they differ by organizational characteristics?

Recent reports suggest the need for further study of the impact of organizational characteristics on quality-related activities in health centers. To better understand these issues, a cross-sectional assessment of quality-related activities in Health Resources and Services Administration-funded health centers was conducted using a mailed questionnaire. Associations between the extent and frequency of quality-related activities and organizational characteristics, including location, size, and accreditation status, were examined. In general, the frequency and type of most quality-related activities did not vary greatly by size and location, but differed by accreditation status. The findings can be explained in part by Health Resources and Services Administration/Bureau of Primary Health Care requirements and implementation of their Accreditation Initiative.

The effects of sexual orientation on body image and attitudes about eating and weight.

SUMMARY We assessed the effect of sexual orientation on body image and attitudes toward eating and weight using data collected from lesbians and heterosexual women in three US cities. Data were analyzed using ordinary least squares regression controlling for a number of demographic characteristics. Findings indicate that while lesbian sexual orientation is predictive of positive body image and fewer negative attitudes toward eating and weight, the effects are modest. Body mass index (BMI), frequency of exercise, race, and self-image were the strongest predictors of body image; BMI, race, and city of residence were the strongest predictors of attitudes toward eating and weight. The authors conclude that while belonging to a lesbian subculture may provide some protection against the societal imperative toward thinness, it likely does not counter the larger societal preference that women be thin.

Environmental Survey for Listeria Species in Frozen Milk Product Plants in California.

A survey of frozen milk product (FMP) plants in California was conducted to determine prevalence of Listeria spp. among plants and within specific areas in plants. Association of possible factors contributing to the presence of Listeria was analyzed. Of 922 samples, 111 (12%) were positive for Listeria spp. Listeria monocytogenes and L. innocua were the only species isolated. Of 39 plants sampled, L. monocytogenes was the only species recovered from 5 (12.8%) plants and L. innocua was the only species recovered from 13 (33.3%) plants. Both species were isolated from 9 (23.1%) plants. No Listeria was isolated from 12 (30.8%) plants. A minimum of five colonies was identified from each positive site. Only one species was identified from 105 of the 111 positive sites (94.6%). There was a statistically significant association of culture results from selected sites in plants with corresponding drain cultures; however, from 9 of 106 (8.5%) site/drain combinations no Listeria was isolated from the drain when the selected sites were positive. Type of product received and type of pasteurization did not influence recovery of Listeria from a plant. There was a significant association with size of the plant and recovery of Listeria . Level of sanitation and extent of environmental contamination control program (ECCP), individually, were not associated with recovery of Listeria from a plant. However, the rate of recovery of Listeria from plants with above average sanitation and excellent or moderate ECCP (N=7) was 6.81%, whereas the recovery rate from plants with below average sanitation and slight or no ECCP (N=7) was 27.5%. The highest recovery rates of Listeria in FMP plants were in batch flavoring, freezing and ingredient blending, and packaging filling areas.