Emotional Pre-Occupation And Variations in Stress Scores During Chronic Hemodialysis Management.

INTRODUCTION: Hemodialysis (HD) patients experience significant psychological stress related to HD. Different types of coping strategies are utilized by these patients to cope with this stress. METHODS: Variations in different types of coping strategies with the variations in HD-related stress scores and disparities by sex were assessed. HD patients aged 18 years and above who were seeking regular treatment in a specific HD-unit of a hospital in the upper Midwest, were surveyed between March 2020 and July 2020. RESULTS: Descriptive statistics, correlational analyses, and regression analyses were performed. Females could be expected to have emotional coping scores 8 units greater than males, as B = 8.017 for sex in the model, p =.000. Females could be expected to have coping scores 6.4 points higher than males when adjusted for stress levels, as: B= 6.351, p =0.001 for sex in the model. For each 1 point increase in Stress Score, the Coping Score could be expected to: increase 6.8 points when adjusted for sex, where B = 6.751 and p =0.000. CONCLUSION: Increased prevalence of emotional pre-occupation was only observed among female patients which increased with the increase in stress. Psychological interventions in female HD patients should be strongly considered in addressing emotional pre-occupation coping.

Burnout, Personal, and Occupational Factors as Predictors of Physician Assistant Faculty Intent to Leave After the COVID-19 Pandemic.

INTRODUCTION: This study addressed whether burnout, personal, or occupational factors predicted physician assistant (PA) faculty intent to leave and established a new postpandemic national benchmark for PA faculty burnout and intent to leave. METHODS: In spring 2023, a nonexperimental, cross-sectional survey was emailed to 2031 PA faculty drawn from program faculty listings and the PA Education Association member database. Descriptive statistics were used to describe the sample, and a multiple regression analysis was conducted to analyze the predictive ability of the independent variables on intent to leave. RESULTS: The response rate was 30% (609 of 2031), with 496 responses (24.4%) included in the analysis. The sample reflected the population of PA faculty. The regression model significantly predicted intent leave ( P < .001). The adjusted R2 was 0.46, indicating the combination of independent variables predicted 46% of the variance in PA faculty intent to leave. Significant predictors included emotional exhaustion and identifying as multiracial ( P < .001), control and values ( P < .01), and depersonalization, fairness, rewards, and clinical year faculty role ( P < .05). The sample had moderate levels of burnout and experienced burnout at higher rates than in prepandemic studies. Physician assistant faculty in administrative leadership roles had the highest levels of burnout and intent to leave. Despite this, PA faculty intent to leave measures were similar to prepandemic levels. DISCUSSION: Several of the predictive variables were related to well-being and social-emotional aspects of the workplace. These findings have implications for institutional policies and practices that support faculty well-being and workplace culture to enhance retention.

Analyzing the training of PAs in ophthalmology.

OBJECTIVE: This study sought to determine the role of physician associates/assistants (PAs) in ophthalmology, the balance between barriers and facilitators in training, and optimal training for PAs in ophthalmology. METHODS: In this explanatory qualitative case study, 17 of the 94 PAs in ophthalmology in the United States participated in qualitative, semistructured interviews. Qualitative interviews were conducted using a validated interview guide. Interpretational data analysis methods helped in the development of various themes. RESULTS: Themes suggest that PAs play a unique role in assisting ophthalmologists in surgery, performing procedures autonomously, and evaluating and treating patients autonomously. PAs in ophthalmology reported current training programs as unfavorable, reported satisfaction in their careers, and identified formal postgraduate training programs as optimal training for PAs. CONCLUSIONS: Findings of this study suggest that formal postgraduate training programs can help PAs gain the necessary skills to successfully fulfill their roles in ophthalmology.

Shift schedule effects on firefighter health and fitness.

BACKGROUND: Firefighter health is of utmost importance both to first responders and the individuals they serve daily. The impact of shift schedule on firefighter health remains poorly understood. OBJECTIVE: The purpose of this study was to examine differences in health and performance outcomes in firefighters across two different shift schedules. METHODS: Firefighter (N = 1995) body composition, muscular strength, endurance, flexibility, and cardiorespiratory endurance were assessed and described. A Mann-Whitney U test was conducted to compare differences between shift schedules (48/96 and 4's and 6's). RESULTS: There was a statistically significant difference in BMI (U = 70115, z=-1.988, p = .047), BF% (U = 67341, z=-2.779, p = .005), and trunk flexion score (U = 81362, z = 1.979, p = .048) favoring the 48/96 shift schedule. CONCLUSION: Firefighters following a 48/96 shift schedule exhibited improved body composition and fitness performance in comparison to peers who followed a 4's and 6's shift schedule. Findings may guide regional firefighter scheduling to optimize health and performance.

Celiac Disease Dietary Adherence on the Rural-Urban Continuum.

Poor adherence to a gluten-free diet for those with celiac disease is a well-established risk factor, leading to gastrointestinal symptoms, malabsorption of nutrients, and psychiatric complications. Previous studies have shown that those outside urban areas encounter unique barriers to dietary adherence and are less likely to engage in health management behaviors than those in urban regions. This study aimed to examine the relationship between gluten-free dietary adherence and individual, relationship, and community factors, including the geographic location of residence on the rural-urban continuum, for 253 adults with celiac disease living in the United States. Those with celiac disease residing in urban regions had significantly better dietary adherence than those residing in nonurban areas (p < 0.05). Those living in nonurban communities had, on average, poor enough adherence scores to suggest ongoing intestinal damage from gluten consumption. Geographic location, age, years since diagnosis, and annual income significantly predicted compliance with a gluten-free diet for those with celiac disease, accounting for nearly 20% of the variance. Those living outside urban areas with a lower income, younger age, and more recent diagnosis of celiac disease had the worst dietary adherence, placing them at the most risk for ongoing disease progression and complications.

Retention of Sterile Compounding Knowledge Among Pharmacy Technicians.

Background: Patient safety is in jeopardy due to a rise in the preparation of adulterated parenteral products with poor technique identified as a significant contributing factor. Pharmacy technicians perform an overwhelming majority of aseptic compounding practices; however, this group's progressive loss of aseptic technique knowledge has not been documented. Objective: The purpose of this correlational research study was to investigate the association between sterile compounding knowledge and years in the field controlling for formal training in sterile compounding techniques. Methods: An assessment tool of fundamental sterile compounding content was electronically distributed to sterile compounding technician members of pharmacy organizations in the southeastern United States. A multiple regression was conducted to predict sterile compounding knowledge from number of years in the field and prior years of formal compounding training. Results: Sixty-eight assessments were returned complete. The overall model was significant (P < .0005), explaining 22% of the variance in knowledge retention. Years in the field was the only significant predictor (P < .001). Each additional year of work experience was associated with a 0.18 drop in the assessment score. Conclusions: The longer pharmacy technicians remain in the field, the more aseptic technique knowledge they will lose. Modeling of poor sterile compounding techniques in the workplace may promote loss of competency of the skill. As a result, a plan to address continuing education for pharmacy technician sterile compounders is necessary to ensure patient safety.

Investigation of the Cultural Competence of Dental Hygienists Practicing in a Region of Low Diversity.

Purpose: The profession of dental hygiene is lacking in racial and ethnic diversity, a contributory factor to providing culturally competent patient care. The purpose of the study was to determine the cultural competence (CC) of licensed dental hygienists (DHs) in a region of low racial and ethnic diversity and explore the contributory factors.Methods: modified version of the Cultural Competency Assessment (CCA), a survey developed using the 3-D Model of Culturally Congruent Care was used to identify the levels of (CC) of DHs practicing in a area of low diversity. Utah was identified as a region of low racial and ethnic diversity. DHs holding a license to practice in the state of Utah were invited to participate in the 35-item, electronically delivered survey. Multiple regression was used to analyze associations between cultural competence and salient participant characteristics.Results: Of the 3,231 RDHs invited to participate, 673 responses were included for analysis, for a 20% response rate. The mean score was 10.153 (SD=1.3), indicating moderate cultural competence, unequally distributed between cultural awareness and sensitivity and culturally competent behavior scores. Possessing a graduate degree, cultural education during dental hygiene school, cultural continuing education, and employment in public health, significantly predicted CC. The regression model was significant F(8,664)=8.616 (p<0.0005) with a small effect size (R 2=0.094).Conclusion: Education and types of practice experiences were predictors of CC. Specific educational interventions that may influence the various components of cultural competency were not determined. Dental hygiene providers possessed moderate CC however there was a disconnect in translating awareness into behavior, possibly reinforced by environments lacking racial and ethnic diversity with limited opportunities to develop and exercise CC.

Evaluation of Ethics Curricula and Faculty in Accredited Undergraduate Radiologic Technology Programs.

PURPOSE: To investigate the state of ethics curricula in accredited undergraduate radiologic technology programs. METHODS: A causal-comparative research design was used to collect and analyze data about faculty degrees, their knowledge of the Realm-Individual Process-Situation (RIPS) Model of Ethical Decision-Making, the degree level offered, and the ethics curriculum. Postprimary certification programs and applicant programs for accreditation were excluded. RESULTS: Analysis was conducted on 226 completed surveys. The findings showed a significant association between teaching strategies and program degree (P = .001) and assessment strategies and faculty degree (P = .006). However, no significant association existed between assessment strategies and program degree (P = .070), ethical course content and program degree (P = .122), teaching strategies and faculty degree (P = .159), or ethics course content and faculty degree (P = .558). DISCUSSION: Study findings showed reliance of faculty on lectures to present ethical content, tests to assess student understanding, and teaching using the American Registry of Radiologic Technologists Standards of Ethics. A small number used other methods such as case-based studies, group discussions, and other ethical theories. The high variance in responses showed a need for a structured ethics curriculum. CONCLUSION: In accredited radiologic technology programs, the methods for teaching ethics and assessment techniques might be related to the level of the degree being offered and the education of the instructing faculty member, respectively. These findings demonstrate a need for developing a standardized ethics curriculum in these programs.

Evaluation of a drug and alcohol safety education program in aviation using interrupted time series and the Kirkpatrick framework.

Compliance with drug and alcohol regulations are required by 14 CFR Part 120/ and 49 CFR Part 40. These regulations affect approximately 7200 aviation-related companies and their associated services. Consequences for noncompliance can include loss of revenue from imposition of civil penalties, suspension, or revocation of the company's certificate to conduct business. Front End Analysis (FEA) was conducted to determine specific performance problems and provide five tailored educational interventions to address them. Program evaluation was conducted using Interrupted Time Series (ITS) modeling. Results showed significant (p < .05) decreases in nonconformities across all five models with small to moderate effect sizes. Based on the relative effects, values for reductions in civil penalty costs between 16% and 47%, were predicted. Actual sanction reductions from the pre-to-post-intervention periods were confirmed to be 24.21%. The study supported the efficacy of the ITS approach for implementation of level four Kirkpatrick evaluation.

Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial.

BACKGROUND: Post-discharge support is a key component of effective treatment for hospitalized smokers, but few hospitals provide it. Many hospitals and care settings fax-refer smokers to quitlines for follow-up; however, less than half of fax-referred smokers are successfully contacted and enrolled in quitline services. "Warm handoff" is a novel approach to care transitions in which health care providers directly link patients with substance abuse problems with specialists, using face-to-face or phone transfer. Warm handoff achieves very high rates of treatment enrollment for these vulnerable groups. METHODS: The aim of this study-"EQUIP" (Enhancing Quitline Utilization among In-Patients)-is to determine the effectiveness, and cost-effectiveness, of warm handoff versus fax referral for linking hospitalized smokers with tobacco quitlines. This study employs a two-arm, individually randomized design. It is set in two large Kansas hospitals that have dedicated tobacco treatment interventionists on staff. At each site, smokers who wish to remain abstinent after discharge will be randomly assigned to groups. For patients in the fax group, staff will provide standard in-hospital intervention and will fax-refer patients to the state tobacco quitline for counseling post-discharge. For patients in the warm handoff group, staff will provide brief in-hospital intervention and immediate warm handoff: staff will call the state quitline, notify them that a warm handoff inpatient from Kansas is on the line, then transfer the call to the patients' mobile or bedside hospital phone for quitline enrollment and an initial counseling session. Following the quitline session, hospital staff provides a brief check-back visit. Outcome measures will be assessed at 1, 6, and 12 months post enrollment. Costs are measured to support cost-effectiveness analyses. We hypothesize that warm handoff, compared to fax referral, will improve care transitions for tobacco treatment, enroll more participants in quitline services, and lead to higher quit rates. We also hypothesize that warm handoff will be more cost-effective from a societal perspective. DISCUSSION: If successful, this project offers a low-cost solution for more efficiently linking millions of hospitalized smokers with effective outpatient treatment-smokers that might otherwise be lost in the transition to outpatient care. TRIAL REGISTRATION: Clinical Trials Registration NCT01305928.

Body measurement variability, fatness, and fat-free mass in children 8, 11, and 14 years of age: Project HeartBeat!

Project HeartBeat! is a four year mixed-longitudinal study of the development of cardiovascular risk factors in White and African American children who at baseline comprised three age cohorts 8, 11, and 14 years. This paper focuses on the anthropometric variables which were chosen to reflect body fat and fat-free mass. Selected anthropometric dimensions are compared with those of samples from the combined National Health and Nutrition Examination Surveys I and II to explore the similarities of the samples in terms of central tendencies and variances. The measurements were then explored in terms of their ability to estimate the two compartment model of body composition: fat-free mass (FFM) and body fat (BF) from bioelectrical impedance (BIA). Project HeartBeat! children are slightly larger than NHANES children and have variances that are generally comparable to the national surveys. Over seven percent (7.7%) of children were overweight (BMI) and 25% had 'mild obesity' by %BF. Three different factor analytic methods (incomplete principal components, alpha and maximum likelihood) produced two latent variables from 17 anthropometric dimensions which together accounted for 76-83% of the variation: (1) A body mass factor (F1) which was weighted highly on six circumferences, weight and six skinfolds, and (2) a linear growth factor (F2) which was strongly associated with height, arm length, and sitting height. Triceps, subscapular and midaxillary skinfolds were consistently highly loaded on the body mass factor and their sum was highly correlated to %BF and fat mass (0.90-0.99). This suggests that this sum could be used to estimate fatness in children in studies where the BIA or other body composition techniques are unavailable. FFM and %BF were predicted from the anthropometric factors. Both factors contributed to the estimate of FFM (R(2) = 0.81-0.93), although F2 contributed proportionately more. The 'body mass' factor (F1) was the main predictor of %BF (R(2) = 0.86-0.93), though at some ages the linear factor (F2) was significantly and negatively related to %BF. This set of anthropometric dimensions, taken for the purpose of estimating body composition and summarized as two latent vectors by factor analysis, strongly reflects body fat and FFM in children and adolescents. Am. J. Hum. Biol. 11:69-78, 1999. Copyright 1999 Wiley-Liss, Inc.