The feasibility and acceptability of a dementia care training program for registered dietitian nutritionists.

There is a need for more Registered Dietitian Nutritionists (RDNs) trained to provide nutritional care to older adults with dementia who experience mealtime difficulties. The purpose of this single-arm, pre/post pilot study was to adapt a generalized dementia care curriculum to the learning needs of RDNs who work with individuals with dementia and to determine the feasibility and acceptability of the adapted program. Using an existing evidence-based dementia care curriculum, the research team identified learning objectives and content pertinent to the scope of RDNs. The adapted program was piloted with RDNs who work with older adults with dementia. Twenty-five RDNs registered for the training while 80% (20) attended the training and completed the post-training survey. All participants agreed that the module met the learning needs of RDNs who work with older adults with dementia, the two-hour workshop was a good use of their time, and the experience and skills gained would be useful in their work as an RDN. Implementation costs totaled $1,310. Based on the post-training feedback, the adapted program was deemed feasible and acceptable by RDN participants, who also expressed interest in using the module to train other caregivers on providing mealtime assistance to older adults with dementia.

Health Workers' Knowledge and Perceptions on Dementia in Skilled Nursing Homes: A Pilot Implementation of Teepa Snow's Positive Approach to Care Certification Course.

INTRODUCTION: A knowledge gap on caring for people with dementia exists among health workers employed in skilled nursing facilities. This article reports on knowledge gained and perceptions changed among 24 skilled nursing facility health workers who completed Teepa Snow's innovative Positive Approach to Care Certification course as a regional initiative. METHODS: This pilot study used a quasi-experiment with a one-group pretest-posttest design to assess the dementia knowledge and perceptions of health workers who participated in the course. Paired responses (n = 22) for the 54-item dementia knowledge and training/coaching perceptions survey were compared using the McNemar test, Paired t test, and Wilcoxon signed-rank test to analyze the improvement in knowledge and perceptions of dementia. RESULTS: Significant knowledge gain was found among health workers after completing the program (t(21) = -7.46, P < .001). Statistical differences (P < .05) were present in eight knowledge items (ie, working memory, mental health, temporal lobe, "sapphire", "space and awareness", personal space, binocular vision, and hippocampus) and four perception areas (ie, approaching, understanding, calming, and instructing) about dementia. Significant changes were also found in four areas of health workers' perceptions about dementia (P < .05). DISCUSSION: The certification course can improve knowledge and facilitate perceptual change on dementia. Implementing this program as a novel regional initiative has robust potential in ensuring continuing workforce development in health care settings challenged with ever-changing people living with dementia needs and high staff turnover.

RADICLE Moms study: Minority stress and implications for lesbian mothers.

Little is known about depressive symptoms among mothers who identify as lesbian. The aim of the researchers in the Relationships And Depression In Childbearing LEsbian (RADICLE) Moms study was to investigate the minority stress model to determine if higher levels of social support altered the relationship between gay-specific minority stress and depressive symptoms in a sample of self-identified lesbian women who had one or more children less than 18 years of age living in the household. The authors hypothesized that social support would influence the relationship between depressive symptoms and minority stress. Participants (n = 131) completed an anonymous Internet survey between May and December, 2011. Controlling for demographic factors and utilizing independent hierarchical multiple regression analyses the authors examined the relationships between depressive symptoms and social support, minority stress, and general stress. While each of these factors had a significantly positive relationship to depressive symptoms, using stepwise regression analyses the authors identified general stress as the most significant factor. Mediation analysis revealed that social support fully mediated the relationship between minority stress and depressive symptoms. This pilot study provides support for development of intervention strategies to decrease general stress and or increase social support among lesbian mothers.

Policies and Procedures That Facilitate Implementation of Evidence-Based Clinical Guidelines in U.S. Dental Schools.

The aim of this study was to determine the degree to which dental schools in the United States have policies and procedures in place that facilitate the implementation of evidence-based clinical guidelines. The authors sent surveys to all 65 U.S. dental schools in 2014; responses were obtained from 38 (58%). The results showed that, of the nine policies and procedures examined, only two were fully implemented by 50% or more of the responding schools: guidelines supported through clinical faculty education or available chairside (50%), and students informed of guidelines in both the classroom and clinic (65.8%). Although 92% of the respondents reported having an electronic health record, 80% of those were not using it to track compliance with guidelines. Five schools reported implementing more policies than the rest of the schools. The study found that the approach to implementing guidelines at most of the responding schools did not follow best practices although five schools had an exemplary set of policies and procedures to support guideline implementation. These results suggest that most dental schools are currently not implementing guidelines effectively and efficiently, but that the goal of schools' having a comprehensive implementation program for clinical guidelines is achievable since some are doing so. Future studies should determine whether interventions to improve implementation in dental schools are needed.

Behavioral Health Providers for Persons Who Are Deaf, Deafblind, or Hard-of-Hearing: A National Survey of the Structural and Process Domains of Care.

Research suggests higher prevalence of mental health problems for those with hearing problems than in the general population. Despite barriers, mental health services for persons who are deaf and hard-of-hearing (HOH) have developed to meet the cultural and communication needs of this population. The authors conducted a national survey of mental health service providers to persons who are deaf, deafblind, or HOH, to learn about their structural and process domains of care. Results indicate that services for persons who are deaf, deafblind, or HOH are inadequate for consumers with serious mental illness. Results also uncovered unique pathways to care and practitioners.

Success of the 4 pillars toolkit for influenza and pneumococcal vaccination in adults.

BACKGROUND: Standing order programs (SOPs) allowing nonphysician personnel to assess patients' immunization status and administer vaccines without an individual physician order are a proven method of increasing adult vaccinations, yet they are underutilized by primary care physicians. METHODS: In a before-and-after trial, a pilot-tested and revised SOP toolkit (4 Pillars Toolkit) was implemented in four diverse primary care practices. Changes in influenza and pneumococcal polysaccharide vaccine (PPSV) vaccination rates were measured. The toolkit was evaluated using direct observation, group interviews, and surveys of each practice's staff. RESULTS: Use of the 4 Pillars Toolkit varied across sites. PPSV rates increased significantly overall for high-risk adults (18-64 years; 25% in 2010-2011 vs. 40% in 2011-2012, p = .02) but not for older adults (≥65 years; 44% vs. 52%, p = .26) and in two of four practices among both high-risk and older adults (p < .05). Influenza vaccination rates increased significantly in three of four sites and overall (22% in 2010-2011 vs. 33% in 2011-2012, overall; p < .001). Practices more fully implementing the toolkit demonstrated larger increases in vaccination rates. CONCLUSIONS: The 4 Pillars Toolkit is a promising means of improving primary care practice across diverse settings, with better results observed when strategies were maximally utilized.

We're working hard, but is it hardly working? Why process is critical in the delivery of worksite health promotion programs.

OBJECTIVE: To evaluate the relationship between the process and outcomes of worksite wellness committees (WWCs) implementing worksite health promotion programs at PPG Industries, Inc. METHODS: We developed two unique tools to understand how WWCs function and to assess their program implementation. We then analyzed survey data from 65 PPG worksites, measuring process and program implementation. RESULTS: Worksites that scored higher on the process indicator had more robust program implementation. CONCLUSIONS: The WWCs need increased attention from researchers and evaluators. Employers should consider administering worksite health promotion structural assessments to identify gaps in management support and program implementation that may influence program effectiveness.

Peer-mentored research development meeting: a model for successful peer mentoring among junior level researchers.

OBJECTIVE: This report describes a model for the development, process, and tracking methods of a Peer-mentored Research Development Meeting (PRDM), an interdisciplinary peer mentoring program. The program was initiated in 2004 by a group of postdoctoral scholars and junior faculty from the Schools of the Health Sciences at the University of Pittsburgh. METHOD: From February 2004 through February 2006, PRDM's first five members tracked and documented their research activity (e.g., manuscripts, grants) every 4 months. The defining features of PRDM are adherence to a structured frequency and format for meetings, systematic tracking and evaluation of research development activities, and maintenance of ongoing relationships with senior mentors. RESULTS: During the 24-month data collection period, members were involved in 91 research development projects including grant applications, journal article manuscripts, book chapters, and conference abstracts. Members' productivity increased during the 24-month period, as did the efficiency and focus of the completed projects. CONCLUSION: Members increased the efficiency and focus of their research development activities during the study period. Structured peer-mentoring groups have the potential to enhance research productivity among junior investigators in research intensive environments.

Facilitating resident information seeking regarding meals in a special care unit: an environmental design intervention.

Repetitive questions and requests for information are common in older adults with dementia. The purpose of this environmental design intervention was to provide residents continuous access to information about common mealtime questions with the intent of decreasing agitation around mealtimes and facilitating more pleasant patient-staff and patient-patient interactions. A special care unit for residents with dementia of the Alzheimer's type was the setting. During the intervention conditions, a large clock and a sign with large lettering that identified mealtimes were hung in the dining area. Direct observations of 35 residents were conducted at mealtimes for a 5-month period. Results showed reductions from baseline to the intervention phase in food-related questions or requests. These results suggest a simple, inexpensive environmental change intervention can reduce repetitive questions commonly exhibited by individuals with dementia.