Development and preliminary evaluation of a novel physician-report tool for assessing barriers to providing care to autistic patients.

BACKGROUND: Individuals on the autism spectrum face significant disparities in health and physicians often report difficulties in providing care to autistic patients. In order to improve the quality of care autistic individuals receive, it is important to identify the barriers that physicians experience in providing care so that these may be addressed. This paper reports the initial development and preliminary evaluation of a physician-report 'Barriers to Providing Healthcare' measurement tool. METHOD: An established taxonomy of healthcare barriers for autistic individuals informed the initial draft of a 22-item measurement tool. This measurement tool was distributed to physicians working in various healthcare specialties and settings. Exploratory factor analysis (EFA) was conducted to determine the construct validity of the tool; discriminant validity between, and internal consistency of, the resultant factors were assessed. Multiple regressions were used to explore variables potentially associated with barriers endorsed by physicians. RESULTS: A total of 203 physicians were included in the analyses. The EFA resulted in a 17-item tool with three distinct factors which explained 37.6% of the variance: 1) Patient-related barriers (Cronbach's α = 0.83; e.g., the patient's reactivity to the healthcare environment); 2) Healthcare provider (HCP)/family-related barriers (Cronbach's α = 0.81; e.g., a lack of providers willing to work with autistic patients); and 3) System-related barriers (Cronbach's α = 0.84; e.g., there is a lack of support for patients and families). Discriminant validity between the factors was adequate (r < .8). The barriers that were most frequently endorsed as occurring 'often' or 'very often' included a lack of support for patients and families (endorsed by 79.9% of physicians); communication difficulties (73.4%); and a lack of coordination between services (69.9%). The regression analyses identified no significant associated variables. CONCLUSION: A preliminary version of a novel physician-report tool to assess barriers to providing care to autistic patients has been developed although further validation work is required. The use of this tool will help physicians to identify issues specific to different medical specialities and healthcare settings. This information may help identify the supports physicians require to recognise and implement the required accommodations. Future research which elucidates barriers to healthcare provision for autistic patients is required to support systemic change in healthcare so as to improve care experiences and health outcomes for people on the autism spectrum.

Called to Nurse: Nursing, Race, and Americanization in Early 20th–Century Puerto Rico

The article begins with a description of the consonances between Americanization and the overall Portestant missionary project to establish missionaries'relationship to the imperial project. it also argue tha pre-1898 material conditions and ideologies pushed missionaires tom odify their original plans for recruiting nursing studentes which produced a more inclusive admission policy. Two decades later, however, amreicanization wrought changes in thise arenas that led to a racially exclusive policy. The article addresses worthy citizens of Christian America, a finer womanhood,a stronger manhood, and a healthier nation, Rosa A. González and the professionalization of nursing, the unknown facts, and the problems of recruiting consecrated women, and no sorority of consciousness.(AU)

Identification of novel transaminases from a 12-aminododecanoic acid-metabolizing Pseudomonas strain.

A Pseudomonas species [Pseudomonas sp. strain amino alkanoate catabolism (AAC)] was identified that has the capacity to use 12-aminododecanoic acid, the constituent building block of homo-nylon-12, as a sole nitrogen source. Growth of Pseudomonas sp. strain AAC could also be supported using a range of additional ω-amino alkanoates. This metabolic function was shown to be most probably dependent upon one or more transaminases (TAs). Fourteen genes encoding putative TAs were identified from the genome of Pseudomonas sp. AAC. Each of the 14 genes was cloned, 11 of which were successfully expressed in Escherichia coli and tested for activity against 12-aminododecanoic acid. In addition, physiological functions were proposed for 9 of the 14 TAs. Of the 14 proteins, activity was demonstrated in 9, and of note, 3 TAs were shown to be able to catalyse the transfer of the ω-amine from 12-aminododecanoic acid to pyruvate. Based on this study, three enzymes have been identified that are promising biocatalysts for the production of nylon and related polymers.

Safety and feasibility of a novel vascular closure device in neurointerventional procedures.

This retrospective study evaluated the safety and feasibility of a new arterial femoral access closure device in neurointerventional procedures. The study includes all consecutive adult patients who underwent femoral arteriotomy closure with the MynxGrip™ closure device after Neurointerventional procedures performed between June and December 2012. All patients had a follow-up color Doppler ultrasound (US) within 48 hours after the procedure, which was independently interpreted by two experienced radiologists to evaluate for access site complications. Device success/failure, sheath size, ambulation time, and periprocedural complications were recorded. Fifty-five closure devices were deployed in 53 patients. There were 23 (43%) males and 30 (57%) females; age ranged from 22 to 84 years (mean: 52.1 years). Thirty of the 55 procedures (55%) were therapeutic and 25 were diagnostic interventions (45%). Sheath sizes used were 5F in 35 procedures (64 %) and 6F in 20 procedures (36%). The right femoral artery was accessed in 51 procedures (93 %) and the left in four procedures (7%). There was only one (1.8 %) minor periprocedural complication (small hematoma). Hemostasis was successful in 51 of the 55 procedures (93 %) with subsequent early ambulation. No device-induced complications associated with serious clinical sequelae were reported. In our small series, the MynxGrip™ femoral access closure device provided a safe and feasible way of closing the femoral artery puncture site after neurointerventional procedures with low minor complication rates and no major complications. Further large prospective randomized trials are necessary to evaluate the efficacy of the device.

Get real with workload measurement. This innovative technique accurately determines the hours needed for comprehensive patient care.

Workload measurement enables clinicians to evaluate work performance and to identify the necessary level of health care resources to efficiently provide patient care.