Understanding organizational perspectives from clinical research stakeholders involved in recruitment for biopharmaceutical-sponsored clinical trials in the United States: Recommendations for organizational initiatives to improve access and inclusivity in clinical research.

Background: Equitable representation of racially and ethnically diverse subpopulations in clinical trials continues to be a problem, and trial participants do not always reflect the demographics of the population that the investigational product will be used to treat. The imperativeness of equitable representation of clinically relevant populations in clinical trials has implications for improving health outcomes, increasing knowledge about the safety and efficacy of new treatments across a wider population, and broadening access to innovative treatment options offered in clinical trials. Methods: The purpose of this study was to understand organizational elements that are involved in the active implementation of racially and ethnically diverse inclusive recruitment practices for biopharmaceutical-funded trials in the United States. Semi-structured, in-depth interviews were used in this qualitative study. The interview guide was designed to explore the perceptions, practices and experiences of 15 clinical research site professionals related to recruiting diverse trial participants. Data analysis utilized an inductive coding process. Results: Five themes were identified pertaining to the actual implementation of inclusive recruitment practices that provided explanations for organizational components: 1) provision of culturally appropriate, general disease and clinical trial education 2) organizational structure tailored for diverse recruitment 3) strong sense of mission related to improving healthcare through clinical research 4) culture of inclusion 5) inclusive recruitment practices evolving based on learning. Conclusion: The findings from this study offer insight into improving access to clinical trials by focusing on organizational change initiatives.

Environmental Health Needs Among Latinas in Cleaning Occupations: A Mixed Methods Approach.

In the U.S., approximately half of maids and housekeeping cleaners are Latino or Hispanic, while the vast majority are women (88.3%). This largely immigrant, underserved workforce faces complex factors, which may contribute to adverse health outcomes. To understand relevant barriers and challenges, this mixed-methods study explored the environmental health needs of a heterogeneous group of Latinas in New Jersey (NJ) who clean occupationally, and consisted of 3 focus groups (N = 15) with a cross-sectional survey (N = 9), both conducted in Spanish. Participants were recruited from community-based English as a Second Language classes in Hackensack, NJ. Analysis of focus group audio recordings included descriptive and in vivo coding followed by inductive coding to explore thematic analysis. The survey responses were evaluated using descriptive statistics. As per the survey results, the environmental health needs of this population include sore muscles, back problems, asthma, other respiratory issues, migraine or headache, and skin issues (rash, etc.). In the group discussions, the roles of genetics, food, and chemical exposures in cancer etiology were of great interest and a variety of opinions on the topic were explored. Both the focus group discussions and survey responses suggested that this population also faces barriers including lack of training, chemical exposures and inadequate personal protective equipment (PPE). These barriers are compounded by daily environmental exposures from personal home cleaning practices. The development of culturally- and linguistically-appropriate interventions are warranted to better protect the health of essential occupational cleaners who keep homes, businesses and schools clean.

Knowledge, attitudes and behaviors of Latinas in cleaning occupations in northern New Jersey: a cross-sectional mixed methods study.

BACKGROUND: In the United States, 88.3% of all 1,163,000 maids and housekeeping cleaners are female, and approximately half of them Latinas. Latinas are understudied and underrepresented in health research, particularly involving chemical exposure in cleaning practices, lack of job training, and inadequate access to personal protective equipment. The purpose of this study is twofold: 1) to examine the knowledge (via training experiences), attitudes and behaviors of a heterogeneous group of Latinas who clean occupationally and 2) to assess their cleaning practices at work and at home. METHODS: This mixed-method study consisted of two phases: 1) three focus groups to explore knowledge (via training experiences), attitudes, and behaviors regarding cleaning practices (N = 15) and 2) a 43-question cross-sectional survey. Focus group audio recordings were analyzed using descriptive and in vivo coding and then coded inductively to explore thematic analysis. Statistical analysis of the survey evaluated means, frequency and percentage for each of the responses. RESULTS: Participants (n = 9) were women (mean age = 48.78 and SD = 6.72) from South America (n = 5), Mexico (n = 1), El Salvador (n = 1) and Dominican Republic (n = 2). The mean length of time living in the US was 18.78 years and over half (55.6%) worked in the cleaning industry for 10 or more years. Findings from the three focus groups (n = 15) included that training in cleaning often occurred informally at a very young age at home. Participants reported cleaning in groups where tasks are rotated and/or shared. Most were the primary person cleaning at home, suggesting increased exposure. Gloves and masks were the most frequently used PPE, but use was not consistent. For participants who purchase their own products, driving factors included price, smell and efficacy. Some participants used products supplied or preferred by the employer. CONCLUSIONS: Latinas in cleaning occupations face a range of social and health barriers including lack of safety and health training, inadequate PPE and low literacy. To address these issues, the development of an intervention is warranted to provide training and resources for this critical population of essential workers.

Mind Mapping to Enhance Critical Thinking Skills in Physician Assistant Education: A Randomized Controlled Study.

Physician assistant (PA) students need to assimilate and integrate voluminous information quickly and effectively to promote critical thinking skills required to deliver competent care. Mind mapping (MM) is an innovative strategy used to facilitate students' recognition and recall of essential information and to ensure depth in their understanding via making connections between pieces of information. The establishment of relationships between concepts expressed in mind maps enhances critical thinking skills. The purpose of this study was to determine the overall critical thinking skills of PA students using MM as a learning strategy and to determine if there was a significant difference in critical thinking skills between students who used MM versus standard note-taking in their learning environment. In this randomized control study, a convenience sample of 74 PA students was assigned to a standard note-taking group (SNTG) or mind-mapping group (MMG). After completing the Health Science Reasoning Test (pre-HSRT), MMG members were instructed on how to construct mind maps and then asked to create weekly mind maps for 9 weeks, while the SNTG followed their method of study without mind maps for 9 weeks. Differences in the mean pre- and post-overall HSRT scores between groups and within groups were analyzed using independent and dependent t-tests, respectively. There was no significant difference between pre- and post-overall critical thinking scores as measured by HSRT after 9 weeks of intervention in both groups. However, there was a significant difference in the mean overall post-HSRT scores between groups (p=0.026). Hence, mind mapping is a viable active learning strategy to promote critical thinking in PA students.

Exploring the Relationship Between Timed Up and Go Test Times and Fall History in an Inpatient Geriatric Psychiatry Unit: A Retrospective Case-Control Study.

BACKGROUND AND PURPOSE: Inpatient geriatric psychiatry units have the highest fall rates in the acute care setting and most falls in this population occur during the mobility tasks of transfers and ambulation. The Timed Up and Go (TUG) test includes these 2 specific functional tasks and has been used to predict falls in other geriatric populations but has never been tested in an inpatient geriatric psychiatry unit. The purpose of this study was to determine whether the TUG time measurements of inpatient geriatric psychiatry patients were associated with falling. METHODS: The study was a retrospective chart review using a case-control design. The sample was obtained from patients admitted to 1 inpatient geriatric psychiatry unit during the 4-month study period. RESULTS: The total sample size was N = 62 and included older adults with (N = 29; "fallers") and without (N = 33; "nonfallers") a history of falls in the 6 months prior to admission. The mean age of fallers (M = 75.8, SD = 9.6) was not significantly different from the age of nonfallers (M = 74.0, SD = 7.6), P = .424. Both groups had higher proportions of female subjects; nonfallers were 75.8% (n = 25) female and fallers were 69.0% (n = 20) female. Most nonfallers (84.8%) completed the TUG testing without an assistive device, while most fallers (48.3%) used a walker. A significant difference was found between the TUG times of nonfallers and fallers, U = 737.00, z = 3.65, P < .001, r = 0.46. Fallers took longer to complete the TUG test (median = 26.5) than nonfallers (median = 13.6). The TUG time explanatory variable was statistically significant, P = .002. Increasing TUG times were associated with an increased likelihood of patient falls (odds ratio = 1.10). The optimal TUG cutoff score was 16.5 seconds, with 79.3% sensitivity and 72.7% specificity. CONCLUSIONS: The TUG time measurement was found to be associated with falling. A cutoff time of 16.5 seconds is recommended to identify nonfallers from fallers in the inpatient geriatric psychiatry setting.

Living with chronic kidney disease: related issues and treatment.

Chronic kidney disease is becoming a major health concern in patients with diabetes and hypertension. Patients often present with no symptoms, and practitioners must understand and utilize the proper treatment and health promotion activities to identify, prevent, and reverse the serious implications of this disease.

Too toxic.

Firm up on the facts and considerations associated with acetaminophen toxicity.