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1.
Nursing ; 51(10): 42-48, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34580263

RESUMO

ABSTRACT: Patient safety attendants (PSAs) provide constant direct observation to patients who have cognitive impairments or thoughts. Some estimates report that an acute care hospital in the United States may spend more than $1 million annually on PSAs, an expenditure often not reimbursed. With no national defined standards to regulate or monitor PSA use, this study sought to determine the impact of COVID-19 on a PSA reduction program in a large Midwestern healthcare system.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , COVID-19/epidemiologia , Segurança do Paciente , Pessoal Técnico de Saúde/economia , Disfunção Cognitiva/enfermagem , Humanos , Meio-Oeste dos Estados Unidos/epidemiologia , Avaliação de Programas e Projetos de Saúde
2.
Mayo Clin Proc ; 96(10): 2528-2539, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34538426

RESUMO

OBJECTIVE: To identify risk factors associated with severe COVID-19 infection in a defined Midwestern US population overall and within different age groups. PATIENTS AND METHODS: We used the Rochester Epidemiology Project research infrastructure to identify persons residing in a defined 27-county Midwestern region who had positive results on polymerase chain reaction tests for COVID-19 between March 1, 2020, and September 30, 2020 (N=9928). Age, sex, race, ethnicity, body mass index, smoking status, and 44 chronic disease categories were considered as possible risk factors for severe infection. Severe infection was defined as hospitalization or death caused by COVID-19. Associations between risk factors and severe infection were estimated using Cox proportional hazard models overall and within 3 age groups (0 to 44, 45 to 64, and 65+ years). RESULTS: Overall, 474 (4.8%) persons developed severe COVID-19 infection. Older age, male sex, non-White race, Hispanic ethnicity, obesity, and a higher number of chronic conditions were associated with increased risk of severe infection. After adjustment, 36 chronic disease categories were significantly associated with severe infection. The risk of severe infection varied significantly across age groups. In particular, persons 0 to 44 years of age with cancer, chronic neurologic disorders, hematologic disorders, ischemic heart disease, and other endocrine disorders had a greater than 3-fold increased risk of severe infection compared with persons of the same age without those conditions. Associations were attenuated in older age groups. CONCLUSION: Older persons are more likely to experience severe infections; however, severe cases occur in younger persons as well. Our data provide insight regarding younger persons at especially high risk of severe COVID-19 infection.


Assuntos
COVID-19/epidemiologia , Disparidades nos Níveis de Saúde , Índice de Gravidade de Doença , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Doença Crônica/epidemiologia , Comorbidade , Grupos Étnicos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Fatores de Risco , Adulto Jovem
3.
Med Care ; 59(10): 888-892, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34334737

RESUMO

BACKGROUND: Despite many studies reporting disparities in coronavirus disease-2019 (COVID-19) incidence and outcomes in Black and Hispanic/Latino populations, mechanisms are not fully understood to inform mitigation strategies. OBJECTIVE: The aim was to test whether neighborhood factors beyond individual patient-level factors are associated with in-hospital mortality from COVID-19. We hypothesized that the Area Deprivation Index (ADI), a neighborhood census-block-level composite measure, was associated with COVID-19 mortality independently of race, ethnicity, and other patient factors. RESEARCH DESIGN: Multicenter retrospective cohort study examining COVID-19 in-hospital mortality. SUBJECTS: Inclusion required hospitalization with positive SARS-CoV-2 test or COVID-19 diagnosis at three large Midwestern academic centers. MEASURES: The primary study outcome was COVID-19 in-hospital mortality. Patient-level predictors included age, sex, race, insurance, body mass index, comorbidities, and ventilation. Neighborhoods were examined through the national ADI neighborhood deprivation rank comparing in-hospital mortality across ADI quintiles. Analyses used multivariable logistic regression with fixed site effects. RESULTS: Among 5999 COVID-19 patients median age was 61 (interquartile range: 44-73), 48% were male, 30% Black, and 10.8% died. Among patients who died, 32% lived in the most disadvantaged quintile while 11% lived in the least disadvantaged quintile; 52% of Black, 24% of Hispanic/Latino, and 8.5% of White patients lived in the most disadvantaged neighborhoods.Living in the most disadvantaged neighborhood quintile predicted higher mortality (adjusted odds ratio: 1.74; 95% confidence interval: 1.13-2.67) independent of race. Age, male sex, Medicare coverage, and ventilation also predicted mortality. CONCLUSIONS: Neighborhood disadvantage independently predicted in-hospital COVID-19 mortality. Findings support calls to consider neighborhood measures for vaccine distribution and policies to mitigate disparities.


Assuntos
COVID-19/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Características de Residência/estatística & dados numéricos , Fatores Etários , Teste para COVID-19 , Comorbidade , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos/epidemiologia , Pobreza/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais
4.
LGBT Health ; 8(6): 395-403, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34424726

RESUMO

Purpose: The study purpose was to compare suicide risk between lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ) and non-LGBTQ adolescents in a psychiatric hospital. Methods: Data were obtained from self-report measures completed by patients 12-17 years of age (n = 334) in a Midwestern psychiatric hospital from 2016 to 2017. Factors analyzed included sexual orientation, gender identity, suicidality, depression, nonsuicidal self-injury, abuse, substance use, bullying, perceived discrimination, and adult support. Results: Nearly one-third of patients identified as LGBTQ. A lifetime suicide attempt was reported by 69.6% of LGBTQ patients compared with 43.6% of non-LGBTQ patients. However, the prevalence of suicide attempts among LGBTQ patients with high adult support did not differ from that of non-LGBTQ patients. In the full logistic regression model adjusting for 13 factors, the adjusted odds ratio of a suicide attempt was 5.25 among transgender/questioning patients and 2.41 among nontransgender lesbian, gay, bisexual, queer, or questioning patients. All risk factors, apart from substance use, were more prevalent among LGBTQ than non-LGBTQ patients (p < 0.005). Among LGBTQ patients of color (Black/Latinx/Other), 91.3% had a lifetime suicide attempt versus 62.3% of White LGBTQ patients (p = 0.009). Conclusion: LGBTQ patients overall, and LGBTQ patients of color in particular, had higher rates of suicide attempts than non-LGBTQ patients. LGBTQ patients also had a higher prevalence of risk factors for suicide; however, the study variables did not fully explain the higher prevalence of suicide attempts. Future research should further examine possible risk factors for suicide among LGBTQ youth, such as stigma and discrimination.


Assuntos
Hospitalização/estatística & dados numéricos , Transtornos Mentais/terapia , Minorias Sexuais e de Gênero/psicologia , Suicídio/psicologia , Adolescente , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Meio-Oeste dos Estados Unidos , Fatores de Proteção , Fatores de Risco , Minorias Sexuais e de Gênero/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos
5.
Pediatrics ; 148(3)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34426531

RESUMO

BACKGROUND AND OBJECTIVES: Hospital-wide patient safety programs have been used to ensure appropriate provision of care. Similar approaches have not been widely applied to child maltreatment. In this study, we describe a hospital-system child maltreatment safety program by characterizing the frequency of patients needing further intervention, associations between the age of patient and location of care and need for further intervention, and patients who require immediate intervention. METHODS: For all staff concerns for child maltreatment, a social worker completed a patient at risk (PAR) form. All PAR forms were reviewed within 24 hours by the child abuse team and categorized on the basis of 6 types of interventions, most significantly an "immediate callback." Wilcoxon rank and χ2 tests were used for group comparisons. RESULTS: Over a 30-month period, program interventions occurred in 2061 of 7698 PARs (26.8%). The most common reason for a PAR form was physical abuse (32.5%). Subjects requiring an intervention were no different in age than those who did not (median age: 5.6 vs 5.2 years). PAR forms performed in the emergency departments or urgent care were more likely to require an intervention than inpatient (odds ratio: 4.4; 95% confidence interval 3.6-5.3) or clinic (odds ratio: 2.0; 95% confidence interval 1.7-2.3) PAR forms. Of the 53 immediate callbacks, potential diagnostic errors and safe discharge concerns occurred in nearly one-half, and >40% involved subjects with bruising. Immediate follow-up in the child abuse pediatrician clinic occurred in 87% (46 of 53) of cases, resulting in a new or changed diagnosis in 57% of such cases. CONCLUSIONS: A child maltreatment safety program encompassing a health system can identify and address medical errors.


Assuntos
Maus-Tratos Infantis/diagnóstico , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Pré-Escolar , Humanos , Meio-Oeste dos Estados Unidos , Política Organizacional , Segurança do Paciente , Estudos Retrospectivos , Assistentes Sociais
6.
Nutrients ; 13(6)2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34199833

RESUMO

During COVID-19 restrictions in spring 2020, college students experienced closed dormitories and increased unemployment and many students moved in with their families. College students were vulnerable to food insecurity pre-pandemic and this study examined how the living situations and food security status changed for Midwestern university students due to COVID-19 restrictions. An email survey administered to Iowa State University students between the ages of 18 and 30 who physically attended campus prior to its closure produced 1434 responses. Students living with a parent or guardian increased by 44% and were less likely to experience food insecurity or less likely to work. They had lower stress and ate more home-cooked meals. Students living on their own had higher rates of food insecurity, greater stress, poorer health status, higher cooking self-efficacy, and worked more hours. Seventeen percent of all students were food insecure; related factors were non-White ethnicity, lower cooking self-efficacy, undergraduate status, receipt of financial aid, employment, stress, living in the same situation as before the campus closure, and consumption of more take-out or fast food. These individuals had more barriers to food access. Knowledge of these factors provide useful information to inform future support services for this population in similar conditions.


Assuntos
COVID-19 , Controle de Doenças Transmissíveis , Segurança Alimentar , Pandemias , Características de Residência , Estudantes , Universidades , Adolescente , Adulto , Culinária , Estudos Transversais , Emprego , Família , Fast Foods , Comportamento Alimentar , Feminino , Nível de Saúde , Humanos , Masculino , Meio-Oeste dos Estados Unidos , Fatores Socioeconômicos , Estresse Psicológico , Estudantes/psicologia , Inquéritos e Questionários , Adulto Jovem
7.
J Environ Manage ; 293: 112910, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34098350

RESUMO

Nitrogen (N) and phosphorus (P) loss from crop production agriculture is transported to adjacent and downstream water bodies, resulting in negative environmental impacts including harmful and nuisance algal blooms. Cover crops are a conservation management practice that replaces bare soil with vegetation outside of the cash crop growing season, purportedly reducing N and P loss by increasing water and nutrient demand in agroecosystems. In this study, we compared nitrate (NO3--N), total N (TN), dissolved reactive P (DRP), and total P (TP) loads in subsurface (tile) drainage and surface runoff from fields with cover crop management (CC) and fields without cover crop management (NoCC) using continuous monitoring data from 40 agricultural fields located throughout northcentral Ohio, United States (US). We found that average monthly tile NO3--N and TN loads from CC fields were ~50% less than NoCC fields, while average monthly tile discharge, DRP, and TP loads did not differ between CC and NoCC fields. Cover crops also did not significantly influence average monthly surface metrics. Cover crops reduced monthly totals of tile NO3--N and TN loads by ~1.0-2.6 kg N ha-1 from January to June (winter and spring), coinciding with critical periods of nutrient loss from agroecosystems in the midwestern US, but increased monthly totals of tile DRP (by 0.4-12.1 g DRP ha-1) and TP (by 1.2-31.6 g TP ha-1) loads during some months. We found similar patterns at the annual time scale whereby CC fields had lesser cumulative annual totals of tile NO3--N and TN but greater cumulative annual totals of tile DRP and TP. These results show that the influence of cover crops on N loads, but not P, were consistent across temporal scales of examination, demonstrating that cover crops effectively increased N demand and mitigated N losses from agricultural fields. The variable influence of cover crops on P loads underscores the need for greater understanding of the factors and mechanisms that control P loss in systems that include cover crop management. Furthermore, these findings stress the importance of identifying and selecting conservation management practices tailored to the natural resource concern.


Assuntos
Nitrogênio , Fósforo , Agricultura , Produtos Agrícolas , Meio-Oeste dos Estados Unidos , Ohio , Fósforo/análise , Movimentos da Água
8.
PLoS One ; 16(6): e0243676, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34111144

RESUMO

Since March 2020, the United States has lost over 580,000 lives to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. A growing body of literature describes population-level SARS-CoV-2 exposure, but studies of antibody seroprevalence within school systems are critically lacking, hampering evidence-based discussions on school reopenings. The Lake Central School Corporation (LCSC), a public school system in suburban Indiana, USA, assessed SARS-CoV-2 seroprevalence in its staff and identified correlations between seropositivity and subjective histories and demographics. This study is a cross-sectional, population-based analysis of the seroprevalence of SARS-CoV-2 in LCSC staff measured in July 2020. We tested for seroprevalence with the Abbott Alinity™ SARS-CoV-2 IgG antibody test. The primary outcome was the total seroprevalence of SARS-CoV-2, and secondary outcomes included trends of antibody presence in relation to baseline attributes. 753 participants representative of the staff at large were enrolled. 22 participants (2.9%, 95% CI: 1.8% - 4.4%) tested positive for SARS-CoV-2 antibodies. Correcting for test performance parameters, the seroprevalence is estimated at 1.7% (90% Credible Interval: 0.27% - 3.3%). Multivariable logistic regression including mask wearing, travel history, symptom history, and contact history revealed a 48-fold increase in the odds of seropositivity if an individual previously tested positive for COVID-19 (OR: 48, 95% CI: 4-600). Amongst individuals with no previous positive test, exposure to a person diagnosed with COVID-19 increased the odds of seropositivity by 7-fold (OR: 7.2, 95% CI: 2.6-19). Assuming the presence of antibodies is associated with immunity against SARS-CoV-2 infection, these results demonstrate a broad lack of herd immunity amongst the school corporation's staff irrespective of employment role or location. Protective measures like contact tracing, face coverings, and social distancing are therefore vital to maintaining the safety of both students and staff as the school year progresses.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Professores Escolares , Instituições Acadêmicas , Adolescente , Adulto , Idoso , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , COVID-19/sangue , COVID-19/imunologia , Teste Sorológico para COVID-19 , Estudos Transversais , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos/epidemiologia , SARS-CoV-2/imunologia , SARS-CoV-2/isolamento & purificação , Estudos Soroepidemiológicos , Adulto Jovem
9.
J Affect Disord ; 292: 751-756, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34167024

RESUMO

INTRODUCTION: Lower socioeconomic status (SES) has been associated with poor healthcare outcomes in depression. However, reliable individual-level SES data rarely exists for clinical research. The HOUSES index relies on publicly available data allowing for evaluation of individual-level SES on patient outcomes. HYPOTHESIS: Primary care patients with depression within the lower SES quartile (Quartile 1 vs. Quartile 4, of the HOUSES index) would experience worse clinical outcomes of their symptoms six months after diagnosis. STUDY DESIGN: A retrospective cohort study which followed 4313 adult primary care patients that were diagnosed with depression during the study period of 2008-2015. The outcome measures were the six month PHQ-9 scores. RESULTS: At six months, a higher HOUSES quartile was associated with greater odds of remission of depressive symptoms (RDS) and lower odds of persistent depressive symptoms (PDS), after controlling for covariates. Patients in Quartile 4 had 27% more likelihood of RDS and a 24% lower likelihood of PDS at six months compared to a Quartile 1 patient. LIMITATIONS: As a retrospective study only can observe associations but not causation. Only one institution participated and not all treatments were readily available, limiting the generalizability of these findings. CONCLUSIONS: Lower SES as demonstrated by a lower HOUSES quartile (Quartile 1 versus 4) was associated with lower odds of RDS and increased odds of PDS at six months. HOUSES index is a useful tool for identifying patients at risk for worse clinical outcomes and may help health care systems plan resource allocation for depression care.


Assuntos
Depressão , Classe Social , Adulto , Depressão/epidemiologia , Humanos , Meio-Oeste dos Estados Unidos , Questionário de Saúde do Paciente , Estudos Retrospectivos
10.
Nutrients ; 13(5)2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34065195

RESUMO

The study aim was to test hypotheses informed by self-determination theory (SDT) regarding associations of adolescent motivators for weight loss and family feeding practices on understanding adolescent weight management and dietary behaviors. Adolescents (n = 71) with obesity were recruited from a large medical center in the Midwest USA and completed questionnaire assessments via an online survey. Results supported hypotheses that endorsement of health motivators for weight loss, conceptualized as autonomous (intrinsic) motivation, and positive family support would be associated with healthier weight management practices and dietary behaviors. Nuanced findings related to social- and self-esteem-related motivators for weight loss indicated a need for further understanding of these weight-loss motivators in the context of SDT. The current study findings highlight the importance of addressing motivational factors and family influences in research and practice related to promoting healthy dietary habits and weight management strategies among adolescents with obesity.


Assuntos
Família/psicologia , Comportamento Alimentar/psicologia , Motivação , Manejo da Obesidade , Obesidade Pediátrica/psicologia , Adolescente , Índice de Massa Corporal , Feminino , Humanos , Masculino , Meio-Oeste dos Estados Unidos , Poder Familiar/psicologia , Obesidade Pediátrica/terapia , Perda de Peso
11.
Mycopathologia ; 186(4): 499-505, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34143393

RESUMO

Pulmonary aspergillosis has been reported at high rates in patients with coronavirus disease 2019 (COVID-19) and is associated with high morbidity and mortality. We retrospectively assessed all patients admitted to an intensive care unit during the early COVID-19 surge (3/17/20-5/10/20) at our medical center in the midwestern USA for the presence of COVID-19-associated pulmonary aspergillosis (CAPA). Patients were not routinely screened for CAPA; diagnostic work-up for fungal infections was pursued when clinically indicated. Among 256 patients admitted to the ICU with severe COVID-19, 188 (73%) were intubated and 62 (24%) ultimately expired within 30 days of admission to the ICU. Only three patients (1%) were found to have CAPA; diagnosis was made by tracheal aspirate cultures in two cases and by bronchoalveolar lavage fluid Aspergillus galactomannan in one case. None of the patients who developed CAPA had classic risk factors for invasive fungal infection. The occurrence of CAPA was much lower than that reported at other centers, likely reflecting the local epidemiology.


Assuntos
COVID-19 , Aspergilose Pulmonar , Centros Médicos Acadêmicos , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos/epidemiologia , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/epidemiologia , Estudos Retrospectivos , Adulto Jovem
13.
BMC Pregnancy Childbirth ; 21(1): 434, 2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34158016

RESUMO

BACKGROUND: To identify the association between inpatient postpartum opioid consumption, race, and amount of opioids prescribed at discharge after vaginal or cesarean delivery. METHODS: A total of 416 women who were prescribed an oral opioid following vaginal or cesarean delivery at a single tertiary academic institution between July 2018 and October 2018 were identified. Women with postoperative wound complications, third and fourth degree lacerations, cesarean hysterectomy, or a history of opioid abuse were excluded. The primary outcome was the number of oxycodone 5 mg tablets prescribed at discharge, stratified by race and mode of delivery. Only "Black" and "White" women were included in analyses due to low absolute numbers of other identities. Black women were compared to white women using multivariable logistic regression. Multiple sensitivity analyses were performed. RESULTS: The median number of oxycodone tablets consumed during hospitalization following cesarean delivery was seven (IQR: 2.5-12 tablets) and following vaginal delivery was one (IQR: 0-3). White women were more likely to be older at delivery regardless of route (median 32 vs. 30 years for cesarean delivery, and 29 vs. 27 years for vaginal delivery; p < 0.01 for both). White women undergoing cesarean delivery did so at a lower maternal BMI (31.6 vs. 34.5; p = 0.02). White women were also significantly more likely to have private insurance and to experience perineal lacerations following vaginal delivery. The number of inpatient opioid tablets consumed, as well as the number prescribed at discharge, were not statistically different between Black and White women, regardless of mode of delivery. These findings persisted in sensitivity analyses. CONCLUSION: At our large, academic hospital the number of tablets prescribed at discharge had no association with patient race or inpatient usage regardless of mode of delivery.


Assuntos
Parto Obstétrico , Prescrições de Medicamentos , Oxicodona/administração & dosagem , Período Pós-Parto , Fatores Raciais/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Pacientes Internados , Meio-Oeste dos Estados Unidos , Alta do Paciente , Estudos Retrospectivos
14.
Curr Pharm Teach Learn ; 13(7): 826-834, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34074514

RESUMO

BACKGROUND: Student ePortfolios provide an interactive space for faculty, student peers, and potential employers to view skillsets and reflective expressions of students. EDUCATIONAL ACTIVITY: The adoption of ePortfolios in an interdisciplinary, competency-based, master's degree program in clinical research at a university in the Midwestern United States is described. Students submitted their ePortfolios as their culminating assessment. A survey was used to collect objective and open-ended responses from 104 students between 2015 and 2019 followed by a voluntary post-survey interview. Two ePortfolio platforms and instructional methods were compared. CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY: A user-friendly platform enhanced student engagement and reduced student and faculty frustration with the ePortfolio requirement. Thirty-seven students and alumni responded to an ePortfolio survey, and five students shared their experiences in a post-survey interview. Students described positive experiences related to their academic program and job search as a result of completing the ePortfolio. However, alumni were not strongly motivated to maintain their ePortfolio post-graduation. ePortfolios provide evidence of student acquisition of core competencies in a professional graduate degree. Facilitating the process of ePortfolio creation with instruction guides, exemplar ePortfolios, and an evaluation rubric support student success. A user-friendly ePortfolio platform with social media linking features will enhance exposure of the student's work to key stakeholders during and after their academic program. If the ePortfolio is to have an impact on a student's professional trajectory after graduation, it should contain meaningful examples of academic work that can be shared publicly and allow updating of ePortfolio content.


Assuntos
Logro , Avaliação Educacional , Humanos , Meio-Oeste dos Estados Unidos , Estudantes , Inquéritos e Questionários
15.
Psychiatry Res ; 302: 114034, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34098158

RESUMO

Given concerns of increased suicide risk among university students during the COVID-19 pandemic, this study examined rates of lifetime and past-year suicidal ideation (SI) among university students in Fall 2020 (vs. two earlier semesters), overall and across gender, racial/ethnic background, and sexual identity. Participants included 1700 university students enrolled in a general education psychology course in Fall 2020, Fall 2014, or Fall 2013. Rates of SI were not significantly higher in Fall 2020 versus the earlier semesters and did not differ across racial/ethnic background. However, rates of SI in Fall 2020 were significantly higher among sexual minority than heterosexual students.


Assuntos
COVID-19/psicologia , Pandemias , Estudantes/psicologia , Ideação Suicida , Adolescente , COVID-19/epidemiologia , Grupos de Populações Continentais/psicologia , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/psicologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Meio-Oeste dos Estados Unidos/epidemiologia , Fatores de Risco , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades , Adulto Jovem
16.
J Nurses Prof Dev ; 37(3): 147-150, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33961359

RESUMO

Nurse educators play an important role in implementing changes within hospital orientation, supporting a learner-focused orientation. Utilizing different learning styles and delivery methods, an orientation can promote an environment where registered nurses are active participants and guide the learning. This article discusses the process of incorporating multiple learning styles and modalities into an experienced registered nurse orientation program, creating a learner-centered environment promoting engagement, increased satisfaction, and retention of experienced staff.


Assuntos
Capacitação em Serviço , Modelos Educacionais , Enfermeiras e Enfermeiros , Aprendizagem Baseada em Problemas , Desenvolvimento de Programas , Docentes de Enfermagem , Humanos , Meio-Oeste dos Estados Unidos
17.
J Pediatr Adolesc Gynecol ; 34(5): 666-672, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33989806

RESUMO

STUDY OBJECTIVE: To assess postoperative management of pediatric patients with benign ovarian neoplasms, to develop recommendations for postoperative care. DESIGN: A retrospective cohort study. SETTING: Eight pediatric hospitals in the midwestern United States. PARTICIPANTS: Patients up to 21 years of age who underwent surgery for a benign ovarian neoplasm between January 2010 and December 2016 were included. INTERVENTIONS: No prospective interventions were evaluated. MAIN OUTCOME MEASURES: Main outcome measures included postoperative imaging findings, recurrence rates, reoperation rates, and the timing of the aforementioned results. RESULTS: A total of 427 patients met inclusion criteria. After the index surgery, 155 patients (36%) underwent a routine imaging study. Among those with routine imaging, abnormalities were noted in 48 patients (31%); 7 went on to have reoperation (5%), and no malignant pathologies or torsion were identified. Excluding the 7 patients who went on to have a reoperation as a result of routine imaging, 113 patients developed symptoms postoperatively and underwent imaging as a result (27%, 113/420). Abnormalities were noted in 44 (10%); 15 of these patients underwent reoperation (4%), among them 2 with malignancies and 3 with torsion. Of these 44 patients, 23 had initially undergone routine imaging and subsequently went on to have symptomatic imaging, with 17% (4/23) undergoing reoperation. CONCLUSIONS: Routine imaging did not identify malignancy; most lesions identified on routine imaging were incidental findings. Although the study was not powered to appreciate a statistically significant difference, patients with malignancy or torsion were identified in the symptomatic group. This suggests no benefit from routine imaging, and supports symptomatic imaging postoperatively to minimize costs and patient/family burden.


Assuntos
Neoplasias Ovarianas , Criança , Feminino , Humanos , Meio-Oeste dos Estados Unidos , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/epidemiologia , Cuidados Pós-Operatórios , Reoperação , Estudos Retrospectivos
18.
AORN J ; 113(5): 476-485, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33929736

RESUMO

A lack of targeted perioperative academic preparation may have led to not enough nursing graduates entering and staying in the perioperative field. This deficit and a large portion of the workforce approaching retirement age have contributed to a perioperative nursing shortage. In collaboration with an associated medical center, a college of nursing in the midwestern United States offered and evaluated a redesigned perioperative elective for student nurses. After implementation, interviews and focus groups were used to determine the effect on the student nurses' confidence, their progression through orientation after graduating and being hired into the perioperative department, and the perioperative department's retention rates. Recently graduated nurses with perioperative educational experience have a better understanding of the role of a perioperative nurse. Increasing prelicensure student exposure to the perioperative clinical environment is associated with positive outcomes for the department, organization, nurses, and patients. Similar results in other specialties may be possible.


Assuntos
Bacharelado em Enfermagem , Estudantes de Enfermagem , Humanos , Meio-Oeste dos Estados Unidos , Enfermagem Perioperatória , Seleção de Pessoal , Recursos Humanos
19.
JAMA Netw Open ; 4(4): e218075, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33904912

RESUMO

Importance: Overuse of health care services exposes patients to unnecessary risk of harm and costs. Distinguishing patterns of overuse among hospitals requires hospital-level measures across multiple services. Objective: To describe characteristics of hospitals associated with overuse of health care services in the US. Design, Setting, and Participants: This retrospective cross-sectional analysis used Medicare fee-for-service claims data for beneficiaries older than 65 years from January 1, 2015, to December 31, 2017, with a lookback of 1 year. Inpatient and outpatient services were included, and services offered at specialty and federal hospitals were excluded. Patients were from hospitals with the capacity (based on a claims filter developed for this study) to perform at least 7 of 12 investigated services. Statistical analyses were performed from July 1, 2020, to December 20, 2020. Main Outcomes and Measures: Outcomes of interest were a composite overuse score ranging from 0 (no overuse of services) to 1 (relatively high overuse of services) and characteristics of hospitals clustered by overuse rates. Twelve published low-value service algorithms were applied to the data to find overuse rates for each hospital, normalized and aggregated to a composite score and then compared across 6 hospital characteristics using multivariable regression. A k-means cluster analysis was used on normalized overuse rates to identify hospital clusters. Results: The primary analysis was performed on 2415 cohort A hospitals (ie, hospitals with capacity for 7 or more services), which included 1 263 592 patients (mean [SD] age, 72.4 [14] years; 678 549 women [53.7%]; 101 017 191 White patients [80.5%]). Head imaging for syncope was the highest-volume low-value service (377 745 patients [29.9%]), followed by coronary artery stenting for stable coronary disease (199 579 [15.8%]). The mean (SD) composite overuse score was 0.40 (0.10) points. Southern hospitals had a higher mean score than midwestern (difference in means: 0.06 [95% CI, 0.05-0.07] points; P < .001), northeast (0.08 [95% CI, 0.06-0.09] points; P < .001), and western hospitals (0.08 [95% CI, 0.07-0.10] points; P < .001). Nonprofit hospitals had a lower adjusted mean score than for-profit hospitals (-0.03 [95% CI, -0.04 to -0.02] points; P < .001). Major teaching hospitals had significantly lower adjusted mean overuse scores vs minor teaching hospitals (difference in means, -0.07 [95% CI, -0.08 to -0.06] points; P < .001) and nonteaching hospitals (-0.10 [95% CI, -0.12 to -0.09] points; P < .001). Of the 4 clusters identified, 1 was characterized by its low counts of overuse in all services except for spinal fusion; the majority of major teaching hospitals were in this cluster (164 of 223 major teaching hospitals [73.5%]). Conclusions and Relevance: This cross-sectional study used a novel measurement of hospital-associated overuse; results showed that the highest scores in this Medicare population were associated with nonteaching and for-profit hospitals, particularly in the South.


Assuntos
Hospitais com Fins Lucrativos/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Sobremedicalização/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Planos de Pagamento por Serviço Prestado , Feminino , Número de Leitos em Hospital/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Hospitais Filantrópicos/estatística & dados numéricos , Humanos , Masculino , Medicare , Meio-Oeste dos Estados Unidos , New England , Noroeste dos Estados Unidos , Estudos Retrospectivos , Provedores de Redes de Segurança/estatística & dados numéricos , Sudeste dos Estados Unidos , Sudoeste dos Estados Unidos , Estados Unidos
20.
Clin Nurse Spec ; 35(3): 129-137, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33793175

RESUMO

PURPOSE/AIMS: The aim of this study was to describe how persons given a diagnosis of a brain tumor who have had a craniotomy describe the quality of their pain after surgery. DESIGN: A qualitative descriptive design was used. METHODS: Qualitative descriptive methods as described by Sandelowski guided this study. Semistructured interviews were conducted with patients hospitalized on a neurological step-down unit in an urban teaching hospital in the Midwestern United States. Interviews focused on the quality of participants' pain after surgery. Narratives were analyzed using standard content analysis. RESULTS: Twenty-seven participants were interviewed. Most were White and female. Most underwent a craniotomy using an anterior approach with sedation. Participants described the quality of their pain with 6 different types of descriptors: pain as pressure, pain as tender or sore, pain as stabbing, pain as throbbing, pain as jarring, and pain as itching. CONCLUSIONS: Participants' descriptions of their pain quality after surgery provide a different understanding than do numerical pain ratings. Clinicians should use questions to explore patients' individual pain experiences, seeking to understand the quality of patients' pain and their perceptions.


Assuntos
Neoplasias Encefálicas/cirurgia , Dor Pós-Operatória/psicologia , Pacientes/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Hospitais de Ensino , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Narração , Enfermeiras Clínicas , Manejo da Dor/enfermagem , Dor Pós-Operatória/enfermagem , Pacientes/estatística & dados numéricos , Pesquisa Qualitativa , Adulto Jovem
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