Background
The cesarean birth rate for low‐risk pregnant individuals in the United States exceeds the recommended Healthy People 2020 rate. One recommended strategy to reduce cesarean in this ...population is delaying hospital admission until active labor commences. A quality improvement program was implemented at a community hospital using the early labor lounge (ELL) to promote admission in active labor. This study focuses on identifying the barriers and facilitators from the clinician perspective to implementing the ELL.
Methods
Interviews were conducted with a purposive sample of clinicians. Interview transcripts were open coded and themes identified inductively. A framework analysis was then conducted using the Consolidated Framework for Implementation Research (CFIR).
Results
Twenty‐five staff members participated. Barriers and facilitators were identified in four of the CFIR domains. Facilitators included the strength of the evidence and the ELL itself, including the tools it contained for supporting women in latent labor. Barriers to implementation included clinician self‐efficacy and perceived low usage of the ELL.
Conclusion
This analysis using, CFIR identified several barriers and facilitators to the implementation of the ELL. The context of the individual woman presenting in triage and the acceptability and self‐efficacy of the individual clinicians represented important factors for implementation.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Michigan Central Station is making a comeback as a new state-of-the-art research hub for the Ford Motor Co. The historic depot in Detroit MI is being retrofitted as the site of the latest ...technological advances in transportation. The grand Beaux Arts-style station was a symbol of progress when it opened in 1913. The main waiting room welcomed visitors with marble floors, 68 ft (21 m) Corinthian columns, and Guastavino tile vaults divided by coffered arches. However, after World War II, Detroit's other transportation claim-to-fame--cars--changed the fate of the terminal. The interstate highway system and the rise in car ownership contributed to rail's obsolescence across the US. Left in partial use and then abandoned for decades, the once glorious station became an infamous symbol of Detroit's decline. That's all changing. Ford Motor purchased the depot in 2018 as the centerpiece of its Corktown Campus, which will focus on creating autonomous and electric vehicles. When complete, the 1.2 million ft2 campus will include offices, retail space, housing, parks, and community places. It's expected to bring 5000 new jobs to the Corktown neighborhood of the city.
Transgender adolescents are a marginalized and at risk population; compared to cisgender (non-transgender) peers. they are more likely to experience bullying, victimization, and depression. Given the ...evidence that gender dysphoria and psychological functioning improve following social and medical gender affirmation, it is imperative that medical providers identify transgender adolescents and connect them to appropriate services. The purpose of this study was to elucidate the health care experiences of transgender adolescents in primary care. Transgender adolescents, aged 13-21 years, were recruited from primary care offices and gender management clinics in Massachusetts and Rhode Island. Participants completed a brief demographic questionnaire followed by a single, semi-structured interview performed by one of two trained interviewers. During the qualitative interview, participants answered questions regarding their experience of being transgender within their primary care setting and their recommendations for making medical homes more welcoming for transgender adolescents. Interview recordings were transcribed and two members of the research team conducted a preliminary thematic analysis. These results represent interview data from seven participants (a total of 20 participants will be recruited). Participant ages ranged from 13-19 years old and 71% identified as white, non-Hispanic. All of the participants to date were assigned female at birth and had a gender identity of male, trans male/trans man, or identified as both trans male/trans man and male. All seven participants had a specialty gender management physician and most (71 %) had seen their primary care provider in the past year. Overall, most participants had positive experiences with their primary care provider and found their clinician to be accepting of their gender identity. Six main themes emerged from the transcripts: pronouns and names; privacy; physical spaces; conversations with providers; provider knowledge ("I would have loved to hear some informative stuff from my pediatrician" ); and medical staff roles ("it's really important that pediatricians ... just step up, learn transgender stuff'). Most participants commented on distress resulting from being called the incorrect name or use of the incorrect pronouns, described by one participant as, "the cringing pain of being called the wrong name." Several recommendations emerged from the interviews, including that providers should ask all patients about their gender identity and pronouns at every visit in a confidential manner and waiting rooms should incorporate rainbow images or transgender brochures to create a welcoming space. Participants emphasized the importance of providers and front desk staff using their preferred name and pronouns and wanted their primary care providers to be knowledgeable about transgender health. Initial results from this ongoing qualitative study of a rarely interviewed population demonstrate that transgender youth, even when reporting positive experiences with their primary care provider as participants in our study did, had several recommendations to improve care in their medical home to better meet their needs. Delivery of primary care services for transgender adolescents may be optimized if gender identity is routinely assessed and discussed confidentially with patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The COVID-19 pandemic has triggered several new measures in public and private companies to limit the spread of the virus. One of the most effective measures was shown to be social distancing, but ...such measure is not easy to implement for every entity, especially for hospitals. In this work, we study the case of an Italian hospital whose goal is to find the best layout of outpatient services to reduce overcrowding in the waiting rooms. We propose an Integer Linear Programming model to identify the weekly optimal layout and we test it on a set of real data from the year 2019. The results obtained by our model reduce the overcrowding by 80% on average with respect to the results obtained with the configuration used by the hospital, but such results can only be obtained if the layout is allowed to change every week. We then study the case in which we force the layout to be fixed for two or three consecutive weeks and outline that both the computational time and the solution quality worsen significantly.
In this paper, we first use the information we have on the patients of an oncology day hospital to distribute the treatment schedules they have in each of the visits to this centre. To do this, we ...propose a deterministic mathematical programming model in such a way that we minimise the duration of the waiting room stays of the total set of patients and taking into account the restrictions of the circuit. Secondly, we will look for a solution to the same problem under a stochastic approach. This model will explicitly consider the existing uncertainty in terms of the different times involved in the circuit, and this model also allows the reorganisation of the schedules of medical appointments with oncologists. The models are complemented by a tool that solves the problem of assigning nurses to patients. The work is motivated by the particular characteristics of a real hospital and the models are used and compared with data from this case.
Diverse socioeconomic and clinical factors influence susceptibility to tuberculosis (TB) disease in Mexico. The role of genetic factors, particularly those that differ between the parental groups ...that admixed in Mexico, is unclear. The objectives of this study are to identify the socioeconomic and clinical predictors of the transition from latent TB infection (LTBI) to pulmonary TB disease in an urban population in northeastern Mexico, and to examine whether genetic ancestry plays an independent role in this transition. We recruited 97 pulmonary TB disease patients and 97 LTBI individuals from a public hospital in Monterrey, Nuevo León. Socioeconomic and clinical variables were collected from interviews and medical records, and genetic ancestry was estimated for a subset of 142 study participants from 291,917 single nucleotide polymorphisms (SNPs). We examined crude associations between the variables and TB disease status. Significant predictors from crude association tests were analyzed using multivariable logistic regression. We also compared genetic ancestry between LTBI individuals and TB disease patients at 1,314 SNPs in 273 genes from the TB biosystem in the NCBI BioSystems database. In crude association tests, 12 socioeconomic and clinical variables were associated with TB disease. Multivariable logistic regression analyses indicated that marital status, diabetes, and smoking were independently associated with TB status. Genetic ancestry was not associated with TB disease in either crude or multivariable analyses. Separate analyses showed that LTBI individuals recruited from hospital staff had significantly higher European genetic ancestry than LTBI individuals recruited from the clinics and waiting rooms. Genetic ancestry differed between individuals with LTBI and TB disease at SNPs located in two genes in the TB biosystem. These results indicate that Monterrey may be structured with respect to genetic ancestry, and that genetic differences in TB susceptibility in parental populations may contribute to variation in disease susceptibility in the region.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The aim of this study was to evaluate whether community-based nurse-led continence care interventions are effective in improving outcomes for adult Chinese primary care patients with lower urinary ...tract symptoms (LUTS).
A case-controlled intervention study was conducted. An intervention group of 360 primary care patients enrolled into a nurse-led continence care programme were recruited by consecutive sampling. A control group of 360 primary care patients with LUTS identified by screening were recruited from the waiting rooms of primary care clinics by consecutive sampling. Both groups were monitored at baseline and at 12 months.
Outcome measures included symptom severity, health-related quality of life (HRQOL), self-efficacy, global health and self-reported health service utilization at 12-months. The effect of the continence care programme on symptom severity and HRQOL was assessed by the difference-in-difference estimation, using independent t-test and multiple liner regression. Chi-square test was used to compare the self-efficacy, global health and self-reported health service utilization between the two groups at 12-months.
After adjusting for baseline severity and socio-demographics, the intervention group had significant improvements in LUTS severity (P<0.05) and HRQOL (P<0.05). Improvements in the amount of urine leakage were not significantly different between the two groups. A higher proportion of subjects in the intervention group reported increased self-efficacy (43.48% vs. 66.83%), improved global health condition (17.74% vs. 41.5%), having doctor consultation (18.5% vs. 8.06), having medication due to LUTS (26.50% vs.11.29%) and having non-drug therapy due to LUTS (59.5% vs.9.68%).
Community-based nurse-led continence care can effectively alleviate symptoms, improve health-related quality of life, and enhance self-efficacy and the global health condition of Chinese male and female primary care patients with LUTS.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Don't throw the past away You might need it some rainy day Dreams can come true again When everything old is new again -Everything Old is New Again, Peter Allen It was August 1971 when our Corps ...published the very first edition of The Army Lawyer (TAL). ...TAL published in August 1971, along with the approximately 530 subsequent monthly editions, were distributed in hard copy format to every active duty judge advocate. To every judge advocate, legal administrator, paralegal, and JAGC civilian, on behalf of MG Risch, RCSM Martinez, Mr. Steddum, Mr. Shea, and the entire JAGC leadership team, we hope that this hard copy publication finds its way into your inbox, your office waiting rooms, gathering areas, metro bus commute bags, night stands, kitchen counters, and coffee tables.
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