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To decide to change from paper to a paperless hospital, one decides to go on a journey. This chapter will outline the destination, the reasons to make the journey and describe the best route to the destination. Becoming paperless is the route taken to the destination.

BACKGROUND: Mood and adjustment disorders are two major causes of long-term sick leave among employees, leading to large social losses. Therefore, a return to work (RTW) intervention was attempted, targeting patients with mood and adjustment disorders. OBJECTIVE: This study aimed to investigate the outcome of an interdisciplinary RTW intervention including occupational therapy implemented within the Japanese healthcare framework. METHODS: An interdisciplinary RTW intervention including occupational therapy was conducted five times a week for approximately three months, targeting individuals with mood and adjustment disorders who took a leave of absence. Their mental symptoms, cognitive functioning, job performance, temperament, social adaptation, psychosocial state, and readiness to RTW before and after the intervention were evaluated. Full-time RTW ratios at 3, 6, 12, 18, and 24 months from baseline were followed up and compared with those of prior studies. RESULTS: A total of 30 individuals completed the intervention. After the intervention, participants' psychological symptoms, cognitive function, vocational aptitude, temperament, social adaptation, psychosocial state, and readiness to RTW improved (p≤0.001–0.0279). The ratios of RTW at 3, 6, 12, 18, and 24 months from the baseline were 6.7%, 46.7%, 73.3%, 77.8%, and 82.6%, respectively, reflecting a higher pattern than prior reports. CONCLUSIONS: The interdisciplinary RTW intervention including occupational therapy has the potential to improve not only depressive symptoms but also cognitive functioning, job performance, social adaptation, and readiness to RTW. They can also raise RTW ratios. [ABSTRACT FROM AUTHOR]

Current approaches for capacity building in Health Informatics (HI) in developing countries mostly focus on training, and often rely on support from foreign entities. In this paper, we describe a comprehensive and multidimensional capacity-building framework by Lansang & Dennis, and its application for HI capacity building as implemented in a higher-education institution in Kenya. This framework incorporates training, learning-by-doing, partnerships, and centers of excellence. At Moi University (Kenya), the training dimensions include an accredited Masters in HI Program, PhD in HI, and HI short courses. Learning-by-doing occurs through work within MOH facilities at the AMPATH care and treatment program serving 3 million people. Moi University has formed strategic HI partnerships with Regenstrief Institute, Inc. (USA), University of Bergen (Norway), and Makerere University (Uganda), among others. The University has also created an Institute of Biomedical Informatics to serve as an HI Center of Excellence in the region. This Institute has divisions in Training, Research, Service and Administration. The HI capacity-building approach by Moi provides a model for adoption by other institutions in resource-limited settings.

Despite decades of international experience with the use of information and communication technologies in healthcare delivery, widespread telehealth adoption remains limited and progress slow. Escalating health system challenges related to access, cost and quality currently coincide with rapid advancement of affordable and reliable internet based communication technologies creating unprecedented opportunities and incentives for telehealth. In this paper, we will describe how Human Factors Engineering (HFE) and user-centric elements have been incorporated into the establishment of telehealth within a large academic medical center to increase acceptance and sustainability. Through examples and lessons learned we wish to increase awareness of HFE and its importance in the successful implementation, innovation and growth of telehealth programs.

Background: REGISTRY is the largest European observational study of Huntington's disease (HD). The Leiden University Medical Center (LUMC) in The Netherlands is the largest recruiting site. Objective: The aim of this paper is to give an overview of the baseline characteristics of all Leiden participants from the start of the study in 2005 until the close of REGISTRY at the LUMC in September 2014. Methods: The Leiden cohort is described in two different ways: CAG repeat length and presence of motor signs. Results: Division into groups based on prolonged CAG length revealed that the cohort consists of 4 intermediate - (27–35 CAG), 22 reduced penetrance - (36–39 CAG), 465 full penetrance - (>39 CAG) and 60 control participants (<27 CAG). The second way of dividing the participants based on present or absent of motor signs, showed that 170 pre-motormanifest - and 317 motormanifest participants were enrolled. Conclusion: The Leiden REGISTRY cohort at baseline is mainly characterized by full penetrance gene expansion carriers who have been clinically diagnosed with HD but who remain relatively functionally independent. For the majority of these participants, disease onset was based on motor signs followed by psychiatric and cognitive signs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Burnout is not only related to mental health but also to efficiency. Thus, recognizing effective coping strategies has a significant role in improving mental health, the efficiency and productivity of human resources, and making better the level of quality of service. OBJECTIVE: To determine burnout syndrome and examine related factors among the employees of Mashhad University of Medical Sciences. METHOD: This cross-sectional study was conducted among 600 employees at Mashhad University of Medical Sciences. They were selected by a stratified sampling method. The data collection tool was the demographic information and the Burnout Self-Test Maslach Burnout Inventory (MBI) questionnaire. Data were analyzed through SPSS software version 20, using descriptive statistics and independent samples t-tests, one-way ANOVA, and Pearson and Spearman regression. RESULTS: The findings showed that emotional exhaustion (EE) and depersonalization (DP) in the majority of employees were high and personal accomplishment (PA) was low at 88.33% of cases. All participants presented burnout. However, participants aged 35-40 years, those with professional and Ph.D. degrees, and research staff reported higher burnout levels. CONCLUSION: Job burnout and its subscale levels among the employees were high. Job burnout is associated with socioeconomic status that can be affected by individual, organizational, management, and environmental factors. Therefore, this study suggests that employees need to get out of EE and DP conditions for higher job performance. Additionally, further research is required to examine the long-term effects of workplace burnout. [ABSTRACT FROM AUTHOR]

BACKGROUND: Physicians' narratives are means to approach and comprehend the practice of medicine, and physicians' embedment in their work and the healthcare context. OBJECTIVE: This study aimed to explore physicians' professional experiences and to examine how they are affected by factors related to their inner (psychological) and outer (institutional and social) worlds. METHODS: The study was designed as an exploratory qualitative study based on "narrative facilitators" (NF). Their goal is to encourage storytelling and to support the narrative process. The analytic approach was specific for each NF. RESULTS: Thirty-three physicians participated in the study. The findings showed a focus on the transformations of a profession, the need for physicians to adapt in terms of role and status, and their withstanding of conflicting projections from the public and patients (NF: press articles). The institutional context was described as not welcoming and impersonal (NF: photo-based story). When reacting to the quotes from their peers, participants showed a variety of un-patterned stances with respect to different aspects of medicine and the medical profession, illustrating heterogeneity with regard to professional attitudes and identities (NF: quotes from biographies/narrative accounts). Finally, findings also indicated that physicians often limited their narratives to a description of the materiality of the elements put into play (NF: blurred video sequences). CONCLUSION: Disenchanted physicians are not beneficial, neither for the patient nor for the health care system, and their feeling of being worn out may do harm and negatively affect themselves and their families. [ABSTRACT FROM AUTHOR]

BACKGROUND: Traffic road crashes are the leading cause of fatal crashes at work. The circumstances of work-related road accidents have been a regular focus of study, but there is still a lack of knowledge about commuting accidents. OBJECTIVE: The aims of this study were to estimate the overall incidence of commuting accidents for non-physician professionals in a major French university hospital, by gender and different professional categories, and to assess its evolution over a 5-year period. METHODS: A descriptive analysis was performed on 390 commuting accidents from 2012 to 2016 extracted from the university hospital's occupational health service. Incidences of commuting accidents were calculated according to gender, occupational categories, and years. Crude relative risk (RR) for the association of commuting accidents with gender, occupational categories, and year of the accident was also estimated using log-binomial regressions. RESULTS: The annual incidence ranged from 354 to 581 accidents per 100,000 employees. Compared with administrative staff, the relative risk (RR) for commuting accidents for service agents was 1.6 (95% confidence interval (CI): 1.1–2.4) and for auxiliary nurses and childcare assistants was 1.3 (95% CI: 1.0–1.9). Nursing executives had a non-significantly lower RR of 0.6 (95% CI: 0.3–1.5). CONCLUSION: The increased risk observed for the auxiliary nurses and childcare assistants and for the service agents may be related in part to the fatigue caused by work schedules, long commuting distances, physical work, and psychological burden. [ABSTRACT FROM AUTHOR]

The course of developing a new product from an idea is a complicated process. This paper will discuss that process, in detail, from conception to product. We approach this by first discussing what the inventor must do begin the process of developing his or her idea, and then two pathways that occur simultaneously: the Technology Transfer process of patenting, marketing, and licensing the invention; and the engineering process of developing, modifying, and manufacturing the invention. Although the process is lengthy and most ideas never become a marketed product, there are those few ideas that do become realized into marketed products.

BACKGROUND: Increased fear and anxiety among the general public following the emergence of coronavirus 2019 (COVID-19) can lead to hypochondriasis as well as indiscriminate use of drugs, versus the disease. OBJECTIVE: The present study was conducted to identify the frequency and causes of self-medication and hypochondriasis among students. METHODS: This descriptive cross-sectional study was conducted among 241 students of different disciplines of Khalkhal University of Medical Sciences in northwestern Iran over a period of six months. SPSS 26 software, Chi-square and Fisher tests were used to analyze the data. RESULTS: The rate of self-medication was calculated 51%. The highest rate of self-medication was in the form of tablets (75.6%) and capsules (28.5%) and the highest type of medication was herbal medicine (59.3%) and multivitamins and complementary drugs (54.5%). The most common cause of self-medication was previous use and the effectiveness of the drug in the past (79.7%). The mean score of hypochondriasis was calculated at 21.52 (11.02) and the majority of students (49.8%) were in the healthy group. There was a statistically significant association between hypochondriasis and self-medication (p = 0.002). CONCLUSION: Based on the findings, more than half of the participants in the study had self-medication. About 20% of students also experienced mild to moderate hypochondriasis. Therefore, it is suggested that the necessary training and support be provided to deal with the side effects of these two phenomena. [ABSTRACT FROM AUTHOR]

BACKGROUND: Promotions in academic medicine are frequently based on number of publications and leadership positions held. While prior study has established women publish less than men, many evaluations are limited to individual specialties and do not evaluate involvement with educational activities. OBJECTIVE: To compare gender differences in academic output, intramural leadership positions, and educational leadership positions of academic physicians. METHODS: The curriculum vitae and de-identified demographic data of all permanent physicians employed at a multi-site academic medical center were reviewed from April to May 2020. Multivariable logistic and Poisson regressions evaluated leadership positions and number of publications. RESULTS: Of 3,359 physicians in the demographic database, 32.3% (n = 1,087) were women and 72.5% were white (n = 2,510). Of the 3,015 physicians in the curriculum vitae database, 32% (n = 962) were women. Women were more likely (p < 0.001) to be assistant professor (54% vs. 42.7%) and less likely to be associate (18.1% vs. 20.3%) or full professor (14.6% vs. 29.1%). Women assistant professors published 22% fewer articles (ratio estimate = 0.78, p < 0.001), associate professors 18% less (coefficient = 0.82, p < 0.001), and full professors 23% less (coefficient = 0.77, p < 0.001). Fewer women were program directors for residencies (1.6% vs. 2.9%, p = 0.02) or fellowships (5.4% vs. 7.4%, p = 0.04), and held fewer division or department leadership positions (OR 0.8, 95% CI as [0.6, 1.0], p = 0.03). CONCLUSION: Women physicians do not outperform men across any education, leadership, or publication category. A cultural shift is needed to redefine traditional metrics for leadership appointments if academic medicine hopes to achieve equity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Moderate-intensity interval training (MIIT) may be a viable exercise format for improving body composition, aerobic fitness, and health-related variables. OBJECTIVES: This randomized trial aimed to analyze the effect of MIIT or high-intensity interval training (HIIT) on aerobic fitness, body composition variables, and resting metabolic rate (RMR) in women with overweight or obesity. METHODS: 31 sedentary adult women with overweight or obesity performed 7 weeks × 3 weekly sessions of either HIIT or MIIT. Physical and physiological tests were applied before and after training. RESULTS: In both analyses (intention-to-treat and by adherence to the training), aerobic fitness showed a time effect (p = 0.041 and p = 0.015), but without differences between groups (p > 0.05). No group (HIIT vs. MIIT), time (pre vs. post), or interaction effects (group vs. time) were found for RMR, body composition markers (fat mass, body fat percentage, lean mass), or body mass index – BMI (p > 0.05). In addition, MIIT induced a relatively high drop-out rate. CONCLUSIONS: This study suggested that the short-term (7-weeks) interval exercise training was effective for increasing aerobic fitness, and moderate-intensity intervals were as effective as high-intensity intervals. However, neither training format was effective for changing RMR, body composition variables, or BMI of women with overweight or obesity. Clinical trial ID: RBR-9jd7b7. [ABSTRACT FROM AUTHOR]

BACKGOUND: Work ability is an important issue from a social point of view, as it is essential for workers health and welfare. OBJECTIVE: This study aimed to determine work ability among healthcare personnel and to investigate its relationship with demographic and lifestyle-related factors. METHODS: Data were collected using the Work Ability Index (WAI) questionnaire among 517 personnel of a hospital in Tehran, Iran. RSULTS: Findings showed a mean WAI of 40.3 (±5.2) for the study population. Work ability was significantly lower in the older personnel and higher for men. A significant correlation was observed between BMI and exercise activity and WAI score. Moreover, employees with experience of less than five years had significant higher work ability than those with 16-20 years of service. CONCLUSIONS: Considering the young study population, it seems the mean WAI is not as desirable. The use of lifestyle promoting programs, besides workplace interventions, can be an effective strategy to increase work ability among healthcare workers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ophthalmic surgeons experience high levels of physical strain in the neck, lower back, and buttocks. While ergonomic interventions may help to solve these problems, only a few studies have reported chair designs for ophthalmic microsurgery. OBJECTIVE: To design a chair that reduces the physical strain on surgeons and examine its effectiveness in improving posture and reducing seat pressure. METHODS: A prototype chair with a three-dimensional seat surface and a sliding adjustment mechanism for the backrest was designed to fit the surgeon's body. A conventional chair (A) and the prototype chair (B) were compared during microsurgeries performed by five surgeons. Seat pressure was measured using a pressure-sensing device, and the pelvic tilt angle was measured using a gyroscope sensor. RESULTS: A paired t-test indicated significant differences between the chairs: average seat pressure was 70.4±12.7 mmHg for A and 40.5±3.8 mmHg for B (p = 0.008); the maximum seat pressure was 242.2±19.7 mmHg for A and 170.5±38.5 mmHg for B (p = 0.024); contact area was 906.1±114.5 cm2 for A and 1,255.9±60.1 cm2 for B (p < 0.001); and relative value of the pelvic tilt angle was –13.7°±3.7° for A and –7.1°±4.9° for B (p = 0.032). CONCLUSIONS: The prototype chair was associated with lower seat pressure and maintenance of a more neutral posture than the conventional chair, indicating that it may help to reduce physical strain in ophthalmic surgeons. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study is the second leg of a two-leg project. In the first leg, the effect of the COVID-19 pandemic on healthcare workers (HCWs) was investigated in the period between the first case in Turkey and the arrival of the first case in the hospital. OBJECTIVE: In this second leg, three months after the first evaluation, we aimed to investigate whether psychological effects of COVID-19 such as stress, anxiety, depression, and sleep quality have been changed on HCWs. METHODS: This was a 3-month observational study. 169 hospital staff who participated in the first leg of the study were reached and asked to participate in the second leg evaluation in Gaziantep University Medical Faculty Hospital.110 HCWs accepted to participate. Impact of Event Scale (EIS-R), Depression Anxiety Stress Scale (DASS-21), and Pittsburgh Sleep Quality Index (PSQI) were used to assess in both two legs. Paired Sample T-test was used for comparison of normally distributed variables. Wilcoxon test was used for the comparison of abnormally distributed variables. SPSS 22.0 software was used in the analysis of variables. RESULTS: Of the HCWs with an average age of 33.9±6.6 years, 59% (65) were males. There was no significant difference between the two legs in terms of IES-R, DASS-21, and PSQI scales. CONCLUSION: This study suggests that the psychological effects of the COVID-19 pandemic on HCWs started with the pandemic, before the arrival of the first case in the hospital. Also, these psychological effects continued similarly without significant change after the initiation of direct contact with COVID-19 patients and even after the increase in COVID-19 patients in a hospital which in they work. [ABSTRACT FROM AUTHOR]

BACKGROUND: Inappropriate design of chairs and disproportion with students' body dimensions can influence their physical and mental health as well as their educational efficiency and concentration. OBJECTIVE: The aim of this study was to examine the ergonomic status of commonly used chairs in Iran's universities using combinational equations and anthropometric indices. METHODS: Participants in this cross-sectional study were 166 students in Iran. Eleven anthropometric parameters of the students and nine dimensions in seven types of commonly used chairs in Iran's universities were measured. Combinational equations were used to determine the fitness of the chairs. RESULTS: There was a major mismatch between most students' anthropometric measurements and the dimensions of the chairs. Backrest height and seat height were the best and the worst features, respectively, according to ergonomic recommendations for chairs. The recommended measurements of seat height, seat depth, seat width, desk height, desk width, desk length, backrest width, backrest height, and desk distance were 332, 420, 436, 245, 95, 511, 426, 550, and 281 mm, respectively. CONCLUSION: None of the commonly used chairs in Iran's universities were found to be a good fit to the students' anthropometric dimensions. Therefore, in order to prevent inappropriate body postures, chair designs have to reviewed, and made to fit with Iranian students' anthropometric data. The recommended measurements obtained in this study can be used to design a suitable ergonomic chair to match with a high percentage of Iranian students. [ABSTRACT FROM AUTHOR]

The Early Detection Research Network's (EDRN) purpose is to discover, develop and validate biomarkers and imaging methods to detect early-stage cancers or at-risk individuals. The EDRN is composed of sites that fall into four categories: Biomarker Developmental Laboratories (BDL), Biomarker Reference Laboratories (BRL), Clinical Validation Centers (CVC) and Data Management and Coordinating Centers. Each component has a crucial role to play within the mission of the EDRN. The primary role of the CVCs is to support biomarker developers through validation trials on promising biomarkers discovered by both EDRN and non-EDRN investigators. The second round of funding for the EDRN Lung CVC at Vanderbilt University Medical Center (VUMC) was funded in October 2016 and we intended to accomplish the three missions of the CVCs: To conduct innovative research on the validation of candidate biomarkers for early cancer detection and risk assessment of lung cancer in an observational study; to compare biomarker performance; and to serve as a resource center for collaborative research within the Network and partner with established EDRN BDLs and BRLs, new laboratories and industry partners. This report outlines the impact of the VUMC EDRN Lung CVC and describes the role in promoting and validating biological and imaging biomarkers. [ABSTRACT FROM AUTHOR]

The Implementing FAIR Data for People and Machines: Impacts and Implications workshop was organized by the Board on Research Data and Information of the National Academies of Sciences, Engineering, and Medicine (NASEM), the CENDI Federal Information Managers Group, the Research Data Alliance (RDA), and the National Federation of Advanced Information Services (NFAIS), and held at NASEM's Keck Center in Washington, DC on September 11, 2019. The goals of the Implementing FAIR Data workshop were to discuss the current status of FAIR data implementation, share what is being done to encourage scientists to share data in machine-readable formats, and examine the implications of FAIR data implementation for people and machines. FAIR data policies, tools, and measures of FAIR data compliance were considered from multiple perspectives. Marcia McNutt, President of the National Academy of Sciences (NAS), offered opening remarks, and the keynote address was presented by Barend Mons, Professor of Bioinformatics at Leiden University Medical Center and President of the International Science Council's Committee on Data (CODATA). Three panel discussions addressed (1) the perspectives of scientists and administrators from U.S. federal agencies, (2) case studies on the implementation of FAIR data practices, and (3) principles and methods of measuring FAIR data compliance. The automation of scientific workflows was discussed by Stuart Feldman, Chief Scientist of Schmidt Futures, a philanthropic organization devoted to investing in research, technology, and science. The workshop closed with highlights and takeaways from each session as summarized by the moderators, followed by general questions. [ABSTRACT FROM AUTHOR]

BACKGROUND: The brachial plexus is a network of nerves exiting the spinal cord through the fifth, sixth, seventh, and eighth cervical nerves (C5-C8) as well as the first thoracic nerve (T1) to conduct signals for motion and sensation throughout the arm. Brachial plexus birth injuries (BPBI) occur in 1.5 per 1,000 live births. The purpose of this study was to determine the perceived change in musculoskeletal health-related quality of life of brachial plexus patients utilizing the Pediatric Outcomes Data Collection Instrument (PODCI). PODCI scores were examined along with the patient's procedure history (surgical or Botulinum Toxin), extent of involvement and demographics. PATIENTS: A total of 81 patients from two to eighteen years of age from nine different states met the inclusion criteria of having a pre-procedure and post-procedure PODCI score along with a Narakas score from 2002–2017. These patients were seen at the Brachial Plexus Center, which is an interdisciplinary clinic at a large academic medical center METHODS: This retrospective study utilized PODCI data collected annually during their regular brachial plexus clinic visits. Upper extremity (UE) and global functioning (GFx) scores pre- and post-procedure were stratified by Narakas Classification. Data were analyzed using paired t-test and ANOVA testing. RESULTS: Patients with a Brachial Plexus Birth Injury (BPBI) had lower PODCI scores for UE and GFx when compared with the pediatric normative scores for age-matched healthy children. Scores in both UE and GFx domains were higher after procedure in the groups of Narakas I and IV. There was significant correlation between UE and GFx scores and documented first PODCI score (2 years of age) and age at intervention (5 years of age). CONCLUSION: Procedures increased the perceived quality of life for children with a BPBI and increased their overall PODCI scores for both UE and GFx. [ABSTRACT FROM AUTHOR]

BACKGROUND: Several professionals in hospitals can be affected by work-related musculoskeletal disorders (WMSDs). OBJECTIVE: To evaluate and compare the body posture and self-reported musculoskeletal symptoms of employees in the healthcare and administrative section of a university hospital. METHODS: Body posture and self-reported musculoskeletal symptoms of 106 employees were quantitatively evaluated. The sample was divided into two groups: health care group (HCG) composed of 57 professionals (88% were females) with an average age of 34±7 years, mass of 66.52±14.78 kg, height of 1.62±0.07 m, and body mass index (BMI) of 25.37±4.50 kg/m2; and the administrative section group (ADMG) composed of 49 professionals (57% were females) with an average age of 30±7 years, mass of 74.90±14.12 kg, height of 1.68±0.09 m, and BMI of 26.76±4.40 kg/m2. RESULTS: The only significant difference between groups for the body posture was the greater right Q-angle in the CG (p = 0.039). Self-reported musculoskeletal symptoms in the seven days prior to assessment were not associated with work section. CONCLUSION: The work section within the university hospital did not influence body posture or self-reporting of musculoskeletal symptoms among the healthcare and administrative staff. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although work-related injuries are on the decline, rates of work-related traumatic brain injury (wrTBI) continue to rise. As even mild wrTBI can result in cognitive, behavioural, and functional impairments that can last for months and even years, injury prevention is a primary research focus. Administrative claims data have provided valuable insights into the mechanisms that cause wrTBI; however, data from the perspective of injured workers on wrTBI prevention is limited. OBJECTIVE: Our study aimed to better understand the factors that precipitate wrTBI, as perceived by injured workers. METHODS: We recruited 101 injured workers from a neurology services clinic with a province-wide catchment area in a large, urban teaching hospital and studied perceived preventability of these injuries from the injured workers' perspective. RESULTS: Key findings were that nearly 80% of injuries were perceived as preventable, and nearly 25% and 50% of workers reported that they did not receive job and health and safety training, respectively. Less than half of all workers reported being regularly supervised, and of those who were supervised, approximately two-thirds reported that supervision was adequate. Moreover, 84% and 77% reported they were advised to rest and take time-off after the injury, respectively. CONCLUSIONS: Our study is the first to show that the vast majority of injured workers consider their wrTBI to be preventable. In addition, we found that training and supervision are two areas that can be targeted by wrTBI prevention strategies. Our study provides valuable and unique perspectives to consider when designing wrTBI prevention initiatives. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ontario’s occupational health and safety prevention system has identified a need for the systematic collection of occupational exposure data for ongoing surveillance and targeted prevention initiatives. OBJECTIVES: To examine the feasibility of collecting occupational exposure information within a primary care clinical setting. METHODS: Five healthcare centres were recruited. Working patients answered basic occupational exposure questions. Clinicians reviewed the answers with patients. Answers were entered into the patient’s electronic medical records (EMRs). A knowledge broker supported the health centres throughout the trial with background information and linking to occupational expertise. Interviews with administrators and clinicians examined the usefulness of the survey to primary care, the barriers and facilitators, and sought suggestions for sustaining the practice. A cross-case analysis, framed by a conceptual model, was conducted from the feedback. RESULTS: Themes highlighted the importance of clinician and administrator buy-in, the perceived relevance of occupational exposures to primary care clinicians and the patient population, and the need for clinicians to feel confident about the health impact and relevance of occupational exposures to presenting clinical problems. CONCLUSION: Clinicians ask work exposure-related questions when patients have a health concern that the clinicians suspect may be related to a work exposure. No clear clinical purpose for routinely asking exposure questions emerged. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite a rich literature on association between psychosocial factors, the demand-control-support (DCS) model and burnout, there are few integrated frameworks encompassing the DCS model, burnout and intention to quit, particularly in a technological context. OBJECTIVE: This manuscript examines the relationships between psychosocial risks, the demand-control-support (DCS) model, burnout syndrome and intention to quit following the introduction of new software at work. METHODS: Data was collected from agents and advisors working at a Canadian university and using new study management software. An online questionnaire was sent via the university’s internal mail. Finally, 112 people completed the online survey for a response rate of 60.9%. RESULTS: The results of structural equation modeling show that psychological demands, decision latitude and social support are associated with burnout. It is also clear that burnout, in particular depersonalization and emotional exhaustion, is positively associated with intention to quit. CONCLUSIONS: The few studies that raise the negative consequences of technology on quality of life in the workplace, and particularly on health, have not succeeded in establishing a direct link between a deterioration of health and the use of technology. This is due to the fact that there are few epidemiological studies on the direct consequences of the use of ITC on health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Kinesiophobia, fear of physical movement, is the most common reason for not returning to sport after ACLR. Psychological factors influence recovery after anterior cruciate ligament (ACL) reconstruction (ACLR). Those who undergo ACLR display elevated pain levels as a barrier limiting return to pre-surgical levels of sports performance. To date no study investigating this link has been conducted in an Irish population PURPOSE: To identify individuals who have elevated levels of kinesiophobia after ACLR surgery and ascertain if kinesiophobia was a barrier to return to sport. METHODS: Adults who underwent ACLR in University Hospital during a three year period were eligible to participate. Individuals who had a previous history of ACL rupture and with concomitant injuries were excluded. The 179 eligible individuals were posted the Tampa Scale of Kinesiophobia (TSK) a demographic questionnaire and information leaflet to invite them to participate in the study. RESULTS: Forty-five participants that met the inclusion criteria were included in the study. The majority of the respondents (78.4%) reported high levels of kinesiophobia. Many (73.7%) returned to sports participation, however only 42.1% and 47.2% returned to pre-injury sports participation and performance respectively. Subjectively kinesiophobia was a key barrier limiting return to pre-injury level of sports participation and performance. CONCLUSIONS: Kinesiophobia appears to be a key barrier preventing return to pre-injury level of sports participation and performance after ACLR. [ABSTRACT FROM AUTHOR]

BACKGROUND: Non-steroidal anti-inflammatory drugs are considered potentially harmful for patients with heart failure. OBJECTIVE: To determine the prevalence of in-hospital NSAID use their type, associated diagnosis and impact in clinical outcomes among patients with a diagnosis of heart failure. METHODS: The University Health System Consortium Database was used to identify all first hospitalizations with an International Classification of Diseases-9 discharge diagnosis code of systolic heart failure as the primary diagnosis between January 1, 2011 and December 31st 2014. RESULTS: Among 65,902 patients admitted for a primary diagnosis of SHF, 2675 (4.1%) were exposed to NSAID. The most frequent NSAID used was ibuprofen (51.63%), followed by ketorolac (29.38%) naproxen (8.07%) celecoxib (5.61%) and others. On multivariable analyses the length of stay of patients exposed to NSAID was longer compared to non-exposed (OR: 4.67, p < 0.001, 95% CI 4.10-5.25), but differences in mortality were not statistically different (OR: 0.90, p = 0.476, 95% CI 0.69-1.19). CONCLUSION: The use of NSAID in patients admitted with a primary diagnosis of systolic heart failure was low but was associated with longer length of stay. Further studies are needed to understand the impact of NSAID use in this patient population. [ABSTRACT FROM AUTHOR]

The article provides information on aspects related to patient safety and adverse event reporting in a University Hospital. Topics discussed include patient risk management based on mapping and associating events, collection of data based on hospital acquired infection, and diagnosis related group (DRG).

OBJECTIVE: Compare the efficacy of orthoses and patient education with and without the addition to Low-Level Laser Therapy (LLLT - 660 nm, 30 mW, a continuous regime and bean area of 0.06 cm2). The laser irradiation was delivered with the fluency of 10J/cm2 in patients with mild and moderate Carpal Tunnel Syndrome (CTS). METHODS: 48 patients were randomized and 30 finished the protocol (a sample loss of 37.5%), 90% female and 10% males. Randomization was applied to allocate the patients in each one of the groups, with association or not to LLLT (group orthoses or LLLT and orthoses). All of them were submitted to ergonomic home orientations. The short-term symptoms and function outcome were assessed through: Boston Carpal Tunnel Questionnaire (BCTQ) - Severity of Symptoms (SS) Functional Score (FS). Pain (VAS), Semmes-Weinstein monofilaments, 2PD and pinch strength was used for characterization of the sample. Most of the participants were women, over 4th decade enrolled on heavy hand duties occupations, right-handed, 66.7% affected on dominant hand, without alterations in sensory median nerve thresholds or pinch strength. RESULTS: Both groups showed a reduction of total BCTQ score and its subdomains after six weeks, with significant difference (p <0.05), comparing to baseline. No significant difference was found between groups. A Minimal clinical change was observed after the intervention in 92.3% of participants for BCTQ subdomain severity of symptoms at individual comparison for LLLT and orthoses group and 76.5% for the orthoses group, demonstrating clinical relevance. Effect size Cohen's index was moderate for the severity of symptoms. CONCLUSION: LLLT in association to orthoses and ergonomic orientation seems to be effective in short-term symptoms relieve for patients with mild and moderate CTS. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: This double-blind, sham-controlled, crossover case study combined transvertebral direct current stimulation (tvDCS) and locomotor training on a robot-assisted gait orthosis (LT-RGO). OBJECTIVE: Determine whether cathodal tvDCS paired with LT-RGO leads to greater changes in function and neuroplasticity than sham tvDCS paired with LT-RGO. SETTING: University of Kentucky (UK) HealthCare Stroke and Spinal Cord Neurorehabilitation Research at HealthSouth Cardinal Hill Hospital. METHODS: A single subject with motor incomplete spinal cord injury (SCI) participated in 24 sessions of sham tvDCS paired with LT-RGO before crossover to 24 sessions of cathodal tvDCS paired with LT-RGO. Functional outcomes were measured with 10 Meter Walk Test (10MWT), 6 Minute Walk Test (6MWT), Spinal Cord Independence Measure-III (SCIM-III) mobility component, lower extremity manual muscle test (MMT), and Berg Balance Scale (BBS). Corticospinal changes were assessed using transcranial magnetic stimulation. RESULTS: Improvement in 10MWT speed, SCIM-III mobility component, and BBS occurred with both conditions. 6MWT worsened after sham tvDCS and improved after cathodal tvDCS. MMT scores for both lower extremities improved following sham tvDCS but decreased following cathodal tvDCS. Corticospinal excitability increased following cathodal tvDCS but not sham tvDCS. CONCLUSION: These results suggest that combining cathodal tvDCS and LT-RGO may improve functional outcomes, increase corticospinal excitability, and possibly decrease spasticity. Randomized controlled trials are needed to confirm these conclusions. SPONSORSHIP: This publication was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR000117, and the HealthSouth Cardinal Hill Stroke and Spinal Cord Endowment (1215375670). [ABSTRACT FROM AUTHOR]

The Garrison Institute on Aging (GIA) is an established institute within Texas Tech University Health Sciences Center, whose mission is to promote healthy aging through cutting-edge research on Alzheimer's disease (AD) and other diseases of aging through innovative educational opportunities for students, clinicians, researchers, health care professionals, and the public. The GIA has multiple programs, including both research and education on healthy aging and AD, community outreach, caregiving, the Retired Senior Volunteer Program, Healthy Lubbock, the GIA Brain Bank, healthy aging seminars, research seminars, and collaborations and scholarships. The GIA programs connect basic and clinical researchers and health care professionals, and provide a unique environment to help our growing elderly population and patients with AD and their families. [ABSTRACT FROM AUTHOR]

Background: Pagers are the most commonly used method of communications in American hospitals. However, its financial cost and efficiency is unknown.Objective: To evaluate the efficiency of conventional hospital pagers and to estimate the financial cost of time wasted by the use of these pagers.Methods: We conducted a survey among 100 clinicians, nurses and pharmacists in our community teaching hospital, estimating the time spent in the process of sending and responding to pages and the financial equivalent of this time, and evaluating the potential advantages of hospital-based wireless telephones compared with traditional pagers.Results: A total of 70 clinicians completed the survey for a response rate of 70%. The average time spent per daytime shift in using the paging system was between 48 and 66 minutes for physicians, 120 minutes for nurses and 165 minutes for pharmacists. The financial cost of time lost for a single medical ward for one month was estimated to be $2,732-$17,250, depending on the case scenario.Conclusions: Our study suggests that the traditional paging system is an inefficient means of communication between clinicians and hospital staff and that a switch to direct phone calls might be far more cost-effective. Similar considerations probably apply to most hospitals that still use traditional pagers. [ABSTRACT FROM AUTHOR]

BACKGROUND: The lack of specific medicines and labeling recommendations for the pediatric population is a long-standing problem. Using data from an observational study of adverse drug reactions (ADRs) among pediatric inpatients, we aimed to test the hypothesis that off-label status is a risk factor for ADRs. METHODS: A prospective intensive surveillance was conducted at a pediatric ward of a public teaching hospital. Adverse events to labeled and off-label use were assessed for incidence, severity and predictors. A multivariate Cox proportional hazards regression model used to assess off-label use is a risk factor for ADR occurring. RESULTS: Off-label and labeled use were responsible for 34 (67%) and 17 (33%) ADRs respectively. Medicines which lacked complete pediatric labeling had the greatest odds for ADRs (9.21% of medicines in this category were implicated, OR 2.84 (95% CI 1.37-7.09). Number of off-label medicines given to patient significantly increased the hazard of an ADR (hazard ratio (HR) 1.28, 95% CI 0.43-3.78, P = 0.002). Number of medicines given also significantly increased the hazard (HR 1.2, 95% CI 0.80-1.71, P < 0.001). CONCLUSIONS: Use of off-label medicines were more likely to be implicated in an ADR than labeled medicines. This off-label use would be acceptable if evidence of potential benefits outweighs ADRs risk. [ABSTRACT FROM AUTHOR]

BACKGROUND: The goal of this study was to measure an adverse event rate and determine the potential usefulness of the Institute for Healthcare Improvement's Global Trigger Tool (GTT). Besides using the GTT to measure the adverse event rate, a comparison was also made with the internal Voluntary Reporting Notification System (VRNS) to identify and compare the strengths and weaknesses of the two approaches. METHOD: Retrospective data were collected from reported patient safety incidents covering a one-year period at Duzce University Hospital, Turkey. Using a range of selection criteria, a total of 219 patient records were selected and then reviewed by a trained GTT team, to investigate the positive triggers in the content of the patient records. RESULTS: It was determined that adverse events per 1000 patient days totalled 80.72. Adverse events per 100 admissions were 29.39, and the rate of admissions with adverse events was 16.67%. The comparison between the GTT and the VRNS showed that the GTT is 19 times more sensitive than the VRNS in the adverse event evaluation process. CONCLUSION: This is the first published study of the rate of adverse events in a Turkish healthcare setting using the GTT. It was found that the GTT was applicable in this setting, yielding more accurate measurement of the adverse event rate. However, the content of the GTT should be adjusted regarding the standards and documentations used in the Turkish healthcare system to be more useful. [ABSTRACT FROM AUTHOR]

BACKGROUND: The available literature is lacking in reports on the quantitative analysis of posture in patients with lumbar stenosis. OBJECTIVE: The aim of this study was to analyze body posture in patients with lumbar spinal canal stenosis. METHODS: The study involved 100 people: 49 persons with severe lumbar spine stenosis and 51 control subjects without any history of back pain. All participatants were evaluated by a photogrammetric method. RESULTS: Photogrammetric measurements showed statistically significant differences in the shape of the anterior-posterior curvatures of the spine. In the study group thoracic kyphosis was significantly greater (p = 0.043), and the depth of lumbar lordosis was significantly smaller (p = 0.038). The inclination of the thoracolumbar segment was also significantly lower (p = 0.013). CONCLUSIONS: 1. Measurements of body posture indicate a deepening of thoracic kyphosis and flattening of lumbar lordosis in lumbar stenosis patients. 2. Flattening of physiological lordosis seems to be caused by enlargment of the space of the spinal canal and dural sac in this position. [ABSTRACT FROM AUTHOR]

BACKGROUND: Forty to sixty percent of MS patients suffer from cognitive impairments. Cognitive deficits are a great burden for patients affected. In particular they may lead to a reduced quality of life, loss of work and problems with the social environment. OBJECTIVE: The aim of this study was to evaluate a specific neuropsychological rehabilitation program for MS patients according to the ICF to be able to meet more properly individual requirements on the therapy level of function as well as of activities and participation. METHODS: Forty patients with MS were randomised in an intervention (IG) - and a control group (CG). The outcome measure of the IG, who started an intensive computer based home training of attention and attended psychological counselling was compared to the untrained CG. RESULTS: In specific domains of attention (simple and cued alertness and divided attention) significant group differences between CG and IG could be found. The IG reported an improvement of mental fatigue and retardation. CONCLUSION: These findings support the idea that a neuropsychological rehabilitation program, which based on the model of ICF, could improve cognitive impairment and could also have a positive influence of activities and participation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate occupational therapists' job satisfaction under a changing regime by using a time-geographic approach focusing on the therapists' everyday working lives. PARTICIPANTS: Nine occupational therapists at the Copenhagen University Hospital, Gentofte, Denmark. METHOD: A mixed-method design was employed. Occupational therapists kept time-geographic diaries, and the results from them were grounded for individual, semi-structured in-depth interviews. Individual reflections on everyday working life were recorded. Transcribed statements from the interviews were analysed to determine factors influencing job satisfaction. RESULTS: The nine therapists kept diaries for one day a month for a total of 70 preselected days over a period of nine months; six participated in individual interviews. Four factors constraining OT job satisfaction were revealed. Economic concerns, new professional paradigms and methods in combination with a new organisational structure for the occupational therapy service caused uncertainty. In addition, decreasing possibilities for supervision by colleagues influenced job satisfaction. Opportunities for experiencing autonomy in everyday working life were described as facilitators for job satisfaction.CONCLUSION: The time-geographic and interview methods were useful in focusing on the job satisfaction of occupational therapists, who provided individual interpretations of the balance between autonomy and three types of constraints in everyday working life. The constraints related to organisation, power relations and - not least - how the organisational project of the department fitted in with OTs' individual projects. Matching of organisational and individual projects is of crucial importance, not only for OTs but for most workplaces where individuals are employed to serve patients in the healthcare sector. [ABSTRACT FROM AUTHOR]

BACKGROUND: Several studies have examined gender differences in various stroke outcomes. There is however little information on the influence of gender on post-stroke functioning in the context of the International Classification of Functioning, Disability and Health (ICF). OBJECTIVE: Gender differences in selected components of functioning, namely motor performance (body function), activity and participation, were examined in a sample of Nigerian stroke survivors. METHODS: This longitudinal study involved consenting first-incidence stroke survivors who were consecutively recruited from in-patient wards of a University teaching hospital in northern Nigeria. Demographic and clinical data were obtained at recruitment while motor performance, activity and participation were assessed at the 1st, 3rd, 6th, 9th and 12th months using the Simplified Fugl Meyer scale, the Functional Independence Measure Motor Sub-scale and the London Handicap Scale respectively. RESULTS: Participants were thirty-three male (60%) and 22 female (40%) stroke survivors who did not significantly differ in age, stroke sub-type, laterality and initial severity (P > 0.05). There were also no significant differences in motor performance, activity and participation between the male and female stroke survivors across the time points. CONCLUSION: Gender differences were not observed in the components of functioning over the first 12 months post-stroke. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the effect of motor swallowing exercises on swallowing dynamic, quality of life and swallowing complaints in Parkinson's disease (PD). DESIGN: A before-after trial. SETTING: University Medical Center. PARTICIPANTS: Parkinson's disease patients with dysphagia complaints. INTERVENTIONS: Motor swallowing exercises designed to increase the strength and range of motion of the mouth, larynx and pharyngeal structures, coordination between breathing and swallowing, and airway protection. Patients should perform the exercises twice a day, five days a week, for five weeks. MAIN OUTCOME MEASURE(S): The primary outcome was the difference before and after the intervention in number of swallowing videofluoroscopic events (Swallowing Score). The secondary outcomes were quality of life (QOL) and swallowing complaints. RESULTS: Fifteen patients concluded the study (10 man/5 woman; mean age 59.2 ± 9.17). The videofluoroscopic events with greater improvement were loss of bolus control (P < 0.03), piecemeal swallow (P = 0.05) and residue on the tongue (P < 0.01), valleculae (P = 0.01) and pyriform sinuses (P = 0.05). Lingual pumping and dental absence were interfering factors associated with treatment failure (beta standardized coefficient = -16.6, 26.2; P = 0.02, 0.002, respectively). The domains with greater improvements in QOL were fear (P = 0.02) and symptom frequency (P = 0.05). Regarding swallowing complaints, patients reported to have reduced mainly their difficulty in moving food in the mouth when chewing (P = 0.02). Reduction in swallowing disorders was not related with QOL improvement (cor = 0.13, [95% CI, 0.6-0.4], P = 0.63). CONCLUSIONS: Motor swallowing exercises may reduce swallowing disorders in PD patients without lingual pumping and dental absence and impact positively QOL and swallowing complaints in individuals with PD. [ABSTRACT FROM AUTHOR]

BACKGROUND: Elderly persons with traumatic brain injury (TBI) are increasingly admitted to inpatient rehabilitation, but we have limited knowledge of their characteristics, the treatments they receive, and their short-term and medium-term outcomes. This study explored these issues by means of comparisons between age groups. METHODS: Data on 1419 patients admitted to 9 inpatient rehabilitation facilities for initial rehabilitation after TBI were collected by means of (1) abstraction from medical records; (2) point-of care forms completed by therapists after each treatment session; and (3) interviews at 3 months and 9 months after discharge, conducted with the patient or a proxy. RESULTS: Elderly persons (65 or older) had a lower brain injury severity, and a shorter length of stay (LOS) in acute care. During rehabilitation, they received fewer hours of therapy, due to a shorter LOS and fewer hours of treatment per day, especially from psychology and therapeutic recreation. They regained less functional ability during and after inpatient rehabilitation, and had a very high mortality rate. CONCLUSIONS: Elderly people can be rehabilitated successfully, and discharged back to the community. The treatment therapists deliver, and issues surrounding high mortality need further research. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the relationships between the upper extremity functions, upper extremity strength and hand sensation in patients with Multiple Sclerosis (MS). Twenty-two patients with MS (mean age: 38.5 ± 8.31 years, median Expanded Disability Status Scale (EDSS): 2) and 10 healthy subjects were included. Upper extremity function was measured with the Nine-hole peg test, upper extremity strength (shoulder flexion-abduction, elbow flexion, pinch and grip) with hand-held dynamometer, hand grip dynamometer and manual pinch meter, threshold of light touch-pressure with Semmes-Weinstein monofilament, duration of vibration with 128-Hz frequency tuning fork, and distance of two-point discrimination with an aesthesiometer. Strength and functional level of the upper extremity, light touch-pressure, two-point discrimination, vibration sensations of the hand were lower in patients with MS compared with healthy controls (p < 0.05). Light touch-pressure sensation of thumb and index fingers, two-point discrimination of index finger and elbow flexion strength were found to be related with upper extremity function in patients with MS (p< 0.05). These results indicate that the hand sensation, upper extremity strength and function were affected in MS patients. Additionally upper extremity functions seem to be related with light touch-pressure and two-point discrimination sensations of the hand and elbow flexion strength. Upper extremity strengthening and sensorial training of the hand may contribute to the upper extremity function in patients with MS. [ABSTRACT FROM AUTHOR]