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Introduction: Previous studies have shown that patients in the emergency department (ED) are frequently given incomplete discharge instructions that are written at least four grade levels above the recommended sixth-grade reading level, leading to poor understanding. Our aims in this study were to implement standardized discharge instructions containing six key components written at a more appropriate reading level for common emergency department (ED) diagnoses to improve patient understanding.Methods: We conducted this study in a 20-bed ED at an urban Veteran’s Administration hospital. Data was collected via in-person patient and clinician interviews. Patient interviews were conducted after patients received their discharge instructions. We compared patient responses to clinician responses and marked them as incorrect, partially correct, or correct with a score of 0, 0.5, or 1, respectively. The maximum possible score for each interview was six. Six key components of discharge instructions were asked about: diagnosis; new medications; at-home care; duration of illness; reasons to return; and follow-up. There were 25 patients in the pre-intervention group and 20 in the intervention group with the standardized set of instructions. We performed a Mann-Whitney U test on the total interview scores in the control and intervention groups and conducted a sub-analysis on the individual scores for each of the six key components.Results: The patients in the intervention demonstrated a statistically significant increase in patient-clinician correlation when compared to the patients in the pre-intervention group overall (P < 0.05), and two of the six key components of the discharge instructions individually showed statistically significant increase in patient-clinician correlation when standardized discharge instructions were used.Conclusion: Patients who received the standardized discharge instructions had improved understanding of their discharge instructions. Future opportunities extending off this pilot study include expanding the number of diagnoses for which standardized instructions are used and investigating patient-centered outcomes related to these instructions.

Public health agencies are increasingly concerned with ensuring that they are maximizing limited resources by delivering effective programs to enhance population-level health outcomes. Preventing mis-implementation (ending effective activities prematurely or continuing ineffective ones) is necessary to sustain public health efforts and resources needed to improve health and well-being. The purpose of this paper is to identify the important qualities of leadership in preventing mis-implementation of public health programs. In 2019, 45 state health department chronic disease employees were interviewed via phone and audio-recorded, and the conversations were transcribed verbatim. Thematic analysis focused on items related to mis-implementation and the manners in which leadership were involved in continuing ineffective programs. Final themes were based on a Public Health Leadership Competency Framework. The following themes emerged from their interviews regarding the important leadership competencies to prevent mis-implementation: '(1) leadership and communication; (2) collaborative leadership (3) leadership to adapt programs; (4) leadership and organizational learning and development; and (5) political leadership'. This first of its kind study showed the close interrelationship between mis-implementation and leadership. Increased attention to public health leader competencies might help to reduce mis-implementation in public health practice and lead to more effective and efficient use of limited resources.

BackgroundAvoidant/Restrictive Food Intake Disorder (ARFID) is a comparatively new DSM-5 diagnosis. In an effort to better understand this heterogeneous patient group, this study aimed to describe the physical and psychological attributes of children and adolescents with ARFID, and to compare them to patients with full-threshold or atypical anorexia nervosa (AN).MethodsChildren and adolescents aged 7-to-19 years (N = 193) were examined upon presenting at a pediatric eating disorder center between July 2015 and December 2017. Data included diagnosis assessed via the semi-structured Eating Disorder Examination interview along with measures of anthropometrics, depression, anxiety, self-esteem, perfectionism and clinical impairment.ResultsCompared to AN and atypical AN (n = 87), patients with ARFID (n = 106) were significantly younger (12.4 vs. 15.1 years, p

Objective: Fear of Aversive Consequences (FOAC), such as choking or vomiting, is an important associated feature of Avoidant/Restrictive Food Intake Disorder (ARFID). However, the manifestation of FOAC in young children is poorly understood. This study aimed to describe the fears of children with ARFID symptoms and examine the concordance between parent and child ratings of fear. Method: Child‐reported FOAC was assessed using an interview designed for children between 6 and 10 years old, the Gustatory Avoidance and Gastrointestinal Stress Symptoms (GAGSS). Parents were administered a semi‐structured diagnostic interview regarding their child's symptoms, the Pica, ARFID, and Rumination Interview. Results: Among 68 children with ARFID diagnoses or symptoms (41.2% female, 85.3% White, mean age = 8.2 years, SD = 1.1 years; range 5.2–9.9 years), 91.2% of children endorsed at least one fear relative to 26.5% of parents. Among parent–child dyads, 36.8% disagreed about the child's fear of stomach pain (κ = 0.12) and 48.5% disagreed about the child's fear of vomiting, (κ = 0.08), both indicating low inter‐rater reliability. On average, children endorsed 4.3 (SD = 2.3) fears out of 9 options. The most frequently endorsed fears were that food will "taste bad," (n = 43, 63.2%), "make you gag" (n = 37, 54.4%), and "look disgusting" (n = 36, 52.9%). Discussion: Findings highlight ways in which fear may manifest in children with ARFID that are not easily discernable by adults. Greater precision in depicting childhood fears may facilitate the earlier detection of problematic eating behaviors. [ABSTRACT FROM AUTHOR]

Objective: This study was the first phase of a broader project designed to develop a new tool to screen social and emotional well‐being (SEWB). Its objective was to identify words used by First Nations people living in the Torres Strait (Zenadth Kes) and Northern Peninsula Area (NPA) to describe and discuss SEWB. We pay our respects to Elders past and present. We acknowledge the First Nations peoples who took part in this project as holders of their cultural knowledge now and forevermore. Setting: This study took place in community and primary health care settings located on islands of the Torres Strait and NPA of Australia. Participants: Twelve yarns with 35 community members and health professionals were led by Torres Strait Islander members of the project team between August and December 2022. Design: This study employed a descriptive qualitative design. Yarning, an Australian First Nations relational method, was used to share stories about SEWB. All but one yarn was audio recorded and subsequently professionally transcribed. Inductive thematic analysis was used to analyse the yarns. Results: Worry, sad and stress were the words most often used by participants to describe feelings of low SEWB. Signs of low SEWB included behaviour change, particularly significantly reduced community engagement. Conclusions: Worry is not a word that is used in Australian mainstream tools that screen for psychological distress. Findings of this study indicate that a question that asks about worries should be included when screening for low SEWB in Australian First Nations peoples living in the Torres Strait and NPA. [ABSTRACT FROM AUTHOR]

Original citation: J Clin Invest. 2011;121(12):4758-4774. https://doi.org/10.1172/JCI59492. Citation for this corrigendum: J Clin Invest. 2023;133(20):e175163. https://doi.org/10.1172/JCI175163. In the original version of Figure 1C, the genotype labels were incorrect for the [...]

Purpose: Describe direct oral anticoagulant (DOAC) level ordering and interpretation practices in association with clinical outcomes at a vascular medicine clinic. Methods: This study was a retrospective, observational study including patients who had a DOAC level ordered and assessed while on DOAC therapy. The primary outcome was the proportion of DOAC levels within previously reported ranges. Secondary outcomes included thrombotic events, major and clinically relevant non-major bleeding events, and the proportion of DOAC level results which prompted a change in the therapeutic plan. Results: A total of 43 patients who had a DOAC level ordered while on DOAC therapy were included in the study. More patients were on apixaban than other DOACs, and the most common indication for anticoagulation was deep vein thrombosis (DVT) or pulmonary embolism (PE). The most common reasons for ordering DOAC levels included history of gastric bypass (n = 20) and drug-drug interactions (n = 8). Most patients on apixaban had in-range levels (n = 24) compared to out of-range levels (5 patients). More patients on rivaroxaban had a level out-of-range (n = 10) than in-range (n = 4). One patient had a DVT, resulting in hospitalization and change in DOAC therapy. Two patients had bleeding events, with 1 hospitalization and change in DOAC therapy. DOAC level results also prompted changes in therapeutic plans for 9 of the patients. Conclusion: DOAC level results did not always correlate with expected outcomes, and further research is warranted to clarify which clinical situations may benefit from ordering DOAC levels. [ABSTRACT FROM AUTHOR]

Children with Autism Spectrum Disorder (ASD) and other Developmental Disabilities (DD) often have deficits in social, play, and language which often require substantial support to develop the skills. Caregivers and educators are often tasked with developing these skills and working to transfer those acquired skill sets across settings and people (i.e. parents, day care workers, family members). Oftentimes, these naturally occurring skills are more challenging to teach since they require ongoing attention, interaction, and skill promotion from the educators and caregivers. As a result, these skills are sometimes underdeveloped or not worked on as frequently, which in turn, presents greater hardships on families and caregivers. The current study used a multiple treatment design to evaluate the efficacy of three different interventions on promoting and maintaining staff to client interactions during breaks. Treatment one included the antecedent intervention of posted rules; treatment two included the consequence intervention of posted graphical data; the final treatment was a function based treatment (based upon the results of the PDC-HS) which included direct manipulation of immediate consequences for staff to client interactions. Results showed that staff performed at a higher, and more consistent rate, when the treatment was function-based and directly/immediately related to their behavior. This simple manipulation shows promise in promoting the development of staff and family responses that are needed to enhance skill sets that are sometimes more challenging, yet necessary, to develop.

Background: Post-extubation dysphagia occurs in 3% to 62% of adults who have received invasive mechanical ventilation in an intensive care unit (ICU). A stepwise approach to identify dysphagia includes a routine swallow screening in patients who are recently extubated followed by a formal assessment by a Speech and Language Pathologist (SLP), in the event of a failed swallow screen, has been suggested. This quality improvement project aimed to implement and evaluate a new post-extubation swallow screening process. Methods: Using the Model for Improvement framework, a new process that included the Yale Swallow Protocol (YSP) was developed, implemented, and evaluated between July and December 2022 in a 20-bed tertiary ICU. All patients with at least four hours post-extubation were included in the project. Process development included a literature review and feedback from ICU educators, nurses, physicians, SLPs, and Registered Dietitians (RDs). Education was provided to critical care nurses prior to implementation. Data on patient characteristics, process indicators, and outcomes were collected between September and December 2022 to evaluate the project implementation. Descriptive statistics were used to describe the data and bivariate analyses were used to compare data between patients who passed and failed the YSP. Results: Fifty-four patients were extubated and evaluated using the new swallow screening process. Post-extubation dysphagia was diagnosed by an SLP in 30.0% of patients. Dysphagia was diagnosed in 90.0% of patients who failed, compared with 8.6% of patients who passed the YSP (P<0.001). Conclusion: A swallow screening process using the YSP was successfully adopted in a tertiary ICU. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to validate the Kimberley Indigenous Cognitive Assessment—Cognitive Component (KICA‐Cog) adapted for dementia screening in Torres Strait Islander Peoples. Methods: Data were obtained from a broader dementia prevalence study completed in the Torres Strait and Northern Peninsula Area between 2015 and 2018. Modifications were made to items from the original KICA‐Cog to ensure they were culturally appropriate for the Torres Strait. All participants completed a KICA‐Cog and had a comprehensive dementia assessment with a geriatrician experienced in cross‐cultural assessment. Results: A total of 255 Torres Strait residents aged 45 years and over completed a KICA‐Cog and underwent geriatric assessment. The adapted KICA‐Cog showed good validity for dementia diagnosis with a cut point of 33/34 associated with a sensitivity of 81% and specificity of 92% with an area under the ROC curve of 0.91. Conclusions: The KICA‐Cog, when modified for the Torres Strait, is a valid cognitive screening tool for dementia. Caution is required when interpreting test scores, as the adapted KICA‐Cog had slightly lower sensitivity (ability to detect people with dementia) than the original KICA‐Cog. As with all short cognitive tests, individuals with a low KICA‐Cog scores should undergo further medical investigations before a dementia diagnosis is considered. [ABSTRACT FROM AUTHOR]

Health promotion programs and strategies have the potential to support people to live healthier lives. Dementia, a collective name for brain disorders that impact thinking and memory, affects over 55 million people worldwide. Currently, there is no cure for dementia, so prevention is critical. Health promotion has the potential to reduce dementia by targeting the twelve potentially modifiable risk factors. A project currently being undertaken by the research team aims to strengthen the quality of clinical care and health services that specifically address dementia risk for Australian Aboriginal and Torres Strait Islander peoples. One of the intended strategies supporting the project's aim is the need for appropriate and safe health promotion programs and resources that support dementia risk reduction. Consequently, the aim of this scoping review is to identify and determine the quality and appropriateness of existing health promotion programs and resources aimed at dementia risk reduction developed or modified for Indigenous populations of Canada, the USA, Aotearoa New Zealand, and Australia that could be incorporated into the broader project. The Joanna Briggs Institute method for scoping reviews will be used to identify programs and resources focussed on dementia risk reduction for Indigenous peoples. Searches will be limited to the English language and literature published since January 2010. Databases to be searched include: CINAHL, Medline, PsychInfo, PubMed, Scopus and Google. Data that answers the research questions will be extracted from the literature and recorded on a data charting form. A combination of quantitative and qualitative methods will be used to analyse the findings of the scoping review. Dissemination of the findings through continuing community engagement, conference presentations and publications will be led by Aboriginal and Torres Strait Islander members of the research team. [ABSTRACT FROM AUTHOR]

Employee health promotion programs increase work productivity and effectively reduce employer costs related to health care and absenteeism, and enhance worker productivity. Components of an effective worksite health program include stress management, exercise and nutrition and/or weight management classes or counseling. Few studies have documented correlates of health behaviors in school-based employees. A multi-component survey was used to examine relationships among stress, physical activity and specific food choices among employees in a southeastern Louisiana school district. Significant differences were found in coping styles by gender and employee status. Findings also indicated that employees who selected healthful foods were more likely to use task-oriented coping, considered an effective coping style. Further those employees who engaged in vigorous physical activity on a regular basis reported less perceived stress as well as more effective coping strategies. Since these behaviors appear to be interrelated, those conducting health promotion programs may consider a multi-dimensional approach when planning programs for employees. Intervention studies in a school-based population are needed to examine specific effects of different coping styles and healthy behaviors on employee productivity. (Contains 5 tables.)