Universal Screening in Primary Care Practices by Self-administered Tablet vs Nursing Staff.
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ABSTRACT:
SUBMITTER: Miller DP
PROVIDER: S-EPMC8905387 | biostudies-literature | 2022 Mar
REPOSITORIES: biostudies-literature
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Universal Screening in Primary Care Practices by Self-administered Tablet vs Nursing Staff.
Miller David P DP Foley Kristie L KL Bundy Richa R Dharod Ajay A Wright Elena E Dignan Mark M Snavely Anna C AC
JAMA network open 20220301 3
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Project description:BACKGROUND:There is evidence to suggest that rates of hearing loss are increasing more rapidly than the capacity of traditional audiometry resources for screening. A novel innovation in tablet, self-administered portable audiometry has been proposed as a solution to this discordance. The primary objective of this study was to validate a tablet audiometer with adult patients in a clinical setting. Secondarily, word recognition with a tablet audiometer was compared against conventional audiometry. METHODS:Three distinct prospective adult cohorts underwent testing. In group 1 and group 2 testing with the automated tablet audiometer was compared to standard sound booth audiometry. In Group 1, participants' pure tone thresholds were measured with an automated tablet audiometer in a quiet clinic exam room. In Group 2, participants completed monosyllabic word recognition testing using the NU-6 word lists. In Group 3, internal reliability was tested by having participants perform two automated tablet audiometric evaluation in sequence. RESULTS:Group 1 included 40 patients mean age was 54.7 ± 18.4 years old and 60% female; Group 2 included 44 participants mean age was 55.2 ± 14.8 years old and 68.2% female; Group 3 included 40 participants with mean age of 39.4 + 15.9 years old and 60.5% female. In Group 1, compared to standard audiometry, 95.7% (95% CI: 92.6-98.9%) of thresholds were within 10 dB. In Group 2, comparing word recognition results, 96.2% (95% CI: 89.5-98.7%) were clinically equivalent and within a critical difference range. In Group 3, One-way Intraclass Correlation for agreement for the both left- and right-ear pure tone average was 0.98. The mean difference between repeat assessments was 0 (SD = 2.1) in the left ear, and 0.1 (SD = 1.1) in the right ear. CONCLUSION:Puretone audiometry and word recognition testing appears valid when performed by non-healthcare experts using a tablet audiometer outside a sound booth in a quiet environment. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT02761798. Registered April, 2016 < https://clinicaltrials.gov/ct2/show/NCT02761798>.
| S-EPMC6839098 | biostudies-literature
Project description:IntroductionAs the population ages, the prevalence of cognitive impairment is expanding. Given the recent pandemic, there is a need for remote testing modalities to assess cognitive deficits in individuals with neurological disorders. Self-administered, remote, tablet-based cognitive assessments would be clinically valuable if they can detect and classify cognitive deficits as effectively as traditional in-person neuropsychological testing.MethodsWe tested whether the Miro application, a tablet-based neurocognitive platform, measured the same cognitive domains as traditional pencil-and-paper neuropsychological tests. Seventy-nine patients were recruited and then randomized to either undergo pencil-and-paper or tablet testing first. Twenty-nine age-matched healthy controls completed the tablet-based assessments. We identified Pearson correlations between Miro tablet-based modules and corresponding neuropsychological tests in patients and compared scores of patients with neurological disorders with those of healthy controls using t tests.ResultsStatistically significant Pearson correlations between the neuropsychological tests and their tablet equivalents were found for all domains with moderate (r > 0.3) or strong (r > 0.7) correlations in 16 of 17 tests (p < 0.05). All tablet-based subtests differentiated healthy controls from neurologically impaired patients by t tests except for the spatial span forward and finger tapping modules. Participants reported enjoyment of the tablet-based testing, denied that it provoked anxiety, and noted no preference between modalities.ConclusionsThis tablet-based application was found to be widely acceptable to participants. This study supports the validity of these tablet-based assessments in the differentiation of healthy controls from patients with neurocognitive deficits in a variety of cognitive domains and across multiple neurological disease etiologies.
| S-EPMC10247386 | biostudies-literature
Project description:BackgroundIn many regions of the world, tracheostomy care is a major health concern. Many patients die as a result of nurses' lack of awareness regarding tracheostomy care. This study was carried out to report the acquired training, clinical experience and team approach while caring for patients with tracheostomies and then evaluate these aspects on nurses' confidence in caring for these patients.MethodsA cross-sectional descriptive study involving a self-administered questionnaire was carried out among nurses from October 2020 to June 2021. A self-administered questionnaire including questions on sociodemographic characteristics, tracheostomy training and support and confidence in caring for patients with tracheostomies. It was disseminated electronically to the nurses working in a tertiary medical center in Saudi Arabia with multiple reminders. Group difference was determined using t test and chi square tests appropriately with a set p value to less than 0.05.ResultsA total of 315 nurses with different educational backgrounds were included. The majority were females, middle aged and gained their nursing degree from outside the country. Over 30% of the nurses cared for patients with tracheostomies while more than two thirds did not receive adequate training to care for this patient population. Confidence was reflected in the working units, the time spent caring for these patients and the number of patients cared for. Additionally, nurses caring for children and adults with tracheostomies were more confident in their care than those caring for adolescents and older adults.ConclusionContinuous training and competency evaluation are vital in delivering optimal care. Confidence level is impacted by training received and by the presence of assisted ventilation. Future studies should aim for a national representation of this topic to inform policy and practice.
| S-EPMC9780093 | biostudies-literature
Project description:This study highlights the organisational-level factors that become the reason for propagating hostile behaviours among female nurses. Freire’s theory of oppression has been used as an underpinning theory for developing the conceptual framework. This study empirically verifies the conceptual framework of the study that gender discrimination and lack of administrative support are the antecedents of person-related hostility, which is the reason for poor job performance in the healthcare sector. We applied a quantitative research approach, using questionnaires to collect data. Total of 707 survey forms were collected from female nurses working in public sector hospitals in four main cities of Pakistan. The software SPSS 20 and SmartPLS 3 were used for the final data analysis. All hypotheses regarding the direct and indirect relationship of variables were accepted. Gender discrimination and lack of administrative support were positively associated with person-related hostility. Moreover, person-related hostility also mediated the relationship between independent variables (gender discrimination, lack of administrative support) and dependent variable (poor job performance). Future research is directed to study person-related hostility among nursing staff of semi-urban areas and small towns with low literacy rates, considering other dependent variables like burnout, mental well-being, and mental health. HR strategies and policies for fair performance evaluation and timely promotions of nursing professionals are proposed in the study for building an overall healthy environment.
| S-EPMC10020078 | biostudies-literature
Project description:BackgroundIn the United States, universal screening for human T-lymphotropic virus (HTLV) in deceased organ donors was discontinued in 2009. Since then, the transplant guideline suggests considering targeted screening. However, the outcomes of this change in HTLV screening have not been evaluated.MethodsUsing the Organ Procurement and Transplantation Network database between 2010 and 2022, we analyzed the HTLV antibody screening frequency and seroprevalence in potential deceased organ donors and their correlations with HTLV infection risks, including race and high-risk behaviors for blood-borne pathogen infection. Although targeted screening has not been established for HTLV, we hypothesized that screening rates should correlate with the proportions of donors with infection risk if screening is targeted. We also evaluated the organ utilization of HTLV-seropositive donors.ResultsOf 130 284 potential organ donors, 22 032 (16.9%) were tested for HTLV antibody. The proportion of donors tested for HTLV varied between Organ Procurement Organizations (median [interquartile range], 3.8% [1.0%-23.2%]; range, 0.2%-99.4%) and was not correlated to HTLV infection risks. There were 48 seropositive donors (0.22%), and at least 1 organ from 42 of these donors (87.5%) was transplanted. The number of organs recovered and transplanted per donor was significantly lower in HTLV-seropositive than in HTLV-negative donors (recovered, 2 [2-3] versus 3 [3-5], P < 0.001; transplanted, 2 [1-3] versus 3 [2-4], P < 0.001). However, HTLV-1 infection was not attributed as the cause of nonrecovery except for only 1 HTLV-seropositive donor.ConclusionsHTLV screening practices varied across the United States. Our findings suggest that targeted screening was not performed after the elimination of universal screening.
| S-EPMC11410323 | biostudies-literature
Project description:BackgroundSubstance use disorders, depression and anxiety disproportionately affect people with HIV (PWH) and lead to increased morbidity and mortality. Routine screening can help address these problems but is underutilized. This study sought to describe patient and provider perspectives on the acceptability and usefulness of systematic electronic, self-administered screening for tobacco, alcohol, other substance use, and mental health symptoms among patients in HIV primary care.MethodsScreening used validated instruments delivered pre-appointment by both secure messaging and clinic-based tablets, with results integrated into the electronic health record (EHR). Qualitative analysis of semi-structured interviews with 9 HIV primary care providers and 12 patients in the 3 largest HIV primary care clinics in the Kaiser Permanente Northern California health system who participated in a clinical trial evaluating computerized screening and behavioral interventions was conducted. Interviews were audio-recorded and transcribed. A thematic approach was utilized for coding and analysis of interview data using a combination of deductive and inductive methods.ResultsFour key themes were identified: (1) perceived clinical benefit of systematic, electronic screening and EHR integration for providers and patients; (2) usefulness of having multiple methods of questionnaire completion; (3) importance of the patient-provider relationship to facilitate completion and accurate reporting; and (4) barriers, include privacy and confidentiality concerns about reporting sensitive information, particularly about substance use, and potential burden from repeated screenings.ConclusionsFindings suggest that electronic, self-administered substance use and mental health screening is acceptable to patients and may have clinical utility to providers. While offering different methods of screening completion can capture a wider range of patients, a strong patient-provider relationship is a key factor in overcoming barriers and ensuring accurate patient responses. Further investigation into facilitators, barriers, and utility of electronic screening for PWH and other high-priority patient populations is indicated. Trial registration ClinicalTrials.gov, NCT03217058. Registered 13 July 2017, https://clinicaltrials.gov/ct2/show/NCT03217058.
| S-EPMC8827178 | biostudies-literature
Project description:The time required to conduct drug and alcohol screening has been a major barrier to its implementation in mainstream healthcare settings. Because patient self-administered tools are potentially more efficient, we translated the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) into an audio guided computer assisted self interview (ACASI) format. This study reports on the test-retest reliability of the ACASI ASSIST in an adult primary care population. Adult primary care patients completed the ACASI ASSIST, in English or Spanish, twice within a 1-4 week period. Among the 101 participants, there were no significant differences between test administrations in detecting moderate to high risk use for tobacco, alcohol, or any other drug class. Substance risk scores from the two administrations had excellent concordance (90-98%) and high correlation (ICC 0.90-0.97) for tobacco, alcohol, and drugs. The ACASI ASSIST has good test-retest reliability, and warrants additional study to evaluate its validity for detecting unhealthy substance use.
| S-EPMC4035183 | biostudies-literature
Project description:BackgroundBurnout among primary care physicians, advanced practice clinicians (nurse practitioners and physician assistants [APCs]), and staff is common and associated with negative consequences for patient care, but the association of burnout with characteristics of primary care practices is unknown.ObjectiveTo examine the association between physician-, APC- and staff-reported burnout and specific structural, organizational, and contextual characteristics of smaller primary care practices.DesignCross-sectional analysis of survey data collected from 9/22/2015-6/19/2017.SettingSample of smaller primary care practices in the USA participating in a national initiative focused on improving the delivery of cardiovascular preventive services.Participants10,284 physicians, APCs and staff from 1380 primary care practices.Main measureBurnout was assessed with a validated single-item measure.Key resultsBurnout was reported by 20.4% of respondents overall. In a multivariable analysis, burnout was slightly more common among physicians and APCs (physician vs. non-clinical staff, adjusted odds ratio [aOR] = 1.26; 95% confidence interval [CI], 1.05-1.49, APC vs. non-clinical staff, aOR = 1.34, 95% CI, 1.10-1.62). Other multivariable correlates of burnout included non-solo practice (2-5 physician/APCs vs. solo practice, aOR = 1.71; 95% CI, 1.35-2.16), health system affiliation (vs. physician/APC-owned practice, aOR = 1.42; 95%CI, 1.16-1.73), and Federally Qualified Health Center status (vs. physician/APC-owned practice, aOR = 1.36; 95%CI, 1.03-1.78). Neither the proportion of patients on Medicare or Medicaid, nor practice-level patient volume (patient visits per physician/APC per day) were significantly associated with burnout. In analyses stratified by professional category, practice size was not associated with burnout for APCs, and participation in an accountable care organization was associated with burnout for clinical and non-clinical staff.ConclusionsBurnout is prevalent among physicians, APCs, and staff in smaller primary care practices. Members of solo practices less commonly report burnout, while members of health system-owned practices and Federally Qualified Health Centers more commonly report burnout, suggesting that practice level autonomy may be a critical determinant of burnout.
| S-EPMC6258608 | biostudies-literature
Project description:BackgroundFood hygiene in hospital poses peculiar problems, particularly given the presence of patients who could be more vulnerable than healthy subjects to microbiological and nutritional risks. Moreover, in nosocomial outbreaks of infectious intestinal disease, the mortality risk has been proved to be significantly higher than the community outbreaks and highest for foodborne outbreaks. On the other hand, the common involvement in the role of food handlers of nurses or domestic staff, not specifically trained about food hygiene and HACCP, may represent a further cause of concern. The purpose of this study was to evaluate knowledge, attitudes, and practices concerning food safety of the nursing staff of two hospitals in Palermo, Italy. Association with some demographic and work-related determinants was also investigated.MethodsThe survey was conducted, by using a semi-structured questionnaire, in March-November 2005 in an acute general hospital and a paediatric hospital, where nursing staff is routinely involved in food service functions.ResultsOverall, 401 nurses (279, 37.1%, of the General Hospital and 122, 53.5%, of the Paediatric Hospital, respectively) answered. Among the respondents there was a generalized lack of knowledge about etiologic agents and food vehicles associated to foodborne diseases and proper temperatures of storage of hot and cold ready to eat foods. A general positive attitude towards temperature control and using clothing and gloves, when handling food, was shared by the respondents nurses, but questions about cross-contamination, refreezing and handling unwrapped food with cuts or abrasions on hands were frequently answered incorrectly. The practice section performed better, though sharing of utensils for raw and uncooked foods and thawing of frozen foods at room temperatures proved to be widely frequent among the respondents. Age, gender, educational level and length of service were inconsistently associated with the answer pattern. More than 80% of the respondent nurses did not attend any educational course on food hygiene. Those who attended at least one training course fared significantly better about some knowledge issues, but no difference was detected in both the attitude and practice sections.ConclusionResults strongly emphasize the need for a safer management of catering in the hospitals, where non professional food handlers, like nursing or domestic staff, are involved in food service functions.
| S-EPMC1852552 | biostudies-literature
Project description:BackgroundCognitive screening is limited by clinician time and variability in administration and scoring. We therefore developed Self-Administered Tasks Uncovering Risk of Neurodegeneration (SATURN), a free, public-domain, self-administered, and automatically scored cognitive screening test, and validated it on inexpensive (<$100) computer tablets.MethodsSATURN is a 30-point test including orientation, word recall, and math items adapted from the Saint Louis University Mental Status test, modified versions of the Stroop and Trails tasks, and other assessments of visuospatial function and memory. English-speaking neurology clinic patients and their partners 50 to 89 years of age were given SATURN, the Montreal Cognitive Assessment (MoCA), and a brief survey about test preferences. For patients recruited from dementia clinics (n = 23), clinical status was quantified with the Clinical Dementia Rating (CDR) scale. Care partners (n = 37) were assigned CDR = 0.ResultsSATURN and MoCA scores were highly correlated (P < .00001; r = 0.90). CDR sum-of-boxes scores were well-correlated with both tests (P < .00001) (r = -0.83 and -0.86, respectively). Statistically, neither test was superior. Most participants (83%) reported that SATURN was easy to use, and most either preferred SATURN over the MoCA (47%) or had no preference (32%).DiscussionPerformance on SATURN-a fully self-administered and freely available (https://doi.org/10.5061/dryad.02v6wwpzr) cognitive screening test-is well-correlated with MoCA and CDR scores.
| S-EPMC7771179 | biostudies-literature