Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

Prolonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.     

Interstitial Lung Diseases in the U.S. Mining Industry: Using MSHA Data to Examine Trends and the Prevention Effects of Compliance with Health Regulations, 1996–2015

Given the recent increase in dust‐induced lung disease among U.S. coal miners and the respiratory hazards encountered across the U.S. mining industry, it is important to enhance an understanding of lung disease trends and the organizational contexts that precede these events. In addition to exploring overall trends reported to the Mine Safety and Health Administration (MSHA), the current study uses MSHA's enforcement database to examine whether or not compliance with health regulations resulted in fewer mine‐level counts of these diseases over time. The findings suggest that interstitial lung diseases were more prevalent in coal mines compared to other mining commodities, in Appalachian coal mines compared to the rest of the United States, and in underground compared to surface coal mines. Mines that followed a relevant subset of MSHA's health regulations were less likely to report a lung disease over time. The findings are discussed from a lung disease prevention strategy perspective.     

Teaching technologies for immigrant children: an exploratory study of elementary school teachers in Russia*

ABSTRACT

Educational institutions are an important setting where psychological, pedagogical, sociocultural, and language adaptation of immigrant children occurs. A number of teaching strategies, practices, approaches, and methods have been described in the literature. In the Russian context, such strategies have been called ‘technologies’. The purpose of the present exploratory study was to describe teaching technologies used by teachers in Russia when working with immigrant students in elementary schools. Responses of forty-five elementary school teachers to open-ended questions describing technologies they use when teaching children with migration backgrounds were analyzed using content analysis. Findings suggest that Russian elementary school teachers used ethno-cultural group, communicative technologies, games, individualized instruction, and differentiated teaching. Many approaches mentioned can be used inclusively with groups of immigrant and non-immigrant students. Importantly, while teachers supplemented classroom instruction with additional Russian language lessons, none mentioned specific techniques for teaching Russian as a non-native language. These findings are discussed in relation to teaching strategies described in the international literature focused on migrant students. Finally, implications for further research are discussed.     

Exploring gaps in the online economic inclusion of persons with disabilities in Korea

ABSTRACT

This paper explores the difference in the online economic activities of people with and without disabilities in Korea. We conducted a multiple regression analysis to investigate the impact of socioeconomic characteristics, internet access, and internet skills on online economic activities. Our sample, based on a 2016 dataset that included 1554 people with disabilities and 6004 people without disabilities, was developed using quota sampling based on gender, age, and residence. We determined that individuals with disabilities were more likely to engage in online economic activities if they had higher levels of education, lived in urban areas, were employed, or had greater internet skills. Individuals without disabilities were more likely to engage in online economic activities if they were women, had higher levels of education, were employed, lived in a two-generation or more household, or had greater internet skills. For both people with and without disabilities, the level of education, employment status, and internet skills positively contribute to online economic activites. We also determined that education level, participation in economic activity, living in a two-generation or more household, and internet skills had a statistically significant influence on online economic activity for people both with and without disabilities. These results highlight the importance of education and internet training for people with disabilities, as well as social support systems that help them learn to use the internet in diverse ways through both formal and informal networks. The study also underscores the importance of information and communications technology that adequately addresses people’s needs.     

Heterogeneity in treatment effects across diverse populations

Differences in patient characteristics, including age, sex, and race influence the safety and effectiveness of drugs, biologic products, and medical devices. Here we provide a summary of the topics discussed during the opening panel at the 2018 Johns Hopkins Center for Excellence in Regulatory Science and Innovation symposium on Assessing and Communicating Heterogeneity of Treatment Effects for Patient Subpopulations: Challenges and Opportunities. The goal of this session was to provide a brief overview of FDA-regulated therapeutics, including drugs, biologics and medical devices, and some of the major sources of heterogeneity of treatment effects (HTE) related to patient demographics, such as age, sex and race. The panel discussed the US Food and Drug Administration's role in reviewing and regulating drugs, devices, and biologic products and the challenges associated with ensuring that diverse patient populations benefit from these therapeutics. Ultimately, ensuring diverse demographic inclusion in clinical trials, and designing basic and clinical research studies to account for the intended patient population's age, sex, race, and genetic factors among other characteristics, will lead to better, safer therapies for diverse patient populations.     

Trends in cardiovascular diseases and associated risks in sub-Saharan Africa: a review of the evidence for Ghana,Nigeria, South Africa,Sudan and Tanzania

Background: Sub-Saharan Africa (SSA) countries are facing an epidemiological shift from infectious disease to chronic diseases, such as cardiovascular diseases (CVDs). CVDs incidence in SSA are frequently attributed to the prevalence of hypertension, diabetes, and overweight/obesity. Nevertheless, some researchers contend that CVDs are not a priority public health problem in SSA.

Method: This paper systematically reviews the evidence on CVDs and their relation with hypertension, diabetes mellitus and obesity/overweight in Ghana, Nigeria, South Africa, Sudan and Tanzania. The publication’s content was analyzed qualitatively using the directed content analysis method and the results were presented in a tabular format.

Result: The paper illustrates the rising prevalence of CVDs as well as the three related risk conditions in the selected SSA countries.

Conclusion: The review indicates a poor health system response to the increasing risk of CVDs in SSA. The conditions and major drivers that contribute to this underlying increasing trend need to be further studied.     

“Ours is the Strangest Situation,Ours is Different from Most Peoples”: Spousal Caregiver Perspectives on the Complex Challenges of Dementia Caregiving in Late-Life Marriage

The relationship between the person with dementia with family caregivers is a key factor in maintaining a sense of self and personhood. Spousal caregiving in particular can create a world of shared meaning, and in the context of the presence of cognitive decline in one spouse, couple hood is essential to a full understanding of how spouses live with and respond to the impact of dementia. While much research has focused on the strengths of long-term married couples caring for a spouse with dementia, there is currently little research on how dementia impacts couples in late-life marriage. This qualitative case study focusses on two female caregivers in late-life marriages negotiating the challenges of caregiving for a spouse with dementia. Spouse 1 returned to live with her ex-husband in order to care for him through his dementia journey and they recently remarried. Spouse 2 married a close friend of the family prior to his dementia diagnosis. While participant shared perspectives include: (1) family dynamics, (2) isolation, (3) financial concerns, and (4) acceptance of their role in their spouse’s dementia journey, their long-term outlooks are divergent due to the complexity of their motives for entering in to late-life marriage.     

Deaths of people with serious mental disorder: An exploration of deaths in custody and fatal police contacts

People with serious mental disorders (PSMDs) are overrepresented both in prison deaths and during fatal encounters with the police in the community (deaths after police contact, DAPC). To identify common factors present across cases of who died during contact with the criminal justice system in Queensland, publicly available coroners reports were analysed (N = 38). The findings of the study indicated psychosis and mood disorders were the most common diagnosis in incarcerated PSMD deaths, and suicide was the most common cause of death for incarcerated PSMDs. Within incarcerated settings, access to healthcare records, medication compliance, risk assessment and monitoring, and safe housing of at‐risk prisoners may be potential areas to explore with regard to prevention. Similarly, PSMD DAPCs were more likely to be experiencing mood or psychosis disorders than other forms of mental disorder, and suicide and police shootings were the most common causes of death. In PSMD DAPC, inadequate mental health access, treatment noncompliance and comorbid substance use were included as potential areas that could direct research efforts toward prevention.     

The empirical Bayes estimators of the parameter of the Poisson distribution with a conjugate gamma prior under Stein's loss function

For the hierarchical Poisson and gamma model, we calculate the Bayes posterior estimator of the parameter of the Poisson distribution under Stein's loss function which penalizes gross overestimation and gross underestimation equally and the corresponding Posterior Expected Stein's Loss (PESL). We also obtain the Bayes posterior estimator of the parameter under the squared error loss and the corresponding PESL. Moreover, we obtain the empirical Bayes estimators of the parameter of the Poisson distribution with a conjugate gamma prior by two methods. In numerical simulations, we have illustrated: The two inequalities of the Bayes posterior estimators and the PESLs; the moment estimators and the Maximum Likelihood Estimators (MLEs) are consistent estimators of the hyperparameters; the goodness-of-fit of the model to the simulated data. The numerical results indicate that the MLEs are better than the moment estimators when estimating the hyperparameters. Finally, we exploit the attendance data on 314 high school juniors from two urban high schools to illustrate our theoretical studies.