The Productivity Consequences of Two Ergonomic Interventions

Pre- and post-intervention data on health outcomes, absenteeism, and productivity from a longitudinal, quasi-experimental design field study of office workers was used to evaluate the economic consequences of two ergonomic interventions. Researchers assigned individuals in the study to three groups: a group that received an ergonomically designed chair and office ergonomics training; a group that received office ergonomics training only; and a control group. The results show that while training alone has neither a statistically significant effect on health nor productivity, the chair-with-training intervention substantially reduced pain and improved productivity. Neither intervention affected sick leave hours.ergonomics, chair, pain, DeRango, Upjohn

Preliminary Evaluation of a Laparoscopic Common Bile Duct Simulator for Pediatric Surgical Education

Purpose: Laparoscopic common bile duct exploration (LCBDE) decreases overall costs and length of stay in patients with choledocolithiasis. However, utilization of LCBDE remains low. We sought to evaluate a previously developed general surgery LCBDE simulator among a cohort of pediatric surgical trainees. The study purpose was to evaluate the content validity of an LCBDE simulator to support or refute its use in pediatric surgery education. Materials and Methods: After IRB exempt determination, 30 participants performed a transcystic LCBDE using a previously developed simulator and evaluated the simulator using a self-reported 28-item instrument. The instrument consisted of two primary domains (Quality and Ability to Perform) that were rated using twenty-five 4-point rating scales and one 4-point global rating scale. Validity evidence relevant to test content was evaluated using a many-facet Rasch model. Interitem consistency was estimated using Cronbach's alpha. P?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140153/1/lap.2016.0248.pd

Determination of clinical competencies for exercise physiology students

Introduction: Clinical placements and assessment are a key part of health professional education. However, quality assessment in a clinical environment is difficult to achieve without a clear picture of what constitutes competence. The aim of this study was to establish a set of competencies that describe the attributes considered critical to ensuring an entry-level exercise physiologist (EP) can practice safely and effectively with a client-centred philosophy. Methods: This study used a mixed methods, multiphase approach. The competencies, which are organised into units of competency with underlying elements, were developed following online surveys and focus groups involving those with expertise in the area, with additional refinement provided by the project team. A first-stage validation was conducted via electronic survey where (i) participants rated the importance of each unit of competency to practice as an entry-level EP; and (ii) those participants who were recently graduated EPs rated the extent to which they perceived they were competent in each unit. Results: The final set of competencies is described as 19 elements organised into 6 units. The units are: (i) Communication, (ii) Professionalism, (iii) Assessment and Interpretation, (iv) Planning and delivery of an exercise and/or physical activity intervention, (v) Lifestyle Modification and (vi) Risk Management. The majority of survey participants (93-97%) considered each unit of competency as being important to practice successfully as an entry-level EP. The majority (78-95%) of the sub-group who identified as new EPs considered themselves competent in each unit, suggesting the competencies are articulated at the level of a new EP. Conclusion: The competencies resulted from an extensive, iterative process involving those with expertise in the area followed by initial validation. The competencies will have a range of applications, including informing the development of a student placement assessment tool

Determination of clinical competencies for exercise physiology students

Introduction: Clinical placements and assessment are a key part of health professional education. However, quality assessment in a clinical environment is difficult to achieve without a clear picture of what constitutes competence. The aim of this study was to establish a set of competencies that describe the attributes considered critical to ensuring an entry-level exercise physiologist (EP) can practice safely and effectively with a client-centred philosophy. Methods: This study used a mixed methods, multiphase approach. The competencies, which are organised into units of competency with underlying elements, were developed following online surveys and focus groups involving those with expertise in the area, with additional refinement provided by the project team. A first-stage validation was conducted via electronic survey where (i) participants rated the importance of each unit of competency to practice as an entry-level EP; and (ii) those participants who were recently graduated EPs rated the extent to which they perceived they were competent in each unit. Results: The final set of competencies is described as 19 elements organised into 6 units. The units are: (i) Communication, (ii) Professionalism, (iii) Assessment and Interpretation, (iv) Planning and delivery of an exercise and/or physical activity intervention, (v) Lifestyle Modification and (vi) Risk Management. The majority of survey participants (93-97%) considered each unit of competency as being important to practice successfully as an entry-level EP. The majority (78-95%) of the sub-group who identified as new EPs considered themselves competent in each unit, suggesting the competencies are articulated at the level of a new EP. Conclusion: The competencies resulted from an extensive, iterative process involving those with expertise in the area followed by initial validation. The competencies will have a range of applications, including informing the development of a student placement assessment tool

Determining when a hospital admission of an older person can be avoided in a subacute setting: a systematic review and concept analysis

Objective To conduct a systematic review of the evidence for when a hospital admission for an older person can be avoided in subacute settings. We examined the definition of admission avoidance and the evidence for the factors that are required to avoid admission to hospital in this setting. Methods Using defined PICOD criteria, we conducted searches in three databases (Medline, Embase and Cinahl) from January 2006 to February 2018. References were screened by title and abstract followed by full paper screening by two reviewers. Additional studies were searched from the grey literature, experts in the field and forward and backward referencing. Data were narratively described, and concept analysis was used to investigate the definition of admission avoidance. Results A total of 17 studies were considered eligible for review; eight provided a definition of admission avoidance and 10 described admission avoidance criteria. We identified three factors which play a key role in admission avoidance in the subacute setting: (1) ambulatory care sensitive conditions and common medical scenarios for the older person, which included respiratory infections or pneumonia, urinary tract infections and catheter care, dehydration and associated symptoms, falls and behavioural management, and managing ongoing chronic conditions; (2) criteria/tools, referring to interventions that have used clinical expertise in conjunction with a range of general and geriatric triage tools; in condition-specific interventions, the decision whether to admit or not was based on level of risk determined by defined clinical tools; and (3) personnel and resources, referring to the need for experts to make the initial decision to avoid an admission. Supervision by nurses or physicians was still needed at subacute level, requiring resources such as short-stay beds, intravenous antibiotic treatment or fluids for rehydration and rapid access to laboratory tests. Conclusion<jats:p/> The review identified a set of criteria for ambulatory care sensitive conditions and common medical scenarios for the older person that can be treated in the subacute setting with appropriate tools and resources. This information can help commissioners and care providers to take on these important elements and deliver them in a locally designed way

Frailty assessment in primary health care and its association with unplanned secondary care use:a rapid review

Background: The growing frail, older population is increasing pressure on hospital services. This is directing the attention of clinical commissioning groups towards more comprehensive approaches to managing frailty in the primary healthcare environment. Aim: To review the literature on whether assessment of frailty in primary health care leads to a reduction in unplanned secondary care use. Design & setting: A rapid review involving a systematic search of Medline and Medline In-Process. Method: Relevant data were extracted following the iterative screening of titles, abstracts, and full texts to identify studies in the primary or community healthcare setting which assessed the effect of frailty on unplanned secondary care use between January 2005–June 2016. Results: The review included 11 primary studies: nine observational studies; one randomised controlled trial (RCT); and one non-randomised controlled trial (nRCT). Eight out of nine observational studies reported a positive association between frailty and secondary care utilisation. The RCT and nRCT reported conflicting findings. Conclusion: Older people identified as frail in a primary healthcare setting were more likely to be admitted to hospital. Based on the limited and equivocal trial evidence, it is not possible to draw firm conclusions regarding appropriate tools for the identification and management of frail older people at risk of hospital admission

The XMM Cluster Survey: Evidence for energy injection at high redshift from evolution of the X-ray luminosity-temperature relation

We measure the evolution of the X-ray luminosity-temperature (L_X-T) relation since z~1.5 using a sample of 211 serendipitously detected galaxy clusters with spectroscopic redshifts drawn from the XMM Cluster Survey first data release (XCS-DR1). This is the first study spanning this redshift range using a single, large, homogeneous cluster sample. Using an orthogonal regression technique, we find no evidence for evolution in the slope or intrinsic scatter of the relation since z~1.5, finding both to be consistent with previous measurements at z~0.1. However, the normalisation is seen to evolve negatively with respect to the self-similar expectation: we find E(z)^{-1} L_X = 10^{44.67 +/- 0.09} (T/5)^{3.04 +/- 0.16} (1+z)^{-1.5 +/- 0.5}, which is within 2 sigma of the zero evolution case. We see milder, but still negative, evolution with respect to self-similar when using a bisector regression technique. We compare our results to numerical simulations, where we fit simulated cluster samples using the same methods used on the XCS data. Our data favour models in which the majority of the excess entropy required to explain the slope of the L_X-T relation is injected at high redshift. Simulations in which AGN feedback is implemented using prescriptions from current semi-analytic galaxy formation models predict positive evolution of the normalisation, and differ from our data at more than 5 sigma. This suggests that more efficient feedback at high redshift may be needed in these models.Comment: Accepted for publication in MNRAS; 12 pages, 6 figures; added references to match published versio

The impact of testing and infection prevention and control strategies on within-hospital transmission dynamics of COVID-19 in English hospitals

Nosocomial transmission of SARS-CoV-2 is a key concern, and evaluating the effect of testing and infection prevention and control strategies is essential for guiding policy in this area. Using a within-hospital SEIR transition model of SARS-CoV-2 in a typical English hospital, we estimate that between 9 March 2020 and 17 July 2020 approximately 20% of infections in inpatients, and 73% of infections in healthcare workers (HCWs) were due to nosocomial transmission. Model results suggest that placing suspected COVID-19 patients in single rooms or bays has the potential to reduce hospital-acquired infections in patients by up to 35%. Periodic testing of HCWs has a smaller effect on the number of hospital-acquired COVID-19 cases in patients, but reduces infection in HCWs by as much as 37% and results in only a small proportion of staff absences (approx. 0.3% per day). This is considerably less than the 20–25% of staff that have been reported to be absent from work owing to suspected COVID-19 and self-isolation. Model-based evaluations of interventions, informed by data collected so far, can help to inform policy as the pandemic progresses and help prevent transmission in the vulnerable hospital population. This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’

The impact of testing and infection prevention and control strategies on within-hospital transmission dynamics of COVID-19 in English hospitals.

Nosocomial transmission of SARS-CoV-2 is a key concern, and evaluating the effect of testing and infection prevention and control strategies is essential for guiding policy in this area. Using a within-hospital SEIR transition model of SARS-CoV-2 in a typical English hospital, we estimate that between 9 March 2020 and 17 July 2020 approximately 20% of infections in inpatients, and 73% of infections in healthcare workers (HCWs) were due to nosocomial transmission. Model results suggest that placing suspected COVID-19 patients in single rooms or bays has the potential to reduce hospital-acquired infections in patients by up to 35%. Periodic testing of HCWs has a smaller effect on the number of hospital-acquired COVID-19 cases in patients, but reduces infection in HCWs by as much as 37% and results in only a small proportion of staff absences (approx. 0.3% per day). This is considerably less than the 20-25% of staff that have been reported to be absent from work owing to suspected COVID-19 and self-isolation. Model-based evaluations of interventions, informed by data collected so far, can help to inform policy as the pandemic progresses and help prevent transmission in the vulnerable hospital population. This article is part of the theme issue 'Modelling that shaped the early COVID-19 pandemic response in the UK'