Cultural Competence in Physician Assistants and Their Associated Characteristics

ABSTRACT BACKGROUND: Cultural diversity continues to expand within the United States- People of diverse cultural backgrounds have diverse expectations about the healthcare they should receive. When expectations of healthcare providers and patients conflict, quality of care, patient outcomes, ind the healthcare economy suffer. Consequently, the need for culturally competent healthcare has risen to the attention of healthcare professionals. Physician assistants (PAs) have acknowledged the need to provide culturally competent care. This study aimed to determine the level of cultural competence in PAs and identify characteristics of PAs that are associated with cultural competence. PARTICIPANTS AND METHODS: Culrural competence was measured in PAs from the North Central region of the American Academy of Physician assistants attending the March 28, 2003 Minnesota Academy of Physician Assistants Spring CME conference. The Inventory for Assessing the Process of Cultural Competence Among Healthcare professionals (IAPCC) was used to measure cultural competence. A questionnaire containing demographic characteristics was completed by participants. RESULTS: Thirty-six PAs completed the IAPCC and demographic questionnaire. Median number races/ethnicities represented in co-workers was one (r=1-5), while that in patients was three (r=1-6). Median number of previous cultural education exposures was 3 (r=l-6). Based on IAPCC scores, one (2.8%) PA could be labeled culturally competent and 35 (97.27%) were culturally aware . A diverse body of co-workers was associated with a high IAPCC score (p=0.007, as was a history of greater exposure to cultural education (p=0.038); when controlling for all variables measured, none was independently predictive of a high IAPCC score. CONCLUSION: Most (35/36; 97.2%) PAs were culturally aware , but only one (2.87%) was culturally competent . Higher IAPCC scores are associated with having a diverse coworker population and more cultural education

A comparison of the phonetic accuracy of spelling errors of normal and retarded readers, second through sixth grade.

Dept. of Psychology. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis1976 .B84. Source: Masters Abstracts International, Volume: 40-07, page: . Thesis (M.A.)--University of Windsor (Canada), 1976

SOCIAL NETWORK CHARACTERISTICS, SOCIAL SUPPORT, AND COMPLIANCE TO A CHRONIC HEMODIALYSIS REGIMEN.

Nonadherence to hemodialysis fluid restrictions is a particularly difficult and dangerous problem for chronic dialysis patients. Review of noncompliance studies suggests that enmeshment in a stable supportive family and peer network is predictive of improved compliance. The network model and mapping techniques, used to study how people adapt to different life stresses, provides a useful means to evaluate the relationship between support network characteristics and dialysis compliance. Forty chronic hemodialysis patients were recruited from three metropolitan dialysis units in southeastern Michigan. Noncompliance was defined as 3-month mean interdialysis weight gains one standard deviation above the population mean. Twenty noncompliant patients were demographically matched pairwise with twenty compliant patients. Network predictor variables, determined through a structured interview, were: size, density, homogeneity, multiplexity, staff and family percentage, duration, frequency, proximity, reciprocity, dialysis awareness, influence, change, and level of desired interaction, value simularity, concern, trust, and assistance. Results showed that compliant patients had larger, more spread out and long-standing networks, with fewer staff and more multiple-role relationships. Compliant patients appeared to also have more dense networks consisting of more family members. Information from all the variables was used to correctly classify 85 percent of noncompliant and 95 percent of compliant patients. Factor analysis produced six factors: Change, Family Enmeshment, Size, Medical Status Awareness, Support, and Reachability. Size and Family Enmeshment demonstrated significant associations with compliance, accounting for 30 percent of individual compliance variance. The findings of more dense, family oriented networks for compliant patients is interpreted as partial confirmation of the importance of emotional support, empathy and stable sense of self identity for compliance. The negative findings for direct measures of relationship support, using the five scales--assistance, concern, trust, value similarity and desired interaction--are interpreted as an indication of response bias, present in the hemodialysis population, towards denial of any problems in their personal lives. The outcome of this study is taken as (1) further evidence of the utility of the network model and network mapping techniques, and (2) as additional support for the hypothesized relationship between compliance and emotional support. Implications for clinical intervention with noncompliant patients are drawn, along with suggestions for future research.Dept. of Psychology. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis1982 .B844. Source: Dissertation Abstracts International, Volume: 43-03, Section: B, page: 0865. Thesis (Ph.D.)--University of Windsor (Canada), 1982

Patient-Centered Outcomes and Use of Palliative Care Among Seriously-Ill and Non-Surviving Mechanically Ventilated ICU Patients

Background: A considerable proportion of mechanically ventilated (MV) patients in the ICU are at high risk of dying or die during hospitalization. Patients face threats to comfort, social connectedness, and dignity as a result of experiencing pain, ICU-acquired pressure ulcers, heavy sedation, and physical restraint, all inconsistent with standards for high quality end-of-life (EOL) care. Receipt of palliative care consultation (PCC) services has been associated with improved outcomes for seriously-ill and dying individuals. Objectives: 1) Describe patient-centered outcomes (unrelieved pain, ICU-acquired pressure ulcers, heavy sedation and days in restraint) among sampled patients who were seriously-ill or non-surviving; 2) Identify patient-level predictors of these outcomes; and 3) Explore the relationship between presence, timing and duration of PCC services and patient outcomes among sampled patients who were seriously-ill or non-surviving. Methods: A retrospective cohort design was used to conduct an expanded secondary analysis of data from the parent study (SPEACS-2; RWJF INQRI #66633). Additional data on receipt of PCC services were abstracted from the electronic medical records of parent study subjects. Results: Of the 1440 sampled patients, 773 were at high risk of dying or did not survive hospitalization. This cohort had a mortality rate of 29.8%; and of ICU days evaluated in the parent study, they spent on average 50% with unrelieved pain, 40% with some heavy sedation, and 40.8% with physical restraint. 12.3% experienced at least one ICU-acquired pressure ulcer. Being at EOL was independently associated with greater odds of experiencing heavy sedation (OR=2.64) and ICU-acquired pressure ulcer (OR=1.60); greater percentage of the ICU stay in heavy sedation (b=0.088; p< .001); and lower percentage of ICU days with unrelieved pain (b=-0.063; p=.002), after adjusting demographic and clinical covariates. Among those at EOL, 73 (9.4%) received PCC services, occurring on average, after 62% of the stay had elapsed. Compared to pre-consultation, subjects post consultation experienced a lower proportion of days in restraint (-0.17, p<.001), a higher proportion of days in heavy sedation (0.13, p=.015), and similar proportions of days with pain. Conclusion: These findings suggest that seriously-ill and non-surviving MV adults in the ICU experience a high prevalence of poor outcomes on measures of patient-centered care

Porcine circovirus modulates swine influenza virus replication in pig tracheal epithelial cells and porcine alveolar macrophages

The pathogenesis of porcine circovirus type 2b (PCV2b) and swine influenza A virus (SwIV) during co-infection in swine respiratory cells is poorly understood. To elucidate the impact of PCV2b/SwIV co-infection, newborn porcine tracheal epithelial cells (NPTr) and immortalized porcine alveolar macrophages (iPAM 3D4/21) were co-infected with PCV2b and SwIV (H1N1 or H3N2 genotype). Viral replication, cell viability and cytokine mRNA expression were determined and compared between single-infected and co-infected cells. Finally, 30mRNA sequencing was performed to identify the modulation of gene expression and cellular pathways in co-infected cells. It was found that PCV2b significantly decreased or improved SwIV replication in co-infected NPTr and iPAM 3D4/21 cells, respectively, compared to single-infected cells. Interestingly, PCV2b/SwIV co-infection synergistically up-regulated IFN expression in NPTr cells, whereas in iPAM 3D4/21 cells, PCV2b impaired the SwIV IFN induced response, both correlating with SwIV replication modulation. RNAsequencing analyses revealed that the modulation of gene expression and enriched cellular pathways during PCV2b/SwIV H1N1 co-infection is regulated in a cell-type-dependent manner. This study revealed different outcomes of PCV2b/SwIV co-infection in porcine epithelial cells and macrophages and provides new insights on porcine viral co-infections pathogenesis

Utilizing Multimedia Case Studies to Teach the Professional Side of Project Management

This research was conducted to evaluate the effectiveness of using a LITEE multimedia case study to teaching concepts in engineering courses. The LITEE Superstar case study was implemented in an engineering Project Management course. Numerous surveys regarding student expectations, outcomes, and attitudes were collected and results are presented herein. Overall, the study provided evidence that the students felt that the LITEE case study added value to the course via the different methods of teaching material, aided in the understanding of the project selection process, and ultimately helped them be successful in their course project which was conducted for a real rural Missouri city. The data was unable to be tracked on a per student basis; this yields areas for future research to track individual student improvement and attitudes. This research provides evidence that using multimedia case studies, such as the case studies published by LITEE, are effective and well received by engineering students in their coursework

Effective approaches to public involvement in care home research: a systematic review and narrative synthesis

Background Public involvement (often referred to as patient and public involvement or PPI) integrates the voices of the public in health and care research. However, groups such as care home residents are often excluded from involvement opportunities due to the complexities of involving people with additional care and communication needs. Despite a range of approaches being used, there is little understanding about how best to incorporate their experiences, and those of other care home stakeholders, into the design and conduct of research. Objective A systematic review was conducted to identify PPI methods that better meet the specific needs of care home stakeholders. This was undertaken by (1) outlining effective PPI approaches used in care home research and the key stakeholders involved; (2) describing the role of PPI in different care home contexts and (3) identifying stakeholders’ experiences and attitudes towards PPI in care homes. Methods Databases CINAHL, Embase, MEDLINE, PsycINFO and Scopus were searched for English language papers from inception to November 2021. A narrative synthesis approach was utilised to organise the extracted data into five themes. Results The search initially yielded 2314 articles (following de-duplication), with 27 meeting the inclusion criteria. Articles reported a range of input from stakeholders (including residents, staff, relatives and community stakeholders), with the impact of PPI varying according to the type of care establishment and research context. The experiences and reflections of stakeholders’ about their involvement in care home research varied, with some studies offering first-hand accounts compared with summaries from researchers. Some articles explicitly evaluated the effectiveness of the PPI approach using specific outcome measures whilst others indirectly described the impact of their approach. Five themes were identified as characterising an effective PPI approach: (1) valuing stakeholders’ perspectives, (2) awareness of the multi-faceted research context, (3) ensuring inclusivity and transparency, (4) maintaining flexibility and adaptability and (5) utilising resources and wider support. Conclusion Effective PPI in care home research requires researchers to create person-centred opportunities to adequately involve groups with physical and cognitive impairments. The findings led to the creation of evidence-based practical recommendations to support future involvement opportunities and help researchers develop strategies for inclusive opportunities for involvement