Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors

Initiatives for addressing resident wellness are a recent requirement of the Accreditation Council for Graduate Medical Education in response to high rates of resident burnout nationally. We review the literature on wellness and burnout in residency education with a focus on assessment, individual-level interventions, and systemic or organizational interventions

The relationship between career anchors, organisational commitment and turnover intention

The primary objectives of the study were as follows: (1) to explore the relationship between career anchors (as measured by the Career Orientations Inventory), organisational commitment (as measured by the Organisational Commitment Questionnaire) and turnover intention (as measured by a three-item questionnaire, developed by Mobley, Horner, and Hollingsworth, 1978); and (2) to determine whether employees from different gender, race, employment positions and age groups differ significantly in their career anchors, organisational commitment and turnover intention. A quantitative survey was conducted on a non-probability sample of 343 employed adults at managerial and general staff levels in the South African retail sector. The results of this study suggest that there was a significant but weak relationship between employees‟ career anchors and their organisational commitment. Career anchors were also found to be significantly related to organisational commitment and turnover intention; with entrepreneurial creativity, lifestyle and service/dedication to a cause career anchors being the best predictors of these two variables. The relationship between organisational commitment and turnover intention was significant and negative, with affectively and normatively committed participants being more likely to remain with the organisation (i.e. having lower turnover intentions). In addition, the findings indicate that although gender has no relationship with turnover intention, race, employment position and age do. African, general staff and 30 years and younger participants indicated higher intentions to leave the organisation.Industrial and Organisational PsychologyM. Com. (Industrial and Organisational Psychology

A Parallel Randomized Clinical Trial Examining the Return of Urinary Continence After Robot- Assisted Radical Prostatectomy with or without a Small Intestinal Submucosa Bladder Neck Sling

Purpose Urinary continence is a driver of quality of life after radical prostatectomy. In this study we evaluated the impact of a biological bladder neck sling on the return of urinary continence after robot-assisted radical prostatectomy. Materials and Methods This study compared early continence in patients undergoing robot-assisted radical prostatectomy with a sling and without a sling in a 2-group, 1:1, parallel, randomized controlled trial. Patients were blinded to group assignment. The primary outcome was defined as urinary continence (0 to 1 pad per day) at 1 month postoperatively. Inclusion criteria were organ confined prostate cancer and a prostate specific antigen less than 15 ng/ml. Exclusion criteria were any prior surgery on the prostate, a history of neurogenic bladder and history of pelvic radiation. A chi-squared test was used for the primary outcome. Results A total of 147 patients were randomized (control 74, sling 73) and 92% were available for primary end point analysis at 1 month. There were no significant differences in baseline or perioperative data except that operating room time was 20.1 minutes longer for the sling group (p=0.04). The continence rate was similar between the control and sling groups at 1 month (47.1% vs 55.2%, p=0.34) and 12 months (86.7% vs 94.5%, p=0.15), respectively. Adverse events were similar between the control and sling groups (10.8% vs 13.7%, p=0.59). Conclusions The application of an absorbable urethral sling at robot-assisted radical prostatectomy was well tolerated with no increase in obstructive symptoms in this randomized trial. However, the sling failed to show a significant improvement in continence

Small dams drive Anopheles abundance during the dry season in a high malaria burden area of Malawi

This study explores the influence of small dams on the exposure to malaria vectors during the dry season in Kasungu district, Malawi, an area recently identified as high priority for malaria interventions by the National Malaria Control Programme. Small dam impoundments provide communities with a continuous supply of water for domestic and agricultural activities across sub‐Saharan Africa and are considered vital to food security and climate change resilience. However, these permanent water bodies also create ideal breeding sites for mosquitoes in typically arid landscapes. The study focuses on a specific dam impoundment and its vicinity, aiming to assess its spatial and temporal influence on indoor vector densities. From May to August 2021, CDC light traps were used to measure indoor mosquito densities for two consecutive nights per month in three communities located at increasing distances from the dam (0, ~1 and ~2 km). Simultaneously, drone imagery was captured for each community, enabling the identification of additional standing water within approximately 400 m of selected households. Larval sampling was carried out within the impoundment periphery and in additional water bodies identified in the drone imagery. Generalised linear mixed models (GLMMs) were employed to analyse the indoor Anopheles abundance data, estimating the effects of household structure (open/closed eaves), month, temperature and water proximity on malaria vector exposure. Throughout 685 trapping nights, a total of 1256 mosquitoes were captured, with 33% (412) being female Anopheles. Among these, 91% were morphologically identified as Anopheles funestus s.l., and 5% as Anopheles gambiae s.l. Catches progressively decline in each consecutive trapping month as the environment became drier. This decline was much slower in Malangano, the community next to the dam, with abundance being notably higher in June and July. Further, the majority of An. gambiae s.l. were caught in May, with none identified in July and August. Anopheles larvae were found both in the impoundment and other smaller water bodies such as irrigation wells in each survey month; however, the presence of these smaller water bodies did not have a significant impact on adult female mosquito catches in the GLMM. The study concludes that proximity to the dam impoundment was the primary driver of differences between survey communities with the abundance in Chikhombwe (~1 km away) and Chiponde (~2 km away) being 0.35 (95% confidence interval [CI], 0.19–0.66) and 0.28 (95% CI, 0.16–0.47) lower than Malangano, respectively, after adjusting for other factors. These findings underscore the importance of targeted interventions, such as larval source management or housing improvements, near small dams to mitigate malaria transmission risks during the dry season. Further research is needed to develop cost‐effective strategies for vector control within and around these impoundments

Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care

In response to widespread concerns regarding Veterans\u27 access to VA care, Congress enacted the Veterans Access, Choice and Accountability Act of 2014, which required VA to establish the Veterans Choice Program (VCP). Since the inception of VCP, more than two million Veterans have received care from community providers, representing approximately 25% of Veterans enrolled in VA care. However, expanded access to non-VA care has created challenges in care coordination between VA and community health systems. In March 2018, the VA Health Services Research and Development Service hosted a VA State of the Art conference (SOTA) focused on care coordination. The SOTA convened VA researchers, program directors, clinicians, and policy makers to identify knowledge gaps regarding care coordination within the VA and between VA and community systems of care. This article provides a summary and synthesis of relevant literature and provides recommendations generated from the SOTA about how to evaluate cross-system care coordination. Care coordination is typically evaluated using health outcomes including hospital readmissions and death; however, in cross-system evaluations of care coordination, measures such as access, cost, Veteran/patient and provider satisfaction (including with cross-system communication), comparable quality metrics, context (urban vs. rural), and patient complexity (medical and mental health conditions) need to be included to fully evaluate care coordination effectiveness. Future research should examine the role of multiple individuals coordinating VA and non-VA care, and how these coordinators work together to optimize coordination

To Join or Not to Join? Understanding the Succession Intentions of Next-generation Family Business Members

Looking towards 2030 and beyond, Irish businesses must address the interlocking challenges of transitioning to a low-carbon economy, embracing digital transformation, and absorbing external shocks and higher operational costs resulting from global insecurity. Given their continued prominence in the Irish economy, family businesses will have a leading role to play in remaining strong when faced with the financial uncertainties, and unexpected shocks that these trends will bring. The NCFB led this timely all-island university partnership, recruiting almost 400 next-generation family business students to give the pursuit of succession in turbulent times a contemporary voice. We found that succession aspirations are healthy across the island of Ireland, and the shaping of next-generation intentions regarding educational choices, sustainability, emotional well-being and socio-emotional wealth has a vital role to play in the realisation of these aspirations. With its rich and novel set of findings and recommendations, this report aims to better inform Irish Government and European Union policy positions on family business succession

Cardiorespiratory Fitness and Incident Stroke Types: The FIT (Henry Ford ExercIse Testing) Project

OBJECTIVE: To study the association between cardiorespiratory fitness (CRF) and incident stroke types. PATIENTS AND METHODS: We studied a retrospective cohort of patients referred for treadmill stress testing in the Henry Ford Health System (Henry Ford ExercIse Testing Project) without history of stroke. CRF was expressed by metabolic equivalents of task (METs). Using appropriate International Classification of Diseases, Ninth Revision codes, incident stroke was ascertained through linkage with administrative claims files and classified as ischemic, hemorrhagic, and subarachnoid hemorrhage (SAH). Multivariable-adjusted Cox proportional hazards models examined the association between CRF and incident stroke. RESULTS: Among 67,550 patients, mean ± SD age was 54±13 years, 46% (n=31,089) were women, and 64% (n=43,274) were white. After a median follow-up of 5.4 (interquartile range 2.7-8.5) years, a total of 7512 incident strokes occurred (6320 ischemic, 2481 hemorrhagic, and 275 SAH). Overall, there was a graded lower incidence of stroke with higher MET categories. Patients with METs of 12 or more had lower risk of overall stroke [0.42 (95% CI, 0.36-0.49)], ischemic stroke [0.69 (95% CI, 0.58-0.82)], and hemorrhagic stroke [0.71 (95% CI, 0.52-0.95)]. CONCLUSION: In a large ethnically diverse cohort of patients referred for treadmill stress testing, CRF is inversely associated with risk for ischemic and hemorrhagic stroke

The context, influences and challenges for undergraduate nurse clinical education: Continuing the dialogue

Introduction – Approaches to clinical education are highly diverse and becoming increasingly complex to sustain in complex milieu Objective – To identify the influences and challenges of providing nurse clinical education in the undergraduate setting and to illustrate emerging solutions. Method: A discursive exploration into the broad and varied body of evidence including peer reviewed and grey literature. Discussion - Internationally, enabling undergraduate clinical learning opportunities faces a range of challenges. These can be illustrated under two broad themes: (1) Legacies from the past and the inherent features of nurse education and (2) Challenges of the present, including, population changes, workforce changes, and the disconnection between the health and education sectors. Responses to these challenges are triggering the emergence of novel approaches, such as collaborative models. Conclusion(s) – Ongoing challenges in providing accessible, effective and quality clinical learning experiences are apparent

Syn3DWound: A Synthetic Dataset for 3D Wound Bed Analysis

Wound management poses a significant challenge, particularly for bedridden patients and the elderly. Accurate diagnostic and healing monitoring can significantly benefit from modern image analysis, providing accurate and precise measurements of wounds. Despite several existing techniques, the shortage of expansive and diverse training datasets remains a significant obstacle to constructing machine learning-based frameworks. This paper introduces Syn3DWound, an open-source dataset of high-fidelity simulated wounds with 2D and 3D annotations. We propose baseline methods and a benchmarking framework for automated 3D morphometry analysis and 2D/3D wound segmentation.Comment: In the IEEE International Symposium on Biomedical Imaging (ISBI) 202