Student Perspectives of the Effective Behaviors of Occupational Therapy Level II Fieldwork Educators

Occupational therapy students complete a period of clinical education, when they apply academic learning in clinical situations, supervised by a fieldwork educator. Fieldwork education supports the student in developing technical and clinical reasoning skills, engaging in evidence-based practice, and socialization to the profession. Despite the key role fieldwork educators play in occupational therapy student professional and skill development, evaluation of educator skills and the fieldwork experience are slight. This descriptive study explored occupational therapy fieldwork educator behaviors to determine those behaviors indicative of a quality experience from the student perspective, using the Clinical Teaching Effectiveness Inventory (CTEI). Student responses identified the quality and frequency of fieldwork educator behaviors experienced. A Spearman correlation showed frequency and quality of educator behaviors were positively associated, possibly indicating students perceive higher quality of the behavior when observed more frequently. Behaviors associated with a quality clinical experience included both educator characteristics and teaching skills pertinent to learning. Specifically, an approachable fieldwork educator who uses teaching strategies to develop clinical skills creates a positive learning environment. The results of this study can inform academic programs in providing professional development opportunities for fieldwork educators to enhance their teaching skills. Additionally, the results guide fieldwork educators in interpersonal and teaching skills to create a positive fieldwork experience. Through improvement of fieldwork experiences, both the profession and clients benefit

EFFECTS OF HYDROCEPHALUS ON HOSPITAL USE, ASSOCIATED COSTS, AND ACCESS TO CARE AMONG CHILDREN WITH SPINA BIFIDA

Objectives: This study examined hospital resource use, including timeliness of surgical repair of spina bifida (SB), and geographical access to hospital care, by the presence of hydrocephalus, isolated or non-isolated SB, and selected sociodemographic characteristics among children with SB. Methods: This was a retrospective, statewide, population-based study of children with SB, born in Florida 1998-2007, identified by the Florida Birth Defects Registry and linked to hospital discharge records. Information about hospitalizations, lengths of stay, and costs were obtained from hospital discharge data for infants (<1 year) and children ages one to four years. Time to SB surgical repair was calculated using procedural codes and hospital discharge data. One-way travel time and distance to access hospital care were calculated using geocoded maternal residential addresses, hospital addresses, and Florida road networks. Chi-square tests and logistic, Poisson, generalized linear regression, and ordinary least squares were used to examine the study objectives. Models were adjusted for hydrocephalus; isolated (no other major birth defect) vs. non-isolated SB, and selected predisposing, enabling, and need characteristics Results: Of 614 children, 42.4% of children had isolated SB and hydrocephalus; 32.3% had isolated SB without hydrocephalus; 14.5% had non-isolated SB and hydrocephalus, and 10.9% had non-isolated SB without hydrocephalus. In adjusted results, infants with isolated SB and hydrocephalus had 53% more hospitalizations and 2.6 times the number of hospitalized days and costs compared with infants with isolated SB without hydrocephalus. Infants and children with non-isolated SB and hydrocephalus had twice the number of post-birth hospitalizations and hospitalized days than children with isolated SB without hydrocephalus, but only about 40% higher costs. Regarding timeliness of surgical repair, of 299 infants with a recorded repair, 68.6% had repair by day two, 15.1% had repair days three through seven, and 16.4% had repair after day seven. In adjusted results, hydrocephalus was the only characteristic associated with repair by day two (adjusted prevalence ratio=1.80, 95% confidence interval: 1.31-2.48). Of 612 children with a geocoded address, 56.4% of infants and 61.4% of children had a one-way average travel time of =30 minutes to hospitals. Infants with non-isolated SB and hydrocephalus traveled the longest to hospitals (mean: 60.8; median: 34.2; range 5- 494 minutes). In adjusted results, non-isolated SB, maternal minority race/ethnicity, lower maternal education, and rural residence were associated with lower likelihood of traveling =30 minutes to hospitals during infancy. Discussion: Comorbidities substantially increase hospital resource use for children with SB, particularly during infancy. Results also showed that the majority of infants with SB had a timely repair. Infants with non-isolated SB and hydrocephalus traveled the longest to access hospital care. Findings underscore the need to consider comorbidities when examining hospital resource use for children with SB and other birth defects. Results also demonstrate that birth defects registry data and GIS-based methods are useful to evaluate geographical access to hospitals for children with birth defects

Building Community Partnerships: Using Social Network Analysis to Strengthen Service Networks Supporting a South Carolina Program for Pregnant and Parenting Teens

In 2013, South Carolina implemented a multi-year program providing support services for pregnant and parenting teens. Local lead sites were responsible for coordinating service delivery in partnership with other multidisciplinary community-based organizations. We used social network theory and analyses (SNA) to examine changes in partnerships over time. Using two-stage purposeful sampling, we identified three lead sites and their self-reported community partners. We administered two web-based surveys grounded in social network theory that included questions about partnership relationships and organizational characteristics. We calculated selected whole-network measures (size, cohesion, equity, diversity). Following the Year 1 surveys, we reviewed our findings with the lead sites and suggested opportunities to strengthen their respective partnerships. Following the Year 3 surveys, we observed changes across the networks. Survey response rates were 91.5% (43/47) in Year 1 and 68.2% (45/66) in Year 3. By Year 3, the average network size increased from 15.6 to 20.3 organizations. By Year 3, one lead site doubled its measure of network cohesion (connectedness); another lead site doubled in size (capacity). A third lead site, highly dense in Year 1, increased in size but decreased in cohesion by Year 3. Innovative use of SNA findings can help community partnerships identify gaps in capacity or services and organizations needed to fulfill program aims. SNA findings can also improve partnership function by identifying opportunities to improve connectedness or reduce redundancies in program work. The ability of lead sites to strategically reconfigure partnerships can be important to program success and sustainability

Modeling Travel Impedance to Medical Care for Children with Birth Defects Using Geographic Information Systems

Background: Children with birth defects may face significant geographic barriers accessing medical care and specialized services. Using a Geographic Information Systems–based approach, one-way travel time and distance to access medical care for children born with spina bifida was estimated. Methods: Using 2007 road information from the Florida Department of Transportation, we built a topological network of Florida roads. Live-born Florida infants with spina bifida during 1998 to 2007 were identified by the Florida Birth Defects Registry and linked to hospital discharge records. Maternal residence at delivery and hospitalization locations were identified during the first year of life. Results: Of 668 infants with spina bifida, 8.1% (n = 54) could not be linked to inpatient data, resulting in 614 infants. Of those 614 infants, 99.7% (n = 612) of the maternal residential addresses at delivery were successfully geocoded. Infants with spina bifida living in rural areas in Florida experienced travel times almost twice as high compared with those living in urban areas. When aggregated at county levels, one-way network travel times exhibited statistically significant spatial autocorrelation, indicating that families living in some clusters of counties experienced substantially greater travel times compared with families living in other areas of Florida. Conclusion: This analysis demonstrates the usefulness of linking birth defects registry and hospital discharge data to examine geographic differences in access to medical care. Geographic Information Systems methods are important in evaluating accessibility and geographic barriers to care and could be used among children with special health care needs, including children with birth defects. Birth Defects Research (Part A) 97:673–684, 2013. © 2013 Wiley Periodicals, Inc

Modeling the natural history of Pelizaeus–Merzbacher disease

Major gaps in our understanding of the leukodystrophies result from their rarity and the lack of tissue for the interdisciplinary studies required to extend our knowledge of the pathophysiology of the diseases. This study details the natural evolution of changes in the CNS of the shaking pup (shp), a model of the classical form of the X-linked disorder Pelizaeus–Merzbacher disease, in particular in glia, myelin, and axons, which is likely representative of what occurs over time in the human disease. The mutation in the proteolipid protein gene, PLP1, leads to a delay in differentiation, increased cell death, and a marked distension of the rough endoplasmic reticulum in oligodendrocytes. However, over time, more oligodendrocytes differentiate and survive in the spinal cord leading to an almost total recovery of myelination, In contrast, the brain remains persistently hypomyelinated. These data suggest that shp oligodendrocytes may be more functional than previously realized and that their early recruitment could have therapeutic value