Basic Academic Skills and Post-Secondary Technical Education

The purpose of this quantitative study was to determine if there is a significant difference in WorkKeys score, skills score, theory score, and job placement rates as compared by credential and program of study at a technical college in Tennessee. The study used data retrieved from a WorkKeys database and SIMS (Student Information Management System) at a technical college. The population consisted of 445 students in seven programs from 2010-2016 who had participated in the WorkKeys online academic training modules. The dependent variables for the study were WorkKeys score, skill score, and theory score. The independent variables were job placement status (related, non-related, not placed), program of study (Collision Repair/Motorcycle Repair, Computer Information, Welding/Machine Tool and Industrial Maintenance/Residential Maintenance), and graduation credential (diploma, certificate, none). Based on the data collected, it was found that there was a significant difference in the WorkKeys score by credential, skill score by credential, theory score by credential, WorkKeys score by job placement status, skill score by job placement status and theory score by job placement status. The job placement status was significantly affected by the program of study. Finally, the WorkKeys score was not affected by the program of study. Additionally, the not placed status for the Computer Information program was higher than the other two categories (related and non-related) whereas the related status was the highest for the other three programs of study (WEL/MT, CRT/MOT, and IM/RBM)

Measuring the Contribution and Complexity of Nurse and Physiotherapy Consultants: A Feasibility Study

Advanced practice roles in nursing and other health professions have become integral to a range of healthcare services world-wide providing experienced practitioners with the opportunity to extend their roles and influence decision making whilst maintaining patient contact. However, there has been limited research to evaluate the impact on health services of these advanced practice roles

Understanding the implementation of interventions to improve the management of chronic kidney disease in primary care: a rapid realist review

Summary table and references for secondary search. (DOCX 204 kb

Cultural orientation of self-bias in perceptual matching

This work was supported by grants from the Economic and Social Research Council (ES/K013424/1), the National Natural Science Foundation of China (31371017), and the Research Grants Council of Hong Kong (HKU758412H)Peer reviewedPublisher PD

Incidence and prevalence of juvenile idiopathic arthritis in the United Kingdom, 2000-2018: results from the Clinical Practice Research Datalink.

OBJECTIVE: The incidence and prevalence of JIA was last estimated in the UK in 1994. Since then the disease has been reclassified, the specialty of paediatric rheumatology has evolved and there has been a significant shift in disease management with new advanced therapies. This study aimed to provide up-to-date national estimates of this disease. METHODS: Children and young people (CYP) with JIA were identified in the Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases, which source data from the two most commonly used primary care electronic health record systems in the UK. These databases were combined and the cohort was identified (2000-18) using predefined code lists. Validation was performed through linkage to the England Hospital Episode Statistics. Annual incidence and prevalence rates were calculated and stratified by gender, age group and nation of the UK. Direct standardization to the UK population was performed and 5 year incidence rates were calculated between 2003 and 2018. RESULTS: The age-standardized incidence rate was 5.61 per 100 000 population. The age-standardized prevalence rate in 2018 was 43.5 per 100 000. Rates were higher in Scotland compared with England: incidence rate ratio 1.27 (95% CI 1.11, 1.46). The 5 year incidence rates did not change significantly over time. CONCLUSIONS: This study has provided the first contemporaneous estimates of occurrence of JIA in the UK in 25 years. These data provide important estimates to inform resource allocation and health service development for management of JIA

Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative.

QUALITY PROBLEM: Undiagnosed chronic kidney disease (CKD) contributes to a high cost and care burden in secondary care. Uptake of evidence-based guidelines in primary care is inconsistent, resulting in variation in the detection and management of CKD. INITIAL ASSESSMENT: Routinely collected general practice data in one UK region suggested a CKD prevalence of 4.1%, compared with an estimated national prevalence of 8.5%. Of patients on CKD registers, ∼ 30% were estimated to have suboptimal management according to Public Health Observatory analyses. CHOICE OF SOLUTION: An evidence-based framework for implementation was developed. This informed the design of an improvement collaborative to work with a sample of 30 general practices. IMPLEMENTATION: A two-phase collaborative was implemented between September 2009 and March 2012. Key elements of the intervention included learning events, improvement targets, Plan-Do-Study-Act cycles, benchmarking of audit data, facilitator support and staff time reimbursement. EVALUATION: Outcomes were evaluated against two indicators: number of patients with CKD on practice registers; percentage of patients achieving evidence-based blood pressure (BP) targets, as a marker for CKD care. In Phase 1, recorded prevalence of CKD in collaborative practices increased ∼ 2-fold more than that in comparator local practices; in Phase 2, this increased to 4-fold, indicating improved case identification. Management of BP according to guideline recommendations also improved. LESSONS LEARNED: An improvement collaborative with tailored facilitation support appears to promote the uptake of evidence-based guidance on the identification and management of CKD in primary care. A controlled evaluation study is needed to rigorously evaluate the impact of this promising improvement intervention

Pelvic orientation for total hip arthroplasty in lateral decubitus:can it be accurately measured?

Introduction During total hip arthroplasty (THA), accurately predicting acetabular cup orientation remains a key challenge, in great part because of uncertainty about pelvic orientation. This pilot study aimed to develop and validate a technique to measure pelvic orientation; establish its accuracy in the location of anatomical landmarks and subsequently; investigate if limb movement during a simulated surgical procedure alters pelvic orientation. Methods The developed technique measured 3-D orientation of an isolated Sawbone pelvis, it was then implemented to measure pelvic orientation in lateral decubitus with post-THA patients (n = 20) using a motion capture system. Results Orientation of the isolated Sawbone pelvis was accurately measured, demonstrated by high correlations with angular data from a coordinate measurement machine; R-squared values close to 1 for all pelvic axes. When applied to volunteer subjects, largest movements occurred about the longitudinal pelvic axis; internal and external pelvic rotation. Rotations about the anteroposterior axis, which directly affect inclination angles, showed &gt;75% of participants had movement within ±5° of neutral, 0°. Conclusions The technique accurately measured orientation of the isolated bony pelvis. This was not the case in a simulated theatre environment. Soft tissue landmarks were difficult to palpate repeatedly. These findings have direct clinical relevance, landmark registration in lateral decubitus is a potential source of error, contributing here to large ranges in measured movement. Surgeons must be aware that present techniques using bony landmarks to reference pelvic orientation for cup implantation, both computer-based and mechanical, may not be sufficiently accurate. </jats:sec

Continuing specialist care into adulthood in young people with juvenile idiopathic arthritis: a retrospective cohort study using electronic health records in England.

OBJECTIVES: This study aimed to measure (1) the proportion of children who continue to receive specialist care (rheumatology/ophthalmology) as adults, (2) the characteristics associated with continuing specialist care, and (3) the frequency of specialist care appointments in both paediatric and adult services. METHODS: A retrospective cohort of young people with JIA was identified from UK primary care electronic health records (Clinical Practice Research Datalink) between 1 April 2003 and 31 December 2018. To be included in the study, cases needed to have at least 1 year of registration at their general practice beyond age 18 and linkage to Hospital Episodes Statistics data for secondary care information. All specialist care outpatient visits were identified from Hospital Episodes Statistics outpatient data. RESULTS: There were 666 young people included in the study. Of these, 427 (64%) received specialist care beyond age 18, 90 (13%) had their last recorded contact at 16-17 years and 149 (22%) did not continue after 16 years. Older age at diagnosis, female gender, less deprivation and a childhood diagnosis of uveitis were associated with continuing specialist care beyond age 18. Of those continuing beyond 18, 35% (n = 153) were subsequently discharged by the study end date. Of all those discharged, 32% had a missed appointment recorded after the last attended visit, suggesting failure to attend. CONCLUSIONS: Two-thirds of young people with JIA continue to receive specialist care beyond age 18. This is useful information for children and young people with JIA and their families planning for their future, and for clinicians planning health-care services

Perceptions of the mental health impact of intimate partner violence and health service responses in Malawi

Background and objectives: This study explores the perceptions of a wide range of stakeholders in Malawi towards the mental health impact of intimate partner violence (IPV) and the capacity of health services for addressing these. Design: In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in three areas of Blantyre district, and in two additional districts. A total of 10 FGDs, 1 small group, and 14 IDIs with health care providers; 18 FGDs and 1 small group with male and female, urban and rural community members; 7 IDIs with female survivors; and 26 key informant interviews and 1 small group with government ministry staff, donors, gender-based violence service providers, religious institutions, and police were conducted. A thematic framework analysis method was applied to emerging themes. Results: The significant mental health impact of IPV was mentioned by all participants and formal care seeking was thought to be impeded by social pressures to resolve conflict, and fear of judgemental attitudes. Providers felt inadequately prepared to handle the psychosocial and mental health consequences of IPV; this was complicated by staff shortages, a lack of clarity on the mandate of the health sector, as well as confusion over the definition and need for ‘counselling’. Referral options to other sectors for mental health support were perceived as limited but the restructuring of the Ministry of Health to cover violence prevention, mental health, and alcohol and drug misuse under a single unit provides an opportunity. Conclusion: Despite widespread recognition of the burden of IPV-associated mental health problems in Malawi, there is limited capacity to support affected individuals at community or health sector level. Participants highlighted potential entry points to health services as well as local and national opportunities for interventions that are culturally appropriate and are built on local structures and resilience