Translating veterinary clinical experiences into effective educational experiences with case studies

Poster presentationEducating the next generation of veterinary practitioners is evolving and medical knowledge is growing rapidly, outstripping the practitioners’ ability to keep up with the medical literature. One challenge is shifting from primarily testing factual knowledge, towards demonstrating proficiencies in professional competencies. This emphasis highlights the importance of collaborating with content specialists, such as partnering with librarians, to support the development of information competencies. Teaching professional competencies in a curriculum can be overwhelming, especially for those without a background in educating adult learners. However, a variety of teaching methods and tools can facilitate moving from clinic to classroom. Frameworks may assist in constructing case studies to support contextual teaching. This approach is advantageous because the content is familiar and the framework facilitates chunking the information into a case study with a logical progression of information for learning. We designed a case study worksheet that we then used to create the “PubMed for Veterinarians” tutorial. It is a simple case study providing context for users while they learn an information competency searching PubMed. The tutorial provides a framework that practitioners can use as a model to translate clinical experiences to educational experiences for the classroom. In this example, the medical case was intentionally uncomplicated to emphasize the PubMed skills. The “PubMed for Veterinarians” tutorial is a collaborative effort that emphasizes clinical information as context for learning and information competency. As an instructor, the practitioner can use tools like this case study worksheet to translate experiences into context for teaching that emphasizes competencies and develops skills for practitioners in practice.This project has been funding in whole or part with Federal funds from the National Library of Medicine, National Institutes of Health, under Contract. No. HHSN-276-2001-00007-C with the Houston Academy of Medicine - Texas Medical Center Library

Behavioral health emergencies encountered by community paramedics: lessons from the field and opportunities for skills advancement

INTRODUCTION: When an individual calls 911 because of a behavioral health emergency, paramedics may be the first health care professional on scene to address that crisis. Traditionally, the paramedic profession has been educated to respond to life-threatening medical emergencies.1 Paramedics are increasingly expected to respond to behavioral health crises but may not be adequately prepared to do so. 1 There has been limited research regarding paramedics’ experiences, attitudes, and perceptions about responding to behavioral health crises, with a particular dearth of literature on this subject from the USA. 1,2,3,4,5 As the first point of contact, paramedics may influence the quality of care individuals experiencing behavioral health emergencies receive, rendering this gap in knowledge concerning. 1,4 Paramedics encounter a range of behavioral health crises, from individuals who have self-harmed, substance use, to older adults experiencing social isolation. 6,7 This study aimed to answer the following questions: Do paramedics feel well prepared to respond to behavioral health crises? How do paramedics describe the challenges and facilitators involved in responding to these situations? What are the skills they use to respond to these situations? The present study examined paramedics’ experiences and perceptions regarding behavioral health emergencies, aiming to address a significant gap in the literature on paramedics’ ability to respond to the needs of individuals experiencing behavioral health crises. BACKGROUND: Limited research based in the UK, Europe, and Australia has examined the extent to which paramedics feel equipped by their training to respond to situations of a behavioral health nature, with a marked lack of USA-based research in this area. In a survey of members of the College of Paramedics (UK), 98% of the 623 respondents endorsed the need for increased mental health education and training. 2 Paramedic training curriculums in the UK have evolved to incorporate more of an emphasis on behavioral health, yet whether or not this behavioral health training is effective has not yet been investigated. 1 Several Australian studies investigated paramedic perceptions of their mental health training and decision-making during mental health emergencies.5,8. Paramedic participants reported inadequate mental health training and indicated a need for increased education on mental illness, particularly regarding possible treatment options that are feasible as part of prehospital care.8. Paramedics described relying more on intuition than education when faced with challenging cases.5 In a mixed methods study, Australian paramedics reported the need for more education on how to adequately respond to older adults experiencing complex mental health crises including depression, social isolation, and food insecurity.7 Limited research has explored paramedic perceptions, attitudes, and experiences responding to behavioral health emergencies, but the existing research indicates that many emergency healthcare providers consider physical health emergencies more valuable or important than behavioral health emergencies.8,9,10 Studies indicate that paramedic students do not consider training in mental health issues as relevant to the profession,1 with an Australian study of paramedic undergraduate students indicating a lower level of regard for those with intellectual disabilities, substance abuse disorders, or acute mental illness compared to students studying in other health professions.11 A multi-site, qualitative study based in Paris, France and New York, New York examined how social and professional values influenced prehospital emergency workers’ responses.9 The authors found that patients deemed to have lower social value were lower priority to emergency providers, with cases involving substance use or calls from lower socioeconomic areas, for instance, regarded as less legitimate uses of emergency services.9 Notably, situations that required more complex or heroic medical or surgical actions were also attributed higher value by emergency healthcare workers.9 Greater importance was attributed to medical (versus behavioral health) emergencies across additional studies, with paramedic participants implying that behavioral health calls were not valid emergencies,5 and with paramedic participants indicating that their role is mainly to transport—not to treat—individuals experiencing behavioral health crises.8 Additionally, paramedic participants perceived their services as often used inappropriately for behavioral health emergencies due to the limited availability of more appropriate behavioral health services.8 Related research regarding the perceptions of emergency department physicians and nurses in the USA also revealed a greater value placed on physical versus behavioral health emergencies, as well as perceptions that certain crises (such as self-harm) were less valid, or less worthy of emergency treatment.10 This is particularly concerning given that emergency department healthcare providers interact with a substantial number of persons seeking behavioral health emergency care: in 2015, approximately 4.1% of visits to an emergency department were related to diagnosed mental health disorders (approximately 5,666,000 visits).12 The number of emergency department visits related to opioid overdose increased by 29.7% in the USA between July 2016 and September 2017.13 Emergency healthcare workers are treating a significant number of behavioral health emergencies, rendering improved understanding of healthcare providers’ perceptions and attitudes towards this population crucial. Existing research into the perceptions of experienced paramedic practitioners regarding behavioral health emergencies is limited.1,3,4 With the exception of a multi-site study based in New York, New York and Paris, France,9 a thorough review of the extant literature failed to unearth research on the perceptions and experiences of paramedics responding to behavioral health crises in the USA. This is a particularly significant gap, as differences in paramedic education, relevant behavioral health legislation, and culture may exist across countries. The present study used qualitative analyses of in-depth interviews of practicing paramedics to address this gap by examining paramedics’ perceptions and experiences responding to behavioral health crises in the USA. METHODS: This study was part of a Patient-Centered Outcomes Research Institute (PCORI) contract funding an examination of the Acute Community Care Program (ACCP) at Commonwealth Care Alliance (CCA). The Acute Community Care Program is a state-funded community paramedicine intervention for the patients of CCA, in conjunction with EasCare Ambulance Company. INTERVIEW GUIDE AND RECRUITMENT: The research team, which included experienced paramedics at EasCare Ambulance Company, worked together to create an open-ended guide to interview paramedics. The interview protocol consisted of six sections: (1) history of career as paramedic, (2) current skills and job experiences, (3) views of paramedic experience, (4) career goals, (5) final questions and wrap up, and (6) demographics. The research team revised the original guide after several pilot interviews and based on feedback from key informants, namely seasoned paramedic supervisors from the research team. Interviews with paramedics lasted approximately 1 h and were conducted over the phone by either the PI or Co-PI, who are experienced in qualitative research. The research team intended to interview 25 paramedics who would be identified through two large ambulance companies in the Greater Boston area of Massachusetts. The director at these ambulance companies asked their paramedics on staff if they would be willing to be interviewed and, if they agreed, the director gave us their contact information. Six paramedics who had initially agreed could not be reached, and arrangements were made with one paramedic who did not follow through with the interview. In total, the researchers conducted telephone interviews with 23 paramedics, after receiving verbal informed consent to perform and record the interview. Participants were mailed a $50 gift card to thank them for their time. Professional transcription service transcribed digital recordings verbatim, and the project manager reviewed all transcripts against the digital recording, making small corrections as needed. DATA ANALYSIS: Audiotapes of the sessions were analyzed by three research team members. A thematic analysis approach was utilized, starting with familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing a final analysis.14 The researchers worked both separately and collaboratively, working individually at each stage of the process and then coming together to compare results in order to ensure the validity of identified themes. Early readings of the transcript data allowed the researchers to develop preliminary ideas regarding potential themes. Each researcher then thoroughly analyzed the individual transcripts, generating initial codes and beginning to search for themes both within and across documents. During this stage, the researchers met frequently to compare and contrast the results of each individual’s analysis, reviewing emerging themes and collaborating to refine themes into a coherent set. To asses inter-rater reliability, two un-read transcripts were reviewed by all team members and coded independently, followed by meetings as a research team to compare coding decisions on each transcript and reconcile any discrepancies. This rigorous process helped to ensure strong inter-rater reliability as we were able to gain consensus in our coding process for all other transcripts. Researchers individually arranged transcript data verbatim into groups of initial themes, and a master document was then created collaboratively, which outlined each finalized theme and included transcript excerpts embodying each theme. Memo-writing was employed throughout the analytic process to document coding decisions.15 As a final check for validity, the two experienced paramedic supervisors from the research team reviewed the themes and subthemes and provided feedback about the findings. The paramedic supervisors confirmed that these themes were what they might have expected the data to reveal, further validating the findings. RESULTS: Table 1 shows demographic characteristics of the 23 participants. Results for this paper will focus on three themes identified in the data analysis. Namely, paramedics (1) report frequently working with patients who are having a behavioral health crisis, (2) report having inadequate behavioral health training, and (3) have many difficulties managing these patients, relying primarily on their professional experiences and/or strong interpersonal skills rather than explicit training to address patients’ needs (see Table 2).Accepted manuscrip

Pain Coping Skills Training for African Americans With Osteoarthritis Study: Baseline Participant Characteristics and Comparison to Prior Studies

Background: The Pain Coping Skills Training for African Americans with OsteoaRTthritis (STAART) trial is examining the effectiveness of a culturally enhanced pain coping skills training (CST) program for African Americans with osteoarthritis (OA). This disparities-focused trial aimed to reach a population with greater symptom severity and risk factors for poor pain-related outcomes than previous studies. This paper compares characteristics of STAART participants with prior studies of CST or cognitive behavioral therapy (CBT)-informed training in pain coping strategies for OA. Methods: A literature search identified 10 prior trials of pain CST or CBT-informed pain coping training among individuals with OA. We descriptively compared characteristics of STAART participants with other studies, in 3 domains of the National Institutes of Minority Health and Health Disparities' Research Framework: Sociocultural Environment (e.g., age, education, marital status), Biological Vulnerability and Mechanisms (e.g, pain and function, body mass index), and Health Behaviors and Coping (e.g., pain catastrophizing). Means and standard deviations (SDs) or proportions were calculated for STAART participants and extracted from published manuscripts for comparator studies. Results: The mean age of STAART participants, 59 years (SD = 10.3), was lower than 9 of 10 comparator studies; the proportion of individuals with some education beyond high school, 75%, was comparable to comparator studies (61-86%); and the proportion of individuals who are married or living with a partner, 42%, was lower than comparator studies (62-66%). Comparator studies had less than about 1/3 African American participants. Mean scores on the Western Ontario and McMaster Universities Osteoarthritis Index pain and function scales were higher (worse) for STAART participants than for other studies, and mean body mass index of STAART participants, 35.2 kg/m2 (SD = 8.2), was higher than all other studies (30-34 kg/m2). STAART participants' mean score on the Pain Catastrophizing scale, 19.8 (SD = 12.3), was higher (worse) than other studies reporting this measure (7-17). Conclusions: Compared with prior studies with predominantly white samples, STAART participants have worse pain and function and more risk factors for negative pain-related outcomes across several domains. Given STAART participants' high mean pain catastrophizing scores, this sample may particularly benefit from the CST intervention approach

Pain coping skills training for African Americans with osteoarthritis (STAART): study protocol of a randomized controlled trial

Background: African Americans bear a disproportionate burden of osteoarthritis (OA), with higher prevalence rates, more severe pain, and more functional limitations. One key barrier to addressing these disparities has been limited engagement of African Americans in the development and evaluation of behavioral interventions for management of OA. Pain Coping Skills Training (CST) is a cognitive-behavioral intervention with shown efficacy to improve OA-related pain and other outcomes. Emerging data indicate pain CST may be a promising intervention for reducing racial disparities in OA symptom severity. However, there are important gaps in this research, including incorporation of stakeholder perspectives (e.g. cultural appropriateness, strategies for implementation into clinical practice) and testing pain CST specifically among African Americans with OA. This study will evaluate the effectiveness of a culturally enhanced pain CST program among African Americans with OA. Methods/Design: This is a randomized controlled trial among 248 participants with symptomatic hip or knee OA, with equal allocation to a pain CST group and a wait list (WL) control group. The pain CST program incorporated feedback from patients and other stakeholders and involves 11 weekly telephone-based sessions. Outcomes are assessed at baseline, 12 weeks (primary time point), and 36 weeks (to assess maintenance of treatment effects). The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index, and secondary outcomes include self-efficacy, pain coping, pain interference, quality of life, depressive symptoms, and global assessment of change. Linear mixed models will be used to compare the pain CST group to the WL control group and explore whether participant characteristics are associated with differential improvement in the pain CST program. This research is in compliance with the Helsinki Declaration and was approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill, Durham Veterans Affairs Medical Center, East Carolina University, and Duke University Health System. Discussion: This culturally enhanced pain CST program could have a substantial impact on outcomes for African Americans with OA and may be a key strategy in the reduction of racial health disparities.Funded by Patient-Centered Outcomes Research Institute (PCORI) Award (AD-1408-19519)

Depressive Symptoms in Children with Chronic Kidney Disease

To assess depression in children with chronic kidney disease (CKD) and to determine associations with patient characteristics, intellectual and educational levels, and health related quality of life (HRQoL)

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Partnering to cope with pain: A pilot study of a caregiver-assisted pain coping skills intervention for patients with cognitive impairment and dementia

ObjectiveTo develop a new caregiver-assisted pain coping skills training protocol specifically tailored for community-dwelling persons with cognitive impairment and pain, and assess its feasibility and acceptability.MethodIn Phase I, we conducted interviews with 10 patient-caregiver dyads to gather feedback about intervention content and delivery. Phase II was a single-arm pilot test to evaluate the intervention's feasibility and acceptability. Dyads in the pilot study (n = 11) completed baseline surveys, received five intervention sessions, and then completed post-intervention surveys. Analyses focused on feasibility and acceptability.ResultsDyads responded positively to the pain coping skills presented in the interviews; their feedback was used to refine the intervention. Findings from the pilot study suggested that the intervention was feasible and acceptable. 69% of eligible dyads consented, 82% completed all five intervention sessions, and 100% completed the post-treatment assessment. Caregivers reported high satisfaction ratings. They also reported using the pain coping skills on a regular basis, and that they found most of the skills helpful and easy to use.Significance of resultsThese preliminary findings suggest that a caregiver-assisted pain coping skills intervention is feasible and acceptable, and that it may be a promising approach to managing pain in patients with cognitive impairment

Fear of movement in children and adolescents undergoing major surgery : a psychometric evaluation of the Tampa Scale for Kinesiophobia

Background The objective of this study was to evaluate the psychometric properties of the 17-item Tampa Scale for Kinesiophobia (TSK) in youth. Methods Participants were 264 children and adolescents (58.7% female, Mage = 14.1 years, SDage = 2.51) scheduled for major surgery who were assessed before surgery, while in hospital postoperatively, and at 6 and 12 months after surgery. Exploratory factor analyses (EFA) were conducted to determine the factor structure of pre-operative TSK scores. Reliability, and convergent, discriminant, and predictive validity were examined. Results EFA on the 17-item TSK revealed a two-factor model distinguishing the 13 positively scored items from the 4 reverse scored items, but the fit was poor. A second EFA was conducted on the 13 positively scored items (TSK-13) revealing a three-factor model: Fear of injury, bodily vulnerability, and activity avoidance. The TSK-13 showed adequate internal consistency (Ω = 0.82) and weak convergent validity. The TSK-13 was not correlated with postoperative, in-hospital physical activity (actigraphy; r (179) = −0.10, p = 0.18) and showed adequate discriminant validity, that is correlations less than 0.70, with measures of depression (r (225) = 0.41, p < 0.001) and general anxiety (r (224)=0.35, p < 0.001). Predictive validity for pain-related disability at 12 months (r (70) = 0.34, p < 0.001) was adequate. Conclusions The original TSK-17 does not appear to be a meaningful measure of kinesiophobia in youth after surgery possibly because of the syntactic structure of the reverse scored items. In contrast, a modified TSK-13, comprised of only the positively scored items, revealed a 3-factor structure that is reliable and demonstrates adequate convergent, discriminant, and predictive validity. Significance Kinesiophobia is an important construct to evaluate in the transition from acute to chronic pain among children and adolescents. The 17 item Tampa Scale for Kinesiophobia (TSK) does not show adequate validity or reliability in youth undergoing major surgery, however, the psychometric properties of a 13-item modified scale (TSK-13) are promising