Are You Safe at Home?: Rebuilding a Program

The purpose of this doctoral capstone project was to complete a program evaluation of the Safe at Home program provided by Rebuilding Together Minnesota (RTMN). The program evaluation assessed the efficiency of the program and identified areas for improvement. The program evaluation used the Framework for Program Evaluation from the Centers for Disease Control and Prevention (CDC) as the conceptual framework. Four themes were identified by RTMN staff to guide the program evaluation activities: 1) operational efficiency, 2) funding and resource deficits, 3) future goals, and 4) relationship and communication. The key themes from the other participants that informed the program evaluation process included: 1) a set volunteer schedule, 2) improved communication after an installation, and 3) other Rebuilding Together affiliates have occupational therapists complete home assessments year-round. The program evaluation resulted in the creation of 1) a logic model of the Safe at Home program, 2) a Safe at Home protocol for new staff to use as a cheat-sheet, 3) process updates to the program including a Shared Drive on Google Drive, 4) updated pre- and post-screen script and tables, 5) a new method for scheduling installations using My Maps from Google Maps, 6) a home modification handout, and 7) a presentation to RTMN about the program evaluation. A post- survey completed following the program evaluation activities found that the program evaluation improved the program’s efficiency and ability to get services to clients in a more timely manner. The recommendations as a result of the program evaluation include 1) set volunteer times, 2) having a Salesforce super-user, 3) mechanisms to increase outreach, 4) updating the pre- screen assessments, 5) opportunities to increase funding, and 6) conducting a program evaluation for the Home Repair and Ramps programs

Addressing occupational stress among health staff in non-government controlled Northern Syria: Supporting resilience in a dangerous workplace

Introduction: Syrian medical staff working in non-government controlled areas of Syria operate in situations that expose them to great personal danger, while they must often face the same challenges as the people they help. Supporting the wellbeing of these staff is crucial to the operation of health services for internally displaced Syrians given the large-scale destruction of healthcare infrastructure. Methods: Findings from a staffcare programme designed by a grassroots Syrian psychosocial organisation in Southern Turkey and implemented in a medical nongovernment organisation in Idlib in Northern Syria are presented. An iterative and collaborative process employed individual, team and organisational level consultation to identify occupational stresses within the workplace. A six-month programme involved group sessions across eight sites with 56 staff working in three primary health clinics, two mobile teams and one sexual and reproductive health clinic, serving eight internally displaced persons camps in Idlib. Results: Following the programme, staff reported significant reductions in role ambiguity, and improvements in the nature of their work, personal relationships with colleagues and superiors and physical conditions in the workplace. There were no significant differences in reported organisational structure or job satisfaction. Discussion: This evaluation of a grassroots programme, designed to address the expressed needs of displaced staff, suggests that reductions in daily living stresses can be achieved even in the context of ongoing crisis

Not All Patients Need Supervised Physical Therapy After Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Although postoperative physical therapy (PT) has long been considered essential to successful total knee arthroplasty (TKA) recovery, recent literature has suggested that unsupervised home exercise regimens may offer similar benefits to formal supervised sessions. We aimed to compare objectively measured physical function and subjective patient-reported outcomes (PROs) between primary TKA patients who received formal supervised physical therapy sessions and those who received unsupervised home exercise regimens after discharge. Six electronic databases were queried to identify randomized controlled trials comparing supervised physical therapy to unsupervised home exercise regimens in primary TKA patients after discharge. Outcomes of interest included change from baseline in objective measures (knee flexion range of motion (ROM), lower extremity strength, and aerobic capacity) and PROs (physical function and quality of life scores). These outcomes were subdivided into short-term (surgery; closest data point to three months is used if multiple measurements were made in this time period) and long-term (≥6 months from surgery; closest data point to 12 months is used if multiple measurements were made in this time period) assessments. A total of 1,884 cases performed in 11 studies were included in this review. There were no significant differences between cohorts with regard to short-term knee flexion ROM (p = 0.7), lower extremity strength (p = 0.6), or patient-reported quality of life (p = 0.5), as well as long-term knee flexion ROM (p = 0.7), patient-reported quality of life (p = 0.2), or patient-reported physical outcome scores (p = 0.3). A small difference in short-term patient-reported physical outcomes was observed in favor of the supervised cohort (standardized mean difference (SMD): 0.3 (95% confidence interval (CI): 0.01, 0.6); I2 = 82%; p = 0.04). Formal supervised physical therapy regimens do not confer clinically significant benefits over unsupervised home exercise regimens following primary TKA. The routine use of supervised physical therapy after discharge may not be warranted. Further study is needed to determine the subset of patients that may benefit from supervised care

Laboratory-Reported Normal Value Ranges Should Not Be Used to Diagnose Periprosthetic Joint Infection.

INTRODUCTION: Clinical laboratories offer several multipurpose tests, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are not intended to diagnose any specific disease but are used by clinicians in multiple fields. The results and laboratory interpretation (normal/abnormal) of these multipurpose tests are based on laboratory-reported normal thresholds, which vary across clinical laboratories. In 2018, the International Consensus Meeting on Musculoskeletal Infection (2018 ICM) provided a gold-standard definition to diagnose periprosthetic joint infection (PJI) which included many multipurpose laboratory tests, along with thresholds optimized to diagnose PJI. The discrepancy between laboratory-reported normal thresholds and 2018 ICM-recommended PJI-optimized test thresholds has never been studied. The purpose of this study was to assess the existing variation in laboratory-reported normal thresholds for tests commonly used to diagnose PJI and evaluate the potential diagnostic impact of using laboratory-reported normal thresholds instead of 2018 ICM-recommended PJI-optimized thresholds. METHODS: Clinical laboratories (N=85) were surveyed to determine the laboratory-reported units of measure and normal thresholds for common multipurpose tests to diagnose PJI, including the ESR, CRP, D-dimer, synovial fluid white blood cells (SF-WBC), and polymorphonuclear cell percent (SF-PMN%). The variability of units of measure and normal thresholds for each test was then assessed among the 85 included clinical laboratories. A representative dataset from patients awaiting a revision arthroplasty was used to determine the clinical significance of the existing discrepancy between laboratory-reported normal test interpretations and 2018 ICM-recommended PJI-optimized test interpretations. RESULTS: Two units of measure for the CRP and six units of measure for the D-dimer were observed, with only 59% of laboratories reporting the CRP in terms of mg/L and only 16% reporting the D-dimer in ng/ml, as needed to utilize the 2018 ICM definition of PJI. Across clinical laboratories surveyed, the mean laboratory-reported normal thresholds for the ESR (20 mm/h), CRP (7.69 mg/L), D-dimer (500 ng/mL), SF-WBC (5 cells/uL), and SF-PMN% (25%) were substantially lower than the 2018 ICM-recommended PJI-optimized thresholds of 30 mm/h, 10 mg/L, 860 ng/mL, 3,000 cells/uL, and 70%, respectively. Interpretation of test results from a representative PJI dataset using each laboratory\u27s normal test thresholds yielded mean false-positive rates of 14% (ESR), 18% (CRP), 42% (D-dimer), 93% (SF-WBC), and 36% (SF-PMN%) versus the ICM-recommended PJI-optimized thresholds. CONCLUSION: When reporting the results for multipurpose laboratory tests, such as the ESR, CRP, D-dimer, SF-WBC, and SF-PMN%, clinical laboratories utilize laboratory-reported units of measure and normal thresholds that are not intended to diagnose PJI, and therefore may not match the 2018 ICM recommendations. Our findings reveal that laboratory-reported normal thresholds for these multipurpose tests are well below the 2018 ICM recommendations to diagnose PJI. Clinical reliance on laboratory-reported results and interpretations, instead of strict use of the 2018 ICM-recommended units and PJI-optimized thresholds, may lead to false-positive interpretation of multipurpose laboratory tests

Those Who Teach Can Do: Skill Development Through Undergraduate Teaching

Upon entering the workforce or progressing into a graduate program, undergraduate students are expected to possess a number of both technical and psychological skills, as well as transferable skills, often termed “soft skills” (Appleby, 2003). In addition to coursework, experience through institutional research or undergraduate teaching may provide the necessary opportunities for development of transferable skills. Research presently supports the idea that undergraduate teaching assistants report the acquisition of professional skills through interactions with students and professors (Fingerson & Culley, 2001). These interactions and responsibilities may create similar effects, in terms of professional skill development, to those expected from performing undergraduate research, such as confident communication and leadership (Shalk et al., 2009). Through work as an undergraduate teaching assistant, it is thought that students will develop key knowledge, skills, and characteristics (KSC’s) identified as essential by potential employers through the U.S. Department of Labor’s Occupational Information Network (Appleby, 2019). The aim of the present study is to measure gains in teaching assistants’ perceptions of their transferable skills and professional abilities. The researchers have constructed a survey intended to assess students’ perceived competencies and expectations of competencies following completion of the teaching assistant experience. Over the course of three semesters the researchers have surveyed students enrolled in an undergraduate teaching assistant practicum. Students receive course credit and, in addition to gaining professional experience, engage in reflection intended to encourage self-evaluation and integration of professional abilities and goals. The constructed survey is based on the work of Appleby (2007; 2019) and it measures perceived competency in the following domains: integrity, attention to detail, dependability, initiative, flexibility, persistence, communication, goal setting, analytical thinking, self-control, stress tolerance and cooperation. Individual difference measures were also captured, for example, Need for Cognition (Cacioppo et al., 1984) and Brief Resilience Scale (Smith et al., 2008). The researchers also created additional questions to assess the impact of the global pandemic. We hypothesize that this scale will effectively capture gains in perceptions of transferable skills and professional abilities following a TA practicum course. We also hypothesize that individual differences, such as resilience and need for cognition may be correlated. This survey has potential for use with diverse groups of teaching assistants in various departments and educational institutions

Unsupervised Home Exercises Versus Formal Physical Therapy After Primary Total Hip Arthroplasty: A Systematic Review

Historically, postoperative exercise and physical therapy (PT) have been viewed as crucial to a successful outcome following primary total hip arthroplasty (THA). This systematic review and meta-analysis aimed to assess differences in both short- and long-term objective and self-reported measures between primary THA patients with formal supervised physical therapy versus unsupervised home exercises after discharge. A search was conducted of six electronic databases from inception to December 14, 2020, for randomized controlled trials (RCTs) comparing changes from baseline in lower extremity strength (LES), aerobic capacity, and self-reported physical function and quality of life (QoL) between supervised and unsupervised physical therapy/exercise regimens following primary THA. Outcomes were separated into short-term (surgery, closest to 3 months) and long-term (≥6 months from surgery, closest to 12 months) measures. Meta-analyses were performed when possible and reported in standardized mean differences (SMDs) with 95% confidence intervals (CI). Seven studies (N=398) were included for review. No significant differences were observed with regard to lower extremity strength (p=0.85), aerobic capacity (p=0.98), or short-term quality of life scores (p=0.18). Although patients in supervised physical therapy demonstrated improved short-term self-reported outcomes compared to those performing unsupervised exercises, this was represented by a small effect size (SMD 0.23 [95% CI, 0.02-0.44]; p=0.04). No differences were observed between groups regarding long-term lower extremity strength (p=0.24), physical outcome scores (p=0.37), or quality of life (p=0.14). The routine use of supervised physical therapy may not provide any clinically significant benefit over unsupervised exercises following primary THA. These results suggest that providers should reconsider the routine use of supervised physical therapy after discharge

Evaluation of Participation and Environments for Individuals with Disabilities: An Evidence-Based Practice Project Bailey

This Evidence-Based Practice (EBP) project considered the following question: What measures are available to evaluate participation and environmental supports and barriers for individuals with disabilities and what are their psychometric properties

Abundance and diversity of bees visiting flowering pennycress, a new oilseed crop in the midwestern USA

Oilseed pennycress (Thlaspi arvense) is a new, autumn-sown, “cash cover crop” for the Midwestern USA and elsewhere. Anthesis occurs in early spring when few other plants bloom, and its flowers attract early-emerging bees. However, the taxonomic composition of these bees was unknown. Consequently, we systematically captured and identified the genera and species of bees visiting pennycress flowers throughout anthesis at five site-years: two in Illinois and three in Minnesota. A cumulative total of 28 bee species were found across site-years. The most common genera were Andrena (10 species), Lasioglossum (12 species), and Halictus (2 species). Rarer genera were Apis, Ceratina, Hylaeus, and Nomada. Bee abundance and diversity were related closely and in a negative exponential manner with percent land area devoted to annual cropping. The inclusion of new early flowering crops, such as pennycress, may enhance bee abundance and diversity, especially if even small areas of uncropped land are nearby