Search

Objectives The aim of the study was to evaluate feasibility and utility of an electronic health record (EHR) activity to assess transitional readiness, deliver services to meet individual needs, and to track patient progress. Methods We developed a Transition EHR activity (TEA) to track patients through a standardized process where transition readiness is annually assessed and services distributed based on need. The process assesses transition skills starting at age 12 years and sets goals through shared decision-making, delivers resources according to need, reviews patients' personal medical histories, and documents healthcare transfer to adult gastroenterology. We piloted TEA among patients with inflammatory bowel disease (IBD) ages ≥12 years. Distribution to patients was measured and tolerability assessed via patient self-report evaluations. Results Since launch, TEA has been distributed to all eligible patients (N = 53) with a median age of 16 (14,18) years (median [IQR]), 62% male, 58% white, 26% Hispanic at our weekly dedicated IBD clinic. All have performed the transition skills' self-assessment and practicum, and set transition goals with their healthcare provider. Of these individuals, 41 (77%) participated in survey feedback. On a utility rating scale of 0 (not helpful at all) to 10 (very helpful), patients reported median (IQR) utility scores of 8 (7,10) for the transition readiness assessment, 9 (7,10) for transition resources provided, and 9 (7,10) for the medical history summary. Most (91%) would recommend TEA to other patients. Conclusions TEA standardized delivery of resources among pediatric IBD patients and was well received and friendly to clinical workflow.

The ability to respond to public health emergencies involving infectious diseases as well as our ability to adequately prepare for as yet unknown or unrecognized emerging infectious diseases requires suitable facilities within which scientific investigations can take place. To ensure the safe conduct of such investigations so that laboratory workers and the general public are protected from potential consequences of accidental or intentional release of high consequence pathogens, special containment facilities have been designed and constructed. Evaluation of the adequacy of containment for these types of investigations requires a risk assessment (RA) as part of the overall construction project for these types of laboratories. A discussion of the RA process along with considerations that impact the design of such studies and the overall results is presented.

The design, construction, and mitigation of a shredded tire embankment that underwent pyrolysis and full combustion are discussed. The embankment was constructed to repair a 45-m-long section of SR-100 near Ilwaco, Washington, after a landslide occurred in native weathered siltstone. Because of foundation soil characteristics and the proximity of environmentally sensitive areas, the roadway was rebuilt using shredded tires as a lightweight embankment material. Construction of the 8-m (maximum depth of shredded tire chips) embankment went smoothly. Less than 2 months after completion, however, unusual asphalt cracking, odors, and steam were observed in the embankment. The steam and elevated surface temperature readings suggested pyrolysis or combustion of shredded tire chips. Weekly monitoring and sampling were conducted while mitigation options were evaluated. Less than 4 months following construction, an oily substance was observed in the water seeping from the drainage blanket underlying the embankment. The oil was immediately contained using booms, sumps, and a containment berm. Because exposure to oxygen could cause a flare-up, several in situ cooling methods were evaluated to minimize oxygenation of the material. Because of environmental and logistical concerns, excavation and water immersion of shredded tire chips was deemed the preferred mitigation measure. If using shredded tire chips as an embankment material is to be continued, it will be necessary to identify factors contributing to the pyrolysis/combustion so that preventive design criteria can be developed, and methods for remediating pyrolysis and combustion problems should they arise.

Many clinicians working in inner-city community mental health centers find themselves overwhelmed by the complexity of the treatment cases presented. This paper illustrates the application of a multisystems model of family therapy that allows the clinician to organize and implement a treatment plan at the nuclear family, extended family, and systems levels.

Based on a literature review and a survey of existing programs, this preventive outreach program emphasizes staff training in order to prepare college staff to implement a variety of outreach efforts following the suicide attempt or death of a student on campus. Specific guidelines are offered for the management of the suicide crisis, with special attention focused on the friends of the suicide victim.

Fostering competence in clinical practitioners is a goal easier stated than accomplished. This article translates selected concepts from ego psychology and communications theory into specific guidelines for developing competent clinical practitioners. The "life model" approach to supervision presented here emphasizes building from the strenghts of the supervisee and promoting growth in a nuturing, supportive supervisory environment.

The close relationship between crisis intervention and prevention is examined in the context of social work consultation with preschool and senior citizen centers. The location of service in community settings provides opportunities to reach “nonclient” populations facing either anticipated or unanticipated crises.

The development of a group therapy approach for black women is reported. The therapeutic and support functions of the group are discussed and the recurrent themes arising in group sessions are examined. Many group members achieved their goals of self-exploration, insight, and significant behavioral change.