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BACKGROUND: The optimal therapeutic approach for acute myocardial infarction (AMI) is still evolving; however, many would consider one of two basic options: 'medical'-only thrombolysis or reperfusion, or an early (invasive), percutaneous coronary intervention (PCI). The decision about which is most appropriate depends (perhaps unfortunately) on more than just medical factors. That is, the choice for some patients is also limited by payor source and the technical capabilities at the site of the initial treatment. Practically speaking, a significant portion of the US population simply does not have the option of (at least, initial) PCI. METHODS AND RESULTS: Kino Community Hospital in Tucson, AZ, serves primarily an indigent population in southern Arizona, near the border with Mexico. This facility does not have in-house capability for PCI. Therefore, shortly after the publication of the original Thrombolysis in Myocardial Infarction (TIMI) 14 study (June 1999), we implemented their combination reperfusion protocol for the initial therapy of eligible patients admitted to the hospital with AMI. This report documents our experience with this medical reperfusion regimen in 42 patients over a span of almost 3 years. A retrospective chart review was conducted to evaluate outcome in 42 patients with ST-segment elevation myocardial infarction given the TIMI-14 reperfusion regimen. Resolution of ST-segment changes occurred in 30 patients (71.4%) [complete resolution in 25 patients (59.5%) and incomplete resolution in 5 patients (1.9%)], with major bleeding complicating the therapy of only 1 patient (2.38%) [corrected]. After stabilization in our facility, 28 patients (66.6%) needed PCI. CONCLUSION: This report summarizes the experience of a small county hospital where medical thrombolysis is the only immediate therapy available. [ABSTRACT FROM AUTHOR]

Nurse-social worker collaborative interactions in long-term care settings have received limited attention. This qualitative thematic study of 23 participants (11 social workers and 12 nurses) at an urban retirement and assisted living community explores experiences of collaborative work. Two themes of contrasts in responding to resident complexity and contrasts in peer-to-peer work highlight four subthemes reflecting: (a) social workers' orientation toward resident self-determination, requisite care, and advocacy; (b) nurses' orientation toward resident safety, tasks, and clinical outcomes; (c) social workers' devalued professional identity; and (d) nurses' attribution of collaborative challenges to individuals. Social workers showed greater openness toward working with nurses and viewed nurses as close partners. Nurses showed greater separation from social workers and non-clinical peers and maintained a greater intraprofessional focus. Whereas challenges may stem from antecedent disciplinary training nurses and social workers receive, organizational triggers related to residents' care and associated decision-making exacerbate them. Interprofessional education may strengthen collaboration., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

There has been widespread outrage within the social work profession regarding racial disparities in pass rates of licensing exams developed and administered by the Association of Social Work Boards (ASWB). The most supported remedy has been to eliminate testing for some categories of licensure with Connecticut, Illinois, and Rhode Island leading the way. Standardized testing has historically been a gatekeeping practice criticized for its exclusionary nature with no empirical evidence linking it to more competent mental health and other social work practice. Thus, the profession is correct in questioning an exam's relevance in social work regulation. However, the licensure test has become a lightning rod issue preventing more substantive analyses, debate, and antiracist reforms within the profession's policy, practice, and education arenas. This article uses the disparity in ASWB pass rates as the impetus for a more critical look at systemic issues in social work adversely impacting Black individuals entering the profession. The authors acknowledge that an anti-racist agenda in social work requires tackling long-standing problems that will not be as easily solved as eliminating multiple choice testing.

COVID-19 highlights the need for portability of social work licensure to be a priority. The Association of Social Work Boards (ASWB) spearheaded some initiatives, such as the creation and promotion of the Social Work Registry and Model Social Work Practice Act, with the hope that these efforts would enhance the ability of social workers to be licensed in multiple states. Neither has solved the portability problem. Licensure endorsement, an approach historically supported by ASWB, does not have the advantages of mutual recognition that is being supported by other professions to facilitate interstate practice. This article, the first written on licensure portability in the social work scholarly literature, examines existing licensure portability models and supports the establishment of a social work interstate compact to overcome barriers to social work mobility and access to client care., (© 2022 National Association of Social Workers.)

Developing coping and self-care strategies has always been important for social work students as they prepare for work that can take a psychological, emotional, mental, and physical toll and adversely impact their health and well-being. The COVID-19 pandemic is unprecedented in its impact on social work education as it forced students to quickly transition to online learning and leave field sites abruptly to do remote activities. The degree to which and how social work students effectively coped with these changes has not been adequately studied, despite recognition that understanding how personal experiences and affective reactions influence professional judgment and behavior is a critical social work competency. To help fill this void, a mixed-methods study was conducted using video narratives and survey data to assess the coping and self-regulation skills of a cohort of undergraduate social work students. Findings indicate that these students experienced multiple stressors in all aspects of their biopsychosocial functioning due to COVID-19. Many coping skills learned for use with clients were demonstrated by students themselves. Self-sufficient, avoidant, and socially-supported coping mechanisms were frequently used and relied on by students. Use of self-distraction and active coping increased, while denial decreased within the first month after transitioning to remote learning. Implications of the findings for social work education, practice, and research are discussed., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature 2021.)

Objectives: To estimate the impact that pharmacist immunization programs have on immunization rates., Data Sources: Pubmed, Ovid/Medline, and Google Scholar were searched. References were checked and citation searches using identified studies conducted., Study Selection: Studies were eligible for the systematic review and meta-analysis if the study compared pharmacist as immunizer versus usual care. Any study design that involved a comparison group was acceptable., Data Extraction: Data were extracted by 2 investigators independently with the use of a standardized data extraction form; any differences were resolved by consensus., Results: A total of 8 studies with 11 study arms met inclusion criteria. A wide variety of immunizations were provided, including influenza, herpes zoster, pneumococcal, Tdap, hepatitis A and B, MMR, varicella, meningococcal, and human papillomavirus. Immunizations were provided in a variety of settings, including hospitals, single community sites, multiple sites, and a university. The overall risk ratio (RR) for immunizations was 2.95 (P <0.001) but varied substantially based on type of vaccine administered (heterogeneity: I(2) = 93.28%). For influenza, the RR was 2.23 (P <0.001), for herpes RR was 4.78 (P <0.001), and for other vaccines RR was 3.44 (P <0.001). The RR for comparisons by type of vaccine and sample size was significant (P = 0.010 and P <0.001, respectively)., Conclusion: Pharmacist immunization programs can have a substantial impact on immunization rates, but the impact varied widely. Widespread implementation of pharmacist immunization programs that include an advocacy component could help in the reaching of Healthy People 2020 immunization goals., (Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

The purpose of the study was to characterize natural ventilation in full-scale gravity collection system components while measuring other parameters related to ventilation. Experiments were completed at four different locations in the wastewater collection systems of Los Angeles County Sanitation Districts, Los Angeles, California, and the King County Wastewater Treatment District, Seattle, Washington. The subject components were concrete gravity pipes ranging in diameter from 0.8 to 2.4 m (33 to 96 in.). Air velocity was measured in each pipe using a carbon-monoxide pulse tracer method. Air velocity was measured entering or exiting the components at vents using a standpipe and hotwire anemometer arrangement. Ambient wind speed, temperature, and relative humidity; headspace temperature and relative humidity; and wastewater flow and temperature were measured. The field experiments resulted in a large database of measured ventilation and related parameters characterizing ventilation in full-scale gravity sewers. Measured ventilation rates ranged from 23 to 840 L/s. The experimental data was used to evaluate existing ventilation models. Three models that were based upon empirical extrapolation, computational fluid dynamics, and thermodynamics, respectively, were evaluated based on predictive accuracy compared to the measured data. Strengths and weaknesses in each model were found and these observations were used to propose a concept for an improved ventilation model.

The Indian Health Service (IHS), an agency of the US Public Health Service, instituted a broad range of clinical pharmacy services for ambulatory patients in the 1960s and early 1970s. One outgrowth of these services was that pharmacists were authorized to provide certain prescription legend drugs directly to patients without physician preauthorization. Also, pharmacists monitored patients' progress and were authorized to make therapeutic substitutions of drugs. Pharmacist prescribing privileges in these programs were defined by P & T Committee-approved protocols. Success with these programs led to expanding the pharmacist's role to include physical assessment and differential diagnosis of patients with specific diseases and to manage their care when that care consisted primarily of medications. The development and implementation of these programs and the results of a study of pharmacist prescribing within the IHS are described in this article, as is the IHS clinical pharmacy training program.

Since 1973, the Indian Health Service has been training pharmacists to provide primary care to patients in an expanded role, including the compilation of complete medical histories, physical examination, diagnosis, and treatment of outpatients with selected acute and chronic illnesses. This article discusses the evolution of the Pharmacist Practitioner Training Program, the training and experience received through this program, and the utilization of graduates in the clinical setting.