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The purpose of this study was to determine the effectiveness of a process-based translation method for a health survey instrument, Searching for Hardships and Obstacles to Shots (SHOTS), using a community-based participatory approach with the Hmong community. The study was based on a cross-sectional survey to assess the reliability and validity of the SHOTS immunization survey, an instrument used in the Hmong community, who are refugees originally from Laos living in the United States. Process-based universalistic health survey translation methods were used in a six-step procedure to translate the instrument. Mixed methods were used to analyze results, including cognitive interviewing, content validity indexing, Cronbach's α, t tests, and the Kolmogorov-Smirnov test. Participants were able to accurately complete the SHOTS survey in either Hmong or English, depending on participant preference. Universalistic, process-based, mixed methods used to analyze language translation, in combination with the principles of community-based participatory research, provide effective methods to translate health surveys. Involvement of the community strengthens the quality of translation and improves reliability and validity of survey results. Healthcare providers require accurate and reliable information from evidence-based health surveys to plan for culturally responsive care. Cross-cultural research often relies on language translation. Translation of a health survey instrument may be improved with universalistic, process-based methodology. [ABSTRACT FROM AUTHOR]

The Papanicolaou (Pap) smear has been used to screen women for cervical cancer since 1940. Recently, a number of new technologies have been developed to improve the detection of cervical cancer and its precursors. However, there is substantial controversy about whether the new tests offer meaningful advantages over the conventional Pap smear. Ideally, these new tests will increase the early detection of meaningful Pap smear abnormalities, reduce the number of unsatisfactory smears and provide fewer ambiguous results. It is also hoped that these new screening methods will not increase the number of false-positive results, but will improve the productivity of cytology laboratories without substantially increasing costs. The new tests include liquid-based/thin-layer preparations to improve the quality and adequacy of the Pap smear; computer-assisted screening methods to improve Pap smear interpretation; and new-generation human papillomavirus testing methods that may be useful in triaging patients with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions. Evidence on these new tests is reviewed and the advantages and disadvantages of their use are discussed. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of this study was to evaluate whether Put Prevention Into Practice (PPIP) materials affected the delivery of 8 clinical preventive services. METHODS: Program materials were provided to a family medicine practice serving a diverse, low-income population. Appropriate use of clinical preventive services was assessed via medical record reviews at baseline, 6 months, 18 months, and 30 months at both intervention and control sites. RESULTS: The delivery rates of 7 clinical preventive services were higher in the intervention site at 6 months. These rates had flattened or decreased by 30 months. CONCLUSIONS: Use of PPIP materials modestly improved delivery of certain clinical preventive services. Sustained improvement will require substantial system changes and ongoing support. [ABSTRACT FROM AUTHOR]

Compliance with medication and medical appointments is presumed to have a critical influence on outcomes of medical interventions. However, compliance may not always be easily defined or accurately measured. No single method of measuring compliance with appointments or medication is applicable in all settings. The apparent effects of compliance on outcome may be both direct and indirect; research is needed to define more clearly how these effects may be mediated. Identifying effective methods of enhancing compliance requires accurate methods of measuring compliance. In addition, the effectiveness of interventions may decay over time, and differences in effectiveness in acute versus long-term settings have not been well studied. Researchers conducting clinical trials of medical interventions must evaluate compliance in the population studied and consider the potential impact of noncompliance on trial results and their generalizability. In some trial designs, data may best be analyzed by considering compliance a dependent or an outcome variable. Under appropriate circumstances, compliance may be considered an independent variable. Readers of the medical literature should consider how compliance was measured and analyzed when interpreting the results of clinical trials. Table 4 suggests criteria for critical appraisal of compliance-related issues in reports of clinical trials. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to compare long-term neurological outcomes in low-risk patients with traumatic intracranial hemorrhage (tICH) admitted to the ICU (intensive care unit) versus patients admitted to the floor. Methods: This retrospective study was conducted at a Level 1 trauma center from October 1, 2008, to February 1, 2013. We defined low-risk patients as age less than 65 years, isolated head injury, normal admission mental status, and no shift or swelling on initial head CT (computed tomography). Clinical data were abstracted from a trauma registry and linked to a brain injury database. We compared the Extended Glasgow Outcome Scale (GOS-E) score at six months between patients admitted to the ICU and patients admitted to the floor. We did a risk-adjusted analysis of the influence of floor admission on a normal GOS-E. Results: We identified 151 patients; 45 (30%) were admitted to the floor and 106 (70%) to the ICU. Twenty-three (51%; 95% CI [36-66%]) patients admitted to the floor and 55 (52%; 95% CI [42-62%]) patients admitted to the ICU had a normal GOS-E. On adjusted analysis; the odds ratio for floor admission was 0.77 (95% CI [0.36-1.64]) for a normal GOS-E at six months. Conclusion: Long-term neurological outcomes in low-risk patients with tICH were not markedly different between patients admitted to the ICU and those admitted to the floor. However, we were unable to demonstrate non-inferiority on adjusted analysis. Future work aimed at a larger, prospective cohort may better evaluate the relative impacts of admission type on outcomes. [West J Emerg Med. 2015;16(2):284–290.]

The objective was to determine whether obstetric opinion leaders can be identified and to characterize them in terms of their demographic and professional characteristics and their attitudes toward caesarean delivery. In late 1998, we surveyed 527 obstetricians, 138 family physicians, and 80 certified nurse midwives (overall response rate, 57.8%) practicing in a stratified random sample of California hospitals with at least 1000 annual deliveries (n=52). Participants reported on demographic and professional characteristics and attitudes towards caesarean delivery; they also checked off those hospital colleagues from whom they had sought or would seek advice on labour and delivery. A composite measure of nomination frequency was used to characterize each respondent's degree of 'opinion leadership'. All analyses were corrected for the complex survey design. Using a nomination cutoff of 0.4 (0-1 scale), opinion leaders were identified in 31% of California hospitals; they were identified in 81% of hospitals using a cutoff of 0.2. Compared with their peers in the lowest fifth of the nomination distribution, clinicians in the top fifth were younger and more likely to be male, to speak English as a first language, to practice obstetrics, to have a maternal-foetal medicine subspecialty, and to practice in higher volume hospitals (p<0.05). Regardless of discipline, opinion leaders held attitudes concordant with reducing the caesarean delivery rate more often than non-opinion leaders. However, only 48% of obstetrical opinion leaders would support reducing the caesarean delivery rate to levels targeted by Healthy People 2000. In conclusion, obstetric opinion leaders could be identified in many California hospitals. However, they did not consistently support policies designed to reduce the caesarean delivery rate. The results have implications for the generalizability of opinion leader strategies. [ABSTRACT FROM AUTHOR]

The article discusses a study on the effectiveness of ultrasonography and computed tomography as the initial imaging method for patients with suspected nephrolithiasis. It mentions the administration of either point-of-care ultrasonography, radiology ultrasonography and abdominal computed tomography (CT), primary outcomes of high-risk diagnosis with complications, cumulative radiation exposure and total costs, and finding that ultrasonography results to lower cumulative radiation exposure.

Background: A prolonged first episode of psychosis (FEP) without adequate treatment is a predictor of poor clinical, functional, and health outcomes and significant economic burden. Team-based "coordinated specialty care" (CSC) for early psychosis (EP) has established effectiveness in promoting clinical and functional recovery. However, California's CSC program implementation has been unsystematic and could benefit from standardizing its processes and data collection infrastructure. To address this, we established a consortium of EP clinics across the state via a Learning Health Care Network (LHCN) framework to develop the Early Psychosis Intervention Network of California (EPI-CAL). EPI-CAL's LHCN developed a core battery of evidence-based measures for service users and family members and linked them together using a unique data collection and visualization application, Beehive., Methods and Objectives: EPI-CAL's LHCN collects, visualizes, and aggregates data at the individual and clinic level for EP programs across California via Beehive. Beehive was designed to: (1) collect outcomes data from service users receiving care at EP programs and their support persons, (2) provide the data to providers on a secure web-based dashboard to support measurement-based care, and (3) allow data to be used for program or research analysis. We will (1) determine the feasibility of implementing an LHCN across a diverse, decentralized network of early psychosis programs, (2) determine if the implementation of an LHCN increases the delivery of measurement-based care, and (3) determine if the implementation of measurement-based care is associated with significant improvements in key service user outcomes. EPI-CAL's network will contribute data to the Early Psychosis Intervention Network (EPINET) program., Discussion: The current study aims to establish an LHCN of EP clinics in California that implements harmonized data collection using Beehive and assesses the feasibility of establishing such a network. Our goal is for this harmonized data collection approach to be used to inform decisions and develop learning opportunities for service users, staff, and administrators, and to improve outcomes for service users and their supporters in CSC care. Further, the data will enable programs and research teams to examine what elements of care lead to program success and improved treatment outcomes for service users., Clinical Trials Registration: www., Clinicaltrials: gov , identifier NCT04007510; registered 07/05/2019., Competing Interests: Declarations Ethics approval and consent to participate The University of California, Davis Institutional Review Board approved the study (1403828-21, California Collaborative Network to Promote Data-Driven Care and Improve Outcomes in Early Psychosis [CORE]). Additionally, several of the counties and universities with a program participating in EPI-CAL required a separate review and approval of the project by their institutional review board (e.g., Los Angeles County Department of Mental Health Human Subjects Research Committee; San Mateo County Behavioral Health and Recovery Services Institutional Review Board; Sacramento County Department of Health and Human Services Research Review Committee; Napa County Institutional Review Board; County of San Diego Behavioral Health Services Research Review Board; and Orange County Health Care Agency Human Subjects Review Committee) or compliance or oversight departments. Multisite/single IRB with reliance from UCSD and UCSF on UC Davis IRB. Associated IRB protocols include 1411596-5 (UCD), 1411602-2 (UCSD), 1411601-5 (UCSF). Competing interests Tara A. Niendam is a cofounder and shareholder in Safari Health, Inc. No other authors disclosed any competing interests., (© 2024. The Author(s).)

Objective: Expanded funding to support care across the crisis continuum is intended to improve behavioral health outcomes. A greater understanding of how to effectively implement and integrate local crisis care systems has been identified as a research and policy priority. The aim of this study was to explore provider perceptions of the barriers and facilitators associated with implementing effective behavioral health crisis services., Methods: The authors conducted semistructured qualitative interviews with personnel from 15 behavioral health crisis care programs across California. Purposive sampling was used to ensure adequate representation of peer specialists, clinicians, mental health workers, and program leaders. Interview transcripts were analyzed via an inductive approach to thematic analysis. On the basis of patterns identified in the data, initial codes were developed, reviewed, and combined into overarching preliminary themes and subthemes., Results: Twenty-nine crisis care personnel participated. Facilitators of effective crisis care included an optimal crisis service structure, a client-centered approach, engagement with clients' support systems, and collaboration with community partners to link clients to services and enable safe delivery of crisis care. Barriers at the client, program, and system levels were identified, with solutions proposed for each., Conclusions: The participants identified features of crisis care that could improve program implementation and effectiveness or could help mitigate identified barriers. As states and local municipalities work to implement an integrated system of care across the crisis care continuum, input from frontline providers can be used to support the development of new programs, refine existing services, and inform future directions for research., Competing Interests: The authors report no financial relationships with commercial interests.

Background: A concern before 2020, physician burnout worsened during the COVID-19 pandemic. Little empirical data are available on pandemic workplace support interventions or their influence on burnout. We surveyed a national sample of frontline physicians on burnout and workplace support during the pandemic., Methods: We surveyed a stratified random sample of 12,833 US physicians most likely to care for adult COVID-19 patients from the comprehensive AMA Physician Professional Data ™ file. The sample included 6722 primary care physicians (3331 family physicians, 3391 internists), 880 hospitalists, 1783 critical care physicians (894 critical care physicians, 889 pulmonary intensivists), 2548 emergency medicine physicians, and 900 infectious disease physicians. The emailed survey elicited physicians' perceptions of organizational interventions to provide workplace support and/or to address burnout. Burnout was assessed with the Professional Fulfillment Index Burnout Composite scale (PFI-BC). Proportional specialty representation and response bias were addressed by survey weighting. Logistic regression assessed the association of physician characteristics and workplace interventions with burnout., Results: After weighting, respondents were representative of the total sample. Overall physician burnout was 45.4%, significantly higher than in our previous survey. Open-ended responses mentioned that staffing shortages (physician, nursing, and other staff) combined with the increased volume, complexity, and acuity of patients during the pandemic increased job demands. The most frequent workplace support interventions were direct pandemic control measures (increased access to personal protective equipment, 70.0%); improved telehealth functionality (43.4%); and individual resiliency tools (yoga, meditation, 30.7%). Respondents placed highest priority on workplace interventions to increase financial support and increase nursing and clinician staffing. Factors significantly associated with lower odds of burnout were practicing critical care (compared with emergency medicine) OR 0.33 (95% CI 0.12 - 0.93), improved telehealth functionality OR 0.47 (95% CI 0.23 - 0.97) and being in practice for 11 years or longer OR 0.44 (95% CI 0.19-0.99)., Conclusions: Burnout across frontline specialties increased during the pandemic. Physician respondents focused on inadequate staffing in the context of caring for more and sicker patients, combined with the lack of administrative efforts to mitigate problems. Burnout mitigation requires system-level interventions beyond individual-focused stress reduction programs to improve staffing, increase compensation, and build effective teams., (© 2024. The Author(s).)