Search

Objectives To address the usability challenge of Prescription Drug Monitoring Program (PDMP) among office-based physicians in the USA imposed by the difficulty barrier for the system usage, we sought: (1) to estimate the association between the PDMP difficulty of use and reducing or eliminating controlled substance prescriptions; and (2) to test the mediating effect of the frequency of PDMP check in the association between the PDMP difficulty of use and the reduction of controlled substance prescriptions. Methods We conducted a cross-sectional study using nationally representative data from the 2019 National Electronic Health Records Survey with a weighted sample of 214 889 office-based physicians. Weighted bivariate chi-square tests and multivariate logistic regressions with a confidence interval of 95% were performed. Bootstrap technique was used to conduct the causal mediation analysis. Key findings A PDMP that is easier to use was significantly associated with a higher reduction or elimination of controlled substance prescriptions (OR = 1.68; 95% CI: 1.01, 2.77). Easier PDMP use was also significantly associated with more frequent PDMP check prior to prescribing a controlled substance to a patient for the first time (OR = 6.39; 95% CI: 3.36, 12.15). About third (29.79%) of the observed association between PDMP difficulty of use and reducing or eliminating controlled substance prescriptions was mediated through the frequency of PDMP check. Conclusion The difficulty of PDMP limits the system’s usability which undermines the process of mitigating controlled substance prescriptions. Future efforts are needed to re-assess and regulate facilitators for difficult PDMP usage to maximise the success of this system and reach the goals behind its implementation.

BackgroundEmergency departments (EDs) have become entry points for treating behavioural health (BH) conditions, thereby rendering the evaluation of their utilisation necessary.ObjectivesThis study estimated behavioural-related hospital-based ED visits and outcomes of leaving against medical advice as well as the incurred charges within the primarily rural State of Nebraska. Also, the study correlated behavioural workforce distribution and location of EDs with ED utilisation.MethodsNebraska State Emergency Department Database provided information on utilisation of services, charges, diagnoses and demographic. Health Professional Tracking Services survey provided the distribution of EDs and BH workforce by region. To examine the effect of patient characteristics on discharge against medical advice, multivariable logistic regression modelling was used.FindingsUS$96.4 million were ED charges for 52 035 visits for BH disorders over 3 years. Of these, 35% and 50% were between 25 and 44-years old and privately insured, respectively. The uninsured (OR:1.53, p=0.0047) and 45–64 years old (OR:2.31, pConclusionsThere were high ED rates among the limited number EDs facilities in rural Nebraska. Rural regions of Nebraska faced workforce shortages and had high numbers of ED visits at relatively few accessible EDs.Clinical implicationsCustomised rural-centric public health programmes, which are based in clinical settings, can encourage patients to adhere to ED-treatment. Also, increasing the availability of BH workforce (either via telehealth or part-time presence) in rural areas can alleviate the problem and reduce ED revisits.

During the COVID‐19 pandemic, frontline nursing home staff faced extraordinary stressors including high infection and mortality rates and ever‐changing and sometimes conflicting federal and state regulations. To support nursing homes in evidence‐based infection control practices, the Massachusetts Senior Care Association and Hebrew SeniorLife partnered with the Agency for Healthcare Research and Quality AHRQ ECHO National Nursing Home COVID‐19 Action Network (the network). This educational program provided 16 weeks of free weekly virtual sessions to 295 eligible nursing homes, grouped into nine cohorts of 30–33 nursing homes. Eighty‐three percent of eligible nursing homes in Massachusetts participated in the Network, and Hebrew SeniorLife's Training Center served the vast majority. Each cohort was led by geriatrics clinicians and nursing home leaders, and coaches trained in quality improvement. The interactive sessions provided timely updates on COVID‐19 infection control best practices to improve care and also created a peer‐to‐peer learning community to share ongoing challenges and potential solutions. The weekly Network meetings were a source of connection, emotional support, and validation and may be a valuable mechanism to support resilience and well‐being for nursing home staff.

Over the course of this project, we utilized pharmacists at 159 community pharmacies in Nebraska and Iowa to administer vaccinations to adults 19 years of age or older with the objective of improving immunization rates in both states. We implemented a pharmacy-based technology platform and partnered with public health via the state immunization registries of both states to ensure that immunizations provided at the pharmacy were transmitted to the statewide registry, for which reporting is currently voluntary for health care providers. After using the technology platform for one year, an increase of immunization rates for influenza, herpes zoster, and pertussis vaccination rates by 37%, 12%, and 74%, respectively, was recorded in comparison to the prior year numbers. However, there was about 16% decrease in vaccination rates for pneumococcal vaccine. For the first time, the project’s participating pharmacies in Nebraska reported immunization counts to their state’s immunization registries. This project leveraged community pharmacies as healthcare destinations to achieve further gains in increasing immunization rates, improving the health of adults, and creating a community-wide network for prevention.

Network planning is an important step in the design of wireless networks, especially for 5 generation (5G). 5G networks must provide good service quality, high data rate and capacity. Therefore, 5G networks must be plan efficiently to deal with the increase of the data traffic. So, 5G wireless networks requires high grade of heterogeneity of small cell base stations, micro-cell base stations and macro cell base stations. In this paper, 5G wireless access network is planned for urban area in Ibb city, Yemen. The band 28 GHz of millimeter wave (mm-Wave) is used in this paper. Simulation results show that we need 223 micro cells to provide an acceptable services to 186532 subscribers in the covered urban area of Ibb city to satisfy densification network. The results also show that, the maximum achievable downlink and uplink throughput are 6.5 Gbps and 3.2 Gbps, respectively.

Background Training emergency medical services (EMS) workforce is challenging in rural and remote settings. Moreover, critical access hospitals (CAHs) struggle to ensure continuing medical education for their emergency department (ED) staff. This project collected information from EMS and ED providers across Nebraska to identify gaps in their skills, knowledge, and abilities and thus inform curriculum development for the mobile simulation-based training program. Methods The needs assessment used a three-step process: (1) four facilitated focus group sessions were conducted in distinct geographical locations across Nebraska to identify participants’ perceived training gaps; (2) based on the findings from the focus group, a needs assessment survey was constructed and sent to all EMS and ED staff in Nebraska; and (3) 1395 surveys were completed and analyzed. Results Thematic areas of training gaps included cardiopulmonary conditions, diabetes management, mass casualty incidents (MCI), maternal health and child delivery, patient assessment, pediatric care (PC), and respiratory emergency care. Gaps in non-clinical skills were related to crisis management such as maintaining effective teamwork. Participants frequently identified cardiopulmonary care, PC, and MCI as highly needed trainings. Other needs included life support-related retaining courses, sessions informing protocol updates, the availability of retraining tailored for rural areas, substance use-related emergencies, and farming-related injuries. Conclusion EMS and ED staff identified several skill gaps and training needs in the provision of emergency services in rural communities. These results allow for the development of customized training curricula and, with the help of an on-site simulation-based program, can identify gaps in health professionals’ skills, knowledge, and abilities and thus help them respond to acute healthcare needs of rural communities.

BACKGROUND In 2015, the Hospital Readmissions Reduction Program mandated financial penalties to hospitals with greater rates of readmissions for certain conditions. Alcohol-related disorders (ARD) are the fourth leading cause of 30-day readmissions. Yet, there is a dearth of national-level research to identify high-risk patient populations and predictors of 30-day readmission. This study examined patient- and hospital-level predictors for index hospitalizations with principal diagnosis of ARD and predicted the cost of 30-day readmissions. METHODS The 2014 Nationwide Readmissions Database was used to identify ARD-related index hospitalizations. Multivariable logistic regression was used to estimate patient- and hospital-level predictors for readmissions, and a 2-part model was used to predict the incremental cost conditional upon readmission. RESULTS In 2014, 285,767 index hospitalizations for ARD were recorded, and 18.9% of ARD-associated hospitalizations resulted in at least one 30-day readmission. Patients who were males, aged 45 to 64 years, Medicaid enrollees, living in urban and low-income areas, or with 1 to 2 comorbidities had high risk of readmission. Index hospitalization costs were higher among readmitted patients ($8,840 vs. $8,036, p

ObjectiveTo determine the effectiveness of a workplace wellness programme intervention in improving participants’ behaviour towards choosing a healthy diet and the correlation with health indicators.DesignA retrospective cohort study.SettingWellness programme in the Midwest, USA.SubjectsEmployees (n 12 636) who participated in a wellness programme for three consecutive years during years 2004 to 2013 and who completed web-based health risk questionnaires. The wellness programme included annual health screening, laboratory measures, health risk questionnaire and personalized health-care programme. Participants’ food group intakes, BMI and health indicators were compared between the first and last year of participation. McNemar’s non-parametric test was used for paired nominal data. Pearson correlations were computed for paired food and health indicator measurements. Correlations between dietary intake and BMI, cholesterol and TAG were computed using Pearson correlations and McNemar’s test.ResultsThere were negative correlations between intakes of fruits, vegetables, grains, dairy, healthy eating pattern and health outcome indicators such as BMI and TAG levels. Additionally, the percentage of employees who increased their consumption of fruits (16·88 v. 12·08 %, Pv. 11·44 %, Pv. 7·27 %, P 0·001) was significantly higher than the percentage of participants who decreased their intake of these food groups during the third-year follow-up.ConclusionsThe wellness programme improved some health indicator parameters and had a positive impact on increasing participants’ intakes of fruits, vegetables and whole grains at the third year of follow-up.

This study aimed at characterizing epidemiologic and clinical profiles of breast diseases in Niger during the period of 2010-2013 at the National Hospital of Niamey. Medical records were abstracted for demographic, reproductive, clinical, and treatment information. A process map of patient navigation and barriers to seeking medical care was developed after interviewing 26 local health professionals who encounter and/or manage breast diseases. We identified 245 breast cancers and 122 other breast diseases. Mean age of breast cancer patients was 45.4 (±13.26 years) and that of breast diseases was 31(±12.5 years) with 1/3 of cancers under age 44. Infection-related diseases represented 24% of non-cancers. Male breast diseases represented 4.75% of diseases and 2.05% of cancers. Only 37.1% of cancers had histopathologic confirmation and 90% of cancer patients presented at advanced stages and mastectomy was performed for 66% of breast cancers. Patient and system barriers to care were common in diagnosing and treating breast diseases. Women in Niger have double burden of infectious breast diseases and emerging breast cancer. Younger age and late diagnosis are common features. Reducing barriers to access to care, down-staging of cancer, implementation of clinical guidelines for managing advanced cases are important needs for reducing breast cancer morbidity and mortality in Niger.

Endothelial cells (ECs) are critical determinants of vascular homeostasis and inflammation, but transcriptional mechanisms specifying their identities and functional states remain poorly understood. Here, we report a genome-wide assessment of regulatory landscapes of primary human aortic endothelial cells (HAECs) under basal and activated conditions, enabling inference of transcription factor networks that direct homeostatic and pro-inflammatory programs. We demonstrate that 43% of detected enhancers are EC-specific and contain SNPs associated to cardiovascular disease and hypertension. We provide evidence that AP1, ETS, and GATA transcription factors play key roles in HAEC transcription by co-binding enhancers associated with EC-specific genes. We further demonstrate that exposure of HAECs to oxidized phospholipids or pro-inflammatory cytokines results in signal-specific alterations in enhancer landscapes and associate with coordinated binding of CEBPD, IRF1, and NFκB. Collectively, these findings identify cis-regulatory elements and corresponding trans-acting factors that contribute to EC identity and their specific responses to pro-inflammatory stimuli. DOI: http://dx.doi.org/10.7554/eLife.22536.001

Aim Visual impairment affects people of all ages, but its prevalence increases with age. The aim of this initiative was to better understand the uptake of NHS sight tests in Walsall in the over 60s age group. Methods The following data were analysed: i) NHS sight tests for England and Walsall Healthcare NHS Trust; ii) ophthalmic manpower in England and Walsall from April 2008 to March 2013; iii) the location of practices in the borough of Walsall. Results We noted a steady increase in the uptake of NHS sight tests (9%) and domiciliary sight tests (17%) in England from April 2008 to March 2013. In Walsall, the uptake of NHS sight tests was marginally lower for the same period (8%), but showed an increase of 11.7% in domiciliary sight tests. There was a significant reduction in the uptake of NHS sight tests from the over 60s in Walsall, from 42.58% in 2008/09 to 23% in 2012/13. This in contrast to a steady uptake of about 44% over the same period in England for the same age group. We noted fewer practitioners per 100 000 population in Walsall compared with the national picture and a neighbouring statistically equivalent primary care trust. Fewer practices are located in the east of the borough and outside the inner ring road, and considerable areas of Walsall are not within a 15-minute walking distance of an optometric practice—a significant factor for attenuation of attendance. Conclusions There has been a substantial decrease in the uptake of NHS sight tests in the over 60s in Walsall over a five-year period. The low uptake of sight tests among older people is a major shortcoming of present arrangements at meeting the eye health needs of Walsall residents. This is exacerbated by a lower than national average of ophthalmic practitioners per 100 000 population in Walsall.

Background: Diabetic retinopathy is the second most frequent cause of registerable blindness in the working-age population in the UK. Despite the implementation of the NHS Diabetic Eye Screening Programme in England and Wales, many patients with diabetes continue to become sight impaired. Aim: The purpose of this study was to better understand the impact of a Digital Diabetic Retinopathy Screening Service (DDRSS) provided to residents of Walsall in the West Midlands, UK. Methods: An analysis of data from the UK National Diabetes Audit and a plot of the location of DDRSS providers against a ‘heat map’ of the resident population density of those aged 60 years and over in Walsall provided a gauge of the impact of the service, including accessibility to and reach of the service. Results: DDRSS providers were not necessarily located in residential areas of older people, nor within a 15-minute walking distance for a significant proportion of residents. The DDRSS pathway extensively involves community optometrists but appears to under-deliver in meeting the key performance indicators of the service. Conclusions: There is a need to better understand the barriers to the uptake of the DDRSS in Walsall. The feasibility of a mobile DDRSS service is also being considered so that the areas not within easy access of residents can be provided with the screening service. Further consideration should be given to the provision of the service to patients in their homes, and in residential homes and day-care centres.