Abstract Objective. Emergency medical services (EMS) often transports patients who suffer simple falls in assisted-living facilities (ALFs). An EMS "falls protocol" could avoid unnecessary transport for many of these patients, while ensuring that patients with time-sensitive conditions are transported. Our objective was to retrospectively validate an EMS protocol to assist decision making regarding the transport of ALF patients with simple falls. Methods. We conducted a retrospective cohort study of patients transported to the emergency department from July 2010 to June 2011 for a chief complaint of "fall" within a subset of ALFs served by a specific primary care group in our urban EMS system (population 900,000). The primary outcome, "time-sensitive intervention" (TSI), was met by patients who had wound repair or fracture, admission to the ICU, OR, or cardiac cath lab, death during hospitalization, or readmission within 48 hours. EMS and primary care physicians developed an EMS protocol, a priori and by consensus, to require transport for patients needing TSI. The protocol utilizes screening criteria, including history and exam findings, to recommend transport versus nontransport with close primary care follow-up. The EMS protocol was retrospectively applied to determine which patients required transport. Protocol performance was estimated using sensitivity, specificity, and negative predictive value (NPV). Results. Of 653 patients transported across 30 facilities, 644 had sufficient data. Of these, 197 (31%) met the primary outcome. Most patients who required TSI had fracture (73) or wound repair (92). The EMS protocol identified 190 patients requiring TSI, for a sensitivity of 96% (95% CI: 93-98%), specificity of 54% (95% CI: 50-59%), and NPV of 97% (95% CI: 94-99%). Of 7 patients with false negatives, 3 were readmitted (and redischarged) after another fall, 3 sustained hip fractures that were surgically repaired, and 1 had a lumbar compression fracture and was discharged. Conclusions. In this cohort, two-thirds of patients with falls in ALFs did not require TSI. An EMS protocol may have sufficient sensitivity to safely allow for nontransport of these patients with falls in ALFs. Prospective validation of the protocol is necessary to test this hypothesis.
The study of positive well-being of children and adolescents in general is a relatively recent phenomenon. Although there is a long history of attention to poor mental health and behavior problems (e.g., conduct disorders, depression) and schooling (see Roeser et al. 1998), attention to indicators, determinants, and consequences of positive well-being has lagged behind. In particular, serious research efforts focused on positive subjective well-being (SWB) among children and youth have only recently been undertaken (Huebner 2004). In contrast to models of mental illness represented by the presence of psychopathological symptoms (e.g., aggressive behavior, chronic negative emotions), models of SWB attempt to differentiate the presence of more optimal levels of functioning. Diener (1984) developed a widely used tripartite model of SWB for adults, which has been extended downward to children of ages 8–18 (Huebner 1991a; Huebner and Dew 1996). The model includes three major components: positive affect, negative affect, and life satisfaction. Positive affect refers to the experience of frequent positive emotions, such as joy or interest, while negative affect refers to the infrequent experience of negative emotions, such as anger or sadness. Life satisfaction generally refers to an individual’s judgment of the positivity of her or his life as a whole (i.e., global life satisfaction) or with specific life domains (e.g., school or family satisfaction). Life satisfaction judgments are usually designed so that an individual can report a broad array of judgments ranging from very negative (e.g., “terrible”) through neutral and higher levels of satisfaction (e.g., “pleased” or “delighted”). Thus, persons who have high SWB are ones who, over time, experience frequent positive emotions and infrequent negative emotions as well as report positive levels of satisfaction with their lives.
Abstract Background Infectious diseases (ID) and antimicrobial stewardship (AS) improve Staphylococcus aureus bacteremia (SAB) outcomes. However, many small community hospitals (SCHs) lack on-site access to these services, and it is not known if ID telehealth (IDt) offers the same benefit for SAB. We evaluated the impact of an integrated IDt service on SAB outcomes in 16 SCHs. Methods An IDt service offering IDt physician consultation plus IDt pharmacist surveillance was implemented in October 2016. Patients treated for SAB in 16 SCHs between January 2009 and August 2019 were identified for review. We compared SAB bundle adherence and outcomes between patients with and without an IDt consult (IDt group and control group, respectively). Results A total of 423 patients met inclusion criteria: 157 in the IDt group and 266 in the control group. Baseline characteristics were similar between groups. Among patients completing their admission at an SCH, IDt consultation increased SAB bundle adherence (79% vs 23%; odds ratio [OR], 16.9; 95% CI, 9.2–31.0). Thirty-day mortality and 90-day SAB recurrence favored the IDt group, but the differences were not statistically significant (5% vs 9%; P = .2; and 2% vs 6%; P = .09; respectively). IDt consultation significantly decreased 30-day SAB-related readmissions (9% vs 17%; P = .045) and increased length of stay (median [IQR], 5 [5–8] days vs 5 [3–7] days; P = .04). In a subgroup of SAB patients with a controllable source, IDt appeared to have a mortality benefit (2% vs 9%; OR, 0.12; 95% CI, 0.01–0.98). Conclusions An integrated ID/AS telehealth service improved SAB management and outcomes at 16 SCHs. These findings provide important insights for other IDt programs.
Abstract Maternal relationship characteristics have been found to impact academic and behavioral outcomes for youth. However, less is known about how and through what mechanisms these characteristics impact outcomes for mentored youth. In this study, we examined if mentoring relationship quality mediated the relations between maternal relationship characteristics and academic and behavioral outcomes targeted by mentoring programs. Data were drawn from 205 participants who participated in a mentoring program that pairs adolescent girls with college women mentors for 1 year of mentoring. Mentoring relationship quality was the hypothesized mechanism of change and was included in the analysis as a mediator. Results revealed that maternal relationship characteristics (i.e., maternal quality communication/trust and maternal alienation) were directly related to academic and behavioral outcomes of mentoring. The relationship between maternal relationship characteristics and behavioral outcomes was mediated by mentoring relationship quality. Results suggested that girls with stronger maternal quality communication and trust as well as girls who felt more alienated from their mothers may benefit more from mentoring. Results can be used to inform mentor training to include a focus on relationship development with girls experiencing a variety of relational difficulties with their mothers to help improve targeted mentoring outcomes.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)