Nurses’ stress and resilience before and after evaluation for hospital accreditation

ABSTRACT Objectives: to analyze and compare levels of stress and resilience in nurses before and after the assessment for maintenance of the Hospital Accreditation Certification. Methods: quantitative, observational, and longitudinal research, with 53 nurses from a philanthropic hospital, in the Rio Grande do Sul. Data collected in two stages, March, and July 2019, before the assessment visit and 60 days after, using the Bianchi Stress Scale and Resilience Scale. Descriptive and analytical statistics were employed. Results: the majority of participants showed an average stress level before and after the evaluation. The highest stress scores were related to Domains E (coordination of unit activities) and C (activities related to personnel administration). In both moments of the study, the participants had medium and high resilience. Conclusions: managing people, processes, and assistance are stressful activities in the Accreditation process and increase the nurses’ stress levels.

Insight into intraindividual variability across neuropsychological tests and its association with cognitive dysfunction in patients with lupus

ObjectiveDispersion, or variability in an individual’s performance across multiple tasks at a single assessment visit, has been associated with cognitive dysfunction (CD) in many neurodegenerative and neurodevelopmental disorders. We aimed to compute a dispersion score using neuropsychological battery (NB) tests and determine its association with CD in patients with SLE.MethodsCD was defined as a z-score of ≤−1.5 on ≥2 domains of the NB. To compute a type of dispersion score known as the intraindividual SD (ISD), the SD of age-adjusted and sex-adjusted z-scores was calculated for each visit in each patient. To estimate the association between ISD and cognitive status (CD and non-CD), we used multilevel logistic regression, adjusting for clinically important covariates.ResultsA total of 301 adult patients with SLE completed the NB at baseline, 187 of whom were reassessed at 6 months and 189 at 12 months. CD was observed in 35.2% of patients at baseline, 27.8% at 6 months and 28.0% at 12 months. Prior to covariate adjustment, the mean ISD for non-CD was 1.10±0.31 compared with 1.50±0.70 for CD. After adjusting for ethnicity, education, employment, socioeconomic status and anxiety/depression, there was a statistically significant association between ISD and CD (OR for one-unit increase in ISD: 13.56, 95% CI 4.80 to 38.31; OR for 1/10th-unit increase in ISD: 1.30, 95% CI 1.17 to 1.44). Findings were valid across multiple sensitivity analyses.ConclusionThis is the first study to show that patients with SLE who were classified as having CD by the NB had more variability across the NB tests (ie, higher ISD score) compared with those who were not classified as having CD.

Cognitive and Behavioral Factors Differentially Related to Intuitive Eating

Objectives Inhibitory control measured by the Go/No-Go Task measures automatic inhibition. Difficulty with inhibition can extend into eating behavior, leading to unhealthy patterns such as emotional eating. Individuals who eat emotionally may also be less likely to engage in adaptive patterns of eating, such as intuitive eating (IE). IE is based on internal regulation of eating behaviors rather than eating for non-physiological reasons (e.g., emotions). This study sought to investigate the relationship between inhibitory control, emotional eating, and IE. Methods 108 adults with overweight/obesity enrolled in a weight loss trial participated in the study. The sample was 46 ± 11 years old, 72% female, 76% White, and had a mean BMI of 35.7 ± 5.9 kg/m2. All data were collected at the baseline assessment visit. Emotional eating and IE were measured via self-report with the Emotional Eating Scale (EES) and Intuitive Eating Scale-2 (IES-2), respectively. The EES provides a total score and the IES-2 provides a total score and four subscale scores: Unconditional Permission to Eat (PERM), Eating for Physical Rather than Emotional Reasons (PHYS), Reliance on Hunger and Satiety Cues (REL), and Body-Food Choice Congruence (CON). Inhibitory control was measured via behavioral tests with the Automated Neuropsychological Assessments Metrics-4 (ANAM-4) Go/No-Go subtest. Results A theoretically-driven path analysis model was calculated using AMOS, using the Go/No-Go subtest and EES as determinates of the four IE subscales. Overall, the path model was effective at capturing variability in two (PHYS & REL) of the four outcome variables. Substantial differences were observed in terms of the magnitude of the path coefficients (PERM ß = .04; PHYS ß = –.74) and the amount of variance captured across the IES-2 subscales criterion measure (R2 ranged from .00—.54). The overall fit indices for the model were above threshold: χ2(7) = 2.19, P = .95, χ2/DF = 0.31, CFI = 1.00, TLI = 1.20, and RMSEA = .000 (.000; .011). Conclusions These findings help shed light on how inhibitory control, emotional eating, and IE are associated with one another. Surprisingly, inhibitory control was unrelated to IE. Further, emotional eating may only contribute to certain facets of IE — eating for physical rather than emotional reasons and reliance on hunger and satiety cues. Funding Sources K23DK103941.

117 AusTOMs An Outcome Measure to Determine the Impact of Environmental Adaptations on Functional Performance

Background Occupational Therapists routinely perform pre-discharge home assessment visits. The import of a supportive home environment to successful ageing has been established in the literature (Tanner, Tilse & Desleigh de Jonge, 2008), with housing adaptations and aids recognised as a method of promoting independence within the home (Stark et al, 2009). In this hospital, home assessment visits review functional mobility, functional transfers and assess for environmental barriers within the home. The purpose of this study was to detect any change in functional performance following a pre-discharge home assessment visit and implementation of OT recommended aids/railings or both. The AusTOMs (Australian Therapy Outcome Measures) for Occupational Therapy scale was used as the outcome measurement tool. Methods The study was applied to a cohort of 20 consenting inpatients over 65 years of age. Convenience sampling was used for the purposes of the study. Inclusion criteria comprised of patients that attended a minimum of one pre-discharge OT home assessment visit. It was conducted over a ten week period in 2018. The study was conducted by two occupational therapists (OTs) on the general rehabilitation team. The scale was applied to review the following functional transfers within the home environment on initial home assessment visit and following the implementation of OT recommended aids/railings. 1. Access2. Stairs3. Bed4. Toilet5. Bath/Shower6. Seating Results The group Average AusTOMs Resultant score at initial home assessment was 3.05. The group average score following implementation of recommendations was 4.08. This indicates a change in performance from a Moderate Limitation experience to a Mild Limitation experience. This is reflected in Paired T test results. The two-tailed P value is less than 0.0001. Conclusion The AusTOMs Activity Limitation/Transfer scale indicated there is a positive correlation with the provision of OT recommended aids and equipment at improving functional transfer performance within the home context.

SMS as a Tool to Improve Information Flow on Humanitarian Logistics

This chapter assesses the suitability of mobile phone technology, an established technology (humanitarian), to support humanitarian operations, create an inventory of support donations, and track the needs of people throughout humanitarian logistics after the disaster. The main objective is to reduce the exposure to the consequences of disasters by reducing the time of information flow through SMS interaction technology. Quebrada Quirio was used as a prototype. The process consists of using the INDECI rapid assessment visit to collect basic data, including a telephone number, of the people affected by the disaster, and based on this information, multiple initiatives aligned with the optimization of the flow of information were created.

Implementing a Universal Well-Being Assessment to Mitigate Barriers to Resident Utilization of Mental Health Resources

ABSTRACT Background Physician utilization of well-being resources remains low despite efforts to promote use of these resources. Objective We implemented a well-being assessment for internal medicine residents to improve access and use of mental health services. Methods We scheduled all postgraduate year 1 (PGY-1) and PGY-2 residents at West Virginia University for the assessment at our faculty and staff assistance program (FSAP). While the assessment was intended to be universal (all residents), we allowed residents to “opt out.” The assessment visit consisted of an evaluation by a licensed therapist, who assisted residents with a wellness plan. Anonymous surveys were distributed to all residents, and means were compared by Student's t test. Results Thirty-eight of 41 PGY-1 and PGY-2 residents (93%) attended the scheduled appointments. Forty-two of 58 residents (72%, including PGY-3s) completed the survey. Of 42 respondents, 28 (67%) attended the assessment sessions, and 14 (33%) did not. Residents who attended the sessions gave mean ratings of 7.8 for convenience (1, not convenient, to 9, very convenient), and 7.9 for feeling embarrassed if colleagues knew they attended (1, very embarrassed, to 9, not embarrassed). Residents who attended the assessment sessions reported they were more likely to use FSAP services in the future, compared with those who did not attend (P < .001). Conclusions Offering residents a well-being assessment may have mitigated barriers to using counseling resources. The majority of residents who participated had a positive view of the program and indicated they would return to FSAP if they felt they needed counseling.

Dietary assessment in UK Biobank: an evaluation of the performance of the touchscreen dietary questionnaire

UK Biobank is an open access prospective cohort of 500 000 men and women. Information on the frequency of consumption of main foods was collected at recruitment with a touchscreen questionnaire; prior to examining the associations between diet and disease, it is essential to evaluate the performance of the dietary touchscreen questionnaire. The objectives of the present paper are to: describe the repeatability of the touchscreen questionnaire in participants (n 20 348) who repeated the assessment centre visit approximately 4 years after recruitment, and compare the dietary touchscreen variables with mean intakes from participants (n 140 080) who completed at least one of the four web-based 24-h dietary assessments post-recruitment. For fish and meat items, 90 % or more of participants reported the same or adjacent category of intake at the repeat assessment visit; for vegetables and fruit, and for a derived partial fibre score (in fifths), 70 % or more of participants were classified into the same or adjacent category of intake (κweighted > 0·50 for all). Participants were also categorised based on their responses to the dietary touchscreen questionnaire at recruitment, and within each category the group mean intake of the same food group or nutrient from participants who had completed at least one web-based 24-h dietary assessment was calculated. The comparison showed that the dietary touchscreen variables, available on the full cohort, reliably rank participants according to intakes of the main food groups.

Interindividual Variability and Intraindividual Reliability of Intermittent Theta Burst Stimulation-induced Neuroplasticity Mechanisms in the Healthy Brain

We combined patterned TMS with EMG in several sessions of a within-subject design to assess and characterize intraindividual reliability and interindividual variability of TMS-induced neuroplasticity mechanisms in the healthy brain. Intermittent theta burst stimulation (iTBS) was applied over M1 to induce long-term potentiation-like mechanisms as assessed by changes in corticospinal excitability. Furthermore, we investigated the association between the observed iTBS effects and individual differences in prolonged measures of corticospinal excitability. Our results show that iTBS-induced measures of neuroplasticity suffer from high variability between individuals within a single assessment visit and from low reliability within individuals across two assessment visits. This indicates that both group and individual effects of iTBS on corticospinal excitability cannot be assumed to be reliable and therefore need to be interpreted with caution, at least when measured by changes in the amplitudes of motor-evoked potentials.