Browsing by Subject "Preparedness"
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Item Assessing the LGBT cultural competency of dementia care providers(Wiley, 2021-02-14) Nowaskie, Dustin Z.; Sewell, Daniel D.; Psychiatry, School of MedicineIntroduction: Although dementia risk factors are elevated in lesbian, gay, bisexual, and transgender (LGBT) older adults and are perpetuated by a lack of cultural competency, no known studies have quantified LGBT cultural competency among dementia care providers. Methods: Dementia care providers (N = 105) across the United States completed a survey consisting of the 7-point Likert LGBT-Development of Clinical Skills Scale. Results: Dementia care providers reported very high affirming attitudes (M = 6.67, standard deviation [SD] = 0.71), moderate knowledge (M = 5.32, SD = 1.25), and moderate clinical preparedness (M = 4.93, SD = 1.23). Compared to previously published data, they reported significantly lower knowledge than medical students. There were no differences compared to psychiatry residents. Discussion: The current state of dementia care providers' LGBT cultural competency has significant, yet modifiable, gaps. Better education, including more LGBT patient exposure, is necessary to improve the care being provided to members of the LGBT community impacted by dementia illness.Item Correction: How much is needed? Patient exposure and curricular education on medical students' LGBT cultural competency(BMC, 2022-06-07) Nowaskie, Dustin Z.; Patel, Anuj U.; Psychiatry, School of MedicineCorrection: BMC Med Educ 20, 490 (2020); https://doi.org/10.1186/s12909-020-02381-1Item Digging through disaster rubble in search of the determinants of organizational mitigation and preparedness(DOI: 10.2202/1944-4079.1005, 2010-07) Sadiq, Abdul-AkeemDisaster researchers have established the determinants of mitigation and preparedness at the household level of analysis. However, at the organizational level, there is limited research and no theory to guide research on the determinants of mitigation and preparedness. The research question is “what are the determinants of mitigation and preparedness at the organizational level?” The data come from a survey of 227 organizations in Memphis, Tennessee. This study uses Tobit regression technique to identify the determinants and finds that organizational size and concern over disaster impact are strong positive determinants of mitigation and preparedness in organizations. In addition, there is a significant and nonlinear relationship between organizational obstacle and mitigation and preparedness activities. This study concludes with policy implications and recommendations for future studies.Item FEMA versus local governments: Influence and reliance in disaster preparedness(Springer, 2016) Sadiq, Abdul-Akeem; Tharp, Kevin; Graham, John D.; School of Public and Environmental Affairs, IUPUIThis study uses an experimental approach to examine whether disaster information sourced to the Federal Emergency Management Agency (FEMA) influences intentions to adopt hazard adjustments. Survey questions are also used to determine whether individuals rely more on FEMA or local governments when preparing for disasters. Using an online sample of 2008 US employees, the results indicate that information sourced to FEMA is no more influential than information sourced to local governments and that individuals rely less on FEMA than on local agencies during disaster preparedness. These results have significant implications for practice and future research on natural hazard preparedness.Item How much is needed? Patient exposure and curricular education on medical students’ LGBT cultural competency(BMC, 2020-12-04) Nowaskie, Dustin Z.; Patel, Anuj U.; Psychiatry, School of MedicineBackground: For medical students, providing exposure to and education about the lesbian, gay, bisexual, and transgender (LGBT) patient population are effective methods to increase comfort, knowledge, and confidence in caring for LGBT people. However, specific recommendations on the number of patient exposures and educational hours that relate to high LGBT cultural competency are lacking. Methods: Medical students (N = 940) at three universities across the United States completed a survey consisting of demographics, experiential variables (i.e., number of LGBT patients and LGBT hours), and the 7-point Likert LGBT-Development of Clinical Skills Scale (LGBT-DOCSS). LGBT-DOCSS scores were stratified by 1-point increments, and experiential variable means were computed per each stratification to characterize the mean LGBT patients and hours of medical students with higher scores and those with lower scores. Results: Medical students reported caring for some LGBT patients annually (M = 6.02, SD = 20.33) and receiving a low number of annual LGBT curricular hours (M = 2.22, SD = 2.85) and moderate number of annual LGBT extracurricular hours (M = 6.93, SD = 24.97). They also reported very high attitudinal awareness (M = 6.54, SD = 0.86), moderate knowledge (M = 5.73, SD = 1.01), and low clinical preparedness (M = 3.82, SD = 1.25). Medical students who cared for 35 or more LGBT patients and received 35 or more LGBT total hours reported significantly higher preparedness and knowledge. Conclusions: Medical students have shortcomings in LGBT cultural competency and limited LGBT patient exposure and education. To improve LGBT cultural competency, medical schools and accrediting bodies should consider providing medical students with at least a total of 35 LGBT patient contacts and 35 LGBT education hours (10 h of required curricular education and 25 h of supplemental education).Item National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic(Baishideng Publishing Group, 2020-12-18) Abulebda, Kamal; Ahmed, Rami A.; Auerbach, Marc A.; Bona, Anna M.; Falvo, Lauren E.; Hughes, Patrick G.; Gross, Isabel T.; Sarmiento, Elisa J.; Barach, Paul R.; Pediatrics, School of MedicineBackground: The coronavirus disease pandemic caught many pediatric hospitals unprepared and has forced pediatric healthcare systems to scramble as they examine and plan for the optimal allocation of medical resources for the highest priority patients. There is limited data describing pediatric intensive care unit (PICU) preparedness and their health worker protections. Aim: To describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a set of PICUs within a simulation-based network nationwide. Methods: A cross-sectional multi-center national survey of PICU medical director(s) from children's hospitals across the United States. The questionnaire was developed and reviewed by physicians with expertise in pediatric critical care, disaster readiness, human factors, and survey development. Thirty-five children's hospitals were identified for recruitment through a long-established national research network. The questions focused on six themes: (1) PICU and medical director demographics; (2) Pediatric patient flow during the pandemic; (3) Changes to the staffing models related to the pandemic; (4) Use of personal protective equipment (PPE); (5) Changes in clinical practice and innovations; and (6) Current modalities of training including simulation. Results: We report on survey responses from 22 of 35 PICUs (63%). The majority of PICUs were located within children's hospitals (87%). All PICUs cared for pediatric patients with COVID-19 at the time of the survey. The majority of PICUs (83.4%) witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicated units, and 74.6% pivoted to accept adult COVID-19 patients. All PICUs implemented changes to their staffing models with the most common changes being changes in COVID-19 patient room assignment in 50% of surveyed PICUs and introducing remote patient monitoring in 36% of the PICU units. Ninety-five percent of PICUs conducted training for donning and doffing of enhanced PPE. Even 6 months into the pandemic, one-third of PICUs across the United States reported shortages in PPE. The most common training formats for PPE were hands-on training (73%) and video-based content (82%). The most common concerns related to COVID-19 practice were changes in clinical protocols and guidelines (50%). The majority of PICUs implemented significant changes in their airway management (82%) and cardiac arrest management protocols in COVID-19 patients (68%). Simulation-based training was the most commonly utilized training modality (82%), whereas team training (73%) and team dynamics (77%) were the most common training objectives. Conclusions: A substantial proportion of surveyed PICUs reported on large changes in their preparedness and training efforts before and during the pandemic. PICUs implemented broad strategies including modifications to staffing, PPE usage, workflow, and clinical practice, while using simulation as the preferred training modality. Further research is needed to advance the level of preparedness, support staff assuredness, and support deep learning about which preparedness actions were effective and what lessons are needed to improve PICU care and staff protection for the next COVID-19 patient waves.Item A National US Survey of Pediatric Emergency Department Coronavirus Pandemic Preparedness(Wolters Kluwer, 2020-12-17) Auerbach, Marc A.; Abulebda, Kamal; Bona, Anna Mary; Falvo, Lauren; Hughes, Patrick G.; Wagner, Michael; Barach, Paul R.; Ahmed, Rami A.; Emergency Medicine, School of MedicineObjective: We aim to describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a diverse set of pediatric emergency departments (PEDs) within the United States. Methods: We conducted a prospective multicenter survey of PED medical director(s) from selected children's hospitals recruited through a long established national research network. The questionnaire was developed by physicians with expertise in pediatric emergency medicine, disaster readiness, human factors, and survey development. Thirty-five children's hospitals were identified for recruitment through an established national research network. Results: We report on survey responses from 25 (71%) of 35 PEDs, of which 64% were located within academic children's hospitals. All PEDs witnessed decreases in non-COVID-19 patients, 60% had COVID-19-dedicated units, and 32% changed their unit pediatric patient age to include adult patients. All PEDs implemented changes to their staffing model, with the most common change impacting their physician staffing (80%) and triaging model (76%). All PEDs conducted training for appropriate donning and doffing of personal protective equipment (PPE), and 62% reported shortages in PPE. The majority implemented changes in the airway management protocols (84%) and cardiac arrest management in COVID patients (76%). The most common training modalities were video/teleconference (84%) and simulation-based training (72%). The most common learning objectives were team dynamics (60%), and PPE and individual procedural skills (56%). Conclusions: This national survey provides insight into PED preparedness efforts, training innovations, and practice changes implemented during the start of COVID-19 pandemic. Pediatric emergency departments implemented broad strategies including modifications to staffing, workflow, and clinical practice while using video/teleconference and simulation as preferred training modalities. Further research is needed to advance the level of preparedness and support deep learning about which preparedness actions were effective for future pandemics.Item Preparedness for Residency: Now More Than Ever(American Medical Association, 2020-08-12) Choi, Jennifer N.; Stefanidis, Dimitrios; Dunnington, Gary L.; Surgery, School of MedicineTransitions in medical education, particularly the transition to residency training, are increasingly identified as meriting additional thought and care for the appropriate development of the new physician. In this issue of JAMA Surgery, Engelhardt and colleagues aptly demonstrate that a resident’s sense of preparedness for this transition plays a crucial role in their mental health; the identified association between resident preparedness and meaningful on-call experiences as students likely applies to most specialties requiring in-house call.Item The current state of lesbian, gay, bisexual, and transgender cultural competency among U.S. dermatology residents(Wolters Kluwer, 2022-07-08) Nowaskie, Dustin Z.; Garcia-Dehbozorgi, Sara; Cortez, Jose L.; Psychiatry, School of MedicineLesbian, gay, bisexual, and transgender (LGBT) people interface with dermatology providers for many reasons. Implementing culturally competent LGBT dermatologic care necessitates evaluating provider competency to identify where gaps remain. Objectives: To assess the LGBT cultural competency among U.S. dermatology residents. Methods: A self-reporting, cross-sectional survey was emailed to U.S. dermatology program coordinators (N = 143). LGBT patient exposure, LGBT educational hours, and LGBT cultural competency via the LGBT-Development of Clinical Skills Scale (with the subscales Clinical Preparedness, Attitudinal Awareness, and Basic Knowledge) were measured. Results: Dermatology residents (N = 119) across the United States completed the survey. They reported caring for less than 20 LGBT patients per year and receiving less than 75 minutes of LGBT education per year. They reported significantly higher Attitudinal Awareness than both Clinical Preparedness and Basic Knowledge; they reported significantly higher Basic Knowledge than Clinical Preparedness. They reported significantly less adequate clinical training and supervision, experience, and competence to assess transgender patients compared to lesbian, gay, and bisexual patients. In general, dermatology residents who reported more LGBT patients and LGBT education also reported higher LGBT cultural competency. Limitations: A larger national sample of U.S. dermatology residents is necessary for generalizability. Conclusions: Currently, there is a lack of LGBT education in U.S. dermatology residency curricula, which may delay addressing the health disparities that exist in this patient population. Due to such dearth of standardized LGBT education, dermatology residents likely do not feel adequately knowledgeable or prepared to address LGBT needs. Both LGBT education and LGBT patient experiences may help alleviate these shortcomings and help LGBT patients feel affirmed in their dermatologic care.Item Understanding Factors Related to Decision Making by State Health Officials in a Public Health Emergency(2022-10) Barishansky, Raphael M.; Halverson, Paul; Menachemi, Nir; Yeager, ValerieBackground and Purpose - State Health Officials (SHOs), as the leaders of state governmental public health agencies, play a critical role in their respective states. Their decisions guide the overall actions of their organizations in executing programs, policies and activities that ultimately affect the health of the state’s population. This study will add to the research and serve as a potential guide to future SHO training, specific to decision making, in a public health emergency Methods – Twenty-one individuals, who are either currently working as SHOs or who were former SHOs, were interviewed to understand their perspectives on issues that may impact their response to a public health emergency: decision-making, interaction with the public and the media and the role of politics in public health, and other areas of consequence. Results – While the study was focused more broadly, all of the respondents specifically mentioned the COVID19 pandemic as the most complicated public health emergency they have responded to as a SHO. All respondents also mentioned that they did not have a specific decision-making tool to utilize during this emergency and primarily relied on a consensus-driven decision-making process. Additionally, issues such as the challenges of managing the media and the politicization of public health during this pandemic, were mentioned by many of the respondents. Conclusion - These findings pointed to the need for a step-by-step decision-making tool to be utilized by SHOs in a public health emergency. This has the potential to lead to a more methodical approach to SHOs decision-making during a public health emergency, including a focus on various operational aspects such as understanding the role of the media in a public health emergency, managing elected officials in a public health emergency, and lessons learned from past public health emergencies.