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The Centers for Medicare & Medicaid Services have mandated that hospitals implement measures to screen social determinants of health (SDoH). We sought to report on available SDoH screening tools. PubMed, Scopus, Web of Science, as well as the grey literature were searched (1980 to November 2023). The included studies were US-based, written in English, and examined a screening tool to assess SDoH. Thirty studies were included in the analytic cohort. The number of questions in any given SDoH assessment tool varied considerably and ranged from 5 to 50 (mean: 16.6). A total of 19 SDoH domains were examined. Housing (n = 23, 92%) and safety/violence (n = 21, 84%) were the domains assessed most frequently. Food/nutrition (n = 17, 68%), income/financial (n = 16, 64%), transportation (n = 15, 60%), family/social support (n = 14, 56%), utilities (n = 13, 52%), and education/literacy (n = 13, 52%) were also commonly included domains in most screening tools. Eighteen studies proposed specific interventions to address SDoH. SDoH screening tools are critical to identify various social needs and vulnerabilities to help develop interventions to address patient needs. Moreover, there is marked heterogeneity of SDoH screening tools, as well as the significant variability in the SDoH domains assessed by currently available screening tools.
This study aimed to develop the conversation tool “I-HARP for COPD” for timely identification of palliative care needs in Dutch patients with chronic obstructive pulmonary disease (COPD).
Methods
An iterative and participatory research design was used to develop “I-HARP for COPD”. There were 2 phases to the development of “I-HARP for COPD”: content development and testing. A review of current literature, parallel focus groups, and a questionnaire among experts were used to develop the content of “I-HARP for COPD”. “I-HARP for COPD” was then assessed by health-care professionals (HCPs) in clinical practice for understanding, difficulty, and relevance.
Results
A total of 46 HCPs, 6 patients, 1 informal caregiver, and 1 bereaved informal caregiver participated in this study. “I-HARP for COPD” included 14 screening questions, additional in-depth questions, and recommendations to address identified needs. The content of “I-HARP for COPD” was accepted by 86.2% of the HCPs.
Significance of results
“I-HARP for COPD” was successfully developed for providing guidance in the palliative care of Dutch patients with COPD and their informal caregivers. By supporting HCPs with “I-HARP for COPD”, they are better able to timely identify and direct palliative care needs.
This chapter explores how policymakers and practitioners in settings beyond the sites of evaluation might make use of evidence from realist trials and systematic reviews, plus local needs assessment, to identify the best candidate interventions for their local contexts. To do this, local decision-makers need to assess how likely are interventions to achieve benefits in their contexts. This is partly a matter of assessing whether interventions are likely to be feasible, accessible and acceptable in their settings, which will be influenced by local capacity and norms. It is also a matter of assessing whether intervention mechanisms will be triggered and whether these are likely to generate beneficial outcomes. This will be influenced by what aetiological mechanisms are generating adverse outcomes in the context and hence what vulnerabilities exist which the intervention may be able to address. It will also be influenced by whether the local context provides affordances so that potential beneficiaries may be able to benefit from the intervention. Thinking through these issues should enable local policymakers and practitioners to decide whether such interventions could be delivered immediately at scale, be implementing but only within evaluated pilot studies or be rejected in favour of other interventions.
We aimed to translate and linguistically and cross-culturally validate Sheffield Profile for Assessment and Referral for Care (SPARC) in Spanish for Colombia (SPARC-Sp).
Methods
The linguistic validation of SPARC followed a standard methodology. We conducted focus groups to assess the comprehensibility and feasibility. The acceptability was assessed using a survey study with potential users.
Results
The comprehensibility assessment showed that additional adjustments to those made during the translation-back-translation process were required to apply SPARC-Sp in rural and low-schooled populations. It also identified the need for alternative administration mechanisms for illiterate people. The acceptability survey showed that potential users found SPARC-Sp as not only acceptable but also highly desirable. However, they desired to expand the number of items in all domains.
Significance of results
Beyond the semantic and conceptual validity attained through the back-translation process, actual cultural validity could be acquired thanks to the comprehensibility tests. Although extending the instrument is something potential users would like to do, it would make it less feasible to utilize the SPARC-Sp in clinical settings. Nonetheless, the instrument might benefit from the inclusion of a domain that evaluates challenges encountered when accessing the health-care system. For communities lacking literacy, alternate administration methods must also be considered.
There is concern that junior doctors are not prepared for their post-graduate attachments in ENT. The aims of this study were to capture the learning priorities of those in the ENT first on-call role and facilitate further educational opportunities to address these needs.
Method
Semi-structured interviews were undertaken to explore the learning needs of junior doctors with seven junior and two senior ENT clinicians.
Results
The thematic analysis generated three themes: the role of the ENT Junior; the perceived, expressed and prescribed learning needs; and attitudes towards future learning. These themes explored the misalignment between undergraduate training and post-graduate expectations, the lack of competence in ENT practical skills and the need for focused ENT training prior to commencing on-call shifts.
Conclusion
All interviewees identified the need for greater experience in practical interventional skills prior to their ENT attachments and expressed interest towards a standardised, bootcamp-style induction with simulated emergency experience.
Queens County was identified as the epicenter of the coronavirus disease 2019 (COVID-19) outbreak in United States, representing a significant proportion of racial and ethnic minorities. As the pandemic surged and new variants emerged, one factor that has not been explored is the level of pandemic readiness (preparedness) in urban communities.
Methods:
This was a cross-sectional study using a survey to assess pandemic readiness among residents in Queens County, New York, which was disseminated online by means of elected officials. The survey included basic demographics, health status, essential supplies (such as food, water, and prescription medication), social support, spatial capacity, and access to COVID-19 health information.
Results:
A total of 306 participants completed the survey (59% response rate). Eighty-two percent of participants were not pandemic ready with only 11.4% at beginner-level and 7% advanced-level readiness. Beginner- and advanced-level readiness was more common among participants with college experience. Regarding employment, 85% of participants who were employed were not ready for the pandemic, compared with 68% of those who were not employed. More strikingly, over 60% of participants learned something new by completing the survey.
Conclusions:
This study adds to the existing literature on pandemic preparedness and highlights the need for greater outreach and education among racial and ethnic minorities.
Patients with metastatic upper gastrointestinal (GI) cancer may experience a large physical symptom burden. However, less is known about existential, social, and psychological symptoms. To provide the patient with palliative care, quality-of-life questionnaires are used for structured needs assessment. These are sporadically implemented, and there seems to be uncertainty to the efficiency of current practice. The aim of study was to explore the experienced assessment-process and treatment of palliative symptoms, as well as the experienced symptom burden, in patients with metastatic upper GI cancer.
Methods
Qualitative, semi-structured interviews were conducted in 10 patients with metastatic upper GI cancer. Data were analyzed using content analysis.
Results
The patients did not expect treatment for all physical symptoms. Existential symptoms revolved around death and dying, social issues were mainly related to family, and psychological issues were based in the continuous dealing with serious illness. Existential, social, and psychological symptoms were mostly not considered part of the expected care when admitted to hospital. Patients had only vague recollections of their experiences with structured needs assessment, and the process had been inconsequential in the treatment of symptoms.
Significance of results
Patients with upper GI cancer experience symptoms related to all 4 areas of palliative care being physical, existential, social, and psychological, but these are differentiated in the way patients perceive their origins and treatability. Structured needs assessment was not routinely carried out, and in cases where this had been done, no follow-up was effectuated. This calls for increased focus and proper implementation for the process to be relevant in the treatment of palliative symptoms.
Socially assistive robots (SARs) are a promising tool to manage children’s pain and distress related to medical procedures, but current options lack autonomous adaptability. The aim of this study was to understand children’s and caregivers' perceptions surrounding the use of an artificial intelligence (AI)-enhanced SAR to provide personalized procedural support to children during intravenous insertion (IVI) to inform the design of such a system following a user-centric approach.
Methods:
This study presents a descriptive qualitative needs assessment of children and caregivers. Data were collected via semi-structured individual interviews and focus groups. Participants were recruited from two Canadian pediatric emergency departments (EDs) between April 2021 and January 2022.
Results:
Eleven caregivers and 19 children completed 27 individual interviews and one focus group. Three main themes were identified: A. Experience in the clinical setting, B. Acceptance of and concerns surrounding SARs, and C. Features that support child engagement with SARs. Most participants expressed comfort with robot technology, however, concerns were raised about sharing personal information, photographing/videotaping, and the possibility of technical failure. Suggestions for feature enhancements included increasing movement to engage a child’s attention and tailoring language to developmental age. To enhance the overall ED experience, participants also identified a role for the SAR in the waiting room.
Conclusion:
Artificial intelligence-enhanced SARs were perceived by children and caregivers as a promising tool for distraction during IVIs and to enhance the overall ED experience. Insights collected will be used to inform the design of an AI-enhanced SAR.
The Communication (C), Maintaining Health (M), Independence (I), Services, Support and Self-Determination (S), and Transportation (T) is a framework (C-MIST) for identifying functional needs in an emergency response. A C-MIST documentation tool provides shelter staff with a list of potential client needs and actions to address them. This retrospective review describes the needs and actions indicated on completed C-MIST documentation tools (ie, records) within domestic general population shelters following Hurricane Florence in 2018.
Methods:
A convenience sample of 1209 records completed by shelter disaster health services personnel was provided by the American Red Cross. The records correspond to client stays in 19 shelters between September and October 2018. Data abstracted from hardcopy forms were de-identified and recorded in a database. Summary statistics were computed.
Results:
High incidence needs included medical supplies for everyday care (including medications) not related to mobility (15.4%), medically or culturally needed diets (12.2%), durable medical equipment (9.7%), mental health care (8.8%), and transportation (8.4%). High incidence actions included replacement medication (9.3%), refer to Disaster Mental Health Services (6.4%), provide assistive mobility equipment (5.1%), provide diabetes management supplies (5.0%), provide alternative food and beverages (4.1%), and provide transportation (3.9%).
Conclusions:
The process for identifying health and functional support needs in shelters should be standardized through the use of the C-MIST framework.
In January 2022, Fiji was hit by multiple natural disasters, including a cyclone causing flooding, an underwater volcanic eruption, and a tsunami. This study aimed to investigate perceived needs among the disaster-affected people in Fiji and to evaluate the feasibility of the Humanitarian Emergency Settings Perceived Needs Scale (HESPER Web) during the early stage after multiple natural disasters.
Methods:
A cross-sectional study using a self-selected, non-representative study sample was conducted. The HESPER Web was used to collect data.
Results:
In all, 242 people participated. The number of perceived serious needs ranged between 2 and 14 (out of a possible 26), with a mean of 6 (SD = 3). The top 3 most reported needs were access to toilets (60%), care for people in the community who are on their own (55%), and distress (51%). Volunteers reported fewer needs than the general public.
Conclusions:
The top 3 needs reported were related to water and sanitation and psychosocial needs. Such needs should not be underestimated in the emergency phase after natural disasters and may require more attention from responding actors. The HESPER Web was considered a usable tool for needs assessment in a sudden onset disaster.
The investigators conducted a psychosocial needs assessment of mesothelioma patients through self-report measures of quality of life (QOL), coping, depression, and social support.
Methods
Patients with malignant pleural mesothelioma (MPM) (N = 67) completed a battery of assessments at a single timepoint after being approached during routine medical oncology clinic appointments or by letter.
Results
Participants were predominately male (70.0%; n = 47) and ranged in age from 35 to 83 years old (M = 65.61, SD = 9.71). Most participants were white (88.0%; n = 59), and 10.0% (n = 7) were identified as Hispanic. The majority were married or living with a partner (93.0%; n = 62) and had some college or more education (64.0%; n = 43). Fourteen percent of participants (n = 11) endorsed significantly elevated depression symptoms. No significant demographic or clinical differences in depressed compared to nondepressed participants were observed, with a trend toward those identifying as Hispanic and those who were divorced as being more likely to be depressed. For the total sample, the most frequently endorsed coping strategies were active coping, emotional support, and acceptance.
Significance of results
The present study did not identify any clear correlates of depression or QOL among patients with MPM. This research contributes to the small literature on psychosocial functioning in patients with MPM and provides putative directions for future larger studies and the development of interventions to provide appropriate support to diverse patients with MPM.
The global trend of urbanization coupled with an increasing awareness of the importance of food systems resilience, has led to an increasing interest in urban agriculture to sustainably feed the rapidly growing urban population and mitigate against food supply chain disruptions. While home and community gardens have been long studied, there has been relatively little empirical research focused specifically on commercial urban agriculture (CUA) operations. The purpose of this study was to characterize commercial urban farms, and to identify their primary barriers to business development and expansion, their perceptions of future opportunities, and their specific informational needs. Because CUA has received relatively less attention in previous empirical research, a qualitative approach was used for this needs assessment to collect rich, contextualized information to help differentiate the specific barriers, opportunities and needs of CUA operations as opposed to their rural counterparts. We conducted semi-structured interviews (n = 29) of CUA producers in Florida. These interviews revealed that CUA operations face many of the same barriers that are common to establishing and growing small farms, with additional barriers due to local government regulations and tensions associated with farming on land that is not traditionally used for agriculture. Despite these difficulties, CUA operators believe their urban location is a key benefit to their operation and they see a variety of opportunities for future business and market expansion.
To identify the informatics educational needs of clinical and translational research professionals whose primary focus is not informatics.
Introduction:
Informatics and data science skills are essential for the full spectrum of translational research, and an increased understanding of informatics issues on the part of translational researchers can alleviate the demand for informaticians and enable more productive collaborations when informaticians are involved. Identifying the level of interest in different topics among various types of of translational researchers will help set priorities for development and dissemination of informatics education.
Methods:
We surveyed clinical and translational science researchers in Clinical and Translational Science Award (CTSA) programs about their educational needs and preferences.
Results:
Researchers from 23 out of the 62 CTSA hubs responded to the survey. 67% of respondents across roles and topics expressed interest in learning about informatics topics. There was high interest in all 30 topics included in the survey, with some variation in interest depending on the role of the respondents.
Discussion:
Our data support the need to advance training in clinical and biomedical informatics. As the complexity and use of information technology and data science in research studies grows, informaticians will continue to be a limited resource for research collaboration, education, and training. An increased understanding of informatics issues across translational research teams can alleviate this burden and allow for more productive collaborations. To inform a roadmap for informatics education for research professionals, we suggest strategies to use the results of this needs assessment to develop future informatics education.
Most emergency preparedness planning seeks to identify vulnerable population subgroups; however, focusing on chronic conditions alone may ignore other important characteristics such as location and poverty. Social needs were examined as correlates of anticipated needs and desire for assistance during an emergency.
Methods:
A retrospective, secondary analysis was conducted using assessments of 8280 adult Medicaid beneficiaries in Louisiana, linked with medical (n = 7936) and pharmacy claims (n = 7473).
Results:
The sample was 73% female; 47% Black; 34% White; mean age 41 y. Many had at least 1 chronic condition (75.9%), prescription (90.3%), and social need (45.2%). Across assessments, many reported food (40%), housing (34%), and transportation (33%) needs. However, far more people anticipated social needs during an emergency than in the next month. Having social needs increased the odds of anticipating any need (odds ratio [OR] = 1.5, 1.44-1.56) and desire for assistance during an emergency, even after controlling for significant covariates including older age, race, geographic region, Medicaid plan type, and prescriptions. Chronic conditions were significantly correlated with all anticipated needs in bivariate analyses, but only modestly associated (OR = 1.03, 1.01-1.06) with anticipated medication needs in multivariable analyses.
Conclusions:
Identifying individuals with social needs, independent of their chronic disease status, will benefit emergency preparedness outreach efforts.
This study seeks the opinions of qualified doctors on what they feel medical students should learn about otolaryngology. It aims to identify both the content deemed relevant and the performance levels for medical students in otolaryngology.
Methods
A national survey developed from a content analysis of undergraduate otolaryngology curricula from the UK was undertaken, accompanied by a review of the literature and input from an expert group. Data were collected from a wide range of doctors.
Results
Participants felt that graduating students should be able to: recognise, assess and initiate management for common and life-threatening acute conditions; take an appropriate patient history; and perform an appropriate examination for the majority of otolaryngology clinical conditions but manage only a select few.
Conclusion
This study reports performance levels for otolaryngology topics at an undergraduate level. Participating doctors felt that a higher level of performance should be expected of students treating life-threatening, acute and common otolaryngology conditions.
Edited by
Uta Landy, University of California, San Francisco,Philip D Darney, University of California, San Francisco,Jody Steinauer, University of California, San Francisco
A curriculum in reproductive and sexual health (SRH) serves as the foundation on which the learner builds and integrates knowledge in the family planning field.In the United States, accreditation organizations at all levels of medical education require written curricula with clearly defined educational objectives, methods, and evaluations to address core competencies in health care delivery. In this chapter, the authors describe a rigorous framework for developing a curriculum in sexual and reproductive health, beginning with conducing a general and targeted needs assessment, defining goals and objectives, outlining educational strategies, implementing the curriculum and collecting evaluation and feedback. Readers will have the tools they need to create a SRH curriculum in their own institution.
Any community involved in revitalization work will benefit from having a strategic language plan in place, with clearly identified short and long term goals. Ideally, projects are a carefully planned set of activities within a specific time frame and with well-defined outcomes. This chapter sets out a series of steps, beginning from the “good idea” and progressing through assessing the needs that a project will address, outlining the project and relating its intended outcomes to the broader strategic needs and goals of the community. It then covers specific details that need to be addressed in planning, such as resources, audience, budget, funding, timeline and other matters, before moving on to implementation, contingency plans and evaluation. The capsule provides a set of tips on how to maximize use of emotional resources and minimize use of money, emphasizing how much can be achieved through positive attitudes and commitment, even without financial resources.
Overview of needs assessment and application to forensic mental health service users; summary of key research using the CANFOR scales; consideration of broader fit with issues of risk and recovery.
The Camberwell Assessment of Need Forensic Version (CANFOR) is a tool for assessing the needs of people with mental health problems who are in contact with forensic services. It is based on the CAN, a widely used needs assessment for people with severe mental health problems. Individual needs are assessed in 25 areas of life, spanning health, social, clinical and functional domains. Comprehensive versions are available for research (CANFOR-R) and clinical use (CANFOR-C), as well as a short summary version (CANFOR-S) suitable for both research and clinical use. CANFOR was rigorously developed by a multidisciplinary team at the Institute of Psychiatry, London, and is suitable for use in all forensic mental health and prison settings. This second edition provides an update of the CANFOR tools and their application in clinical and research settings. The assessment forms are freely available to download from the CAN website (researchintorecovery.com/can) and cambridge.org.
The Camberwell Assessment of Need for Adults with Developmental and Intellectual Disabilities (CANDID) is introduced. It was developed at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London in 1999, and published in book form in 2003. It was developed by modification of the Camberwell Assessment of Need (CAN), the most widely used needs assessment approach for people with severe mental health problems. In addition to CANDID, a number of other variants of CAN have been developed including needs assessment for forensic patients, for mothers and pregnant women, for older adults and for people in disaster and relief situations. In this 2nd edition, the need rating for the presence or absence of need and met or unmet needs is discussed. In addition, a need rating algorithm has been introduced. Both changes are in line with changes in the 2nd edition CAN. Moreover, the terminology in this 2nd edition has changed to reflect terminology used in contemporary intellectual disabilities services.