Mayoly Spindler (France)

Basic concussion symptom knowledge is fundamental to concussion identification; however, racial disparities in concussion knowledge exist in high school and youth sports. It is unknown whether similar differences exist in collegiate-athletes. Identifying racial disparities in concussion knowledge and sources of concussion information is essential to inform equitable approaches to knowledge translation and educational interventions. This study examined how Black and White collegiate-athletes differed in their knowledge of concussion symptoms and use of concussion information sources. National Collegiate Athletic Association (NCAA) institutions. Collegiate-athletes. Cross-sectional. Collegiate-athletes completed a questionnaire that assessed personal and sports demographics, concussion symptom knowledge, and use of concussion information sources. Fisher's exact tests and Wilcoxon rank-sum tests examined differences in outcome measures between Black and White collegiate-athletes. A multivariable Poisson regression model examined the association between race and concussion symptom knowledge scores while accounting for sex, sports contact level, NCAA division, concussion history, and specific concussion information sources. Incidence rate ratios (IRRs) with 95% CIs excluding 1.00 were deemed significant. A total of 768 (82.6% White, 17.4% Black) collegiate-athletes completed the questionnaire. Black athletes were more likely to have lower concussion symptom knowledge scores than White athletes (P < .001). In the multivariable Poisson regression model controlling for covariates, this finding was retained (IRR = 0.97; 95% CI, 0.94-0.997). White athletes were more likely to report school-based professional (P < .001), online medical sources (P = .02), and the NCAA (P = .008) as sources of concussion information. Black athletes were more likely to report referees (P = .03) as a source of concussion knowledge. Despite NCAA concussion education requirements for athletes, Black collegiate-athletes were found to have lower concussion knowledge than White collegiate-athletes. The findings highlight the need for equitable strategies to disseminate concussion information to diverse populations by improving the physician-patient relationship and investing in culturally appropriate educational materials.

Die Olmuhle Fandler ist seit 1926 ein eingesessener Familienbetrieb im steirischen Pollau, der mit 46 Mitarbeiterinnen und Mitarbeitern derzeit knapp € 7 Mio. jahrlich erwirtschaftet. Mit der Ubernahme der Gesamtverantwortung 2005 hat sich Julia Fandler den Freiraum fur ein alternatives Wirtschaften herausgenommen – eine sehr personlich gepragte Unternehmensfuhrung, basierend auf dem Erbe ihrer Vorfahren, ihren Werten und ihrer Lebenseinstellung. Die Olmuhle Fandler wachst langsam, gesund und nachhaltig, aber nicht um jeden Preis und eroffnet Innovationspotenziale, wahrend gleichzeitig strenge, gesetzliche Rahmenbedingungen und selbst auferlegte Anforderungen eingehalten werden. Den Schlussel des Erfolgs der Olmuhle sieht Julia Fandler in der Personalpolitik, die Raum fur Menschlichkeit und individuelle Entwicklung eroffnet, sowie in einem kompromisslosen Qualitatsanspruch in allen Produktions- und Geschaftsbereichen.

Community-based programs deploying community health workers (CHWs) who collaborate with other entities are beginning to emerge as the US health system evolves. Although these programs have used various evaluation criteria to determine program success, little research has been completed to examine the experiences of program participants as they receive these services. The purpose of this qualitative descriptive study was to describe what it was like to experience the benefit of improved care coordination through a community-based program featuring CHWs, in collaboration with community-based interprofessional providers. Knowing the help I needed emerged as the overarching theme.

Introduction: The success of thrombectomy trials for acute ischemic stroke create 2 options for prehospital decision-making-(1) transport the patient to the nearest endovascular capable center (ECC) even though this may mean bypassing a closer non-ECC (mothership model): or (2) transport to nECC for intravenous thrombolysis and then transfer the patient to the nearest ECC for endovascular therapy (drip and ship model). Methods: A decision- analytical modelling study was constructed to simulate a 50-year old man with acute stroke. Input probabilities were derived from recent literature with thrombectomy data and outcomes from the HERMES. We include extensive subgroup analysis by varying each possible time interval and evaluate the two strategies under different circumstances. Multiple sensitivity analysis were performed to give the threshold values. Results: In the base case calculation , we found Mothership to be the better strategy. The results shows when time to nECC is 30 min, Mothership is the better strategy until the time to ECC exceeds 93 min, or when it takes less than 126 min to transfer patients from nECC to ECC. When the time to nECC is 90 min, Drip and Ship becomes the better strategy regardless of the additional time to ECC and the transfer time. Subsequently we assigned the time to perform IA in transferred patients as 1.5 longer than patients who are directly sent to ECC and performed further sensitivity analyses. When nECC is within 30 min away, Drip and Ship is the better strategy when it takes more than 78 min to get to ECC, regardless of the transfer time. Conclusion: We have used decision analysis, modelling based technique to address the problem of acute stroke triage from a population-based perspective. By feeding in the time to the nearest ECC and nECC, the EMS and stroke team can make the most appropriate decision on where to transfer the patient for the best outcomes based on the currently available data.

Background: To address the increasingly strident call for better, more informed shared decision-making about treatment decisions and goals of care in patients with end-stage heart failure (HF), we designed and implemented a supportive care intervention for hospitalized patients with a very poor prognosis. Methods: All patients admitted to the advanced HF service at a single hospital over a 6-mo. period were screened for inclusion criteria (deemed non-candidacy for LVAD/transplantation and high likelihood for death or persistently poor quality of life at 6 months, based on the Allen risk score). Enrollees were given a written exercise, The Conversation Starter Kit, to complete with their healthcare proxy before an outpatient visit with a HF nurse practitioner (NP) trained in supportive care techniques. The intervention provided at this visit consisted of 5 domains: disease understanding, symptom control, legal matters, goals of care, and the role of the healthcare proxy. The KCCQ, PEACE Illness Acceptance Scale, Decisional Conflict Scale, and Kaldjian’s Goals of Care were collected at enrollment and 1 month after the intervention, along with 6-month outcomes of readmission and death. Results: Of 77 patients admitted to the service who were not candidates for advanced therapies, 16 met eligibility criteria. Nine declined participation and 7 of a planned 10 were enrolled; the pilot was terminated early due to low enrollment. Only 2 patients completed the intervention; reasons for not completing varied for the 5 remaining patients. (Table) Despite a pre-existing relationship between patients and NPs, rigorous facilitator training, and a comprehensive, evidence-based, outpatient intervention, significant barriers to implementation included patient reluctance/fear, uncertainty surrounding disease progression, time constraints of completing the intervention within a scheduled clinic visit, and lack of efficacy due to patients having too-advanced disease. Conclusions: An intervention to engage very high-risk, advanced HF patients in shared decision-making about end-of-life care failed to be successfully and sustainably implemented. Future work should assess the feasibility and efficacy of designing an early and iterative intervention in a larger population of HF patients with less advanced disease.

Com o fim de aprofundar o papel mediador do formato discursivo na retenção e recordação de informação de crianças de pré-escolar e 1.º ciclo, realizaram-se dois estudos a propósito de uma pintura de Picasso e de uma visita ao Oceanário de Lisboa. Os resultados evidenciam a importância da verbalização da informação para posterior recordação e que a estrutura enquadradora do tipo narrativo é adequada nestas duas situações, pois, para além de não inibir a efabulação e capacidade de inventar, não funcionou como distractor na observação e retenção da informação exterior, mas sobretudo, facilitou a retenção da informação previamente verbalizada e organização da recordação.

RESUMEN DE LOS EDITORESEste artículo fue publicado originalmente en la Revista Punto de vista en agosto de 1994. No es difícil constatar, dado el número de veces que aparece citado en otros textos, que a pesar del tiempo transcurrido no ha perdido su actualidad a la hora de pensar los problemas que hacen a la representación cinematográfica de acontecimientos históricos. No obstante esto, el artículo no estaba hasta ahora disponible en la web y era complicado encontrarlo en bibliotecas. Por este motivo decidimos, con la autorización de su autor, reeditarlo en este primer número de Toma Uno. Agradecemos a Raúl Beceyro su generoso aporte.

The nursing shortage affects all levels, including the pivotal role of nurse managers, who may find themselves functioning in a complex, stressful work environment. In this increasingly difficult milieu, succession planning for nurse manager turnover is imperative. The authors describe an evidence-based, theoretically driven nurse management internship that allows staff nurses to explore the nurse manager role.

Increased production and accumulation of melanin lead to hyperpigmentation disorders. Several inhibitors of tyrosinase, the key enzyme in melanin synthesis have been developed but exhibited lack of efficiency or some adverse side effects. Therefore, it appears very important to find new agents that will be able to promote inhibition of tyrosinase and pigmentation. In this study, some phenylalkylcinnamide molecules were synthesized and evaluated for their ability to act as tyrosinase inhibitors. Compounds 2 (IC(50)=0.03 mM) and 12 (IC(50)=0.028 mM) showed strong tyrosinase inhibitory potential comparable to standard hydroquinone (IC(50)=0.037 mM). Taken together, compounds 2 and 12 can be considered as good candidates for further investigations to evaluate their effect on the inhibition of melanin synthesis and skin pigmentation.