Incongruence between nurses\u27 and patients\u27 understandings and expectations of rehabilitation

Aims and objectives. To explore nurses\u27 understandings and expectations of rehabilitation and nurses\u27 perceptions of patients\u27 understandings and expectations of rehabilitation.Background. Within the context of a broadening appreciation of the benefits of rehabilitation, interest in the nature of rehabilitation is growing. Some believe that rehabilitation services do not adequately meet the needs of patients. Others are interested in the readiness of patients to participate in rehabilitation.Design. Qualitative.Method. Grounded theory using data collected during interviews with nurses in five inpatient rehabilitation units and during observation of the nurses\u27 everyday practice.Findings. According to nurses working in inpatient rehabilitation units, there is a marked incongruence between nurses\u27 understandings and expectations of rehabilitation and what they perceive patients to understand and expect.Conclusion. Given these different understandings, an important nursing role is the education of patients about the nature of rehabilitation and how to optimise their rehabilitation.Relevance to clinical practice. Before patients are transferred to rehabilitation, the purpose and nature of rehabilitation, in particular the roles of patients and nurses, needs to be explained to them. The understandings of rehabilitation that nurses in this study possessed provide a framework for the design of education materials and orientation programmes that inform patients (and their families) about rehabilitation. In addition, reinforcement of the differences between acute care and rehabilitation will assist patients new to rehabilitation to understand the central role that they themselves can play in their recovery.<br /

Coccidioidomycosis seasonality in California: a longitudinal surveillance study of the climate determinants and spatiotemporal variability of seasonal dynamics, 2000–2021

BackgroundCoccidioidomycosis, an emerging fungal disease in the western USA, exhibits seasonal patterns that are poorly understood, including periods of strong cyclicity, aseasonal intervals, and variation in seasonal timing that have been minimally characterized, and unexplained as to their causal factors. Coccidioidomycosis incidence has increased markedly in recent years, and our limited understanding of intra- and inter-annual seasonality has hindered the identification of important drivers of disease transmission, including climate conditions. In this study, we aim to characterize coccidioidomycosis seasonality in endemic regions of California and to estimate the relationship between drought conditions and coccidioidomycosis seasonal periodicity and timing.MethodsWe analysed data on all reported incident cases of coccidioidomycosis in California from 2000 to 2021 to characterize seasonal patterns in incidence, and conducted wavelet analyses to assess the dominant periodicity, power, and timing of incidence for 17 counties with consistently high incidence rates. We assessed associations between seasonality parameters and measures of drought in California using a distributed lag nonlinear modelling framework.FindingsAll counties exhibited annual cyclicity in incidence (i.e., a dominant wavelet periodicity of 12 months), but there was considerable heterogeneity in seasonal strength and timing across regions and years. On average, 12-month periodicity was most pronounced in the Southern San Joaquin Valley and Central Coast. Further, the annual seasonal cycles in the Southern San Joaquin Valley and the Southern Inland regions occurred earlier than those in coastal and northern counties, yet the timing of annual cycles became more aligned among counties by the end of the study period. Drought conditions were associated with a strong attenuation of the annual seasonal cycle, and seasonal peaks became more pronounced in the 1-2 years after a drought ended.InterpretationWe conclude that drought conditions do not increase the risk of coccidioidomycosis onset uniformly across the year, but instead promote increased risk concentrated within a specific calendar period (September to December). The findings have important implications for public health preparedness, and for how future shifts in seasonal climate patterns and extreme events may impact spatial and temporal coccidioidomycosis risk.FundingNational Institutes of Health

Recent and forecasted increases in coccidioidomycosis incidence in California linked to hydroclimatic swings

Coccidioidomycosis, or Valley fever, is an infectious disease caused by inhalation of Coccidioides spp., fungi found primarily in soils of the southwestern United States. Prior work showed that coccidioidomycosis cases in California sharply increase by nearly 2-fold following wet winters that occur one- and two-years following drought. Statewide drought between 2020-2022 followed by heavy precipitation during the 2022-2023 winter raised concerns over potential increases in coccidioidomycosis cases in the fall of 2023, prompting California Department of Public Health (CDPH) to issue public health alerts. As anticipated, California saw a near record number of cases in 2023, with 9,054 provisional cases reported. During the 2023-2024 California wet season, precipitation was 115% the long-term average, furthering concerns about continued high coccidioidomycosis risk. We developed an ensemble model to forecast coccidioidomycosis cases in California in 2024-2025. Using this model, we predicted a total of 11,846 cases (90% PI: 10,056-14,094) in California between April 1, 2023, and March 31, 2024, encompassing the preliminary state report of 10,593. Our model forecasted 12,244 cases statewide between April 1, 2024, and March 31, 2025 - a 62% increase over the cases reported during the same period two years prior, and on par with the high incidence seen in 2023. The Southern San Joaquin Valley (5,398 cases, 90% PI: 4,556-6,442), Southern Coast (3,322, 90% PI: 2,694-3,961), and Central Coast (1,207 cases, 90% PI: 867-1,585) regions are expected to see the largest number of infections. Our model forecasts that disease incidence will exhibit pronounced seasonality, particularly in endemic regions, with cases rising in June and peaking in November at 1,411 (90% PI: 815-2,172) cases statewide - 98% higher than the peak two years prior (714) and nearly as high as the peak in 2023 (1,462). Near-term forecasts have the potential to inform public health messaging to enhance provider and patient awareness, encourage risk reduction practices, and improve recognition and management of coccidioidomycosis

Designing evaluation and research into educational initiatives: The global perspectives program

We describe the planning for evaluation research using a curriculum initiative project as a case study. The project was to design a generic Global Perspectives (GP) learning program to embed in first year units of study offered by the Faculty of Health Science. The pilot phase of the GP program delivery was used to explore and define an educational evaluation research (EER) plan that addresses, 1) the GP program design; 2) its implementation and ongoing refinement and, 3) the management of the project. The GP program is presented from an e-learning design perspective and its EER plan is based on the design framework in (Phillips, McNaught et al. 2012). The paper provides a high level view of the EER plan for the GP program over each stage of the design life cycle and for the evaluation of project management. The paper discusses the rationale for an EER plan, the book as a guide for research and practice in evaluating e-learning and the relationship of the GP program to learning, teaching and leading for the future

You're going to rehab'. A study into the experience of patients moving from acute care settings to an inpatient rehabilitation unit

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