Explore the vast range of titles available.

Background As an imaging modality, point-of-care ultrasound (POCUS) holds substantial value to health professionals who are adequately trained in its use. The athletic training profession is an allied health profession with significant potential to adopt POCUS in training and practice. However, published research on POCUS curricula for graduate entry-level programs in athletic training is lacking. Furthermore, there are no published studies of learning outcomes from POCUS courses for graduate entry-level athletic training students. Methods We developed a POCUS curriculum tailored for a graduate athletic training program. Following updated Commission on Accreditation of Athletic Training Education standards, we described POCUS evaluation of select organ systems in the abdomen and thorax, as well as the extended focused assessment with sonography in trauma (eFAST) protocol. Course efficacy was assessed with a prospective observational study using a convenience sample of entry-level graduate athletic training students enrolled in our elective course. All ( n  = 15) students were starting the second year in a Master of Science in Athletic Training (MSAT) program. Pre-and post-course tests were administered to assess cognitive learning outcomes, and an imaging practical exam was developed to gauge students’ psychomotor proficiency. In addition, students’ experiences were evaluated with a post course survey in the following self-perceived domains: (1) confidence in their future education and clinical practice; (2) satisfaction with the course; and (3) confidence in their POCUS proficiency. Results Students demonstrated significant learning in cognitive domains (pre-test average = 48%, post-test average = 73%, P  < 0.001), displayed proficiency in congruence with our course objectives in a practical evaluation, reported satisfaction with a variety of course features, and gained confidence in POCUS skills. Notably, students were dissatisfied with the brevity of the course and displayed heterogeneous proficiency across applications. Conclusions Students in a professional MSAT program can develop meaningful knowledge and proficiency in the use of POCUS across organ systems following a brief elective. Additional training is needed to facilitate clinical implementation across the profession. Positive perceptions and self-confidence among students following POCUS training may help support POCUS adoption by athletic trainers.

Project ECHO (Extension for Community Health Outcomes) is an innovative program that uses videoconferencing technology to connect health care providers with experts. The model has been successful in reaching health care providers in rural and underserved areas and positively impacting clinical practice. ECHO Idaho, a replication partner, has developed programming that has increased knowledge and confidence of health care professionals throughout the state of Idaho, United States. Although the ECHO model has a demonstrated ability to recruit, educate, and train health care providers, barriers to attending Project ECHO continuing education (CE) programs remain. The asynchronous nature of podcasts could be used as an innovative medium to help address barriers to CE access that health care professionals face. The ECHO Idaho \"Something for the Pain\" podcast was developed to increase CE accessibility to rural and frontier providers, while upscaling their knowledge of and competence to treat and assess substance use disorders, pain, and behavioral health conditions. This paper describes the creation and preliminary assessment of the ECHO Idaho \"Something for the Pain\" podcast. Podcast episodes consisted of interviews with individuals as well as didactic lectures. Audio from these recordings were edited for content and length and then professionally reviewed by subject matter experts (eg, featured episode speakers). Target audiences consisted of health care providers and community members interested in behavioral health and substance use disorders. Metrics on podcast listeners were assessed using SoundCloud's RSS feed, continuing education survey completion, and iECHO. The ECHO Idaho \"Something for the Pain\" podcast's inaugural season comprised 14 episodes with 626 minutes of CE material. The podcast series received a total of 2441 listens from individuals in 14 different cities across Idaho, and 63 health care providers listened and claimed CE credits. The largest professional group was social workers (n=22; 35%). We provide preliminary evidence that podcasts can be used to provide health care providers with opportunities to access CE material. Health care providers listened to and claimed CE credits from the ECHO Idaho \"Something for the Pain\" podcast. Project ECHO programs should consider creating podcasts as an additional platform for disseminating ECHO material.

Digital health technologies, such as telehealth, remote patient monitoring, and smartphone apps, have the potential to reduce access disparities faced by rural patients with cardiovascular disease, but little is known about rural health care providers' perspectives on adopting digital health in their practice. This study used diffusion of innovations theory as a guiding framework to interpret interview findings on rural and rural-serving health care providers' perspectives on the use of digital health to deliver rural cardiovascular care. We conducted semistructured interviews with rural and rural-serving health care providers, including primary care advanced practice providers and physicians, as well as referring cardiologists from 6 primary care clinics in Alaska, Idaho, and Washington. We performed a directed content analysis of interview data informed by diffusion of innovations theory and identified emergent subthemes related to each of the 5 factors that influence adoption: relative advantage, compatibility, complexity, trialability, and observability. Seventeen health care providers participated in this study. Participants described cycles of adopting and discontinuing the use of digital health in their practice. Participants identified advantages of digital health including reduced patient travel, the ability to leverage nonphysician health care workers, and the availability of objective patient data from remote patient monitoring. Compatibilities included increased patient adherence and follow-up and the ability to involve specialists in patient care. The trialability of digital health was described through experiences with remote patient monitoring and scaled-up use of telehealth during the COVID-19 pandemic, and participants observed the benefits of digital health in other disciplines and as patients. We also identified several disadvantages, incompatibilities, and complexities that may hinder the adoption of digital health technologies in rural practice, most of which were highlighted at the clinic and patient levels. These disadvantages, incompatibilities, and complexities included substandard equipment, inability to perform a physical examination, connectivity issues caused by poor internet and cell phone service, concerns about patient age and technical abilities, concerns about proper fit and distribution of remote patient monitoring equipment, and questions about billing and data management for digital health technologies. Rural health care providers recognize the many advantages of using digital health in caring for patients with cardiovascular disease but find that digital health is often complex and incompatible with their needs and the needs of their patients. There may be a disconnect between the potential of digital health and how it works in practice, as evidenced by the cycles of adoption and discontinuance of digital health technologies described by rural health care providers. Future rural digital health interventions in cardiovascular care should take into consideration specific complexities and incompatibilities in the rural context.

Background A shortage of healthcare providers, particularly in primary care and mental health, exists in the predominately rural state of Idaho. There are also barriers to retaining healthcare providers to work in rural and remote communities. Limited research using U.S. samples has explored factors that may affect the retention of healthcare providers in rural areas. Additionally, due to differences between communities, it is important to conduct community-level investigations to better understand how these factors may affect retention in rural areas. Therefore, the purpose of this study was to explore factors affecting healthcare provider retention in a rural community in Northern Idaho. Methods A modified version of the Nursing Community Apgar Questionnaire (NCAQ) was completed by 30 healthcare providers in a rural and frontier community in Northern Idaho to assess factors influencing healthcare provider retention. Factors were classified into classes including geographic, economic, scope of practice , medical support , and facility and community support classes . Retention factors were assessed on their perceived importance to retention as well as whether they were perceived as an advantage or challenge to retention based on Likert scales. A “Community Apgar” score was also created by combining the importance and advantage/challenge factors. Results Overall, items in the medical support group had the highest importance of any other class and included factors such as nursing workforce. Additionally, the facility and community support class, which included factors such as televideo support, was rated the highest advantage class and had the highest Apgar score, indicating it contained the factor that healthcare providers identified as the most important advantage (i.e., medical reference resources). Conclusion Our study identified multiple factors that healthcare providers deemed as important advantages or disadvantages to retaining healthcare providers in rural areas. Overall, facility and community support factors were found to have the highest advantage in the retention of rural providers. Rural healthcare organizations looking to increase healthcare provider retention should target retention efforts towards these factors. Additional research should also be conducted on other rural samples across the U.S. to make comparisons of findings.

This study investigated the association between self-compassion and psychological pain across various demographic variables. Using canonical correlation analysis, we observed an inverse relationship between the combined factors of the Self-Compassion Scale (SCS) and the Orbach and Mikulincer Mental Pain Scale (OMMP-8). Subgroup analyses revealed differences in SCS subscales among demographic groups with females, individuals with mental health diagnoses, and non-athletes displaying higher scores on negative SCS subscales and PsyPn. Injury status did not significantly affect self-compassion levels, although injured individuals scored higher on the irreversibility subscale of PsyPn. Negative SCS factors exhibited larger group differences and stronger correlations with PsyPn, indicating the potency of negative thinking in influencing psychological pain. These findings underscore the importance of self-compassion in mental health and suggest potential implications for intervention strategies.

Background The field of point-of-care ultrasound (POCUS) has advanced in recent decades due to the benefits it holds for medical providers. However, aspiring POCUS practitioners require adequate training. Unfortunately, there remains a paucity of resources to deliver this training, particularly in rural and underserved areas. Despite these barriers, calls for POCUS training in undergraduate medical education are growing, and many medical schools now deliver some form of POCUS education. Our program lacked POCUS training; therefore, we developed and implemented a POCUS curriculum for our first-year medical students. Methods We developed a POCUS curriculum for first year medical students in a rural medically underserved region of the United States. To evaluate our course, we measured learning outcomes, self-reported confidence in a variety of POCUS domains, and gathered feedback on the course with a multi-modal approach: an original written pre- and post-test, survey tool, and semi-structured interview protocol, respectively. Results Student ( n =24) knowledge of POCUS significantly increased (pre-test average score = 55%, post-test average score = 79%, P <0.0001), and the course was well received based on student survey and interview feedback. In addition, students reported increased confidence toward a variety of knowledge and proficiency domains in POCUS use and their future clinical education and practice. Conclusions Despite a lack of consensus in POCUS education, existing literature describes many curricular designs across institutions. We leveraged a combination of student initiatives, online resources, remote collaborations, local volunteers, and faculty development to bring POCUS to our institution in a rural and medically underserved region. Moreover, we demonstrate positive learning and experiential outcomes that may translate to improved outcomes in students’ clinical education and practice. Further research is needed to evaluate the psychomotor skills, broader learning outcomes, and clinical performance of students who take part in our POCUS course.

IntroductionHepatitis C virus (HCV) infection and excessive alcohol consumption are major public health concerns that frequently co-occur, compounding the risk of liver-related morbidity and mortality. Despite the clinical implications of their intersection, few nationally representative studies have explored this relationship using recent data. This study updates prior research by examining alcohol use patterns among HCV-positive individuals using NHANES data from 2011 to March 2020.MethodsWe analyzed cross-sectional data from NHANES, focusing on adults aged 20 years and older (N = 19,571). Participants were categorized by alcohol use patterns: lifetime abstainers, former drinkers, non-excessive current drinkers, and excessive current drinkers. Associations between HCV status and alcohol use were examined using survey-weighted logistic regression models adjusted for sociodemographic and health-related factors.ResultsHCV-positive individuals had nearly four times the prevalence of excessive alcohol use compared to HCV-negative individuals (PR: 3.7; 95% CI: 2.2–6.0), even after adjusting for covariates. Excessive alcohol use was also more common among men, those without health insurance, and individuals with lower educational attainment. No significant association was observed between HCV status and former drinking. Former drinkers were more likely to be older, female, and living near or below the poverty line.ConclusionExcessive alcohol consumption is disproportionately high among individuals with current HCV infection. These findings underscore the need for targeted screening and behavioral interventions to reduce alcohol-related harm in this population. Expanding access to care and tailoring public health efforts to vulnerable subgroups may improve outcomes for individuals living with HCV.

Background: Student-athletes and competitive dancers experience significant physical, psychological, and emotional stress, often coupled with academic and social pressures. These stressors may lead to unhealthy coping mechanisms, negatively impacting mental health, quality of life, and athletic performance. While assessing mental illness is important, measuring positive mental health (PMH) can offer valuable insights into overall well-being and resilience. The positive mental health Instrument (PMHI) was developed to assess PMH, but its psychometric properties in student-athletes and competitive athletes have not been explored. Methods: Collegiate student-athletes and competitive dancers completed a survey, including the PMHI-19 and a demographic questionnaire. Confirmatory factor analysis (CFA) was conducted to assess the factor structure of the PMHI-19. An exploratory factor analysis (EFA) was then conducted to identify a more parsimonious structure. Results: The CFA of the PMHI-19 did not meet recommended model fit indices. EFA resulted in two different parsimonious models: a 4-factor, 11-item model (PMHI-11) and a 3-factor, 9-item model (PMHI-9), both meeting recommended fit indices. Conclusions: The condensed PMHI-11 and PMHI-9 models may be more suitable for use in collegiate athletic populations. Further research is needed to refine these instruments and explore their applicability across diverse athletic groups.

Background The Foot Function Index Revised Short version (FFI-RS) is a foot- and ankle- patient-reported outcome measure (PROM), developed from the Foot Function Index (FFI). Previous studies, estimating item parameters and multidimensional properties, have limitations properly establishing the measurement properties of the FFI-RS. A multi-faceted Rasch analysis with a larger sample would allow for a more robust validation approach to improve the clinical interpretation of the FFI-RS using a multidimensional perspective. Therefore, the purpose of this study was to assess the psychometric properties of the FFI-RS as a PROM of foot function. Method A total of 2184 patients with foot pathology who completed the FFI-RS were included in the data. Data were extracted from the cloud-based orthopedic and sports medicine global registry Surgical Outcome System (SOS). The psychometric properties of the FFI-RS were assessed using a many-faceted Rasch analysis that included model-data fit, rating scale function, item-person map (distribution of item difficulty and person ability), and item difficulty of the subscale. Results Two misfit items were discovered and deleted; 32-items from the original FFI-RS were retained. The 4-item Likert scale functioned effectively and item difficulty (-0.58 to 1.48), subscale difficulty (-0.58 to 1.15), and person’s foot function (-6.62 to 6.24) had wide distributions. Conclusions Many-faceted Rasch analysis revealed the FFI-RS had sound psychometric properties using the many-faceted Ranch analysis and retained 32 of the original items. Clinicians and researchers should consider weaknesses identified with items in the ‘Difficulty” subscale and future work should be conducted to modify or develop items that will more accurately evaluate a wide range of foot function levels.

Background: The prevalence of mental health disorders calls for valid and reliable instruments that are easy to administer and assess for clinicians and researchers. The Depression Anxiety Stress Scale-21 (DASS-21) is a commonly used instrument to assess psychological distress; however, model fit and internal reliability issues have been reported. Our objective was to assess the factorial and structural validity of the DASS-21. Methods: A confirmatory factor analysis (CFA) was conducted on the full sample (n = 1036) to assess the proposed three-factor DASS-21 using a priori cut-off values. Because model fit indices were not met, an exploratory factor analysis (EFA) was conducted to identify a parsimonious model. The resulting three-factor structure (i.e., DASS-9) was then assessed using CFA and multigroup invariance testing procedures. Results: The proposed three-factor DASS-21 did not meet model fit criteria. The DASS-9 did meet recommended model fit criteria and was invariant between sex, injury status, mental health diagnosis, and activity level groups. Statistically different group means were found between mental health diagnosis and activity level groups, while no differences between sex or injury status groups were found. Conclusions: The current study provides support to use a condensed DASS-21 instrument, such as the DASS-9. Future research is necessary to establish the DASS-9 prior to its adoption in research and clinical practice. Additionally, there is a need to identify and review all condensed versions of the DASS-21, so individuals know which instrument can be used for clinical or research purposes.