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With the coming of the new century, talk of change and new beginnings is everywhere-the new family, the new workforce, the new corporation, the new employee-employer contract. In the midst of all this talk of change, however, policies and practices in the work-life area remain surprisingly the same. No innovative ways of framing the issues have captured the imagination of policymakers; no dramatically new approaches have been embraced to meet the needs of changed constituencies. The author argues that this stagnation is due to well-entrenched but out-of-date assumptions about men and women, work and family. These assumptions have served to severely limit the development of creative approaches to corporate work-family policies. The challenge for the new century is to break the hold of these assumptions and find fresh approaches to work-life issues. The aim of this article is to articulate one such fresh approach.

BackgroundIndividuals with sickle cell disease (SCD) experience poor clinical outcomes while transitioning from paediatric to adult care. Standards for SCD transition are needed. We established a Quality Improvement (QI) Collaborative that aimed to improve the quality of care for all young adults with SCD by establishing a standardised SCD transition process. This study evaluates the implementation of the Six Core Elements (6CE) of Health Care Transition, which was a fundamental component of the cluster-randomised Sickle Cell Trevor Thompson Transition Project (ST3P-UP) study.MethodsA central QI team trained 14 ST3P-UP study sites on QI methodologies, 6CE and Got Transition’s process measurement tool (PMT). Site-level QI teams included a transition coordinator, clinic physicians/staff, patients/parents with SCD and community representatives. Sites completed the PMT every 6 months for 54 months and monthly audits of 10 randomly-selected charts to verify readiness/self-care assessments and emergency care plans.ResultsOf a possible 100, the aggregate mean (±SD) PMT score for paediatric clinics was 23.9 (±13.8) at baseline, 95.9 (±6.0) at 24 months and 98.9 (±2.1) at 54 months. The aggregate mean PMT score for adult clinics was 15.0 (±13.5) at baseline, 88.4 (±11.8) at 24 months and 95.8 (±6.8) at 54 months. The overall QI Collaborative PMT score improved by 402%. At baseline, readiness/self-care assessments were current for 38% of paediatric and 20% of adult patients; emergency care plans were current for 20% of paediatric and 3% of adult patients. Paediatric clinics had one median readiness assessment shift (76%) and four median emergency care plan shifts (65%, 77%, 79%, 84%). Adult clinics experienced three median self-care assessment shifts (58%, 63%, 70%) and two median emergency care plan shifts (57%, 70%).ConclusionsThe ST3P-UP QI Collaborative successfully embedded the 6CE of Health Care Transition into routine care and increased administration of assessments and emergency care plans for transition-aged patients with SCD.

IntroductionChildren with medical complexity (CMC) have chronic, intensive care needs managed by many healthcare practitioners. Medical advances have enabled CMC to survive well into adulthood. However, the availability of supports as CMC transition into the adult care system remain suboptimal, contributing to poor care coordination, and discontinuity. Promoting Intensive Transitions for Children and Youth with Medical Complexity from Paediatric to Adult Care (PITCare) aims to assess whether intensive patient and caregiver-oriented transition support beyond age 18 will improve continuity of care for CMC compared with usual care.Methods and analysisThis is a pragmatic superiority randomised controlled trial in a parallel group, two-arm design with an embedded qualitative component. CMC turning 17.5 years old will be recruited (n=154), along with their primary caregiver. Participants randomised to the intervention arm will be provided with access to a multidisciplinary transition team who will support patients and caregivers in care planning, integration with an adult primary care provider (PCP), adult subspecialty facilitation and facilitation of resource supports for 2 years. Outcomes will be measured at baseline, 12 and 24 months. The primary outcome measure is successful transfer completion, defined as continuous care in the 2 years after age 18 years old. Secondary outcomes include satisfaction with transitional care, self-management, care coordination, healthcare service use, caregiver fatigue, family distress, utility and cost-effectiveness. Qualitative interviews will be conducted to explore the experiences of patients, caregivers, the transition team, and healthcare providers with the PITCare intervention.Ethics and disseminationInstitutional approval was obtained from the Hospital for Sick Children Research Ethics Board. Our findings and resources will be shared with child health policymakers and transitions advocacy groups provincially, nationally, and internationally.Trial registration numberClinicalTrials.gov, US National Library of Medicine, National Institutes of Health, #NCT06093386.

Background: More than 50% of intensive care unit (ICU) survivors suffer from long-lasting physical, psychosocial, and cognitive health impairments, also called “post-intensive care syndrome” (PICS). Intensive care admission during the COVID-19 pandemic was especially uncertain and stressful, both for patients and for their family. An additional risk of developing symptoms of PICS was feared in the absence of structural aftercare for the patient and family shortly after discharge from the hospital. The purpose of this quality improvement study was to identify PICS symptoms and to support post-intensive care patients and families in the transition from the hospital to the home. Therefore, we offered post-ICU patients and families structured telephone support (STS). Methods: This was a quality improvement study during the 2019 COVID-19 pandemic. A project team developed and implemented a tool to structure telephone calls to identify and order symptoms according to the PICS framework and to give individual support based on this information. We supported post-ICU patients diagnosed with COVID-19 pneumonia and their family caregivers within four weeks after hospital discharge. The reported findings were both quantitative and qualitative. Results: Forty-six post-ICU patients received structured telephone support and reported symptoms in at least one of the three domains of the PICS framework. More than half of the patients experienced a loss of strength or condition and fatigue. Cognitive and psychological impairments were reported less frequently. Family caregivers reported fewer impairments concerning fatigue and sleeping problems and expressed a need for a continuity of care. Based on the obtained information, the ICU nurse practitioners were able to check if individual care plans were optimal and clear and, if indicated, initiated disciplines to optimize further follow-up. Conclusions: The implementation of the STS tool gave insight in the impairments of post-ICU patients. Surprisingly, family caregivers expressed fewer impairments. Giving support early after hospital discharge in a structured way may contribute to providing guidance in the individual care plans and treatment of the early symptoms of PICS (-F).

Career issues of professionals working in the biotechnology industry give insight into work and life strategies of the future. Through in-depth case studies, we explore commonalities and differences between men and women. We examine individual and organizational factors that serve as barriers or enablers to full integration of work and life issues. The structure of the professionals' work itself contributes to new constructions of the employment relation and to the very concept of career in these firms. The old employment contract no longer concerns employment alone (since key workplace decisions have implications for family life, and vice versa), nor is it clearly any longer a contract, but rather an emergent, ever changing interactive set of adaptations. We argue that this requires a new conception of career, which is more fluid, more adaptable to different life stages and needs, and more variable than the traditional conception.

Background Organizational socialization is a significant factor in new graduate nurses’ transition from students to professional nursing roles. However, there is a lack of understanding about the impact of external influences such as community and societal conditions. This study aimed to examine personal, community, and societal conditions on the organizational socialization of new graduate nurses. Methods New graduate nurses with two years or less experience at South Korean national university-affiliated hospitals participated in the survey. The main outcome variable was organizational socialization, with potential factors including personal conditions (grit, confusion in professional nursing values), community conditions (social support), and societal conditions (perceived social awareness of nurses, job opportunities). Bivariate analyses and multiple linear regression were conducted to determine the associations between organizational socialization and these factors. Results The final analysis included 262 responses, with a mean (SD) age of 24.32 (2.42) years. Most participants were female (91.60%), held a bachelor of science in nursing degree (91.98%), and were in their first nursing position (88.55%). The average (SD) duration of employment at the current hospital was 7.90 (2.56). Organizational socialization averaged 3.07 (SD = 0.36) out of 5. The results of the multiple regression analysis indicated that grit (coefficient = 0.24, p  <.001), confusion in professional nursing values (coefficient = -0.18, p  <.001), social support (coefficient = 0.09, p  =.01), perceived social awareness of nurses (coefficient = 0.06, p  =.03), and gender (female) (coefficient = -0.19, p  =.002), were significantly associated with new graduate nurses’ organizational socialization, accounting for 49% of the variance. Conclusion The findings showed significant associations between new graduate nurses’ organizational socialization and personal (grit, confusions in professional nursing values), community (social support) and societal (perceived social awareness of nurses) conditions. These findings may offer insights for developing effective educational and training programs to improve new graduate nurses’ organizational socialization and transition.

In the fields of partnership research and social innovation, there has been an increasing number of calls for evidence regarding the kind of collaborative multi-level governance structures that might support large-scale transformation processes, especially in regard to climate-neutral cities. This paper conceptualizes a new type of intermediary actor, the Systemic Collaborative Platform (SCP). Using the example of a multi-stakeholder arrangement set up to design and implement Madrid’s Climate Neutrality Roadmap, the key features of an SCP include a focus on multi-stakeholder and cross-sectoral collaboration for public policy development, in this case operating at both a systemic level and a city scale, and a strong link to a key actor within this regime (a city council). Our study reveals how an SCP can contribute to articulation of a shared mandate among city actors and enhance the efficiency and effectiveness of a targeted transition by attracting, aligning and managing a wide and diverse organizational ecosystem through distributed facilitation, collaborative leadership, and continuous learning.

Background When young adults transfer from pediatric to adult diabetes care they are at risk for deterioration of glycemic control, putting them at an increased risk of developing both acute and chronic complications. Despite increased awareness of these risks, there are gaps in care delivery during this vulnerable time and variability in the implementation of recommended transition practice. Audit and feedback (AF) interventions have a positive but variable effect on implementation of best practices. An expert group identified specific suggestions for optimizing the effectiveness of AF interventions. We aim to test an AF-based intervention incorporating these specific suggestions to improve transition practices and glycemic control in the first year after transfer from pediatric to adult diabetes care. Methods This is a pragmatic quasi-experimental study; a series of three cohort studies (pre-implementation, early-implementation, and post-implementation) to compare the baseline adjusted hemoglobin A1c (HbA1c) in the 12 months after the final pediatric visit in five pediatric diabetes centres within the Ontario Pediatric Diabetes Network in Ontario, Canada. The intervention includes three components: 1) centre-level feedback reports compiling data from chart abstraction, linked provincial administrative datasets, and patient-reported experience measures; 2) webinars for facilitated conversations/coaching about the feedback; and 3) online repository of curated transition resources for providers. The primary outcome will be analyzed using a multivariable linear regression model. We will conduct a qualitative process evaluation to understand intervention fidelity and to provide insight into the mechanisms of action of our results. Discussion There is a need to develop an innovative system-level approach to improve outcomes and the quality of care for young adults with type 1 diabetes during the vulnerable time when they transfer to adult care. Our research team, a collaboration of health services, implementation science, and quality improvement researchers, are designing, implementing, and evaluating an AF-based intervention using recommendations about how to optimize effectiveness. This knowledge will be generalizable to other care networks that aim to deliver uniformly high-quality care in diverse care settings. Trial registration ClinicalTrials.gov NCT03781973 . Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.

In particular, health care reimbursement from major governments (e.g., U.S) was declining for devices and masks that treat sleep-disordered breathing. [...]the health care insurers were also looking to contain the costs associated with diagnosing and treating the condition. While the science behind the solutions was unclear, they nevertheless made inroads at the lower end of the market. [...]the channel intermediaries – termed HMEs – were experiencing significant price pressures. [...]analysts were expecting a “shake out” of smaller, less operationally excellent distributors. Think about what a health care system can do to reduce costs and manage chronic disease better.

Many adolescents may experience a deterioration in metabolic control—attributable to one or several of the following: endocrine changes leading to increased insulin resistance (B) erratic meal and exercise patterns (C) poor adherence to treatment regimens (C) eating disorders (C) hazardous and risk-taking behaviors (C/E) It is essential to develop appropriate communication skills to facilitate teaching and education, and recognize the need for privacy and confidentiality for this age group (E). In the context of type 1 diabetes, many adolescents may experience a deterioration in metabolic control often attributable to erratic meal and exercise patterns, poor adherence to treatment regimens, hazardous and risk-taking behaviors, disordered eating behaviors, other mental health issues, and endocrine changes associated with puberty, leading to greater insulin resistance. Understand that attending to the developmental needs of young people may be just as important for quality of life as diabetes-specific treatment. When there is conflict between the needs of diabetes management and the adolescent's social development and peer activities, a stepwise approach with interim achievable goals can be used to bridge competing priorities Providing well-directed education to help understand the physiological changes of puberty, their effect on insulin dose, difficulties of weight control and dietary regulation.