bluuebunny/crossref_metadata_2025 huggingface dataset:
814 VHA’s TeleSleep Program improves rural Veteran access to sleep care through expansion of telehealth networks
Authors: Sarmiento Kathleen , Kuna Samuel , Boudreau Eilis , Atwood Charles , Pineda Lilibeth , Thompson William , Zeidler Michelle , Fields Barry , Uzzaman Afifa , Totten Annette , Smith Connor , Folmer Robert , Williams Katherine , Zhang Ning , Whooley Mary
Published: May 2021

Introduction

Rurality is a known contributor to health disparities, including Sleep medicine. Over 1 million (>350,000 rural, >650,000 non-rural) Veterans who received care from VHA in 2020 have obstructive sleep apnea (OSA). VHA’s Office of Rural Health (ORH) TeleSleep Program (FY17-20) aimed to increase access to sleep care for rural veterans by establishing telehealth services at 12 hubs and 63 spokes across the country. The TeleSleep program has three components: (1) Telemedicine; (2) Home Sleep Apnea Testing (HSAT); and (3) REVAMP (Remote Veterans Apnea Management Platform), a web-application for comprehensive sleep apnea care.

Methods

Each of the three TeleSleep components was evaluated independently using specific metrics. We report here on the impact of leveraging telemedicine to improve access to sleep care. Patient care encounters are defined by VA-specific stop codes and are thus identifiable as telehealth or in-person visits. Data used in the evaluation were obtained from the VA Corporate Data Warehouse.

Results

During FY20, 33,743 rural Veterans had 74,458 sleep encounters within the TeleSleep network. Visits included in-person care, virtual initial and follow up visits, electronic consultations, asynchronous telehealth (remote monitoring of PAP data and HSAT), remote PAP initiation by video or phone, and email exchanges between patients and providers. Between FY17-20, the number of rural Veterans seen for sleep-related disorders at TeleSleep sites tripled (from 10,702 to 33,743), and the number of encounters for sleep-related disorders more than doubled (from 32,894 to 74,458). In FY20, 72% (up from 53% in FY18) of rural Veterans at the TeleSleep hubs or spokes had at least one virtual sleep visit. This was significantly higher than non-TeleSleep VA sites where only 64% of rural Veterans had virtual visits (72% vs. 64%; p<0.001). In addition, the proportion of Veterans who had face-to-face only visits (28% at TeleSleep sites vs. 36% at non-TeleSleep sites; p<0.001) indicates that the TeleSleep program was highly successful in promoting virtual (instead of face-to-face) visits.

Conclusion

The ORH TeleSleep Program has improved access to comprehensive sleep care for rural Veterans by increasing the proportion and type of sleep visits conducted virtually vs. in person.

Support (if any)

Funding provided by VHA Office of Rural Health
Innovative Simulation Roadmap for Faculty to Prepare Advanced Practice Registered Nurses for Entry Into Practice
Authors: Busch Deborah W. , Flagg JoAnne Silbert , VanGraafeiland Brigit , Russell Nancy G. , Sloand Elizabeth , Mudd Shawna , Mclltrot Kimberly , D’Aoust Rita
Published: May 2021

Advanced practice registered nurse (APRN) programs are challenged to provide clinical learning experiences that prepare graduates with the full continuum of expected competencies. Preparing the APRN in academia, in terms of didactic and clinical application for novice entry, is often a vexing balance between board certification preparedness and the actualities of clinical practice. This article presents an innovative strategy to examine the perplexing reflective question often asked by educators: Does the current approach for simulation development prepare our APRN students sufficiently for entry into practice, and is it current to what is occurring in practice?
Lessons Learned From Pairing Education-Intensive and Research-Intensive Faculty to Increase Scholarship in Nursing
Authors: Clark Ricketta , Stanfill Ansley Grimes
Published: May 2021

Many nurse faculty find scholarship goals difficult to achieve while also maintaining education, practice, and service duties. This article describes a partnership between education-intensive and research-intensive faculty members that increased scholarly output. Challenges included conflicting schedules and responsibilities and an increasing desire to accomplish more than was possible in the allotted time. Differences in educational preparation and experiences were found to be a facilitator that enabled the team to be more productive. An equally felt commitment to the process and dedicated meetings also helped this team to be successful.
A Virtual Coaching Workshop for a Nurse-Led Community-Based Palliative Care Team in Liberia, West Africa, to Promote Staff Well-Being During COVID-19
Authors: Rosa William E. , Karanja Viola , Kpoeh Julius D. N. , McMahon Cory , Booth Janet
Published: May 2021

The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented system and clinician strain worldwide, disproportionately impacting resource poor settings. This project describes the use of a virtual nurse coaching session to improve the well-being of a nurse-led community-based palliative care team in Liberia, West Africa. Staff response was overwhelmingly positive. Discussion is underway to expand this educational coaching intervention to support additional teams confronting COVID-19 in both East and West Africa. Virtual nurse coaching is an innovative way to enhance staff well-being, improve global health partnerships and knowledge exchange, and foster communication across all levels of education and clinical practice.
Bunion Surgery: An Evolution
Authors: Coughlin Michael J. , Doty Jesse F.
Published: May 2021

While correction of hallux valgus deformities has been a subject of interest in the medical literature for over 2 centuries, the major contributions and published evidence has occurred over the last 75 years. Mc Bride, Keller, Mitchell, Mann, and Lapidus are names which reference techniques but they also present principles of treatment that establish the basis for current bunion surgery. Many components of these methods are used today and incorporated into modern bunion surgery.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Students’ and Qualified Radiographers’ Perspectives and Understanding on Occupational Dose Monitoring and Prevention Strategies
Authors: Makanjee Chandra R. , Lipscombe Erin , Haniz Adrianna Niza , Cho Yun Sook
Published: May 2021

Effective implementation and ongoing monitoring of occupational radiation safety and protection is key for radiographers as prolonged exposure to ionizing radiation can increase the risk of long-term ill health effects. It is important that radiographers are aware of what is required of them to remain within the permitted dose limit. Topics and training on dose monitoring and occupational practice safety and practice are embedded in both undergraduate and postgraduate courses and ongoing as part of continuous professional development. However, whether these are accurately, effectively implemented and adhered too in practice needs to be monitored. This study aimed to investigate students and radiographers’ awareness, observations, and understandings of their compliance to occupational radiation safety and protection and monitoring thereof in the clinical setting. A cross sectional survey design with a questionnaire consisting of closed and open-ended items were used. The data were analysed with the use of SPSS statistical software tool. The response rates for student radiographers were 62% and qualified radiographers 23.19%. Most participants indicated that they were knowledgeable on best practice methods regarding radiation protection and safety. However, regarding the importance of personal monitoring devices, the responses varied and there were some inconsistencies. The perspectives of participants on rotating through different imaging examination types revealed that of least importance was the occupational exposure. Students were focused as part of their training on acquiring the necessary skills to conduct imaging examinations. Qualified radiographers focused on upkeeping their skills when it came to their rotation between the general and specialized imaging examinations. To overcome some of these inconsistencies it is recommended that standardized practice guidelines be reviewed by both the academic institution and the clinical training sites enforcing the importance of dose monitoring and radiation safety and best practice principles.
Association of Preinjury Medical Diagnoses With Pediatric Persistent Postconcussion Symptoms in Electronic Health Records
Authors: Yengo-Kahn Aaron M. , Hibshman Natalie , Bonfield Christopher M. , Torstenson Eric S. , Gifford Katherine A. , Belikau Daniil , Davis Lea K. , Zuckerman Scott L. , Dennis Jessica K.
Published: May 2021

Objective:

To identify risk factors and generate hypotheses for pediatric persistent postconcussion symptoms (PPCS).

Setting:

A regional healthcare system in the Southeastern United States.

Participants:

An electronic health record–based algorithm was developed and validated to identify PPCS cases and controls from an institutional database of more than 2.8 million patients. PPCS cases (n = 274) were patients aged 5 to 18 years with PPCS-related diagnostic codes or with PPCS key words identified by natural language processing of clinical notes. Age, sex, and year of index event–matched controls (n = 1096) were patients with mild traumatic brain injury codes only. Patients with moderate or severe traumatic brain injury were excluded. All patients used our healthcare system at least 3 times 180 days before their injury.

Design:

Case-control study.

Main Measures:

The outcome was algorithmic classification of PPCS. Exposures were all preinjury medical diagnoses assigned at least 180 days before the injury.

Results:

Cases and controls both had a mean of more than 9 years of healthcare system use preinjury. Of 221 preinjury medical diagnoses, headache disorder was associated with PPCS after accounting for multiple testing (odds ratio [OR] = 2.9; 95% confidence interval [CI]: 1.6-5.0; P = 2.1e-4). Six diagnoses were associated with PPCS at a suggestive threshold for statistical significance (false discovery rate P < .10): gastritis/duodenitis (OR = 2.8; 95% CI: 1.6-5.1; P = 5.0e-4), sleep disorders (OR = 2.3; 95% CI: 1.4-3.7; P = 7.4e-4), abdominal pain (OR = 1.6; 95% CI: 1.2-2.2; P = 9.2e-4), chronic sinusitis (OR = 2.8; 95% CI: 1.5-5.2; P = 1.3e-3), congenital anomalies of the skin (OR = 2.9; 95% CI: 1.5-5.5; P = 1.9e-3), and chronic pharyngitis/nasopharyngitis (OR = 2.4; 95% CI: 1.4-4.3; P = 2.5e-3).

Conclusions:

These results support the strong association of preinjury headache disorders with PPCS. An association of PPCS with prior gastritis/duodenitis, sinusitis, and pharyngitis/nasopharyngitis suggests a role for chronic inflammation in PPCS pathophysiology and risk, although results could equally be attributable to a higher likelihood of somatization among PPCS cases. Identified risk factors should be investigated further and potentially considered during the management of pediatric mild traumatic brain injury cases.
Vocational Outcomes After Traumatic Brain Injury; Prevalence and Risk Factors After 1 Year in a Multivariable Model
Authors: Singh Rajiv , Dawson Jeremy , Basu Subhashis , Humphries Thomas J. , Mason Suzanne , Lecky Fiona
Published: May 2021

Objective:

To determine the prevalence of employment status (ES) or full-time study after traumatic brain injury (TBI) in a representative population and its predictive factors.

Design:

Prospective cohort study.

Setting:

Regional Major Trauma Centre. Participants: In total, 1734 consecutive individuals of working age, admitted with TBI to a Regional Trauma Centre, were recruited and followed up at 8 weeks and 1 year with face-to-face interview. Median age was 37.2 years (17.5-58.2); 51% had mild TBI, and 36.8% had a normal computed tomographic (CT) scan.

Main Outcome Measure:

Complete or partial/modified return to employment or study as an ordinal variable.

Results:

At 1 year, only 44.9% returned to full-time work/study status, 28.7% had a partial or modified return, and 26.4% had no return at all. In comparison with status at 6 weeks, 9.9% had lower or reduced work status. Lower ES was associated with greater injury severity, more CT scan abnormality, older age, mechanism of assault, and presence of depression, alcohol intoxication, or a psychiatric history. The multivariable model was highly significant (P < .001) and had a Nagelkerke R
2 of 0.353 (35.3%).

Conclusions:

Employment at 1 year is poor and changes in work status are frequent, occurring in both directions. While associations with certain features may allow targeting of vulnerable individuals in future, the majority of model variance remains unexplained and requires further investigation.
Path Analysis of the Mediating Roles of Personality, Distress, and Cognitive Flexibility in the Subjective Well-Being of Combat Veterans With Traumatic Brain Injury
Authors: Donnelly Kerry , Donnelly James P.
Published: May 2021

Objective:

To determine the interrelationships among traumatic brain injury (TBI), maladaptive personality traits (MPT), psychological distress, and cognitive flexibility in the prediction of subjective well-being of post-9/11 veterans concurrently and over time.

Setting:

Five Veterans Affairs (VA) medical centers and 1 VA outpatient clinic in urban, suburban, and rural areas.

Participants:

Five hundred Operation Enduring Freedom/Operation Iraqi Freedom veterans at baseline (219 with TBI), 292 at 18-month follow-up (108 with TBI), drawn from a regional registry and clinic referrals.

Design:

Path analysis of data from a prospective cohort study.

Main Measures:

Satisfaction with Life Scale, 36-ltem Short-Form Health Survey (SF-36) Health Scale, Personality Assessment Screener, Beck Depression Inventory-II, Beck Anxiety Inventory, Posttraumatic Stress Disorder Checklist-Military, Trail Making Test, Part B, Delis-Kaplan Executive Function System (D-KEFS) Category-Switching Verbal Fluency, and D-KEFS Color-Word Interference Test.

Results:

There was no direct effect of TBI on well-being at baseline or 18 months later. Psychological distress, MPT, and cognitive flexibility had significant direct effects on well-being at baseline and 18 months. Baseline model accounted for 66% of the variance in well-being; follow-up model accounted for 43% of well-being variance. Negative influence of distress significantly decreased from baseline to follow-up. Direct negative effect of MPT diminished slightly over 18 months; effect of cognitive flexibility increased. Significant relationships were estimated in prediction of distress by MPT, cognitive flexibility, and TBI. TBI predicted MPT. MPT, cognitive flexibility, and TBI had indirect effects on well-being. TBI had a positive indirect influence on distress. Total effects included 4 significant predictors of well-being at baseline and 18 months: distress, MPT, cognitive flexibility, and TBI.

Conclusion:

Experience of TBI alone did not predict subjective well-being at baseline or 18 months later. Psychological distress, MPT, and cognitive flexibility had direct effects on well-being at both time points. Interventions aimed at reducing distress and bolstering resilience and cognitive flexibility are recommended to increase subjective well-being in this population.
Performance Validity Testing in Patients Presenting to a Specialty Clinic With a Mild Traumatic Brain Injury
Authors: Sherry Natalie , Ernst Nathan , French Jonathan E. , Eagle Shawn , Collins Michael , Kontos Anthony
Published: May 2021

Objective:

To evaluate predictors of performance validity testing (PVT) and clinical outcome in patients presenting to a specialty clinic with a mild traumatic brain injury (mTBI).

Setting:

An outpatient mTBI specialty clinic.

Participants:

Seventy-six (47% female) patients aged 16 to 66 (mean = 40.58, SD = 14.18) years within 3 to 433 days (mean = 30.63, SD = 54.88, median = 17.00) of a suspected mTBI between 2018 and 2019.

Design:

A cross-sectional, observational study comparing patients who passed PVT (n = 43) with those who failed (n = 33). A logistic regression (LR) was conducted to evaluate factors that predicted failed PVT. Independent-samples t tests and general linear model were used to evaluate PVT groups on clinical outcomes. The LR with a receiver operating characteristic (ROC) curve was conducted to evaluate embedded validity indicators.

Main Measures:

Performance validity testing, computerized neurocognitive testing, vestibular/oculomotor screening, symptom reports.

Results:

At their initial clinic visit 43% of patients failed PVT. PVT failure was predicted by presence of secondary gain (odds ratio [OR] = 8.11, P = .02), while a history of mental health predicted passing of PVT (OR = 0.29, P = .08). Those who failed PVT performed significantly worse on computerized neurocognitive testing (P < .05) and took an average of 33 days longer to return to work (P = .02). There was no significant difference (P = .20) in recovery time between failed/passed PVT groups when covarying for those who sustained a work injury. Word memory learning percentage less than 69% and design memory learning percentage less than 50% accurately classified patients who failed PVT (area under the ROC curve = 0.74; P < .001).

Conclusion:

Secondary gain was the best predictor of failed PVT. Patients presenting for mTBI evaluation and rehabilitation who fail PVT demonstrate worse performance on cognitive testing and take longer to return to work post-injury, but recover in a similar time frame compared with those who pass PVT. Clinicians should be cautious in discounting patients who yield invalid test results, as these patients appear to be able to achieve recovery in a treatment setting.
Next-Generation Sequencing Quickly Identifies Mycobacterium smegmatis in Spine Implant Infection
Authors: Clarkson Samuel J. , Goswami Karan , Paziuk Taylor , Belden Katherine A. , Hilibrand Alan S. , Parvizi Javad
Published: May 2021

We present the case of a 62-year-old woman who underwent revision surgery because of screw displacement after C1 to C3 laminectomy and occiput to C5 posterior fusion. Culture of tissue obtained intraoperatively grew nontuberculous mycobacteria (NTM) in 5 days; however, a specific species was not identified using culture until 5 weeks after sample collection. In contrast, next-generation sequencing analysis performed on samples obtained during a subsequent irrigation and debridement confirmed the presence of Mycobacterium smegmatis within 1 week. Although traditional culture identified a rapidly growing NTM in this case of spine implant infection, the species was not identified in a timely manner. Accurate and rapid species-level pathogen identification is imperative in the targeted treatment of NTM infections including spine implant infection. The use of molecular testing, such as next-generation sequencing, is helpful in identifying infecting organisms and guiding antimicrobial treatment.
Delayed Onset of COVID-19 in an Immunosuppressed Patient
Authors: Liroff Kaitlin , Fleury Christine , Dumitrescu Cristian , Kassaye Seble
Published: May 2021

We report on a case of delayed presentation of COVID-19 in a postpartum immunosuppressed patient with the confounding variable of cytomegalovirus viremia. This case highlights the importance of maintaining high suspicion for COVID-19 disease even with delayed onset of symptoms, as this diagnosis as important treatment and public health implications.
Multisystem Inflammatory Syndrome in an Adult With COVID-19—A Trial of Anakinra
Authors: Aggarwal Abhimanyu , Cohen Ezra , Figueira Marisol , Sabharwal Vishakha , Herlihy Julie M. , Bronwen Carroll , Barnett Elizabeth D. , Pelton Stephen I. , Camelo Ingrid Y.
Published: May 2021

COVID-19 disease has been a pandemic caused by a β-coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A life-threatening multisystem inflammatory syndrome (MIS), secondary to SARS-CoV-2 virus infection, sharing common features with Kawasaki disease shock syndrome, staphylococcal/streptococcal shock syndrome, and macrophage activation syndrome in pediatric patients has been described. A total of 27 cases in adults (MIS-A) with a similar presentation have been reported so far. Here we describe the case of a 21-year-old man admitted with abdominal pain, diarrhea, tachycardia, and low blood pressure. He had elevated troponin, ferritin, and interleukin-2 receptor levels and had evidence of myocarditis. He tested positive for SARS-CoV-2 IgG antibody, and a diagnosis of MIS-A was made. Our case adds to the scant literature on this topic, and to our knowledge, it is the first case where anakinra was administered. He recovered well. MIS-A should be considered when young adults present with multiorgan dysfunction.
Preprocedural Anxiety in the Transradial Cardiac Catheterization Era
Authors: Fernandez Ritin , Ellwood Laura , Lord Heidi , Curtis Elizabeth , Khoo John , Lee Astin , Weaver James
Published: May 2021

Background

Transradial cardiac catheterization is increasingly being used for the management of coronary artery disease given the low risk of procedural discomfort and complications with this approach. However, the evidence relating to preprocedural anxiety levels in these patients is scarce.

Objective

The aim of this study was to evaluate the anxiety levels and the predictors of anxiety in patients undergoing transradial cardiac catheterization procedures.

Methods

Data were collected using a self-administered survey. Anxiety was measured using the Spielberg's State-Trait Anxiety Inventory questionnaire. Multiple regression analysis was used to identify whether gender, age, family history of heart disease, smoking status, history of depression, and trait anxiety scores were predictors of preprocedural anxiety.

Results

A total of 198 patients participated in this study. More than half of the patients (53.5%) were classified as having a high state anxiety level. The mean (SD) preprocedural trait and state anxiety scores were 35.34 (9.8) and 36.43 (11.4), respectively. Female patients, those younger than 65 years, current smokers, and those with a family history of heart disease, a history of depression, and a history of anxiety had significantly higher anxiety scores. Having high trait anxiety scores was the only predictor of preprocedural anxiety.

Conclusion

Although the transradial approach has a low procedural risk and causes less discomfort to the patient, anxiety persists in more than 50% of patients, with trait anxiety being the best predictor. Nurses should therefore try to decrease anxiety levels in the preprocedural phase to minimize postprocedural adverse outcomes in this group of patients.
Evaluation of the Reliability of Medicare Spending Per Beneficiary for Post-Acute Care
Authors: Garrett Bowen , Carter Carol , Wissoker Doug
Published: May 2021

Background:

A measure of episode spending, such as Medicare Spending Per Beneficiary (MSPB) is increasingly used to evaluate provider performance. Yet if the measure is unreliable, as is often true for low-volume providers, it cannot distinguish “good” from “poor” performance.

Objective:

The objective of this study was to evaluate the reliability of a uniformly calculated MSPB measure for post-acute care (PAC) and the tradeoffs involved in setting a minimum case count threshold.

Data:

Medicare claims for 15 million PAC episodes from April 2013 to March 2015.

Research Design:

Given the overlap in patients treated in PAC settings, we developed a uniformly calculated MSPB measure for PAC providers that measures spending during the PAC stay and the following 30 days. We examine variation in the MSPB-PAC measure and characterize the measure’s reliability and its relationship to provider case counts.

Results:

Applied to our MSPB-PAC measure, a minimum threshold of 20 Medicare episodes as currently used by the Centers for Medicare & Medicaid Services (CMS) would not establish reasonably reliable measures and could result in drawing unduly erroneous conclusions about provider performance. The measures for home health agencies were considerably less stable and reliable than for institutional PAC providers.

Conclusions:

CMS should consider adopting a more stringent reliability standard for setting minimum case counts for MSPB-PAC and other measures. Its current threshold (R-statistic=0.4) reflects more random variation than differences in actual provider performance. To include as many providers as possible, CMS should consider pooling data over multiple years to avoid drawing incorrect conclusions about low-volume providers.
The Effects of Patient Demographics on Outpatient Endoscopy Utilization in Children With Eosinophilic Esophagitis
Authors: Bose Paroma , Hon Emily C. , Vitalpur Girish V. , Bennett William E.
Published: May 2021

Objectives:

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus that requires esophagogastroduodenoscopy (EGD) for diagnosis and treatment monitoring. We aimed to identify the frequency of endoscopic monitoring in children with EoE and observe the effect of age, race, socioeconomic factors, and atopy on the rate of endoscopy.

Methods:

We queried the Pediatric Health Information System over a 15-year period for ambulatory EGDs in children with EoE. Subjects with at least 1 year of data were included. Age, sex, ethnicity, race, insurance type, median household income, and atopy were collected for each subject.

Results:

16,517 subjects were included (mean age 8.5 years). 3211 (19%) of subjects had ≥1 EGD per subject year (EGD/SY). Subjects >13 years old were more likely to have ≥1 EGD/SY compared to children 6–12 years (odds ratio [OR] 2.29, P < 0.001, 95% confidence interval [CI] = 2.06–2.54). Males were more likely to have ≥1 EGD/SY compared to females (OR 1.19, P < 0.001, 95% CI = 1.08–1.31). African-American subjects were 16% less likely than Caucasian subjects to have ≥1 EGD/SY (OR 0.84, P = 0.05, 95% CI = 0.71–1.00). Subjects with allergic rhinitis or anaphylaxis, food allergy, and/or oral allergy syndrome were more likely to have ≥1 EGD/SY (OR 1.67, P < 0.001, 95% CI = 1.47–1.90 and OR 3.65, P < 0.001, 95% CI = 3.25–4.11, respectively).

Conclusions:

Nineteen percent of subjects had ≥1 EGD/SY. Older age, male sex, allergic rhinitis, and food allergies were associated with more frequent endoscopic monitoring in children with EoE. Caucasian subjects had more frequent endoscopy than African-American subjects. This study raises awareness about underrecognized variation in the care of children with EoE.
Nurses on Boards
Authors: Sanford Kathleen D.
Published: May 2021

Multiple articles have explained the benefits of nurses as hospital board members. The Nurses on Boards Coalition has been working for several years to increase the number of nurse board members. Yet, the percentage of hospital and health care board positions filled by nurses has been decreasing. This article shares what all nurse leaders can do to increase the visibility of nurses as competent, valuable voices at the board table.
The Dual Epidemics of 2020
Authors: Hayes Carolyn , Wood Laura J. , Gaden Nancy W. , Gennaro Susan , Gross Anne H. , Hudson-Jinks Therese M. , Loescher Cori W. , Maurer Marsha L. , Mittelman Michele , Pearson Madelyn M. , Sharp-McHenry Lepaine , Thompson Linda S. , Van Pelt Maria
Published: May 2021

The Greater Boston Nursing Collective, a consortium composed of university nursing deans and chief nursing officers within academic medical centers and specialty hospitals in Boston, Massachusetts, was formed in 2014. Since the group's inception, our mission has been to create and reinforce whole-person/whole-system healing environments to improve the health of all communities. Through our collaboration in navigating the dual epidemics of COVID-19 and structural racism within our respective organizations, and across the United States and the world, we share experiences and lessons learned. Our common mission is clearer than ever: to create safe and joyful work environments, to protect the dignity of those we are privileged to serve, and to generate policies to advance health equity to rectify societal forces that have shaped this dual epidemic. We are humbled by the many who persist despite limited rest and respite, and whose stories, innovations, and leadership we are honored to witness and share. They have defined our generation, just as nurses in earlier crises have done: leading through service to others as our purpose and privilege.
COVID-19
Authors: Saputo Mary , Maloney Mary , Ohler Linda
Published: May 2021

New York City quickly became the epicenter of coronavirus disease-2019 (COVID-19) in early March of 2020. While hospitals were aware of the potential of COVID-19, the volume of critically ill patients that flooded the hospitals in the New York City area was clearly not anticipated. Hospital staff worked quickly to create COVID-19-free areas, but were overcome with the volume of COVID-positive critically ill patients. Many newly admitted patients required respiratory support with mechanical ventilation. As Governor Cuomo issued executive orders to stay at home in mid-March, some patients were afraid to go into hospitals despite symptoms of respiratory distress. Once these patients came to the hospital, they were often critically ill. Emergency departments and intensive care units filled rapidly, overwhelming staff and equipment needs with such things as pumps, dialysis machines, medications, and personal protective equipment. Plans for the day were disrupted with frequent rapid response calls and the need for additional beds. Key issues that confronted the COVID-19 response in critical care units at NYU Langone Health included communication, patient and staff safety.
Influencing Factors of Inflammatory Bowel Disease–Fatigue
Authors: Davis Suja P. , Chen Ding-Geng , Crane Patricia B. , Bolin Linda P. , Johnson Lee Ann , Long Millie D.
Published: May 2021

Background

Fatigue is a common symptom in adults with inflammatory bowel disease (IBD) and is influenced by many physiological, psychological, and situational factors. However, the influencing factors of fatigue associated with IBD have not been evaluated.

Objective

This study aims to examine factors associated with fatigue during IBD and develop a parsimonious model that describes the influencing factors of fatigue.

Methods

The study was a secondary analysis of cross-sectional data obtained from IBD Partners, an online cohort of adults with the disease, including 12,053 eligible participants. Data were collected using the Patient-Reported Outcomes Measurement Information System short-form scales measuring fatigue, sleep disturbances, pain interference, anxiety, depression, and satisfaction with social roles. Physical activity was measured using a single question. Demographic and clinical variables were collected. Path analysis was computed to identify the direct and indirect effects of situational, physiological, and psychological factors on IBD–fatigue based on the middle range theory of unpleasant symptoms’ conceptual framework.

Results

Most of the participants were White females. The data best fit a model with situational factors (physical activity and satisfaction with social roles as the mediators). The direct effect of IBD activity, age, sleep disturbances, pain interference, anxiety, and depression on IBD–fatigue was significant. Significant indirect effects were noted on IBD–fatigue from sleep disturbances, pain interference, and depression via physical activity and satisfaction with social roles.

Discussion

The study identified two important intervening variables from the tested model. In addition, other symptoms such as sleep, pain, anxiety, and depression are essential and also influence IBD–fatigue.
eSIMPLER: A Dynamic, Electronic Health Record–Integrated Checklist for Clinical Decision Support During PICU Daily Rounds
Authors: Geva Alon , Albert Ben D. , Hamilton Susan , Manning Mary-Jeanne , Barrett Megan K. , Mirchandani Dimple , Harty Matthew , Morgan Erin C. , Kleinman Monica E. , Mehta Nilesh M.
Published: May 2021

OBJECTIVES:

Design, implement, and evaluate a rounding checklist with deeply embedded, dynamic electronic health record integration.

DESIGN:

Before-after quality-improvement study.

SETTING:

Quaternary PICU in an academic, free-standing children’s hospital.

PATIENTS:

All patients in the PICU during daily morning rounds.

INTERVENTIONS:

Implementation of an updated dynamic checklist (eSIMPLER) providing clinical decision support prompts with display of relevant data automatically pulled from the electronic health record.

MEASUREMENTS AND MAIN RESULTS:

The prior daily rounding checklist, eSIMPLE, was implemented for 49,709 patient-days (7,779 patients) between October 30, 2011, and October 7, 2018. eSIMPLER was implemented for 5,306 patient-days (971 patients) over 6 months. Checklist completion rates were similar (eSIMPLE: 95% [95% CI, 88–98%] vs eSIMPLER: 98% [95% CI, 92–100%] of patient-days; p = 0.40). eSIMPLER required less time per patient (28 ± 1 vs 47 ± 24 s; p < 0.001). Users reported improved satisfaction with eSIMPLER (p = 0.009). Several checklist-driven process measures—discordance between electronic health record orders for stress ulcer prophylaxis and user-recorded indication for stress ulcer prophylaxis, rate of venous thromboembolism prophylaxis prescribing, and recognition of reduced renal function—improved during the eSIMPLER phase.

CONCLUSIONS:

eSIMPLER, a dynamic, electronic health record–informed checklist, required less time to complete and improved certain care processes compared with a prior, static checklist with limited electronic health record data. By focusing on the “Five Rights” of clinical decision support, we created a well-accepted clinical decision support tool that was integrated efficiently into daily rounds. Generalizability of eSIMPLER’s effectiveness and its impact on patient outcomes need to be examined.
Survey on Reporting of Endometrial Biopsies From Women on Progestogen Therapy for Endometrial Atypical Hyperplasia/Endometrioid Carcinoma
Authors: Ganesan Raji , Gilks C. Blake , Soslow Robert A. , McCluggage W. Glenn
Published: May 2021

Histologic assessment of response to progestogen therapy is a cornerstone of nonsurgical management of atypical hyperplasia/low-grade endometrioid carcinoma. Pathologists are required to assess whether there is ongoing preneoplastic or neoplastic change in the biopsies (often multiple) taken during therapy. There have been few studies documenting the specific histologic changes induced by therapeutic progestogens and currently there are no guidelines on terminology used in this scenario. Given the need for uniformity in reporting and the lack of guidance in the current literature, we initiated an online survey (including questions, categories of reporting, and scanned slides for assessment) which was sent to all members of British Association of Gynaecological Pathologists (BAGP) and the International Society of Gynecological Pathologists (ISGyP) with the aim to assess the variability among pathologists in reporting these specimens and to come up with a consensus-based terminology for reporting of endometrial biopsies from women on progestogen therapy for endometrial atypical hyperplasia/endometrioid carcinoma. In total, 95 pathologists participated in this survey. This manuscript elaborates on the results of the survey with recommendations aimed at promoting uniform terminology in reporting these biopsies.
Virtual Reality Augments Movement During Physical Therapy
Authors: Hemphill Sydney , Rodriguez Samuel , Wang Ellen , Koeppen Kurt , Aitken-Young Bryn , Jackson Christian , Simons Laura , Caruso Thomas J.
Published: May 2021

Objective

Virtual reality facilitates physical therapy via improved engagement. Although shown to benefit specific patient populations, such as stroke patients, it is less established in otherwise healthy adults and children receiving outpatient physical therapy. The primary objective was to compare total physical therapy–guided movement supplemented with virtual reality with physical therapy–guided movement alone without virtual reality.

Design

This pragmatic, randomized, crossover study compared physical therapy–guided movement supplemented with virtual reality with physical therapy–guided movement alone without virtual reality in outpatients (ages 6–80 yrs). This community sample had variable physical therapy indications (injury, postoperative, chronic pain), and in pre-existing conditions, therefore, participants served as their own controls. Participants received 10 mins of both physical therapy–guided movement supplemented with virtual reality and physical therapy–guided movement alone without virtual reality separated by 5 mins. The primary outcome was differences in aggregate movement of physical therapy–guided exercises. Secondary outcomes explored OMNI rating of perceived exertion and participant and physical therapist satisfaction. Paired t tests, χ2 tests, and regression models were used to analyze differences.

Results

The 41 participants (17 pediatric and 24 adult) moved significantly more during physical therapy–guided movement supplemented with virtual reality compared with physical therapy–guided movement alone without virtual reality (1120.88 vs. 672.65 m, P < 0.001), regardless of which intervention was completed first. Physical therapy–guided movement supplemented with virtual reality treatment was associated with more movement of the target limbs, lower body (P < 0.001), and upper body (P < 0.05). The OMNI rating of perceived exertion scores did not differ between those who started with physical therapy–guided movement supplemented with virtual reality or physical therapy–guided movement alone without virtual reality, and physical therapist and patient surveys endorsed physical therapy–guided movement supplemented with virtual reality.

Conclusions

Patients completed more physical therapy–guided movement during physical therapy–guided movement supplemented with virtual reality than physical therapy–guided movement alone without virtual reality, and therapists and patients supported its use. Future studies will examine finer tracking of movements.
Alterations in Brain Network Organization in Adults With Obesity as Compared With Healthy-Weight Individuals and Seniors
Authors: Ottino-González Jonatan , Baggio Hugo César , Jurado María Ángeles , Segura Bàrbara , Caldú Xavier , Prats-Soteras Xavier , Tor Encarnació , Sender-Palacios María José , Miró Nuria , Sánchez-Garre Consol , Dadar Mahsa , Dagher Alain , García-García Isabel , Garolera Maite
Published: May 2021

Objective

Life expectancy and obesity rates have drastically increased in recent years. An unhealthy weight is related to long-lasting medical disorders that might compromise the normal course of aging. The aim of the current study of brain connectivity patterns was to examine whether adults with obesity would show signs of premature aging, such as lower segregation, in large-scale networks.

Methods

Participants with obesity (n = 30, mean age = 32.8 ± 5.68 years) were compared with healthy-weight controls (n = 33, mean age = 30.9 ± 6.24 years) and senior participants who were stroke-free and without dementia (n = 30, mean age = 67.1 ± 6.65 years) using resting-state magnetic resonance imaging and graph theory metrics (i.e., small-world index, clustering coefficient, characteristic path length, and degree).

Results

Contrary to our hypothesis, participants with obesity exhibited a higher clustering coefficient compared with senior participants (t = 5.06, p < .001, d = 1.23, 95% CIbca = 0.64 to 1.88). Participants with obesity also showed lower global degree relative to seniors (t = −2.98, p = .014, d = −0.77, 95% CIbca = −1.26 to −0.26) and healthy-weight controls (t = −2.92, p = .019, d = −0.72, 95% CIbca = −1.19 to −0.25). Regional degree alterations in this group were present in several functional networks.

Conclusions

Participants with obesity displayed greater network clustering than did seniors and also had lower degree compared with seniors and individuals with normal weight, which is not consistent with the notion that obesity is associated with premature aging of the brain. Although the cross-sectional nature of the study precludes causal inference, the overly clustered network patterns in obese participants could be relevant to age-related changes in brain function because regular networks might be less resilient and metabolically inefficient.
Introduction of an Ambulatory Care Medication Reconciliation Service in Dialysis Patients: Positive Impact on Medication Prescribing and Economic Benefit
Authors: Alghanem Sarah S. , Bayoud Tania , Taher Sameer , Al-Hazami Mai , Al-Kandari Nasser , Al-Sharekh Monther
Published: May 2021

Objective

The aim of the study was to assess the implementation of medication reconciliation (MedRec) and medication-related costs in dialysis-dependent patients.

Methods

Completed best possible medication history and reconciliation forms were collected within 6 months from 77 patients’ file at the dialysis center. Outcome measures were number and types of medication discrepancies, medication-related problems (MRPs), and their potential to cause harm, in addition to the type and number of interventions conducted during MedRec and the resulted medication costs reduction.

Results

The mean number of medications was 11 ± 4, which was reduced to 8 ± 3 (P < 0.0001) after MedRec. Medication discrepancies accounted for 55, and MRPs were raised by pharmacists 216 times, and 55% had the potential to cause moderate patient discomfort. Mediations were held in 1.2%, discontinued in 21.2%, and changed in 5.4%, which led to €75.665 (U.S. $85.33) and €459.93 (U.S. $511.979) reduction in medication costs per patient for 1 and 6 months, respectively.

Conclusions

Several discrepancies and MRPs were identified in the present study that put patients undergoing dialysis at risk for potential harm and adverse drug events. Regularly performing ambulatory MedRec and involving pharmacists in the model of care can improve the quality of healthcare delivered to dialysis-dependent patients and reduce cost.
Anti–Polymyositis/Scl Antibodies in Systemic Sclerosis
Authors: Iniesta Arandia Nerea , Espinosa Gerard , Guillén del Castillo Alfredo , Tolosa-Vilella Carles , Colunga-Argüelles Dolores , González de Echávarri Pérez de Heredia Cristina , Lledó Gema M. , Comet Luis Sáez , Ortego-Centeno Norberto , Vargas Hito José Antonio , Rubio-Rivas Manuel , Freire Mayka , Ríos-Blanco Juan José , Rodríguez-Carballeira Mónica , Trapiella-Martínez Luis , Fonollosa-Pla Vicent , Simeón-Aznar Carmen Pilar
Published: May 2021

Objectives

To assess the clinical profile of patients with anti–polymyositis/Scl (PM/Scl) antibodies in a cohort of Spanish patients with systemic sclerosis.

Methods

From the Spanish Scleroderma Study Group database, we selected patients in whom PM/Scl antibodies had been tested. We compared demographic, clinical, laboratory, and survival data between patients with and without PM/Scl antibodies.

Results

Seventy-two of 947 patients (7.6%) tested positive for PM/Scl antibodies. Patients with PM/Scl antibodies presented initially with more puffy fingers and arthralgias but less Raynaud phenomenon. Regarding cumulative manifestations, myositis and arthritis were more prevalent in patients with PM/Scl antibodies, as well as pulmonary fibrosis. On the contrary, patients with PM/Scl antibodies had less pulmonary hypertension. No difference in terms of survival at 5 and 10 years was noticed between the 2 groups.

Conclusions

In systemic sclerosis patients from Spain, PM/Scl antibodies are associated with a distinct clinical profile. However, PM/Scl antibodies did not influence survival.
18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT Findings of Abdominal Leiomyosarcoma
Authors: Güzel Yunus , Can Canan , Söğütçü Nilgün , Gündeş Ebubekir , Gündoğan Cihan
Published: May 2021

A 56-year-old woman presented with abdominal pain and vomiting. Her abdominal CT revealed an retroperitoneal mass in the left upper quadrant of the abdomen. 18F-FDG PET/CT performed for metabolic characterization showed low to moderate heterogenous FDG uptake. 68Ga–fibroblast activation protein-specific inhibitor (FAPI)–04 PET/CT performed according to a research carried out in our department showed high heterogenous radiopharmaceutical uptake. The patient was diagnosed with leiomyosarcoma after R0 tumor resection. This case showed that 68Ga-FAPI-04 PET/CT could be a promising radiopharmaceutical in the evaluation of leiomyosarcomas.
Serial 18F-FP-CIT and FDG PET in Fulminant Corticobasal Syndrome
Authors: Park Don Gueu , An Young Sil , Yoon Jung Han
Published: May 2021

Corticobasal syndrome (CBS) is characterized by a slow progressive cognitive decline, apraxia, myoclonus, dystonia, and parkinsonism. We experienced a rapidly progressing CBS patient (onset to bed-ridden within 2 years) presenting only with resting tremor but showing complete unilateral loss of dopamine transporter binding. This case exhibited distinct FDG PET findings involving the unilateral severe anterior frontal cortex, caudate nucleus, and contralateral cerebellum, which is different from classical CBS. However, to date, no detailed serial functional imaging study has been performed in rapidly progressing CBS, so these FDG PET and CIT PET findings may help clinicians to recognize this fulminant type of corticobasal degeneration.
Early and Sustained Elevation in Serum Pancreatic Amylase Activity
Authors: Bannone Elisa , Marchegiani Giovanni , Balduzzi Alberto , Procida Giuseppa , Vacca Pier Giuseppe , Salvia Roberto , Bassi Claudio
Published: May 2021

Objective:

To characterize early postoperative serum pancreatic amylase (spAMY) trends after pancreatic resections.

Summary Background Data:

A postoperative spAMY elevation is a common finding but uncertainties remain about its meaning and prognostic implications.

Methods:

Analysis of patients who consecutively underwent pancreatectomy from 2016 to 2019. spAMY activity was assessed from postoperative day (POD) 0 to 3. Different patterns of spAMY have been identified based on the spAMY standard range (10–52 U/l).

Results:

Three patterns were identified: (#1) spAMY values always < the lower limit of normal/within the reference range /a single increase in spAMY > upper limit of normal at any POD; (#2) Sustained increase in spAMY activity on POD 0 + 1; (#3) Sustained increase in spAMY activity including POD 1 + 2. Shifting through spAMY patterns was associated with increase morbidity (21% in #1 to 68% in #3 at POD 7; log rank < 0.001). Almost all severe complications (at least Clavien-Dindo ≥3) occurred in patients with pattern #3 (15% vs 3% vs 5% in #1 and #2 at POD 7, P = 0.006), without difference considering >3-times or >the spAMY normal limit (P = 0.85). POPF (9% in #1 vs 48% in #3, P < 0.001) progressively increased across patterns. Pre-operative diabetes (OR 0.19), neoadjuvant therapy (OR 0.22), pancreatic texture (OR 8.8), duct size (OR 0.78), and final histology (OR 2.2) were independent predictors of pattern #3.

Conclusions:

A sustained increase in spAMY activity including POD 1 + 2 (#3) represents an early postoperative predictor of overall and severe early morbidity. An early and dynamic evaluation of spAMY could crucially impact the subsequent clinical course with relevant prognostic implications.