bluuebunny/crossref_metadata_2025_split huggingface dataset:
792 Sleep and Daytime Function in Patients with Multiple Sclerosis
Authors: Aljundi Nawar , Arvai Kelsey , Mitchell Michael , Pandya Nishtha , Zeineddine Salam , Salloum Anan , Sankari Abdulghani , Martin Jennifer , Badr Safwan 
Published: May 2021

Abstract

Introduction
Fatigue is a core symptom of Multiple Sclerosis (MS) and impairs function and quality of life. Studies show that sleep-disordered breathing (SDB) is also common in persons with MS and may exacerbate fatigue. Within a larger study of patients with spinal cord injuries and disorders, we evaluated the relationships among sleep-disordered breathing severity, sleep quality, and functional outcomes in patients with MS. Our objective was to examine the impact of SDB severity and sleep quality on the severity of fatigue and functional impairment in this population.

Methods
Twenty-five subjects (average age=57(11), min=35, max=79; 80% male; average AHI=27(20) min=3, max=70; and 67% with AHI &gt; 15) 24 completed in-laboratory polysomnography (PSG) to measure apnea-hypopnea index (AHI) and sleep efficiency (SE) and questionnaires about sleep and function: Insomnia Severity Index (ISI), Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), PHQ-9 depression scale (excluding sleep item), Brief Pain Inventory (BPI) and World Health Organization Quality of Life (WHOQOL). Relationships between sleep measures (AHI and SE from PSG, ISI and PSQI) and daytime function (ESS, FFS, PHQ-9, BPI and WHOQOL) were assessed by bivariate correlation.

Results
At the baseline visit, we assessed participant’s daytime sleepiness, fatigue, sleep quality, and depression. The mean scores on questionnaires: ESS was 8.0(5.6), ISI was 11.5(6.7), PSQI was 9.3(4.4), FFS was 17.3(8.7), BPI severity was 3.4 (3.13), BPI interference was 3.5 (3.5), PHQ-9 was 7.3(5.8). There were significant relationships between ISI and FFS (r=0.78, p&lt;0.001), PSQI and FFS (r=0.68, p=0.001), ISI and WHOQOL Physical Domain (r=-0.64 p=0.001), as well as SE and FFS (r=-0.45, p=0.041). There was no significant correlation between AHI and FFS (p=0.395).

Conclusion
In veterans with MS, insomnia symptom severity was associated with daytime fatigue and decreased quality of life (QOL). Insomnia may represent a modifiable cause of daytime fatigue in patients with MS. Recognition and management of insomnia may improve outcomes in this population. Further research should evaluate whether insomnia interventions may benefit daytime fatigue and improve QOL.

Support (if any)
VA Rehabilitation Research and Development Service, (RX002116; PI Badr); VA HSR&D RCS20-191 and NIH/NHLBI K24 HL143055 (PI Martin).
794 Contribution of sleep disorders to dementia incidence following traumatic brain injury: A decade-long retrospective cohort study
Authors: Mollayeva Tatyana , Hurst Mackenzie , Escobar Michael , Colantonio Angela 
Published: May 2021

Abstract

Introduction
We aimed to examine the association between sleep disorders and dementia risk in a population-based cohort of adult male and female patients with traumatic brain injury (TBI).

Methods
We studied a province-wide retrospective cohort of all adult patients (≥ 18 years) free of dementia at the admission to the emergency department or acute care hospital with diagnoses of TBI between May 2003 and April 2013. All patients were followed through until May 2016. The primary exposure was a sleep disorder, and the primary outcome was dementia, both defined by the International Classification of Diseases, tenth revision diagnosis. Associations of sleep disorders with dementia were analyzed in multivariate Cox Proportional Hazard modeling.

Results
In total, 712,708 patients with TBI of all severities were included in this study. Their median age was 44 years, 59% were males. Over a median follow-up of 52 months (interquartile range, 19–86 months), 32,834 (4.6%) developed dementia. Controlling for age, sex, income level, injury severity, and known comorbidity risks, diagnosed sleep disorder was a significant predictor of incident dementia: hazard ratio (HR), 1.250 [95% CI, 1.146–1.363]. When results were stratified by sex, the association of sleep disorder with dementia remained significant in male: HR 1.255 [95% CI, 1.112–1.415] and in female patients: HR 1.234 [95% CI, 1.088–1.400]. Sensitivity analyses on Alzheimer’s disease case definition and using Fine and Gray competing risk models confirmed the association between sleep disorder and dementia in both sexes.

Conclusion
In both sexes, sleep disorders were independently associated with dementia onset (adjusted HRs&gt;1.2). Thus, screening for sleep disorders should be part of regular care for TBI patients, as with the steady increase of TBI survivorship and life expectancy, undiagnosed sleep disorders can initiate a new cascade of cognitive deficits independent from TBI.

Support (if any)
This work was supported by the postdoctoral research grant from the Alzheimer’s Association (AARF-16-442937) to T.Mollayeva. The authors were also supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R21HD089106 and the Canadian Institutes for Health Research Grant–Institute for Gender and Health (#CGW-126580).
799 Automated Detection of Slow Wave Coherence in Sleep EEG: A potential neurophysiological correlate of cognitive decline
Authors: Lim Miranda , Reynolds Christina , Jones Carolyn , Lambert Sophia , Balba Nadir , Elliott Jonathan , Ju Yo-El 
Published: May 2021

Abstract

Introduction
A bidirectional relationship exists between sleep disruption and neuropathology in Alzheimer’s disease (AD). The sleep electroencephalogram (EEG) is a highly stereotyped, direct neurophysiological window into brain function; prior studies have identified abnormalities in EEG slow waves in early AD. EEG coherence across channels during sleep, a normally highly coherent brain state, could be an indicator of network coordination across brain regions. Accordingly, altered slow wave coherence during sleep may be an early indicator of cognitive decline.

Methods
EEG was collected during an attended overnight polysomnogram (PSG) from a community-based cohort of older subjects (n=44, average age = 71), approximately 25% of whom met criteria for mild cognitive impairment or early AD. Files were exported to EDF and a slow wave peak detector was implemented in MATLAB to count the number of slow wave oscillations, with automated artifact rejection, across 6 EEG leads standard for PSG (C3, C4, F3, F4, O1, and O2). Slow wave coherence was inferred when slow waves occurred in temporal synchrony across channels within 100 ms.

Results
Subjects with cognitive impairment showed significantly reduced total sleep time and time spent in rapid eye movement (REM) sleep compared to age-matched controls. EEG slow wave coherence was reliably quantified during wake, non-REM stages N1, N2, N3, and REM vigilance states as well as during transition periods between sleep stages. Using this algorithm, specific signatures of slow wave propagation during sleep were identified, including increased variability in slow wave activity and coherence, that appeared more prominent in subjects with impaired cognition.

Conclusion
EEG slow wave coherence during sleep and wake states can be calculated by applying automated algorithms to PSG data, and may be associated with cognitive impairment.

Support (if any)
NIH R01 AG059507
808 Sleep and Fatigue Mitigation: Paving The Way For Training Health Care Trainees
Authors: Fatima Zara , Haider Sharez , Nelson Kaz , Irfan Muna 
Published: May 2021

Abstract

Introduction
The health care workforce is undoubtedly prone to fatigue and sleep deprivation due to extensive hours, shift work and intense demands of the training. The physical and behavioral effects of sleep deprivation can compromise well being and also negatively impact clinical performance. ACGME has been actively engaged in efforts to promote protection of health care trainees from the deleterious effects of sleep deprivation but the grass root level educational efforts towards teaching trainees to mitigate sleep deprivation are lacking.

Methods
We conducted a 60 minute long “Sleep and Fatigue Training Session” with the goals of increasing the understanding of effects of sleep deprivation and training in countermeasures. The session was conducted as a part of the annual GME orientation session for all the incoming learners. 274 trainees (residents & fellows) participating from all the departments were divided into 25 small groups of 7–12 members each. Clinical vignettes, brief presentation and moderator facilitated interactive discussion were utilized as teaching tools. Handouts with strategies and resources for the trainees were disseminated. Pre and post session surveys were designed to assess trainees baseline understanding of sleep impairment, impact on performance, recognition of impact, possible countermeasures and the impact of module on the aforementioned parameters after the intervention.

Results
Based on the cumulative trend of participant’s responses obtained on a Likert scale of 1 to 5, results showed improvement in all the parameters including access to training (3.67 to 4.44), awareness (4.31 to 4.46), recognition (4.04 to 4.36), strategies (3.6 to 4.36), and resource availability (3.24 to 4.33). Attendees reported a cumulative score of 4.23/5 in terms of beneficial impact of the module. The resource availability parameter demonstrated the highest average increase (33.6%) after the intervention. The lowest increase in the cumulative trend was displayed (3.5%) in the self-awareness parameter.

Conclusion
The feedback from learners demonstrated that the interactive model of sleep training session was very favorably received with improved scores in all the parameters assessed. Our model paves the way for other institutes to adopt similar training sessions for learners.
Support (if any):
811 Lessons from a Pandemic - Streamlining Sleep Apnea Care; is the future here?
Authors: Akinnusi Folu , Rifkin Daniel 
Published: May 2021

Abstract

Introduction
Ready access to optimal care for sleep-related breathing disorders (SRBD) remains a major barrier to the vast majority of an estimated 25 million Americans with undiagnosed obstructive sleep apnea. This barrier includes lack of readily available sleep medicine expert contact, health care insurance navigation challenges and difficulties with continuity of care. Chronic pervasive gaps in sleep medicine care were exacerbated by the COVID-19 pandemic in 2020. While numerous models were previously proposed to bridge SRBD care gaps, sustained and quantifiable success has been elusive.

Methods
Deploying interactive technology and artificial intelligence, we designed and implemented a novel, user-friendly integrated medium named Ognomy - the Sleep Apnea App, to mitigate widespread SRBD care access gaps. Multi-faceted but unified open access was made widely available, allowing bidirectional patient-provider interaction through a Web App. Individuals or surrogates who suspect that they or dependents suffer from SRBD are able to readily establish secure access to Ognomy. Patients can independently download and interact with the application on-demand and around the clock.

Results
From April 2020 to date, more than seven thousand (7,726) Ognomy App downloads have been documented. Over a thousand (1,169) patient registrations have occurred on Ognomy. Five hundred seventy-four (49.1%) of Ognomy App registrants have since been provided hitherto difficult, cumbersome access to full care, by a board-certified Sleep Medicine provider. Four hundred eighty-nine (85.2%) of the 574 patients managed via Ognomy’s care provision chain proceeded to complete sleep diagnostic testing and follow up.

Conclusion
Availability of a readily accessible and affordable multi-faceted platform for care of sleep-related breathing disorders will mitigate the burden of untreated SRBD in the United Sates and worldwide. Ognomy, a Sleep as a Software service, is a novel integrated tool, bridging chronic gaps in sleep apnea care. Measures that significantly alter the trajectory of Sleep Medicine care now and in the future, have the potential to systematically close existing SRBD care gaps worldwide. Innovative tools such as algorithmic scheduling, Blockchain utility for platform interoperability, facilitating insurance benefit verifications, deployed in tandem with delivery drone systems for home sleep testing, should enhance turnaround time and improve care currently available for SRBD.
Support (if any):
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

Abstract

Introduction
Rurality is a known contributor to health disparities, including Sleep medicine. Over 1 million (&gt;350,000 rural, &gt;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&lt;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&lt;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

Abstract
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

Abstract
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

Abstract
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.
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

Abstract
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.