Search

Purpose: There are an increasing number of techniques and tools to improve the capacity for children to relay their perceptions of their symptom experience while undergoing blood and marrow transplant (BMT). Network analysis (NA) is a tool that can illustrate associations between symptoms and the distress they cause. We aimed to develop a biopsychosocial assessment clinical analytic tool to examine symptom relationships for children undergoing BMT to find actionable relationships for intervention to improve clinical outcomes including mood., Design and Methods: This pilot study used an analytical mobile application tool to support a wide scope of 15 biopsychosocial symptom distress levels and five mood assessments. Children recorded their symptom distress and mood using the app. NA was used to explore relationships between symptom distress and mood., Results: Four children, 11-14 years old, undergoing BMT used the app daily during hospitalization. We found a strong presence of emotional distress and its associations symptom distress and mood. Multiple symptom associations were identified including associations between the set of symptoms difficulty breathing and fever (0.557), sad and worried (0.429). Of note, pain distress had a strong capacity to bridge other symptoms and was connected directly to many symptoms., Practice Implications: We found the significance of patient struggles with emotional and symptom distress and the importance of this relationship to other clinical outcomes. This provides valuable insights and an improved understanding of the child's symptoms. Our findings support early assessment, intervention, and improved symptom communication to enhance sense of well-being and the child's care experience., (© 2024 The Authors. Journal for Specialists in Pediatric Nursing published by Wiley Periodicals LLC.)

Abstract: Opioid overdose deaths remain a major public health concern in the United States and led to the recent changes in regulations that allow nurse practitioners (NPs) to prescribe buprenorphine without the previously required Drug Addiction Treatment Act waiver. Previously, waiver requirements included 24 hours of opioid use disorder (OUD) and medications for OUD (MOUD) training. Although this training is no longer required, NPs need education related to providing nonstigmatizing care to individuals with OUD and safe MOUD prescribing practices. A combination of online didactic modules, in-person simulation activities, and experiential learning was provided to psychiatric mental health NP (PMHNP) and family NP (FNP) students enrolled in a Doctor of Nursing Practice (DNP) program. OUD was presented through a chronic care lens to normalize treatment and decrease stigma, and harm reduction principles were included to increase safe prescribing of MOUD. Fifty-six students completed the didactic training, 51 students participated in the simulation, and 11 students completed shadowing experiences with an experienced MOUD provider. Psychiatric mental health NP and FNP graduates of this DNP program have the knowledge and skills to provide MOUD to individuals struggling with OUD, thus potentially increasing access to care and decreasing overdose deaths., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2023 American Association of Nurse Practitioners.)

Introduction: Given the increased prevalence of obesity and the existence of negative attitudes among health care providers toward patients with obesity (PWO), strategies are needed to assist nursing students in identifying and examining attitudes and beliefs related to the provision of care for individuals with obesity. Nursing school curricula should incorporate effective interventions for students in order to reduce stigmas and to modify negative attitudes and behaviors that interfere with quality nursing care for PWO. This article describes the process of developing and implementing an innovative bariatric sensitivity intervention (BSI) for prelicensure nursing students., Methods: The BSI includes six trigger films that address the multi-faceted aspects of caring for PWO and provoke reflection on obesity-related attitudes and beliefs, as well as a facilitated debrief., Conclusion: We discuss the practical aspects of video production and the successful use of multimedia instruction to affect prelicensure nursing students' behaviors., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: The purpose of this article is to describe the development, implementation, and evaluation of a Simulation Interprofessional Education (Sim-IPE) activity for healthcare students from different disciplines (athletic training [AT] and nursing). The objective for the Sim-IPE activity was to engage AT and prelicensure nursing students in a realistic healthcare scenario to enhance knowledge about one another's profession, develop interprofessional skills, collaborate with one another, and communicate effectively as a team as they performed care., Methods: This mixed methods study employed a one-time posttest design for a convenience sample of AT and prelicensure nursing students following a simulation intervention. Students completed the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) survey and answered open-ended response questions., Results: Thirteen students (N = 13) from Cohort 1 and 12 students (N = 12) from Cohort 2 completed the SPICE-R survey. Most students strongly agreed/agreed for each of the SPICE-R survey questions. Qualitative findings indicated the students positively perceived the Sim-IPE activity as it helped them discover the value of interprofessional patient care., Discussion: The quantitative findings indicated that the students found the Sim-IPE an effective learning methodology to achieve the objectives while the qualitative findings gave further insight into the students' perceptions of interprofessional teamwork and the value of the prebrief session conducted before the simulation. The findings will inform future Sim-IPE activities involving additional groups of healthcare students., (© 2022 The Authors. Nursing Forum published by Wiley Periodicals LLC.)

During the COVID-19 pandemic, students from two schools of nursing, in China and the United States respectively, engaged in a transcultural simulation activity to explore how a global healthcare crisis has been managed within their different cultures. This article describes the development and implementation of the project and evaluates student perspectives on the simulation...s influence on increasing awareness of diversity, equity, and inclusion. Data for this project were collected through student verbal and written reflections and faculty comments., Results: Students reported the virtual simulation positively impacted their learning and enjoyed the opportunity to navigate through a virtual scenario collaboratively while discussing cultural similarities and differences. Faculty noted the simulation was valuable and described challenges faced during the development., Conclusions: Students and faculty found the simulation was a meaningful learning experience. Findings suggests that the transcultural simulation improved student knowledge of cultural competence and understanding of diversity, equity, and inclusion constructs., (© 2022 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.)

Background: Mobile health (mHealth) applications (app) have proven to be useful in gathering symptom data for a variety of populations living with chronic and serious illnesses. These mHealth tools have been built for a variety of populations but can quickly lose their novelty over time due to the lack of changes and engagement between the mHealth tool and the user. High costs, constantly changing timelines, and difficulties in building compliant data storage systems are some of the reasons why mHealth development and implementation can be a challenge., Methods: Our team's tool, QuestExplore (QE), was built in collaboration with healthcare providers, child-life specialists, a music therapist, mobile app developers, data specialists, cyber security specialists, researchers, and children living with chronic illnesses alongside their families. Through this process, our team learned various ways to reduce costs, streamline the app development process, and build compliant data storage systems. In addition, our frequent interactions with stakeholders provided us with the ability to continuously make improvements, to build an engaging mHealth app., Results: Based upon our findings, our team needed to include prompting, condensing, gamification, data visualizations, and an engaging user design in the remodel of QE. Through a three-stage process of redesigning our previous symptom monitoring apps, QE was developed to better communicate between our users and their providers, with the overall hope of improving symptom management of these children., Conclusions: In the paper, we aim to explain how our team developed QE with feedback from our stakeholders, while also continuously improving our development process through the lessons we gained through the app's development. QE is now being used in both Duke University and the University of North Carolina at Chapel Hill and will soon be implemented in Amsterdam University Medical Center., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-21-51/coif). AS and EH both report that they are owners of QuestExplore Inc. NS has grant funding from the National Institute of Health (NIH), Patient-Centered Outcomes Research Institute (PCORI), Global Blood Therapeutics (GBT), and Novartis. NS is a consultant for GBT, Novartis, Emmaus Medical, and Forma Therapeutics. NS has also received honoraria for lectures from GBT, Novartis, and Alexion. The other authors have no conflicts of interest to declare., (2022 mHealth. All rights reserved.)

Aim: The purpose of this project was to connect nursing students from schools of nursing in China and the United States for colearning using virtual simulations., Background: With technology and international partnerships, nursing programs can offer global education without students traveling to other countries., Method: Virtual simulations were produced by each school for the project. Students completed them in two synchronous 1.5-hour virtual sessions, one month apart. At the end of each session, students completed the Simulation Effectiveness Tool-Modified and the Nurses Clinical Reasoning Scale., Results: Scores on the Simulation Effectiveness Tool-Modified ranged from 75.0 percent to 100 percent on Simulation 1 (video vignettes focused on prioritization) and 88.9 percent to 100 percent on Simulation 2 (computer-based obstetrics case). Most students strongly agreed or agreed that the simulation improved their clinical reasoning skills., Conclusion: Virtual simulations allowed students to learn together and develop an awareness of differences in nursing practices across countries., Competing Interests: The authors have declared no conflict of interest., (Copyright © 2022 National League for Nursing.)

Introduction: The coronavirus-19 (COVID-19) pandemic forced changes in program delivery across nursing education. This article describes the innovative virtual lab sessions designed and implemented for Foundations and Pediatrics courses in an Accelerated Baccalaureate Science in Nursing program. The objectives of this quality improvement project were to (1) ascertain student perceptions of learning in virtual lab environment (2) identify benefits and barriers to planning and implementing virtual learning experiences, and (3) explore student attitudes and perceptions regarding group dynamics and the sense of community provided by virtual lab sessions., Methods: A cross-sectional approach was employed with two cohorts (Cohort 1, n = 71; Cohort 2, n = 86). Students completed a survey and responded to open-ended questions regarding their virtual clinical lab experiences., Results: The four themes of small group dynamics, resource availability, hands-on activities, and sense of community emerged as the characteristics students liked most about virtual lab sessions with 95% of students reporting the virtual lab sessions were engaging. Overall student survey responses were favorable to the virtual labs., Discussion: This project demonstrates that nursing educators were able to design and implement innovative teaching and learning strategies in a virtual environment to promote knowledge, skills, and attitudes while nurturing a sense of community., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.)

Purpose: This study identified facilitators and barriers pertaining to the use of multiple mobile health (mHealth) devices (Fitbit Alta® fitness tracker, iHealth® glucometer, BodyTrace® scale) that support self-management behaviors in individuals with type 2 diabetes mellitus (T2DM)., Design: This qualitative descriptive study presents study participants' perceptions of using multiple mobile devices to support T2DM self-management. Additionally, this study assessed whether participants found visualizations, generated from each participant's health data as obtained from the three separate devices, useful and easy to interpret., Methods: Semistructured interviews were completed with a convenience sample of participants (n = 20) from a larger randomized control trial on T2DM self-management. Interview questions focused on participants' use of three devices to support T2DM self-management. A study team member created data visualizations of each interview participant's health data using RStudio., Results: We identified two themes from descriptions of study participants: feasibility and usability. We identified one theme about visualizations created from data obtained from the mobile devices. Despite some challenges, individuals with T2DM found it feasible to use multiple mobile devices to facilitate engagement in T2DM self-management behaviors., Discussion: As mHealth devices become increasingly popular for diabetes self-management and are integrated into care delivery, we must address issues associated with the use of multiple mHealth devices and the use of aggregate data to support T2DM self-management., Clinical Relevance: Real-time patient-generated health data that are easily accessible and readily available can assist T2DM self-management and catalyze conversations, leading to better self-management. Our findings lay an important groundwork for understanding how individuals with T2DM can use multiple mHealth devices simultaneously to support self-management., (© 2021 Sigma Theta Tau International.)

Changes in academia have occurred quickly in response to the COVID-19 pandemic. In-person simulation-based education has been adapted into a virtual format to meet course learning objectives. The methods and procedures leveraged to onboard faculty, staff, and graduate nurse practitioner students to virtual simulation-based education while ensuring simulation best practice standards and obtaining evaluation data using the Simulation Effectiveness Tool-Modified (SET-M) tool are described in this article., Competing Interests: The remaining authors have no financial relationships relevant to this article to disclose. The remaining authors have no competing interests to declare., (© 2021 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.)

Objective: This study examined the perspectives on the use of data visualizations and identified key features seriously ill children, their parents, and clinicians prefer to see when visualizing symptom data obtained from mobile health technologies (an Apple Watch and smartphone symptom app)., Materials and Methods: Children with serious illness and their parents were enrolled into a symptom monitoring study then a subset was interviewed for this study. A study team member created symptom data visualizations using the pediatric participant's mobile technology data. Semi-structured interviews were conducted with a convenience sample of participants (n = 14 children; n = 14 parents). In addition, a convenience sample of clinicians (n = 30) completed surveys. Pediatric and parent participants shared their preferences and perspectives on the symptom visualizations., Results: We identified 3 themes from the pediatric and parent participant interviews: increased symptom awareness, communication, and interpretability of the symptom visualizations. Clinicians preferred pie charts and simple bar charts for their ease of interpretation and ability to be used as communication tools. Most clinicians would prefer to see symptom visualizations in the electronic health record., Discussion: Mobile health tools offer a unique opportunity to obtain patient-generated health data. Effective, concise symptom visualizations can be used to synthesize key clinical information to inform clinical decisions and promote patient-clinician communication to enhance symptom management., Conclusions: Effectively visualizing complex mobile health data can enhance understanding of symptom dynamics and promote patient-clinician communication, leading to tailored personalized symptom management strategies., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Children with life-threatening illness (C-LTI) experience considerable symptom distress. Mobile technology may offer opportunities to better obtain symptom data that will lead to better symptom management. A mixed-methods study was conducted to explore the feasibility of monitoring and visualizing symptoms using 2 mobile health devices in C-LTI. Participants engaged with the Apple Watch 56% and recorded in the study app 63% of their study days. Our findings showed feasibility of using mobile technology for monitoring symptoms and further explored opportunities to visualize these data showing symptom occurrences, patterns, and trajectories in C-LTI., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objectives: The high level of acceptance and consistent use of smartphones by children and adolescents present new opportunities to monitor and collect health data. For acutely ill children and adolescents, collecting symptom data via smartphone applications (apps) provides patient-reported data that can be collected daily and offers the potential to provide a more comprehensive picture of the symptom experience. The purpose of this study was to employ user-centered design principles and medical professional input in order to obtain feedback and insight into redesigning our Technology Recordings for better Understanding Blood and Marrow Transplant (TRU-PBMT) app. This redesigned app will be used for children and adolescents with cancer or undergoing blood and marrow transplantation. Method: We interviewed six pediatric blood and marrow transplant patients (ages 10-17 years) who had pilot tested the app, and we surveyed 30 pediatric oncology clinicians. Results: Interview feedback from previous app users and survey feedback from clinicians guided the app redesign. We incorporated suggestions to make the app more engaging, meaningful, personal, and motivating in order to increase symptom reporting. We added emojis to the symptom tracker, a mood scale, and personalized symptom graphs. Conclusion: Leveraging mobile health technologies may be a useful and acceptable approach to obtain symptom data; however, design and software development needs to be evidenced-based and informed by user needs. Our approach using patient and clinician feedback was valuable in the redesign of the TRU-PBMT app and will contribute to symptom research for acutely ill children and adolescents.

Staphylococcus aureus is one of the major bacterial mastitis pathogens with significant effects on animal and human health. Some studies showed that S. aureus strains that infect different host species are genetically distinct, although most strains can infect a wide range of host species. However, there are no clearly defined clonal patterns of S. aureus strains that are known to infect a specific host. The objectives of this study were to evaluate the clonal diversity and virulence characteristics of S. aureus isolates from cases of bovine mastitis. Bacteriological tests were conducted on milk samples from cases of bovine mastitis from 11 dairy farms including some milk samples from unknown farms in Eastern Tennessee. Overall, a total of 111 S. aureus were isolated and identified, and further evaluated for their genetic diversity by pulsed-field gel electrophoresis (PFGE) and virulence characteristics by PCR. Genotypic virulence factors including staphylococcal enterotoxins, and toxic shock syndrome toxin 1 (tsst-1) were tested by PCR. In addition, the association among several known virulence factors of these isolates based on our current and previous studies in our lab were evaluated. Previously generated data that were included in the analysis of association among virulence factors were the presence of biofilm production associated genes in the ica operon such as icaA, icaD and icaAB, and phenotypic virulence characteristics such as hemolysis on blood agar, slime production and resistance or susceptibility to ten commonly used antimicrobials in dairy farms. The PFGE results showed the presence of 16 PFGE types (designated A - P) throughout farms, of which three pulsotypes, I, M and O were the most frequently isolated PFGE types from most farms. The PFGE type M was the most prevalent of all 16 PFGE types, with 64 isolates being present among nine farms. The PCR results of enterotoxin genes showed that out of the total 111 tested 84 (75.7%) were negative whereas 13 (11.7%), 2 (1.8%), 3 (2.7%), 1 (0.9%) and 8 (7.2%) were positive for seb, seb and sec, sec, see, and tsst-1, respectively. All 111 isolates were negative for sea and sej. Results of the evaluation of I, M and O strains adhesion to and invasion into mammary epithelial cells showed that the total count of each strain of bacteria adhered to and invaded into mammary epithelial cell line (MAC-T cells) was not significantly different (P > 0.05). This may be an indication that there is no significant difference in their ability to establish early host-pathogen interaction and colonization of the host. There were no statistically significant associations among PFGE types and other known virulence factors of these strains. However, PFGE types O and M tend to cluster with β-hemolysin, absence of enterotoxins and susceptibility to antimicrobials. In conclusion, there was not any association between pulsotype and genotypic and phenotypic virulence factors. S. aureus isolates from cases of bovine mastitis had diverse genotypes that possessed variable virulence factors., Competing Interests: Declaration of competing interest No competing financial interests exist for all authors., (Published by Elsevier Ltd.)

Sickle Cell Disease (SCD) is a hereditary disorder of red blood cells in humans. Complications such as pain, stroke, and organ failure occur in SCD as malformed, sickled red blood cells passing through small blood vessels get trapped. Particularly, acute pain is known to be the primary symptom of SCD. The insidious and subjective nature of SCD pain leads to challenges in pain assessment among Medical Practitioners (MPs). Thus, accurate identification of markers of pain in patients with SCD is crucial for pain management. Classifying clinical notes of patients with SCD based on their pain level enables MPs to give appropriate treatment. We propose a binary classification model to predict pain relevance of clinical notes and a multiclass classification model to predict pain level. While our four binary machine learning (ML) classifiers are comparable in their performance, Decision Trees had the best performance for the multiclass classification task achieving 0.70 in F-measure. Our results show the potential clinical text analysis and machine learning offer to pain management in sickle cell patients.

Background: Sustained self-monitoring and self-management behaviors are crucial to maintain optimal health for individuals with type 2 diabetes mellitus (T2DM). As smartphones and mobile health (mHealth) devices become widely available, self-monitoring using mHealth devices is an appealing strategy in support of successful self-management of T2DM. However, research indicates that engagement with mHealth devices decreases over time. Thus, it is important to understand engagement trajectories to provide varying levels of support that can improve self-monitoring and self-management behaviors., Objective: The aims of this study were to develop (1) digital phenotypes of the self-monitoring behaviors of patients with T2DM based on their engagement trajectory of using multiple mHealth devices, and (2) assess the association of individual digital phenotypes of self-monitoring behaviors with baseline demographic and clinical characteristics., Methods: This longitudinal observational feasibility study included 60 participants with T2DM who were instructed to monitor their weight, blood glucose, and physical activity using a wireless weight scale, phone-tethered glucometer, and accelerometer, respectively, over 6 months. We used latent class growth analysis (LCGA) with multitrajectory modeling to associate the digital phenotypes of participants' self-monitoring behaviors based on their engagement trajectories with multiple mHealth devices. Associations between individual characteristics and digital phenotypes on participants' self-monitoring behavior were assessed by analysis of variance or the Chi square test., Results: The engagement with accelerometers to monitor daily physical activities was consistently high for all participants over time. Three distinct digital phenotypes were identified based on participants' engagement with the wireless weight scale and glucometer: (1) low and waning engagement group (24/60, 40%), (2) medium engagement group (20/60, 33%), and (3) consistently high engagement group (16/60, 27%). Participants that were younger, female, nonwhite, had a low income, and with a higher baseline hemoglobin A 1c level were more likely to be in the low and waning engagement group., Conclusions: We demonstrated how to digitally phenotype individuals' self-monitoring behavior based on their engagement trajectory with multiple mHealth devices. Distinct self-monitoring behavior groups were identified. Individual demographic and clinical characteristics were associated with different self-monitoring behavior groups. Future research should identify methods to provide tailored support for people with T2DM to help them better monitor and manage their condition., International Registered Report Identifier (irrid): RR2-10.2196/13517., (©Qing Yang, Daniel Hatch, Matthew J Crowley, Allison A Lewinski, Jacqueline Vaughn, Dori Steinberg, Allison Vorderstrasse, Meilin Jiang, Ryan J Shaw. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 11.06.2020.)

Background: Pediatric blood and marrow transplant (PBMT) patients experience significant symptom distress. Mobile health (mHealth) technologies can be leveraged to improve understanding of the patient's symptom experience by providing continuous, real-time, in situ, patient-generated symptom data. This rich data stream can subsequently enhance symptom management strategies. However, limited research has been conducted in this area., Objectives: This pilot study seeks to (a) explore the feasibility of integrating mHealth technologies to monitor symptom data for PBMT patients and (b) evaluate the study design, measures, and procedures., Methods: An exploratory longitudinal design was employed to assess the feasibility of monitoring 10 PBMT patients' symptoms using data from two mHealth technologies: (a) a smartphone mHealth application (app) to collect symptom data and (b) a wearable tracking device (Apple watch) to collect physiological data. Feasibility was measured as usability and acceptability. Monthly patient interviews and an end-of-study feasibility survey were employed and analyzed to further understand reasons for sustained interest in and attrition from the study., Results: Overall usability of the wearable was 51%, and app was 56%. Children reported devices were easy to use and acceptable. The study demonstrated acceptability with an enrollment rate of 83% and an attrition rate of 30%, with 70% of the children remaining in the study for at least 40 days., Discussion: This pilot study is among the first to explore the feasibility of using mobile technologies to longitudinally obtain patient-generated symptom data to enhance understanding of the PBMT symptom experience. In addition, it will improve our understanding of how these data present, interact, and cluster together throughout the posttransplant period.

Background: Pediatric blood and marrow transplant (PBMT) patients experience significant symptom distress, and the use of mobile health (mHealth) technologies may enhance symptom management by providing patient-generated health data to foster personalized health strategies., Objectives: The aim of this study was to present a study protocol to explore feasibility, acceptability, and usability of integrating mHealth technologies to collect and monitor symptom data for PBMT patients., Methods: An exploratory mixed-methods design is employed for 20 PBMT patients to monitor symptoms using real-time data from two mHealth devices: (a) a self-developed mHealth application and (b) a wearable tracking device. Patient-Reported Outcomes Measurement Information System surveys for fatigue, pain, and sleep disturbance are obtained monthly. Interviews are conducted to obtain further feasibility and usability data., Results: The study began in October 2017; data collection should be completed in 2018. Feasibility and usability results to monitor and record symptom-related data daily via mobile devices will be reported. Patient-Reported Outcomes Measurement Information System surveys and interviews will further explore patients' symptoms and experiences with the mobile devices., Discussion: This study will be among the first to explore the feasibility, acceptability, and usability of integrating multiple mHealth technologies to obtain patient-generated symptom data for the PBMT population. Results will enhance our understanding of how these data present, interact, and cluster together throughout the posttransplant period for these children and lead to symptom management strategies. Results will focus on a high-risk population that potentially stands to benefit from the use of mobile technologies.

Background: Self-management is integral for control of type 2 diabetes mellitus (T2DM). Patient self-management is improved when they receive real-time information on their health status and behaviors and ongoing facilitation from health professionals. However, timely information for these behaviors is notably absent in the health care system. Providing real-time data could help improve patient understanding of the dynamics of their illness and assist clinicians in developing targeted approaches to improve health outcomes and in delivering personalized care when and where it is most needed. Mobile technologies (eg, wearables, apps, and connected scales) have the potential to make these patient-provider interactions a reality. What strategies might best help patients overcome self-management challenges using self-generated diabetes-related data? How might clinicians effectively guide patient self-management with the advantage of real-time data?, Objective: This study aims to describe the protocol for an ongoing study (June 2016-May 2019) that examines trajectories of symptoms, health behaviors, and associated challenges among individuals with T2DM utilizing multiple mobile technologies, including a wireless body scale, wireless glucometer, and a wrist-worn accelerometer over a 6-month period., Methods: We are conducting an explanatory sequential mixed methods study of 60 patients with T2DM recruited from a primary care clinic. Patients were asked to track relevant clinical data for 6 months using a wireless body scale, wireless glucometer, a wrist-worn accelerometer, and a medication adherence text message (short message service, SMS) survey. Data generated from the devices were then analyzed and visualized. A subset of patients is currently being interviewed to discuss their challenges and successes in diabetes self-management, and they are being shown visualizations of their own data. Following the data collection period, we will conduct interviews with study clinicians to explore ways in which they might collaborate with patients., Results: This study has received regulatory approval. Patient enrollment ongoing with a sample size of 60 patients is complete, and up to 20 clinicians will be enrolled. At the patient level, data collection is complete, but data analysis is pending. At the clinician level, data collection is currently ongoing., Conclusions: This study seeks to expand the use of mobile technologies to generate real-time data to enhance self-management strategies. It also seeks to obtain both patient and provider perspectives on using real-time data to develop algorithms for software that will facilitate real-time self-management strategies. We expect that the findings of this study will offer important insight into how to support patients and providers using real-time data to manage a complex chronic illness., International Registered Report Identifier (irrid): DERR1-10.2196/13517., (©Ryan J Shaw, Angel Barnes, Dori Steinberg, Jacqueline Vaughn, Anna Diane, Erica Levine, Allison Vorderstrasse, Matthew J Crowley, Eleanor Wood, Daniel Hatch, Allison Lewinski, Meilin Jiang, Janee Stevenson, Qing Yang. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 03.06.2019.)

As the appeal and use of mobile health (mHealth) technologies continues to grow, where does mHealth fit into clinical practice? This article explores the approach and obstacles encountered when integrating mHealth data into existing clinical frameworks and explores data visualization design tradeoffs. Specifically, this paper discusses the successes and challenges that arose when using commercial mHealth technologies, synthesizing multiple mHealth device data, and tailoring visualizations based on iterative feedback from type II diabetes mellitus patients. This research aims to influence the development of patient portals within electronic health records by understanding and addressing the challenges involved in acquiring, interpreting, and displaying this data set. In particular, we need to ensure that the presentation of these data is accessible and understandable by diverse populations.

Purpose: Our investigative team is integrating mobile health technologies into pediatric blood and marrow transplant (PBMT) care. We aim to evaluate whether patient-generated health data can be used to monitor health status and enhance symptom management. While there are numerous health-related apps, none address the symptoms or care needs specific to PBMT patients. This article describes development of the Technology Recording to better Understand Pediatric Blood and Marrow Transplant (TRU-PBMT) mobile application., Design and Methods: A one-time survey was distributed to PBMT clinicians, caregivers, and outpatients to elicit feedback and suggestions for the app's design., Results: Feedback from clinicians (n = 23), caregivers (n = 5), and PBMT outpatients (n = 4) indicated the app would be acceptable and useable with this group of patients between eight and eighteen years of age. Suggestions from respondents included: making the app language and graphics more child-friendly; adding symptoms such as fatigue, mucositis, bleeding; and a visual stool chart., Conclusion: Patient, caregiver, and clinician feedback was valuable in creation of the TRU-PBMT app. We designed a pediatric friendly, PBMT-symptom-specific app, which we will test in future studies., Implications for Practice: This app facilitates patient-generated health data collection and informs health care plans., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Staphylococcus aureus is a frequent and major contagious mastitis bacterial pathogen. The antibiotic treatment cure rates vary considerably from 4% to 92%. Staphylococcus aureus readily becomes resistant to antibiotics, resulting in persistent noncurable intramammary infection that usually results in culling of infected animals. Because of its notorious ability to acquire resistance to the commonly used as well as last resort antimicrobials such as methicillin and vancomycin and the development of multidrug-resistant strains, antimicrobial resistance (AMR) in S. aureus is of paramount importance in human medicine. The objective of this study was to evaluate the prevalence of AMR and genetic diversity of S. aureus isolates from milk of dairy cattle. Staphylococcus aureus isolates (n = 239) from 33 dairy farms in Tennessee were tested against 10 antimicrobials by broth microdilution method using the Sensititer system. Genetic diversity of resistant isolates was evaluated by pulsed-field gel electrophoresis (PFGE). Overall, AMR of the S. aureus isolates varied from as low as 1.3% for ceftiofur to as high as 25% for sulfadimethoxine. Out of 239 S. aureus isolates, 82 (34.3%) of them were resistant to at least 1 of the 10 antimicrobials. The AMR isolates belonged to two major PFGE types, indicating the presence of dominant clonal patterns among the resistant isolates. In general, there was a variation of prevalence of AMR within and among farms over time, with an increasing trend in tetracycline resistance. Judicious use of antimicrobials in dairy cattle farms can reduce the development of antimicrobial-resistant S. aureus.

Rationale: Care in the hospital is hazardous. Harm in the hospital may prolong hospitalization, increase suffering, result in death, and increase costs of care. Although the interprofessional team is critical to eliminating hazards that may result in adverse events to patients, professional students' formal education may not prepare them adequately for this role., Objectives: To determine if medical and nursing students can identify hazards of hospitalization that could result in harm to patients and to detect differences between professions in the types of hazards identified., Methods: Mixed-methods observational study of graduating nursing (n = 51) and medical (n = 93) students who completed two "Room of Horrors" simulations to identify patient safety hazards. Qualitative analysis was used to extract themes from students' written hazard descriptions. Fisher's exact test was used to determine differences in frequency of hazards identified between groups., Results: Identification of hazards by students was low: 66% did not identify missing personal protective equipment for a patient on contact isolation, and 58% did not identify a medication administration error (medication hanging for a patient with similar name). Interprofessional differences existed in how hazards were identified: medical students noted that restraints were not indicated (73 vs. 2%, P < 0.001), whereas nursing students noted that there was no order for the restraints (58.5 vs. 0%, P < 0.0001). Nursing students discovered more issues with malfunctioning or incorrectly used equipment than medical students. Teams performed better than individuals, especially for hazards in the second simulation that were similar to those in the first: need to replace a central line with erythema (73% teams identified) versus need to replace a peripheral intravenous line (10% individuals, P < 0.0001). Nevertheless, teams of students missed many intensive care unit-specific hazards: 54% failed to identify the presence of pressure ulcers; 85% did not notice high tidal volumes on the ventilator; and 90% did not identify the absence of missing spontaneous awakening/breathing trials and absent stress ulcer prophylaxis., Conclusions: Graduating nursing and medical students missed several hazards of hospitalization, especially those related to the intensive care unit. Orientation for residents and new nurses should include education on hospitalization hazards. Ideally, this orientation should be interprofessional to allow appreciation for each other's roles and responsibilities.

This article provides an overview of the use of telepresence robots in clinical practice and describes an evaluation of an educational project in which distance-based nurse practitioner students used telepresence robots in clinical simulations with on-campus Accelerated Bachelor of Science in Nursing students. The results of this project suggest that the incorporation of telepresence in simulation is an effective method to promote engagement, satisfaction, and self-confidence in learning.

We describe a pilot study that incorporated an innovative hybrid simulation designed to increase the perception of realism in a high-fidelity simulation. Prelicensure students (N = 12) cared for a manikin in a simulation lab scenario wearing Google Glass, a wearable head device that projected video into the students' field of vision. Students reported that the simulation gave them confidence that they were developing skills and knowledge to perform necessary tasks in a clinical setting and that they met the learning objectives of the simulation. The video combined visual images and cues seen in a real patient and created a sense of realism the manikin alone could not provide.

Background: Studies show that students who use fidelity-based simulation technology perform better and have higher retention rates than peers who learn in traditional paper-based training. Augmented reality is increasingly being used as a teaching and learning tool in a continual effort to make simulations more realistic for students., Objective: The aim of this project was to assess the feasibility and acceptability of using augmented reality via Google Glass during clinical simulation scenarios for training health science students., Methods: Students performed a clinical simulation while watching a video through Google Glass of a patient actor simulating respiratory distress. Following participation in the scenarios students completed two surveys and were questioned if they would recommend continued use of this technology in clinical simulation experiences., Results: We were able to have students watch a video in their field of vision of a patient who mimicked the simulated manikin. Students were overall positive about the implications for being able to view a patient during the simulations, and most students recommended using the technology in the future. Overall, students reported perceived realism with augmented reality using Google Glass. However, there were technical and usability challenges with the device., Conclusions: As newer portable and consumer-focused technologies become available, augmented reality is increasingly being used as a teaching and learning tool to make clinical simulations more realistic for health science students. We found Google Glass feasible and acceptable as a tool for augmented reality in clinical simulations., Competing Interests: Conflicts of Interest: None declared.