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Background: Although the prescription of physical activity in clinical care has been advocated worldwide, in the Netherlands, "Exercise is Medicine" (E = M) is not yet routinely implemented in clinical care. Methods: A set of implementation strategies was pilot implemented to test its feasibility for use in routine care by clinicians in 2 departments of a university medical center. An extensive learning process evaluation was performed, using structured mixed methods methodology, in accordance with the Reach, Effect, Adoption, Implementation, and Maintenance framework. Results: From 5 implementation strategies employed (education, E = M tool embedded in the electronic medical records, lifestyle coach situated within the department, overviews of referral options, and project support), the presence of adequate project support was a strong facilitator of the implementation of E = M. Also, the presence of the lifestyle coach within the department seemed essential for referral rate. Although clinicians appreciated the E = M tool, barriers hampered its use in practice. Conclusions: Specific implementation strategies, tailored to the setting, are effective in facilitating the implementation of E = M with specific regard to education for clinicians on E = M, deployment of a lifestyle coach within a department, and project coordination. Care providers do see a future for lifestyle coaches who are structurally embedded in the hospital, to whom they can easily refer. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of using a customized xenograft shell with a 1:1 mixture of particulate xenograft and autogenous bone for the reconstruction of horizontally deficient anterior maxillary alveolar ridges. Materials and Methods: CBCT images of the atrophic maxilla of eight patients were acquired and generated into 3D models. The data were transferred to a 3D printer for fabrication. During the surgery, xenograft blocks were manually sliced and customized on the 3D-printed models into bone shells. Then they were fixed to the atrophic site, and the gap was augmented with a 1:1 mixture of particulate xenograft and autogenous bone. Results: Clinical assessment showed no adverse effects; however, one patient exhibited wound dehiscence. The mean difference between the preoperative and 6-month postoperative CBCTs showed a net average bone gain of 4.06 mm at 2 mm from the crest and 4.34 mm at 5 mm from the crest, which was statistically significant. On the other hand, a statistically significant graft resorption of 1.41 mm at 2 mm from the crest and 2.19 mm at 5 mm from the crest was found when the mean difference between the immediate and 6-month postoperative CBCTs was calculated. Conclusions: Within the limitations of the study, the use of xenograft shells as a barrier for maxillary alveolar ridge reconstruction is a predictable technique; however, further investigations regarding the required time for graft consolidation are required. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the impact of injectable plateletrich fibrin (iPRF) and concentrated growth factor on postoperative pain, edema, trismus, and quality of life in impacted mandibular third molar surgery. The primary aim of this study was to minimize common sequelae following third molar surgery by using iPRF and concentrated growth factor. The secondary objective was to compare the postoperative effects of these products. Method and materials: This study represents a single-center, randomized prospective clinical trial conducted at the Ordu University Faculty of Dentistry. It involved patients who underwent third molar surgery for various reasons between July and October 2022. The predictor variables were the use of concentrated growth factor and i-PRF. They were categorized as concentrated growth factor, i-PRF, and control groups. The outcome variables include pain levels and analgesic consumption measured on a visual analog scale, distances between predetermined anatomical points, maximum mouth opening capacity, and data from the postoperative symptom severity (PoSSe) scale. Some statistical tests were performed with a 95% confidence interval, which was considered significant. Results: Total analgesic use was notably lower in the concentrated growth factor group (P = .044). Concentrated growth factor and iPRF outperformed the control group in all edema measurements by postoperative day 7 (tragus–pogonion, lateral canthus–angulus, tragus–commissura; P < .05). Concentrated growth factor significantly reduced trismus on days 2 and 7. Quality of life was notably higher in the concentrated growth factor group than in the control group (P = .026), although iPRF group differences were not significant. Conclusion: The results indicate that concentrated growth factor has a limited impact on postoperative pain, but significantly reduces edema, trismus, and enhances quality of life. The iPRF group experienced positive effects on pain, edema, and trismus, although the statistically significant differences observed with concentrated growth factor highlight its potential for use instead of iPRF after third molar surgery. An increased sample size is essential for more comprehensive results [ABSTRACT FROM AUTHOR]

Employers face many dilemmas in effectively implementing work–life flexibility to support employees' personal lives. A key issue is that some employees hold jobs with limited opportunities for work–life flexibility, making them susceptible to burnout; yet most employers believe they can do little to mitigate this dynamic. Furthermore, even when employees hold jobs with greater access to work–life flexibility, some do not take advantage of their flexibility to more fully engage in work and/or home roles. These issues are further exacerbated when supervisors are unsure of their role in supporting work–life flexibility. We identify work–life supportive context as a key factor that provides solutions to these dilemmas. Drawing on job demands resources theory, we posit that, when organizations provide work–life supportive training to supervisors, it promotes a work–life supportive context (i.e., signaling that the organization is supportive of employees' managing their work–life interface), which mitigates burnout for those with limited work–life flexibility and promotes engagement in work and home roles for those with greater work–life flexibility. Results from a year‐long randomized field experiment suggest that, in contexts with trained supervisors and lower employee control over work schedules and boundaries (i.e., lower work–life flexibility), emotional exhaustion is reduced. In contexts with trained supervisors and higher employee control over work boundaries (i.e., higher work–life flexibility), family engagement increases. Surprisingly, irrespective of job access to work‐life flexibility, supervisor participation in work–life support training did not enhance employee work engagement. Implications of our findings for fostering work–life supportive contexts are considered. [ABSTRACT FROM AUTHOR]

BACKGROUND: Neurotrophic tyrosine receptor kinase (NTRK) gene fusions are rare oncogenic drivers prevalent in 0.3% of solid tumors. They are most common in salivary gland cancer (2.6%), thyroid cancer (1.6%), and soft-tissue sarcoma (1.5%). Currently, there are 2 US Food and Drug Administration-approved targeted therapies for NTRK gene fusions: larotrectinib, approved in 2018, and entrectinib, approved in 2019. To date, the real-world uptake of tyrosine receptor kinase inhibitor (TRKi) use for NTRK-positive solid tumors in academic cancer centers remains largely unknown. OBJECTIVE: To describe the demographics, clinical and genomic characteristics, and testing and treatment patterns of patients with NTRK-positive solid tumors treated at US academic cancer centers. METHODS: This was a retrospective chart review study conducted in academic cancer centers in the United States. All patients diagnosed with an NTRK fusion-positive (NTRK1, NTRK2, NTRK3) solid tumor (any stage) and who received cancer treatment at participating sites between January 1, 2012, and July 1, 2023, were included in this study. Patient demographics, clinical characteristics, genomic characteristics, NTRK testing data, and treatment patterns were collected from electronic medical records and analyzed using descriptive statistics as appropriate. RESULTS: In total, 6 centers contributed data for 55 patients with NTRK-positive tumors. The mean age was 49.3 (SD = 20.5) years, 51% patients were female, and the majority were White (78%). The median duration of time from cancer diagnosis to NTRK testing was 85 days (IQR = 44-978). At the time of NTRK testing, 64% of patients had stage IV disease, compared with 33% at cancer diagnosis. Prevalent cancer types in the overall cohort included head and neck (15%), thyroid (15%), brain (13%), lung (13%), and colorectal (11%). NTRK1 fusions were most common (45%), followed by NTRK3 (40%) and NTRK2 (15%). Across all lines of therapy, 51% of patients (n = 28) received a TRKi. Among TRKi-treated patients, 71% had stage IV disease at TRKi initiation. The median time from positive NTRK test to initiation of TRKi was 48 days (IQR = 9-207). TRKis were commonly given as first-line (30%) or second-line (48%) therapies. Median duration of therapy was 610 (IQR = 182-764) days for TRKi use and 207.5 (IQR = 42-539) days for all other first-line therapies. CONCLUSIONS: This study reports on contemporary real-world NTRK testing patterns and use of TRKis in solid tumors, including time between NTRK testing and initiation of TRKi therapy and duration of TRKi therapy.

Purpose: To report the prevalence of early implant failure and evaluate factors that contribute to the early failure of dental implants placed at a teaching clinic. The study also aims to identify risk indicators for early implant loss to better predict and prevent early implant loss in the future. Materials and Methods: This retrospective study included all patients with a dental implant placed by the Section of Oral Surgery and Oral Medicine, Department of Clinical Dentistry, University of Bergen, between January 2011 and December 2018. All information was collected from operation logbooks and from patient records. A failed implant in this study was defined as an implant lost before functional loading. Results: A total of 1,005 dental implants were placed in the studied time period, of which 54 failed early, giving an early failure rate (EFR) of 5.4%, with functional loading obtained for the remaining 94.6%. Analysis showed an increased hazard for early implant failure among smokers, men, and younger patients. With an age increase of 10 years, the risk of implant failure was reduced by 14% (hazard ratio [HRR] = 0.86, P = .037). A higher failure rate was found in anterior maxillary implants than in posterior maxillary implants (7.79% vs 3.29%, respectively; HRR = 0.47; P = .041). The probability for early failure in the posterior mandible was significantly increased compared to the posterior maxilla (HRR = 3.68, P = .005). If the first implant failed, it was more likely that the consecutive implant would also fail (HRR = 1.82). In the study, 53.4% of the placed implants were Straumann (EFR = 5.2%), 30.3% were Nobel Biocare (EFR = 7.2%), and 16.3% were Astra Tech (EFR = 2.5%). Conclusions: This study found that younger, male, and smoker patients were associated with an increase in early failure of dental implants. Significantly increased failure rates were also seen for implants placed in the mandible, and there were differences with respect to implant system. Although differences were found in early failure both for patient- and implant-related factors, the overall early failure rate (5.4%) in this study was low. [ABSTRACT FROM AUTHOR]

BACKGROUND: Diabetic cardiomyopathy (DbCM) is characterized by asymptomatic stage B heart failure (SBHF) caused by diabetes-related metabolic alterations. DbCM is associated with an increased risk of progression to overt heart failure (HF). The prevalence of DbCM in patients with type 2 diabetes (T2D) is not well established. This study aims to determine prevalence of DbCM in adult T2D patients in real-world clinical practice. METHODS: Retrospective multi-step review of electronic medical records of patients with the diagnosis of T2D who had echocardiogram at UC San Diego Medical Center (UCSD) within 2010-2019 was conducted to identify T2D patients with SBHF. We defined pure DbCM when SBHF is associated solely with T2D and mixed SBHF when other medical conditions can contribute to SBHF. Pure DbCM was diagnosed in T2D patients with echocardiographic demonstration of SBHF defined as left atrial (LA) enlargement (LAE), as evidenced by LA volume index ≥ 34 mL/m2, in the presence of left ventricular ejection fraction (LVEF) ≥ 45%, while excluding overt HF and comorbidities that can contribute to SBHF. RESULTS: Of 778,314 UCSD patients in 2010-2019, 45,600 (5.9%) had T2D diagnosis. In this group, 15,182 T2D patients (33.3%) had echocardiogram and, among them, 13,680 (90.1%) had LVEF ≥ 45%. Out of 13,680 patients, 4,790 patients had LAE. Of them, 1,070 patients were excluded due to incomplete data and/or a lack of confirmed T2D according to the American Diabetes Association recommendations. Thus, 3,720 T2D patients with LVEF ≥ 45% and LAE were identified, regardless of HF symptoms. In this group, 1,604 patients (43.1%) had overt HF and were excluded. Thus, 2,116 T2D patients (56.9% of T2D patients with LVEF ≥ 45% and LAE) with asymptomatic SBHF were identified. Out of them, 1,773 patients (83.8%) were diagnosed with mixed SBHF due to comorbidities such as hypertension (58%), coronary artery disease (36%), and valvular heart disease (17%). Finally, 343 patients met the diagnostic criteria of pure DbCM, which represents 16.2% of T2D patients with SBHF, i.e., at least 2.9% of the entire T2D population in this study. CONCLUSIONS: Our findings provide insights into prevalence of DbCM in real-world clinical practice and indicate that DbCM affects a significant portion of T2D patients.

INTRODUCTION: Effective communication in the operating room (OR) is crucial. Addressing a colleague by their name is respectful, humanising, entrusting and associated with improved clinical outcomes. We aimed to enhance team communication in the perioperative environment by offering personalised surgical caps labelled with name and provider role to all OR team members at a large academic medical centre. MATERIALS AND METHODS: This was a quasi-experimental, uncontrolled, before-and-after quality improvement study. A survey regarding perceptions of team communication, knowledge of names and roles, communication barriers, and culture was administered before and after cap delivery. Survey results were measured on a 5-point Likert Scale; descriptive statistics and mean scores were compared. All cause National Surgical Quality Improvement Project (NSQIP) morbidity and mortality outcomes for surgical specialties were examined. RESULTS: 1420 caps were delivered across the institution. Mean survey scores increased for knowing the names and roles of providers around the OR, feeling that people know my name and feeling comfortable communicating without barriers across disciplines. The mean score for team communication around the OR is excellent was unchanged. The highest score both before and after was knowing the name of an interdisciplinary team member is important for patient care. A total of 383 and 212 providers participated in the study before and after cap delivery, respectively. Participants agreed or strongly agreed that labelled surgical caps made it easier to talk to colleagues (64.9%) while improving communication (66.0%), team culture (60.5%) and patient care (56.8%). No significant differences were noted in NSQIP outcomes. CONCLUSIONS: Personalised labelled surgical caps are a simple, inexpensive tool that demonstrates promise in improving perioperative team communication. Creating highly reliable surgical teams with optimal communication channels requires a multifaceted approach with engaged leadership, empowered front-line providers and an institutional commitment to continuous process improvement.

Academic medical institutions seek to recruit and retain a diverse workforce to foster equitable, supportive environments in which early-stage investigators, especially those who are underrepresented in medicine, can thrive. Intersectionality is a critical theoretical framework rooted in Black feminist activism and scholarship that elucidates how power and privilege are differentially structured for groups at different intersectional sociodemographic positions. As a dynamic method of analyzing multiple axes of power and inequality, intersectionality has the potential to offer a critical lens through which to view the mentor-mentee relationship. In this article, we seek to elaborate upon and extend the concept of intersectional mentoring, elucidate its essential components, and explore its application in the context of mentoring early-stage investigators in academic medicine. We propose that intersectional mentorship requires an orientation toward deep cultural humility, lifetime learning about the impact of systemic oppressions on present-day opportunities and experiences of mentees, and changing systems that perpetuate inequities by centering praxis-the application of principles of intersectionality through action to transform power dynamics in academic culture and institutions. Intersectional mentorship can help build a more equitable and representative workforce to advance intersectionally relevant and innovative approaches to achieving health equity.

Objectives: The aim of the study was to evaluate the effect of injectable platelet-rich fibrin (i-PRF) on gingival thickness and gingival recession in individuals with thin periodontal phenotypes. Method and materials: In this prospective study, i-PRF was applied via a semisurgical method to augment 53 tooth regions with thin periodontal phenotypes. In order to ensure that sufficient blood clot formed on the side of the gingiva facing the bone and that i-PRF reached the area, a minimal incision was made with the help of a scalpel in the apical region of the relevant region, and the periosteum was elevated with a microsurgical instrument. To ensure sustained exposure to angiogenetic growth factors and enhance the histoconductive properties, i-PRF injection was applied to the relevant areas in foursessions at 10-dayintervals. Results: An increase in gingival thickness was achieved in 92.5% of the areas treated with i-PRF, and the desired gingival thickness (0.8 mm) was achieved in 44.9% of these areas. In addition, significant reductions in the amount of recession were observed in 83.3% of the 12 gingival recession areas (P= .005). Moreover, complete coverage was achieved in 60% of these regions. Conclusion: With the new i-PRF semisurgical method, it was shown that gingival thickness can be increased in tooth regions with thin gingiva, andthat areas of gingival recession can be covered. Further comprehensive studies are needed to fully understand the role of i-PRF in enhancing angiogenesis and the histoconductive properties of this fully autogenous blood concentrate. [ABSTRACT FROM AUTHOR]

Sponsorship describes a set of actions wherein an influential champion (sponsor) uses their position to actively support a colleagues career by helping them gain visibility, recognition, and/or positions. There is growing awareness of the importance of sponsorship for career advancement in academic medicine, particularly for women and those who are historically underrepresented and excluded in medicine (UIM). This scoping review examines the current landscape of evidence, and knowledge gaps, on sponsorship as it relates to career advancement in academic medicine for women and UIM faculty. We searched peer-reviewed literature in PubMed, Embase, and Web of Science (WoS) over the past 50 years (from 1973 through July 2023). Sixteen studies were included in the final review. We found relative consensus on sponsorship definition and value to career advancement. Heterogeneity in study design limited our ability to directly compare study outcomes. All included studies focused on gender differences in sponsorship: two of four quantitative studies found men were more likely to receive sponsorship, one reported no gender differences, and one was insufficiently powered. All but one of the qualitative studies reported gender differences, with women less likely to access or be identified for sponsorship. The mixed-methods studies suggested sponsorship may vary by career stage. Only two studies analyzed sponsorship for UIM populations. The existing data are inconclusive regarding best ways to measure and assess sponsorship, what institutional support (e.g., structured programs, formal recognition, or incentives for sponsorship) should look like, and at what career stage sponsorship is most important. Addressing this knowledge gap will be critically important for understanding what sponsorship best practices, if any, should be used to promote equity in career advancement in academic medicine. We advocate for commitment at the institutional and national levels to develop new infrastructure for transparently and equitably supporting women and UIM in career advancement.

Purpose Manipulation of tablet medications to produce a customized dose is common practice, and splitting tablets may reduce the acquisition cost of the medication. However, cost savings may be diminished by the cost of the increased labor and repackaging materials needed when splitting tablets. Splitting tablets may also result in safety concerns if the final products are under (eg, reduced benefit) or over (eg, toxicity) the desired dosage. The purpose of this quality improvement project was to evaluate and recommend changes for all half- and quarter-tablet medications prepared and distributed from the inpatient pharmacy at University of Utah Health (U of U Health). Summary The evaluation included all half- and quarter-tablet medications prepared by pharmacy technicians for administration to patients admitted to U of U Health hospitals. A final list of 173 half- and quarter-tablet dosages was evaluated for opportunities to decrease the total number. On the basis of the developed criteria, 93 half- and quarter-tablet dosages (54%) were recommended to be removed from routine stock in the inpatient pharmacy. Systems remain in place to create customized half and quarter tablets if required for patient care. Conclusion Reducing the number of medications for which half and quarter tablets are used may allow pharmacy technicians to prioritize other patient care tasks and potentially decrease waste. [ABSTRACT FROM AUTHOR]

Background: Examining the privacy experiences of mothers in neonatal intensive care units (NICUs) can play a crucial role in bolstering patient privacy safeguards and elevating the overall quality of health care. However, our understanding of mothers' experiences regarding privacy issues they may face after their infants' hospitalization in the NICU is limited. Aim: This study aimed to investigate the experiences of mothers concerning privacy within NICUs to contribute valuable insights for improving infant care and privacy protection. Design: A qualitative content analysis using a conventional approach was conducted. A total of 18 participants, with diverse sociodemographic backgrounds, were interviewed using open‐ended questions. Qualitative content analysis was undertaken for data analysis. Setting: The study was conducted in the NICU of an urban teaching hospital in Iran. Results: The study identified four main themes: 'understanding of privacy', 'fluctuating respect for privacy', 'efforts to maintain privacy' and 'privacy barriers'. Participants viewed privacy as multidimensional, influenced by cultural and religious factors. Respect for privacy varied, with instances of both adherence and violation. Mothers employed strategies to preserve privacy, emphasizing the importance of their infants' privacy. Privacy barriers included hospital attire, the physical space of the NICU, inhomogeneous human resources and insufficient supervision and training. Conclusion: This study, the first of its kind in the NICU context, provides valuable insights into maternal experiences of privacy. Integrating these insights into practice and future research can contribute to creating more empathetic and privacy‐respecting NICU environments. Relevance to Clinical Practice: Health care providers can use these findings to enhance support for mothers, potentially reshaping physical spaces and communication practices within NICUs. [ABSTRACT FROM AUTHOR]

Background: Nurses in neurointensive care units (NCUs) commonly use physical restraint (PR) to prevent adverse events like unplanned removal of devices (URDs) or falls. However, PR use should be based on evidenced decisions as it has drawbacks. Unfortunately, there is a lack of research‐based PR protocol to support decision‐making for nurses, especially for neurocritical patients. Aim: This study developed a restraint decision tree for neurocritical patients (RDT‐N) to assist nurses in making PR decisions. We assessed its effectiveness in reducing PR use and adverse events. Study Design: This study employed a baseline and post‐intervention test design at a NCU with 19 beds and 45 nurses in a tertiary hospital in a metropolitan city in South Korea. Two‐hundred and thirty‐seven adult patients were admitted during the study period. During the intervention, nurses were trained on the RDT‐N. PR use and adverse events between the baseline and post‐intervention periods were compared. Results: Post‐intervention, total number of restrained patients decreased (20.7%–16.3%; χ2 = 7.68, p =.006), and the average number of PR applied per restrained patient decreased (2.42–1.71; t = 5.74, p <.001). The most frequently used PR type changed from extremity cuff to mitten (χ2 = 397.62, p <.001). No falls occurred during the study periods. On the other hand, URDs at baseline were 18.67 cases per 1000 patient days in the high‐risk group and 5.78 cases per 1000 patient days in the moderate‐risk group; however, no URD cases were reported post‐intervention. Conclusions: The RDT‐N effectively reduced PR use and adverse events. Its application can enhance patient‐centred care based on individual condition and potential risks in NCUs. Relevance to Clinical Practice: Nurses can use the RDT‐N to assess the need for PR in caring for neurocritical patients, reducing PR use and adverse events. [ABSTRACT FROM AUTHOR]

Background: Nursing care dependency is a key, yet under‐studied, nursing phenomenon. Patients in intensive care units are highly dependent on nursing care. Patients find dependency challenging, experiencing feelings of powerlessness and shame. The nurse–patient care relationship can influence patients' perception of dependency. Understanding how nurses experience their care for dependent patients is crucial, as nurses might not always grasp the impact of their actions on patients' dependency experiences. Aim: To explore and interpret ICU nurses' perceptions of patients' nursing care dependency and their experiences in caring for nursing care‐dependent patients. Study Design: A qualitative interpretative phenomenological study inspired by Merleau‐Ponty's philosophical stance was conducted using focus groups with nurses who had been caring for adult patients for at least 6 months in ICUs of two hospitals. Data analysis followed Smith et al.'s guidance. Researchers immersed themselves in the transcripts, noted individual's experiences before transitioning to shared insights, coded significant phrases and generated themes and superordinate themes. Results: Four focus groups were conducted with 18 nurses with widely ranging ages and work experience. Four superordinate themes emerged: 'Time and context define dependency', 'Empathetic relationships help nurses understand patients' experience of dependency', 'Trusting nurse‐patient relationships change the dependency experience' and 'Nurses' skills help patients to recover independence'. Conclusion: This study increases critical care nurses' awareness of the overlooked phenomenon of caring for nursing care dependent patients and offers them an opportunity to reflect on their care for dependent patients and adapt it to patients' experiences. Further studies are needed with nurses and patients in different ICUs, cultures and countries, to gain a broader picture of experiences of nursing care dependency. Relevance to Clinical Practice: ICU nurses need strong relational skills to offer high‐quality care for dependent patients, facilitating meaningful nurse–patient relationships based on empathy and trust. These relationships can significantly impact the patient's experience of dependence. [ABSTRACT FROM AUTHOR]

Undertaking an authentic interprofessional simulation experience may be a useful and consistent strategy for healthcare professional students to build competencies required for a rural healthcare context. An observational comparative study design was adopted to evaluate a clinical simulation experience created to develop the interprofessional competencies of a sample of healthcare professional students at a regional university situated on multiple campuses in New South Wales (NSW), Australia. Over 200 students across three campuses of the university were involved in a simulation experience that included four interprofessional activities. Of these students, 189 (89%) agreed to participate in the study. The healthcare professional students who participated in the study were from second year occupational therapy, physiotherapy, and podiatry, and third year speech pathology programs. Retrospective pre and post self-assessed interprofessional collaborative competencies were compared for all students using the revised Interprofessional Collaborative Attainment Survey (ICCAS). Results demonstrated a statistically significant improvement in self-perceived scores using the validated revised ICCAS survey. The findings of this study suggest that carefully designed and authentic interprofessional simulation experiences can facilitate the development of competencies required for effective interprofessional practice, which are necessary for successful rural practice. [ABSTRACT FROM AUTHOR]

Interprofessional (IP) education is imperative to foster collaboration within and between healthcare professions to improve healthcare delivery and outcomes. Increasing the capacity of health professions faculty to effectively deliver learning about IP knowledge and skills fosters sustainability of IP care in health systems. This short report describes a series of three virtual IP faculty development workshops during 2020–2021 that used a Train-the-Trainer approach and adopted flexible and context-specific teaching methods to enhance learning. The collaboration involved interprofessional researchers from the University of Washington Center for Health Sciences Interprofessional Education, Research, and Practice and Kenyan health professions faculty and was supported by a global health grant. Learners were drawn from multiple health professions and healthcare institutions in Kenya. Content was packaged in lectures, videos, pictures, and session notes. Teaching methods adopted included lecturing, discussing, playing videos, interpretation of pictures, and reading text notes. The Train-the-Trainer approach helped ensure that workshop content and plans were relevant to participants. Workshop participants shared positive feedback about the trainings and showed a good grasp of the concepts and skills. In-built feedback mechanisms in training were key in supporting the programme and ensured continuous improvement within and between sessions. This collaboration offers an innovative example of a global partnership to support IP faculty development and mainstreaming of IPE in training and in practice. [ABSTRACT FROM AUTHOR]

Background: Per oral endoscopic myotomy (POEM) is a safe therapy for the treatment of achalasia. Long-term effects of untreated achalasia include worsening dysmotility and disruptions in esophageal anatomy, i.e., tortuosity and dilation. We hypothesize that long-standing achalasia prior to intervention will have worse outcomes following POEM than in patients with symptoms for shorter duration. Methods: We retrospectively analyzed achalasia patients who underwent POEM at our institution from 2011 to 2023, categorizing them into symptom duration cohorts (< 1 year, 1–3 years, 4–10 years, > 10 years). Inclusion criteria comprised patients with documented achalasia diagnosis who received POEM treatment at our facility. Exclusion criteria encompassed individuals lacking data pertaining to achalasia diagnosis, the time frame before intervention, or those missing pre and postoperative Eckardt scores. POEM failure was defined as symptom recurrence, necessity for repeat intervention, or high postoperative Eckardt score. We compared demographic, preoperative, and postoperative outcomes across these cohorts, and employed multivariable logistic regression to explore the link between symptom duration and POEM response. Results: During the study period, in our increased cohort 234 patients met inclusion criteria. 75 patients had symptoms for < 1 year, 78 patients had symptoms from 1 to 3 years, 47 patients had symptoms from 4 to 10 years, and 34 patients had symptoms > 10 years. Patient demographics such as age, sex, BMI, Charleson-Deyo-Comorbidity-Index, and diabetes did not differ amongst cohorts. High-resolution manometry data, including achalasia type, Median IRP, LES residual pressure, and Basal LES pressure did not differ between groups. Preoperative Eckardt scores ranged from 4 to 5 across groups (p 0.24). Patients endorsed an average of three total preoperative symptoms across groups (p 0.13). Patients with symptoms greater than 4 years had significantly more endoscopic interventions prior to POEM (37% vs, 68% p.001). There was no significant difference in post-procedure mean Eckardt scores between cohorts. All cohorts experienced the same number of post-POEM symptoms. Post-POEM manometric measurements remained consistent across cohorts. Similarly, there were no significant differences in terms of symptom recurrence, requirement for repeat interventions, or repeat POEM among the cohorts. Multivariable logistic regression analysis determined achalasia symptoms greater than a decade did not result in increased odds of having a higher postoperative Eckardt score, worse dysphagia, regurgitation, or weight loss. Conclusions: In this increased cohort, this data once again suggests that longer symptom duration is not associated with increased rates of POEM failure. [ABSTRACT FROM AUTHOR]

Introduction: Management of gastroesophageal reflux disease after bariatric procedures can be challenging. There are very few long-term studies in this arena. This study aims to evaluate the long-term outcomes of the magnetic sphincter augmentation (MSA) reflux management system in a cohort of bariatric patients who had previously undergone sleeve gastrectomy and Roux-en-Y gastric bypass, with a focus on assessing gastroesophageal reflux disease (GERD) scores, medication use, and patient-reported symptoms. Methods: We conducted a retrospective chart review of 16 consecutive bariatric patients who received MSA implants following sleeve gastrectomy (n = 14) or gastric bypass (n = 2) surgeries. Data were collected regarding BMI, GERD quality of life assessments (GERD-HRQL), reflux symptoms, and use of PPIs in the sleeve/RGB patients through an extended period with a mean follow-up of 48 months. Results: Patients were followed up for a range of.5–84 months. Preoperative assessments included upper gastrointestinal imaging (UGI), high-resolution manometry, Bravo pH studies, and esophagogastroduodenoscopy (EGD). Three patients exhibited reflux on UGI, and 13/13 patients had positive Bravo studies preoperatively. Sixteen patients had a lower esophageal sphincter (LES) pressure under 18 mmHg, and eight patients had biopsy-proven esophagitis. Long-term outcomes are as follows. Daily PPI use fell from 88 to 25% at greater than three years. GERD-HRQL scores fell from 50.6 at baseline (range 27–70) and normalized at long-term follow-up. GERD symptom of regurgitation completely resolved. At long term, two patients had dysphagia and two patients had ongoing reflux. No adverse events were noted. Conclusion: This is the first long-term outcomes study of magnetic sphincter augmentation placement after bariatric surgery. Our study showed the majority of patients had long-term improvement in GERD-HRQL scores and resolution/ relief of their reflux symptoms, with decreased use of PPIs. MSA is a safe, effective and durable management tool for reflux after bariatric surgery in carefully selected patients. [ABSTRACT FROM AUTHOR]

Background: Few studies have evaluated the use of laparoscopic staplers in robotic procedures (bedside stapling, BS). This study aims to evaluate the effectiveness of BS compared with robotic staplers (RS) in bariatric robotic procedures. Methods: Patients who underwent robotic sleeve gastrectomy or gastric bypass elective procedures between 1/1/2021 and 12/31/2021 were extracted from PINC AI™ Healthcare Data. The following clinical outcomes were compared: blood transfusion, bleeding, anastomotic leak, intensive care unit (ICU) visit, and 30-day readmission, operating room (OR) time, inpatient costs, and length of stay. We evaluated baseline balance in BS and RS and bivariate association between covariates and outcomes using Chi-square or Fisher exact test and t-test or ANOVA. Multivariable general linear mixed models (GLMMs) with respective gamma or binomial distribution and log-link function were used to obtain adjusted outcomes variations between BS and RS. Results: Total of 7268 discharges were included with 1603 (22.1%) BS and 5665 (77.9%) RS cases. RS cases consisted of a higher number of patients who were Hispanic (17.0% vs. 9.4%), had Medicaid (26.9% vs. 19.4%) and underwent sleeve gastrectomy (68.4% vs. 53.5%). Higher proportions of RS cases were done by providers in Northeast region (35.5% vs. 24.3%), smaller size (< 500 beds; 71.1% vs. 52.3%), and teaching hospitals (59.4% vs. 39%). The adjusted outcomes variations demonstrated that patients that had RS were significantly more likely to have blood transfusions, ICU stays, increased ORT (19 min) and costs ($1273). Sensitivity analysis showed similar results, except no significant differences in blood transfusion rates in both groups. Conclusions: Bedside staplers significantly reduce healthcare resource utilization with equivalent effectiveness and fewer ICU stays compared to robotic staplers. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic simultaneous resection (LSR) of primary colorectal tumors and synchronous colorectal liver metastases (sCRLM) has been recently performed. This study aimed to evaluate the postoperative outcomes after LSR and determine the risk factors for resection surface-related complications (RSRC), such as postoperative biliary fistula and liver-transection surface abscess. Methods: Between 2009 and 2022, consecutive patients with sCRLM who underwent LSR were included. We retrospectively analyzed clinicopathological data, including intraoperative factors and postoperative outcomes. The difficulty level of all liver resections was classified according to the IWATE difficulty scoring system (DSS). We then performed univariate and multivariate analyses to identify the risk factors for RSRC. Results: Of the 112 patients, 94 (83.9%) underwent partial hepatectomy and colorectal surgery. The median DSS score was 5 points (1–11), with 12 (10.7%) patients scoring ≥ 7 points. Postoperative complications were observed in 41 (36.6%) patients, of whom 16 (14.3%) experienced severe complications classified as Clavien–Dindo grade IIIa or higher. There was no postoperative mortality. The most common complication was RSRC (19 patients, 17.0%). Multivariate analysis identified American Society of Anesthesiologists (ASA) classification ≥ 3 [odds ratio (OR) 10.3, 95% confidence interval (CI) 1.37–77.8; P = 0.023], DSS score ≥ 7 points (OR 5.08, 95% CI 1.17–20.0; P = 0.030), and right-sided colectomy (OR 4.67, 95% CI 1.46–15.0; P = 0.009) as independent risk factors for RSRC. Postoperative hospital stays were significantly longer for patients with RSRC than for those without RSRC (22 days vs. 11 days; P < 0.001). Conclusion: Short-term outcomes of LSR for patients with sCRLM were acceptable in an experienced center. RSRC was the most common complication, and high-difficulty hepatectomy, right-sided colectomy, and ASA classification ≥ 3 were independent risk factors for RSRC. [ABSTRACT FROM AUTHOR]

Portuguese and Azorean immigrants make up 0.4% of the United States population, but they comprise over 6% of the population of Rhode Island. A vast number of Azorean immigrants in this region have made immense contributions to our medical community and the local cultural identity. Within Rhode Island Hospital (RIH), the roles held by staff who are Azorean immigrants are critical in maximizing the quality of care and efficiency of a large academic medical center. To properly illustrate their contributions, we highlight the experiences of four Azorean immigrants with decades of experience at RIH. Much like how the keelson is a structural member that provides continuity and connects the bow stem, frames, and transom to hold a whaleboat or wooden vessel together, these stalwart employees have long done similarly for Rhode Island’s only tertiary care center. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate and compare responsiveness characteristics for the Foot Function Index revised short form (FFI-RS), RAND-12 Health Status Inventory (RAND-12), and Numeric Rating Scale (NRS), in patients with plantar fasciopathy receiving non-surgical treatment. Materials and methods: This study was conducted on a sub-group of patients from an ongoing randomised controlled trial. One-hundred fifteen patients were included. The patient-reported outcome measures (PROMs) were applied at baseline and after 6 months. Responsiveness was calculated using standardised response mean and area under the receiver operating characteristic (ROC) curve. ROC curves were used to compute the minimal important change (MIC) for the outcome measures. Results: The region specific FFI-RS had best responsiveness and the NRS at rest had lowest responsiveness. Conclusion: FFI-RS were marginally more responsive than the other PROMs. Responsiveness and MIC estimates should be regarded as indicative rather than fixed estimates. IMPLICATIONS FOR REHABILITATION: The region-specific Foot Function Index Revised Short Form could, based on responsiveness perspectives, be recommended as an outcome measurement for patients with plantar fasciopathy. Responsiveness and minimal important change estimates are indicative and should be interpreted with caution. [ABSTRACT FROM AUTHOR]

This article discusses a new approach to reconstruct upper medial eyelid defects. The case study involves a 69-year-old female with a basal cell carcinoma on her right upper medial eyelid. The defect was successfully reconstructed using a combination of a rotation flap from the upper eyelid and a full-thickness skin graft from the ipsilateral temple. The approach aimed to optimize functional and aesthetic outcomes by concealing incision scars, reducing the risk of complications such as ectropion or ptosis, and using a donor site with similar thickness, texture, and color to the eyelid. The patient was highly satisfied with the cosmetic outcome. [Extracted from the article]

Context.--Clinical, dermoscopic, and histologic diagnostic criteria may overlap in cases with scarring and nonscarring alopecia, making diagnosis difficult for clinicians and pathologists. New histopathologic discoveries indicate that the cutaneous adnexal structural and homeostatic unit made up of the pilosebaceous unit, eccrine sweat gland coils (ESGCs), and dermal white adipose tissue may have a role in hair follicle renewal. Objective.--To verify the presence of adipose tissue in the dermis at the level of the isthmus, infiltrating the bundles of the arrector pili muscle in biopsies from the scalp of 3 scarring alopecias: frontal fibrosing alopecia (FFA), fibrosing alopecia in a pattern distribution (FARD), and lichen planopilaris (LPP). Design.--We performed a retrospective and descriptive survey of 71 female scalp biopsies from 2016 to 2022 diagnosed at the Dermatopathology Laboratory at Fluminense Federal University of Rio de Janeiro. Two pathologists reviewed and diagnosed the cases, correlating pathologic features with clinical and dermoscopic findings. Results.--The histopathologic findings of adipose tissue infiltration in the dermis at the level of the isthmus and in the bundles of the arrector pili muscle and the displacement of ESGCs were more frequently identified in FFA, followed by FARD and less frequently found in LRR. Conclusions.--According to our research, adipose tissue infiltration in the dermis at the level of the isthmus and in the bundles of the arrector pili muscle and the displacement of ESGCs were observed in 3 scarring alopecias (FFA, FARD, and LRR) and seems to be involved in the development of scarring alopecia. [ABSTRACT FROM AUTHOR]

Coaching has become increasingly popular as a mechanism to support learning across the health professions education (HPE) continuum. While there is a growing body of literature in this area, there is minimal guidance related to the design and implementation of academic coaching in health professional courses. This paper seeks to contribute to this literature by presenting guidance for academic developers who are considering introducing academic coaching into a health professional course. The 12 tips are based on the authors' collective experiences of designing and implementing academic coaching in university medical courses in Australia and the UK. Although focused on medical education, this paper is intended to have applicability across the health professions, and potentially across university and postgraduate training contexts. Together, the tips offer a strategic and operational framework to guide the design and implementation of academic coaching initiatives in health professions education. [ABSTRACT FROM AUTHOR]

An excessive rise in systolic blood pressure (SBP) during exercise has been linked to increased risk of cardiovascular disease. Hypertensive individuals have been shown to have an exaggerated blood pressure (BP) response to exercise. However, research is limited on the impact of chronic antihypertensive medication use on the exercise BP response. Purpose: To determine if individuals chronically (>1 yr) prescribed antihypertensive medications have a normal BP response to peak exercise compared with unmedicated individuals. Methods: Participants included 2555 adults from the Ball State Adult Fitness Longitudinal Lifestyle STudy cohort who performed a peak treadmill exercise test. Participants were divided into groups by sex and antihypertensive medication status. Individuals prescribed antihypertensive medications for >1 yr were included. Exaggerated and blunted SBP within each group was categorized using the Fitness Registry and the Importance of Exercise: A National Database (FRIEND) and absolute criteria as noted by the American Heart Association. Results: The unmedicated group had a greater prevalence (P < 0.05) of blunted SBP responses, whereas the medicated group had a higher prevalence (P < 0.05) of exaggerated SBP responses using both the FRIEND and absolute criteria. Peak SBP was higher (P < 0.01) in medicated compared with unmedicated participants in the overall cohort when controlling for age and sex, but not after controlling for resting SBP (P = 0.613), risk factors (P = 0.104), or cardiorespiratory fitness (P = 0.191).When men and women were assessed independently, peak SBP remained higher in the medicated women after controlling for age and resting SBP (P = 0.039), but not for men (P = 0.311). Individuals on betablockers had a higher peak SBP even after controlling for age, sex, risk factors, and cardiorespiratory fitness (P = 0.022).Conclusions: Individuals on antihypertensive medications have a higher peak SBP response to exercise. Given the prognostic value of exaggerated peak SBP, control of exercise BP should be considered in routine BP assessment and in the treatment of hypertension. [ABSTRACT FROM AUTHOR]

Severe uveitis is a rare complication of interleukin-4 receptor alpha blocking by dupilumab in topic dermatitis (AD) patients. The aim of this study was to describe five moderate-to-severe AD patients who developed uveitis during dupilumab treatment and to compare the proteomic profile of aqueous humor (AqH) of dupilumab-associated uveitis (n=3/5 available samples) with non-infectious uveitis (n=27) and cataract controls (n=11). Included patients were treated at the University Medical Center Utrecht (the Netherlands). Active dupilumab-associated uveitis complicated by serous detachment, cystoid macular edema, or secondary glaucoma developed within a median of 6.0 months (interquartile range 2.3–16.5 months) after starting dupilumab. Uveitis resolved after discontinuation of dupilumab and/or treatment with local or systemic corticosteroids. Proteomic profiling of AqH revealed that the molecular profile of dupilumab-associated uveitis resembled that of non-infectious uveitis. In conclusion, dupilumab-associated uveitis is a severe adverse event of dupilumab therapy, requiring urgent referral to an ophthalmologist. [ABSTRACT FROM AUTHOR]

The American College of Rheumatology and the US Food and Drug Administration co‐sponsored a public meeting in May 2022 about challenges in the clinical development of drugs for rheumatoid arthritis (RA) and psoriatic arthritis (PsA), focusing on innovative clinical trial designs, outcome measures, and data collection methods. Recommendations include early dose‐ranging studies and use of active comparators. Challenges and opportunities in assessing long‐term safety by leveraging real‐world data from electronic health records (EHRs) and claims data are discussed, along with insights from European registries and the evolving role of real‐world evidence and artificial intelligence in regulatory evaluations. Endpoints for assessing disease activity and outcome measures used in RA and PsA trials are explored, emphasizing challenges in defining remission, assessing clinical response, and evaluating structural progression. The need for outcome measures that better reflect treatment targets and the potential of advanced imaging in future trials are highlighted. Challenges with placebo‐controlled trials in RA are discussed and use of non‐inferiority clinical trial design, in which new drugs are evaluated with active comparators, is proposed. Pragmatic trials in RA and PsA, employing decentralized approaches, are highlighted for their real‐world relevance and administrative efficiencies. Strategies for identifying at‐risk populations for RA and the challenges of using EHRs and insurance claims data in drug development are discussed. Registry data and digital health technologies show promise in bridging the gap between clinical trials and real‐world effectiveness. [ABSTRACT FROM AUTHOR]

Background: Community health centers grapple with high no-show rates, posing challenges to patient access and primary care provider (PCP) utilization. Aim: To address these challenges, we implemented a virtual waiting room (VWR) program in April 2023 to enhance patient access and boost PCP utilization. Setting: Academic community health center in a small urban city in Massachusetts. Participants: Community health patients (n = 8706) and PCP (n = 14). Program Description: The VWR program, initiated in April 2023, involved nurse triage of same-day visit requests for telehealth appropriateness, then placing patients in a standby pool to fill in as a telehealth visit for no-shows or last-minute cancellations in PCP schedules. Program Evaluation: Post-implementation, clinic utilization rates between July and September improved from 75.2% in 2022 to 81.2% in 2023 (p < 0.01). PCP feedback was universally positive. Patients experienced a mean wait time of 1.9 h, offering a timely and convenient alternative to urgent care or the ER. Discussion: The VWR is aligned with the quadruple aim of improving patient experience, population health, cost-effectiveness, and PCP satisfaction through improving same-day access and improving PCP schedule utilization. This innovative and reproducible approach in outpatient offices utilizing telehealth holds the potential for enhancing timely access across various medical disciplines. [ABSTRACT FROM AUTHOR]

Objective: Determine whether patient-level or provider-level factors have greater influence on patient satisfaction scores in an academic general internal medicine clinic. Methods: Two years of data (2017–2019) from the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) surveys from ambulatory internal medicine clinic visits in an academic health center located in the Midwest United States were used. Patient satisfaction was measured using the overall provider satisfaction score (0–10), dichotomized with 9–10 defined as satisfactory and 0–8 as unsatisfactory. Provider-level independent variables included age, sex, race/ethnicity, provider type, service type, clinical effort, academic rank, and years since graduation. Patient-level factors included age, sex, race/ethnicity, education, and Epic Risk Score. Generalized mixed-effects logistic regression models were used to investigate associations between top-box satisfaction score and patient- and provider-level factors, accounting for the nesting of patients within providers. Results: Thirty-three providers and 4597 patients were included in the analysis. Male providers (OR, 1.57; 95% CI, 1.00, 2.47), minority group 2 (OR, 3.54; 95% CI, 1.24, 10.07) and minority group 3 (OR, 6.04; 95% CI, 1.45, 25.12), faculty (OR, 3.83; 95% CI, 1.56, 9.36), and primary care providers (OR, 5.60; 95% CI, 1.62, 19.34) had increased odds of having a top-box rating compared with females, minority group 1, advanced practice providers, and perioperative providers respectively. Age was the only patient independent correlate of top-box rating with a 3% increased odds of top-box rating for every year increase in age (OR, 1.03; 95% CI 1.02, 1.03). Conclusions: In this academic general internal medicine clinic, top-box satisfaction scores were more strongly associated with provider-level factors, including provider race/ethnicity, provider type, and service type, as opposed to patient-level factors. Further research is needed to confirm these findings and identify potential system-level interventions. [ABSTRACT FROM AUTHOR]

Background: Studies investigating the quality of the diet and dietary intake of children with Down syndrome (DS) are required because the features attributed to the syndrome can affect growth, development and quality of life. Methods: This cross‐sectional study was conducted with 77 Brazilian children with DS between 5 and 36 months of age receiving care at the multidisciplinary outpatient clinic of the University Hospital. Participants' sociodemographic, dietary and anthropometric data were collected from the care protocols. Dietary data were collected from 24‐h recalls and dietary practices were assessed according to the WHO dietary guidelines. Associations between inadequate feeding practices and demographic variables were assessed using logistic regression models. Results: Fruits, milk or infant formula, vegetables, beans and meat were among the five most consumed foods by the children investigated. Overall, we observed a high number of cases of early weaning (50.6%), low minimum dietary diversity (MDD; 40.3%), inadequate consistency for age (64.9%), early presence of ultra‐processed foods (76.6%), sugars and sweets (33.8%) in the diet of the children with DS. In the associations of inadequate feeding practices by age group, low MDD [odds ratio (OR): 18.6; 95% confidence interval (CI): 3.4; 57.1] and inadequate consistency (OR: 6.65; 95% CI: 1.8; 24.7) were more frequent among children aged below 12 months while this relationship was inverse for early introduction of sugar and sweets (OR: 0.04; 95% CI: 0.01; 0.29). Conclusion: Our findings showed a high number of cases of inadequate dietary practices in children with DS investigated, which could adversely affect the long‐term health of this population. [ABSTRACT FROM AUTHOR]

Psychotherapy has historically focused on symptom reduction. However, there are calls for increasing our understanding of how psychotherapy impacts clients' flourishing. In this study, licensed mental health professionals and trainees across different clinical settings with diverse therapeutic orientations were interviewed about their perspectives on the cultivation of flourishing in psychotherapy, as well as their own personal experiences with flourishing. We were interested in understanding how therapists define flourishing, how they integrate flourishing into their work with clients, and any barriers or catalysts for engaging in this process. To do so, we conducted eight focus groups, and interviews were analyzed using grounded theory to form a hierarchy of categories. The results were used to create a three-part grounded theory. Results suggested that flourishing is a distinct concept from well-being that involves active engagement, emotional connection and meaning making. Our three-part grounded theory of flourishing elucidates how flourishing can be pursued by guiding clients towards their experiences of suffering in order to engage in meaning making and to identify their values, as well how systemic barriers can be navigated. Themes emerged related to the training of psychotherapists to promote flourishing, and the associated clinical and training implications are discussed [ABSTRACT FROM AUTHOR]

This study examined the effects of an intervention package using high-tech augmentative and alternative communication (AAC) with Naturalistic Instruction (NI), time delay, and prompting during social routines for preschoolers on the autism spectrum. The AAC was a communication application on a tablet programmed with color photo representations of participants and communication partners engaged in social routines. The primary dependent measure was a linguistic communication turn on the AAC device completing the instructor's cloze phrase related to the routine. A secondary dependent measure was prelinguistic communication –nonspecific vocalizations and smiling – within each turn of the routine. Results indicated that all communication types increased and maintained for all three participants with two participants meeting mastery criteria within the minimal number of sessions. These results are significant in providing additional evidence for the effectiveness of AAC intervention beyond teaching simple object requests and in teaching more socially meaningful communication to children on the autism spectrum. Additionally, this study supports the use of color photo representations to promote social interaction. Future research should continue to evaluate such interventions on a larger scale and include naturally occurring communication partners, such as siblings and peers. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to examine the effect of professional and individual characteristics, practice environments and psychological empowerment perceptions of nurses on their care behaviours. Design: The study used a cross‐sectional research design following the STROBE guidelines. Methods: The sample of this descriptive and correlational study consisted of 584 nurses working in a university hospital in Turkey. The data were collected between January and June 2023 using the Nursing Information Form, the Practice Environment Scale of the Nursing Work Index (PES‐NWI), the Psychological Empowerment Scale (PES), and the Caring Behaviours Scale‐30, and analysed using descriptive statistics, Spearman's correlation and multiple linear regression. Results: It was determined that PES‐NWI, PES and Caring Behaviours Scale (CBI‐30) scores of nurses were higher than the average. The study revealed that certain professional and individual characteristics of nurses, practice environments and psychological empowerment perceptions had an effect on their care behaviours. Conclusion: The results of the study showed that nurses' PES‐NWI, PES and CBI‐30 scores were higher than the average, and that certain professional and individual characteristics of nurses, practice environments and psychological empowerment perceptions had an effect on care behaviours. Nursing service managers, in particular, are required to understand the importance of this relationship and create appropriate working conditions which are integrated with psychological empowerment to improve caring behaviours of nurses. [ABSTRACT FROM AUTHOR]

Rationale: Cardiac monitoring has often been identified as an area of overutilization and remains a limited resource in many hospitals. With the aim of reducing telemetry overuse, we added clinical decision support to our health system's telemetry order with guidance on appropriate indications for monitoring. The new order requires selection of an appropriate clinical indication. Aims and Objectives: In this study, we aimed to understand provider engagement with this tool by assessing concordance between selected indications within the order and the clinical presence of those conditions as documented within the patient chart. Methods: We randomly selected 100 telemetry orders from July to October 2022 across four different hospitals at NYU Langone Health. Two independent, blinded reviewers used a structured protocol to identify documentation of actual indications for telemetry in each selected chart. We calculated the rate of concordance between indications selected in the order and indications that were determined to be clinically present on chart review. Results: There were 30,839 telemetry orders placed during the study timeframe. Overall concordance between the selection within the order and the actual indication was 48% (95% confidence interval [CI], 38.21%−57.79%). We observed especially low concordance rates for vague indications, such as 'Other', and for 'Confirmed Stroke', which was the only indication allowing for indefinite telemetry. Conclusion: The overall low concordance suggests a disconnect between the support tool and clinical practice. Providers are more likely to select an indication that reduces downstream work regardless of a patient's true clinical indication. [ABSTRACT FROM AUTHOR]

Purpose This project aimed to characterize the resources necessary for pharmacists to support the required steps for obtaining and handling investigational drugs outside of a study protocol in the individual patient and intermediate-size population Expanded Access Program (EAP) processes. The second aim was to characterize the types of EAP requests received. Summary This retrospective, single-center, observational study was performed by reviewing EAP requests initiated at Duke University Hospital (DUH) between August 1, 2017, and February 11, 2023. The annualized cost of unreimbursed EAP study services was projected to be approximately $196,500 at DUH for 2023. Of the 168 EAP requests submitted after the institutional policy requiring pharmacy and therapeutics (P&T) committee approval was established, 162 (96.4%) were approved by the P&T committee. Conclusion Given the lack of published information on a pharmacist-led workflow related to EAP services, this study sought to share DUH's process for managing EAP requests. As there is no mechanism for reimbursement of EAP services, they can be difficult to manage given the labor resources required. Further work is needed to recoup unreimbursed investigational drug service labor costs to ensure compassionate use programs can be implemented in a manner that is financially sustainable for a health system. [ABSTRACT FROM AUTHOR]

Purpose The fast-paced environment of the emergency department (ED), with frequent admissions, discharges, and transfers, poses a challenge for pharmacy departments to effectively distribute and store medications. The purpose of this study is to propose a unique workflow of patient-specific medication delivery to the ED from a hospital pharmacy to reduce the number of missing medications resulting in medication messages and redispenses. Methods The medication delivery workflow proposed in this study consists of batching the preparation and distribution of patient-specific medications sent from the pharmacy to the ED in the 1 to 2 hours prior to their administration time. Chi-square analysis was completed to compare medication redispenses and "missing medication" messages before and after the intervention, with the significance level set at P < 0.05. Results The percentage of redispensed medications was effectively decreased following implementation of the workflow change from 21.6% to 9.2% (P < 0.001), with unit doses having the greatest reduction (25.8% vs 6.1%, P < 0.001). Benefits of this workflow change were also illustrated through a reduction in the percentage of missing-medication messages sent by nursing staff from 97.7% to 93.9% (P < 0.001). Conclusion This study showed that implementation of standard, hourly batches of medications dispensed from the pharmacy to the ED resulted in a significant reduction in the total percentage of redispensed medications and missing-medication messages. The overall reduction in redispensed medications as a result of this innovative workflow change not only benefited nursing and pharmacy staff but can reduce medication waste and improve patient care through timely administration of medications. [ABSTRACT FROM AUTHOR]

As value-based health care arrangements gain traction in spine care, understanding the true cost of care becomes critical. Historically, inaccurate cost proxies have been used, including negotiated reimbursement rates or list prices. However, time-driven activity-based costing (TDABC) allows for a more accurate cost assessment, including a better understanding of the primary drivers of cost in 1-level lumbar fusion. To determine the variation of total hospital cost, differences in characteristics between high-cost and nonhigh-cost patients, and to identify the primary drivers of total hospital cost in a sample of patients undergoing 1-level lumbar fusion. Retrospective, multicenter (one academic medical center, one community-based hospital), observational study. A total of 383 patients undergoing elective 1-level lumbar fusion for degenerative spine conditions between November 2, 2021 and December 2, 2022. Total hospital cost of care (normalized); preoperative, intraoperative, and postoperative cost of care (normalized); ratio of most to least expensive 1-level lumbar fusion. Patients undergoing a 1-level lumbar fusion between November 2, 2021 and December 2, 2022 were identified at two hospitals (one quaternary referral academic medical center and one community-based hospital) within our health system. TDABC was used to calculate total hospital cost, which was also broken up into: pre-, intra-, and postoperative timeframes. Operating surgeon and patient characteristics were also collected and compared between high- and nonhigh-cost patients. The correlation of surgical time and cost was determined. Multivariable linear regression was used to determine factors associated with total hospital cost. The most expensive 1-level lumbar fusion was 6.8x more expensive than the least expensive 1-level lumbar fusion, with the intraoperative period accounting for 88% of total cost. On average. the implant cost accounted for 30% of the total, but across the patient sample, the implant cost accounted for a range of 6% to 44% of the total cost. High-cost patients were younger (55 years [SD: 13 years] vs 63 years [SD: 13 years], p=.0002), more likely to have commercial health insurance (24 out of 38 (63%) vs 181 out of 345 (52%), p=.003). There was a poor correlation between time of surgery (ie, incision to close) and total overall cost (ρ:.26, p<.0001). Increase age (RC: -0.003 [95% CI: -0.006 to -0.000007], p=.049) was associated with decreased cost. Surgery by certain surgeons was associated with decreased total cost when accounting for other factors (p<.05). A large variation exists in the total hospital cost for patients undergoing 1-level lumbar fusion, which is primarily driven by surgeon-level decisions and preferences (eg, implant and technology use). Also, being a "fast" surgeon intraoperatively does not mean your total cost is meaningfully lower. As efforts continue to optimize patient value through ensuring appropriate clinical outcomes while also reducing cost, spine surgeons must use this knowledge to lead, or at least be active participants in, any discussions that could impact patient care. [ABSTRACT FROM AUTHOR]

Background: General surgeons in rural communities face unique challenges due to broad scopes of practice with limited support and difficulties providing training. In 1998, this academic medical center initiated a rural program consisting of senior level rotations in rural communities. We surveyed past residents to determine scope of practice, level of preparedness, and recommendations. Methods: The survey was sent to n = 89 residents and n = 34 surveys were completed. Of those, 85% took part in the rural program, 23.5% practice in a zip code defined as rural by HRSA, and 53% had fellowship training most commonly vascular (n = 5), critical care (n = 5), cardiothoracic (n = 3), and MIS (n = 3). Most common procedures reported were MIS (64.7%), vascular (38.2%), cardiothoracic (26.5%), hepatobiliary (23.5%), and pediatric (23.5%). Results: Over 97% of participants were satisfied/very satisfied with their overall program, and 94% were satisfied/very satisfied with their preparedness for rural surgery. When prompted with, "A general surgery program must have some type of rural specific specialized curriculum and extended rotations to facilitate a career path in rural general surgery," 41.2% responded strongly agree, 47.1% agree, and 11.8% neutral. Recommendations for bolstering a rural program included urology (59%), MIS (59%), vascular (56%), OBGYN (47%), and pediatrics (38%). Regarding non-surgical education, residents felt underprepared for billing (79.4%) and administration (50.0%). Discussion: Although satisfaction scores were high, improvements to better prepare surgeons for rural practice include increasing residents' exposure and training in OBGYN, MIS, vascular, urology, and billing and administration. These results should direct programs to prepare surgeons for effective rural practice. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the effects of music intervention on quality of life, anxiety, and fatigue among patients with breast cancer. SAMPLE & SETTING: 170 individuals from the general surgery unit of Kaohsiung Chang Gung Memorial Hospital in Taiwan. METHODS & VARIABLES: Individuals who had received a mastectomy were randomly assigned to a treatment group or control group. In the treatment group, participants received music intervention for an hour each week, totaling 12 hours during 12 consecutive weeks. The primary variable was quality of life, and secondary variables were anxiety and fatigue. RESULTS: Greater quality of life was seen in the treatment group at 12 weeks. In the treatment group, participants showed significant improvement in State-Trait Anxiety Inventory (trait), which was most significant at eight weeks. No statistically significant difference was observed in fatigue levels after 4, 8, and 12 weeks of music intervention. IMPLICATIONS FOR NURSING: Music intervention may improve anxiety and quality of life of patients with breast cancer. Music intervention could be established following mastectomy and continued throughout recovery. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To measure baseline work gratitude among nurses and staff on a blood and marrow transplantation unit; to evaluate the impact of a positive workplace recognition intervention on work gratitude, sense of belonging and community, and job satisfaction; and to explore the relationships among these variables and job satisfaction. SAMPLE & SETTING: In total, 40 survey responses (preintervention =24, postintervention = 16) were collected from nurses and staff on a blood and marrow transplantation unit at a large academic hospital. METHODS & VARIABLES: A pre- and postintervention survey included a demographic questionnaire and the Work Gratitude Scale. Publicfacing digital signage was installed and used to project positive recognition, including expressions of gratitude from patients and staff. RESULTS: Those with higher job satisfaction and a stronger sense of belonging and community reported higher work gratitude scores. There were no significant changes in job satisfaction, sense of belonging and community, and work gratitude scores. IMPLICATIONS FOR NURSING: Creating a positive work environment through gratitude and positive recognition could increase job satisfaction and sense of belonging and community among nurses and staff. [ABSTRACT FROM AUTHOR]

Background: Gender clinic and single‐item questionnaire‐based data report increased co‐occurrence of gender diversity and neurodevelopmental conditions. The nuances of these associations are under‐studied. We used a transdiagnostic approach, combining categorical and dimensional characterization of neurodiversity, to further the understanding of its associations with gender diversity in identity and expression in children. Methods: Data from 291 children (Autism N = 104, ADHD N = 104, Autism + ADHD N = 17, neurotypical N = 66) aged 4–12 years enrolled in the Province of Ontario Neurodevelopmental Network were analyzed. Gender diversity was measured multi‐dimensionally using a well‐validated parent‐report instrument, the Gender Identity Questionnaire for Children (GIQC). We used gamma regression models to determine the significant correlates of gender diversity among age, puberty, sex‐assigned‐at‐birth, categorical neurodevelopmental diagnoses, and dimensional neurodivergent traits (using the Social Communication Questionnaire and the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Rating Scales). Internalizing and externalizing problems were included as covariates. Results: Neither a categorical diagnosis of autism nor ADHD significantly correlated with current GIQC‐derived scores. Instead, higher early‐childhood dimensional autistic social‐communication traits correlated with higher current overall gender incongruence (as defined by GIQC‐14 score). This correlation was potentially moderated by sex‐assigned‐at‐birth: greater early‐childhood autistic social‐communication traits were associated with higher current overall gender incongruence in assigned‐males‐at‐birth, but not assigned‐females‐at‐birth. For fine‐grained gender diversity domains, greater autistic restricted‐repetitive behavior traits were associated with greater diversity in gender identity across sexes‐assigned‐at‐birth; greater autistic social‐communication traits were associated with lower stereotypical male expression across sexes‐assigned‐at‐birth. Conclusions: Dimensional autistic traits, rather than ADHD traits or categorical neurodevelopmental diagnoses, were associated with gender diversity domains across neurodivergent and neurotypical children. The association between early‐childhood autistic social‐communication traits and overall current gender diversity was most evident in assigned‐males‐at‐birth. Nuanced interrelationships between neurodivergence and gender diversity should be better understood to clarify developmental links and to offer tailored support for neurodivergent and gender‐diverse populations. [ABSTRACT FROM AUTHOR]

Background: Previous research has shown a significant link between gut microbiota in children with autism spectrum disorder (ASD) and attention‐deficit hyperactivity disorder (ADHD). However, much remains unknown because of the heterogeneity of disorders and the potential confounders such as dietary patterns and control group variations. Methods: Children aged 6–12 years who had been clinically diagnosed with ASD and/or ADHD, their unaffected neurotypical siblings, and non‐related neurotypical volunteers were recruited cross‐sectionally. The ASD diagnosis was confirmed using the Autism Diagnostic Observation Schedule‐2 (ADOS‐2) in all patients, including those with ADHD. Standardized DNA extraction and sequencing methods were used to compare gut microbial alpha‐diversity among the groups. Dietary diversity was calculated from a standardized dietary questionnaire form. We compared the difference in gut microbiome between patients with ASD and/or ADHD with neurotypical siblings and non‐related neurotypical controls. Results: Ninety‐eight subjects were included in the study (18 with ASD, 19 with ADHD, 20 with both ASD and ADHD, 13 neurotypical siblings, and 28 non‐related neurotypical controls). The alpha‐diversity indices, such as Chao 1 and Shannon index, showed a significant difference between the groups in a Linear mixed‐effect model (F(4, 93) = 4.539, p =.02), (F(4, 93) = 3.185, p =.017), respectively. In a post‐hoc pairwise comparison, patients with ASD had lower alpha‐diversity compared with non‐related controls after Bonferroni correction. Dietary diversity shown in Shannon index did not differ among the groups (F(4, 84) = 1.494, p =.211). Conclusions: Our study indicates disorder‐specific microbiome differences in patients with ASD. In future research on gut microbiota in neurodevelopmental disorders, it is necessary to consider the impact of ASD and ADHD co‐occurrence, and strictly control for background information such as diet, to elucidate the gut–microbiota interaction in ASD and ADHD for exploring the potential of therapeutic interventions. [ABSTRACT FROM AUTHOR]

Introduction: Acute pediatric mastoiditis is a bacterial infection of the mastoid bone most commonly associated with acute otitis media. Complicated mastoiditis is traditionally characterized by intracranial complications or subperiosteal abscess, but definitions are inconsistent in the literature. Surgical intervention is identified as the main treatment for complicated mastoiditis, but there is some evidence to support medical management of uncomplicated mastoiditis. This study sought to clarify the diagnostic criteria and management of uncomplicated acute mastoiditis. Methods: All cases of acute pediatric mastoiditis were identified from a single institution over a 16-year period and reviewed for demographic and clinical data. Two different definitions of uncomplicated mastoiditis were compared; the traditional one that excluded patients with intracranial complications or subperiosteal abscess (SPA) and the proposed definition that also excluded patients with any evidence of bony erosion including coalescence, not just SPA. Univariate and multivariate analysis was conducted. Results: Eighty cases were identified. Using the traditional definition of uncomplicated mastoiditis, 46.3% of cases were uncomplicated, compared to 36.2% when using the proposed definition. Truly uncomplicated patients, categorized with the proposed definition, were treated more consistently: no patients underwent mastoidectomy and they were less likely to receive a long term course of antibiotics. On multivariate regression analysis, only categorization with the proposed definition of uncomplicated mastoiditis was independently associated with less long-term antibiotic therapy and non-surgical management. Conclusion: Uncomplicated acute mastoiditis should be defined using clinical criteria and exclude any cases with evidence of bony erosion, including coalescence or subperiosteal abscess. These truly uncomplicated patients often do not require mastoidectomy and can be prescribed a shorter course of antibiotics. Further research into treatment pathways is necessary to optimize the management of uncomplicated acute pediatric mastoiditis. [ABSTRACT FROM AUTHOR]

Even in academic fields dominated by women students (e.g., educational research), academic careers are characterized by vertical gender segregation in favor of men. This clashes with the public understanding of educational research as a women's domain that is more strongly associated with warmth (a stereotypically feminine trait) than competence (a stereotypically masculine trait), as revealed in our first study. We thus conducted an experimental vignette study of 189 adults from the general public to explore how women versus men researchers working in educational research versus physics (as a contrasting domain clearly dominated by men) were perceived on several dimensions of competence and warmth. Whereas the female researcher in physics was rated as more competent than the female researcher in educational research, the woman in physics was penalized for her gender stereotype-incongruent domain choice by being perceived as less warm. However, the male researcher in educational research was perceived as both warmer and more competent than his man counterpart in physics, and as smarter than the female researcher in educational research. These findings suggest rewards instead of penalties for men pursuing academic careers in initially women-dominated domains, likely contributing to the increasing gender gap in academic careers in these domains. [ABSTRACT FROM AUTHOR]

Purpose: To characterize Vanishing White Matter Disease (VWM) cases from a Brazilian University Tertiary hospital, focusing on brain magnetic resonance image (MRI) aspects, clinical and molecular data. Methods: Medical records and brain MRI of 13 genetically confirmed VWM patients were reviewed. Epidemiological data such as age at symptom onset, gender and main symptoms were analyzed, along with genetic mutations and MRI characteristics, such as the distribution of white matter lesions and atrophy. Results: The majority of patients were female, with the age of symptom onset ranging from 1 year and 6 months to 40 years. All mutations were identified in the EIF2B5 gene, the most prevalent being c.338G > A (p.Arg113His), and a novel mutation related to the disease was discovered, c.1051G > A (p.Gly351Ser). Trauma or infection were significant triggers. The most frequent symptoms were ataxia and limb spasticity. All MRI scans displayed deep white matter involvement, cystic degeneration, with U-fibers relatively spared and a predilection for the frontoparietal region. Lesions in the corpus callosum and posterior fossa were present in all patients. Follow-up exams revealed the evolution of white matter lesions and cerebral atrophy, which correlated with clinical deterioration. Conclusions: VWM affects various age groups, with a significant clinical and genetic variability. A novel mutation associated with the disease is highlighted. MRI reveals a typical pattern of white matter involvement, characterized by diffuse lesions in the periventricular and deep regions, with subsequent extension to the subcortical areas, accompanied by cystic degeneration, and plays a crucial role in diagnosis and follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Despite tenacious efforts of continuing professional development (CPD) developers and educators, physician engagement in CPD is fraught with challenges. Research suggests that these educational interventions and the maintenance of professional competence systems that mandate them are often seen as impractical, decontextualized and check‐box activities by participants. This study explores physicians' learning post graduate medical education (GME) training across their CPD journey to understand how they (a) conceive of themselves as learners and (b) engage in lifelong learning across the course of their professional careers. Methods: Using narrative inquiry and holistic narrative analysis situated within a social constructivist orientation, we carried out individual interviews with physicians from across a large children's hospital network including academic hospitals, community hospitals and primary care practices. Timelines and story arcs were used to support the narrative analysis's re‐storying. Results: Twelve physicians from six different sub‐specialties were interviewed. We identified three noteworthy challenges as particularly salient across participants' re‐storied narratives: (i) train‐on‐a‐track to treading water, (ii) learning takes a backseat, and (iii) learning through foraging or hunting and gathering. Participants described significant change when transitioning from GME to CPD learning. While participants identified as learners, they described the disorienting impact of losing GME's formal supports and structures. They articulated that patient care trumped learning as their top priority. They lamented having limited insight into their learning needs (e.g. little feedback data) and so resorted to engaging in CPD activities that were readily at hand—but not necessarily relevant—and to finding learning resources that might not be formally recognised for CPD credit. Conclusions: Physicians' learning journeys post‐GME are challenging, and the systems created to support that learning are ill equipped to meet the needs of physicians transitioning from GME to CPD. To encourage meaningful learning, the complex interplay of factors impeding CPD engagement should inform future innovations. What do physician learning journeys after formal training look like? Allen ete al. used narrative analysis to explore how physicians' learning journey changes across their careers. [ABSTRACT FROM AUTHOR]

Aim: To communicate how the Dutch postgraduate nursing education landscape was redesigned using entrustable professional activities (EPAs). The goal of this initiative was to reduce training time, enhance transfer across nursing specialities and contribute to a better‐aligned continuum of initial education, postgraduate education and continuing professional development. Background: Nursing shortages continue to worsen worldwide. An approach to address this growing shortage is to create a more flexible postgraduate training structure, offering training in the just‐in‐time and just‐as‐needed models. EPAs can be used as building blocks for training and assessment. Experience with EPAs (i.e. units of professional practice that can be entrusted once a trainee has demonstrated the required competencies) in health professions education, including nursing, is rising rapidly. While EPAs are largely used to create training flexibility within a programme, they can also be used to create flexibility across programmes. In 2018–2022, training hospitals and education institutions in the Netherlands collaborated in the CZO Flex Level Project to redesign the postgraduate nursing education landscape using EPAs. Discussion: The implementation of a flexible postgraduate nursing education model nationwide will face several challenges. An overview of these challenges and suggestions for future research on the effects of the new structure on nursing competence, satisfaction and career development are provided. Conclusion: EPAs can imbue flexibility within and across training programmes. Designing an EPA‐based educational landscape requires nationally coordinated efforts. Implications for nursing policy: Redesigning educational structures to allow for more flexibility is critical to address major societal challenges in healthcare. [ABSTRACT FROM AUTHOR]

Aim: To understand the experiences of Filipino internationally educated nurses (FIENs) on their recognition and credentialing pathway in the recruitment process in Finland. Background: The nursing shortage in Finland results in the recruitment of internationally educated nurses (IENs) such as those from the Philippines. In the context of migration, IENs experience a rigorous process to become qualified nurses in the destination country. Methods: A thematic analysis of the secondary data from qualitative interviews was conducted. Ten FIENs (n = 10) were recruited from university hospitals in Finland through purposeful and snowball sampling. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist. Results: Three main themes were identified. First, pre‐migration victories and predicaments described the experiences of FIENs during the recruitment process and the pathway to acquiring a Registered Nurse qualification. Second, ambiguous integration implied integrating into the workplace while working on the top‐up education programme as a prerequisite to nursing registration. Lastly, migration uncertainty discussed the interest among FIENs to continue practising as Registered Nurses (RNs) in Finland. Conclusions: Pre‐migration orientation and workplace integration experiences influenced FIENs' choice to practise as RNs in Finland. The licensure pathway for FIENs required collaboration from various stakeholders in Finnish society. It is recommended to structure the system for the recognition and qualification process of IENs by creating a national model in line with international standards and requirements in collaboration with higher education institutions. Implication for nursing policy: Recognition of previous education and clinical experience can facilitate the transition to becoming an RN for IENs, but the lack of a clear education model and recognition of foreign nursing qualifications leads to deskilling and hinders IENs from practising. Policies prioritising education and integration into the local healthcare system can facilitate the integration and professional growth of IENs, enabling them to contribute significantly to the healthcare system. [ABSTRACT FROM AUTHOR]