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Context: Recruitment of targeted samples into hospice clinical trials is often challenging. While electronic medical records (EMR) are commonly used in hospital-based research, it is uncommon in hospice research. The community setting and the variability in hospices and their medical record creates unique challenges., Objectives: This paper compares recruitment in two hospice randomized controlled trials, each of which had a group recruited by using the EMR identification and a group recruited by nurse referral. We sought to answer three questions: 1) What is the impact of using the EMR to identify hospice participants for clinical research? 2) How do the referral count and consent rate (referrals that ultimately result in verbal informed consent to participate in research) differ between hospice agencies using an EMR participant identification approach compared to those using a nurse referral approach? and 3) What are the challenges associated with using the EMR to identify potential research participants?, Method: Recruitment data from two hospice clinical trials was combined into a new database. Data from hospice nurse referral agencies was compared with data from those agencies who participated in EMR-identified referrals., Results: The EMR identification process was feasible and efficient, resulting in more referrals and more consented participants than the nurse referral method. Of particular interest is that 8% more black caregivers were recruited using the EMR identification process than the nurse referral., Conclusions: The EMR-identified recruitment process is the recommended method in hospice research., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects about 20% to 30% of infants born at less than 32 weeks of gestation. Diagnosis is made if an infant requires oxygen therapy at 36 weeks' corrected age or discharge home. BPD increases healthcare costs, mortality rates, and risk of long-term respiratory complications and neurosensory impairments., Purpose: The purpose of this project was to improve rates and severity of BPD in very premature infants without increasing length of hospitalization., Methods: A multidisciplinary care bundle involving respiratory support and medication use guidelines was created and implemented along with a noninvasive ventilation algorithm for the delivery room. This bundle was utilized for infants born in a Midwest hospital in 2019 at less than 32 weeks of gestation and the outcomes were compared to infants born in 2017., Results: Implementation of this BPD prevention bundle contributed to a decrease in the use of oxygen at discharge for very premature infants without increasing length of hospitalization. Use of invasive mechanical ventilation and the severity of BPD also decreased., Implications for Practice and Research: A multidisciplinary bundle approach can be successful in decreasing the rates of BPD for very premature infants. Future quality improvement projects should focus on improving delivery room management of extremely premature infants, with an emphasis on optimizing noninvasive ventilation strategies. More research is still needed to determine the best method of ventilation for premature infants and the best utilization of surfactant and corticosteroids., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 by The National Association of Neonatal Nurses.)

Importance: Public assistance policies may play a role in preventing child maltreatment by improving household resources among families of low incomes. The Supplemental Nutrition Assistance Program (SNAP) is one of the largest public assistance programs in the US. However, the association of state SNAP policy options to Child Protective Services (CPS) outcomes has not been rigorously examined., Objective: To model the association of state SNAP policies with changes in CPS and foster care outcomes in the US over time., Design, Setting, and Participants: This cohort study used panel data to examine the association between SNAP policy options and study outcomes from 2004 to 2016 for 50 US states and the District of Columbia in 2-way fixed-effects regression models. The count of SNAP policies was used as an instrument for SNAP caseloads in instrumental variables models. Data analysis was conducted in November 2021., Exposures: The adoption of 1 or more state SNAP income generosity policies that improves or stabilizes household resources for SNAP participants., Main Outcomes and Measures: Reports of child maltreatment accepted for CPS investigation, children in substantiated reports, and children receiving foster care services for all forms of maltreatment, and specifically for child neglect per 100 000 child population., Results: The mean (SD) number of SNAP income generosity policies increased from 1.47 (0.95) in 2004 to 2.37 (0.94) in 2010, to 2.49 (0.86) in 2016 across states; the median increased from 1 to 3 (range, 0-4) over the same period. A count of state income generosity policies was associated with large reductions in reports accepted for CPS investigation (-352.6 per 100 000 children; 95% CI, -557.1 to -148.2). Income generosity policy was associated with -94.8 (95% CI, -155.6 to -34.0) fewer substantiated reports and -77.0 (95% CI, -125.4 to -28.6) fewer reports substantiated for neglect per 100 000. Each additional income generosity policy adopted by a state was associated with -45.1 (95% CI, -71.6 to -18.5) to -42.3 (95% CI, -64.8 to -19.8) fewer total foster care placements per 100 000 children., Conclusions and Relevance: State SNAP policies that improve and stabilize household resources appear to be associated with reductions in CPS involvement and use of foster care. The number of policies implemented had cumulative outcomes beyond individual policy outcomes.

Facebook ® is a popular platform for older adults, especially as they try to stay in contact with their family around the country. It is also a popular platform for hosting online support groups. The readily available, socially acceptable, and free platform holds many advantages not only for older adults but also for nurse researchers designing and implementing interventions for older adults. The literature is void of proven methods to measure individual engagement with the Facebook platform. The current article describes efforts to develop a measurement process and evaluate the impact that engagement with Facebook has on improved mental health outcomes for older adults. Scores were severely skewed and ranged from no engagement to very high engagement. Engagement differed based on sex, race, and living arrangements with patients. Further work in this area is needed if nurse researchers are to consider the role of engagement in social media interventions. [ Journal of Gerontological Nursing, 48 (7), 10-17.].

Objective/aims: To determine the cerebrospinal fluid concentrations and percent CNS penetration of intravenous vancomycin in patients with cerebrospinal devices at a pediatric institution., Methods: We performed a prospective evaluation of intravenous (IV) vancomycin in patients who received a single prophylactic dose of vancomycin (15-20 mg/, maximum dose 1 g) prior to insertion of a CNS shunt (group I) or a therapeutic regimen (a dose of 10-20 mg/kg every 6-12 h) for a documented/suspected shunt infection (group II). Ventricular cerebrospinal fluid (VCSF) samples were taken during the procedure in group I and multiple serum and VCSF samples were collected in group II. Pharmacokinetic parameters were calculated using a one-compartment model, and percent CNS penetration was estimated using area-under-the-curve methodology., Results: Group I: 21 VCSF samples were analyzed from 19 patients (mean age 7.2 +/- 6.4 years). Over 40% of samples failed to have detectable vancomycin concentrations (range 0-2 microg/ml). Group II: 6 patients (mean age 11 +/- 8.7 years) had VCSF concentrations ranging from nondetectable to 6.59 microg/ml (mean 2.48 +/- 0.52 microg/ml). Percent penetration ranged from 0.77 to 18%., Conclusions: Single-dose, pre-operative vancomycin results in low VCSF vancomycin concentrations and repeated dosing in patients with documented/presumed device infections yields variable CNS penetration., ((c) 2007 S. Karger AG, Basel.)

We prospectively compared image and report delivery times in our Urgent Care Center (UCC) during a film-based practice (1995) and after complete implementation of an electronic imaging practice in 1997. Before switching to a totally electronic and filmless practice, multiple time periods were consistently measured during a 1-week period in May 1995 and then again in a similar week in May 1997 after implementation of electronic imaging. All practice patterns were the same except for a film-based practice in 1995 versus a filmless practice in 1997. The following times were measured: (1) waiting room time, (2) technologist's time of examination, (3) time to quality control, (4) radiology interpretation times, (5) radiology image and report delivery time, (6) total radiology turn-around time, (7) time to room the patient back in the UCC, and (8) time until the ordering physician views the film. Waiting room time was longer in 1997 (average time, 26:47) versus 1995 (average time, 15:54). The technologist's examination completion time was approximately the same (1995 average time, 06:12; 1997 average time, 05:41). There was also a slight increase in the time of the technologist's electronic verification or quality control in 1997 (average time, 7:17) versus the film-based practice in 1995 (average time, 2:35). However, radiology interpretation times dramatically improved (average time, 49:38 in 1995 versus average time 13:50 in 1997). There was also a decrease in image delivery times to the clinicians in 1997 (median, 53 minutes) versus the film based practice of 1995 (1 hour and 40 minutes). Reports were available with the images immediately upon completion by the radiologist in 1997, compared with a median time of 27 minutes in 1995. Importantly, patients were roomed back into the UCC examination rooms faster after the radiologic procedure in 1997 (average time, 13:36) than they were in 1995 (29:38). Finally, the ordering physicians viewed the diagnostic images and reports in dramatically less time in 1997 (median, 26 minutes) versus 1995 (median, 1 hour and 5 minutes). In conclusion, a filmless electronic imaging practice within our UCC greatly improved radiology image and report delivery times, as well as improved clinical efficiency.

In order to gain experience with vendor-supplied picture archive and communication system (PACS) products, a Vantage PACS from Lockheed-Martin was installed in a Mayo community medicine practice in Rochester. This practice produces about 45,000 radiology examinations annually. The PACS includes central long- and short-term storage devices, 10 image display workstations, and a dedicated high-speed image distribution network. Digital images are produced using two Fuji computed radiography readers. Custom worklists were created to facilitate efficient system usage. Currently, all radiographic examinations for this practice are acquired digitally, and interpreted and distributed using the PACS. Remote softcopy interpretation via PACS has decreased the turnaround time for both routine and urgent examinations, and has allowed subspecialty interpretation or consultation for pediatric examinations. These results have significantly improved the radiology component of this community medicine practice.

It is the fate of certain fashionable legal terms that capture the attention of the media to have their usage expanded beyond the contexts for which they were originally designed. Such is the case with the term sexual harassment. Essentially, it describes situations in which a powerful person attempts to influence an individual's economic or academic status based on his or her response to sexual comments or behaviors. Title VII and Title IX of the US Code contain federal laws that prohibit discrimination based on sex in the workplace and in the education system, respectively. Accordingly, sexual harassment that occurs within the context of the employment or academic arena is prohibited under Title VII and Title IX and has evolved to apply to hostile work or academic environments that do not per se influence an individual's economic or academic status.

In the face of evidence suggesting that there is a substantial incidence of sexual contact between physicians of all specialties and their patients, the medical profession and the courts have not yet reached a consensus regarding appropriate responses. Some commentators, including the American Medical Association, have urged bans on sexual contact during treatment and extensive restriction of posttreatment sexual relationships. Others favor looser restrictions, particularly after termination of the physician-patient relationship. These differences in approach stem from the varying importance given the two conflicting values involved: (1) protecting patients from being harmed by unfair manipulation by physicians and (2) insulating choices about intimate relationships from intrusion by society. We propose a model for balancing these interests that would bar sexual contact during the physician-patient relationship and for a fixed period after termination; thereafter, in most cases, sexual relationships would not be proscribed. A waiting-period approach of this sort is likely to diminish most of the harms that might result from physician-patient sexual contact and may constitute a template for the resolution of similar issues elsewhere in society.

Therapist sexual misconduct has its genesis in the therapeutic relationship. The mental health professions have long recognized the delicacy with which the therapist must handle the therapeutic relationship, with its power imbalance, inherent vulnerability of the patient, and transference and countertransference reactions. The prevention of sexual contact starts with the careful attention to boundary violations, which, though themselves perhaps not harmful, may escalate into sexualized behavior. Methods of preventing this behavior include the establishment of clear guidelines for practitioners and the expansion of the educational process for therapists, therapists' employers, patients, and other professionals. Last resorts lie in the legal and quasi-legal proceedings available to victims, such as civil suits for damages, criminal complaints, board of licensing complaints, and actions before professional associations. The best method of preventing sexual contact with patients involves respecting the boundaries of the professional relationship and avoidance of the slippery slope.

Psychotherapists' and physicians' sexual contact with their patients has been long held as unethical conduct. However, lawyers' sexual contact with clients has been largely ignored in the professional literature. This article uniquely anatomizes the similarities in the vulnerabilities and power imbalances that exist between psychotherapists' and lawyers' relationships with patients/clients. These characteristics enable the professional to exert undue influence over the less-powerful party, and for these reasons lawyers should be held to fiduciary standards in their personal dealings with clients. The authors propose a rebuttable presumption that sexual contact between an attorney and client was obtained through the attorney's exercise of undue influence and was therefore a breach of the attorney's fiduciary duties to the client.

Controversy over the legitimate extent, if any, of sexual contact between psychotherapists and former patients remains intense. In this paper the authors review current approaches to controlling posttermination sexual contact, offer a conceptual framework within which the problematic aspects of therapist-patient sex both during and after treatment can be understood, and develop a set of recommendations for policies that balance the goals of protecting former patients and avoiding unnecessary interventions into consensual relationships. Review of ethical, legal, and administrative controls on posttermination sex revealed considerable heterogeneity of approaches, which appeared to be based on confusion concerning the rationale for restriction. An analysis of the problems with therapist-patient sexual contact suggests four areas of concern: impaired decision making, coercion, fraud, and exploitation of a fiduciary relationship. The nature and magnitude of these problems differ in pre- and posttermination sexual relationships. The authors conclude that clarity of restrictions on posttreatment sex is important, but an absolute ban is not essential to protecting former patients. Rather, a 1-year waiting period after termination, during which even social contact would be precluded, should minimize problems and allow former patients and therapists to enter into intimate relationships. The authors discuss the advantages and disadvantages of this approach over other approaches.

Legislative enactment of criminal penalties for psychotherapists' sexual contact with their patients is pending in several states. The arguments in favor of criminalization are that it serves as a deterrent, offers retribution, provides redress when other avenues are blocked, deals with unlicensed psychotherapists, makes victims' assistance funds available, and provides due process protection against false accusations. In opposition to criminalization are the arguments that civil and administrative measures already exist to deal with the problem, it may have a chilling effect on the reporting of misconduct, it may void malpractice insurance, it makes guilty psychotherapists place themselves in jeopardy if they acknowledge their wrongdoing in attempting to make amends, it removes control of the legal process from the victim, it fails to offer rehabilitation, and it singles out psychotherapists from other fiduciaries for more stringent treatment. APA district branches inevitably will be called on to take positions with regard to legislation criminalizing sexual exploitation of patients. The current public outrage over patient victimization, however appropriate it may be, appears to make it difficult to publicly justify anything other than support for criminalization.

Although there is unanimity among mental health professionals as to the unethical aspect of psychotherapist-patient sexual contact, there is disagreement as to whether subsequent treating psychotherapists should be required to report the abuse of a former therapist to a licensing agency. Such reporting may have negative effects upon the patient and upon the patient's relationship with the therapist. It may also, however, prevent further exploitation by the original abusing therapist. Three states have adopted reporting statutes designed to protect patients from this type of abuse. The current statutory enactments of California, Wisconsin, and Minnesota are compared in terms of their differing approaches to the problem.