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Reducing Falls in Medical-Surgical Patients
No full textPICO: In adult patients at risk for falls on Med Surg units, how does the implementation of fall-reducing interventions compare to standard fall precautions impact inpatient fall rates?https://knowledgeconnection.mainehealth.org/nurseresidency/1131/thumbnail.jp
Psychometric Evaluation of the Modified Neonatal Resuscitation Program® Adherence Assessment Tool When Utilized for In Situ Simulation and Telesimulation Scenarios
No full textOBJECTIVE: Neonatal resuscitation is a high acuity, low occurrence event that requires precision, teamwork, and rapid decision-making. Simulation using NRP guidelines allows teams to build competency and preparedness, improving neonatal outcomes. Accurate, reliable performance evaluation during simulation is essential to the provision of meaningful feedback. Evidence supporting the reliability and validity of existing tools when used in telesimulation (TS) is limited. We sought to evaluate the psychometric properties of the modified NRP (mNRP) tool when assessing interprofessional team performance in onsite and TS environments. STUDY DESIGN: We employed a methodological design to conduct secondary analyses of data from a larger study using simulation to enhance resuscitation skills as assessed by the mNRP. Item-level data from 96 simulations was subjected to Classical Test Theory-based item analyses including evaluation of item difficulty, discrimination, and item-to-total correlation; reliability; and exploratory factor analysis (EFA). Interrater reliability (IRR) between novice and expert raters was assessed for a subset of cases. RESULTS: Item difficulties reflected a desirable mix of difficulty in endorsement, suggesting that items capture a range of guideline adherence. Most item discrimination (range: 0.05-0.81) and corrected item-total correlation (range: 0.005-0.68) values had moderate-to-strong, positive correlations with total scores, indicating discriminative ability. EFA yielded three-and-four-components for the onsite and TS groups, respectively. Cronbach\u27s alpha was 0.76 (onsite) or 0.78 (TS). Lowest vs. highest mNRP quartiles differed significantly in both formats (p\u3c 0.001 for each), supporting construct validity. IRR ranged from 0.5 to 0.9, supporting moderate to good agreement between novice and expert raters. CONCLUSIONS: Findings provide evidence supporting the reliability and validity of the mNRP tool when applied in both the in situ and TS settings. IRR was acceptable for expert and novice evaluators. This analysis provides additional validity evidence for the mNRP when used to evaluate interprofessional team performance in both onsite and TS formats
Best Practices in the Conduct of Community Engagement Studios at MaineHealth Institute for Research
No full textProblem Statement: Community engagement (CE) Studios are an established method for integrating lived-experience expertise into research at 1 or more specific points within a project. Although many researchers understand the value of incorporating community input, they often lack the tools, skills, or infrastructure to do so effectively. CE Studios address this challenge by offering a structured, consultative approach to engagement.
Background: CE Studios occur at any point across the research lifecycle and are used to inform research design, feasibility, relevance, recruitment, implementation, and translation. In a 1-time, 2-hour consultation, CE Studios bring lived-experience expertise into the research process, helping projects center patients’ perspectives and inform research direction. Rooted in prior work by the Vanderbilt Institute for Clinical and Translational Research, this model builds rapport with intended audiences and strengthens capacity for engagement among researchers and community members.
Application: CE Studios require institutional support through the establishment of a neutral team trained in the model. At MaineHealth Institute for Research, a CE Studios team comprising community engagement and outreach navigators and staff was established in fall 2022. The CE Studio program is supported by the Northern New England Clinical and Translational Research Network infrastructure grant and nested within a larger community-engaged research effort. Since launch, the team has supported 14 CE Studios for 11 projects and collaborated with 5 institutions across Northern New England. This paper describes the implementation process at MaineHealth Institute for Research, as well as team roles, CE Studios structure, and lessons learned from launching and sustaining the model
Effects of weight-loss interventions on bone health in people living with obesity
No full textStrategies to reduce weight in people living with obesity (PwO) include calorie restriction, metabolic and bariatric surgery (MBS), and anti-obesity drugs including glucagon-like peptide-1 receptor agonists (GLP-1Ra), such as liraglutide and semaglutide. Although weight loss in PwO has many health benefits, it can result in increased bone loss and fracture risk. Indeed, the consequences of weight loss interventions are well known: (i) significant weight loss induced by caloric restriction and MBS results in high turnover bone loss and (ii) unlike calorie restriction, PwO experience a substantial deterioration in bone microarchitecture and strength associated with an increased risk of fracture after MBS, especially malabsorptive procedures. GLP-1 may enhance bone metabolism and improve bone quality, and liraglutide appears to have a positive effect on bone health despite significant weight loss in several rodent models. However, most of the positive effects on bone have been observed at concentrations much higher than those approved for obesity care in humans. The effects of GLP-1Ra on bone health in PwO are still limited; however, significant weight loss induced by GLP-1Ra may also result in accelerated bone turnover and bone loss, and semaglutide could lead to an increased risk of fractures in the at-risk population. The mechanisms responsible for the adverse skeletal effects of MBS are not yet fully understood, and there are insufficient human studies supporting pathophysiological hypotheses. However, data suggest that multiple mechanisms are involved, including nutritional factors, mechanical unloading, hormonal factors, adipokines, and alterations in the gut microbiome. Recommendations for the prevention and treatment of osteoporosis secondary to MBS are now available, and the efficacy of anti-osteoporosis medications in preventing bone loss has been evaluated in two randomized controlled trials. Priorities for future research include the development of effective approaches to reduce fracture risk in PwO following MBS and investigation of the effects of anti-obesity drugs on bone health
Beyond challenging behaviors, sleep maintenance problems in autistic youth at the time of hospitalization are associated with increased caregiver strain
No full textPURPOSE: Autistic children are at increased risk for psychiatric hospitalization for challenging behaviors. Sleep problems may increase this risk due to the added strain they place on caregivers and their ability to maintain safety at home. We evaluate if caregiver-reported sleep problems in autistic children at the time of the child\u27s hospital admission predict caregiver reported stress and self-efficacy, above and beyond the severity of the child\u27s challenging behaviors. METHODS: Participants included 598 autistic children (ages 4-20) admitted to specialized psychiatric inpatient units and a primary caregiver. Caregivers reported if their child had sleep initiation and/or sleep maintenance problems. Caregivers completed the Parenting Stress Index-Short Form and Difficult Behavior Self-Efficacy Scale. Hierarchical linear regression models examined associations between sleep problems and caregiver outcomes, controlling for child irritability, and both household- and child-level characteristics. RESULTS: Fifty-nine percent of children had a caregiver-reported sleep problem. Sleep maintenance problems were significantly associated with increased parental distress, more dysfunctional parent-child interactions, and greater perception of the child as difficult to manage, above and beyond challenging behavior severity and other covariates. Sleep initiation problems were unrelated to caregiver outcomes. Self-efficacy in single caregivers and those in lower-income households was more negatively impacted by sleep problems than other caregivers. CONCLUSIONS: Sleep maintenance problems may independently contribute to caregiver strain above and beyond challenging behaviors. Social and financial resources may buffer against the negative effect of sleep problems. Preventative interventions targeting sleep may provide needed support for vulnerable families
FSH and longitudinal changes in bone marrow adipose tissue composition in older adults
No full textBone marrow adipose tissue (BMAT) expansion and distinct BMAT composition profiles, including lower unsaturated levels, are cross-sectionally associated with older age. Prospective changes in BMAT composition with aging and the effect of serum follicle stimulating hormone (FSH), which influences both bone and fat metabolism, are unknown. We examined these associations in the AGES-Reykjavik Bone Marrow Adipose cohort, using sex-stratified linear regression models adjusted for covariates including estradiol and testosterone. At baseline, 236 women and 245 men had mean age 81 (SD 4) and 83 (4) years, respectively. Over a mean 3.3 years for 154 women and 2.6 years for 151 men, there was no significant change in total or saturated BMAT. However, mean unsaturated BMAT increased in women (+0.26 %/year, 95 % CI +0.21 %/year to +0.32 %/year) and men (+0.24 %/year, 95 % CI +0.18 %/year to +0.30 %/year). Among women, greater increases in unsaturated BMAT were associated with significantly greater reductions in vertebral trabecular volumetric BMD. At baseline, women in the highest FSH quartile had highest total (66.6 %, 95 % CI 64.3 %-69.0 %) and saturated BMAT (95 % CI 49.3 %, 47.5 %-51.0 %). No relationship existed between FSH and unsaturated BMAT in women or any BMAT outcome in men. Longitudinally, in women, higher FSH was associated with greater increase in unsaturated BMAT. There was no relationship between FSH and change in total or saturated BMAT in women or any change outcome in men. In older adults, total BMAT was stable, but BMAT composition changed with increases in unsaturated BMAT. In women, higher FSH correlated cross-sectionally with higher saturated BMAT but longitudinally with greater gain in unsaturated BMAT. These novel findings warrant further longitudinal studies to better characterize BMAT changes and the role of FSH
Prolactin: A Key Immunoregulator in Viral Infections and Autoimmune Diseases
No full textProlactin (PRL) is secreted by various cells in the anterior pituitary gland, mammary glands, placenta, uterus, ovaries, testes, skin, adipose tissue, endothelial cells, immune system, and central nervous system. The expression and secretion of PRL are influenced by several factors such as suckling, thyrotropin-releasing hormone (TRH), cytokines, dopamine, estrogen, and vasoactive intestinal polypeptide. It operates through a complex receptor, which is expressed in mammary gland cells, pancreatic beta cells, adipocytes, and immune cells. PRL is essential for various physiological functions, in particular milk production, breast development, metabolism, and immune regulation. Serum PRL levels fluctuate daily and can be affected by exercise, diet, and stress. Hyperprolactinemia is linked to autoimmune diseases and viral infections. In viral infections such as HIV, HCMV, HCV, and COVID-19, PRL levels are often increased, which may influence the immune responses. PRL can modulate the activity of various immune cells, including T cells, B cells, natural killer cells, and macrophages, mounting an effective immune response against viral infections. Moreover, PRL influences the production of cytokines that mediate and regulate immunity and inflammation. PRL stimulates B cells to produce antivirus antibodies that are essential for neutralizing viruses and preventing their spread within the body. PRL levels, varying by sex and life stage, may affect immune responses and susceptibility to viral infections. Moreover, overexpression of PRL was indicated in various autoimmune diseases. Overall, PRL is a complex hormone with significant implications for endocrine function, immune regulation, and immune responses to viral infections, highlighting the need for further research into its diverse roles in health and disease. This review summarizes current knowledge of the immunomodulatory effects of PRL in human viral infections and possibly its contribution to the development of autoimmune diseases
Patient and Parent Perceptions of Disorders of Sex Development Terminology: A Pilot Study
No full textDiagnostic terminology used for disorders of sex development (DSD) has been controversial even before the introduction of the umbrella term at the 2006 International Consensus Conference on Intersex. Agreement on nomenclature can enhance communication among clinicians, researchers, patients, and their families. However, disagreements over the implications of nomenclature can also result in a proliferation of terms contributing to confusion. The objective of this pilot study was to assess the connotative meaning assigned by adolescent patients with a DSD and parents to the terms used to describe their medical condition. In a sample of 27 adolescents/young adults with a DSD and 22 of their parents/caregivers recruited from three pediatric medical centers in mid-West and mid-Atlantic states, a semantic rating scale measuring self-esteem was used to characterize the connotative meaning ascribed to the person\u27s specific diagnosis (or anatomical phenotype), the umbrella terms disorders of sex development, intersex, and yourself / your child. Youth and parents rated themselves or their children more positively compared to how they rated either the specific diagnosis, the umbrella terms DSD or intersex. The ratings for the latter three terms were generally neutral and did not significantly differ from each other. These pilot findings suggest that neither youth with DSD nor their parents equate the person with their diagnosis. They also evaluated the person more positively than any of the diagnostic or umbrella terms rated. In contrast with previous studies assessing preferences for particular terms, this study suggests a novel strategy for assessing the personal meanings ascribed to each
Current Approaches to the Treatment of Pediatric Soft Tissue Sarcomas: Rhabdomyosarcoma and Nonrhabdomyosarcoma Soft Tissue Sarcomas
No full textSoft tissue sarcomas (STS) are rare mesenchymal tumors representing up to 7% of all cancers in children. In the pediatric population, rhabdomyosarcoma (RMS) is the most common histology while the remainder is composed of several distinct histotypes collectively known as nonrhabdomyosarcoma soft tissue sarcoma (NRSTS). RMS and NRSTS have individualized staging and treatment paradigms. Through cooperative group clinical trials, our understanding of STS and outcomes have improved. However, patients with distant metastases and who relapse continue to fare poorly. Global collaborations are necessary to make greater progress for this highest risk population