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Early life adversity increases risk for chronic post-traumatic pain, data from humans and rodents
No full textTraumatic stress exposures (TSEs) are common in life. Although most individuals recover after a TSE, a substantial subset develop adverse post-traumatic neuropsychiatric sequelae such as chronic post-traumatic musculoskeletal pain (CPMP). Vulnerability factors for CPMP are poorly understood, which hinders identification of high-risk individuals for targeted interventions. One known vulnerability factor for many pain types is exposure to early life adversity (ELA), but few studies have assessed whether ELA increases risk for CPMP. This study used data from the Advancing Understanding of RecOvery afteR traumA study, a prospective human cohort study of TSE survivors, to test the hypothesis that ELA increases risk for CPMP. In addition, in secondary analyses, we assessed which subtypes of ELA (including childhood bullying) were most predictive of CPMP and whether a rat ELA model consisting of neonatal limited bedding, combined with single prolonged stress (SPS) in adulthood, would accurately model human findings. In Advancing Understanding of RecOvery afteR traumA study participants (n = 2480), using multinomial logistic regression modeling of 4 identified latent pain classes, we found that ELA increased vulnerability to the high unremitting pain class (odds ratio [OR] = 1.047, P \u3c 0.001), the moderate pain class (OR = 1.031, P \u3c 0.001), and the moderate recovery pain class (OR = 1.018, P = 0.004), with physical abuse, emotional abuse, and bullying being the strongest predictors of high pain class assignment. Similarly, in male and female Sprague Dawley rats, in comparison with SPS alone, neonatal limited bedding combined with SPS caused increased baseline sensitivity and prolonged mechanical hypersensitivity (F(11,197) = 3.22, P \u3c 0.001). Further studies in animals and humans are needed to understand mechanisms by which ELA confers vulnerability to CPMP.
Keywords: Bullying; Childhood abuse; Childhood trauma questionnaire; Chronic pain; Early life adversity; Motor vehicle collision; Multinomial modeling; Musculoskeletal pain; Neonatal limited bedding; Post-traumatic; Single prolonged stress; Traumatic stress; von Frey
Validity and Reliability of the New Innovation Culture Scale© for Use in Healthcare Settings
No full textObjective: To assess the psychometric properties of the new 10-item Innovation Culture Scale©.
Background: American healthcare is expensive with poor health outcomes as the norm. Nurses can disrupt this paradigm through innovation; however, innovation cannot flourish without a supportive organizational culture. There is a lack of scales to measure innovation culture within healthcare settings, thus supporting improvements in quality of care.
Methods: A Northeastern health system provided a convenience sample of 5658 nurses, physicians, and allied health professionals. Scale responses were obtained digitally. Item correlations, scree plot, and confirmatory factory analysis examined the scale\u27s internal structure and assessed model fit.
Results: Two hundred sixteen participants completed the scale. Item correlations were positive and significant (P \u3c 0.001). Scree plot confirmed a single factor structure. Several indices supported an acceptable model fit (comparative fit index = 0.935, Tucker-Lewis index = 0.916, standardized root mean square residual = 0.05), although root mean square error of approximation (0.119) was poor. Cronbach\u27s α was 0.94.
Conclusion: The Innovation Culture Scale is a valid and reliable measure to assess innovation culture in healthcare settings
Comparative outcomes of culprit-only versus complete revascularisation in cardiogenic shock complicating acute myocardial infarction: insights from the Gulf-Cardiogenic Shock registry
No full textObjectives: To compare in-hospital and long-term outcomes between culprit-only percutaneous coronary intervention (PCI) and multivessel PCI in patients with acute myocardial infarction complicated by cardiogenic shock and multivessel coronary artery disease.
Design: Retrospective subgroup analysis of the multicentre Gulf-Cardiogenic Shock registry.
Setting: 13 tertiary care centres across six Gulf countries (Saudi Arabia, Qatar, Oman, UAE, Kuwait and Bahrain) between January 2020 and December 2022.
Participants: 961 patients with angiographically confirmed multivessel coronary artery disease who underwent PCI were included from the Gulf-Cardiogenic Shock registry. Patients were divided into culprit-only PCI group (n=792, 82.4%) and multivessel PCI group (n=169, 17.6%). Patients with single-vessel disease were excluded.
Interventions: Patients underwent either culprit-only PCI (intervention limited to the culprit artery) or multivessel PCI (immediate intervention to both culprit and non-culprit arteries during the same procedure).
Primary and secondary outcome measures: The primary outcome was in-hospital all-cause mortality. Secondary outcomes included reinfarction, cerebrovascular accident, major and minor bleeding events, target lesion revascularisation, target vessel revascularisation, hospital stay duration and freedom from major adverse cardiac and cerebrovascular events (MACCEs) at 6 and 12 months.
Results: Hospital mortality was comparable between multivessel PCI and culprit-only PCI groups (43.2% vs 46.1%; p=0.493). Freedom from MACCE rates at 6 and 12 months were 62% and 46% for multivessel PCI versus 70% and 49% for culprit-only PCI, respectively (log-rank p=0.711). Subgroup analysis revealed that culprit-only PCI was associated with increased hospital mortality in patients older than 70 years (OR 1.55, 95% CI: 1.01 to 2.39). Multivariable analysis of the interaction between revascularisation strategy and the subgroups revealed that culprit vessel revascularisation was associated with increased mortality in patients with left main disease (OR: 1.99 (95% CI: 1.22 to 3.27), p=0.006) and left anterior descending lesions (OR: 1.54 (95% CI: 1.06 to 2.25), p=0.025).
Conclusions: No statistically significant differences in hospital mortality or long-term MACCE-free survival were observed between culprit-only PCI and multivessel PCI strategies in patients with cardiogenic shock complicating acute myocardial infarction. However, patients older than 70 years may benefit from a multivessel PCI approach. These findings support current guideline recommendations favouring culprit-only PCI due to reduced procedural complexity while highlighting the need for individualised treatment strategies based on patient age and clinical factors. Further prospective randomised studies are needed to validate these age-specific findings and identify optimal patient selection criteria for each revascularisation strategy.
Keywords: Coronary intervention; Myocardial infarction; Observational Study
Pre-hospital proton pump inhibitor use and clinical outcomes in hospitalized COVID-19 patients: A retrospective case-control study
No full textdings highlight a potentially protective role of PPIs and support continued therapy in eligible patients.
Keywords: COVID-19; Case-control study; Comorbidities; Intensive care unit; Mortality; Proton pump inhibitors; SARS-CoV-2
Racial and Ethnic Representation in Studies of Psychological Trauma During Pregnancy in the United States
No full textPurpose: Women are more likely to experience certain types of psychological trauma, including intimate partner violence and pregnancy-specific psychological trauma. Psychological trauma exposure also varies across racial and ethnic groups. Moreover, racial disparities persist in health care and contribute to high maternal mortality and morbidity in the United States (US). Considering the role of trauma at the intersection of pregnancy and racial and ethnic identity, it is critical to understand the extent to which psychological trauma is assessed during pregnancy across differing racial and ethnic identities.
Methods: We conducted a secondary analysis of a systematic review on the measurement of psychological trauma history during pregnancy, focusing on studies conducted in the US to assess the frequency and type of psychological trauma measured during pregnancy by racial and ethnic groups.
Results: We identified 216 relevant studies, 91.7% of which reported racial and ethnic information. Of the combined nearly 120,000 participants, 46% were white, 25.8% Black/African American, 13.5% Hispanic, 6.4% Asian, 0.8% Native American, 0.03% Middle Eastern, 5.2% other, 0.7% were multiracial, and 3.0% not reported. Across all racial and ethnic groups, interpersonal trauma was the most commonly assessed psychological trauma, followed by childhood abuse and general trauma history. Pregnancy-specific psychological trauma was the least commonly assessed across all groups.
Conclusion: Our findings show that racial and ethnic representation was comparable to US census numbers in many categories. Future works should continue to recruit and assess psychological trauma during pregnancy from minoritized participants to inform clinical practice, particularly among underrepresented groups, and should adopt a consistent method of assessing race and ethnicity across studies.
Keywords: Ethnicity; Pregnancy; Psychological trauma; Race
Comparison of immunization information systems, electronic medical records, and self-report to ascertain RSV vaccination status among US adults aged ≥60 years, 2023-2024
No full textBackground: Respiratory syncytial virus (RSV) vaccines were recommended for US adults aged ≥60 years in 2023. Immunization information systems (IISs) are important sources of RSV vaccination data; however, the completeness of documented RSV vaccinations in IISs is unknown.
Methods: The IVY network prospectively enrolled hospitalized adults with acute respiratory illness aged ≥60 years at 26 hospitals in 20 states during October 1, 2023-April 30, 2024. At enrollment, RSV vaccination history was abstracted from jurisdictional IISs, inpatient electronic medical records (EMRs), and through patient (or proxy) interviews with final RSV vaccination status adjudicated from all three sources. Frequencies and proportions of RSV vaccinations identified by IISs, EMRs, and self-report were compared to each other and to adjudicated RSV vaccination status using an unweighted Cohen\u27s kappa coefficient (κ), sensitivity, and specificity. RSV vaccinations documented in IISs were compared by jurisdictional consent policies. Statistical significance was determined using Wilcoxon rank sum or Pearson\u27s chi-squared tests, with a 2-sided P value \u3c 0.05.
Results: Among 7219 enrolled patients, 749 (10.4 %) had received RSV vaccination adjudicated from all sources, 613 (8.5 %) RSV vaccinations were detected by IISs, 439 (6.1 %) by self-report, and 334 (4.6 %) by EMRs. Self-report had the highest frequency of missing RSV vaccination history (30.1 %). Among 4422 patients with non-missing RSV vaccination data, agreement with adjudicated RSV vaccination status was highest for self-report (κ = 0.90) followed by IISs (κ = 0.88) and EMRs (κ = 0.55). Among 6208 patients with IIS data, the sensitivity of detecting RSV vaccinations was higher in states with mandatory inclusion of vaccination data in IISs than in those that required explicit consent (92 % vs. 65 %, P \u3c 0.001).
Conclusions: In this multicenter analysis, IISs detected more RSV vaccinations than self-report or EMRs, especially in jurisdictions with mandatory inclusion policies. Combining multiple data sources remains the optimal approach to ascertain RSV vaccination status in the US.
Keywords: Adult RSV vaccination; Electronic medical records; Immunization information systems; Respiratory syncytial virus; Vaccination status; Vaccine registry
Research Mentorship Models in Hospital Medicine: A Narrative Review
No full textAims/Background Mentorship is crucial to research success, but a detailed assessment and evaluation of the different types of mentorship models in hospital medicine have not been conducted. We sought to identify and define research mentorship models in hospital medicine. We also assessed the effectiveness of each model for the identified studies that met this narrative review\u27s criteria. Methods Narrative review of peer-reviewed, USA-published literature on hospital medicine research mentorship. Articles from 1996 to 2023 with selected search terms on hospitalists\u27 mentorship in research were searched in PubMed, Scopus and Embase. Finalized articles obtained from the search were approved by the Society of Hospital Medicine\u27s Research Committee. Results Ten articles published between 2008 and 2023 were identified and assessed by the Society of Hospital Medicine\u27s Research Committee members. Three major research mentorship models were identified: (1) traditional mentor-mentee dyad, (2) peer mentorship, and (3) research coaching. Some hospital medicine groups combined mentorship models. All articles reported successful implementation with positive faculty receptivity and/or research output. However, the studies had small sample sizes and short evaluation periods. Conclusion Hospitalist research mentorship is essential to bolstering and enhancing research in hospital medicine. Further studies with larger samples, extended time frames, those conducted outside the USA, and frequent reassessments are urgently needed to determine the sustained effectiveness of any model.
Keywords: coaching; hospitalists; mentoring; mentors; research
Genomic surveillance uncovers regional variation in HCV transmission networks in rural United States
No full textHepatitis C virus (HCV) remains a public health concern in the United States, particularly in rural communities where the opioid epidemic accelerates transmission among people who use drugs (PWUD). Despite this growing burden, the genetic features and transmission dynamics of HCV in these settings are poorly understood. We analyze 692 HCV antibody-positive specimens collected from rural communities in ten U.S. states using amplicon-based deep sequencing and the Global Hepatitis Outbreak and Surveillance Technology (GHOST) platform to reconstruct transmission networks. Among sequenced individuals, 29.5% are linked within clusters. Cluster structure varies by region from sparse networks in Ohio to dense clusters in New England and phylogenetic analyses show that some networks persist for over a decade, indicating sustained transmission. Nearly half of all clusters involve individuals connected through social recruitment, suggesting peer-referral strategies effectively identify transmission chains. Penalized regression retains only a few individual factors including younger age, peer or partner recruitment, illegal income, methamphetamine use, each with modest effects. These findings suggest that clustering is shaped primarily by social and structural contexts rather than individual characteristics and underscore the importance of integrating genomic surveillance with social-network insights to detect emerging HCV clusters and guide targeted interventions in underserved rural communities
One Stick Per Hospital Stay: Enhancing Vascular Access Outcomes in the ED by Utilizing Vascular Access Specialty Team
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1025/thumbnail.jp