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Improving fever management of hospitalized children with cancer: barriers, facilitators, and proposed interventions from healthcare providers in Kenya
No full textChildren with cancer in lower-middle-income countries (LMICs) are at increased risk of dying from infections. Prompt treatment of fever episodes improves outcomes, yet poorly described challenges impair management. This qualitative study explored healthcare provider perspectives on barriers to and facilitators of inpatient fever management in children with cancer at a public tertiary referral children's hospital in Kenya. Healthcare providers involved in fever management were recruited. Semi-structured interviews were audio-recorded, transcribed verbatim, and entered into NVivo software. Coding was informed by a theoretical fever framework and the Consolidated Framework for Implementation Research. Thematic analysis and mind mapping identified recurrent themes and subthemes. Strategies were mapped to identified barriers. The sixteen participants included nurses (n = 2), clinicians (n = 6), pharmacists (n = 2), phlebotomists (n = 2), and microbiology laboratory staff (n = 4). We identified three overarching themes: empowerment of healthcare providers and caregivers, the importance of timely management, and teamwork/human resource availability. Healthcare provider attributes served as facilitators: motivation to improve care, eagerness to learn, willingness to change practice, and need for treatment guidance. Factors within the hospital system were barriers, with subthemes including poor communication between cadres, delays in laboratory results, and staffing shortages. Participants suggested knowledge sharing, a treatment guideline, task shifting, and hiring additional healthcare providers as potential interventions. Managing fever episodes in children with cancer is complex, requiring multiple cadres of healthcare providers and caregiver participation. The proposed interventions may overcome barriers, but future studies are needed to assess the effectiveness of these strategies in improving fever management
2023 Indiana Registered Nurse (Clinical Nurse Specialists Only) Workforce Snapshot
No full textThis report provides an overview of Indiana’s Clinical Nurse Specialist (CNS) workforce as of the 2023 renewal period. It presents data on actively practicing CNSs, including their primary practice settings, specialties, populations served, and educational backgrounds. It also includes geographic distribution and service area information, offering a valuable resource for healthcare workforce planning, policy development, and system evaluation
A Qualitative Examination of Resilience Among Grandparents Raising Grandchildren Using the Resilience Portfolio Model
No full textIUIGrandparents in the United States continue to show up and support their families in difficult times when parents are not able to do so. This indicates a form of strength and resilience worthy of study to expand literature, policy, and practice centered on caregiving with grandchildren. Although some studies have explored areas such as grandparents’ resourcefulness, positive caregiving appraisal, protective factors, and social support separately, there is a call for more holistic examination of their strength and resilience. To bridge this gap in literature, this study adopted the resilience portfolio model (RPM) using a qualitative method to examine the experience of grandparents raising grandchildren. A thematic analysis was conducted after semi-structured interviews with 13 GRG living in a mid-western state. Findings reveal a holistic view of how GRG demonstrate strengths and resilience in four different areas including 1) how they respond to daily challenges/crises, 2) the positive strategies they use to promote family well-being 3) how their earlier experiences in life influence their parenting experience with their grandchildren and 4) how they not only protect their families from future crises but how others are testifying of seeing positive changes in their lives of their grandchildren. The result of this study show the pertinency of the RPM in studying the experiences of GRG and the critical strengths and resilience that grandparents possess that could help not only in developing interventions that are more effective and efficient for GRG but also further policy and research with grandparents raising grandchildren
Scene as Occupancy and Reconstruction: A Comprehensive Dataset for Unstructured Scene Understanding
No full textAs autonomous driving technology steps into the phase of large-scale commercialization, safety and comfort have become key indicators for measuring its performance. Currently, some studies have begun to focus on improving the safety and comfort of urban driving by paying attention to irregular surface regions. However, datasets and studies for unstructured scenes, which are characterized by numerous irregular obstacles and road surface undulations, remain exceedingly rare. To expand the scope of autonomous driving applications, a perception dataset, which focuses on irregular obstacles and road surface vibrations in unstructured scenes, has been built. It takes into consideration the fact that the detection of various irregular obstacles in unstructured scenes plays a key role in trajectory planning, while the recognition of undulating road surface conditions in these scenes is crucial for speed planning. Therefore, we investigate unstructured scene understanding through 3D semantic occupancy prediction, which is used to detect irregular obstacles in unstructured scenes, and road surface elevation reconstruction, which characterizes the bumpy and uneven conditions of road surfaces. The dataset provides detailed annotations for 3D semantic occupancy prediction and road surface elevation reconstruction, offering a comprehensive representation of unstructured scenes. In addition, trajectory and speed planning information is provided to explore the relationship between perception and planning in unstructured scenes. Natural language descriptions of scenes are also provided to explore the interpretability of autonomous driving decision-making. Experiments have been conducted with various state-of-the-art methods to demonstrate the effectiveness of our dataset and the challenges posed by these tasks. To the best of our knowledge, this is the world's first comprehensive benchmark for perception in unstructured scenes, which serves as a valuable resource for extending autonomous driving technology from urban to unstructured scenes
Artificial Intelligence-Assisted Colonoscopy With or Without Mucosal Exposure Device for Detection of Colorectal Adenomas: A Meta-Analysis
No full textBackground and study aims: Artificial intelligence (AI) and mucosal exposure devices like Endocuff have independently improved the adenoma detection rate (ADR) during colonoscopy. This meta-analysis evaluated the combined effect of Endocuff and AI versus AI alone on colorectal neoplasia detection rates.
Methods: We searched PubMed, Embase, and Web of Science for randomized controlled trials (RCTs) comparing the impact of Endocuff+AI versus AI alone on colorectal neoplasia detection. Primary outcome was ADR; secondary outcomes included advanced adenoma detection rate (AADR), sessile serrated lesion detection rate (SSLDR), cecal intubation time, and withdrawal time. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Results: Three RCTs with 2404 subjects were included (n = 1198 Endocuff+AI vs. n = 1206 AI alone). ADR was significantly higher in the Endocuff+AI group than in the AI alone group (54% vs. 48%, respectively) (RR 1.12, 95% CI 1.03-1.21, P = 0.01, I 2 = 0%). There was a trend toward higher AADR (12.3% vs. 10%, RR 1.23, 95% CI 0.96-1.59, P = 0.10, I 2 = 17%) and SSLDR (17.6% vs. 15.5%, RR 1.16, 95% CI 0.96-1.40, P = 0.13, I 2 = 0%) in the Endocuff+AI group compared with the AI alone group, but it did not reach statistical significance. Both cecal intubation time (MD -0.61 minutes; 95% CI -1.54-0.33; P = 0.20; I 2 = 87%) and withdrawal time (MD -0.42 minutes; 95% CI -1.01-0.17; P = 0.17, I 2 = 60%) were similar between the two groups.
Conclusions: Endocuff combined with AI was superior to AI alone in improving the adenoma detection rate without increasing intubation or withdrawal times
Cognitive impairment and p-tau217 are high in a vascular patient cohort
No full textIntroduction: Vascular comorbidities are modifiable contributors to cognitive impairment and Alzheimer's disease (AD), yet brain health outcomes are rarely evaluated in cardiovascular patients.
Methods: This study prospectively evaluated cognition and AD pathology in 162 community-dwelling adults with asymptomatic cardiovascular disease who did not have a clinical diagnosis of dementia or cognitive impairment.
Results: Twenty-nine percent of the cohort had Montreal Cognitive Assessment (MoCA) scores indicative of cognitive impairment or dementia after adjusting for age, sex, and education based on National Alzheimer's Coordinating Center normative data. AD blood biomarker phosphorylated tau217 was elevated in 55% of the cohort, significantly associated with decreased MoCA scores (β = -1.46, 95% confidence interval [CI] -2.53 to -0.39, p < 0.01), and accurately differentiated cognitive impairment (area under the curve 0.94, 95% CI 0.88-0.99).
Discussion: This level of undiagnosed cognitive impairment and AD pathology exceeds what would be expected in the general population and highlights a potential need for screening and future work to better identify treatment options.
Highlights: Brain health outcomes are rarely evaluated in vascular patients. One hundred sixty-two adults with asymptomatic cardiovascular disease but without diagnoses of cognitive impairment or dementia were evaluated. Phosphorylated tau217 accurately differentiated cognitive impairment in patients with cardiovascular disease. High levels of cognitive impairment and Alzheimer's disease pathology are greatly underdiagnosed in the cardiovascular population
Racial Disparities in Analgesic and Psychiatric Medication Use During End-Of-Life Care in Advanced-Stage Colorectal Cancer: A Retrospective Cohort Study
No full textThis study examined racial and ethnic disparities in the use of analgesic and psychiatric medications during end-of-life care among Medicare beneficiaries with advanced-stage colorectal cancer. Using the Surveillance, Epidemiology, and End Results-Medicare-linked database from 2005 to 2017, we identified 28,212 patients with stage IV colorectal cancer who died within 1 year of diagnosis. Multivariable logistic regression models were used to assess differences in medication use by race and ethnicity. Compared with non-Hispanic White patients, Black patients had significantly lower odds of opioid use [adjusted OR (aOR) = 0.86; 95% confidence interval (CI), 0.80-0.93] and overall analgesic use, whereas Hispanic patients had higher use of opioids (aOR = 1.12; 95% CI, 1.03-1.22) and non-opioid analgesics (aOR = 1.22; 95% CI, 1.06-1.40). Asian patients had increased non-opioid use (aOR = 1.71; 95% CI, 1.44-2.03) and decreased skeletal muscle relaxant use (aOR = 0.59; 95% CI, 0.43-0.82). Across all minority groups, psychiatric medication use was consistently lower than in non-Hispanic White patients. These disparities persisted after adjusting for demographic, clinical, and socioeconomic factors. Findings highlight the urgent need for equitable, culturally responsive symptom management strategies to improve the quality of end-of-life care in this population.
Significance: We identified significant disparities in the use of analgesic and psychiatric medications among patients with advanced-stage colorectal cancer. Our findings are significant given the emerging importance of symptom management on health-related quality of life and survival. Future research is needed to understand causal factors, their influence on patient-reported outcomes such as symptom relief, and the development of strategies to close these medication use gaps
A critical narrative review of the experiences of Latinas, Hispanic, or Spanish origin (LHS+) women in medical field using Latina/Chicana feminist perspective
No full textWomen who identify as Latinas, Hispanic, or Spanish Origin (LHS+) are members of one of the fastest growing ethnic groups in the US. When we consider this fact regarding providing quality healthcare, we find that it is important to have a physician workforce that is representative of this population. However, there is little research about the experiences of LHS+ women in the medical field. The purpose of this study was to explore narratives found in medical education literature documenting the experiences of LHS+ women as learners, trainees, and professionals across the medicine continuum. We conducted a critical narrative review using Latina Chicana Feminist Perspective as a theoretical framework to identify and synthesize literature on LHS+ women in medicine. From July 2021 to October 2021 and November 2023 to January 2024, we performed searches using one database (MEDLINE [OVID]) and selected studies consistent with narrative integrity and relevance to the experiences of LHS+ women using the data software Covidence. After four phases of review, which included the identification phase, screening phase, and eligibility phase, we found 12 articles that discuss the experiences of LHS+ women. The literature allowed us to provide a preview of what is being discussed in terms of the experiences of LHS+ women populations. Although the articles found provided some information about the experiences of LHS+ women in medical education literature, more information is needed. Given the limited representation of narratives about LHS+ women in medical education research, there is a narrow opportunity to explore what their medical school experiences are and have been to develop interventions for their success. Medical educators and administrators are therefore limited in how they can address the possibilities of enhancing or replicating positive experiences and environments for LHS+ women in medicine
Systemic 4-1BB stimulation augments extrafollicular memory B cell formation and recall responses during Plasmodium infection
No full textT-dependent germinal center (GC) output, comprising plasma cells and memory B cells (MBCs), is crucial for clearance of Plasmodium infection and protection against reinfection. In this study, we examine the effect of an agonistic antibody targeting 4-1BB (CD137) during experimental malaria. We show that exogenous 4-1BB stimulation, despite delaying the effector GC response, surprisingly enhances humoral memory recall and protection from reinfection. Single-cell RNA and assay for transposase-accessible chromatin (ATAC) sequencing of MBCs from mice receiving 4-1BB stimulation reveal populations with distinct transcriptional signatures and a chromatin landscape indicative of superior recall and proliferative potential. Importantly, our results indicate that the effects of 4-1BB stimulation are dependent on interleukin (IL)-9R signaling in B cells but independent of parasite load during primary infection. Our study proposes an immunomodulatory approach to enhance the quality of the MBC pool, providing superior protection during infection and vaccination, particularly in the context of malaria
Real‐world observations of GLP‐1 receptor agonists and SGLT‐2 inhibitors as potential treatments for Alzheimer's disease
No full textIntroduction: Glucagon-like peptide-1 (GLP-1) receptor agonists, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, and dipeptidyl peptidase-4 (DPP-4) inhibitors have potential beneficial effects in Alzheimer's disease (AD).
Methods: We conducted pharmacoepidemiologic studies using two large-scale real-world databases. We fitted covariate-adjusted Cox models to compare the risks of AD among initiators of GLP-1 receptor agonists, SGLT-2 inhibitors, and DPP-4 inhibitors.
Results: We identified GLP-1 receptor agonist initiation compared to DPP-4 inhibitors initiation was associated with a reduced risk of AD (hazard ratio [HR] ≤ 0.69 and P value < 0.001) and SGLT-2 inhibitor initiation compared to DPP-4 inhibitor initiation was associated with a reduced risk of AD (HR ≤ 0.67 and P value < 0.001).
Discussion: GLP-1 receptor agonist initiation and SGLT-2 inhibitor initiation are associated with a reduced risk of AD. Randomized clinical trials are warranted to validate the causal beneficial effects of GLP-1 receptor agonists and SGLT-2 inhibitors in AD.
Highlights: Glucagon-like peptide-1 (GLP-1) receptor agonists are significantly associated with a reduced risk of Alzheimer's disease (AD) compared to dipeptidyl peptidase-4 (DPP-4) inhibitors. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are significantly associated with a reduced risk of AD compared to dipeptidyl peptidase-4 (DPP-4) inhibitors. Two GLP-1 receptor agonists (liraglutide and semaglutide) and three SGLT-2 inhibitors (dapagliflozin, canagliflozin, and empagliflozin) are associated with a reduced risk of AD in drug-specific sensitivity analyses