Abstract Background: The global rise in noncommunicable diseases (NCDs) demands innovative public health strategies. Key NCD risk factors are lifestyle-related, emphasizing the importance of behavior change (BC) interventions. Here, empathy plays a pivotal role by fostering rapport, enhancing patient-provider communication, and promoting an individual's motivation to change. However, the role of empathy in BC interventions and its potential intersection with BC techniques (BCTs) remains understudied, especially in telehealth. This study seeks to investigate this intersection in the context of asynchronous health coaching. Methods: We conducted a two-round survey with 11 health coaches (HCs) who responded to 10 participant messages from the Bump2Baby and Me trial. In total, we examined 88 HC messages for empathic responses and the presence of techniques from the taxonomies of BC techniques (BCTs), Motivational BCTs (MBCTs), and Self-Determination Theory techniques (SDTTs). Results: We identified 121 empathic responses that strongly overlapped with MBCTs (79%, n=213) in the form of Praise (47%, n=100) via unconditional positive regard and acknowledging patient perspectives and feelings, and Normalizing (23%, n=49) via neutral support and unconditional regard. While BCTs and SDTTs showed no substantial overlaps with empathic responses, 67% of BCTs elicited participants’ feelings and views about their coaching program. Conclusions: The role of MBCTs in empathy expressions boosts patient engagement and self-perception, fostering relatedness. BCTs supported a patient-centered approach by empowering patients to articulate and plan their goals, which promotes autonomy. The lack of alignment in other categories suggests that considering empathy and BC techniques in isolation provides an incomplete picture of BC interventions.

This study examined the relationships between the dimensions of the nurse manager (NM) practice environment (PE) and burnout. NMs are critical to the success of their unit(s). Understanding the degree to which their PE characteristics impact their level of burnout is important to NM retention. A cross-sectional research design using a 71-item questionnaire was used to measure NM characteristics, hospital characteristics, NM PE, and burnout. There were 110 completed respondents across 22 hospitals in the United States. Moderate inverse relationships exist between the NM PE and 2 of the 3 (work and personal) dimensions of burnout. NM age and tenure also showed an inverse relationship with burnout. This study added evidence showing a statistically significant relationship between NM PE and the work and personal dimensions of burnout. These results also suggest the relationships NMs have with the patients on their unit(s) do not add to their level of burnout.

Background Use of the antiparasitic agent ivermectin as a potential treatment for early coronavirus disease 2019 (COVID-19) is not recommended, yet inpatient administration continues to be seen. Methods This was a retrospective analysis of more than 100,000 patients admitted to a large health system of community hospitals for COVID-19 to assess the association of ivermectin administration, either early in disease course or at higher severity, with mortality and disease progression (intensive care unit admission or use of mechanical ventilation). Propensity match analysis was used to account for covariates. Results Of the 122,002 patients hospitalized with COVID-19 included in this analysis, 1.1% (1380) received ivermectin while at mild to moderate severity (on room air or nasal cannula), and 0.2% (n = 293) received the drug while severe (noninvasive or mechanical ventilation). Among those who received it with mild to moderate severity, there was no effect on relative risk (RR) of mortality (RR, 1.01; 95% confidence interval [CI], 0.802–1.27), intensive care unit admission (RR, 0.984; 95% CI, 0.865–1.12), or use of mechanical ventilation (RR, 0.976; 95% CI, 0.777–1.23), but an increase in average length of stay (mean days, 8.0 vs 7.5; P < 0.001). Of those who received their first dose of ivermectin with more severe COVID-19, there was an increase in the RR of mortality (RR, 1.63; 95% CI, 1.34–1.99; P < 0.001). Conclusion Among hospitalized patients admitted with mild to moderate COVID-19, in-hospital administration of ivermectin provides no benefit in mortality or disease progression when administered early in the disease course, and may contribute to excess mortality when administered to patients at more severe disease states.

The purpose of this quality improvement project was to retrospectively evaluate pharmacist time to clinical surveillance alert intervention before and after implementing a pharmacy-directed alert priority category across a large for-profit United States health system with well-established clinical pharmacy surveillance software integrated into the clinical pharmacy workflow. The findings contributed to a financial evaluation of pharmacist productivity compared with drug spend for pharmacy-directed interventions that included intravenous (IV)-to-oral-conversion and renal dosing opportunities. A retrospective quality improvement pre-/postanalysis of deidentified, prepopulated clinical surveillance alert data for the preimplementation period of January 1, 2021, through September 30, 2021, was compared with that for the postimplementation period of November 1, 2021, to January 31, 2022, for 169 hospitals. Clinical pharmacist workflow was mapped pre- and postimplementation. The average time to alert intervention was calculated using the mean time in minutes between the alert firing within the software and when the pharmacist reviewed the alert, grouped by hospital, alert status, and priority category. Medications converted from IV to oral were assessed using the clinical surveillance software IV-to-oral calculator. Postimplementation renal dose cost savings were modeled using pharmacist-completed alerts by rule name that indicated a possible dose decrease based on the patient's renal function and current medication. Time to alert intervention for all completed pharmacist interventions was reduced for high-priority alerts by 32.6 min (p < .001) and routine-priority alerts by 65.1 min (p = .147). Alerts that moved to the pharmacy-directed alert priority category resulted in a reduced time to alert intervention of 38.7 min (p = .003). Normalized average wholesale price (AWP) cost savings from IV-to-oral conversion within 3 days of conversion eligibility were $1,693,600 in the preimplementation period and $1,867,400 in the postimplementation period, a $173,700 increase in cost savings. A total of 7,972 completed postimplementation renal dose adjustments resulted in a modeled AWP normalized cost savings of $1,076,700. Results indicated that optimizing clinical surveillance software alerts was effective and increased pharmacist productivity. Specifically, creating a pharmacy-directed alert category that pharmacists were able to complete by hospital policy or protocol improved workflow efficiency and increased IV-to-oral medication conversion cost savings. Further study is needed to validate the renal dose-modeled cost savings and address the financial benefits of quality measures to prevent acute kidney injury.

Introduction/BackgroundIn the phase 3 RUBY trial (NCT03981796) in patients with primary advanced or recurrent endometrial cancer (pA/rEC) dostarlimab+carboplatin/paclitaxel significantly improved PFS versus carboplatin/paclitaxel alone in the mismatch repair deficient/microsatellite instability-high (HR 0.28) and overall populations (HR 0.64) with a favourable OS trend (HR 0.64). Here, we report on safety for the RUBY trial.MethodologyPatients with pA/rEC were randomised 1:1 to dostarlimab 500 mg, or placebo, plus carboplatin AUC 5 and paclitaxel 175 mg/m2 Q3W for 6 cycles, followed by dostarlimab 1000 mg, or placebo, Q6W for up to 3 years. Adverse events (AEs) were assessed according to CTCAE v4.03.ResultsThe safety population included 487 patients who received ≥1 dose of treatment (241 dostarlimab+carboplatin/paclitaxel; 246 placebo+carboplatin/paclitaxel). Treatment-emergent adverse events (TEAEs) were experienced by 100% of patients; 70.5% of the dostarlimab arm and 59.8% of the placebo arm experienced grade ≥3 TEAEs (table 1). Median time to TEAE was 2.0 days in the dostarlimab+carboplatin/paclitaxel arm and 2.5 days in the placebo+carboplatin/paclitaxel arm. TEAEs led to discontinuation in 23.7% of the dostarlimab+carboplatin/paclitaxel arm and 16.7% of the placebo+carboplatin/paclitaxel arm. Higher rates of discontinuation were reported during the chemotherapy phase (cycles 1–6) versus the monotherapy phase (cycles ≥7). TEAEs led to discontinuation of dostarlimab or placebo in 17.4% and 9.3% of patients (table 1). Discontinuation rates of carboplatin or paclitaxel were similar between arms. Immune-related AEs related to dostarlimab or placebo were reported in 38.2% of the dostarlimab arm and 15.4% of the placebo arm. Five deaths were reported in the dostarlimab arm; 2 were related to dostarlimab.ConclusionThe safety profile of dostarlimab+carboplatin/paclitaxel was consistent with that of the individual components. The addition of dostarlimab did not compromise the completion rate of chemotherapy. Dostarlimab+carboplatin/paclitaxel has a favourable benefit-risk profile that makes it a valuable treatment option for patients with pA/rEC.DisclosuresThis study (NCT03981796) was sponsored by GSK, Waltham, MA, USA. #540 Table 1Third-party medical writing supportWriting and editorial support, funded and coordinated by GSK (Waltham, MA, USA), was provided by Shannon Morgan-Pelosi, PhD, and Mary Wiggin of Ashfield MedComms, an Inizio company.

Abstract Aims To validate a previously derived definition for major abdominal surgery that has potential for widespread adoption and use in patient-driven outcome studies. Methods We codified our narrative definition for MAS using CCSD and OPCS-4 schedules. Data was extracted from electronic health records over a 5-year period to validate this definition by comparing relevant proxy measurements between MAS and non-MAS groups. Unsupervised machine learning, using the Partitioning Around Medoids algorithm, was used to cross-validate the definition by clustering all procedure codes into MAS and non-MAS groups based on these proxy measures. Results 337 CCSD codes and 214 OPCS-4 codes were reviewed. Of these, 84 CCSD and 45 OPCS-4 codes were considered to be MAS, while 195 CCSD and 111 OPCS-4 codes were considered to be non-MAS. The remaining codes were excluded as they involved non-operative procedures. We extracted data on 16,353 procedures, covering 214 CCSD procedure codes over a 5 year period. There was statistically significant difference between MAS and non-MAS operations, when comparing patient age, procedure duration, length of hospital stay, percentage of ICU admissions (p&amp;lt;0.001 for all values). Unsupervised machine learning allocated 127 CCSD codes, that contained data on more than 10 patients, into 2 distinct clusters with percentage agreement being 87.4% and Cohen’s kappa of 0.736 between narrative definition and machine learning analysis. Conclusions We have arrived at a validated definition of major abdominal surgery, which can now be confirmed using a larger data set. We propose that this will prove useful in the development of comparative patient-driven outcome data.

Psychological torture, in its broadest sense, is the intentional infliction of suffering without resorting to direct physical violence, in what is known as 'no-touch' torture. While several other definitions of psychological torture have been suggested, there is no one precise definition. Given the rapidly evolving current global political climate and the intensification of conflict, war and asylum seeking, the need for better recognition of psychological torture among clinicians, followed by the provision of appropriate treatment support for victims, has become increasingly pertinent. This article raises awareness of the concept of psychological torture among clinicians, through an overview of its debated definitions, the modalities which constitute this form of torture, and its clinical sequelae and treatment approach.