Chronic Health Care Research Articles

Social Needs, Chronic Conditions, and Health Care Utilization among Medicaid Beneficiaries.

Health care organizations are increasingly assessing patients' social needs (eg, food, utilities, transportation) using various measures and methods. Prior studies have assessed social needs at the point of care and many studies have focused on correlates of 1 specific need (eg, food). This comprehensive study examined multiple social needs and medical and pharmacy claims data. Medicaid beneficiaries in Louisiana (n = 10,275) completed a self-report assessment of 10 social needs during July 2018 to June 2019. Chronic health conditions, unique medications, and health care utilization were coded from claims data. The sample was predominantly female (72%), Black (45%) or White (32%), had a mean age of 42 years, and at least 1 social need (55%). In bivariate analyses, having greater social needs was associated with greater comorbidity across conditions, and each social need was consistently associated with mental health and substance use disorders. In multivariable logistic analyses, having ≥2 social needs was positively associated with emergency department (ED) visits (OR = 1.39, CI = 1.23 - 1.57) and negatively associated with wellness visits (OR = 0.87, CI = 0.77 - 0.98), inpatient visits (OR = 0.87, CI = 0.76 - 0.99), and 30-day rehospitalization (OR = 0.66, CI = 0.50 - 0.87). Findings highlight the greater concomitant risk of social needs, mental health, and substance use. Admission policies may reduce the impact of social needs on hospitalization. Chronic disease management programs offered by health plans may benefit from systematically assessing and addressing social needs outside point-of-care interactions to impact health outcomes and ED utilization. Behavioral health care management programs would benefit from integrating interventions for multiple social needs.

Children with Cerebral Palsy and Unmet Need for Care Coordination.

To examine the physical and functional health of children with cerebral palsy (CP) and determine the prevalence and correlates of unmet need for health care coordination among this population. We analyzed data from the 2016 to 2018 National Survey of Children's Health (n = 102,341). Bivariate and multivariable analyses were conducted to compare the prevalence of chronic health conditions, functional disabilities, and care coordination among children with and without CP. Multivariable logistic regression models were used to estimate the adjusted odds ratio of comorbid conditions, functional disabilities, and unmet need for care coordination. Associations between select sociodemographic factors and unmet need for care coordination were assessed. Children with CP had significantly higher prevalence of all the comorbid conditions and functional disabilities examined. The most prevalent health conditions among children with CP were allergies (34.2%), anxiety (26.5%), and asthma (25.1%). Notably, children with CP had higher odds of autism spectrum disorder (adjusted odds ratio [aOR] = 2.97; 95% confidence interval [CI] 1.40-6.30) and mental health conditions (aOR = 3.65; 95% CI 2.15-6.21). More than half (53.8%) of children with CP had unmet need for care coordination. They also had higher odds of unmet need for care coordination than children without CP (aOR = 2.63; 95% CI 1.69-4.10). Children with CP have high prevalence of chronic health conditions and are also more likely to have unmet need for care coordination. Given the complexity of CP, our study supports the need for robust efforts to ensure that all children with CP have effective care coordination.

Implementing patient-centred integrated care for multiple chronic conditions: Evidence-informed framework.

Fifteen years ago, the term multimorbidity rarely appeared in chronic disease health care policies. Today, research has revealed very high rates of multimorbidity, leading to it being labeled the number one challenge in developed countries.[1][1]-[5][2] Paradoxically, chronic disease prevention and

African American Pediatric Liver Transplant Recipients Have an Increased Risk of Death After Transferring to Adult Healthcare

To analyze the long-term outcomes in pediatric liver transplant recipients after they have transferred to an adult provider and assess for racial disparities in health outcomes. This is a single-center, retrospective review of pediatric patients who underwent liver transplantation between July 1990 and August 2015 at a tertiary healthcare system with a large transplant center. Patient mortality and retransplantation were assessed after transfer to adult care. There were 120 patients who were transferred, of whom 19 did not meet the inclusion criteria. Of the remaining 101 patients, 64 (63%) transferred care to a nearby affiliated tertiary adult facility, 29 (29%) were followed by other healthcare systems, and 8 (8%) were lost to follow-up. Of the patients followed at our affiliated adult center, 18 of the 64 (28%) died. Of those 18 deaths, 4 (22%) occurred within the first 2years after transfer, and 10 (55%) within 5years of transfer. Four patients were retransplanted by an adult provider, of whom 2 eventually received a third transplant. African Americans had higher rates of death after transfer than patients of other races (44% mortality vs 16%, representing 67% of all cases of death; P=.032), with nearly 50% mortality at 20years from time of transplantation. Death is common in pediatric liver transplant recipients after transfer to adult care, with African Americans having disproportionately higher mortality. This period of transition of care is a vulnerable time, and measures must be taken to ensure the safe transfer of young adults with chronic health care needs.

Core outcome set for pediatric chronic pain clinical trials: results from a Delphi poll and consensus meeting.

Appropriate outcome measures and high-quality intervention trials are critical to advancing care for children with chronic pain. Our aim was to update a core outcome set for pediatric chronic pain interventions. The first phase involved collecting providers', patients', and parents' perspectives about treatment of pediatric chronic pain to understand clinically meaningful outcomes to be routinely measured. The second phase was to reach consensus of mandatory and optional outcome domains following the OMERACT framework. A modified Delphi study with 2 rounds was conducted including 3 stakeholder groups: children with chronic pain (n = 93), their parents (n = 90), and health care providers who treat youth with chronic pain (n = 52). Quantitative and qualitative data from round 1 of the Delphi study were summarized to identify important outcomes, which were condensed to a list of 10 outcome domains. Round 2 surveys were analyzed to determine the importance of the 10 domains and their relative ranking in each stakeholder group. A virtual consensus conference was held with the steering committee to reach consensus on a set of recommended outcome domains for pediatric chronic pain clinical trials. It was determined, by unanimous vote, that pain severity, pain interference with daily living, overall well-being, and adverse events, including death, would be considered mandatory domains to be assessed in all trials of any type of intervention. Emotional functioning, physical functioning, and sleep were important but optional domains. Last, the research agenda identifies several important emerging areas, including biomarkers. Future work includes selecting appropriate validated measures to assess each outcome domain.

Deliberative and Paternalistic Interaction Styles for Conversational Agents in Digital Health: Procedure and Validation Through a Web-Based Experiment

BackgroundRecent years have witnessed a constant increase in the number of people with chronic conditions requiring ongoing medical support in their everyday lives. However, global health systems are not adequately equipped for this extraordinarily time-consuming and cost-intensive development. Here, conversational agents (CAs) can offer easily scalable and ubiquitous support. Moreover, different aspects of CAs have not yet been sufficiently investigated to fully exploit their potential. One such trait is the interaction style between patients and CAs. In human-to-human settings, the interaction style is an imperative part of the interaction between patients and physicians. Patient-physician interaction is recognized as a critical success factor for patient satisfaction, treatment adherence, and subsequent treatment outcomes. However, so far, it remains effectively unknown how different interaction styles can be implemented into CA interactions and whether these styles are recognizable by users.ObjectiveThe objective of this study was to develop an approach to reproducibly induce 2 specific interaction styles into CA-patient dialogs and subsequently test and validate them in a chronic health care context.MethodsOn the basis of the Roter Interaction Analysis System and iterative evaluations by scientific experts and medical health care professionals, we identified 10 communication components that characterize the 2 developed interaction styles: deliberative and paternalistic interaction styles. These communication components were used to develop 2 CA variations, each representing one of the 2 interaction styles. We assessed them in a web-based between-subject experiment. The participants were asked to put themselves in the position of a patient with chronic obstructive pulmonary disease. These participants were randomly assigned to interact with one of the 2 CAs and subsequently asked to identify the respective interaction style. Chi-square test was used to assess the correct identification of the CA-patient interaction style.ResultsA total of 88 individuals (42/88, 48% female; mean age 31.5 years, SD 10.1 years) fulfilled the inclusion criteria and participated in the web-based experiment. The participants in both the paternalistic and deliberative conditions correctly identified the underlying interaction styles of the CAs in more than 80% of the assessments (X21,88=38.2; P<.001; phi coefficient rφ=0.68). The validation of the procedure was hence successful.ConclusionsWe developed an approach that is tailored for a medical context to induce a paternalistic and deliberative interaction style into a written interaction between a patient and a CA. We successfully tested and validated the procedure in a web-based experiment involving 88 participants. Future research should implement and test this approach among actual patients with chronic diseases and compare the results in different medical conditions. This approach can further be used as a starting point to develop dynamic CAs that adapt their interaction styles to their users.

A Medical Student Initiative to Enhance the Pediatric Hemodialysis Experience.

Background:Children and young adults receiving hemodialysis (HD) face unique challenges including frequent school absenteeism, psychosocial issues, and social isolation, placing them at risk for decreased academic achievement and health literacy.Objective:To address this, we implemented the Child and Adolescent Motivation and Enrichment Program (CHAMP) at Holtz Children's Hospital in Miami, FL. The objective of this study is to describe the organizational structure and program design of CHAMP and provide preliminary program opinions.Methods:Medical students served as longitudinal one-on-one mentors to patients receiving HD. Face-to-face intervention, books, board games, and electronic tablets were used to enhance patients' educational and recreational experience. We surveyed participating patients, medical students, and unit nurses regarding their opinions of CHAMP.Key Results: Patients responded to a series of questions on a Likert scale scored from 1 to 5 and reported the highest scores on questions pertaining to having fun with mentors (mean = 4.88), enjoying mentor visits (mean = 4.78), and learning during visits (mean = 3.88). Mentors reported the highest level of agreement (mean = 4.82) that CHAMP helped them gain empathy for patients with chronic and/or special health care needs. Nurses scored highly on the point that “overall, the program was useful and helped the patient” (mean = 6.86 of a possible 7).Conclusion:CHAMP is an academic and psychosocial enrichment program for children and adolescents receiving HD. The program is regarded highly by participating patients, medical students, and unit nurses. Patients report enjoying and learning from mentor sessions, whereas nurses report improved interactions with patients. Medical students who participate as mentors also gain important exposure to the field of pediatric nephrology. The program design as described herein positions CHAMP for replication at academic medical centers nationwide, allowing for optimization of the health and well-being of the pediatric HD population. [HLRP: Health Literacy Research and Practice. 2021;5(1):e60–e69.]Plain Language Summary:Pediatric patients undergoing hemodialysis (HD) are at risk for decreased academic achievement and health literacy. To address this, we implemented the Child and Adolescent Motivation and Enrichment Program, a longitudinal mentorship program pairing medical students as one-on-one mentors to patients undergoing HD. Preliminary results from this program demonstrate satisfaction and enjoyment by participating patients, medical students, and dialysis unit nurses.

The Impact of Incarceration on Health and Health Care Utilization: a System Perspective.

Previously incarcerated individuals report high rates of chronic disease and reduced health care access. We characterized the impact of recent incarceration in jail or prison on chronic disease burden and health care utilization. Incarceration data over 10 years were matched to health system data and patients were classified by recent incarceration status. Each cohort was stratified by gender and neighborhood socioeconomic status for utilization analysis. Main outcomes were chronic disease incidence and health care utilization. Incarceration had a significant but small effect on chronic disease incidence. Incarceration had a moderate to large effect on emergency department and behavioral health utilization, with additional differences seen by gender and socioeconomic status. Incarceration's impact on quantity and type of health care utilization varies with socioeconomic status and gender. Future work should evaluate the impact of length or number of cycles of incarceration on health or health care utilization.

The Impact of Nurse Specialists in Improving Health Economy

The role of the clinical nurse specialist has evolved significantly over time. Many countries already have implemented comprehensive programs for the education of nurse specialists. There are a number of projects showing that clinical nurse specialist is uniquely suited to lead health care institutions’ efforts to employ programs, practices, and interventions that will expand care quality and reduce cost in a variety of practice areas. This may mainly be able to be performed by education of patients to prevent various type of disease. Clinical nurse specialists may affect costs in three main areas which can be direct costs, indirect costs, and equipment expenses. There is a huge body of evidence that these types of health providers may decrease health care expenditures through management of a patient’s primary and chronic health care and by care coordination and transitions using advanced nursing knowledge, skill, and abilities. This manuscript focus on the importance of nurse specialists to improve the health economy of developing countries through education of patients, screening, and even management of special diseases.

When public health messages become stressful: Managing chronic disease during COVID-19.

To curb the spread of COVID-19, the United States has endorsed a variety of public health measures and distributed their content expediently. While these measures are critical for saving the lives of thousands, they may be sources of stress for individuals managing a chronic disease or make disease management more challenging. Forty-five percent of Americans live with chronic disease and already manage a range of everyday stressors related to their disease, making the additional stress produced by this public health guidance and their messages more difficult. Guided by Cohen and colleagues’ Stage Model of Stress and Disease (Cohen et al., 2016) and Ryan and Sawin’s Individual and Family Self-Management Theory (Ryan & Sawin, 2009), this paper identifies the various dimensions of these public health measures that may cause stress and negatively impact individuals managing chronic disease. Further, this paper presents a conceptual model for understanding how these stressors and common stressors associated with managing chronic disease interact and significantly impact chronic disease management. Considering the impact of these stressors on individuals managing chronic disease is paramount to ensure this population is empowered to manage this additional stress healthily and effectively. Recommendations for individuals managing chronic disease and health care professionals working with this population are provided.

Trends in Physical and Mental Health, Mortality, Life Expectancy, and Social Inequalities Among American Indians and Alaska Natives, 1990-2019

Objective: To address the continuing gap in data and research on health and socioeconomic inequities characterizing Native Americans in the United States, this study examines major health and social inequality trends for the American Indian and Alaska Native (AIAN) populations covering several broad areas, including infant and child health, life expectancy and leading causes of death, physical and mental health, chronic disease prevalence, disability, health-risk behaviors, and health care access and quality. Methods: We used trend data from the 1990-2019 National Vital Statistics System, 2014-2018 National Health Interview Survey, and 2014-2018 American Community Survey to examine health, health care, mortality, and disease patterns for AIANs in relation to other racial/ethnic groups and the general population. Life tables, age-adjusted rates, risk ratios, and logistic regression were used to examine health inequalities. Results: In 2019, life expectancy of AIANs was 76.9 years, 11.3 years shorter than that for Asian/Pacific Islanders. The infant mortality rate for AIANs was 8.7 per 1,000 live births, 79% higher than the rate for non-Hispanic Whites. Risks of infant mortality from birth defects, low birthweight/prematurity, maternal complications, SIDS, and unintentional injury were significantly greater among AIANs compared with non Hispanic Whites. Excess mortality among AIANs, particularly in rural areas, was found for working ages, diabetes, liver cirrhosis, alcohol-related causes, youth suicide, and unintentional injuries. About 18% of AIANs assessed their overall health as fair or poor, at twice the rate of non-Hispanic Whites or the general population. About 10% of AIAN adults experienced serious psychological distress, 2-to-5 times higher than the prevalence for other racial/ethnic groups. AIANs had the highest overall disability, mental and ambulatory disability, health uninsurance, unemployment, and poverty rates in the US, with differences in these indicators varying markedly across the AIAN tribes. Conclusion and Implications for Translation: AIANs remain a disadvantaged segment of the US population in a number of key health indicators and in socioeconomic and living conditions, with poverty rates in some tribal groups approaching or exceeding 40%.

Changes in chronic medication adherence, costs, and health care use after a cancer diagnosis among low-income patients and the role of patient-centered medical homes.

Approximately 40% of patients with cancer also have another chronic medical condition. Patient-centered medical homes (PCMHs) have improved outcomes among patients with multiple chronic comorbidities. The authors first evaluated the impact of a cancer diagnosis on chronic medication adherence among patients with Medicaid coverage and, second, whether PCMHs influenced outcomes among patients with cancer. Using linked 2004 to 2010 North Carolina cancer registry and claims data, the authors included Medicaid enrollees who were diagnosed with breast, colorectal, or lung cancer who had hyperlipidemia, hypertension, and/or diabetes mellitus. Using difference-in-difference methods, the authors examined adherence to chronic disease medications as measured by the change in the percentage of days covered over time among patients with and without cancer. The authors then further evaluated whether PCMH enrollment modified the observed differences between those patients with and without cancer using a differences-in-differences-in-differences approach. The authors examined changes in health care expenditures and use as secondary outcomes. Patients newly diagnosed with cancer who had hyperlipidemia experienced a 7-percentage point to 11-percentage point decrease in the percentage of days covered compared with patients without cancer. Patients with cancer also experienced significant increases in medical expenditures and hospitalizations compared with noncancer controls. Changes in medication adherence over time between patients with and without cancer were not determined to be statistically significantly different by PCMH status. Some PCMH patients with cancer experienced smaller increases in expenditures (diabetes) and emergency department use (hyperlipidemia) but larger increases in their inpatient hospitalization rates (hypertension) compared with non-PCMH patients with cancer relative to patients without cancer. PCMHs were not found to be associated with improvements in chronic disease medication adherence, but were associated with lower costs and emergency department visits among some low-income patients with cancer.

Recomendaciones de Rama de Gastroenterología para situaciones relacionadas con infección COVID-19 en niños

A pandemic disease caused by a new infectious agent, SARS-CoV-2 coronavirus, also known as COVID-19 is currently an urgent Public Health problem. This highly contagious and moderate lethal agent is rapidly spreading worldwide. Patients with chronic diseases and health care personnel are particularly vulnerable groups to this virus. Hence the importance of developing preventive strategies and disseminating them widely. This document, generated at the request of the Pediatric Gastroenterology Branch Directory of SOCHIPE, aims to provide tools for health care professionals working with children to make the best decision when faced with a patient requiring an endoscopic procedure or managing a patient with suspected or diagnosed Inflammatory Bowel Disease to properly prevent COVID-19.

Comparing Biological Age Estimates Using Domain-Specific Measures From the Canadian Longitudinal Study on Aging.

Many studies have shown that estimates of biological age (BA) can predict health-related outcomes in older adults. Often, researchers employ multiple measures belonging to a variety of biological/physiological systems, and assess the validity of BA estimates by how well they approximate chronological age (CA). However, it is not clear whether this is the best approach for judging a BA estimate, or whether certain groups of measures are more informative to this end. Using data from the Canadian Longitudinal Study on Aging, we composed panels of biological measures based on the physiological systems/domains they belong to (blood, organ function, physical/cognitive performance), and also composed a panel of measures that optimized the association of BA with CA. We then compared BA estimates for each according to their association with CA and health-related outcomes, including frailty, multimorbidity, chronic condition domains, disability, and health care utilization. Although BA estimated using all 40 measures (r = 0.74) or our age-optimized panel (r = 0.77) most closely approximated CA, the strength of associations to health-related outcomes was comparable or weaker than that of our panel composed only of physical performance measures (CA r = 0.59). All BA estimates were significantly associated to the outcomes considered, with exception to the neurological and musculoskeletal disease domains, and only varied slightly by sex. In summary, while the approximation of CA is important to consider when estimating BA, the strength of associations to prospective outcomes may be of greater importance. Hence, the context in which BA is estimated should be influenced by an investigator's specific research goals.

The Special Perils of Being Old and Sick in Prison

The United States Supreme Court declared in 1976 that deliberate indifference to the serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain…proscribed by the Eighth Amendment. It matters not whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards intentionally denying or delaying access to medical care or intentionally interfering with treatment once prescribed—adequate prisoner medical care is required by the United States Constitution. My incarceration for four years at the Oakdale Satellite Prison Camp, a chronic health care level camp, gives me the perspective to challenge the generally promoted claim of the Bureau of Federal Prisons that it provides decent medical care by competent and caring medical practitioners to chronically unhealthy elderly prisoners. The same observation, to a slightly lesser extent, could be made with respect to deficiencies in the delivery of health care to prisoners of all ages, as it is all significantly deficient in access, competencies, courtesies and treatments extended by prison health care providers at every level of care, without regard to age. However, the frailer the prisoner, the more dangerous these health care deficiencies are to his health and, therefore, I believe, warrant separate attention. This paper uses first-hand experiences of elderly prisoners to dismantle the tale that prisoner healthcare meets constitutional standards.

When Public Health Messages Become Stressful: Managing Chronic Disease During COVID-19

In an effort to curb the spread of COVID-19, the United States has endorsed a variety of public health measures and distributed their content expediently. While these measures are critical for saving the lives of thousands, they may be sources of stress for individuals managing chronic disease or make disease management more challenging. Individuals living with chronic disease already manage a range of everyday stressors related to their disease, making the additional stress produced by this public health guidance and their messages more difficult. This paper identifies the various dimensions of these public health measures that may cause stress and negatively impact individuals managing chronic disease. Further this paper presents a conceptual model for understanding how these stressors and common stressors associated with managing chronic disease interact and significantly impact chronic disease management. Considering the impact of these stressors on individuals managing chronic disease is paramount to ensure this population is empowered to manage this additional stress in a healthy and effective manner. Recommendations for individuals managing chronic disease and health care professionals working with this population are provided.

The Emergency Prescription Assistance Program's (EPAP): Providing continuing chronic health care for Hurricane Maria survivors from USVI

In this study we explore the capabilities and the impact of Emergency Prescription Assistance Program (EPAP) during Hurricane Maria in the U.S. Virgin Islands (USVI) using descriptive analytic methods and mapping from the data provided by the Department of Health and Human Services. To date, this is the first peer-reviewed analysis of EPAP claims conducted since its launch in 2008 post Hurricanes Ike and Gustav. Three primary study objectives are explored: a) characterization of the chronic care medication needs met by EPAP; b) characterization and analysis of the type and timing of claims processed and c) involved pharmacy characterization. During the study period of November 2017–April 2018, EPAP has served over 2000 patients amounting to over 17,000 prescription claims. Maintenance medications claims for hypertension, diabetes and antibiotics were the top three drug categories processed by the program. Through local pharmacies enrolled with EPAP, continuity of care for the uninsured was safeguarded, and local business operations were not required to donate inventory and services to provide that continuity of care. EPAP services are a critical component of the disaster recovery efforts to address chronic care medication needs of displaced disaster survivors.

Integrative physiology and traditional naturopathic practice: results of an international observational study

BackgroundNaturopathy is one of seven distinct traditional medical systems acknowledged by the World Health Organization. Naturopathic principles and philosophies encourage a focus on multiple body systems during case-taking and the design of treatments. Little is known about whether such teaching translates into practice. This study aimed to characterise naturopathic practice as it relates to the identification of multiple physiological systems in the diagnosis and treatment of patients. MethodsA cross sectional study was conducted in collaboration with the World Naturopathic Federation. A survey capturing clinical diagnostic and treatment considerations for up to 20 consecutive patients was administered to naturopaths in 14 countries. ResultsNaturopaths (n=56) were mostly female (62.5%), aged between 36 and 45 years (37.5%), in practice for 5–10 years (44.6%), and consulting between 11 and 20 patients per week (35.7%). Participants completed the survey for 851 patient cases. Naturopaths reported a greater number of physiological systems relevant to clinical cases where the patients were working age (18–65 years) (IRR 1.3, p=.042), elderly (65 years and over) (IRR 1.4, p=.046), or considered by the naturopath to have a chronic health condition (IRR 1.2, p=.003). The digestive system was weakly associated with patients based on chronicity of the health complaint (V=.1149, p=.004), or having a musculoskeletal complaint (V=.1067, p=.002) autoimmune pathophysiology (V=.1681, p<.001), and considered relevant in respiratory (V=.1042, p=.002), endocrine (V=.1023, p=.003), female reproductive (V=.1009, p=.003), and integumentary (V=.1382, p<.001) systems. ConclusionNaturopaths across the world adopt an integrative physiological approach to the diagnosis and treatment of chronic and complex health care complaints..

A Pilot Study of Mindfulness-Based Cognitive Therapy to Improve Well-Being for Health Professionals Providing Chronic Disease Care

To assess the efficacy of mindfulness-based cognitive therapy delivered onsite during work hours in reducing stress and improving well-being in an interdisciplinary chronic care health care team. A longitudinal, mixed methods, observational pilot study using a survey created from validated assessment tools to measure effectiveness of training. Surveys were completed before training, and 1 and 15months after training. Twenty-four professionals in the cystic fibrosis Centers at Cincinnati Children's Hospital and the University of Cincinnati participated in 6 mindfulness-based cognitive therapy training sessions. Sessions incorporated mindfulness, cognitive therapy, and experiential exercises for processing feelings related to stress and burnout. The presurvey and 1-month postsurvey responses revealed statistically significant improvements for empathy, perceived stress, depersonalization, anxiety, perspective taking, resilience, and negative affect. Sustained effects were seen at 15months for empathy, perspective taking, and depressive symptoms. The 1-month post-training surveys reported a quarter of respondents (25%) practiced skills at least 5 times in between sessions; at 15months, 35% reported practicing at the same frequency. Participants reported using mindfulness skills for personal stressful events (74%), work-related general stress (65%), patient-related stress (30%), sleep or general relaxation (22%), and wellness (13%). Group mindfulness-based cognitive therapy training was feasible and effective in decreasing stress for interdisciplinary cystic fibrosis care team members who elected to participate. Further investigation is needed to determine optimal dose of training, durability of perceived benefits, and generalizability to health care professionals working with other chronic disorders.

Perioperative Implications of Vaping

Over the past 10 - 15 years, there has been a significant increase in the use of electronic cigarettes. These devices are generally used to deliver nicotine through inhalation by aerosolization. While the long-term risk of lung cancer is yet to be known, the chemicals and impurities in the solutions may have other acute and chronic effects on the respiratory system including respiratory failure from adult respiratory distress syndrome. Recent concerns have been raised regarding the potential for significant acute and chronic health care risks of these devices including pneumonitis, airway reactivity and respiratory failure. Given that many of the acute effects are related to the respiratory system, anesthetic care may be required during diagnostic procedures including bronchoscopy to investigate the etiology of acute respiratory symptomatology. We present an adolescent who presented to the operating room for bronchoscopy and bronchoalveolar lavage to investigate the etiology of respiratory involvement following an episode of vaping. The healthcare and end-organ effects of nicotine, tobacco smoke and vaping are discussed, and potential anesthetic implications are presented. J Med Cases. 2020;11(5):129-134 doi: https://doi.org/10.14740/jmc3451