Clinical Practice Sites Research Articles

Bidirectional Risk Modulator and Modifier Variant of Dilated and Hypertrophic Cardiomyopathy in BAG3

ImportanceThe genetic factors that modulate the reduced penetrance and variable expressivity of heritable dilated cardiomyopathy (DCM) are largely unknown. BAG3 genetic variants have been implicated in both DCM and hypertrophic cardiomyopathy (HCM), nominating BAG3 as a gene that harbors potential modifier variants in DCM.ObjectiveTo interrogate the clinical traits and diseases associated with BAG3 coding variation.Design, Setting, and ParticipantsThis was a cross-sectional study in the Penn Medicine BioBank (PMBB) enrolling patients of the University of Pennsylvania Health System’s clinical practice sites from 2014 to 2023. Whole-exome sequencing (WES) was linked to electronic health record (EHR) data to associate BAG3 coding variants with EHR phenotypes. This was a health care population-based study including individuals of European and African genetic ancestry in the PMBB with WES linked to EHR phenotypes, with replication studies in BioVU, UK Biobank, MyCode, and DCM Precision Medicine Study.ExposuresCarrier status for BAG3 coding variants.Main Outcomes and MeasuresAssociation of BAG3 coding variation with clinical diagnoses, echocardiographic traits, and longitudinal outcomes.ResultsIn PMBB (n = 43 731; median [IQR] age, 65 [50-76] years; 21 907 female [50.1%]), among 30 324 European and 11 198 African individuals, the common C151R variant was associated with decreased risk for DCM (odds ratio [OR], 0.85; 95% CI, 0.78-0.92) and simultaneous increased risk for HCM (OR, 1.59; 95% CI, 1.25-2.02), which was confirmed in the replication cohorts. C151R carriers exhibited improved longitudinal outcomes compared with noncarriers as assessed by age at death (hazard ratio [HR], 0.85; 95% CI, 0.74-0.96; median [IQR] age, 71.8 [63.1-80.7] in carriers and 70.3 [61.6-79.2] in noncarriers) and heart transplant (HR, 0.81; 95% CI, 0.66-0.99; median [IQR] age, 56.7 [46.1-63.1] in carriers and 55.6 [45.2-62.9] in noncarriers). C151R was associated with reduced risk of DCM (OR, 0.42; 95% CI, 0.24-0.74) and heart failure (OR, 0.27; 95% CI, 0.14-0.50) among individuals harboring truncating TTN variants in exons with high cardiac expression (n = 358).Conclusions and RelevanceBAG3 C151R was identified as a bidirectional modulator of risk along the DCM-HCM spectrum, as well as an important genetic modifier variant in TTN-mediated DCM. This work expands on the understanding of the etiology and penetrance of DCM, suggesting that BAG3 C151R is an important genetic modifier variant contributing to the variable expressivity of DCM, warranting further exploration of its mechanisms and of genetic modifiers in DCM more broadly.

Sustainable Academic-Clinical Alliance: A Model to Improve Academic-Practice Partnerships.

Background: National nurse shortages, ongoing nurse faculty retirements, and a dearth of clinical sites make it challenging to prepare advanced practice registered nurses (APRNs) who are ready to transition into independent provider roles, especially in acute care settings. One of the most effective ways to address these experiential learning challenges is for academic institutions and healthcare systems to form collaborative academic-practice partnerships. However, many partnerships between schools of nursing and healthcare institutions have found numerous challenges, including time to devote to the partnership, funding of ideas, competing initiatives and needs, and sustainability. Objective: The University of Maryland School of Nursing (UMSON) set out to expand the traditional academic-clinical partnership approach with a new collaborative model. Methods: Rather than both parties coming to the table with their own goals, the partnership focused on intentional relationship building, transparency, measurable outcomes, and sustainability. This model, further called the Sustainable Academic-Clinical Alliance (SACA), assures that both sides of the partnership benefit. The SACA model was used to create an academic-practice partnership with the University of Maryland Upper Chesapeake Health System in order to increase APRN clinical practice sites and readiness of APRN students to provide care across the continuum in the state of Maryland. Results: Since July 2016, the SACA model has enabled over 40 clinical providers in over 20 different clinical areas to offer 329 different clinical and nonclinical experiences to APRN students from UMSON. At the end of the 5-year alliance, 150 unique UMSON APRN students completed 257 different clinical rotations. Conclusion: The SACA model effectively promotes the development and achievement of sustainable academic-practice partnerships by focusing on (a) intentional relationship building, (b) transparency in goal setting and alliance maintenance, (c) development of outcome measures, and (d) sustainability. Implications for Nursing: The components of the SACA model made sustainability more achievable, which has eluded previous academic-clinical partnerships. This model can serve as a blueprint for other academic and healthcare institutions to establish sustainable academic-practice partnerships.

Challenges of Clinical Education: From the Perspective of Clinical Instructors and Clinical Staffs at Dire Dawa University, Dire Dawa, Ethiopia, Qualitative Study.

To explore the challenges of clinical education from the perspective of clinical instructors and clinical staff at Dire Dawa University College of Health Science. An institutional-based phenomenological qualitative study was conducted. Clinical instructors and staff provided data through in-depth interviews and key informant discussions, which were facilitated by a semistructured tool and a voice recorder. A total of 17 participants, including 11 in-depth interviews (IDIs) with clinical instructors (including two key informants) and six IDIs with clinical staff were included in this study. A purposive sampling method was used to select study participants, and the data were analyzed thematically using the computer-assisted qualitative data analysis software Atlas.ti7. The thematic analysis with an inductive approach involves six steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and writing. Clinical instructors and clinical staff noted a number of challenges in clinical education, including insufficient medical equipment, low incentives, clinical site repetition, unfavorable clinical practice sites, lack of communication from instructors, skill attrition, lack of orientation for instructors and students, client/patient unwelcomingness, uncooperative healthcare workers, and poor university cooperation. The aforementioned issues contributed to the quality of clinical education and its desired impact, as outlined in this research. A multidisciplinary and collaborative effort is needed to address these challenges.

Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial

Sparsentan, a novel, non-immunosuppressive, single-molecule, dual endothelin angiotensin receptor antagonist, significantly reduced proteinuria versus irbesartan, an angiotensin II receptor blocker, at 36 weeks (primary endpoint) in patients with immunoglobulin A nephropathy in the phase 3 PROTECT trial's previously reported interim analysis. Here, we report kidney function and outcomes over 110 weeks from the double-blind final analysis. PROTECT, a double-blind, randomised, active-controlled, phase 3 study, was done across 134 clinical practice sites in 18 countries throughout the Americas, Asia, and Europe. Patients aged 18 years or older with biopsy-proven primary IgA nephropathy and proteinuria of at least 1·0 g per day despite maximised renin-angiotensin system inhibition for at least 12 weeks were randomly assigned (1:1) to receive sparsentan (target dose 400 mg oral sparsentan once daily) or irbesartan (target dose 300 mg oral irbesartan once daily) based on a permuted-block randomisation method. The primary endpoint was proteinuria change between treatment groups at 36 weeks. Secondary endpoints included rate of change (slope) of the estimated glomerular filtration rate (eGFR), changes in proteinuria, a composite of kidney failure (confirmed 40% eGFR reduction, end-stage kidney disease, or all-cause mortality), and safety and tolerability up to 110 weeks from randomisation. Secondary efficacy outcomes were assessed in the full analysis set and safety was assessed in the safety set, both of which were defined as all patients who were randomly assigned and received at least one dose of randomly assigned study drug. This trial is registered with ClinicalTrials.gov, NCT03762850. Between Dec 20, 2018, and May 26, 2021, 203 patients were randomly assigned to the sparsentan group and 203 to the irbesartan group. One patient from each group did not receive the study drug and was excluded from the efficacy and safety analyses (282 [70%] of 404 included patients were male and 272 [67%] were White) . Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6-110) was -2·7 mL/min per 1·73 m2 per year versus -3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2 per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1-week 110) was -2·9 mL/min per 1·73 m2 per year versus -3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI -0·03 to 1·94; p=0·058). The significant reduction in proteinuria at 36 weeks with sparsentan was maintained throughout the study period; at 110 weeks, proteinuria, as determined by the change from baseline in urine protein-to-creatinine ratio, was 40% lower in the sparsentan group than in the irbesartan group (-42·8%, 95% CI -49·8 to -35·0, with sparsentan versus -4·4%, -15·8 to 8·7, with irbesartan; geometric least-squares mean ratio 0·60, 95% CI 0·50 to 0·72). The composite kidney failure endpoint was reached by 18 (9%) of 202 patients in the sparsentan group versus 26 (13%) of 202 patients in the irbesartan group (relative risk 0·7, 95% CI 0·4 to 1·2). Treatment-emergent adverse events were well balanced between sparsentan and irbesartan, with no new safety signals. Over 110 weeks, treatment with sparsentan versus maximally titrated irbesartan in patients with IgA nephropathy resulted in significant reductions in proteinuria and preservation of kidney function. Travere Therapeutics.

Zibotentan in combination with dapagliflozin compared with dapagliflozin in patients with chronic kidney disease (ZENITH-CKD): a multicentre, randomised, active-controlled, phase 2b, clinical trial

In patients with chronic kidney disease, SGLT2 inhibitors and endothelin A receptor antagonists (ERAs) can reduce albuminuria and glomerular filtration rate (GFR) decline. We assessed the albuminuria-lowering efficacy and safety of the ERA zibotentan combined with the SGLT2 inhibitor dapagliflozin. ZENITH-CKD was a multicentre, randomised, double-blind, active-controlled clinical trial, done in 170 clinical practice sites in 18 countries. Adults (≥18 to ≤90 years) with an estimated GFR (eGFR) of 20 mL/min per 1·73 m2 or greater and a urinary albumin-to-creatinine ratio (UACR) of 150-5000 mg/g were randomly assigned (2:1:2) to 12 weeks of daily treatment with zibotentan 1·5 mg plus dapagliflozin 10 mg, zibotentan 0·25 mg plus dapagliflozin 10 mg, or dapagliflozin 10 mg plus placebo, as adjunct to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers if tolerated. The primary endpoint was a change from baseline in log-transformed UACR (zibotentan 1·5 mg plus dapagliflozin vs dapagliflozin plus placebo) at week 12. Fluid retention was an event of special interest, defined as an increase in bodyweight of at least 3% (at least 2·5% must have been from total body water) from baseline or an increase of at least 100% in B-type natriuretic peptide (BNP) and either a BNP concentration greater than 200 pg/mL if without atrial fibrillation or BNP greater than 400 pg/mL if with atrial fibrillation. This trial is registered with ClinicalTrials.gov, NCT04724837, and is completed. Between April 28, 2021, and Jan 17, 2023, we assessed 1492 participants for eligibility. For the main analysis, we randomly assigned 449 (30%) participants, 447 (99%) of whom (mean age 62·8 years [SD 12·1], 138 [31%] female, 309 [69%] male, 305 [68%] White, mean eGFR 46·7 mL/min per 1·73 m2 [SD 22·4], and median UACR 565·5 mg/g [IQR 243·0-1212·6]) received treatment with zibotentan 1·5 mg plus dapagliflozin (n=179 [40%]), zibotentan 0·25 mg plus dapagliflozin (n=91 [20%]), or dapagliflozin plus placebo (n=177 [40%]). Zibotentan 1·5 mg plus dapagliflozin and zibotentan 0·25 mg plus dapagliflozin reduced UACR versus dapagliflozin plus placebo throughout the treatment period of the study. At week 12, the difference in UACR versus dapagliflozin plus placebo was -33·7% (90% CI -42·5 to -23·5; p<0·0001) for zibotentan 1·5 mg plus dapagliflozin and -27·0% (90% CI -38·4 to -13·6; p=0·0022) for zibotentan 0·25 mg plus dapagliflozin. Fluid-retention events were observed in 33 (18%) of 179 participants in the zibotentan 1·5 mg plus dapagliflozin group, eight (9%) of 91 in the zibotentan 0·25 mg plus dapagliflozin group, and 14 (8%) of 177 in the dapagliflozin plus placebo group. Zibotentan combined with dapagliflozin reduced albuminuria with an acceptable tolerability and safety profile and is an option to reduce chronic kidney disease progression in patients already receiving currently recommended therapy. AstraZeneca.

Midwifery students’ experiences of their clinical internship placement during the COVID-19 pandemic in Ireland: A qualitative descriptive study

ObjectiveTo explore the impact of the COVID-19 global pandemic on midwifery students’ experiences of clinical internship placement in the final year of their midwifery programme. DesignA qualitative descriptive study was conducted following ethical approval. Four online focus groups were facilitated. Setting and participantsTo prepare for autonomous practice, BSc Midwifery students in the Republic of Ireland (RoI) undertake a 36-week internship in the final year of their programme. Midwifery students (n = 15), from one Higher Education Institute (HEI), who were undertaking internship across two clinical practice sites volunteered to participate in the study. FindingsFour overarching themes were identified: Fear and uncertainty of internship in the context of a pandemic, Consequences of COVID-19 within the clinical environment, Student supports, Opportunities and challenges during internship. Working within a health care environment dominated by the presence of COVID-19 had significant consequences for the students and their provision of care for women and families. Students were challenged with managing increased responsibility within the context of COVID-19 practice requirements and restrictions. Students balanced their need to progress to autonomous practice, whilst acknowledging their needs as learners. COVID-19 also brought unexpected benefits, which included enhancing students’ ability to develop relationships with women in their care, and students described a sense of belonging within the midwifery team. Key conclusions and implications for practiceMidwifery students identified internship, during the COVID-19 pandemic as challenging and stressful. However, students also portrayed a sense of pride in their achievements. Support structures assisted students to cope during this period which included peer support, protective reflective time (PRT) in the HEI and support from clinical placement coordinators in midwifery (CPC-Midwifery) within clinical placements sites. It is essential that these support structures continue within midwifery educational programmes. Promoting peer support in a more formal support structure may need consideration. These support structures need to be protected and enhanced during unprecedented times, such as the COVID-19 pandemic.

Fostering Nursing Faculty Practices Within a University-Based Student Health Care Center

Graduate-level clinical nursing faculty who maintain clinical practice can ensure clinical relevancy in the classroom and serve as clinical preceptors for doctor of nursing practice students. Finding flexible and supportive clinical practice sites can be challenging for nursing faculty. Using a continuous quality improvement approach, an academic-practice partnership was formed between a college of nursing and a university-based student health care center to serve both organizations. Integrating 1 clinical faculty member increased patient visits and provider availability during semesters with high patient demand while offering a flexible clinical environment, increasing preceptor availability, and fostering faculty practices across the college.

Successful development and implementation of a clinical practice site with community partners to engage family nurse practitioner students in health equity.

Family nurse practitioner (FNP) student clinical practice site availability is limited. Concurrently, many populations lack healthcare access, a common health inequity. Collaboration with community partners to develop clinical practice sites offer students active learning opportunities to increase their engagement and understanding of health equity. Using community collaboration, develop and implement an FNP student clinical practice site that can provide learning opportunities in addressing health equity. Local health data was reviewed, and health gaps were associated with social determinant of health inequities. A community partner was identified with the goal of facilitating students to provide proactive health care to homeless women. Health promotion and disease identification has been the focus of care provided by FNP students and faculty during an early-program clinical course, increasing access to care for an underserved population. A community-academic partnership has developed where FNP students provide health promotion and safety net health care to homeless women since 2017. Student reflections have shown a positive impact on their understanding of health equity. The community partner has identified positive impacts to client health. This partnership has impacted health equity by increasing healthcare access for an underserved population while facilitating FNP student learning.

Factors associated with academic motivation in nursing students: A cross-sectional study

Academic motivation encourages people to participate in learning activities and directs, maintains, and determines the intensity of learning behaviors. Therefore, nursing students require high-quality academic motivation to continuously and effectively improve their medical knowledge and skills continuously and effectively. This study measures nursing students' academic motivation and identifies the associated factors. A cross-sectional study design was used. The total sample included 237 undergraduate nursing students. The data were collected from October to November 2022 in a public university located in Southwestern Vietnam. The level of academic motivation was measured using the Vietnamese version of the Academic Motivation Scale. The data were analyzed using the independent Student's t-tests, ANOVA, Pearson's correlation, and regression analysis. The study showed that nursing students had high academic motivation. However, there were still more than one-third of students (39.3%) whose quality of academic motivation was not good. Through simple linear regression analysis, it showed that appropriate training regulations of the school; getting support/questions answers or good examples in learning from lecturers/medical staff at the clinical practice site; joining a club about learning; intending to teach in the field of nursing, ability to deal with difficulties were the factors that affect nursing students' academic motivation. Many associated factors influence the academic motivation of nursing students. Further effective interventions are needed to address this issue.

Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial

Sparsentan is a novel, non-immunosuppressive, single-molecule, dual endothelin and angiotensin receptor antagonist being examined in an ongoing phase 3 trial in adults with IgA nephropathy. We report the prespecified interim analysis of the primary proteinuria efficacy endpoint, and safety. PROTECT is an international, randomised, double-blind, active-controlled study, being conducted in 134 clinical practice sites in 18 countries. The study examines sparsentan versus irbesartan in adults (aged ≥18 years) with biopsy-proven IgA nephropathy and proteinuria of 1·0 g/day or higher despite maximised renin-angiotensin system inhibitor treatment for at least 12 weeks. Participants were randomly assigned in a 1:1 ratio to receive sparsentan 400 mg once daily or irbesartan 300 mg once daily, stratified by estimated glomerular filtration rate at screening (30 to <60 mL/min per 1·73 m2 and ≥60 mL/min per 1·73 m2) and urine protein excretion at screening (≤1·75 g/day and >1·75 g/day). The primary efficacy endpoint was change from baseline to week 36 in urine protein-creatinine ratio based on a 24-h urine sample, assessed using mixed model repeated measures. Treatment-emergent adverse events (TEAEs) were safety endpoints. All endpoints were examined in all participants who received at least one dose of randomised treatment. The study is ongoing and is registered with ClinicalTrials.gov, NCT03762850. Between Dec 20, 2018, and May 26, 2021, 404 participants were randomly assigned to sparsentan (n=202) or irbesartan (n=202) and received treatment. At week 36, the geometric least squares mean percent change from baseline in urine protein-creatinine ratio was statistically significantly greater in the sparsentan group (-49·8%) than the irbesartan group (-15·1%), resulting in a between-group relative reduction of 41% (least squares mean ratio=0·59; 95% CI 0·51-0·69; p<0·0001). TEAEs with sparsentan were similar to irbesartan. There were no cases of severe oedema, heart failure, hepatotoxicity, or oedema-related discontinuations. Bodyweight changes from baseline were not different between the sparsentan and irbesartan groups. Once-daily treatment with sparsentan produced meaningful reduction in proteinuria compared with irbesartan in adults with IgA nephropathy. Safety of sparsentan was similar to irbesartan. Future analyses after completion of the 2-year double-blind period will show whether these beneficial effects translate into a long-term nephroprotective potential of sparsentan. Travere Therapeutics.

Improving learning using a layered learning model in the ambulatory care setting

IntroductionLayered learning models (LLMs) are becoming increasingly popular at various clinical practice sites and give rotational student pharmacists the opportunity to learn from pharmacist preceptors and resident mentors. The purpose of this article is to give additional insight into implementation of a LLM in an ambulatory care clinical practice setting. Given the expanding services of ambulatory care pharmacy practice sites, this is poised as an excellent opportunity to train both current and future pharmacists through utilization of LLM. CommentaryThe LLM employed at our institution gives student pharmacists an opportunity to work within a unique team consisting of a pharmacist preceptor and a postgraduate year one and/or postgraduate year two resident mentor if applicable. The LLM gives student pharmacists the opportunity to apply clinical knowledge into practice while refining soft skills that many student pharmacists might struggle with during pharmacy school or may not have the chance to develop prior to graduation. Embedding a resident within a LLM provides an ideal environment for preceptorship experience towards the student pharmacist while developing skills or attributes required to become an effective educator. The pharmacist preceptor in the LLM is able to teach the resident how to precept student pharmacists by tailoring their rotational experience to enhance learning. ImplicationsLLMs are continuing to grow in popularity in clinical practice settings. This article offers additional insight into how a LLM can improve the learning experience of everyone involved which includes student pharmacists, resident mentors, and pharmacist preceptors.

Learning as a life proposal: Reflection from teaching in health sciences

The following reflection is the result of a microanalysis exercise in education carried out during the Masters in Higher Education Teaching of the Universidad El Bosque, which arose from the analytical and descriptive elaboration of categories, properties, and dimensions from the following questions: what is learning? What should a professor of medicine do for the student to learn in the clinical practice site?

Ad hoc digital communication and assessment during clinical placements in nursing education; a qualitative research study of students', clinical instructors', and teachers' experiences.

There was a concern about the shortage of nurses that resulted from the Covid-19 pandemic. Therefore, universities and university colleges were instructed to continue educating nursing professionals but were challenged by the social distancing and the limitations of clinical placements and clinical-field instructors. Clinical placement is essential in the students' development of practical skills and knowledge. Thus, transitioning to a digital follow-up platform of communication with the students between the universities/college and the clinical practice sites became necessary. To obtain knowledge about the experiences from the university/college teachers, students, and clinical-field instructors regarding the transition to a digital learning environment that resulted from the COVID-19 pandemic. Qualitative individual digital interviews were conducted for data collection at three different nursing education programs from three Norwegian university/university college sites. Five students, four clinical-field instructors, and nine university/college teachers participated (n = 18). The inductive analyses identified two main themes: (1) Efficiency compromising pedagogical quality, and (2) Digital alienation. Students and university/college teachers were worried about fluctuating quality with digital pedagogical. There were concerns that the students educated during this period will have reduced clinical competencies.

Patient Reported Outcomes after Ferric Carboxymaltose Treatment for Iron Deficiency Anemia: A Prospective Observational Study

Objective: Fatigue is a common symptom reported by iron deficiency anemia (IDA) patients. Iron deficiency has also been shown to reduce physical function independent of anemia. Parenteral iron therapy is indicated for the treatment of iron deficiency anemia (IDA) in patients who are intolerant or nonresponsive to oral iron. This study assessed fatigue symptoms and patient-reported functioning in IDA patients for up to 6 months after treatment with ferric carboxymaltose (FCM). Methods: This prospective, single arm, longitudinal observational study included adult patients diagnosed with IDA who were prescribed FCM under routine clinical care across 7 clinical practice sites in US. Eligible patients had baseline serum hemoglobin of >7 g/dL and <13 for males or <12 for females, no potential contraindications to FCM, and no parenteral iron therapy within 3 months before study enrollment. Patients completed patient-reported outcome (PRO) questionnaires prior to receiving FCM treatment, and at 3 months and 6 months after the first course of FCM. PROs included the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-Fatigue) scale, the Patient Reported Outcomes Measurement and Information System (PROMIS) Physical Function v2.0 Short Form, and the PROMIS Global Health v1.2 Short Form (physical and mental health). A higher FACIT-Fatigue or a lower PROMIS Physical Function, PROMIS Global Physical Health or Mental Health score indicate more health problems. For each measure, a mean change from baseline of ≥5 points was considered clinically meaningful. Associations between baseline serum hemoglobin and each PRO score were assessed using Spearman's rank correlation coefficient. Results: 152 patients with median IDA history of 2.0 years were included in the intent-to-treat population (mean age=47.4 ± 16.0 years, 82.2% females, 17.1% with inflammatory bowel disease, 13.8% with abnormal uterine bleeding, 9.2% with cancer, mean baseline serum Hgb =10.19±1.35 g/dL). About one-third of patients (34.9%) had oral iron treatment and 2.6% had a blood transfusion within 3 months prior to FCM treatment. A small proportion of patients (6.6%) had parenteral iron treatment in the 12 months before study enrollment. Most patients (83.6%) were prescribed 2 doses of FCM (total dose of 1500mg) at baseline. Within 6 months after the first course of FCM, no patient received treatment with erythropoietin stimulating agents, 1 patient received a blood transfusion, and 14 (9.7%) patients required additional IV iron treatment after the initial course of FCM treatment prescribed at baseline. Median time from baseline to additional IV treatment was 86.5 days. Fatigue symptoms were improved after FCM treatment, as indicated by significantly lower mean FACIT-Fatigue scores at 3 months (50.19 ± 9.51) and at 6 months (52.42 ± 9.31) compared to baseline (61.01 ± 8.96), with p<0.0001 each. A majority of patients had a reduction of at least 5 points in FACIT-Fatigue score from baseline to 3 months (72.7%) and 6 months (67.3%), respectively. Physical function also improved, as indicated by significantly higher mean PROMIS Physical Function score at 3 months (46.08 ± 8.52) and 6 months (45.15±8.85) compared to baseline (41.31±8.63), with p<0.0001 each. Improvements in PROMIS Global Physical Health (p<0.0001) and the PROMIS Global Mental Health score (p=0.0027) were also observed at 3 months and 6 months compared to baseline. Correlations between baseline serum hemogloblin levels and PRO scores were borderline to highly significant, with correlation coefficients of 0.151 (p=0.0647) with PROMIS Global Mental Health, 0.276 (p=0.0006) with Global Physical Health, 0.286 (p=0.0004) with PROMIS Physician Function and -0.294 (p=0.0002) with FACIT-Fatigue. Conclusions: IDA patients treated with FCM reported significant reduction in fatigue symptoms and improvements in physical function, physical health and mental health at 3 months after treatment. These benefits were sustained at 6 months after treatment, with only a small proportion of patients requiring re-treatment with additional IV iron beyond the initial course of FCM treatment. Significant correlations between serum Hgb and PRO scores observed in this study suggest that data collected directly from patients in a real-world setting can provide a valuable supplement to traditional clinical outcomes for evaluating treatment effectiveness. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Barriers to Implementation of Music Listening Interventions for Cancer-Related Phenomena: A Mapping Review.

Introduction: Despite music listening interventions (MLIs) being recommended in multiple clinical practice guidelines, implementation into oncology clinical practice sites has been slow. This mapping review aimed to critique and identify barriers to MLI clinical implementation, as well as offer practical solutions for both clinicians and researchers. Methods: A PRISMA-based mapping review of MLI literature was performed using CINAHL, PubMed, PsycINFO, and Web of Science databases. Eligibility criteria included studies with MLIs as independent variables and cancer-related phenomena as outcome variables. Search was performed in October 2021, and no date limit was set. Results: Thirty-eight studies met the eligibility criteria for inclusion. Several aspects of MLI studies suggested potential barrier status to clinician or patient adoption. These findings included choice of music, music delivery hardware, dose of MLI, and timing of MLI specific to outcomes of interest (e.g., pain, anxiety, mood). Few investigators addressed the concurrent effects of pharmaceuticals (e.g., analgesics, anxiolytics), and controlling for the effects of competing auditory stimuli was minimal. Discussion: This review has identified several barriers that may obstruct clinician and patient adoption of MLIs, despite level of evidence for MLIs that presently exists in the literature. The review makes practical suggestions for clinicians, researchers, and patients to overcome the present barriers and ease MLIs into common practice in clinics and homes.

Dannelse og tværprofessionalitet i sundhedsuddannelse

In this article, we explore the relevance of a focus on professional formation (Bildung) in health education in the context of interprofessionalism as a condition for working in health care. We outline general aspects of the concept of professional formation and distinguish two key elements: an adaptation and a transgression orientation. We argue that a transgression orientation is important in health education and professional formation today. Partly as an end in itself, given fundamental features of human existence, partly because the interprofessional demand in health professional work means that the distinction between adaptation and transgression orientation collapses: adaptation to contemporary conditions in health care requires, both a temporal and a spatial transgression orientation in the form of a perspective flexibility that allows the development of new professional perspectives as well as the appropriate consideration of different existing professional perspectives. Drawing on considerations of philosophy of existence, and on qualitative interviews with practicum teachers, we highlight key conditions and obstacles for a focus on professional formation to be feasible in clinical education. Among other things, we highlight knowledge of and experience with each other's professions, a common cause and professional goals, and not least an educational mindset and a learning culture that is not too rigid and over-controlling. On the other hand, it is important to focus on first-hand experience of interprofessionality framed by good communication and shared reflections on interprofessional practice. The latter is hampered by different professional languages and identities, physical distance between clinical practice and the workplace, and by a lack of knowledge of and experience with each other's professional practices, a common cause and professional goals, and, not least, an educational mindset and a learning culture that is not too rigid and over-controlling. On the other hand, it is important to focus on first-hand experience of interprofessionality framed by good communication and shared reflections on practice. The latter is hampered by different professional languages and identities, physical distance between clinical practice sites and pressure on resources in both health care and training.

Meeting the need for nurse practitioner clinicals: A survey of practitioners.

The increase in the number of nurse practitioner (NP) students requires increased clinical practice sites and prepared preceptors. This study describes NPs' clinical experiences as a student and their current practices as an NP preceptor. A descriptive study design used a 38-item web-based survey conducted in June and July 2021. A total of 334 NPs practicing in Texas responded; most had been NPs for 10 or fewer years (58.2%) and in their positions less than 5 years (50.3%). A plurality of respondents was required to find their own clinical placements (46%). The most common challenge in obtaining clinical placements was finding preceptors (33%). Nurse practitioners reported excellent clinical experiences (39.3%) as a student and believed that they were generally well prepared for the NP role (38.9%) and to care for their specialty patient population (46.1%) upon graduation. Sixty percent of respondents reported not currently precepting, 37.6% had never been asked to precept, whereas 32.8% reported that employers restricted precepting. Family NPs were the least likely to precept. Nurse practitioners report positive clinical experiences that prepare them for NP careers. Multiple opportunities exist to enlist additional NPs as preceptors for NP students. There is capacity within the current NP workforce to meet the clinical educational needs of NP students. Future work should examine best practices to engage NPs who are not currently preceptors. As policies change NP education, research should examine the implications of the preparation for NP roles at the time of graduation, organizational outcomes, and quality of care.

Examination of Online Interprofessional Education to Develop Graduate Students’ Interprofessional Socialization and Collaborative Competencies

ABSTRACT Interprofessional education (IPE) is important to prepare graduate students for collaborative practice. This mixed methods study sought to evaluate a full-semester, asynchronous online IPE course for graduate students. Thirty-one graduate social work, nursing, public health, and health administration students participated. Interprofessional socialization and collaborative competencies were measured at three points in the semester. There were statistically significant improvements in self-reported socialization and competencies. Qualitative analysis revealed participants experienced new perspectives, developed appreciation of interprofessional collaboration, practiced communication and teamwork skills, and used course lessons in clinical practice. Study findings indicate that online IPE can help improve graduate students’ interprofessional socialization and collaborative competencies. Further, students indicated they applied course lessons to their school and work clinical practice sites.

Quality of pre-service midwifery education in public and private midwifery schools in Afghanistan: a cross sectional survey

BackgroundMidwives are the key skilled birth attendants in Afghanistan. Rapid assessment of public and private midwifery education schools was conducted in 2017 to examine compliance with national educational standards. The aim was to assess midwifery education to inform Afghanistan Nurses and Midwives Council and other stakeholders on priorities for improving quality of midwifery education.MethodsA cross-sectional assessment of midwifery schools was conducted from September 12–December 17, 2017. The Midwifery Education Rapid Assessment Tool was used to assess 29 midwifery programs related to infrastructure, management, teachers, preceptors, clinical practice sites, curriculum and students. A purposive sample of six Institute of Health Sciences schools, seven Community Midwifery Education schools and 16 private midwifery schools was used. Participants were midwifery school staff, students and clinical preceptors.ResultsLibraries were available in 28/29 (97%) schools, active skills labs in 20/29 (69%), childbirth simulators in 17/29 (59%) and newborn resuscitation models in 28/29 (97%). School managers were midwives in 21/29 (72%) schools. Median numbers of students per teacher and students per preceptor were 8 (range 2–50) and 6 (range 2–20). There were insufficient numbers of teachers practicing midwifery (132/163; 81%), trained in teaching skills (113/163; 69%) and trained in emergency obstetric and newborn care (88/163; 54%). There was an average of 13 students at clinical sites in each shift. Students managed an average of 15 births independently during their training, while 40 births are required. Twenty-four percent (7/29) of schools used the national 2015 curriculum alone or combined with an older one. Ninety-one percent (633/697) of students reported access to clinical sites and skills labs. Students mentioned, however, insufficient clinical practice due to low case-loads in clinical sites, lack of education materials, transport facilities and disrespect from school teachers, preceptors and clinical site providers as challenges.ConclusionsPositive findings included availability of required infrastructure, amenities, approved curricula in 7 of the 29 midwifery schools, appropriate clinical sites and students’ commitment to work as midwives upon graduation. Gaps identified were use of different often outdated curricula, inadequate clinical practice, underqualified teachers and preceptors and failure to graduate all students with sufficient skills such as independently having supported 40 births.

Creation of a remote clinical practice curriculum for first year nursing students: Reflections and lessons learned

Introduction: A problem-based learning approach using intentionally created client profiles and nursing care summaries formed the foundation of a remote clinical experience for first year undergraduate nursing students. Methods: Using carefully designed client scenarios, care summaries and active learning strategies, students were introduced to the nursing profession and provided the opportunity to develop skills in collaboration, critical thinking, clinical reasoning, and clinical judgement. Results: Based on discussion with students, the remote experience assisted in the development of several skills addressing communication, theoretical foundation, and critical thinking. As well, this experience allowed for the integration and application of newly acquired nursing knowledge, and an enhanced understanding of the role of the professional nurse. Implications: Significant lessons learned may serve other nursing programs around the world as we continue to navigate both current and future public health mandates while managing competing demands for in-person clinical practice sites. Conclusion: Face-to-face clinical experiences remain a critical component of comprehensive nursing education, however, given today’s climate and continued restrictions, a hybrid model, utilizing a remote platform, is worthy of further exploration.