Email Distribution Research Articles

Patient and carer experiences of nutrition in cancer care: a mixed-methods study.

Evidence-based guidelines exist to guide health professionals and services about cancer nutrition care; however, the views of cancer patients and carers are not well understood. This study aimed to understand the experience and needs of cancer patients and carers regarding nutrition care across the care continuum. Using a mixed-methods approach, cancer patients and carers completed a cross-sectional online survey and focus groups. Participants were recruited through health services and cancer organisation consumer networks via email distribution lists, e-newsletters, and social media. Focus groups were audio-recorded, transcribed, and analysed using content analysis. Of 165 survey respondents, only 51% (n=84) reported they talked to a health professional about their nutrition care at any time-point, and only 32% with a dietitian. The majority (84%) of patients and carers felt nutrition was important at one or more time-points in their cancer path, indicating during and after cancer treatment the most important. However, perceived support from health professionals for nutrition care was deemed low at all time-points. Five focus groups were held (n=20; 16 patients, 2 carers, 2 both patients/carers) and five themes emerged: nutrition information, experiences and need; control over diet and nutrition; importance and value of nutrition; access to support; what optimal nutrition care looks like. Patients and carers felt nutrition was important during their cancer path, but perceived support from health professionals for nutrition care was low. This study has highlighted patient and carer nutrition experiences that will inform development of a co-designed optimal cancer nutrition care pathway.

The PANDEMIC framework for encouraging COVID-19 vaccinations.

After sufficient doses are manufactured and logistical barriers are reduced, convincing an overwhelming majority of people to receive a COVID-19 vaccination may be the next major challenge during this pandemic. A group of experts recently proposed strategies that have compelling rationales and are well grounded in behavioral science. However, their approaches may sometimes be unacceptable, impractical, and/or unsuccessful. Therefore, other strategies will be greatly needed to address vaccine hesitancy. The present commentary offers 8 additional promising approaches forming a framework known as PANDEMIC. This acronym stands for the following strategies: presumptive language, asking for advice, norms on an anonymous level, description of favorable attributes, emphasizing clinicians' own experiences, mandated choice, images, and communication of risk. Each of the strategies is discussed in turn. Many of the proposed strategies have empirical support for achieving desired outcomes in other domains. However, the PANDEMIC framework is untested in regard to increasing the uptake of COVID-19 vaccinations. Therefore, the strategies should be carefully evaluated before they are widely disseminated through public health announcements, email distribution lists, electronic health record messages, and other outlets.

Determinants of the Implementation of Telemedicine in the German Navy-A Mixed Methods Study.

ABSTRACTIntroductionThe history of the use of telemedicine in maritime medicine dates back to the 1930s. In the early 2000s, the German Navy built up a telemedicine network which today is installed in all ships and provides a connection to the medical infrastructure ashore. The objective of this study was to optimize the implementation of telemedicine based on the experience gained in the German Navy. For this purpose, qualitative and quantitative methods were used to identify determinants which affect the use of telemedicine in order to determine whether there is any need for optimization.MethodsThe study was conducted using a mixed methods design. First, guideline-based interviews were conducted with Navy medical officers who had been recruited via various email distribution lists. The interviews were then transcribed and coded. In an analysis, deductive and inductive categories were derived from the codes. Hypotheses were deduced from the interviews, too, and used to develop a questionnaire.Besides the medical officers, other Navy medical personnel with experience in the field of telemedicine took part in the survey. The study was concluded by a descriptive analysis of the quantitative data.ResultsThe analysis of the interviews revealed that a regular use of telemedicine workstations increased the users’ confidence and, in their opinion, improved medical treatment. Technical and organizational problems posed obstacles, which increased the use of partly insecure alternatives. A proper technical support was regarded as a precondition for effectively using telemedicine.The results of the quantitative analysis showed that consultation was mainly sought for dermatological (46%), surgical (24%), and internal (22%) conditions.ConclusionThe study revealed determinants for the use of telemedicine in the German Navy. Factors improving the motivation of the users should be strengthened in order to optimize the use of telemedicine. Furthermore, it can be assumed that a successful implementation will be supported by reducing or eliminating obstacles. The findings on the main reasons for seeking medical advice could be taken into account in the further planning of specific training.

The Epidemiology of Patients' Email Addresses in a French University Hospital: Case-Control Study.

BackgroundHealth care professionals are caught between the wish of patients to speed up health-related communication via emails and the need for protecting health information.ObjectiveWe aimed to analyze the demographic characteristics of patients providing an email, and study the distribution of emails’ domain names.MethodsWe used the information system of the European Hospital Georges Pompidou (HEGP) to identify patients who provided an email address. We used a 1:1 matching strategy to study the demographic characteristics of the patients associated with the presence of an email, and described the characteristics of the emails used (in terms of types of emails—free, business, and personal).ResultsOverall, 4.22% (41,004/971,822) of the total population of patients provided an email address. The year of last contact with the patient is the strongest driver of the presence of an email address (odds ratio [OR] 20.8, 95% CI 18.9-22.9). Patients more likely to provide an email address were treated for chronic conditions and were more likely born between 1950 and 1969 (taking patients born before 1950 as reference [OR 1.60, 95% CI 1.54-1.67], and compared to those born after 1990 [OR 0.56, 95% CI 0.53-0.59]). Of the 41,004 email addresses collected, 37,779 were associated with known email providers, 31,005 email addresses were associated with Google, Microsoft, Orange, and Yahoo!, 2878 with business emails addresses, and 347 email addresses with personalized domain names.ConclusionsEmails have been collected only recently in our institution. The importance of the year of last contact probably reflects this recent change in contact information collection policy. The demographic characteristics and especially the age distribution are likely the result of a population bias in the hospital: patients providing email are more likely to be treated for chronic diseases. A risk analysis of the use of email revealed several situations that could constitute a breach of privacy that is both likely and with major consequences. Patients treated for chronic diseases are more likely to provide an email address, and are also more at risk in case of privacy breach. Several common situations could expose their private information. We recommend a very restrictive use of the emails for health communication.

The Distribution of Emails In An Organization As A Proxy for Information Flow

The faster an organization is able to make decisions, the better capable an organization it is—but that requires that information transit the organization quicker. If so, organizations should be structured with a form ideally capable of transmitting information. I propose a method for measuring the closeness of a real-world organization to the ideal form.

Pilot Study Characterizing the Hematology-Oncology Fellow Job Search Process: Tools Used and Identification of Potential New Resources

While the search for post-fellowship employment is an essential part of early career development, little is known about the tools and techniques fellows use during their job search and the specific challenges they face during the process. In this pilot survey study of hematology-oncology (HO) fellows at a large academic training program, the majority of 20 respondents (43% of all fellows) reported a plan to specialize in medical oncology, and most planned to practice in an academic setting. Fellows who had started the job search process reported using several tools/techniques including online job centers and email distribution lists, word of mouth, prior connections with other institutions, and their HO fellowship program leadership, and most reported that their current institution provided help for their job search in at least one way. Job search challenges included learning about available positions, lack of mentorship on the process, lack of sufficient time for the process, and lack of preparation for negotiation. Fellows suggested additional resources that could be helpful to future job searchers including access to information about prior HO fellowship graduates, training in negotiation and interviewing, and career development mentorship. We plan to use this information to expand our own Career Development program for fellows enacting many of these suggestions, and we encourage the use of this information as pilot data for the development of larger studies across other medical and surgical specialties.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13187-021-01967-7.

Use of Artificial Intelligence to understand adults' thoughts and behaviours relating to COVID-19.

Aims:The outbreak of severe acute respiratory syndrome coronavirus 2 (COVID-19) is a global pandemic that has had substantial impact across societies. An attempt to reduce infection and spread of the disease, for most nations, has led to a lockdown period, where people’s movement has been restricted resulting in a consequential impact on employment, lifestyle behaviours and wellbeing. As such, this study aimed to explore adults’ thoughts and behaviours in response to the outbreak and resulting lockdown measures.Methods:Using an online survey, 1126 adults responded to invitations to participate in the study. Participants, all aged 18 years or older, were recruited using social media, email distribution lists, website advertisement and word of mouth. Sentiment and personality features extracted from free-text responses using Artificial Intelligence methods were used to cluster participants.Results:Findings demonstrated that there was varied knowledge of the symptoms of COVID-19 and high concern about infection, severe illness and death, spread to others, the impact on the health service and on the economy. Higher concerns about infection, illness and death were reported by people identified at high risk of severe illness from COVID-19. Behavioural clusters, identified using Artificial Intelligence methods, differed significantly in sentiment and personality traits, as well as concerns about COVID-19, actions, lifestyle behaviours and wellbeing during the COVID-19 lockdown.Conclusions:This time-sensitive study provides important insights into adults’ perceptions and behaviours in response to the COVID-19 pandemic and associated lockdown. The use of Artificial Intelligence has identified that there are two behavioural clusters that can predict people’s responses during the COVID-19 pandemic, which goes beyond simple demographic groupings. Considering these insights may improve the effectiveness of communication, actions to reduce the direct and indirect impact of the COVID-19 pandemic and to support community recovery.

ICMA: An Efficient Integrated Congestion Control Approach

Background: With the growing popularity of various group communication applications, such as file transfer, multimedia events, distance learning, email distribution, multiparty video conferencing, and teleconferencing, multicasting seems to be a useful tool for efficient multipoint data distribution. An efficient communication technique depends on various parameters like processing speed, buffer storage, and amount of data flow between the nodes. If data exceeds beyond the capacity of a link or node, then it introduces congestion in the network. A series of multicast congestion control algorithms have been developed, but due to the heterogeneous network environment, these approaches do not respond nor reduce congestion quickly whenever network behavior changes. Objective: Multicasting is a robust and efficient one-to-many (1: M) group transmission (communication) technique to reduced communication cost, bandwidth consumption, processing time, and delays with similar reliability (dependability) as of regular unicast. This patent presents a novel and comprehensive congestion control method known as an integrated multicast congestion control approach (ICMA) to reduce packet loss. Methods: The proposed mechanism is based on a leave-join flow control mechanism along with a Proportional Integrated and Derivate (PID) controller to reduce packet loss, depending on the congestion status. In the proposed approach, the Proportional integrated and derivate controller computes expected incoming rate at each router and feedback this rate to upstream routers of the multicast network to stabilize their local buffer occupancy. Results: Simulation results using NS-2 exhibit the immense performance of the proposed approach in terms of delay, throughput, bandwidth utilization, and packet loss than other existing methods. Conclusion: The proposed congestion control scheme provides better bandwidth utilization and throughput than other existing approaches. Moreover, we have discussed existing congestion control schemes with their research gaps. In the future, we are planning to explore the fairness and quality of service issues in multicast communication.

Radiation oncology education and experience in the undergraduate medical setting

ABSTRACT The goal of this study was to determine the impact and experience of radiation oncology (RO) education in the undergraduate medical experience in the USA. A list of American medical schools was complied from various sources including the Association of American Medical Colleges (AAMC) and American Association of Colleges of Osteopathic Medicine (AACOM) in the summer of 2019. Data was extracted through institution website review, individual phone calls and email distribution. A total of 198 programs (155 allopathic and 43 osteopathic medical schools) were included. Every medical school curriculum had oncology lecture during MS year 1 and 2, although a minimal amount (4%) had a RO-specific lecture during MS year 1 and 2. There were significant differences in the RO education and experience in allopathic (MD) versus osteopathic (DO) programs. Home radiation oncology programs and career advising were associated with a radiation oncology elective during year 3 and 4. Furthermore, RO career advisors and older schools were associated with having one student match into radiation oncology. RO education during the didactic portion of the undergraduate medical experience remains extremely limited. This limitation is even more pronounced in medical schools without RO mentorship and in osteopathic medical schools. This lack of RO exposure perpetuates itself by bringing less students into the field. These issues require attention both on a national and medical-school-specific level.

A survey of pediatric hematologists/oncologists' perspectives on single patient Expanded Access and Right to Try.

Introduction:Physicians in the United States play an essential role guiding patients through single patient pre-approval access (PAA) to investigational medical products via either the Food and Drug Administration (FDA)’s Expanded Access (EA) or the federal Right To Try (RTT) pathways. In this study, we sought to better understand pediatric hematologist/oncologists’ attitudes about seeking PAA, on behalf of single patients, to investigational drugs outside of clinical trials.Methods:A cross-sectional survey was developed and sent to pediatric hematologist/oncologists via St. Baldrick’s Foundation’s email distribution list.Results:Of 73 respondents (10.1% of those who received the survey), 56 met eligibility criteria and are included in the analysis. Over 80% (n = 46) had prior experience with single patient PAA. Respondents were most concerned about the unknown risks and benefits of investigational drugs and financial implications of PAA for patients. One hundred percent and 91.1% of respondents indicated a willingness to support patients through EA and RTT pathways, respectively. When asked about their most recent experience with PAA, 40 out of 46 indicated that they used the FDA’s EA pathway to seek PAA and 4 out of 46 indicated that they used the RTT pathway. Of 44 respondents who had used the EA or RTT pathway, 43 indicated that the biotechnology or pharmaceutical company they solicited granted access to the requested product.Conclusion:Survey results support other findings suggesting a need for additional physician support and education about PAA and that physicians may have unequal access to information about investigational drugs and concerns about financial implications of PAA for their patients.

Incidence of work related musculoskeletal disorders in medical dosimetry.

Musculoskeletal disorders (MSDs) account for almost 70 million physician office visits per year in the United States and are the most common workplace injuries. These are conditions involving the nerves, tendons, muscles, and supporting structures of the body. Previous studies have concluded that computer users are at high risk of developing work-related musculoskeletal disorders (WRMSDs). As computer users, medical dosimetrists are at risk of developing WRMSDs, yet there is a lack of information regarding the incidence of WRMSDs among medical dosimetrists. The purpose of this study was to determine the incidence of WRMSDs and variables of workstation ergonomics that contribute to the increased risk of WRMSDs in medical dosimetrists. A Qualtrics survey was created to support the 3 research questions guiding this study. The survey was distributed to 2,646 full members of the American Association of Medical Dosimetrists (AAMD), which included only certified medical dosimetrists (CMDs), via email. The distribution of email surveys sent through the AAMD email distribution list resulted in 988 emails opened, for a contact rate of 37% (988/2646). One hundred sixty-four responses were recorded yielding a completion rate of 17% (164/988). Fifty-five percent (90/163) of participants responded that they have experienced WRMSDs. Forty-four percent (289/652) of responses indicated WRMSDs have a slight or moderate interference on work. Sixty-two percent (94/152) of participants felt that their workstations were not ergonomically designed; even greater 68% (104/153) did not feel their workstations were designed for their individually needs. Of those respondents 64% (98/152) would like to see further adaptations made to their workspaces.

Pediatric biobanks and parents of disabled children associations opinions on establishing children repositories in developing countries.

Pediatric biobanks are an indispensable resource for the research needed to bring advances in personalized medicine into pediatric medical care. It is unclear how or when these advances in medical care may reach children, but it is unlikely that research in adults will be adequate. We conducted the screening for a hypothetic problem in various European and American pediatric biobanks based on online surveys through e-mail distribution based on the Biobank Economic Modeling Tool (BEMT) questionnaire model. Participants in the survey had work experience in biobanking for at least 3 years or more. Contact information about the survey participants was confirmed on the social networks profiles (LinkedIn), as well as on generally available websites. First, we tried creating a model which can show the pediatric preclinical and basic clinical phase relationship and demonstrate how pediatric biobanking is linked to this process. Furthermore, we tried to look for new trends, and the final goal is to put the acquired knowledge into practice, so medical experts and patients could gain usable benefit from it. We concluded that leading positions must take into account ethical and legal aspects when considering the decision to include children in the biobank collection. However, communication with parents and children is essential. The biobank characteristics influence the biobank's motives to include children in the consent procedure. Moreover, the motives to include children influence how the children are involved in the consent procedure and the extent to which children are able to make voluntary decisions as part of the consent procedure.

Work-Addiction Risk in Athletic Trainers and Its Relationship to Work-Family Conflict and Burnout.

Individual factors can affect numerous work-life interface outcomes, including work-family conflict and burnout. Recently, the concept of work addiction has been investigated as an individual factor that could affect numerous outcomes. Despite the large body of literature investigating work-family conflict and burnout in athletic training, little is known about the incidence of work addiction or its potential effect on these outcomes. To gather descriptive data on the work-addiction risk and examine the effect work addiction may have on work-life interface outcomes in athletic training. Cross-sectional study. Online web-based survey. Athletic trainers (ATs) employed in all work settings were recruited to participate via social media and email distribution lists. Data from 226 (n = 65, 28.8% males; n = 161, 71.2% females) ATs, currently employed in more than 13 work settings, were included in data analysis. The online questionnaire consisted of 4 main sections: demographic questions, work-family conflict scale, Copenhagen Burnout Inventory, and the Work Addiction Risk Test. We calculated Mann-Whitney U and Kruskal-Wallis tests to determine if group differences existed. Simple linear regressions were used to assess if work-addiction risk scores predicted burnout and work-family conflict. The ATs experienced moderate levels of personal (55.0 ± 19.1) and work-related (50.0 ± 16.0) burnout and were at medium risk for work addiction (58.3 ± 11.2). No demographic differences were observed in burnout or work-family conflict scores, but these scores differed based on the work-addiction risk. Women were more at risk for compulsive tendencies than were men. Work-addiction risk scores predicted both burnout and work-family conflict, but only a relatively small percentage of the variability was explained. Those ATs at higher risk for work addiction reported higher levels of burnout. Because of the medium risk for work addiction among ATs, work-addiction mitigation strategies should be implemented by individuals and organizations.

The Alzheimer's Prevention Registry: Success metrics and lessons learned in registry member retention through online engagement campaigns

AbstractBackgroundWe developed the web‐based Alzheimer’s Prevention Registry (APR) program to provide resources to the AD scientific community, aiming to accelerate recruitment and enrollment into studies and to complement local efforts. Considerable efforts have been given to strengthening retention and engagement of APR members over time, regardless of whether they enroll in an AD study.MethodsAdults age 18+ are eligible to join the APR at www.endALZnow.org. At enrollment, individuals provide their name, email address, zip/postal code and year of birth; after enrollment they provide additional demographic information. Immediately after enrollment members begin receiving APR emails welcoming and orienting them to the APR. The APR sends members monthly newsletters and study opportunity announcements via email for engagement and retention purposes. We developed a 4‐part re‐engagement campaign for members who either have not opened an APR email within 6 months or fall below our engagement scoring model. If a member does not act on a re‐engagement email, then APR removes them from its email distribution list. Only “actively engaged” members remain on the APR email distribution list.ResultsThe APR has enrolled >347,000 members since its launch in 2012. As of January 2020, 86,175 people are considered “actively engaged” members of the APR. In 2019, 12 monthly e‐newsletters were sent to APR members. The average e‐newsletter open rate was 45% (compared to nonprofit healthcare industry average of 16%); and the average e‐newsletter click rate (percentage of APR members who clicked on the email in relation to those who opened/viewed the email) was 24% (compared to the industry average of 1.6%). In 2019, 36 study opportunity emails were sent to APR members with similar open and click rates. To date, approximately 54,000 members have been added to the re‐engagement campaign, and nearly 10,000 (18.5%) have been successfully re‐engaged.ConclusionDeploying online engagement campaigns as a retention tool is a valuable resource for the APR. Thoughtfully engaging and re‐engaging APR members promotes increased likelihood of email opens and clicks when study opportunities are offered. Future work will examine the relationship between email engagement and responsiveness to study opportunities.

Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey

Background: Transgender, nonbinary, and gender-expansive (TGE) people experience pregnancy. Quantitative data about pregnancy intentions and outcomes of TGE people are needed to identify patterns in pregnancy intentions and outcomes and to inform clinicians how best to provide gender-affirming and competent pregnancy care. Aims: We sought to collect data on pregnancy intentions and outcomes among TGE people assigned female or intersex at birth in the United States. Methods: Collaboratively with a study-specific community advisory team, we designed a customizable, online survey to measure sexual and reproductive health experiences among TGE people. Eligible participants included survey respondents who identified as a man or within the umbrella of transgender, nonbinary, or gender-expansive identities; were 18 years or older; able to complete an electronic survey in English; lived in the United States; and were assigned female or intersex at birth. Participants were recruited through The PRIDE Study – a national, online, longitudinal cohort study of sexual and gender minority people – and externally via online social media postings, TGE community e-mail distribution lists, in-person TGE community events, and academic and community conferences. We conducted descriptive analyses of pregnancy-related outcomes and report frequencies overall and by racial and ethnic identity, pregnancy intention, or testosterone use. Results: Out of 1,694 eligible TGE respondents who provided reproductive history data, 210 (12%) had been pregnant. Of these, 115 (55%) had one prior pregnancy, 47 (22%) had two prior pregnancies, and 48 (23%) had three or more prior pregnancies. Of the 433 pregnancies, 169 (39%) resulted in live birth, 142 (33%) miscarried, 92 (21%) ended in abortion, two (0.5%) ended in stillbirth, two (0.5%) had an ectopic pregnancy, and seven (2%) were still pregnant; nineteen pregnancies (4%) had an unknown outcome. Among live births, 39 (23%) were delivered via cesarean section. Across all pregnancies, 233 (54%) were unintended. Fifteen pregnancies occurred after initiation of testosterone, and four pregnancies occurred while taking testosterone. Among all participants, 186 (11%) wanted a future pregnancy, and 275 (16%) were unsure; 182 (11%) felt “at risk” for an unintended pregnancy. Discussion: TGE people in the United States plan for pregnancy, experience pregnancy (intended and unintended) and all pregnancy outcomes, and are engaged in family building. Sexual and reproductive health clinicians and counselors should avoid assumptions about pregnancy capacity or intentions based on a patient’s presumed or stated gender or engagement with gender-affirming hormone therapy.

Patient satisfaction survey experience among American otolaryngologists.

Patient Satisfaction (PS) is a commonly used metric in health care settings to assess the quality of care given by physicians. Monitoring physicians in this way may impact physician quality of life. Studies evaluating this impact are not available. This study sought to examine the physician experience of measuring PS among practicing otolaryngologists. Using an online survey platform, a 34-item survey was given to practicing otolaryngologists through email distribution. The survey included questions about physician, practice and patient demographics, as well as inquiries regarding the way in which PS was measured and how it affected physician work and personal life. Data from these questions were reviewed and analyzed. 174 otolaryngologists responded to the survey. A majority of physicians' (55.3%) PS scores had been tracked with 89.9% reporting being tracked for a length of at least 1year. PS scores for individual physicians were noted to be inconsistent and vary significantly between reports. Measuring patient satisfaction led to increased occupational stress, yet most physicians (63.8%) felt the monitoring did not lead to improvements in their practice. Some physicians (36.2%) reported that the collection of patient satisfaction scores had negatively influenced the way they practiced medicine, including the pressure to order superfluous tests or to prescribe unnecessary medications. Overall, physicians are negatively affected by the tracking of patient satisfaction scores. Occupational stress caused by the collection of patient satisfaction scores may contribute to physician burnout.

Total body irradiation in Australia and New Zealand: results of a practice survey.

Total body irradiation (TBI) is an important treatment modality for the preparation of patients for bone marrow transplants. It is technically challenging and the actual delivery may vary from clinic to clinic. Knowledge of the pattern of practice may be helpful for clinics to determine future practice. We carried out an email survey from April to September 2019 sending 48 TBI related questions to all radiotherapy clinics in Australia and New Zealand via the Australasian College of Physical Scientists in Medicine email distribution list. Centres not performing TBI were not expected to complete the survey and centres that had participated in a previous survey, or that were known to perform the treatment, were followed up if no response was received. Of a total of approximately 70 centres, 14 clinics responded to the survey. The vast majority of clinics use conventional lateral and/or anterior-posterior beams at extended SSD for TBI treatment delivery. However, treatment planning, ancillary equipment (used for immobilisation/modulation), beam energy and prescribed lung doses vary considerably-with some clinics delivering the prescription dose to the lungs and some aiming to deliver a lung dose which is lower than the prescription dose. Only one clinic reported using an advanced delivery technique with modulated arcs at extended SSD. Centres either said they had no access to outcome data or did not answer this question. Compared with an earlier survey from 2005, 3 clinics have lowered their linac dose rate and 7 are the same or similar. The TBI practice in Australia and New Zealand remains varied, with considerable differences in treatment planning, beam energy, accepted lung doses and delivered dose rates.

Pre-licensure nursing students' attitudes toward clinical research, education research, and pedagogical research participation in the United States

BackgroundResearchers worldwide have found that nursing students tend to have favorable attitudes toward clinical research. However, little is known about their attitudes toward education research and pedagogical research participation. ObjectivesThe purposes of this study were to: describe nursing students' attitudes toward clinical research, education research, and pedagogical research participation; explore the association of select demographic and academic factors with students' attitudes; and identify facilitators and barriers of pedagogical research participation. DesignA convergent mixed-methods design with questionnaire variant was used. SettingsPre-licensure students from nursing programs throughout the United States. ParticipantsFour hundred and thirty-six pre-licensure students, aged 18 or older, who were active members of the National Student Nurses' Association (NSNA). MethodsResearch participants were recruited using the NSNA e-mail distribution list. Nursing students completed a demographic survey and three instruments that measured attitudes toward clinical research, education research, and pedagogical research participation. ResultsQuantitative findings indicated that nursing students had generally positive attitudes toward clinical research, education research, and pedagogical research participation. Prior experience as a research assistant or a research participant was significantly associated with students' attitudes on all three measures. Factors identified by students to enhance pedagogical research participation were the potential to improve practice, research topic interest, and opportunities for personal and professional development; while time-related concerns were identified as barriers to research participation. Qualitative data supported these findings, and also revealed some negative attitudes toward pedagogical research participation, concerns about current educational practices, and confusion about the definition of education research. ConclusionsFindings from this study provide nurse educators with students' perspectives of education research, which may be used to develop a student-driven framework to enhance the implementation of pedagogical research. Further research is warranted to more fully understand these phenomena with explicit attention to international students' perspectives.

Ice Capades: Skating Around Current Practice of Cryobiopsy for ILD.

Transbronchial lung cryobiopsy (TBLC) has been proposed as a potentially safer alternative in the diagnosis of interstitial lung disease. The current practice of TBLC is unknown as most published data come from case reports, case series, and a few trials. The authors report the practice patterns of TBLC on the basis of survey responses. The authors created an anonymous online survey to assess how proceduralists evaluate patients, perform, and manage complications of TBLC. Surveys were distributed through social media and e-mail distribution lists from the American Association of Bronchology and Interventional Pulmonology and the Society of Advanced Bronchoscopists. Aggregated responses are reported as counts, percentages, and averages. Surveys show significant variation in parameters providers use to assess appropriate patients for procedures, how specific aspects of TBLC are performed, and how complications and results are managed. This is the first and largest survey of providers describing the current large variation in the use of cryobiopsy for the evaluation of interstitial lung disease. The standardized practice is essential to understand the true diagnostic accuracy or rate of complications related to TBLC.

Risk of Coronavirus Disease 2019 Transmission During Autopsy

To the Editor.—We wish to advance the discussion regarding potential transmission of coronavirus disease 2019 (COVID-19) infection from decedents to autopsy and/or morgue personnel.1In March 2020 one of us (A.K.W.) started an email distribution list among nearly 200 participants, most of whom are autopsy pathologists, for discussing issues relating to decedent management and autopsy amid the COVID-19 pandemic. A recent survey of the listserv participants asked how many autopsies had been performed on individuals known to be COVID-19 positive, what protective gear and conditions such offices used to conduct the autopsies, and whether autopsy personnel had experienced symptoms of, or tested positive for, COVID-19 infection.Based on the survey results, during the course of the pandemic to date in the United States, at least 225 autopsies have been conducted on individuals presented as being positive for COVID-19 based on the clinical impression, laboratory tests, or both. These autopsies have been performed in 14 states (Alabama, California, Florida, Illinois, Iowa, Maryland, Massachusetts, New York, Rhode Island, Tennessee, Texas, Vermont, Washington, and Wisconsin). At least 102 of these postmortem examinations involved brain removal using various methods, including oscillating saws used in conjunction with vacuum attachments, running water over the incision, or plastic barriers around the head, as well as hand saws. Personal protective equipment used in each case included: a head cover; face shield; mask (N95), powered air-purifying respirators or controlled air-purifying respirators; gown; scrubs; boot covers; and nitrile gloves. The postmortem examinations were performed in rooms with and without negative pressure relative to surrounding areas.Survey respondents reported that 1 person involved with performing these 225 autopsies has developed COVID-19 infection to date, which occurred early in the pandemic. Another 12 persons working in that same morgue have not developed symptoms of or had a diagnosis of COVID-19 infection. That office considers it likely that the 1 conversion occurred from community exposure rather than exposure during autopsy.Respondents reported that from 1 to 6 persons are in a morgue during an autopsy at their institutions. Assuming an average of 3 person exposures per autopsy results in 675 total person-exposures. As of May 25, 2020, the Centers for Disease Control and Prevention reported that 1 637 456 persons have become infected with COVID-19 in the United States.2 The US Census Bureau population clock estimates the US population to be 329 701 526.3 Calculations using these figures demonstrate that approximately 1 in 201 persons in the United States has become infected with COVID-19. Given that 1 person involved with COVID-19 autopsies has acquired COVID-19 infection out of approximately 675 exposures, it appears that performing autopsy while wearing recommended personal protective equipment presents exceedingly little risk of transmission of COVID-19 infection to autopsy personnel.Editor's Note.—Two letters12 commenting on the content of this letter were recently accepted and posted online.