Email Listserv Research Articles

Congenital Cytomegalovirus and Hearing Loss: A Pilot Cross-Sectional Survey of Otologists' and Pediatric Otolaryngologists' Knowledge.

ObjectiveTo evaluate pediatric otolaryngologists, neurotologists, and otologists on awareness and knowledge of congenital cytomegalovirus (cCMV).Study DesignPilot cross-sectional online survey.SettingOtolaryngology practices.Subjects and MethodsAn electronic multiple-choice questionnaire was sent email listserv to physician members of the American Society of Pediatric Otolaryngology and American Otological Society. The survey assessed demographics, physician awareness, and practice patterns. Data were collected and analyzed.ResultsSeventy (14.5%) pediatric otolaryngologists and otologists responded. All responded that they are familiar with cCMV. Most were familiar with symptoms associated with cCMV with the exception of petechia/purpura. Less than 50% knew the incidence/natural history of cCMV-induced hearing loss. Only 63% knew that saliva or urine polymerase chain reaction/culture should be performed prior to 3 weeks of age. Less than half knew the indications for dry blood spot testing, and many incorrectly recommended serologic saliva or urine testing in a child >3 weeks old. Most respondents do not offer any diagnostic testing for cCMV or referral for antiviral therapy for those who may benefit from this treatment. Most either did not know the cCMV screening policy or did not have one at their institution.ConclusionDespite a relatively low overall response rate, this study suggests several knowledge gaps and underutilization of cCMV testing by physicians who frequently encounter pediatric hearing loss. The findings from this pilot study demonstrate the need for further educational directives focused on cCMV to improve knowledge and incorporation of cCMV best practices.

Supporting Grass Roots Implementation of an Evidence-Based Psychotherapy Through a Virtual Community of Practice: A Case Example in the Department of Veterans Affairs

In contrast to a top-down dissemination approach, the present approach identified existing clinicians using an evidence-based psychotherapy (EBP), dialectical behavior therapy, throughout the Department of Veterans Affairs (VA) system, and created a virtual community of practice (VCoP) to facilitate sharing of materials, resources, information, and clinical expertise. This “bottom-up” or grassroots approach to building a VCoP has potential to support the adoption of EBPs in settings without the resources required to support a large-scale training and consultation initiative. The objective of the current paper is to describe creation, dissemination, and web analytics data of this VCoP to connect providers using an EBP in a national health care system. The VCoP was created using SharePoint and development included user acceptance testing. Dissemination was achieved through a variety of outlets, including use of e-mail listservs, promotion on internal Web sites, and presentations. Monthly Web analytics data were collected on number of unique users, location of users, and number of requests or visits. Monthly Web analytics data indicated that the site was visited every workday in the first year and consistently across 5 years. Number of unique users and number of requests was relatively stable with increases corresponding to efforts to increase site engagement. Location of users demonstrates a wide reach across the VA system. Web analytics data indicate sustained use of the site by providers and methods to facilitate and increase use and interaction appeared to have a positive impact. Future research should investigate the effectiveness of such a strategy on provider behavior.

234 A Multi-center Survey of Vitamin D Monitoring and Supplementation in Patients with Thermal Injuries

The pleotropic effects of vitamin D supplementation in deficient patients have been demonstrated. There are few studies of vitamin D in burn patients. The optimal dose, formulation, and route of administration for vitamin D supplementation is unknown, as is the frequency or necessity of monitoring vitamin D concentrations in burn patients. The primary objective of this study is to describe the current practice of monitoring and supplementing vitamin D in burn patients admitted to a burn center. This was a survey conducted of subscribers to the American Burn Association Pharmacy Special Interest Group email listserv in May 2018. Recipients were asked whether their center monitored vitamin D concentrations and if supplementation was routine. Data collected included: whether vitamin D concentrations were obtained on admission, preferred replacement regimen, and timing of subsequent concentration obtainment. A total of 21 responses were received. Eight respondents (38.1%) routinely check 25-hydroxyvitamin D concentrations. Two centers check concentrations on admission, two centers check within 48 hours of admission, three centers check within one week of admission. One center specifically monitors concentrations only for patients with a > 20% total body surface area (TBSA) burned. Five centers report rechecking concentrations within weeks to months of the initial level,. Four centers primarily use ergocalciferol, three use cholecalciferol, and one has no preference. Dosing varied greatly between sites. Two respondents reported adjusting dose based on degree of deficiency and admission concentration. One respondent reported a dosing regimen adjusted to age and percent TBSA burned. Thirteen respondents (61.9%) do not routinely check vitamin D concentrations, but may if patients are healing poorly, malnourished, or per nutritionist or nephrologist recommendations. One of the burn centers, who does not routinely monitor concentrations, supplements all burn patients who have ≥ 15% TBSA with cholecalciferol 2000 units daily. Barriers to routinely monitoring vitamin D concentrations cited were cost, inability to analyze in-house, and lack of evidential recommendations for monitoring and supplementing patients with thermal injuries. The current practice of monitoring and supplementing vitamin D varies widely across burn centers. Future studies using consistent monitoring and dosing should be conducted to determine the clinical benefit of adequate vitamin D levels in burn patients. Suggest performing a multi-center clinical trial and developing recommendations for routine monitoring and supplementation of vitamin D in burn patients.

Ureteral stenting practices following routine ureteroscopy: an international survey.

Stent omission after routine ureteroscopy (rtURS) is accepted by current guidelines and may result in decreased patient morbidity and treatment costs. In a value-based healthcare model, the added morbidity and cost of routine stent placement may be scrutinized. Furthermore, data are limited on urologist cost knowledge and it is effect on ureteral stent placement. As such, we seek to describe ureteral stenting practices and urologist cost knowledge amongst US and non-US-based urologists. The ureteroscopic practice patterns and cost awareness of members of the Endourological Society were surveyed using an international email listserv. Respondents were grouped by practice location (US vs non-US). Logistic regression was used to evaluate the associations of surgeon practice location with stenting practices. 233 completed responses were received with a response rate of 13.5%. Results revealed that 55% and 71% of respondents reported ureteral stent insertion after rtURS more than 75% of the time for ureteral and renal stones, respectively. Reporting stent insertion following more than 75% of rtURS was more common among US participants for both ureteral and renal stones. Overall, reported cost knowledge was high, but lower among US participants. On multivariable analysis, US respondents were more likely to place ureteral stents after rtURS for ureteral stones more than 75% of the time when compared to those abroad (OR 3.43 p < 0.01). Ureteral stenting after rtURS is over utilized in the US compared to other countries. While this phenomenon is multifactorial in nature, cost knowledge may be under recognized as a determinant of ureteral stent placement following rtURS.

Perceptions of Parental Tobacco Dependence Treatment Among a Children's Hospital Staff.

To assess employee support for and knowledge of smoking cessation programs for patients' parents and staff and employees' level of comfort discussing smoking with patients and their families before and during a hospital-wide study of a tobacco cessation and/or exposure reduction program for inpatients' parents who smoke. Clinical staff were invited to complete online surveys at the beginning of and 19 months into a randomized controlled trial to test the efficacy of an inpatient tobacco cessation and exposure reduction program for parents of hospitalized children. The program included educating pediatric inpatient clinical staff about available resources, such as the Colorado QuitLine, and smoking cessation interventions for the parents of hospitalized children. Clinical staff were recruited via e-mail listservs, a weekly e-mail newsletter, and posted flyers. Baseline and midstudy results were compared, and χ2 tests were performed. At the baseline, 192 clinical staff responded; 235 responded midstudy. At the baseline and midstudy, at least 90% of the respondents believed that the hospital should support parents in quitting smoking, although the support for free nicotine replacement therapy was low (27% at the baseline to 35% at midstudy). One-fifth of the respondents were uncomfortable discussing smoking; this proportion decreased after educational interventions. Knowledge about hospital cessation resources had also increased at midstudy. There was strong support for helping parents and staff quit smoking. Comfort among clinical staff in addressing tobacco dependence in patients and families and awareness of cessation resources increased over the course of the study.

Learning from the Field and Its Listserv: Issues That Concern Health Literacy Practitioners.

This study assesses the content of email messages posted to the Health Literacy Discussion List (HLDL) during a two-year period. The study identifies issues of concern to list subscribers, describes the purposes the list serves for health professionals, and contributes to the health literacy literature by providing an email listserv as a research corpus. The authors conducted an inductive qualitative analysis of email posts to the HLDL from October 2013 to October 2015. Using an iterative process, the authors identified descriptive categories for types of posts and topics of posts. The first (SKR) and second (JM) authors reviewed subject lines of all 2,036 posts and brainstormed type and topic categories, independently read and sorted a random sample of 200 posts into those categories, and then discussed discrepancies. Based on the latter experience, the authors combined, added, or excluded certain categories and jointly created a detailed description for each type and topic category. We then sorted another random sample of 200 posts and generated a list of key words relating emails to topic categories. A Cohen's kappa reliability coefficient was calculated to establish intercoder reliability. The third author (RVR) then conducted key word searches for sorting the remaining 1,836 email posts. The existence and frequency of email clusters and the content of emails in these clusters were used to identify and explore in greater detail the "hot topics" of interest to the field. Our analysis suggests the utility of the HLDL as a platform for sharing information and resources, announcements and calls for action, technical assistance and professional discourse.

Assessing the Impact of the Position Paper “Prescribing and Administering Opioid Doses Based Solely on Pain Intensity”

BackgroundA task force of members of the American Society for Pain Management Nursing (ASPMN) authored a position paper “Prescribing and Administering Opioid Doses Based Solely on Pain Intensity.” Some of the authors of this ASPMN position paper presented a concurrent session at the September 2016 ASPMN National Conference discussing the content of the position paper. As a follow-up, the authors designed a research study to identify the impact of the position statement in facilitating change in institutional practice of dosing analgesics based solely on pain intensity. AimsOur aim was to ascertain the effect of the American Society for Pain Management Nursing ASPMN position paper “Prescribing and Administering Opioid Doses Based Solely on Pain Intensity” (2016) on changes in institutional practices. DesignThe study used an online anonymous questionnaire that included open-ended questions. SettingsAn anonymous electronic questionnaire was used to assess the impact across the United States. Participants/SubjectsParticipants were members of the American Society for Pain Management Nursing. MethodsAn eight-question anonymous questionnaire created through Survey Monkey was sent to members of the American Society for Pain Management Nursing via an e-mail listserv and the monthly e-newsletter. ResultsOf the 142 members who consented to participate in the study, 120 members answered one or more questions. Those who responded to the question about changes in practice, only 13 (11.1%) reported that the position paper had influenced a change in practice at their institution. The majority, 89 (75%), reported that practice had not changed in their institution. ConclusionsAmong those clinicians who participated in this study, the position paper “Prescribing and Administering Opioid Doses Based Solely on Pain Intensity” reportedly had minimal impact on changing institutional practices.

Acne disparities in Native Americans

Acne disparities in Native Americans

Pediatric Nephrology and Rheumatology Practice Patterns in Granulomatosis with Polyangiitis: A Midwest Pediatric Nephrology Consortium Study.

Objective To assess practice pattern similarities and differences amongst pediatric rheumatologists and nephrologists in the management of pediatric Granulomatosis with Polyangiitis (GPA). Methods A voluntary survey was distributed to the Midwest Pediatric Nephrology Consortium Group (MWPNC) and an international pediatric rheumatology email listserv in 2016-2017. Data were collected on general practice characteristics and preferences for induction management under three clinical scenarios (A-C): newly diagnosed GPA with glomerulonephritis, GPA with rapidly progressive glomerulonephritis, and GPA with pulmonary hemorrhage. In addition, individual preferences for GPA maintenance medications, disease monitoring, and management of GPA with end-stage renal disease were ascertained. Results There was a 68% response rate from the MWPNC membership and equal numbers of rheumatology respondents. Survey results revealed Rituximab plus Cyclophosphamide is a more common induction choice for rheumatologists than nephrologists in induction Scenarios A and B, whereas Cyclophosphamide is more commonly chosen by nephrologists in Scenario A. Plasmapheresis rates increased for Scenarios A, B, and C for both specialties, but were overall low. There was no clear consensus on the duration of maintenance therapy nor diagnostic work-up. Rheumatologists more frequently chose Rituximab for maintenance and induction compared to nephrologists. There was also a higher than expected proportion of Mycophenolate Mofetil use for both specialties. Conclusion This survey has revealed important differences in the way that rheumatologists and nephrologists manage this disease. It highlights the need for well-designed clinical trials in pediatric GPA patients and reveals that both specialties must be represented during consensus-building and clinical trial design efforts.

Source of Health Information and Unmet Healthcare Needs in Asian Americans

Background: Responding to the disparities in accessing and obtaining health information and healthcare among immigrant populations, the present study focused on Asian Americans. Using a sample that reflects Asian Americans’ cultural and linguistic diversities, the goal was to explore the typologies of health information source and their predictability to unmet healthcare needs (i.e., the experience of not being able to get needed medical care).Methods: Data were drawn from the 2015 Asian American Quality of Life Survey (N = 2,592), conducted using culturally and linguistically sensitive approaches. Latent class analysis on nine sources of health information across interpersonal networks (family members, close friends, acquaintances, and health professionals) and Internet-based communication technologies (mobile apps, email listservs, social networking sites, online communities, and health websites) identified six classes: ‘resource-heavy,’ ‘human-oriented,’ ‘expertise-focused,’ ‘family-dominant,’ ‘resource-scarce,’ and ‘health professional-dominant.’ Results: Compared to the resource-heavy group, the odds of having an unmet healthcare need were 2.94 times greater in the family-dominant group and 4.13 times greater in the resource-scarce group.Discussion: Findings provide implications for interventions with respect to subgroups to be prioritized and areas to be targeted in efforts to promote access and acquisition of health information and health services in Asian Americans.

Supporting instructional change in mathematics: using social network analysis to understand online support processes following professional development workshops

BackgroundStudies continually show benefits of active learning in college classrooms, yet it is difficult to get faculty to adopt these methods. Particularly challenging is the final step of the instructional change process, “refreezing,” when after making initial changes in instructional methods, instructors decide whether to continue with new instructional methods or return to their previous methods. Though this stage is important, it is not well studied. Most available studies about ongoing support following professional development on teaching merely state that facilitators made an effort to offer support, or report how frequently participants engaged with online support mechanisms through counting postings on listservs or message boards. Such measures do not show evidence that participants actually received positive reinforcement or intellectual and emotional support, which are crucial to refreezing, nor do these frequency analyses help other professional developers learn how to create productive ongoing support mechanisms that yield high participant engagement.ResultsThis workshop for 35 college mathematics instructors used online and in-person communities to provide support to participants during the post-workshop period of “refreezing.” Almost all workshop attendees participated in “e-mentoring” (94%), primarily through a productive, engaging group email listserv. By combining qualitative coding of message content with the techniques of social network analysis, we reveal how facilitators and participants on the group listserv provided intellectual and emotional support, as well as positive reinforcement through feedback loops. The analysis also shows how the facilitators made this a helpful group and maintained participant engagement through frequent encouragement, deliberate community building, and thoughtfully timed responses.ConclusionsThough many professional development workshops offer online support through email listservs, there is little evidence that these listservs successfully engage and support participants. Applying the analytic approach of social network analysis allowed us to model the conversation threads in one highly engaged and supportive listserv following a mathematics professional development workshop. This method revealed the processes of ongoing support in ways that traditional frequency-based analyses cannot. This method also revealed lessons for how other professional developers can create productive, helpful online support listservs. Since this is an innovative application of social network analysis, we describe the method in detail.

Increasing Physical Activity in Mothers Using Video Exercise Groups and Exercise Mobile Apps: Randomized Controlled Trial.

BackgroundWomen significantly decrease their activity levels in the transition to motherhood. Digital health technologies are low cost, scalable, and can provide an effective delivery mechanism for behavior change. This is the first study that examines the use of videoconferencing and mobile apps to create exercise groups for mothers.ObjectiveThe aim of the study was to test the feasibility, acceptability, and effectiveness of an individually adaptive and socially supportive physical activity intervention incorporating videoconferencing and mobile apps for mothers.MethodsThe Moms Online Video Exercise Study was an 8-week, 2-armed, Web-based randomized trial comparing the effectiveness of a group exercise intervention with a waitlist control. Healthy mothers with at least 1 child under the age of 12 years were recruited through Facebook and email listservs. Intervention participants joined exercise groups using videoconferencing (Google Hangouts) every morning on weekdays and exercised together in real time, guided by exercise mobile apps (eg, Nike+, Sworkit) of their choice. Waitlist control participants had access to recommended mobile apps and an invitation to join an exercise group after the 8-week study period. Main outcomes assessed included changes in self-reported moderate, vigorous, and moderate to vigorous physical activity (MVPA) minutes per week in aggregate and stratified by whether women met Centers for Disease Control and Prevention guidelines for sufficient aerobic activity at baseline. Outcomes were measured through self-assessed Web-based questionnaires at baseline and 8 weeks.ResultsThe intervention was effective at increasing exercise for inactive women and proved to be feasible and acceptable to all participants. A total of 64 women were randomized, 30 to intervention and 34 to control. Women attended 2.8 sessions per week. There was a strong, but not statistically significant, trend toward increasing moderate, vigorous, and MVPA minutes for all women. As hypothesized, in the prespecified stratum of women who were inactive at baseline (n=51), intervention participants significantly increased their activity by an average of 50 (95% CI 4.0-95.9, P=.03) MVPA minutes per week more than control participants. They had a corresponding statistically significant net increase of 19 (95% CI 3.2-34.8, P=.02) minutes of vigorous activity. Inactive women in the intervention arm also experienced promising reductions in depression, reporting a statistically significant net decrease in their depression score (−3.8, 95% CI −7.0 to −0.6; P=.02).ConclusionsWe found that a group exercise intervention using videoconferencing and mobile apps was a feasible and acceptable way to deliver a physical activity intervention to mothers. The intervention increased physical activity in inactive mothers. Further studies are needed to better establish how long these changes in physical activity can be maintained and whether these findings can be reproduced in a more diverse population.Trial RegistrationClinicalTrials.gov NCT02805140; https://clinicaltrials.gov/ct2/show/NCT02805140 (Archived by WebCite at http://www.webcitation.org/6yYZwRveg)

Communication and Healthcare: Self-Reports of People with Hearing Loss in Primary Care Settings

ABSTRACTObjectives: To assess the experiences of people with hearing loss in healthcare environments to characterize miscommunication and unmet needs, and guide recommendations for improving outcomes and access.Methods: Anonymous survey developed by subject-matter experts was posted on a large national hearing-loss consumer and advocacy organization website and email listserv. Data were collected and managed via RedCAP.Results: Responses were received from 1581 individuals. Respondents reported moderate or significant difficulty communicating with all listed providers. Three communication situations emerged as often presenting communication difficulties: hearing one’s name when called in the waiting room, hearing when the speaker’s back was turned, and hearing when communicating by telephone. Despite 93% of respondents indicating they sometimes or often let providers know about their hearing loss, 29.3% of all respondents still reported that no arrangements were made to improve communication.Conclusions: This study clearly demonstrates the ongoing difficulties faced by individuals with hearing loss, particularly older adults, as they attempt to navigate both providers and situations associated with a typical primary care office visit.Clinical Implications: Inexpensive and efficient changes to improve communication include (1) Improving one-on-one provider communication by facing the individual with good lighting, clear speaking, and not obstructing one’s mouth; (2) Environmental changes such as using visual or tactile alerting devices in waiting rooms and adding noise-dampening carpeting and curtains; and (3) Avoiding telephones and conveying health information in writing.

Survey of how different groups of veterinarians manage the use of neuromuscular blocking agents in anesthetized dogs

ObjectiveTo analyze practice habits associated with the use, reversal and monitoring of nondepolarizing neuromuscular blocking agents (NMBAs) in dogs by different groups of veterinarians. Study designOnline anonymous survey to veterinarians. PopulationData from 390 answered surveys. MethodsA questionnaire was sent to e-mail list servers of the American College of Veterinary Anesthesia and Analgesia (ACVAA-list), Sociedad Española de Anestesia y Analgesia Veterinaria (SEEAV-list), Colégio Brasileiro de Anestesiologia Veterinária (Brazilian College of Veterinary Anesthesiology; CBAV-list) and American College of Veterinary Ophthalmologists (ACVO-list) to elicit information regarding use of NMBAs and reversal agents, monitoring techniques, criteria for redosing, reversing and assessing adequacy of recovery of neuromuscular function. Binomial logistic regression was used to test for association between responses and group of veterinarians in selected questions. ResultsVeterinarians of the ACVO-list use NMBAs on a higher fraction of their caseload than other groups (all p < 0.0001). Subjective assessment (observation) of spontaneous movement, including spontaneous breathing, is the most common method for assessing neuromuscular function (43% of pooled responses); 18% of participants always reverse NMBAs, whereas 16% never reverse them. Restoration of neuromuscular function is assessed subjectively by 35% of respondents. Residual neuromuscular block is the most common concern regarding the use of NMBAs for all groups of veterinarians. Side effects of reversal agents (anticholinesterases) were of least concern for all groups. Conclusions and clinical relevanceWhile most veterinarians are concerned about residual neuromuscular block, relatively few steps are implemented to reduce the risks of this complication, such as routine use of quantitative neuromuscular monitoring or routine reversal of NMBAs. These results suggest a limitation in transferring information among groups of veterinarians, or in implementing techniques suggested by scientific research.

Mapping the global health employment market: an analysis of global health jobs

BackgroundThe number of university global health training programs has grown in recent years. However, there is little research on the needs of the global health profession. We therefore set out to characterize the global health employment market by analyzing global health job vacancies.MethodsWe collected data from advertised, paid positions posted to web-based job boards, email listservs, and global health organization websites from November 2015 to May 2016. Data on requirements for education, language proficiency, technical expertise, physical location, and experience level were analyzed for all vacancies. Descriptive statistics were calculated for the aforementioned job characteristics. Associations between technical specialty area and requirements for non-English language proficiency and overseas experience were calculated using Chi-square statistics. A qualitative thematic analysis was performed on a subset of vacancies.ResultsWe analyzed the data from 1007 global health job vacancies from 127 employers. Among private and non-profit sector vacancies, 40% (n = 354) were for technical or subject matter experts, 20% (n = 177) for program directors, and 16% (n = 139) for managers, compared to 9.8% (n = 87) for entry-level and 13.6% (n = 120) for mid-level positions. The most common technical focus area was program or project management, followed by HIV/AIDS and quantitative analysis. Thematic analysis demonstrated a common emphasis on program operations, relations, design and planning, communication, and management.ConclusionsOur analysis shows a demand for candidates with several years of experience with global health programs, particularly program managers/directors and technical experts, with very few entry-level positions accessible to recent graduates of global health training programs. It is unlikely that global health training programs equip graduates to be competitive for the majority of positions that are currently available in this field.

Report of the Third Heart Surgery Forum Scientific Sessions: Zagreb, Croatia December 6-8, 2017: Conference Highlights.

The Heart Surgery Forum is an online community dedicated to topics related to all aspects of cardiothoracic surgery. It consists of an informative website (www.hsforum.com), a traditional indexed journal both in print and online, and an email-based "list-serv" for discussion of surgical cases and techniques. The email list-serv, "OpenHeart-L" (The Forum) is composed of surgeons and allied specialties (perfusion, anesthesia, nursing). Dr. Mark Levinson (USA) started The Forum originally in 1995. He also served as the first Editor-in-Chief of the print journal for many years. Coinciding with the popularity of The Forum, and the desire by many members to meet in person, the First Heart Surgery Forum Conference (#1 HSF) was held in Savudrija, Istria, Croatia in 2010. The overwhelming success of this meeting, in terms of attendance and scientific content, resulted in #2 HSF being held in Split, Croatia in 2014. Recently, the #3 HSF meeting was held in Zagreb, Croatia on December 6-8th, 2017. This report highlights the scientific events of this meeting, and more importantly aims to inspire greater involvement by the international cardiothoracic community. Substantial increasing attendance was seen at each subsequent meeting, not only in terms of the number of participants and lectures, but also in the number of countries represented.

Abstract P4-15-11: “Is it cancer or not?” A qualitative exploration of patient perspectives surrounding the diagnosis and treatment of DCIS

Abstract Background: Approximately 53,000 women in the US undergo treatment for ductal carcinoma in situ (DCIS) each year, of whom only 20-30% may benefit. To better understand both the clinical and psychosocial impact of a DCIS diagnosis and different management approaches, we sought to engage women with DCIS regarding their experience surrounding diagnosis (dx) and treatment. Methods: In July 2014, we administered a web-based survey through an email listserv to the Susan Love Army of Women that resulted in over 2000 respondents self-identified as patients with DCIS. The survey included open-ended questions designed to assess patients' perspectives on their experiences with the dx and treatment of their DCIS. Responses were coded using an inductive coding schema; common themes were identified and summarized. Women who reported an invasive cancer, a second primary or recurrent tumor, or other benign breast lesions (in absence of DCIS) were excluded from analysis. Results: Among 1,857 women included in the analytic sample, the average age at dx was 60 years; 18% women were ≤2 years from their dx; most women (93%) identified as white. Four primary themes were identified: 1) uncertainty about DCIS dx; 2) uncertainty surrounding treatment; 3) concern about side effects from treatment; and 4) concern about recurrence and invasive breast cancer. Uncertainty about treatment often manifested as women questioning whether they were over-treated for their DCIS, “over-reacting by having surgery,” or wondering if “watchful waiting might be better.” In addition to recalling bothersome side effects and sequelae from both their local and systemic (hormonal) therapy, women also expressed doubt about their treatment choices, specifically, that they were not necessarily “doing enough” with many women citing recurrence, the “cancer spreading”, or becoming invasive, as primary concerns. Uncertainty about whether DCIS was cancer or not, was noted by many women, with one calling it a “grey zone” and others articulating that DCIS is “having a dx that's not really cancer… yet you might still lose your breast,” and experiencing “confusion about my status as a cancer patient - as in I wasn't sure if I even was a cancer patient. I had no idea where I fit in…” Conclusion: A DCIS dx can be confusing and distressing, with women making treatment decisions based on a limited understanding of the disease, its risks, and pros and cons of treatment options. There is a need to develop additional strategies to improve the management of this disease and other screen-detected conditions, through better understanding of the disease and its outcomes, coupled with improved methods to communicate this information to those affected. Our study highlights the potential value of collecting patient reported outcomes (PROs) to inform clinical research and care. Ongoing clinical trials like the COMET, LORIS, and LORD studies, which incorporate robust PROs, should provide additional evidence for patients, health care providers and other stakeholders regarding the medical and psychosocial benefits and harms of different DCIS management options. Citation Format: Rosenberg SM, Gierisch JM, Lowenstein C, Frank ES, Collyer D, Partridge AH, Hwang ES. “Is it cancer or not?” A qualitative exploration of patient perspectives surrounding the diagnosis and treatment of DCIS [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-15-11.

Predictors of Moral Distress in a US Sample of Critical Care Nurses.

Moral distress in registered nurses causes decreased job satisfaction, turnover in staffing, burnout, and heightened states of psychological distress. To date, investigation of modifiable factors, such as perceptions of the practice environment and patient safety, among a diverse sample of critical care nurses has been limited. To explore the relationships among the severity of moral distress, the practice environment, and patient safety in a national sample of critical care nurses. Critical care nurses experienced in working with adults (> 1 year of intensive care unit experience) and who were subscribers to the American Association of Critical-Care Nurses' e-mail listserv and social media sites anonymously participated in this descriptive study. Participants completed a demographic questionnaire, the Moral Distress Scale-Revised, and the Practice Environment Scale of the Nursing Work Index. Descriptive statistics, bivariate correlation coefficients, and a hierarchical regression analysis were used to describe the sample characteristics and to assess relationships among the study variables. Of a national sample of 328 critical care nurses, 56% had less than 20 years of experience as a registered nurse. Moral distress was modestly associated with negative perceptions of the practice environment and patient safety. Job satisfaction, practice environment, and the participant's age were statistically significant predictors of moral distress in this sample. Modifications of organizational factors such as the development of healthy work environments that promote collegial relationships could reduce moral distress among critical care nurses.

A Survey of Morcellator Preference and Cost Comparison of the Lumenis VersaCut and Wolf Piranha Morcellators

To evaluate operating room (OR) costs associated with the 2 available morcellators in the United States in a matched cohort and to determine benign prostatic hyperplasia surgeon's morcellator preference. Patients from 2013, the last year our institution exclusively used the VersaCut device, were matched 1:1 with the most recent patient cohort, utilizing the Wolf Piranha morcellator. Cost of morcellation including the expense of OR time and disposable instrument costs were calculated. A survey to the Endourological Society e-mail listserv was sent to determine morcellator preference. We identified 142 patients who underwent holmium laser enucleation of the prostate in 2013. When compared with the VersaCut group, morcellation efficiency (4.4 vs 7.0 g/min, P <.01) and expense of OR time ($1420.80 vs $992.21, P <.005) both favored the Piranha morcellator system even when the costs of disposable instruments were factored into the analysis ($1338.81 vs $1637.50, P <.05). A total of 126 urologists responded to the survey. Of these, 56 (44.5%) perform transurethral prostate enucleations, which included 48 (86%) holmium. More endourologists use the VersaCut (n = 33, 59%) than the Piranha (n = 24, 43%) morcellator. Qualities that impacted the preference of morcellator included the preferred device is safer, faster, easier to use, reusable, and less expensive. We identified a significant improved efficiency and improved cost savings utilizing the Piranha morcellator even when controlling for disposable costs. Of the endourologists who responded to the survey, less than half perform transurethral enucleation. Morcellator preference is largely based on safety, efficiency, and ease of use, whereas cost and reusablility were of lesser importance.

114 A Survey of Emergency Medicine Resident Education in Prescribing Medications for Pregnant and Breastfeeding Women in the Emergency Department

Prescribers in the emergency department (ED) face many challenges when caring for pregnant or breastfeeding women, including time constraints, a lack of evidence on medication use in this patient population, and a tendency to overestimate teratogenicity. Nevertheless, it is crucial for ED prescribers to understand medication use in this patient population, as the majority of women report some medication use during pregnancy and breastfeeding. The purpose of this study was to determine the need for further education for medical residents on use of medications in this patient population, as well as to determine the need for a reference which can provide ED prescribers with timely information on medications commonly used in pregnant or breastfeeding women in the ED. This study was an electronic survey of the 1249 emergency physicians identified through the Council of Emergency Medicine Residency Directors email listserv. The survey consisted of questions assessing the amount of education emergency medicine residents receive on treating pregnant and breastfeeding women, as well as their understanding of available references. Descriptive statistics were used to summarize demographic information. Frequencies were used for nominal variables, means and standard deviations were used for continuous variables, and confidence intervals were used to quantify the certainty concerning estimates. There were 91 respondents included in the analysis. 54.3% of responders strongly agreed that a specific drug information resource for this patient population would be beneficial for EM residents. Those who treated pregnant and breastfeeding patients in the ED more frequently were more likely to strongly agree with a specific drug information resource in this population being beneficial (p = 0.0096). Availability of drug information resources was positively correlated with both training for EM medical residents as well as need for a specific reference. The majority of responders stated “no” or “unsure” when asked whether their residency program dedicated time to teaching residents about medication safety in this population. We note that availability of information was significantly positively associated with both training and need. As a result, the higher a respondent assessed the availability of information, the more attention was paid to addressing medications use in breastfeeding and pregnant patients. Likewise, the higher the availability of information, the higher the perceived need for an emergency department specific resource. The majority of providers surveyed agreed or strongly agreed that a specific drug information resource for this patient population would be useful for their EM residents. This study suggests a need for further education for EM residents on medication safety in this population.