Health Care Provider Interventions Research Articles

Adult Smoking Cessation - United States, 2022.

Tobacco dependence is a chronic condition driven by nicotine addiction. Successful quitting can be increased by health care provider intervention and evidence-based treatment. CDC assessed national estimates of cigarette smoking cessation indicators among U.S. adults using 2022 National Health Interview Survey data. In 2022, approximately two thirds (67.7%) of the 28.8 million U.S. adults who smoked wanted to quit, and approximately one half (53.3%) made a quit attempt, but only 8.8% quit smoking. One half of adults who smoked and saw a health professional during the past year received health professional advice (50.5%) or assistance (49.2%) to quit smoking. Among those who tried to quit, 38.3% used treatment (i.e., counseling or medication). Adults who usually smoked menthol (versus nonmenthol) cigarettes had higher prevalences of quitting interest (72.2% versus 65.4%; p<0.05) and past-year quit attempts (57.3% versus 50.4%; p<0.05), lower prevalences of receiving quit advice (48.2% versus 53.8%; p<0.05) and using cessation treatment (35.2% versus 41.5%; p<0.05), but similar prevalence of quit success (9.5% versus 7.9%; p = 0.19). Opportunities exist for both public health and health care sectors to increase smoking cessation, including expanding access to and utilization of cessation services and supports. Incorporating equitable cessation strategies into all commercial tobacco prevention and control efforts can help advance and support smoking cessation for all population groups.

Male involvement in family planning and its association with knowledge and spouse discussion in Ethiopia: a systematic review and meta-analysis

ObjectiveThis study aimed to estimate the pooled prevalence of male involvement in family planning (FP) and its association with knowledge and spouse discussion in Ethiopia.DesignSystematic review and meta-analysis using the...

Creating Space: A Resilience Room for Nursing Students.

Employer-based wellness interventions for health care providers are popular within acute care settings. A new intervention is a resilience room or serenity room, a specialized breakroom designed to promote relaxation. This article describes the implementation of a resilience room in an undergraduate, prelicensure nursing program.

Shared medical appointments and quality of life for children with HIV-AIDS

Background The human immunodeficiency virus (HIV) infects immune cells and weakens the immune system. There are 36.9 million HIV sufferers worldwide, with 1.8 million of them being children. Children with HIV and their parents may benefit from focus group discussions, also known as shared medical appointments (SMAs). SMAs represent an educational method capable of enhancing the quality of healthcare services. However, this method remains relatively under-researched in HIV/AIDS patients.&#x0D; Objective To assess the impact of SMA on the quality of life of children with HIV-AIDS.&#x0D; Methods This quasi-experimental study with a cross-sectional approach was carried out for 2 months. Subjects participated in SMAs, accompanied by a pediatrician as facilitator. Subjects filled three Pediatric Quality of Life (PedsQL) questionnaires (Inventory 4.0, General Well-Being Scale 3.0, and Healthcare Satisfaction 3.0), before and after attending SMAs. We compared the results.&#x0D; Results There were 12 respondents, with the majority aged 5-10 years (50%), and a higher proportion of male than female (33.3%). The majority of boys had stage 3 HIV, while most girls had stage 2 HIV. According to the PedsQL Inventory module, the average quality of life for the physical aspect was the highest (83), while the lowest was observed in the school aspect (45). In the General Well-being module, the average emotional health scores were 84 before and 93 after SMAs, which were higher than the overall health scores (68 and 77 before and after SMAs, respectively). In the Healthcare Satisfaction module, the lowest average scores were in family satisfaction (52 before and 64 after SMAs), whereas the highest were in satisfaction with healthcare provider treatment (87 and 81 before and after SMAs, respectively). There was a significant increase before and after the SMAs in emotional health (P=0.009).&#x0D; Conclusion An improvement in emotional health was observed based on the General Well-being module of the PedsQL before and after SMAs intervention. Thus, SMAs may potentially improve the quality of life for children with HIV-AIDS.

Revised one-bag IV fluid protocol for pediatric DKA: a feasible approach and retrospective comparative study.

This study compared the effectiveness of the traditional and revised one-bag protocols for pediatric diabetic ketoacidosis (DKA) management. This single-center retrospective cohort study included children diagnosed with DKA upon admission between 2012 and 2019. Our institution reevaluated and streamlined the traditional one-bag protocol (revised one-bag protocol). The revised one-bag protocol rehydrated all pediatric DKA patients with dextrose (5 g/100 ml) containing 0.45% NaCl at a rate of 3500 ml/m2 per 24 h after the first 1 h bolus of normal saline, regardless of age or degree of dehydration. This study examined acidosis recovery times and the frequency of healthcare provider interventions to maintain stable blood glucose levels. The revised one-bag protocol demonstrated a significantly shorter time to acidosis recovery than the traditional protocol (12.67 and 18.20 h, respectively; p < 0.001). The revised protocol group required fewer interventions for blood glucose control, with an average of 0.25 dextrose concentration change orders per patient, compared to 1.42 in the traditional protocol group (p < 0.001). Insulin rate adjustments were fewer in the revised protocol group, averaging 0.52 changes per patient, vs. 2.32 changes in the traditional protocol group (p < 0.001). The revised one-bag protocol for pediatric DKA is both practical and effective. This modified DKA management achieved acidosis recovery more quickly and reduced blood glucose fluctuations compared with the traditional one-bag protocol. Future studies, including randomized controlled trials, should assess the safety and effectiveness of the revised protocol in a broad range of pediatric patients with DKA.

Single vs. multiple fraction non-inferiority trial of stereotactic ablative radiotherapy for the comprehensive treatment of oligo-metastases/progression: SIMPLIFY-SABR-COMET

BackgroundRadiotherapy delivery regimens can vary between a single fraction (SF) and multiple fractions (MF) given daily for up to several weeks depending on the location of the cancer or metastases. With limited evidence comparing fractionation regimens for oligometastases, there is support to explore toxicity levels to nearby organs at risk as a primary outcome while using SF and MF stereotactic ablative radiotherapy (SABR) as well as explore differences in patient-reported quality of life and experience.MethodsThis study will randomize 598 patients in a 1:1 ratio between the standard arm (MF SABR) and the experimental arm (SF SABR). This trial is designed as two randomized controlled trials within one patient population for resource efficiency. The primary objective of the first randomization is to determine if SF SABR is non-inferior to MF SABR, with respect to healthcare provider (HCP)-reported grade 3-5 adverse events (AEs) that are related to SABR. Primary endpoint is toxicity while secondary endpoints include lesional control rate (LCR), and progression-free survival (PFS). The second randomization (BC Cancer sites only) will allocate participants to either complete quality of life (QoL) questionnaires only; or QoL questionnaires and a symptom-specific survey with symptom-guided HCP intervention. The primary objective of the second randomization is to determine if radiation-related symptom questionnaire-guided HCP intervention results in improved reported QoL as measured by the EuroQoL-5-dimensions-5levels (EQ-5D-5L) instrument. The primary endpoint is patient-reported QoL and secondary endpoints include: persistence/resolution of symptom reporting, QoL, intervention cost effectiveness, resource utilization, and overall survival.DiscussionThis study will compare SF and MF SABR in the treatment of oligometastases and oligoprogression to determine if there is non-inferior toxicity for SF SABR in selected participants with 1-5 oligometastatic lesions. This study will also compare patient-reported QoL between participants who receive radiation-related symptom-guided HCP intervention and those who complete questionnaires alone.Trial registrationClinicaltrials.gov identifier: NCT05784428. Date of Registration: 23 March 2023.

Evaluation of a Guided Nature and Forest Therapy Walk for Internal Medical Residents - A Brief Report.

Medical residents commonly face compassion fatigue, burnout, anxiety, and depression. Studies of nature-based interventions show improved mental and physical health; few focus on healthcare providers. To explore potential benefits of forest bathing for medical residents' wellbeing. Using the Association of Nature and Forest Therapy's framework, we piloted a forest bathing intervention among medical residents with pre/post-participation surveys assessing perceptions of mindfulness and psychological wellbeing. Responses were analyzed using a Fisher's exact test and Student's t-test for independent samples. Fourteen of fifteen participants completed both surveys. We observed significantly improved mindfulness scores and expressions of feeling calm, vital, or creative, as well as a decreased sense of anxiety and depression. Nonsignificant trends towards decreased burnout and irritability were seen. This quality improvement pilot demonstrates trends that forest bathing can improve medical residents' psychological wellbeing and mindfulness. Further exploration of this intervention for healthcare providers is warranted.

Implementation strategies for hospital-based probiotic administration in a stepped-wedge cluster randomized trial design for preventing hospital-acquired Clostridioides difficile infection

BackgroundClostridioides difficile infection (CDI) is associated with considerable morbidity and mortality in hospitalized patients, especially among older adults. Probiotics have been evaluated to prevent hospital-acquired (HA) CDI in patients who are receiving systemic antibiotics, but the implementation of timely probiotic administration remains a challenge. We evaluated methods for effective probiotic implementation across a large health region as part of a study to assess the real-world effectiveness of a probiotic to prevent HA-CDI (Prevent CDI-55 +).MethodsWe used a stepped-wedge cluster-randomized controlled trial across four acute-care adult hospitals (n = 2,490 beds) to implement the use of the probiotic Bio-K + ® (Lactobacillus acidophilus CL1285®, L. casei LBC80R® and L. rhamnosus CLR2®; Laval, Quebec, Canada) in patients 55 years and older receiving systemic antimicrobials. The multifaceted probiotic implementation strategy included electronic clinical decision support, local site champions, and both health care provider and patient educational interventions. Focus groups were conducted during study implementation to identify ongoing barriers and facilitators to probiotic implementation, guiding needed adaptations of the implementation strategy. Focus groups were thematically analyzed using the Theoretical Domains Framework and the Consolidated Framework of Implementation Research.ResultsA total of 340 education sessions with over 1,800 key partners and participants occurred before and during implementation in each of the four hospitals. Site champions were identified for each included hospital, and both electronic clinical decision support and printed educational resources were available to health care providers and patients. A total of 15 individuals participated in 2 focus group and 7 interviews. Key barriers identified from the focus groups resulted in adaptation of the electronic clinical decision support and the addition of nursing education related to probiotic administration. As a result of modifying implementation strategies for identified behaviour change barriers, probiotic adherence rates were from 66.7 to 75.8% at 72 h of starting antibiotic therapy across the four participating acute care hospitals.ConclusionsUse of a barrier-targeted multifaceted approach, including electronic clinical decision support, education, focus groups to guide the adaptation of the implementation plan, and local site champions, resulted in a high probiotic adherence rate in the Prevent CDI-55 + study.

Prenatal ultrasound screening and pregnancy outcomes in HIV-positive women in Germany: results from a retrospective single-center study at the Charité-Universitätsmedizin Berlin.

The aim of this study was to investigate the rate of Mother-to-child-transmission (MTCT) in women living with HIV (WLWH) in a tertiary care institution. Furthermore, we aimed to assess prenatal ultrasound screening for fetal anomalies and outcomes in high-risk pregnancies due to maternal HIV infection." In this single-center study, retrospective data related to pregnancy and childbirth were collected from 420 WLWH. All data were evaluated descriptively. From January 2014 to December 2020, a total number of 420 pregnant WLWH delivered 428 newborns. 415 (98.8%) were receiving antiretroviral therapy (ART) and 88.8% had a viral load of < 50 cop/ml prior delivery. 46 (11%) of the newborns were born prematurely. Low birth weight < 2500g occurred in 38 (9.1%) of the children. 219 (52.1%) caesarean sections (CS) were performed. The most frequent indication for an elective CS was a previous CS (70.2%). 8 severe malformations were detected using first and second trimester ultrasound. In one child, MTCT was detected postpartum, resulting in an HIV transmission rate of 0.2% in the presented cohort. The low rate of vertical HIV-transmission in our cohort of 0.2% is the result of interdisciplinary prenatal care and high experience of healthcare providers in treatment of WLWH. Despite high ART coverage and adherence, good maternal immune system and very low vertical HIV transmission rate, maternal HIV infection remains a challenge in obstetric care. First and second ultrasound screening should be a part of prenatal care for HIV-infected women and should also be offered to HIV-negative women. A reduction of the rate of unnecessary elective caesarean deliveries in WLWH is necessary to reduce complications in subsequent pregnancies.

Frequency of digital vaginal examination and associated factors among mothers admitted to labor and delivery wards in public health facilities of Arba Minch town, southern Ethiopia.

To assess the frequency of digital examination and its associated factors among laboring mothers in public health facilities in Arba Minch town, southern Ethiopia. Digital vaginal examination (DVE) is the commonly applied clinical assessment method used to discover the progress of labor and delivery. However, frequent DVE may not be free of risk for maternal and neonatal health, and pain during intrapartum care. An institution-based descriptive cross-sectional study was employed from May 3 to July 6, 2022. Study participants were selected by a serial sampling method. Data were entered into epi data version 7.2 and exported to SPSS v.25 for data analysis. Binary and multivariate logistic regression analyses were employed to assess associations between study variables. Statistical significance was declared at a P value less than 0.05. A total of 374 women responded to the interview, making a response rate of 98.4%. In all, 230 (61.5%) of the laboring mothers underwent five or more DVE. Being a primipara, being in latent phase at admission, having augmentation of labor, prolonged labor, being admitted with intact membranes, and vacuum delivery showed significant associations with frequent DVE. Frequency of DVE among laboring mothers is relatively high in the study area. The frequent DVE were mainly caused by healthcare provider's interventions to shorten the time of labor. Emphasis on training and monitoring the practice of healthcare givers would be helpful to mitigate this problem.

Improving adherence to PAP therapy: A brief PAP coaching intervention for health care providers

ObjectivesTo evaluate a training program for non-specialist health care providers in a brief coaching intervention to improve positive airway pressure (PAP) usage in Veterans with sleep apnea. MethodsWe conducted a national webinar training designed for non-specialist providers to implement a brief telephone coaching intervention to improve PAP adherence. The curriculum was crafted by experts in sleep medicine and behavioral sleep medicine based on principles of PAP desensitization. Providers who participated in this training were asked to complete evaluations at 30 days and 1 year. ResultsProvider surveys indicated that most respondents had incorporated the intervention into their clinical practice and felt comfortable counseling patients about sleep apnea and adherence to PAP. Provider feedback suggested that future training programs should include refresher trainings, more training on PAP equipment specifics, and facilitated collaboration with local sleep medicine staff. ConclusionsThis pilot training program demonstrated that a webinar format was a feasible method to increase training in PAP adherence among non-specialist health care providers. InnovationNon-specialists can be trained as PAP coaches in webinar format, improving patients' access to effective strategies and support to be successful with PAP therapy.

P15 Women’s satisfaction with the management of urinary tract infections during the COVID-19 pandemic: a qualitative analysis of free-text comments from a national survey in England

Abstract Background Urinary tract infections (UTIs) are one of the most common bacterial infections affecting women. The COVID-19 pandemic altered how healthcare was accessed and delivered with rapid adoption of remote technologies. This study explored women’s satisfaction with the care they received for UTI in general practice during the pandemic. Methods We analysed 799 responses to an open-ended question regarding women’s satisfaction with the management of their most recent UTIs. A thematic analysis was inductively conducted and supported by NVivo V.12. Results Most women (72.7%) were satisfied with their UTI management. Main study themes related to consultation, management, patient’s feelings, and safety during the pandemic. Themes on positive aspects of care were related to thorough assessment and treatment by a doctor and having a positive experience with the healthcare provider (HCP). Themes on the negative aspects of care were related to long waiting times, use of virtual consultations, and patients feeling uninformed and invalidated about their UTIs. Conclusions Patient satisfaction was closely linked to a positive face-to-face HCP interaction, prompt assessment and treatment, and discussion about prevention and self-care. To improve satisfaction, systems and consultations should account for patient choice in the HCP they consult with, allow for additional information about when and why a urine test should be provided, and ensure there is a platform for discussing patient preferences for antibiotic prescription or alternative therapy. Using resources to discuss these topics with patients may help address these issues, including risks and benefits of antibiotics, alternative treatments, prevention and self-care.

Identifying the Needs of Health Care Providers in Advanced First-Line Renal Cell Carcinoma: A Mixed-Methods Research.

Systemic treatments for metastatic or unresectable renal cell carcinoma (mRCC) are rapidly evolving. This study aimed at investigating challenges in the care of mRCC to inform future educational interventions for health care providers (HCPs). The sequential mixed-method design consisted of a qualitative phase (semistructured interviews) followed by a quantitative phase (online surveys). Participants included US-based medical oncologists, nephrologists, physician assistants, nurse practitioners, and registered nurses. Interview transcripts were thematically analyzed. Survey data was descriptively and inferentially analyzed. Forty interviews and 265 surveys were completed. Analysis revealed four challenges in the care of mRCC patients. A challenge in staying current with emerging evidence and treatment recommendations was found with 33% of surveyed HCPs reporting suboptimal skills interpreting published evidence on the efficacy and safety of emerging agents. A challenge weighing patient health and preferences in treatment decisions was found, especially among HCPs with 3 to 10 years of practice (37%) who reported suboptimal skills in assessing patients' tolerance to side effects. Promoting a collaborative care approach to the management of immune-related adverse events was a challenge, specifically related to barriers involving nephrologists (eg, diverging treatment goals). Breakdowns in communication were reported (46% of HCPs), especially in the monitoring of side effects and treatment adherence. This study revealed key challenges faced by HCPs when treating and managing patients with mRCC across multiple providers. Future interventions (eg, community of practice) should aim to address the identified gaps and promote a team-based approach to care that strengthens the complementary competencies of HCPs involved.

Worksite exercise intervention for hospital health care providers: Outcomes and resource utilization of a pilot study

ObjectivesWorkplace exercise has been demonstrated to improve health outcomes and productivity. Hospital staffs may have a large potential to benefit from workplace exercise; however, implementation of workplace exercise faces the challenges of the workflow in hospitals. This study aimed to explore the economic and productivity consequences of a 12-week exercise intervention for hospital health care providers in a Danish hospital department. MethodsThe outcome measures included the costs of providing the intervention, sick leave, self-reported quality of life (EQ-5D-5 L), work engagement (Utrecht Work Engagement Scale), and employees’ workplace social capital. Ordinary Least Squares and Generalized Linear Models were employed to assess whether the extent of participation in the intervention was associated with the outcome measures. ResultsA total of 80 participants completed an average of 9 sessions during the 12-week study period, at an estimated mean cost of €77 per person. Increasing number of exercise sessions was associated with improvements on the pain domain of the EQ-5D-5 L (mean (SD) -0.2570 (0.723), p = 0.0049), and with improved work engagement (by 4.6%) over the intervention period. We found no significant associations between exercise session participation and the other outcome measures. ConclusionsThe pilot study demonstrates relatively high acceptance of a worksite exercise program at a hospital, at a relatively low cost, with several important directions in outcomes. Further work should explore whether these results can be replicated in a larger, randomized trial.

Change in depression during the COVID-19 pandemic among healthcare providers in Addis Ababa, Ethiopia.

The COVID-19 pandemic has increased mental health problems among healthcare workers globally. However, studies from low- and middle-income countries on this matter were minimal. This study assessed the change in depression prevalence during the first year of the COVID-19 pandemic and associated factors among healthcare providers in Addis Ababa, Ethiopia. We conducted surveys among healthcare workers in Addis Ababa at two-time points, September 2020 and October 2021. A total of 577 study participants were randomly selected based on registers obtained from professional associations. Computer-assisted telephone interviewing technique was used for data collection. The Patient Health Questionnaire (PHQ-9) was used to screen for depression. Multivariable logistic regression analysis was performed to identify potential factors associated with depression. The prevalence of depression among healthcare workers was 2.3% (95% CI [1.1-4.8]) in Time 1 and 6.5% (95% CI [4.1-10.1]) in Time 2; nearly a three-fold increase in Time 2 compared to Time 1. The most frequently reported symptoms at both times based on the PHQ-9 item were having poor energy, sleep problem, and anhedonia, while reported suicidal ideation was less than 5%. Depression showed a positive and significant association with a positive COVID-19 test result (AOR 7.25 95% CI [1.32-39.4]) in Time 1, and with being a female healthcare provider (AOR 3.96 95% CI [1.08-14.51]) and lack of COVID-19 related policy or guidelines at the workplace (AOR 3.22 95% CI [1.11-9.35]) in Time 2. The prevalence of depression among healthcare workers tripled during the first year of the COVID-19 pandemic. Panic reaction to positive COVID-19 test result seems to have a negative effect at the beginning while lack of disease-specific prevention guidelines and comprehensive psychological interventions for healthcare providers had an adverse effect on the mental health of health workers.

Effectiveness of Training Program on Improving Health Care Providers' Readiness for Managing Domestic Violence in Jimma Medical Center: Pre-Experimental Study.

Domestic violence (DV) is a pervasive human-right violation and is an impediment to the achievement of Sustainable Development Goals by 2030. Although they may not often disclose their violence, survivors of DV are most likely to be treated by health care providers. Thus, this study aimed to assess the effectiveness of training intervention in improving the readiness of health care providers for managing domestic violence in Jimma Medical Center. Pre-experimental study design was undertaken among 64 health care providers of Jimma Medical Center on two rounds from March 16 to 19 and from May 18 to 21/2022. Data were collected by using a structured self-administered questionnaire and entered into Epi-data version 4.6 and exported to SPSS version 23 for analysis. To test the difference in the participants' readiness to manage DV in terms of knowledge and attitude; a Paired-samples t-test analysis was done at 95%-confidence-interval and p-value <0.05. To quantify the magnitude of the intervention's effect, Eta-squared was computed as an effect size statistic. The overall knowledge score was improved from pre-intervention (M= 12.44, SD=4.55) to post-intervention (M=15.66, SD= 5.48, t(4.29), p<0.0005). The overall attitude score was improved from pre-intervention (M= 156.4, SD= 15.68) to post-intervention (M=169.1, SD=20.67, t(3.8), p<0.0005). The Eta-squared value for the knowledge was 0.23 and for the attitude was 0.19 both indicating a large effect size. Significant improvement in the study participants' readiness for managing DV was a result in this study with a large effect size. Thus, different concerned stakeholders should provide training intervention for health care providers of Jimma Medical center to improve their readiness to manage survivors of domestic violence thereby contributing to the reduction of the negative consequences that can be resulted from poor management of domestic violence.

Prevalence of Implicit Bias in Practicing Physical Therapists

Background: Implicit biases (IB) are unconscious or automatic attitudes and stereotypes that all people hold towards individuals or groups based on social group membership, categories, or traits. While implicit biases are unconscious or automatic, one is by definition more aware and conscious of their explicit biases. In the healthcare setting, implicit biases can and do impact perceptions, interactions, and clinical decision-making involving patients. Most research regarding the prevalence of implicit bias in healthcare, to date, focuses on physicians and nurses, but no evidence exists regarding implicit bias prevalence in physical therapists (PTs). Our objectives were to determine the difference, if any, between levels of race- and disability-related implicit biases using Implicit Association Test (IAT) score comparisons between PTs practicing in orthopedic and pediatric settings. Methods: A total of 59 licensed orthopedic and pediatric PTs completed the IAT race and disability subtests, self-reported levels of explicit racial and disability biases, and demographic characteristics. Results: On average, participants reported slight levels of IB favoring White over Black people despite reports of neutral explicit bias (EB). Similarly, participants reported moderate levels of IB favoring individuals without disabilities over those with disabilities despite reports of only neutral to slight EB on average. PTs practicing in pediatric settings reported significantly higher levels of race-related IB than those practicing in orthopedic settings (Wilcoxon S=623.5, p=0.014), but there was no significant difference between the levels of disability-related IB based on practices setting (Wilcoxon S= 850, p=0.245). Conclusions: This sample of PTs demonstrated rates of IB on the basis of race or disability status similar to other healthcare providers and the general population. Furthermore, participants generally rated their EBs towards racial minorities and individuals with disabilities more favorably than IAT test results indicated. The disconnect between IBs and EBs was confirmed in our study and highlights the continued need for IB awareness and subsequent bias reduction interventions for healthcare providers given the negative consequences.

‘It turned my life upside down’: Parents' emotional experience of the transition with their preterm infant from birth to discharge Home—A qualitative study

BackgroundA smooth transition from the neonatal intensive care unit (NICU) to home is critical for establishing parents' competence as primary caregivers and ensuring infant health. In the clinical context with a restrictive visiting policy, family-centred care is challenging to implement, prohibiting a smooth transition of care for the families. According to Meleis’ Transition Theory, parents might experience emotional change initiated by critical events during this transition. ObjectivesThe aim of this study was to understand parents' emotional experience of their preterm infant's birth to discharge home from the NICU to facilitate the care transition better. MethodsThis qualitative descriptive study using semistructured interviews was conducted between June and August 2020. Purposive sampling was used to recruit 17 parents (6 fathers and 11 mothers) from the NICU of a tertiary hospital in eastern China. Data were analysed using content analysis. ResultsThe following three situational themes characterised by three-phase emotions related to 16 critical events were obtained from the data and were used to describe parents’ experiences during the transition: Theme 1, Life falling apart; Theme 2, Feeling anxious and struggling with uncertainty; and Theme 3, Feeling both hopeful and inadequate at discharge. ConclusionsParents of preterm infants have distinctive emotional experiences in each phase during their infants' transition from the NICU to home. Awareness of parents’ critical events and emotional experiences in each phase could help NICU staff anticipate and provide timely and targeted support for parents. The next step is to develop a family-centred intervention for healthcare providers to better prepare parents for the transition from the NICU to home.

The perceived impact of project ECHO networks in Northern Ireland for health and social care providers, patients, and the health system: A qualitative analysis.

This study assesses the perceived impact and benefits of Project ECHO (Extension for Community Healthcare Outcomes), a tele-mentoring intervention for health and social care providers, patients and the health system in Northern Ireland. Having access to a specialist, a space to share experiences, and being able to disseminate up-to-date best practice were all cited as improving provider knowledge as well as improving quality of care for patients. Healthcare providers reported being more confident in managing patients and that relationships had been improved between different levels of the health system. ECHO was described as improving access to education and training by removing geographic and time barriers. This is one of the first studies to qualitatively analyse impact across a number of different clinical and social care ECHO networks. The results strongly indicate the perceived benefit of ECHO in improving provider, patient and health system outcomes such as increased healthcare provider knowledge and confidence to manage patients at primary levels of the health system. This has implications for future service design, particularly within the context of COVID-19 in which virtual and online training is necessitated by social distancing requirements.

Development and validation of a nomogram to predict postoperative delirium in type B aortic dissection patients underwent thoracic endovascular aortic repair.

Postoperative delirium (POD) is a common postoperative complication after cardiovascular surgery with adverse outcomes. No prediction tools are currently available for assessing POD in the type B aortic dissection (TBAD) population. The purposes of this study were to develop and validate a nomogram for predicting POD among TBAD patients who underwent thoracic endovascular aortic repair (TEVAR). The retrospective cohort included 631 eligible TBAD patients who underwent TEVAR from January 2019 to July 2021. 434 patients included before 2021 were in the develop set; 197 others were in the independent validation set. Least absolute shrinkage and selection operator (LASSO) and logistic regression were applied to identify the most useful predictive variables for constructing the nomogram. Discrimination and the agreement of the model was assessed with the area under the receiver operating characteristic curve (AUC), Brier score and the Hosmer-Lemeshow goodness-of-fit test. The results were validated using a bootstrap resampling and the validation set. The incidence rate of POD observed in the development and validation cohort were 15.0% and 14.2%, respectively. Seven independent risk factors, including age ≥60 years, syncope or coma, postoperative blood transfusion, atelectasis, estimated glomerular filtration rate (eGFR) <80 ml/min/1.73 m2, albumin <30 g/L, and neutrophil to lymphocyte ratio, were included in the nomogram. The model showed a good discrimination with an AUC of 0.819 (95% CI, 0.762-0.876) in the developed set, and adjusted to 0.797 (95% CI, 0.735-0.849) and 0.791 (95% CI, 0.700-0.881) in the internal validation set and the external validation, respectively. Favorable calibration of the nomogram was confirmed in both the development and validation cohorts. The nomogram based on seven readily available predictors has sufficient validity to identify POD risk in this population. This tool may facilitate targeted initiation of POD preventive intervention for healthcare providers.