Met Screening Criteria Research Articles

Business Engagement Strategies for Vocational Rehabilitation Professionals: A Scoping Review

The purpose of this scoping review was to identify research-based resources that explore vocational rehabilitation-related business engagement strategies as they relate to three steps: (a) understanding business needs, (b) marketing to businesses, and (c) supporting businesses. In doing so, this review begins to identify strategies that may support vocational rehabilitation agencies and their compliance with the business engagement requirements mandated by the Workforce Innovation and Opportunity Act. The search of several databases and gray literature identified 153 resources with titles and abstracts that met screening criteria, 54 of which met the inclusion criteria after a review of the full text. Because the purpose of a scoping review is to describe the landscape of available literature on a given topic, this review did not vet studies for quality, nor did it exclude studies of interventions that did not lead to successful business engagement outcomes. Given its goal of identifying broadly relevant information available, the review included resources from non–peer-reviewed, practitioner-oriented sources.

Universal COVID-19 screening at hospitals in a large Canadian health region

Background: Hospitals were affected by COVID-19, with significant concern regarding transmission from unidentified cases. Fraser Health, a Canadian regional health authority, implemented universal testing along with screening questions for emergency department (ED) admissions. We sought to determine which factors were associated with SARS-CoV-2–positive test on admission as well as patient outcome, stratified by screening question responses. Methods: This retrospective analysis included patients aged ≥6 years admitted through 12 hospital EDs between November 1, 2020, and June 30, 2022. Admission, laboratory, and screening data were extracted from electronic health records. Patients who had a first SARS-CoV-2 PCR–positive test in the prior 60 days collected within 48 hours of admission were classified as positive. Covariates included age, geographical region, and SARS-CoV-2 variant era. All questions were modeled using multinomial logistic regression, with components informed through crude analysis in R Studio software. Results: There were 88,511 unique eligible admissions, with 7,642 positive tests (8.6%). The positivity rate over the study period ranged from 0.6% to 21.8%, with a mean of 6.5%. Patients meeting screening criteria were 4.7 times (95% CI, 4.43–4.92) as likely to test positive as those who did not. Patients in the SARS-CoV-2 omicron variant era were 3.2 times (95% CI, 2.98–3.47) as likely to test positive as those in the earlier era of the pandemic. Patients later in the pandemic were less likely to be identified by screening questions than those in earlier eras, with patients in the SARS-CoV-2 omicron variant era only 14% (95% CI, 12%–17%) as likely as in the earlier stages of the pandemic to be identified by screening questions. Patients who tested positive were 1.5 (95% CI, 1.37–1.64) times as likely to die as patients who tested negative, whereas patients in later stages of the pandemic were less likely to die overall. Discussion: Patients who tested positive on admission were more likely to meet screening criteria; however, screening missed half of all positive cases. It is not known whether patients who tested positive without meeting screening criteria would have resulted in transmission. Conclusions: Due to changes in COVID-19 epidemiology, Fraser Health has discontinued universal admission screening. Although universal testing increased resource needs, more than half of patients who tested positive during the study period would not have been identified based on screening criteria alone, allowing for implementation of precaution measures to prevent possible transmission. Ultimately, the decision to conduct universal testing must be a balance of the resources required, community prevalence, and patient population.Disclosures: None

48 Iatrogenic Vitamin A Toxicity Leading to Hypervitaminosis and Hypercalcemia: A Case Series and Cautionary Tale

Abstract Introduction Patients with major burn injuries receive micro-nutrient supplementation to promote wound healing and mitigate hypermetabolic complications. Vitamin A promotes epithelialization, angiogenesis and collagen synthesis and is included in ‘trauma vitamin’ bundles. As a fat-soluble vitamin, prolonged supplementation can lead to cumulative toxicity. Hypercalcemia can cause polyuria, ECG changes, and organ dysfunction. We report a case series of potential iatrogenic vitamin A toxicity among people with major burn injury. Methods Concern for vitamin A toxicity was raised by pharmacy and endocrinology after two patients were found with severe hypercalcemia and a consistent toxidrome. In response, we performed a chart review of adult patients with ≥20% TBSA who received vitamin A 25,000 units thrice weekly for at >2 weeks during March 2021 – July 2022. Hypercalcemia was defined as serum calcium concentration >10.4 mg/dL ( >2.60 mmol/L) or ionized serum calcium >5.2 mg/dL ( >1.30 mmol/L). Kruskal-Wallis test examined differences in median values. Results A total of 67 patients met screening criteria with 25 included in the series. Nine patients (36%) developed hypercalcemia. One patient developed hypercalcemia on day 5 of admission and was excluded. Median days to hypercalcemia was 52 (IQR 39-72). There were no differences in age, burn size, or weight between patients with and without hypercalcemia. Patients with hypercalcemia had significantly longer courses of vitamin A (56 vs 27 days, p=0.03) as well as length of stay (122 vs 63 days, p=0.01). One patient required treatment with a bisphosphonate. All improved with cessation of vitamin A supplementation. Conclusions A third of patients who received high-dose vitamin A as per a micronutrient supplementation protocol developed hypercalcemia. Our protocol was changed to limit vitamin A therapy to 21 days. Given that hypercalcemia among hospitalized patients is multifactorial, further evaluation with a larger case-control study is required to determine if high-dose vitamin A is a contributing factor. Applicability of Research to Practice Recommended daily allowance of vitamin A is ~3,000 units daily. Given that patients on enteral feedings receive approximately 3,600 units daily, vitamin A supplementation may result in toxicity if provided for >3-5 weeks.

Efficacy of Transcervical Balloon Catheter Versus Hygroscopic Dilator for Outpatient Prelabor Cervical Ripening [ID: 1382587

INTRODUCTION: Outpatient preinduction cervical ripening with mechanical agents has been associated with reduced length of stay and cesarean delivery rates. This study aimed to demonstrate equivalence in efficacy and patient satisfaction between balloon catheter and hygroscopic dilators for outpatient cervical ripening. METHODS: This randomized control equivalence trial compared the 30-cc silicone Foley catheter (off-label) to Dilapan-S. Inclusion criteria were elective induction, low risk, group B streptococcus negative, and Bishop score of less than 6. The primary outcome was time from admission to delivery. Secondary outcomes included cesarean delivery rates, pain scores, and patient satisfaction. A power calculation determined 150 patients per arm were needed. Ochsner Health IRB approved CR00003326. RESULTS: Between March 1, 2019, and May 31, 2021, 8,150 deliveries occurred, with 1,605 patients meeting screening criteria and 175 completing the study. Time from admission to delivery for balloon was 17.7 hours versus 17.9 hours for dilators. The mean time difference was −0.1524 hours (90% CI –2.4617 to 2.1569), which was statistically significantly equivalent within the specified symmetrical 3-hour equivalence margin (P=.0215). Pain scores with insertion were 3.52 with balloon versus 3.87 with dilators. Satisfaction with outpatient cervical ripening was 91.7% with balloon versus 97.4% with dilators. Cesarean delivery rate of primiparous patients was 31% with balloon versus 25.3% with dilators. CONCLUSION: Although the enrollment goal was unmet, metrics suggested outpatient cervical ripening with balloon catheter and hygroscopic dilators were equivalent in time from admission to delivery and patient-reported pain scores. Further research is needed to assess a potential trend toward improved satisfaction and cesarean delivery rate with dilators.

Abstract TP108: Early Palliative Care Consultation In Patients With Disabling Stroke

Severe disability and critical illness due to stroke can be burdensome to patients, caregivers, and resource intensive, particularly in the elderly. Management of these patients is multifaceted and includes optimizing quality of life through palliative care (PC). PC in stroke patients can improve comfort while reducing overutilization of resources unlikely to prolong life or contribute meaningful quality. We investigated the impact of early PC involvement in disabled stroke patients, which we defined as NIH Stroke Score ≥ 5 and ICU admission. A screening program was implemented in 2019 at the Loyola University Medical Center for automatic PC consults in disabling stroke (ischemic or hemorrhagic) patients over age 70 or who require a ventilator. We hypothesized that early PC consultation via this protocol reduced resource consumption without compromising patient care. This pilot study gathered data prospectively for patients with a positive screen from 2020 to 2021 (“screening”, n=71), and retrospectively for those who met screening criteria in 2017 and 2018 prior to its application (“control”, n=193). Comparing the screening and control groups, there was no significant difference in age (75.9 ± 2.7 vs 72.1 ± 1.1, p>0.1), NIH stroke score (16.6 ± 0.5 vs 17.5 ± 0.9, p=0.2), stroke type (61% vs 69% ischemic, p>0.2), or proportion who expired (22% vs 18%, p=0.4). However, the screening group had more frequent code status change from full to DNR/DNI (42% versus 19%, p<0.01) and more frequent discharges to home (20% vs 8%, p<0.01) when compared to the control. These findings suggest that our samples were similar in stroke severity and screening did not affect mortality. More frequent code status changes with PC screening implies better early identification of patient centered goals of care during admission. Increased discharges to home among these patients may reduce overall long term health care utilization with clear future directives. In conclusion, our pilot study demonstrates that early palliative care involvement in patients with disabling stroke is feasible and expedites establishing goals of care without affecting the quality of care patients receive. We plan to further investigate resource utilization including ICU length of stay and cost.

Exclusion of Patients with Autoimmune Disease in Lung Cancer Clinical Trials.

The exclusion of patients with autoimmune disease has been a topic of cancer immunotherapy trial. This study aims to find recent trends in exclusion of autoimmune disease. Using the website clinicaltrials.gov, we searched for clinical trials that were initiated in 2012 or later and enrolled patients with lung cancer who were treated with PD-1/PD-L1 therapy. Only trials including US locations were analyzed. A total of 198 trials met screening criteria in this study. There were 68 trials which had complete exclusion of any autoimmune disease in patients. In addition, 13 trials excluded active autoimmune disease and 87 trials excluded active autoimmune disease requiring treatment. The remaining 37 trials had undefined exclusion. Studies that had larger enrollment of patients with autoimmune diseases were largely in industry. The complete exclusion of patients with autoimmune diseases has decreased recently. Exclusion of patients with active autoimmune disease requiring treatment was one of the common exclusion criteria found. Strict exclusion of patients with autoimmune diseases has been decreasing over the years.

The mastery lifestyle intervention to reduce biopsychosocial risks for pregnant Latinas and African Americans and their infants: protocol for a randomized controlled trial

BackgroundPregnant Mexican Americans (hereafter called Latinas) and Black/African American women are at increased risk for psychological distress, contributing to preterm birth and low birthweight; acculturative stress combined with perceived stress elevates depressive symptoms in Latinas. Based on our prior research using a psychoneuroimmunology framework, we identified psychological and neuroendocrine risk factors as predictors of preterm birth in Latina women that are also identified as risk factors for Black/African American women.Methods/designIn this prospective, randomized controlled trial with parallel group design we will explore psychosocial, neuroendocrine, and birth outcome effects of the Mastery Lifestyle Intervention (MLI). The MLI is a culturally relevant, manualized, psychosocial, group intervention integrating two cognitive behavioral therapies for both pregnant Latinas and Black/African American women (total n = 221). Study inclusion criteria are: women with current pregnancy at 14–20 weeks gestation, ability to read and speak English or Spanish, self-identify as Latina of Mexican heritage or Black/African American, 18–45 years old, born in the US or Mexico, and currently living in the US. Participants must receive Medicaid or other government-supported insurance, and meet screening criteria for anxiety, depressive symptoms, or stress. Participants are randomly assigned to either the intervention (MLI) or usual care group (UCG) in groups of 6–8 participants that occur over 6 consecutive weeks. Data are collected at 3 time points: enrollment (14–20 weeks gestation), following treatment (20–26 weeks), and 6 weeks after treatment (32–36 weeks gestation). Additional outcome, mediating, and moderating data are collected from the electronic health record during pregnancy and at birth. Analyses will primarily use generalized linear mixed modeling (GLMM) to evaluate the relationships between predictors and outcomes.DiscussionThis RCT will test the efficacy of two combined third generation cognitive behavioral therapies (the MLI), given in a group format over 6 sessions, as compared to a usual prenatal care group, for both Latina and African American pregnant women. If efficacious, it may be provided as an adjunct to routine prenatal care and improve mental health, as well as babies being born too small and too soon.Trial registrationThe trial was retrospectively registered at ClinicalTrials.gov. Bethesda (MD): National Library of Medicine. Identifier NCT05012072, Reducing Pregnancy Risks: The Mastery Lifestyle Intervention (MLI); August 19, 2021. The trial is currently recruiting participants.

2173. Co-Occurring Dysphagia and Frailty are Common and Associated with Increased Disease Severity in Older Adults Presenting with Community-Acquired Pneumonia

Abstract Background Impaired swallowing (dysphagia) and physical (frailty) function are associated with community-acquired pneumonia (CAP), however, neither are routinely screened for in patients with CAP. We sought to: 1) examine frailty and dysphagia screening profiles in a cohort of older adults with CAP; and 2) determine if these screening profiles differ across CAP severity levels. Methods Older adults (≥65) meeting diagnostic criteria for pneumonia are included as participants. During the index encounter, dysphagia (3-ounce water swallow) and frailty (FSQ;4 ≥3 = frailty) screeners are administered. Thirty days post-enrollment, a standardized clinical severity scale is used to document CAP severity (mild (ambulatory management); moderate-severe (hospitalization)). Statistical analysis included descriptives and cross tabulations. Results We enrolled 26 participants (13 female) with a mean age of 73 (SD: 7.1). Nine (34.6%) and 17 (65.4%) patients had mild and moderate-severe CAP severity, respectively. Twenty (76.9%) and 14 (53.8%) patients met screening criteria for dysphagia and frailty, respectively. Screening profiles included: no frailty or dysphagia (15.4%), frailty and no dysphagia (11.5%), no frailty but dysphagia (30.8%), frailty and dysphagia (42.3%). No frailty but dysphagia (44.4%) was the most common mild CAP severity profile. When CAP severity worsened (moderate-severe), co-occurring frailty and dysphagia was most prevalent (47.1%). Fig. 1.Combined dysphagia and frailty screening profiles for this cohort.Dysphagia only was highly prevalent (31%), however, the majority of individuals presented with co-occurring dysphagia and frailty (42%).Fig. 2.Screening profiles across CAP severity levels.No frailty/dysphagia (44.4%) was the most common mild CAP profile. Co-occurring frailty/dysphagia was most prevalent (47.1%) in mod-severe CAP. Conclusion In this cohort, standardized screenings for dysphagia and frailty revealed both were common and frequently co-occurred, particularly in the high acuity CAP group. These data suggest older adults with pneumonia may have underlying dysphagia and/or frailty that warrant further evaluation. These potential impairments should be considered in care pathways (e.g. antibiotic therapy and rehabilitation services consultation) to mitigate negative sequelae. Disclosures All Authors: No reported disclosures.

The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection.

Hepatitis D virus (HDV) infection is highly prevalent in patients with chronic hepatitis B (CHB). AASLD guidelines recommend a risk-based screening approach. Our aim was to ascertain if the risk-based approach leads to appropriate HDV screening, identify targets to improve screening rates, and study HDV clinical burden. CHB patients screened for HDV from 01/2016 to 12/2021 were identified. Level of training and specialty of providers ordering HDV screening tests were determined. HDV seropositive (HDV+) patient charts were reviewed for the presence of individual risk factors per the AASLD guidelines to determine if they met screening criteria. The severity of liver disease at the time of HDV screening was compared between the HDV+ group and a matched (based on age, hepatitis B e antigen status, BMI and sex) HDV seronegative (HDV-) group. During the study period, 1444/11,190 CHB patients were screened for HDV. Most screening tests were ordered by gastroenterology (90.2%) specialists and attending physicians (80.5%). HDV+ rate was 88/1444 (6%), and 72 HDV+ patients had complete information for analysis. 18% of HDV+ patients would be missed by a risk-based screening approach due to unreported or negative risk factors (see Table). A significantly higher number of HDV+ patients had developed significant fibrosis (p= 0.001) and cirrhosis (p< 0.01) by the time of screening than HDV- (n= 67) patients. In conclusion, targeted interventions are needed towards trainees and primary care clinics to improve screening rates. Current risk-based criteria do not appropriately screen for HDV. It is time for universal screening of HDV in CHB patients.

Sins of omission: A meta-research study evaluating the omission of operability in published retrospective comparisons of surgery with stereotactic body radiotherapy in patients with early-stage non-small cell lung cancer

IntroductionPatients receiving stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) are typically inoperable, in concordance with guidelines that advocate surgical resection as preferred treatment for operable patients. This differential treatment allocation complicates retrospective comparisons of surgery with SBRT by introducing the potential for confounding by operability. MethodsPubMed was queried for manuscripts reporting primary data from retrospective comparisons of overall survival (OS) between patients undergoing surgery versus SBRT for early-stage NSCLC. Each manuscript was categorized for two outcomes: (1) whether treatment allocation was based on a determination of patient operability, and (2) whether a direct OS comparison between operable SBRT patients and surgically treated patients was included. Associations with variables of interest were measured with statistical significance prespecified at p < 0.10. ResultsFrom 3,072 manuscripts identified in our query, sixty-one analyses met screening criteria. Twenty-one (34 %) reported operability status influencing treatment allocation. These were more likely to be published in journals with a surgical focus (52 vs 20 %) and impact factor < 5 (81 vs 58 %), and to contain cohorts from institutional datasets (81 vs 55 %), and to have a radiation oncologist as first (43 vs 25 %) or senior (43 vs 28 %) author. Seven (11 %) manuscripts featured a direct OS comparison between SBRT and surgery. ConclusionNearly-two-thirds of peer-reviewed retrospective studies that have compared OS between surgery and SBRT for early-stage NSCLC lack information on patient operability status, and nearly 90% lack a direct comparison between operable SBRT patients and those receiving surgery.

Development and Implementation of an Evidence-Based Pregnancy Screening Protocol in an Academic Radiation Oncology Department

<h3>Purpose/Objective(s)</h3> National guidelines give broad recommendations for which patients should be screened and timing of screening. Previous survey of ASTRO member institutions indicated that approximately 30% of centers did not have a clear pregnancy screening protocol. In this department, screening was done on the basis of individual physician clinical judgement. The purpose of this project is to develop an institutional protocol that defined patient criteria and timing for pre-radiation pregnancy screening in patients and to compare rates of screening before and after policy implementation. <h3>Materials/Methods</h3> A review of both radiation oncology and OB/GYN literature was performed with attention to risks of radiation to the fetus, current pregnancy screening protocols, and women at risk for pregnancy. Our institutional protocol defined the "at risk" population as female patients age 12-50 with intact reproductive organs. Contraceptive use was not considered an exclusion from screening. Screening would not be required for boost simulations or replans. Screening had to be performed within 30 days of CT simulation. Our policy was implemented 10/1/21. All CT simulations from 1/1/18-9/30/21 were reviewed. The medical record of patients meeting screening criteria was reviewed in further detail to establish the baseline screening rate. The medical records of patients meeting screening criteria from 10/1/21-1/31/22 was reviewed to establish an adherence rate after implementation. <h3>Results</h3> From 1/1/18-9/30/21, a total of 5,107 CT simulations were performed. Of these, 414 were performed on women age 12-50. 49 had prior removal of reproductive organs. This left 365 women as the baseline population. Screening occurred per the newly developed protocol in 189 of these women (51.8%.) There was one positive test. Retesting was negative, and the patient proceeded with treatment. An additional 64 patients underwent screening deviating from our current protocol. This included testing within 3 months but greater than 1 month from the date of CT simulation as well as screening after the date of simulation but prior treatment initiation. 112 of 365 women did not have documented pregnancy screening prior to CT and treatment initiation (30.6%). After the implementation of the screening protocol on 10/1/21, a total of 403 patients underwent CT simulation through 1/31/21. Of these, 34 were women age 12-50. 7 had prior removal of reproductive organs. Of the remaining 27 patients, 25 underwent screening per protocol (92.5%). One patient was 49 years old and refused testing. The other was tested before the initiation of therapy. <h3>Conclusion</h3> Our conclusion is implementation of a pregnancy screening protocol in an academic medical center radiation oncology department improved the screening rate for women at risk for pregnancy prior to radiation treatment planning. The use of a standardized policy eliminates inter-provider variation and improves patient safety.

A Scoping Review of Psychological Assessment in Mission and Ministry Candidates

Missionary attrition together with the problem of institutional child sexual abuse in the Church has highlighted the importance of a standardized psychological assessment process for mission and ministry candidates. This scoping review aimed to examine peer-reviewed publications, from 2001 to 2021, which focused on the psychological assessment of ministry and cross-cultural mission candidates, to find knowledge gaps that exist. Using scoping review guidelines, 6,739 references were identified and 2,476 duplicates were removed. A further 4,254 references were excluded because they did not meet screening criteria. A total of nine high-quality articles remained, together with five articles that were added based on the bibliography of these references. This scoping review found the few papers published either focused on the use of personality tests or made recommendations about how these assessments should be conducted. The studies reported that candidates for ministry and mission in US samples have normative personality profiles regardless of age or ethnicity. Other papers reviewed knowledge and opinion and highlighted the need for screening for psychosexual development and to prevent attrition in mission and ministry roles. The overall dearth of publications suggested a need for more international research into how to standardize and utilize psychological assessments.

Screening for primary aldosteronism in the diabetic population: a cohort study.

Primary aldosteronism (PA) is the most common endocrine cause of hypertension. It is associated with higher cardio-metabolic risk than essential hypertension. Hypertension is common in patients with type 2 diabetes who carry increased cardiovascular risk; however, it is unknown how frequently they are tested for PA. To assess the extent to which the Endocrine Society's 2016 PA screening guidelines have been applied in a tertiary diabetes care setting and evaluate the demographic, clinical and biochemical characteristics of patients who met screening criteria compared with those who did not. This is a retrospective cohort study. Data were collected from 272 patients who attended tertiary diabetes clinics and had two or more blood pressure measurements from January to December 2018. Of 272 patients, 60 (22.1%) had indication(s) for PA screening, but only 14 (23.3%) of 60 were screened using the aldosterone-to-renin ratio (ARR). Five patients who did not meet screening criteria were screened. Only one of 19 patients screened had an abnormal ARR; however, 16 were taking medications known to affect aldosterone and/or renin production. In a tertiary diabetes outpatient setting, only a minority of patients who fulfilled the Endocrine Society criteria for PA screening were actually screened. Appropriate screening for PA in the diabetic hypertensive population is necessary for the diagnosis and targeted treatment of a highly modifiable cardiovascular risk factor. Further studies are needed to develop feasible strategies to identify patients with PA in this population.

Mental health services use among Canadian Armed Forces members and Veterans: Data from the 2018 Canadian Armed Forces members and Veterans mental health follow-up survey (CAFMVHS).

Differences in healthcare delivery systems and pathways to mental healthcare for Canadian Armed Forces (CAF) members and Veterans may contribute to variations in mental health services use (MHSU) and the factors associated with it. We: (1) estimated the prevalence of past 12-month MHSU (≥1 visit with a medical or mental health professional); and (2) identified sociodemographic, military-, trauma-, and health-related variables associated with MHSU among CAF members and Veterans. The current study used data from the 2018 CAF Members and Veterans Mental Health Follow-Up Survey (CAFVMHS). Model variables were selected a priori, and their respective associations with MHSU were estimated among (1) CAF members and (2) Veterans using separate multivariable logistic regression models. Similar proportions of CAF members and Veterans reported past 12-month MHSU (26.9 vs. 27.5%, respectively). For both CAF members and Veterans, meeting criteria for at least one past 12-month MH disorder was associated with past 12-month MHSU [adjusted odds ratio (AOR) = 7.80, 95% confidence interval (CI) = 7.18-8.46; and AOR = 11.82, 95% CI: 11.07-12.61, respectively). Past-year suicide ideation, a history of sexual trauma, and endorsement of adverse childhood experiences were also significantly associated with MHSU among CAF members and Veterans. Similar to previous research, meeting screening criteria for a past 12-month MH disorder was strongly associated with MHSU among both samples. This study extends our existing knowledge about factors associated with MHSU among CAF members and Veterans, and offers direction for future research to increase MHSU.

A mixed-methods study of problematic social media use, attention dysregulation, and social media use motives

Problematic social media use (PSMU) refers to excessive uncontrolled use of social media which impacts upon daily functioning (Blackwell et al., 2017). Self-regulation is central to the development and experience of PSMU, and conceptually interrelates with individual usage motivations (Reinecke et al., 2022). While there is a growing body of research on social media use motivations, how usage motivations and self-regulation combined influence PSMU is not well understood. There are also persistent questions around the effectiveness of addiction-based measures of PSMU. The quantitative component of this nested mixed-methods study (N = 607) employed hierarchical regression and structural equation modelling, principally identifying that impulsive social media usage mediates the pathway between perceived executive/attentional functioning and the Bergen Social Media Addiction Scale (BSMAS, Andreassen et al., 2012, 2016), a popular tool used to measure PSMU. In contrast, social-engagement motivations had a negative influence on the BSMAS. The qualitative component, comprising interview/open-ended questionnaire, explored individual experiences self-regulating social media use. Participants (N = 24) were recruited from the survey study, based on meeting screening criteria for executive dysfunction (Adult Self-Report ADHD Scale, Kessler et al., 2005), with sub-groups defined by top and bottom quartile BSMAS scores (evenly grouped). Thematic analysis found that most individuals with attention dysregulation, regardless of their BSMAS category, perceive self-regulation of social media use as highly challenging and effortful, describing broadly problematic relationship with social media. They also described rich combination of motivations and context of using social media, and strategies for managing use. This research questions the effectiveness of the BSMAS as a measure of general PSMU (lacking a formed self-regulation component), especially in individuals with attentional dysregulation. Future research investigating self-regulation strategies and focusing on characteristics of positive social media use is needed.

Complications associated with removal of airway devices under deep anesthesia in children: an analysis of the Wake Up Safe database

BackgroundPrevious studies examining removal of endotracheal tubes and supraglottic devices under deep anesthesia were underpowered to identify rare complications. This study sought to report all adverse events associated with this practice found in a large national database of pediatric anesthesia adverse events.MethodsAn extract of an adverse events database created by the Wake Up Safe database, a multi-institutional pediatric anesthesia quality improvement initiative, was performed for this study. It was screened to identify anesthetics with variables indicating removal of airway devices under deep anesthesia. Three anesthesiologists screened the data to identify events where this practice possibly contributed to the event. Event data was extracted and collated.ResultsOne hundred two events met screening criteria and 66 met inclusion criteria. Two cardiac etiology events were identified, one of which resulted in the patient’s demise. The remaining 97% of events were respiratory in nature (64 events), including airway obstruction, laryngospasm, bronchospasm and aspiration. Some respiratory events consisted of multiple distinct events in series. Nineteen respiratory events resulted in cardiac arrest (29.7%) of which 15 (78.9%) were deemed preventable by local anesthesiologists performing independent review. Respiratory events resulted in intensive care unit admission (37.5%), prolonged intubation and temporary neurologic injury but no permanent harm. Provider and patient factors were root causes in most events. Upon investigation, areas for improvement identified included improving patient selection, ensuring monitoring, availability of intravenous access, and access to emergency drugs and equipment until emergence.ConclusionsSerious adverse events have been associated with this practice, but no respiratory events were associated with long-term harm.

Peer Educators in the Facilitation of Sexuality and Respectful Relationship Education for People with an Intellectual Disability: A Scoping Review and Narrative Synthesis

A scoping review was conducted to identify how peer-education models are being used in sexuality and respectful relationship education for people with a disability. The search was conducted in August 2021 using the Joanna Briggs framework to scope and map the literature and research activity. Using strict criteria, 7 online databases, grey literature and reference lists were searched for resources written or published in the last 15 years (2006–2021). Relevant sources were shortlisted and assessed by the two authors. Six sources met the criteria for inclusion in this review. In total, four educational programs are described and discussed. The results identify four sexuality and respectful relationship programs that met screening criteria: (1) “Telling it like it is!”, (2) “Sexual Lives and Respectful Relationships”, (3) “Talking about sex and relationships: the views of young people with learning disabilities”, and (4) “Health, Safety & Sexuality Training for You & Me”. Peer-educators experienced increased confidence and feelings of empowerment, while people without an intellectual disability reported a greater understanding of the challenges and experiences of people with a disability. The use of peer educators to deliver sexuality and respectful relationship education for people with intellectual disability is a promising education model with multiple potential benefits for participants. However, more research is needed to understand the consequences and limitations of such programs.

Community Screening of Probable Dementia at Primary Care Center in Western India: A Pilot Project.

Introduction Timely detecting dementia is an important goal of clinicians and public health professionals alike for better management and prevention of complications. Community screening of dementia could be a powerful strategy. Facilities for dementia screening at primary care level are virtually nonexistent and are a prominent implementation gap. Hence, a study was done to assess the feasibility of dementia screening at primary care using General Practitioner Assessment of Cognition (GPCoG) scale among older adults with subjective memory complaints. It was further aimed to assess the frequency of cardiovascular risk factors in those who met screening criteria for cognitive impairment. Materials and Methods Older adults coming to three urban primary care centers in western India for screening of noncommunicable diseases such as diabetes and hypertension (opportunistic screening) with subjective memory complaints were enrolled and screened for dementia using GPCoG. A Mini-Mental State Examination (MMSE) was done in patients who came alone for referral purpose in case the score levels in GPCoG examination met cutoff limits for informant interview. Written medical records were examined to assess status of comorbid vascular risk factors such as diabetes, hypertension, coronary artery disease, and cerebrovascular accidents. Results A total of 350 older adults (M:F = 276: 74; mean age ± 68 ± 6.7 years) were screened out of 3,000 older adults who reported during the study period. There were 161 older adults with GPCoG score less than or equal to 5 (56.14%) and 149 subjects with MMSE less than or equal to 24 indicating significant cognitive impairment (42.5%). There were very few ( n = 11, 3.14%) out of 350 people who came with caregivers; hence, MMSE was done along with for referral to healthcare providers. A total of 142 had comorbid diabetes/and or hypertension (40.5%). A total of 86 had diabetes alone (24.5%) and a total of 128 had hypertension (36.5%). Conclusion Current study results indicate that using a simple screening tool such as GPCoG, community screening of probable dementia, is feasible in primary care settings, as is indicated by significant yield of probable dementia cases (42.5%). These cases can be referred to appropriate centers for further workup, confirmation of diagnosis, and treatment. Also, detection of comorbid cardiovascular conditions, for example, diabetes and hypertension, that can be managed along with cognitive impairment/dementia for potential prevention/further deterioration, which can strengthen noncommunicable disease screening.

Association between lung cancer screening and smoking cessation

IntroductionAdults with high-risk smoking histories benefit from annual lung cancer screening. It is unclear if there is an association between lung cancer screening and smoking cessation among U.S. adults who receive screening. MethodsWe performed this population-based cross-sectional study using data from the Behavioral Risk Factor Surveillance System (2017–2020). We defined individuals eligible for lung cancer screening as adults 55–80 years old with ≥ 30 pack-year smoking history who were currently smoking or quit within the last 15 years. We assessed the association between lung cancer screening and current smoking status. ResultsBetween 2017 and 2020, 12,382 participants met screening criteria. Current smoking was reported by 5685 (45.9 %) participants, of whom 40.4 % (2298) reported a cessation attempt in the prior year. Lung cancer screening was reported by only 2022 (16.3 %) eligible participants. Lung cancer screening was associated with lower likelihood of currently smoking (odds ratio [OR] 0.705, 95 % CI 0.626–0.793) compared to individuals who did not receive screening. Screening was also associated with higher likelihood of reporting a cessation attempt in the prior year (OR 1.562, 95 % CI 1.345–1.815) compared to individuals who did not receive screening. ConclusionsReceipt of lung cancer screening was associated with lower smoking rates and more frequent cessation attempts among U.S. adults. Better implementation of lung cancer screening programs is critical and may profoundly increase smoking cessation in this population at risk of developing lung cancer.

Applicability of the USPSTF Lung Cancer Screening Guidelines in a Predominantly Black Veteran Population.

Black individuals and veterans are at higher risk for developing lung cancer compared with that of the general population. Evidence suggests the screening criteria have been too conservative for this population. This study is a retrospective chart review examining the applicability of the 2013 United States Preventive Services Task Force lung cancer screening guidelines in a US Department of Veteran Affairs institution that served a a predominantly black population. Patients diagnosed with stage 1 or 2 lung cancer from 2005 through 2017 were included and grouped by whether or not they met United States Preventive Services Task Force screening criteria. There was a significantly higher proportion of Black patients in the study group that did not meet screening criteria (68% vs 54%, P = .04), highlighting the concern that this population was being underscreened with the 2013 guidelines. An individualized, risk-based screening model could be more effective at diagnosing early-stage lung cancer and requires more investigation.