On-site Program Research Articles

The Impact of Cardiac Rehabilitation on Quality of Life in Elderly Heart Failure Patients-Literature Review

The research investigates how cardiac rehabilitation impacts life quality in elderly heart failure patients. Older patients often encounter distinctive issues, such as other health conditions and age-linked frailty, affecting their ability to join and gain from rehab programs. This study examines customized rehab plans to meet these needs, which entail using both traditional and new methods like telerehabilitation and activities such as Tai Chi and yoga. Results show that specific rehab programs notably improve functional ability and cut hospital stays for elderly heart failure patients. Also, home-based rehab plans, like the REACH-HF program, appear cost-effective, boosting life quality and reducing health problems. Telerehabilitation has shown to expand access to rehab services, especially aiding elderly patients who struggle to attend on-site programs. This study also asseses the improvement in quality of life, namely the physical and psychological health, such as the augmentation/improvement of patients’ exercise tolerance, participation in social activities or even the increased desire of taking care of themselves. The research highlights the significance of including risk understanding, precise nursing activities, and diverse physical exercises to enhance involvement and commitment, improving results and patient happiness. These findings support the ongoing creation and execution of patient-focused cardiac rehab strategies to better the overall health and well-being of elderly heart failure patients.

Science Education for the Youth (SEFTY): A Neuroscience Outreach Program for High School Students in Southern Nevada during the COVID-19 Pandemic.

Laboratory outreach programs for K-12 students in the United States from 2020 to 2022 were suspended or delayed due to COVID-19 restrictions. While Southern Nevada also observed similar closures for onsite programs, we and others hypothesized that in-person laboratory activities could be prioritized after increasing vaccine doses were available to the public and masking was encouraged. Here, we describe how the Laboratory of Neurogenetics and Precision Medicine at the University of Nevada Las Vegas (UNLV) collaborated with administrators from a local school district to conduct training activities for high school students during the COVID-19 pandemic. The Science Education for the Youth (SEFTY) program's curriculum was constructed to incorporate experiential learning, fostering collaboration and peer-to-peer knowledge exchange. Leveraging neuroscience tools from our UNLV laboratory, we engaged with 117 high school applicants from 2021 to 2022. Our recruitment efforts yielded a diverse cohort, with >41% Pacific Islander and Asian students, >9% African American students, and >12% multiracial students. We assessed the impact of the SEFTY program through pre- and postassessment student evaluations, revealing a significant improvement of 20.3% in science proficiency (p < 0.001) after participating in the program. Collectively, our laboratory curriculum offers valuable insights into the capacity of an outreach program to actively foster diversity and cultivate opportunities for academic excellence, even in the challenging context of a global pandemic.

From an On-site Program to a Mobile App for Prehabilitation and Rehabilitation for Robotic Radical Prostatectomy: Lessons Learned from 5 Years of Experience, the COVID-19 Outbreak, and Comparison with Nationwide Data

Prehabilitation programs play a key role in optimizing patient experiences and outcomes after surgery. However, there are few data on robot-assisted radical prostatectomy, and prehabilitation programs may be challenging to launch and maintain over time for every patient. Here we report our 5-yr experience of an on-site prehabilitation program and its impact on patient and hospital outcomes. During the study period, we observed continuous improvements in the same-day discharge rate (from 0% to 26.4%), hospital stay (from 3 to 0.9. d), costs (-63%), days out of hospital within 30 d after surgery in our center, and in comparison to contemporary nationwide data. However, despite these advantages, maintenance and diffusion of this program could be challenging owing to the absence of incentive support and lack of human resources. This led us to develop two free-access mobile apps, available on the app stores for both patients and surgeons, that include checklists, remote monitoring, and multiple educational materials aimed at simplifying the widespread use of optimized perioperative pathways. Patient summaryWe found that a prehabilitation program before surgery can help in optimizing patient outcomes after robot-assisted removal of the prostate. We translated this program into a mobile app available for every patient.

The experiences of doctorally prepared nurses and doctoral nursing students with being mentored in the Nurse-Lead programme: A focus group study

Aimto explore experiences of being mentored and the contribution of the mentoring to leadership and professional development of doctorally prepared nurses and doctoral nursing students participating in the Nurse-Lead programme. BackgroundMentoring is considered important for career development of academic nurses. Doctorally prepared nurses need a wide range of professional competences to develop sustainable careers. Therefore, they may benefit from a larger network of mentors, outside their own organization, to support their professional development. Therefore, a web-based leadership and mentoring programme was developed - the Nurse Lead programme. DesignA descriptive study with semi-structured focus groups. MethodThree focus groups were conducted during an on-site programme meeting in 2019 with twenty-one doctorally prepared nurses and doctoral nursing students. The interview guide included questions about mentoring relationships and meaning of mentoring for leadership and professional development. The interviews were thematically analysed. ResultsFive themes were identified: “Preferred characteristics of mentors”, “Developing trusting relationships”, “Engagement of the mentors”, “Becoming a proficient researcher and team leader” and “Becoming an empowered and confident professional”. ConclusionMentoring supported the leadership and professional development of doctorally prepared nurses and doctoral nursing students. Participants were engaged in rewarding mentoring trajectories. The results indicate that a similar approach could be followed when developing mentoring programmes in the future.

Implementing a virtual mind-body prehabilitation program for patients undergoing thoracic surgery: A quality improvement project

BackgroundPrehabilitation before thoracic surgery has been found to improve outcomes in patients with cancer; however, COVID-19 presented challenges to access on-site programs. We describe the development, implementation, and evaluation of a synchronous, virtual mind-body prehabilitation program developed in response to COVID-19. MethodsEligible participants were patients seen at a thoracic oncology surgical department of an academic cancer center, aged 18 years or older with a diagnosis of thoracic cancer and referred at least 1 week before surgery. The program offered 2 45-minute preoperative mind-body fitness classes each week delivered via Zoom (Zoom Video Communications, Inc). We collected data for referrals, enrollment, participation, and evaluated patient-reported satisfaction and experience. We conducted brief semistructured interviews about participants’ experience. ResultsAmong 278 patients referred, 260 were approached, and of those 197 (76%) patients agreed to participate. Among participants, 140 (71%) attended at least 1 class, with an average of 11 attendees per class. The majority of participants reported being extremely satisfied (97.8%), extremely likely to recommend the classes to others (91.2%), and indicated that classes were very much helpful in preparing for surgery (90.8%). Patients also reported that the classes helped reduce anxiety/stress (94.2%), fatigue (88.5%), pain (80.7%), and shortness of breath (86.5%). Qualitative data further suggest that the program made participants feel stronger, more connected to their peers, and better prepared for surgery. ConclusionsThis virtual mind-body prehabilitation program was well received with high satisfaction and benefits and is highly feasible to implement. This approach may help overcome some of the challenges to in-person participation.

Results of a virtual multi-institutional program for quality improvement training and project facilitation.

The purpose of this project was to describe the results of this multi-institutional quality improvement (QI) program conducted in a virtual format. Developed at Stanford in 2016, the Realizing Improvement through Team Empowerment (RITE) program utilizes a team-based, project-based improvement approach to QI. The program was planned to be replicated at two other institutions through respective onsite programs, but was converted to a multi-institutional virtual format in 2020 in response to the COVID-19 pandemic. The virtual program began in July 2020 and ended in December 2020. The two institutions participated jointly in the cohort, with ten 2-hour training sessions every two weeks for a total of 18 weeks. Project progress was monitored using a predetermined project progress scale by the program manager, who provided more direct project support as needed. The cohort consisted of six teams (37 participants) from two institutions. Each team completed a QI project in subjects including MRI, US, CT, DR and ACR certification. All projects reached levels of between 3.0 (initial test cycles begun with evidence of modest improvement) and 4.0 (performance data meeting goal and statistical process control criteria for improvement), and met graduation criteria for program completion. We found the structured problem-solving method, along with timely focused QI education materials via a virtual platform, to be effective in simultaneously facilitating improvement projects from multiple institutions. The combination of two institutions fostered encouragement and shared learning across institutions.

Group Telegaming Through Immersive Virtual Reality to Improve Mental Health Among Adolescents With Physical Disabilities: Pre- and Posttrial Protocol.

BackgroundAdolescents with physical disabilities have higher rates of mental health conditions and issues than adolescents without disabilities, and this disparity was exacerbated by the onset of the COVID-19 pandemic. They also have limited access to on-site programs and nearby peers.ObjectiveThis pilot aims to investigate the potential effects of a low-dose multiplayer virtual reality telegaming program on depression, socialization, and loneliness among a cohort of children with physical disabilities. A secondary aim is to describe feasibility metrics, namely, recruitment and adherence rates and perceived program enjoyment and satisfaction. The tertiary aim is to describe behavioral mechanisms that affect participant adherence and social participation in the classes.MethodsThis study is a single-group pre- and posttest–designed trial. A single cohort of 12 children with physical disabilities will pilot a 1-month program that includes 2 supervised 1-hour sessions per week of group-based exergaming. Participants will complete questionnaires before and after the program. The primary aim measures will include the Children’s Depression Inventory 2 Short Form, a measure of feelings of depression, and the UCLA Loneliness Scale, a measure of both loneliness and social isolation. Secondary aim measures will include three posttest Likert scale questionnaires: perceived program enjoyment, program satisfaction, and satisfaction with multiplayer experiences. At postintervention or dropout, participants will undergo semistructured interviews to identify behavioral mechanisms that underlie participation. Data will be reported descriptively and be supported by t tests as appropriate.ResultsRecruitment procedures started in July 2022. All data are expected to be collected by January 2023. Full trial results are expected to be published by March 2023. Secondary analyses of data will be subsequently published.ConclusionsThis trial tests a peer-to-peer virtual reality telegaming program that includes a completely remote enrollment, assessment, and intervention protocol. This program is accessible and short in duration and frequency, allowing it to be integrated into other interventions. Knowledge obtained from this study will inform the development of a larger trial for improving the mental health and well-being of adolescents with physical disabilities.Trial RegistrationClinicalTrials.gov NCT05259462; https://clinicaltrials.gov/ct2/show/NCT05259462International Registered Report Identifier (IRRID)PRR1-10.2196/42651

Availability of child care resources for patients undergoing cancer treatment at NCI-designated cancer centers.

e13508 Background: The National Cancer Institute (NCI) estimates that approximately one-quarter of adults with cancer are parents to children less than 18 years. Further, it is estimated that 2.85 million minor children in the United States have a parent undergoing cancer treatment. Previous studies have demonstrated that parents with cancer experience significant stress and disruptions to familial life following a cancer diagnosis. In a study of women with breast, gynecologic cancer and other cancers undergoing cancer therapy, 48.7% of women endorsed needing help with childcare and 64.1% needing help with household management. Despite this evidence supporting both a need for childcare among patients with cancer, data regarding the availability of on-site childcare programs and resources at NCI-designated cancer centers is limited. The objective of this cross-sectional study was to assess the availability of childcare resources for parents who are undergoing cancer treatment at NCI-Designated Cancer Centers. Methods: The availability of childcare resources for parents undergoing cancer treatment at all 51 NCI-designated comprehensive cancer centers and 13 NCI-designated cancer was assessed in January 2021 and February 2021. Childcare resources were assessed via online search and telephone calls. Specifically, centers were queried regarding availability of daycare programs for children of patients undergoing treatment and whether resources were available to assist patients in need of childcare. Descriptive statistics were performed. Results: In total, only 1/64 (1.6%) of NCI-designated cancer centers currently offer childcare resources for patients undergoing cancer treatment. This center offers childcare for children ages 2–8, free of charge with multiple outpatient locations. One additional institution previously provided patients with access to daycare, but has closed due to the COVID-19 pandemic. Further, only 1/64 (1.6%) NCI-designated cancer center offers financial assistance grants to aid patients to subsidizing childcare costs during cancer treatment. Conclusions: Institution sponsored options for childcare for patients undergoing cancer treatments are highly limited, even in the best resourced cancer care settings. The COVID-19 pandemic has limited options further, and many hospitals now restrict visitors under the age of 18. Patient grants or institutionally sponsored childcare provider networks may represent an avenue for supporting parents who are facing a cancer diagnosis. Supporting families of patients with cancer has great potential to impact quality of life, economic and psychological stress.

Who holds a shared responsibility view of minimizing gambling harm? Results from a multiwave survey of casino gamblers.

Objective: Academics, gambling regulators, and the gambling industry increasingly espouse a shared responsibility view of preventing gambling harm, considering individual gamblers and external stakeholders (e.g., gambling industry employees, government regulators, and public health workers) to be jointly responsible for this task. This study is the third in a series exploring gamblers' beliefs about responsibility for preventing gambling harm. Method: A sample of 4,336 subscribers to MGM Resorts International (MGM)'s loyalty card program as of January 2020 completed a web-based survey. Results: We observed that 58.1% of participants only held individual gamblers responsible for helping prevent gambling harm. However, two factors increased the likelihood of holding a shared responsibility viewpoint and assigning responsibility to casinos for reducing gambling harm: (a) scoring positive on the Brief Biosocial Gambling Screen (BBGS) or an Expanded Problem Gambling Screen (EPGS) and (b) being aware of GameSense, an onsite responsible gambling education program. Those who screened positive on the BBGS or EPGS also were more likely than their counterparts to deny personal responsibility for minimizing gambling harm to individual gamblers; that is, they were more likely to hold a purely external responsibility viewpoint. A meta-analytic year-over-year comparison revealed that compared to being aware of GameSense, screening positive for problem gambling was more strongly associated with assigning responsibility to casinos for minimizing gambling harm. Conclusions: We discuss these findings in the context of self-determination theory and suggest implications for health promotion and best practices for message design in responsible gambling programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effect of an on-site physical therapy on pain, posture, function and composition, and work-related health status in workers in Korea.

The incidence of work-related musculoskeletal disease is increasing despite automated manufacturing processes. To examine the effect of a customized on-site exercise program on pain, posture, body function, body composition, and work-related health status of workers at an auto-parts factory. Fifty-six participants were randomly divided into one of two groups: experimental (EG), which received a customized exercise program that included manual and exercise therapy from physiotherapy at the workplace; and control (CG), which received customized exercise sheets for a self-directed program at home. The program was performed 3 times per week for 12 weeks. Assessments were performed according to numerical rating scale (NRS), Exbody, Selective Functional Movement Assessment (SFMA), InBody, Short-Form-12 version 2 (SF-12v2), and Work Ability Index (WAI), which were evaluated before and after the program. The EG exhibited significant within-group changes in NRS, Exbody, SFMA, SF-12v2, and WAI; the CG exhibited significant within-group changes only in NRS and SFMA (p < 0.05). There were significant between-group differences in NRS, Exbody, SFMA, and WAI (p < 0.05). An on-site program including manual and exercise therapy directed by a physiotherapist among workers at an auto-parts manufacturer was effective in improving pain levels, posture, body function, and work-related health status.

Inclusive Approaches by VAW Shelters: Respecting Women's Choice to be Together With Companion Animals

Women often delay moving to VAW shelters if their companion animals’ safety is not ensured. Yet, few shelters accommodate them together. The purpose of this study is to explore what may help to promote services for women with companion animals facing violence, through learning from professionals who already provide support. Our email survey with VAW shelters in Ontario, Canada identified services and potential interviewees. Nine semi-structured telephone interviews with professionals were conducted to explore their experiences and views on human–animal relationships. All agencies that provided onsite programs, plus one about to start, participated. We utilized Critical Animal Studies as a theory to understand human–animal relationships through concepts such as intersectionality, anthropocentrism, speciesism, and feminist ethics of responsibility. The study found: (1) seven approaches shelters used to help women with companion animals; (2) programs that accept companion animals helped women move to shelters quickly but also affirmed women’s mutually respectful relationships with companion animals; (3) shelters also benefited, including expanding support from local communities and opportunities to educate them. The study suggests that by shifting ontological and theoretical approaches and including a critical examination of human–animal relationships at interpersonal and social structural levels, professional education promotes mobilizing resources for women with companion animals.

The PRO-TEST Program: HIV and Hepatitis C Services at the Parole Office.

This article describes an on-site program for HIV and hepatitis C (hep-C) services at a parole office in an impoverished U.S. state. Both officers and their supervisees participated in the program. The officers attended workshops on the biology of HIV, and hep-C, and workplace safety, and collaborated in development and implementation of the services. The supervisees received HIV and hep-C education, voluntary testing, and referral for treatment after a positive diagnosis. Test results showed that few supervisees were positive for HIV and 16% of White individuals were diagnosed with hep-C. These findings support the need for on-site services for supervisees in community corrections.

Emergency Remote Education in the Perception of On-Site Accounting Sciences Students during the Covid-19 pandemic

This study aimed to investigate the perception of on-site students of the Accounting Sciences Program of a public university that adopted emergency remote learning during the Covid-19 pandemic in Brazil, highlighting the aspects that favor or hinder learning. A qualitative and descriptive study was carried out, with data collected through 4 focus groups with the participation of 80 students from an on-site undergraduate program in Accounting Sciences. The results indicate that the students perceive the structural factors (flexibility in the deadlines for delivery of activities), personal and collective factors (autonomy in the learning process) and didactic-pedagogical factors (use of active methodologies by the professor) as facilitating aspects of the remote education. As for the aspects that hinder learning, we highlight external factors (lack of internet access), individual factors (not maintaining a study routine and increased stress levels) and traditional remote education (monotonous videoconference classes). Finally, an optimistic vision for future trends is observed, with changes in the human aspects (change of paradigm of the student's role), institutional aspects (greater use of technology) and formative aspects (use of active methodologies). It is concluded that the use of active methodologies in the didactic and pedagogical aspect raises the participation of the number of students in remote classes and improves the quality of learning. This study can contribute to educational institutions that adopt emergency remote education for continuity of academic activities in periods of crisis, as well as to professors who plan their activities. It emphasizes the role of the professor and the importance of active methodologies in the development of knowledge.

Start moving - benefits of an onsite workplace health program in the age of digitalization

BackgroundThe process of digitization should simplify our work and improve related processes (i.e. quality, transparency). Moreover, it enables the home office, which is greatly expanded due to the current pandemic. Regarding workplace health, it should be noted that with increasing digitization, physical activity decreases, and as a result, the number of work-related diseases will increase. On the other hand, increasing digitization also offers promising opportunities for new approaches to workplace health promotion. With these positive as well as negative effects in mind, we designed a workshop to increase physical activity at work. This protocol describes our approach to a live workshop concept.MethodsWe use a randomized controlled trial with two intervention groups: a live workshop with and without additional reminders. The workshop intervention design consists of a baseline measurement, two workshops, and one follow-up measurement. Each workshop takes place in small groups (n < 11). We use a randomized allocation to both groups. To control for health-related effects and the expected behavior change we examine (i) physical activity (i.e. active time, taken steps, etc.) by a tracking device (ii) physical wellbeing, motivation, and volition by an online questionnaire, and (iii) participants also report physical activity by a diary. All measurements are taken one week before the respective workshop and 24 weeks after the initial baseline measures.DiscussionA live workshop offers advantages such as very personal interactions and a low technical effort. However, during the current pandemic, there are some limitations (i.e. small groups, pay attention to hygienic guidelines). Based on the upcoming experiences of this workshop, a web-based approach might offer some advantages (i.e. easier daily implementation, independent from a participant’s location) regarding home office workplaces and the increasing digitization. On the other hand, there are also mandatory requirements as a stable internet connection and technical equipment (i.e. webcam, microphone). Overall, a step by step development of a web-based workshop, based on the experience of the live workshop, can be regarded as advantageous.Trial registrationSince this article reports a health promotion intervention concept with human participants, we registered it in the German Clinical Trials Register (DRKS). Number:DRKS00021512, Date:30.10.2020.

Onsite screening and enhanced EAP counseling improves overall health, depression, and work outcomes: Four-wave longitudinal pilot study at a community health center in Vermont

Over a 2-year period, patients at a rural community health center in Vermont were screened on-site for multiple behavioral health risk factors and, if found at risk, were offered no-cost counseling on-site at the health center. The treatment was delivered by two licensed employee assistance program (EAP) counselors highly proficient in an evidence-based motivational interviewing approach. Longitudinal data at four time points were examined: baseline; end of treatment (3 months); and 3 and 6 months post-treatment. Tests of paired data of baseline versus each later time point found significant improvement for global health (Patient-Reported Outcomes Measurement Information System [PROMIS]-10) in the total sample (N = 120); depression symptoms (Patient Health Questionnaire 9-item scale [PHQ-9]) among a subsample with depression as a clinical issue (n = 68); and work presenteeism and estimated hours of lost work time among the employed subsample (n = 46). Improvement in global health was significantly associated with improvement (reductions) in hours of lost work productivity at all later times (r = .33, .35, .50). Improvement in global health was moderated by level of household income (more improvement among patients with lower income levels), but not by clinical or demographic factors. Practical implications for behavioral health screening and intervention (BSI) in medical settings and onsite EAP counseling programs are discussed.

Physiological and Behavioral Benefits for People and Horses during Guided Interactions at an Assisted Living Residence.

Assisted living is a fast-growing living option for seniors who require residence-based activities for maintaining mental and physical health. Guided equine interactions may benefit seniors, so an on-site equine program was started at Hacienda at the River senior living community. For research purposes, twenty-four residents and associates, aged fifty-five or over, consented to physiological measurements before, during and after four guided sessions of stroking one of three horses for 10 min over 4–6 weeks. Heart rate variability (HRV) was measured simultaneously in humans and horses during interactions. We hypothesized that human heart rate (HR) and HRV would increase during stroking and HRV power would shift toward the very low frequency (VLF) range common in horses, indicative of healthy function. During stroking, human HR increased (p < 0.05) but HRV (SDRR) and %VLF of HRV power did not change. Diastolic blood pressure (DBP), an exploratory measure, significantly increased after stroking, consistent with arousal. Two horses showed no significant changes in HR or HRV, but one relaxed. Sixteen horse–human pairs demonstrated synchronized HRV peak frequencies during sessions, suggestive of social connection. Participants used more positive than negative words describing their experience during exit interviews (p < 0.05). These data show that horses animate seniors without causing emotional stress and provide opportunities for social bonding.

WITHDRAWN: A survey on cloud computing approaches

Finally, “infrastructure as a software” has taken form as a cloud computing, which has long been thought about. The greatest feeling in the field of computation today is this change of perspective. This should be viewed more than innovation as an advancement of current technology. The cloud's fundamental criteria include scalability, adaptability, extendability and manageability, to satisfy the diverse needs of corporate organizations. As the cloud infrastructure improvements in the code situation becomes more apparent, the data center is transferred offsite to a third party and sells software instead of running on-site programs directly. By utilizing it businesses will save money on running expenses, so instead of thinking about specific IT challenges, they will concentrate on the core market. In comparison, the true portability is offered by the Web via the Internet via generic hardware only to access software and documentation everywhere in the world. We also defined in this paper the core principles of cloud storage in brief so that readers may understand an important feature of the newly established technology. .

131 Equine assisted psychotherapy and learning as an effective complementary form of substance use disorder treatment for college-age young adults in a residential treatment program

The young adult population in the United States has faced a substance use disorder (SUD) epidemic with significant increases recently due to the stressors of the COVID-19 pandemic. Relapse has been prevalent within this population due to ineffectiveness of traditional intervention strategies, and thus, non-traditional treatment options have been a growing trend for SUD treatment in young adults. In particular, equine assisted psychotherapy and learning (EAPL) has been documented as a successful complementary treatment strategy for mental health conditions in young adults but research concerning the use of EAPL in residential treatment programs for SUD is lacking. Therefore, the objective of this study was to assess the efficacy of EAPL in a residential treatment program for developing an emotionally safe environment for learning for college-age young adults with SUD. Participants were college-age young adults (ages 18–25 years) that were in a substance abuse residential treatment program with an EAPL onsite program. Participants (n = 61) received weekly equine therapy sessions during their stay at a residential facility and were assessed at the beginning and end of their treatment program using the following 3 assessment methods: a self-reporting emotional safety survey, an equine knowledge exam, and an instructor-based equine physical skill evaluation. t -tests were performed comparing the scores for the assessments at the beginning and end of the treatment program. Total scores for emotional safety ( t (58) = 2.36, P = 0.02), equine knowledge ( t (58) = −2.53, P = 0.01), and physical skills ( t (63) = −8.91, P = 0.00) showed a significant improvement by the end of the program. These results suggest EAPL can be an effectual complementary form of SUD therapy for developing an emotional safety environment for learning in a college-age young adult residential addiction treatment program. These young adults not only felt emotionally safe, but were able to develop their knowledge and skills in equine while going through SUD treatment. EAPL may offer an avenue for creating an emotionally safe environment for learning for other mental health conditions for young adults within a residential treatment program.

Effect of On-Site Cardiac Surgery Program on General Thoracic Surgery Outcomes.

Limited data exist exploring the relationship between multispecialty surgical collaboration and outcomes in general thoracic surgery. To address this, the Nationwide Inpatient Sample (NIS) was analyzed to determine whether the presence of an on-site cardiac surgery program is associated with improved general thoracic surgery outcomes. The NIS (1999-2008) was utilized to identify 389,959 patients who had a lobectomy, pneumonectomy, or esophagectomy. Short-term outcomes of patients undergoing these procedures were compared between hospitals with and without an on-site cardiac surgery program. Univariate and multivariate analyses were performed to determine patient and hospital predictors of mortality and morbidity. During the study period, patients undergoing lobectomy (n = 314,130), pneumonectomy (n = 34,860), or esophagectomy (n = 40,969) were identified. Univariate analysis demonstrated lower mortality for lobectomy (P < 0.001) and esophagectomy (P < 0.001) but not pneumonectomy (P = 0.344) in hospitals with a cardiac surgery program. All-cause morbidity was significantly lower for all 3 procedures in hospitals with a cardiac surgery program. However, multivariate analysis demonstrated that a cardiac surgery program was not an independent predictor when adjusted for known confounders, particularly procedure volume and hospital academic teaching status. The presence of an on-site cardiac surgery program is not in and of itself associated with improved general thoracic surgery outcomes. The presence of a cardiac surgery program is likely a surrogate for other known predictors of improved outcomes such as hospital teaching status and procedure volume.

Patient perspective: Wearable and digital health tools to support managing our health during the COVID-19 pandemic and beyond

Patient perspective: Wearable and digital health tools to support managing our health during the COVID-19 pandemic and beyond