Penn State Health Research Articles

Creation of a Human Factors Board to Support Well-Being in General Surgery Residents.

Demands placed on resident physicians can make it difficult to keep up with personal needs, often affecting well-being. For military pilots, confidential and nonpunitive human factors boards (HFBs) identify pilots' human factors (personal or professional problems that might interfere with the ability to perform effectively) and make recommendations for support. The authors sought to determine the feasibility of establishing an HFB for resident physicians and its utility for general surgery residents. Publicly available information on HFBs was reviewed and translated to the structure of a general surgery residency. An HFB consisting of a faculty member, resident representative, and neutral third party was established for the general surgery residency program (consisting of 42 residents during the study period) at Penn State Health. From January 1 to July 1, 2020, the HFB responded to human factors needs of general surgery residents. Residents could make requests for themselves or another resident. If all HFB members were in agreement that a request was reasonable, the appropriate resource was directed to the requesting resident and funding was disbursed (if applicable) by the third party. From January 1 to July 1, 2020, 14 requests were made. Of these, 3 (21%) were made for another resident and 12 (86%) were fulfilled through resources arranged by the HFB. All requests occurred between January 1 and April 1, 2020, likely because of the COVID-19 pandemic. The overall cost of the program was $932.80. The HFB represents an adaptable tool that can meet residents' specific needs as they arise and a mechanism through which residents can receive a tangible response to human factors. Formal feedback is needed to identify areas that could be improved. This structure could be generalized to other graduate medical education programs and physicians at all levels.

Does adding an alpha-1 blocker to finasteride relieve lower urinary tract symptoms in elderly men with benign prostatic hyperplasia?

Penn State Health Family and Community Medicine Residency at Mount Nittany Medical Center, State College, PA The corresponding author Joseph Wiedemer; [email protected]. The authors declare no conflicts of interest.

Reply by Authors.

No AccessUrology PracticeSpecialty1 Sep 2022Reply by Authorsis a reply to letterEditorial Commentary Tullika Garg, William D. Meeks, R. Matthew Coward, Suzanne B. Merrill, William C. Huang, and Arthur L. Burnett Tullika GargTullika Garg *Correspondence: Department of Urology, Geisinger, 100 N. Academy Ave., Mail Code 01-27, Danville, Pennsylvania 17822 telephone: 570-271-6328; FAX: 570-217-6955; email address: E-mail Address: [email protected] https://orcid.org/0000-0003-2679-7460 Departments of Urology and Population Health Sciences, Geisinger, Danville, Pennsylvania Current institution: Department of Urology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania. More articles by this author , William D. MeeksWilliam D. Meeks Data Management and Statistical Analysis, American Urological Association, Linthicum, Maryland More articles by this author , R. Matthew CowardR. Matthew Coward Department of Urology, University of North Carolina, Chapel Hill, North Carolina UNC Fertility, Raleigh, North Carolina More articles by this author , Suzanne B. MerrillSuzanne B. Merrill Colorado Urology, United Urology Group Affiliate, Denver, Colorado More articles by this author , William C. HuangWilliam C. Huang Departments of Urology and Radiology, NYU Grossman School of Medicine, New York, New York More articles by this author , and Arthur L. BurnettArthur L. Burnett Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000311.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Reply by Authors." Urology Practice, 9(5), p. 490 Reference 1. : The decline in rural medical students: a growing gap in geographic diversity threatens the rural physician workforce. Health Aff (Millwood) 2019; 38: 2011. Google Scholar © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesUrology Practice1 Jun 2022Editorial Commentary Volume 9Issue 5September 2022Page: 490-490 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tullika Garg Departments of Urology and Population Health Sciences, Geisinger, Danville, Pennsylvania *Correspondence: Department of Urology, Geisinger, 100 N. Academy Ave., Mail Code 01-27, Danville, Pennsylvania 17822 telephone: 570-271-6328; FAX: 570-217-6955; email address: E-mail Address: [email protected] Current institution: Department of Urology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania. More articles by this author William D. Meeks Data Management and Statistical Analysis, American Urological Association, Linthicum, Maryland More articles by this author R. Matthew Coward Department of Urology, University of North Carolina, Chapel Hill, North Carolina UNC Fertility, Raleigh, North Carolina More articles by this author Suzanne B. Merrill Colorado Urology, United Urology Group Affiliate, Denver, Colorado More articles by this author William C. Huang Departments of Urology and Radiology, NYU Grossman School of Medicine, New York, New York More articles by this author Arthur L. Burnett Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Expand All Advertisement PDF downloadLoading ...

678-P: Racial and Ethnic Disparities in CGM Use among Adults with Diabetes

Introduction: Continuous glucose monitoring (CGM) is increasingly being used in the management of diabetes. Racial disparities in use of CGM may contribute to disparities in health outcomes. Studies have shown disparities in use of CGM among different races. However, most of these studies were done in the pediatric population. Objectives: To determine whether there are racial differences in the use of CGM in adults with type 1 or type 2 diabetes. Methodology: In this cross-sectional study, the TriNetX query tool was used to search electronic medical records of patients seen at Penn State Health Hershey Medical Center. Inclusion Criteria were age 18 to 80 years old, and type 1 or type 2 diabetes. Patient measures collected include age, gender, race, ethnicity, using CGM or not, using insulin or not, and A1c. Results: The total number of patients with type 1 or type 2 diabetes was 73,210. Among those, 1,330 patients were using CGM, including 1,090 White patients (1.88% of Whites with type 1 or type 2 diabetes) , 80 Black patients (1.39% of diabetic Blacks) , 79 Hispanic patients (1.82 % of diabetic Hispanics) , and 26 Asian patients (1.77% of diabetic Asians) . In patients with type 2 diabetes who are on insulin, CGM use was as the following: 2.03% of White patients, 1.% of Black patients, 1.09% of Hispanic patients, and 1.89% of Asian patients. Among insulin-treated patients with type 2 diabetes, mean A1c was 7.76% in those using CGM, compared to 7.89% in those not using CGM. Among patients with type 1 diabetes, 9.13% of White patients, 6.84% of Black patients, 7.57% of Hispanic patients and 8.82% of Asian patients were using CGM. In patients with type 1 diabetes, mean A1C was 8.43% in those using CGM and 8.36% in those not using CGM. Discussion: Only patients who were billed for CGM during visits were included as CGM users in the study, which could result in fewer patients identified as CGM users. Rates of CGM use were lowest in Black and Hispanic adults indicating that racial and ethnic disparities exist in the use of CGM among adults with diabetes. Disclosure S.M.Aljedaani: None. A.S.Siddiqui: Advisory Panel; Alexion Pharmaceuticals, Inc. N.Raja-khan: None.

0338 Association of Evening Circadian Preference and Languid/Flexible Circadian Type with Predisposing, Perpetuating Factors, and Treatment Acceptability in Patients with Chronic Insomnia Disorder

Abstract Introduction Circadian factors may contribute to sleep difficulties among chronic insomnia disorder (CID) patients who do not otherwise meet full criteria for a circadian rhythm sleep-wake disorder, particularly delayed and advanced sleep-wake phase disorders. Current nosology suggests that using circadian preference measures can provide important diagnostic information and aid in differential diagnosis. However, there is a lack of research identifying clinical factors associated with circadian dimensions in patients with CID. Methods 195 patients (45.50±15.99 years old, 66.2% female, 15.9% minority) with a diagnosis of CID and absent of any other sleep disorder were evaluated at the Behavioral Sleep Medicine (BSM) program of Penn State Health Sleep Research & Treatment Center. All patients completed measures of circadian preference and type, insomnia severity, arousability, sleep reactivity, pre-sleep arousal, sleep-wake schedule and incompatible behaviors, dysfunctional beliefs and attitudes, mood and stress, and insomnia treatment acceptability. Multivariable linear regression examined which predisposing, perpetuating and treatment acceptability factors were associated with each circadian dimension, while adjusting for age, sex, race/ethnicity and insomnia severity. Results About 30% of the sample was classified as evening, 29% as morning, 74% as languid, and 43% as flexible types. Sleep-wake irregularity was associated with eveningness (β=-0.276, p<0.01), languidity (β=0.280, p<0.01) and flexibility (β=0.184, p<0.01). Pre-sleep cognitive arousal (β=-0.182, p<0.01) and sleep expectations (β=-0.127, p<0.05) were associated with eveningness. Negative cognitions about the consequences of insomnia (β=0.230, p<0.01) and sleep expectations (β=0.268, p<0.01) were associated with languidity. Sleep-incompatible behaviors (β=0.165, p<0.05) and perceived stress (β=0.267, p<0.01) were associated with flexibility, while trait anxiety (β=-0.137, p=0.058) and negative cognitions about the consequences of insomnia (β=-0.318, p<0.01) were associated with rigidity. Less agreeability to pharmacotherapy over behavioral therapy was associated with morningness (β=0.129, p<0.05), while greater agreeability to behavioral therapy over pharmacotherapy (β=-0.158, p<0.05) was associated with rigidity. Conclusion Sleep-wake irregularity in patients with CID is a perpetuating factor strongly associated with evening and languid/flexible circadian types, while other predisposing and perpetuating factors can be also determined by circadian preference and/or type. Circadian measures in the evaluation of CID patients may help clinicians individualize BSM treatments, including patients’ acceptability. Support (If Any)

Impact of trainee experience on shave biopsy specimen size.

Skin biopsies are crucial for the diagnosis of many cutaneous pathologies, yet specimen adequacy is essential for definitive diagnosis. Recent literature has noted a trend in decreasing biopsy size over time, which has created concern over implications regarding adequacy for diagnosis. This study sought to evaluate if clinician training length or type of residency training impacted the average biopsy size and sample adequacy. Dermatopathology reports for shave biopsies between January 1, 2021, and June 30, 2021, at Penn State Health were queried through PathNet, the software application for pathology reports in this health system's electronic medical record system. Biopsy dimensions, volume, diagnosis, location, clinician training level, and descriptions of evaluation of deeper sections (recuts) and superficial sampling were recorded for each biopsy. Basic statistical calculations were performed to assess the mean and standard deviation for biopsy sizes per clinician group. Differences in biopsy size between training levels were statistically significant despite qualitatively similar biopsy locations and final diagnosis categories for each clinician training group. After evaluating measures for sample adequacy, our data showed significantly smaller biopsies; however, overall frequencies were minimal. Additionally, more inadequate specimens were noted for clinician groups with the least amount of dermatology experience. The results of this study identify a correlation with decreasing biopsy size amidst increased experience in dermatology training but find no evidence to support that this trend currently threatens sample adequacy.

Sodium-glucose cotransporter 2 inhibitor associated diabetic ketoacidosis in chronic heart failure: a case series

Abstract Funding Acknowledgements Type of funding sources: None. Background The sodium-glucose cotransporter 2 inhibitor (SGLT2i) medications have proven mortality and morbidity benefit for patients with type 2 diabetes mellitus (T2DM) and chronic heart failure (HF) over the previous decade leading to a rapid expansion of societal guideline recommendations and US FDA indications. With this rapid expansion of SGLT2i indications and prescribing, it is essential that we understand the safety and adverse effects of this drug class. Diabetic ketoacidosis (DKA) is a life-threatening adverse effect of the SGLT2i that has been described in post-marketing reports, prompting an FDA warning. The clinical characteristics of patients with T2DM and HF who develop SGLT2i associated DKA are lacking. Purpose To describe the clinical characteristics of patients with T2DM and chronic HF prescribed SGLT2i who develop DKA. Methods Data was collected retrospectively with Penn State Health TriNetX Local, a web-based tool for healthcare system research population queries, between January 1, 2013-December 31, 2020. Patients with T2DM and chronic HF who were prescribed empagliflozin, canagliflozin or dapagliflozin and subsequently developed DKA were eligible for inclusion. Patients with type 1 diabetes mellitus were excluded. Patient health records were reviewed to confirm SGLT2i use at the time of DKA hospitalization. Baseline characteristics, clinical features and outcome data of hospitalized patients were collected. Results Four unique patient records were identified. Mean age was 59.8 years, BMI 30.5 kg/m2, HbA1c 10.6%. Two patients had baseline heart failure mid-range ejection fraction and two patients had heart failure preserved ejection fraction. All patients were baseline NYHA class II, ACC/AHA stage C. Three patients were on a baseline diuretic, two were on ACE/ARB, two were on beta blocker, three were on metformin, two were on pioglitazone and none were on insulin. Two patients were on baseline empagliflozin 10 mg daily and two were on canagliflozin 100 mg daily. Two patients were on SGLT2i for less than 1 month prior to presentation. Three patients presented with SGLT2i associated DKA and one with euglycemic DKA. None of the patients presented with decompensated congestive HF. Three patients presented with concomitant acute medical conditions; Fournier’s gangrene, asthma exacerbation and alcoholic hepatitis. One patient developed acute stress induced cardiomyopathy while hospitalized. Another patient suffered cardiac arrest secondary to acidosis. Average duration of insulin infusion was 60 hours before resolution of DKA. All of the patients recovered. Conclusions In this single center study, we presented four unique cases of SGLT2i associated DKA in patients with T2DM and chronic HF. Diagnosis can be challenging as concomitant acute medical conditions and/or euglycemia can mask underlying DKA. Early diagnosis and management of SGLT2i associated DKA is important as this condition is life-threatening.

PD05-11 USE OF MINI SIP IT BEHAVIORAL INTERVENTION INCREASES FLUID INTAKE IN PATIENTS WITH KIDNEY STONES

You have accessJournal of UrologyCME1 May 2022PD05-11 USE OF MINI SIPIT BEHAVIORAL INTERVENTION INCREASES FLUID INTAKE IN PATIENTS WITH KIDNEY STONES Necole Streeper, James Marks, Jason Fairbourn, Emily Frith, Edison Thomaz, Nilam Ram, and David Conroy Necole StreeperNecole Streeper More articles by this author , James MarksJames Marks More articles by this author , Jason FairbournJason Fairbourn More articles by this author , Emily FrithEmily Frith More articles by this author , Edison ThomazEdison Thomaz More articles by this author , Nilam RamNilam Ram More articles by this author , and David ConroyDavid Conroy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002524.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Wearable technology is both increasingly prevalent and successfully improving a variety of health behaviors. We previously showed that digital tools are capable of identifying lapses in drinking behavior and delivering just-in-time messages to promote fluid consumption. The purpose of this study was to determine the feasibility, acceptability and impact of mini sipIT, a context-sensitive reminder system that incorporates a connected water bottle and mobile app with text messaging, for kidney stone patients – a population that often has poor adherence to increasing fluid intake for prevention. METHODS: Patients with a history of kidney stones and urine volume less than 2 liters/day were recruited to participate in a 1-month feasibility trial. Patients were given an H2OPal connected water bottle and received hourly text message reminders when they were not meeting fluid intake goals. Perceptions of drinking behavior, intervention acceptability and 24-hour urine volumes were obtained at baseline and after the 1-month mini sipIT behavioral intervention. RESULTS: Patients with a history of kidney stones were enrolled (n = 26, 77% female, age = 50.4 ± 14.2 years). There was a significant increase in 24-hour urine volume at the end of the 1-month mini sipIT behavioral intervention compared to baseline (2006.5 ± 980.8 mL vs. 1352.7 ± 449.9 mL, t (25) = 3.66, p = .001, d = 0.84). 24-hour urine volumes increased at the end of the 1-month trial for 73% of participants. Most participants perceived that mini sipIT intervention helped them to increase their fluid intake (85%) and reach their fluid intake goals (65%). The majority used the connected water bottle and mobile app every day of the intervention (92%). However, 35% of participants reported that carrying the water bottle was cumbersome. CONCLUSIONS: Mini sipIT behavioral intervention is feasible and provides automated lapse-detection that improves fluid intake with a significant increase in 24-hour urine volume. Although patients found the intervention acceptable, reports that carrying the water bottle was cumbersome suggest use of a different water bottle design or multimodal intake monitoring systems may be necessary to reduce patient burden. Digital tools in combination with behavioral science may help to improve adherence to fluid intake recommendations for kidney stone prevention. Source of Funding: Keith and Lynda Harring Fund for Kidney Research at Penn State Health and National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK124469) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e90 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Necole Streeper More articles by this author James Marks More articles by this author Jason Fairbourn More articles by this author Emily Frith More articles by this author Edison Thomaz More articles by this author Nilam Ram More articles by this author David Conroy More articles by this author Expand All Advertisement PDF DownloadLoading ...

Impact of a Multidisciplinary Research Team Approach to Prevent Avoidable Mistakes for Neonatal CPB Population.

Significant progress has been made in neonatal cardiopulmonary bypass (CPB) over the years. At Penn State Health Children's Hospital, we have established a multidisciplinary research team that brings clinicians, engineers, scientists, research nurses, neuromonitoring technicians, perfusionists, and students from various departments to help reduce adverse outcomes following CPB in neonates. With the help of this team, we evaluate each CPB component in simulated conditions identical to those used in clinical practice. The objective of this review is to demonstrate the results of these translational projects and present critical mistakes to avoid for neonatal CPB patients.

Collaborative health systems ECHO: The use of a tele-education platform to facilitate communication and collaboration with recipients of state targeted response funds in Pennsylvania

Background: The opioid epidemic continues to erode communities across Pennsylvania (PA). Federal and PA state programs developed grants to establish Hub and Spoke programs for the expansion of medications for opioid use disorders (MOUD). Employing the telementoring platform Project ECHO (Extension for Community Health Outcomes), Penn State Health engaged the other seven grant awardees in a Collaborative Health Systems (CHS) ECHO. We conducted key informant interviews to better understand impact of the CHS ECHO on health systems collaboration and opioid crisis efforts. Methods: For eight one-hour sessions, each awardee presented their unique strategies, challenges, and opportunities. Using REDCap, program characteristics, such as number of waivered prescribers and number of patients served were collected at baseline. After completion of the sessions, key informant interviews were conducted to assess the impact of CHS ECHO on awardee’s programs. Results: Analysis of key informant interviews revealed important themes to address opioid crisis efforts, including the need for strategic and proactive program reevaluation and the convenience of collaborative peer learning networks. Participants expressed benefits of the CHS ECHO including allowing space for discussion of challenges and best practices and facilitating conversation on collaborative targeted advocacy and systems-level improvements. Participants further reported bolstered motivation and confidence. Conclusions: Utilizing Project ECHO provided a bidirectional platform of learning and support that created important connections between institutions working to combat the opioid epidemic. CHS ECHO was a unique opportunity for productive and convenient peer learning across external partners. Open dialogue developed during CHS ECHO can continue to direct systems-levels improvements that benefit individual and population outcomes.

Court rules against former employee

Case name: Soutner v. Penn State Health, No. 20‐1763 (3d Cir. 01/13/21).

Vulnerable Patient Outreach Program (VPOP)

The COVID-19 pandemic has significantly disrupted many traditional patient care delivery models. To help meet patient needs, the Penn State Health Department of Family and Community Medicine started a medical student-run Vulnerable Patient Outreach Program (VPOP). This program pairs medical students with providers to address healthcare needs for the most vulnerable patients. At the program outset, a total of 125 patients were identified and 64 agreed to participate. All patients were over the age of 65 and had multiple medical comorbidities. This study reviews the impact of VPOP on the care of 34 participants. Each participant completed pre-structured satisfaction surveys over the phone. The results indicate a high degree (94%) of patient satisfaction. Patients were particularly comfortable communicating their health needs to medical students and specifically highlighted medical student professionalism. Medical students also found this program to be beneficial, citing an ability to help during pandemic times in a clinically meaningful way. The highly positive reactions from both patients and medical students suggest that outreach programs, like this one, are one way to meet the needs of vulnerable patients. These findings also suggest that, as a longitudinal experience beyond COVID-19, medical students may benefit from participation in vulnerable patient outreach programs.

Court rules against former employee

Case name: Soutner v. Penn State Health, No. 20‐1763 (3d Cir. 01/13/21).

Court rules against former employee

CASE NAME: Soutner v. Penn State Health, No. 20‐1763 (3d Cir. 01/13/21).

Re-evaluating Safe Osmolarity for Peripheral Parenteral Nutrition in Neonatal Intensive Care Patients.

To reach nutrition goals for neonatal patients, institutions often exceed the American Society for Parenteral and Enteral Nutrition recommended maximum of 900 mOsm/L for peripheral parenteral nutrition (PPN). Evidence is limited regarding the safety of PPN osmolarities above this maximum, specifically in neonatal patients. The purpose of this study was to determine if PPN with osmolarities ≥ 1000 mOsm/L is associated with an increased rate of line-related complications. This retrospective study included infants admitted to the Penn State Health Children's Hospital NICU from January 1, 2013, through July 31, 2018, who were receiving PPN, to assess if solutions with osmolarities ≥ 1000 mOsm/L versus < 1000 mOsm/L are associated with increased rates of line-related complications. A total of 200 patients were included in the study, and 618 individual PPN days were analyzed. Baseline patient characteristics were similar between groups. The PPN osmolarities ranged from 610 to 1267 mOsm/L. Overall, the incidence of line-related complications for PPN < 1000 (n = 342 PPN days) and ≥ 1000 mOsm/L (n = 276 PPN days) was 28.9% and 29.0%, respectively (OR 1.00 [95% CI 0.72-1.40, p = 0.99]). Irrespective of PPN osmolarity, infants weighing > 1.5 kg had significantly greater odds of experiencing line complications compared with patients < 1 kg, but showed no difference compared with patients weighing 1 to 1.5 kg. There were no significant differences in the incidence of line-related complications in NICU patients receiving PPN with osmolarities 1000 to 1250 versus < 1000 mOsm/L.

Commentary on "Imagist Poetry and Clinical Medicine: Arts of Observation, Precision, and Expression".

Commentary on "Imagist Poetry and Clinical Medicine: Arts of Observation, Precision, and Expression".

The Case Files

The Case Files

Impact of Video Describing Cataract Surgical Simulator Training on Patients' Perceptions of Resident Involvement in Cataract Surgery

Abstract Purpose The aim of this article is to investigate the impact of a 1-minute video describing resident training with a cataract surgical simulator on patients' perceptions regarding resident involvement in cataract surgery and to identify factors associated with patient willingness to have cataract surgery performed by a resident. Design Cross-sectional survey. Methods An anonymous Likert-style survey was conducted among 430 consecutive adult patients who presented for eye examination at the Penn State Health Eye Center. The survey included questions regarding demographics, understanding of the medical training hierarchy, and patient willingness to have a resident perform their cataract surgery. There were six questions regarding patient willingness to have residents perform their cataract surgery and the second question in this set informs the patient that residents are supervised by an experienced cataract surgeon. Patients were randomly assigned to one of two groups: patients in Group 1 completed the survey only, while patients in Group 2 watched a 1-minute video describing resident training with a cataract surgical simulator prior to completing the survey. Results Four hundred fourteen of the 430 patients (96.3%) completed the survey. Overall, 24.7% (n = 102) of respondents expressed willingness to allow an ophthalmology resident to perform their cataract surgery, and that proportion increased to 54.0% (n = 223) if the patient was informed that the resident would be supervised by an experienced cataract surgeon. Patients in Group 2 were twice as likely compared with patients in Group 1 to express willingness to allow an ophthalmology resident to perform their cataract surgery (odds ratio 1.92 [1.18–3.11], p = 0.009). Conclusions A thorough informed consent process including information regarding attending supervision and a brief video detailing resident training with a cataract surgery simulator may increase patient willingness to allow resident participation in cataract surgery.

The Hypersomnia Severity Index: reliability, construct, and criterion validity in a clinical sample of patients with sleep disorders.

The Hypersomnia Severity Index (HSI) was designed to assess the severity and impairment of hypersomnolence and has been validated in persons with psychiatric disorders. Little is known about its psychometric properties in clinical samples of patients with sleep disorders. One hundred fifty-eight patients (aged 44.1 ± 16.4 years, 29.1% male, 19.6% racial/ethnic minority) evaluated at the Behavioral Sleep Medicine program of the Penn State Health Sleep Research and Treatment Center completed the HSI and other patient-reported outcomes. We examined the HSI's reliability and factorial, construct, and criterion validity. The HSI showed satisfactory internal consistency (α = 0.79). A 2-factor structure, reflecting symptoms (HSI-S) and impairment, explained 56.2% of the variance. Convergent validity with the Epworth Sleepiness Scale was optimal (r = .65) but greater for HSI-S (r = .69) than for impairment (r = .39). Divergent validity was optimal for HSI-S against unrelated measures of sleep effort, reactivity, and incompatible behaviors (r ≤ .02). Construct validity showed higher scores in patients with central disorders of hypersomnolence and lower scores in patients with chronic insomnia disorder compared to those with other sleep disorders; however, these divergent scores were primarily driven by HSI-S rather than impairment. Criterion validity showed that an HSI-S cutoff score ≥ 8 provided the best balance in sensitivity/specificity (0.82/0.78) to identify central disorders of hypersomnolence (area under the curve, 0.85). The HSI shows satisfactory indices of reliability and validity in a clinical patient sample. Its construct and criterion validity are supported by its divergent association with other patient-reported outcomes and central disorders of hypersomnolence vs chronic insomnia disorder diagnoses and the adequate sensitivity/specificity of its HSI-S cutoff score to reliably identify central disorders of hypersomnolence. Fernandez-Mendoza J, Puzino K, Amatrudo G, etal. The Hypersomnia Severity Index: reliability, construct, and criterion validity in a clinical sample with sleep disorders. J Clin Sleep Med. 2021;17(11):2249-2256.

An online non-meditative mindfulness intervention for people with ALS and their caregivers: a randomized controlled trial

Objectives: Mindfulness-based interventions seem to be effective in promoting QOL of ALS patients and caregivers, but most require substantial time. In the Langerian approach, mindfulness can be easily promoted with mental tasks and short lectures. This study aims to explore the impact of an ALS-specific online Langerian mindfulness training program on QOL of ALS patients. Methods: We developed and tested with an Randomized Controlled Trial (RCT) a 5-week active learning mindfulness program. Participants were recruited from the ALS clinic at Penn State Health and online and were randomly assigned to either the mindfulness group or a wait-list control group. The primary outcome was the patient’s QOL after the treatment. 3 and 6-month follow-ups, together with anxiety, depression, care burden, and physical function, assessed at all times for both patients and caregivers, were explored as secondary outcomes. Results: 47 ALS patients and 27 caregivers were recruited. Among the ALS patients, the experimental group reported higher levels of QOL at the end of the treatment (d = 0.54). Moreover, they showed lower values of depression, anxiety, and negative emotions, compared to the controls, over time. The caregivers from the mindfulness group reported lower scores of care burden, depression, and anxiety, with higher values of energy and emotional well-being over time. Conclusions: This small RCT provides preliminary evidence that this intervention leads to an increase of QOL and a reduction in psychological comorbidities in ALS patients and caregivers. Given the relatively short time commitment, it may be easily implemented by the ALS community.