Preliminary Efficacy of an Occupation-Oriented Purpose in Life Intervention After Breast Cancer.

Background. Purpose in life is important to health and well-being; purpose disruption often goes unidentified after breast cancer. Purpose. To evaluate the efficacy of a purpose renewal intervention and utility of a screening question for identifying people with purpose-related distress. Method. In this prospective pretest-posttest study, participants with breast cancer received an 8-session purpose renewal group intervention (n = 35). Participants completed standardized measures of meaning and purpose at pretest, posttest, and two-month follow-up and a forced-choice Purpose Status Question (PSQ) at pretest. Findings. Participants made statistically significant pretest-to-posttest and pretest-to-follow-up improvements. The PSQ demonstrated construct validity: 40% of participants lacked purpose direction at pretest and this subgroup made significantly greater improvements than participants who reported purpose direction at pretest. Implications. The PSQ warrants further study as a screener to identify people with purpose-related distress. Many breast cancer survivors may benefit from a purpose in life intervention; a subgroup may benefit more.

Grace Notes: feasibility of a manualized intervention to advance spiritual well-being for clients with acquired brain injury.

Spiritual well-being appears to contribute to mental health and adaptation in adults with acquired brain injury (ABI). ABI-related interventions, including those associated with spirituality, must be specifically designed with learning-related impairments in mind. We conducted a feasibility study of a manualized intervention to support spiritual well-being after ABI called Grace Notes. The goal is to provide clients with time tested, easily accessible spiritual practices that help them experience deeper feelings of being in relationship with their Higher Power as they understand it. Findings suggest that Grace Notes can be implemented by both its developer with the context of an interdisciplinary outpatient rehabilitation program and a rehabilitation clinician as a stand-alone group. People with ABI appear to be interested in a spiritually intervention that draws from a variety of spiritual practices and traditions. Further study related to the efficacy of spiritual well-being intervention after ABI is warranted.

Cognitive Dysfunction: Feasibility of a Brief Intervention to Help Breast Cancer Survivors.

BACKGROUND: Many cancer survivors experience cancer-related cognitive dysfunction (CRCD), which is believed to be the result of multiple contributing biologic, situational, and personal factors. Efficacious, clinically implementable interventions addressing the multifactorial nature of CRCD are needed. OBJECTIVES: This study evaluated the feasibility of an intervention to help breast cancer survivors mitigate the effects of modifiable factors that contribute to CRCD and improve cognitive functioning. METHODS: A single-group pre-/post-test design was used. Treatment fidelity was tracked to evaluate implementability; attendance rates, experience surveys, and homework engagement were used to characterize acceptability. Pre- and post-test cognitive functioning, stress, fatigue, and mood were measured to evaluate preliminary efficacy. FINDINGS: The intervention was implementable and acceptable to participants. Participants made statistically significant improvements.

Association of Self-Administered Nitrous Oxide for Labor Analgesia With Maternal and Neonatal Process and Outcome Measures.

OBJECTIVE: To describe patterns of use of self-administered nitrous oxide (N2O) during labor and to determine if maternal and neonatal process and outcome measures differ for women who use N2O compared to women who do not use N2O. DESIGN: Retrospective, full-census, observational cohort. SETTING: An upper midwestern U.S., urban, 75-bed quaternary perinatal center with more than 5,000 annual births. PARTICIPANTS: The participants included two groups of women: 400 who used N2O during labor and a comparison group of 6,733 who met N2O eligibility but did not use N2O. METHODS: We used descriptive statistics to examine patterns of use of N2O during labor between January 2015 and March 2017. We examined associations of N2O with process (length of first and second stages of labor, time from hospital admission to birth, time from birth to hospital discharge, and total length of stay) and outcome measures (shoulder dystocia, instrumentation, vaginal lacerations, Apgar scores at 5 minutes, nursery disposition) using multivariate linear, logistic, and ordinal regression models. RESULTS: Three percent (12/400) of women who used N2O discontinued because of side effects. Among participants with vaginal births who used N2O, 17.6% (62/352) used N2O as the only form of pain medication during labor. We found no significant differences in maternal and neonatal outcome measures between the two groups. Among the process measures examined, we found a mean 2-hour-longer time from admission to birth and total length of stay in the N2O group (p < .05) compared to the non-N2O group. CONCLUSION: Most participants who used N2O (290/352, 82.3%) transitioned to other pain modalities during labor. Maternal and neonatal process and outcome measures were comparable relative to other pain management modalities, with the exception of longer time durations for two measures.

Front Desk Duty Multitasking Test After Mild Stroke: Preliminary Reliability and Validity.

BACKGROUND.: Performance-based multitasking assessments may be more sensitive than cognitive screens to detect executive dysfunction after a mild stroke. PURPOSE.: This cross-sectional study examined inter-rater reliability and preliminary convergent and discriminant validity of the Front Desk Duty Test (FDDT). METHOD.: Adults with mild stroke (n = 35) and community controls (n = 33) were administered the FDDT and other measures of executive functions. FINDINGS.: Inter-rater reliability of the FDDT subscores were high (ICC 0.971-0.999). There were weak but statistically significant correlations between participants' scores on some of the executive function tests and some FDDT subscores. Participants with mild stroke and community controls had statistically significant different FDDT scores (performance accuracy p = .006; performance time, p = .033), with rank order FDDT score patterns across community controls, participants with mild stroke who passed the executive function screen, and participants with mild stroke who failed the executive function screen. IMPLICATIONS.: Preliminary validation results suggest that the FDDT warrants further study.

Implementing Practice Standards for Inpatient Electrocardiographic Monitoring.

BACKGROUND: Although electrocardiographic monitoring is common in hospitalized patients, many patients receive unnecessary monitoring, contributing to patients' inconvenience, clinicians' alarm fatigue, and delayed admissions. OBJECTIVE: To evaluate the impact of implementation of an electronic order set based on the American Heart Association practice standards for electrocardiographic monitoring on the occurrence of appropriate monitoring. METHODS: The sample for this preintervention-to-postintervention quasi-experimental study consisted of 297 adult patients on medical, surgical, neurological, oncological, and orthopedic patient care units that used remote electrocardiographic monitoring in a 627-bed hospital in Minneapolis, Minnesota. The intervention was the introduction into the electronic health record of order sets prompting physicians to order electrocardiographic monitoring per the American Heart Association practice standards. Indications for monitoring according to the practice standards and adverse outcomes (unexpected transfer to intensive care unit, death, code blue events, and call for the rapid response team) were compared before and after implementation of the order set. RESULTS: Implementation of the order set was associated with an increase in appropriate monitoring (48.0% to 61.2%; P = .03); the largest increase was in ordering by medical residents (30.8% to 76.5%; P = .001). No significant increase in adverse patient outcomes was noted. CONCLUSIONS: Implementation of the practice standards via an electronic order set was associated with a statistically significant increase in appropriate monitoring, with no increase in adverse events. Use of electronic order sets is an effective and safe way to enhance appropriate electrocardiographic monitoring.