Safe to Sleep in Tennessee: A Statewide Quality Improvement Initiative.

OBJECTIVE: Sleep-related deaths were the fourth leading cause of infant death in Tennessee between 2014 and 2018. In response, the Tennessee Initiative for Perinatal Quality Care developed a statewide quality improvement project, which focused on the demonstration and enforcement of a safe sleep environment in participating birthing hospitals to help families learn and practice the same at home. The project's aim was to improve the percent of infants audited for safe sleep practices (0-12 mo of age, cared for in participating newborn nurseries or neonatal intensive care units) that were compliant with the practices recommended by the 2016 American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death Syndrome. STUDY DESIGN: Participating teams were required to develop and implement safe sleep policies in compliance with the AAP recommendations, provide safe sleep education to staff and families, and complete monthly safe sleep audits. A tool was provided to assess whether each audited infant was compliant with safe sleep recommendations and any reason(s) the infant was not compliant. Teams met virtually for monthly huddles and semiannual learning sessions to discuss the development and testing of change ideas. RESULTS: The project teams were able to improve the percent of infants audited that were compliant with safe sleep recommendations by 22% over the course of the project. Audits revealed the main reasons for noncompliance were additional objects in the crib (49%, 329/671), unsafe bedding (27%, 181/671), and head of bed elevation (24%, 164/671). CONCLUSION: This project demonstrates the positive impact that a statewide quality improvement initiative can have on identifying and addressing barriers, sharing resources and education, and monitoring local and statewide data, which led to increased compliance with safe sleep recommendations in the hospital. Safe sleep education and monitoring should be ongoing as new parents and staff always need to be educated on safe sleep principles. KEY POINTS: · In 2020, 25% of all infant deaths in Tennessee were due to an unsafe sleep environment.. · Sleep-related deaths in infants are frequently preventable.. · State quality improvement projects are effective in increasing safe sleep compliance.. · State perinatal quality collaboratives can partner with their State Department of Health, local hospitals, and providers, to increase awareness, educate parents, and model a safe sleep environment..

Lower Expression of CFTR Is Associated with Higher Mortality in a Meta-Analysis of Individuals with Colorectal Cancer.

Individuals with cystic fibrosis (CF), caused by biallelic germline mutations in the cystic fibrosis transmembrane conductance regulator (CFTR), have higher risk and earlier onset of colorectal cancer (CRC). A subset of CRC patients in the non-CF population expresses low levels of tumoral CFTR mRNA which may also cause decreased CFTR activity. To determine the consequences of reduced CFTR expression in this population, we investigated association of tumoral CFTR expression with overall and disease-specific mortality in CRC patients. CFTR mRNA expression, clinical factors and survival data from 1177 CRC patients reported in the Cancer Genome Atlas (TCGA) and Gene Expression Omnibus studies GSE39582 and GSE17538 were included. Log-transformed and z-normalized [mean = 0, standard deviation (SD) = 1] CFTR expression values were modeled as quartiles or dichotomized at the median. Univariate and multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for overall and disease-specific mortality in individual studies and meta-analyses. Analyses of each of the three individual datasets showed a robust association of decreased CFTR expression with increased mortality. In meta-analyses adjusted for stage at diagnosis, age and sex, CFTR expression was inversely associated with risk of overall death [pooled HR (95% CI): 0.70 (0.57-0.86)] and disease-specific death [pooled HR (95% CI): 0.68 (0.47-0.99)]. Associations did not differ by stage at diagnosis, age, or sex. Meta-analysis of overall death stratified by microsatellite instable (MSI) versus microsatellite stable (MSS) status indicated potential interaction between MSI/MSS status and CFTR expression, (p-interaction: 0.06). The findings from these three datasets support the hypothesis that low CFTR expression is associated with increased CRC mortality.

CFTR and Gastrointestinal Cancers: An Update.

Cystic Fibrosis (CF) is a disease caused by mutations in the CFTR gene that severely affects the lungs as well as extra-pulmonary tissues, including the gastrointestinal (GI) tract. CFTR dysfunction resulting from either mutations or the downregulation of its expression has been shown to promote carcinogenesis. An example is the enhanced risk for several types of cancer in patients with CF, especially cancers of the GI tract. CFTR also acts as a tumor suppressor in diverse sporadic epithelial cancers in many tissues, primarily due to the silencing of CFTR expression via multiple mechanisms, but especially due to epigenetic regulation. This review provides an update on the latest research linking CFTR-deficiency to GI cancers, in both CF patients and in sporadic GI cancers, with a particular focus on cancer of the intestinal tract. It will discuss changes in the tissue landscape linked to CFTR-deficiency that may promote cancer development such as breakdowns in physical barriers, microbial dysbiosis and inflammation. It will also discuss molecular pathways and mechanisms that act upstream to modulate CFTR expression, such as by epigenetic silencing, as well as molecular pathways that act downstream of CFTR-deficiency, such as the dysregulation of the Wnt/ß-catenin and NF-κB signaling pathways. Finally, it will discuss the emerging CFTR modulator drugs that have shown promising results in improving CFTR function in CF patients. The potential impact of these modulator drugs on the treatment and prevention of GI cancers can provide a new example of personalized cancer medicine.

Quality Initiative to Reduce Extrauterine Growth Restriction in Very Low Birth Weight Infants.

BACKGROUND: We report a statewide quality improvement initiative aimed to decrease the incidence of extrauterine growth restriction among very low birth weight infants cared for in Tennessee NICUs. METHODS: The cohort consisted of infants born appropriate for gestational age between May 2016 and December 2018 from 9 NICUs across Tennessee. The infants were 23 to 32 weeks gestation and 500 to 1499 g birth weight. The process measures were the hours of life (HOL) when parenteral protein and intravenous lipid emulsion were initiated, the number of days to first enteral feeding, and attainment of full enteral caloric intake (110-130 kcal/kg per day). The primary outcome was extrauterine growth restriction, defined as weight <10th percentile for weight at 36 weeks postmenstrual age. Statistical process control charts and the Shewhart control rules were used to find special cause variation. RESULTS: Although special cause variation was not indicated in the primary outcome measure, it was indicated for the reduction in specific process measures: HOL when parenteral protein was initiated, HOL when intravenous lipid emulsion was initiated, and the number of days to attainment of full enteral caloric intake (among the hospitals considered regional perinatal centers). CONCLUSIONS: A statewide quality improvement initiative led to earlier initiation of parenteral and enteral nutrition and improved awareness of the importance of postnatal nutrition.

Adaptation and Preliminary Validation of the Arabic Version of the Role Checklist Version 3 (RCv3).

Arab occupational therapists are in need either to develop their own outcome measures or to translate well-known outcome measures to their culture. The objective of this study was to translate, cross-culturally adapt, and validate preliminarily the Role Checklist Version 3 (RCv3) into Arabic language. The translation and cross-cultural adaptation process of the RCv3 into Arabic language was conducted in four main steps: (a) forward translation, (b) back translation, (c) expert panel review process, and (d) psychometric testing (Validity). The expert panel established the face validity and the content validity of the Arabic RCv3. Pilot testing was conducted, and the utility and content validity of the tool were confirmed. The final version of the Arabic RCv3 is now available for use in the Arab countries. However, further psychometric properties including reliability and responsiveness of this tool is warranted, thus supporting its wide use and proper application.

Cancer spectrum in TP53-deficient golden Syrian hamsters: A new model for Li-Fraumeni syndrome.

BACKGROUND: The TP53 tumor suppressor gene is the most commonly mutated gene in human cancers. Humans who inherit mutant TP53 alleles develop a wide range of early onset cancers, a disorder called Li-Fraumeni Syndrome (LFS). Trp53-deficient mice recapitulate most but not all of the cancer phenotypes observed in TP53-deficient human cancers, indicating that new animal models may complement current mouse models and better inform on human disease development. MATERIALS AND METHODS: The recent application of CRISPR/Cas9 genetic engineering technology has permitted the emergence of golden Syrian hamsters as genetic models for wide range of diseases, including cancer. Here, the first cancer phenotype of TP53 knockout golden Syrian hamsters is described. RESULTS: Hamsters that are homozygous for TP53 mutations become moribund on average ~ 139 days of age, while hamsters that are heterozygous become moribund at ~ 286 days. TP53 homozygous knockout hamsters develop a wide range of cancers, often synchronous and metastatic to multiple tissues, including lymphomas, several sarcomas, especially hemangiosarcomas, myeloid leukemias and several carcinomas. TP53 heterozygous mutants develop a more restricted tumor spectrum, primarily lymphomas. CONCLUSIONS: Overall, hamsters may provide insights into how TP53 deficiency leads to cancer in humans and can become a new model to test novel therapies.

Coping Behaviors of African Americans With Inflammatory Bowel Disease: A Focused Ethnography.

INTRODUCTION: Increased numbers of African Americans (AAs) are being diagnosed with inflammatory bowel disease (IBD), little is known about the influence of culture on their coping. PURPOSE: To explore the beliefs and experiences of AAs with IBD and coping in the context of their culture. METHOD: Twelve AA adults with IBD were interviewed and observed using focused ethnography. RESULTS: Data analysis revealed four themes: (1) spending time living in the bathroom, (2) time and food restricted eating practices and cultural food avoidance, (3) dealing with chronic stress and perceived racial injustice, and (4) the practice of seclusion to manage bathroom urgency and emotions of fear, anxiety, and embarrassment. DISCUSSION: Participants described coping and culture with experiences similar to other IBD populations, except in the area of perceived racial injustice. Opportunities for nurses to assist with stressors related to bathroom access, cultural eating practices, and participating in activities outside their homes.

Imperatives for Integrating Culture of Health Concepts Into Nursing Education.

BACKGROUND: In all nursing care, nurses should address the social determinants of health that make it difficult for people to lead healthy lives. The Future of Nursing: Campaign for Action recommends transforming nursing education to prepare nurses to address social determinants through building a culture of health. Our study examined integration of culture of health/population health concepts into nursing education and assessed nursing deans' and directors' perceived barriers, facilitators, and readiness to incorporate culture of health into curricula. METHOD: Modified Delphi techniques were used in two neighboring southern states through two rounds of data collection to develop quantitative surveys in each state. RESULTS: Consensus emerged on the need to integrate population/culture of health concepts into nursing curricula. Deans and directors described barriers and facilitators to educational integration. CONCLUSION: Population/culture of health concepts must become a fundamental component of nursing education at all educational levels. [J Nurs Educ. 2020;59(11):605-609.].

A Tristate Education Model to Prepare Nurses to Serve on Health-Promoting Boards.

BACKGROUND: The tristate Nurses on Boards Coalition (NOBC) education program prepares nurses to serve on boards that promote a culture of health, such as housing and transportation authorities, school wellness teams, mental health nonprofits, and planning commissions. METHOD: Three state nursing organizations developed an evidence-informed, innovative, interactive NOBC education model through a review of board service, leadership, and continuing education literature; key informant interviews with national NOBC experts; and evaluation data from previous NOBC education held in our individual states. RESULTS: Attendees in the 2018 and 2019 tristate education programs reported increased knowledge regarding the social determinants of health and how they can influence population health by serving on health-promoting boards. CONCLUSION: The tristate NOBC education is a successful model in preparing nurses to serve on boards that promote a culture of health. [J Contin Educ Nurs. 2020;51(11):528-532.].

Cystic Fibrosis, CFTR, and Colorectal Cancer.

Cystic fibrosis (CF), caused by biallelic inactivating mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, has recently been categorized as a familial colorectal cancer (CRC) syndrome. CF patients are highly susceptible to early, aggressive colorectal tumor development. Endoscopic screening studies have revealed that by the age of forty 50% of CF patients will develop adenomas, with 25% developing aggressive advanced adenomas, some of which will have already advanced to adenocarcinomas. This enhanced risk has led to new CF colorectal cancer screening recommendations, lowering the initiation of endoscopic screening to age forty in CF patients, and to age thirty in organ transplant recipients. The enhanced risk for CRC also extends to the millions of people (more than 10 million in the US) who are heterozygous carriers of CFTR gene mutations. Further, lowered expression of CFTR is reported in sporadic CRC, where downregulation of CFTR is associated with poor survival. Mechanisms underlying the actions of CFTR as a tumor suppressor are not clearly understood. Dysregulation of Wnt/ß-catenin signaling and disruption of intestinal stem cell homeostasis and intestinal barrier integrity, as well as intestinal dysbiosis, immune cell infiltration, stress responses, and intestinal inflammation have all been reported in human CF patients and in animal models. Notably, the development of new drug modalities to treat non-gastrointestinal pathologies in CF patients, especially pulmonary disease, offers hope that these drugs could be repurposed for gastrointestinal cancers.

Role of ion channels in gastrointestinal cancer.

In their seminal papers Hanahan and Weinberg described oncogenic processes a normal cell undergoes to be transformed into a cancer cell. The functions of ion channels in the gastrointestinal (GI) tract influence a variety of cellular processes, many of which overlap with these hallmarks of cancer. In this review we focus on the roles of the calcium (Ca2+), sodium (Na+), potassium (K+), chloride (Cl-) and zinc (Zn2+) transporters in GI cancer, with a special emphasis on the roles of the KCNQ1 K+ channel and CFTR Cl- channel in colorectal cancer (CRC). Ca2+ is a ubiquitous second messenger, serving as a signaling molecule for a variety of cellular processes such as control of the cell cycle, apoptosis, and migration. Various members of the TRP superfamily, including TRPM8, TRPM7, TRPM6 and TRPM2, have been implicated in GI cancers, especially through overexpression in pancreatic adenocarcinomas and down-regulation in colon cancer. Voltage-gated sodium channels (VGSCs) are classically associated with the initiation and conduction of action potentials in electrically excitable cells such as neurons and muscle cells. The VGSC NaV1.5 is abundantly expressed in human colorectal CRC cell lines as well as being highly expressed in primary CRC samples. Studies have demonstrated that conductance through NaV1.5 contributes significantly to CRC cell invasiveness and cancer progression. Zn2+ transporters of the ZIP/SLC39A and ZnT/SLC30A families are dysregulated in all major GI organ cancers, in particular, ZIP4 up-regulation in pancreatic cancer (PC). More than 70 K+ channel genes, clustered in four families, are found expressed in the GI tract, where they regulate a range of cellular processes, including gastrin secretion in the stomach and anion secretion and fluid balance in the intestinal tract. Several distinct types of K+ channels are found dysregulated in the GI tract. Notable are hERG1 upregulation in PC, gastric cancer (GC) and CRC, leading to enhanced cancer angiogenesis and invasion, and KCNQ1 down-regulation in CRC, where KCNQ1 expression is associated with enhanced disease-free survival in stage II, III, and IV disease. Cl- channels are critical for a range of cellular and tissue processes in the GI tract, especially fluid balance in the colon. Most notable is CFTR, whose deficiency leads to mucus blockage, microbial dysbiosis and inflammation in the intestinal tract. CFTR is a tumor suppressor in several GI cancers. Cystic fibrosis patients are at a significant risk for CRC and low levels of CFTR expression are associated with poor overall disease-free survival in sporadic CRC. Two other classes of chloride channels that are dysregulated in GI cancers are the chloride intracellular channels (CLIC1, 3 & 4) and the chloride channel accessory proteins (CLCA1,2,4). CLIC1 & 4 are upregulated in PC, GC, gallbladder cancer, and CRC, while the CLCA proteins have been reported to be down-regulated in CRC. In summary, it is clear, from the diverse influences of ion channels, that their aberrant expression and/or activity can contribute to malignant transformation and tumor progression. Further, because ion channels are often localized to the plasma membrane and subject to multiple layers of regulation, they represent promising clinical targets for therapeutic intervention including the repurposing of current drugs.

The Revised Role Checklist: Improved Utility, Feasibility, and Reliability.

The Role Checklist is used by occupational therapists across the globe. Developed in 1981 and consistent with the Model of Human Occupation (MOHO), until recently, the Role Checklist was not updated. This is of concern as the Role Checklist originally was established to measure role performance. In 2008, Kielhofner, in the fourth edition of A Model of Human Occupation, differentiated occupational performance in 10 roles which clearly fall into occupational participation in the Role Checklist Version 3. The objective of the study was to describe changes and establish utility, feasibility, and reliability of the Role Checklist Version 3. The Role Checklist Version 3 was administered electronically to N = 114 occupational therapists and students. A short time span was used due to sensitivity to history bias. Test-retest reliability using Cohen's Kappa and Cronbach's alpha mirrored analysis done on the original version. Qualitatively, nine themes emerged regarding utility and feasibility. Test-retest reliability is acceptable to excellent for present role incumbency (κ = 0.74-1.00), desired future role engagement (κ = 0.44-1.00), and satisfaction with performance (α = 0.77-0.98). Participants (91%) found it useful for treatment planning and 75% would recommend Version 3 over the original Role Checklist. Data support the Role Checklist Version 3 as a reliable, electronic instrument feasible for occupational therapists to measure participation.

Coping in African Americans With Inflammatory Bowel Disease: An Integrative Review of the Literature.

Given the chronic nature of inflammatory bowel disease, understanding the coping behaviors of individuals affected with the disease is important to influence health outcomes. Although minorities comprise a significant portion of individuals with the disease, little is known about the potential influence of one's culture, specifically among African Americans, on coping with inflammatory bowel disease. This integrative literature review examined the past decade of research related to the coping behaviors of African Americans living with inflammatory bowel disease to identify opportunities for further research. Five studies were identified via database searches of PubMed, PsychInfo, CINAHL, and the Cochrane Library and limited to studies published in English, full-text, peer-reviewed, and adult samples that included African Americans. Findings lacked information specific to coping in African Americans. Results were categorized by coping and disease activity, acquisition of knowledge, and personal coping. An association between poor coping behaviors and active disease was reported. The disease frequently hindered academic pursuits of college students, with increased knowledge about the disease associated with the use of better coping strategies. Personal coping behaviors were reported in stressful social situations, food choices, and religion. Results emphasized the need for future research to explore the influence of culture on the coping behaviors of African Americans with inflammatory bowel disease.

A novel cancer syndrome caused by KCNQ1-deficiency in the golden Syrian hamster.

BACKGROUND: The golden Syrian hamster is an emerging model organism. To optimize its use, our group has made the first genetically engineered hamsters. One of the first genes that we investigated is KCNQ1 which encodes for the KCNQ1 potassium channel and also has been implicated as a tumor suppressor gene. MATERIALS AND METHODS: We generated KCNQ1 knockout (KO) hamsters by CRISPR/Cas9-mediated gene targeting and investigated the effects of KCNQ1-deficiency on tumorigenesis. RESULTS: By 70 days of age seven of the eight homozygous KCNQ1 KOs used in this study began showing signs of distress, and on necropsy six of the seven ill hamsters had visible cancers, including T-cell lymphomas, plasma cell tumors, hemangiosarcomas, and suspect myeloid leukemias. CONCLUSIONS: None of the hamsters in our colony that were wild-type or heterozygous for KCNQ1 mutations developed cancers indicating that the cancer phenotype is linked to KCNQ1-deficiency. This study is also the first evidence linking KCNQ1-deficiency to blood cancers.

High-Flow Nasal Cannula Practice Patterns Reported by Neonatologists and Neonatal Nurse Practitioners in the United States.

BACKGROUND: High-flow nasal cannula (HFNC) is widely used to treat neonatal respiratory conditions. Significant evidence emerged in recent years to guide practice, yet current practice patterns and their alignment with the evidence remain unknown. PURPOSE: To examine current HFNC practice patterns and availability of clinical practice guidelines used in neonatal intensive care units in the United States. METHODS/ANALYSIS: A nonexperimental, descriptive study was designed using a web-based survey to elicit a convenience sample of US neonatal providers. Quantitative data were analyzed using descriptive statistics, χ tests were used to test for differences among the categories, and post hoc comparisons among each combination of categories were conducted using a Bonferroni-corrected α of .05 to determine significance as appropriate. RESULTS: A total of 947 responses were analyzed (626 neonatologists and 321 neonatal nurse practitioners). Univariate analyses suggested wide variations in practice patterns. One-third of the respondents used clinical guidelines, the majority utilized HFNC devices in conjunction with nasal continuous positive airway pressure, more than two-thirds used HFNC as a primary respiratory support treatment, and among all respondents, significant differences related to HFNC device types were reported. IMPLICATIONS FOR PRACTICE: US providers revealed wide practice variations related to HFNC therapy. In addition, type of device used appears to impact practice patterns and approaches. Use of standardized guidelines was reported by one third of the respondents, and as such may be the contributing factor for wide practice variations. IMPLICATIONS FOR RESEARCH: Future Research is needed to target aspects of practice where practice variations exist, or practice is not supported by evidence. Significant practice differences related to the device types should be considered in future research design.

A study of measuring participation according to the International Classification of Functioning, Disability and Health with the Revised Role Checklist.

OBJECTIVE:: To empirically test the hypothesis that the 10 roles on the Revised Role Checklist are represented in the International Classification of Functioning, Disability and Health participation areas. DESIGN:: Cross-sectional survey. SUBJECTS:: Investigators from Japan, Norway, Sweden, Switzerland, the United Kingdom and the United States recruited a total of 295 adults from the general population. There were 103 (34.9%) male and 191 (64.7%) female participants with one participant not indicating gender. The age distribution of participants was from <25 ( n = 68) to 75+ with a mode of 25-34 years. MAIN MEASURE:: The Revised Role Checklist Part 1 was used to assess perceived incumbency in 10 roles. In addition, subjects were asked to provide role examples. RESULTS:: Of the 7087 examples provided by participants, 6578 (92.8%) fit the original hypothesis that the roles in the Revised Role Checklist were covered in participation areas. Fit was determined when the role example was either named in the associated International Classification of Functioning, Disability and Health participation area or when the criteria of: "does this example conceivably fit in the respective area as 'a person's involvement in life situations' fit relative to each role." Slight modification of the scope of three roles of the original hypothesis resulted in a 97.6% match. CONCLUSION:: The roles in the Revised Role Checklist are well represented in the International Classification of Functioning, Disability and Health categories of participation.

TRAP1 regulates autophagy in lung cancer cells.

BACKGROUND: Expression of TRAP1, a member of the HSP90 chaperone family, has been implicated in tumour protective effects, based on its differential mitochondrial localization and function. DESIGN: This work was designed to provide new insights into the pathways involved in TRAP1-provided cytoprotection on NSCLC. For this, TRAP1-depleted A549 human NSCLC cells and MRC-5 normal lung fibroblasts were produced using a siRNA approach and main cellular quality control mechanisms were investigated. RESULTS: TRAP1-depleted A549 cells displayed decreased cell viability likely due to impaired mitochondrial function including decreased ATP/AMP ratio, oxygen consumption and membrane potential, as well as increased apoptotic indicators. Furthermore, the negative impact of TRAP1 depletion on mitochondrial function was not observed in normal MRC-5 lung cells, which might be due to the differential intracellular localization of the chaperone in tumour versus normal cells. Additionally, A549 TRAP1-depleted cells showed increased autophagic flux. Functionally, autophagy inhibition resulted in decreased cell viability in both TRAP1-expressing and TRAP1-depleted tumour cells with minor effects on MRC-5 cells. Conversely, autophagy stimulation decreased cell viability of both A549 and MRC-5 TRAP1-expressing cells while in A549 TRAP1-depleted cells, increased autophagy augmented viability. CONCLUSIONS: Our results show that even though TRAP1 depletion affects both normal MRC-5 and tumour A549 cell proliferation, inhibition of autophagy per se led to a decrease in tumour cell mass, while having a reduced effect on the normal cell line. The strategy of targeting TRAP1 in NSCLC shows future potential therapeutic applications.

Establishing Concurrent Validity of the Role Checklist Version 2 with the OCAIRS in Measurement of Participation: A Pilot Study.

Persons experiencing problems with adaptation following disease, disability, or overwhelming life circumstances are often referred by their physicians to occupational therapists. Given time constraints, therapists may skip administration of a client-centered participation focused assessment and instead use an impairment or limitation focused assessment. This approach assumes that skill remediation will naturally lead to return of participation in valued occupational roles because most participation measures take 30 minutes or longer. In response to the need for an efficient measure of desired role participation, this study establishes concurrent validity of the 10-15-minute Role Checklist Version 2 (RCV2: QP) with the 50 minute Occupational Circumstances Assessment And Rating Scale (OCAIRS) in measuring occupational participation in individuals recovering from surgery following liver transplantation. 20 subjects (mean age of 55 and a mean time-since-transplant of 5.2 months) completed both instruments. The hypothesis was supported (r = .63), showing concurrent validity between the OCAIRS and the RCV2: QP. This provides therapists with an efficient, client-centered measure of occupational participation for a client-centered treatment plan. Using the RCV2: QP in place of the OCAIRS provides a more efficient assessment tool for occupational therapists to set treatment goals and monitor client progress over time.

TeamSTEPPS Virtual Teams: Interactive Virtual Team Training and Practice for Health Professional Learners.

Medical errors because of communication failure are common in health care settings. Teamwork training, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), improves team performance and patient outcomes. Academic institutions seek high-quality, low-cost curricula for interprofessional education (IPE) to prepare learners for clinical experiences before and after graduation; however, most IPE curricula involve lectures, simple tabletop exercises, and in-person simulations and are not readily accessible to geographically distributed and asynchronously engaged learners. To address this need, interprofessional faculty from multiple institutions and specialties created a series of eight screen-based interactive virtual simulation cases featuring typical clinical situations, with the goal of preparing learners to provide safe and effective care in clinical teams. Virtual simulations permit flexible, asynchronous learning on the learner's schedule and allow educators an opportunity to identify gaps in knowledge and/or attitudes that can be addressed during class or forum discussions. In 2016, 1,128 unique users accessed the scenarios. As a result of such virtual activities, learner selection of the appropriate TeamSTEPPS tool increased with progression through the scenarios.

Registered nurses' experiences of organizational change in acute care settings: a systematic review protocol.

REVIEW OBJECTIVE: The objective of this review is to explore how registered nurses working in acute care settings experience organizational change.