Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity.

The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity.

Trends in publication impact of evidence-based healthcare terminology (2013-2022).

AIMS: This article explored the publication impact of evidence-based healthcare terminology to determine usage and discuss options for low usage terms. BACKGROUND: A plethora of terms describe the scholarship of evidence-based healthcare. Several terms are synonyms, creating redundancy and confusion. The abundance and overlap of terms may impede the discovery of evidence. DESIGN: This discursive article explored and discussed publication impact of evidence-based healthcare terms. METHODS: Evidence-based healthcare terms were identified, and their 10-year (2013-2022) publication impact was assessed in the CINAHL and Medline databases. A card sort method was also used to identify terms with low usage. RESULTS: A total of 18/32 terms were included in the review. The terms evidence-based practice, quality improvement, research and translational research were the most highly published terms. Publication data were presented yearly over a 10-year period. Most terms increased in publication use over time, except for three terms whose use decreased. Several terms related to translational research have multiple synonyms. It remains unknown whether these terms are interchangeable and possibly redundant, or if there are nuanced differences between terms. CONCLUSION: We suggest a follow-up review in 3-5 years to identify publication trends to assess context and terms with continued low publication usage. Terms with persistent low usage should be considered for retirement in the reporting of scholarly activities. Additionally, terms with increasing publication trends should be treated as emerging terms that contribute to evidence-based healthcare terminology. IMPLICATIONS FOR NURSING: Confusion about the use of appropriate terminology may hinder progress in the scholarship of evidence-based healthcare. We encourage scholars to be aware of publication impact as it relates to the use of specific terminology and be purposeful in the selection of terms used in scholarly projects and publications.

A Mixed Methods Approach to Understand Mother-Father Relationship and Perceived Stress Among Black Pregnant Women.

BACKGROUND: Black women in the United States report moderate to high levels of perceived stress during pregnancy. Though lower levels of involvement and support from father of the baby (FOB) and higher levels of conflict have been associated with higher levels of maternal perceived stress, it is not clear how Black pregnant women experience the mother-father relationship and its influence on perceived stress. PURPOSE: To examine and describe the mother-father relationship and its role in experiences of perceived stress from the perspective of Black pregnant women. METHODS: Using a convergent, mixed methods approach with ideal-type analysis, we conducted a secondary analysis of data among 60 Black pregnant women enrolled in the Biosocial Impact on Black Births study. Women completed online self-report questionnaires and participated in a semi-structured interview by telephone. RESULTS: Participants who reported more conflict with FOB also reported higher levels of perceived stress (ρ(47) = .431, P= .002). Themes (importance, communication, support, conflict, satisfaction, and stress) emerged from the data. Five distinct mother-father relationship typologies were identified following an ideal-type analysis of the combined dataset: Cared For; Managing Expectations; Just Friends, For the Kids; It's Complicated; and Can't be Bothered. CONCLUSIONS: These findings are an innovative exemplar of ideal-type analysis and provide a deeper understanding of the nuance and dynamics within the mother-father relationship and how it influences perceived stress among Black pregnant women. IMPLICATIONS: Clinicians must recognize the significance of the mother-father relationship and, when appropriate, encourage paternal involvement or intervene if there is conflict during pregnancy.

Effects of chronotype-tailored bright light intervention on post-treatment symptoms and quality of life in breast cancer survivors.

PURPOSE: Bright light therapy holds promise for reducing common symptoms, e.g., fatigue, experienced by individuals with cancer. This study aimed to examine the effects of a chronotype-tailored bright light intervention on sleep disturbance, fatigue, depressive mood, cognitive dysfunction, and quality of life among post-treatment breast cancer survivors. METHODS: In this two-group randomized controlled trial (NCT03304587), participants were randomized to receive 30-min daily bright blue-green light (12,000 lx) or dim red light (5 lx) either between 19:00 and 20:00 h or within 30 min of waking in the morning. Self-reported outcomes and in-lab overnight polysomnography sleep study were assessed before (pre-test) and after the 14-day light intervention (post-test). RESULTS: The sample included 30 women 1-3 years post-completion of chemotherapy and/or radiation for stage I to III breast cancer (mean age = 52.5 ± 8.4 years). There were no significant between-group differences in any of the symptoms or quality of life (all p > 0.05). However, within each group, self-reported sleep disturbance, fatigue, depressive mood, cognitive dysfunction, and quality of life-related functioning showed significant improvements over time (all p < 0.05); the extent of improvement for fatigue and depressive mood was clinically relevant. Polysomnography sleep findings showed that a number of awakenings significantly decreased (p = 0.011) among participants who received bright light, while stage 2 sleep significantly increased (p = 0.015) among participants who received dim-red light. CONCLUSION: The findings support using light therapy to manage post-treatment symptoms in breast cancer survivors. The unexpected symptom improvements among dim-red light controls remain unexplained and require further investigation. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03304587, October 19, 2017.

Exploring cognitive impairment in the early stages of an out-of-hospital cardiac arrest - a consecutive case series study.

Cognitive deficits are common, although often mild, in out-of-hospital cardiac arrest patients. Prevalence and severity of cognitive deficits on discharge from acute hospital, however, are not systematically assessed in clinical practice, and not frequently reported in scientific literature, potentially hindering the development of appropriate follow-up care pathways for these patients. We hereby present data from a consecutive case series of 75 out-of-hospital cardiac arrest patients discharged from our hospital over a period of 16 months; for 46 of them we were able to obtain a cognitive profile around the time of discharge from hospital, with 37 of them experiencing cognitive deficits, ranging from mild to severe. Memory, verbal fluency and cognitive flexibility were the areas more frequently impaired. The patients we were able to assess did not differ for age, cerebral performance category score and time to return of spontaneous circulation from those we were unable to assess. Cognitive deficits were not associated with duration of "no/low blood flow" during cardiac arrest or with age. Our results suggest that cognitive deficits in the immediate aftermath of out-of-hospital cardiac arrest are common; however, these may be missed due to lack of systematic assessment and use of poorly sensitive cognitive tests.

Unintended consequences of the electronic health record and cognitive load in emergency department nurses.

AIM: The study aimed to explore the relationship between the unintended consequences of the electronic health record and cognitive load in emergency department nurses. METHODS: The study utilized a correlational quantitative design with a survey method approach. This study had a 30.4 % response rate for a total of 304 ED nurse participants who were members of a national ED nursing organization. Data analysis included descriptive and correlational measurements of two instruments. RESULTS: In this study, there was a statistically significant, weak negative relationship between CL and UC-EHR in ED nurses, rs (264) = -0.154, p 0.002. Although a significant weak relationship was identified in this study, the study variables, subscales, and demographic data groupings presented moderate-to-strong positive, statistically significant correlations. Descriptive frequency data unveiled EHR stimulated patient safety threats occurring once a week to monthly. CONCLUSIONS: The novelty of this research study provided profound implications for the future of nursing practice, policy, and nursing science. EHR optimization to minimize patient safety risks is recommended with the inclusion of end-users from this study's identified subgroups. The researchers propose a reduction of EHR burden in nursing practice.

Substance use disorders among African-American men in the rural south: A scoping review.

African American (AA) men in the rural South may be at high risk for experiencing adverse health outcomes from substance use (SU). We conducted a scoping review to explore the research on SU among rural AA men in the rural South of the United States (US). Ten articles addressed the following thematic areas pertaining to SU: factors associated with SU (n = 6), associations between substance use and health outcomes (n = 2), and the influence of impulsivity on SU (n = 2). Additional research on SU among AA men in the rural South is needed, particularly pertaining to treatment-related considerations.

Longitudinal and cross-sectional associations between the dietary inflammatory index and objectively and subjectively measured sleep among police officers.

Police officers experience exposures associated with increased inflammation, such as the stress associated with shiftwork and poor-quality diet, both of which have been shown to affect sleep duration and quality. This study examined the longitudinal and cross-sectional effects of the Energy-density Dietary Inflammatory Index (E-DII™) on objectively and subjectively measured sleep among police officers. Data were derived from the Buffalo Cardio-Metabolic Occupational Police Stress Cohort (n = 464 at baseline), with longitudinal data collected from 2004 to 2019. A food frequency questionnaire obtained estimated dietary intake from which E-DII scores were calculated. Dependent variables were objectively (Micro Motion Logger Sleep Watch™) and subjectively (Pittsburgh Sleep Quality Index) measured sleep quality and quantity. The analyses included a series of linear mixed-effects models used to examine cross-sectional and longitudinal associations between the E-DII and sleep quantity and quality. Cross-sectionally, more pro-inflammatory diets were associated with higher wake-after-sleep-onset but improved subjective sleep quality. In models accounting for both longitudinal and cross-sectional effects, for every 1-unit increase in the E-DII scores over time (representing a pro-inflammatory change), wake-after-sleep-onset increased by nearly 1.4 min (p = 0.07). This result was driven by officers who primarily worked day shifts (ß = 3.33, p = 0.01). Conversely, for every 1-unit increase in E-DII score, the Pittsburgh Sleep Quality Index global score improved. More pro-inflammatory diets were associated with increased wake-after-sleep-onset, an objective measure of sleep quality. Intervention studies to reduce dietary inflammatory potential may provide greater magnitude of effect for changes in sleep quality.

A Mixed-Methods Study of Experiences During Pregnancy Among Black Women During the COVID-19 Pandemic.

Pregnant women experienced disruptions in their prenatal care during the coronavirus disease-2019 (COVID-19) pandemic. While there is emerging research about the impact of COVID-19 on experiences of pregnancy, the majority of studies that have reported on prenatal care and birth during COVID-19 have not incorporated the first-person accounts of Black women. The purpose of this mixed-methods study was to explore the perspectives of Black women on prenatal care, labor, and birth during the pandemic. A total of 33 participants completed questionnaires. Fourteen of these 33 women and an additional 2 participated in qualitative interviews. Descriptive statistics and a mixed-methods analysis were employed. Participants expressed disappointment about disruptions in their experiences of pregnancy including the way their prenatal care was experienced, cancellation of planned "rites of passage," and visitor policy restrictions during and after the birth. Forty-five percent of participants reported being worried about getting COVID-19 and (61%) about their infant getting COVID-19. Many participants experienced a sense of loss that may permeate through other aspects of their lives. Providing extra support and points of contact can help lessen feelings of isolation during the pandemic and can also offer more explanation for rapidly changing policies and procedures.

Physical activity changes among non-Hispanic Black pregnant women.

OBJECTIVE: To examine aerobic physical activity (PA) among non-Hispanic Black pregnant women. DESIGN: Longitudinal prospective cohort study. SAMPLE: A subset of 161 non-Hispanic Black pregnant women from the Midwestern US participating in a larger study completed questionnaires about aerobic physical activity (PA) before pregnancy (reported at 24.46±2.13 weeks gestation), mid-pregnancy (24.46±2.13 weeks gestation), and late pregnancy (31.78±1.95 weeks gestation). MEASUREMENTS: Aerobic PA was measured using the Rapid Assessment of Physical Activity (RAPA). RESULTS: Most participants reported being active prior to pregnancy (n = 101, 63%), with 60 (37%) underactive/sedentary. Aerobic RAPA scores were highest pre-pregnancy (3.29±1.11, median = 4, interquartile range [IQR] = 1) compared with mid-pregnancy (3.05±1.26, median = 4, IQR = 2) and late pregnancy (3.05±1.24, median = 4, IQR = 2). Pre-pregnancy scores were significantly higher than mid-pregnancy scores (Wilcoxon test = 1472, p = .008) and late pregnancy scores (Wilcoxon test = 1854, p = .01). CONCLUSION: Most Black pregnant participants reported high levels of aerobic PA both before pregnancy and during pregnancy. However, many were underactive or sedentary. Aerobic PA decreased during pregnancy compared with pre-pregnancy, without the drop in third trimester PA found in other populations. Providers should assess PA across pregnancy and promote adequate PA for maternal and infant health, particularly among Black women.

Sleep and self-care correlates before and after implantation of a left-ventricular assist device (LVAD).

The impact of sleep on LVAD patients' self-care behaviors is unknown. This study examined the patterns and changes of patients sleep quality (SQ), daytime sleepiness (DS), instrumental activities of daily living (IADL), and self-care capability (SCC) before and after LVAD. In addition, the relationships among these variables were explored. This observational study consisted of 38 subjects from two VAD Centers in Michigan. The subjects completed self-reported demographics and psychometrically sound SQ, DS, IADL, and SCC questionnaires before LVAD implant and at 1, 3, and 6 months after implant. Data were analyzed using descriptive statistics, linear mixed models, and partial least square models. Subjects (mean age, 56.3 ± 10.3 years) were predominantly white (63%), male (68%), married (60%), and living with caregivers (92%). Over 70% had axial flow LVADs implanted as bridge-to-transplant (55%). Subjects' SQ was poor throughout the study period, along with high normal-to-excessive levels of DS. Problems with IADL before implant were significantly reduced at 1 through 6 months after implant. SCC ranged from "good" to "excellent" before and after implant. Significant relationships between SQ and IADL (ß = 0.43, p < 0.01) and DS and SCC (ß = - 0.62, p < 0.01) were found. In conclusion, poor SQ and high degrees of DS were prevalent before and up to 6 months after LVAD implant. The data inferred that the improvement in IADL was associated with an improvement in SQ. Research is needed to clarify the negative impact of DS on SCC and explain the contributions of caregivers on patients' SCC over time.

Night-time care routine interaction and sleep disruption in adult cardiac surgery.

AIMS AND OBJECTIVES: To explore the context and the influence of night-time care routine interactions (NCRIs) on night-time sleep effectiveness (NSE) and daytime sleepiness (DSS) of patients in the cardiac surgery critical-care and progressive-care units of a hospital. BACKGROUND: There exists a paucity of empirical data regarding the influence of NCRIs on sleep and associated outcomes in hospitalised adult cardiac surgery patients. METHODS: An exploratory repeated-measures research design was employed on the data provided by 38 elective cardiac surgery patients (mean age 60.0 ± 15.9 years). NCRI forms were completed by the bedside nurses and patients completed a 9-item Visual Analogue Sleep Scale (100-mm horizontal lines measuring NSE and DSS variables). All data were collected during postoperative nights/days (PON/POD) 1 through 5 and analysed with IBM SPSS software. RESULTS: Patient assessment, medication administration and laboratory/diagnostic procedures were the top three NCRIs reported between midnight and 6:00 a.m. During PON/POD 1 through 5, the respective mean NSE and DSS scores ranged from 52.9 ± 17.2 to 57.8 ± 13.5 and from 27.0 ± 22.6 to 45.6 ± 16.5. Repeated-measures ANOVA showed significant changes in DSS scores (p < .05). NSE and DSS were negatively correlated (r = -.44, p < .05), but changes in NSE scores were not significant (p > .05). Finally, of 8 NCRIs, only 1 (postoperative exercises) was significantly related to sleep variables (r > .40, p < .05). CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Frequent NCRIs are a common occurrence in cardiac surgery units of a hospital. Further research is needed to make a definitive conclusion about the impact of NCRIs on sleep/sleep disruptions and daytime sleepiness in adult cardiac surgery. Worldwide, acute and critical-care nurses are well positioned to lead initiatives aimed at improving sleep and clinical outcomes in cardiac surgery.

An exploratory study of the patients' sleep patterns and inflammatory response following cardiopulmonary bypass (CPB).

AIMS AND OBJECTIVES: To describe sleep patterns and inflammatory response postCPB, determine sleep pattern changes and inflammatory response over time and explore relationships between sleep and biomarkers of stress and inflammation. BACKGROUND: Despite the numerous citations of the role of sleep in restoration and health maintenance, a paucity of research exists about this phenomenon in patients undergoing CPB. Specifically, there is no research that has explored correlations between sleep patterns and systemic inflammatory response in adult cardiac surgery patients. DESIGN: Exploratory, repeated-measures, correlational study. METHOD: Subjects were recruited from a Midwestern urban hospital. Of the 25 eligible subjects, 16 males and four females completed the study. Wrist actigraphy was used to measure sleep variables. Salivary cortisol and C-reactive protein (C-RP) levels were measured daily. Data were collected during postoperative nights/days 1 through 4 (T1-T4). RESULTS: Subjects' sleep onset latency (SOL) median scores (0 minute) were within normal range across time periods, whereas median scores for wake after sleep onset (WASO > 270 minutes), sleep fragmentation index (SFI >51%), total sleep time (<153 minutes) and sleep efficiency index (SEI <36%) fell outside the normal ranges. Changes in the median sleep scores over time, however, were not significant at p > 0·05. Median cortisol levels were within normal range (0·3-0·8 µg/dl) from T1-T4, but the C-RP level peaked at T2 (median = 2370 pg/ml). Strong correlations were found: (1) between SFI-cortisol (rs = 0·82), C-RP (rs = 0·65) - WBC (rs = 0·69); (2) between SEI-C-RP (rs = 0·58); (3) between WASO-WBC (rs = 0·48), WASO and cross-clamp time (rs = 0·50); and (4) between SOL-age (rs = -0·55) at p < 0·05. CONCLUSIONS: Subjects were severely sleep-deprived with inflammatory response exaggerations warranting further investigations using larger sample sizes. RELEVANCE TO CLINICAL PRACTICE: This study offers a foundation for developing a conceptual model explaining mechanisms of sleep disturbance and inflammatory response postCPB. This knowledge is crucial for testing sleep-promoting interventions to modulate inflammatory responses essential for preventing complications, and restoring health.

Profile of the average organ non-donor: can it be used predictively?

OBJECTIVE: To describe the profile of the average organ non-donor, compare it to that of the average donor, and identify characteristics that predict the likelihood that a given individual will be a non-donor. METHODS: The charts of 397 consenting potential organ donors of LifeLink of Puerto Rico from 2009 through 2011 were reviewed. Data regarding gender, age, BMI, the presence of diabetes, hypertension and/or kidney injury, death from cerebrovascular accident, and smoking were collected. RESULTS: Of the 397 charts reviewed, 283 were from donors, 96 were from non-donors, and 18 were excluded from the analysis. When compared to donors, non-donors were found more frequently to be 60 years old or older, diabetic, hypertensive, or obese; to have suffered from kidney injury, to have smoked and to have died of a cerebrovascular accident. On multivariate analysis, age, diabetes, kidney injury and smoking remained significant. However, after adjusting for age, only smoking and death from cerebrovascular accident remained statistically associated to non-donor status. CONCLUSION: Although being over 60 years old, having smoked and dying from a cerebrovascular accident were characteristics found significantly more frequently in non-donors, these characteristics were also present in some donors. Therefore, a careful evaluation of each potential donor is still mandatory to avoid the loss of transplantable organs.

Racial and gender differences in relapse potential and treatment acceptance among rural residents in a substance use disorder treatment program.

PURPOSE: To examine racial and gender differences in treatment acceptance and relapse potential among rural residents admitted to a substance use disorder (SUD) treatment program. METHODS: A cross-sectional study using data collected from a sample of 1850 rural residents admitted to a South Carolina state-run SUD treatment center between the years of 2018 and 2020. Chi-square and t-tests were used to compare treatment acceptance and relapse potential by race and gender. Multivariate logistic regression analyses was conducted to further examine the relationship of race and gender with treatment acceptance and relapse potential after adjusting for potential confounding variables. FINDINGS: Approximately 50% of participants were classified as being accepting of their treatment and committed to changing their substance use, and there were no racial or gender differences in the bivariate and multivariate analyses. Approximately 25% of participants were classified as having low/no potential risk for relapsing, and there were no racial or gender differences in the bivariate analysis. However, the adjusted odds ratio of relapsing risk were lower among White compared to Black adults [AOR = 0.49 with 95% CI (0.31-0.77)]. CONCLUSION: This study suggests there are no gender or racial differences in treatment acceptance for SUD but that Black adults are at greater risk of relapsing relative to White adults. Additional research is needed to identify factors that increase Black adults' risk for relapse to inform interventions that can improve SUD treatment outcomes in this population.

Pilot Study of the FitMoms2B Physical Activity Promotion Program Among Black Women With High-Risk Pregnancies.

OBJECTIVE: To explore the feasibility of recruitment, adherence, and retention and the acceptability of the FitMoms2B physical activity promotion program and study measures among non-Hispanic Black women with high-risk pregnancies. DESIGN: One-arm pilot feasibility study. SETTING: A large regional high-risk prenatal clinic in the southeastern United States. PARTICIPANTS: Non-Hispanic Black women who had singleton, high-risk pregnancies at 16 to 23 weeks gestation with no contraindications to physical activity (N = 13). METHOD: We evaluated the feasibility and acceptability of a multicomponent intervention, which included physical activity coaching, support from a workout partner, and an activity tracker. We also assessed the feasibility of study measures for future trials of the program. RESULTS: Of 179 patients screened, 20 were eligible, and 13 consented and enrolled (65%). Of the 13 participants, 9 completed data collection at Time Point (T) 1 (16-23 weeks gestation) and T2 (24-30 weeks), and 8 completed data collection at T3 (31 or more weeks). Adherence met expectations for coaching (63%), exercise with a workout partner (100%), and use of the activity tracker (92%). Acceptability was high (100%). CONCLUSION: We found that recruitment, retention, and adherence are feasible for the FitMoms2B physical activity promotion program. The program and study measures were acceptable to participants in our sample. We provide preliminary support for a randomized controlled trial to study physical activity promotion with virtual coaching, workout partner support, and activity tracking among Black pregnant women with high-risk pregnancies without contraindications to physical activity.

Dietary inflammatory index (DII) and sleep quality, duration, and timing: A systematic review.

Sleep has strong inflammatory underpinnings and diet is one of the primary determinants of systemic inflammation. A systematic literature review was conducted to synthesize current research associating dietary inflammatory potential, as measured by the dietary inflammatory index (DII®) or the energy-adjusted DII (E-DII™) and sleep quality and duration. The National Library of Medicine (Medline), Web of Science, and PsycInfo databases were searched through March 2023. Studies must have used the DII/E-DII as the independent variable and sleep outcomes as dependent variables. Study characteristics, based on STROBE guidelines, were scored based on the presence of the recommendation. Out of the initial 14 studies identified, a total of 12 studies were included for data synthesis. In all 12 studies, more anti-inflammatory diets (i.e., low DII/E-DII scores) were associated with better sleep in at least one sleep domain (most often sleep efficiency and wake-after-sleep-onset). Among those studies with more rigorous diet and sleep measurements, such as dietary recalls and actigraphy, associations between DII/E-DII and sleep outcomes were stronger and more consistent compared to studies using primarily subjective assessments. More rigorous measurement of diet and sleep, especially those relating to sleep stage structure, should be considered in future studies with prospective designs.

Definition, prevalence and characteristics of sudden exhaustion: a possible syndrome of fatigue in cancer?

PURPOSE: Although sudden fatigue/exhaustion is a symptom expression that oncology clinicians frequently hear from their patients, empirical information about this phenomenon is limited. This study investigated the occurrence and characteristics of sudden fatigue in patients treated for breast cancer. METHODS: This cross-sectional descriptive study enrolled 114 breast cancer chemotherapy outpatients from a cancer clinic and an urban teaching hospital in the Midwestern United States. Subjects were screened for sudden fatigue and completed an investigator-developed Sudden Onset of Fatigue Questionnaire on the day of their chemotherapy treatment. Descriptive statistics were used to examine prevalence and clinical characteristics. RESULTS: Approximately half (46 %) of the patients (age 31-67, 62 % Black, and 70 % unemployed) experienced sudden fatigue. The majority (81 %) reported more than one (median = 3) episode per day; 67 % of episodes lasted 60 min or less. The sudden fatigue was most likely (77 %) to occur between 10 a.m. and 5 p.m., while individuals were active (94 %). When it occurred, individuals stopped activities and sought immediate rest. It was described as abrupt exhaustion/weakness often (66 %) accompanied by other symptoms. Fatigue intensity before, during, and after a specific episode were 5, 9, and 5, respectively, on 0-10 (highest) scale. CONCLUSIONS: To better characterize sudden fatigue, a new descriptor, sudden exhaustion syndrome, which encompasses observed abrupt onset, transitory exhaustion/paralysis, and multiple symptoms, is proposed. Individuals may experience multiple occurrences of sudden exhaustion across a day, especially during activities. The syndrome needs to be recognized by oncology professionals. Patients should be educated about the syndrome to enhance sense of control and prevent harm.

Effects of Chronotype-tailored Bright Light Intervention on Symptoms and Quality of Life in Breast Cancer Survivors.

Purpose: Bright light therapy holds promise for reducing common symptoms, e.g., fatigue, experienced by individuals with cancer. This study aimed to examine the effects of a chronotype-tailored bright light intervention on sleep disturbance, fatigue, depressive mood, cognitive dysfunction, and quality of life among post-treatment breast cancer survivors. Methods: In this two-group randomized controlled trial (NCT03304587), participants were randomized to receive 30-min daily bright blue-green light (12,000 lux) or dim red light (5 lux) either between 19:00-20:00 h or within 30 min of waking in the morning. Self-reported outcomes and in-lab overnight polysomnography sleep study were assessed before (pre-test) and after the 14-day light intervention (post-test). Results: The sample included 30 women 1-3 years post-completion of chemotherapy and/or radiation for stage I to III breast cancer (mean age = 52.5 ± 8.4 years). There were no significant between-group differences in any of the symptoms or quality of life (all p > 0.05). However, within each group, self-reported sleep disturbance, fatigue, and depressive mood, and quality of life-related functioning showed significant improvements over time (all p < 0.01); the extent of improvement for fatigue and depressive mood was clinically relevant. Polysomnography sleep findings showed that number of awakenings significantly decreased (p = 0.011) among participants received bright light, while stage 2 sleep significantly increased (p = 0.015) among participants received dim-red light. Conclusion: The findings provide some evidence to support using chronotype-tailored light therapy to manage sleep disturbance, fatigue, depressive mood in post-treatment breast cancer survivors. The unexpected symptom improvements among dim-red light controls remain unexplained and requires further investigation. ClinicalTrialsgov Identifier: NCT03304587 Study was registered on October 19, 2017.

Primary care nurse practitioner practices to lower type 2 diabetes risks in women with a history of gestational diabetes mellitus.

BACKGROUND: Women with a gestational diabetes mellitus (GDM) history have increased lifetime type 2 diabetes (T2D) risk, with 16 times greater risk 3 to 6 years after the pregnancy, compared with women without GDM. Offspring from diabetes-complicated pregnancies also face increased health risks. PURPOSE: The study purpose was to describe the primary care practices of nurse practitioners (NPs) aimed at reducing T2D-related health risks in women with a history of GDM. METHODOLOGY: Florida-licensed primary care NPs (n = 47) completed a 57-item online survey that included an 8-item scale about recommended practices to reduce T2D risks for women with GDM history. Descriptive statistics, Chi Square test, and Fisher exact test were conducted. RESULTS: Most (67%) participants "often/always" screened for T2D every 1-3 years per guidelines, but only 31.8% "often/always" advised about pregnancy planning/preconception T2D assessment. Compared with "none" or ≤2 hours of GDM care education, participants with >2 hours were more likely (p < .05) to "often/always" perform five recommended practices: 1) counsel about increased T2D risks; 2) educate about self-advocacy for T2D screening; 3) T2D screening every 1-3 years; 4) counsel about breastfeeding to reduce T2D risk; and 5) discuss postpartum weight loss and increased physical activity to lower T2D risk. CONCLUSION: Findings indicate inconsistent care practices and suggest that >2 hours of education about care of women with GDM history may increase primary care NPs performing recommended practices to reduce T2D risks and prevent health problems for women and future offspring. IMPLICATIONS: Nurse practitioner education is needed involving care of women with GDM history to mitigate risks for T2D.