Teaming Up for Community Health Simulation Intervention: A Quasi-Experimental Study.

AIM: The aim of this study was to examine whether participating in a team-based simulation intervention would improve nursing students' empathy and commitment to addressing social determinants of health (SDOH) and interprofessional teamwork attitudes, beliefs, and behaviors. Outcomes were compared for intraprofessional versus interprofessional team participation. BACKGROUND: Nursing students must learn strategies to address SDOH, but this content is not well integrated in curricula. Teaming Up for Community Health was created to provide SDOH experiential team learning. METHOD: Eighty-five nursing students participated in the intraprofessional comparison group or interprofessional intervention group. Surveys were completed before and after the intervention and two months later. RESULTS: Participants had heightened empathy and commitment to addressing SDOH at baseline. Interprofessional teamwork beliefs and behaviors improved for both groups. CONCLUSION: Experiential learning about SDOH should focus on improving students' self-confidence and performance. Based on the study results, experiential team learning should be threaded through curricula.

Preparing nursing students for home health using an escape room: A qualitative study.

BACKGROUND: As healthcare continues to shift from hospitals to community settings, it is vital to prepare nursing students for community-based care, including home health. DESIGN AND OBJECTIVES: This exploratory descriptive qualitative study examined students' experiences with a home health escape room and their perceptions of how the experience affected their learning. METHODS: To escape the simulated apartment residence, student teams solved three challenges related to fall risks, food insecurity, and polypharmacy. Sixteen baccalaureate nursing students participated in focus groups and thematic analysis was conducted. RESULTS: Four themes emerged: Being in the home and taking it all in; Elements that maximized thinking; Practicing and reflecting on teamwork; and Using lessons learned. CONCLUSIONS: Simulated escape rooms offer a unique way to provide experiential learning to prepare students for home health clinical experiences.

Driving Access to Care: Use of Mobile Units for Urine Specimen Collection During the Coronavirus Disease-19 (COVID-19) Pandemic.

Patients with substance use disorders (SUD) are at increased risk of both coronavirus disease-19 complications as well as exacerbations of their current conditions due to social distancing and isolation. Innovations that provide increased access to support substance use disorder patients may mitigate long-term sequelae associated with continued or renewed drug use. To improve patient access during the coronavirus disease-19 pandemic, we deployed a mobile unit to enable access to urine drug testing where needed for patients suffering from substance use disorder. Over a 3-week pilot program, 54 patients received urine drug testing across 5 providers and 8 zip codes. The mobile unit was cost-effective, demonstrating a volume-dependent 19% lower cost compared to pre-coronavirus disease-19 patient service centers in a similar geographic region. The mobile unit was well-received by patients and providers with an average of 9 out of 10 satisfaction scores and allowed for access to urine drug testing for 67% patients who would not have received testing during this time frame. No statistically significant differences were found in substance use positivity rates in comparison to pre-coronavirus disease findings; however, some shifts in use included higher rates of fentanyl and opioid positivity and reductions in tetrahydrocannabinol and cocaine use in the mobile collections setting. Deployment of mobile collection services during the coronavirus disease-19 pandemic has shown to be an effective mechanism for supporting patients suffering from substance use disorder, allowing for access to care of this often stigmatized, vulnerable population.

Integrating Social Determinants of Health and Laboratory Data: A Pilot Study To Evaluate Co-Use of Opioids and Benzodiazepines.

As the opioid crisis continues to have devastating consequences for our communities, families, and patients, innovative approaches are necessary to augment clinical care and the management of patients with opioid use disorders. As stewards of health analytic data, laboratories are uniquely poised to approach the opioid crisis differently. With this pilot study, we aimed to bridge laboratory data with social determinants of health data, which are known to influence morbidity and mortality of patients with substance use disorders. For the purpose of this pilot study, we focused on the co-use of opioids and benzodiazepines, which can lead to an increased risk of fatal opioid-related overdoses and increased utilization of acute care. Using the laboratory finding of the copresence of benzodiazepines and opioids as the primary outcome measure, we examined social determinants of health attributes that predict co-use. We found that the provider practice that ordered the laboratory result is the primary predictor of co-use. Increasing age was also predictive of co-use. Further, co-use is highly prevalent in specific geographic areas or "hotspots." The prominent geographic distribution of co-use suggests that targeted educational initiatives may benefit the communities in which co-use is prevalent. This study exemplifies the Clinical Lab 2.0 approach by leveraging laboratory data to gain insights into the overall health of the patient.

A free-boundary model of a motile cell explains turning behavior.

To understand shapes and movements of cells undergoing lamellipodial motility, we systematically explore minimal free-boundary models of actin-myosin contractility consisting of the force-balance and myosin transport equations. The models account for isotropic contraction proportional to myosin density, viscous stresses in the actin network, and constant-strength viscous-like adhesion. The contraction generates a spatially graded centripetal actin flow, which in turn reinforces the contraction via myosin redistribution and causes retraction of the lamellipodial boundary. Actin protrusion at the boundary counters the retraction, and the balance of the protrusion and retraction shapes the lamellipodium. The model analysis shows that initiation of motility critically depends on three dimensionless parameter combinations, which represent myosin-dependent contractility, a characteristic viscosity-adhesion length, and a rate of actin protrusion. When the contractility is sufficiently strong, cells break symmetry and move steadily along either straight or circular trajectories, and the motile behavior is sensitive to conditions at the cell boundary. Scanning of a model parameter space shows that the contractile mechanism of motility supports robust cell turning in conditions where short viscosity-adhesion lengths and fast protrusion cause an accumulation of myosin in a small region at the cell rear, destabilizing the axial symmetry of a moving cell.