Developing a Statewide Research Compendium: Key Points and Steps for Success.

Engaging clinical nurses in nursing research requires value for the nurses and a structured process. One way to involve nurses in research is through development of a research compendium. A professional development specialist can lead the creation of a research compendium. Identifying key stakeholders, developing a technologic infrastructure, piloting the compendium, gaining feedback, and identifying outcomes that will be evaluated are key. [J Contin Educ Nurs. 2022;53(3):106-108.].

COVID-19's Impact on American Women's Food Insecurity Foreshadows Vulnerabilities to Climate Change.

The COVID-19 pandemic is wreaking havoc on human lives and the global economy, laying bare existing inequities, and galvanizing large numbers to call for change. Women are feeling the effects of this crisis more than others. This paper explores the pre-COVID relationships and amplified negative feedback loops between American women's economic insecurity, lack of safety, and food insecurity. We then examine how COVID-19 is interacting with these intersecting risks and demonstrate how climate change will likely similarly intensify these feedback loops. The COVID-19 pandemic may be revealing vulnerabilities that societies will face in the wake of an increasingly warming world. It is also an opportunity to build resilience, inclusiveness, and equity into our future, and can help inform how to include gender equity in both COVID-19 and climate recovery policies. Finally, we identify possible strategies to build resilience, specifically highlighting that gendered economic empowerment may create a buffer against environmental health hazards and discuss how these strategies could be integrated into a women-centered Green New Deal.

A prognostic information system for real-time personalized care: Lessons for embedded researchers.

Embedded researchers could play a central role in developing tools to personalize care using electronic medical records (EMRs). However, few studies have described the steps involved in developing such tools, or evaluated the key factors in success and failure. This case study describes how we used an EMR-derived data warehouse to develop a prototype informatics tool to help oncologists counsel patients with pancreatic cancer about their prognosis. The tool generated real-time prognostic information based on tumor type and stage, age, comorbidity status and lab tests. Our multidisciplinary team included embedded researchers, application developers, user experience experts, and an oncologist leader.This prototype succeeded in establishing proof of principle, but did not reach adoption into actual practice. In pilot testing, oncologists succeeded in generating prognostic information in real time. A few found it helpful in patient encounters, but all identified critical areas for further development before implementation. Generalizable lessons included the need to (1) include a wide range of potential use cases and stakeholders when selecting use cases for such tools; (2) develop talking points for clinicians to explain results from predictive tools to patients; (3) develop ways to reduce lag time between events and data availability; and (4) keep the options presented in the user interface very simple. This case demonstrates that embedded researchers can lead collaborations using EMR-derived data to create systems for real-time personalized patient counseling, and highlights challenges that such teams can anticipate.

Developing a Prognostic Information System for Personalized Care in Real Time.

CONTEXT: Electronic medical records hold promise to transform clinical practice. However, technological and other barriers may preclude using them to guide care in real time. We used the Virtual Data Warehouse (VDW) to develop a tool that enables physicians to generate real-time, personalized prognostic information about survival after cancer. CASE DESCRIPTION: Patients with cancer often ask their oncologists, "Have you ever seen a patient like me?" To help oncologists answer this question, we developed a prototype Prognostic Information System (PRISM), a web-based tool that gathers data about the index patient from Kaiser Permanente's clinical information systems, selects a historical cohort of similar patients, and displays the survival curve of the similar patients relative to key points in their treatment course. FINDINGS AND MAJOR THEMES: The prototype was developed by a multidisciplinary team with expertise in oncology, research, and technology. We have completed two rounds of user testing and refinement. Successful development rested on: (1) executive support and a clinical champion; (2) collaboration among experts from multiple disciplines; (3) starting with simple cases rather than ambitious ones; (4) extensive research experience with the Virtual Data Warehouse, related databases, and an existing query tool; and (5) following agile software development principles, especially iterative user testing. CONCLUSION: Clinical data stored in health care systems' electronic medical records can be used to personalize clinical care in real time. Development of prognostic information systems can be accelerated by collaborations among researchers, technology specialists, and clinicians and by use of existing technology like the Virtual Data Warehouse.

Impact of a continence training program on patient safety and quality.

PURPOSE: The purpose of this study is to examine the impact of an evidence-based training program on patient outcomes of continence, falls, and discharge disposition in the rehab population. METHODS: Criteria for inclusion required new onset of two or more episodes of urinary incontinence. Sixty-six subjects were enrolled with 33 subjects receiving evidence-based interventions. RESULTS: The intervention group showed improvement in continence (p = .020), with no difference between groups on discharge disposition (p = .744). Results showed an unexpected higher occurrence of falls in the treatment group (p = .000). DISCUSSION AND CLINICAL RELEVANCE: This study supports existing literature indicating that continence is not an independent predictor of nursing home admission and offers new evidence that use of an evidence-based intervention bundle can significantly improve patient continence including those patients with mild to moderate cognitive impairment.

Serotonin influences locomotion in the nudibranch mollusc Melibe leonina.

Serotonin (5-HT) influences locomotion in many animals, from flatworms to mammals. This study examined the effects of 5-HT on locomotion in the nudibranch mollusc Melibe leonina (Gould, 1852). M. leonina exhibits two modes of locomotion, crawling and swimming. Animals were bath-immersed in a range of concentrations of 5-HT or injected with various 5-HT solutions into the hemolymph and then monitored for locomotor activity. In contrast to other gastropods studied, M. leonina showed no significant effect of 5-HT on the distance crawled or the speed of crawling. However, the highest concentration (10(-3) mol l(-1) for bath immersion and 10(-5) mol l(-1) for injection) significantly increased the time spent swimming and the swimming speed. The 5-HT receptor antagonist methysergide inhibited the influence of 5-HT on the overall amount of swimming but not on swimming speed. These results suggest that 5-HT influences locomotion at the behavioral level in M. leonina. In conjunction with previous studies on the neural basis of locomotion in M. leonina, these results also suggest that this species is an excellent model system for investigating the 5-HT modulation of locomotion.

Femoral lengthening over a humeral intramedullary nail in preadolescent children.

BACKGROUND: Femoral lengthening over an intramedullary nail has been described in adults. A technique of femoral lengthening over a humeral intramedullary nail in children is described, and the results and complications are presented. METHODS: Nine preadolescent patients (average age, nine years and ten months) with femoral length discrepancy were treated with femoral lengthening over a humeral intramedullary nail. After nail insertion, a monolateral external fixator was placed with half-pins either anterior or posterior to the intramedullary nail, and lengthening was performed through a proximal osteotomy. RESULTS: The femora were lengthened a mean of 6.1 cm (range, 5.0 to 8.0 cm), 19.5% (range, 15.9% to 26.2%) of the preoperative femoral length. Patients had a mean lengthening index of 12.2 days/cm of length (range, 9.5 to 16.9 days/cm of length). Five complications including osteomyelitis, failure of the distal interlocking site, and femoral fracture at the distal end of the nail occurred in four patients; four of the complications led to surgical intervention. No case of proximal femoral valgus secondary to nailing through the greater trochanter had developed by the time of final follow-up. All patients were followed for a minimum of two years postoperatively, with a mean of 128 weeks (range, 111 to 161 weeks). CONCLUSIONS: The technique is effective but has a high rate of complications, including osteomyelitis, which developed in two of the nine patients. No avascular necrosis or proximal femoral valgus was noted.