Using machine-learning methods to predict in-hospital mortality through the Elixhauser index: A Medicare data analysis.

Accurate in-hospital mortality prediction can reflect the prognosis of patients, help guide allocation of clinical resources, and help clinicians make the right care decisions. There are limitations to using traditional logistic regression models when assessing the model performance of comorbidity measures to predict in-hospital mortality. Meanwhile, the use of novel machine-learning methods is growing rapidly. In 2021, the Agency for Healthcare Research and Quality published new guidelines for using the Present-on-Admission (POA) indicator from the International Classification of Diseases, Tenth Revision, for coding comorbidities to predict in-hospital mortality from the Elixhauser's comorbidity measurement method. We compared the model performance of logistic regression, elastic net model, and artificial neural network (ANN) to predict in-hospital mortality from Elixhauser's measures under the updated POA guidelines. In this retrospective analysis, 1,810,106 adult Medicare inpatient admissions from six US states admitted after September 23, 2017, and discharged before April 11, 2019 were extracted from the Centers for Medicare and Medicaid Services data warehouse. The POA indicator was used to distinguish pre-existing comorbidities from complications that occurred during hospitalization. All models performed well (C-statistics >0.77). Elastic net method generated a parsimonious model, in which there were five fewer comorbidities selected to predict in-hospital mortality with similar predictive power compared to the logistic regression model. ANN had the highest C-statistics compared to the other two models (0.800 vs. 0.791 and 0.791). Elastic net model and AAN can be applied successfully to predict in-hospital mortality.

A 10-year examination of a one-on-one grant writing partnership for nursing pre- and post-doctoral trainees.

BACKGROUND: The training and mentoring of pre- and post-doctoral trainees in nursing research is essential to feed the pipeline of nurses prepared to launch an independent program of research. PURPOSE: The purpose of this report is to describe a one-on-one grant writing Partnership developed in a school of nursing targeting pre- and post-doctoral trainees and quantify its impact on funding rates. METHODS: The Partnership includes four key elements: regular meetings, setting a timeline with milestones, writing and editing support, and attention to administrative documents. Forty grant applications by pre- and post-doctoral trainees were developed and submitted from 2011 to 2020. FINDINGS: Among Partnership participants, 81.0% (17/21) received funding as compared with 42.1% (8/19) who did not participate, p = .02. DISCUSSION: Schools of nursing and other disciplines should consider investing in a Partnership to provide grant writing support their pre- and post-doctoral trainees and increase their overall research capacity.

Programmatic details and outcomes of an Academic-Practice Research Fellowship for clinical nurses.

AIM: Describe the programmatic details and outcomes of a competitive, two-year Academic-Practice Research Fellowship for clinical nurses. BACKGROUND: Numerous barriers challenge clinical nurses in their ability to conduct and disseminate research. We describe and evaluate a competitive, semi-structured, two-year Academic-Practice Research Fellowship in which clinical nurse 'fellows' accepted into the program are paired with a faculty mentor at a school of nursing to conduct and disseminate a research study that addresses a clinical problem identified by the fellow. The fellowship is facilitated by the Director of Academic-Practice Partnerships jointly appointed between a school of nursing and affiliated acute care hospitals, and with resources provided by both. The vast majority of didactic training is provided outside the classroom. METHODS: We reviewed administrative records to describe the programmatic details and outcomes of the program. RESULTS: Thirteen nurses were accepted into the first three cohorts of the Academic-Practice Research Fellowship. Among the five fellows in the graduating first cohort, all successfully completed their research, presented their findings at national or international conference(s) and four have submitted manuscripts for publication, with two being accepted for publication. The eight current fellows are meeting all delineated milestones and timelines. Evaluations demonstrate the effectiveness of the fellowship in enhancing the professional development and research capacity of clinical nurses. CONCLUSIONS: The Academic-Practice Research Fellowship program integrates expertise and resources across academia and practice and has resulted in the successful conduct and dissemination of clinically relevant research by fulltime practicing nurses in the acute care setting.

Promoting nursing research globally: the writing to improve nursing science (WINS) program.

AIM: To test the feasibility of a remote writing programme, Writing to Improve Nursing Science (WINS), for nursing scholars in low- and middle-income countries and assess its impact on scholarly writing and dissemination. BACKGROUND: The ability to write and publish scholarly manuscripts is critical for successful nursing research careers. Yet, there is a lack of resources to appropriately mentor nurse scholars in this area. This is especially true for low- and middle-income countries with fewer resources and a dearth of doctorally prepared nursing faculty. INTRODUCTION: We adapted an existing university-based writing class to mentor 10 nurse scientists through the writing and publication process utilizing three components: online didactic training, remote one-to-one mentorship and an in-person peer-reviewed writing workshop. METHODS: Ten nurse faculty from 10 countries selected via competitive application developed manuscripts with remote mentorship and online training for 6 months. Then, an in-person workshop was held to conduct peer reviews of manuscripts. Mentorship continued for an additional year until the manuscript was either published or the participant no longer wished to pursue publication. RESULTS: All participants prepared a manuscript and were trained in manuscript writing, editing, and the peer review and submission process. To date, four manuscripts have been published. DISCUSSION: The Writing to Improve Nursing Science Program is a feasible model to increase publications among nursing faculty or students globally and allow the sharing of resources across countries. CONCLUSION AND IMPLICATIONS FOR NURSING POLICY: Innovative solutions for sharing of intellectual resources, such as this program may contribute to improving the evidence base globally. Nursing research policies should include a mentorship component to increase publications to improve nursing practice and related patient outcomes.

Intramural pilot funding and internal grant reviews increase research capacity at a school of nursing.

BACKGROUND: Strategies for increasing research capacity such as internal funding mechanisms and internal peer reviews for grants are essential for schools of nursing. Although these are documented in the literature, their processes and outcomes have not been reported. PURPOSE: The purposes of this study were to describe three protocols for building research capacity at a school of nursing-intramural pilot grants, Specific Objectives and Aims Reviews, and mock reviews-and quantify their outcomes. METHODS: We assessed outcome data on 14 intramural pilot grants and 88 external grant applications from 2012 to 2016. FINDINGS: Pilot grants produced 16 peer-reviewed articles, 33 presentations, and 11 funded grants. For grant applications that underwent any type of internal review, 41.7% (20/48) received funding compared with 20% (8/40) that did not participate, p = .03. Given the resources required to prepare grant applications, internal funding and reviews can enhance return on investment. CONCLUSION: Schools of nursing should consider implementing intramural pilot grants and internal review sessions.

Time and costs of preparing and submitting an NIH grant application at a school of nursing.

BACKGROUND: Schools of nursing spend considerable time and finances pursuing federal research funding, yet the costs of such efforts are unknown. PURPOSE: The purpose of this study was to determine the time and costs to a school of nursing to prepare a National Institutes of Health grant application. METHOD: We prospectively recorded time and calculated costs in grant preparation undertaken by principal investigators and research administrators in one school of nursing. RESULTS: Principal investigators' time ranged from 69.8 to 162.3 hr, research administrators' time ranged from 33.9 to 56.4 hr, and costs ranged from $4,784 to $13,512 per grant. With funding rates of 5% to 15%, costs for one funded R01 would be $72,460 to $270,240. DISCUSSION: Grant writing activities represent a major time commitment to faculty and staff and costs to the school. To maximize potential for success, schools of nursing must provide costly resources to support its grant writing enterprise. CONCLUSIONS: Less costly and more efficient models of attaining research funding are needed for the sustainability of the nursing profession.

NIH Funding Ranked "Per Capita": An Alternative Method for Assessing Research Productivity.

Ordinal rankings of schools of nursing by research funding in total dollars awarded by the National Institutes of Health (NIH) is a common metric for demonstrating research productivity; however, these data are not based on the number of doctorally prepared faculty eligible to apply for funding. Therefore, we examined an alternative method for measuring research productivity which accounts for size differences in schools: NIH funding ranked "per capita." We extracted data on total average funding and compared them with average funding secured per faculty member across top-ranked schools of nursing in the United States from 2013 to 2017. When examining data by number of doctorally prepared faculty, 4 of 12 (33%) schools that ranked lower in total average funding ranked higher in average funding per faculty member. School size is an important but neglected factor in current funding rankings; therefore, we encourage schools to use multiple approaches to track their research productivity.

Supporting dissertation work through a nursing PhD program federal grant writing workshop.

BACKGROUND: Nurse researchers need skills to secure external funding; therefore, we created a grant writing workshop for PhD students focused on the F31 Individual Fellowship and R36 Dissertation Grant. PURPOSE: Describe a nursing PhD program federal grant writing workshop and present participant impressions and outcomes. METHODS: We designed a three half-day workshop covering essential aspects of grant writing combined with mentor participation and follow-up. We assessed participant satisfaction in evaluations, subsequent grant submissions, project implementation, and time from PhD program entry to completion. FINDINGS: Evaluations were overwhelmingly positive. Seventeen of 29 (58.6%) participants submitted 21 applications; five (23.8%) were funded. The majority (75.0%) conducted the proposed dissertation project regardless of funding. Writing and submitting a grant did not increase time to program completion. DISCUSSION: The workshop efficiently supports PhD students' dissertation research. Timing and mentor participation are key for success. We recommend schools of nursing implement PhD program grant writing workshops.

How has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-analysis.

We conducted a 5-year follow-up systematic review and meta-analysis to determine change in frequency of autism spectrum disorder (ASD) diagnosis since diagnostic and statistical manual 5 (DSM-5) publication and explore the impact of Social Communication Disorder (SCD). For 33 included studies, use of DSM-5 criteria suggests decreases in diagnosis for ASD [20.8% (16.0-26.7), p < 0.001], DSM-IV-TR Autistic Disorder [10.1% (6.2-16.0), p < 0.001], and Asperger's [23.3% (12.9-38.5), p = 0.001]; pervasive developmental disorder-not otherwise specified decrease was not significant [46.1% (34.6-58.0), p = 0.52]. Less than one-third [28.8% (13.9-50.5), p = 0.06] of individuals diagnosed with DSM-IV-TR but not DSM-5 ASD would qualify for SCD. Findings suggest smaller decreases in ASD diagnoses compared to earlier reviews. Future research is needed as concerns remain for impaired individuals without a diagnosis.

Implementation and Outcomes of a Faculty-Based, Peer Review Manuscript Writing Workshop.

The publication of scholarly work and research findings is an important expectation for nursing faculty; however, academic writing is often neglected, leaving dissemination through manuscript writing an area of concern for the nursing profession. Writing initiatives have been utilized to promote scholarly dissemination in schools of nursing, but those described in the literature have been primarily non-United States based and student focused. This article describes a faculty-based manuscript writing workshop, assesses participants' impressions, and describes its impact on scholarly output. The workshop is a collaborative learning process utilizing peer review to improve manuscript quality and model behaviors for improving writing and peer-reviewing skills. Seventeen workshop participants including three predoctoral students, 6 postdoctoral fellows, and 8 faculty members completed an anonymous workshop survey (81% response rate). All but 1 of 17 manuscripts reviewed in the workshop are published, accepted, or in the review process. All participants indicated that the workshop was a valuable use of time and would recommend it to colleagues. The greatest reported workshop benefit was its function as an impetus to complete and submit manuscripts. We recommend the manuscript writing workshop model for other schools of nursing seeking ways to expand their scholarly output and create accountability for dissemination through manuscript writing.

Beyond positivism: Understanding and addressing childhood obesity disparities through a Critical Theory perspective.

PURPOSE: We apply Critical Theory to examine menu labeling with the aim of uncovering important implications for nursing practice, research, and policy. CONCLUSIONS: Our critical analysis uncovers barriers to menu labeling's effectiveness, particularly for vulnerable populations. Nurses must work to minimize the impact of these barriers and optimize the effectiveness of menu labeling, in order to strengthen the fight against obesity. PRACTICE IMPLICATIONS: We suggest changes, guided by this critical analysis, which can be implemented by nurses working in clinical practice, research, and policy.

How will DSM-5 affect autism diagnosis? A systematic literature review and meta-analysis.

We conducted a systematic review and meta-analysis to determine the effect of changes to the Diagnostic and Statistical Manual (DSM)-5 on autism spectrum disorder (ASD) and explore policy implications. We identified 418 studies; 14 met inclusion criteria. Studies consistently reported decreases in ASD diagnosis (range 7.3-68.4%) using DSM-5 criteria. There were statistically significant pooled decreases in ASD [31% (20-44), p = 0.006] and DSM-IV-TR subgroups of Autistic disorder [22% (16-29), p < 0.001] and pervasive developmental disorder-not otherwise specified (PDD-NOS) [70% (55-82), p = 0.01]; however, Asperger's disorder pooled decrease was not significant [70% (26-94), p = 0.38]. DSM-5 will likely decrease the number of individuals diagnosed with ASD, particularly the PDD-NOS subgroup. Research is needed on policies regarding services for individuals lacking diagnosis but requiring assistance.

Establishing a program of global initiatives for nursing education.

In the global nursing community, schools of nursing are increasingly developing initiatives and networks across national boundaries. This article describes the process undertaken at a school of nursing to determine its global health priorities and develop a program of global initiatives for nursing education. A series of meetings were held to determine faculty global activities and gauge interest in designing a 5-year strategic plan for the program. A volunteer Strategic Planning Work-group was convened to formalize a mission, vision, and strategic plan for the program, which were presented to, refined by, and vetted by an advisory board and the faculty at large. We recommend this process to schools committed to developing or expanding a program dedicated to global initiatives and a global perspective in educational planning. Involving stakeholders, building on current strengths, and aligning with mission and vision are essential elements for developing a meaningful program of global initiatives for nursing education.

Refocusing research priorities in schools of nursing.

It is critical for schools of nursing to periodically reassess their scholarly programs to ensure that their conceptual framework and approaches address current challenges and enhance productivity. This article describes the process undertaken at Columbia University School of Nursing to evaluate scholarly enterprise so that it remains relevant and responsive to changing trends and to revise our research conceptual model to be reflective of the foci of our clinicians and researchers. As part of a larger strategic initiative, a two-phase Research Excellence Planning and Implementation Workgroup was convened, consisting of a broad representation of faculty and administrative staff, with an overall goal of expanding scholarly capacity. During Phase I, members developed measurable outcomes and tactics and revised the school's conceptual research model. In Phase II, the workgroup implemented and monitored tactics and presented final recommendations to the dean. To measure progress, faculty members completed a survey to establish baseline scholarship and collaboration with results indicating room for growth in interdisciplinary and inter-institutional collaboration. Ongoing assessment of outcomes includes Web-based tracking of scholarly activities and follow-up surveys to monitor expansion of faculty collaboration. We recommend this process to other schools committed to sustainable, increasingly relevant scholarship.

Sharing facilities and administrative cost recovery to facilitate interdisciplinary research.

PURPOSE: Despite increasing interest in interdisciplinary research, researchers consistently cite institutional barriers as deterrents. Researchers, administrators, and others have suggested developing processes for sharing facilities and administrative (F&A) cost recovery as one way to support collaborative research. Therefore, the authors reviewed current policies for sharing F&A cost recovery and user satisfaction with them. METHOD: In 2010, through reviewing institutional Web sites and surveying researchers and grants administrators from a range of institutions, the authors identified different policies currently employed and assessed user satisfaction with them. RESULTS: Whereas most respondents (80.7%, 205/254) agreed that a standard policy for sharing F&A cost recovery would facilitate interdisciplinary collaboration, only 35.4% (90/254) reported that their institutions had such a policy. Among the 85 respondents who answered questions about their institution's policy, most (66 [77.6%]) reported that the policy applied to grants with multiple principal investigators or coinvestigators across departments or schools, and 68 (80.0%) reported satisfaction with the policy. Respondents from institutions with policies were significantly more likely to endorse the notion that policies are helpful compared with those who reported that their institutions did not have such policies or were unsure of their existence (89% versus 76%, P = .014). The authors detected no significant differences in satisfaction scores based on policy type, whether determined by investigator effort, space allocation, or other considerations (P = .29). CONCLUSIONS: These data support the need for institutions to establish formal policies for sharing F&A cost recovery as a way to promote interdisciplinary research collaboration.