Visibility of inflicted bruises by alternate light: Results of a randomized controlled trial.

Difficulty visualizing bruises resulting from interpersonal violence, especially in individuals with dark skin, contributes to disparities in access to justice. The purpose of this analysis was to compare bruise visibility of detected injuries using white light versus alternate light sources (ALS). Visibility was assessed using the 5-point Bruise Visibility Scale (BVS) for white light and the ALS Visibility Scale (AVS) for ALS. Bruises were induced using controlled application of a paintball to the upper arm on 157 healthy adults across six skin color categories. Using a crossover design, the light source used first to assess the bruise (white light or ALS) was randomized. Each bruise was examined up to 21 times over 4 weeks using white light and 10 combinations of wavelengths (350 nanometer [nm] - 535 nm) and colored filters (yellow, orange, and red). Multilevel modeling was used to analyze the repeated measures data with a total 20,103 bruise assessments. Results revealed 415 nm with yellow filter resulted in an almost 0.5-point increase in BVS/AVS score across all skin colors (Estimate = 0.46; 95% CI: 0.43, 0.49; p < 0.001), a clinically significant improvement in ability to visualize bruises. Conversely, 515 nm (Estimate = -0.80; 95% CI: -0.84, -0.76; p < 0.001) and 535 nm (Estimate = -0.64, 95% CI: -0.67, -0.60; p < 0.001) with red filter resulted in more than 0.5-point decrease in BVS/AVS score. The use of ALS is supported by the data and results in improved bruise visibility during medical forensic examinations.

Remote Delivery of the Fugl-Meyer Assessment for the Upper Extremity: A Pilot Study to Assess Feasibility, Reliability, and Validity.

Objective: To develop a remote protocol for the upper extremity Fugl-Meyer Assessment (reFMA) and assess the reliability and validity with in-person delivery. Design: Feasibility testing. Setting: Remote/virtual and in-person in participants' homes. Participants: Three triads of therapists, stroke survivors, and carepartners (N=9) participated in Phases 1 and 2. Twelve different stroke survivors participated in Phase 3. Intervention: The FMA was administered and received remotely using the instructional protocol (Phases 1 and 2). Pilot testing with the delivery of the reFMA remotely and the FMA in-person occurred in Phase 3. Main Outcome Measures: Feedback for refinement and feasibility of obtaining the reFMA (including the System Usability Scale) and the FMA scores remotely and in-person to assess reliability and validity of the reFMA. Results: The reFMA was refined to incorporate feedback and suggestions from users. Interrater reliability between 2 therapists evaluating the FMA remotely was found to be poor with little agreement. For criterion validity, only 1 out of 12 (8.3%) total scores were in agreement between the in-person and remote assessments. Conclusion: Reliable and valid remote administration of the FMA is an important aspect of telerehabilitation for the upper extremity after stroke, but further research is needed to address current protocol limitations. This study provides preliminary support for the need for alternative strategies to improve appropriate implementation of the FMA remotely. Possible explanations for the poor reliability are explored and suggestions for improvement of the remote delivery of the FMA are provided.

Mindfulness-Based Smoking Cessation Delivered Through Telehealth and Text Messaging for Low-Income Smokers: Protocol for a Randomized Controlled Trial.

BACKGROUND: Tobacco use is the leading cause of preventable morbidity and mortality. Adults with low income and members of certain racial and ethnic minority groups are less likely to quit, and therefore, they experience profound tobacco-related health disparities. Mindfulness training can increase the rates of smoking cessation and lapse recovery, and telehealth and SMS text messaging have the potential to provide more accessible treatment. OBJECTIVE: This study aims to test the efficacy of delivering mindfulness-based smoking cessation treatment through text messaging (iQuit Mindfully) and telehealth (group videoconferencing), both as stand-alone interventions and in combination. In addition, it aims to examine the underlying mechanisms of mindfulness treatment. METHODS: In this 2×2 randomized controlled trial, participants are randomized into 1 of 4 groups based on assignment to iQuit Mindfully text messages (yes or no) and mindfulness videoconference groups (yes or no). The primary outcomes are biochemically verified smoking abstinence at 8, 12, and 24 weeks after the start of treatment. Secondary outcomes include the frequency of home mindfulness practice and self-reported levels of mindfulness, emotions, craving, withdrawal, dependence, self-efficacy, and social support. RESULTS: Recruitment, treatment, and assessment began in spring and summer 2021, and data collection is expected to continue through spring 2024. CONCLUSIONS: This project aims to improve smoking cessation outcomes for low-income, racially and ethnically diverse smokers through mindfulness-based telehealth group counseling and text messaging support. We also aim to advance the scientific study of the mechanisms of action of mindfulness treatment, which could inform the development of more efficacious and efficient treatments to reduce tobacco disparities. TRIAL REGISTRATION: Clinicaltrials.gov NCT04965181; https://clinicaltrials.gov/ct2/show/NCT04965181. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/35688.

Medicaid Expansion and Racial/Ethnic Differences in Readmission After Acute Ischemic Stroke.

To examine whether rates of 30-day readmission after acute ischemic stroke changed differentially between Medicaid expansion and non-expansion states, and whether race/ethnicity moderated this change, we conducted a difference-in-differences analysis using 6 state inpatient databases (AR, FL, GA, MD, NM, and WA) from the Healthcare Cost and Utilization Project. Analysis included all patients aged 19-64 hospitalized in 2012-2015 with a principal diagnosis of ischemic stroke and a primary payer of Medicaid, self-pay, or no charge, who resided in the state where admitted and were discharged alive (N=28 330). No association was detected between Medicaid expansion and readmission overall, but there was evidence of moderation by race/ethnicity. The predicted probability of all-cause readmission among non-Hispanic White patients rose an estimated 2.6 percentage points (or 39%) in expansion states but not in non-expansion states, whereas it increased by 1.5 percentage points (or 23%) for non-White and Hispanic patients in non-expansion states. Therefore, Medicaid expansion was associated with a rise in readmission probability that was 4.0 percentage points higher for non-Hispanic Whites compared to other racial/ethnic groups, after adjustment for covariates. Similar trends were observed when unplanned and potentially preventable readmissions were isolated. Among low-income stroke survivors, we found evidence that 2 years of Medicaid expansion promoted rehospitalization, but only for White patients. Future studies should verify these findings over a longer follow-up period.

A comparative cross-sectional assessment of statistical knowledge of faculty across five health science disciplines.

INTRODUCTION: The purpose of this study was to compare statistical knowledge of health science faculty across accredited schools of dentistry, medicine, nursing, pharmacy, and public health. METHODS: A probability sample of schools was selected, and all faculty at each selected school were invited to participate in an online statistical knowledge assessment that covered fundamental topics including randomization, study design, statistical power, confidence intervals, multiple testing, standard error, regression outcome, and odds ratio. RESULTS: A total of 708 faculty from 102 schools participated. The overall response rate was 6.5%. Most (94.2%) faculty reported reading the peer-reviewed health-related literature. Respondents answered 66.2% of questions correctly across all questions and disciplines. Public health had the highest performance (80.7%) and dentistry the lowest (53.3%). CONCLUSIONS: Knowledge of statistics is essential for critically evaluating evidence and understanding the health literature. These study results identify a gap in knowledge by educators tasked with training the next generation of health science professionals. Recommendations for addressing this gap are provided.

Establishing fidelity for the creating opportunities for personal empowerment: Symptom and technology management resources (COPE-STAR) intervention.

AIM: To establish intervention fidelity for the Creating Opportunities for Personal Empowerment: Symptom and Technology Management Resources web-based intervention to assist caregivers of children aged 1-5 years in managing their child's symptoms and medical technology of tracheostomies and feeding tubes at home. DESIGN: Descriptive study of the strategies used to establish intervention fidelity, specifically using expert and caregiver reviewers. METHODS: To establish fidelity of the intervention, experts and caregivers were asked to evaluate the usefulness, ease of use, and acceptability of the intervention and provide any suggestions for the modules. Caregivers provided caregiver and child characteristics and were administered a health literacy measure, the Newest Vital Sign. Intervention fidelity was established from April 2019-July 2019. RESULTS/FINDINGS: Expert and caregiver reviewers (N = 13) all agreed or strongly agreed that the intervention was useful, easy to use, and acceptable. In addition, caregiver reviewers provided care to children who required multiple technologies and a variety of care needs at home and confirmed adequate health literacy (N = 5). CONCLUSION: The use of expert and caregiver reviewers was very beneficial in establishing intervention fidelity. Caregivers are experts in the care of their child and provide valuable feedback based on their daily experiences at home. Experts provided evidence-based feedback. IMPACT: This nursing intervention addresses caregivers of children who require medical technology by targeting caregiver management for common symptoms, related technologies, and resources for the child and caregiver in the home setting. Intervention fidelity was established and expert and caregiver reviewers confirmed the usefulness, ease of use, and acceptability of the intervention. This study is essential to nursing, other healthcare providers, and healthcare systems in planning and implementing programmes and services for children and their caregivers and for nurse researchers establishing intervention fidelity. TRIAL REGISTRATION: This study is not designated as a clinical trial per NIH/NINR study and grant proposal guidelines.

A cross-sectional assessment of statistical knowledge among pharmacy faculty.

INTRODUCTION: The debate about the optimal level of research methods incorporated in doctor of pharmacy curricula is ongoing. Yet relatively little has been published about the research-based knowledge of the faculty in these programs. This study seeks to assess pharmacy faculty members' knowledge of fundamental statistical concepts. METHODS: A cross-sectional survey included a random sample of US-based pharmacy schools. Invitations were sent to faculty in each selected pharmacy school to participate in the online survey comprised of demographic questions and a multiple-choice statistics knowledge assessment covering eight fundamental biostatistics concepts. Each question had three answer options, with an additional fourth 'opt-out' option for those wishing to avoid guessing. RESULTS: The random sample of selected pharmacy schools resulted in email invitations sent to 2036 faculty from 30 pharmacy schools. The final study sample consisted of 139 pharmacy faculty members with a mean of 10.2 years of experience as a faculty member. Over 95% of pharmacy faculty reported that they read peer-reviewed scientific journal articles, while nearly 99% said the understanding of statistics was either 'somewhat important' (35%) or 'very important' (64%) in their role as a researcher. Pharmacy faculty achieved a mean of 5.1 correct responses out of eight knowledge-based questions. CONCLUSIONS: Pharmacy faculty provided correct responses to 64% of the items about fundamental statistical concepts. These study results are useful for making decisions about biostatistics education and curriculum content, particularly as pharmacy programs continue to incorporate a prominent role for research.

Predictors of Unplanned Hospitalizations in Patients With Nonmetastatic Lung Cancer During Chemotherapy.

PURPOSE/OBJECTIVES: To determine predictors of unplanned hospitalizations in patients with lung cancer to receive chemotherapy in the outpatient setting and examine the potential financial burden of these events.
. DESIGN: Retrospective, longitudinal cohort study.
. SETTING: The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database.
. SAMPLE: Of 104,388 incident cases of lung cancer diagnosed from 2005-2009, 2,457 cases of patients with lung cancer who received outpatient chemotherapy were identified. Patients were aged 66 years or older at diagnosis, had uninterrupted Medicare Part A and B coverage with no health maintenance organization enrollment, and received IV chemotherapy at least once.
. METHODS: Generalized estimating equations was used.
. MAIN RESEARCH VARIABLES: Patient age, sex, race, marital status, degree of residential urbanization, median income, education level, stage, receipt of radiation therapy, and comorbidities.
. FINDINGS: Younger age, non-White race, lower education, higher income, receipt of radiation therapy, and lack of preexisting comorbidity were significant predictors of the likelihood of an initial unplanned hospitalization for lung cancer. Non-White race, receipt of radiation therapy, and comorbidity were factors associated with an increased number of hospitalizations. 
. CONCLUSIONS: Unplanned hospitalizations are frequent, disruptive, and costly. This article defines areas for further exploration to identify patients at high risk for unexpected complications. 
. IMPLICATIONS FOR NURSING: This article represents a foundation for development of risk models to enable nursing evaluation of patient risk for chemotherapy treatment interruption and unplanned hospitalization.

A Mixed Methods Study of Contraceptive Effectiveness in a Relationship Context Among Young Adult, Primarily Low-Income African American Women.

BACKGROUND: Unintended pregnancy is an important public health issue. Rates of unintended pregnancy are disproportionately higher among women from racial and ethnic minority groups among whom rates of contraceptive use are lower. Women's multifaceted feelings about pregnancy and perceptions of their intimate relationships may influence contraceptive behavior. METHODS: We used mixed methods to examine women's perceptions of pregnancy, motherhood, and contraceptives within the context of their intimate relationships. A convenience sample of 130 primarily low-income African American women ages 18-29 completed a cross-sectional, computerized survey; 12 women provided in-depth qualitative interview data. Generalized linear mixed models were used to identify associations between study variables and contraceptive effectiveness. Interview data were analyzed using qualitative descriptive methods and integrated with quantitative data. RESULTS: Higher positive pregnancy attitude [odds ratio (OR) 0.78; 95 % confidence interval (CI) 0.63, 0.98], lower contraceptive attitude (OR 1.17; 95 % CI 1.01, 1.36), and more than one recent sexual partner (OR 0.03; 95 % CI <0.01, 0.60) were associated with less effective contraceptive use. Qualitative results included three themes: You get pregnant that's on you; Motherhood means everything; and Make sure you're stable. Women's qualitative reports primarily supported but occasionally diverged from quantitative findings, reflecting discrepancies from their stated ideals, personal goals, and behavior. CONCLUSION: The incongruities between women's ideals and their actual contraceptive behavior demonstrate the complexity of making reproductive decisions based on existing life circumstances and challenges. Health care providers should have broad understanding of women's pregnancy goals in order to recommend the most appropriate contraceptive methods and pre-conception counseling.

Reliability of tristimulus colourimetry in the assessment of cutaneous bruise colour.

BACKGROUND: Bruising is one of the most common types of injury clinicians observe among victims of violence and other trauma patients. However, research has shown commonly used qualitative description of cutaneous bruise colour via the naked eye is subjective and unreliable. No published work has formally evaluated the reliability of tristimulus colourimetry as an alternative for assessing bruise colour, despite its clinical and research applications in accurately assessing skin colour. The purpose of this study was to systematically evaluate the test-retest and inter-observer reliability of tristimulus colourimetry in the assessment of cutaneous bruise colour. METHODS: Two researchers obtained repeated tristimulus colourimetry measures of cutaneous bruises with participants of diverse skin colour. Measures were obtained using the Minolta CR-400 Chomameter. Commission Internationale d'Eclairage (CIE) L*a*b* colour space was used. Data was analysed using intraclass correlation coefficients (ICC), Cronbach's alpha, and minimal detectable change (MDC) on all three L*a*b* values. RESULTS: The colorimeter demonstrated excellent test-retest or intra-rater reliability (L* ICC=0.999; a* ICC=0.973; b* ICC=0.892) and inter-rater reliability (L* ICC=0.997; a* ICC=0.976; b* ICC=0.982). CONCLUSIONS: With consistent placement, the tristimulus colourimetry is reliable for the objective assessment and documentation of cutaneous bruise colour for purposes of clinical practice and research. Recommendations for use in practice/research are provided.

Factors Associated With Unplanned Hospitalizations Among Patients With Nonmetastatic Colorectal Cancers Intended for Treatment in the Ambulatory Setting.

BACKGROUND: Chemotherapy administration and supportive management for solid tumors is intended to take place in the ambulatory setting, but little is known about why some patients experience treatment-related adverse events so severe as to require acute inpatient care. OBJECTIVE: The aim of the study was to identify predictors of initial and repeated unplanned hospitalizations and potential financial impact among Medicare patients with early-stage (Stages I-III) colorectal cancer receiving outpatient chemotherapy. METHODS: Advanced statistical modeling was used to analyze a cohort of patients (N = 1,485) from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed from 2003 to 2007 with colorectal cancer as their first primary malignancy. Patients were of ages 66 and older at diagnosis, had uninterrupted Medicare Parts A and B coverage with no health maintenance organization component, and received chemotherapy at least one time. RESULTS: Female gender, younger age, multiple comorbidities, rural geography, higher high school completion rates, and lower median income per census tract were significant predictors of the likelihood of initial unplanned hospitalizations. Non-White race, receipt of radiation therapy, rural geography, and higher weighted comorbidity scores were factors associated with the number of hospitalizations experienced. The total Medicare charges calculated for these admissions was $38,976,171, with the median charge per admission at $20,412. DISCUSSION: Demographic and clinical factors that form the foundation of work toward development of a risk factor profile for unplanned hospitalization were identified. Further work is needed to incorporate additional clinical data to create a clinically applicable model.

Guidelines for Assessment and Instruction in Statistics Education (GAISE): extending GAISE into nursing education.

Statistics coursework is usually a core curriculum requirement for nursing students at all degree levels. The American Association of Colleges of Nursing (AACN) establishes curriculum standards for academic nursing programs. However, the AACN provides little guidance on statistics education and does not offer standardized competency guidelines or recommendations about course content or learning objectives. Published standards may be used in the course development process to clarify course content and learning objectives. This article includes suggestions for implementing and integrating recommendations given in the Guidelines for Assessment and Instruction in Statistics Education (GAISE) report into statistics education for nursing students.

The influence of maternal-fetal attachment and health practices on neonatal outcomes in low-income, urban women.

Maternal-fetal attachment (MFA) has been associated with health practices during pregnancy, but less is known about this relationship in low-income women, and no identified studies have examined this relationship to neonatal outcomes. This longitudinal descriptive study was conducted to examine the relationships among MFA, health practices during pregnancy, and neonatal outcomes in a sample of low-income, predominantly African-American women and their neonates. MFA was associated with health practices during pregnancy and adverse neonatal outcomes. Health practices during pregnancy mediated the relationships of MFA and adverse neonatal outcomes. The results support the importance of examining MFA in our efforts to better understand the etiology of health disparities in neonatal outcomes.

Joint modeling of performance and subjective reporting to assess sensitivity to drug-induced sleepiness.

In an NASA ground study, two forms of cognitive tests were evaluated in terms of their sensitivity to sleepiness induced by the drug promethazine (PMZ). Performance for the two test modes (Y(1) and Y(2)), PMZ concentration, and a self-reported sleepiness using the Karolinska Sleepiness Scale (KSS) were monitored for 12 h post dose. A problem arises when using KSS to establish an association between true sleepiness and performance because KSS scores are discrete and also because they tend to concentrate on certain values. Therefore, we define a latent sleepiness measure X as an unobserved continuous random variable describing a subject's actual state of sleepiness. Under the assumption that drug concentration affects X, which then affects Y(1), Y(2), and KSS, we use Bayesian methods to estimate joint equations that permit unbiased comparison of the performance measures' sensitivity to X. The equations incorporate subject random effects and include a negativity constraint on subject-specific slopes of performance with respect to sleepiness.

A Bayesian approach to net health benefits: an illustration and application to modeling HIV prevention.

PURPOSE: To conduct a cost-effectiveness analysis of HIV prevention when costs and effects cannot be measured directly. To quantify the total estimation of uncertainty due to sampling variability as well as inexact knowledge of HIV transmission parameters. METHODS: The authors focus on estimating the incremental net health benefit (INHB) in a randomized trial of HIV prevention with intervention and control conditions. Using a Bernoulli model of HIV transmission, changes in the participants' risk behaviors are converted into the number of HIV infections averted. A sampling model is used to account for variation in the behavior measurements. Bayes's theorem and Monte Carlo methods are used to attain the stated objectives. RESULTS: The authors obtained a positive mean INHB of 0.0008, indicating that advocacy training is just slightly favored over the control condition for men, assuming a $50,000 per quality-adjusted life year (QALY) threshold. To be confident of a positive INHB, the decision maker would need to spend more than $100,000 per QALY.