Improving Retention Through a Purposeful Multidisciplinary Mentorship Program.

In response to high nurse turnover, a 12-hospital health system team created a sustainable, formalized, and interprofessional mentoring model to improve nurse retention. In the 1st year of the program, 506 mentor-mentee matches were made, and nearly 5000 hours of mentoring time were logged. Data revealed that turnover was significantly reduced in both the mentor and mentee groups compared with employees who were not in the program.

Measuring asymmetry in facial morphea via 3-dimensional stereophotogrammetry.

BACKGROUND: Objectively determining tissue loss in craniofacial morphea is challenging. However, 3-dimensional (3D) stereophotogrammetry is a noninvasive modality that may be a useful adjunct. OBJECTIVE: To prospectively evaluate 3D stereophotogrammetry in the assessment of craniofacial linear morphea. METHODS: Participants underwent clinical, quality-of-life, and 3D-stereophotogrammetry assessments. Traditional photographs and 3D-stereophotogrammetry images were rated as mild, moderate, or severe by 2 experts and 2 nonexperts. In addition, interrater and intrarater reliability (on delayed rescoring) were calculated. RESULTS: Of 23 patients with craniofacial morphea, 3D stereophotogrammetry detected pathologic asymmetry in 14 (20.6%) patients. Providers rated patients as more severely affected when using 3D stereophotogrammetry versus when using traditional photographs (19% severe on 3D stereophotogrammetry vs 0% severe on traditional photographs, P = .004). Qualitative ratings of both traditional and 3D images showed high inter- and intrarater reliability between experts and nonexperts alike. Physicians' Global Assessment of Damage scores correlated with mouth asymmetry (P = .0021), cheek asymmetry (P = .04), and 3D-stereophotogrammetry ratings (median, mild: 27.5 vs moderate: 46.5 vs severe: 64, P = .0152). Lower face asymmetry correlated with worse quality-of-life scores (P = .013). LIMITATIONS: Small sample size and cross-sectional design. CONCLUSION: 3D stereophotogrammetry can reliably detect and quantify asymmetry in craniofacial morphea with greater sensitivity than that observed with traditional assessment alone. 3D stereophotogrammetry may be a useful adjunct to clinical examination.

Learning to draw parametric faces.

Humans' ability to draw faces accurately from memory is extremely rare. One source of difficulty is the drawing process itself, which requires converting a complex, three-dimensional mental representation to a two-dimensional drawing. To simplify the drawing process and more directly assess people's recall of faces, we used the Parameterized Face Drawing (PFD) model (Day & Davidenko, Visual Cognition, 26(2), 89-99, 2018; Day & Davidenko, Journal of Vision, 19(11):7, 1-12, 2019) to generate simplified face stimuli that non-artists could draw. In Experiment 1, participants (N = 37) completed a sequential drawing-by-copying task in which they were given 60 s to draw each of 18 target faces by copying them using a stylus on a touchscreen. Following each drawing, participants were prompted to label a set of 20 key points on their drawing based on a reference face, which were used to compute the drawing's accuracy. In Experiment 2, participants (N = 22) observed each target face for 15 s and were then given 60 s to draw it from memory. In Experiment 1, the accuracy of drawings improved slightly over the course of the 18 trials, although most of the improvement occurred during the first few trials. In Experiment 2 (drawing-from-memory), there was no evidence of improvement, although the null results are tentative given the small sample size. Despite weak evidence of learning, participants' drawings captured the likeness of the target faces significantly better than chance. We discuss implications of these findings for the use of drawing as a method of face recall.

Academy of Clinical Essentials: A Revolutionary Nurse Staffing and Education Model.

A revolutionary academic-practice partnership model was implemented at the University of Maryland Medical System (UMMS) with the University of Maryland School of Nursing, through which the preparation and transition to practice of new graduate nurses were reimagined, resulting in intentional support for staffing the nursing workforce. Groups of nursing students were paired with a UMMS-funded clinical instructor to take a full patient assignment for one 12-hour shift in a UMMS hospital each week. This instructor-led cohort is equivalent to one UMMS nurse and was included in the staffing numbers of participating units.

When is synchronous telehealth acceptable for pediatric dermatology?

BACKGROUND/OBJECTIVES: We evaluated the acceptance of synchronous (live video) telehealth for pediatric dermatology. METHODS: This was a prospective, single-center study of patient and dermatologist surveys paired at the encounter level for telehealth encounters with Children's Hospital Colorado Pediatric Dermatology Clinic between 21 April 2020 and 22 May 2020. RESULTS: Dermatologists were most receptive to a telehealth encounter for isotretinoin monitoring (96.6%) and non-isotretinoin acne (89.5%). In contrast, 71.8% and 58.8% of patients surveyed were open to telehealth for isotretinoin encounters and non-isotretinoin acne encounters, respectively. There was no significant correlation between patient and dermatologist satisfaction regarding a telehealth encounter (r = 0.09, CI [-0.09, 0.26], p = .34) or between patient and dermatologist preference for telehealth encounter (r = 0.07, CI [-0.11, 0.25] p = .46). Dermatologists reported needing a photo to aid their physical examination in 38/363 (10.7%) of encounters and preferred in-person examinations when an encounter would have benefitted from laboratories, procedures, dermatoscopic examination, examination by palpation, and accurate weights in infants. CONCLUSIONS: Synchronous, live-video telehealth is an effective method of healthcare delivery in certain situations for pediatric dermatology, but it does not replace in-person encounters. Families and dermatologists have different perceptions about its acceptance.

The Cal-DSH diversion guidelines.

The Cal-DSH Diversion Guidelines provide 10 general guidelines that jurisdictions should consider when developing diversion programs for individuals with a serious mental illness (SMI) who become involved in the criminal justice system. Screening for SMI in a jail setting is reviewed. In addition, important treatment interventions for SMI and substance use disorders are highlighted with the need to address criminogenic risk factors highlighted.

Parametric face drawings: A demographically diverse and customizable face space model.

We introduce a novel face space model-parametric face drawings (or PFDs)-to generate schematic, though realistic, parameterized line drawings of faces based on the statistical distribution of human facial features. A review of existing face space models (including FaceGen Modeller, Synthetic Faces, MPI, and active appearance model) indicates that current models are constrained by their reliance on ethnically homogeneous face databases. This constraint has led to negative consequences for underrepresented populations, such as impairments in automatized identity recognition of certain demographic groups. Our model is based on a demographically diverse sample of 400 faces (200 female, 200 male; 100 East Asian/Pacific Islander, 100 Latinx/Hispanic, 100 black/African-American, and 100 white/Caucasian) compiled from several face databases (including FERET face recognition technology and the Chicago Face Database). Each front-view face image is manually coded with 85 landmark points that are then normalized and rendered with MATLAB (MathWorks, Natick, MA) tools to produce a smooth, parameterized face line drawing. We present data from two behavioral experiments to validate our model and demonstrate its applicability. In Experiment 1 we show that PFDs produce a reliable "inversion effect" in short-term recognition, a hallmark of holistic processing. In Experiment 2, we conduct a celebrity recognition task, comparing performance on PFDs to performance on untextured renderings from FaceGen Modeller. Participants successfully recognized approximately 50% of celebrity faces based on the PFD models, comparable to performance based on FaceGen Modeler (also 50% correct). We highlight a range of potential applications of our model, list some limitations, and provide MATLAB resources for researchers to utilize our face space, including the ability to customize the demographic makeup of the face space, add new faces, and produce morphs and caricatures.

Rate of serious infection in patients who are prescribed systemic biologic or nonbiologic agents for psoriasis: A large, single center, retrospective, observational cohort study.

BACKGROUND: Systemic biologic and nonbiologic agents used to treat psoriasis may or may not contribute to serious infection (SI) risk. Safety data, particularly for biologic agents, and associated risk for SI, are scarce. The study's aim was to explore the risk for SI in psoriasis patients exposed to systemic biologic or nonbiologic agents. METHODS: A large, single-center electronic medical record repository was searched between January 2010 and December 2014. Records for patients prescribed a systemic agent for psoriasis (SAP) with psoriasis or psoriatic arthritis diagnoses were included (ICD-9 codes 696.1 and 696.0, respectively). SIs were those who required hospitalization, and/or injectable antibacterial, antiviral or antifungal therapy. SIs occurring within 120 days after exposure to a SAP, were included for study. RESULTS: A total of 1,346 patients were exposed to a SAP between January 2010 and December 2014; 27 (2%) had a SI. Comparing biologic and nonbiologic agent exposure, no statistically significant difference for risk of SI was detectable (p = .83). CONCLUSION: In this population, the SI rate for biologic and nonbiologic systemic agents was clinically indistinguishable, thereby supporting consideration of the entire spectrum of available systemic therapeutic agents, both biologic and nonbiologic agents, for management of moderate to severe psoriasis.

Exploring the Best Practices of Nursing Research Councils in Magnet® Organizations: Findings From a Qualitative Research Study.

OBJECTIVE: The objective of this descriptive qualitative study was to identify best practices of nursing research councils (NRCs) at Magnet®-designated hospitals. BACKGROUND: Nursing research (NR) is essential, adding to the body of nursing knowledge. Applying NR to the bedside improves care, enhances patient safety, and is an imperative for nursing leaders. METHODS: We interviewed NR designees at 26 Magnet-recognized hospitals about the structure and function of their NRCs and used structural coding to identify best practices. RESULTS: Most organizations link NR and evidence-based practice. Council membership includes leadership and clinical nurses. Councils conduct scientific reviews for nursing studies, supporting nurse principal investigators. Tracking and reporting of NR vary widely and are challenging. Councils provide education, sponsor research days, and collaborate interprofessionally, including with academic partners. CONCLUSIONS: Findings from this study demonstrate the need to create formal processes to track and report NR and to develop outcome-focused NR education.

Inpatient Dialysis Unit Project Development: Redesigning Acute Hemodialysis Care.

Executive leaders of an acute care hospital performed a market and financial analysis, and created a business plan to establish an inpatient hemodialysis unit operated by the hospital to provide safe, high-quality, evidence-based care to the population of individuals experiencing end stage renal disease (ESRD) within the community. The business plan included a SWOT (Strengths - Weaknesses - Opportunities - Threats) analysis to assess advantages of the hospital providing inpatient hemodialysis services versus outsourcing the services with a contracted agency. The results of the project were a newly constructed tandem hemodialysis room and an operational plan with clearly defined key performance indicators, process improvement initiatives, and financial goals. This article provides an overview of essential components of a business plan to guide the establishment of an inpatient hemodialysis unit.

An Integrative Review of Engaging Clinical Nurses in Nursing Research.

PURPOSE: To review the literature for best practices for engaging clinical nurses in nursing research. DESIGN: Review of the research and nonresearch papers published between 2005 and 2015 that answered the evidence-based practice (EBP) question: what are the best practices for engaging clinical nursing staff in nursing research? METHODS: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Joanna Briggs Institute, and Cochrane were searched using a combination of controlled vocabulary and key words. Nineteen papers that answered the EBP question were selected for review. RESULTS: It can be difficult to involve clinical nurses in research. There are multiple factors to consider when nursing leadership looks to engage clinical nurses in nursing research. CONCLUSIONS: Nurse leaders can take many approaches to engage clinical nurses in research. Each organization must perform its own assessment to identify areas of opportunity. Nursing leadership can take these areas of opportunity to structure a multifaceted approach to support clinical staff in the conduct and dissemination of nursing research. CLINICAL RELEVANCE: The evidence from this review offers EBP recommendations as well as reports on the gaps in the literature related to best practices for engaging clinical nurses in nursing research.

Community investment in wind farms: funding structure effects in wind energy infrastructure development.

Wind energy development is an increasingly popular form of renewable energy infrastructure in rural areas. Communities generally perceive socioeconomic benefits accrue and that community funding structures are preferable to corporate structures, yet lack supporting quantitative data to inform energy policy. This study uses the Everpower wind development, to be located in Midwestern Ohio, as a hypothetical modeling environment to identify and examine socioeconomic impact trends arising from corporate, community and diversified funding structures. Analysis of five National Renewable Energy Laboratory Jobs and Economic Development Impact models incorporating local economic data and review of relevant literature were conducted. The findings suggest that community and diversified funding structures exhibit 40-100% higher socioeconomic impact levels than corporate structures. Prioritization of funding sources and retention of federal tax incentives were identified as key elements. The incorporation of local shares was found to mitigate the negative effects of foreign private equity, local debt financing increased economic output and opportunities for private equity investment were identified. The results provide the groundwork for energy policies focused to maximize socioeconomic impacts while creating opportunities for inclusive economic participation and improved social acceptance levels fundamental to the deployment of renewable energy technology.

Illustrative cases to support the Cal-VAT guidelines.

There is increasing interest in developing more nuanced methods for managing aggression and violence in long-term psychiatric inpatient settings. However, the dearth of controlled studies has, at times, hampered presentation of viable options. Following the publication of guidelines developed in the California State Hospital forensic system, the authors present a group of 7 cases illustrating different approaches to violence management, including pharmacological, psychotherapeutic, and environmental interventions.

Health visitors' perceptions of barriers to health and wellbeing in European migrant families.

Since 2004 the population of European migrant workers and their families living in the UK has increased. In 2012 a small qualitative pilot study was conducted involving interviews with eight health visiting professionals working in a Merseyside borough in the north west of England. Health visitors were asked about their perceptions of barriers to health and wellbeing faced by European migrant families and common challenges experienced in practice. Interviews were analysed thematically and interpreted using a constructivist approach. Multiple perceptions emerged regarding migrant families'barriers to health and wellbeing; housing; language; and health service access, knowledge and attitudes. Health visitors provided confirmation of their important role within the public health agenda, identifying vulnerability and challenging inequalities particularly among minority ethnic and lower socio-economic groups. This study highlights areas for future consideration by public health and other agencies, particularly wider determinants of health and barriers in accessing health, public and community services. However, further quantitative and qualitative research is needed to investigate the needs, inequalities, service use and barriers to health and wellbeing experienced by European migrants.

California State Hospital Violence Assessment and Treatment (Cal-VAT) guideline.

Here we provide comprehensive guidelines for the assessment and treatment of violence and aggression of various etiologies, including psychotic aggression and impulsive aggression due to schizophrenia, mood disorders, ADHD, or trauma, and predatory aggression due to psychopathy and other personality disorders. These guidelines have been developed from a collection of prescribing recommendations, clinical trial results, and years of clinical experience in treating patients who are persistently violent or aggressive in the California Department of State Hospital System. Many of the recommendations provided in these guidelines employ off-label prescribing practices; thus, sound clinical judgment based on individual patient needs and according to institution formularies must be considered when applying these guidelines in clinical practice.

California State Hospital Violence Assessment and Treatment (Cal-VAT) guidelines.

Here we provide comprehensive guidelines for the assessment and treatment of violence and aggression of various etiologies, including psychotic aggression and impulsive aggression due to schizophrenia, mood disorders, ADHD, or trauma, and predatory aggression due to psychopathy and other personality disorders. These guidelines have been developed from a collection of prescribing recommendations, clinical trial results, and years of clinical experience in treating patients who are persistently violent or aggressive in the California Department of State Hospital System. Many of the recommendations provided in these guidelines employ off-label prescribing practices; thus, sound clinical judgment based on individual patient needs and according to institution formularies must be considered when applying these guidelines in clinical practice.

Compassion fatigue in adult daughter caregivers of a parent with dementia.

Adult daughters face distinct challenges caring for parents with dementia and may experience compassion fatigue: the combination of helplessness, hopelessness, an inability to be empathic, and a sense of isolation resulting from prolonged exposure to perceived suffering. Prior research on compassion fatigue has focused on professional healthcare providers and has overlooked filial caregivers. This study attempts to identify and explore risk factors for compassion fatigue in adult daughter caregivers and to substantiate further study of compassion fatigue in family caregivers. We used content analysis of baseline interviews with 12 adult daughter caregivers of a parent with dementia who participated in a randomized trial of homecare training. Four themes were identified in adult daughter caregiver interviews: (a) uncertainty; (b) doubt; (c) attachment; and (d) strain. Findings indicated adult daughter caregivers are at risk for compassion fatigue, supporting the need for a larger study exploring compassion fatigue in this population.

Deletion of a core APC/C component reveals APC/C function in regulating neuronal USP1 levels and morphology.

Introduction: The Anaphase Promoting Complex (APC/C), an E3 ubiquitin ligase, plays a key role in cell cycle control, but it is also thought to operate in postmitotic neurons. Most studies linking APC/C function to neuron biology employed perturbations of the APC/C activators, cell division cycle protein 20 (Cdc20) and Cdc20 homologue 1 (Cdh1). However, multiple lines of evidence indicate that Cdh1 and Cdc20 can function in APC/C-independent contexts, so that the effects of their perturbation cannot strictly be linked to APC/C function. Methods: We therefore deleted the gene encoding Anaphase Promoting Complex 4 (APC4), a core APC/C component, in neurons cultured from conditional knockout (cKO) mice. Results: Our data indicate that several previously published substrates are actually not APC/C substrates, whereas ubiquitin specific peptidase 1 (USP1) protein levels are altered in APC4 knockout (KO) neurons. We propose a model where the APC/C ubiquitylates USP1 early in development, but later ubiquitylates a substrate that directly or indirectly stabilizes USP1. We further discovered a novel role of the APC/C in regulating the number of neurites exiting somata, but we were unable to confirm prior data indicating that the APC/C regulates neurite length, neurite complexity, and synaptogenesis. Finally, we show that APC4 SUMOylation does not impact the ability of the APC/C to control the number of primary neurites or USP1 protein levels. Discussion: Our data indicate that perturbation studies aimed at dissecting APC/C biology must focus on core APC/C components rather than the APC/C activators, Cdh20 and Cdh1.

Identifying the priorities for supervision by lived experience researchers: a Q sort study.

BACKGROUND: Lived experience researchers draw on their lived and living experiences to either lead on or inform research. Their personal experiences are relevant to the research topic and so they must manage the interplay of their health and healthcare experiences with the research, population, and data they work with, as well as the more general challenges of being a researcher. Lived experience researchers must navigate these dilemmas in addition to queries over their competency, due to issues relating to intersectionality and epistemic injustice. This justifies a motivation to better understand the experiences of lived experience researchers and develop appropriate and personalised supervision based on their preferences and needs. METHODS: Q methodology was used to identify a collection of identity-related issues that impact lived experience researchers during PhD research in the context of the UK. These issues were presented in the form of 54 statements to 18 lived experience researchers to prioritise as topics to explore in supervision. RESULT: It was found that lived experiences researchers could be grouped into three distinct factors following an inverted factor analysis: Factor 1: Strengthening my identity, skills, growth, and empowerment; Factor 2: Exploring the emotional and relational link I have with the research and Factor 3: Navigating my lived and professional experiences practically and emotionally. The findings suggest that there may be three types of lived experience researchers, each with different needs from supervision, suggesting the population is heterogeneous. CONCLUSION: The research identified a deeper understanding of the needs of lived experience researchers and highlights the importance of personalised supervision according to the individual needs of the researcher and their preferences for supervision. The findings reinforce the importance of integrating a clinical dimension into supervision to support the needs of all lived experience researchers.