Implementation of an interprofessional education program in a community teaching hospital and its impact on student perceptions of other healthcare professions.

In this single-center, prospective study we evaluated the impact of an interprofessional education program (IPE) on healthcare students' perceptions of other healthcare professions. The program consisted of four one-hour, roundtable, case-based sessions with students and several facilitators from medicine, nursing, pharmacy, and physician assistant programs. Included students were 18 years of age or older and currently enrolled in a healthcare program during the study time frame. The primary outcome of student perceptions of other healthcare professions was measured by baseline and follow-up surveys using the Adapted Attitudes Toward Interprofessional Health Care Teams scale. Perceptions of students who participated in the IPEP (intervention group) were compared to similar healthcare program students who did not participate in the program (control group). Overall, the intervention group had significantly higher perceptions of other healthcare professions comparing pre-intervention to post -intervention data (pre-intervention mean ± SD of 57.2 ± 5.24; post-intervention mean 60.7 ± 5.63; p = .02). This improvement in perceptions was also seen when comparing the post-intervention group to the control group (control mean 56.7 ± 5.1; post-intervention mean 60.7 ± 5.63; p = .008).

Linguistic networks associated with lexical, semantic and syntactic predictability in reading: A fixation-related fMRI study.

The ability to make predictions is thought to facilitate language processing. During language comprehension such predictions appear to occur at multiple levels of linguistic representations (i.e. semantic, syntactic and lexical). The neural mechanisms that define the network sensitive to linguistic predictability have yet to be adequately defined. The purpose of the present study was to explore the neural network underlying predictability during the normal reading of connected text. Predictability values for different linguistic information were obtained from a pre-existing text corpus. Forty-one subjects underwent simultaneous eye-tracking and fMRI scans while reading these select paragraphs. Lexical, semantic, and syntactic predictability measures were then correlated with functional activation associated with fixation onset on the individual words. Activation patterns showed both positive and negative correlations to lexical, semantic, and syntactic predictabilities. Conjunction analysis revealed regions specific to or shared between each type of predictability. The regions associated with the different predictability measures were largely separate. Results suggest that most linguistic predictions are graded in nature, activating components of the existing language system. A number of regions were also found to be uniquely associated with full lexical predictability, most notably the anterior temporal lobe and the inferior posterior temporal cortex.

A retrospective study of helmet use and head injury in severe equestrian trauma.

Objectives: The aim of the study was to examine helmet use, incidence of injury, and patient outcomes in a rural cohort of equestrian accidents. Material and Methods: EHR records of patients admitted to a Level II ACS trauma center in the North-west United States were reviewed for helmet use. Injuries were categorized according to International Classification of Diseases-9/10 code. Results: Of 53 identified cases, helmets only reduced superficial injury (χ2 (1) = 4.837, P = 0.028). Intracranial injury rates were not different between those with and without helmets (P > 0.05). Conclusion: In equine related injury, helmets protect against superficial injury but not intracranial injury in Western riders. More investigation is needed to assess why this is the case and determine ways to decrease intracranial injury.

Transition Into Practice: Outcomes of a Nurse Residency Program.

Background Nurse residency programs (NRPs) have been proposed to meet the educational needs of new graduate nurses and facilitate the transition into practice. Although most studies indicate the benefits of NRPs to assist nurses during transition into practice, only one study compared an NRP with a control group. This study examined whether nurses in an NRP transitioned into practice more successfully than nurses in a traditional orientation program. Method This study enrolled 106 newly employed graduate nurses into study arms by unit: a nurse residency intervention group or a control group of standard nursing orientation. Casey-Fink Readiness for Practice, Nurse Retention, and Nurse Job Satisfaction surveys measured group outcomes. Results Readiness for practice improved significantly for nurse residents, as did nurse retention perceptions, indicating that nurse residents were more likely to be retained at the organization. The 1- and 2-year nurse retention rates during the 3 years of the study showed marked improvement. Conclusion The NRP resulted in improved readiness for practice, improved nurse retention, and higher job satisfaction compared with standard orientation. [J Contin Educ Nurs. 2023;54(1):32-39.].

Outcomes in necrotizing soft tissue infections are worse in rural versus urban Montana: a 10-year single center retrospective review.

Time to definitive surgical debridement has been recognized as a predictor for morbidity and mortality in necrotizing soft-tissue infections (NSTI). Rural patients are at particular risk due to limited local resources, decreased access to care, and prolonged transport times. The aim of the current study was to examine the outcomes of NSTI requiring surgical treatment in a previously non-described setting. This retrospective study (2010-2020) from a single tertiary care center in Montana reviewed patients ≥18 years old with a NSTI via ICD9/10 codes. Rural-Urban Continuum Codes (RUCC; characterizing counties by population size) were used to distinguish urban versus rural counties. Race (White and American Indian/Alaskan Native (AI/AN)) was self-described. Qualitative and quantitative comparisons between groups were determined using the appropriate two-tailed statistical tests. An aggregate of 177 patients was identified. Mean age in AI/AN was significantly lower (P<0.0001) compared to White patients with no preexisting condition delineation. NSTI demonstrated an elevated incidence in both rural areas and AI/AN patients. Diabetes was also significantly higher (P=0.0073) in rural versus urban patients. Both rural and AI/AN patients faced extended travel distance for treatment. AI/AN patients had a significantly different infection location than White. Furthermore, polymicrobial species were significantly more prevalent in AI/AN patients. Morbidities (defined as septic shock and/or amputation) were significantly higher in AI/AN patients and rural environments (P<0.01). There was no significant difference in all-cause mortality between respective groups. The state of Montana presents unique challenges to optimizing NSTI treatment due to excessive distances to regional tertiary care facilities. This delay in treatment can lead to increased morbidity.

A retrospective comparison of the emergent use of fixed-dose four-factor prothrombin complex versus weight-based dosing for intracranial hemorrhage assessing medication delivery time and cost.

OBJECTIVES: The goal of this study was to evaluate a low fixed-dose versus weight-based dosing strategy for four-factor prothrombin complex (4F-PCC) time to administration in intracranial hemorrhage (ICH) patients. METHODS: A retrospective analysis was conducted at a single rural Tertiary referral center in patients ≥18 years old on warfarin with ICH who received 4F-PCC. Continuous variables were summarized using mean (±95% CI) and compared using two-tailed tests; p values ≤0.05 were considered statistically significant. RESULTS: A total of 46 ICH patients were reversed using 4F-PCC (Fixed, n = 27 and Weight, n = 19). Baseline characteristics were equivalent. Total units of 4F-PCC (mean dose units 2525.1 versus 1623.3) and dose per kg were significantly reduced in the fixed-dose group. Total time from order to delivery was significantly reduced with the fixed-dose strategy (mean time 43.0 versus 29.0 minutes). Hospital length of stay (LOS), intensive care unit LOS, and mortality were equivalent with a similar mechanism. International Normalized Ratio (INR) reversal success (≤1.5) and total INR change was comparable with no difference in adverse thromboses between groups. CONCLUSIONS: A fixed-dosed strategy reduced time to 4F-PCC administration for warfarin reversal in ICH, as compared to a weight-based strategy; with no increase in LOS, mortality, or need for additional dosing. This also resulted in significant cost savings.

Impact of Medicaid Expansion Status and Race on Metastatic Disease at Diagnosis in Patients with Melanoma.

BACKGROUND: Black patients are diagnosed with melanoma at a later stage, as compared with their white counterparts. It is unknown if Medicaid expansion might ameliorate this disparity. METHODS: Using data from the 2016 National Cancer Database, we conducted a retrospective cohort study. The primary objective was to evaluate whether being diagnosed with melanoma at a Medicaid Expansion State (MES) and black race are associated with a late diagnosis of melanoma.  Main exposure: Being diagnosed in a MES. Secondary exposure: Race. Main outcome: Odds of Stage IV vs Stages 0-III at diagnosis. Univariate, multivariate logistic regression, and propensity score analyses were conducted to evaluate the potential associations. Sub-group analysis was conducted according to age < 65 or ≥ 65 years. RESULTS: A total of 216,604 patients were included, 40-90 years of age, [Formula: see text] 64 years [SD 12.47]. In univariate analysis, patients diagnosed in MES were 15% less likely (95% CI, 0.81-0.88) to be diagnosed with Stage IV melanoma. Black race (vs white) had 3.04 increased odds (95% CI, 2.56-3.60) of late diagnosis. In multivariate analysis, adjusting for socio-economic confounders, patients < 65 years of age were 13% less likely (95% CI, 0.82-0.92) to be diagnosed with Stage IV melanoma. By propensity score analysis, the strength of the associations remained. Black race (vs white) was associated with higher odds (95% CI, 1.91-3.08) of being diagnosed with Stage IV disease. For black patients < 65 years, being diagnosed in a state without Medicaid expansion had 2.55 higher odds (95% CI, 1.93-3.38) of being diagnosed with Stage IV melanoma, which decreased to 2.11 odds (95% CI, 1.34-3.33) in MES. The interaction between race and MES was statistically significant (P = 0.008). CONCLUSIONS: This study suggests that patients are less likely to be diagnosed with Stage IV melanoma in MES. This beneficial effect is more pronounced among Black minorities.

Best practices in eye tracking research.

This guide describes best practices in using eye tracking technology for research in a variety of disciplines. A basic outline of the anatomy and physiology of the eyes and of eye movements is provided, along with a description of the sorts of research questions eye tracking can address. We then explain how eye tracking technology works and what sorts of data it generates, and provide guidance on how to select and use an eye tracker as well as selecting appropriate eye tracking measures. Challenges to the validity of eye tracking studies are described, along with recommendations for overcoming these challenges. We then outline correct reporting standards for eye tracking studies.

The effect of convolving word length, word frequency, function word predictability and first pass reading time in the analysis of a fixation-related fMRI dataset.

The data presented in this document was created to explore the effect of including or excluding word length, word frequency, the lexical predictability of function words and first pass reading time (or the duration of the first fixation on a word) as either baseline regressors or duration modulators on the final analysis for a fixation-related fMRI investigation of linguistic processing. The effect of these regressors was a central question raised during the review of Linguistic networks associated with lexical, semantic and syntactic predictability in reading: A fixation-related fMRI study [1]. Three datasets were created and compared to the original dataset to determine their effect. The first examines the effect of adding word length and word frequency as baseline regressors. The second examines the effect of removing first pass reading time as a duration modulator. The third examines the inclusion of function word predictability into the baseline hemodynamic response function. Statistical maps were created for each dataset and compared to the primary dataset (published in [1]) across the linguistic conditions of the initial dataset (lexical predictability, semantic predictability or syntax predictability).

Individuals' eye movements in reading are highly consistent across time and trial.

Eye movements are used to study a variety of cognitive phenomena, including attention, perception, memory, language, reading, decision making, and many others, as well as cognitive impairments and individual differences in cognition. These studies assume, with little evidence, that eye movements are stable across time and trials. Eye movement stability must be better characterized to understand the full theoretical and clinical implications of individual differences in eye movement behavior. The present study examined eye movement reliability in normal individuals during reading. Thirty-nine participants completed 2 sessions of a reading task separated by 1 month. Means and standard deviations of fixation duration, saccade amplitude, first fixation duration, gaze duration, total time, go-past time, skipping, refixation and regression probabilities were compared both between sessions and across trials within sessions. All correlations were highly significant, indicating that eye movement behaviors are stable within individuals across several weeks and highly stable across trials within each individual. The different components of the ex-Gaussian distribution of fixation durations were also highly stable over time. Differences in sensitivity to lexical variables (frequency, predictability, length) were also compared, and were also observed to be highly stable across time. Eye movements in reading are therefore suitable for studying cognition and its neural underpinnings, as well as cognitive development and longitudinal change. Theoretical and clinical implications of these findings are discussed. (PsycINFO Database Record

Ex vivo lung perfusion with adenosine A2A receptor agonist allows prolonged cold preservation of lungs donated after cardiac death.

OBJECTIVE: Ex vivo lung perfusion has been successful in the assessment of marginal donor lungs, including donation after cardiac death (DCD) donor lungs. Ex vivo lung perfusion also represents a unique platform for targeted drug delivery. We sought to determine whether ischemia-reperfusion injury would be decreased after transplantation of DCD donor lungs subjected to prolonged cold preservation and treated with an adenosine A2A receptor agonist during ex vivo lung perfusion. METHODS: Porcine DCD donor lungs were preserved at 4°C for 12 hours and underwent ex vivo lung perfusion for 4 hours. Left lungs were then transplanted and reperfused for 4 hours. Three groups (n = 4/group) were randomized according to treatment with the adenosine A2A receptor agonist ATL-1223 or the dimethyl sulfoxide vehicle: Infusion of dimethyl sulfoxide during ex vivo lung perfusion and reperfusion (DMSO), infusion of ATL-1223 during ex vivo lung perfusion and dimethyl sulfoxide during reperfusion (ATL-E), and infusion of ATL-1223 during ex vivo lung perfusion and reperfusion (ATL-E/R). Final Pao2/Fio2 ratios (arterial oxygen partial pressure/fraction of inspired oxygen) were determined from samples obtained from the left superior and inferior pulmonary veins. RESULTS: Final Pao2/Fio2 ratios in the ATL-E/R group (430.1 ± 26.4 mm Hg) were similar to final Pao2/Fio2 ratios in the ATL-E group (413.6 ± 18.8 mm Hg), but both treated groups had significantly higher final Pao2/Fio2 ratios compared with the dimethyl sulfoxide group (84.8 ± 17.7 mm Hg). Low oxygenation gradients during ex vivo lung perfusion did not preclude superior oxygenation capacity during reperfusion. CONCLUSIONS: After prolonged cold preservation, treatment of DCD donor lungs with an adenosine A2A receptor agonist during ex vivo lung perfusion enabled Pao2/Fio2 ratios greater than 400 mm Hg after transplantation in a preclinical porcine model. Pulmonary function during ex vivo lung perfusion was not predictive of outcomes after transplantation.