Patient-centric assessment of rheumatoid arthritis using a smartwatch and bespoke mobile app in a clinical setting.

Rheumatoid arthritis (RA) is a fluctuating progressive disease requiring frequent symptom assessment for appropriate management. Continuous tracking using digital technologies may provide greater insights of a patient's experience. This prospective study assessed the feasibility, reliability, and clinical utility of using novel digital technologies to remotely monitor participants with RA. Participants with moderate to severe RA and non-RA controls were monitored continuously for 14 days using an iPhone with an integrated bespoke application and an Apple Watch. Participants completed patient-reported outcome measures and objective guided tests designed to assess disease-related impact on physical function. The study was completed by 28 participants with RA, 28 matched controls, and 2 unmatched controls. Completion rates for all assessments were > 97% and were reproducible over time. Several guided tests distinguished between RA and control cohorts (e.g., mean lie-to-stand time [seconds]: RA: 4.77, control: 3.25; P < 0.001). Participants with RA reporting greater stiffness, pain, and fatigue had worse guided test performances (e.g., wrist movement [P < 0.001] and sit-to-stand transition time [P = 0.009]) compared with those reporting lower stiffness, pain, and fatigue. This study demonstrates that digital technologies can be used in a well-controlled, remote clinical setting to assess the daily impact of RA.

TEAMwork! An Innovative Hospital Medicine Teaching Program to Enhance Learners' Educational Experience.

PROBLEM: Workplace-based learning and assessment are dependent on frequent observations, feedback, teaching, and evaluations. Yet high physician workload and multiple learners limit these efforts. A local needs assessment demonstrated insufficient direct observations, small-group teaching, and high-quality evaluations for learners. In response, the authors developed and implemented Teaching Excellence Among Medical providers (TEAM), a teaching program to enhance the educational experience of learners in pediatric hospital medicine (PHM). APPROACH: The TEAM program, grounded in a self-regulated learning framework, launched in 2019. The University of Colorado Department of Pediatrics provided salary support. TEAM hospitalists completed professional development for teaching and feedback skills. During their TEAM shifts, they observed, provided feedback, completed evaluations, and led teaching sessions for learners on PHM rotations. The program's impact was evaluated by using an electronic work tracking form and surveying learners, attending hospitalists, and TEAM hospitalists, leading to iterative program improvements. OUTCOMES: Over an 18-month period, TEAM hospitalists completed 1,573 direct observations, 265 teaching sessions attended by 1,921 learners, and more than 497 learner evaluations. Survey results showed that 95% of learners indicated TEAM was "very effective" or "somewhat effective" in helping achieve individualized learning goals, and a similar percentage "strongly agreed" or "agreed" that TEAM hospitalists were effective educators. Eighty-four percent of attending hospitalist survey respondents reported TEAM contributed "very much" or "somewhat" to learner education. Attending hospitalists particularly appreciated TEAM's ability to focus on learners identified as struggling, while TEAM hospitalists rated observation of rounds and small-group teaching sessions as the most valuable TEAM activities. NEXT STEPS: The TEAM program employed concepts of self-regulated learning to enhance education in PHM through direct observation, feedback, written evaluations, and teaching efforts. This program can mitigate many challenges facing attending physicians and can serve as a model for other institutions. Next steps include evaluation of higher-level learning outcomes.

A Passport for a New Era of Learning.

Over the last several years, there has been a surge of readily available curricular resources for global health (GH) educators that theoretically has enabled them to overcome the barrier of needing to create new content for their programs. Despite this increase in available resources, integrating GH education into the already busy schedule of residency is a common challenge to the growing number of GH track directors. In this perspectives piece, GH educators from multiple institutions will share a novel model for packaging, administering, and monitoring GH educational curricula. This model transposes traditional GH learning objectives into self-paced, longitudinal maps of opportunities suitable for the time-intensive demands of residency, with flexibility for individual learning preferences and built-in tracking mechanisms.

Educating Nursing Students About Delivering Culturally Sensitive Care to Lesbian, Gay, Bisexual, Transgender, Questioning/Queer, Intersex, Plus Patients: The Impact of an Advocacy Program on Knowledge and Attitudes.

AIM: This study evaluated the effects of a program designed to help students provide culturally competent care for lesbian, gay, bisexual, transgender, questioning/queer, intersex, plus (LGBTQI+) patients. BACKGROUND: The LGBTQI+ community faces disparities linked to stigma and discrimination. The Advocacy™ Program was developed to supplement the curriculum in schools of nursing. METHOD: Nursing students from six schools of nursing (n = 1,398) received advocacy training. Students were administered the Genderism and Transphobia Scale, the Homonegativity Scale, and additional knowledge questions before and after training. RESULTS: The findings were positive, indicating an increase in student attitude scores, vocabulary and disparity knowledge, and knowledge regarding care for an LGBTQI+ client (p < .05). CONCLUSION: By building a culture of inclusion through recognition of diverse patients in the curriculum, nursing schools can develop a culture of connection that strengthens patient-provider relationships and improves mental and physical health.

Nurse Practitioners Improving Emergency Department Quality and Patient Outcomes.

Emergency departments across the United States struggle to balance the overutilization of emergency services. Nurse practitioners (NPs) practicing in emergency departments improve quality indicators leading to the increased efficiency, timeliness, and effectiveness of care. NPs providing emergency services improve multiple national metrics, such as door-to-provider time, patient satisfaction, diagnostic test ordering, and left without being seen rates. NPs should be aware of the positive impact they make on the quality of care. NPs should monitor and trend patient outcomes they directly effect. More research is needed to identify ways NPs can continue to improve the quality of emergency services provided.

Providing Culturally Sensitive Care to Women Who Are in the Sexual Minority or Are Gender Nonconforming.

Women who are in the sexual minority or are gender nonconforming experience more physical and mental health disparities compared with those in the sexual majority. Individuals in the minority have reported a fear of being judged or a feeling of being invisible to health care providers. Many nurses believe that they treat all patients the same, but they may be unaware of the special cultural needs of individuals in the minority. In this article, we describe health disparities experienced by lesbian, gay, bisexual, transgender, questioning/queer, and intersex (LGBTQI) populations; explain definitions and terms to improve communication; and discuss best practices to provide inclusive environments for these individuals. We also discuss the process of coming out and how nurses can best meet the needs of individuals in the different stages of coming out.

Acute and Chronic Hypertension: What Clinicians Need to Know for Diagnosis and Management.

Hypertension is the most common primary diagnosis in the United States. Multiple sequelae of disease states are attributable to hypertension. Minimal to modest improvements in blood pressure can result in improved cardiovascular-related health outcomes. Despite the wealth of information available regarding the management and treatment of hypertension, the widespread control of hypertension continues to be an elusive challenge. A collaborative effort between patient and clinician using a balance of pharmacologic and nonpharmacologic interventions is essential to effectively manage and treat hypertension to avoid target organ damage. Prevention of acute organ damage related to hypertensive emergencies demands immediate intervention.

Early Identification and Management of the Septic Patient in the Emergency Department.

Sepsis and septic shock affect millions of people around the globe and kills more than 1 in 4 patients worldwide. Emergency departments (EDs) nationwide have implemented evidence-based protocols to facilitate the early detection and treatment of patients with sepsis. Despite these efforts, patients present to the ED undifferentiated and can often have an unclear source of infection. The latest literature provides refined definitions and clinical criteria for sepsis identification and indicates that early detection combined with the appropriate early management improves the septic patients' morbidity and mortality rates.

The emerging threat from carbapenem-resistant enterobacteriaceae.

The emergence of carbapenem-resistant enterobacteriaceae (CRE) in the United States represents a serious danger to people who are hospitalized and is associated with case mortality rates as high as 50 percent. CRE infections have limited treatment options and the potential to spread widely if prevention and transmission measures are not employed. Decreasing the impact of CRE requires coordinated efforts between nurses and other clinicians, as well as administrators, to improve patient outcomes.