Reducing donor acceptance practice variation - Learnings from a discussion forum.

PURPOSE: Although waitlist mortality is unacceptably high, nearly half of donor heart offers are rejected by pediatric heart transplant centers. The Advanced Cardiac Therapy Improving Outcome Network (ACTION) and Pediatric Heart Transplant Society (PHTS) convened a multi-institutional donor decision discussion forum (DDDF) aimed at assessing donor acceptance practices and reducing practice variation. METHODS: A 1-h-long virtual DDDF for providers across North America, the United Kingdom, and Brazil was held monthly. Each session typically included two case presentations posing a real-world donor decision challenge. Attendees were polled before the presenting center's decision was revealed. Group discussion followed, including a review of relevant literature and PHTS data. Metrics of participation, participant agreement with presenting center decisions, and impact on future decision-making were collected and analyzed. RESULTS: Over 2 years, 41 cases were discussed. Approximately 50 clinicians attended each call. Risk factors influencing decision-making included donor quality (10), size discrepancy (8), and COVID-19 (8). Donor characteristics influenced 63% of decisions, recipient factors 35%. Participants agreed with the decision made by the presenting center only 49% of the time. Post-presentation discussion resulted in 25% of participants changing their original decision. Survey conducted reported that 50% respondents changed their donor acceptance practices. CONCLUSION: DDDF identified significant variation in pediatric donor decision-making among centers. DDDF may be an effective format to reduce practice variation, provide education to decision-makers, and ultimately increase donor utilization.

Animal-Assisted Interventions on a College Campus to Improve Wellness: Adventures With the Northern Michigan University Wildpups.

BACKGROUND: The prevalence of anxiety and stress among university students has been well established. However, limited studies document the effects of animal-assisted interventions (AAI) on college campuses. METHOD: An AAI program was created and implemented during the 2021-2022 academic year to study the effects on students' stress and anxiety. Five faculty dog and handler teams, called the "Wildpups," participated in events that allowed individuals to interact with registered therapy dogs. Nursing students assessed vital signs including heart rate, respiratory rate, and blood pressure before and after events. The State-Trait Anxiety Inventory survey was used to assess pre- and postperceived anxiety, and a visual analog scale was used to assess pre- and postperceived stress. RESULTS: Participants' blood pressure, heart and respiratory rates, and perceived stress and anxiety decreased significantly after events. CONCLUSION: Embedded AAI programs on college campuses positively affect the life and mental well-being of individuals. [J Nurs Educ. 2023;62(11):631-637.].

Did the COVID-19 pandemic impact the dietary intake of individuals living with and beyond breast, prostate, and colorectal cancer and who were most likely to experience change?

PURPOSE: The present work investigated dietary changes amongst individuals living with and beyond cancer (LWBC) from before to during the pandemic. To identify those at greatest risk of unhealthy changes, it was further examined whether patterns varied by sociodemographic, health-related, and COVID-19-related characteristics. METHODS: This longitudinal cohort study analysed data from 716 individuals LWBC participating in the Advancing Survivorship Cancer Outcomes Trial (ASCOT). Using data provided before and during the pandemic, changes in fruit and vegetable, snack, and alcohol intake were tested using mixed-effect regression models. RESULTS: Fruit and vegetable (95%CI: - 0.30; - 0.04) and alcohol consumption (95%CI: - 1.25; - 0.31) decreased, whilst snacking increased (95%CI: 0.19; 0.53). Women and individuals with limited social contact were more likely to reduce fruit and vegetable intake during the pandemic. Women and individuals with poorer sleep quality, limited social contact, and shielding requirements and without higher education were more likely to increase snacking during the pandemic. Individuals with poorer sleep quality, poorer mental health, and regular social contact were more likely to decrease alcohol consumption during the pandemic. CONCLUSIONS: Findings suggest decreased intake for fruit, vegetable, and alcohol consumption and increased snack intake in response to the pandemic amongst individuals LWBC. These changes appear to differ across various characteristics, suggesting the pandemic has not equally impacted everyone in this population. Findings highlight the need for targeted post-COVID strategies to support individuals LWBC most adversely affected by the pandemic, including women and socially isolated individuals. This encourages resources to be prioritised amongst these groups to prevent further negative impact of the pandemic. Whilst the findings are statistically significant, practically they appear less important. This is necessary to acknowledge when considering interventions and next steps.

Seafood-Associated Outbreak of ctx-Negative Vibrio mimicus Causing Cholera-Like Illness, Florida, USA.

Vibrio mimicus caused a seafood-associated outbreak in Florida, USA, in which 4 of 6 case-patients were hospitalized; 1 required intensive care for severe diarrhea. Strains were ctx-negative but carried genes for other virulence determinants (hemolysin, proteases, and types I-IV and VI secretion systems). Cholera toxin-negative bacterial strains can cause cholera-like disease.

Employees' support strategies for mental wellbeing during and beyond the COVID-19 pandemic: Recommendations for employers in the UK workforce.

Throughout the COVID-19 pandemic, and beyond for many businesses, employees have had to adapt to new ways of working due to disruptions in traditional practices. It is therefore crucial to understand the new challenges that employees are facing when it comes to taking care of their mental wellbeing at work. To that end, we distributed a survey to full-time UK employees (N = 451) to explore how supported they felt throughout the pandemic, and to identify whether there are any additional types of support they would like to receive. We also compared employees' intentions to seek help before versus during the COVID-19 pandemic, and assessed their current attitudes toward mental health. Based on direct employee feedback, our results show remote workers felt more supported throughout the pandemic compared to hybrid workers. We also found that employees who had previously experienced an episode of anxiety or depression were significantly more likely to want extra support at work compared to those who had not. Furthermore, employees were significantly more likely to seek help for their mental health during the pandemic compared to before. Interestingly, the largest increase in intentions to seek help during the pandemic compared to before was with digital health solutions. Finally, we found that the strategies managers have adopted to better support their employees, an employee's mental health history, and their attitude to mental health all contributed to significantly increasing the likelihood that an employee would disclose a mental health concern to their line manager. We provide recommendations that encourage organisations to make changes to better support their employees, and we highlight the importance of mental health awareness training for both managers and employees. This work is of particular interest to organisations who are looking to tailor their current employee wellbeing offer to a post-pandemic world.

Universal Design for Learning Supports Distance Learning for Deaf Students.

When the COVID-19 pandemic began in 2020, teachers around the United States shifted to distance learning practically overnight. In both general education and special education, many teachers did not have tools or strategies in place to provide deaf students with accessible lessons and support. Teachers needed to change their materials quickly and clearly in order to meet the needs of all their students in the new distance format. The unique needs of deaf and hard of hearing students meant that unique accommodations and solutions needed to be considered and used for the distance learning formats. In the present article, we provide an overview of the challenges schools faced in the quick move to distance learning, present the principles of Universal Design for Learning (UDL), and give some examples of ways in which UDL can benefit students who are deaf in distance learning.

The relationship of adverse childhood experiences, hair cortisol, C-reactive protein, and polygenic susceptibility with older adults' psychological distress during the COVID-19 pandemic.

Adverse childhood experiences (ACEs) are linked to poorer mental health outcomes, and growing evidence implicates biological and genetic pathways from early adversity to psychopathology. However, little is known about the relationship of ACEs and their underlying biological and genetic mechanisms with older people's mental health responses to the COVID-19 pandemic. We tested the associations of ACEs, hair cortisol, C-reactive protein (CRP), and polygenic scores (PGS) with depression, anxiety, and loneliness among older adults during the COVID-19 pandemic, accounting for the potential interplay of ACEs with biological and genetic risk markers. Data were drawn from the English Longitudinal Study of Ageing, a prospective cohort study of older adults living in England. Retrospective information on ACEs were collected in 2006/7, while CRP and hair cortisol were measured at wave 6 (2012/13). Psychological distress was assessed before the pandemic (2018-19) and at two COVID-19 assessments in 2020 (June-July and November-December). Associations were tested on 2050 participants using linear/logistic regression models adjusted for pre-pandemic outcome measures and mixed-effect models to assess changes before and during the pandemic. The results showed that ACEs were associated with higher levels of depression (OR = 2.55[95%CI:1.81,3.59]) anxiety (OR = 1.84[95%CI:1.13,3.01]), and loneliness (b = 0.28[95%CI:0.14,0.42]) during the pandemic. Hair cortisol was related to an increased risk of depression (OR = 1.15[95%CI:1.04,1.26]), and CRP was associated with greater loneliness scores (b = 0.16[95%CI:0.03,0.30]). The relationship between cortisol and psychological distress was larger among participants with ACEs (e.g., ORdepression = 1.07[95%CI:1.00,1.14]). Further, individuals with high CRP experienced greater increases in feelings of loneliness from before to during the pandemic, compared to those with lower CRP levels (interaction effect=0.23; 95%CI:0.1-0.37). Individuals with 2+ ACEs experienced greater increases in depressive symptoms compared to those with none (interaction effect=2.09; 95%CI:1.1-3.98). Higher levels of hair cortisol were also related to worse changes in depressive symptoms across timepoints (interaction effect=1.84;95%CI:1.41-2.41). These results highlight the lasting impact of biosocial vulnerabilities on older adults' mental health responses to new environmental stressors. They also implicate biological mechanisms in the pathophysiology of later-life psychological distress.

Clinical characteristics and outcomes of SARS-Cov-2 B.1.1.529 infections in hospitalized patients and multi-surge comparison in Louisiana.

BACKGROUND: Peer reviewed data describing SARS-CoV-2 Omicron variant symptoms and clinical outcomes as compared to prior surges in the United States is thus far limited. We sought to determine disease severity, presenting features, and epidemiologic factors of the SARS-CoV-2 Omicron variant compared to prior surges. METHODS: Retrospective cohort analysis was performed on patients admitted during five surges in Louisiana between March 2020 and January 2022. Patient data was pulled from the medical record and a subset of patients during Surge 5 were manually abstracted. Patients who were admitted to one of six Louisiana hospitals with a positive SARS-CoV-2 test during the 5 defined surge periods were included. Surges were compared using chi-squared tests and one way ANOVA for age, sex, vaccination status, length of stay, ICU status, ventilation requirement, and disposition at discharge. The records of patients admitted during the omicron surge were analyzed for presenting symptoms and incidental SARS-CoV-2 diagnosis. RESULTS: With each subsequent surge, a smaller proportion of patients presenting to the emergency department were admitted. Patients admitted during surge 5 had shorter lengths of stay and fewer comorbidities than prior surges. Fewer patients in surge 5 presented with a respiratory condition and fewer required ICU admission. In surges 4 and 5, fewer vaccinated patients were admitted compared to their unvaccinated counterparts. Overall mortality was lower in surge 5 (9%) than in surge 4 (15%) p < .0005. Of the SARS-Cov-2 admissions in surge 5, 22.3% were felt to be incidental diagnoses. CONCLUSIONS: As the COVID-19 pandemic progressed, a younger and less vaccinated population was associated with higher risk for severe disease, fewer patients required ICU admission and overall mortality decreased. Vaccinations seemed to be protective for overall risk of hospitalization but once admitted did not seem to confer additional protection against severe illness during the omicron surge. Age also contributed to patient outcomes.

Effectiveness and Safety of Antibiotic Prophylaxis for Persons Exposed to Cases of Invasive Group A Streptococcal Disease: A Systematic Review.

Among close contacts of patients with invasive group A streptococcal (iGAS) infection, the benefits and harms of chemoprophylaxis are uncertain. We conducted a systematic review of studies that reported on persons who, after being exposed to a case of laboratory-confirmed or probable iGAS, received any antibiotic prophylaxis for the prevention of GAS infection or carriage. Thirty-seven studies including 26 outbreak investigations and 11 case series or reports were included with predominantly descriptive information that suggested that antibiotic prophylaxis may be effective in preventing GAS infection or GAS carriage, with very few serious adverse events. However, current available evidence is scant (with limited information on contacts of iGAS cases) and largely based on studies with weak design and small sample size. Therefore, definitive conclusions on effectiveness of antibiotic prophylaxis cannot be drawn. Well designed prospective studies are required to establish the benefit-harm profile of antibiotic prophylaxis for secondary prevention of GAS disease among close contacts of iGAS cases.

First case of minimal change nephrotic syndrome resolving with antifungal therapy for isolated pleural cryptococcal infection.

We report the case of a 71-year-old male with poorly controlled diabetes mellitus who presented with lower extremity edema and acute renal failure. He was diagnosed with nephrotic syndrome secondary to minimal change disease (MCD). Treatment with steroids was withheld due to concern for hyperglycemia in the context of his poorly controlled diabetes mellitus. A week after discharge, he was subsequently re-hospitalized four times within a month with pleural effusions, dyspnea, and fever. Work up revealed isolated pleural cryptococcosis, demonstrated on two separate admissions. There was neither evidence of disseminated disease nor immunocompromising condition. Immunosuppression was not initiated for the treatment of MCD in the setting of poorly controlled diabetes and active infection. After six months of treatment with fluconazole 400 mg/day, the nephrotic syndrome, renal failure, and cryptococcal pleuritis resolved. This case is the first to our knowledge of isolated pleural cryptococcosis associated with nephrotic syndrome. The patient's course lends further support to the hypothesis that there may be causal relationship between cryptococcosis and nephrotic syndrome.

Weak links: Instabilities and areas for improvement in the drug supply chain.

OBJECTIVE: To evaluate the current pharmaceutical supply chain, from both a regulatory and market perspective, to identify instabilities as well as propose methods to ensure consistent drug quality and access. DATA SOURCES: Data sources include publicly available Food and Drug Administration (FDA) databases. SUMMARY: Recent recalls of important drugs such as angiotensin receptor blockers, heparin, epinephrine, and acyclovir highlight the importance of ensuring access to essential medications. However, the current drug supply chain has multiple weaknesses from both regulatory and market perspectives. A lack of adequate inspection and quality standards means that quality issues often go unfound, but when they are found, disruptions to the supply chain are amplified by a dependence on India and China for active pharmaceutical ingredients. The mutual recognition agreement, India Pilot Program, and increased number of FDA foreign inspectors were steps in the right direction, but more must be done to ensure access. CONCLUSION: Ensuring drug quality and access is not possible without first providing greater transparency into the drug supply chain. This allows both health care consumers and the FDA to respond to drug quality issues. Additionally, extra steps including broadening the scope of the mutual recognition agreement, encouraging increased self-regulation in China and India, and mandating unannounced inspections of foreign manufacturers may help in providing a more stable supply chain.

Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care.

Hospital palliative care is an essential part of the COVID-19 response but data are lacking. We identified symptom burden, management, response to treatment, and outcomes for a case series of 101 inpatients with confirmed COVID-19 referred to hospital palliative care. Patients (64 men, median [interquartile range {IQR}] age 82 [72-89] years, Elixhauser Comorbidity Index 6 [2-10], Australian-modified Karnofsky Performance Status 20 [10-20]) were most frequently referred for end-of-life care or symptom control. Median [IQR] days from hospital admission to referral was 4 [1-12] days. Most prevalent symptoms (n) were breathlessness (67), agitation (43), drowsiness (36), pain (23), and delirium (24). Fifty-eight patients were prescribed a subcutaneous infusion. Frequently used medicines (median [range] dose/24 hours) were opioids (morphine, 10 [5-30] mg; fentanyl, 100 [100-200] mcg; alfentanil, 500 [150-1000] mcg) and midazolam (10 [5-20] mg). Infusions were assessed as at least partially effective for 40/58 patients, while 13 patients died before review. Patients spent a median [IQR] of 2 [1-4] days under the palliative care team, who made 3 [2-5] contacts across patient, family, and clinicians. At March 30, 2020, 75 patients had died; 13 been discharged back to team, home, or hospice; and 13 continued to receive inpatient palliative care. Palliative care is an essential component to the COVID-19 response, and teams must rapidly adapt with new ways of working. Breathlessness and agitation are common but respond well to opioids and benzodiazepines. Availability of subcutaneous infusion pumps is essential. An international minimum data set for palliative care would accelerate finding answers to new questions as the COVID-19 pandemic develops.

Integrating behavioral health services at employer-sponsored health clinics: A descriptive analysis.

INTRODUCTION: Approximately, 20% of adults in the United States have a behavioral health concern, resulting in $732M in direct medical spending and over 5 million lost workdays annually. Employers bear a substantial share of these costs. The objective of this study was to describe the integration of behavioral health services at employer-sponsored health clinics. METHOD: Retrospective cohort analysis of patients seen for individual behavioral health services from 1/1/2018 to 12/31/2018 in employer-sponsored clinics. RESULTS: Among the 2,954 patients cared for by a behavioral health provider, 49% met criteria for moderate or severe depression and/or anxiety. The median duration between appointment scheduling and a behavioral health triage visit was 2 days (SD = 7.2 days), and median interval to an initial psychotherapy visit was 10 days (SD = 14 days). The mean number of visits with a behavioral health provider within the initial 3 months after presenting for care was 5.3 visits (SD = 2.8 visits). During the course of treatment, anxiety (Generalized Anxiety Disorder-7 [GAD-7] scores) decreased by 31% and depression (Patient Health Questionnaire-9 [PHQ-9] scores) decreased by 24%. Patient satisfaction with their behavioral health care was excellent. DISCUSSION: Integrating behavioral health services into employer-sponsored clinics can result in timely access to psychotherapy, improvements in clinical symptoms, and excellent patient satisfaction. Employers interested in providing greater access to behavioral health care should evaluate integrating such services into onsite or near-site health clinics. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prevalence, Predictors, and Treatment of Impostor Syndrome: a Systematic Review.

BACKGROUND: Impostor syndrome is increasingly presented in the media and lay literature as a key behavioral health condition impairing professional performance and contributing to burnout. However, there is no published review of the evidence to guide the diagnosis or treatment of patients presenting with impostor syndrome. PURPOSE: To evaluate the evidence on the prevalence, predictors, comorbidities, and treatment of impostor syndrome. DATA SOURCES: Medline, Embase, and PsycINFO (January 1966 to May 2018) and bibliographies of retrieved articles. STUDY SELECTION: English-language reports of evaluations of the prevalence, predictors, comorbidities, or treatment of impostor syndrome. DATA EXTRACTION: Two independent investigators extracted data on study variables (e.g., study methodology, treatments provided); participant variables (e.g., demographics, professional setting); diagnostic tools used, outcome variables (e.g., workplace performance, reductions in comorbid conditions); and pre-defined quality variables (e.g., human subjects approval, response rates reported). DATA SYNTHESIS: In total, 62 studies of 14,161 participants met the inclusion criteria (half were published in the past 6 years). Prevalence rates of impostor syndrome varied widely from 9 to 82% largely depending on the screening tool and cutoff used to assess symptoms and were particularly high among ethnic minority groups. Impostor syndrome was common among both men and women and across a range of age groups (adolescents to late-stage professionals). Impostor syndrome is often comorbid with depression and anxiety and is associated with impaired job performance, job satisfaction, and burnout among various employee populations including clinicians. No published studies evaluated treatments for this condition. LIMITATIONS: Studies were heterogeneous; publication bias may be present. CONCLUSIONS: Clinicians and employers should be mindful of the prevalence of impostor syndrome among professional populations and take steps to assess for impostor feelings and common comorbidities. Future research should include evaluations of treatments to mitigate impostor symptoms and its common comorbidities.

Integrated Physical Medicine at Employer-Sponsored Health Clinics Improves Quality of Care at Reduced Cost.

OBJECTIVE: The aim of the study was to evaluate clinical and economic outcomes associated with integrating physical medicine in employer-sponsored clinics. METHODS: Retrospective cohort analysis comparing clinical and economic outcomes of physical medicine services delivered in employer-sponsored clinics with the community. RESULTS: Integrating physical medicine in employer-sponsored clinics decreased wait times to access these services to 7 days (2 to 4× faster than in the community). Patients receiving care in employer-sponsored clinics experienced marked improvements in fear of pain avoidance behaviors (P < 0.00001) and functional status (P < 0.01) in eight fewer visits than in the community (P < 0.0001), resulting in $472 to $630 savings/patient episode. Noncancer patients received 1/10th the opioid prescriptions in employer-sponsored clinics compared with the community (2.8% vs 20%). Patients were highly likely to recommend integrated employer-sponsored care (Net Promoter Score  = 84.7). CONCLUSIONS: Findings suggest robust clinical and economic benefits of integrating physical medicine services into employer-sponsored clinics.

Comparison of Self-Reported and Objectively Measured Sedentary Behavior and Physical Activity in Undergraduate Students.

OBJECTIVE: To investigate differences between estimates of sedentary behavior and physical activity (PA) from the International Physical Activity Questionnaire (IPAQ) and accelerometry in undergraduate students. PARTICIPANTS: 91 students participated in the study. METHODS: Sedentary behavior and PA were objectively measured by an accelerometer for 7 days and then self-reported with the IPAQ. Partial correlations were used to assess associations among PA variables and participant characteristics between the methods. Agreement was assessed via the Bland-Altman method. RESULTS: Correlation coefficients between self-reported and objectively measured PA ranged from 0.21 to 0.38 (p≤0.05 for all). A higher proportion of students were classified as meeting PA guidelines via self-report compared to objective measurements. Bland-Altman plots revealed acceptable agreement between methods, however, bias was evident for all PA intensities. Sex and lean body mass impacted these differences. CONCLUSIONS: Researchers should exercise caution when interpreting PA assessed via the IPAQ in undergraduate students.

An Account of 'Life after Guantánamo': a rehabilitation project for former Guantánamo detainees across continents.

This paper describes a project established in 2009 by the human rights charity, Reprieve, to coordinate rehabilitation for men who have been released from long-term detention at the US military base of Guantánamo Bay. The majority of the men referred to the project were deemed unable to return to their home country because of the risk they faced of torture or other persecution and were therefore resettled in a third country. This paper also refers to Tunisian former Guantánamo detainees with whom Reprieve worked, who had initially been resettled in a third country but then following the Jasmine Revolution and the fall of the Ben Ali regime, were able to return to their home country. Reprieve then provided assistance to them and their families under the Life after Guantánamo in Tunisia project. This paper briefly outlines the abuse and nature of psychological control at Guantánamo and, based on the first-hand experiences of the Project Coordinator and Caseworker, offers non-clinical observations of the apparent consequences of this control on the former detainees who were referred to the project. The Life after Guantánamo project facilitated social, medical, psychological, legal and financial assistance in partnership with local service providers and through liaison with host governments and intergovernmental organisations, such as the International Organisation for Migration (IOM), United Nations High Commissioner for Refugees (UNHCR) and the International Committee of the Red Cross (ICRC). The paper recounts the type of assistance provided, highlights some of the challenges faced and, based on learnings made over the project's eight year duration, makes recommendations, for future work with former Guantánamo detainees and others who have been detained and subject to torture and inhuman and degrading treatment in the 'War on Terror'.

Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England.

OBJECTIVE: In most developed countries, substantial disparities exist in access to mental health services for black and minority ethnic (BME) populations. We sought to determine perceived barriers to accessing mental health services among people from these backgrounds to inform the development of effective and culturally acceptable services to improve equity in healthcare. DESIGN AND SETTING: Qualitative study in Southeast England. PARTICIPANTS: 26 adults from BME backgrounds (13 men, 13 women; aged >18 years) were recruited to 2 focus groups. Participants were identified through the registers of the Black and Minority Ethnic Community Partnership centre and by visits to local community gatherings and were invited to take part by community development workers. Thematic analysis was conducted to identify key themes about perceived barriers to accessing mental health services. RESULTS: Participants identified 2 broad themes that influenced access to mental health services. First, personal and environmental factors included inability to recognise and accept mental health problems, positive impact of social networks, reluctance to discuss psychological distress and seek help among men, cultural identity, negative perception of and social stigma against mental health and financial factors. Second, factors affecting the relationship between service user and healthcare provider included the impact of long waiting times for initial assessment, language barriers, poor communication between service users and providers, inadequate recognition or response to mental health needs, imbalance of power and authority between service users and providers, cultural naivety, insensitivity and discrimination towards the needs of BME service users and lack of awareness of different services among service users and providers. CONCLUSIONS: People from BME backgrounds require considerable mental health literacy and practical support to raise awareness of mental health conditions and combat stigma. There is a need for improving information about services and access pathways. Healthcare providers need relevant training and support in developing effective communication strategies to deliver individually tailored and culturally sensitive care. Improved engagement with people from BME backgrounds in the development and delivery of culturally appropriate mental health services could facilitate better understanding of mental health conditions and improve access.