Healthcare Providers' Experiences of Caring for Patients With COVID-19 Requiring Extracorporeal Membrane Oxygenation Support.

BACKGROUND: Coronavirus 19 (COVID-19) affected healthcare workers (HCW) in ways more than increasing the volume of patients needing care. Increased numbers of patients at younger ages required support with extracorporeal membrane oxygenation (ECMO). Providing this care requires an interdisciplinary team. AIM: This study explored the experiences of HCW caring for patients with COVID-19 on ECMO. METHODS: Face-to-face semi-structured interviews were conducted via videoconferencing, and transcript comparison was used for the analysis. FINDINGS: Open coding of the data generated 7 categories including (1) fearing the unknown, (2) confronting challenges in patient and/or family interactions, (3) encountering barriers to providing care, (4) facing moral distress, (5) working through exhaustion, (6) persevering by strengthening teamwork, (7) and acknowledging frustration with non-believers. DISCUSSION: HCW balanced pessimism and optimism while caring for patient with COVID-19 on ECMO. They used negative experiences caring for these patients to strength teamwork and bonding among peers. CONCLUSION: The practice implications for caring for patients with COVID-19 on ECMO include viligance by clinician and organization to protect the wellbeing of healthcare providers, particularly in ICU and ECMO units were moral distress and burnout can be high.

Community reintegration: Children with special healthcare needs in rural areas.

PURPOSE: The purpose of this study was to gather descriptions from caregivers and providers of children with special healthcare needs (CSHCN) about their experiences with community reintegration. This study focused on three community support areas: the healthcare structure, community of support, and school systems. The research question was, "How do caregivers and providers of CSHCN describe reintegration into community-based systems?" METHOD: This descriptive qualitative study used focus group design to interview caregivers and providers about their experiences. Data were analyzed using conventional content analysis with open coding, clustering into categories, and abstracting into themes. RESULTS: Eight themes were found within three categories. 1. Planning life and caregiving while fighting for everything needed, 2. Deciding to seek help while living with stigma, shame, and fear, 3. Coping with caregiving while feeling isolated, stressed, and overwhelmed, 4. Arranging transportation while living far away, 5. Underwhelming support in community and school systems, 6. Managing finances and covering expenses, 7. Improving communication of complex needs, and 8. Building a community, increasing confidence, and providing hope. CONCLUSION: Community reintegration was described by caregivers and providers as balancing responsibilities, securing resources, and facilitating collaboration, which offer guidance for future care. IMPLICATIONS: Engaging in open dialogue structured by the themes can help nurses understand the unique needs of caregivers of CSHCN. Social policy reform focused on access to care, financial resources, and school support may reduce inequities, and additional research focused on community-based systems, coping, and caregiving may identify needs based on sociodemographics and existing resources.

Differences in smoking behaviors and readiness to change for patients with COPD and differing categories of depressive symptoms: a descriptive cross-sectional design.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world with nearly 90% of cases caused by tobacco smoking. Nearly 40% of people with COPD are diagnosed with depression which impacts quality of life and smoking cessation. The purpose of this study was to describe factors influencing smoking behaviors and readiness to change in people with comorbid COPD and depression. METHODS: A descriptive cross-sectional design was used. A convenience sample of 222 participants self-reported and/or had a documented diagnosis of COPD. Participants completed study measures which included the PHQ-9 for depressive symptoms, assessment of smoking behaviors using The Cigarette Dependence Scale, report of readiness to change using The Smoking Stage of Change Questionnaire, The Smoking Decisional Balance Questionnaire, and The Processes of Change Questionnaire. Electronic and paper questionnaires were used. Data was stored in RedCap and analyzed using SPSS version 26. Based on variable type, descriptive and comparative analyses were conducted using ANOVA, t-test, chi-square, Pearson correlation, linear regression, and multiple linear regression to determine the relationships between smoking behaviors, COPD, and depressive symptoms. RESULTS: Only 18 participants were classified as having no depressive symptoms. Participants who smoked had high nicotine dependence and wanted to quit smoking. Overall, participants saw more cons to smoking and were engaged in the processes of change. The majority of participants were in the maintenance or contemplation stage. Cigarette dependence could decrease by 9% if depressive symptoms are treated. CONCLUSIONS: There is a need to assess COPD patients for depression and to assess COPD patients' smoking behaviors and readiness to change. Adequate treatment of depression could promote an individual to move through the stages of change from chronic contemplation to action, thus improving smoking cessation efforts for individuals with COPD. Understanding patients' smoking behaviors and readiness to change can aid in developing personalized interventions to achieve smoking cessation and improve long-term outcomes.

Women Veterans' Descriptions of Interactions With Civilian Health Care Providers: A Qualitative Inquiry.

Women veterans often obtain care for unique gender- and military-related health issues from civilian health care settings. There is a gap in the literature surrounding woman veterans' perspectives about the care they receive. The purpose of this study was to apply the Interaction Model of Client Health Behavior framework to study the patient-provider interaction described by women veterans. A qualitative descriptive methodology, using directed content analysis, was employed. Six themes were identified. Consistent screening, provider knowledge about service roles and experiences of women veterans, and familiarity with military-related health conditions support holistic care. Further research in this area is warranted.

Best practices in scholarly publishing for promotion or tenure: Avoiding predatory journals.

BACKGROUND: Predatory publishing has adverse impacts on scientific literature including nursing literature. These publishers have been described as having questionable publication standards. Many faculty have expressed challenges associated with assessing publisher and journal quality. PURPOSE: The purpose of this article is to describe the development and implementation of faculty retention, promotion, and tenure guidelines offering explicit instructions and guidance for faculty on assessing the quality of publishers and journals. METHOD: An appointed committee representing research, teaching, and practice scholarship performed a literature review on the topics of journal quality, scholarship for promotion and tenure, and best practices for evaluating scholarship in academic institutions. RESULTS: The committee developed additional guidance to support and assist faculty assessing journal quality. Based on these guidelines, the faculty retention, promotion, and tenure guidelines for each of the research, teaching, and practice tracks were edited to reflect these practices. CONCLUSIONS: The guidelines provided clarity for our promotion and tenure review committee and faculty.

Living Through COVID-19: A Family Experience.

Through qualitative inquiry grounded in story theory, this study described the impact of COVID-19 on a 5-member family. Using conventional content analysis, 8 themes were abstracted and organized around the story plot of being exposed, facing the challenge, and moving to resolution. Findings offer an approach for holistic nursing practice.

Mothering a child while participating in a substance use disorder program: A phenomenological study.

PURPOSE: The purpose of this study is to describe what it is like to live the everyday moments of mothering while actively participating in a substance use disorder (SUD) program from the mother's perspective. This study was guided by the research question: What is the structure of meaning of the lived experience of mothering a child while participating in a substance use disorder program? METHOD: This qualitative study integrated phenomenology and story theory in the gathering and analysis of the stories. The study setting included two ambulatory clinics that are part of a larger biobehavioral health center of a large south-eastern academic medical center. Nine mothers confirmed voluntary participation, beginning in October 2020 through February 2021, yet only 4 could meet for face to face story gathering sessions. Van Manen's approach to data analysis was used to determine themes in the gathered stories. RESULTS: The finding revealed six themes, along with specific descriptors in the words of the mothers. The themes were synthesized into a structure of meaning that includes: 1. Living the tensions of the everyday; 2. being pressured in mother/family/community relationships; and 3. reflecting on moving forward. These findings could be established in practice protocols for mothers in SUD recovery programs. CONCLUSION: To support the mental health of mothers in SUD recovery programs, it is essential to understand their situation from their perspective. To get that perspective, the nurse needs to encourage the mother to share her experiences in SUD recovery programs.

A graph placement methodology for fast chip design.

Chip floorplanning is the engineering task of designing the physical layout of a computer chip. Despite five decades of research1, chip floorplanning has defied automation, requiring months of intense effort by physical design engineers to produce manufacturable layouts. Here we present a deep reinforcement learning approach to chip floorplanning. In under six hours, our method automatically generates chip floorplans that are superior or comparable to those produced by humans in all key metrics, including power consumption, performance and chip area. To achieve this, we pose chip floorplanning as a reinforcement learning problem, and develop an edge-based graph convolutional neural network architecture capable of learning rich and transferable representations of the chip. As a result, our method utilizes past experience to become better and faster at solving new instances of the problem, allowing chip design to be performed by artificial agents with more experience than any human designer. Our method was used to design the next generation of Google's artificial intelligence (AI) accelerators, and has the potential to save thousands of hours of human effort for each new generation. Finally, we believe that more powerful AI-designed hardware will fuel advances in AI, creating a symbiotic relationship between the two fields.

Integrating an Online Statistics Course With a Graduate Nursing Research Course for Enhanced Learning.

BACKGROUND: Exploration for innovative pedagogical techniques to teach statistics led to examination of the Open and Free Courses offered through the Carnegie Mellon University Online Learning Initiative (CMU OLI). This study examined the impact of the CMU OLI statistics course on graduate nursing students' course grades and course evaluations. METHOD: This retrospective study of a hybrid course compared three teaching modalities for statistics: 1) face-to-face workshop, 2) CMU OLI course, and 3) CMU OLI course plus online discussions. RESULTS: Mean grade point averages increased sequentially and significantly. Individual students' grades improved and student evaluations of instruction mean scores for critical thinking, teaching effectiveness, overall course rating, and overall learning increased significantly (p < .01). CONCLUSION: Future studies are needed that build knowledge of how open and free online courses can be used in nursing education to facilitate retention of content, allay statistics anxiety, and increase student motivation toward research. [J Nurs Educ. 2020;59(4):227-230.].

Affective and enjoyment responses to 12 weeks of high intensity interval training and moderate continuous training in adults with Crohn's disease.

The aim was to undertake secondary data analysis from a three-arm randomised feasibility trial of high intensity interval training (HIIT), moderate intensity continuous training (MICT), and usual care control in adults with Crohn's disease (CD; n = 36), with a primary focus on exploring affective and enjoyment responses. Twenty-five participants with quiescent or mildly-active CD were randomised to one of the two exercise groups: HIIT (n = 13) and MICT (n = 12). Both groups were offered thrice weekly sessions for 12 weeks. MICT consisted of cycling for 30 minutes at 35% peak power (Wpeak), whereas HIIT involved ten 1-minute bouts at 90% Wpeak, interspersed with 1-minute bouts at 15% Wpeak. Heart rate (HR), differentiated ratings of perceived exertion for legs (RPE-L) and central (RPE-C), along with feeling state (Feeling Scale; FS) were measured at 92.5% of each session. Enjoyment was measured at the end of training using the Physical Activity Enjoyment Scale (PACES). Post-hoc exploratory analysis involved a mixed-model two-way ANOVA to compare HR, RPE-L, RPE-C and FS for the exercise sessions in weeks 1, 6 and 12 between groups. Overall, HR was greater (p < 0.01) during HIIT (173 ± 8 bpm) compared with MICT (128 ± 6 bpm). Similarly, RPE-L and RPE-C responses were greater overall (p = 0.03 and p = 0.03, respectively) during HIIT (5.5 ± 1.6 and 5.1 ± 1.7, respectively) compared to MICT (3.3 ± 1.5 and 2.9 ± 1.5, respectively). Overall, FS was 2.2 ± 1.9 for HIIT and 2.1 ± 1.4 for MICT with no effect of treatment group (p = 0.25) or time (p = 0.94). There was also no significant difference in PACES scores between HIIT (99.4 ± 12.9) and MICT (101.3 ± 17.4; p = 0.78). The findings suggest HIIT and MICT protocols elicited similar enjoyment and affect in adults with quiescent or mildly-active CD.

Interventions for self-management of type 2 diabetes: An integrative review.

BACKGROUND: Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes? PURPOSE/OBJECTIVES: The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus. DESIGN: An integrative review design, with a comprehensive methodological approach of reviews, allowing inclusion of experimental and non-experimental studies. PROCEDURES: A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycArtiCLES, and PsycInfo. The final number of papers used for this review were: motivational interviewing (6), peer support/coaching (10), problem solving therapy (3), technology-based interventions (30), lifestyle modification programs (7), patient education (11), mindfulness (3), and cognitive behavioral therapy (5). RESULTS: Studies were examined from seventeen countries including a broad range of cultures and ethnicities. While interventions have shown mixed results in all interventional categories, many studies do support small to modest improvements in physiologic, behavioral, and psychological outcome measures. Considerable heterogeneity of interventions exists. The most commonly reported physiologic measure was HbA1c level. Outcome measures were collected mostly at 6 and 12 months. Duration of most research was limited to one year. CONCLUSIONS: Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes, from offering suggestions for improving care, to stimulating new questions for research. However, implications for clinical practice remain inconclusive, and limitations in existing research suggest caution in interpreting results of studies.

Gender differences in loneliness, anger, depression, self-management ability and biomarkers of chronic illness in chronically ill mid-life adults in Appalachia.

AIMS: This study describes gender differences and relationships among loneliness, anger, depression, self-management ability and biomarkers of chronic illness in chronically ill mid-life adults in Appalachia. BACKGROUND: Loneliness predicts poor health, functional decline, and mortality in adults. Though self-management ability is linked to improved health outcomes, a gap existed when examining how loneliness impacts self-management ability (SMA). METHODS: This cross-sectional study recruited 90 patients from a primary care center. Instruments measured loneliness, anger, depression, and SMA. Measures were taken for BMI, blood pressure, and glucose. Descriptive and hierarchical multiple regression was used to test hypotheses. RESULTS: Participants were majority female (68%), white (89%), married (52%), employed (66%), and impoverished (70%). They were moderately lonely (M = 41.29, SD 12.13) and men were lonelier than women (p < .01). Men and women did not differ on anger, depressive symptoms, or SMA. Anger (5.64, SD 7.32) and depressive symptoms (M = 5.89, SD 5.54) were low. Loneliness positively correlated with anger (r = 0.415, p < .01) and depression (r = 0.558, p < .01), and inversely related to subscales of SMA (p < .01) [taking initiative (TI), investment behavior (IB), variety (V), multifunctionality (MF), self-efficacy (SE), and positive frame of mind (PM)]. After controlling for age, anger, and depression, loneliness was explanatory for poorer SMA (R squared change = 0.32, F change (1, 67) = 47.67, p < .001). CONCLUSIONS: Loneliness impacts SMA and should be included in the care planning or study of chronically ill adults who struggle with self-management.

High-intensity interval training and moderate-intensity continuous training in adults with Crohn's disease: a pilot randomised controlled trial.

BACKGROUND: This study assessed the feasibility and acceptability of two common types of exercise training-high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT)-in adults with Crohn's disease (CD). METHODS: In this mixed-methods pilot trial, participants with quiescent or mildly-active CD were randomly assigned 1:1:1 to HIIT, MICT or usual care control, and followed up for 6 months. The HIIT and MICT groups were offered three exercise sessions per week for the first 12 weeks. Feasibility outcomes included rates of recruitment, retention, outcome completion, and exercise attendance. Data were collected on cardiorespiratory fitness (e.g., peak oxygen uptake), disease activity, fatigue, quality of life, adverse events, and intervention acceptability (via interviews). RESULTS: Over 17 months, 53 patients were assessed for eligibility and 36 (68%) were randomised (47% male; mean age 36.9 [SD 11.2] years); 13 to HIIT, 12 to MICT, and 11 to control. The exercise session attendance rate was 62% for HIIT (288/465) and 75% for MICT (320/429), with 62% of HIIT participants (8/13) and 67% of MICT participants (8/12) completing at least 24 of 36 sessions. One participant was lost to follow-up. Outcome completion rates ranged from 89 to 97%. The mean increase in peak oxygen uptake, relative to control, was greater following HIIT than MICT (2.4 vs. 0.7 mL/kg/min). There were three non-serious exercise-related adverse events, and two exercise participants experienced disease relapse during follow-up. CONCLUSIONS: The findings support the feasibility and acceptability of the exercise programmes and trial procedures. A definitive trial is warranted. Physical exercise remains a potentially useful adjunct therapy in CD. [ID: ISRCTN13021107].

Living With Diabetes in Appalachia: A Focus Group Study.

This article presents an innovative holistic practice application based on evidence from a focus group study on managing diabetes. The purpose of this study addressed the research question: How do persons with type 2 diabetes describe ways of managing the challenge of living with diabetes? A second purpose was to link the findings on ways to manage diabetes to holistic nursing practice through story theory. Nine adults with type 2 diabetes living in rural West Virginia participated in 3 focus groups. Using content analysis, the study findings integrated themes with core qualities, and are as follows: living life as an evolving process is awakening to the present and doing it your way, being on guard is a vigilant ongoing responsibility, attending to bodily experience is awareness of body and facing life stress, and knowing the consequences is awareness of potential problems and taking charge. Merging the study findings with the concepts of story theory led to the development of an innovative practice application for managing diabetes. Managing diabetes in this practice application goes beyond problem-centeredness to a patient-centered approach, offering attention to individual preferences. Since managing diabetes is a major problem in Appalachia, there a need for innovative approaches. This study adds to the body of knowledge on how persons from Appalachia manage diabetes. In addition, it offers a story practice approach for managing diabetes-replacing a problem focus to a more holistic approach to practice leading to more meaningful and fulfilling outcomes.

Strategies for recruiting a sample of adults with type 2 diabetes from primary care clinics in rural Appalachia: Incorporating cultural competence.

BACKGROUND: Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics, making it critically important to incorporate strategies of cultural competence in the overall design of clinical research. OBJECTIVES: The purpose of this paper is to describe culturally competent strategies used for recruitment and data collection with a sample of adults with type 2 diabetes from primary care settings in Appalachia. DESIGN: The Purnell model of cultural competence and relevant literature served as a framework for study design. Four overarching approaches informed the organization of recruitment strategies and development of the data collection plan. PROCEDURES: The approaches included selection of research sites, establishing collaborations, sustaining collaborative relationships, and enhancing understanding of benefits of participation. Four recruitment sites were selected based on potential to enhance diversification of participants; multiple steps were included in each of the three remaining approaches to build relationships and gain participation. A study log was maintained to provide evaluation data. RESULTS: Recruitment took 14 months and a sample of 102 subjects provided consent with 101 participants providing complete data. Demographics were representative of the region except that African American participation was higher (6.9%) compared to current north central Appalachia (3%). Over 72% of participants indicated they would be interested in participating in future studies. CONCLUSIONS: These findings emphasize the importance of employing strategies for cultural competence in study design. Use of concepts from the Purnell model led to enhanced representativeness and potential for subsequent generalizability.

Feasibility of high-intensity interval training and moderate-intensity continuous training in adults with inactive or mildly active Crohn's disease: study protocol for a randomised controlled trial.

BACKGROUND: Structured exercise training has been proposed as a useful adjunctive therapy for Crohn's disease by improving immune function and psychological health, reducing fatigue and promoting gains in muscle and bone strength. However, the evidence for exercise in Crohn's disease is sparse, with only a handful of small prospective trials [1, 2], with methodological limitations, including the use of non-randomised and non-controlled study designs and small sample sizes. Here, we describe the protocol for a study that aims to assess the feasibility and acceptability of two common types of exercise training-high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT)-in adults with inactive or mildly active Crohn's disease (CD). METHODS: This is a randomised, controlled, assessor-blinded, feasibility trial with three parallel groups. Forty-five adults with inactive or mildly active Crohn's disease will be randomly assigned 1:1:1 to HIIT, MICT or usual care control. Participants in the HIIT and MICT groups will be invited to undertake three sessions of supervised exercise each week for 12 consecutive weeks. HIIT sessions will consist of ten 1-min intervals of cycling exercise at 90% of peak power output separated by 1 min of active recovery. MICT sessions will involve 30 min of continuous cycling at 35% of peak power output. Participants will be assessed before randomisation and 13 and 26 weeks after randomisation. Feasibility outcomes include rates of recruitment, retention and adherence. Interviews with participants will explore the acceptability of the exercise programmes and study procedures. Clinical/health outcomes include cardiorespiratory fitness, body mass index, resting blood pressure, markers of disease activity (faecal calprotectin and Crohn's Disease Activity Index) and activated T cell cytokine profiles. Study questionnaires include the Inflammatory Bowel Disease Quality of Life Questionnaire, EQ-5D-5L, IBD Fatigue Scale, Hospital and Anxiety Depression Scale, and International Physical Activity Questionnaire. DISCUSSION: This study will provide useful information on the feasibility and acceptability of supervised exercise training in adults with inactive and mildly active Crohn's disease and will inform the design of a subsequent, adequately powered, multi-centre trial. TRIAL REGISTRATION: The trial is registered with the International Standard Randomised Controlled Trial Register (ISRCTN13021107). Date registration assigned was 02/12/2015.

Locomotor Muscle Fatigue Does Not Alter Oxygen Uptake Kinetics during High-Intensity Exercise.

The [Formula: see text] slow component ([Formula: see text]) that develops during high-intensity aerobic exercise is thought to be strongly associated with locomotor muscle fatigue. We sought to experimentally test this hypothesis by pre-fatiguing the locomotor muscles used during subsequent high-intensity cycling exercise. Over two separate visits, eight healthy male participants were asked to either perform a non-metabolically stressful 100 intermittent drop-jumps protocol (pre-fatigue condition) or rest for 33 min (control condition) according to a random and counterbalanced order. Locomotor muscle fatigue was quantified with 6-s maximal sprints at a fixed pedaling cadence of 90 rev·min-1. Oxygen kinetics and other responses (heart rate, capillary blood lactate concentration and rating of perceived exertion, RPE) were measured during two subsequent bouts of 6 min cycling exercise at 50% of the delta between the lactate threshold and [Formula: see text] determined during a preliminary incremental exercise test. All tests were performed on the same cycle ergometer. Despite significant locomotor muscle fatigue (P = 0.03), the [Formula: see text] was not significantly different between the pre-fatigue (464 ± 301 mL·min-1) and the control (556 ± 223 mL·min-1) condition (P = 0.50). Blood lactate response was not significantly different between conditions (P = 0.48) but RPE was significantly higher following the pre-fatiguing exercise protocol compared with the control condition (P < 0.01) suggesting higher muscle recruitment. These results demonstrate experimentally that locomotor muscle fatigue does not significantly alter the [Formula: see text] kinetic response to high intensity aerobic exercise, and challenge the hypothesis that the [Formula: see text] is strongly associated with locomotor muscle fatigue.