Escape the Anxiety: An Interactive Dosage Calculations Escape Room as a Contextualized Math Review.

ABSTRACT: An innovative teaching strategy was designed to prepare undergraduate nursing students for their dosage calculations assessment. An interactive virtual escape room presented students with the opportunity to help discharge their patient from the hospital. Within Google Forms, nurse educators created a branching storyline where the answers selected determined the path the students would take to meet the learning objectives.

The application of communication accommodation theory to understand receiver reactions in healthcare speaking up interactions.

Speaking up for patient safety is a well-documented, complex communication interaction, which is challenging both to teach and to implement into practice. In this study we used Communication Accommodation Theory to explore receivers' perceptions and their self-reported behaviors during an actual speaking up interaction in a health context. Intergroup dynamics were evident across interactions. Where seniority of the participants was salient, the within-profession interactions had more influence on the receiver's initial reactions and overall evaluation of the message, compared to the between profession interactions. Most of the seniority salient interactions occurred down the hierarchy, where a more senior professional ingroup member delivered the speaking up message to a more junior receiver. These senior speaker interactions elicited fear and impeded the receiver's voice. We found that nurses/midwives and allied health clinicians reported using different communication behaviors in speaking up interactions. We propose that the term "speaking up" be changed, to emphasize receivers' reactions when they are spoken up to, to help receivers engage in more mutually beneficial communication strategies.

Screening for Psychological Distress in Healthcare Workers Using Machine Learning: A Proof of Concept.

The purpose of this study was to train and test preliminary models using two machine learning algorithms to identify healthcare workers at risk of developing anxiety, depression, and post-traumatic stress disorder. The study included data from a prospective cohort study of 816 healthcare workers collected using a mobile application during the first two waves of COVID-19. Each week, the participants responded to 11 questions and completed three screening questionnaires (one for anxiety, one for depression, and one for post-traumatic stress disorder). Then, the research team selected two questions (out of the 11), which were used with biological sex to identify whether scores on each screening questionnaire would be positive or negative. The analyses involved a fivefold cross-validation to test the accuracy of models based on logistic regression and support vector machines using cross-sectional and cumulative measures. The findings indicated that the models derived from the two questions and biological sex accurately identified screening scores for anxiety, depression, and post-traumatic stress disorders in 70% to 80% of cases. However, the positive predictive value never exceeded 50%, underlining the importance of collecting more data to train better models. Our proof of concept demonstrates the feasibility of using machine learning to develop novel models to screen for psychological distress in at-risk healthcare workers. Developing models with fewer questions may reduce burdens of active monitoring in practical settings by decreasing the weekly assessment duration.

Prevalence of ADHD among Black Youth Compared to White, Latino and Asian Youth: A Meta-Analysis.

OBJECTIVE: To systematically review the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among Black children and adolescents compared to White, Latino and Asian children and adolescents. METHOD: Peer-reviewed articles were identified in seven databases and included if they reported prevalence of ADHD among Black children and adolescents living in a minority context and compared rates to at least one of White, Latino or Asian samples. A total of 7050 articles were retrieved and 155 articles were subjected to full evaluation. Twenty-three studies representing 26 independent samples were included. RESULTS: The pooled sample size was n = 218,445 (k = 26), n = 835,505 (k = 25), n = 493,417 (k = 24), and n = 66,413 (k = 7) of Black, White, Latino, and Asian participants, respectively. Pooled prevalence rate of ADHD was 15.9% (95%CI 11.6% - 20.7%) among Black children and adolescents, 16.6% (95%CI 11.6% - 22.2%) among Whites, 10.1% (95%CI 6.9% - 13.8%) among Latinos and 12.4% (95%CI 1.4% - 31.8%) among Asians. There was no significant difference in prevalence between ethnic groups, whereas both Black and White children and adolescents had marginally statistically significant higher prevalence than Asians. The results of a meta-regression analysis showed no moderating effects of the type of sample and the year of publication of studies. A significant publication bias was observed, suggesting that other moderators were not identified in the present systematic review. CONCLUSION: In contrast to the assertion in the DSM-5 that clinical identification among Black children and adolescents is lower than among White children and adolescents, the present meta-analysis suggests similar rates of ADHD among these two groups. The importance of considering cultural appropriateness of assessment tools and processes is emphasized.

Endovascular Thrombectomy for Treatment of Acute Ischemic Stroke During Pregnancy and the Early Postpartum Period.

BACKGROUND AND PURPOSE: Acute ischemic stroke (AIS) is a rare occurrence during pregnancy and the postpartum period. Existing literature evaluating endovascular mechanical thrombectomy (MT) for this patient population is limited. METHODS: The National Inpatient Sample was queried from 2012 to 2018 to identify and characterize pregnant and postpartum patients (up to 6 weeks following childbirth) with AIS treated with MT. Complications and outcomes were compared with nonpregnant female patients treated with MT and to other pregnant and postpartum patients managed medically. Complex samples regression models and propensity score matching were implemented to assess adjusted associations and to address confounding by indication, respectively. RESULTS: Among 4590 pregnant and postpartum patients with AIS, 180 (3.9%) were treated with MT, and rates of utilization increased following the MT clinical trial era (2015-2018; 1.9% versus 5.3%, P=0.011). Compared with nonpregnant patients with AIS treated with MT, they experienced lower rates of intracranial hemorrhage (11% versus 24%, P=0.069) and poor functional outcome (50% versus 72%, P=0.003) at discharge. Pregnant/postpartum status was independently associated with a lower likelihood of development of intracranial hemorrhage (adjusted odds ratio, 0.26 [95% CI, 0.09-0.70]; P=0.008) following multivariable analysis adjusting for age, illness severity, and stroke severity. Following propensity score matching, pregnant and postpartum patients treated with MT and those medically managed differed in frequency of venous thromboembolism (17% versus 0%, P=0.001) and complications related to pregnancy (44% versus 64%, P=0.034), but not in functional outcome at discharge or hospital length of stay. Pregnant and postpartum women treated with MT did not experience mortality or miscarriage during hospitalization. CONCLUSIONS: This large-scale analysis utilizing national claims data suggests that MT is a safe and efficacious therapy for AIS during pregnancy and the postpartum period. In the absence of prospective clinical trials, population-based cross-sectional analyses such as the present study provide valuable clinical insight.

Psychological Safety in Simulation-Based Prelicensure Nursing Education: A Narrative Review.

BACKGROUND: Psychological safety, essential in high-quality simulation-based education, positively influences learning behaviors and outcomes in corporate organizations. Current assessment of psychological safety is grounded in Edmondson's work team learning model. To understand applicability of this model in nursing education, a literature review was conducted. We reviewed literature on psychological safety in nursing education to assess support for this learning model constructs. Adapting existing models and assessment instruments in different contexts is an important contribution to the profession. METHODS: A structured narrative review examined psychological safety in nursing education simulation literature to identify support for Edmondson's work team learning model constructs. RESULTS: Included articles (n = 13) supported the Edmondson model constructs. When faculty practiced specific leader behaviors, learners experienced psychological safety and demonstrated specific learning-oriented behaviors. CONCLUSION: Psychological safety literature in nursing education supports the work team learning model constructs. This link offers promise for transfer to an assessment instrument in nursing education.

Prevalence and Risk Factors Associated With Attention-Deficit/Hyperactivity Disorder Among US Black Individuals: A Systematic Review and Meta-analysis.

Importance: As stated in the DSM-5, it is generally reported that the prevalence of attention-deficit/hyperactivity disorder (ADHD) is lower among Black individuals compared with the general population. However, Black individuals living in countries where they are considered a minority population group (eg, in Northern America and Europe) are underrepresented in studies evaluating ADHD. Objective: To estimate the pooled prevalence of ADHD and identify associated risk factors among US Black individuals. Data Sources: This systematic review and meta-analysis identified peer-reviewed studies published until October 18, 2019, using the APA PsycInfo, MEDLINE, Embase, Cochrane CENTRAL, CINAHL, ERIC, and Education Source databases. Study Selection: Eligible trials were published in French or English, had empirical data on the prevalence of ADHD in samples or subsamples of Black people, and were conducted in countries with Black minority populations. All studies were assessed and passed quality evaluation. Data Extraction and Synthesis: The PRISMA guideline was used for extracting and reporting data. Random-effects meta-analyses were generated to estimate the prevalence of ADHD among Black individuals using the metafor package in R. Main Outcomes and Measures: Prevalence and risk factors associated with ADHD among Black individuals were identified. Results: A total of 24 independent samples and subsamples from 21 studies published between 1979 and 2020 (154 818 Black participants) were included in this systematic review and meta-analysis. All included studies were conducted in the US. Two studies were conducted assessing adults (aged 18 years or older), 8 assessing children (0-12 years), 1 assessing adolescents (aged 13-17 years), and 13 assessing both children and adolescents. The pooled prevalence of ADHD was 14.54% (95% CI, 10.64%-19.56%). In a narrative review of the studies in this analysis, some studies found risk factors associated with ADHD, such as sociodemographic characteristics (age, sex, race, and socioeconomic status), familial factors, environmental factors, and risk behaviors, but the data did not permit a moderation analysis to assess these findings in this study. Conclusions and Relevance: Contrary to what is stated in the DSM-5, the results of this systematic review and meta-analysis suggest that Black individuals are at higher risk for ADHD diagnoses than the general US population. These results highlight a need to increase ADHD assessment and monitoring among Black individuals from different social backgrounds. They also higlight the importance of establishing accurate diagnoses and culturally appropriate care.

Sexual victimization, PTSD, depression, and social support among women survivors of the 2010 earthquake in Haiti: a moderated moderation model.

BACKGROUND: In 2010, an important earthquake devastated Haiti and caused thousands of deaths. In a social context where women are particularly vulnerable, this cross-sectional study examined the associations between sexual assaults experienced by women before the earthquake, the earthquake exposure, the traumatic consequences, and their satisfaction of social support received. METHODS: A total of 660 women aged 18 to 86 completed questionnaires assessing exposure to the earthquake, sexual assault victimization, peritraumatic distress, Posttraumatic stress disorder (PTSD), depression, and social support. A moderated moderation model was computed to examine associations between exposure to the earthquake, sexual assault, social support, and traumatic consequences. RESULTS: Results showed that 31.06% of women were victims of sexual assault before the earthquake. They presented higher prevalence of peritraumatic distress, PTSD, and depression symptoms, compared to non-victims. The moderated-moderation model showed that sexual assault and exposure to the earthquake were positively associated with traumatic consequences (respectively, B = 0.560, p < 0.001; B = 0.196, p < 0.001), while social support was negatively associated with them (B = -0.095, p < 0.05). Results showed a triple interaction: women victim of sexual assault who were satisfied with received social support are less likely to develop traumatic consequences after being exposed to the earthquake(B = -0.141, p < 0.01). CONCLUSIONS: By demonstrating the role of sexual assault in the development of mental health problems after the Haitian earthquake, this study shows the importance for clinicians to investigate interpersonal trauma experienced before or following natural disasters among survivors. Results also indicate the key role of family and communities to help survivors build resilience and coping strategies with their social support.

Curricular Innovations for Teaching Undergraduate Nursing Students Care of Older Adults.

BACKGROUND: By 2030, 1 in 5 persons will be 65 years or older. To address the health care needs of the burgeoning elderly population, nursing faculty need to use curricular models that are poised to deliver age-appropriate nursing care to the specialized needs of the older adult population. PROBLEM: The lack of geriatric clinical experiences and clinical faculty who do not have expertise in geriatric nursing assessment create barriers to guide students in learning about care of older adults. APPROACH: A new curricular approach to educate prelicensure nursing students about caring for older adults was created, which used 6 types of learning assignments during a 7-week clinical practicum. Students were exposed to interactive learning assignments based on competencies involving interviewing, performance-based assessment, clinical decision making, and problem-based learning. OUTCOME: Prelicensure nursing students (n = 124) rated the interactive, performance-based functional evaluation assignment highest for perceived understanding and as the best type of learning experience.

An Overview of Anesthetic Management for the Brain-Dead Donor and Organ Recovery.

Transplantation of tissue is playing an increasing role in modern therapeutics. Survival of recipients and transplanted organs is excellent, making transplantation of many major organs a very successful therapeutic option. Evidence shows that a multidisciplinary approach to managing the brain-dead donor (BDD) offers a better opportunity for successful organ survival after transplantation. Organ procurement procedures are most commonly performed in community hospitals and rural settings. The anesthesia provider's role in organ procurement procedures and BDD management is essential for maintaining allograft organ survival and the CRNA may be asked to assume a collaborative role in nontertiary hospitals in community or rural settings. The perioperative role of the CRNA immediately before and during organ procurement is an important piece in the progression to a successful outcome. The CRNA therefore must understand the overall process to guide appropriate BDD treatment and allograft protection. The focus of this article is to present a historical overview of organ donation and procurement, and an evidence-based examination of clinical management of the BDD from diagnosis to organ procurement, including anesthetic management.

Potential youth exposure to alcohol advertising on the internet: A study of internet versions of popular television programs.

BACKGROUND: No previous paper has examined alcohol advertising on the internet versions of television programs popular among underage youth. OBJECTIVES: To assess the volume of alcohol advertising on web sites of television networks which stream television programs popular among youth. METHODS: Multiple viewers analyzed the product advertising appearing on 12 television programs that are available in full episode format on the internet. During a baseline period of one week, six coders analyzed all 12 programs. For the nine programs that contained alcohol advertising, three underage coders (ages 10, 13, and 18) analyzed the programs to quantify the extent of that advertising over a four-week period. RESULTS: Alcohol advertisements are highly prevalent on these programs, with nine of the 12 shows carrying alcohol ads, and six programs averaging at least one alcohol ad per episode. There was no difference in alcohol ad exposure for underage and legal age viewers. CONCLUSIONS: There is a substantial potential for youth exposure to alcohol advertising on the internet through internet-based versions of television programs. The Federal Trade Commission should require alcohol companies to report the underage youth and adult audiences for internet versions of television programs on which they advertise.

Promoting quality and safety in women's health through the use of transdisciplinary clinical simulation educational modules: methodology and a pilot trial.

This manuscript presents the methodology used to assess the impact of a clinical simulation module used for training providers specializing in women's health. The methodology presented here will be used for a quantitative study in the future.

Variation in arterial inflow temperature: a regional quality improvement project.

Peer-reviewed evidence (Class IIa, Level B) suggests that arterial blood temperature should be limited to 37 degrees C during cardiopulmonary bypass. We implemented a regional quality improvement initiative to reduce regional variability in our performance around this recommendation at four northern New England medical centers between January 2006 and June 2010. Cardiovascular perfusionists at four medical centers collaborated by conference calls regarding blood temperature management. Evidence from the recommendations were reviewed at each center, and strategies to prevent hyperthermia and to improve performance on this quality measure were discussed. Centers submitted data concerning highest arterial blood temperatures among all isolated coronary artery bypass grafting procedures between 2006 through June 2010. Scope and focus of local practice changes were at the discretion of each center. The timing of each center's quality improvement initiatives was recorded, and adherence to thresholds of 37 degrees C and 37.5 degrees C were analyzed. Data were collected prospectively through our regional perfusion registry. Data were available for 4909 procedures (1645 before interventions, 3264 after interventions). Prior to the quality improvement interventions, 90% of procedures had elevated arterial line temperatures (37 degrees C or more), and afterwards it was 69% (p < .001) for an absolute difference of 21%. Prior to the intervention, 53% of procedures had temperatures beyond a threshold of 37.5 degrees C versus 19% subsequent to interventions, for an absolute difference of 34% (p < .001). This regional effort to reduce patient exposure to elevated arterial line temperatures resulted in a significant sustained reduction in high arterial outflow temperatures at three of the four centers. A regional registry provides a means for assessing performance against evidence-based recommendations, and evaluating short and long-term success of quality improvement initiatives.

Update on pediatric perfusion practice in North America: 2005 survey.

The devices and techniques used for pediatric cardiopulmonary bypass (CPB) undergo continuous change. New techniques and clinical comparisons of devices are frequently reported in the literature; however, information about the extent to which these techniques and devices are adopted into clinical practice at pediatric heart centers are not well described. We conducted a mail survey of North American pediatric cardiac surgery centers to gain perspective on the extent to which various devices and techniques were used for CPB along with program demographic data. In January 2005, surveys were mailed to 180 North American open heart centers. The survey was nearly identical in format and content to three earlier surveys completed in 1989, 1994, and 1999, with the exception that new questions were added to address new techniques and devices that have emerged over the years. Responses were received from 76 hospitals, for an overall response rate of 42%. Of the responding centers, 53 were performing pediatric open heart surgery and 23 were not. Twenty centers performed only pediatric open heart surgery, and 33 performed both pediatric and adult open heart surgery. The mean pediatric annual caseload of responding centers was 195 procedures/yr (range, 20-650 procedures/yr; median, 154 procedures/yr). A total of 9943 pediatric open heart procedures were performed at responding centers in 2004. Most of the centers surveyed reported use of an open venous reservoir system (88%), use of roller pumps (90%), and use of arterial line filtration (98%). Most centers used circuits that have surface treatments with heparin or some other surface-modifying agent (74%). There has been an increase in the use of all types of safety devices. Modified ultrafiltration is used at 75% of the centers surveyed. Centers reported an increase in the availability of all types of cardiac support devices including extracorporeal membrane oxygenation for postcardiotomy cardiac support (90%). This survey provides an overview of clinical practice in 2004. The series of surveys document the historical progression of clinical practice over the past 16 years. Practice surveys may also be useful for identifying gaps between evidence-based knowledge and clinical practice. These surveys document the diffusion of innovation related to CPB during the past 16 years and areas of variation in practice that need further study.