Response and innovations of advanced practice nurses during the COVID-19 pandemic: A scoping review.

AIM: Identify and map international evidence regarding innovations led by or involving advanced practice nurses in response to COVID-19. BACKGROUND: COVID-19 necessitated unprecedented innovation in the organization and delivery of healthcare. Although advanced practice nurses have played a pivotal role during the pandemic, evidence of their contributions to innovations has not been synthesized. Evidence is needed to inform policies, practices, and research about the optimal use of advanced practice nurses. METHODS: A scoping review was conducted and reported using the PRISMA-ScR checklist. Electronic databases were searched for peer-reviewed articles published between January 2020 and December 2021. Papers were included that focused on innovations emerging in response to COVID-19 and involved advanced practice nurses. RESULTS: Fifty-one articles were included. Four themes were identified including telehealth, supporting and transforming care, multifaceted approaches, and provider education. Half of the articles used brief and mostly noncomparative approaches to evaluate innovations. CONCLUSION: This is the first synthesis of international evidence examining the contributions of advanced practice nurses during the pandemic. Advanced practice nurses provided leadership for the innovation needed to rapidly respond to healthcare needs resulting from COVID-19. Innovations challenged legislative restrictions on practice, enabled implementation of telehealth and new models of care, and promoted evidence-informed and patient-centered care. IMPLICATIONS FOR PRACTICE: Advanced practice nurses led, designed, implemented, and evaluated innovations in response to COVID-19. They facilitated the use of telehealth, supported or transformed models of care, and enabled health providers through education, mentorship, and mental health support. IMPLICATION FOR POLICY: Advanced practice nurses are a critical resource for innovation and health system improvement. Permanent removal of legislative and regulatory barriers to their full scope of practice is needed.

Adjuvant Radiotherapy for Stages II and III Resected Thymoma: A Single-institutional Experience.

INTRODUCTION: The role of adjuvant radiation for Masaoka stages II and III thymoma remains controversial. The aim of this study was to evaluate the clinical benefit of radiation therapy for resected stages II and III thymoma patients. METHODS: We retrospectively reviewed the medical records of 175 thymoma patients treated from July 1996 to January 2013 at University of Washington Medical Center; 88 patients with adequate follow-up and who met histologic criteria were included. We evaluated progression-free survival (PFS) and overall survival (OS), and compared these outcomes in patients treated by surgery (S) alone versus surgery plus radiotherapy (S+RT). Cox regression models and log-rank tests were used to compare PFS and OS for S versus S+RT, and they were further assessed by margin-positive versus margin-negative subgroups using Kaplan-Meier curves. RESULTS: Among the 88 thymoma patients, 22 were stage II and 18 were stage III. For all stages II and III patients, adjuvant radiation was not identified as a significant predictor for PFS (P=0.95) or OS (P=0.63). A positive surgical margin predicted for a worse OS (hazard ratio=7.1; P=0.004). Further investigation revealed for resection margin-positive patients; S+RT had higher OS than S alone (P=0.006). CONCLUSIONS: For stages II and III thymoma, postoperative adjuvant radiation was not associated with statistically significant differences in PFS or OS in this study. Our results indicated a potential OS benefit of adjuvant RT in patients with positive resection margins, and therefore may be considered in this patient population.

Vehicle factors and outcomes associated with hand-out-window motor vehicle collisions.

BACKGROUND: Patients can experience devastating injuries when an upper extremity travels out of a window during a motor vehicle collision. These injuries are typically very severe and may even result in loss of the affected limb. The purposes of this retrospective study were to determine the clinical fate of these extremities and analyze for common factors during the collisions. METHODS: A retrospective chart review of 20 patients between 2003 and 2010, evaluating the patient's age, arm involvement, number and types of surgeries, as well as the Mangled Extremity Severity Score (MESS) was conducted. In addition, patients were contacted to survey them about accident and vehicle factors and to complete the Quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) survey. The data were then analyzed for common factors. RESULTS: The mean age of the 20 patients involved was 28.8 years. There were 11 men and 9 women. The mean MESS was 5.4. Two patients required amputation of some form. Fifteen patients were wearing a seatbelt at time of collision, four were not, and the restraint status of one patient is unknown. The closest extremity to the window was involved in 18 (90%) of 20 patients. Vehicle rollover was the most common mechanism of injury with 16 patients (80%) involved, while 4 patients (20%) were involved in head-on or side-impact type collisions. The average quickDASH score was 24 (range, 5-91). CONCLUSION: The hand-out-of-the-window phenomenon during motor vehicle crashes results in very serious injury to the affected extremity. Most patients were involved in rollover accidents, and most were wearing a seatbelt. The arm closest to the window was nearly always involved. The mean MESS is high in these patients but did not necessarily correlate with amputation. LEVEL OF EVIDENCE: Therapeutic, level IV.

Monostotic fibrous dysplasia of the distal radius metaphysis: case report.

We report the case of a 56-year-old male with distal radius monostotic fibrous dysplasia that was detected when the patient suffered a pathologic fracture. This case is unusual because of the location of the tumor and the age of the patient.