Deficit Accumulation and Phenotype Assessments of Frailty Both Poorly Predict Duration of Hospitalization and Serious Complications after Noncardiac Surgery.

BACKGROUND: Frailty is associated with adverse postoperative outcomes, but it remains unclear which measure of frailty is best. This study compared two approaches: the Modified Frailty Index, which is a deficit accumulation model (number of accumulated deficits), and the Hopkins Frailty Score, which is a phenotype model (consisting of shrinking, weakness, exhaustion, slowness, and low physical activity). The primary aim was to compare the ability of each frailty score to predict prolonged hospitalization. Secondarily, the ability of each score to predict 30-day readmission and/or postoperative complications was compared. METHODS: This study prospectively enrolled adults presenting for preanesthesia evaluation before elective noncardiac surgery. The Hopkins Frailty Score and Modified Frailty Index were both determined. The ability of each frailty score to predict the primary outcome (prolonged hospitalization) was compared using a ratio of root-mean-square prediction errors from linear regression models. The ability of each score to predict the secondary outcome (readmission and complications) was compared using ratio of root-mean-square prediction errors from logistic regression models. RESULTS: The study included 1,042 patients. The frailty rates were 23% (Modified Frailty Index of 4 or higher) and 18% (Hopkins Frailty Score of 3 or higher). In total, 12.9% patients were readmitted or had postoperative complications. The error of the Modified Frailty Index and Hopkins Frailty Score in predicting the primary outcome was 2.5 (95% CI, 2.2, 2.9) and 2.6 (95% CI, 2.2, 3.0) days, respectively, and their ratio was 1.0 (95% CI, 1.0, 1.0), indicating similarly poor prediction. Similarly, the error of respective frailty scores in predicting the probability of secondary outcome was high, specifically 0.3 (95% CI, 0.3, 0.4) and 0.3 (95% CI, 0.3, 0.4), and their ratio was 1.00 (95% CI, 1.0, 1.0). CONCLUSIONS: The Modified Frailty Index and Hopkins Frailty Score were similarly poor predictors of perioperative risk. Further studies, with different frailty screening tools, are needed to identify the best method to measure perioperative frailty.

Bridging conditional and marginal inference for spatially referenced binary data.

Spatially referenced binary data are common in epidemiology and public health. Owing to its elegant log-odds interpretation of the regression coefficients, a natural model for these data is logistic regression. To account for missing confounding variables that might exhibit a spatial pattern (say, socioeconomic, biological, or environmental conditions), it is customary to include a Gaussian spatial random effect. Conditioned on the spatial random effect, the coefficients may be interpreted as log odds ratios. However, marginally over the random effects, the coefficients no longer preserve the log-odds interpretation, and the estimates are hard to interpret and generalize to other spatial regions. To resolve this issue, we propose a new spatial random effect distribution through a copula framework which ensures that the regression coefficients maintain the log-odds interpretation both conditional on and marginally over the spatial random effects. We present simulations to assess the robustness of our approach to various random effects, and apply it to an interesting dataset assessing periodontal health of Gullah-speaking African Americans. The proposed methodology is flexible enough to handle areal or geo-statistical datasets, and hierarchical models with multiple random intercepts.

Application of guided imagery to facilitate the transition of new graduate registered nurses.

Traditionally, the new graduate registered nurse (RN) transition has included a didactic and skills-based orientation accompanied by a period of preceptored practice. However, these methods do not ensure that new RNs are in a state of reduced anxiety to fully interact with their new environment. Transition to practice may cause anxiety, and the new graduate RN may perceive moderate to severe stress. One method of stress reduction is the use of guided imagery, which has shown strong potential with a variety of populations undergoing stressful events. Today, new graduate RNs expect institutions to facilitate orientation to their new employment settings and assist in the transition to their role as a professional nurse. This article proposes a model that incorporates guided imagery for refining the new graduate RN transition process. The model can be adapted for use in the context of orienting other adult learners to unfamiliar practice situations.

Interprofessional telehealth simulations for pharmacy and nursing students: Development and evaluation of an online experience.

INTRODUCTION: The authors evaluated student achievement of interprofessional education (IPE) core competencies during two formats (one hybrid and one completely online) of an IPE simulation designed for pharmacy and nursing students. METHODS: This IPE simulation was designed to teach students to use distance technologies to collaborate on patient care. In 2019, pharmacy (n = 83) and nursing (n = 38) students attended the hybrid (in-person and online) IPE simulation (SIM 2019) with the use of a telepresence robot. In 2020, pharmacy (n = 78) and nursing (n = 48) students attended the simulations completely online (SIM 2020), without the use of a robot. Both sessions aimed to achieve IPE core competencies through interprofessional student collaboration sessions using telehealth distance technologies. Students completed quantitative and qualitative evaluation surveys for both simulations. During SIM 2020, faculty and students used an observation tool to directly assess student team collaboration skills. RESULTS: Statistically significant improvements in self-assessment of IPE core competency scores were found in both formats of the simulation sessions. There were no statistical differences in faculty ratings with student ratings of team skills using the direct observation of team collaboration. Qualitative results indicated that students found interprofessional collaboration to be the most important lesson learned from the activity. CONCLUSIONS: Both formats for the simulation achieved core competency learning objectives. IPE is an essential experience for health care education and is achievable online.