The use of mHealth apps to improve hospital nurses' mental health and well-being: A systematic review.

BACKGROUND: Nursing well-being has become a heightened focus since the COVID-19 pandemic. Nurses are leaving the profession early in their careers or retiring sooner than expected. Those who remain in the workforce report higher levels of burnout, anxiety, depression, and exhaustion. There is concern that there may be a shortage of at least half a million nurses by 2030. AIMS: This systematic review aimed to investigate the evidence of using a mental health promotion mHealth app to improve the mental health of hospital nurses. METHODS: A systematic search was conducted in CINAHL Plus with Full Text, MEDLINE with Full Text, Professional Development Collection, Psychology and Behavioral Sciences Collection, Sociological Collection, PsycInfo, Embase, and PubMed with search dates of January 2012-November 15, 2022. The mHealth intervention needed to be asynchronously delivered through a smartphone with hospital nurse participants to be included in this review. RESULTS: Of the 157 articles screened for this review, six were included. Primary outcome variables were anxiety, burnout, coping, depression, self-efficacy, stress, well-being, and work engagement. Intervention types included mindfulness-based interventions (MBIs), cognitive behavioral therapy (CBT), stress inoculation therapy (SIT), psychoeducation, and stress management. Anxiety, depression, well-being, and burnout improved with MBIs; depression improved with CBT; and anxiety and active coping improved with SIT. LINKING EVIDENCE TO ACTION: This review demonstrated promising findings in using mHealth apps to improve the mental health of hospital nurses. However, more randomized controlled trials with larger sample sizes may reveal which type of mHealth app and how much exposure to the intervention is more effective in improving specific mental health symptoms. Longitudinal follow-up is also recommended to study sustainability of the mental health improvements.

A cognitive-behavioral skills building program improves mental health and enhances healthy lifestyle behaviors in nurses and other hospital employees.

BACKGROUND: Mental health outcomes in nurses have historically indicated a greater prevalence of anxiety, depression, and suicide than the general population. It is vital to provide programming for healthcare workers to gain the necessary skills to reduce burnout and improve their mental and physical health. AIMS: The aims of this study were to evaluate mental health outcomes and healthy lifestyle beliefs and behaviors among nurses and other hospital employees who completed MINDBODYSTRONG, a cognitive-behavioral skill building program. METHODS: A pre-experimental, pre- and poststudy design was used to examine mental health and well-being outcomes among 100 hospital personnel who participated in MINDBODYSTRONG, a program designed to improve coping and resiliency and decrease stress, anxiety, and depressive symptoms. Outcomes measured included healthy lifestyle behaviors, healthy lifestyle beliefs, anxiety, depression, stress, and burnout. RESULTS: One hundred hospital personnel, including 93 nurses, completed the pre- and post-survey. Among all participants, post- MINDBODYSTRONG scores for healthy lifestyle beliefs (p = .00; Cohen's d = 0.52) and healthy lifestyle behaviors (p = .00; Cohen's d = -0.74) increased significantly with medium effects, while depression (p = .00; Cohen's d = -0.51), anxiety (p = .00; Cohen's d = -0.54), stress (p = .00; Cohen's d = -0.33), and burnout (p = .00; Cohen's d = -0.37) decreased significantly with small and medium effects. The program produced even stronger positive effects on mental health outcomes for participants who started the study with higher levels of depression and anxiety. LINKING EVIDENCE TO PRACTICE: Anxiety, depression, stress, and burnout decreased significantly postintervention. Participants also significantly improved their healthy lifestyle beliefs and behaviors with the MINDBODYSTRONG program. MINDBODYSTRONG is an effective program that reduces anxiety, depression, burnout, and stress and improves healthy lifestyle beliefs and behaviors in hospital-based clinicians. It is of utmost importance to provide evidence-based programs to improve mental resiliency and decrease stress, anxiety, burnout, and depressive symptoms, which will ultimately improve the safety and quality of health care.

Natural polymorphism in protein kinase G modulates functional senescence in Drosophilamelanogaster.

The common fruit fly, Drosophila melanogaster, is a well-characterized model for neurological disorders and is widely used to investigate the biology of aging, stress tolerance and pleiotropy. The foraging (for) gene encodes a cGMP-dependent protein kinase (PKG), which has been implicated in several behavioral phenotypes including feeding, sleep, learning and memory, and environmental stress tolerance. We used the well-established Drosophila activity monitor (DAM) to investigate the effects of the conserved NO/cGMP/PKG signaling pathway on functional senescence. Our results show that the polymorphic for gene confers protection during low oxygen stress at the expense of longevity and a decline in locomotor activity with age in D. melanogaster, which suggests a novel role for the PKG pathway in healthy aging and senescence.

Alterations in the Thymic Selection Threshold Skew the Self-Reactivity of the TCR Repertoire in Neonates.

Neonatal and adult T cells differ in their effector functions. Although it is known that cell-intrinsic differences in mature T cells contribute to this phenomenon, the factors involved remain unclear. Given emerging evidence that the binding strength of a TCR for self-peptide presented by MHC (self-pMHC) impacts T cell function, we sought to determine whether altered thymic selection influences the self-reactivity of the TCR repertoire during ontogeny. We found that conventional and regulatory T cell subsets in the thymus of neonates and young mice expressed higher levels of cell surface CD5, a surrogate marker for TCR avidity for self-pMHC, as compared with their adult counterparts, and this difference in self-reactivity was independent of the germline bias of the neonatal TCR repertoire. The increased binding strength of the TCR repertoire for self-pMHC in neonates was not solely due to reported defects in clonal deletion. Rather, our data suggest that thymic selection is altered in young mice such that thymocytes bearing TCRs with low affinity for self-peptide are not efficiently selected into the neonatal repertoire, and stronger TCR signals accompany both conventional and regulatory T cell selection. Importantly, the distinct levels of T cell self-reactivity reflect physiologically relevant differences based on the preferential expansion of T cells from young mice to fill a lymphopenic environment. Therefore, differences in thymic selection in young versus adult mice skew the TCR repertoire, and the relatively higher self-reactivity of the T cell pool may contribute to the distinct immune responses observed in neonates.

Likelihood of depressive symptoms in US older adults by prescribed opioid potency: National Health and Nutrition Examination Survey 2005-2013.

OBJECTIVES: To investigate the relationships between depressive symptoms and opioid potency among adults aged 50 years and older reporting use of one or more prescription opioids in the past 30 days. MATERIALS/DESIGN: Adjusted multiple linear regression models were conducted with 2005-2013 files from a secondary cross-sectional dataset, the National Health and Nutrition Examination Survey (NHANES). Respondents were community-dwelling, noninstitutionalized adults 50 years or older (n = 1036). Predictor variables included a positive screen for minor depression symptoms (Patient Health Questionnaire [PHQ-9] score greater than or equal to 5 and less than or equal to 9), moderate depression symptoms (PHQ-9 greater than or equal to 10 and less than or equal to 14), and severe depression symptoms (PHQ-9 greater than or equal to 15). Criterion variables included weaker-than-morphine analgesics (eg, codeine and tramadol) and morphine-equivalent opioids (eg, morphine and hydrocodone), which served as the reference category, as well as stronger-than-morphine opioid analgesics (eg, fentanyl and oxycodone). RESULTS: Prevalence rates for symptoms of minor depression, moderate depression, and severe depression were n = 236 (22.8%), n = 135 (13.0%), and n = 122 (11.8%), respectively. Severe depression was significantly associated with high-potency opioid use (odds ratio [OR]: 2.27; confidence interval [CI], 1.16-4.46). In post hoc tests, severe depression remained significantly associated with high-potency opioid use only among respondents without arthritis (OR: 5.80; CI, 1.59-21.13). CONCLUSIONS: Compared with older adults without depressive symptoms, older adults with severe depressive symptoms are more likely to be taking high-potency opioid medications. Future prescription opioid medication research should prioritize investigations among older adults with pain-related diagnoses, other than arthritis, reporting preexisting or new symptoms of severe depression.

Contribution of a natural polymorphism in protein kinase G modulates electroconvulsive seizure recovery in Drosophila melanogaster.

Drosophila melanogaster is a well-characterized model for neurological disorders and is widely used for investigating causes of altered neuronal excitability leading to seizure-like behavior. One method used to analyze behavioral output of neuronal perturbance is recording the time to locomotor recovery from an electroconvulsive shock. Based on this behavior, we sought to quantify seizure susceptibility in larval D. melanogaster with differences in the enzymatic activity levels of a major protein, cGMP-dependent protein kinase (PKG). PKG, encoded by foraging, has two natural allelic variants and has previously been implicated in several important physiological characteristics including: foraging patterns, learning and memory, and environmental stress tolerance. The well-established NO/cGMP/PKG signaling pathway found in the fly, which potentially targets downstream K+ channel(s), ultimately impacts membrane excitability, leading to our hypothesis: altering PKG enzymatic activity modulates time to recovery from an electroconvulsive seizure. Our results show that by both genetically and pharmacologically increasing PKG enzymatic activity, we can decrease the locomotor recovery time from an electroconvulsive seizure in larval D. melanogaster.

Systematic Review of Cyberbullying Interventions for Youth and Parents With Implications for Evidence-Based Practice.

BACKGROUND: Cyberbullying is a new risk factor for the well-being of pediatric populations. Consequences of cyberbullying include both physical and mental health concerns such as depression, anxiety, and somatic concerns. Adolescents who have been victims of cyberbullying and developed secondary symptoms are often recommended to visit a healthcare provider to obtain effective, evidence-based treatment. To date, no interventions exist in the healthcare setting for adolescents who are victims of cyberbullying. AIMS: The purpose of this project is to review interventional studies on cyberbullying that have components for adolescents who have been involved with cyberbullying and their parents and to provide recommendations on effective intervention components with the goal of guiding clinical practice. METHODS: A systematic review was conducted using the Institute of Medicine guidelines. A comprehensive electronic literature search was completed targeting interventions of cyberbullying in any setting. No date limits were used. Literature was searched in MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, Communication and Mass Media Complete, Education Information Resource Center (ERIC), and PsycINFO databases. The following search terms were applied "cyberbullying" + "intervention" or "treatment" or "therapy" or "program." Only articles with a pediatric population were selected for review. RESULTS: Seventeen cyberbullying intervention programs in 23 articles were found to meet the search criteria. The most frequently used intervention components included education on cyberbullying for the adolescent, coping skills, empathy training, communication and social skills, and digital citizenship. Parent education on cyberbullying was also found to be important and was included in programs with significant outcomes. LINKING EVIDENCE TO ACTION: As youth present to healthcare providers with symptoms related to cyberbullying, effective interventions are needed to guide evidence-based practice. This review supports educating the individual youth and parent on cyberbullying and teaching the youth skills in communication and social, empathy, coping with cyberbullying, and digital citizenship.

A systematic review of mediators of physical activity, nutrition, and screen time in adolescents: Implications for future research and clinical practice.

BACKGROUND: Adolescents are not meeting current recommendations for daily physical activity, nutrition, and screentime which has been associated with overweight and obesity. Understanding the mediators that facilitate teens in improving their healthy lifestyle behaviors may be helpful in halting this crisis. PURPOSE: The purpose of this systematic review was to assess published findings regarding mediators of adolescent energy balance behaviors. METHOD: We followed the Institute of Medicine guidelines for completing a systematic review. DISCUSSION: Fourteen analyses from 12 studies were included with mediating variables tested for nutrition, physical activity, and screen time. Mediators were identified for all three behaviors and were primarily on the individual level of the social ecological model. CONCLUSIONS: Combining findings from this and other reviews of mediators can help guide researchers in choosing mediating factors for specific target behaviors.

Comparison of intervention fidelity between COPE TEEN and an attention-control program in a randomized controlled trial.

Fidelity in implementing an intervention is critical to accurately determine and interpret the effects of an intervention. It is important to monitor the manner in which the behavioral intervention is implemented (e.g. adaptations, delivery as intended and dose). Few interventions are implemented with 100% fidelity. In this study, high school health teachers implemented the intervention. To attribute study findings to the intervention, it was vital to know to what degree the intervention was implemented. Therefore, the purposes of this study were to evaluate intervention fidelity and to compare implementation fidelity between the creating opportunities for personal empowerment (COPE) Healthy Lifestyles TEEN (thinking, emotions, exercise, and nutrition) program, the experimental intervention and Healthy Teens, an attention-control intervention, in a randomized controlled trial with 779 adolescents from 11 high schools in the southwest region of the United States. Thirty teachers participated in this study. Findings indicated that the attention-control teachers implemented their intervention with greater fidelity than COPE TEEN teachers. It is possible due to the novel intervention and the teachers' unfamiliarity with cognitive-behavioral skills building, COPE TEEN teachers had less fidelity. It is important to assess novel skill development prior to the commencement of experimental interventions and to provide corrective feedback during the course of implementation.

[Clinical and biochemical characteristics in patients with histology compatible with steatothepatitis in National Hospital Arzobispo Loayza, Lima, Peru, from 2010 to 2012]. / Características clínicas y bioquímicas en pacientes con histología compatible con esteatohepatitis del Hospital Nacional Arzobispo Loayza, Lima, Perú en el 2010-2012.

OBJECTIVES: Describe the clinical and biochemical characteristics of patients with histopathological findings compatible with steatohepatitis of HNAL patients between 2010-2012. Determine the frequency of alcoholic and non-alcoholic steatohepatitis, presence of metabolic syndrome and other factors associated to non-alcoholic steatohepatitis, its main indications for liver biopsy and biochemical characteristics according to the severity of the histological findings. MATERIALS AND METHODS: We evaluated all histological slides of liver biopsies of the period between 2010-2012, of which, those with the diagnosis of steatohepatitis were selected. Their medical records were then reviewed. RESULTS: 32 patients met inclusion criteria. 28 were female and 4 male, the average age was 49±12 years. Two patients had a history of chronic alcohol consumption, representing the group of alcoholic steatohepatitis. The more frequent clinical finding in patients with NASH (non-alcoholic steatohepatitis), was obesity (37%). 50% of patients had AST/ALT ratio <1. CONCLUSIONS: Among population studied, non-alcoholic steatohepatitis was more common than alcoholic steatohepatitis, being obesity the most associated factor.

Autism in a recently arrived immigrant population.

UNLABELLED: This study aims to establish whether children of an immigrant maternal population presented with a higher rate of autism than the indigenous population and to explore their presentation with regard to severity of symptoms, demographics and ethnicity. It is a retrospective case note analysis of 366 children who presented to the paediatric developmental service in the Adelaide and Meath incorporating the National Children's Hospital, Tallaght, Ireland between 2007 and 2009. During the study period, 366 children presented. Fifty-eight children (16 %) had mothers who were born in Africa and 53 (14 %) were born to mothers originating from a wider variety of countries. Two hundred and forty-eight children (68 %) had mothers born in Ireland. Maternal origin was not identified for seven children (2 %). An autistic spectrum disorder (ASD) was diagnosed in 131 children and speech and language delay in 132. Of the children with an ASD diagnosis, a higher proportion of the African cohort 13/18 (72.2 %) presented with moderate/severe cognitive disability compared to the Irish group 9/55(16.3 %), and the children in the African cohort showed a higher heritability with 36.9 % having a positive family history of autism reported compared to 26.3 % of the Irish cohort with an ASD diagnosis. CONCLUSION: This study highlights an observation of increased rates of ASD among a migrant population derived particularly from children born to mothers originating in Sub-Saharan Africa. This cohort is more severely affected. Further validation in an epidemiological sample is warranted, which if replicated, may help to identify possible aetiological risk factors.

Outcomes and Feasibility of a Manualized Cognitive-Behavioral Skills Building Intervention: Group COPE for Depressed and Anxious Adolescents in School Settings.

PROBLEM: Despite the increasing prevalence of depressive and anxiety disorders in adolescents, less than 25% of affected teens receive any treatment. METHODS: A preexperimental one-group pre- and posttest pilot study design with 4-week follow-up was used to assess the feasibility and preliminary effects of the COPE (Creating Opportunities for Personal Empowerment) brief-focused manualized seven-session cognitive-behavioral skills building group intervention delivered in two high schools to 16 adolescents referred by a school-based nurse practitioner for depression or elevated anxiety symptoms. FINDINGS: Adolescents reported significant decreases in depression and anxiety on the Beck Youth Inventory as well as increases in personal beliefs about managing negative emotions. Evaluations indicated that the group COPE intervention was a positive experience for the teens. CONCLUSIONS: COPE is a promising brief-focused cognitive behavioral therapy-based intervention that can be delivered effectively to teens in school settings using a group format.

Impact of the COVID-19 Pandemic on Conduct and Results of CLEAR Outcomes Trial.

INTRODUCTION: The COVID-19 pandemic disrupted clinical research. CLEAR Outcomes investigated the effect of bempedoic acid (BA) versus placebo in 13 970 patients with statin intolerance and high cardiovascular (CV) risk. BA reduced the risk of the primary endpoint (composite of CV death, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization) by 13%. CLEAR Outcomes began before and continued for 2.7 years after the start of the pandemic. METHODS: The impact of the COVID-19 pandemic on patient disposition, adverse events, and major adverse CV events (MACE) in CLEAR Outcomes was assessed. RESULTS: Rates of severe infection, hospitalization, or first MACE associated with a positive COVID-19 test were low and balanced between treatment groups. Rates of all-cause death, non-CV death, and undetermined death increased in the pandemic period compared with the pre-pandemic period, while rates of CV death with a known etiology remained stable. A sensitivity analysis excluding undetermined deaths occurring after the onset of the pandemic from the CV death designation yielded hazard ratios of 0.84 (95% CI, 0.76-0.93) for the primary endpoint and 0.94 (95% CI, 0.76-1.16) for the secondary endpoint of CV death, compared with 0.87 (95% CI, 0.79-0.96) and 1.04 (95% CI, 0.88-1.24), respectively, in the original analysis. CONCLUSION: The CLEAR Outcomes trial continued uninterrupted throughout the COVID-19 pandemic. Certain trial endpoints may have been impacted by the pandemic. Specifically, the classification of undetermined deaths as CV deaths may have attenuated the effect of BA on key efficacy endpoints.

Enhancing the Workforce Pathway: A Physical and Occupational Therapy Career Exploration Camp for High School Youth.

There is a workforce shortage in the physical therapy (PT) and occupational therapy (OT) fields. Pathway programs may help guide students with career exploration. This retrospective study assessed changes in students' knowledge about health careers and intent to pursue a health career based on their experience at a PT OT career exploration camp. Between 2018 and 2022, 60 high-school students participated in the camp and completed a pre- and post-program evaluation survey. The results showed a significant improvement in participants' knowledge about health careers and plans to pursue education to become a health professional. Partnering with organizations with the resources to offer career exploration programs help build a strong pathway of students into the PT and OT professions.

Predicting physical activity and fruit and vegetable intake in adolescents: a test of the information, motivation, behavioral skills model.

Most adolescents do not meet national recommendations regarding physical activity and/or the intake of fruits and vegetables. The purpose of this study was to explore whether variables in the information, motivation, behavioral skills (IMB) model of health promotion predicted physical activity and fruit and vegetable intake in 404 adolescents from 2 high schools in the Southwest United States using structural equation modeling (SEM). The SEM models included theoretical constructs, contextual variables, and moderators. The theoretical relationships in the IMB model were confirmed and were moderated by gender and race. Interventions that incorporate cognitive-behavioral skills building may be a key factor for promoting physical activity as well as fruit and vegetable intake in adolescents.

Systematic review of text-messaging interventions to promote healthy behaviors in pediatric and adolescent populations: implications for clinical practice and research.

BACKGROUND: Unhealthy lifestyle behaviors are major public health problems. Promoting positive behavior change is an ongoing challenge that warrants innovative solutions. Mobile phone use is becoming widespread across populations and merits further exploration as a strategy to promote wellness and reduce health disparities. AIMS: The purpose of this paper is to review the evidence using text messaging as a tool to deliver healthy lifestyle behavior intervention programs in pediatric and adolescent populations. The following question was used to guide the systematic review, "In pediatric and adolescent populations, how does the use of text-message-based interventions versus control or comparison interventions affect healthy lifestyle behaviors?" METHODS: A systematic search for relevant literature was conducted in the following databases: MEDLINE, PubMed, Google Scholar, Cochrane Library, and PsycINFO, and by hand-searching bibliographies. Evidence was compiled from experimental studies in peer-reviewed journals published from 2004 to May 15, 2011. Data were extracted using guidelines set forth by the Centre for Reviews and Dissemination. RESULTS: Thirty-seven articles were identified from the comprehensive search. Eight articles representing seven studies (two articles were published describing different aspects of the outcomes from one study) met inclusion for this review. Mean age of participants in the study ranged from 8.7 to 17.9 years of age. Differences between groups on healthy lifestyle behaviors were significant in five studies. CONCLUSIONS: This review supports previous literature suggesting that mobile phones are uniquely positioned to bridge gaps in health disparities and reach across demographics. Interventions using short messaging service may be most effective as a reminder system to support disease management behaviors. Existing recommendations for tailored, interactive, and family-centered care are supported with mobile technology recommended to augment clinical practice and health behavior change efforts. However, more rigorous, theory-based intervention research using mobile technology is warranted in pediatric and adolescent populations.

Psychometric Properties of the Healthy Lifestyle Beliefs Scale for Adolescents.

INTRODUCTION: Healthy lifestyle behaviors are at the core of maintaining health. This study analyzed the psychometric properties of the 16-item healthy lifestyle beliefs (HLB) scale that measures a person's beliefs about their ability to live a healthy lifestyle. METHOD: Descriptive statistics, exploratory factor analysis, confirmatory analysis, and measurement invariance were conducted for this study. RESULTS: Cronbach alpha was 0.894. The Exploratory factor analysis scree plot identified two factors with eigenvalues greater than one. All factor loadings were greater than 0.40 and no items cross-loaded. A two-factor solution was retained for Confirmatory factor analysis. The measurement invariance results suggested that there was no gender difference in HLB regarding factor structure, factor loading, threshold, and residual variances. DISCUSSION: The HLB scale was found to have adequate internal consistency and fit with the data. Findings show it is valid and acceptable for both boys and girls.

The Relationship between Nurses' Training and Perceptions of Electronic Documentation Systems.

Electronic documentation systems have been widely implemented in the healthcare field. These systems have become a critical part of the nursing profession. This research examines how nurses' general computer skills, training, and self-efficacy affect their perceptions of using these systems. A sample of 248 nurses was surveyed to examine their general computer skills, self-efficacy, and training in electronic documentation systems in nursing programs. We propose a model to investigate the extent to which nurses' computer skills, self-efficacy, and training in electronic documentation influence perceptions of using electronic documentation systems in hospitals. The data supports a mediated model in which general computer skills, self-efficacy, and training influence perceived usefulness through perceived ease of use. The significance of these findings was confirmed through structural equation modeling. As the electronic documentation systems are customized for every organization, our findings suggest value in nurses receiving training to learn these specific systems in the workplace or during their internships. Doing so may improve patient outcomes by ensuring that nurses use the systems consistently and effectively.

Lipid lowering with bempedoic acid added to a proprotein convertase subtilisin/kexin type 9 inhibitor therapy: A randomized, controlled trial.

BACKGROUND: Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9is) lower low-density lipoprotein cholesterol (LDL-C) in patients with hypercholesterolemia. However, some patients receiving PCSK9i therapy might require additional lipid-lowering therapy (LLT) to reach LDL-C goals. Bempedoic acid is an oral, once-daily, ATP-citrate lyase inhibitor that significantly lowers LDL-C in patients with hypercholesterolemia when given alone or as add-on therapy to statins and/or ezetimibe. OBJECTIVE: Assess safety and efficacy of bempedoic acid added to PCSK9i (evolocumab) background therapy in patients with hypercholesterolemia. METHODS: This phase 2, randomized, double-blind, placebo-controlled study was conducted in three phases: 1.5-month screening/washout period including discontinuation of all LLTs, a 3-month period wherein patients initiated background PCSK9i therapy, and a 2-month treatment period in which patients were randomized 1:1 to receive bempedoic acid 180 mg or placebo once daily while continuing PCSK9i therapy. RESULTS: Of 59 patients randomized, 57 completed the study. Mean baseline LDL-C after 3 months of PCSK9i background therapy was 103.1 ± ±â€¯30.4 mg/dL. Bempedoic acid added to background PCSK9i therapy significantly lowered LDL-C by 30.3% (P < .001) vs placebo. Compared with placebo, bempedoic acid significantly lowered apolipoprotein B, non-high-density lipoprotein cholesterol, and total cholesterol (nominal P < .001 for all), and high-sensitivity C-reactive protein (P = .029). When added to background PCSK9i therapy, the safety profile of bempedoic acid was comparable to that observed for placebo. CONCLUSIONS: When added to a background of PCSK9i therapy, bempedoic acid significantly lowered LDL-C levels with a safety profile comparable to placebo in patients with hypercholesterolemia.

Implementation and Assessment of a Proning Protocol for Nonintubated Patients With COVID-19.

INTRODUCTION: The COVID-19 pandemic has caused over 1,250,000 deaths worldwide. With limited therapeutic options, proning nonintubated patients emerged as a safe and affordable intervention to manage hypoxemia. METHODS: A proning protocol to identify and prone eligible patients was implemented. Patients were encouraged to self-prone for 2-3 hours, 3 times daily. Investigators created educational materials for nurses and patients and developed a COVID-19-specific proning order within the electronic health record (EHR). Investigators completed an 800-person retrospective chart review to study the implementation of this protocol. RESULTS: From March 22, 2020, to June 5, 2020, 586 patients were admitted to the COVID-19 floor. Of these patients, 42.8% were eligible for proning. Common contraindications were lack of hypoxia, altered mental status, and fall risk. The proning protocol led to a significant improvement in provider awareness of patients appropriate for proning, increasing from 12% to 83%, as measured by placement of a proning order into the EHR. There was a significant improvement in all appropriate patients documented as proned, increasing from 18% to 45% of eligible patients. CONCLUSIONS: The creation of an effective hospital-wide proning protocol to address the exigencies of the COVID-19 pandemic is possible and may be accomplished in a short period of time.