Tag: nevin manimala

J Nurs Educ. 2024 Dec;63(12):854-856. doi: 10.3928/01484834-20240627-01. Epub 2024 Dec 1.

ABSTRACT

BACKGROUND: As health care continues to evolve, the electronic medical record (EHR) has emerged as an important decision-making tool. To ensure that nursing students work toward competency with the EHR, this study sought to gather information regarding how students use the EHR.

METHOD: Students in a direct-entry, prelicensure program were observed using the EHR during a simulation-based experience (SBE). Focus groups gathered qualitative student perceptions of EHR use.

RESULTS: Minimal use of the EHR during SBE was identified. Students reported using the EHR for information gathering, validating findings, and nursing tasks.

CONCLUSION: This study highlights the need for more robust EHR development and program integration with SBEs in schools of nursing to better align with the clinical practice environment. More research is needed to evaluate how schools of nursing integrate the EHR and how nursing students use the EHR in health care settings to make patient-related decisions. [J Nurs Educ. 2024;63(12):854-856.].

PMID:39642259 | DOI:10.3928/01484834-20240627-01

J Nurs Educ. 2024 Dec;63(12):844-849. doi: 10.3928/01484834-20240730-01. Epub 2024 Dec 1.

ABSTRACT

BACKGROUND: Diversifying the nursing workforce entails concerted efforts to recruit and retain students from under-represented racial and socioeconomic groups who are especially vulnerable to barriers hindering academic success. This article describes faculty strategies for retaining and supporting students toward program completion and first-time National Council Licensure Examination for Registered Nurses (NCLEXRN) passage at a mission-driven school in rural Appalachia where most of the students have socioeconomically disadvantaged backgrounds.

METHOD: Independent samples t tests were used to compare academic variables between students who passed the NCLEX-RN on their first attempt and students who did not. Qualitative data were elicited from interviews and surveys. Data analysis informed policy change and student support services.

RESULTS: An action plan supported under-represented students’ success in first-time NCLEX-RN passage with an average rate of 96% for the past decade.

CONCLUSION: Focused multimodal support can promote the success of students with socioeconomic challenges who will enrich the nursing workforce with the diversity that the profession seeks. [J Nurs Educ. 2024;63(12):844-849.].

PMID:39642257 | DOI:10.3928/01484834-20240730-01

J Nurs Educ. 2024 Dec;63(12):818-825. doi: 10.3928/01484834-20240725-02. Epub 2024 Dec 1.

ABSTRACT

BACKGROUND: In the United States, English for Speakers of Other Languages (ESOL) health care providers are important to the nursing workforce but often face challenges when taking the NCLEX-RN examination. This study evaluated the effects of removing slang and words with multiple meanings from high-stakes examination questions.

METHOD: This study used a quantitative, experimental posttest-only control group design and included a convenience sample of 169 nursing students from a college in southern Florida.

RESULTS: Nursing students performed significantly better on the experimental (M = 79.9 [7.48]) than on the control examination (M = 75.08 [10.51]), t(151.8) = 2.973, p = .003. Students with low language acculturation scores achieved significantly higher scores on the experimental (M = 81.48 [SD = 6.05]) versus the control examinations (M = 72.21 [10.09]), t(60.9) = 4.975, p = .001.

CONCLUSION: Modifying examination questions linguistically can help ESOL nursing students perform better and aid examination creators to design bias-free tests. [J Nurs Educ. 2024;63(12):818-825.].

PMID:39642255 | DOI:10.3928/01484834-20240725-02

Magn Reson Med. 2024 Dec 6. doi: 10.1002/mrm.30401. Online ahead of print.

ABSTRACT

PURPOSE: To develop a deep learning-based method for robust and rapid estimation of the fatty acid composition (FAC) in mammary adipose tissue.

METHODS: A physics-based unsupervised deep learning network for estimation of fatty acid composition-network (FAC-Net) is proposed to estimate the number of double bonds and number of methylene-interrupted double bonds from multi-echo bipolar gradient-echo data, which are subsequently converted to saturated, mono-unsaturated, and poly-unsaturated fatty acids. The loss function was based on a 10 fat peak signal model. The proposed network was tested with a phantom containing eight oils with different FAC and on post-menopausal women scanned using a whole-body 3T MRI system between February 2022 and January 2024. The post-menopausal women included a control group (n = 8) with average risk for breast cancer and a cancer group (n = 7) with biopsy-proven breast cancer.

RESULTS: The FAC values of eight oils in the phantom showed strong correlations between the measured and reference values (R² > 0.9 except chain length). The FAC values measured from scan and rescan data of the control group showed no significant difference between the two scans. The FAC measurements of the cancer group conducted before contrast and after contrast showed a significant difference in saturated fatty acid and mono-unsaturated fatty acid. The cancer group has higher saturated fatty acid than the control group, although not statistically significant.

CONCLUSION: The results in this study suggest that the proposed FAC-Net can be used to measure the FAC of mammary adipose tissue from gradient-echo MRI data of the breast.

PMID:39641987 | DOI:10.1002/mrm.30401

JAMA Health Forum. 2024 Dec 6;5(12):e244365. doi: 10.1001/jamahealthforum.2024.4365.

ABSTRACT

IMPORTANCE: Medicaid programs have expanded coverage of substance use disorder treatment and undertaken many other initiatives to reduce drug overdoses among beneficiaries. However, to date, no information has been published that tracks overdose deaths among the Medicaid population.

OBJECTIVE: To determine the rate of drug overdose among Medicaid beneficiaries.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, US Centers for Medicare & Medicaid Services data from 2016 to 2020 that linked enrollment and demographic data from all Medicaid beneficiaries in the US with the US Centers for Disease Control and Prevention National Death Index were used to determine the rate of drug overdose death among Medicaid beneficiaries. The Medicaid population rates were compared with those of the total US population, overall and by age and sex.

EXPOSURE: Participation in the Medicaid program.

MAIN OUTCOME: Death of a drug overdose.

RESULTS: In 2020, the drug overdose death rate among Medicaid beneficiaries was 54.6 per 100 000, a rate that was twice as high as the drug overdose rate among all US residents (27.9 per 100 000). In 2020, Medicaid beneficiaries comprised 25.0% of the US population but 48% of all overdose deaths (44 277 of 91 783). For each age and sex group older than 15 years, overdose deaths were higher for the Medicaid population than for the US population, with the greatest difference occurring among adults ages 45 to 64 years. From 2016 to 2020, Medicaid overdose deaths increased by 54%.

CONCLUSIONS AND RELEVANCE: The results of this study suggest that more research is needed to understand why Medicaid beneficiaries have higher rates of drug overdoses than all US residents. Additionally, research is needed to understand how best to prevent overdoses among Medicaid beneficiaries. The federal government should support these efforts by routinely linking Medicaid claims and enrollment data to death records.

PMID:39641942 | DOI:10.1001/jamahealthforum.2024.4365

JAMA Health Forum. 2024 Dec 6;5(12):e244304. doi: 10.1001/jamahealthforum.2024.4304.

ABSTRACT

IMPORTANCE: Medicare finances health care for most US patients with end-stage kidney disease (ESKD), regardless of age. Medicare enrollment may have slowed for patients with incident ESKD who gained access to new private insurance options with the 2014 passage of the Affordable Care Act (ACA) and introduction of the ACA Marketplace.

OBJECTIVE: To describe trends in public and private insurance coverage and dialysis spending among patients with incident ESKD from 2012 to 2017.

DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study included patients 18 to 64 years old in Colorado who were not enrolled in Medicare at dialysis initiation. Data analysis was conducted from May to August 2023.

EXPOSURE: Introduction of the ACA Marketplace in 2014.

MAIN OUTCOMES AND MEASURES: Medicare, Medicaid, or private insurance enrollment in the first year after dialysis initiation, and dialysis spending by insurance type.

RESULTS: Of 2005 patients included in the sample, 1416 (70.6%) were 45 to 64 years old, and 1259 (62.8%) were male. A lower proportion of patients with incident ESKD starting dialysis were newly enrolled in Medicare in the years following the ACA (361 of 713 [50.6%]) compared to 2 years prior (420 of 595 [70.6%]). Unadjusted rates of switching from Medicaid to Medicare 1 year after dialysis initiation decreased 14.3 percentage points over time (68.9% in 2012-2013 vs 58.3% and 54.6% in 2014-2015 and 2016-2017, respectively). Unadjusted rates of switching from private insurance to Medicare 1 year after dialysis initiation decreased by 22.3 percentage points (68.1% in 2012-2013 vs 52.2% and 45.8% in 2014-2015 and 2016-2017, respectively). Over the entire 2012 to 2017 period, quarterly dialysis spending in the first year of dialysis among patients with private insurance was higher than among those with Medicare coverage ($26 351-$29 781 vs $10 039-$12 741).

CONCLUSIONS AND RELEVANCE: This cross-sectional study demonstrates that lower Medicare enrollment rates over time among those initiating dialysis may be inducing higher social spending. This finding raises concerns about the effectiveness of Medicare policies and federal leverage to improve access, outcomes, and value of dialysis care.

PMID:39641939 | DOI:10.1001/jamahealthforum.2024.4304

JAMA Netw Open. 2024 Dec 2;7(12):e2444983. doi: 10.1001/jamanetworkopen.2024.44983.

ABSTRACT

IMPORTANCE: Pressure ulcers (PUs) are (1) prevalent secondary complications after spinal cord injury (SCI), (2) present with elevated systemic inflammatory tone, and (3) may interfere with healing processes underlying neurological recovery (disrepair).

OBJECTIVE: To investigate whether PUs acquired during initial hospitalization are associated with neurological and functional long-term outcome and survival after SCI.

DESIGN, SETTING, AND PARTICIPANTS: Multicenter cohort study at 20 centers of the prospective SCI Model Systems (SCIMS) Database (Birmingham, AL). Patients with acute traumatic cervical SCI with relevant motor impairment (ie, American Spinal Injury Association [ASIA] impairment scale [AIS] A, B, and C) were enrolled from January 1996 to September 2006 and followed up until June 2016. Data were analyzed from April 2021 to September 2024.

EXPOSURES: PUs acquired during surgical or first rehabilitative SCI care.

MAIN OUTCOMES AND MEASURES: The change in the ASIA motor score at 1 year after SCI was the primary end point. Secondary end points included the recovery of functional independence measure (FIM) motor score at 1 year after SCI and mortality up to 10 years. ASIA and FIM motor score were analyzed applying linear mixed models with random intercept adjusted for baseline neurological level, AIS, and sociodemographic factors. Mortality was analyzed using Cox regression.

RESULTS: The study included 1282 patients with a mean (SD) age of 38.0 (15.7) years and consisted of 1028 (80.2%) male patients. Regarding race and ethnicity, 349 of 1249 (27.9%) were African American patients, 1139 of 1273 (89.5%) were non-Hispanic patients, and 834 of 1249 (66.8%) were White patients. During initial hospitalization, 594 patients (45.7%) acquired PUs. Exposure to PUs was associated with impaired motor recovery 1 year after SCI compared with unexposed patients (-9.1 ASIA motor score points; 95% CI, -12.3 to -6.0; P < .001). In addition, PUs were associated with lower recovery of physical independence 1 year after SCI (-8.3 FIM motor score points; 95% CI: -11.1 to -5.5; P < .001). Cox regression confirmed PUs as a risk marker for death up to 10 years after SCI (hazard ratio, 1.41; 95% CI, 1.09 to 1.82; P = .01).

CONCLUSIONS AND RELEVANCE: In this cohort study, PUs acquired during initial hospitalization after SCI were independently associated with poor long-term neurofunctional outcome. PUs constitute a modifiable factor associated with risk for worse long-term disability (recovery confounder) and elevated mortality.

PMID:39641930 | DOI:10.1001/jamanetworkopen.2024.44983

JAMA Netw Open. 2024 Dec 2;7(12):e2447902. doi: 10.1001/jamanetworkopen.2024.47902.

ABSTRACT

IMPORTANCE: The American Heart Association proposed Life’s Essential 8 (LE8) as an enhanced measurement tool for cardiovascular health.

OBJECTIVE: To examine the association of LE8 with risk of atherosclerotic cardiovascular disease (ASCVD) incidence and prognosis in veterans.

DESIGN, SETTING, AND PARTICIPANTS: This was a prospective cohort study of US veterans enrolled in the Department of Veterans Affairs (VA) Million Veteran Program (MVP) between 2011 and 2022. Data were analyzed from 2023 to 2024.

EXPOSURE: LE8 score ranged from 0 to 100, with higher score indicating better cardiovascular health.

MAIN OUTCOMES AND MEASURES: The primary outcome was total ASCVD incidence in veterans without baseline ASCVD, and the secondary outcome was incidence of a major adverse cardiovascular event (MACE) among veterans with and without ASCVD at baseline.

RESULTS: A total of 413 052 veterans (mean [SD] age, 65.8 [12.1] years; 378 162 [91.6%] male) were included. Based on 1.7 million person-years of follow-up of 279 868 veterans without any ASCVD at baseline, 45 067 veterans had an ASCVD event during follow-up. Total LE8 score and each component LE8 factor score was associated with incident ASCVD in an inverse, linear, dose-response manner. For veterans without prior ASCVD, those with an LE8 score between 80 and 100 had lower risk of ASCVD compared with those with an LE8 score of 0 to 49 (adjusted hazard ratio [aHR], 0.36 [95% CI, 0.35-0.38]). Similarly, risk of MACE was significantly lower among veterans with an LE8 score of 80 to 100 regardless of baseline ASCVD status (with ASCVD: aHR, 0.52 [95% CI, 0.48-0.56]; without ASCVD: aHR, 0.14 [95% CI, 0.13-0.15]) compared with those with ASCVD and an LE8 score of 0 to 49.

CONCLUSIONS AND RELEVANCE: In this cohort study of US veterans, higher LE8 scores were associated with significantly lower ASCVD incidence risk and lower likelihood of developing adverse cardiovascular events regardless of ASCVD status at baseline. These results support the utility of LE8 for health promotion and ASCVD prevention.

PMID:39641929 | DOI:10.1001/jamanetworkopen.2024.47902

JAMA Netw Open. 2024 Dec 2;7(12):e2449243. doi: 10.1001/jamanetworkopen.2024.49243.

ABSTRACT

IMPORTANCE: Understanding whether there are racial and ethnic and residential disparities in prenatal telehealth uptake is necessary for ensuring equitable access and guiding implementation of future hybrid (ie, both telehealth and in-person) prenatal care.

OBJECTIVE: To assess temporal changes in individuals using hybrid prenatal care before and during the COVID-19 public health emergency (PHE) by race and ethnicity and residence location in the US.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study analyzed electronic health record data of prenatal care visits from the National COVID Cohort Collaborative Data Enclave, comprising data from 75 health systems and freestanding institutes in all 50 US states. Data were analyzed on 349 682 nationwide pregnancies among 349 524 people who gave birth from June 1, 2018, through May 31, 2022. Multivariable generalized estimating equations were used to examine variations in receiving hybrid vs only in-person prenatal care. Data phenotyping and analysis occurred from June 13, 2023, to September 27, 2024.

EXPOSURES: Prenatal period overlap (never, partially, or fully overlapping) with the COVID-19 PHE, maternal race and ethnicity, and urban or rural residence.

MAIN OUTCOMES AND MEASURES: Hybrid vs in-person-only prenatal care.

RESULTS: Of 349 682 pregnancies (mean [SD] age, 29.4 [5.9] years), 59 837 (17.1%) were in Hispanic or Latino individuals, 14 803 (4.2%) in non-Hispanic Asian individuals, 65 571 (18.8%) in non-Hispanic Black individuals, 162 677 (46.5%) in non-Hispanic White individuals, and 46 794 (13.4%) in non-Hispanic individuals from other racial and ethnic groups. A total of 31 011 participants (8.9%) resided in rural communities. Hybrid prenatal care increased from nearly none before March 2020 to a peak of 8.1% telehealth visits in November 2020, decreasing slightly to 6.2% by March 2022. Among the fully overlapping group, urban residents had nearly 2-fold odds of hybrid prenatal care compared with rural people (adjusted odds ratio [AOR], 1.98; 95% CI, 1.84-2.12). Hispanic or Latino people (AOR, 1.48; 95% CI, 1.41-1.56), non-Hispanic Asian people (AOR, 1.47; 95% CI, 1.35-1.59), and non-Hispanic Black people (AOR, 1.18; 95% CI, 1.12-1.24) were more likely to receive hybrid prenatal care than non-Hispanic White people.

CONCLUSIONS AND RELEVANCE: In this cohort study, hybrid prenatal care increased substantially during the COVID-19 PHE, but pregnant people living in rural areas had lower levels of hybrid care than urban people, and individuals who belonged to racial and ethnic minority groups were more likely to have hybrid care than White individuals. These findings suggest that strategies that improve equitable access to telehealth for people who live in rural areas and people in some minority racial and ethnic groups may be useful.

PMID:39641928 | DOI:10.1001/jamanetworkopen.2024.49243

JAMA Netw Open. 2024 Dec 2;7(12):e2449430. doi: 10.1001/jamanetworkopen.2024.49430.

ABSTRACT

IMPORTANCE: Comprehensive data on the prevalence of various life stressors and their role in posttraumatic stress disorder (PTSD) among women are lacking.

OBJECTIVE: To determine the prevalence of a broad range of life stressors and their association with PTSD in a large nationally representative cohort of women.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used data from the population-based Stress-And-Gene-Analysis, which invited women in Iceland to complete an online survey from March 1, 2018, to July 1, 2019. Participants were a nationally representative sample of women 18 to 69 years of age. This analysis was conducted from January 21, 2022, to September 13, 2024.

EXPOSURES: History of 23 life stressors assessed with the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) and additional survey questions.

MAIN OUTCOMES AND MEASURES: The main outcome was probable PTSD during the past month assessed for the worst life stressor experienced as evaluated with the PTSD Checklist for DSM-5. Modified Poisson log-linear models were used to assess prevalence ratios (PRs) of PTSD by type of life stressor, adjusting for multiple covariates, including number of life stressors and time since the worst life stressor.

RESULTS: Overall, 28 199 women participated in the study (mean [SD] age, 43.8 [13.7] years). The prevalence of life stressors varied substantially, ranging from 3.3% for war or armed conflict-related events to 66.4% for unwanted sexual experiences. The overall prevalence of probable PTSD was 15.9% and varied substantially across life stressor types. The highest prevalence of probable PTSD was for sexual assault (1427 of 3872 [36.9%]) and lowest for natural disasters (15 of 456 [3.3%]). Interpersonal trauma, specifically sexual assault (adjusted PR [APR], 6.66 [95% CI, 4.01-11.04]), other unwanted sexual experience (APR, 4.33 [95% CI, 2.53-7.42]), and physical assault (APR, 4.44 [95% CI, 2.63-7.49]) were associated with the highest prevalence increase of probable PTSD compared with natural disasters as the reference category.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of 28 199 women in Iceland, which ranks highest globally in gender equality, found that sexual and physical assaults were among the most common life stressors reported and were associated with the highest prevalence of probable PTSD. The propensity of such trauma to result in PTSD calls for widespread societal efforts to prevent sexual and physical violence and reduce gender-based disparities in mental health.

PMID:39641927 | DOI:10.1001/jamanetworkopen.2024.49430