Comfort with Communication in Palliative and End of Life Care (C-COPE)

The C-COPE instrument is based on literature review, content from the COMFORT model, and iterative input from four content experts. The COMFORT communication model is grounded in patient-centered care and narrative medicine, where patients, families, and the healthcare team value each other’s story and collaboratively identify wishes and goals of care. COMFORT communication skills include bearing witness, understanding health literacy, actively listening, understanding family communication patterns, talking through the tension, embracing patient and family goals of care, and learning to collaborate with members of the team. The C-COPE operationalizes the key components of the COMFORT model: Communication, Orientation and opportunity, Mindful presence, Family, Openings, Relating, and Team. The 28-item instrument includes two ranked items and 26 items rated on a 5-point Likert-type scale (1 = not difficult, 2 = slightly difficult, 3 = uncertain, 4 = difficult, 5 = very difficult) to assess healthcare professional comfort with palliative and end-of-life communication. The range of possible C-COPE total scores is 26-130 points, with higher scores indicating less comfort with palliative and end-of-life communication. Rated items were categorized according to patient communication, family communication, and team communication. Preliminary psychometric analysis based on this pilot test of the C-COPE instrument supports test-retest reliability with ICC \u3e 0.77, internal reliability for total score with Cronbach’s alpha = 0.91, and four factors with Cronbach’s alpha ranging from 0.81- 0.90

Implementation of Survivorship Care Plans at Three Health System-Based Cancer Centers in a Rural State

The purpose of this project is to describe the development and implementation of cancer SCPs at three health systems’ cancer centers in a rural state. Collectively, these centers serve most cancer patients residing in SD, making the partnership across the cancer centers innovative. Each of the three health systems and their affiliated cancer centers is unique in its history, culture, and infrastructure. In addition, each cancer center was at a different point in the development and implementation of SCPs at the time of this project. Therefore, a description of the processes, successes, and challenges involved in the development and implementation of SCPs at each health system provides useful insights to support the adoption of SCP’s in similar low-population states or regions

PREPARE-ing South Dakota Farm and Ranch Women for Advance Care Planning

Purpose: Evaluate the impact of an advance care planning (ACP) educational session utilizing PREPARE for Your Care for South Dakota farm and ranch women and its ability to increase engagement in ACP and documentation of medical wishes in the form of an advance directive. Sample: A convenience sample of women (n = 23) represented members of the farm and ranch community in South Dakota who were participating in the Power of Women as AgVocates Conference. Inclusion criteria for this study included being 18 years old or older, female, and conference participation. Exclusion criteria included men and those under the age of 18. Method: This was a cross-sectional investigation, consisting of three phases, and included comparisons of the same sample population before and after an ACP intervention at different time intervals (baseline, 1 week after the educational session and 3 months after the educational session). Increased engagement in ACP was evaluated using a pre-test, post-test design and utilized the 15-item Advance Care Planning Engagement Survey. Demographic information including age and highest level of education completed was collected. Findings: In total, 23 women participated in the education session. The median age range was 35- 44 years of age. There were statistically significant increases in self-efficacy and readiness to complete ACP reported by participants. The objectives of this education session were met. Per the participants, this was an effective format for ACP. Advance directive completion rates did not increase. Conclusions: The use of PREPARE for Your Care during an education session on ACP can increase self-efficacy and readiness to engage in ACP. The format of this program is appropriate for future use in community settings with the farm and ranch population

The First Anniversary: Stress, Well-Being, and Optimism in Older Widows

The first anniversary for older widows (n = 47) has been explored during Months 11, 12, and 13. Concurrent correlations show that optimism inversely correlates with psychological (intrusion and avoidance) stress as measured with the Impact of Event Scale (r = —.52 to —.66, p \u3c .005) and positively correlates with well-being (physical: r = .36 to .46, p \u3c .025; psychosocial: r = .58 to .72, p \u3c .005; spiritual: r = .50 to .69, p \u3c .005). Lagged correlation patterns suggest that higher levels of optimism at a given time are associated with higher life satisfaction and spiritual well-being at later times. Psychological stress is higher at Month 12 when compared to Month 13, t(43) = 2.54, p = .01, but not when compared to Month 11, t(43) = 1.49, p \u3e .10. There are no significant differences in physiologic stress (salivary cortisol) or well-being during the first anniversary of spousal bereavement

Effect of HER2 Expression on NUPL2 Protein in Cervical Cancer Cells

Recurring cervical cancer patients frequently present overexpressed Human Epidermal Growth Factor Receptor 2 (HER2) protein, which promotes the growth of the cancer. Some HER2-expressing cells and cervical cancer patients have enhanced gene expression of Nucleoporin-like 2 (NUPL2). As part of the nuclear pore complex, the NUPL2 protein serves to selectively export substances from the nucleus to the cytoplasm. In this experiment, HER2 was expressed in cervical cancer cells to examine its effect on NUPL2 protein expression and localization. Interestingly, there was no difference in NUPL2 protein levels between HER2-expressing and non-expressing cells. Importantly, consistent instances of NUPL2 protein localization specific to the nucleus occurred in a large sampling of HER2-expressing cells. This is significant because it suggests a mechanism as to how HER2 promotes excessive cell growth, via changes in NUPL2 localization, potentially impacting its function and ability to selectively export substances that modulate cell growth

Improving Patient Outcomes With High Nurse To Patient Ratios: A Quality Improvement Study

According to the United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit published in the May/June 2018 issue of the American Journal of Medical Quality, a shortage of registered nurses is projected to spread across the country between 2016 and 2030. Surveyed nurses see the shortage in the future as a catalyst for increasing stress on nurses (98%), lowering patient care quality (93%) and causing nurses to leave the profession (93%) (American Association of Colleges of Nursing, 2021). A thorough literature review was conducted, and 40 studies were reviewed. Common themes that emerged include: high nurse to patient ratios increased the risk for hospital acquired infections, higher levels of understaffing are associated with higher mistreatment rates, and there is a decrease in patient outcomes associated with nurse understaffing. A set of guidelines have been developed to assist the nursing staff during a shortage of nurses or nursing technicians.https://scholarworks.moreheadstate.edu/celebration_posters_2021/1026/thumbnail.jp

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Procalcitonin Is Not a Reliable Biomarker of Bacterial Coinfection in People With Coronavirus Disease 2019 Undergoing Microbiological Investigation at the Time of Hospital Admission

Abstract Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11–1.70] ng/mL vs 0.24 [0.10–0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51–.60]).</jats:p

Implementation of corticosteroids in treating COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK:prospective observational cohort study

BACKGROUND: Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. METHODS: We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. FINDINGS: Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70–0·89], p=0·0001, for 70–79 years; 0·52 [0·46–0·58], p80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75–80% in January, 2021. INTERPRETATION: Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. FUNDING: UK National Institute for Health Research and UK Medical Research Council