Enhancing Nurse Leadership Through a Cohort-Based Model

The Doctor of Nursing Practice leadership program at Case Western Reserve University was designed to prepare nurses for advanced practice and leadership roles. The program is delivered off-campus, in a hospital setting. This delivery model allowed for a more intimate learning experience, as well as the opportunity to learn from and work with experienced nursing leaders. The Doctor of Nursing Practice leadership cohort model is an effective way to train future nursing leaders. It allows for a more intimate learning experience and the opportunity to learn from and work with experienced nursing leaders. During the coronavirus disease 2019 pandemic, this delivery model proved to be advantageous. The Doctor of Nursing Practice students were able to work closely with nursing leaders who were on the front lines of the pandemic response. They gained valuable firsthand experience in leading a team of nurses during a crisis. Additionally, they were able to take what they learned back to their own hospitals and apply it to their own responses to coronavirus disease 2019. © 2022 Elsevier Inc.

Enhancing Nurse Leadership Through a Cohort-Based Model

The Doctor of Nursing Practice leadership program at Case Western Reserve University was designed to prepare nurses for advanced practice and leadership roles. The program is delivered off-campus, in a hospital setting. This delivery model allowed for a more intimate learning experience, as well as the opportunity to learn from and work with experienced nursing leaders. The Doctor of Nursing Practice leadership cohort model is an effective way to train future nursing leaders. It allows for a more intimate learning experience and the opportunity to learn from and work with experienced nursing leaders. During the coronavirus disease 2019 pandemic, this delivery model proved to be advantageous. The Doctor of Nursing Practice students were able to work closely with nursing leaders who were on the front lines of the pandemic response. They gained valuable firsthand experience in leading a team of nurses during a crisis. Additionally, they were able to take what they learned back to their own hospitals and apply it to their own responses to coronavirus disease 2019. © 2022 Elsevier Inc.

Prenatal alcohol prevention in the UK: mapping the landscape through systematic collaborative review

BACKGROUND: UK policy makers have called for urgent action to reduce prenatal alcohol exposure (PAE), but evidence on what is effective is scarce. We aimed to identify, evaluate, and synthesise evidence on content, process aspects, and effectiveness of UK PAE prevention initiatives. METHODS: We conducted a systematic search of published and grey literature on UK PAE prevention (PROSPERO: CRD42020209460);consultations with 61 academic, practice, policy, third sector, and public stakeholders;and semi-structured 12 interviews with pregnant people (who were aged ≥18 years and ≥12 weeks' gestation) and service providers to discuss experiences of PAE prevention. Participants were purposively sampled to cover each UK region and identified through maternity sites, social media and, for stakeholder consultees, researcher networks. Information from relevant PAE prevention initiatives from the literature was independently extracted by two reviewers. Ethical approval and informed consent were obtained for interviews, which were recorded and transcribed. Qualitative evidence was synthesised using thematic analysis. Quantitative data will be summarised using descriptive statistics and meta-analysis. FINDINGS: We identified 14 PAE prevention initiatives through literature searches (22 of 4064 results were eligible), stakeholder consultation, and interviews. Initiatives included screening and intervention, campaigns, and education or training. Seven initiatives were identified in the north of England. Two initiatives were identified in Scotland and two in Wales. The East of England, West Midlands, and South East of England had one each. None were identified in Southwest of England or Northern Ireland. Barriers to prevention included absence of resources, excessive workload, concerns around blame, and COVID-19. Enablers included workforce training and trust between pregnant people and service providers. Effectiveness of evidence was scarce. INTERPRETATION: Key strengths include extensive searches and multidisciplinary consultation. Data collection and analyses are ongoing and will be finalised before November, 2022. This research will provide a comprehensive analysis of current provision, providing crucial evidence to inform research and practice. FUNDING: The National Institute for Health and Care Research.

Using Chlamydia and Gonorrhea Coinfection to Estimate Missing Chlamydia Case Reports in 2020

BACKGROUND: Chlamydia case reports decreased in 2020 in North Carolina (NC). COVID-19 social distancing restrictions and NAAT shortages undoubtedly impacted chlamydia screening practices, but the magnitude is unknown. Persons coinfected with gonorrhea may be less susceptible to changing screening practices because symptoms are more likely to be present. We assessed coinfection rates over time to estimate missed chlamydia case reports in 2020. METHOD(S): We reviewed all chlamydia cases reported to NC surveillance during 2012 to 2020 to identify those with gonorrhea diagnosed within 14 days of their chlamydia diagnosis. We calculated yearly proportions of gonorrhea coinfection by gender. We mulitplied the number of coinfections in 2020 by the inverse proportion of coinfections observed during the most recent 3-year period (2017-2019) to estimate the number of chlamydia cases likely to have been reported in 2020 without COVID- 19. RESULT(S): During 2012 to 2020, 526,882 chlamydia cases were reported in NC (men: N=151,665;women: N=375,146;unknown gender: N=71). Gonorrhea coinfection was identified in 14.0% of chlamydia cases in men and 8.2% in women. Gonorrhea coinfections increased steadily between 2012 (men: 1248;women: 2878) and 2020 (men: 3597;women: 4251). Proportions of coinfected cases remained stable by gender between 2012 and 2019 (Range: men: 11.1%-14.6%;women: 7.5%- 8.6%), increasing in 2020 (men: 17.2%;women: 9.7%). Dividing the 2020 coinfection counts by the most recent 3-year average coinfection proportion (men: 14.3%;women: 8.3%), we estimated 25,137 men and 51,074 women should have been reported with chlamydia in 2020. Subtracting the 2020 case reports from these estimates, 11,700 chlamydia cases went unreported in 2020 (4262 men;7438 women). CONCLUSION(S): Chlamydia went undiagnosed in 2020 due to the COVID-19 pandemic. Quantifying the number of unreported, and possibly untreated, chlamydia cases can help health departments mitigate their impact on transmission rates and long-term sequelae associated with failure to treat.

Lung Cancer Surgery in the Early Phase After Acute COVID-19 Pneumonitis

As the number of post-COVID-19 patients requiring surgery increases, it becomes pressing to develop guidelines outlining time requirements between active COVID-19 infection and surgery. We present a case of successful pulmonary segmentectomy 6 weeks following an acute COVID-19 infection in a 65-year-old female. The case patient was scheduled for a robotic assisted left upper lobectomy for radiologically diagnosed early-stage lung cancer. Unfortunately, prior to surgery she contracted Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2), resulting in the operation being rescheduled for 6 weeks' time. She was managed in the community for COVID pneumonitis and developed significant shortness of breath. At admission, with resolution of breathlessness, a repeat chest computed tomography scan showed the nodule had increased in size from 2 to 2.5cm, and widespread interstitial pneumonitis. The patient was saturating at 91% on air with no respiratory compromise. On balance of risk, surgery went ahead as planned due to concerns over tumour progression. A smaller lung resection was undertaken, with robot-assisted left upper division segmentectomy preferred to lobectomy. Post-operatively the patient received aggressive physiotherapy and high flow nasal oxygen to aid sputum expectoration. Chest tube was removed on day 2 post-operatively and the patient discharged 5 days following surgery without complication. Final histology confirmed a fully resected stage T1cN0M0 adenocarcinoma of the lung. This case highlights the importance of timing surgery correctly in post-COVID-19 patients to achieve the most favourable outcomes. We must balance clinical priority and the risk of disease progression against the severity of COVID-19 infection and the patient's comorbid status.

Salvage Pulmonary Resection in Stage IIIb-IV Lung Cancer After Treatment with Immune Checkpoint Inhibitors - A Case Series

Aim: Immune checkpoint inhibitors (ICIs) have been shown to prolong survival in patients that have locally advanced stage III/IV and metastatic non-small cell lung cancer (NSCLC). The role that salvages surgery plays in persistent localised disease and unresponsive synchronous cancer following treatment with a course of ICIs is not yet fully clear. We present a case series of nine patients with stage III/ IV NSCLC that underwent surgical resection after treatment with the ICI, pembrolizumab. Method: Six cases underwent salvage surgery after downstaging of the primary cancer following pembrolizumab treatment and three patients had resection of contralateral lung nodules that were unresponsive to ICI therapy. Three of the cases were open thoracotomies, 3 were robotic-assisted and 2 were video-assisted. One case was converted to open due to pulmonary artery involvement. Results: There was complete, successful macroscopic resection in all cases with each showing histological evidence for active cancer cells. One patient died of COVID pneumonitis in the community within 60 days of surgery. All other patients are alive with no evidence of localised disease or of any disease reoccurrence within 3-18 months of their surgery. Conclusions: Our case series demonstrates the potential for salvage pulmonary resection in select patients with advanced stage NSCLC who have persistent localised disease or unresponsive synchronous cancer after treatment with the ICI, pembrolizumab. Salvage surgery in this group of patients is safe and pragmatic despite high levels of post-immunotherapy hilar fibrosis. Further studies will be required in order to assess overall survival rates.

Almost Like the Dodo: Terminus in Richard Matheson's I Am Legend

This article considers Richard Matheson's short novel I Am Legend. Central to the discussion is the topic of contagion and an exploration of vampirism in literature. The article shows the lineage from Edgar Allan Poe's "The Masque of the Red Death", to Jack London's The Scarlet Plague and Bram Stoker's Dracula, as sources and influences in Matheson's novel. Prompted by the Covid-19 pandemic, the article explores literary expressions of plague and contagion, as well as the theme of vampirism. Theorists whose work informs the argument include Rosemary Jackson, whose work on fantasy provides insights into subversive elements of speculative literature;Marie Mulvey-Roberts, who addresses the Gothic genre;and J. J. Cohen, who addresses monster theory in detail. The article addresses the subversion of the conventional social order through the vampire narrative, and includes the reconfiguration of human identity in the context of social change.

College entrance exams: A modern “shibboleth”?

The Covid-19 pandemic led many US colleges to drop requirements for admissions tests. Daniel Robinson and Howard Wainer consider what the consequences of this decision might be – for students and universities. © 2022 The Royal Statistical Society.

Educating the Future Environmental Health Workforce During COVID-19: Developing a Virtual Curriculum for Navajo Student Interns Using the Environmental Health and Land Reuse Certificate Program

Beginning in 2016, the Agency for Toxic Substances and Disease Registry (ATSDR) and the National Environmental Health Association (NEHA) launched a partnership to create a free online course with the goal of building capacity within communities to help remediate and redevelop brownfields sites. Brownfields are land reuse sites often contaminated by harmful chemicals or redeveloped without proper environmental oversight. Due to their potentially hazardous status, brownfields sites can lead to harmful exposures in humans while accentuating and often exacerbating socioeconomic disparities within their communities. As a result of this partnership, NEHA and ATSDR launched the Environmental Health and Land Reuse (EHLR) Certificate Program in 2020. The Journal is pleased to feature this column to highlight an example of how the EHLR Certificate Program was used to build understanding and increase knowledge on this important topic within environmental health students. The findings and conclusions in this column are those of the authors and do not necessarily represent the views or official position of NEHA, ATSDR, or the Centers for Disease Control and Prevention. Furthermore, verbal permission was given by the students to use their work in this column.

Clinical signs of possible serious infection and associated mortality among young infants presenting at first-level health facilities.

BACKGROUND: The World Health Organization recommends inpatient hospital treatment of young infants up to two months old with any sign of possible serious infection. However, each sign may have a different risk of death. The current study aims to calculate the case fatality ratio for infants with individual or combined signs of possible serious infection, stratified by inpatient or outpatient treatment. METHODS: We analysed data from the African Neonatal Sepsis Trial conducted in five sites in the Democratic Republic of the Congo, Kenya and Nigeria. Trained study nurses classified sick infants as pneumonia (fast breathing in 7-59 days old), severe pneumonia (fast breathing in 0-6 days old), clinical severe infection [severe chest indrawing, high (> = 38°C) or low body temperature (<35.5°C), stopped feeding well, or movement only when stimulated] or critical illness (convulsions, not able to feed at all, or no movement at all), and referred them to a hospital for inpatient treatment. Infants whose caregivers refused referral received outpatient treatment. The case fatality ratio by day 15 was calculated for individual and combined clinical signs and stratified by place of treatment. An infant with signs of clinical severe infection or severe pneumonia was recategorised as having low- (case fatality ratio ≤2%) or moderate- (case fatality ratio >2%) mortality risk. RESULTS: Of 7129 young infants with a possible serious infection, fast breathing (in 7-59 days old) was the most prevalent sign (26%), followed by high body temperature (20%) and severe chest indrawing (19%). Infants with pneumonia had the lowest case fatality ratio (0.2%), followed by severe pneumonia (2.0%), clinical severe infection (2.3%) and critical illness (16.9%). Infants with clinical severe infection had a wide range of case fatality ratios for individual signs (from 0.8% to 11.0%). Infants with pneumonia had similar case fatality ratio for outpatient and inpatient treatment (0.2% vs. 0.3%, p = 0.74). Infants with clinical severe infection or severe pneumonia had a lower case fatality ratio among those who received outpatient treatment compared to inpatient treatment (1.9% vs. 6.5%, p<0.0001). We recategorised infants into low-mortality risk signs (case fatality ratio ≤2%) of clinical severe infection (high body temperature, or severe chest indrawing) or severe pneumonia and moderate-mortality risk signs (case fatality ratio >2%) (stopped feeding well, movement only when stimulated, low body temperature or multiple signs of clinical severe infection). We found that both categories had four times lower case fatality ratio when treated as outpatient than inpatient treatment, i.e., 1.0% vs. 4.0% (p<0.0001) and 5.3% vs. 22.4% (p<0.0001), respectively. In contrast, infants with signs of critical illness had nearly two times higher case fatality ratio when treated as outpatient versus inpatient treatment (21.7% vs. 12.1%, p = 0.097). CONCLUSIONS: The mortality risk differs with clinical signs. Young infants with a possible serious infection can be grouped into those with low-mortality risk signs (high body temperature, or severe chest indrawing or severe pneumonia); moderate-mortality risk signs (stopped feeding well, movement only when stimulated, low body temperature or multiple signs of clinical severe infection), or high-mortality risk signs (signs of critical illness). New treatment strategies that consider differential mortality risks for the place of treatment and duration of inpatient treatment could be developed and evaluated based on these findings. CLINICAL TRIAL REGISTRATION: This trial was registered with the Australian New Zealand Clinical Trials Registry under ID ACTRN 12610000286044.

Enhanced stress-resilience training for surgical trainees.

INTRODUCTION: Core surgical training programmes are associated with a high risk of burnout. This study aimed to assess the influence of a novel enhanced stress-resilience training (ESRT) course delivered at the start of core surgical training in a single UK statutory education body. METHOD: All newly appointed core surgical trainees (CSTs) were invited to participate in a 5-week ESRT course teaching mindfulness-based exercises to develop tools to deal with stress at work and burnout. The primary aim was to assess the feasibility of this course; secondary outcomes were to assess degree of burnout measured using Maslach Burnout Inventory (MBI) scoring. RESULTS: Of 43 boot camp attendees, 38 trainees completed questionnaires, with 24 choosing to participate in ESRT (63.2 per cent; male 13, female 11, median age 28 years). Qualitative data reflected challenges delivering ESRT because of arduous and inflexible clinical on-call rotas, time pressures related to academic curriculum demands and the concurrent COVID-19 pandemic (10 of 24 drop-out). Despite these challenges, 22 (91.7 per cent) considered the course valuable and there was unanimous support for programme development. Of the 14 trainees who completed the ESRT course, nine (64.3 per cent) continued to use the techniques in daily clinical work. Burnout was identified in 23 trainees (60.5 per cent) with no evident difference in baseline MBI scores between participants (median 4 (range 0-11) versus 5 (1-11), P = 0.770). High stress states were significantly less likely, and mindfulness significantly higher in the intervention group (P < 0.010); MBI scores were comparable before and after ESRT in the intervention cohort (P = 0.630, median 4 (range 0-11) versus 4 (1-10)). DISCUSSION: Despite arduous emergency COVID rotas ESRT was feasible and, combined with protected time for trainees to engage, deserves further research to determine medium-term efficacy.

Impacts of the 2008 Great Recession on dietary intake: a systematic review and meta-analysis

BACKGROUND: The 2008 Great Recession significantly impacted economies and individuals globally, with potential impacts on food systems and dietary intake. We systematically reviewed evidence on the impact of the Great Recession on individuals' dietary intake globally and whether disadvantaged individuals were disproportionately affected. METHODS: We searched seven databases and relevant grey literature through June 2020. Longitudinal quantitative studies with the 2008 recession as the exposure and any measure of dietary intake (energy intake, dietary quality, and food/macronutrient consumption) as the outcome were eligible for inclusion. Eligibility was independently assessed by two reviewers. The Newcastle Ottawa Scale was used for quality and risk of bias assessment. We undertook a random effects meta-analysis for changes in energy intake. Harvest plots were used to display and summarise study results for other outcomes. The study was registered with PROSPERO (CRD42019135864). RESULTS: Forty-one studies including 2.6 million people met our inclusion criteria and were heterogenous in both methods and results. Ten studies reported energy intake, 11 dietary quality, 34 food intake, and 13 macronutrient consumption. The Great Recession was associated with a mean reduction of 103.0 cal per adult equivalent per day (95% Confidence Interval: - 132.1, - 73.9) in high-income countries (5 studies) and an increase of 105.5 cal per adult per day (95% Confidence Interval: 72.8, 138.2) in middle-income countries (2 studies) following random effects meta-analysis. We found reductions in fruit and vegetable intake. We also found reductions in intake of fast food, sugary products, and soft drinks. Impacts on macronutrients and dietary quality were inconclusive, though suggestive of a decrease in dietary quality. The Great Recession had greater impacts on dietary intake for disadvantaged individuals. CONCLUSIONS: The 2008 recession was associated with diverse impacts on diets. Calorie intake decreased in high income countries but increased in middle income countries. Fruit and vegetable consumption reduced, especially for more disadvantaged individuals, which may negatively affect health. Fast food, sugary products, and soft drink consumption also decreased which may confer health benefits. Implementing effective policies to mitigate adverse nutritional changes and encourage positive changes during the COVID-19 pandemic and other major economic shocks should be prioritised.