Belonging, Affirmation, Safety, and Efficacy (BASE): An Integrative Model for Shame Resilience, Social Support, and Humor in r/hemorrhoid.

The present study sought to understand how participants in r/hemorrhoid used three coping strategies to improve their health and wellbeing. Drawing upon Shame Resilience Theory (SRT), the typology of social support, and the classification of humor styles, a theory-driven approach to qualitative analysis resulted in the identification of the following themes: Belongingness (building authentic connections with others), Affirmation (asserting the value of own experiences), Safety (feeling able to express emotions and needs), and Efficacy (exchanging information and advice for recovery). The study presents a coping model (BASE) that can inform research on communication patterns in contexts beyond other health conditions. Practical implications are derived from users' psychological distress and their reliance on diagnostics and treatment advice from peers, offering directions for supporting individuals with hemorrhoids.

Challenges in Media Attention toward COVID-19-Preventive Behaviors: Dual Roles of Threat and Perceived Capability for Information Systems and Health Care.

Based on the extended parallel process model, this study investigated the relationship between young adults' media exposure to COVID-19 and their adoption of protective behaviors. This study surveyed 141 college students and found that increased risk perceptions led to greater intentions to engage in COVID-19-preventive behaviors and that these intentions were mediated by normative beliefs. There was no significant difference in risk perceptions between traditional media and social media. The results showed that college students took precautions against COVID-19 because they perceived themselves to be both vulnerable and capable.

Type of Prior Operation Does Not Predict Surgical Intervention for Small Bowel Obstruction.

Background: Patients with prior abdominal surgeries are at higher risk for intra-abdominal adhesive tissue formation and subsequently higher risk for small bowel obstruction (SBO).Purpose: In this study, we investigated whether surgical intervention for SBO was more likely following specific types of abdominal surgeries.Research Design: With retrospective chart review, we pooled data from 799 patients, ages 18 to 89, admitted with SBO between 2012 and 2019. Patients were evaluated based on whether they underwent surgery or were managed conservatively. They were further compared with regard to past surgical history by way of type of abdominal surgery (or surgeries) undergone prior to admission.Results: Of the 799 patients admitted for SBO, 206 underwent surgical intervention while 593 were managed nonoperatively. There was no significant difference in number of prior surgeries (2.07 ± 1.56 vs 2.36 ± 2.11, P = .07) or in number of comorbidities (2.39 ± 1.97 vs 2.65 ± 1.93, P = .09) for surgical vs non-surgical intervention. Additionally, of the operations evaluated, no specific type of abdominal surgery predicted need for surgical intervention in the setting of SBO. However, for both surgical and non-surgical intervention following SBO, pelvic surgery was the most common type of prior abdominal surgery (45% vs 43%). There are significantly more female pelvic surgeries in both the operative (91.4% vs 8.6%, P < .0001) and nonoperative groups (89.9% vs 10.2%, P < .0001).Conclusion: Ultimately, no specific type of prior operation predicted the need for surgical intervention in the setting of SBO.

Indications for Readmission for Small Bowel Obstruction: A Comparison of Medical vs Surgical Service Admission.

Small bowel obstruction (SBO) impacts the health care system and patient quality of life. Previously, we evaluated differences between medical and surgical admissions in the management of SBO. This study investigates indications for readmission based on original admission to medical (MS) or surgical services (SS). A retrospective chart review was performed for 799 patients aged 18 to 89 admitted between 2012 and 2019 with a diagnosis of SBO. Patient characteristics examined included length of stay (LOS), prior abdominal operations, prior SBO, use of small bowel follow through imaging, operative intervention, mortality, and 30-day readmission. There was no difference in readmission rates in patients originally admitted to MS or SS (13.2% vs 12.7%, P = .86). Patients admitted to SS were more likely to be readmitted for recurrent SBO (39% vs 8.6%, P = .006). Patients admitted to MS were more likely to be readmitted for other reasons (73.9% v. 40.2%, P = .004). In the MS cohort, 30.4% (7 patients) had surgery during their initial admission for SBO, and none of those patients were readmitted for recurrent SBO (rSBO). In the SS cohort, 23% had surgery during their initial admission and 31.6% were readmitted for rSBO (P = .002). Patients admitted to SS were more likely to be readmitted for rSBO and to require surgery. Patients admitted to MS were more likely to be readmitted for other reasons. None of the MS patients who had surgery were readmitted for SBO. 31.6% of SS patients who had surgery were readmitted for SBO.

Does Organizational Messaging Make a Difference? Investigating Themes and Language Style in Twitter Discourse and Engagement by Mental Health Organizations.

The present study investigated the latent topics and language styles present in mental health organizational discourse on Twitter. The researchers sought to analyze identifying the prevalence of and language used in social support messaging in tweets about mental health care, the overarching topics regarding mental health care, and predicted that tweets with higher engagement will have increased frequency of words with positively valenced emotion and cognitive processing. A GSDMM was run to uncover latent themes that emerged in a data set of 326.9k tweets and 7.2 m words about organizational discussions of mental health. A generalized linear model using the Poisson distribution was used to assess the role of engagement, positive emotion, and cognitive processing. The study found support for both positive emotion and cognitive processing as statistically significant predictors of engagement. Directions for research include the development of health message strategies, policy needs, and online interventions.

Patient and provider perception of home blood pressure monitoring kits.

BACKGROUND: Pregnant patients of racial/ethnic minorities have higher preeclampsia rates. Home blood pressure monitoring (HBPM) has been investigated for disparity reduction. Smaller studies showed patients find HBPM to be a helpful intervention postpartum. Further investigation is needed to define the role of HPBM in an at-risk and diverse population antepartum. OBJECTIVE: To assess patient perception of HBPM among diverse patients at high risk of disease development. STUDY DESIGN: Prospective study conducted from April 2020-September 2021. HBPM kits were advertised and interested parties across the United States responded. Cuff Kits were then distributed to participating providers. Providers distributed the kits to patients meeting high-risk criteria for disease development, prioritizing those of racial/ethnic minorities. Surveys were distributed quarterly to providers and patients to assess HBPM perception. RESULTS: 2910 Cuff Kits were distributed to patients at 179 sites in 14 states. Of those, 1160 were distributed to Black patients, 1045 to White patients, and 500 to Hispanic patients. 117 patients completed surveys, with most patients finding Cuff Kits "very valuable" or "valuable" (68.4% and 19.7%, respectively). Most providers (73.4%) felt the Cuff Kits influenced patient care. CONCLUSIONS: Most patients receiving Cuff Kits reported a beneficial impact on disease understanding and most belonged to racial/ethnic groups at higher risk of adverse outcomes. Providers found HBPM had a beneficial impact on care. Though more research is needed to illustrate the impact of HBPM on outcomes, this study suggests that among racial/ethnic minorities and those at the high risk, HBPM is a well-received intervention.

Outcomes of Small Bowel Obstructions by Admitting Specialty and Hospital Type.

BACKGROUND: Small bowel obstructions (SBOs) account for a significant burden on the health care system. Should the ongoing trend of regionalizing medicine extend to these patients? We investigated if there is a benefit to admitting SBOs to larger teaching hospitals and to surgical services. METHODS: We performed a retrospective chart review of 505 patients admitted to a Sentara Facility between 2012 and 2019 with a diagnosis of SBO. Patients between the ages of 18 and 89 were included. Patients were excluded if they required emergent operation. Outcomes were evaluated based on patient's admission either to a teaching or community hospital as well as the admitting service's specialty. RESULTS: Of 505 patients admitted with a SBO, 351 (69.5%) were admitted to a teaching hospital. 392 (77.6%) patients were admitted to a surgical service. The average length of stay (LOS) (4 vs 7 days, P < .0001) and cost ($18,069.79 vs $26,458.20, P < .0001) were lower at teaching hospitals. The same trends in LOS (4 vs 7 days, P < .0001) and cost ($18,265.10 vs $29 944.82, P < .0001) were seen with surgical services. The 30-day readmission rate was higher in teaching hospitals (18.2% vs 11%, P = .0429), and no difference was seen in operative rate or mortality. DISCUSSION: These data would suggest that there is a benefit to admitting SBO patients to larger teaching hospitals and to surgical services with regard to LOS and cost, suggesting that these patients might benefit from treatment at centers with emergency general surgery (EGS) Services.

Social Media as Risk-Attenuation and Misinformation-Amplification Station: How Social Media Interaction Affects Misperceptions about COVID-19.

This study addresses how social media interaction affects misperceptions about COVID-19 via risk perceptions thereof and whether political orientation moderates the relationship. Using original two-wave panel survey data (N = 679), this study reveals that social media interaction increases misperception directly, as well as indirectly by reducing the extent of risk perception. The extent of risk perception is found to be a negative predictor of misperception. The deleterious role of social media interaction on misperception is pronounced across groups of conservatives and liberals, but in different ways. Although the effects of social media interaction on the level of misperception are observed in both conservatives and liberals, this relationship is particularly salient among conservatives. Furthermore, whereas conservatives consistently show low levels of risk perception toward COVID-19 regardless of how much they interact with others on social media, the more liberals interact on social media, the less likely they are to perceive COVID-19-related risks. The findings expand our understanding of the role of interaction behaviors on social media in forming risk perceptions and misperceptions on the politicized COVID-19 pandemic.

Communication Expressed on the COVID-19 Subreddit in the Midst of a Global Pandemic.

The manner in which scientific information related to the COVID-19 pandemic has been shared and discussed in similar venues has, to date, been largely neglected. Considering the role that such discourse plays in knowledge sharing and knowledge production, it is essential to understand such communication processes as they relate to global health crises like the COVID-19 pandemic. The current study examines communication expressed by participants in the r/COVID19 subreddit, a community that facilitates scientific discussion of the ongoing coronavirus pandemic. A computational content analysis was performed to identify the primary themes of users' communication on r/COVID19, while stepwise segmented regression was used to assess identify longitudinal changes in the volume of user contributions. Findings showed that while conversations were centered on scientific conversations, they were catalyzed by sociological and political developments rather than scientific breakthroughs. Future studies should examine the effects of pandemic-related communities on lurkers, the effects of visibility on scientific and medical contributions, and the implications of pseudonymity and ambiguous credentials in a community addressing a volatile health and scientific topic.

Finding the Invisible Leader: When A Priori Opinion Leader Identification is Impossible.

Opinion leaders are increasingly recruited to diffuse information, attitudes, and behaviors to serve communication campaigns. However, this has historically required opinion leader identification before launching the campaign. A priori identification is impossible in many contexts, such as when addressing unfamiliar topics or insular communities. The authors introduce a two-stage campaign approach that resolves this problem, and a public health campaign is used to demonstrate it. This approach is applicable to a wider variety of contexts than traditional a priori opinion leader identification.

Diatrizoate (Gastrograffin®) Small Bowel Follow Through for Small Bowel Obstructions: Timing and Outcomes.

INTRODUCTION: The advent of the Gastrograffin® small bowel follow through (G-SBFT) has resulted in a decreased rate of operative intervention of small bowel obstructions (SBO); however, there is no data to suggest when G-SBFT should be performed. METHODS: We retrospectively reviewed 548 patients, admitted to 1 of 9 hospitals with a diagnosis of SBO. Patients were divided into two categories with regards to timing of G-SBFT: before (early) or after (late) 48 hours from admission. Primary outcomes were length of stay (LOS) and total cost. Secondary outcomes were operative interventions and mortality. RESULTS: Of the reviewed patients, 71% had the G-SBFT ordered early. Comparing early versus late, there were no differences in patient characteristics with regards to age, sex, or BMI. There was a significant difference between LOS (4 vs 8 days, P < 0.05) and total cost ($17,056.19 vs $33,292.00, P < 0.05). There was no difference in mortality (1.3% vs 2.6%, P = 0.239) or 30-day readmission rates (15.6% vs 15.9%, P = 0.509). Patients in the early group underwent fewer operations (20.7% vs 31.9%, P = 0.05). DISCUSSION: Patients that had a G-SBFT ordered early had a decreased LOS, total cost, and operative intervention. This suggests there is a benefit to ordering G-SBFT earlier in the hospital stay to reduce the overall disease burden, and that it is safe to do so with regards to mortality and readmissions. We therefore recommend ordering a G-SBFT within 48 hours to reduce LOS, cost, and need for an operation.

Oral Healthcare Implications of Dedicated Online Communities: A Computational Content Analysis of the r/Dentistry Subreddit.

The current study explores communication expressed by participants in a subreddit surrounding oral health care, moderated by dentists and dental hygienists. The corpus was analyzed through Leximancer, a computer-assisted program used for computational content analyses of large data sets. Users' personal disclosures about ongoing dental concerns, advice about others' self-care, and the role of interpersonal communication with and among health care providers emerged as dominant themes. The findings suggest that online communities may serve an important role that dentists are unable to fill in their limited interactions with individual patients. Such interaction spaces may therefore offer a fertile environment for future interventions to promote beneficial practices and achieve positive health-related outcomes.

"Sharing Hope and Healing": A Culturally Tailored Social Media Campaign to Promote Living Kidney Donation and Transplantation Among Native Americans.

In this article, the authors discuss a community-based participatory research (CBPR)-driven and culturally tailored social media campaign to promote living kidney donation and transplantation (LKDT) serving Native American communities, who are disproportionately burdened by kidney failure. The effort represents a collaboration among researchers, tribal leaders and community members, medical centers, and other stakeholders to facilitate health promotion related to LKDT among the broader Native American community. Campaign objectives were collaboratively established by the researchers and stakeholders, and the campaign approach and materials were likewise developed in consultation with the community. The results indicated that the use of success stories about LKDT within campaign materials was a statistically significant predictors of heightened campaign engagement (p = .003, ß = .223). Recommendations are offered for partnering with tribal communities and other stakeholders, as well as for building tailored health promotion strategies.

Readmission after emergency general surgery.

BACKGROUND: Readmission rates are an important metric because they enable an evaluation of care and affect Medicare funding. This study evaluates factors contributing to readmission after emergency general surgery. METHODS: The Virginia Health Information database was used to identify patients who had undergone the most common emergency general surgery procedures from 1/2011-6/2016. Analyses were performed for 30 and 90-day readmission. RESULTS: 121,223 records met initial inclusion criteria and 54,372 remained after exclusions. In 30 days there were 5050 readmissions and 7896 readmissions in 90 days. Factors significant in contributing to 30-day readmission were length of stay, discharge location, and several comorbidities. For 90-day readmission the same factors were significant with the addition of urgent vs emergency admission and insurance status as well as additional comorbidities. Discharge to rehab, SNF, or with home healthcare had particularly high rates of 90 day readmission. CONCLUSIONS: We identified factors that contribute to readmission after emergency general surgery providing targets for future interventions. Improved follow up for patients discharged with rehab or home health needs is our next step.

Native Americans' Memorable Conversations About Living Kidney Donation and Transplant.

Living kidney donation and transplant (LKDT) offers a path of hope for patients on indefinite dialysis treatment. However, identification of a living donor can be challenging; initiating these conversations is difficult. Our study analyzes memorable conversations about LKDT that occurred in response to an LKDT campaign targeted to Native Americans. Our analysis of n = 28 memorable conversations revealed that the campaign prompted conversations and increased communication efficacy about LKDT. Based on these findings, we suggest that campaign designers utilize narratives within campaigns to model communication self-efficacy and then analyze the content of postcampaign conversations as an indicator of campaign effectiveness.

The Glove Made from Love: A History of Surgical Attire.

The development of surgical attire is well documented in historical photographs and evolved in response to the changing understanding of aseptic and antiseptic techniques. Surgeons throughout time remained significantly opposed to changes in attire, and it was over a century that we evolved from wearing black frock coats to the current attire of today. Interestingly, surgical attire remains a source of controversy even today, with a recent argument regarding skull versus bouffant caps that was quite publicly debated.

Metabolic Diversity in Human Non-Small Cell Lung Cancer Cells.

Intermediary metabolism in cancer cells is regulated by diverse cell-autonomous processes, including signal transduction and gene expression patterns, arising from specific oncogenotypes and cell lineages. Although it is well established that metabolic reprogramming is a hallmark of cancer, we lack a full view of the diversity of metabolic programs in cancer cells and an unbiased assessment of the associations between metabolic pathway preferences and other cell-autonomous processes. Here, we quantified metabolic features, mostly from the 13C enrichment of molecules from central carbon metabolism, in over 80 non-small cell lung cancer (NSCLC) cell lines cultured under identical conditions. Because these cell lines were extensively annotated for oncogenotype, gene expression, protein expression, and therapeutic sensitivity, the resulting database enables the user to uncover new relationships between metabolism and these orthogonal processes.

Barriers to Colonoscopy in an Uninsured Patient Population-A Quality Improvement Project.

Colorectal cancer remains common, with the "80 per cent by 2018" initiative proposed by the National Colorectal Cancer Roundtable. This study was designed to examine obstacles for patients who did not receive their scheduled colonoscopy, focusing on the impact of insurance status. Retrospective chart review was carried out on patients who did not complete their colonoscopy as scheduled from January 2013 to June 2017. The control group consisted of patients who completed their scheduled colonoscopy. One hundred and seventy five patients missed 200 colonoscopies. The most common reasons for cancellation were patient illness (16%), no-show (14%), no prep carried out (13%), inadequate prep (10%), and no transportation (11%). The canceled patients were significantly more likely to have the combination of no insurance and no Primary Care Provider (PCP) (13% vs 4%, P = 0.008), personal history of cancer (22% vs 12%, P = 0.02), and higher rates of prior GI issues (78% vs 50%, P < 0.001). The canceled group had a significantly lower history of colon polyps (37% vs 53%, P = 0.006). Difficulty with the bowel prep in addition to lack of insurance and poverty likely does create a barrier, even in a system that has a safety net, atop other issues such as transportation and inability to miss work playing a role.

Acute Diverticulitis Outcomes in the Acute Care Surgery Model.

BACKGROUND: The acute care surgery (ACS) model has been widely implemented, with single institution studies demonstrating improved outcomes but multicenter studies questioning the efficiency. Acute care surgery programs care for sicker and more economically disadvantaged patients. This study compares outcomes between ACS and traditional models in the management of diverticulitis across an entire state. STUDY DESIGN: The Virginia Health Information administrative database for adults discharged with diverticulitis from January 2008 through September 2015, was reviewed. Patient characteristics were analyzed and compared between ACS and traditional models. Outcome differences were compared using logistic regression. RESULTS: We reviewed 23,943 admissions, with 2,330 (9.7%) patients cared for in ACS programs. The ACS patients were more likely to be uninsured (10.6% vs 6.8%, p < 0.0001) or covered by Medicaid (5.5% vs 3.4%, p < 0.0001), and the ACS hospitals cared for a higher percentage of minority patients than in the traditional programs (30.4% vs 19.8%, p < 0.0001). Operative rates were higher in ACS hospitals (14.7% vs 11.8%, p < 0.0001), as were rates of complicated diverticulitis (24.5% vs 20.3%, p < 0.0001). The ACS patients had significantly higher rates of comorbidities. After adjusting for patient comorbidities and demographics, ACS patients had a higher rate of complications (odds ratio [OR] 1.36, p = 0.0017). However, there was no difference in mortality, length of stay, or costs. When comparing only operative patients, there were no outcome differences after adjusting for patient factors. CONCLUSIONS: Acute care surgery patients present to the hospital with more severe disease, higher rates of medical comorbidities, and lower socioeconomic status. Once patient factors are accounted for, outcomes are equivalent for operative patients in either model. Acute care surgery hospitals provide high quality and efficient care to sicker and more complex patients than traditional programs.