Learning to Fly in the Time of COVID-19: Nurse Resident Experiences During the First Surge.

This qualitative study, designed by nursing professional development specialists, explored novice nurses' experiences working during the first COVID-19 surge of 2020. Semistructured focus group interviews were conducted in June-December 2020 with 23 novice nurses who cared for patients with COVID-19 in March-April 2020. Sixteen themes were identified under three broad categories (viz., stimuli, coping, and adaptation). These themes and participant exemplars are shared along with recommendations on how best to support novice nurses working through the ongoing pandemic.

Colchicine in Acute Coronary Syndrome: A Systematic Review.

OBJECTIVE: The purpose of this review is to evaluate the efficacy and safety of colchicine after acute coronary syndrome (ACS). DATA SOURCES: English-language searches were made of MEDLINE and EMBASE from database inception through mid-June 2020. STUDY SELECTION AND DATA EXTRACTION: Randomized trials characterizing the effects of colchicine in ACS were considered. Of 627 title and abstracts identified, nine trials were included. Two reviewers extracted data and rated study quality. DATA SYNTHESIS: Four studies showed colchicine did not attenuate C-reactive protein production. Colchicine did modulate the NOD-like receptor family pyrin domain containing 3 inflammasome in 3 studies and reduced production of chemokine ligand 2 (CCL2), CCL5, and C-X3-C motif chemokine ligand 1 in 1 study. Major adverse cardiovascular events (MACE) were not significantly different at 30 days in 3 studies, administered as 1.8 mg preprocedurally or scheduled 1 mg daily. One study found a significant reduction in MACE with colchicine 0.5 mg daily over median 22.6 months (hazard ratio = 0.77; 95% CI = 0.61-0.96). Colchicine is associated with increased gastrointestinal adverse events but was generally well tolerated. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Colchicine is likely to reduce MACE in an ACS population if administered for greater than 30 days but does not improve MACE when administered only preprocedurally. CONCLUSIONS: Adjunctive colchicine 0.5 mg daily for greater than 30 days is reasonable for an ACS population on guideline-directed medical therapy treated with PCI. Additional studies are needed to validate and determine the durability of these benefits.

Standard Versus Extended Duration Direct-Acting Antiviral Therapy in Hepatitis C Patients With Slow Response to Treatment.

BACKGROUND: Response-guided hepatitis C therapy was standard with interferon-based regimens but is not used for direct-acting antivirals (DAAs). Week 4 viral kinetics may predict sustained virological response (SVR) with DAAs, but it is unclear whether extending therapy in slow responders affects outcomes. OBJECTIVES: The primary objective was to compare SVR rates between traditional and extended duration groups. Secondary objectives were to compare SVR rates among subgroups and to determine factors associated with SVR. METHODS: This institutional review board-approved, retrospective, single-center study identified patients with chronic hepatitis C virus (HCV) infection with detectable week 4 HCV RNA who were treated with DAAs. Patients were excluded for early discontinuation, treatment regimen not recommended first-line, or missing HCV RNA labs. Patients were stratified into traditional and extended duration groups. The primary end point was SVR. Secondary end points included factors associated with SVR and rationale for extension of therapy duration. RESULTS: A total of 363 patients were included; 58 (16%) received extended therapy. Patients were primarily genotype 1a (70%) and treatment naïve (80%). More than half had advanced fibrosis or cirrhosis. SVR12 rates were 100% in the extended duration group and 96.7% in the traditional duration group (P = 0.37). There were no associations with SVR and prespecified patient-specific factors. Sample size was limited. CONCLUSION AND RELEVANCE: Based on these findings, a recommendation for extension of therapy cannot be made for patients with detectable HCV RNA at week 4 of treatment at this time. Cost analyses may help guide recommendations to re-treat rare failures versus extend therapy in all slow responders.

Technology for spinal cord injury rehabilitation and its application to youth.

Spinal cord injury (SCI) often results in a sudden, devastating loss of function. SCI is particularly challenging for the pediatric and adolescent populations who, under normal circumstances, are still achieving developmental milestones, but following SCI face additional barriers posed by paralysis and the accompanying secondary complications. Advancing technology in rehabilitation is changing the course of how people with spinal cord injury participate in rehabilitation. Technology plays an ever-increasing role in both restorative and compensatory rehabilitative interventions. While the practical or functional needs of the pediatric patient may differ from those of the adult, technology can and does play a role in restoring function for this population. Applications of technology span broad areas, providing improved options for care in grasp and manipulation, seating and mobility, augmentative and alternative communication, electronic aids to daily living, and computer access and use. This article reviews select applications of technology that have great impact on the functional needs of people with spinal cord injury (SCI): therapeutic and functional stimulation, EMG biofeedback and EMG-triggered stimulation, assistive technology for computer access, and implanted functional electrical stimulation systems. Some of these technologies are already in use in the pediatric population, while some are not - yet have great potential for restoring function in this group. The challenges and potential solutions for implementing these technologies in the pediatric population are discussed.