Citations

AbstractRegistered nurses increasingly work in remote care and digital interaction roles, offering flexibility and expansion of their scope of practice. These roles may expose nurses to digital compassion fatigue, a phenomenon proposed to be characterized by the negative psychological and emotional impact of caring for patients remotely through the use of technology.The first objective of this work is to propose the phenomenon of “digital compassion fatigue” as a potentially further evolved and differentiated form of “compassion fatigue.” The second objective is to produce a comparative analysis of attributes, antecedents, and consequences through literature reviews.An evolutionary concept analysis approach was selected as a guide for exploring, discussing, and defining the new concept of digital compassion fatigue. Concept analysis was selected given the need for a framework that accounts for the dynamic nature of technology and practice. The process of conducting a concept analysis includes consideration of diverse and multidisciplinary perspectives. As a result, those in caring, educational, and/or support service roles (e.g., social work, counseling, and teaching) for which distance suffering and technostress could feasibly be present were also included in the literature searches and reviews. Health care-specific studies often included nurses in the sample but may not have differentiated their specific insights or data points in the results.The concept analysis explored the attributes, antecedents, and consequences of digital compassion fatigue, differentiating it from its evolutionary parent, compassion fatigue. Key antecedents included technostress, distant suffering, and the unique challenges of delivering care remotely. A major confounding variable was the COVID-19 pandemic, which may have heightened or introduced new technology-related stressors or highlighted the existence of digital compassion fatigue.Further defining and understanding digital compassion fatigue is crucial for developing effective strategies to support nurses who may experience it or who are at risk.

AbstractAlthough electricity has been used in medicine for thousands of years, bioelectronic medicine for treating epilepsy has become increasingly common in recent years. Invasive neurostimulation centers primarily around three approaches: vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS). These approaches differ by target (e.g., cranial nerve, cortex, or thalamus) and stimulation parameters (e.g., triggered stimulation or continuous stimulation). Although typically noncurative, these approaches can dramatically reduce the seizure burden and offer patients new treatment options. There remains much to be understood about optimal targets and individualized stimulation protocols. Objective markers of seizure burden and biomarkers that quickly quantify neural excitability are still needed. In the future, bioelectronic medicine could become a curative approach that remodels neural networks to reduce pathological activity.

AbstractAlthough endoscopic submucosal dissection (ESD) is associated with higher en-bloc and R0 resection rates than cap-assisted endoscopic mucosal resection (cEMR), its comparative impact on achieving complete remission of dysplasia (CRD) and intestinal metaplasia (CRIM) in BE endoscopic eradication therapy (EET) is not well defined. We aimed to compare the journey of patients from initial endoscopic resection (ER) with ESD and cEMR to achieving CRD and CRIM.Patients undergoing ESD or cEMR followed by ablation for BE neoplasia at two academic institutions in the United States were included. Primary outcomes included CRD and CRIM rates following ER in the two groups. Secondary outcomes included the number of resection/ablative procedures from initial ER to achieving CRD and CRIM. Inverse probability treatment weighting (IPTW) was used to balance confounding variables between groups.A total of 801 patients (606 cEMR, 195 ESD) were included. ESD group patients had higher en-bloc resection rates (ESD 94.4%, cEMR 44.7%). Higher rates of CRD were observed in patients undergoing initial ESD (HR 1.53, P < 0.01). With time-to-event and IPTW analyses, rates of achieving CRD and CRIM were comparable between the groups. There were no significant differences in mean number of endoscopic resection or ablative procedures among patients undergoing initial cEMR resection compared with those treated with initial ESD.Despite larger lesion sizes and more cancers in patients undergoing ESD, the EET journey to achieving CRD and CRIM was comparable to that in patients receiving cEMR. Prospective studies are required to further study differences between these two treatment approaches.