Citations

Abstract Statistical learning (SL) is a powerful mechanism that supports the ability to extract regularities from environmental input. Yet, its neural underpinnings are not well understood. Previous EEG studies of SL have found that the brain tracks regularities by synchronizing its activity with the presented stimuli—a phenomenon known as neural entrainment. However, EEG lacks the spatial resolution to unveil the specific brain regions where this process takes place. In our study, 18 patients with drug-resistant epilepsy who were implanted with intracranial electrodes for presurgical investigation listened to a continuous speech stream containing embedded trisyllabic words. Neural entrainment was measured at the syllable and word frequencies, with the latter providing an online index of learning. SL was further assessed through both explicit and implicit behavioral measures. Behaviorally, we found evidence of learning at the group level in both tasks. At the neural level, our analyses revealed three temporal tuning profiles: 25% of contacts showed entrainment at the syllable frequency, 11% of contacts showed entrainment at both the word and syllable frequencies, and 4% showed entrainment only to the word frequency. Word entrainment, indicating sensitivity to word structures, was most commonly found in auditory and language-related regions, including insula, middle temporal gyrus, superior temporal gyrus, and supramarginal gyrus. In contrast, evidence for neural entrainment in the hippocampus was weak. Overall, these results support the idea that speech-based SL is largely supported by modality-specific brain regions.

Abstract Aims and Objectives To determine the frequency, timing, and duration of post‐acute sequelae of SARS‐CoV‐2 infection (PASC) and their impact on health and function. Background Post‐acute sequelae of SARS‐CoV‐2 infection is an emerging major public health problem that is poorly understood and has no current treatment or cure. PASC is a new syndrome that has yet to be fully clinically characterised. Design Descriptive cross‐sectional survey ( n = 5163) was conducted from online COVID‐19 survivor support groups who reported symptoms for more than 21 days following SARS‐CoV‐2 infection. Methods Participants reported background demographics and the date and method of their covid diagnosis, as well as all symptoms experienced since onset of covid in terms of the symptom start date, duration, and Likert scales measuring three symptom‐specific health impacts: pain and discomfort, work impairment, and social impairment. Descriptive statistics and measures of central tendencies were computed for participant demographics and symptom data. Results Participants reported experiencing a mean of 21 symptoms (range 1–93); fatigue (79.0%), headache (55.3%), shortness of breath (55.3%) and difficulty concentrating (53.6%) were the most common. Symptoms often remitted and relapsed for extended periods of time (duration M = 112 days), longest lasting symptoms included the inability to exercise ( M = 106.5 days), fatigue ( M = 101.7 days) and difficulty concentrating, associated with memory impairment ( M = 101.1 days). Participants reported extreme pressure at the base of the head, syncope, sharp or sudden chest pain, and “brain pressure” among the most distressing and impacting daily life. Conclusions Post‐acute sequelae of SARS‐CoV‐2 infection can be characterised by a wide range of symptoms, many of which cause moderate‐to‐severe distress and can hinder survivors' overall well‐being. Relevance to Clinical Practice This study advances our understanding of the symptoms of PASC and their health impacts.

Abstract Aim The aim of this review was to synthesise current knowledge of high‐fidelity simulation practices and its impact on nurse clinical competence in the acute care setting. Background There is no consensus or standardisation surrounding best practices for the delivery of high‐fidelity simulation in the acute care setting. This is an understudied area. Design An integrative review using Johns Hopkins Nursing Evidence‐Based Practice Model. Methods Medical subject heading terms ‘Clinical Competence’, AND ‘High Fidelity Simulation Training’, AND ‘Clinical Deterioration’ were systematically searched in PubMed, CINAHL and Embase databases for peer‐reviewed literature published through September 2020. The current study was evaluated using PRISMA checklist. Results Seven studies met the inclusion criteria. Three main concepts were identified: modes of delivery, approach to learner participation and outcome measurement. Conclusions This review substantiated the use of high‐fidelity simulation to improve acute care nurses’ early identification and management of clinical deterioration. Global variations in course design and implementation highlight the need for future approaches to be standardised at the regional level (i.e., country‐centric approach) where differing scopes of practice and sociocultural complexities are best contextualised. Relevance to clinical practice These findings add to the growing body of evidence of simulation science. Important considerations in course planning and design for nursing clinical educators were uncovered. This is especially relevant given the current COVID‐19 pandemic and urgent need to train redeployed nurses safely and effectively from other units and specialties to acute care.

AbstractAims and ObjectivesThe purpose of this paper is to describe a model to guide nursing science in a clinical practice‐based setting. Exemplars are provided to highlight the application of this nursing research model, which can be applied to other clinical settings that aim to fill evidence gaps in the literature.BackgroundNurse scientists are well positioned to develop new knowledge aimed at identifying global health solutions to multiple disparities. The generation and application of this knowledge are essential to inform and guide professional nursing practice. While a number of evidence‐based practice models exist to guide the integration of literature findings and other sources of evidence into practice, there is a need for additional models that serve as a guide and focus for the conduct of research in distinct scientific areas in practice‐based settings.DesignModel development and description.MethodsMayo Clinic is a large, comprehensive healthcare system with a mission to address unmet patient needs through practice, research and education. PhD‐prepared nurse scientists engage in practice‐based research as an integral component of Mayo Clinic's mission. A practice‐based nursing research model was developed with the intent to advance nursing research in a clinical setting.ResultsThe components of the Mayo Clinic Nursing Research model include symptom science, self‐management science and caregiving science. The generation of nursing science is focused on addressing needs of patients with complex health conditions, inclusive of caregivers.ConclusionsWhile clinical settings provide rich opportunities for the conduct of research, priorities need to be established in which to focus scientific endeavours. The Mayo Clinic Nursing Research model may be applicable to nurses around the globe who are engaged in the generation of knowledge to guide practice.Relevance to Clinical PracticeThe Mayo Clinic Nursing Research model can be used by nurse scientists embedded in healthcare settings to address clinically relevant questions, advance the generation of new nursing knowledge and ultimately improve the health and well‐being of patients and caregivers.

AbstractAims and ObjectivesTo determine the level of convergent validity of the ‘6‐Clicks’ Basic Mobility and Daily Activity with the Bedside Mobility Assessment Tool (BMAT) in patients admitted to a tertiary care academic hospital.BackgroundAccurately measuring a patient's ability to mobilise during hospitalisation is necessary but can be challenging. Two instruments, the Activity Measure for Post‐Acute Care short‐form ‘6‐Clicks’ and the BMAT, are commonly used to determine patients’ mobility levels; however, these instruments have not been psychometrically evaluated together. Understanding the characteristics between these tools can support the process of shared decision making amongst healthcare providers.DesignRetrospective Cohort adhering to the STROBE statement.MethodsUsing 13,498 individual patient admissions from an electronic health record, the BMAT score measured closest in time to the ‘6‐Clicks’ Basic Mobility and Daily Activity evaluation was collected. Spearman rank correlations with 95% confidence intervals (CIs) were calculated to determine the level of convergent validity between the ‘6‐Clicks’ Basic Mobility and Daily Activity with the BMAT. Pairwise correlations were also calculated and stratified by admitting medical service.ResultsAll correlations for the ‘6‐Clicks’ Basic Mobility or Daily Activity summative scores and the BMAT mobility levels were statistically significant and moderately correlated. The weakest correlations were seen within the Orthopaedic admitting service group. Most correlations stratified by admitting service [CVD/Pulmonary, Medicine/Hospitalist, Other Surgery and Solid Organ Transplant] were moderate. The strongest correlations were seen within the Neuro/Stroke admitting service.ConclusionModerate levels of convergent validity exist between the ‘6‐Clicks’ and the BMAT in this sample. These findings demonstrate that the construct of patient mobility is not being assessed similarly between the two instruments.Relevance to Clinical PracticeThese findings suggest the continued use of both instruments to allow interdisciplinary assessment of patient mobility status during a hospital stay.

AbstractCOVID‐19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ranging from lesions to open wounds are concerning because they increase the susceptibility of viral infection and transmission to other individuals. Early into the COVID‐19 pandemic (April 2020), the U. S. National Pressure Injury Advisory Panel (NPIAP) developed a series of position statements to improve wear‐ability of PPE and protect healthcare professionals and their patients as safe from harm as possible under the circumstances. The NPIAP positions, which were formed by conducting a systematic review of what was known at the time, include: (a) Prepare skin before and after wearing PPE with skin sealants, barrier creams and moisturisers; (b) Frequent PPE offloading to relieve pressure and shear applied to skin; (c) treat visible skin injuries immediately caused by PPE to minimise future infection; (d) non‐porous dressings may provide additional skin protection, but lack evidence; (e) health systems should take care to educate clinicians about placement and personal hygiene related to handling PPE. Throughout all of these practices, handwashing remains a top priority to handle PPE. These NPIAP positions provided early guidance to reduce the risk of skin injury caused by PPE based on available research regarding PPE injuries, a cautious application of evidence‐based recommendations on prevention of device‐related pressure injuries in patients and the expert opinion of the NPIAP Board of Directors. Clinicians who adhere to these recommendations reduce the prospects of skin damage and long‐term effects (e.g. scarring). These simple steps to minimise the risk of skin injury and reduce the risk of coronavirus infection from PPE can help.

The NCCN Guidelines for Non–Small Cell Lung Cancer (NSCLC) address all aspects of management for NSCLC. These NCCN Guidelines Insights focus on recent updates in immunotherapy. For the 2020 update, all of the systemic therapy regimens have been categorized using a new preference stratification system; certain regimens are now recommended as “preferred interventions,” whereas others are categorized as either “other recommended interventions” or “useful under certain circumstances.”

Acute myeloid leukemia (AML) is the most common form of acute leukemia among adults and accounts for the largest number of annual deaths due to leukemias in the United States. Recent advances have resulted in an expansion of treatment options for AML, especially concerning targeted therapies and low-intensity regimens. This portion of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for AML focuses on the management of AML and provides recommendations on the workup, diagnostic evaluation and treatment options for younger (age <60 years) and older (age ≥60 years) adult patients.

Aims and objectivesTo compare the incidence of femoral access puncture site complications in the control group, who underwent 6 hr of bed rest, with patients in the case group, who underwent 4 hr of bed rest.BackgroundThe ideal bed rest length after percutaneous coronary intervention with a 7‐French arterial sheath has been investigated by nursing practice. However, in this larger‐sheath‐size group, best practices have not been determined, and bed rest time continues to vary markedly among institutions.DesignRetrospective study.MethodsData were retrieved from the National Cardiovascular Data Registry and electronic health records in this retrospective study. Sample size was 401 patients: 152 case patients with 4‐hr bed rest and 249 controls with 6‐hr bed rest. Case group data were obtained from 20 May 2013–31 December 2014; and control group data, 15 June 2011–20 May 2013.ResultsNational Cardiovascular Data Registry event rates were generally low in both groups: Only three patients in each group had a bleeding event within 72 hr (2% vs. 1%) and no patient and only two controls had arteriovenous fistula (0% vs. 1%). Complications documented in the electronic health records with institutional femoral access puncture site complication definitions identified bleeding at the access site in eight case patients (5%) and nine controls (4%). Haematoma at the access site occurred in 21 case patients (14%) and 25 controls (10%).ConclusionsThe practice change of decreasing bed rest from 6–4 hr for patients with 7‐French arterial sheaths post‐percutaneous coronary intervention was associated with no significant change in femoral access puncture site complications in either National Cardiovascular Data Registry data or institutional electronic health records data.Relevance to clinical practiceThis introduces expanded evidence of safety in decreasing bed rest length in larger (7‐French) arterial sheaths post‐percutaneous coronary intervention.

Aims and ObjectivesThis paper explores patients' perspectives on infection prevention and control.BackgroundHealthcare‐associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front‐line clinicians' practices; patients' roles have been less explored.DesignVideo‐reflexive ethnography.MethodsFieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including 11 hours of video footage. This paper focuses on eight occasions, where video footage was shown back to patients in one‐on‐one reflexive sessions.FindingsViewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency.ConclusionThis study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient–provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care.Relevance to clinical practiceThis study suggests that if clinicians seek to reduce infection rates, they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback about infection risk. This will broaden clinicians' understandings of infection control risks and behaviours, and assist them to support appropriate patient self‐care behaviour.