Nurses and Loss: A Call to Action

As we seek to understand how best to support the health and well-being of nurses, we must include a better understanding of the impact of loss and grief on the heart of a nurse. The chronic accumulation of unacknowledged, unattended grief can express itself as detachment, distancing, and avoiding caring connections, but it can also be a primary cause of more severe problems that nurses struggle with. If we courageously explore the inevitable heartbreak that is inherent in our work, it can serve as a catalyst into actions, innovations, and changes that will better prepare and support our nursing workforce.     

Bisexual Mental Health: A Call to Action

Over the past two decades research has consistently found that bisexual people experience poorer mental health than their gay, lesbian or heterosexual counterparts. The reasons behind this high prevalence of poor mental health remain under-researched and largely unknown. In order to improve these outcomes, more research is critically needed with the aim of providing new knowledge upon which health care provision and policy development can be based. This article presents an analysis of the literature to date relating to bisexuality broadly and bisexual mental health specifically, with the aim of providing direction for future research projects.     

Medical Misinformation and Healthy Information Environment: A Call to Action

Medical misinformation existed even before the digital era. However, with the surge in Internet use, misinformation spreads faster to a broader audience. Easy access to misinformation and the lack of trustworthy resources increase people’s vulnerability to misinformation. As a result, medical misinformation became a global public health threat. The US Surgeon General’s call to create a “healthy information environment” highlights the responsibility to address health-related misinformation and minimize its impact on health care outcomes.     

Confronting Racism in Pain Research: A Call to Action

Racism is an established health determinant across the world. In this 3-part series, we argue that a disregard of how racism manifests in pain research practices perpetuates pain inequities and slows the progression of the field. Our goal in part-1 is to provide a historical and theoretical background of racism as a foundation for understanding how an antiracism pain research framework - which focuses on the impact of racism, rather than “race,” on pain outcomes - can be incorporated across the continuum of pain research. We also describe cultural humility as a lifelong self-awareness process critical to ending generalizations and successfully applying antiracism research practices through the pain research continuum. In part-2 of the series, we describe research designs that perpetuate racism and provide reframes. Finally, in part-3, we emphasize the implications of an antiracism framework for research dissemination, community-engagement practices and diversity in research teams. Through this series, we invite the pain research community to share our commitment to the active process of antiracism, which involves both self-examination and re-evaluation of research practices shifting our collective work towards eliminating racialized injustices in our approach to pain research.PerspectiveWe call on the pain community to dismantle racism in our research practices. As the first paper of the 3-part series, we introduce dimensions of racism and its effect on pain inequities. We also describe the imperative role of cultural humility in adopting antiracism pain research practices.     

早期发生型妊娠高血压综合征与妊娠结局

妊娠高血压综合征(妊高征)是危害母婴健康的常见疾患之一,其发病原因及机制尚不十分清楚,迄今国际上尚无统一命名与分类. 　　……     

Awareness of Toxic Stress and Adverse Childhood Experiences among Dutch Pediatric Health Care Providers: A National Survey

Introduction: Early recognition of adverse childhood experiences (ACEs) and adequate interventions are required to prevent negative effects on the child’s mental and physical health later in life caused by toxic stress. This study aimed to assess how familiar the concepts of ACEs and toxic stress are among Dutch pediatric health care providers (PHCPs) and whether screening for ACEs is standard practice in the Netherlands.Methods: From October 2018 until March 2019, a nation-wide questionnaire survey was held.Results: Of 548 participating PHCPs, 29% were familiar with toxic stress, 67% were familiar with ACEs, and 63% knew of the relationship between multiple ACEs and somatic diseases. Routine inquiries about ACEs were done always by 17% of the participants and sometimes by 65%. The ACEs which PHCPs asked about the most included divorce (n=288; 76.8%), bullying (n=265; 70.7%), physical domestic violence (n=184; 49.1%), parental psychiatric diseases (n=205; 54.7%) and sexual abuse (n=164; 43.7%). The ACEs asked about the least included deportation of a family member (n=22; 5.9%), gender discrimination (n=9; 2.4%) and racism (n=17; 4.5%).Conclusion: Even in 2019, there is limited awareness among Dutch PHCPs of ACEs and toxic stress. While most acknowledged to be aware of the role that toxic stress plays in the physical and mental health consequences of ACEs later in life, only 17% of the respondents performed standard ACE screening. Our findings underscore the need for standard ACE screening guidelines to support early recognition and adequate treatment of children suffering with toxic stress.     

A Case for an International Health Elective Training Program During Residency: A Four-Points Call for Action

Background: International Health Electives (IHE) are becoming more popular among graduate training programs. This is likely due to the high demands from graduating medical students who are seeking to have an international health experience during their post-graduate training. Despite the important educational experiences associated with an IHE, this opportunity does not exist in all graduate medical programs and fewer have formal established programs. Summary: We are suggesting that graduate training programs are in a unique position to provide such experiences to our future physicians, in turn creating immediate benefits to host nations as well as long-term impacts on our society in the United States. We are proposing Four Points for stakeholders involved in training future physicians to use as they consider designing such opportunities for future trainees. The four points include: residents are capable of providing service to host nations, improve the quality of care to communities in the U.S., foster graduating medical students' global health interests and increase global health mentorship. Conclusions: We hope that addressing these four points will reemphasize the importance of establishing an IHE in all graduate training programs.     

Promoting a Shared Medication Adherence Practice: A Call to Action

Medication nonadherence exists among most patients and leads to increased morbidity, medical costs, and unnecessary hospitalizations. This study trained primary care staff at an urban Federally Qualified Health Center to address medication nonadherence. It included a single educational workshop that described medication nonadherence, demonstrated validated assessment tools to formulate evidence-based interventions, and incorporated motivational interviewing techniques. Evaluations conducted at pre-post training and at 4 weeks showed an increase in staff knowledge (29%), self-confidence (46%), and self-reported practice change (77%). Our findings suggest this training resulted in practice change through increased patient engagement, shared decision making, and strengthening patient-provider trust.     

Changes in Stress and Coping During Late Childhood and Preadolescence

PROBLEM: Little is known about what produces stress in preadolescents. METHODS: Secondary data analysis using hierarchical linear modeling was performed to determine how stressors and coping changed over time in 1,568 preadolescents (51% Hispanic) in 28 public schools. FINDINGS: Over time, participants experienced most stressors less intensely, but intensity varied by gender. Children in lower grades and girls found that coping strategies used were more effective compared with those in upper grades or boys. There were several interactions of grade level, sex, and ethnicity. CONCLUSION: Changes in stress and coping among preadolescents have implications for nurses concerned with mental health.     

Pathways to Quality Inpatient Management of Hyperglycemia and Diabetes: A Call to Action

Currently patients with diabetes comprise up to 25–30% of the census of adult wards and critical care units in our hospitals. Although evidence suggests that avoidance of hyperglycemia (>180 mg/dL) and hypoglycemia (<70 mg/dL) is beneficial for positive outcomes in the hospitalized patient, much of this evidence remains controversial and at times somewhat contradictory. We have recently formed a consortium for Planning Research in Inpatient Diabetes (PRIDE) with the goal of promoting clinical research in the area of management of hyperglycemia and diabetes in the hospital. In this article, we outline eight aspects of inpatient glucose management in which randomized clinical trials are needed. We refer to four as system-based issues and four as patient-based issues. We urge further progress in the science of inpatient diabetes management. We hope this call to action is supported by the American Diabetes Association, The Endocrine Society, the American Association of Clinical Endocrinologists, the American Heart Association, the European Association for the Study of Diabetes, the International Diabetes Federation, and the Society of Hospital Medicine. Appropriate federal research funding in this area will help ensure high-quality investigations, the results of which will advance the field. Future clinical trials will allow practitioners to develop optimal approaches for the management of hyperglycemia in the hospitalized patient and lessen the economic and human burden of poor glycemic control and its associated complications and comorbidities in the inpatient setting.Over the past decade, there has been increasing interest in glycemic management of hospitalized patients. There is now broad consensus that both hyperglycemia and hypoglycemia in hospitalized patients are associated with adverse outcomes, including mortality. There is less agreement, however, as to whether these associations actually reflect the effects of the quality of glucose management or are merely underlying paraphenomena of the severity of acute illness. Even more controversial is the actual potential impact of glycemic control during these hospitalizations that are often relatively brief, the specific glucose ranges that should be targeted, and the methods by which clinicians might achieve these.In the 1960s, research on the benefits of glucose-insulin-potassium infusion during acute myocardial infarction began, but this line of inquiry was not focused on glucose control per se (1). Interest in the general field of glycemic management in the inpatient setting began in the mid 1990s (2). The next 10 years were marked by both prospective observational trials and randomized clinical trials (RCTs), the majority of which seemed to indicate that “lower is better”: hospital complications, length of stay, cost, and even mortality could be dramatically decreased in a variety of critical care settings if mean glucose concentrations were reduced, usually with intravenous insulin, toward or within the euglycemic range (3,4). Some results, however, seemed too good to be true, especially in the context of such short hospital stays. This skepticism led to confirmatory trials, most conducted using a multicenter design. These could not confirm the initial positive findings from single-center investigations (5–7). There was resulting confusion as to how these results might shape clinical practice. Several consensus documents have emerged, each endorsing a more moderate approach to the management of glycemia in the hospitalized patient (8–11). Notably, all have called for more research in this area so that we can better understand the impact of both hyperglycemia and hypoglycemia on inpatient outcomes and better delineate evidence-based standards for hospital practice.To date, most investigations have been funded through local resources or industry, as agencies appear reluctant to commit financial support for research in inpatient glycemic management. However, greater efforts devoted to the study of diabetes in the hospital setting would have broad implications for our health care system (12). In addition to funding, the nascent discipline of inpatient glucose management will benefit from standardized nomenclature, consistent and meaningful metrics, and transparent study designs and analytical methods allowing for comparison of study outcomes.In this article, we outline eight aspects of inpatient glucose management in which RCTs and/or rigorously designed observational studies are needed. We refer to four as system-based issues and four as patient-based issues. Our goal was to identify existing research gaps and clinical care challenges in inpatient glucose management and to suggest future directions for each. These are summarized in Open in a separate window     

College Student Suicide: A Call To Action

This article examines current issues related to the topic of college student suicide and why it continues to be an issue of major concern. The nature/extent of the problem, risk and protective factors, responses to college student suicide, legal issues, and training issues are discussed. The importance of addressing the issue of college student suicide and its prevention on college campuses is emphasized as is the importance of protective factors. Although more is being done to address this issue than has been done in the past, it remains a major concern, and it is an issue that requires a strong national response.