Search

BackgroundDetection and containment of hospital outbreaks currently depend on variable and personnel-intensive surveillance methods. Whether automated statistical surveillance for outbreaks of health care-associated pathogens allows earlier containment efforts that would reduce the size of outbreaks is unknown.MethodsWe conducted a cluster-randomized trial in 82 community hospitals within a larger health care system. All hospitals followed an outbreak response protocol when outbreaks were detected by their infection prevention programs. Half of the hospitals additionally used statistical surveillance of microbiology data, which alerted infection prevention programs to outbreaks. Statistical surveillance was also applied to microbiology data from control hospitals without alerting their infection prevention programs. The primary outcome was the number of additional cases occurring after outbreak detection. Analyses assessed differences between the intervention period (July 2019 to January 2022) versus baseline period (February 2017 to January 2019) between randomized groups. A post hoc analysis separately assessed pre-coronavirus disease 2019 (Covid-19) and Covid-19 pandemic intervention periods.ResultsReal-time alerts did not significantly reduce the number of additional outbreak cases (intervention period versus baseline: statistical surveillance relative rate [RR]=1.41, control RR=1.81; difference-in-differences, 0.78; 95% confidence interval [CI], 0.40 to 1.52; P=0.46). Comparing only the prepandemic intervention with baseline periods, the statistical outbreak surveillance group was associated with a 64.1% reduction in additional cases (statistical surveillance RR=0.78, control RR=2.19; difference-in-differences, 0.36; 95% CI, 0.13 to 0.99). There was no similarly observed association between the pandemic versus baseline periods (statistical surveillance RR=1.56, control RR=1.66; difference-in-differences, 0.94; 95% CI, 0.46 to 1.92).ConclusionsAutomated detection of hospital outbreaks using statistical surveillance did not reduce overall outbreak size in the context of an ongoing pandemic. (Funded by the Centers for Disease Control and Prevention; ClinicalTrials.gov number, NCT04053075. Support for HCA Healthcare's participation in the study was provided in kind by HCA.).

BackgroundThe Veterans Health Administration tracks urine drug tests (UDTs) among patients on long-term opioid therapy (LTOT) and recommends discussing the health effects of cannabis use.ObjectiveTo determine the occurrence of cannabis-related discussions between providers and patients on LTOT during six months following UDT positive for cannabis, and examine factors associated with documenting cannabis use.DesignWe identified patients prescribed LTOT with a UDT positive for cannabis in 2019. We developed a text-processing tool to extract discussions around cannabis use from their charts.SubjectsTwelve thousand seventy patients were included. Chart review was conducted on a random sample of 1,946 patients.Main measuresThe presence of a cannabis term in the chart suggesting documented cannabis use or cannabis-related discussions. Content of those discussions was extracted in a subset of patients. Logistic regression was used to examine the association between patient factors, including state of residence legal status, with documentation of cannabis use.Key resultsAmong the 12,070 patients, 65.8% (N = 7,948) had a cannabis term, whereas 34.1% (N = 4,122) of patients lacked a cannabis term, suggesting that no documentation of cannabis use or discussion between provider and patient took place. Among the subset of patients who had a discussion documented, 47% related to cannabis use for medical reasons, 35% related to a discussion of VA policy or legal issues, and 17% related to a discussion specific to medical risks or harm reduction strategies. In adjusted analyses, residents of states with legalized recreational cannabis were less likely to have any cannabis-related discussion compared to patients in non-legal states [OR 0.73, 95% CI 0.64-0.82].ConclusionsOne-third of LTOT patients did not have documentation of cannabis use in the chart in the 6 months following a positive UDT for cannabis. Discussions related to the medical risks of cannabis use or harm reduction strategies were uncommon.

Two independent temporal-spatial clusters of hospital-onset Rhizopus infections were evaluated using whole-genome sequencing (WGS). Phylogenetic analysis confirmed that isolates within each cluster were unrelated despite epidemiological suspicion of outbreaks. The ITS1 region alone was insufficient for accurate analysis. WGS has utility for rapid rule-out of suspected nosocomial Rhizopus outbreaks.

Although evidence exists that online education can result in comparable outcomes to the equivalent face-to-face (F2F) version of a course, there is still a dearth of literature. The objective of this pilot was to investigate differences in academic performance between students participating in the F2F versus online versions of Nutrition 10, an introductory, college-level nutrition course. Students enrolled in Nutrition 10 (F2F; n = 907) and Nutrition 10V (virtual; n = 1,239) completed a 27-item nutrition knowledge questionnaire before (pre-) and after the class (post-) developed from the learning objectives ([alpha] = 0.92). Students who took the class, regardless of delivery method, improved their nutrition knowledge (+6.9 points; p < 0.01). In the F2F class, students exhibited a greater improvement in nutrition knowledge (+7.7 points; p < 0.01) compared with the virtual class (+6.3 points; p < 0.01). There were significant differences in grades based on the quarter when the course was offered. Fall 2019 F2F students received a grade that was 3% higher than the virtual course (p < 0.05), whereas winter 2020 virtual students received a grade that was 1.2% higher than the F2F course (p < 0.01). Although F2F and online education share many similarities, there are still significant differences between the two modalities.

In this essay, we explore the tension between research using continuous improvement (CI) paradigms, such as improvement science, and conventional research, and the role and regulation of Institutional Review Board (IRB) oversight. We argue that the current regulatory structure privileges traditional research and hinders collaborative inquiry that centers the voice and agency of those traditionally marginalized. We also question whether IRBs should limit CI efforts required of educational leaders as part of their jobs. We offer recommendations for how IRBs and scholar-practitioners can together support CI efforts.

Infection prevention program leaders report frequent use of criteria to distinguish recently recovered coronavirus disease 2019 (COVID-19) cases from actively infectious cases when incidentally positive asymptomatic patients were identified on routine severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing. Guidance on appropriate interpretation of high-sensitivity molecular tests can prevent harm from unnecessary precautions that delay admission and impede medical care.

Reacting to the Past (Reacting) is an active-learning pedagogy utilizing elaborate historical roleplaying games. This study examined the effect of Reacting on student academic self-efficacy, perspective taking, engagement, and perceived learning, and considered whether these outcomes were impacted by the type of role a student assumed. Students from Reacting classes completed surveys prior to beginning and after completing the game. Students in similar non-Reacting classes completed surveys at approximately the same time. Students involved in Reacting reported more engagement, perceived learning, and self-efficacy than students enrolled in comparable courses. Reacting participants in roles that aligned them to a faction with a committed perspective reported more improvement in self-efficacy than participants in non-aligned roles. The article concludes with a consideration of pedagogical interventions to respond to the study's findings.

BackgroundFrom clinical experience, many patients undergoing robotic assisted surgery (RAS) have a poor understanding of the technology. To ensure informed consent and appropriate expectations, a needs assessment for patient-centered education and outcome metrics in RAS is warranted. Our goal was to perform an assessment of patient understanding, comfort with robotic technology, and ability to obtain critical information from their surgeon when undergoing RAS.MethodsTwenty patients planned for RAS by three surgeons were asked to complete a six-item Likert agreement scale survey prior to signing informed consent. The study coordinator administered surveys, while the surgeon left the room. Indicator statements were crafted to reduce bias and two-way evaluated for consistency. The surgeons were additionally asked their perception of each patient's understanding and comfort with RAS. Frequency statistics and tendencies were analyzed.ResultsSurgeons strongly agreed all patients appropriately understood how RAS functioned and would ask more questions before signing consent, if needed. Patients were predominately not familiar with RAS and felt surgeons did not explain how RAS worked. There was wide variability on if patients understood how RAS worked for their treatment. Overall, patients were not completely comfortable with RAS for their care, did not understand the risks of RAS compared to other approaches, and did not feel their surgeon understood what they needed to know to make informed decisions.ConclusionsThis needs assessment demonstrated critical gaps in patient knowledge about RAS, surgeon communication skills, and the ability of surgeons to know what was important from the patient perspective. The development of RAS patient-centered education and outcome metrics could help address these gaps.

As students gain more experience with design concepts, they should progress from novice to expert design thinkers. The purpose of this research was to identify the constructs of growth in design thinking (DT) over short- (one weekend) and long-term (10 weeks) design challenges. A DT mindset questionnaire was completed by students in a third-year undergraduate biomedical design course at the beginning of the course, after a one-weekend design challenge, and on completion of the course. After the short design challenge, an improvement in 15 of the 19 constructs was observed relative to baseline. Six of these constructs: mindfulness and awareness of the process, embracing risk, abductive thinking, envisioning new things, creative confidence, and optimism to make an impact, were sustained over the course of the semester indicating that a prolonged period of experiential learning can maintain short-term gains in DT. Three of the constructs: holistic views (considering the problem as a whole), diversity, and curiosity showed improvement following the short-term design challenge, then deterioration suggesting that situational circumstances are significant contributors to these constructs of DT. DT generally improves with the opportunity to collaborate, communicate, and design for a specific outcome. However, situational factors including team diversity, instructor expertise, dedicated time for team collaboration, and prior experiences can affect changes in the DT skillset.

Since 2011, massive new strandings of holopelagic Sargassum have been reported on the coasts of the Caribbean, northern Brazil, Guiana, and West Africa, causing severe economic and ecological damage. Three common morphotypes (S. fluitans III, S. natans I, and S. natans VIII) were identified as responsible for these catastrophic events, with dominance shifts between them over time. However, the taxonomic status of these holopelagic Sargassum morphotypes remains unclear. Using an integrative taxonomy framework, combining a morphological study and molecular analyses, this study aimed to clarify their taxonomic status. Morphological analyses of 54 characters revealed no intermediate form between the three morphotypes, with the overall shape, nature of the axis, and size and shape of blades and vesicles being the most discriminating. An analysis of mitochondrial (IGS, cox2, cox3, mt16S rRNA, and nad6) and plastid (rbcL) markers confirmed the genetic divergence among the three morphotypes, with a lower level of divergence between the two S. natans morphotypes. Without additional molecular characterization, these morphotypes cannot be classified as three distinct species. However, due to their distinct morphological characteristics and sympatry within drifting aggregations, a revision of holopelagic species names is proposed, with Sargassum fluitans var. fluitans (for S. fluitans III), Sargassum natans var. natans (for S. natans I), and S. natans var. wingei (for S. natans VIII). This revision provides necessary clarity on the species involved in inundations of the tropical Atlantic.

Abstract Background The Veterans Health Administration tracks urine drug tests (UDTs) among patients on long-term opioid therapy (LTOT) and recommends discussing the health effects of cannabis use. Objective To determine the occurrence of cannabis-related discussions between providers and patients on LTOT during six months following UDT positive for cannabis, and examine factors associated with documenting cannabis use. Design We identified patients prescribed LTOT with a UDT positive for cannabis in 2019. We developed a text-processing tool to extract discussions around cannabis use from their charts. Subjects Twelve thousand seventy patients were included. Chart review was conducted on a random sample of 1,946 patients. Main measures The presence of a cannabis term in the chart suggesting documented cannabis use or cannabis-related discussions. Content of those discussions was extracted in a subset of patients. Logistic regression was used to examine the association between patient factors, including state of residence legal status, with documentation of cannabis use. Key Results Among the 12,070 patients, 65.8% (N = 7,948) had a cannabis term, whereas 34.1% (N = 4,122) of patients lacked a cannabis term, suggesting that no documentation of cannabis use or discussion between provider and patient took place. Among the subset of patients who had a discussion documented, 47% related to cannabis use for medical reasons, 35% related to a discussion of VA policy or legal issues, and 17% related to a discussion specific to medical risks or harm reduction strategies. In adjusted analyses, residents of states with legalized recreational cannabis were less likely to have any cannabis-related discussion compared to patients in non-legal states [OR 0.73, 95% CI 0.64–0.82]. Conclusions One-third of LTOT patients did not have documentation of cannabis use in the chart in the 6 months following a positive UDT for cannabis. Discussions related to the medical risks of cannabis use or harm reduction strategies were uncommon.

The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their surgical-site infection (SSI) prevention efforts. This document updates the Strategies to Prevent Surgical Site Infections in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

The effect of vaccination on severity of subsequent COVID-19 in patients with hematologic malignancies (HMs) is unknown. In this single-center retrospective cohort study, we found no difference in severity of COVID-19 disease in vaccinated (n = 16) versus unvaccinated (n = 54) HM patients using an adjusted multiple logistic regression model. Recent anti-B-cell therapy was associated with more severe illness.

Original citation: J Clin Invest. 2017;127(7):2777-2788. https://doi.org/10.1172/JCI92958. Citation for this retraction: J Clin Invest. 2024;134(13):e183295. https://doi.org/10.1172/JCI183295. QIMR Berghofer Medical Research Institute recently notified the JCI of concerns regarding Figure 3C [...]

Abstract Frozen water bodies provide a physiological challenge to fauna by physically limiting access to atmospheric oxygen. To tolerate low temperatures, reptiles use brumation as a physiological strategy in winter. Cryptodira vary in their tolerance to freezing conditions but the extent of tolerance in pleurodirans is largely unknown. Australia's freshwater turtles inhabit warmer regions with less severe winters and have well‐developed mechanisms to cope with high temperatures and drying waterbodies, rather than extreme cold tolerance. Chelodina longicollis is a widespread Australian freshwater turtle species that tolerates high temperatures and desiccation during hot, dry periods while also undergoing brumation during winter months. Despite extensive research, limited observations exist on their behaviour during severe winter periods at the extremes of their range. In an 11‐month tracking study, we monitored adult C. longicollis, noting their movements, locations, and temperature weekly. We observed an adult female C. longicollis which, during a seven‐month period within a single creek pool, survived brumation in extreme cold water including a 15‐day period of total freezing of the surface water. After the ice melted following a rain event, the turtle was recaptured alive. This marks the first observation of brumation for an Australian chelid species under ice.

BackgroundEvidence on the cardiovascular health effects of cannabis use is limited. We designed a prospective cohort study of older Veterans (66 to 68 years) with coronary artery disease (CAD) to understand the cardiovascular consequences of cannabis use. We describe the cohort construction, baseline characteristics, and health behaviors that were associated with smoking cannabis.ObjectiveTo understand the cardiovascular consequences of cannabis use.DesignWe designed a prospective cohort study of older Veterans (66 to 68 years) with CAD.ParticipantsA total of 1,015 current cannabis smokers and 3,270 non-cannabis smokers with CAD.Main measuresUsing logistic regression, we examined the association of baseline variables with smoking cannabis in the past 30 days.ResultsThe current cannabis smokers and non-current smokers were predominantly male (97.2% vs 97.1%, p=0.96). Characteristics associated with recent cannabis use in multivariable analyses included lack of a high school education (odds ratio [OR] 2.15, 95% confidence interval [CI]: 1.10 to 4.19), financial difficulty (OR 1.47, 95% CI: 1.02 to 2.11), tobacco use (OR 3.02, 95% CI: 1.66 to 5.48), current drug use (OR 2.82, 95% CI: 1.06 to 7.46), and prior drug use (OR 2.84, 95% CI: 2.11 to 3.82). In contrast, compared to individuals with 0 to 1 comorbid conditions, those with 5 chronic conditions or more (OR 0.43, 95% CI: 0.27 to 0.70) were less likely to smoke cannabis.ConclusionsIn this older high-risk cohort, smoking cannabis was associated with higher social and behavioral risk, but with fewer chronic health conditions.

ObjectiveIn the United States, adult cannabis use has increased over time, but less information is available on time trends in cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine change over time in cannabis use disorder diagnoses among veterans, an important population subgroup, and whether such trends differ by age group (

ObjectiveWe compared the rates of hospital-onset secondary bacterial infections in patients with coronavirus disease 2019 (COVID-19) with rates in patients with influenza and controls, and we investigated reports of increased incidence of Enterococcus infections in patients with COVID-19.DesignRetrospective cohort study.SettingAn academic quaternary-care hospital in San Francisco, California.PatientsPatients admitted between October 1, 2019, and October 1, 2020, with a positive SARS-CoV-2 PCR (N = 314) or influenza PCR (N = 82) within 2 weeks of admission were compared with inpatients without positive SARS-CoV-2 or influenza tests during the study period (N = 14,332).MethodsNational Healthcare Safety Network definitions were used to identify infection-related ventilator-associated complications (IVACs), probable ventilator-associated pneumonia (PVAP), bloodstream infections (BSIs), and catheter-associated urinary tract infections (CAUTIs). A multiple logistic regression model was used to control for likely confounders.ResultsCOVID-19 patients had significantly higher rates of IVAC and PVAP compared to controls, with adjusted odds ratios of 4.7 (95% confidence interval [CI], 1.7-13.9) and 10.4 (95 % CI, 2.1-52.1), respectively. COVID-19 patients had higher incidence of BSI due to Enterococcus but not BSI generally, and whole-genome sequencing of Enterococcus isolates demonstrated that nosocomial transmission did not explain the increased rate. Subanalyses of patients admitted to the intensive care unit and patients who required mechanical ventilation revealed similar findings.ConclusionsCOVID-19 is associated with an increased risk of IVAC, PVAP, and Enterococcus BSI compared with hospitalized controls, which is not fully explained by factors such as immunosuppressive treatments and duration of mechanical ventilation. The mechanism underlying increased rates of Enterococcus BSI in COVID-19 patients requires further investigation.