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Foetomaternal Haemorrhage (FMH) refers to the passage of foetal blood into the maternal circulation. FMH is rarely diagnosed antenatally as clinical findings are subtle and non specific. Massive FMH is suspected when foetal movements are decreased, and Cardiotocographic (CTG) findings are abnormal with decreased heart rate variability, saw-tooth or a sinusoidal pattern. Massive FMH can lead to foetal demise, stillbirth, hydrops, or the birth of a severely anaemic infant with hypovolaemic shock. A 35-week pregnant woman presented with decreased foetal movements, and an emergency caesarean section was performed due to late deceleration on the cardiotocograph. The baby was very pale at birth and in shock. The Kleihauer-Betke (KB) test performed on the mother’s blood shortly after delivery showed 2.7% foetal red cells, suggesting 135 cc of FMH. The clinical features and outcome of FMH depend on the gestational age, volume, and rapidity of FMH, as well as, whether it is acute or chronic. Packed cell transfusion is recommended, but in babies with severe anaemia and cardiac failure, partial exchange transfusion is performed. The baby was managed with a fluid bolus, inotropic support, respiratory support, and partial exchange transfusion, resulting in a successful outcome. A high index of suspicion enables the obstetrician to undertake diagnostic tests, cordocentesis, plan for intrauterine transfusion or delivery, and alert the neonatal team for a better outcome.

Prolonged unconjugated hyperbilirubinaemia is defined as neonatal jaundice persisting beyond 14 days of life. Hereditary Spherocytosis (HS) often remains underdiagnosed and is a notable cause of prolonged neonatal jaundice. Coombs negative haemolytic anaemias are an important cause of unconjugated hyperbilirubinaemia, and HS is one of the most common inherited red cell membrane disorders. Other causes of prolonged unconjugated jaundice include extravasated blood (cephalhaematoma, bruises, intraventricular haemorrhage in preterm infants), haemolysis (blood group incompatibility, red blood cell enzymopathies, and membranopathies), urinary tract infection, congenital hypothyroidism, and rare familial disorders such as Gilbert’s syndrome and Crigler-Najjar syndromes I and II. Herein, the authors present a case report of two male neonates (three week-old and 25dayold) who presented with hyperbilirubinaemia requiring intensive phototherapy, blood transfusion, an exchange transfusion, and were diagnosed with HS. A significant family history suggested haemolytic anaemia, and red cell indices, namely Mean Corpuscular Haemoglobin Concentration (MCHC), Mean Corpuscular Volume (MCV), and the ratio of MCHC/MCV (neonatal HS index), helped suspect HS. Whole exome sequencing identified the specific mutation and confirmed the diagnosis of HS. Both of these neonates presented with prolonged neonatal jaundice, and HS was suspected based on the family history and red cell indices, namely MCHC and MCHC/MCV ratio, as highlighted in the present case series.

Objectives: Evidence shows that obstructive sleep apnea (OSA) is associated with the development of stroke. This study investigates the relationship between OSA and post-stroke complications, addressing the limited data on how OSA influences the severity and development of these complications through a systematic review of existing literature. Methods: Data was collected from PubMed, Web of Science, and Scopus databases up to December 2023. Studies meeting the inclusion criteria were selected, and statistical analyses were performed using Review Manager 5.4.1. A random-effects model was used for pooling data with heterogeneity, and findings were presented using standard ratios with 95% confidence intervals. Results: The analysis included nine studies. Stroke patients with OSA did not show a significantly higher risk of post-stroke complications, which include mild cognitive impairment, dementia, insomnia, fatigue, reduced sleep quality, depression, anxiety, recurrent strokes, and death, compared with those without OSA (RR = 1.05, 95% CI 0.97 to 1.13). However, patients with high stroke severity and OSA had a slightly higher risk of post-stroke complications (RR = 1.06, 95% CI 1.01 to 1.12). Conclusions: This systematic review and meta-analysis suggests that OSA confers a higher risk of post-stroke complications in patients with high stroke severity. Further studies are required to explore the impact of OSA on post-stroke complications.

Aims: Understanding health behaviors of people with diabetes can inform strategies to reduce diabetes-related burdens., Methods: We used serial cross-sectional National Health and Nutrition Examination Surveys over 2007-2018 to characterize self-reported health behaviors among non-pregnant adults, with and without self-reported diabetes. We estimated weighted proportions meeting recommended health behaviors overall and by sociodemographic and glycemic levels., Results: During 2007-2010, proportions of adults with diabetes meeting recommendations were: 61.9 % for added sugar consumption (<10 % of total calories), 17.2 % for physical activity, 68.2 % for weight management, 14.4 % avoided alcohol, 57.5 % avoided tobacco, 34.1 % got adequate sleep, and 97.5 % saw a healthcare provider (compared with 19.2 %, 33.6 %, 68.8 %, 8.5 %, 44.2 %, 33.0 %, and 82.6 % respectively, among those without diabetes). During 2015-2018, adjusted analyses showed more adults with diabetes met sleep (+16.7 percentage-points[pp]; 95 % CI: 10.6,22.8) and physical activity goals (+8.3 pp; 95 % CI: 3.8,12.8), and fewer met added sugar recommendations (-8.8 pp; 95 % CI -14.7, -2.9). Meeting added sugar, physical activity, and weight management varied by age, education, and glycemic level, but not race and ethnicity., Conclusions: During 2007-2018, there was some improvement in health behaviors. Improving self-management may require targeted interventions for different segments, like age groups or glycemic levels, among those with diabetes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Background: COVID-19 concerns remain among health care providers, as there are few outpatient treatment options. In the early days of the pandemic, treatment options for nonhospitalized patients were limited, and symptomatic treatment and home-grown guidelines that used recommendations from the Global Initiative for Asthma Management and Treatment were used., Objective: The possibility that inhaled corticosteroids (ICS) might reduce the risk of respiratory symptoms and promote recovery was the impetus for this review, as it has already been shown that in the nonhospitalized patient population, oral corticosteroids (OCS) in the acute phase could have an adverse effect on recovery. We investigated if (1) patients treated with ICS were less likely to require referral to a post-COVID-19 clinic or pulmonary specialist than patients without ICS treatment or with OCS therapy, and (2) if OCS use was associated with worse health outcomes., Methods: In a retrospective chart review, we identified all patients with acute illness due to COVID-19 that were followed and managed by a telemedicine clinic team between June and December 2020. The data were electronically pulled from electronic medical records through April 2021 and reviewed to determine which patients eventually required referral to a post-COVID-19 clinic or pulmonary specialist due to persistent respiratory symptoms of COVID-19. The data were then analyzed to compare outcomes between patients prescribed OCS and those prescribed ICS. We specifically looked at patients treated acutely with ICS or OCS that then required referral to a pulmonary specialist or post-COVID-19 clinic. We excluded any patients with a history of chronic OCS or ICS use for any reason., Results: Prescribing ICS during the acute phase did not reduce the possibility of developing persistent symptoms. There was no difference in the referral rate to a pulmonary specialist or post-COVID-19 clinic between patients treated with OCS versus ICS. However, our data may not be generalizable to other populations, as it represents a patient population enrolled in a telemedicine program at a single center., Conclusions: We found that ICS, as compared to OCS, did not reduce the risk of developing persistent respiratory symptoms. This finding adds to the body of knowledge that ICS and OCS medications remain potent treatments in patients with acute and postacute COVID-19 seen in an outpatient setting., (©Michele Cellai, Jodi Roberts, Miranda A Moore, Nikhila Gandrakota. Originally published in JMIR Formative Research (https://formative.jmir.org), 23.02.2023.)

Background: Diabetes and hypertension are common in Asian Americans and vary by subgroup. There may be further variation by social determinants of health (SDOHs), but few studies have examined this previously., Objective: To examine the associations of SDOHs and diabetes and hypertension within and across Asian subgroups in the USA DESIGN: Series cross-sectional analyses SETTING: National Health Interview Surveys (NHIS) from 1999 to 2018 PARTICIPANTS: Asian-American adults (Chinese, Filipino, Asian Indian, and Other Asian [Korean, Vietnamese, Japanese, and other]) MEASUREMENTS: Self-reported diabetes and hypertension prevalence in pooled 5-year increments over 1999-2018 and multivariable regression models to assess the adjusted prevalence of diabetes or hypertension by poverty, marital status, education, and years in the USA, adjusting for age, sex, BMI, and health insurance status RESULTS: From 1999-2003 to 2014-2018, the age- and sex-adjusted prevalence of diabetes increased for Other Asians (absolute change: 4.6%) but not for other subgroups; age- and sex-adjusted hypertension prevalence significantly increased for Asian Indians and Other Asians (absolute change: 5-7.5%). For Filipinos, high school education or less was associated with an increase in diabetes prevalence over time (difference from 1999-2003 to 2014-2018: +6.0 (95% CI: 2.0-10.0)), while for Asian Indians, college education or higher was associated with an increase in diabetes prevalence for the same period (difference: +2.7 (95% CI: 0.01-5.4). Differences over the 2 time periods (1999-2003 and 2014-2018) show that Filipino and Other Asians, who lived in the USA for ≥10 years, increased in diabetes prevalence. Similar variations in associations of SDOHs by Asian subgroup were seen for hypertension., Limitations: Self-reported primary outcomes and multi-year data were pooled due to small sample sizes., Conclusions: The influence of SDOHs on cardiometabolic risk is not uniform among Asian Americans, implying tailored strategies may be needed for different population subgroups., Primary Funding Source: NIH., (© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Competing Interests: Declaration of competing interest None.

Background: Poor diet quality has been found to be an independent risk factor for mortality in stroke. However, it is unknown to what extent Neurologists are trained and are comfortable enough to provide dietary counseling to stroke patients., Objective: To assess the knowledge, attitudes, and practices of neurology residents relating to dietary counseling of stroke patients., Methods: An online anonymous survey was administered to neurology residents throughout the country between August and November 2019 among a total of 109 (68%) US neurology programs. Self-reported practices and knowledge regarding stroke prevention through nutritional counseling were queried using validated questionnaires., Results: 453 responses out of a potential 672 were received. A minority of residents (12.3%) consistently offered nutritional counseling to stroke patients. 47.7% considered that it was not the neurologist's role to provide nutritional counseling to stroke patients. 83.4% of residents felt that it was the responsibility of the dietician to provide nutritional counseling, yet only 21.4% of residents consistently referred stroke patients to a dietician. 77.9% of respondents felt nutritional counseling is important for stroke patients, yet 65.6% felt they were not adequately trained to provide nutritional counseling., Conclusion: Neurologists in training believe diet to be an important part of stroke prevention, but practical knowledge and training in nutrition are suboptimal. This study suggests the need to include nutrition as an integral part of neurology training, to ensure neurologists feel empowered to be an important part of the team providing nutritional counseling to stroke patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Benameur, Gandrakota and Ali.)

The meta-analysis aimed to investigate the prevalence of gallstones (GS) in Inflammatory bowel disease (IBD), especially ulcerative colitis (UC). A systematic and thorough search was conducted on online electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from the databases' inception to April 30th, 2022. Review Manager 5.4.1 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen) was used for all statistical analyses and forest plots. Only studies that met inclusion criteria were selected. The selected studies were pooled using a random-effect model and the results were reported in the odds ratio (OR) with their corresponding 95% confidence interval (CI). Ten studies met the final inclusion criteria and were analyzed. Patients with UC had significantly higher prevalence of GS than those in the control group (OR=1.67 [1.32-2.11]; p < 0.0001; I 2 =58%). There was also significant prevalence of GS in Crohn's disease (CD) than those in control group (OR=2.22 [1.82, 2.69]; p < 0.00001; I 2 =31%). Analysis also showed the prevalence of GS in studies conducted in Asia (OR=2.00 [1.48, 2.70]; p < 0.00001; I 2 =80%) and Europe (OR= 1.84 [1.32, 2.55]; p = 0.0003; I 2 =45%) compared to the control group. This study provided a conclusive answer to whether GS is significant in UC or not. Our meta-analysis provides a well-powered estimate that there is a prevalence of GS in UC. CD is also significantly associated with GS., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Baig et al.)

This study aims to assess the role of vitamin D on systemic lupus erythematosus (SLE) patients and its effects on systemic lupus erythematosus disease activity index (SLEDAI), anti-double-stranded DNA (anti-dsDNA), C3, C4, and fatigue in patients with SLE. A systemic search was conducted using three electronic databases, i.e., PubMed/Medline, Cochrane Library, and Google Scholar. Review Manager 5.4.1 (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) was employed for statistical analysis. All studies meeting the inclusion criteria were selected. A random-effect model was used to pool the studies, and the result was reported in the standard mean difference (SMD) with its corresponding 95% confidence interval. Six randomized controlled trials were selected. Five outcomes were assessed (SLEDAI, anti-dsDNA, C3, C4, and fatigue) to evaluate the role of vitamin D in SLE patients. A significant decrease in SLEDAI (SMD = -0.85 (-1.12, -0.58); p < 0.00001; I 2   = 42%) and a non-significant decrease in anti-dsDNA (SMD = -0.09 (-0.03, 0.12); p = 0.42; I 2   = 0%) was noted. A significant increase in levels of C3 (SMD = 0.30 (0.09, 0.51); p = 0.006; I 2  = 0%) and fatigue (SMD = -1.27 (-2.38, -0.16); p = 0.02; I 2  = 56%) was noted when vitamin D was used. Insignificant difference was observed in C4 (SMD = 0.20 (-0.02, 0.41); p = 0.07; I 2   = 0%). Vitamin D in SLE patients showed a significant decrease in SLEDAI scores and a significant increase in C3 levels. The effect of vitamin D on fatigue was inconclusive. No significant difference in anti-dsDNA and C4 levels was noted., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Irfan et al.)

This study was conducted to review relevant articles and demonstrate the prevalence of coronavirus disease 2019 (COVID-19) reinfection among healthcare workers (HCWs). A systemic search was conducted on PubMed and Medline from their inception to July 17, 2021. All statistical analyses were conducted using ReviewManager 5.4.1. Studies meeting the following inclusion criteria were selected: (a) articles having HCWs with COVID-19; (b) studies describing reinfection of COVID-19; and (c) articles having a defined number of patients and controls. Three studies were selected for meta-analysis. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the cohort studies. NOS scores of 1-5 were considered high risk for bias, scores of 6-7 were deemed moderate, and scores >7 were considered low risk for bias. A random-effect model was used when heterogeneity was seen to pool the studies, and the results were reported in inverse variance (IV) and corresponding 95% confidence interval (CI). Pooled prevalence of reinfection of COVID-19 in HCWs was 3% (OR: 0.03 [-0.04, 0.01]; p=0.44; I 2 =4%). A non-significant prevalence was found among the healthcare professionals in terms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection in Europe. The preformed antibodies were protective against reinfection. However, the waning of antibodies with respect to time was evident, varying differently in different individuals, thereby resulting in reinfection., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kurra et al.)

The prevalence, incidence, and characteristics of bacterial infections in patients infected with severe acute respiratory syndrome coronavirus 2 are not well understood and have been raised as an important knowledge gap. Therefore, our study focused on the most common opportunistic infections/secondary infections/superinfections in coronavirus disease 2019 (COVID-19) patients. This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eligible studies were identified using PubMed/Medline since inception to June 25, 2021. Studies meeting the inclusion criteria were selected. Statistical analysis was conducted in Review Manager 5.4.1. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported as inverse variance and the corresponding 95% confidence interval. We screened 701 articles comprising 22 cohort studies which were included for analysis. The pooled prevalence of opportunistic infections/secondary infections/superinfections was 16% in COVID-19 patients. The highest prevalence of secondary infections was observed among viruses at 33%, followed by bacteria at 16%, fungi at 6%, and 25% among the miscellaneous group/wrong outcome. Opportunistic infections are more prevalent in critically ill patients. The isolated pathogens included Epstein-Barr virus, Pseudomonas aeruginosa , Escherichia coli , Acinetobacter baumannii , Hemophilus influenza , and invasive pulmonary aspergillosis. Large-scale studies are required to better identify opportunistic/secondary/superinfections in COVID-19 patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kurra et al.)

Animal models are crucial for the study of tumorigenesis and therapies in oncology research. Though rare, uveal melanoma (UM) is the most common intraocular tumor and remains one of the most lethal cancers. Given the limitations of studying human UM cells in vitro, animal models have emerged as excellent platforms to investigate disease onset, progression, and metastasis. Since Greene's initial studies on hamster UM, researchers have dramatically improved the array of animal models. Animals with spontaneous tumors have largely been replaced by engrafted and genetically engineered models. Inoculation techniques continue to be refined and expanded. Newer methods for directed mutagenesis have formed transgenic models to reliably study primary tumorigenesis. Human UM cell lines have been used to generate rapidly growing xenografts. Most recently, patient-derived xenografts have emerged as models that closely mimic the behavior of human UM. Separate animal models to study metastatic UM have also been established. Despite the advancements, the prognosis has only recently improved for UM patients, especially in patients with metastases. There is a need to identify and evaluate new preclinical models. To accomplish this goal, it is important to understand the origin, methods, advantages, and disadvantages of current animal models. In this review, the authors present current and historic animal models for the experimental study of UM. The strengths and shortcomings of each model are discussed and potential future directions are explored.

Background: Asian Americans represent one of the fastest-growing immigrant groups in the U.S. and are at high risk for cardiometabolic diseases (CMDs), including type 2 diabetes, hypertension, coronary artery disease, and stroke. Despite the growth of Asians in the U. S, there is a gap in understanding the heterogeneity of CMDs across Asian subgroups and how these might be affected by the social determinants of health (SDOH), or the environment in which people live and work., Objective: The purpose of this systematic review is to examine the current literature on CMDs among Asian Americans and identify the SDOH that are associated with the incidence and/or prevalence of CMDs among specific Asian subgroups., Methods: PubMed, Embase, Web of Science were searched for articles published in Jan 2000-Nov 2020. The reproducible strategy yielded 2732 articles. The articles were reviewed based on the following inclusion criteria: (1) observational study published in the U.S., (2) adult population includes specific Asian subgroups, (3) exposures include SDOH, and (4) outcomes include a CMD, defined as type 2 diabetes, hypertension, coronary artery disease, or stroke., Results: In this review, 14 studies were identified and organized into four key themes: acculturation (n = 9), socioeconomic status (SES) (n = 6), social context (n = 2), and health literacy (n = 1). The most represented Asian subgroups in the literature were Chinese, Filipino, and South Asians. Acculturation was the most described social factor in the included reviews. Seven studies found associations between higher acculturation levels and higher prevalence of CMD. However, the measure of acculturation varied by study and included various combinations of the country of birth, number of years residing in the U.S., and English proficiency. The effects of SES, measured as income level and educational attainment, varied by racial subgroups. One study found that higher levels of education were associated with CMD among South Asians., Conclusion: Acculturation, SES, social context, and health literacy impact the risk of CMD among Asian Americans; these vary across subgroups. Future research disentangling SDOHs on the risk of CMDs by Asian subgroup is necessary to provide better informed preventive practices and interventions., (© 2022. The Author(s).)

Introduction: Dietary modifications in post-stroke patients facilitated by diet counseling improves post-stroke recovery and stroke recurrence. The extent to which clinicians provide dietary counseling for these patients is unknown., Methods: 2011 to 2016 National Ambulatory Medical Care Surveys (NAMCS) data were used to assess trends in post-stroke diet consultations by age. Multivariate logistic regression models assessed the likelihood of dietary counseling provision among patients with and without stroke., Results: The proportion of patients with stroke aged 60-79 who received diet counseling decreased from 18.2% in 2011 to 5.3%, 11.9%, 8.7%, 13.4%, and 15.2% in 2012-2016, respectively. Among patients without stroke aged 60-79, diet counseling rate decreased from 12.9% in 2011 to 7%, 9.5%, 10.5%, 13.5%, and 12% in 2012-2016, respectively. Similar trends were observed among patients with and without stroke aged over 80., Conclusions: The proportion of patients with and without stroke receiving dietary counseling has remained low over the past half-decade. It is likely multifactorial- related to clinician knowledge, patients' receptiveness, and system-level factors of time and reimbursement. Future interventions should explore methods to address barriers to nutrition recommendations for post-stroke patients and patient activation to adopt dietary changes., Competing Interests: Declaration of Competing Interest The authors have declared that no competing interests exist., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The COVID-19 pandemic has required clinicians to pivot to offering services via telehealth; however, it is unclear which patients (users of care) are equipped to use digital health. This is especially pertinent for adults managing chronic diseases, such as obesity, hypertension, and diabetes, which require regular follow-up, medication management, and self-monitoring., Objective: The aim of this study is to measure the trends and assess factors affecting health information technology (HIT) use among members of the US population with and without cardiovascular risk factors., Methods: We used serial cross-sectional data from the National Health Interview Survey for the years 2012-2018 to assess trends in HIT use among adults, stratified by age and cardiovascular risk factor status. We developed multivariate logistic regression models adjusted for age, sex, race, insurance status, marital status, geographic region, and perceived health status to assess the likelihood of HIT use among patients with and without cardiovascular disease risk factors., Results: A total of 14,304 (44.6%) and 14,644 (58.7%) participants reported using HIT in 2012 and 2018, respectively. When comparing the rates of HIT use for the years 2012 and 2018, among participants without cardiovascular risk factors, the HIT use proportion increased from 51.1% to 65.8%; among those with one risk factor, it increased from 43.9% to 59%; and among those with more than one risk factor, it increased from 41.3% to 54.7%. Increasing trends in HIT use were highest among adults aged >65 years (annual percentage change [APC] 8.3%), who had more than one cardiovascular risk factor (APC 5%) and among those who did not graduate from high school (APC 8.8%). Likelihood of HIT use was significantly higher in individuals who were younger, female, and non-Hispanic White; had higher education and income; were married; and reported very good or excellent health status. In 2018, college graduates were 7.18 (95% CI 5.86-8.79), 6.25 (95% CI 5.02-7.78), or 7.80 (95% CI 5.87-10.36) times more likely to use HIT compared to adults without high school education among people with multiple cardiovascular risk factors, one cardiovascular risk factor, or no cardiovascular risk factors, respectively., Conclusions: Over 2012-2018, HIT use increased nationally, with greater use noted among younger and higher educated US adults. Targeted strategies are needed to engage wider age, racial, education, and socioeconomic groups by lowering barriers to HIT access and use., (©Nikhila Gandrakota, Mohammed K Ali, Megha K Shah. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 30.09.2021.)

In a survey of 396 caregivers of children, 119 (30%) reported requesting antibiotics from clinicians and 65 (16%) had stored antibiotics at home. In addition, 47 (12%) reported past or intended nonprescription antibiotic administration; this finding was associated with household income of ≥$75 000 annually (odds ratio 2.042, 95% confidence interval 1.01-4.14, P = .048)., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Importance: Clinician burnout is a major risk to the health of the US. Nurses make up most of the health care workforce, and estimating nursing burnout and associated factors is vital for addressing the causes of burnout., Objective: To measure rates of nurse burnout and examine factors associated with leaving or considering leaving employment owing to burnout., Design, Setting, and Participants: This secondary analysis used cross-sectional survey data collected from April 30 to October 12, 2018, in the National Sample Survey of Registered Nurses in the US. All nurses who responded were included (N = 50 273). Data were analyzed from June 5 to October 1, 2020., Exposures: Age, sex, race and ethnicity categorized by self-reported survey question, household income, and geographic region. Data were stratified by workplace setting, hours worked, and dominant function (direct patient care, other function, no dominant function) at work., Main Outcomes and Measures: The primary outcomes were the likelihood of leaving employment in the last year owing to burnout or considering leaving employment owing to burnout., Results: The weighted sample of 50 273 respondents (representing 3 957 661 nurses nationally) was predominantly female (90.4%) and White (80.7%); the mean (SD) age was 48.7 (0.04) years. Among nurses who reported leaving their job in 2017 (n = 418 769), 31.5% reported burnout as a reason, with lower proportions of nurses reporting burnout in the West (16.6%) and higher proportions in the Southeast (30.0%). Compared with working less than 20 h/wk, nurses who worked more than 40 h/wk had a higher likelihood identifying burnout as a reason they left their job (odds ratio, 3.28; 95% CI, 1.61-6.67). Respondents who reported leaving or considering leaving their job owing to burnout reported a stressful work environment (68.6% and 59.5%, respectively) and inadequate staffing (63.0% and 60.9%, respectively)., Conclusions and Relevance: These findings suggest that burnout is a significant problem among US nurses who leave their job or consider leaving their job. Health systems should focus on implementing known strategies to alleviate burnout, including adequate nurse staffing and limiting the number of hours worked per shift.