Duke University Health System

The present study aimed to assess the viability of Social Skills Training through RPGs during the SARS-CoV-2 pandemic, employing qualitative discourse analysis of residents. Focus groups were conducted with a convenience sample of psychiatry residents who volunteered to participate in the RPG-based training. Eleven residents took part in video conference focus groups, with one researcher acting as a non-participant observer. Over a period of 4 months, residents engaged in weekly 3-h sessions structured around five fundamental steps: rapport building, task discussions, goal setting, gaming, and feedback. Results indicate positive impacts on group dynamics, communication skills, cooperation, assertiveness, empathy, mental health, and quality of life. However, given the exploratory nature of this study, further research incorporating pre- and post-intervention assessments is warranted to thoroughly evaluate the intervention’s effectiveness.

Introduction: Phenobarbital (PHB) has emerged as a first-line therapy for alcohol withdrawal syndrome (AWS), but the ideal dosing strategy and administration route is unclear. Intravenous (IV) PHB has a rapid onset and may require closer monitoring for adverse effects compared to the slower onset of intramuscular (IM) PHB. This study examined differences in efficacy, safety, and resource utilization when PHB is administered IV versus IM for AWS. Methods: This single-center, retrospective, observational study included adult patients presenting to an Emergency Department (ED) between January 2022 and August 2023 who received at least one parenteral PHB dose using the institution’s AWS order set. Patients were excluded if they were pregnant, switched PHB route or left against medical advice prior to completion of PHB load, or if their encounter occurred within five days of prior PHB therapy. The institutional PHB protocol includes a 6 or 10 mg/kg loading dose, divided for administration over one hour for IV or nine hours for IM. Dose and route are selected by the provider. Outcomes including hospital length of stay (LOS), safety endpoints, and supplemental doses given within nine hours of protocol initiation were compared between those treated with IV versus IM PHB. Results: This analysis included 198 patient encounters (IV n=97, IM n=101). No difference was found for hospital LOS between IV and IM groups (3.9 days for each group, p=0.739) or for any pre-specified subgroup. Safety outcomes of intubation, sedation, hemodynamic instability, respiratory depression, or rescue medication use were rare and similar between groups. The IV group received significantly more supplemental PHB than IM group (0.94 mg/kg vs 0.25 mg/kg, p< 0.001), with 51.5% of IV patients receiving any supplemental PHB compared to 14.9% of IM patients. Conclusions: We did not identify safety or efficacy differences between patients receiving IV versus IM loads of PHB for AWS, but the faster onset of IV may have allowed for identification of breakthrough symptoms requiring supplemental doses. This study adds to the safety of PHB as first-line therapy for AWS and emphasizes the need for a streamlined IV dosing regimen for severe AWS to preserve nursing resources and overcome operational limitations in the busy ED setting.

Purpose:Hypertension (HTN) disproportionately affects marginalized communities due to persistent healthcare disparities and socioeconomic barriers. Less than half of patients with HTN achieve blood pressure (BP) control, with Black Americans on antihypertensive medication experiencing lower rates of BP control (34.9%) compared to non-Hispanic Whites (45.0%). This pilot study evaluates the effectiveness of a telephone outreach intervention designed to improve BP control through self-management in a historically underserved population.Major Findings:This single-cohort, pre-post intervention study was conducted at a Federally Qualified Health Center (FQHC). Patients with severe hypertension were identified and contacted by trained student ambassadors (SAs). These SAs provided hypertension-specific health education, health goal-setting, guidance for self-monitoring blood pressure, and referrals to address health-related social needs (HRSN). During in-person classes, patients were educated on BP self-monitoring and goal setting regarding healthy lifestyle practices. Results from this study showed a reduction in SBP and DBP among engaged patients and improved hypertension knowledge.Conclusion:These findings suggest that telephone outreach, when combined with skill-based in-person education, can improve hypertension control in Black American populations.

SUMMARY OBJECTIVE To describe experiences with oxygen therapy and barriers and facilitators to long-term oxygen therapy (LTOT) among individuals living with chronic hypoxemia in a tertiary referral hospital in Eldoret, Kenya. DESIGN A qualitative study using semi-structured interviews with individuals living with chronic hypoxemia. Interview transcripts were analysed using a phenomenological approach for thematic analysis. RESULTS We interviewed 16 participants (50% female), 6 (37.5%) of whom had home oxygen. Five emergent themes were identified: 1) limited knowledge regarding hypoxemia and oxygen therapy, 2) positive impact of oxygen therapy on symptoms, 3) perceived poor communication from health care providers, 4) mixed preference or perceived need for LTOT, and 5) cost impedes access to LTOT. Facilitators for LTOT include benefit of oxygen supplementation on symptoms and a strong desire to use LTOT. Barriers include lack of knowledge around hypoxemia and oxygen therapy, unclear communication regarding medical conditions or treatment plans, and cost. CONCLUSION This qualitative study helped identify key facilitators and barriers for implementation of LTOT in a low-resource setting. It also underscores the need for interventions designed to improve patient and provider knowledge on chronic hypoxemia and LTOT and to identify implementation strategies and policies which can address system-level barriers.

Objective: Image quality evaluation in radiology is most relevant when reflects radiologists’ performance. This study assessed how image quality measurement in terms of in vivo -characterized detectability index ( ) for low-contrast liver lesion assessment in CT is correlated with radiologists’ performance across 2 different CT reconstructions. Methods: Fifty-one contrast-enhanced abdominal studies for investigating colorectal liver metastases were prospectively performed using 2 radiation dose exposures and reconstructed with Filtered back projection (FBP) and deep learning image reconstruction (DL) algorithms for a total of 161 noncalcified hypoattenuating lesions for 3 lesion size (D) subsets (&lt;6 mm, 6 to 10 mm, and &gt;10 mm). Images were assessed by expert radiologists for hepatic lesion detection task and likelihood of malignancy across the 2 imaging conditions. All cases were also evaluated automatically in terms of in vivo as a metric of task-based performance, both using a conventional technique and a new formalism of an added frequency term in the internal noise component of to accommodate the nonlinearity of the DL reconstruction ( adj ). Results: The study found conventionally defined d’ well-reflective of radiologists’ evaluation of FBP images but not well-aligned with that of DL images. The new formalism provided more consistent reflection of performance across reconstruction techniques. In particular, in the lesion group D &lt;=6 mm, the difference between radiologists’ accuracy in images acquired with DL and images acquired with FBP was −26%, and the related adj difference was −9%, whereas the was 34%. Analogously, for the lesion group 6 mm &lt; D &lt;=10 mm, the differences were −15%, −13%, and 29%, respectively. Lastly, for the lesion group D&gt;10 mm, radiologists showed the same accuracy in both FPB and DL images, difference in adj was -11%, and difference in was 31%. Conclusion: The new formalism can robustly reflect CT systems clinical performance irrespective of reconstruction algorithm. The methodology can be more readily applied to assess the real-world performance of CT systems.