Greenville College

Introduction: Research is vital for improving care among critically ill and injured patients, yet despite this awareness, enrollment in critical care trials remains challenging. The high acuity of a patient’s condition often impacts emotional and physical health, in turn affecting disposition on research participation. Furthermore, key demographic groups remain underrepresented. We hypothesized that factors such as race, sex, age, education, and clinical acuity influence willingness to participate in critical care research, and motivators/deterrents vary across these demographic groups. Methods: We conducted a single-center cross-sectional survey at a tertiary hospital over 10 months, enrolling adult ICU patients or their legally authorized representatives (LARs). A validated survey containing 20 closed-ended questions measured willingness to participate in research and identified motivators/deterrents. Demographic and clinical data were obtained from the electronic health record. Statistical analysis included univariate testing and multivariable logistic regression. Results: Out of 700 participants, 70.1% indicated that they would be willing to participate in research. Multivariable analysis revealed that participants of older age (p=.041) and better well-being (p=.071) were predictors of willingness. Key motivators included the belief that research would benefit future patients (81.3%) and personal/family members’ outcomes (74.9%). However, Black participants were significantly less likely than White participants to select benefiting future patients as a motivator (70.9% vs. 23.1%, p=.010). Major deterrents across respondents included fear of being experimented on (46.6%) and potential side effects (43.5%). Participants with lower education were more likely to cite distrust in research and fear of personal data misuse as deterrents. Conclusions: Our study found that the majority of patients/LARs were open to participating in critical care research. Age and current well-being affected willingness to participate, while motivators and deterrents varied widely by demographics. By understanding the motivators and deterrents across demographic groups, we can enable thoughtful engagement with patients/LARs that address their specific concerns, thus increasing research participation among the critically ill.

Background Morbidity and mortality in COVID-19 patients have been associated with hypercoagulability resulting in pulmonary emboli and associated venous thromboembolism. Methods All COVID-19 patients with deep vein thromboses at a single institution were retrospectively evaluated. Typical demographic and clinicopathologic data to include outcomes were collected. Results Overall, 145 patients were assessed. Hypertension (66%), diabetes (43%), and previous thrombotic events (43%) were more prevalent in the study cohort; none were significantly associated with outcomes. Atrial fibrillation/arrhythmias (n = 22; 15%; P = 0.0110) and chronic kidney disease (n = 23; 16%; P = 0.0015) were associated with increased hospitalization and mortality in this cohort, as well as patients who had a recent hospitalization within 3 months (n = 30; P = 0.0164). Conclusions These data suggest that screening for venous thromboembolism in select COVID-19 patients should be completed to promote early diagnosis and treatment of deep vein thromboses with the goal to prevent pulmonary emboli and, overall, maximize patient outcomes.

Objectives: The healthcare sector strives to ensure employees are more dedicated to their work and tolerate inherent pressures in official duties, assignments, and responsibilities. This study investigated the relationship between work overload (WO) and organisational commitment (OC) and the moderating effect of emotional intelligence (EI) among nurses in a public hospital. Methods: The researchers used a quantitative (validated questionnaire) approach to elicit information from 89 registered nurses. Pearson correlation analysis and a Multiple linear regression model were applied to test the hypotheses. Results: The results showed that WO did not have a statistically weighty relationship with OC (r = -0.110), whereas the EI had a weak but positive relationship with OC (r = 0.210). The impact size of this association is assessed as having a modest effect. Moreover, the results indicated that EI had a marginally significant negative relationship with WO (r = -0.296). However, the multiple regression analysis produced a statistically insignificant model (F = 1.446; p = 0.235). The interaction term (β3 = 0.038; t = 0.401; p = 0.690, 95% CI [-0.149, 0.224]) does not have a discernible impact on the model, according to parameter estimations of the resulting model. Conclusions: The results alert hospital management to focus on developing subordinates’ EI and enhancing their resilience to reduce WO and increase OC. The nurses’ use of EI to control WO was discussed in this study using the conservation of resources model, thus increasing their commitment to the organisation.

In the treatment of agitation in a pediatric emergency department (PED), it is common to use once or as needed (PRN) medications when nonpharmacological management options have failed. Currently, there is limited available evidence on the treatment of pediatric agitation. The objective of this analysis was to characterize the prescribing practices of once or PRN medications for the treatment of agitation in a PED at an academic medical center. This was a retrospective chart review of all encounters in which a patient was administered once or PRN medications for agitation treatment in the PED from July 1, 2021, to June 30, 2022. Once or PRN medications were defined as any medication in the antipsychotic, benzodiazepine, and barbiturate classes along with diphenhydramine, clonidine, ketamine, and guanfacine. The primary outcome was to describe the prescribing patterns of the most utilized agents for the treatment of agitation in the PED. Secondary outcomes were to assess effectiveness and safety of the agents utilized. We reviewed 109 patient encounters in which a once or PRN medication was used for agitation treatment. The most common initial regimens were benzodiazepine monotherapy (n = 47; 43%), antipsychotic monotherapy (n = 23; 21%), and concurrent use of an antipsychotic, benzodiazepine, and diphenhydramine (n = 16; 15%). Patients required another administration of a once or PRN medication within 5 to 120 minutes of initial administration 11% (n = 12) of the time. No patients required rapid sequence intubation and one patient (0.9%) needed treatment for extrapyramidal symptoms. Results indicate that there is not a standard regimen choice in the treatment of agitation in the PED; however, benzodiazepine monotherapy was used most frequently. Few adverse events occurred. Further research is needed to identify the optimal regimen choice for patients presenting with agitation in a PED.

IntroductionLittle research has explored the constructs of grief and shame-proneness for pregnant and early parenting women seeking recovery from substance use disorders (SUD) and the impact on parents’ and children's well-being.PurposeThis study aimed to explore the contexts of reported guilt and shame and the associations with grief and loss among pregnant and early parenting women in SUD recovery.MethodsUsing a community based participatory research (CBPR) approach, we conducted in-depth interviews with 30 pregnant and early parenting women with SUD who were recruited from a residential drug recovery facility in the Southeastern United States. A qualitative descriptive six-step thematic analysis established by Braun and Clarke (2006) was used to identify core themes surrounding loss events and feelings of grief, guilt, and shame.ResultsThere were 21 (70%) participants that reported at least one significant loss with a total of 56 loss events. Most participants who reported grief associated with a loss also experienced guilt and shame. Events surrounding grief and shame included: losing custody of children, adoption or child death, loss of romantic or familial relationships, guilt from using drugs while pregnant, loss of family support, and perceived loss of maternal attachment. Feelings of guilt and shame were mostly in the context of one's personal feelings of judgement or judgement from their family.DiscussionOur findings highlight multiple challenges and stigma surrounding maternal SUD, particularly during pregnancy and postpartum. We also attend to the critical need for relevant maternal support to adequately address complicated grief and shame-proneness in SUD treatment to facilitate positive parenting, recovery outcomes, and positive child health.

Purpose: Despite improvements in survival, adolescent and young adult (AYA) oncology patients are at high risk for experiencing negative health-related quality of life (HRQOL) outcomes. AYA cancer programs have attempted to develop assessment tools to identify areas of need. We aimed to demonstrate the feasibility/utility of the Patient-Reported Outcome Measurement Information System®-29 (PROMIS®-29) within an AYA oncology program clinic. Methods: AYA patients were referred by oncologists to the AYA oncology program at Prisma Health. The PROMIS-29 v2.0 survey was administered to AYAs at point of care. Feasibility of distribution and completion rate of surveys were determined. PROMIS surveys were self-reported and subsequently scored using standardized methods. The domains assessed included physical function, anxiety, depression, fatigue, sleep disturbance, ability to participate in social roles/activities, pain interference, and pain intensity. Qualitative descriptions of AYA care delivery based on survey responses at the patient level and programmatic level are also presented. Results: Between May 2017 and 2019, 134 AYAs who were newly diagnosed or in treatment completed the survey. Distribution and completion rates for the PROMIS-29 were both 100%, and meaningful changes in program-level services were implemented as a result of PROMIS-29 score patterns. Within the entire cohort, T-scores for anxiety, fatigue, and physical function reached clinically relevant thresholds. Conclusion: PROMIS offers a feasible opportunity for AYA programs to measure clinically useful HRQOL outcomes in AYAs. The survey can be used to deliver real-time AYA care to recently diagnosed and in-treatment AYAs and make programmatic changes within AYA oncology programs.

Background: Management of Maternal Diabetes (MOMs) program provides comprehensive, single-site team care for pregnant patients who are for medically-complex. Objective: To determine whether MOMs improves glycemic control through specialized care and patient engagement in diabetes self-management (DSMES). Methods: General linear models compared longitudinal A1c and time in range (TIR) to pre-enrollment baseline values for patients delivering June 2020 through March 2023. Surveys were conducted on patient satisfaction, diabetes self-management. Results: Among 482 patients, 26% were Black, 30% Hispanic, 39% White, 5% Other. For preferred language, 27% cited Spanish. Insurance included 54% Medicaid and 31% Uninsured with Medicaid only for delivery. At baseline, 44% were obese and 28% morbidly obese. Diabetes type comprised 9% Type 1, 35% Type 2, 45% Gestational-A2, 10% Other. Type 1 patients had A1c decrease (p < 0.01) across all trimesters. Type 2 patients had A1c decrease (p < 0.01) in the 2nd and 3rd trimester. Patients using CGMs increased (p = 0.01) TIR from 64% to 77% to 81% across trimesters. Patient surveys showed 93% were very satisfied/satisfied with the availability of multiple providers and services at a single visit; 91% strongly agreed/agreed that MOMs helped them develop healthier lifestyles. Conclusion: MOMs improved glycemic control and demonstrated a high degree of patient engagement. Disclosure M.M. Schellinger: None. J. Britt: None. D.N. Pasko: None. S. Keiser: None. S.L. Weber: None. H. White: None. J. Odom: None. M.D. Stancil: None. P.L. Schult: None. K. Hunt: None. C.J. Fiocchi: None. K. Fincher: None. C.U. Cart: None. A. Kelly: None. D. Londono: None. L. Perez-Cano: None. D. Fu: None. M.J. Leyva: None. T. Lyons: None. Funding BlueCross BlueShield of South Carolina Foundation, Diabetes Free SC (2020-09)