Brigham and Women's Faulkner Hospital (BWFH) is a 171-bed, non-profit community teaching hospital located in Boston, Massachusetts. Founded in 1900, it is located in the neighborhood of Jamaica Plain across the street from the Arnold Arboretum and just 3.4 miles (5.5 km) from Longwood Medical and Academic Area.Faulkner Hospital joined with Brigham and Women's Hospital in 1998 to form a common parent company, Brigham and Women's/Faulkner Hospitals, a member of Mass General Brigham. The resulting partnership offers Brigham and Women's Faulkner Hospital patients access to many of the same physicians and services as Brigham and Women's Hospital."The Faulkner" (as it is popularly known) offers comprehensive medical, surgical and psychiatric care as well as complete emergency, outpatient and diagnostic services. The hospital's largest inpatient services are internal medicine, cardiology, psychiatry, orthopedics, gastroenterology and general/GI surgery. Effective October 1, 2012, Faulkner Hospital was renamed to Brigham and Women's Faulkner Hospital (BWFH).
OBJECTIVE:This study aimed to evaluate the location-specific and time-sensitive trajectories of pressure injuries (PrIs) stages using real-world electronic health record (EHR) datasets. APPROACH:Using a dataset of 29,475 patients with records of PrIs documented from 2015 to 2023, we developed four PrI patient sub-cohorts with common PrI locations, including coccyx, buttocks, sacrum and heel. We estimated transition intensities between three PrI states: stage 1, stage 2, and a severe stage in each group. Stages and transition paths were derived from domain knowledge provided by clinical experts and The National PrI Advisory Panel (NPIAP) guidelines. RESULTS:The trajectory analysis suggested that stage 2 serves as a "gateway state" in all four locations, meaning that once a PrI reaches stage 2, the likelihood of transiting to severe stages increases significantly. The commonly used Braden Scale and its sub-components are more likely to be associated with transitions from stage 2 to severe stages, suggesting that manual risk assessment tools are suboptimal for predicting early-stage PrI transitions. Further, we observed race-dependent variations across injury location groups. INNOVATION:To our knowledge, this is the first study to introduce multi-state trajectory analysis in PrI research. Our model can investigate PrI status in a dynamic manner, which fills an important gap in the field. CONCLUSION:Our findings underscore the lack of time-sensitive information in existing PrI risk assessment tools, revealing a critical gap in their ability to capture the dynamic nature of PrI progression. Clinical decision support using time sensitive data is needed for delivering personalized, timely, and effective PrI prevention.
Despite the high occurrence of end-of-life (EOL) care in adult intensive care units, the role of the critical care nurse is underutilized. Understanding factors that influence critical care nurses' abilities to provide EOL care is essential to improving patient care at the EOL. This study aimed to synthesize research evidence on facilitators and barriers influencing the provision of EOL care among critical care nurses in adult intensive care units. A structured integrative review, guided by Whittemore and Knafl methodology, was conducted. In July 2025, keywords, synonyms, and Medical Subject Headings were used to search the Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycInfo, and Web of Science databases. Of 786 records screened, 15 studies published between 2016 and 2024 met eligibility criteria. Data were extracted using a standardized template, quality appraisal was performed, and findings were analyzed using the constant comparison method. Four themes emerged: family dynamics, interdisciplinary collaboration, the role of critical care nurses, and systems and environment. Providing EOL care is a meaningful yet complex responsibility that requires clinical expertise, time, and effective communication. Environmental and cultural barriers, along with limited protocols and education, impede critical care nurses' ability to ensure a comfortable death. REGISTRATION:PROSPERO (CRD42024520607).
Objectives:To evaluate supply-chain vulnerabilities affecting medications essential for treating sexually transmitted infection in the United States and identify disruption mechanisms that may predispose these therapies to shortages. Methods:We conducted a qualitative, structured supply-chain vulnerability assessment of first-line medications for five priority sexually transmitted pathogens recommended by the Centers for Disease Control and Prevention and the World Health Organization: azithromycin, doxycycline, ceftriaxone, benzathine penicillin G, metronidazole, tinidazole, acyclovir, and cefixime. Using a predefined framework derived from pharmaceutical supply-chain disruption literature, we evaluated 13 disruption categories spanning raw material sourcing, active pharmaceutical ingredient production, manufacturing, distribution, market dynamics, information systems, and post-distribution loss mechanisms. Each category was assessed using four binary indicators and classified as relevant when at least two criteria were satisfied. Results:Multiple disruption domains applied across the drug set. Recurrent vulnerabilities included geographically concentrated active pharmaceutical ingredient production, limited manufacturing redundancy in low-margin generic markets, manufacturing constraints affecting sterile injectable products, reliance on consolidated distribution networks, and susceptibility to demand surges and information-system disruptions. All eight drugs exhibited at least one regulatory or market signal consistent with potential supply vulnerability, including documented shortages, product discontinuations, or limited manufacturer participation. Conclusions:Supply-chain vulnerabilities were identified across multiple first-line sexually transmitted infection therapies, indicating that disruption risk is not confined to a single drug. There is a need for policy interventions to strengthen supply-chain resilience, including diversification of active pharmaceutical ingredient sourcing and distribution networks, as well as incentives for sustainable generic production.
