We previously demonstrated that a 3-month peer-delivered program (Moving Forward Together, MFT) significantly increased breast cancer survivors’ moderate-to-vigorous PA (MVPA). To enhance MFT’s scalability and reach, we adapted it to an existing web platform and developed webMFT. Our goal was to test the efficacy of webMFT on survivors’ MVPA. In a randomized controlled trial, we trained ten peer coaches from cancer care organizations to deliver webMFT or MVPA Tracking to 61 breast cancer survivors (mean age = 58.10 years [SD = 8.55], 1.40 years post-diagnosis [SD = 0.50], 80

ABSTRACT Disseminated gonococcal infection is the causative agent of approximately 0.6%–1.2% of septic arthritis cases in North America and Europe. Typical presentations of this disorder include tenosynovitis, dermatitis, polyarthralgia, or oligoarticular purulent arthritis affecting the distal joints. Diagnosis is contingent on clinical presentation, with urine nucleic acid amplification testing as the preferred diagnostic modality. Synovial fluid cultures, along with imaging, can confirm diagnosis. The recommended treatment is a third-generation cephalosporin, such as intravenous ceftriaxone for 7–14 days and a dose of oral azithromycin.

Background: Nurse practitioners (NPs) play an important role for patients with sickle cell disease (SCD), an inherited hemoglobinopathy that most often affects African Americans in the United States. This pilot study aimed to understand the perceived NP competencies and attitudes toward patients living with SCD.Methods: This was a cross-sectional descriptive pilot study with a convenience sample (N 1/4 32) of NPs who completed an 80-item online survey.Results: The sample was 74.19% White and 90% female. NPs reported lower key competencies and some negative attitudes about patients with SCD.Conclusion: Interventions are necessary to improve NP SCD competencies and attitudes.(c) 2023 Elsevier Inc. All rights reserved.

BACKGROUND:Advanced practice nursing education is evolving to the doctor of nursing practice (DNP) degree. The American Association of Colleges of Nursing (AACN) DNP Essentials required 1000 hours of direct patient care, whereas the Report of the National Task Force on Quality Nurse Practitioner Education (NTF) Criteria for Evaluation of Nurse Practitioner Programs required 500 direct patient care hours. Indirect hours were unclear and undefined. The AACN Essentials changed the 1000-hour requirement to 500 practice hours, and the NTF increased the direct patient care hours to 750.PURPOSE:The study sought to describe the distribution of direct and indirect hours that the National Organization of Nurse Practitioner Faculties member schools offer in their seamless postbaccalaureate-to-DNP nurse practitioner (NP) program.METHOD:A quantitative survey was distributed to schools of nursing.RESULTS:Eighty-six surveys represented 86 distinct schools and 112 NP programs. Supervised direct patient care hours were an average of 791.31 hours. Indirect hours averaged 170.08 hours. The DNP project hours served as an indirect hour activity.CONCLUSION:Many schools have more than 750 direct hours adhering to the 2022 NTF Standards. The indirect hour allocation varies and weighs heavily on the DNP project.

OBJECTIVE:To examine the effects of three programs aimed at maintaining moderate-to-vigorous physical activity (MVPA) on breast cancer survivors' quality of life, physical functioning, fatigue and mood. METHODS:161 survivors participated in a 12-month randomized controlled study and were assigned to one of three groups: Reach Plus, Reach Plus Message, or Reach Plus Phone. All participants received the same intervention for the first 3 months (weekly calls from peer coach) for MVPA adoption. In Months 4-9, Reach Plus monitored MVPA and received feedback reports. Reach Plus Message monitored MVPA and received weekly text/email messages and feedback reports. Reach Plus Phone participants monitored MVPA and received monthly calls from coaches and feedback reports. Intervention delivery ended at 9 months. Assessments were obtained at baseline, 3, 6, 9, and 12-months. Analyses used a series of longitudinal mixed effects models with subject-specific intercepts. RESULTS:All groups improved significantly across time on psychosocial measures. At 9 months, Reach Plus Message and Reach Plus Phone reported better physical functioning compared to Reach Plus (b = 8.27, 95% CI: [2.27, 14.27]; b = 4.89, 95% CI: [0.01, 10.53]) respectively). At 12 months, Reach Plus Message reported better physical functioning than Reach Plus (b = 4.52, 95% CI: [0.01, 9.75]. Participants who met national PA guidelines reported significantly lower fatigue and higher physical functioning (at 9 and 12 months), and improved mood (at 12 months). CONCLUSIONS:MVPA maintenance via weekly messages or monthly coach calls improved physical functioning. Maintaining MVPA at or above national recommendations was associated with improved physical functioning, mood and less fatigue.

Background: The Together Everyone Achieves More Physical Activity (TEAM-PA) trial is a randomized controlled trial testing the efficacy of a group-based intervention for increasing physical activity (PA) among insufficiently active African American women.Design: The TEAM-PA trial uses a group cohort design, is implemented at community sites, and will involve 360 African American women. The trial compares a 10-week group-based intervention vs. a standard group-delivered PA comparison program. Measures include minutes of total PA/day using 7-day accelerometer estimates (pri-mary outcome), and body mass index, blood pressure, waist circumference, walking speed, sedentary behavior, light physical activity, and the percentage achieving >= 150 min of moderate to vigorous PA/week (secondary outcomes) at baseline, post-intervention, and 6-months post-intervention. Intervention: The intervention integrates elements from Social Cognitive Theory, Self-Determination Theory, Group Dynamics Theory, and a focus on collectivism to evaluate different components of social affiliation (relatedness, reciprocal support, group cohesion, and collective efficacy). The intervention integrates shared goal-setting via Fitbits, group-based problem-solving, peer-to-peer positive communication, friendly competi-tion, and cultural topics related to collectivism. Compared to the standard group-delivered PA program, par-ticipants in the intervention are expected to show greater improvements from baseline to post-and 6-month follow-up on minutes of total PA/day and secondary outcomes. Social affiliation variables (vs. individual-level factors) will be evaluated as mediators of the treatment effect. Implications: The results of the TEAM-PA trial will determine the efficacy of the intervention and identify which aspects of social affiliation are most strongly related to increased PA among African American women. Trial registration: This study was registered on Clinicaltrials.gov (# NCT05519696) in August 2022 prior to initial participant enrollment.

Purpose : To explore the theoretical constructs that functioned as mediators of interventions for moderate-to-vigorous physical activity (MVPA) maintenance among breast cancer survivors. Method : 161 survivors were randomized into 3 groups: Reach Plus, Reach Plus Message or Reach Plus Phone. All participants received a 3-month theory-based intervention delivered by volunteer coaches. During months 4–9, all participants monitored their MVPA and received feedback reports. Additionally, Reach Plus Message received weekly text/email messages and Reach Plus Phone received monthly calls from their coaches. Assessments of weekly MVPA minutes and theoretical constructs (self-efficacy, social support, physical activity [PA] enjoyment and PA barriers) were obtained at baseline, 3, 6, 9 and 12-months. Analyses : Using a multiple mediator analysis with a product of coefficients approach, we examined mechanisms associated with between-group differences over time in weekly MVPA minutes. Results : Self-efficacy mediated effects of Reach Plus Message vs. Reach Plus at 6 ( ab = 16.99) and 9 M ( ab = 27.45); social support mediated effects at 6 ( ab = 4.86), 9 ( ab = 14.30) and 12 M ( ab = 6.18). Self-efficacy mediated effects of Reach Plus Phone vs. Reach Plus at 6 ( ab = 18.76), 9 ( ab = 28.93) and 12 M ( ab = 18.18). Social support mediated effects of Reach Plus Phone vs. Reach Plus Message at 6 ( ab =-5.50) and 9 M ( ab =-13.20); PA enjoyment mediated effects at 12 M (ab=-3.63). Conclusions : PA maintenance efforts should focus on strengthening breast cancer survivors’ self-efficacy and obtaining social support. The trial was registered at ClinicalTrials.Gov: NCT02694640 (Feb. 26, 2016).

Almost half of all pregnancies are unintended. Future nurse practitioners (NPs) need long-acting reversible contraceptive (LARC) training. The purpose of this project was to increase LARC and reproductive health education to NP students at 4 public colleges of nursing. Four universities reported the implementation of LARC and reproductive health trainings from 2017 to 2020. Successful implementation of LARC educational trainings at each university yielded benefits for future providers and patients. Reproductive health content and LARC training offer benefits to NP students and improve patients’ access to contraception.

We aimed to identify the moderators of maintenance strategies’ effects to assist cancer care organizations that offer peer mentoring physical activity programs. A total of 161 inactive breast cancer survivors participated in a 12-month study and were randomized to one of three conditions at baseline. American Cancer Society’s Reach to Recovery coaches delivered weekly calls to participants for the first 3 months. During Months 4–9, participants self-monitored PA and received feedback (Reach Plus) or additionally received monthly calls from coaches (Reach Plus Phone) or weekly text/email messages (Reach Plus Message). Moderate-to-vigorous PA (MVPA) was assessed using self-report and accelerometry at baseline, 3, 6, 9, and 12 months. We examined baseline demographics, cancer-specific, and social cognitive variables as potential moderators of MVPA. Using Latent Class Models, we identified three participant profiles. The profile was used as a moderator in longitudinal mixed-effects models of MVPA. Profile 1 (44 ≥ .10). Among those with Profile 2, Reach Plus Message participants had higher mean MVPA than other groups (f2 ≥ .11). Among those with Profile 3, Reach Plus Phone participants had higher MVPA than other groups, f2 ≥ .11 (all ps < .05). Organizations can choose PA maintenance strategies that are most effective for survivors with specific profiles. Breast cancer survivors with specific profiles increase PA when receiving certain PA maintenance programs. ClinicalTrials.gov ID: NCT02694640 (Feb. 26, 2016).

BACKGROUND:Peer support can extend the reach of physical activity (PA) interventions. In previous studies, peer support via weekly counseling calls increased PA at 3 and 6 months among breast cancer survivors, compared to contact control. However, effects were attenuated at 6 months. Interventions targeting PA maintenance among cancer survivors are limited. Hence, we extended prior work to identify effective PA maintenance interventions.PURPOSE:Following a 3-month PA intervention, the study compared the effects of three 6-month interventions on PA at 12 months.METHODS:One hundred and sixty-one inactive breast cancer survivors participated in a 12-month randomized controlled trial. Intervention delivery was uniform for the first 3-months: all participants received a weekly call with their peer coach to encourage PA. Following month 3, participants self-monitored PA and received feedback reports (Reach Plus) or additionally received, a monthly phone call (Reach Plus Phone), or weekly text message (Reach Plus Message). Moderate-to-vigorous PA (MVPA) was measured using self-report (7 Day PAR) and accelerometry at baseline, 3, 6, 9, and 12 months.RESULTS:At 3 months, there were significant within group increases in self-reported and objectively measured MVPA with no between-group differences (ps > .05). At 6 months, adjusted longitudinal models showed that Reach Plus Message reported an additional 23.83 (SD = 6.33, f2 = .12) min/week of MVPA and Reach Plus Phone reported an additional 18.14 min/week (SD = 5.15, f2 =.16) versus Reach Plus. Results were similar at 9 months. At 12 months, Reach Plus Message and Reach Plus Phone both out-performed Reach Plus (ps = .04 and .05 respectively and effect sizes f2 = .11 and f2 = .21 respectively). Accelerometer data showed similar patterns: Reach Plus Message and Reach Plus Phone out-performed Reach Plus at 6 (f2 = .20) and 9 months (f2 = .09).CONCLUSION:Phone calls from peer mentors and text messaging can support PA maintenance among breast cancer survivors.CLINICAL TRIAL INFORMATION:ClinicalTrials.Gov NCT02694640.

BACKGROUNDAlthough metformin is the preferred initial pharmacological choice in type 2 diabetes, there is evidence that reveals a link between metformin use and vitamin B12 deficiency. The American Diabetes Association (ADA) has recently recommended periodic measurement of B12 levels for all patients on metformin.LOCAL PROBLEMMedical record data collected for the preintervention period showed that only 5% (n = 23) of patients diagnosed with diabetes and on metformin had B12 levels checked at an internal medicine primary care practice.METHODSThis was a quasi-experimental project of preintervention and postintervention design using a checklist containing important measures of diabetes control. The project sample population consisted of data of adults with type 2 diabetes aged 18 years and older who were prescribed metformin in the previous year at the primary care practice.INTERVENTIONSThe intervention focused on revising an existing diabetes measures checklist to include a prompt for an annual measurement of B12 levels.RESULTSThere was significant improvement in monitoring vitamin B12 levels and discovery of low vitamin B12 levels. These data show that the number of B12 levels checked increased from 23 during the preintervention to 155 during the intervention (p ≤ 0.0000).CONCLUSIONSThis project supports a conclusion that including a prompt to check B12 levels to an existing checklist increases B12 monitoring in this patient population. Results may encourage other providers to follow the ADA guidelines for monitoring vitamin B12 levels for patients taking metformin.

Simulation-based interprofessional education (IPE) is challenging to implement, especially on rural campuses. This article describes an innovative approach to IPE implementation using telehealth technology. Twenty-nine interdisciplinary students (nursing, pharmacy, and medical) participated in a simulation-based IPE scenario using a telehealth robot. Student experiences were evaluated using a mixed-methods approach. Surveys and video-recorded debriefing sessions revealed the majority of students felt the experience was superior to their previous IPE experiences, facilitated better understanding of disciplinary roles, and provided experience using telehealth tools. Programs considering this approach should have strong community partnerships, institutional support, and shared vision among key stakeholders.

ObjectivesTo report on fatigue in patients from the United Kingdom primary Sjögren’s syndrome (pSS) registry identifying factors associated with fatigue and robust to assignable causes such as comorbidities and medications associated with drowsiness.MethodsFrom our cohort (n = 608), we identified those with comorbidities associated with fatigue, and those taking medications associated with drowsiness. We constructed dummy variables, permitting the contribution of these potentially assignable causes of fatigue to be assessed. Using multiple regression analysis, we modelled the relationship between Profile of Fatigue and Discomfort physical and mental fatigue scores and potentially related variables.ResultsPain, depression and daytime sleepiness scores were closely associated with both physical and mental fatigue (all p ≤ 0.0001). In addition, dryness was strongly associated with physical fatigue (p ≤ 0.0001). These effects were observed even after adjustment for comorbidities associated with fatigue or medications associated with drowsiness.ConclusionsThese findings support further research and clinical interventions targeting pain, dryness, depression and sleep to improve fatigue in patients with pSS.This finding is robust to both the effect of other comorbidities associated with fatigue and medications associated with drowsiness.

Background: Primary Sjögren's syndrome (pSS) sufferers have rated physical and mental fatigue ('brain fog') as the most important symptoms needing improvement. Previous data from our group suggest that stimulation of the vagus nerve can invoke immunological responses and concurrently an improvement of patient reported symptoms of fatigue1. Objectives: This follow up study uses the gammaCore device (electroCore) and a sham device to assess the effects of non-invasive vagus nerve stimulation (nVNS) on patient reported symptoms of fatigue in pSS. In addition, neurocognitive tests were used to assess the effect of nVNS on short term memory, executive function and attention. Methods: 40 pSS participants were assigned to use active (n = 20) or sham (n = 20) nVNS devices. Participants and research staff were blinded to the active/sham device assignment. The participants were instructed to use the device twice daily for a study period of 56 days. The following patient reported measures of fatigue and neuropsychological tests were collected at baseline and day 56; Profile of Fatigue (PRO-F, Physical and Mental), visual analogue scale (VAS) of abnormal fatigue, trail making, Digit Symbol Substitution Test (DSST), Stroop test and digit span. 7 subjects were excluded from the analysis due to withdrawal from the study. Changes in fatigue and test scores from baseline to day 56 were compared between devices using t-tests. Results: Physical fatigue was significantly reduced between baseline and day 56 in the active group but not the placebo group (p = 0.047) The mean reduction in physical fatigue was 30% and 6% for the active and sham arms respectively (Figure 1). In both the active and sham subject groups there were no significant changes in the patient reported mental fatigue or neuropsychological test scores. Conclusion: This sham controlled scientific study of vagus nerve stimulation in pSS suggests nVNS may improve patient reported symptoms of physical fatigue, which is consistent with our published data. There were no improvements in the neurosychological test scores which is consistent with no improvements in patient reported mental fatigue. nVNS has been shown to activate the anti-inflammatory reflex, therefore assessment of peripheral inflammatory markers may help our understanding of nVNS, inflammation and fatigue. Reference [1] Tarn, J., Legg, S., Mitchell, S., Simon, B. & Ng, W.-F. The Effects of Noninvasive Vagus Nerve Stimulation on Fatigue and Immune Responses in Patients With Primary Sjögren's Syndrome. Neuromodulation49, 844 (2018). Disclosure of Interests: Jessica Tarn: None declared, Victoria Macrae: None declared, Sheryl Mitchell: None declared, Bruce Simon Shareholder of: Bruce Simon is an employee and shareholder of electroCore., Peter Gallagher: None declared, John-Paul Taylor: None declared, Stuart Watson: None declared, Mark Baker: None declared, Stephen Rushton: None declared, Andrew Blamire: None declared, Julia Newton: None declared, Wan Fai Ng: None declared

Background Heterogeneity is a major obstacle to developing effective treatments for patients with primary Sjogren's syndrome. We aimed to develop a robust method for stratification, exploiting heterogeneity in patient-reported symptoms, and to relate these differences to pathobiology and therapeutic response. Methods We did hierarchical cluster analysis using five common symptoms associated with primary Sjogren's syndrome (pain, fatigue, dryness, anxiety, and depression), followed by multinomial logistic regression to identify subgroups in the UK Primary Sjogren's Syndrome Registry (UKPSSR). We assessed clinical and biological differences between these subgroups, including transcriptional differences in peripheral blood. Patients from two independent validation cohorts in Norway and France were used to confirm patient stratification. Data from two phase 3 clinical trials were similarly stratified to assess the differences between subgroups in treatment response to hydroxychloroquine and rituximab. Findings In the UKPSSR cohort (n=608), we identified four subgroups: Low symptom burden (LSB), high symptom burden (HSB), dryness dominant with fatigue (DDF), and pain dominant with fatigue (PDF). Significant differences in peripheral blood lymphocyte counts, anti-SSA and anti-SSB antibody positivity, as well as serum IgG, kappa-free light chain, beta 2-microglobulin, and CXCL13 concentrations were observed between these subgroups, along with differentially expressed transcriptomic modules in peripheral blood. Similar findings were observed in the independent validation cohorts (n=396). Reanalysis of trial data stratifying patients into these subgroups suggested a treatment effect with hydroxychloroquine in the HSB subgroup and with rituximab in the DDF subgroup compared with placebo. Interpretation Stratification on the basis of patient-reported symptoms of patients with primary Sjogren's syndrome revealed distinct pathobiological endotypes with distinct responses to immunomodulatory treatments. Our data have important implications for clinical management, trial design, and therapeutic development. Similar stratification approaches might be useful for patients with other chronic immune-mediated diseases. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.

Statement of purpose: To evaluate survivorship and knee function in patients who have undergone Kinematic Condylar Total Knee Replacement at a minimum of 15 years.Methods: We evaluated all patients undergoing primary cemented TKR with the Kinematic Condylar implant (Howmedica), between January 1981 and December 1988. All operations were performed by a single surgeon through a medial parapatellar approach, with sparing of the PCL, all cemented and no patellae resurfaced.Operation notes were analysed to confirm the type of procedure, underlying diagnosis, and thickness of tibial insert. Information was derived from patient records and postal questionnaire to all surviving patients, which included: WOMAC, SF-36, satisfaction scale and history of revision surgery.Results: We have identified a total of 804 consecutive cases, 185 of these were bilateral giving a total of 619 patients. Mean age at implantation was 66 (range 17 to 83), with female:male ratio of 3:1. The underlying diagnosis was Osteoarthritis in ...