Recent Publications by CFE Educators

: Technology-based interventions are increasingly used to improve physical activity (PA) and diet. : We conducted a systematic review of randomized controlled trials (RCTs) published up to August 2021 that tested mobile health (mHealth) PA and/or dietary interventions among cancer survivors and reported on the feasibility, satisfaction, behavioral change, and/or quality of life (QOL) outcomes. : In total, 61 articles were identified on PubMed, and 23 of those met the inclusion criteria. The most common cancers were breast ( = 1000), prostate ( = 713), and colorectal ( = 650). Participants were predominantly White (median: 84%, interquartile range (IQR): 20%) and college-educated (58%). The interventions varied, but the most common combination of components (six studies) was a website/mobile app with an activity tracker and coaching. In terms of duration, 70% ( = 16) of the interventions lasted 12 weeks. The median total tracker wear was 87% of the study days (IQR: 6%) and the median text-message reply rate was 73% (IQR 4%). Most participants (median: 87%; IQR: 16%) were satisfied with at least one intervention component. Eleven out of 18 studies examining behavioral change reported significant between-group differences and six out of 11 studies examining QoL reported significant improvements. : mHealth interventions are a promising approach to improving the PA and diets of cancer survivors. Research in racially/ethnically and socioeconomically diverse populations is needed.

OBJECTIVE

Interfacility transfers represent a large proportion of neurosurgical admissions to tertiary care centers each year. In this study, the authors examined the impact of the COVID-19 pandemic on the number of transfers, timing of transfers, demographic profile of transfer patients, and clinical outcomes including rates of surgical intervention.

METHODS

A retrospective review of neurosurgical transfer patients at a single tertiary center was performed. Patients transferred from April to November 2020 (the "COVID Era") were compared with an institutional database of transfer patients collected before the COVID-19 pandemic (the "Pre-COVID Era"). During the COVID Era, both emergent and nonemergent neurosurgical services had resumed. A comparison of demographic and clinical factors between the 2 cohorts was performed.

RESULTS

A total of 674 patients were included in the study (331 Pre-COVID and 343 COVID-Era patients). Overall, there was no change in the average monthly number of transfers (P = 0.66) or in the catchment area of referral hospitals. However, COVID-Era patients were more likely to be uninsured (1% vs. 4%), had longer transfer times (COVID vs. Pre-COVID Era: 18 vs. 9 hours; P 0.001), required higher rates of surgical intervention (63% vs. 50%, P = 0.001), had higher rates of spine pathology (17% vs. 10%), and less frequently were admitted to the intensive care unit (34% vs. 52%, P 0.001). Overall, COVID-Era patients did not experience delays to surgical intervention (3.1 days vs. 3.6 days, P = 0.2). When analyzing the subgroup of COVID-Era patients, COVID infection status did not impact the time of transfer or rates of operation, although COVID-infected patients experienced a longer time to surgery after admission (14 vs. 2.9 days, P 0.001).

CONCLUSION

The COVID-19 pandemic did not reduce the number of monthly transfers, operation rates, or catchment area for transfer patients. Transfer rates of uninsured patients increased during the COVID Era, potentially reflecting changes in access to community neurosurgery care. Shorter time to surgery seen in COVID-Era patients possibly reflects institutional policies that improved operating room efficiency to compensate for surgical backlogs. COVID status affeted time to surgery, reflecting the preoperative care that these patients require before intervention.

Adolescent minors in every state can give their own consent for some health care. Although parent consent is generally required for vaccination, there are exceptions in some states. Completion rates are low for recommended adolescent vaccines; allowing adolescents to consent may improve coverage, although more study is needed on barriers to vaccine completion and the feasibility of changes in consent laws. The COVID-19 pandemic highlights the importance of vaccines and related challenges. This policy brief reviews laws governing adolescent consent for health care, including vaccines, and recommends advocacy to support increased adolescent access to vaccines and improved public health.

Since the introduction of the MELD-based allocation system, women are now 30% less likely than men to undergo liver transplant (LT) and have 20% higher waitlist mortality. These disparities are in large part due to height differences in men and women though no national policies have been implemented to reduce sex disparities. Patients were identified using the Scientific Registry of Transplant Recipients (SRTR) from 2014 to 2019. Patients were categorized into five groups by first dividing into thirds by height then dividing the shortest third into three groups to capture more granular differences in the most disadvantaged patients (166 cm). We then used LSAM to model waitlist outcomes in five versions of awarding additional MELD points to shorter candidates compared to current policy. We identified two proposed policy changes LSAM scenarios that resulted in improvement in LT and death percentage for the shortest candidates with the least negative impact on taller candidates. In conclusion, awarding an additional 1-2 MELD points to the shortest 8% of LT candidates would improve waitlist outcomes for women. This strategy should be considered in national policy allocation to address sex-based disparities in LT.

BACKGROUND

The use of psychotherapy has a long history within psychiatric-mental health nurse practitioner (PMHNP) practice. Underutilization of psychotherapy in practice has potentially led to a reduced emphasis in the PMHNP curriculum. To date, no national survey has solely evaluated how PMHNP programs ensure psychotherapy skill acquisition.

AIMS

Survey the PMHNP programs within the United States on how psychotherapy skill acquisition is achieved, including (a) psychotherapeutic curricular content; (b) psychotherapy related clinical practicum hours, including simulation and preceptor-delivered hours; and (c) student interest in psychotherapy skills.

METHOD

Three rounds of e-mail invitations were sent to all PMHNP programs within the United States. Descriptive statistics and reflective thematic analysis were used to examine survey content.

RESULTS

There were 39 (27%) respondents, representing the U.S. regions equally. The most common forms of psychotherapy taught were cognitive-behavioral and motivational interviewing. The content was most often delivered through a hybrid program (65.8%). Psychotherapy clinical hours most often used in psychology and social work were varied (0-720, 132.9) and were usually (63.89%) separate from other clinical hours. Qualitative responses focused on increased emphasis on the use of psychotherapy within PMHNP programs and the need to develop competency checklists for psychotherapy skill acquisition to use with simulation.

CONCLUSION

This survey reported on both similarities and differences in how PMHNP programs ensure student competency in the skill acquisition of psychotherapy. While this article focuses on what skills are needed in psychotherapy education, direction on how programs deliver this content to their students to ensure this skill will be retained in practice is a critical next step.

The authors wish to make the following correction to this paper [...].