Sarah J. Ratcliffe

Background: Multivariate risk prediction models are recommended for assessing cardiovascular disease (CVD) risk and developing effective management plans. The widely used Framingham Risk Score (FRS) requires validation before application, as the original cohorts primarily comprised White, middle-class individuals in the United States. Objectives: To evaluate the FRS’s predictive accuracy over 10 years within the Korean National Health Insurance Service–National Health Screening Cohort. Methods: This retrospective observational study involved 483,643 eligible participants. Discrimination and calibration were assessed using the c -statistic, calibration slope, and intercept, supplemented by graphical calibration plots. Results: Over 10 years, 23,681 men and 16,904 women experienced a CVD event. The FRS showed good discrimination in both men and women. It overestimated CVD risk for men, while showing good calibration in women. Discussion: The observed discrepancy in calibration may be related to differences in risk factor profiles and CVD event rates between the original Framingham cohorts and the Korean validation cohort. In the absence of a Korean-specific model, the FRS remains a practical option for use in primary care. However, to enhance the accuracy of risk prediction, the development and validation of a population-specific CVD risk model for Korea are recommended.

Purpose: We aimed to explore the ethical challenges encountered by nurses when providing family-centered care. Methods: Thematic analysis was conducted using data from 82 semi-structured interviews with practicing nurses across four states in the United States. Findings: Theme 1: Navigating professional and ethical boundaries in nursing care that complement or complicate family advocacy; Theme 2: Experiencing family conflicts and disagreements; Theme 3: Feeling helpless at times from ethical, legal, and familial expectations and moral constraints. Conclusion: Participants showed commitment to involving families in patient care. Yet, we also observed tension in balancing respect for families’ wishes with patient autonomy, which led to moral distress and ethical uncertainty in their professional boundaries. While family-centered care recognizes families’ contributions to patient care and health care decisions, ongoing efforts are needed to address the ethical challenges that arise in its implementation in practice.

IntroductionCoronary microvascular disease (CMD) has been defined as an impairment in myocardial stress flow reactivity not explained by large-vessel obstruction, and is a common cause of angina wi...

Evidence shows the use of interventions to prevent falls are costly to healthcare facilities. Using a sample of older adult patients who fell at least once during the intervention year of a three-year cohort study in one long term care nursing facility, at a continuing care community providing skilled nursing and assisted living, we provide detailed evidence of the number and costs of durable medical equipment and number and type of non- durable medical nursing care interventions utilized to prevent subsequent falls. This level of description can aid healthcare facilities and administrators in their plans to reduce recurrent falls among older adults.

Background: Studies on symptom concordance between patients and their caregivers often use cross-sectional designs, which may fail to capture the longitudinal, dynamic symptom experience. The Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C) is a remote health monitoring system that utilizes smartwatches and ecological momentary assessments (EMAs) to empower patients and caregivers to monitor and manage cancer pain at home. BESI-C collects real-time symptom data in naturalistic settings, enabling longitudinal tracking and analysis of symptom patterns over time. Objective: To define and examine dyadic concordance using participant-initiated symptom reports collected via remote health monitoring. Methods: Dyads of patients with advanced cancer and their family caregivers were recruited to use BESI-C for 2 weeks, reporting pain in real time through EMAs. We used Bangdiwala’s B statistic to determine the concordance of patient-reported pain and caregiver-reported perceived patient pain under different contextual criteria (eg, co-location of participants; user engagement with BESI-C) that we hypothesized would impact concordance. We also explored a hypothesis that concordance would improve between study week 1 versus week 2. Results: Data from 21 patient-caregiver dyads were used for analysis. The reporting of pain events was highly variable between patients and their caregivers. Concordance of pain reporting improved when patients and caregivers were co-located and both wearing their BESI-C smartwatches. We did not observe consistent patterns in patient-caregiver concordance between week 1 and week 2. Conclusion: We propose an analytical approach to define and evaluate concordance between patients’ and caregivers’ real-time symptom reports that can be applied to dyadic, longitudinal symptom data collected using remote health monitoring. Future work should examine the relationship between patient-caregiver symptom concordance with key quality-of-life metrics and sociodemographic factors that impact participant engagement with remote health monitoring technologies.

Falls are a serious global public health issue affecting individuals of all ages, resulting in serious injuries, fatalities, and extended hospital stays. While knowledge and attitude of healthcare staff toward fall prevention are understood to impact patient safety, less well known are the type and content of fall prevention surveys used to identify nurses’ knowledge of fall prevention. Until now, no study has systematically reviewed the universe of existing tests, surveys, and programs used to assess fall prevention knowledge. This systematic review aims to describe existing tests and surveys used to assess the knowledge and attitudes of healthcare staff and nurses regarding fall prevention. Electronic databases PubMed, CINAHL, Scopus, Medline, ScienceDirect, and Psych Info were searched for English articles investigating existing surveys and tests of fall prevention knowledge among healthcare staff from 2005 to August 2024, focusing on studies in healthcare workers working in medical centers, working with adults >65 y.o. Of the 565 studies identified, twelve met the inclusion criteria: eight examined fall prevention knowledge, attitude, self-efficacy tests, and questionnaires among nurses and nursing students, and four examined fall prevention knowledge programs. One study examined the efficacy of a fall prevention program. Across all studies, various types of knowledge/self-efficacy questionnaires were utilized with overlapping content on fall definition, information on falls, teamwork, and reporting falls. Also, the educational studies suggested the importance of using fall prevention programs which include various components: online and in-person lectures, posters, and staff support, highlighting the need for continuous training rather than once for improved results. Overall, understanding the knowledge and attitudes of healthcare staff, especially nurses, toward fall prevention is crucial for improving patient safety and reducing adverse events in healthcare settings. Future research should include an assessment tool that considers all the components of behavioral change and captures all overlapping questions in one questionnaire, as well as including them in frequent training.

This research sought to determine feasibility for RNs to use the Post Fall Index™ (PFI) and to determine if an RN could identify underlying causal event factors for falls, would it be congruent with other providers (advanced practice nurse [APN], physician [MD])? PFI data from 23 falling residents of a nursing home were compiled into clinical vignettes and reviewed by experts for underlying causal event factors/fall sub-types. RNs used the PFI for one month in practice. The RN generated the most diagnoses; percent agreement was lower for RN: MD (between 37 to 87%) comparisons of fall sub-types versus APN: MD (between 57-87%). Significant agreement occurred between APN: MD for chronic problems (kappa = 0.060, p < 0.001) and equipment (p = 0.02), but not for RN: MD. RNs reported the PFI more precise. Although the PFI is feasible to use and an RN could identify underlying causes, percent agreement was higher for APN’s. Finding from this study indicate that three independent raters could generate similar fall related categories reinforcing a working assumption that clinical decision making for identifying specific fall related causal event factors maybe obtainable by multiple level providers when the correct tools are utilized.

BACKGROUND: Alloimmunization to transfused red blood cells (RBCs) remains a significant clinical problem. However, the cells that initiate immune responses to transfused RBCs remain incompletely characterized. Recently published work has identified splenic marginal zone B (MZB) cells as being critically required for the production of anti-RBC alloantibodies in response to RBCs. In infectious models, MZB cell activation has been shown to depend on a unique population of marginal zone macrophages (MZMs). We hypothesized that MZMs would capture stored RBCs and present them to MZBs, and ultimately MZMs would be required for generation of anti-RBC alloantibodies in response to stored RBC transfusion. STUDY DESIGN AND METHODS: Stored GFP ⁺ murine RBCs were utilized to determine the splenic localization and erythrophagocytosis by splenic macrophage populations. To determine the functional impact of MZMs, we compared LXRα-KO mice, which have been reported to lack MZMs, with wild type mice. Both innate and adaptive immune responses to stored HOD allogenic RBC transfusion were measured in LXRα-KO and wild type mice. RESULTS: RBC storage leads to a significant increase in the phagocytosis of transfused RBCs by splenic MZMs. LXRα-KO mice demonstrated a lack of MZMs and had significantly decreased rapid phase production of cytokines MCP-1 and KC, but similar levels of IL-6. Surprisingly, anti-RBC alloantibody levels were unaffected by the absence of splenic MZMs. CONCLUSIONS: Splenic MZMs are involved in the innate response to transfused stored HOD RBCs, contributing to both MCP-1 and KC cytokine production. However, MZMs are dispensable for anti-RBC alloantibody production.

This article describes the Cell Maps for Artificial Intelligence (CM4AI) project and its goals, methods, standards, current datasets, software tools, status, and future directions. CM4AI is the Functional Genomics Data Generation Project in the U.S. National Institute of Health’s (NIH) Bridge2AI program. Its overarching mission is to produce ethical, AI-ready datasets of cell architecture, inferred from multimodal data collected for human cell lines, to enable transformative biomedical AI research.