OBJECTIVE: The study aimed to characterize the experiences of primary caregivers of children with medical complexity (CMC) in engaging with other members of the child\'s caregiving network, thereby informing the design of health information technology (IT) for the caregiving network. Caregiving networks include friends, family, community members, and other trusted individuals who provide resources, information, health, or childcare.
METHODS: We performed a secondary analysis of two qualitative studies. Primary studies conducted semi-structured interviews (n = 50) with family caregivers of CMC. Interviews were held in the Midwest (n = 30) and the mid-Atlantic region (n = 20). Interviews were transcribed verbatim for thematic analysis. Emergent themes were mapped to implications for the design of future health IT.
RESULTS: Thematic analysis identified 8 themes characterizing a wide range of primary caregivers\' experiences in constructing, managing, and ensuring high-quality care delivery across the caregiving network.
CONCLUSIONS: Findings evidence a critical need to create flexible and customizable tools designed to support hiring/training processes, coordinating daily care across the caregiving network, communicating changing needs and care updates across the caregiving network, and creating contingency plans for instances where caregivers are unavailable to provide care to the CMC. Informaticists should additionally design accessible platforms that allow primary caregivers to connect with and learn from other caregivers while minimizing exposure to sensitive or emotional content as indicated by the user.
CONCLUSIONS: This article contributes to the design of health IT for CMC caregiving networks by uncovering previously underrecognized needs and experiences of CMC primary caregivers and drawing direct connections to design implications.

BACKGROUND: Emergency nurses work under sometimes uncertain conditions to provide care to patients with all kinds of illnesses and afflictions from all segments of the population. Despite implications that they must work together to provide efficient and effective patient care, few studies explore reciprocal workplace relationships of emergency nurses.
OBJECTIVE: This research sought to illuminate the lived experience of workplace reciprocity of emergency nurses.
METHODS: Using a phenomenological approach with snowball sampling technique, unstructured, open-ended interviews were conducted with emergency nurses in the mid-Atlantic region of the United States. The original study was conducted in 2013 (n = 9) and a replication study in 2018 (n = 7). Data were collected and analyzed using Giorgi\'s Phenomenological Method. Results from each study were evaluated for thematic congruence.
RESULTS: Six themes of workplace reciprocity of emergency nurses were identified for both studies: emergency department (ED) culture, balancing, technology, caring, bridging, and connection. An additional theme, bonding, was identified with the replication study.
CONCLUSIONS: Exploring workplace reciprocity of emergency nurses provided insight the influences on workplace relationships. Establishing and nurturing workplace reciprocity may create a culture of safety, connection, enhance work engagement, and influence nurse recruitment and retention.

People with advanced Parkinson\'s disease (PD) are living at home being cared for by a family member. Decisions about health care and living preferences are made in a family context. The aims of the study were to (a) examine the types and timing of the decisions being made by dyads (person with Parkinson\'s [PWP] and caregiver) in advanced PD; and (b) explore perceived decision quality relative to specific decisions made. A mixed methods design of semi-structured dyad interviews followed by individual completion of decision measures twice at six months apart was utilized. Decisions involved obtaining more services in the home, moving into assisted living communities, maintaining as is, and initiating hospice. There was high decision quality as reflected by low decisional conflict and regret without statistical differences within the dyad. The findings provide insight into the nature of decisions dyads face and suggest ways that health care providers can support decision-making.

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OBJECTIVE: To describe how home health nurses plan their daily work schedules and what challenges they face during the planning process.
BACKGROUND: Home health nurses are viewed as independent providers and value the nature of their work because of the flexibility and autonomy they hold in developing their work schedules. However, there is limited empirical evidence about how home health nurses plan their work schedules, including the factors they consider during the process and the challenges they face within the dynamic home health setting.
METHODS: Qualitative descriptive design.
METHODS: Semi-structured interviews were conducted with 20 registered nurses who had >2 years of experience in home health and were employed by one of the three participating home health agencies in the mid-Atlantic region of the United States. Data were analysed using conventional content analysis.
RESULTS: Four themes emerged about planning work schedules and daily itineraries: identifying patient needs to prioritise visits accordingly, partnering with patients to accommodate their preferences, coordinating visit timing with other providers to avoid overwhelming patients, and working within agency standards to meet productivity requirements. Scheduling challenges included readjusting the schedule based on patient needs and staffing availability, anticipating longer visits, and maintaining continuity of care with patients.
CONCLUSIONS: Home health nurses make autonomous decisions regarding their work schedules while considering specific patient and agency factors, and overcome challenges related to the unpredictable nature of providing care in a home health setting. Future research is needed to further explore nurse productivity in home health and improve home health work environments.
CONCLUSIONS: Home health nurses plan their work schedules to provide high quality care that is patient-centered and timely. The findings also highlight organisational priorities to facilitate continuity of care and support nurses while alleviating the burnout associated with high productivity requirements.

To assess the noninferiority of vaginal P (Endometrin) compared with daily intramuscular P for replacement in programmed vitrified-warmed blastocyst transfer cycles and to assess the noninferiority of vaginal P in combination with intramuscular progesterone every third day compared with daily intramuscular P.
Three-arm randomized controlled noninferiority study. To enable early recognition of inferiority if present, an a priori interim analysis was planned and completed once ongoing pregnancy data were available for 50% of the total enrollment goal. The results of this interim analysis are presented here.
Assisted reproduction technology practice.
Women undergoing transfer of nonbiopsied high quality vitrified-warmed blastocyst(s) in a programmed cycle.
Vitrified-warmed blastocyst transfer with mode of P replacement determined by randomization to either: (1) 50 mg daily intramuscular P only; (2) 200 mg twice daily vaginal Endometrin; or (3) 200 mg twice daily Endometrin plus 50 mg intramuscular P every 3rd day.
Live birth. The primary outcome of this interim analysis was ongoing pregnancy.
A total of 645 cycles were randomly assigned to one of the three treatment arms, received at least one dose of P replacement therapy according to this assignment and underwent vitrified-warmed blastocyst transfer. These cycles were included in the intention-to-treat analysis. The study team, including the statistician, were blinded to the identity of the treatment arms, which were randomly labeled \"A,\" \"B,\" and \"C\" in the dataset. Ongoing pregnancy occurred in 50%, 47%, and 31% of cycles in arms A, B, and C respectively. Although arm C had an rate of positive hCG equivalent to the other two arms, the rate of pregnancy loss for arm C was significantly higher than for either of the two arms, resulting in a more than one-third lower rate of ongoing pregnancy. There were no statistically significant differences for any outcome tested between arms A and B. Results of a per-protocol analysis were nearly identical to those of the intention-to-treat analysis. On completion of these analyses, arm C was revealed to be the vaginal P only arm.
Relative to regimens inclusive of intramuscular P, vaginal-only P replacement for vitrified-warmed blastocyst transfer results in decreased ongoing pregnancy, due to increased miscarriage, and should be avoided. Randomization to the vaginal-only arm was terminated with these findings. This trial is ongoing to assess the noninferiority of the vaginal plus every 3rd day intramuscular P arm compared with daily intramuscular P in terms of live birth.
NLM identifier NCT02254577.

BACKGROUND: Following adult cardiac surgery, often difficult to detect fluctuations in regional cerebral perfusion can contribute to strokes. Optimal cerebral perfusion remains elusive and traditional monitoring strategies do not consistently identify acute changes. Non-invasive cerebral oximetry may detect perfusion variations.
OBJECTIVE: To assess the feasibility of postoperative non-invasive cerebral oximetry monitoring.
METHODS: Non-invasive cerebral oximetry was performed on adult aortic valve surgery patients in a cardiac surgical intensive care unit. Monitoring feasibility was assessed using an investigator-developed, data extraction tool.
RESULTS: Non-invasive cerebral oximetry was completed in 94% of patients. Sixty percent had values that fell below pre-set ischemic threshold. Nurses reported monitoring was feasible, and they perceived identifying deleterious cerebral perfusion trends may improve patient care.
CONCLUSIONS: Prevalence of low cerebral oximetry values underscores the importance of increasing sensitivity of monitoring tools. Further evaluation is required to assess this modality and the role of nurses in optimizing neurocognitive outcomes. Impact statement: Cerebral oximetry monitoring may help identify adult patients at risk of neurological complications after cardiac surgery, and as a consequence initiate definitive therapeutic strategies.

OBJECTIVE: We examined the relation- ship between sport participation and academic achievement in a sample of adolescents, while accounting for socioeconomic status (SES) and sex.
METHODS: We analyzed data from a cohort of 271 Mid-Atlantic high school students who participated in a longitudinal study of risk and protective factors for substance use, teen parenting, and school drop out.
RESULTS: Sport participation at year one predicted academic achievement in English (p < .05) and mathematics (p < .05) at year 2, while controlling for academic achievement at year one. In both instances over other independent variables and covariates in the models, sport participation explains almost 7% of additional variance in the outcomes variables. We also found a positive relationship for participants who reported parents with some college experience as opposed to parents with no college experience, between sport participation and grades in English (p < .05) but not for mathematics.
CONCLUSIONS: Sport participation is positively related to academic achievement but the relationship diverges when students are compared across sex and by parental education. These findings suggest that the relation ship between sport participation and academic achievement may be influenced by SES and is related to sex.

OBJECTIVE: Research has consistently shown that incarcerated women experience mental illness at disproportionate rates and heavily use psychiatric medication. This study examined factors related to incarcerated women\'s experiences and beliefs about psychotropic medications.
METHODS: The researchers conducted a survey with 274 women incarcerated at a medium-security correctional institution in a Mid-Atlantic state. A 35-item questionnaire was created that solicited data on, among other things, experiences with and perceptions of psychotropic medication use and locus of control.
RESULTS: Over three-quarters of participants (77%) reported currently taking psychotropic medication, and antidepressants were most common (93%). Of those taking psychotropic medication, more than half (51%) took more than one type. Univariate analyses indicated strong endorsement of questionnaire items related to positive effects of medication and personal agency in decision making about medication use. Current medication use predicted perceptions of more positive therapeutic effects (p<.001) and higher impact of medication on life (p<.001). External locus of control predicted four aspects of experience with psychotropic medication, including a decreased perception of personal agency regarding medication use (p=.038) and a greater likelihood of experiencing stigma related to medication use (p<.01).
CONCLUSIONS: Psychotropic medication use during incarceration is a complex phenomenon that is related not only to perceived therapeutic effects of medication but also to issues of impact, personal agency, locus of control, stigma, and perceived biological vulnerability.

OBJECTIVE: To assess the feasibility of a nurse-led heart failure (HF) education program using the Self-Care Heart Failure Index (SCHFI) instrument.
BACKGROUND: HF is a frequent and burdensome condition requiring support with self-care management strategies and education. Translating best practice to health services is important in improving health outcomes.
METHODS: Longitudinal quasi-experimental design.
METHODS: A convenience sample of (N = 41) patients with HF. We implemented a nurse-led education program with 30-day post-discharge home-based telephone follow-up. The SCHFI was used to measure self-care behaviors. 30-day readmission rates were assessed.
RESULTS: A significant difference was found in scores for self-care maintenance (p ≤ .001) and self-care management (p ≤ .001) subscales, not self-care confidence. There was no statistically significant difference between 30-day HF readmission rates.
CONCLUSIONS: Findings suggest that the nurse-led evidence-based HF education program improved self-care behaviors and decreased 30-day readmissions. There is a need for continued development of interventions focused on improving patient self-care confidence.