Palliative nursing's role during COVID-19 and beyond

UNIVERSITY OF PENNSYLVANIA SCHOOL OF NURSING

 

IMAGE: THE UNIVERSITY OF PENNSYLVANIA SCHOOL OF NURSING view more 

CREDIT: PENN NURSING

PHILADELPHIA (July 14, 2020) - As a rapid influx of patients overwhelmed health systems during the coronavirus pandemic, palliative nurses played dual roles supporting patients, patient families, and colleagues. Two researchers at the University of Pennsylvania School of Nursing (Penn Nursing) are among those detailing the important role palliative care has in responding during the COVID-19 pandemic and in future public health crises.

Advancing Palliative Care During COVID-19 Pandemic

As history proves, nursing science and scholarship have consistently improved patient care and outcomes throughout history's most daunting times. Today, nurse scientists and scholars have a unique opportunity to translate lessons learned about the shortcomings of health care during COVID-19 into strategic actions and investigations that reflect the needs of a rapidly changing society.

"Investing in the global culture of palliative care scholarship for nurses and health professionals across practice domains is one of the most accessible approaches to ensuring health care reflects a person-centered and value concordant ethos in the face of a future public health crisis," write William E. Rosa, PhD, MBE, NP-BC, FAANP, FAAN, a Robert Wood Johnson Foundation Future of Nursing Scholar and Salimah H. Meghani, PhD, MBE, RN, FAAN, Professor of Nursing & Term Chair of Palliative Care and Associate Director of the NewCourtland Center for Transitions and Health. They are two of the co-authors of a guest editorial in the Journal of Nursing Scholarship.

Their editorial provides a palliative care perspective on advancing patient care globally during COVID-19 and beyond. It provides recommendations to develop a research agenda rooted in a palliative care philosophy and ethos to meet the current global population health needs and anticipated future health crises.

The editorial, "Opportunities for Nursing Science to Advance Patient Care in the Time of COVID-19:A Palliative Care Perspective" is available online. Co-authors of the editorial include Patricia W. Stone, PhD, RN, FAAN, CIC of the Columbia University School of Nursing; and Betty R. Ferrell, PhD, RN, FAAN, FPCN, of the City of Hope Medical Center.

Optimizing the Palliative Nursing Role

Palliative nurses play a primary and significant role in supporting the broader health care system. As the pandemic continues to evolve, it has become clear that the work of the palliative nurse is indispensable as issues surrounding serious illness, dying, and death are no longer taboo but have become continuous threads of daily mainstream media, politics, and policy-making.

"This crisis offers an opportunity to reimagine the benefits of full palliative care integration to mitigate the effects of this and future health crises for patients, families, and communities," write Rosa and Meghani, two of the co-authors of an article in the Journal of Hospice & Palliative Nursing.

The authors share how best to leverage and integrate the palliative nursing role throughout health care settings. The article has implications for clinical nurses, nurse practitioners, clinical nurse specialists, and multidisciplinary stakeholders and includes resources for self-care and education.

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Their article, "Recommendations to Leverage the Palliative Nursing Role During COVID-19 and Future Public Health Crises," is available online. Co-authors of the article include researchers from around the world: Tamryn F. Gray, PhD, RN, of the Harvard Medical School; Kimberly Chow, RN, ANP-BC, ACHPN, and Shila Pandey, MSN, AGPCNP-BC, ACHPN , both of Memorial Sloan Kettering Cancer Center; Patricia M. Davidson, PhD, RN, FAAN, of Johns Hopkins University School of Nursing; J. Nicholas Dionne-Odom, PhD, MSN, MA, ACHPN, FPCN, of the University of Alabama at Birmingham School of Nursing; Viola Karanja, BSN, RN, and Julius D.N. Kpoeh, ASN, RN , both of Partners in Health Liberia; Judy Khanyola, MSc, RCHN, Chair, of the University of Global Health Equity; Joseph Lusaka, BSc HM, DCM, PA, of the Pleebo Health Centre; Samuel T. Matula, PhD, RN, PCNS-BC, of the University of Botswana; Polly Mazanec, PhD, AOCN, ACHPN, FPCN, FAAN of the Frances Payne Bolton School of Nursing at Case Western Reserve University; Patricia J. Moreland, PhD, CPNP, FAAN, of the Nell Hodgson Woodruff School of Nursing at Emory University; and Amisha Parekh de Campos, PhD, MPH, CHPN of the University of Connecticut.

About the University of Pennsylvania School of Nursing

The University of Pennsylvania School of Nursing is one of the world's leading schools of nursing. For the fifth year in a row, it is ranked the #1 nursing school in the world by QS University and is consistently ranked highly in the U.S. News & World Report annual list of best graduate schools. Penn Nursing is currently ranked # 1 in funding from the National Institutes of Health, among other schools of nursing, for the third consecutive year. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through innovation in research, education, and practice. Follow Penn Nursing on: Facebook, Twitter, LinkedIn, & Instagram

Robert Graham Center: First steps towards gender parity in academic authorship

Trends in the gender ratio of authorship at the Robert Graham Center

AMERICAN ACADEMY OF FAMILY PHYSICIANS

 

Researchers affiliated with the Robert Graham Center for Policy Studies in Family Medicine and Primary Care conducted a descriptive bibliometric analysis to determine the gender ratio of scholarly authorship on publications by its researchers between 2008 and 2018. While the average gender ratio of RGC researchers across this period was 46.3 percent female to 56.4 percent male, gender disparities in authorship were much starker. For example, roughly two-thirds of 229 publications listed a male first author, and almost all had at least one male author. While the RGC team recognizes the limitations of a single-case study, their intention is to broaden the discussion about gender parity in authorship among academic medical researchers.

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Trends in the Gender Ratio of Authorship at the Robert Graham Center
Elizabeth Wilkinson, et al
Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC
https://www.annfammed.org/content/18/4/341

Gemini Observatory's quick reflexes capture fleeting flash

The international Gemini Observatory detects optical afterglow of short gamma-ray burst within hours

ASSOCIATION OF UNIVERSITIES FOR RESEARCH IN ASTRONOMY (AURA)

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VIDEO: LIGHT OF POWERFUL BURST CAPTURED BY GEMINI OBSERVATORY view more 

CREDIT: INTERNATIONAL GEMINI OBSERVATORY/NOIRLAB/NSF/AURA/J. POLLARD/K. PATERSON & W. FONG (NORTHWESTERN UNIVERSITY), NAOJ/NASA'S GODDARD SPACE FLIGHT CENTER/CI LAB, ESO/M. KORNMESSER. IMAGE PROCESSING: TRAVIS RECTOR (UNIVERSITY OF ALASKA ANCHORAGE), MAHDI ZAMANI & DAVIDE DE...

Rapid follow-up of the optical afterglow from one of the most distant confirmed short gamma-ray bursts (SGRB), thought to be the merger of two neutron stars, is casting new light on these enigmatic objects. The observations, made by the international Gemini Observatory, a Program of NSF's NOIRLab, confirmed the object's distance and placed it squarely in the epoch of cosmic high noon, when the Universe was in its "teenage years" and rapidly forming stars. The appearance of an SGRB so early in the history of the Universe could alter theories about their origin, in particular how long it takes two neutron stars to merge to produce these powerful events. Precisely-localized SGRBs are rare, typically only 7-8 are detected per year, and this is the most distant high-confidence SGRB with an optical afterglow detection.

Researchers have used the 8.1-meter Gemini North telescope to measure the optical afterglow of one of the most distant short gamma-ray bursts (SGRB) ever studied. Thought to result from the merger of two neutron stars, SGRBs are cataclysmic events that are almost unfathomable in terms of their basic properties, emitting huge amounts of energy in about one second [1]. Gemini observations of a new, distant SGRB now suggest that this process could occur surprisingly quickly for some systems -- with massive binary star systems surviving supernova explosions to become neutron star binaries, and the binaries then spiraling together in less than a billion years to create an SGRB. The research will be published in he Astrophysical Journal Letters.

This object, named GRB181123B because it was the second burst discovered on 23 November 2018 -- Thanksgiving night -- was initially detected by NASA's Neil Gehrels Swift Observatory. When the alert of an event from the Swift satellite was broadcast around the world, several telescopes trained their view on it. Within hours, a team from Northwestern University used the Gemini Multi-Object Spectrograph (GMOS), which is also an imager, on the Gemini North telescope on Maunakea in Hawai'i to record the very faint afterglow of the object.

"We took advantage of the unique rapid-response capabilities and exquisite sensitivity of Gemini North and its GMOS imager to obtain deep observations of the burst mere hours after its discovery," said Kerry Paterson of the Center for Interdisciplinary Exploration and Research in Astrophysics (CIERA) at Northwestern University, USA, who led the research team. "The Gemini images were very sharp, and allowed us to pinpoint the location to a specific galaxy."

"This is a wonderful example of time-domain astronomy, involving extremely rapid follow-up of a quickly evolving event," said Hans Krimm of the US National Science Foundation. "Gemini's rapid response was critical to catching this event swiftly, and the optical and infrared data add to the excitement of multi-messenger astronomy -- where observations of light, gravitational waves, neutrinos and cosmic rays come together to tell a compelling story."

Along with the Gemini observations, the team made follow-up observations using the W. M. Keck Observatory in Hawai'i and the Multi-Mirror Telescope (MMT), located at the Fred Lawrence Whipple Observatory on Mount Hopkins in Arizona. The researchers then utilized the Gemini South infrared camera and spectrograph, FLAMINGOS-2, in Chile to obtain a spectrum of the host galaxy to pin down the SGRB's distance. The object was found to be some 10 billion light-years away, making it the second most distant confirmed SGRB, and the most distant high-confidence SGRB with an optical afterglow detection [2]. Compared to the detections of gravitational waves from merging neutron stars in the very nearby Universe, SGRBs are distant analogs.

"The identification of certain patterns in the spectrum, together with the colors of the galaxy from the three observatories, allowed us to precisely constrain the distance and solidify it as one of the most distant SGRBs to date in 16 years of Swift operations," said Paterson.

Rapid follow-up of the burst discovery from Swift was essential. Many SGRBs cannot be observed with a telescope in time to catch the optical light. The light from the afterglow fades quickly and it can take a correspondingly long time for a large, sensitive telescope to interrupt its normal observing plan and move to the new target to begin its follow-up observations.

Once the optical detection of the SGRB was made with Gemini, and its host galaxy was identified, the team was able to determine key properties of the parent stellar population within the galaxy that produced the SGRB.

"Performing 'forensics' to understand the local environment of SGRBs and what their home galaxies look like can tell us a lot about the underlying physics of these systems, such as how SGRB progenitors form and how long it takes for them to merge," said Wen-fai Fong of Northwestern University and co-author on the study. "We certainly did not expect to discover an extremely distant SGRB, as they are very rare and faint, but we were pleasantly surprised! This motivates us to go after every one that we possibly can."

The majority of the 43 high-confidence SGRBs used in the study that have had their distances measured to date have been found closer to home. Distant SGRBs offer a unique way to study the same types of events when the Universe was much younger -- a busy period in the Universe when stars were rapidly forming and galaxies were growing fast [3]. The addition of another very distant SGRB to the population could change astronomers' understanding of these events -- in particular, how long it takes two neutron stars to merge, and the rate of neutron star mergers during this epoch of the Universe's history. "Finding an SGRB so early in the Universe's history suggests that at least some neutron star pairs might need to come together relatively rapidly," according to Fong.

"With the proper telescopic resources and dedicated follow-up facilities, such as the Gemini Observatory, we can open a new era of discovery of distant SGRBs, motivating further follow-up studies of past events and similarly intense follow-up of future ones," said Paterson.

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Notes

[1] Despite their spectacular nature, the formation pathway to a SGRB is unknown. Astronomers believe they are likely formed from a pair of massive stars that were born together and "die" together as neutron stars before merging.

[2] The measured redshift is z=1.754.

[3] This era is analogous to the Universe's teenage years -- a lot is happening, everything is kind of messy, and galaxies are growing fast and haven't settled down into the maturity of their later years.

More information

This research was presented in a paper to appear in Astrophysical Journal Letters.

The team is composed of K. Paterson (Northwestern University), W. Fong (Northwestern University), A. Nugent (Northwestern University), A. Rouco Escorial (Northwestern University), J. Leja (Center for Astrophysics | Harvard & Smithsonian), T. Laskar (University of Bath), R. Chornock (Ohio University), A. A. Miller (Northwestern University and The Adler Planetarium), J. Scharwächter (Gemini Observatory/NSF's NOIRLab), S. B. Cenko (NASA Goddard Space Flight Center and University of Maryland), D. Perley (Liverpool John Moores University), N. R. Tanvir (University of Leicester), A. Levan (Radboud University and University of Warwick), A. Cucchiara (College of Marin and the University of the Virgin Islands), B. E. Cobb (The George Washington University), K. De (California Institute of Technology), E. Berger (Center for Astrophysics | Harvard & Smithsonian), G. Terreran (Northwestern University), K. D. Alexander (Northwestern University), M. Nicholl (University of Birmingham and University of Edinburgh), P. K. Blanchard (Northwestern University), and D. Cornish (Northwestern University).

NSF's National Optical-Infrared Astronomy Research Laboratory (NOIRLab), the US center for ground-based optical-infrared astronomy, operates the international Gemini Observatory (a facility of NSF, NRC-Canada, ANID-Chile, MCTIC-Brazil, MINCyT-Argentina, and KASI-Republic of Korea), Kitt Peak National Observatory (KPNO), Cerro Tololo Inter-American Observatory (CTIO), the Community Science and Data Center (CSDC), and the Vera C. Rubin Observatory. It is managed by the Association of Universities for Research in Astronomy (AURA) under a cooperative agreement with NSF and is headquartered in Tucson, Arizona. The astronomical community is honored to have the opportunity to conduct astronomical research on Iolkam Du'ag (Kitt Peak) in Arizona, on Maunakea in Hawai?i, and on Cerro Tololo and Cerro Pachón in Chile. We recognize and acknowledge the very significant cultural role and reverence that these sites have to the Tohono O'odham Nation, to the Native Hawaiian community, and to the local communities in Chile, respectively.

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COVID-19 makes clear the need to address social determinants of health

An opportunity to emphasize equity, social determinants, and prevention in primary care

AMERICAN ACADEMY OF FAMILY PHYSICIANS

University of Michigan public health experts Julia Wolfson and Cindy Leung argue that the COVID-19 pandemic has made glaringly apparent the structural conditions that underlie inequities in our nation's health. Race and ethnicity, housing, income, occupation and chronic health conditions are all key factors that influence one's ability to safely weather highly infectious disease pandemics like COVID-19. Unlike the novel coronavirus strain, these social, economic and structural factors are not new. The authors argue, "An opportunity exists to use the unfolding crisis to advocate for structural changes to a system that has long perpetuated disparities." Wolfson and Leung draw together four articles in the July-August 2020 issue of the Annals of Family Medicine that emphasize social determinants of health and highlight the calls to action for primary care.

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An Opportunity to Emphasize Equity, Social Determinants, and Prevention in Primary Care
Julia A. Wolfson, PhD MPP, et al
University of Michigan, School of Public Health, Departments of Health Management and Policy and Nutritional Sciences, Ann Arbor, Michigan
https://www.annfammed.org/content/18/4/290

International conference on social determinants of health identified change needs

Improving Equity Through Primary Care: Proceedings of the 2019 Toronto International Conference on Quality in Primary Care

AMERICAN ACADEMY OF FAMILY PHYSICIANS

 

In November 2019, clinicians, health administrators, educators and researchers from around the world gathered in Toronto to discuss how to best address social determinants of health from a primary care perspective. Participants developed starting points for accessible and feasible actions to improve health equity in their own primary care setting. They emphasized strategies to incorporate community members, especially those with lived experiences of discrimination, in the health care design team. Additionally, they highlighted the need to address structural determinants of health, including racism, capitalism and colonialism.

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Improving Equity Through Primary Care: Proceedings of the 2019 Toronto International Conference on Quality in Primary Care
Tara Kiran, MD, MSc, CCFP, et al
University of Toronto and St. Michael's Hospital, Department of Family and Community Medicine, Toronto, Ontario, Canada
https://www.annfammed.org/content/18/4/364

NEWS RELEASE 14-JUL-2020

LGBT-friendly medical practices improve STD/HIV screening rates for vulnerable populations

Transforming primary care for lesbian, gay, bisexual, and transgender people: a collaborative quality improvement initiative

AMERICAN ACADEMY OF FAMILY PHYSICIANS

 

This report--describing the first national quality improvement collaborative focused on providing culturally affirming care for LGBT people--finds that making primary care practices more LGBT-friendly and inclusive may improve STD and HIV screening rates among this vulnerable population. The goal of the Transforming LGBT Care program was to help highly motivated community health centers implement LGBT-affirming care by providing infrastructure for training, collaboration, knowledge sharing, leadership buy-in and practice change. Ten federally qualified health centers were selected to participate in the year-long program. Small care teams were formed at each site, and those teams received coaching, training and facilitation from the program's staff, much of which was conducted virtually. By the end of the program, estimated HIV screening of LGBT patients at eight of the reporting sites rose from 14.8 percent to 30.5 percent, with increases in STD screenings as well. Most participating centers had improved their electronic health record system to allow for sexual orientation and gender identity documentation, but very few reported improvements in documenting the sexual histories of LGBT patients. The authors of the program's quality improvement study note, "Ultimately, federally qualified health centers and other primary care organizations have an opportunity and a responsibility to provide equitable care to people of all sexual orientations and gender identities. Even small changes to health care practices may make a large difference for people burdened by health disparities and discrimination."

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Transforming Primary Care for Lesbian, Gay, Bisexual, and Transgender People: A Collaborative Quality Improvement Initiative
Bruce W. Furness, MD, MPH, et al
Centers for Disease Control and Prevention, Atlanta, Georgia
https://www.annfammed.org/content/18/4/292

Experts' high-flying study reveals secrets of soaring birds

New research has revealed when it comes to flying the largest of birds rely on air currents, not flapping to move around

SWANSEA UNIVERSITY

IMAGE: THE ANDEAN CONDOR IN FLIGHT - RECORDING DEVICES REVEALED IT ACTUALLY FLAPS ITS WINGS FOR JUST ONE PER CENT OF ITS FLIGHT TIME. view more 

CREDIT: PICTURE: FACUNDO VITAL

New research has revealed when it comes to flying the largest of birds don't rely on flapping to move around. Instead they make use of air currents to keep them airborne for hours at a time.

The Andean condor - the world's heaviest soaring bird which can weigh in at up to 15kg - actually flaps its wings for one per cent of its flight time.

The study is part of a collaboration between Swansea University's Professor Emily Shepard and Dr Sergio Lambertucci in Argentina, that uses high-tech flight-recorders on Andean condors. These log each and every wingbeat and twist and turn in flight as condors search for food.

The team wanted to find out more about how birds' flight efforts vary depending on environmental conditions. Their findings will help to improve understanding about large birds' capacity for soaring and the specific circumstances that make flight costly.

During the study, the researchers discovered that more than 75 per cent of the condors' flapping was associated with take-off.

However, once in the sky condors can sustain soaring for long periods in a wide range of wind and thermal conditions - one bird managed to clock up five hours without flapping, covering around 172 km or more than 100 miles.

The findings are revealed in a new paper Physical limits of flight performance in the heaviest soaring bird, which has just been published by Proceedings of the National Academy of Sciences.

Dr Hannah Williams, now at the Max Planck Institute for Animal Behaviour, said: "Watching birds from kites to eagles fly, you might wonder if they ever flap.

"This question is important, because by the time birds are as big as condors, theory tells us they are dependent on soaring to get around.

"Our results revealed the amount the birds flapped didn't change substantially with the weather.

"This suggests that decisions about when and where to land are crucial, as not only do condors need to be able to take off again, but unnecessary landings will add significantly to their overall flight costs."

Professor Shepard, who is part of Swansea Lab for Animal Movement, said as all the birds they studied were immature, it demonstrated that low investment in flight is possible even in the early years of a condor's life.

Closer examination showed the challenges the birds faced as they moved between weak thermals. The condors were seen to flap more as they reached the end of the glides between thermals when they were likely to be closer to the ground.

Dr Lambertucci explained: "This is a critical time as birds need to find rising air to avoid an unplanned landing. These risks are higher when moving between thermal updrafts.

"Thermals can behave like lava lamps, with bubbles of air rising intermittently from the ground when the air is warm enough. Birds may therefore arrive in the right place for a thermal, but at the wrong time."

"This is a nice example of where the behaviour of the birds can provide insight into the behaviour of the air."

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About 94 per cent of wild bee and native plant species networks lost, York study finds

YORK UNIVERSITY

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VIDEO: CLIMATE CHANGE AND AN INCREASE IN DISTURBED BEE HABITATS FROM EXPANDING AGRICULTURE AND DEVELOPMENT IN NORTHEASTERN NORTH AMERICA OVER THE LAST 30 YEARS ARE LIKELY RESPONSIBLE FOR A 94 PER... view more 

CREDIT: YORK UNIVERSITY

TORONTO, July 14, 2020 - Climate change and an increase in disturbed bee habitats from expanding agriculture and development in northeastern North America over the last 30 years are likely responsible for a 94 per cent loss of plant-pollinator networks, York University researchers found.

The researchers, corresponding author Professor Sandra Rehan of the Faculty of Science and grad student Minna Mathiasson of the University of New Hampshire, looked at plant-pollinator networks from 125 years ago through present day. The networks are comprised of wild bees and the native plants they historically rely on, although most of those have now been disrupted.

About 30 per cent of plant-pollinator networks were completely lost, which translates to a disappearance of either the bees, the plants or both. In another 64 per cent of the network loss, the wild bees, such as sweat or miner bees, or native plants, such as sumac and willow, are still present in the eco-system, but the bees no longer visit those plants. The association is gone.

The remaining six per cent of the plant-pollinator networks are stable or even thriving with pollinators such as small carpenter bees, which like broken stems for nest making.

"There are several reasons for the losses in the networks. Climate change is likely the biggest driver. We know that over the last 100 years or so annual temperatures have changed by two and a half degrees. This is enough to alter the time when certain native plants bloom," says Rehan.

"For a bee that's out for months on end or is a generalist pollinator, this isn't such a critical mismatch, but for a bee that's only out for two weeks of the year and only has a few floral hosts, this could be devastating." An increase in non-native species of bees and invasive species of plants, which have displaced some of the native species, is another reason for the decline in networks.

"We are getting a lot of invasive species and new records of invasive species every year. This is usually accidentally through trade and through ornamental plants," says Rehan.

Andrena_vacinia, is a miner bee and one of the declining bee species

A lot of these bees live in stems, so it's easy to import plants with non-native bee species without knowing it. "We can actually show routes and means of invasion biology," she says.

These bees are following shipping routes from one continent to the other around the world, including North America through ornamental plants for our gardens.

The researchers say an increase in habitat restoration and native flowering plants in agricultural landscapes are critical for improving wild bee biodiversity, but also food security for humans.

Bees and other pollinators are worth hundreds of billions of dollars globally by pollinating the crops we eat, and wild bees are at the top of the list believed to pollinate more than 87 per cent or 308,006 flowering plant species. Many of these are economically important commercial crops, such as apples and blueberries.

"There is an urgent need to gain a deeper understanding of the environmental circumstances affecting these wild pollinator populations and their specialised, evolutionary relationships with plant communities," says Rehan. "Plant pollinator webs are dependent on changes in the landscape, so knowing how these networks are shaped is important for all regional habitats."

Previous recent research by Rehan and team looked at 119 wild bee species over 125 years and found 14 declining and eight increasing species. All of the wild bee species in decline are native and over half experienced significant range (latitude and elevation) shifts.

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The research, "Wild bee declines linked to plant-pollinator network changes and plant species introductions," was published in the journal Insect Conservation and Diversity.

Video: https://youtu.be/twfwOHptNWo

York University champions new ways of thinking that drive teaching and research excellence. Our students receive the education they need to create big ideas that make an impact on the world. Meaningful and sometimes unexpected careers result from cross-disciplinary programming, innovative course design and diverse experiential learning opportunities. York students and graduates push limits, achieve goals and find solutions to the world's most pressing social challenges, empowered by a strong community that opens minds. York U is an internationally recognized research university - our 11 faculties and 25 research centres have partnerships with 200+ leading universities worldwide. Located in Toronto, York is the third largest university in Canada, with a strong community of 53,000 students, 7,000 faculty and administrative staff, and more than 300,000 alumni. York U's fully bilingual Glendon Campus is home to Southern Ontario's Centre of Excellence for French Language and Bilingual Postsecondary Education.