Common Methodological Challenges in Health Care Quality and Improvement Studies and Related Solutions.

The author describes key barriers to the successful implementation of quality improvement projects and presents potential solutions to avoid common pitfalls.

Importance of Limitation Sections in Clinical Research and Quality Improvement Manuscripts.

A description of study limitations is a critical component of reporting research findings that can help future researchers and clinical teams improve patient outcomes.

Longitudinal Analysis in Maternal Mental Health Research.

The author describes a lifespan-based approach to understanding maternal depression and the statistical considerations essential for evaluating interventions.

Evaluation of Systematic Reviews and Meta-analyses.

The author describes various ways to assess the quality of systematic reviews, particularly meta-analyses.

The Effects of the COVID-19 Pandemic on Resident Education and Burnout.

Background: The COVID-19 pandemic has impacted the residency experience for physicians across all specialties. There have been studies examining resident perspectives on changes in curriculum and clinical experiences due to the pandemic; however, little research has been conducted on how residents in different specialties interpreted their educational experience and rates of burnout during the pandemic.

Methods: We extended surveys to 281 residents across 15 separate residency programs between November 17, 2020, and December 20, 2020.

Working with a Statistician on a Data Analysis Plan.

The author describes collaboration between a statistician and nurse or midwife scientist to develop a data analysis plan.

Statistical Methods for Pre-Post Intervention Design.

The author provides an overview of options for statistical tests in pre-post analysis.

The Role of Confounders in Statistical Analysis.

Researchers can limit the effects of study design limitations on research findings through statistical analysis that includes crucial covariates and accounts for confounding.

Investigational medications in 9,638 hospitalized patients with severe COVID-19: lessons from the "fail-and-learn" strategy during the first two waves of the pandemic in 2020.

Background: The early surge of the novel coronavirus disease 2019 (COVID-19) pandemic introduced a significant clinical challenge due to the high case-fatality rate in absence of evidence-based recommendations. The empirical treatment modalities were relegated to historical expertise from the traditional management of acute respiratory distress syndrome (ARDS) in conjunction with off-label pharmaceutical agents endorsed under the "emergency use authorization" (EUA) paradigm by regulatory agencies. This study was designed to evaluate the insights from the "fail-and-learn" strategy in 2020 before the availability of COVID-19 vaccines and access to reliable insights from high-quality randomized controlled trials.

Nursing opinions on collaborating with residents in new and legacy OB/GYN programs.

Collaboration among physicians and nurses is vital and has shown to lead to better patient care and improve outcomes. Our study surveyed two groups of Labor and Delivery nurses in two regionally similar community hospitals in midwestern United States: one group from a new Obstetrics and Gynecology (OB/GYN) residency program (n = 49) and another from an established (legacy) OB/GYN residency program (n = 49). The survey asked nurses from the hospital with new and legacy residency program about preparedness for working with residents, perceptions of nurse-resident-patient relationships, collaboration and opinions about how resident physicians impact patient safety.

Assessing Nursing Sentiments on Nurse-Resident Physician Collaboration and Administrative Support in the Labor and Delivery Setting: Development and Validation of a Novel Instrument.

Objective: To develop a survey instrument that: 1) investigates the dynamics of collaboration in multidisciplinary care units such as labor and delivery (L&D); and (2) uniquely determines the collaborative relationships between nurses and resident physicians.

Background: An effective interprofessional collaboration between healthcare providers is considered a critical component in delivering high-quality care to patients and lies at the root of ensuring positive patient outcomes.

Methods: Two samples of responses (n = 98) were collected from L&D nurses working in 2 hospitals: 1 with novel obstetrics and gynecology (OB/GYN) residency program and 1 with legacy OB/GYN residency program.

Characterization of Blood-Based Molecular Profiling in Pancreatic Adenocarcinoma.

Background: Molecular profiling is being explored in pancreatic adenocarcinoma (PDAC) as a tool to assist with early detection, prognosis, and patient selection in targeted therapy clinical trials. Due to the challenges and risks of traditional tissue biopsies in pancreatic adenocarcinoma, the utility of blood-based molecular profiling is now being explored more broadly. However, given its novelty, what value blood-based molecular profiling may provide to oncologists caring for individuals with PDAC remains unknown.

Surgeons' re-operative valve replacement practices in patients with endocarditis due to drug use.

Background: This study discerns surgeons' attitudes and practices in the determination of heart valve replacement for patients with infectious endocarditis (IE) due to intravenous drug use (IVDU). We aimed to identify the factors contributing to surgeons' decision-making process for initial and recurrent surgical heart valves and the availability of institutional guidance.

Methods: An IRB-approved, anonymous mixed-methods, open survey instrument was designed and validated with 24 questions.

A Retrospective Analysis Comparing Post-Operative Bleeding with Various Doses of Aspirin after Lower Extremity Joint Arthroplasty or Revision.

Study Objective: Previous studies have shown that aspirin is noninferior to other anticoagulation therapies in preventing postoperative venous thromboembolism following lower extremity arthroplasty or revision; however, its optimal dosing for this indication is less clear. This study aims to compare the odds of bleeding between different aspirin dosages following lower extremity joint arthroplasty or revision.

Design: This is a 3-year retrospective multi-center cohort study across the United States and its territories.

A retrospective analysis of bleeding risk with rivaroxaban, enoxaparin, and aspirin following total joint arthroplasty or revision.

Study Objective: Rivaroxaban, enoxaparin, and aspirin are commonly used medications for thromboprophylaxis following lower extremity joint arthroplasty or revision. Previous research has demonstrated efficacy in preventing venous thromboembolism with each medication, however, the comparative risk of bleeding between them remains poorly understood. The aim of this study was to compare the odds of bleeding between rivaroxaban, enoxaparin, and aspirin following lower extremity joint arthroplasty or revision.

Molecular Profiling Practices in Pancreatic Adenocarcinoma: Academic vs Community Physicians.

Background: Pancreatic adenocarcinoma (PDAC) is relatively rare but highly aggressive, with most patients diagnosed once they have metastatic or locally invasive disease. Molecular profiling is being explored as a tool for selecting patients for targeted therapy clinical trials and for assessing whether targeted therapies may be effective in PDAC. Whether molecular profiling is being performed at both academic and community oncology clinics has yet to be examined.

A Two-Year Longitudinal, Cross-Sectional Evaluation of Resident Physician Burnout: An Exploration of the Effects of Stress, Satisfaction, Exercise and EMR.

Background: There is a need for better understanding of trajectory of burnout in clinical training and what factors are associated with resident well-being and burnout overtime. This study examined medical resident burnout and physical activity throughout different times of the academic year, across several different medical specialties and postgraduate years (PGY), over two years.

Methods: A resident wellness survey was administered throughout five different waves from summer 2018 to winter 2020.

Use of Statistical Power Analysis in Prospective and Retrospective Research.

JOGNN's Assistant Editor for Statistics reviews the use of power analysis for manuscripts submitted for publication consideration.

Unscreened: Urgent and Emergent Surgical Outcomes in the Early COVID-19 Pandemic.

Background Creating useful recommendations for changes in surgical protocols during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been difficult due to a lack of studies based on representative samples. This study evaluates the clinical outcomes and characteristics of patients undergoing urgent or emergent surgeries. Methods This is a multi-center (eight-hospital), retrospective, observational study of urgent and emergent surgical patients from Colorado and Kansas, the United States, in the early stages of the SARS-CoV-2 pandemic.

Barriers to Clinical Trial Enrollment in Patients With Pancreatic Adenocarcinoma Eligible for Early-Phase Clinical Trials.

Background: Early-phase clinical trials are critical to the advancement of cancer care, especially in patients with pancreatic ductal adenocarcinoma, given its aggressive nature and limited available therapeutic options.

Methods: A retrospective chart review of all patients with refractory or metastatic pancreatic ductal adenocarcinoma, referred to the Sarah Cannon Research Institute at HealthONE between 2014 and 2019, were reviewed. Patients who completed genomic profiling and qualified for a phase 1 trial (primarily 1a but some 1b) were identified to assess barriers to trial enrollment.

Improving the Quality and Design of Retrospective Clinical Outcome Studies that Utilize Electronic Health Records.

Description Electronic health records (EHRs) are an excellent source for secondary data analysis. Studies based on EHR-derived data, if designed properly, can answer previously unanswerable clinical research questions. In this paper we will highlight the benefits of large retrospective studies from secondary sources such as EHRs, examine retrospective cohort and case-control study design challenges, as well as methodological and statistical adjustment that can be made to overcome some of the inherent design limitations, in order to increase the generalizability, validity and reliability of the results obtained from these studies.

Correcting Hypokalemia in Hospitalized Patients Does Not Decrease Risk of Cardiac Arrhythmias.

Background: It is currently standard practice to correct hypokalemia for the purpose of preventing cardiac arrhythmias in all hospitalized patients. However, the efficacy of this intervention has never been previously studied.

Objective: The objective of our study was to evaluate whether patients without acute coronary syndrome or history of arrhythmias were at increased risk of clinically significant cardiac arrhythmias if their potassium level was not corrected to ≥3.

Summary of the First Annual Rocky Mountain Healthcare Symposium.

The Medical Center of Aurora, in Aurora, Colorado (USA), served as the host institution for the First Annual Rocky Mountain Healthcare Symposium. The objectives of the Symposium were to offer a series of lectures, provided by a group of internationally recognized leaders in clinical medical research on "How to conduct clinical medical research," and to allow medical residents from regional training programs to highlight their research. Twelve programs, from four US States, were represented.

Adherence to Universal Travel Screening in the Emergency Department During Epidemic Ebola Virus Disease.

Background: During the 2014 West African Ebola Virus Disease (EVD) outbreak, the U.S. Centers for Disease Control and Prevention recommended that all emergency department (ED) patients undergo travel screening for risk factors of importing EVD.