Objectives Acute kidney injury (AKI) is common in very low birth weight infants (VLBW) and is associated with increased mortality. Serum creatinine (SCr) based AKI definitions have many limitations. Non-invasive urinary biomarkers may improve early identification, differentiate etiology, and predict outcomes with AKI. Study Design We performed 2 nested case-control studies to compare the ability of six urine biomarkers to predict AKI (rise in SCr of at least 0.3 mg/dl) and mortality (death before 36 weeks post-menstrual age). Results Compared to non-AKI subjects (N=21), those with AKI (N=9) had higher maximum neutrophil gelatinase-associated lipocalin (NGAL) [OR = 1.2 (1.0, 1.6) p< 0.01; ROC AUC = 0.80] and higher maxiumum osteopontin (OPN) [OR = 3.2 (1.5, 9.9); p< 0.01; ROC AUC = 0.83]. Compared to survivors (N=100), non-survivors (N=23) had higher maximum kidney injury molecule – 1 (KIM-1) [OR = 1.1 (1.0, 1.2); p<0.02; ROC AUC = 0.64]and higher maximum OPN [OR = 1.8 (1.2, 2.7); p<0.001; AUC of ROC = 0.78]. Combination of biomarkers improved predictability for both AKI and mortality. Controlling for gestational age and, birth weight did not considerably affect results. Conclusions Urinary biomarkers can predict AKI and mortality in VLBW infants independent of gestational age and birth weight.

Background: Low health literacy is associated with poor health outcomes in many chronic diseases and may have an important role in determining surgical outcomes. This study aims to comprehensively review the current state of science on adult health literacy in surgery and to identify knowledge gaps for future research. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was conducted to identify all studies from January 2002 through May 2018 that used validated instruments to assess health literacy among adult patients undergoing surgery. Studies were assessed for quality using the Newcastle-Ottawa scale and evaluated on findings by their focus on identifying health literacy levels, understanding associations with surgical outcomes, and/or developing interventions to address low health literacy. Key Results: There were 51 studies on health literacy with data from 22,139 patients included in this review. Low health literacy was present in more than one-third of surgical patients (34%, interquartile range 16%-50%). The most commonly used validated instrument for assessment of health literacy in the surgical population was the Newest Vital Sign. Most studies were focused on identifying the prevalence of low health literacy within a surgery population (84%, n = 43). Few studies focused on understanding the association of health literacy to surgical outcomes (12%, n = 6) and even fewer studies developed interventions to address health literacy (4%, n = 2). Discussion: Low health literacy is common among surgical patients. Important opportunities exist to better understand the role of health literacy in determining surgical outcomes and to develop more health literacy-sensitive models of surgical care. [HLRP: Health Literacy Research and Practice. 2020;4(1):e45-e65.] Plain Language Summary: Health literacy has not been well-studied in surgery but likely plays an important role. In this article, we reviewed all current research on health literacy in surgery to help us understand where we are at and where we need to go. We found that low health literacy is common and we need more ways to address it in surgery. METHODS Systematic Search Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Liberati et al., 2009), a comprehensive search of the National Library of Medicine's PubMed database, Embase, Scopus database, Proquest, PsychInfo, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was performed through May 31, 2018. Through partnerships with Library Services at the University of Alabama Birmingham, keywords and medical subject heading (MESH) terms used in the search included "health literacy, " "surgical, " "post-operative, " and "surgery. " The entire search string for each database along with the number of screened abstracts can be found in Table A. Two authors (S.J.B. and I.C.D.S M.) who are experienced researchers independently evaluated abstracts of the 673 articles obt...

The American Cancer Society is a leader in the development of cancer survivorship resources. One resource of the American Cancer Society is the I Can Cope program, an educational program for cancer survivors and their families. Evaluations of this program indicate that cancer patients highly rate its objectives. Yet, there are gaps in the understanding of the full impact of the program on diverse cancer survivors. In this study, the authors used a randomized trial to evaluate the program. Participants included 140 low-income survivors (79% Black; 38% breast cancer) from community hospitals who were randomized to 4 sessions of I Can Cope (learning about cancer; understanding cancer treatments; relieving cancer pain; and keeping well in mind and body) or 4 sessions of a wellness intervention (humor, meditation, relaxation, and music therapy). The authors’ primary outcome was “met information needs.” After controlling for covariates, their analysis indicated that I Can Cope was no more effective than the wellness intervention in addressing survivor information needs relative to the learning objectives. Participants provided high overall ratings for both interventions. Self-efficacy for obtaining advice about cancer, age, education, and income were associated with information needs. Educational programs tailored to levels of self-efficacy and patient demographics may be needed.

nurses have a key role in providing patient education and support. Tailoring education programs may better target specific needs and improve the quality of cancer care of underserved patients.

Background Low health literacy is common in general populations, but its prevalence in the inflammatory bowel disease (IBD) population is unclear. The objective of this study was to assess the prevalence of low health literacy in a diverse IBD population and to identify risk factors for low health literacy. Methods Adult patients with IBD at a single-institution from November 2017 to May 2018 were assessed for health literacy using the Newest Vital Sign (NVS). Demographic and socioeconomic data were also collected. Primary outcome was the prevalence of low health literacy. Secondary outcomes were lengths of stay (LOS) and 30-day readmissions after surgical encounters. Bivariate comparisons and multivariable regression were used for analyses. Results Of 175 IBD patients, 59% were women, 23% were African-Americans, 91% had Crohn’s disease and mean age was 46 years (SD=16.7). The overall prevalence of low health literacy was 24%. Compared to white IBD patients, African-Americans had significantly higher prevalence of low health literacy (47.5 vs. 17.0%, p&lt;0.05). On multivariable analysis, low health literacy was associated with older age and African-American race (p&lt;0.05). Of 83 IBD patients undergoing abdominal surgery, mean post-operative LOS was 5.5 days and readmission rate was 28.9%. There was no significant difference between LOS and readmissions rates by health literacy levels. Conclusions Low health literacy is present in IBD populations and more common among older African-Americans. Opportunities exist for providing more health literacy-sensitive care in IBD to address disparities and to benefit those with low health literacy.