Aim To describe the experiences of frontline nurses who are working in critical care areas during the COVID‐19 pandemic with a focus on trauma and the use of substances as a coping mechanism. Design A qualitative study based on content analysis. Methods Data were collected from mid‐June 2020 to early September 2020 via an online survey. Nurses were recruited through the research webpage of the American Association of Critical Care Nurses as well as an alumni list from a large, public Midwest university. Responses to two open‐ended items were analysed: (1) personal or professional trauma the nurse had experienced; and (2) substance or alcohol use, or other mental health issues the nurse had experienced or witnessed in other nurses. Results For the item related to psychological trauma five themes were identified from 70 nurses’ comments: (1) Psychological distress in multiple forms; (2) Tsunami of death; (3) Torn between two masters; (4) Betrayal; and (5) Resiliency/posttraumatic growth through self and others. Sixty‐five nurses responded to the second item related to substance use and other mental health issues. Data supported three themes: (1) Mental health crisis NOW!!: ‘more stressed than ever and stretched thinner than ever’; (2) Nurses are turning to a variety of substances to cope; and (3) Weakened supports for coping and increased maladaptive coping due to ongoing pandemic. Conclusions This study brings novel findings to understand the experiences of nurses who care for patients with COVID‐19, including trauma experienced during disasters, the use of substances to cope and the weakening of existing support systems. Findings also reveal nurses in crisis who are in need of mental health services. Impact Support for nurses’ well‐being and mental health should include current and ongoing services offered by the organization and include screening for substance use issues.

Objective-To determine whether a web-based, interactive, breastfeeding monitoring system increased breastfeeding duration, exclusivity, and intensity as primary outcomes and decreased symptoms of postpartum depression as a secondary outcome.Methods-A two arm randomized controlled trial took place in three Midwestern hospitals. Postpartum women were randomly assigned to the control or intervention group. Women in the control group (n=57) followed the standard hospital protocol, while women in the intervention group (n= 49) were given access to an online, interactive, breastfeeding monitoring system and prompted to record breastfeeding and infant output data for 30 days. A follow-up online survey was sent to both groups at 1, 2, and 3 months to assess breastfeeding outcomes and postpartum depression.Results-For mothers and infants, there were no significant differences in demographics between groups. No significant differences in breastfeeding outcomes were found between groups at discharge (p = 0.707). A significant difference in breastfeeding outcomes was found between groups at 1, 2, and 3 months (p = 0.027, p = 0.000 and p = 0.002). Members of the intervention Corresponding Information Azza H Ahmed, DNSc, RN, IBCLC, CPNP, School of Nursing, Purdue University, 502 N. University St, West Lafayette, IN, 47907, ahmedah@purdue.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Disclosure The authors report no conflict of interest or relevant financial relationships. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript group had higher exclusive breastfeeding rates at 1, 2, and 3 months. By the end of the third month, 84% of the intervention group was breastfeeding compared to 66% in the control group. Postpartum depression symptom scores decreased for both groups at 1, 2, and 3 months (4.9±3.9, 4.3±4.9, and 3.2±3.9 for control and 4.7±4.5, 3.0±3.4, and 2.8±3.6 for intervention). However, there was no significant difference between groups at 1, 2, and 3 months (p= 0.389, 0.170, and 0.920) for depression. Conclusion-The web-based interactive breastfeeding monitoring system may be a promising intervention to improve breastfeeding duration, exclusivity, and intensity. KeywordsWeb-based interactive monitoring; Breastfeeding; e-health; Breastfeeding supportThe benefits of breastfeeding and the risks associated with formula feeding are well known. Infants who are not breastfed are at increased risk for infections that include otitis media and diarrhea, elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden ...

Supplementary data are available at Bioinformatics online.

BackgroundPatients who no-show to primary care appointments interrupt clinicians’ efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics.MethodsA prospective cohort study was conducted using data from 8,787 adult diabetic patients attending outpatient clinics associated with a medical center in Indiana. The outcomes examined were hospital admissions or ED visits in the 6 months (182 days) following the patient’s last scheduled primary care appointment. The Andersen-Gill extension of the Cox proportional hazard model was used to assess risk separately for hospital admissions and ED visits. Adjustment was made for variables associated with no-show status and acute care utilization such as gender, age, race, insurance and co-morbid status. The interaction between utilization of the acute care service in the six months prior to the appointment and no-show was computed for each model.ResultsThe six-month rate of hospital admissions following the last scheduled primary care appointment was 0.22 (s.d. = 0.83) for no-shows and 0.14 (s.d. = 0.63) for those who attended (p < 0.0001). No-show was associated with greater risk for hospitalization only among diabetics with a hospital admission in the prior six months. Among diabetic patients with a prior hospital admission, those who no-showed were at 60% greater risk for subsequent hospital admission (HR = 1.60, CI = 1.17–2.18) than those who attended their appointment. The six-month rate of ED visits following the last scheduled primary care appointment was 0.56 (s.d. = 1.48) for no-shows and 0.38 (s.d. = 1.05) for those who attended (p < 0.0001); after adjustment for covariates, no-show status was not significantly related to subsequent ED utilization.ConclusionsNo-show to a primary care appointment is associated with increased risk for hospital admission among diabetics recently hospitalized.

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