bluuebunny/crossref_metadata_2025 huggingface dataset:
Some remarks on the Lipschitz regularity of Radon transforms
Authors: Azzam Jonas , Hickman Jonathan , Li Sean
Published: May 2018

A set in the Euclidean plane is constructed whose image under the classical Radon transform is Lipschitz in every direction. It is also shown that, under mild hypotheses, for any such set the function which maps a direction to the corresponding Lipschitz constant cannot be bounded.
In silico clinical trials: concepts and early adoptions
Authors: Pappalardo Francesco , Russo Giulia , Tshinanu Flora Musuamba , Viceconti Marco
Published: May 2018

Innovations in information and communication technology infuse all branches of science, including life sciences. Nevertheless, healthcare is historically slow in adopting technological innovation, compared with other industrial sectors. In recent years, new approaches in modelling and simulation have started to provide important insights in biomedicine, opening the way for their potential use in the reduction, refinement and partial substitution of both animal and human experimentation. In light of this evidence, the European Parliament and the United States Congress made similar recommendations to their respective regulators to allow wider use of modelling and simulation within the regulatory process. In the context of in silico medicine, the term ‘in silico clinical trials’ refers to the development of patient-specific models to form virtual cohorts for testing the safety and/or efficacy of new drugs and of new medical devices. Moreover, it could be envisaged that a virtual set of patients could complement a clinical trial (reducing the number of enrolled patients and improving statistical significance), and/or advise clinical decisions. This article will review the current state of in silico clinical trials and outline directions for a full-scale adoption of patient-specific modelling and simulation in the regulatory evaluation of biomedical products. In particular, we will focus on the development of vaccine therapies, which represents, in our opinion, an ideal target for this innovative approach.
Nukes and Nudes: Counter-Hegemonic Identities in the Nuclearized Pacific
Authors: Maurer Anaïs
Published: May 2018

France’s current status as a leading world power results directly from its decision to develop a nuclear strike capability. After the loss of most of their empire, the French decided that their territories in the Pacific should remain an integral part of France. There followed an extensive programme of nuclear testing in the region, causing ongoing environmental damage and radiation-related illnesses throughout these remnants of the French empire. The present article examines contemporary francophone Pacific literature as a corpus shaped by France’s nuclear colonialism. Focusing on novels by Déwé Gorodé and Chantal Spitz, I show how these authors replace the colonial imagery of the welcoming native with anti-colonial narratives of radiation-induced diseases and ambient morbidity. I argue that these novels, often critiqued as essentialist, should be read as a reformulation of strategic essentialism putting ecocriticism at the heart of postcolonial thinking. This discussion brings Pacific theories of identity into dialogue with other postcolonial theories such as
créolité
, Negritude, and critiques of orientalism, suggesting that, in a context in which
métissage
and multiculturalism have become ideologies in the service of nuclear colonization, root-based strategic essentialism still has an important role to play in postcolonial narratives.
New Sharp Gagliardo–Nirenberg–Sobolev Inequalities and an Improved Borell–Brascamp–Lieb Inequality
Authors: Bolley François , Cordero-Erausquin Dario , Fujita Yasuhiro , Gentil Ivan , Guillin Arnaud
Published: May 2018

We propose a new Borell–Brascamp–Lieb inequality that leads to novel sharp Euclidean inequalities such as Gagliardo–Nirenberg–Sobolev inequalities in $ {\mathbb{R}}^n$ and in the half-space $ {\mathbb{R}}^n_+$. This gives a new bridge between the geometric point of view of the Brunn–Minkowski inequality and the functional point of view of the Sobolev-type inequalities. In this way we unify, simplify, and generalize results by S. Bobkov–M. Ledoux, M. del Pino–J. Dolbeault, and B. Nazaret.
A lower limit to the accretion disc radius in the low-luminosity AGNNGC 1052 derived from high-angular resolution data
Authors: Reb Lennart , Fernández-Ontiveros Juan A , Prieto M Almudena , Dolag Klaus
Published: May 2018

We investigate the central sub-arcsec region of the low-luminosity active galactic nucleusNGC 1052, using a high-angular resolution data set that covers 10 orders of magnitude in frequency. This allows us to infer the continuum emission within the innermost ∼17 pc around the black hole to be of non-thermal, synchrotron origin and to set a limit to the maximum contribution of a standard accretion disc. Assuming the canonical 10 per cent mass–light conversion efficiency for the standard accretion disc, its inferred accretion power would be too low by one order of magnitude to account for the observed continuum luminosity. We thus introduce a truncated accretion disc and derive a truncation radius to mass–light conversion efficiency relation, which we use to reconcile the inferred accretion power with the continuum luminosity. As a result we find that a disc providing the necessary accretion power must be truncated at rtr ≳ 26 rg, consistent with the inner radius derived from the observations of the Fe Kα line in the X-ray spectrum of this nucleus. This is the first time to derive a limit on the truncation radius of the accretion disc from high-angular resolution data only.
Outcomes According to Discharge Location for Persons Who Inject Drugs Receiving Outpatient Parenteral Antimicrobial Therapy
Authors: D’Couto Helen T , Robbins Gregory K , Ard Kevin L , Wakeman Sarah E , Alves Justin , Nelson Sandra B
Published: May 2018

Background

Opioid use disorder poses a significant public health risk. Persons who inject drugs (PWID) suffer from high mortality and morbidity secondary to serious infectious diseases, often requiring prolonged courses of outpatient parenteral antibiotics. The goal of this study was to determine the outcomes of PWID discharged to home or to a skilled nursing or rehabilitation facility (SNF/rehab) with parenteral antibiotic treatment under an outpatient parenteral antimicrobial therapy (OPAT) program.

Methods

This is a retrospective observational study. The study population was identified via hospital and OPAT databases using substance use disorder diagnoses and confirmed through chart review. The study population included hospitalized PWID with injection drug use in the preceding 2 years who were discharged between 2010 and 2015 to complete at least 2 weeks of parenteral antibiotics and monitored by the OPAT program. Retrospective chart review was used to describe patient characteristics and outcomes.

Results

Fifty-two patients met inclusion criteria, 21 of whom were discharged to home and 31 were discharged to a SNF/rehab. Of the patients discharged to home, 17 (81%) completed their planned antibiotic courses without complication. Twenty (64%) patients discharged to a SNF/rehab completed the antibiotic courses without complication. Six (11%) patients had line infections, 6 (11%) had injection drug use relapse, and 12 (23%) required readmission.

Conclusions

Persons who inject drugs discharged home were not more likely to have complications than those discharged to a SNF/rehab. Home OPAT may be a safe discharge option in carefully selected patients.
Effect of Body Temperature on Cerebral Autoregulation in Acutely Comatose Neurocritically Ill Patients
Authors: Adatia Krishma , Geocadin Romergryko G. , Healy Ryan , Ziai Wendy , Ponce-Mejia Luciano , Anderson-White Mirinda , Shah Dhaval , Radzik Batya R. , Palmisano Caitlin , Hogue Charles W. , Brown Charles , Rivera-Lara Lucia
Published: May 2018

Objectives:

Impaired cerebral autoregulation following neurologic injury is a predictor of poor clinical outcome. We aimed to assess the relationship between body temperature and cerebral autoregulation in comatose patients.

Design:

Retrospective analysis of prospectively collected data.

Setting:

Neurocritical care unit of the Johns Hopkins Hospital.

Patients:

Eighty-five acutely comatose patients (Glasgow Coma Scale score of ≤ 8) admitted between 2013 and 2017.

Interventions:

None.

Measurement and Main Results:

Cerebral autoregulation was monitored using multimodal monitoring with near-infrared spectroscopy–derived cerebral oximetry index. Cerebral oximetry index was calculated as a Pearson correlation coefficient between low-frequency changes in regional cerebral oxygenation saturation and mean arterial pressure. Patients were initially analyzed together, then stratified by temperature pattern over the monitoring period: no change (< 1°C difference between highest and lowest temperatures; n = 11), increasing (≥ 1°C; n = 9), decreasing (≥ 1°C; n = 9), and fluctuating (≥ 1°C difference but no sustained direction of change; n = 56). Mixed random effects models with random intercept and multivariable logistic regression analysis were used to assess the association between hourly temperature and cerebral oximetry index, as well as between temperature and clinical outcomes. Cerebral oximetry index showed a positive linear relationship with temperature (β = 0.04 ± 0.10; p = 0.29). In patients where a continual increase or decrease in temperature was seen during the monitoring period, every 1°C change in temperature resulted in a cerebral oximetry index change in the same direction by 0.04 ± 0.01 (p < 0.001) and 0.02 ± 0.01 (p = 0.12), respectively, after adjusting for Paco
2, hemoglobin, mean arterial pressure, vasopressor and sedation use, and temperature probe location. There was no significant difference in mortality or poor outcome (modified Rankin Scale score of 4–6) between temperature pattern groups at discharge, 3, or 6 months.

Conclusions:

In acute coma patients, increasing body temperature is associated with worsening cerebral autoregulation as measured by cerebral oximetry index. More studies are needed to clarify the impact of increasing temperature on cerebral autoregulation in patients with acute brain injury.
National Trends (2009–2013) for Palliative Care Utilization for Patients Receiving Prolonged Mechanical Ventilation*
Authors: Chatterjee Kshitij , Goyal Abhinav , Kakkera Krishna , Harrington Sarah , Corwin Howard L.
Published: May 2018

Objectives:

Patients requiring mechanical ventilation have high morbidity and mortality. Providing palliative care services has been suggested as a way to improve comprehensive management of critically ill patients. We examined the trend in the utilization of palliative care among adults who require prolonged mechanical ventilation. Primary objectives were to determine the trend in palliative care utilization over time, predictors for palliative care utilization, and palliative care impact on hospital length of stay.

Design:

Retrospective, cross-sectional study.

Setting:

The National Inpatient Sample data between 2009 and 2013 was used for this study.

Patients:

Adults (age ≥ 18 yr) who underwent prolonged mechanical ventilation (≥ 96 consecutive hr) were studied.

Measurements and Main Results:

Palliative care and mechanical ventilation were identified using the corresponding International Classification of Diseases, 9th revision, Clinical Modification, codes. A total of 1,751,870 hospitalizations with prolonged mechanical ventilation were identified between 2009 and 2013. The utilization of palliative care increased yearly from 6.5% in 2009 to 13.1% in 2013 (p < 0.001). Among the mechanically ventilated patients who died, palliative care increased from 15.9% in 2009 to 33.3% in 2013 (p < 0.001). Median hospital length of stay for patients with and without palliative care was 13 and 17 days, respectively (p < 0.001). Patients discharged to either short- or long-term care facilities had a shorter length of stay if palliative care was provided (15 vs 19 d; p < 0.001). The factors associated with a higher palliative care utilization included older age, malignancy, larger hospitals in urban areas, and teaching hospitals. Non-Caucasian race was associated with lower palliative care utilization.

Conclusions:

Among patients who undergo prolonged mechanical ventilation, palliative care utilization is increasing, particularly in patients who die during hospitalization. Using palliative care for mechanically ventilated patients who are discharged to either short- or long-term care facilities is associated with a shorter hospital length of stay.
Insidious Harm of Medication Diluents as a Contributor to Cumulative Volume and Hyperchloremia: A Prospective, Open-Label, Sequential Period Pilot Study*
Authors: Magee Carolyn A. , Bastin Melissa L. Thompson , Laine Melanie E. , Bissell Brittany D. , Howington Gavin T. , Moran Peter R. , McCleary Emily J. , Owen Gary D. , Kane Lauren E. , Higdon Emily A. , Pierce Cathy A. , Morris Peter E. , Flannery Alexander H.
Published: May 2018

Objectives:

Although the potential dangers of hyperchloremia from resuscitation fluids continue to emerge, no study to date has considered the contribution of medication diluents to cumulative volume and hyperchloremia. This study compares saline versus dextrose 5% in water as the primary medication diluent and the occurrence of hyperchloremia in critically ill patients.

Design:

Prospective, open-label, sequential period pilot study.

Setting:

Medical ICU of a large academic medical center.

Patients:

Adult patients admitted to the medical ICU were eligible for inclusion. Patients who were admitted for less than 48 hours, less than 18 years old, pregnant, incarcerated, or who had brain injury were excluded.

Interventions:

Saline as the primary medication diluent for 2 months followed by dextrose 5% in water as the primary medication diluent for 2 months.

Measurements and Main Results:

A total of 426 patients were included, 216 in the saline group and 210 in the dextrose 5% in water group. Medication diluents accounted for 63% of the total IV volume over the observation period. In the saline group, 17.9% developed hyperchloremia compared with 10.5% in the dextrose 5% in water group (p = 0.037), which was statistically significant in multivariable analysis (odds ratio, 0.50; 95% CI, 0.26–0.94; p = 0.031). In the saline group, 34.2% developed acute kidney injury versus 24.5% in the dextrose 5% in water group (p = 0.035); however, this was not statistically significant when adjusting for baseline covariates. No other significant differences in dysnatremias, insulin requirements, glucose control, ICU length of stay, or ICU mortality were observed.

Conclusions:

This study identified that medication diluents contribute substantially to the total IV volume received by critically ill patients. Saline as the primary medication diluent compared with dextrose 5% in water is associated with hyperchloremia, a possible risk factor for acute kidney injury.
Platelet Transfusion Practices in Critically Ill Children
Authors: Nellis Marianne E. , Karam Oliver , Mauer Elizabeth , Cushing Melissa M. , Davis Peter J. , Steiner Marie E. , Tucci Marisa , Stanworth Simon J. , Spinella Philip C.
Published: May 2018

Objectives:

Little is known about platelet transfusions in pediatric critical illness. We sought to describe the epidemiology, indications, and outcomes of platelet transfusions among critically ill children.

Design:

Prospective cohort study.

Setting:

Multicenter (82 PICUs), international (16 countries) from September 2016 to April 2017.

Patients:

Children ages 3 days to 16 years prescribed a platelet transfusion in the ICU during screening days.

Interventions:

None.

Measurements and Main Results:

Over 6 weeks, 16,934 patients were eligible, and 559 received at least one platelet transfusion (prevalence, 3.3%). The indications for transfusion included prophylaxis (67%), minor bleeding (21%), and major bleeding (12%). Thirty-four percent of prophylactic platelet transfusions were prescribed when the platelet count was greater than or equal to 50 × 109 cells/L. The median (interquartile range) change in platelet count post transfusion was 48 × 109 cells/L (17–82 × 109 cells/L) for major bleeding, 42 × 109 cells/L (16–80 × 109 cells/L) for prophylactic transfusions to meet a defined threshold, 38 × 109 cells/L (17–72 × 109 cells/L) for minor bleeding, and 25 × 109 cells/L (10–47 × 109 cells/L) for prophylaxis in patients at risk of bleeding from a device. Overall ICU mortality was 25% but varied from 18% to 35% based on indication for transfusion. Upon adjusted analysis, total administered platelet dose was independently associated with increased ICU mortality (odds ratio for each additional 1 mL/kg platelets transfused, 1.002; 95% CI, 1.001–1.003; p = 0.005).

Conclusions:

The majority of platelet transfusions are given as prophylaxis to nonbleeding children, and significant variation in platelet thresholds exists. Studies are needed to clarify appropriate indications, with focus on prophylactic transfusions.
Benzodiazepines and Development of Delirium in Critically Ill Children: Estimating the Causal Effect*
Authors: Mody Kalgi , Kaur Savneet , Mauer Elizabeth A. , Gerber Linda M. , Greenwald Bruce M. , Silver Gabrielle , Traube Chani
Published: May 2018

Objectives:

Benzodiazepine use may be associated with delirium in critically ill children. However, benzodiazepines remain the first-line sedative choice in PICUs. Objectives were to determine the temporal relationship between administration of benzodiazepines and delirium development, control for time-varying covariates such as mechanical ventilation and opiates, and evaluate the association between dosage of benzodiazepines and subsequent delirium.

Design:

Retrospective observational study.

Setting:

Academic tertiary care PICU.

Patients:

All consecutive admissions from January 2015 to June 2015.

Interventions:

Retrospective assessment of benzodiazepine exposure in a population that had been prospectively screened for delirium.

Measurements and Main Results:

All subjects were prospectively screened for delirium throughout their stay, using the Cornell Assessment for Pediatric Delirium, with daily cognitive status assigned as follows: delirium, coma, or normal. Multivariable mixed effects modeling determined predictors of delirium overall, followed by subgroup analysis to assess effect of benzodiazepines on subsequent development of delirium. Marginal structural modeling was used to create a pseudorandomized sample and control for time-dependent variables, obtaining an unbiased estimate of the relationship between benzodiazepines and next day delirium. The cumulative daily dosage of benzodiazepines was calculated to test for a dose-response relationship. Benzodiazepines were strongly associated with transition from normal cognitive status to delirium, more than quadrupling delirium rates (odds ratio, 4.4; CI, 1.7–11.1; p < 0.002). Marginal structural modeling demonstrated odds ratio 3.3 (CI, 1.4–7.8), after controlling for time-dependent confounding of cognitive status, mechanical ventilation, and opiates. With every one log increase in benzodiazepine dosage administered, there was a 43% increase in risk for delirium development.

Conclusions:

Benzodiazepines are an independent and modifiable risk factor for development of delirium in critically ill children, even after carefully controlling for time-dependent covariates, with a dose-response effect. This temporal relationship suggests causality between benzodiazepine exposure and pediatric delirium and supports limiting the use of benzodiazepines in critically ill children.
Sociocultural factors influencing infant-feeding choices among African immigrant women living with HIV: A synthesis of the literature
Authors: Etowa Josephine , MacDonald Shannan , Hannan Jean , Phillips J. Craig , Boadu Nana Yaa , Babatunde Seye
Published: May 2018

Background and purpose:

The World Health Organizations (WHO) strategy is to eliminate pediatric HIV. HIV prevention guidelines in high-income countries recommend mothers living with HIV avoid breastfeeding. Yet, breastfeeding is promoted as the normal and unequalled method of feeding infants. This creates a paradox for mothers coming from cultures where breastfeeding is an expectation and formula feeding suggests illness. Therefore, the purpose of this literature review is to examine the context influencing infant feeding among African immigrant women living with HIV to develop interventions to reduce the risk of HIV mother-to-child transmission.

Methods:

Using the PEN-3 cultural model as a guide, we selected 45 empirical studies between 2001 and 2016 using 5 electronic databases on the sociocultural factors influencing infant-feeding choices and practices among African women from HIV endemic countries.

Conclusions:

Findings are congruent with the importance of culture when developing guidelines. Our review provides support that culture-centered interventions are crucial toward achieving the WHO's strategy to eliminate pediatric HIV.

Implications for practice:

Understanding the sociocultural determinants of infant-feeding choices is critical to the development of prevention initiatives to eliminate pediatric HIV.
Health and educational implications of prematurity in the United States: National Survey of Children's Health 2011/2012 data
Authors: Kelly Michelle M.
Published: May 2018

Background and purpose:

Preterm birth is a significant public health issue, with children born prematurely experiencing educational and health difficulties throughout childhood. The aim of the descriptive secondary data analysis was to compare health implications and educational experiences in children born prematurely compared with children born at term.

Methods:

The 2011/2012 National Survey of Children's Health data set was explored using separate chi-square tests of homogeneity to investigate differences in the occurrence of chronic health conditions and educationally relevant outcomes: individualized family services plan/individualized education plan (IFSP/IEP), and grade repetition between children born prematurely compared with those born at term.

Conclusions:

The six most frequently occurring chronic health conditions that disproportionally affected children born prematurely include the following: attention deficit disorder/attention deficit hyperactive disorder (odds ratio [OR], 1.59), anxiety (OR, 1.63), asthma (OR, 1.7), learning disability (OR, 2.07), speech problems (OR, 2.27), and developmental delay (OR, 3.17). Preterm birth negatively affects the educational experience of CBP as measured by increased report of IFSP/IEP and repeated grades across all age categories.

Implications for practice:

All health care providers have an important role in preventing preterm birth and in supporting the children and families affected by preterm birth. Appreciation of the incidence and prevalence of the health conditions and educational difficulties associated with preterm birth is essential for facilitating access to appropriate resources. Beyond patient interactions, these modifiable yet additive factors should inform health policy and planning.
Leveraging health care reform to accelerate nurse practitioner full practice authority
Authors: Brom Heather M. , Salsberry Pamela J. , Graham Margaret Clark
Published: May 2018

Background and purpose:

Since development of the nurse practitioner (NP) role, NPs have been advocating for policy allowing them to practice to the full extent of their training. The aim of this research was to determine whether passage of the Affordable Care Act (ACA) had an impact on expansion of NPs' scope of practice.

Methods:

This was a retrospective descriptive study of NPs' scope of practice legislation from 1994 to 2016 using regulatory theory. Data sources included annual reports on NP legislation and state-level legislative and media coverage.

Conclusions:

Eight states adopted full practice authority (FPA) from 2011 to 2016, representing a two-fold increase compared with the previous 10 years. Seven states adopted Medicaid expansion. Nursing interest groups and politicians shaped their argument in favor of FPA around the increasingly insured population because of the ACA, provider shortages, and rural health care access issues.

Implications for practice:

Shaping the discourse of FPA beyond the benefits to the NP profession makes way for broader political interest and participation. Although the future of the ACA is unknown, as the 28 states without FPA continue to advocate for legislative change, they could benefit from the strategies of these newly adapted FPA states.
Management of venous thromboembolism with non–vitamin K oral anticoagulants: A review for nurse practitioners and pharmacists
Authors: Schmerge Michelle , Earl Sally , Kline Carol
Published: May 2018

Background and purpose:

Venous thromboembolism (VTE), comprising deep-vein thrombosis and pulmonary embolism, is associated with significant morbidity and mortality. Non–vitamin K oral anticoagulants (NOACs), including apixaban, betrixaban, dabigatran, edoxaban, and rivaroxaban, are as effective and safe as vitamin K antagonists (VKAs) for primary prophylaxis, treatment, and/or secondary prevention of VTE and present significant advantages in convenience of use. This review provides guidance to nurse practitioners (NPs) and pharmacists on NOAC usage for the management of VTE and examines how traditional anticoagulation clinics can adapt to cater to patients on NOACs.

Methods:

A review of the scientific literature pertaining to treatment guideline recommendations, large randomized clinical trials, and real-world evidence studies related to VTE management was conducted.

Conclusions:

With current data suggesting that NOACs may present as better alternatives over VKAs for the management of VTE, comprehensively educating NPs and pharmacists can help incorporate these agents in their clinical practice.

Implications for practice:

Repurposing anticoagulation clinics, led by well-informed NPs and pharmacists, will allow effective integration and optimal management of patients with VTE taking NOACs as well as those taking VKAs.
Increasing diabetic patient engagement and self-reported medication adherence using a web-based multimedia program
Authors: Elsabrout Kerri
Published: May 2018

Background and purpose:

Evidence-based, multimedia applications to supplement clinical care can improve patient engagement and clinical outcomes. Patients with diabetes with potentially devastating complication of foot ulcers present a substantial opportunity to improve engagement. This project examines how providing an online, multimedia self-management program affects patient engagement and self-reported medication adherence scores within 4–6 weeks compared with preprogram scores.

Methods:

Participants included 14 adult, diabetic outpatients receiving care at a Wound Care Center in suburban New York. Participants watched a Type 2 diabetes Emmi educational module on an electronic tablet during a routine wound treatment visit. Self-reported medication adherence was measured immediately before and at 4–6 weeks after the educational intervention. Patient engagement was measured immediately before, immediately after, and at 4–6 weeks postintervention.

Conclusions:

Self-reported medication adherence results demonstrated a modest increase at the delayed postintervention time. In addition, there was a large increase in engagement scores at the delayed postintervention time. The direction of change for both measures was consistent with the intervention being effective.

Implications for practice:

Incorporating this type of novel, multimedia patient education resource may provide opportunities to enhance diabetes care.
Using a Dyspnea Assessment Tool to Improve Care at the End of Life
Authors: Birkholz Lorri , Haney Tina
Published: May 2018

Dyspnea is experienced by 15% to 70% of patients at end of life. Because of cognitive changes before death, patients may be unable to self-report dyspnea, which requires nurses to accurately assess and initiate symptom management. This study compared practicing nurses' experiential practice in the assessment and management of dyspnea in patients unable to self-report to practice using of the Respiratory Distress Observation Scale (RDOS). This pre-experimental pretest/posttest study evaluated nurse outcomes following a structured educational program aimed at preparing them to use the RDOS. Nurses (n = 39) who provide end-of-life care were recruited for the study. After receiving the educational program, there was not a significant difference in the nurse's ability to assess the patient's overall level of perceived comfort and determine a differential diagnosis. There was, however, improvement in the nurse's ability to correctly determine a patient's level of dyspnea (P = .021) and also in their ability to select appropriate treatment options. This study demonstrates applicability of the RDOS to the end-of-life population replacing experiential practice with an evidence-based tool for the assessment and treatment of dyspnea in patients who cannot self-report.
Measuring the Impact of the Home Health Nursing Shortage on Family Caregivers of Children Receiving Palliative Care
Authors: Weaver Meaghann S. , Wichman Brittany , Bace Sue , Schroeder Denice , Vail Catherine , Wichman Chris , Macfadyen Andrew
Published: May 2018

The national nursing shortage translates into a gap in home nursing care available to children with complex, chronic medical conditions and their family caregivers receiving palliative care consultations. A total of 38 home health nursing surveys were completed by families receiving pediatric palliative care consultation services at a freestanding children's hospital in the Midwest. The gap in the average number of nursing hours allotted versus received was 40 h/wk per family, primarily during evening hours. Parents missed an average of 23 hours of employment per week to provide hands-on nursing care at home, ranking stress regarding personal employment due to nursing shortage at 6.2/10. Families invested an average of 10 h/mo searching for additional nursing coverage and often resorted to utilizing more than 6 different home nurse coverage personnel per month. Families reported multiple delays to hospital discharges (mean, 15 days per delay) due to inability to find home nursing coverage. Respiratory technology and lack of Medicaid coverage (P < .02) correlated with the gap in home nursing access. This study examines how the pediatric home nursing shortage translates into a lived experience for families with children with complex medical conditions receiving palliative care.
Nursing Students’ Perceptions of Spirituality and Spiritual Care and Their Spiritual Care Competencies
Authors: Kalkim Asli , Sagkal Midilli Tulay , Daghan Safak
Published: May 2018

This research aimed to describe nursing students’ perceptions of spirituality and spiritual care and their spiritual care competencies and to investigate the relationship between these variables. The sample of this descriptive and correlational study consisted of 325 nursing students. The questionnaires used in the study were the Student Nurse Information Form, the Spirituality and Spiritual Care Rating Scale, and the Spiritual Care Competency Scale. The mean scores of the Turkish versions of Spirituality and Spiritual Care Rating Scale and Spiritual Care Competency Scale were 3.90 ± 0.45 and 3.69 ± 0.68. Importance to giving spiritual care to the patients in nursing care, willingness to receive training in spiritual care, and listening to patients to meet their spiritual requirements accounted for 17% of the spirituality and spiritual care perceptions of the students (F = 16.118, P = .001, R
2 = 0.17). The participants’ spirituality and spiritual care perception levels accounted for 14% of their spiritual care competences (F = 16.851, P = .001, R
2 = 0.14). It was determined that the students’ perceptions of spiritual care competence were not at the desired level and that they should be improved. Therefore, it is recommended that changes should be made in the curricula and that training programs should be improved in order to strengthen students’ spiritual care competency.
The Advancement of Palliative Care in Rwanda
Authors: Rosa William E. , Male Marcia A. , Uwimana Philomene , Ntizimira Christian R. , Sego Ruth , Nankundwa Evelyne , Byiringiro Samuel , Nsereko Etienne , Moreland Patricia J.
Published: May 2018

At the heart of palliative care philosophy lies the requisite of expert collaboration across disciplines, specialties, and organizations to provide patient- and family-centered care. When working in a global health setting, myriad interpersonal and cross-cultural considerations must be acknowledged to promote effective communication and coordination between stakeholders. The purpose of this article is to share the experiences of those working to advance palliative care in Rwanda, East Africa, and examine their collective journeys in practice, education, and research. Through the exemplar of Rwanda's Human Resources for Health Program, this narrative provides contextual wisdom for nurses endeavoring to advance palliative care in resource-poor settings and offers lessons learned along the journey. When working internationally, understanding the identity of nursing against the backdrop of local-national-professional-political culture is crucial. Developing relationships with on-the-ground leaders to guide cultural adaptation is likely the most critical factor. This experience has sparked evolving palliative care research and the continued dissemination of palliative care knowledge. Mutually beneficial partnerships have been, and continue to be, the backbone of palliative care advancement in Rwanda. It is essential that nurses teaching palliative care continue to adapt education to support the ongoing development of culturally relevant palliative care literacy across nations.
Stroke Severity Affects Timing
Authors: Kwei Kimberly T. , Liang John , Wilson Natalie , Tuhrim Stanley , Dhamoon Mandip
Published: May 2018

Optimizing the time it takes to get a potential stroke patient to imaging is essential in a rapid stroke response. At our hospital, door-to-imaging time is comprised of 2 time periods: the time before a stroke is recognized, followed by the period after the stroke code is called during which the stroke team assesses and brings the patient to the computed tomography scanner. To control for delays due to triage, we isolated the time period after a potential stroke has been recognized, as few studies have examined the biases of stroke code responders. This “code-to-imaging time” (CIT) encompassed the time from stroke code activation to initial imaging, and we hypothesized that perception of stroke severity would affect how quickly stroke code responders act. In consecutively admitted ischemic stroke patients at The Mount Sinai Hospital emergency department, we tested associations between National Institutes of Health Stroke Scale scores (NIHSS), continuously and at different cutoffs, and CIT using spline regression, t tests for univariate analysis, and multivariable linear regression adjusting for age, sex, and race/ethnicity. In our study population, mean CIT was 26 minutes, and mean presentation NIHSS was 8. In univariate and multivariate analyses comparing CIT between mild and severe strokes, stroke scale scores <4 were associated with longer response times. Milder strokes are associated with a longer CIT with a threshold effect at a NIHSS of 4.
Neuromyelitis Optica and Herpes Simplex Virus 2
Authors: Marin Collazo I. Vanessa , Howe Charles L. , Lucchinetti Claudia F. , Tobin W. Oliver
Published: May 2018

The clinical and radiographic spectrum of Neuromyelitis optica spectrum disorder has broadened following the description of the aquaporin-4 antibody. The initial triggering event and reason for disease quiescence between relapses is unclear. We present a case of myeloradiculitis associated with aquaporin-4 antibody and concomitant herpes simplex virus 2 infection.
Signal Changes in the Dentate Nucleus and Globus Pallidus on Unenhanced T1-Weighted Magnetic Resonance Images After Intrathecal Administration of Macrocyclic Gadolinium Contrast Agent
Authors: Ozturk Kerem , Nas Omer Fatih , Soylu Esra , Hakyemez Bahattin
Published: May 2018

Objectives

The aim of this study was to evaluate signal changes in the dentate nucleus and globus pallidus (GP) on unenhanced T1-weighted magnetic resonance (MR) images (T1 WI) in a cohort of patients who have received intrathecal macrocyclic ionic gadolinium-based contrast agent (GBCA) gadoterate meglumine.

Materials and Methods

A group of 20 patients (male/female ratio, 8:12; mean age, 39.5 ± 15.5 years) who had not received intravenous GBCA but had received an intrathecal macrocyclic ionic GBCA (plus baseline and an additional final magnetic resonance imaging [MRI] for reference) from 2012 to 2017 were retrospectively included in this institutional review board–approved study. Two radiologists inspected T1-weighted 2-dimensional spin echo (n = 7) and 3-dimensional isotropic turbo field echo (n = 13) images on a 3 T MRI system to conduct visual evaluation and quantitative analysis. Baseline and final examination signal intensity (SI) ratios were assessed across time by using the same pulse sequences. For visual analysis, SI changes on the GP, thalamus (Th), cerebellar peduncle (CP), and dentate nucleus (DN) were graded as a 3-point scale. For quantitative analysis, SI ratio differences between the baseline and final MR examinations were estimated for the DN-to-CP and GP-to-Th ratios. One-sample t tests were used to investigate whether they differed from 0. In addition, to investigate significant differences between the SI ratios for various pulse sequences, t tests were performed. The regression analysis was additionally used to find any correlation between SI ratio differences and various confounding variables including age, sex, or the mean interval between the baseline and final MR examinations.

Results

The SI ratio differences did not deviate significantly from 0, neither for the DN/CP ratio (0.013 ± 0.0584, P = 0.287) nor the GP/Th ratio (−0.0113 ± 0.0546, P = 0.366). The DN-to-CP and GP-to-Th SI ratio differences did not significantly deviate from 0 in the patient groups in either of the imaging sequences (P > 0.05) as well. Age, sex, and the mean interval between examinations did not influence SI ratio differences between examinations (P > 0.05).

Conclusions

Intrathecal macrocyclic GBCA administration was not associated with measurable T1 SI changes in the GP and DN as an indicator of brain gadolinium deposition detectable by MRI.
Targeted Imaging of Renal Fibrosis Using Antibody-Conjugated Gold Nanoparticles in Renal Artery Stenosis
Authors: Zhu Xiang-Yang , Zou Xiangyu , Mukherjee Rahul , Yu Zhicong , Ferguson Christopher M. , Zhou Wei , McCollough Cynthia H. , Lerman Lilach O.
Published: May 2018

Objectives

The ability to determine the severity of renal fibrosis, which is involved in most chronic kidney diseases, may be beneficial for monitoring disease progression and management. The aim of this study was to assess a new method involving gold nanoparticles conjugated to an anti-collagen-I antibody (Co-I-AuNPs) as a computed tomography (CT) imaging contrast for the evaluation of renal fibrosis in situ.

Materials and Methods

Gold nanoparticles conjugated to an anti-collagen-I antibody were prepared using gold chloride reduction with sodium citrate and coated with polyethylene glycol (PEG), and their size was determined by electron microscopy and nanoparticle tracking analysis. Anti-collagen-I antibody was then conjugated to PEG-SH/COOH on the AuNP surface. The success of antibody conjugation was tested in vitro using collagen-coated plate and mouse stenotic kidney sections and in vivo using micro-CT and multidetector CT imaging.

Results

Bare AuNPs were 18.7 ± 0.6 nm and PEG-coated AuNPs were 45.3 ± 0.1 nm in size. In vitro, Co-I-AuNPs specifically bound to both a collagen-coated plate and mouse fibrotic kidneys. Furthermore, the stenotic mouse kidney showed increased Co-I-AuNPs retention compared with the contralateral kidney (59.3 ± 5.1 vs 45.1 ± 1.7 HU, P = 0.05), which correlated with its collagen deposition. Micro-CT also detected gold signals in situ in the Co-I-AuNP-injected kidney, which colocalized with histological trichrome staining.

Conclusion

Gold nanoparticles conjugated to an anti-collagen-I antibody are able to visualize kidney fibrosis in vitro and in situ and may be useful for nondestructive quantification of tissue fibrosis.
Imaging Features of Extramammary Paget Disease of the Scrotum
Authors: Choi Sang Lim , Park Sung Bin , Lee Eun Sun , Park Hyun Jeong , Lee Jong Beum , Choi Byung Ihn
Published: May 2018

Extramammary Paget disease (EMPD) is a rare intraepithelial malignancy originating in areas rich in apocrine glands, such as the vulva, perineum, perianal area, scrotum, and penis. A few reports of EMPD involving the scrotum have been described in the literature. However, only few reports have described imaging features observed in patients presenting with EMPD. We report EMPD in a patient showing scrotal involvement, focusing on imaging features, particularly those determined ultrasonographically.
Incontinence-Associated Dermatitis and Intertriginous Dermatitis as Nurse-Sensitive Quality Indicators
Authors: Arnold-Long Mary , Emmons Kevin , Chovan John D.
Published: May 2018

PURPOSE:

This purpose of this study was to determine whether consensus exists concerning the need to collect epidemiologic data about 2 forms of moisture-associated skin damage, incontinence-associated dermatitis (IAD) and intertriginous dermatitis (ITD), and whether these data should be part of data routinely collected as part of the National Database of Nursing Quality Indicators (NDNQI).

DESIGN:

Modified Delphi technique.

SAMPLE AND SETTING:

Questionnaires were sent via e-mail to 50 identified experts, with an initial response of 17. Thirteen clinical experts responded to the second round and 11 responded to a third round.

METHODS:

Items on the questionnaires were investigator-developed. Consensus was defined as 80% or more agreement. Three rounds of questionnaires were employed to attempt consensus. Descriptive statistics were performed using mean and standard deviation for continuous data and frequencies and percentages for categorical data. Qualitative data were analyzed question by question by the primary researcher using content analysis.

RESULTS:

Consensus was achieved indicating that individual facilities should regularly collect data about IAD prevalence or incidence. Consensus was not reached about the need to regularly collect data about ITD prevalence or incidence. Panelists also failed to reach consensus that IAD or ITD prevalence or incidence should be incorporated into the NDNQI indicators.

CONCLUSION:

Panelists did not reach consensus that IAD or ITD epidemiologic data should be incorporated on the NDNQI. Additional research is needed, particularly in the area of ITD, before benchmarks can be established regarding these data as nurse-sensitive indicators of quality care.
A Survey of Canadian Occupational Therapy Practices to Prevent Pressure Injuries Among Wheelchair Users via Weight Shifting
Authors: Mortenson W. Ben , Thompson Sarah C. , Wright Alison L. , Boily Jeanette , Waldorf Kevin , Leznoff Sandy
Published: May 2018

PURPOSE:

The purpose of this study was to describe occupational therapy weight-shifting practices and explore recommended strategies for patients, healthcare staff, and family/caregivers across healthcare settings.

DESIGN:

Cross-sectional survey.

SUBJECTS AND SETTING:

Respondents included 97 currently practicing occupational therapists working in 5 main practice settings (ie, acute care, inpatient rehabilitation, outpatient rehabilitation, home and community care, and residential) from 9 out of 10 Canadian provinces.

METHODS:

We created a 25-item questionnaire that included forced choice and open-ended queries. Items queried demographic information, weight-shifting techniques taught to patients, frequency and duration of weight shifting recommended, educational approaches used to teach weight shifting, and resources used to guide decision making. Participants were recruited via professional organizations and health authorities across Canada. Participants were excluded if they were not currently working with manual or power wheelchair users. Descriptive statistics were used to analyze quantitative data, and content analysis was used for qualitative data (responses to open-ended queries).

RESULTS:

The most frequently recommended weight-shifting techniques were tilt (83.3%-92.8%), leaning to one side (47.9%-87.5%), and forward leaning (46.9%-83.3%). Study findings revealed a wide range of recommendations regarding frequency (every 10 minutes or less to >2 to 3 hours) and duration (≤30 seconds to as long as tolerated) of weight shifting. Weight-shifting interventions were most commonly guided by clinical experience (81.7%), practice guidelines (62.4%), and expertise of other team members (54.8%).

CONCLUSIONS:

Results from this study highlight the need for further research to inform weight-shifting techniques and to build a more comprehensive understanding of weight-shifting education practices.
Pressure Injuries Among Hospitalized Patients With Cancer
Authors: Aljezawi Ma'en , Tubaishat Ahmad
Published: May 2018

PURPOSE:

The purpose of this study was to measure the prevalence of pressure injuries (PIs) in hospitalized patients with cancer.

DESIGN:

Multicenter, cross-sectional prevalence survey.

SUBJECTS AND SETTING:

The sample comprised 110 adults with cancer; their mean age was 50.65 years (SD: 17.32); and more than half were females (n = 60, 54.5%). The study setting was 5 hospitals in Jordan.

METHODS:

A prevalence survey was conducted using methods recommended by the European Pressure Ulcer Advisory Panel. Data collection included skin assessment, PI risk, and preventive measures.

RESULTS:

The prevalence of PIs was 15.5% (n = 17); it was 7.3% (n = 8) when grade/category I PIs were excluded. Heel PIs were the most frequent (n = 11; 64.7%) and most PIs were grade I (n = 9; 52.9%). Only 26.9% of at-risk patients received appropriate preventive interventions.

CONCLUSIONS:

Study findings support the need to prioritize PI prevention in patients with cancer. Additional research is needed to add to the knowledge base regarding PIs within vulnerable groups such as individuals with cancer.