bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety critical communication
Authors: Prineas Stavros
Published: September 2024

The high-fidelity transfer of meaning during critical phases of anaesthetic practice is essential to patient safety. In any hierarchical training environment, there are significant implicit barriers to speaking up. A survey of over 1,300 healthcare professionals found that 55% felt barriers to speaking up about patient safety concerns. There was a fear of retaliation or negative feedback, fear of being wrong, or a sense of futility that nothing would change. Rather than assuming that staff will know when and how to assert themselves, healthcare organizations have an obligation to monitor and actively cultivate a work environment where personnel feel comfortable, safe, and supported. This can be done through a range of tools. This chapter details a number of practical tools to facilitate good communication in specific clinical situations, including communication styles, graded assertiveness, handover techniques, leadership styles, debriefing and giving feedback, and other useful techniques.
The theatre team
Authors: Tan Suyin G.M.
Published: September 2024

Communication skills are integral to good teamwork and can be learned and developed. Understanding the similarities and differences between surgeons and anaesthetists helps improve communication. Conflict management is a key skill and there are a variety of techniques that can be employed to achieve resolution. Principles include recognizing emotion; focusing on facts; avoiding blame; taking ownership of the problem and staying focused on patient care. Team members should support each other logistically, professionally, and emotionally. Quality communication during a crisis requires situational awareness, recognition of emotional and subconscious responses, clarity around required tasks, and precision around requests for information and equipment. Handover during anaesthesia is a high-risk procedure and requires a standardized approach. ‘GREAT’ is a helpful template to use.
Benign prostatic hyperplasia and urinary retention
Authors: Garthwaite Mary , Hayes John
Published: September 2024

Benign prostate hyperplasia (BPH) refers to the actual histological changes of stromal-glandular hyperplasia seen within the prostate. The condition becomes clinically significant when this overgrowth of benign tissue is associated with bothersome lower urinary tract symptoms (LUTS) with or without bladder outflow obstruction (BOO). Although the causes of LUTS are multifactorial, a significant proportion will be secondary to benign enlargement of the prostate due to BPH. The prevalence of LUTS and BPH increases with age. Epidemiological studies suggest that >80% of 80 year-olds have the disease. With our ageing population the need for medical and surgical treatment will continue to increase. Progression of the disease can result in complications such as acute or chronic urinary retention, recurrent urinary tract infections, haematuria and bladder stone formation. The aims of treatment are to reduce the severity of LUTS and to prevent the development of complications. Medical therapy including alpha-blockers and 5-alpha reductase inhibitors are the most commonly used. A myriad of surgical treatments now exist and are indicated if maximal medical therapy is insufficient to alleviate symptoms and improve quality of life, or if complications arise. The initial management of acute urinary retention involves prompt catheterization, either urethral or suprapubic, to swiftly alleviate the obstruction, ensure the patient is comfortable, and allow the resolution of any secondary renal impairment. A measurement of bladder residual volume, examination of the prostate via digital rectal examination, and exclusion of obstructive uropathy are important in the initial work-up. Catheterization is usually temporary until surgery can be performed as definitive management, but may be required in the long term if the patient is unfit for surgery or there is detrusor failure secondary to the chronic retention of urine.
Stochastic nature and physiological implications of 5′-NAD RNA cap in bacteria
Authors: Wiedermannová Jana , Babu Ravishankar , Yuzenkova Yulia
Published: September 2024

RNA 5′-modification with NAD+/NADH (oxidized/reduced nicotinamide adenine dinucleotide) has been found in bacteria, eukaryotes and viruses. 5′-NAD is incorporated into RNA by RNA polymerases (RNAPs) during the initiation of synthesis. It is unknown (i) which factors and physiological conditions permit substantial NAD incorporation into RNA in vivo and (ii) how 5′-NAD impacts gene expression and the fate of RNA in bacteria. Here we show in Escherichia coli that RNA NADylation is stimulated by low cellular concentration of the competing substrate ATP, and by weakening ATP contacts with RNAP active site. Additionally, RNA NADylation may be influenced by DNA supercoiling. RNA NADylation does not interfere with posttranscriptional RNA processing by major ribonuclease RNase E. It does not impact the base-pairing between RNAI, the repressor of plasmid replication, and its antisense target, RNAII. Leaderless NADylated model mRNA cI-lacZ is recognized by the 70S ribosome and is translated with the same efficiency as triphosphorylated cI-lacZ mRNA. Translation exposes the 5′-NAD of this mRNA to de-capping by NudC enzyme. We suggest that NADylated mRNAs are rapidly degraded, consistent with their low abundance in published datasets. Furthermore, we observed that ppGpp inhibits NudC de-capping activity, contributing to the growth phase-dependency of NADylated RNA levels.
RIN4 immunity regulators mediate recognition of the core effector RipE1 of Ralstonia solanacearum by the receptor Ptr1
Authors: Lu Jingwei , Cao Peng , Zhang Shuangxi , Wang Qinhu , Xiao Zhiliang , Meng He , Sun Zhimao , Bai Bixin , Cheng Lirui , Yang Aiguo , An Yuyan , Zhang Meixiang
Published: September 2024

Ralstonia solanacearum causes lethal bacterial wilt diseases in numerous crops, resulting in considerable yield losses. Harnessing genetic resistance is desirable for safeguarding plants against phytopathogens. However, genetic resources resistant to bacterial wilt are limited in crops. RipE1, a conserved type Ⅲ effector with cysteine protease activity, is recognized in Nicotiana benthamiana and Arabidopsis (Arabidopsis thaliana). Here, using a virus-induced gene silencing approach, we identified the gene encoding N. benthamiana homolog of Ptr1 (NbPtr1a), a coiled-coil nucleotide-binding leucine-rich repeat receptor (NLR) recognizing RipE1. Silencing or editing NbPtr1a completely abolished RipE1-induced cell death, indicating recognition of RipE1 by NbPtr1a. Genetic complementation confirmed this recognition, which is conserved across multiple solanaceous plants. Expression of RipE1 in planta or within pathogenic bacteria promoted pathogen colonization of Nbptr1a mutant plants, demonstrating its virulence function independent of NLR recognition. Silencing NbRIN4 enhanced RipE1-induced cell death, while expressing NbRIN4 inhibited it, suggesting that NbRIN4 is involved in recognition of NbPtr1a-RipE1. Furthermore, RipE1 associated with and cleaved NbRIN4, AtRIN4, and tomato (Solanum lycopersicum) SlRIN4 proteins through its cysteine protease activity. Silencing NbRIN4 in Nbptr1a mutants did not prevent RipE1 from promoting pathogen colonization, suggesting that NbRIN4 is not the primary target for RipE1-mediated virulence. Additionally, NbRIN4 suppressed self-association of the coiled-coil domain of NbPtr1a, which is critical for NbPtr1a-mediated cell death and resistance. Finally, we demonstrated that activation of NbPtr1a requires RipE1-mediated elimination of NbRIN4. Given the conserved nature of RipE1, Ptr1 holds great potential for protecting crops from diverse R. solanacearum strains and other distinct pathogens.
Aspirin for Secondary Prevention of ASCVD is Equally Safe and Effective for Men and Women
Authors: Rosenberg Karen
Published: September 2024

According to this study:
ISBAR Communication Guideline
Authors: Duah Oliver Boamah , Jonassen Susie Marie
Published: September 2024

Competency in communication and collaboration is essential in forming interprofessional partnerships for nursing practice. However, many students in nursing programs struggle with professional oral and written communication, leading to poor communication and incivility. Generational differences and expectations exacerbate communication breakdown and incivility among students and faculty. Implementing communication guidelines using a standardized communication tool in a traditional bachelor of science in nursing program helped facilitate professional and civil communication between students and faculty. Using the standardized tool improved student civility, professionalism, and accountability.
Meta-Analysis of eVisit Technology on Psychological Anxiety and Factors Influencing the Parents of NICU Newborns
Authors: Wang Jiayi , He Guijuan
Published: September 2024

Background:

Due to the geographical distance, work obligations, and parenting responsibilities, it is often difficult for parents to visit the neonatal intensive care unit (NICU). Limited parent presence might also constrain updates about infant status thus increasing anxiety, which potentially leads to a stronger necessity for visitation.

Purpose:

Examine the evidence for use of electronic visit (eVisit) technology for parents of newborns in NICU, for example, do eVisits decrease anxiety and are there other factors that demonstrate effectiveness.

Data Sources:

Seven databases were used to search for evidence from 1 January 2000 to 13 November 2023.

Study Selection:

Studies were included with terms related to eHealth, NICU, infant, parent and 41 eligible studies were assessed.

Data Extraction:

Data were extracted by 2 reviewers with a systematic-staged review approach.

Results:

Eight studies with a total of 1450 cases were included. Results of meta-analysis showed that eVisit technology improved anxiety compared with conventional visitation (MD = − 5.04, 95% CI [−5.92, − 4.17], P < .01) and hospitalization satisfaction (RR = 1.09, 95% CI [1.05, 1.13], P < .01), but the effect was not significant with regard to reduction in infant length of stay (MD = − 1.07, 95% CI [−5.39, 3.25], P = .63).

Implications for Practice and Research:

A large sample, high-quality, multi-centered randomized controlled study needs to be conducted to validate the effect of eVisit technology on the psychological state of parents, implications for nursing practice as well as potential newborn affects to improve future ease of use.

Video Abstract:

Available for more insights from the authors. This video shows the concept, current status, significance, and implications for practice and research of eVisit technology.
Effectiveness of a Novel Feeding Algorithm for Oral Feeding Transition of Infants Born Prematurely
Authors: Laborde Kelly , Gremillion Nanette , Harper Jeannie , Chapple Andrew G. , Deaton Ashley , Yates Allison , Spedale Steven , Sutton Elizabeth
Published: September 2024

Background:

Feeding skill acquisition is commonly a limiting factor determining when an infant born prematurely can be discharged.

Purpose:

This study aimed to determine if the addition of a novel feeding progression algorithm (combination of objective data from a suck measurement device and slow flow/low variability nipples) to current neonatal intensive care unit (NICU) standards could decrease feeding-related length of stay (primary outcome). We hypothesized that by timing the initiation of oral feedings to coincide with adequate sensory-motor skill development, feeding-related length of stay may be decreased.

Methods:

This was a prospective intervention study, with a historical control cohort, of infants born less than 30 weeks’ gestational age without comorbidities affecting feeding skill acquisition at a Regional Level III-S NICU at a women and infant’s hospital in Louisiana. A novel feeding progression algorithm utilized objective assessment of sucking to determine progression in nipple flow rates with slow flow/low variability nipples (flow rates from 0 to 9 mL/min) for infants receiving intervention (n = 18). Thirty-six controls who did not receive the feeding progression algorithm were identified via electronic medical record retrospective chart review.

Results:

Eighteen completed the study. Compared to the control group, infants receiving feeding interventions had delayed sequencing initiation, extended time between initially off positive pressure ventilation and initiation of sequencing, and decreased feeding-related length of stay, with similar total length of stay.

Implications for Practice and Research:

This study adds to existing research supporting the effectiveness of novel feeding progression algorithms and interventions to support the health and outcomes of infants born prematurely. Future research should focus on implementation studies for feeding progression algorithm integration into standard NICU care.
The Association Between Vasopressin and Adverse Kidney Outcomes in Children and Young Adults Requiring Vasopressors on Continuous Renal Replacement Therapy
Authors: Hasson Denise C. , Gist Katja M. , Seo JangDong , Stenson Erin K. , Kessel Aaron , Haga Taiki , LaFever Sara , Santiago Maria Jose , Barhight Matthew , Selewski David , Ricci Zaccaria , Ollberding Nicholas J. , Stanski Natalja L. ,   on behalf of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) Collaborative
Published: September 2024

OBJECTIVES:

Continuous renal replacement therapy (CRRT) and shock are both associated with high morbidity and mortality in the ICU. Adult data suggest renoprotective effects of vasopressin vs. catecholamines (norepinephrine and epinephrine). We aimed to determine whether vasopressin use during CRRT was associated with improved kidney outcomes in children and young adults.

DESIGN:

Secondary analysis of Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK), a multicenter, retrospective cohort study.

SETTING:

Neonatal, cardiac, PICUs at 34 centers internationally from January 1, 2015, to December 31, 2021.

PATIENTS/SUBJECTS:

Patients younger than 25 years receiving CRRT for acute kidney injury and/or fluid overload and requiring vasopressors. Patients receiving vasopressin were compared with patients receiving only norepinephrine/epinephrine. The impact of timing of vasopressin relative to CRRT start was assessed by categorizing patients as: early (on or before day 0), intermediate (days 1–2), and late (days 3–7).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Of 1016 patients, 665 (65%) required vasopressors in the first week of CRRT. Of 665, 248 (37%) received vasopressin, 473 (71%) experienced Major Adverse Kidney Events at 90 days (MAKE-90) (death, renal replacement therapy dependence, and/or > 125% increase in serum creatinine from baseline 90 days from CRRT initiation), and 195 (29%) liberated from CRRT on the first attempt within 28 days. Receipt of vasopressin was associated with higher odds of MAKE-90 (adjusted odds ratio [aOR], 1.80; 95% CI, 1.20–2.71; p = 0.005) but not liberation success. In the vasopressin group, intermediate/late initiation was associated with higher odds of MAKE-90 (aOR, 2.67; 95% CI, 1.17–6.11; p = 0.02) compared with early initiation.

CONCLUSIONS:

Nearly two-thirds of children and young adults receiving CRRT required vasopressors, including over one-third who received vasopressin. Receipt of vasopressin was associated with more MAKE-90, although earlier initiation in those who received it appears beneficial. Prospective studies are needed to understand the appropriate timing, dose, and subpopulation for use of vasopressin.
The Development and Impact of a Respiratory Patient Care Mobile Application on Nursing Students
Authors: Kim Hyewon
Published: September 2024

This study aimed to develop a virtual experiential application for respiratory patient care and evaluate its impact on nursing students' knowledge, self-efficacy, clinical practice anxiety, and performance confidence. This application with gamification elements was developed following a structured approach encompassing assessment, design, development, implementation, and evaluation. The experimental group consisted of 21 third-year university students who engaged with the application multiple times a day for 1 week; the control group, comprising 21 students, received traditional prelearning. Data were collected 1 week before and immediately before the clinical practice commencement, from March 7 to 24, 2023, using an online survey. Nursing knowledge, self-efficacy, clinical practice anxiety, and performance confidence were evaluated. Significant improvements were observed in the experimental group's knowledge of respiratory patient care, self-efficacy, clinical practice anxiety, and performance confidence. The application proved to be an effective learning resource and assisted students in implementing the nursing process to enhance patient conditions; it highlighted nursing educators' necessity in developing and evaluating educational content. The developed application was effective in enhancing student nurses' competence and confidence, affecting nursing education and patient care.
The burden of pre-operative anaemia and postoperative outcomes in 15 166 surgical patients from a public hospital in Brazil
Authors: Mendanha Clarissa , Neto Paulo C.S. , Borges Rogério B. , Sirtoli Isabela , Pando Cleiton S. , Brandão Mariana , Weber Alexandre , Sekini Leo , Stefani Luciana Cadore
Published: September 2024

BACKGROUND

Preoperative anaemia is associated with poor postoperative outcomes; however, few studies have reported its prevalence in developing countries and its association with significant postoperative outcomes.

OBJECTIVE

We aimed to identify the prevalence of anaemia and its association with postoperative outcomes in a major public hospital in Brazil.

DESIGN

Retrospective cohort study.

SETTING

Single-centre, 860-bed, quaternary university-affiliated teaching hospital in Southern Brazil.

PATIENTS

We included adult patients who had undergone surgery between 2015 and 2019. Main outcome measures: The main outcome was the in-hospital 30-day postoperative mortality. According to the World Health Organisation, we defined anaemia and its sub-classification (mild, moderate, and severe). We developed Poisson regression models to examine the association between preoperative anaemia and outcomes.

RESULTS

We included 15 166 patients, of whom 6387 (42.1%) were anaemic. After adjustment for confounding factors, patients with anaemia had an increased risk of in-hospital 30-day postoperative mortality (relative risk (RR) 1.69, 95% confidence interval (CI) 1.44 to 1.99, P < 0.001). Mild [relative risk (RR) 1.38, 95% CI 1.12 to 1.71, P = 0.003], moderate (RR 1.73, 95% CI 1.43 to 2.10, P < 0.001), and severe anaemia (RR 2.43, 95% CI 1.92 to 3.07, P < 0.001) were associated with the primary outcome. Anaemia increased the transfusion risk (RR 4.44, 95% CI 3.90 to 5.06, P < 0.001) and postoperative intensive care unit (ICU) admission (RR 1.09, 95% CI 1.04 to 1.16, P = 0.001).

CONCLUSIONS

Four out of 10 patients had anaemia. These patients had an increased risk of adverse postoperative outcomes. Comprehension of the magnitude and impact of anaemia is essential to establish interventions in low-resource scenarios to optimise the patient's journey.

STUDY REGISTRATION

Institutional Review Board Registration number 40522820000005327 (Brazilian CEP/CONEP System, available in https://plataformabrasil.saude.gov.br/).
Ocular Surface Squamous Neoplasia In Situ Secondary to Bruton Tyrosine Kinase Inhibitor Therapy
Authors: Bloomquist Ryan F. , Sakhalkar Monali V. , Fowler Teresa E. , Bloomquist Doan T.
Published: September 2024

Bruton tyrosine kinase (BTK) inhibitors have become an important therapeutic option in treating B-cell malignancies including non-Hodgkin lymphoma and chronic lymphocytic leukemia. However, a noted morbidity associated with their use is the potential for the development of second primary malignancy related to immunomodulation. In this case, we report a second primary malignancy of ocular surface squamous neoplasia (OSSN) owing to BTK therapy. The OSSN was successfully treated and has been monitored without recurrence. To our knowledge, this is the first case of OSSN secondary to BTK therapy.
Hemophagocytic Lymphohistiocytosis Secondary to Anaplasmosis With Lyme Coinfection
Authors: Baum Alexandria , Argotsinger Jill , Taha Rami , Gavaghan Victoria
Published: September 2024

Human granulocytic anaplasmosis and Lyme disease are tick-borne infections transmitted by the same vector, Ixodes scapularis, commonly isolated in areas within the Midwest region of the United States. Although typically associated with mild symptoms, both can progress to severe disease. Treatment of choice for a majority of tick-borne illness is doxycycline; however, options are limited in the setting of tetracycline allergy. Here, we present a complex case of human granulocytic anaplasmosis–induced hemophagocytic lymphohistiocytosis complicated by coinfection with Lyme encephalitis in a patient with a documented tetracycline allergy.
Decoding pain: uncovering the factors that affect the performance of neuroimaging-based pain models
Authors: Lee Dong Hee , Lee Sungwoo , Woo Choong-Wan
Published: September 2024

Neuroimaging-based pain biomarkers, when combined with machine learning techniques, have demonstrated potential in decoding pain intensity and diagnosing clinical pain conditions. However, a systematic evaluation of how different modeling options affect model performance remains unexplored. This study presents the results from a comprehensive literature survey and benchmark analysis. We conducted a survey of 57 previously published articles that included neuroimaging-based predictive modeling of pain, comparing classification and prediction performance based on the following modeling variables—the levels of data, spatial scales, idiographic vs population models, and sample sizes. The findings revealed a preference for population-level modeling with brain-wide features, aligning with the goal of clinical translation of neuroimaging biomarkers. However, a systematic evaluation of the influence of different modeling options was hindered by a limited number of independent test results. This prompted us to conduct benchmark analyses using a locally collected functional magnetic resonance imaging dataset (N = 124) involving an experimental thermal pain task. The results demonstrated that data levels, spatial scales, and sample sizes significantly impact model performance. Specifically, incorporating more pain-related brain regions, increasing sample sizes, and averaging less data during training and more data during testing improved performance. These findings offer useful guidance for developing neuroimaging-based biomarkers, underscoring the importance of strategic selection of modeling approaches to build better-performing neuroimaging pain biomarkers. However, the generalizability of these findings to clinical pain requires further investigation.
Therapist-led Microlearning Curriculum for Resident Mobility Education
Authors: Jain Bijal , Ansilio Laura , Baliki Marwan , Neal Jacqueline
Published: September 2024

Background:

Early mobility programs can mitigate or prevent functional decline in hospitalized patients. Studies have shown that insufficient staff mobility-related knowledge can hinder efficacy and sustainability of mobility initiatives. Integrating mobility education into residency training may help to bridge this knowledge gap. The purpose of this randomized pre-post survey study was to evaluate the impact of a standardized microlearning mobility curriculum embedded into daily interdisciplinary rounds on internal medicine residents’ self-reported beliefs, knowledge, and practices related to inpatient mobility.

Methods:

A mobility curriculum utilizing microlearning principles, consisting of 4 weekly 5-10-minute sessions, was developed and implemented at an academically-affiliated Veteran’s Hospital. Residents were randomly assigned by team numbers into an Education (intervention) group and a Control group. A questionnaire was developed and validated to assess the impact of the curriculum on learner perceptions, knowledge, and clinical practices. The survey was administered to the entire cohort of trainees at the beginning and end of their 4-week rotations, with results analyzed for differences between the groups.

Outcomes:

Both the Education and Control groups exhibited consistently positive attitudes towards inpatient mobility at baseline and after the study. The Education group reported higher confidence in mobility knowledge compared to the Control group post-intervention. Though reported mobility practices remained similar between groups, there was higher correlation between knowledge and practice responses in the Education group.

Conclusion:

As part of early mobility programmatic efforts, a microlearning curriculum embedded into interdisciplinary rounds can be effective in enhancing residents’ mobility-related knowledge and confidence.
mHealth Service Effects for Negative Emotions Among Parents of Preterm Infants: A Systematic Review and Meta-Analysis
Authors: He Kexin , Zhang Xin , Gou Jiayan , Wang Fei , Zou Liuni
Published: September 2024

Purpose:

This review aims to ascertain the effects of mHealth on negative emotions among parents of preterm infants and analyze the current state of mHealth services in this context.

Background:

Caring for preterm infants often engenders negative emotions in parents, such as anxiety, depression, and stress. Mobile Health (mHealth) services offer potential benefits for preterm infant care. However, there are several uncertainties regarding the impact of mHealth services on parental emotions.

Methods and study design:

Randomized controlled trial (RCT) and quasi-RCT were published in English and Chinese until 2023 and are available in the electronic databases of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINHAHL), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Database, and China Science and Technology Journal Database were reviewed. Review Manager 5.4 was employed for random-effects meta-analysis.

Results:

Seven RCTs and 6 quasi-RCTs with high risks were included, most of them were based on small sample size and single-centered. Meta-analysis demonstrated that mHealth interventions mitigated negative emotions, including anxiety (standard mean difference [SMD] = −1.07; 95% confidence interval [CI], −1.47 to −0.66; P< 0.0001), depression (SMD = −1.94; 95% CI, −3.01 to −0.86; P< 0.0001), and stress (SMD = −1.24; 95% CI, −2.07 to −0.40; P< 0.0001), among parents of preterm infants.

Conclusions:

It is recommended to develop independent specialized software for mHealth, enhance theoretical underpinnings, and standardize practical protocols. Incorporating early recognition and screening of negative emotions within mHealth could offer comprehensive support for the mental health of parents with preterm infants.

Implications:

The mHealth-based interventions are needed to focus on the parents’ emotional needs and minimize the impacts associated with mental stress.
The Effect of Mother’s Voice and Father’s Voice Listened by Newborns During Heel Blood Collection on Pain Level and Physiological Parameters
Authors: Ünal Tuba , Konuk Sener Dilek
Published: September 2024

Background:

The newborn can learn the voices of its mother and father during intrauterine life, and the reencounter with these familiar voices after birth has a relaxing and calming effect on the baby.

Purpose:

The purpose of this study was to determine the effect of mother’s voice and father’s voice that newborns listened to during the heel blood collection procedure on pain level and physiological parameters.

Methods:

The study was a randomized controlled trial. The study consisted of a total of 90 newborns as participants (mother voice group = 30, father voice group = 30, and control group = 30) at the Düzce Atatürk State Hospital Gynecology Service, Türkiye. Newborns randomly assigned to the intervention groups were made to listen to the mother’s voice/father’s voice during the heel prick procedure. The newborn in the control group received standard heel blood collection procedures.

Results:

When the pain level of newborns was examined, it was determined that the lowest Newborn Infant Pain Scale score was in the mother’s voice group (P < .05). When the physiological parameter results were evaluated, it was determined that the highest oxygen saturation value and the lowest heart rate were found in the mother’s voice group (P < .05).

Conclusion:

It was determined that the mother’s voice was the most effective method in relieving the pain that occurred during the heel prick procedure and in the positive course of physiological parameters in newborns. According to the results of the study, it is recommended to use the mother’s voice in order to reduce the pain caused by the heel prick attempt in newborns and to regulate their physiological parameters.
Adherence to patient blood management strategy in patients with gastrointestinal bleeding: a prospective nationwide multicenter study
Authors: Tejedor-Tejada Javier , Ballester María Pilar , Del Castillo-Corzo Francisco Jose , García-Mateo Sandra , Domper-Arnal María Jose , Parada-Vazquez Pablo , Saiz-Chumillas Rosa M. , Jiménez-Moreno Manuel Alfonso , Hontoria-Bautista Gadea , Bernad-Cabredo Belén , Gómez Concepción , Capilla María , Fernández-De La Varga Margarita , Ruiz-Belmonte Lara , Lapeña-Muñoz Berta , Calvo Iñiguez María , Fraile-González María , Flórez-Díez Pablo , Morales-Alvarado Víctor Jair , Delgado-Guillena Pedro G. , Cañamares-Orbis Pablo , Saez-González Esteban , García-Morales Natalia , Montoro Miguel , Murcia-Pomares Óscar
Published: September 2024

Introduction

Patient blood management (PBM) adherence in clinical practice is unclear. This real-world practice study assessed the management of patients with gastrointestinal (GI) bleeding after the implementation of the PBM strategy.

Methods

This was a nationwide multicenter and prospective study involving consecutive adults with GI bleeding between March 2019 and March 2021. Patients were examined according to hemoglobin (Hb) level at admission (<7 g/dl, n = 93; 7–8 g/dl, n = 47; 8–9 g/dl, n = 61; and >9 g/dl, n = 249). Study outcomes measures were morbidity and mortality during hospitalization and at 3- and 6-month follow-up. Appropriate anemia or iron deficiency management was considered when adherence to PBM policy was higher than 75%.

Results

A total of 450 patients (57.6% men, median age: 74 years, interquartile range: 63–82) were included. Overall, 55.1% and 59.3% of patients received transfusion and iron supplementation, respectively. The rates of appropriate transfusion and iron supplementation adherence were 90.9% (range: 86.9–93.5%, P = 0.109) and 81.8% (range: 78.5–85.1%, P = 0.041), depending on Hb level, respectively. No associations were observed between adherence to the PBM strategy and length of stay (P = 0.263) or risk of further bleeding (P = 0.742). Patients who were transfused [hazard ratio (HR): 0.79, 95% confidence interval (CI): 0.27–0.85] and iron supplemented (HR: 0.91, 95% CI: 0.38–1.41), however, appropriately achieved a lower risk of death. Age (HR: 1.12, 95% CI: 1.12–1.25) and further bleeding (HR: 39.08, 95% CI: 4.01–181.24) were poor prognostic factors. No serious adverse events were reported.

Conclusions

In this nationwide study, there is a high level of adherence and safety of PBM for the treatment of GI bleeding. Adherence to the PBM strategy improved outcomes in patients with GI bleeding.
Evolution of Postpandemic Nurse Orientation Through an Academic–Practice Partnership
Authors: Bathish Melissa , Seng Julia , Duncan Joseph , Wintermeyer-Pingel Susan , Russell Beth , DiClemente Linda , Price Deborah , Wyse Diane , Conrad Christina , Duffy Elizabeth A. , Tschannen Dana
Published: September 2024

An academic–practice partnership engaged in redesigning the postpandemic orientation process for newly hired nurses in a large academic health system. Results from needs assessments and collaboration efforts informed the orientation program redesign, and the National Implementation Research Network framework guided project development. The orientation redesign aimed to enhance efficiency, readiness for unit-specific orientation, and stakeholder satisfaction. This article highlights strategies for fostering successful academic–practice partnerships in addressing nursing workforce challenges postpandemic.
Promoting Safe Practice in New Graduate Nurses
Authors: Nielsen Ann , Lasater Kathie , Monagle Janet , Jessee Mary Ann , Gonzalez Lisa
Published: September 2024

This article reports research that examined how registered nurses in practice develop clinical judgment in new graduate nurses (NGNs) and how NGNs respond. Teaching themes were setting the tone for learning, use of cognitive-focused teaching–learning strategies, including mentoring thinking, debriefing and reflection, and using real-life scenarios. NGN responses were learning focused, emotional, or resistant. Recommendations to support development of clinical thinking are made.
Nursing Students’ Perception of the Clinical Learning Environment
Authors: Nasirudeen A.M.A. , Song Xiao , Sng Brandon , Pan Donghong
Published: September 2024

Background:

The clinical learning environment (CLE) plays a vital role in students’ learning in clinical settings. However, to our knowledge, no longitudinal cohort studies have been published on how CLE influences nursing students’ learning during clinical placements.

Purpose:

This study investigated a cohort of nursing students’ perceptions of CLE during their first and third-year clinical placements.

Methods:

The clinical learning environment inventory (CLEI) questionnaire was used in this study. In 2021, a convenience sample of 450 first-year nursing students was invited to complete the CLEI questionnaire. In 2023, the same cohort of students in their third year of study were invited to complete the questionnaire.

Results:

Personalization, satisfaction, and task orientation had higher mean scores than the other CLEI subscales. The lowest mean scores were found for the teaching innovation and individualization subscales. Multiple regression and bivariate correlation analyses revealed task orientation as the strongest predictor of student satisfaction with the CLE.

Conclusions:

Nursing students in Singapore have a moderately positive satisfaction with their CLE. Clinical instructors should design innovative lesson plans to improve the student experience and learning in the CLE.
Adverse Events in Patients Transitioning From the Emergency Department to the Inpatient Setting
Authors: Tsilimingras Dennis , Schnipper Jeffrey , Zhang Liying , Levy Phillip , Korzeniewski Steven , Paxton James
Published: September 2024

Objectives

The objective of this study was to determine the incidence and types of adverse events (AEs), including preventable and ameliorable AEs, in patients transitioning from the emergency department (ED) to the inpatient setting. A second objective was to examine the risk factors for patients with AEs.

Methods

This was a prospective cohort study of patients at risk for AEs in 2 urban academic hospitals from August 2020 to January 2022. Eighty-one eligible patients who were being admitted to any internal medicine or hospitalist service were recruited from the ED of these hospitals by a trained nurse. The nurse conducted a structured interview during admission and referred possible AEs for adjudication. Two blinded trained physicians using a previously established methodology adjudicated AEs.

Results

Over 22% of 81 patients experienced AEs from the ED to the inpatient setting. The most common AEs were adverse drug events (42%), followed by management (38%), and diagnostic errors (21%). Of these AEs, 75% were considered preventable. Patients who stayed in the ED longer were more likely to experience an AE (adjusted odds ratio = 1.99, 95% confidence interval = 1.19–3.32, P = 0.01).

Conclusions

AEs were common for patients transitioning from the ED to the inpatient setting. Further research is needed to understand the underlying causes of AEs that occur when patients transition from the ED to the inpatient setting. Understanding the contribution of factors such as length of stay in the ED will significantly help efforts to develop targeted interventions to improve this crucial transition of care.
Safety of Medications Used to Treat Autoimmune Rheumatic Diseases During Pregnancy and Lactation
Authors: Siegel Caroline H. , Sammaritano Lisa R.
Published: September 2024

Autoimmune rheumatic diseases (ARDs) often affect women during their reproductive years, and early studies of pregnancy in these patients reported high rates of adverse outcomes. Continuation or initiation of safe and effective medications in the preconception period is beneficial for maintaining or achieving disease quiescence throughout pregnancy thereby improving both maternal and pregnancy outcomes. The European Alliance of Associations for Rheumatology, the American College of Rheumatology, and the British Society for Rheumatology have published recommendations and guidelines regarding management of ARDs during pregnancy. The American College of Obstetricians and Gynecologists and the American Gastroenterological Association have also provided guidance statements with relevant recommendations. This review provides an overview of available recommendations for medication use in ARD pregnancy, with discussion of safety considerations for maternal and fetal well-being. Medications considered compatible with pregnancy include hydroxychloroquine, sulfasalazine, azathioprine, cyclosporine, tacrolimus, and TNF inhibitors. Methotrexate, mycophenolate, leflunomide, and cyclophosphamide should be avoided before and during pregnancy. Other medications, most of them newer, are largely discouraged for use in pregnancy due to inadequate data or concerns for neonatal immunosuppression, including non-TNF biologics and small molecule therapies. Further investigation is needed regarding effects of non-TNF biologics, biosimilars, and small molecules in pregnancy. Important efforts for the future will include improved methodologies to gather critical safety data, with consideration of inclusion of pregnant women in clinical trials, a complex and controversial issue. Long-term information on outcomes in offspring of treated women is lacking for many of these medications.
Extensive Pulmonary AL Amyloidosis Mimicking Miliary Tuberculosis
Authors: Denizmen Dilara , Isik Emine Goknur , Vuralli Bakkaloglu Dogu , Buyukkaya Fikret , Sanli Yasemin
Published: September 2024

Amyloidosis is a misfolded protein deposition disorder within the extracellular matrix, leading to dysfunction in the affected organ. Primary amyloidosis manifests as AL and ATTR subtypes, wherein AL is associated with plasma cell dyscrasias. Herein we present a case of a patient who underwent investigation due to the presence of bilateral reticulonodular lung infiltrates, suggestive of miliary tuberculosis. 99mTc-PYP scan revealed widespread radiotracer uptake in the lungs leading to diagnosis of AL amyloidosis.
68Ga-FAPI and 18F-FDG PET/CT Imaging in Langerhans Cell Histiocytosis for Recurrence and Therapeutic Response Assessment
Authors: Liu Mengna , Tang Ranbie , Chen Xi , Cai Liang , Huang Zhanwen
Published: September 2024

A 2-and-a-half-year-old boy with a previous history of Langerhans cell histiocytosis reached remission as assessed by 18F-FDG PET/CT. Routine follow-up 18F-FDG PET/CT revealed the appearance of new bone lesions in the right scapula and right ischium with abnormal FDG activity 3 months after the end of treatment, and Langerhans cell histiocytosis recurrence was considered. Meanwhile, these lesions also showed increased FAPI uptake. After adjusting the chemotherapy regimen, both FDG and FAPI uptake almost disappeared in these lesions.
Vegetable Intake in People With Type 2 Diabetes
Authors: Mendoza Flora , Karduck Justine , Chapman-Novakofski Karen
Published: September 2024

The purpose of this study was to quantify vegetable intake in people with type 2 diabetes mellitus (T2DM), identify influencing factors, and determine whether intake was associated with hemoglobin A1c (HbA1c). Adults with T2DM (n = 50) completed a vegetable intake survey, supplemented with data from a parent study. Total vegetable intake was not significantly associated with HbA1c. Intake met recommendations (34%) more than the national average (9.3%; Centers for Disease Control and Prevention, 2017) and was significantly associated with length of T2DM diagnosis (B[SE] = 0.611 [0.287]; P < .05) and vegetable variety. Counseling sooner after diagnosis to increase variety could improve diet quality but by itself may not affect HbA1c.
Cross-sectional Association of First-Trimester HbA1c > 5.4% and GDM Diagnosis in a High-Risk Population
Authors: Gonzales-Pacheco Diana , Ortiz Felina
Published: September 2024

This retrospective cross-sectional study of 729 pregnant adults examined the relationship between first-trimester glycosylated hemoglobin A1c (HbA1c) levels (≤5.4% vs >5.4%) and a gestational diabetes mellitus (GDM) diagnosis in a high-risk population. GDM diagnosis was significantly higher in the HbA1c > 5.4% group (n = 45, 34.1%) than in the HbA1c ≤ 5.4% group (n = 119, 19.9%; P < .01). HbA1c > 5.4% was independently associated with a higher risk of GDM diagnosis (aOR = 1.7; 95% CI, 1.10-2.64; P = .018). Identifying early risk factors for GDM offers more intervention options to improve patient outcomes. However, this finding warrants further investigation.
Beyond 75: Graft Allocation and Organ Utility Implications in Liver Transplantation
Authors: Akabane Miho , Kwong Allison , Imaoka Yuki , Esquivel Carlos O. , Kim W. Ray , Melcher Marc L. , Sasaki Kazunari
Published: September 2024

Background.

The global surge in aging has intensified debates on liver transplantation (LT) for candidates aged 75 y and older, given the prevalent donor scarcity. This study examined both the survival benefits and organ utility of LT for this age group.

Methods.

A total of 178 469 adult LT candidates from the United Network for Organ Sharing database (2003–2022) were analyzed, with 112 266 undergoing LT. Post-LT survival outcomes and waitlist dropout rates were monitored across varying age brackets. Multivariable Cox regression analysis determined prognostic indicators. The 5-y survival benefit was assessed by comparing LT recipients to waitlist candidates using hazard ratios. Organ utility was evaluated through a simulation model across various donor classifications.

Results.

Among candidates aged 75 y and older, 343 received LT. The 90-d graft and patient survival rates for these patients were comparable with those in other age categories; however, differences emerged at 1 and 3 y. Age of 75 y or older was identified as a significant negative prognostic indicator for 3-y graft survival (hazard ratio: 1.72 [1.20-2.42], P < 0.01). Dropout rates for the 75 y and older age category were 12.0%, 24.1%, and 35.1% at 90 d, 1 y, and 3 y, respectively. The survival benefit of LT for the 75 y and older cohort was clear when comparing outcomes between LT recipients and those on waitlists. However, organ utility considerations did not favor allocating livers to this age group, regardless of donor type. Comparing 3-y patient survival between LT using donors aged 60 y and younger and older than 60 y showed no significant difference (P = 0.50) in the 75 y or older cohort.

Conclusions.

Although LT offers survival benefits to individuals aged 75 y and older, the system may need rethinking to optimize the use of scarce donor livers, perhaps by matching older donors with older recipients.
Oral semaglutide improves glycemic control and lowers blood lipids: evidence from a real-world study
Authors: Gašparini Dora , Čakanić Fabijan , Tufekčić Tomislav , Rasnek Darko , Wensveen Felix M. , Turk Wensveen Tamara
Published: September 2024

Background

The increasing global prevalence of type 2 diabetes necessitates innovative treatment strategies to mitigate not only hyperglycemia but also its associated cardiovascular risks. Oral semaglutide, a glucagon-like peptide-1 receptor agonist, has shown high efficacy in lowering glucose and inducing weight loss in randomized trials. However, evidence of its beneficial effects in daily clinical practice is limited. In this study we determined the real-world effectiveness of oral semaglutide and investigated whether it impacts metabolic parameters beyond glucose and weight control in patients with moderate to high cardiovascular risk.

Methods

In a single-center outpatient setting, 53 patients with type 2 diabetes treated with oral semaglutide were retrospectively analyzed. Changes in anthropometric measurements and laboratory parameters over a follow-up period of 3–9 months were assessed.

Results

Oral semaglutide significantly improved glycemic control and facilitated weight loss, with 50% of patients achieving a body weight loss of ≥5% in a real-world setting. Moreover, oral semaglutide treatment reduced alanine aminotransferase and hepatic steatosis index significantly. In patients on stable lipid-lowering therapy, we observed a significant reduction in total cholesterol and low-density lipoprotein cholesterol levels following treatment with oral semaglutide. Effects on liver inflammation were associated with glucose and weight control, whereas lipid-lowering effects were associated only with glucose control.

Conclusion

This real-world study demonstrates oral semaglutide efficacy beyond glucose and weight control suggesting its potential in comprehensive cardiovascular risk management in individuals with type 2 diabetes. Research to optimize the clinical use of oral semaglutide in diabetes care and cardiovascular risk reduction may further increase its beneficial effects.