Bacterial urine profile and optimal urine specimen collection timing in asymptomatic chronically catheterized adults with spinal cord injuries and disorders.

BACKGROUND: Adults with spinal cord injuries and disorders (SCI/D) require chronic indwelling catheterization which is associated with an increased risk of catheter-associated (CA) adverse events. METHODS: We studied urine samples (culture and urinalysis) from 2 cohorts of chronically catheterized males with SCI/D. Cohort 1 included 28 participants; 3 samples per patient were collected (before, after, and 7 days after catheter change). Cohort 2 included 21 participants; 7 samples per patient were collected (before, immediately after, 30 minutes, 1 hour, 1 day, 2 days, and 7 days after catheter change). RESULTS: A statistically significant decrease in the post catheter change percentage of "significant cultures" was found in both our cohorts (P<.05). Additionally, our second cohort demonstrated a significant decrease in the number of organisms growing at 100.000 cfu/mL (median=-1, mean=-1.5, P=.0006) and in urinalysis bacterial numbers (median=-0.5, mean=-1, P=.006) from pre- to 1-hour post catheter removal. CONCLUSIONS: Although there appears to be an improvement of organism burden seen after catheter change, this is only temporary, and its significance in chronically catheterized patients is still unknown. Our second cohort demonstrated an optimal time for sample collection at the 1-hour post-catheter change sample, but further research is required for the extrapolation of these findings.

Preventing Type 2 Diabetes Among Midlife Women: A Feasibility Study Comparing a Combined Sleep and Lifestyle Intervention With a Standard Lifestyle Intervention.

PURPOSE: The purpose of this pilot study was to evaluate the feasibility, acceptability, and initial efficacy of adding a sleep extension intervention to a well-established diabetes prevention intervention among midlife women with short sleep duration at risk for type 2 diabetes. METHODS: For this 2-group comparative design, 26 women with prediabetes or metabolic syndrome and sleep duration <7 hours were recruited from the community to participate in an 8-session diet and physical activity lifestyle intervention alone (L-alone) or L-alone plus a behavioral sleep intervention (L+Sleep). Body mass index (BMI), waist circumference, and other outcomes were compared at baseline and 3 and 6 months using analysis of covariance. RESULTS: Incorporating a sleep intervention into lifestyle changes proved feasible and acceptable to midlife women at risk for type 2 diabetes. Significant decreases in BMI and waist circumference over time were observed in both groups, but comparative efficacy of L+Sleep versus L-alone yielded few group differences. Exploratory analysis indicated that women who increased their sleep to ≥7 h/night, regardless of group assignment, lost more weight than women who continued to report sleeping <7 h/night. CONCLUSION: Adding sleep extension to a lifestyle change intervention proved feasible and satisfactory to participants, but initial efficacy did not differentiate the 2 intervention groups.

Advancing Methods of Assessing Bone Quality to Expand Screening for Osteoporosis.

CONTEXT: Dual-energy x-ray absorptiometry (DXA) limits osteoporosis screening because of machine size, technical requirements for operation, and exposure to ionizing radiation. OBJECTIVE: To establish data ranges from calcaneus ultrasonography (US) that correspond to bone mineral density (BMD) stratification identified by DXA and to determine whether vitamin D concentration adds to US bone health assessment. METHODS: Patients scheduled for DXA at the Robert C. Byrd Clinic, a rural primary care facility in Lewisburg, West Virginia, were recruited from June 2015 to June 2016. Ultrasonography was used to scan the left and right calcaneus of the patients, and blood was collected from a finger prick for vitamin D analysis. Information was collected regarding Fracture Risk Assessment tool parameters, menstrual history, and drug and supplement use. The correlations within and between DXA and US measurements were calculated, as well as the correlations between DXA and US measurements and vitamin D levels. Predictive performance of US readings on bone health determined by DXA scan was assessed with area under the curve analysis using receiver operator characteristic curves. RESULTS: Ninety-nine participants were included. Ultrasonography readings of either the left or right foot were predictive of good vs poor bone quality. No differences were found between US scans of the left foot vs the right foot. Area under the curve values for US BMD T scores for the left and right foot were 0.69 and 0.68, respectively. There was no correlation between DXA- and US-assessed BMD and vitamin D concentrations. Negative correlations were observed between the DXA BMD T scores and vitamin D concentration of the spine and right hip; negative correlations were also observed in the Z score from the spine in the subset of participants who reported not taking vitamin D supplements. CONCLUSION: Ultrasonography of the calcaneus offers a low-cost, efficient means to screen bone health. The affordability and mobility of a US machine enables its use as a screening method that may be applicable to large numbers of people. This study established a T score greater than -1.05 as an indicator of good bone quality and a T score less than -1.05 as an indicator of poor bone quality when using US for BMD screening.

Women in Osteopathic and Allopathic Medical Schools: An Analysis of Applicants, Matriculants, Enrollment, and Chief Academic Officers.

In the 1993-1994 academic year, female enrollment was 34.7% in osteopathic medical schools and 40.2% in allopathic medical schools. To assess progress in female enrollment since that time, the authors examined admission data in the ensuing years, including female applicants, matriculants, and first-year students in osteopathic and allopathic medical schools, as well as female chief academic officers at these institutions. In the 2004-2005 academic year, 50.3% of first-year students in osteopathic medical schools were women; however, by the 2013-2014 academic year, that figure dropped to 44.2%. The percentage rose slightly by the 2016-2017 academic year to 45.9%. Additionally, for the 2016-2017 academic year, allopathic medical schools had a significantly higher proportion of female matriculants than did osteopathic medical schools (49.8% vs 45.9%, respectively; P<.001).

Expanded roles of registered nurses in primary care delivery of the future.

BACKGROUND: Primary care in the United States is changing: practice size is increasing, there is a growing shortage of primary care practitioners, and there is a heightened prevalence of chronic disease. Given these trends, it is likely that registered nurses will become important members of the primary care team. PURPOSE: This paper explores the challenges and opportunities in primary care delivery in the 21st century and examines the likelihood of expanded roles for RNs to improve quality and add capacity to the primary care workforce. METHODS: We searched the peer-reviewed and gray literature for publications on primary care, primary care workforce projections, the future of nursing, and team-based care. DISCUSSION: The number of primary care physicians is expected to decrease in relation to the US population while the number of nurse practitioners is increasing, with the result that more and more patients will see nurse practitioners as their primary care practitioner. However, the primary care practitioner (physicians, nurse practitioners and physician assistants) to population ratio is dropping. As a result, other professionals will be needed to deliver primary care. As the nation's largest health profession, registered nurses (RNs) are in sufficient supply and have been shown to improve the care of patients with chronic conditions. It is likely that primary care practices of the future will include an enhanced role for RNs, particularly in chronic disease management. CONCLUSION: For RNs to assume an expanded role in primary care, several barriers need to be overcome: (1) the widespread introduction of payment reform that reimburses RNs to independently provide care for patients, and (2) nursing education reform that includes primary care nursing skills (3) scope of practice clarification for non-advance practice RNs working under standardized procedures.

Osteopathic Medical Students Entering Family Medicine and Attitudes Regarding Osteopathic Manipulative Treatment: Preliminary Findings of Differences by Sex.

CONTEXT: Factors distinguishing osteopathic physicians from their allopathic counterparts include the use of osteopathic manipulative treatment (OMT), application of osteopathic principles and practice (OPP), and a greater likelihood of entering primary care, specifically family medicine (FM). In the United States, the percentage of entering osteopathic medical students who were female rose from 14.3% in fall 1977 to 44.3% in fall 2015. OBJECTIVES: To investigate the perspectives of female osteopathic medical students as they relate to osteopathic distinctiveness. METHODS: Students at the West Virginia School of Osteopathic Medicine who were eligible to participate in graduation exercises in 2014 or 2015 were asked to complete the school's standard Exit Survey. The research team chose 5 items from the survey to include in the current analysis. Sex had been self-identified at admission, and residency in first postgraduate year was categorized as FM or other specialty. Graduates entering a transitional year or traditional internship were removed from analysis. RESULTS: Analysis was conducted for 308 of the 375 students (82%) expected to graduate in 2014 or 2015. χ2 analysis found no difference by sex in the number of graduates entering FM residencies vs other specialties (P=.727). Statistically significant differences were found in 2 survey items: "Use of OMT will enhance my practice" (P=.005) and "What emphasis do you believe OMT will have in your practice?" (P<.001). Graduating female students responded more favorably to OMT on both items. For the latter item, 91.4% of female and 80.3% of male students indicated OMT would have at least some role in their practices. Sex differences remained after statistically controlling for entry into FM. CONCLUSION: Female graduating osteopathic medical students were more likely to report that OMT will have at least some role in their practices. Future studies of the attitudes and practice patterns of osteopathic physicians should analyze for differences by sex.

Pedigree Analysis: A Team-Based Learning Activity.

INTRODUCTION: Regardless of their specialty, physicians, particularly those practicing primary care in rural areas, typically encounter genetic conditions. Therefore, it is important to incorporate genetic principles into medical training prior to students' clinical rotations. METHODS: The advance preparation assignment for this team-based learning (TBL) resource includes lectures and directed study assignments on the following topics: Mendelian genetics, sexual genetics, population genetics, and pedigree analysis. Students then demonstrate their understanding of the content through a formal TBL lesson utilizing a gallery walk for group application exercises. RESULTS: Course evaluations clearly indicated that students enjoyed and learned from this TBL. Student performance on the team readiness assurance test and the summative exam scores showed significant signs of improvement when compared to individual readiness assurance test performance. DISCUSSION: In this TBL module, students develop an understanding of basic genetics, pedigree analysis, and calculation of risks for inheriting autosomal recessive and X-linked recessive diseases. This TBL can be easily adapted to other allied health programs.

Observed characteristics of suicidal hangings: an 11-year retrospective review.

Many studies have been published regarding suicidal hanging deaths, and most forensic pathologists and coroners are very familiar with such causes of death. Forensic pathologists are challenged over their rulings regarding manner of death in part because the general public has a limited scope of knowledge. One such challenge centers on the question of whether a hanging can be a suicide if the individual is not fully suspended. The authors designed a retrospective study to review suspension in hangings and to analyze other criteria used to help in deciding manner of death. We examined 229 suicidal hanging deaths over an 11-year period (1997 through early 2009) using the data from two separate jurisdictions in Ohio. In conclusion, we found that the vast majority (83.4%) of people who hanged themselves were found partially suspended. Among other criteria analyzed, only the presence of petechial hemorrhages and acute neck injury was statistically significant.

Incidence of marine debris and its relationships with benthic features in Gray's Reef National Marine Sanctuary, Southeast USA.

Gray's Reef National Marine Sanctuary (GRNMS) is an increasingly popular site for recreational fishing and diving in the South Atlantic Bight (SAB). As a result, there has been heightened concern about potential accumulation of marine debris and its consequent effects on sanctuary resources. Field surveys were conducted at GRNMS in 2004 and 2005 to provide a spatially comprehensive characterization of benthic communities and to quantify the distribution and abundance of marine debris in relation to bottom features. The spatial distribution of debris was concentrated in the center of the sanctuary and was most frequently associated with ledges rather than other bottom types. On ledges, the presence and abundance of debris was significantly related to observed boating activity and physiographic features including ledge height, ledge area, and percent cover of benthic organisms. The results from this study will aid managers in optimizing cleanup efforts and long-term monitoring of debris accumulation patterns at GRNMS and other hard bottom areas in the SAB.

An audit of medication administration: a glimpse into school health offices.

Many students require prescription and nonprescription medication to be administered during the school day for chronic and acute illnesses. School office staff members are typically delegated this task, yet these individuals are unlicensed assistive personnel without medical training. Five school nurses developed and participated in a medication audit providing a glimpse into the administration and management of medications in school health offices. The audit included 154 medications. Results of the audit showed a wide range of errors and discrepancies, including problems with transcription, physician orders or lack thereof, timing, documentation, and storage. Audit results highlight the importance of training in medication administration and management at schools. It also directs attention to view training not as a once-a-year event, but as a process. A process is needed to ensure and sustain the safe and accurate administration of medication. Towards this end, school nurses need to periodically evaluate school office staff, audit school medication records and documents, and conduct refresher classes throughout the school year.