Evaluating knowledge, confidence, and self-efficacy of NPs and PAs in the emergency department: extended focused assessment using sonography in trauma.

BACKGROUND: Developing and translating knowledge gained in the classroom into skills that are practiced in the clinical setting is an ongoing, iterative, and dynamic process. Health care clinicians require continually evolving knowledge, ongoing education, and hands-on skills practice particular to the specialty. PURPOSE: This prospective observational study was conceived based on the existing evidence demonstrating that Point of Care Ultrasound (POCUS) is not routinely taught in nurse practitioner (NP) or physician assistant (PA) graduate programs. This study examines outcomes of an educational intervention aimed at improving knowledge, self-confidence, and self-efficacy of the Extended Focused Assessment using Sonography in Trauma (E-FAST examination) for both NPs and PAs working in emergency settings. METHODOLOGY: Twenty participants attended a short course including both didactic learning and hands-on learning of the E-FAST examination. Participants rated themselves using a self-assessment tool for pre- and postintervention self-evaluation. The Wilcoxon signed-rank test was used to evaluate data. A second tool used to evaluate participants' hands-on use of the E-FAST examination is the Objective Structured Assessment of Ultrasound, in which participants were evaluated by clinical experts. These data were assessed using regression analysis. RESULTS: Participants showed improvement on the pre/post course self-assessment tool. Participants also showed proficiency using ultrasound and analyzing images as evaluated by experts. CONCLUSIONS: A short multimodal course can improve clinicians' knowledge, confidence, and self-efficacy in the use of POCUS and the E-FAST examination. IMPLICATIONS: Hands-on education is a valuable tool for ongoing learning.

Influence of 10 wk of soy consumption on plasma concentrations and excretion of isoflavonoids and on gut microflora metabolism in healthy adults.

BACKGROUND: Little information is currently available on the role of the gut microflora in modulating isoflavone bioavailability or on sex differences in isoflavone metabolism and bioavailability. OBJECTIVE: We sought to determine whether chronic soy consumption influences isoflavone bioavailability as judged by plasma isoflavone concentrations and modified gut microflora activities [beta-glucoside hydrolysis and equol and O-desmethylangolensin (O-DMA) production]. We also examined whether sex differences in isoflavone metabolism exist. DESIGN: A randomized, parallel, controlled study design was used to compare a high-soy diet (104 +/- 24 mg total isoflavones/d) with a low-soy diet (0.54 +/- 0.58 mg total isoflavones/d) in 76 healthy young adults for 10 wk. RESULTS: Concentrations of isoflavones and their gut microflora metabolites in the plasma, urine, and feces were significantly higher in the subjects who consumed the high-soy diet than in those who consumed the low-soy diet. Concentrations of O-DMA in plasma and urine were higher in the men than in the women. Fecal bacteria from subjects consuming both diets could convert daidzein to equol ex vivo. Fecal beta-glucosidase activity was significantly higher in the subjects who consumed the high-soy diet than in those who consumed the low-soy diet. CONCLUSIONS: Although interindividual variation in isoflavone metabolism was high, intraindividual variation was low. Only concentrations of O-DMA in plasma and urine appeared to be influenced by sex. Chronic soy consumption does not appear to induce many significant changes to the gut metabolism of isoflavones other than higher beta-glucosidase activity.

Chemotherapy-induced vomiting in women treated for breast cancer.

PURPOSE/OBJECTIVES: To describe the incidence and intensity of vomiting in women receiving chemotherapy treatment for breast cancer since the advent of 5-HT3 antagonists. DESIGN: Longitudinal, descriptive. SETTING: 7 outpatient oncology clinics situated in hospitals, 5 outpatient oncology clinics associated with major teaching universities, 27 private outpatient oncology practices, and 1 outpatient clinic located in a county hospital. SAMPLE: Typical participants (N = 303) were 51.9 years, Caucasian (79%), married or partnered (65%), born U.S. citizens (93%), heterosexual (96%), living with someone (84%), and high school graduates (82%). METHODS: Baseline and poststudy questionnaires and a daily diary of vomiting through two cycles of chemotherapy (approximately two months) were used to collect data. MAIN RESEARCH VARIABLE: Vomiting experience. FINDINGS: The worst vomiting occurs three days after having chemotherapy for breast cancer. The types of oral antiemetics ordered for home use were changed between the two cycles of the study only 8% (n = 24) of the time. No demographic factors were associated with acute vomiting at times 1 or 2; younger age (r = -0.16; p = 0.012) was associated with more vomiting. Delayed vomiting was associated with age and body mass index, and younger, heavier women experienced more vomiting. Minority women (n = 55) reported significantly more delayed vomiting than did Caucasian women (mean = 6.56 versus 2.82; t = 2.02; p less than 0.05). CONCLUSIONS: Vomiting continues to be a significant problem for some women receiving chemotherapy for breast cancer. IMPLICATIONS FOR NURSING: Oncology nurses can use the results from this study to provide anticipatory guidance for patients undergoing chemotherapy for breast cancer and to support efforts to provide appropriate symptom management for these women.

Cardiovascular disease risk in lesbian women.

Lesbians may be a higher risk subpopulation of women for cardiovascular disease due to the prevalence of risk factors and attitudes about weight. In a survey of 648 women, we compared various cardiovascular risk factors between 324 lesbians age 40 and older residing in California and their heterosexual sisters closest in age. Compared with their sisters, the lesbians had a significantly higher body mass index, waist circumference, and waist-to-hip ratio (WHR). The lesbians were also more likely to have ever smoked, but were as likely as their sisters to be current smokers. They were significantly less likely to have eaten red meat in the past year, but did not differ significantly from their sisters on the other nutritional variables. They were more likely, however, to report a history of weight cycling. With regard to exercise, the lesbians were significantly more likely to exercise at least weekly. Yet the two groups did not differ in the number of times per week exercised, the length of the exercise session, nor the exercise vigor. This is the first study to report waist circumference measurements and WHR for lesbians. Our findings suggest that lesbians, as a group, may have greater abdominal/visceral adiposity and, thus, a metabolic profile placing them at higher risk for cardiovascular disease. Future studies of cardiovascular risk in lesbians should measure low-density lipoprotein, C-reactive protein, and identifiers of the metabolic syndrome, namely blood pressure, triglyceride and high-density lipoprotein levels, and fasting glucose. Interventions designed to reduce abdominal/visceral adiposity in lesbians should also be examined in future studies.

Delayed chemotherapy-induced nausea in women treated for breast cancer.

PURPOSE/OBJECTIVES: To describe the experience and intensity of delayed nausea in women undergoing chemotherapy for breast cancer since the advent of the 5-HT3 antagonists. DESIGN: Multisite, longitudinal, descriptive. SETTING: 7 outpatient oncology clinics situated in hospitals, 5 outpatient oncology clinics associated with major teaching universities, 27 private outpatient oncology practices, and 1 outpatient clinic located in a county hospital. SAMPLE: Typical participants (N = 303) were 51.9 years old, Caucasian (79%), married or partnered (65%), born U.S. citizens (92%), heterosexual (96%), living with someone (83%), and high school graduates (82%). METHODS: Baseline and poststudy questionnaires plus a daily diary of nausea through two cycles of chemotherapy (approximately two months) were used to collect data. The Rhodes Inventory of Nausea, Vomiting, and Retching was used to assess the nausea experience. MAIN RESEARCH VARIABLES: Nausea. FINDINGS: The worst nausea occurred on the third day after having chemotherapy for breast cancer. The types of oral antiemetics ordered for home use were changed between the two cycles of the study only 8% (n = 24) of the time. Younger, heavier women experienced more delayed nausea. Women who had a history of nausea with stress and women receiving cyclophosphamide experienced more delayed nausea during both time periods. CONCLUSIONS: Delayed nausea is a significant problem for women receiving chemotherapy for breast cancer. IMPLICATION FOR NURSING: Oncology nurses can use the results from this study to provide anticipatory guidance for patients undergoing chemotherapy for breast cancer.

Isoflavone aglycon and glucoconjugate content of high- and low-soy U.K. foods used in nutritional studies.

The isoflavone aglycon and glucoconjugate content of commercially prepared and "home-prepared" high- and low-soy foods selected for use in an on-going nutritional study were measured by LC-MS. The daidzin, daidzein, 6"-O-malonyldaidzin, 6"-O-acetyldaidzin, genistein, genistin, 6"-O-malonylgenistin, 6"-O-acetylgenistin, glycitin, glycitein, 6"-O-malonylglycitin, and 6"-O-acetylglycitin content are expressed in terms of individual isoflavones, total isoflavone equivalents, and milligrams of isoflavones per portion served. Soybeans (774 mg x kg(-1) total isoflavones) and soybean-containing foods had the highest isoflavone content of the foods examined. The low-soy foods all contained very low concentrations (<8 mg x kg(-1) total isoflavones) of the isoflavone aglycons and glucoconjugates. High- and low-soy 11 day rotating menus were constructed from the analyzed foods to deliver 100.0 and 0.5 mg of isoflavones per day, respectively.