Comprehensive radiation shield minimizes operator radiation exposure in coronary and structural heart procedures.

OBJECTIVES: This study evaluated the efficacy of a novel comprehensive shield designed to minimize radiation exposure (RE) to Physicians performing coronary and structural heart procedures. BACKGROUND: The Protego™ radiation shielding system (Image Diagnostics Inc., Fitchburg, Ma) is designed to provide comprehensive protection from RE and has been State certified sufficient to allow operators to perform procedures without orthopedically burdensome lead aprons. METHODS: This single center two-group cohort study assessed the efficacy of this shield in a large number of cardiac procedures (coronary and structural), comparing operator RE compared to standard protection methods (personal lead apparel and "drop down" shield). RESULTS: The Protego™ system reduced operator RE by 99 % compared to Standard Protection. RE was significantly lower at both "Head" level by thyroid median dose 0.0 (0.0, 0,0) vs 5.7 (2.9, 8.2) µSv (p < 0.001), as well as waist dose 0.0 (0.0, 0.0) vs 10.0 (5.0, 16.6) µSv (p < 0.001). "Zero" Total RE was documented by Raysafe™ in 64 % (n = 32) of TAVR cases and 73.2 % (n = 183) of the coronary cases utilizing Protego™. In contrast, standard protection did not achieve "Zero" exposure in a single case. These dramatic differences in RE were achieved despite higher fluoroscopy times in the Protego™ arm (11.9 ± 8.6 vs 14.3 ± 12.5 min, p = 0.015). Per case procedural exposure measured by Dose Area Product was higher in the Protego™ group compared to standard protection (115.4 ± 139.2 vs 74.9 ± 69.3, p < 0.001). CONCLUSION: The Protego™ shield provides total body RE protection for operators performing both coronary and structural heart procedures. This shield allows procedural performance without the need for personal lead aprons and has potential to reduce catheterization laboratory occupational health hazards.

A Randomized Trial Comparing NeoLight Skylife and Blanket Phototherapy in Newborn Indirect Hyperbilirubinemia.

This investigation aimed to assess the safety and efficacy of NeoLight's Skylife phototherapy device for the treatment of hyperbilirubinemia. A prospective, two-arm, randomized, unblinded controlled investigation compared total serum bilirubin (TSB) levels at baseline and discharge for a new phototherapy device (Skylife) with an existing phototherapy treatment in newborn infants. The repeated-measures analysis of variance (RM-ANOVA) indicated a significant main effect for the treatment condition, F(1, 54) = 4.041, P = .049. Post hoc findings showed that the Skylife group had significantly lower TSB levels following treatment (n = 28, Mean = 11.36, SD = 1.69) compared with the standard of care group (n = 28, Mean = 12.37, SD = 2.08), t(54) = 2.01, P = .049). The Skylife phototherapy device was as effective as the currently used therapy, with a shift toward a more rapid decline in bilirubin levels. Using this device may potentially decrease the length of therapy and hospitalization.Clinical Trial Registration Comparison of Phototherapy Using Neolight Skylife Versus Standardized Phototherapy for Hyperbilirubinemia in Newborns is registered at clinicaltrials.gov as NCT03599258.

Clarification of the "pain neuroscience education" concept in the management of patients with persistent low back pain: A scoping review.

BACKGROUND: Patient education is a recommended treatment strategy for persistent low back pain (PLBP). Pain neuroscience education (PNE) is an emerging concept with boundaries still unclear. OBJECTIVE: To clarify the PNE concept and identify its key characteristics in PLBP management. METHODS: A systematic search was conducted using the following databases: Pubmed, ScienceDirect, Google Scholar, Cochrane, and Pedro. INCLUSION CRITERIA: publications in English or French on pain neuroscience education and chronic low back pain, educational books cited in white literature. Three reviewers independently selected eligible studies for final inclusion. Numerical analysis and narrative synthesis were carried out from the extracted data. RESULTS: From 919 identified publications, 54 were selected. Ten educational resources were added. PNE refers to a theoretical framework, a specific educational intervention, and an overall care approach. It is characterized by the intention to help the patient reconceptualize their PLBP from a tissue injury marker to a protective, neurobiological perspective, and then to increase adherence to biopsychosocial rehabilitation and normalize cognitive-behavioral responses. Pain sciences concepts are presented with an optimization of learning strategies. CONCLUSION: PNE stands out from other educational and cognitive behavioral approaches through its objective of changing the pain concept.

A Retrospective Cohort Analysis of Two Computerized Insulin Infusion Protocols.

OBJECTIVE: The primary objective of this analysis was to compare the safety and efficacy of a novel computerized insulin infusion protocol (CIIP), the Lalani Insulin Infusion Protocol (LIIP), with an established CIIP, Glucommander. METHODS: We conducted a 10-month retrospective analysis of 778 patients in whom LIIP was used (August 18, 2020 to June 25, 2021) at six HonorHealth Hospitals in the Phoenix metropolitan area. These data were compared with Glucommander that was used at those same hospitals from January 1, 2018 to August 17, 2020, n = 4700. Primary end points of the project included average time to euglycemia and average time in hyperglycemia (>180 mg/dL) and hypoglycemia (<70 mg/dL). Additional subgroup analysis was done to evaluate CIIP performance in patients in whom maintenance of euglycemia was more challenging. RESULTS: The LIIP had a faster time to euglycemia (191 vs 222 minutes, P < .001) and similar time in hypoglycemia (2.79 vs 2.76 minutes, P = .50) for all patients, when compared with Glucommander. Similar observations were made for the following subgroups: diabetic ketoacidosis/hyperosmolar hyperglycemic state (DKA/HHS) patients, COVID-19 patients, patients on steroids, patients with ≥60 glomerular filtration rate (GFR), patients with renal insufficiency, and patients with sepsis. CONCLUSIONS: The LIIP is a safe and effective CIIP in managing intravenous insulin infusion rates. Utilization of LIIP resulted in reduced time to euglycemia, P < .001, when compared with Glucommander and did not cause increased hypoglycemia during the project period. Contributing factors to the success of LIIP may include improved clinical workflow, learnability and ease of use, compatibility with the Epic electronic health record (EHR), and its unique, dynamic and adaptive algorithm.

Benefits of a Pediatric Clinic Simulation Using Standardized Patients in Family Nurse Practitioner Education.

ABSTRACT: The purpose of this study was to examine the effect of a pediatric clinic simulation with standardized patients on anxiety, self-efficacy, and performance in family nurse practitioner students. A pediatric clinic simulation was developed in which family nurse practitioner students encountered standardized patients presenting for a well-child visit or exhibiting a common chief complaint. Anxiety and self-efficacy were assessed pre/post the simulation intervention, along with faculty-observed student performance. The clinic simulation resulted in increased self-efficacy, lower anxiety, and improved performance (p < .01). High-fidelity simulation of a pediatric clinic was found to foster development of clinical competency, lower student anxiety, and improve self-efficacy.

Nurses' Experiences of "Being Swamped" in the Clinical Setting and Association with Adherence to AWHONN Nurse Staffing Guidelines.

PURPOSE: Being swamped is defined as "when you are so overwhelmed with what is occurring that you are unable to focus on the most important thing." The purpose of this study was to explore the experience of being swamped in the clinical setting among nurses who are members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the relationship of the level of being swamped to adherence to the nurse staffing guidelines. STUDY DESIGN AND METHODS: A 25-item survey was sent to ~21,000 AWHONN members by email in the Fall of 2018. It was completed by 1,198 members, representing 49 states and the District of Columbia. Questions explored timing and causes of being swamped, its effect on health care team members and patients, what helps when a nurse feels swamped, and nurses' reports of their hospital following the AWHONN nurse staffing guidelines. RESULTS: Twenty-eight percent of nurses reported being swamped daily or multiple times per day. Situations that contribute to being swamped include assignments that are too heavy, interruptions, critical patient situations, and mistakes made by others that nurses are expected to catch and fix. Teamwork and someone stepping in to help without being asked were identified as most helpful when a nurse feels swamped. Nurses practicing in hospitals following the AWHONN nurse staffing guidelines always or most of the time reported less frequency of being swamped as compared with those in hospitals that followed the guidelines some of the time, or rarely (p < 0.001). CLINICAL IMPLICATIONS: Being swamped is a common phenomenon among AWHONN members responding to the survey. The reported incidence of being swamped daily is significantly associated with the extent to which hospitals follow the AWHONN nurse staffing guidelines. Nurse leaders, hospital administrators, and staff nurses must work together to identify and initiate timely, feasible nurse staffing solutions that support the safety of patients and nurses.

The Use of Tai-Chi to Reduce Anxiety Among Nursing Students Undergoing Simulation.

This study sought to examine tai-chi as an anxiety-reducing method to increase self-efficacy and improve performance among baccalaureate nursing students experiencing a patient care simulation. The sample included 63 nursing students enrolled in a traditional or second-degree nursing program. The study used a randomized control group pretest-posttest design. Students in the experimental group experienced significant reductions in cognitive and somatic anxiety, along with an increase in self-efficacy and improved performance. Tai-chi can be an effective technique to reduce anxiety and improve self-efficacy and performance among nursing students in simulations.

Meeting Texas Nursing Workforce Needs Through Recruitment and Retention Initiatives.

Evidence demonstrates health inequities can be ameliorated by a workforce whose diversity reflects the population served. The diversity of the Texas nursing workforce, however, is not reflective of the Texas population. This article reports on a project to recruit and retain minority nurses in Texas. The project goals were to improve enrollment for minority students, specifically Hispanic students, in an online South Texas baccalaureate nursing program (traditional BSN, second-degree BSN, and RN to BSN); facilitate student success; and promote student satisfaction. These goals were successfully achieved at one academic institution.

Development of the Self-Rated Abilities for Health Practices-Adolescent Version: A Self-Efficacy Measure.

BACKGROUND AND PURPOSE: An instrument to measure wellness behaviors in adolescent females did not appear in the literature. The purpose of this article is to describe the development and evaluation of the Self-Rated Abilities for Health and Practices Scale-Adolescent Version (SRAHP-A). METHODS: Initial psychometric testing was conducted with a sample of 265 adolescents and young adults aged 13-24 years. Data collection occurred through paper and pencil surveys. RESULTS: Exploratory factor analysis using maximum likelihood factor extraction method and oblique ration was conducted. A four-factor structure consisting of Exercise, Nutrition, Health Practices, and Well-Being emerged. CONCLUSIONS: Initial psychometric testing suggested that it is a valid and reliable measure of wellness behaviors in adolescent females. Further testing is necessary; however, it appears this instrument has the potential to move wellness care for adolescents and young adults forward.

Health science center faculty attitudes towards interprofessional education and teamwork.

The attitudes of faculty towards interprofessional education (IPE) and teamwork impact the education of health professions education (HPE) students. This paper reports on a study evaluating attitudes from health professions educators towards IPE and teamwork at one academic health science center (HSC) where modest IPE initiatives have commenced. Drawing from the results of a previous investigation, this study was conducted to examine current attitudes of the faculty responsible for the training of future healthcare professionals. Survey data were collected to evaluate attitudes from HSC faculty, dentistry, nursing, medicine, pharmacy and public health. In general, positive HSC faculty attitudes towards interprofessional learning, education, and teamwork were significantly predicted by those affiliated with the component of nursing. Faculty development aimed at changing attitudes and increasing understanding of IPE and teamwork are critical. Results of this study serve as an underpinning to leverage strengths and evaluate weakness in initiating IPE.

The Effect of Autogenic Training on Self-Efficacy, Anxiety, and Performance on Nursing Student Simulation.

The increased anxiety experienced by nursing students during simulations can serve as a significant barrier to learning. The use of anxiety-reducing techniques such as autogenic training (AT) can mitigate the negative effects of anxiety and improve the overall learning experience. The investigators in this study sought to understand the effect of AT on student performance and self-efficacy during simulation experiences. The use of AT was an effective technique to decrease anxiety and increase performance among nursing students during nursing simulations. Reducing anxiety during simulations can improve the student learning experience.

Improving Outcomes for Infants with Single Ventricle Physiology through Standardized Feeding during the Interstage.

Congenital heart disease is identified as the most common birth defect with single ventricle physiology carrying the highest mortality. Staged surgical palliation is required for treatment, with mortality historically as high as 22% in the four- to six-month period from the first- to second-stage surgical palliation, known as the interstage. A standardized postoperative feeding approach was implemented through an evidence-based protocol, parent engagement, and interprofessional team rounds. Five infants with single ventricle physiology preprotocol were compared with five infants who received the standardized feeding approach. Mann-Whitney U tests were conducted to evaluate the hypotheses that infants in the intervention condition would consume more calories and have a positive change in weight-to-age z-score (WAZ) and shorter length of stay (LOS) following the first and second surgeries compared to infants in the control condition. After the protocol, the change in WAZ during the interstage increased by virtually one standard deviation from 0.05 to 0.91. Median LOS dropped 32% after the first surgery and 43% after the second surgery. Since first- and second-stage palliative surgeries occur within the same year of life, this represents savings of $500,000 to $800,000 per year in a 10-infant model. The standardized feeding approach improved growth in single ventricle infants while concurrently lowering hospital costs.

Evaluation of an Innovative Program To Improve Outcomes among Military Beneficiaries with Diabetes.

Patients with Type 2 Diabetes Mellitus (T2DM) are a challenging population and the goals of maintaining a HgA1c of 7 or less, and limiting emergency department (ED) visits and hospitalizations, are not new. The Patient-Centered Medical Home (PCMH) is a practice model mandated by the U.S. Air Force. The primary objective of this study was to quantify and evaluate the effects of PCMH implementation on one group of chronic disease patients, those with T2DM, using the outcomes of HgA1c, ED visits, and hospitalized days. A secondary objective was to use PCMH evaluations to explain outcome variations and then help clinic sites recognize areas of strength and weaknesses so they could continue care improvement efforts. Support was found for the effect of PCMH implementation on HgA1c of patients with T2DM seen in military clinics. Support was mixed for PCMH and its positive effect on hospitalized days and ED visits of patients with T2DM.

A comparison of metered-dose inhaled albuterol versus endotracheal liquid bolus albuterol for the treatment of bronchoconstriction.

INTRODUCTION: Aerosolized albuterol delivery is a mainstay treatment for bronchoconstriction; however, almost no data exist that evaluate the clinical outcome of instillation of an endotracheal liquid bolus (ELB) of a bronchodilator directly into the airway. METHODS: This randomized trial sought to evaluate the efficacy of albuterol lavage via artificial airway with accompanied patient positioning. Subjects receiving mechanical ventilation for acute respiratory failure with clinical manifestations of bronchoconstriction were assigned to initially receive either traditional albuterol via metered-dose inhaler (MDI) or albuterol via ELB lavage with follow-up administration of the other therapy after a 4-h washout period. Clinical data were collected at baseline and at 5 and 30 min post-treatment. RESULTS: Fourteen subjects (5 males, 9 females; mean age of 57.5 y) were included in this study. In the group receiving initial ELB, peak airway pressure decreased significantly (P = .02), and a significant decrease in airway resistance mean scores was seen from baseline to 30 min post-treatment (P < .001) and from 5 to 30 min post-treatment (P = .003), with no significant effects seen with follow-up MDI. In the initial MDI treatment group, no significant effect on peak airway pressure or airway resistance was noted. S(pO2) increased at 5 min post-treatment with ELB. In contrast, S(pO2) decreased 30 min post-treatment with MDI. Mean arterial pressure decreased post-treatment with ELB. The pattern in heart rate change post-treatment with ELB was similar to that post-treatment with MDI, with a significant increase at the 5-min interval from baseline (P < .01), followed by a significant decrease at the 30-min interval (P < .001). There were no differences in dynamic compliance at each time interval following administration of both the MDI (P = .92) and ELB conditions (P = .18). CONCLUSIONS: ELB albuterol lavage may be a viable option to reverse bronchoconstriction in intubated patients with limited response to traditional aerosolized albuterol via MDI.

Expectations and self-efficacy of African American parents who discuss sexuality with their adolescent sons: an intervention study.

OBJECTIVE: Despite research that suggests parental communication may help deter high-risk sexual behavior among adolescents, parents report a lack of confidence in their ability to answer sexually related questions. The purpose of this study was to test the effect of a multimedia intervention on outcome expectations and perceived self-efficacy for the sex educator role for parents of African American adolescent males. DESIGN AND SAMPLE: A pilot study using mixed methods was conducted. A nonprobability sample (N = 61) was obtained from a large urban community using a combination of convenience and snowball recruitment methods. MEASURES: Self-efficacy and outcome expectations were measured using self-reported questionnaires. INTERVENTION: A multimedia intervention for use at home and incorporating an audio CD and associated activities was implemented over a 3-week time period. RESULTS: Outcome expectations and self-efficacy both significantly improved after the intervention (p < .001). CONCLUSIONS: Findings indicate that using a multimedia approach may be effective in improving parents' outcome expectancy and self-efficacy for talking about sex with adolescent sons.

The effect of a wellness program on adolescent females.

Guided by Bandura's Social Cognitive Theory, the purpose of this study was to examine the effect of a comprehensive wellness intervention on total wellness, physical fitness, and self-efficacy for health promoting behaviors in adolescent females, ages 14 to 19, enrolled in physical education (PE) classes in Grades 9 to 12. The intervention was administered in an experimental pre-test, post-test, two group design in rural east Texas. Participants (n = 153) were randomly assigned to a 12-week intervention or control group. Independent t-tests to determine differences between the intervention and control groups were nonsignificant for overall wellness and physical fitness. The Wellness Essential-Self subscale score was significantly higher in the intervention group, t(64, 36) = 2.67, p = .005, d = .84. Self-Efficacy Health Promotion subscale scores for the intervention group were also significantly higher, t(20,28) = 2.60, p = .006, d = .74. The intervention has potential to improve overall wellness in adolescent females.

Flipping the classroom to improve student performance and satisfaction.

This study aimed to determine the effects of a flipped classroom (i.e., reversal of time allotment for lecture and homework) and innovative learning activities on academic success and the satisfaction of nursing students. A quasi-experimental design was used to compare three approaches to learning: traditional lecture only (LO), lecture and lecture capture back-up (LLC), and the flipped classroom approach of lecture capture with innovative classroom activities (LCI). Examination scores were higher for the flipped classroom LCI group (M = 81.89, SD = 5.02) than for both the LLC group (M = 80.70, SD = 4.25), p = 0.003, and the LO group (M = 79.79, SD = 4.51), p < 0.001. Students were less satisfied with the flipped classroom method than with either of the other methods (p < 0.001). Blending new teaching technologies with interactive classroom activities can result in improved learning but not necessarily improved student satisfaction.

Effect of the Power Balance® band on static balance, hamstring flexibility, and arm strength in adults.

The purpose of this study was to determine the effect of Power Balance® bands on strength, flexibility, and balance. Strength and flexibility were measured using the MicroFit system. Strength was measured via a bicep curl and flexibility via the sit-and-reach method. Balance was measured by the BIODEX System SD. There were 4 different conditions for the balance test: eyes open on a firm surface (EOFS), eyes closed on a firm surface (ECFS), eyes open on a foam surface (EOFoS), and eyes closed on a foam surface (ECFoS). There were 24 subjects in the study (10 men and 14 women). A counterbalance, double-blind, placebo, controlled within-subject design was used. Each of the subjects participated in 3 treatment sessions, consisting of Power Balance®, placebo band, and no band. An alpha level of p ≤ 0.05 was set a priori. There were no significant differences in strength, flexibility, or balance with regard to the treatments used. There was a significant difference between the conditions in the balance test (p = 0.000): EOFS (0.51), ECFS (0.68), EOFoS (0.99), and ECFoS (2.18); however, these were independent of the treatment conditions. The results indicate that the Power Balance® bands did not have an effect on strength, flexibility, or balance.