An Analysis and Review of the Use of State Legislator Clinical Site Visits to Increase Advocacy for Nurse Anesthesiologists.

Nurse anesthesiologists have successfully influenced legislative change to include full practice authority across the United States. These legislative changes directly impact the scope of practice as well as patient care and the advancement of the nursing profession. However, nurse anesthesiologists remain hesitant to embrace health policy advocacy as a professional responsibility. To act as advocates, awareness must exist around professional responsibility to engage in political advocacy, and how to engage in this role. We describe successful statewide strategies involving members of a professional state organization for nurse anesthesiologists. Leaders from the state organization incorporated clinical site visits to create a shared vision and inform legislators about their role and its influence on providing safe, quality, cost-effective care to patients. These efforts were effective in moving the policy agenda forward. Additionally, this process of educating legislators within the hospital has empowered a new generation of nurse anesthesiology advocates.

Virtual Peer Support in Women's Health for Pregnant People and Mothers With Substance Use Disorder.

OBJECTIVE: To evaluate the effectiveness of a virtual peer support group associated with a women's health unit for mothers and pregnant people with substance use disorder. DESIGN: The project was guided by the Centers for Disease Control and Prevention's Framework for Program Evaluation in Public Health. Pre-/postintervention surveys were used to evaluate outcomes. SETTING: Women's health unit in a 325-bed hospital with 900 births a year in the U.S. Midwest and a virtual online meeting format. PARTICIPANTS: Thirteen people with substance use disorder. INTERVENTION/MEASUREMENTS: Participants were recruited by nurses on the womens health unit and from existing online peer support meetings. Participants attended a 12-week session of facilitated substance use disorder peer support meetings through an online virtual format. Surveys included the Depression, Anxiety, and Stress Scale; the Alcoholics Anonymous Intention Scale; and pre-/postintervention surveys developed by the authors. Descriptive statistics and narrative description of qualitative data were used. RESULTS: The Depression, Anxiety, and Stress Scale scores were reduced, on average, by 25%, indicating that participants showed improvement in these conditions. Responses to open-ended questions showed that participants found the meetings helpful for developing coping mechanisms. The virtual space was seen as a comfortable, safe space where participants were able to develop community. CONCLUSION: Substance use disorder treatment continues to challenge health care providers across the United States. Peer support meetings have been effective in the treatment of people with substance use disorder. Nursing has the holistic historical precedence of creating effectual education and support programs. This program evaluation exemplifies that women's health units are an appropriate location where nurses can integrate this established evidence-based treatment modality.

Diagnosis of pulmonary contusions with point-of-care lung ultrasonography and thoracic radiography compared to thoracic computed tomography in dogs with motor vehicle trauma: 29 cases (2017-2018).

OBJECTIVE: To determine the accuracy of lung ultrasound (LUS) using the Veterinary Bedside Lung Ultrasound Examination (VetBLUE) protocol and 3-view thoracic radiographs (TXR) compared to thoracic computed tomography (TCT) for diagnosing the presence and quantification of pulmonary contusions (PC). DESIGN: Prospective cohort study conducted from February 2017 to June 2018. SETTING: Private emergency and referral center. ANIMALS: Thirty-two dogs having sustained motor vehicle trauma were consecutively enrolled. Three dogs were excluded from statistical analysis. All dogs survived to hospital discharge. INTERVENTIONS: Within 24 hours of sustaining trauma, dogs had LUS, TXR, and TCT performed. Using the VetBLUE protocol, LUS PC were scored according to the presence and number of B-lines and C-lines, indicating extravascular lung water. Thoracic radiographs and TCT were scored for PC in a similar topographical pattern to the VetBLUE protocol. Lung ultrasound and TXR were compared to "gold standard" TCT for the presence and quantification of PC. MEASUREMENTS AND MAIN RESULTS: On TCT, 21 of 29 (72.4%) dogs were positive and 8 of 29 (27.6%) dogs were negative for PC. When LUS was compared to TCT, 19 of 21 dogs were positive for PC (90.5% sensitivity) and 7 of 8 dogs were negative (87.5% specificity) for PC. LUS PC score correlated strongly with TCT PC score (R = 0.8, P < 0.001). When TXR was compared to TCT, 14 of 21 dogs were positive for PC (66.7% sensitivity) and 7 of 8 dogs were negative (87.5% specificity) for PC. TXR PC score correlated strongly with TCT PC score (R = 0.74, P < 0.001). CONCLUSIONS: In this population of dogs with motor vehicle trauma, LUS had high sensitivity for diagnosis of PC when compared to "gold standard" TCT. LUS provides reliable diagnosis of PC after trauma. More patients with PC were identified with LUS than with TXR, and additional studies are warranted to determine whether this increased sensitivity is statistically significant.

Pancreatic torsion in a dog.

A 6-month-old male intact Cane Corso mastiff dog was presented for a recent history of vomiting, abdominal pain, and lethargy. A diagnosis of pancreatic torsion was made during abdominal exploratory surgery and was confirmed with histopathology. The dog underwent partial pancreatectomy and recovered with no complications.

Torsion pancréatique chez un chien. Un chien mastiff Cane Corso mâle intact âgé de 6 mois a été présenté pour une anamnèse récente de vomissements, de douleurs abdominales et d'abattement. Un diagnostic de torsion pancréatique a été posé durant une chirurgie exploratoire abdominale et a été confirmé par histopathologie. Le chien a subi une pancréatomie partielle et s'est rétabli sans complications.(Traduit par Isabelle Vallières).

Hypercalcemia of malignancy in a cat with bronchogenic adenocarcinoma.

A 16-year-old, neutered male, domestic shorthaired cat was presented with a history of progressive lethargy and decreased appetite. Serum biochemical profile demonstrated hypercalcemia, and thoracic radiographs and computed tomography were consistent with pulmonary neoplasia. A thoracotomy was performed, and a pulmonary mass was removed. Histopathology diagnosed a bronchogenic adenocarcinoma, and calcium levels returned to normal limits after excision of the mass. While bronchogenic adenocarcinoma has been a suspected cause for hypercalcemia in cats, to the authors' knowledge, this is the first proven account.

Use of fetal skeletal mineralization for prediction of parturition date in cats.

OBJECTIVE: To determine the relationship between parturition date and fetal skeletal mineralization detected radiographically in cats. DESIGN: Prospective clinical trial. ANIMALS: 31 queens and their 49 pregnancies. PROCEDURE: Seventeen pregnant queens were radiographed with a computed radiography system every 2 to 3 days from 1 week after pregnancy was identified by abdominal palpation until parturition. Radiographs were evaluated to determine the first identifiable mineralization of 16 bony structures and teeth during each pregnancy. This information was used to establish a table of expected parturition dates on the basis of fetal mineralization. Single radiographs from an additional 32 pregnant cats were evaluated, and predictions of parturition dates were made on the basis of the mineralization table. RESULTS: Mineralization was first detected 25 to 29 days prior to parturition (dpp). Mineralization was determined for the spinal column (22 to 27 dpp), skull (21 to 27 dpp), ribs (20 to 25 dpp), scapula (17 to 24 dpp), humerus (20 to 24 dpp), femur (19 to 23 dpp), radius (15 to 22 dpp), tibia (15 to 21 dpp), ulna (5 to 21 dpp), pelvis (8 to 20 dpp), fibula (0 to 17 dpp), tail (8 to 16 dpp), metacarpals and metatarsals (3 to 14 dpp), phalanges (0 to 11 dpp), calcaneus (0 to 10 dpp), and teeth (1 to 6 dpp). Date of parturition was predictable within 3 days in 75% of cats. CONCLUSIONS AND CLINICAL RELEVANCE: Identification of bony structures in the fetus is useful in estimating the time to parturition in queens.

Body condition of feral cats and the effect of neutering.

Considerable debate exists regarding the most appropriate methods for controlling feral cat populations, both from humane and logistical points of view. The physical condition of feral cats has not been reported, and it is not known if these cats benefit from neutering. This study investigates the body condition of feral cats by measuring body weight (BW), body condition score (BCS; Burkholder, 2000; Laflamme, Kealy, & Schmidt, 1994), and falciform fat pad. The study includes lateral abdominal radiographs taken at the time of neutering of 105 adult feral cats for measurement of falciform fat pad depth and area. At that time we also assessed BW and BCS. One year later we assessed the effects of neutering on body condition by evaluating a subsample of 14 cats. At the time of surgery, the cats were lean but not emaciated (BW 3.1 +/- 0.9 kg; BCS 4 +/- 1; based on a 1 to 9 scale ranging from 1 [emaciated] to 9 [grossly obese]). Falciform fat pad depth and area averaged 7.1 mm and 197.4 mm2, respectively, indicating a small amount of fat. Fourteen cats, reevaluated 1 year after neutering, increased 260% + 90% in falciform fat pad depth, 420% +/- 390% in fat pad area, 40% +/- 4% in BW, and 1 level in BCS ranking (1 to 9 scale; all differences p <.001). Similar to confined socialized cats, feral cats gained significant weight and body fat after neutering.