The Williams and McCoy model of motivational spirited cognitive behavioral change communication.

PURPOSE: The Williams and McCoy Motivational Spirited Cognitive Behavioral Change Communication (MIS-CBC) is an innovative model combining the spirit of motivational interviewing (MI) communication, and cognitive behavioral therapy (CBT) as a patient-centered care model to improve continuity of care while enabling patients to progress during therapy. CONCLUSIONS: Incorporating this model into Psychiatric Mental Health Advance Practice Nurse practice allows for provision of best practice with populations experiencing low motivation and subject to dropout. The model aims to improve patient motivation and engagement of CBT to achievement "full dose" CBT with more flexibility to significantly improve patient outcomes, particularly with patient populations subject to interruptions in psychotherapy. PRACTICE IMPLICATIONS: The Williams and McCoy MIS-CBC model has implications in areas of both practice and academia addressing episodic psychotherapy in populations where interruptions and dropout frequently occur.

An innovative behavioral health care curriculum: The integrated advanced practice addictions nursing subspecialty.

INTRODUCTION: There is a significant shortage of behavioral health providers trained in caring for patients with problematic substance use, particularly within integrated care settings. METHOD: An innovative addictions nursing subspecialty curriculum was designed by interdisciplinary faculty from psychiatric nursing, family nursing, counseling, and social work and informed by integrated care, addictions, and telehealth competencies. The subspecialty included prevention, treatment, and recovery approaches to care and encouraged enrollment of students from various health-related disciplines to enhance the students' experiences of integrated care for substance use treatment prior to completion of the program. RESULTS: Subspecialty courses increased the number of advanced practice nurses in the behavioral health care workforce with enhanced knowledge of integrated telehealth substance use treatment. DISCUSSION: Implementation of similar innovative curricula across health disciplines may significantly improve the care delivered to patients with problematic substance use in traditional medical settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Screening, Brief Intervention, and Referral to Treatment/Motivational Interviewing School-Based Therapy Pilot Study.

ABSTRACT: Substance abuse and comorbid psychological disorders are significant problems among adolescents. Hence, school-based interventions could be a promising approach for tackling substance use and mental health symptoms in at-risk youth. This pilot study was aimed at determining the effectiveness of interventions like Screening, Brief Intervention, and Referral to Treatment and motivational interviewing (MI) on depressive anxiety and substance use symptoms in middle school participants. Student psychiatric nurse practitioners who were trained and competent in MI conducted a combined Screening, Brief Intervention, and Referral to Treatment/MI intervention with 19 participants using measurement tools such as the Patient Health Questionnaire-9, the Generalized Anxiety Disorders-7, and the Car, Relax, Alone, Forget, Friends, Trouble Screening Test. Depressive and anxiety symptoms decreased after the intervention. Because the pre-post Car, Relax, Alone, Forget, Friends, Trouble screening period was 4 weeks, there were no significant pre-post differences.

Prospective Phase 2 Study of Radiation Therapy Dose and Volume De-escalation for Elective Neck Treatment of Oropharyngeal and Laryngeal Cancer.

PURPOSE: The required elective nodal dose and volumes for head and neck intensity modulated radiation therapy have largely been extrapolated from conventional radiation therapy fields. In this prospective, dual-center, phase 2 study, we investigated the efficacy and tolerability of reduced elective nodal volume and dose in oropharyngeal and laryngeal squamous cell carcinoma. METHODS AND MATERIALS: Patients with newly diagnosed squamous cell carcinoma of the oropharynx and larynx were eligible for enrollment. Each lymph node was characterized as involved or suspicious based on imaging criteria. For oropharynx cancer, only involved and immediately adjacent stations were treated to 40 Gy in 20 fractions. In larynx patients, at least bilateral levels II and III were treated to 40 Gy, with level IV treated only if level III was involved. Involved and suspicious nodes were then boosted with 30 Gy and 24 Gy in 15 fractions, respectively. Concurrent chemotherapy was required for stage T3N0-1 and IVA/B patients. The primary endpoint of the study was solitary elective volume recurrence, with secondary endpoints including patterns of failure and patient-reported outcomes. RESULTS: A total of 72 (51 oropharynx, 21 larynx) patients completed treatment on this trial from January 2017 through November 2018. The stages at presentations were 5, 17, and 50 stage I-II, III, and IV, respectively, with 90% treated with chemoradiation therapy. At a median follow-up of 24.7 months for surviving patients, there have been no solitary elective nodal recurrences. Seven patients developed a nodal recurrence, 5 of which were in-field and 2 were elective with synchronous in-field recurrence. Patient-reported outcomes assessment at 1 year showed superior or equivalent outcomes compared with baseline, except for saliva and taste measures. CONCLUSIONS: The results of this trial suggest that elective dose and volume reduction is oncologically sound for oropharyngeal and laryngeal cancer treated with intensity modulated radiation therapy, with promising quality-of-life outcomes.

Challenges of conducting qualitative research of non-suicidal self-injury in South Korea: An international nursing research collaboration.

Understanding non-suicidal self-injury in foreign countries considering their cultural context requires collaboration among international researchers. Through an international collaborative approach, gaps in cultural views can be closed, thereby increasing the understanding of non-suicidal self-injury at a global level. The aim of this article was to illustrate the methodological and ethical challenges of an international collaboration that occurred during a qualitative study with South Korean young adults and the corresponding strategies that were implemented. It is hoped that the dissemination of these strategies and lessons learned can assist other researchers as they pursue international collaborative research.

Understanding Underuse of Advance Care Planning Among a Cohort of African American Patients With Advanced Cancer: Formative Research That Examines Gaps in Intent to Discuss Options for Care.

BACKGROUND: Advance care planning (ACP), palliative care (PC), and hospice are often underutilized by African Americans (AAs). This study assessed the impact of stage of intent to discuss ACP options as key potential barriers. METHODS: We examined intent to discuss completion of ACP, PC, and hospice among 22 AA patients with cancer admitted to a local safety net hospital. Participants were asked about intent to discuss an advanced directive or living will (AD/LW), medical power of attorney (MPOA), PC, and hospice with their doctors. Intent to discuss these ACP components was based on the transtheoretical model. Electronic health records were reviewed at various intervals to assess completion of ACP behaviors and survival. RESULTS: Participants had colorectal (33%), breast (44%), and lung (23%) cancer, and 82% had stage III/IV disease. Low percentages of patients were in the precontemplation stage for AD/LW completion (4.6%), MPOA completion (13.6%), and PC discussions (27.2%), but 77.2% were in the precontemplation stage for hospice discussions. At 1 year, only 5% completed an AD/LW, 36.4% appointed an MPOA, 42.9% were referred to PC, and 12.5% were referred to hospice. More than half (54.6%) were deceased by the study's conclusion. Most (81%) of these died within 6 months of their baseline study assessment. CONCLUSIONS: Despite being hospitalized with advanced cancer and having poor prognosis, intent to discuss ACP options, PC, and hospice in this population was variable, and completion of these activities was low. This formative research is needed to develop education and counseling interventions for this high-risk, vulnerable population.

Lead Levels in Landfill Areas and Childhood Exposure: An Integrative Review.

OBJECTIVE: Landfills are high-risk areas for environmental lead exposure for children living in poverty stricken areas in many countries. This review examines landfills and lead toxicity in children. The review discusses the effects of lead toxicity, provides evidenced based recommendations to reduce lead exposure, and identify gaps in the evidence. DESIGN AND SAMPLE: A database search was conducted of articles in English from 1985 to 2014. Ten articles met the inclusion criteria. The Whittemore and Knafl framework and the John Hopkins Research Evidence Appraisal Tool© were used for reviewing the data. RESULTS: Elevated blood lead levels (BLLs) of children living near landfills were related to increased soil lead levels. Toxic effects of lead included adverse outcomes such as encephalopathy or death for children. Different approaches to decrease lead level include environmental surveillance, BLL screening, and soil abatement which are costly. CONCLUSION: Increased BLL through environmental exposure is connected with poor health outcomes and death among children. Evidence-based prevention included monitoring and screening and costly soil abatement. It is recommended that future studies focus on community education for exposure avoidance for children living near landfill areas.

Improving the No-Show Rate of New Patients in Outpatient Psychiatric Practice: An Advance Practice Nurse-Initiated Telephone Engagement Protocol Quality Improvement Project.

PURPOSE: The aim is to improve the uptake of psychiatric services for new patients being referred from primary care, counseling, and hospital discharge follow-up care. DESIGN AND METHODS: A convenience sample of 18 new patients participated in a provider-initiated telephone protocol to increase knowledge related to psychiatric treatment and remind patients of appointments the day before the initial visit. FINDINGS: Fifteen patients attended the initial visit, resulting in a 26% reduction rate of no-show rates from 27% the previous year to 20% in a 3-month period. PRACTICE IMPLICATIONS: Introduction and reminder calls by psychiatric providers improve no-show rates.

Implementation of an Evidence Based Guideline for Assessment and Documentation of the Civil Commitment Process.

The purpose of this quality improvement project was to implement an evidence-based practice guideline for assessment and documentation of the civil commitment process. Participants included six civil commitment examiners who conduct court ordered psychiatric evaluations at two crisis intervention centers in rural area of southeaster state. Data collection was conducted utilizing a chart audit tool both pre and post intervention of 100 civil commitment evaluations. The intervention included the development of an evidenced based form for documentation of civil commitment evaluations and a one on one educational training session was conducted for each participant. Descriptive statistics (t test) was utilized to analyze the data collected. The project demonstrated a significant increase as 25.5 % of evaluations contained the America Psychiatric Association's recommended 11 domains of assessment prior to implementation compared to 65.6 % (p value = 0.018) post implementation. Moreover, participants with family practice training showed an increase in commitment rates from 60 to 77.3 % (p value = 0.066). Whereas, psychiatric trained participants showed a decrease from 83.75 to 77.66 % (p value = 0.38). Demonstrating that court ordered evaluations guided by a standardized form based on evidence affected examiners recommendations for commitments.

Warthin's tumors and their relationship to lung cancer.

Warthin's tumors (WT) are frequently encountered in clinical practice and can be easily mis-identified. To date, there has been no proven association between WT and lung cancer. A retrospective chart review was conducted of records from 2008 to 2013 in the University of Pennsylvania Health System. Nineteen percent of patients had a diagnosis of lung cancer, compared to the general patient population, where 7.62% of males and 6.26% of females have a lifetime risk of developing lung cancer. Patients with WT are at heightened risk of lung malignancy; detection of WT may lead to earlier diagnosis of lung cancer.

Interactions of light intensity, insecticide concentration, and time on the efficacy of systemic insecticides in suppressing populations of the sweetpotato whitefly (Hemiptera: Aleyrodidae) and the citrus mealybug (Hemiptera: Pseudococcidae).

The impact of light intensity on the uptake and persistence of the systemic neonicotinoid insecticides, imidacloprid and dinotefuran, were evaluated in poinsettia (Euphorbia pulcherrima Willd.) and yellow sage (Lantana camara L.). Insecticide residues were measured in leaves sampled from the treated plants at four time intervals after treatment to determine the relationship between insecticide concentration and efficacy against two insect pests: sweetpotato whitefly, Bemisia tabaci Gennadius, and the citrus mealybug, Planococcus citri Risso. The insecticides were evaluated at their respective label rate and at the comparable label rate of the other insecticide under two different light environments: ambient and shade. The uptake of dinotefuran into yellow sage was more rapid at both treatment rates than both rates of imidacloprid, resulting in higher percent mortality of whitefly nymphs (89.8-100) compared with imidacloprid (14.1-89.2) across all 4 wk. Additionally, plants that received both rates of dinotefuran had fewer whitefly pupae (< 1.0) at week 4 compared with imidacloprid-treated plants (23.7-25.3). The uptake of dinotefuran into poinsettia plants was also more rapid and resulted in quicker and higher percent mortality of whitefly nymphs (89.5-99.6) compared with imidacloprid (14.1-89.2) across all 4 wk. However, despite efficient uptake, the efficacy of both systemic insecticides was less for citrus mealybug where percent mortality values were <50% among all the treatments across the 4 wk. The use of the two systemic insecticides evaluated in regards to pest management in horticultural cropping systems is discussed.

Expression of an Arabidopsis Ca2+/H+ antiporter CAX1 variant in petunia enhances cadmium tolerance and accumulation.

Phytoremediation is a cost-effective and minimally invasive technology to cleanse soils contaminated with heavy metals. However, few plant species are suitable for phytoremediation of metals such as cadmium (Cd). Genetic engineering offers a powerful tool to generate plants that can hyperaccumulate Cd. An Arabidopsis CAX1 mutant (CAXcd), which confers enhanced Cd transport in yeast, was ectopically expressed in petunia to evaluate whether the CAXcd expression would enhance Cd tolerance and accumulation in planta. The CAXcd-expressing petunia plants showed significantly greater Cd tolerance and accumulation than the controls. After being treated with either 50 or 100µM CdCl(2) for 6 weeks, the CAXcd-expressing plants showed more vigorous growth compared with controls, and the transgenic plants accumulated significantly more Cd (up to 2.5-fold) than controls. Moreover, the accumulation of Cd did not affect the development and morphology of the CAXcd-expressing petunia plants until the flowering and ultimately the maturing of seeds. Therefore, petunia has the potential to serve as a model species for developing herbaceous, ornamental plants for phytoremediation.

Culturally competent assessment and care of self-mutilation in urological nursing.

Use of self-mutilating behaviors as ineffective coping techniques is increasing, and it cuts across cultural and ethnic populations. With increasing immigration, the chance of facing both issues with a single patient is also increasing. Therefore, the need for assessment and care that is culturally sensitive is a necessity.

Comparing chemical and biological control strategies for twospotted spider mites (Acari: Tetranychidae) in commercial greenhouse production of bedding plants.

Efficacy, costs, and impact on crop salability of various biological and chemical control strategies for Tetranychus urticae Koch (Acari: Tetranychidae) were evaluated on mixed plantings of impatiens, Impatiens wallerana Hook.f (Ericales: Balsaminaceae), and ivy geranium, Pelargonium peltatum (1.) L'Hér. Ex Aiton (Geraniales: Geraniaceae), cultivars in commercial greenhouses. Chemical control consisting of the miticide bifenazate (Floramite) was compared with two biological control strategies using the predatory mite Phytoseiulus persimilis Athias-Henriot (Acari: Phytoseiidae). Treatments were 1) a single, early application of bifenazate; 2) a single, early release of predatory mites at a 1:4 predator:pest ratio based on leaf samples to estimate pest density; 3) a weekly release of predatory mites at numbers based on the area covered by the crop; and 4) an untreated control. T. urticae populations were monitored for 3 wk after the earliest treatment. When plants were ready for market, their salability was estimated. Bifenazate and density-based P. persimilis treatments effectively reduced T. urticae numbers starting 1 wk after plants had been treated, whereas the scheduled, area-based P. persimilis treatment had little or no effect. The percentage of flats that could be sold at the highest market wholesale price ranged from 15 to 33%, 44 to 86%, 84 to 95%, and 92 to 100%, in the control, weekly area-based P. persimilis, bifenazate, and single density-based P. persimilis treatments, respectively. We have shown that in commercial greenhouse production of herbaceous ornamental bedding plants, estimating pest density to determine the appropriate number of predators to release is as effective and offers nearly the same economic benefit as prophylactic use of pesticides.

Twospotted spider mite population level, distribution, and damage on ivy geranium in response to different nitrogen and phosphorus fertilization regimes.

The influence of plant nutrition on arthropod pests has often been studied by comparing plants provided suboptimal nutrients with those provided sufficient or luxurious nutrients, but such results have limited applicability to commercially produced crops because nitrogen (N) and phosphorus (P) are almost never limiting in greenhouse production. We conducted a series of experiments with ivy geranium, Pelargonium peltatum (L.) L'Hr. ex Aiton 'Amethyst 96' to determine the response of twospotted spider mite, Tetranychus urticae Koch (Acarina: Tetranychidae), to six combinations of N (8 or 24 mM) and P (0.32, 0.64, or 1.28 mM) that reflected commercial production practices. All six combinations resulted in saleable plants when plants were free of spider mites, but tissue N and P concentrations among fertilizer combinations were different. On mite-infested plants, no difference in mite numbers or plant damage was found in response to N fertilization rates. Phosphorus had no effect on mite population level until week 8, at which time plants fertilized with 0.64 mM P had slightly more mites than plants fertilized with 0.32 mM. However, overall quality and dry weight of plants fertilized by 0.32 mM P was lower than that of 0.64 and 1.28 mM, which suggests that ivy geranium plants fertilized with the higher P rates may better compensate for mite feeding damage. Positive correlations were found between within-plant distribution of mites and the corresponding tissue N and P concentrations in three foliage strata, suggesting that tissue nutrient content may influence mite selection of feeding sites.

Adolescent self-mutilation: diagnosis & treatment.

Self-mutilation is complicated and difficult to diagnose. Its incidence among adolescents has increased during the past 10 years. Most mental health professionals discover that the behavior has been part of patients' lives long before their initial visit and that patients have become very good at hiding their behavior. The literature on self-mutilation is increasing, but newer statistics, specifically about cutting and picking behaviors, need to be assessed. The disorder often co-exists with another disorder that requires psychotropic medications, the administration of which should be managed by psychiatric clinicians who specialize in children and adolescents. A multidisciplinary team is necessary to achieve the best outcomes.

Inactive nurses: a source for alleviating the nursing shortage?

OBJECTIVE: This study seeks to provide an understanding of why inactive registered nurses chose to become inactive and what they would require for them to return to nursing. BACKGROUND: In 2000, a shortage of 110,000 (6%) registered nurses existed in the United States. If the current trends continue, the shortage is projected to grow to 29% by 2020. One solution to the nursing shortage may be attracting nurses with inactive licenses back into employment. METHODS: This study used a quantitative, cross-sectional survey design. Data analysis included descriptive and inferential statistics. RESULTS: Inactive nurses (N = 428) younger than 60 years in 1 Southern state were surveyed. A major portion (27.6%) of these nurses left nursing because of a conflict between parenting duties and scheduling requirements (13.5%) at work and indicated that they would return to nursing if given the opportunity to work part-time, especially if shifts were flexible and shorter. CONCLUSION: Although the group of registered nurses younger than 60 years do not constitute a large percentage of nurses in this country, they are a potential source of alleviating, to some extent, the critical nursing shortage. Employers can encourage many of these nurses to return to work by providing more flexible work schedules, including part-time and shorter shifts, as well as decreased workloads.

Efficacy and safety of a purified porcine insulin zinc suspension for managing diabetes mellitus in dogs.

The objective of this study was to evaluate the safety and efficacy of a purified porcine insulin zinc suspension for treating dogs with uncomplicated diabetes mellitus. Fifty-three dogs were treated for 60 days after an initial dose determination period. The means of the blood glucose concentrations during 12-hour glucose curves and the means of the blood glucose nadir concentrations during 12-hour glucose curves for all dogs were determined before beginning insulin therapy (time 0), at the end of the dose determination period (time 1), 30 days after time 1 (time 2), and 60 days after time 1 (time 3). Presence of polyuria, polydipsia, and ketonuria was determined at each time point. Adequacy of control of hyperglycemia was based on 12-hour blood glucose curves and improvement in clinical variables (results of physical examinations, historic information, polyuria, polydipsia, and ketonuria). Safety was evaluated by questionnaire, performance of physical examination, CBC, serum chemistry profile, and urinalysis. The means of the blood glucose concentrations during 12-hour glucose curves and the means of the blood glucose nadir concentrations during 12-hour glucose curves for all dogs at times 1, 2, and 3 were significantly lower compared with time 0 (P < .0001). There was a reduction in the proportion of dogs with polyuria, polydipsia, and ketonuria of 82, 86, and 80%, respectively. All of the dogs had adequate glycemic control at time 1, 66% at time 2, and 75% at time 3. At time 3, 66% of dogs required insulin injections q12h. Other than hypoglycemia, there were no important adverse effects of insulin administration. The insulin, was safe and efficacious for reducing blood glucose and clinical signs in dogs with diabetes mellitus.

Perceived barriers to health care access among rural older adults: a qualitative study.

CONTEXT: Many rural elders experience limited access to health care. The majority of what we know about this issue has been based upon quantitative studies, yet qualitative studies might offer additional insight into individual perceptions of health care access. PURPOSE: To examine what barriers rural elders report when accessing needed health care, including how they cope with the high cost of prescription medication. METHODS: During Spring 2001, thirteen 90-minute focus groups were conducted in 6 rural West Virginia communities. A total of 101 participants, aged 60 years and older, were asked several culminating questions about their perceptions of health care access. FINDINGS: Five categories of barriers to health care emerged from the discussions: transportation difficulties, limited health care supply, lack of quality health care, social isolation, and financial constraints. In addition, 6 diverse coping strategies for dealing with the cost of prescription medication were discussed. They included: reducing dosage or doing without, limiting other expenses, relying on family assistance, supplementing with alternative medicine, shopping around for cheapest prices, and using the Veteran's Administration. CONCLUSIONS: Overall, rural older adults encounter various barriers to accessing needed health care. Qualitative methodology allows rural elders to have a voice to expound on their experiences. Research can contribute valuable information to shape policy by providing a forum where older adults can express their concerns about the current health care delivery system.