Social solidarity, social infrastructure, and community food access.

This study examines the case of community resource mobilization within the context of a farmers market incentive program in Washington D.C., USA to illustrate the ways in which providing opportunities for people impacted by food inequities to develop and lead programming can help to promote food access. Through an analysis of interviews with 36 participants in the Produce Plus program, some of whom also served as paid staff and volunteers with the program, this study examines the ways that group-level social interactions among program participants helped to ensure the program was accessible and accountable to the primarily Black communities that it serves. Specifically, we explore a particular set of social interactions, which we collectively term social solidarity, as a community-level form of social infrastructure that program volunteers and participants mobilized to support access to fresh, local food in their communities. We also examine the elements of the Produce Plus program that contributed to the flow of social solidarity within the program, providing insight into the ways in which the structure of food access programs can serve as a social conduit to facilitate or hinder the mobilization of community cultural resources like social solidarity.

A protocol for exploring patients' and support peoples' experiences after prolonged critical illness.

BACKGROUND: Improved survival of critically ill people has increased the number of patients who experience an extended stay in intensive care units (ICU). Evidence suggests the complexities, vulnerabilities, and traumas created by critical illness are substantial for both patients and their support people with a number experiencing devastating impairments across multiple domains of health and function including physical, mental, cognitive, and social health. However, research on survivors predominantly focuses on those who have experienced a relatively short length of stay; only a limited number of studies seek to explore the experiences of survivors and their support people who have had a prolonged stay in intensive care. AIMS: To describe the experiences of survivors of prolonged critical illness (invasively mechanically ventilated in ICU for ≥eight days) and their support people during the first 12 months following hospital discharge in New Zealand. STUDY DESIGN: This research will be a multi-centre study recruiting from three intensive care units in New Zealand. A narrative inquiry methodology will be used to interview 6-8 former long stay patients and 6-8 support people of a former long stay patient. Each participant will be interviewed at 3-, 6-, 9-, and 12-months following hospital discharge. Data will be collected via narrative inquiry interviews. Data analysis will combine two theoretical frameworks: the Clandinin and Connelly narrative inquiry three-dimensional space and the Fairclough situation, discourse and context framework. RESULTS: The phenomenon of investigation will be experiences after prolonged critical illness explored longitudinally across the first-year post-hospital discharge. RELEVANCE TO CLINICAL PRACTICE: This protocol provides a methodological framework for exploring the lived experiences of survivors of prolonged critical illness and their support people. Data analysis will support understanding of the human journey of ICU survivorship and add to the body of knowledge on how to support post-ICU recovery in this population. The barriers and enablers of survivorship at the micro, meso, and macro levels of the health service will also be illuminated.

The long-term ICU patient: Which definition?

AIMS AND OBJECTIVES: To offer a review of the differing terminologies used by clinicians and researchers to describe the long-term intensive care unit (ICU) patient and the underlying propositions that align with this terminology. BACKGROUND: Ongoing medical and technological advances in emergency and intensive care have resulted in improved survival of critically ill patients in recent decades. In addition, these advancements have also resulted in improved survival of complex critically ill patients who progress to a trajectory of prolonged critical illness, having protracted stays in the ICU. There is great variability in terminology used to define the long-term ICU patient. This lack of a common definition for long-term ICU patients is problematic, increasing their vulnerability and risk of care not being centred about their unique needs. DESIGN: In this discursive article, we explore the terminology used to define the long-term ICU patient. An initial broad search of the literature across four electronic databases was conducted to identify common terminology used to define the long-term ICU patient. From here, seven definitions were identified and chosen for inclusion in the review as they meet inclusion criteria and clearly described a group of patients who have an extended ICU stay. The seven selected terms are as follows: prolonged mechanical ventilation; failure to wean; insertion of tracheostomy; chronically critically ill; persistent critical illness; persistent inflammatory-immunosuppressive and catabolic syndrome; and frailty. Following this a focused review of the literature with the selected terms was conducted to explore in greater detail the terminology. DISCUSSION: The lack of clear definition for this patient group can potentiate their care needs being unmet. Acknowledgement of the need to clearly define this patient group is the first step to improve outcomes. Nursing is well positioned to recognise the different terminologies use to describe this group of patients and implement care to suit their unique clinical characteristics. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Recognition and standardisation of these terms are an important priority to pave the way to improve care pathways and outcomes for this group of patients and their family.

Health care staff support for mothers in NICU: a focused ethnography study.

BACKGROUND: Mothers of premature newborns in the neonatal intensive care unit (NICU) have complex needs and require a significant amount of support during the NICU admission. However, little is known about mothers' support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers' support needs in the NICU. METHODS: A focused ethnographic approach was adopted. Observations and interviews with 21 mothers, 18 nurses, and five physicians were undertaken over a seven months period. Qualitative data analysis was conducted using the Roper and Shapira (2000) five-step framework. RESULT: Two main themes of "insufficient provision of the mothers' support needs" (subthemes: inadequate accompany of the mothers in care, assigning monitoring and care to the mothers, inadequate sharing of medical the information) and "supporting the mothers in certain circumstances" (subthemes: reassuring the mothers, supporting the mothers with reduced functional capacity, providing information) were obtained. CONCLUSION: The mothers experienced a gap between expected and actual support provided by health care staff. Although, the health care staff believed that mothers' support was a necessity, it was not their main concerns, and they considered workload as a barrier for the mothers support in the NICU.

Barriers to home-based palliative care in people with cancer: A qualitative study of the perspective of caregivers.

Aim: To investigate the barriers to home-based palliative care for cancer patients from professional caregivers' experiences. Design: A qualitative study. Method: This is a descriptive-qualitative study carried out in the community-based care. Twenty-three participants took part in this study. Data were collected through semi-structured interviews. Results: Data analysis led to the identification of three category of barriers including the lack of instructions (the lack of clinical practice guidelines, the ambiguity of tariffs and the lack of insurance coverage), family desperation (family views of prognosis, distrust and poverty) and lack of professionalism (limited knowledge, the use of amateur nurses and siloed care). Developing a care protocol and providing resources support contribute to the development of home-based palliative care. Moreover, the education of families and training courses for nurses must be fostered.

Single-Meal Nutrient Assessment by a Self-Administered, Electronic Exit Survey Compared with a Multipass Dietary Interview in University Undergraduates in an All-You-Care-to-Eat Campus Dining Hall.

BACKGROUND: Assessing nutritional intake in all-you-care-to-eat dining facilities poses unique challenges. New methods that streamline accurate data collection would facilitate better nutrition intervention research in this dining hall environment, which is common on university campuses. OBJECTIVE: To compare nutrient and food group intake data of university undergraduate students from a single visit to an all-you-care-to-eat campus dining hall, collected by two methods: multiple-pass dietary recall interview and self-administered, electronic survey. PARTICIPANTS/SETTING: Undergraduate students (n=42) ages 18 and older were recruited as they exited the dining hall during lunch service hours during 1 week. DESIGN: Using a cross-sectional design, participants completed two dietary assessment methods in random order: an electronic tablet-based exit survey listing the available menu items at that service with drop-down menus to report portion size consumed and a multiple-pass structured dietary interview by a single, trained interviewer. STATISTICAL ANALYSES PERFORMED: Agreement of nutrients and food groups between the two methods was assessed by Pearson and Spearman correlations and paired t tests. Significance was set at P<0.05. RESULTS: Respondents were primarily underclassmen and women who lived on campus, with 16 of 42 students identifying as white. Students reported an average of 1.1 additional food items via the diet interview method compared with the survey. Average kilocalorie intake by the interview and survey methods was 837±561 and 860±586, respectively. Mean intake of all measured nutrients and all food groups except total and lean protein was not significantly different across the two methods. Spearman correlations between method results ranged across nutrients from r=0.541 to r=0.998 and across food groups from r=0.507 to r=0.948; all were significant at P<0.001. However, mean differences between methods exhibited notable variation. CONCLUSIONS: The electronic survey method performs similar to a multiple-pass dietary interview in assessing mean nutrient intake of ethnically diverse university undergraduates in a single eating occasion at an all-you-care-to-eat dining hall, but the survey may not be as efficient at capturing the total number of food items consumed.

Current Indications for Transnasal Esophagoscopy: An American Broncho-Esophagological Association Survey.

INTRODUCTION:: The aim of this study was to evaluate the current indications for and clinical factors influencing the use of transnasal esophagoscopy (TNE). METHODS:: An online survey was sent to American Broncho-Esophagological Association members, including questions on demographics, indications, and factors influencing the use of TNE. RESULTS:: Sixty of 251 members (24%) completed the survey. Ninety-three percent of respondents reported academic practices, while 98% practice in medium to large urban settings. Thirty-five (58%) completed laryngology fellowships. Mean monthly TNE procedure count was 7.15 (range, <1-35). The most common indications were dysphagia (82%), biopsy (50%), and laryngopharyngeal reflux (47%). Chronic cough, head and neck cancer screening, gastroesophageal reflux (GER), and tracheoesophageal puncture were also commonly reported indications (44% each). For laryngopharyngeal reflux and GER, most respondents perform TNE for recalcitrant disease following a medical trial of at least 3 months. Long-standing GER symptoms, documentation of GER on pH and impedance testing, and abnormal findings on previous esophagoscopy lead to greater TNE use. Specific dysphagia indications included abnormal esophagographic findings (70%), history or examination localizing to the esophagus (60%), solid dysphagia only (53%), and solid and/or liquid dysphagia (40%). The primary sites most likely to prompt TNE use for head and neck cancer surveillance were the esophagus (92.3%) and hypopharynx (84.6%). Balloon dilation was the most common indication for which respondents do not currently perform TNE but would like to (n = 8). CONCLUSIONS:: TNE indications have not been well established. According to respondents from the American Broncho-Esophagological Association, TNE is most commonly used for dysphagia and laryngopharyngeal reflux and slightly less so for GER and head and neck cancer screening and surveillance. Several clinical indicators were identified that influence the decision to perform TNE.

Midcervical scar satisfaction in thyroidectomy patients.

OBJECTIVES/HYPOTHESIS: Assess long-term patient satisfaction with conventional thyroidectomy scars and the impact of thyroidectomy scars on patient quality of life. STUDY DESIGN: Validated survey administration and retrospective review of clinical and demographic data. METHODS: Patients who underwent conventional thyroidectomy through years 2000 to 2010 were identified and administered the validated Patient Scar Assessment Questionnaire. Mean satisfaction, appearance and scar-consciousness scores were determined. Thirty-seven patients also measured the length of their current scar. Patient demographic and operative data were collected retrospectively from the medical record. Data were analyzed with one-way analysis of variance and independent samples t testing. RESULTS: Sixty of 69 patients perceived the appearance of their scar to be "good" or "excellent." Sixty-three patients (91.3%) were satisfied with all scar outcomes; 67 (97.1%) were satisfied with the overall appearance of their scar. Mean total satisfaction score was 17.3 (<26 indicates a high level of satisfaction). Fifty-six (81.2%) were "not at all" self-conscious of their scar; 65 (94.2%) reported no attempt to hide their scar. Seven patients (10.1%) indicated any likelihood of pursuing scar revision. Females had significantly higher total satisfaction scores, consciousness scores, and satisfaction with appearance scores. The effect of perceived scar length was significant for scar-consciousness, not patient satisfaction. CONCLUSIONS: The majority of patients were satisfied with their thyroidectomy scar appearance. Few patients reported a desire to hide the scar or pursue revision. Women were more likely to be dissatisfied than men. Length may play a role in scar consciousness. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:1247-1252, 2017.

The impact of obesity on adult tracheostomy complication rate.

OBJECTIVES/HYPOTHESIS: Prospectively compare tracheostomy-related complications in obese patients with complications in nonobese patients. STUDY DESIGN: Prospective cohort study. METHODS: Adult patients undergoing tracheostomy were studied. Patients who had a prior tracheostomy were excluded. Complications were classified as intraoperative, early (within the first 2 weeks), or late. RESULTS: A total of 151 patients met inclusion/exclusion criteria. Fifty-five percent of obese patients experienced at least one tracheostomy-related complication; 19.5% of the control group had a complication. Mean procedure duration for patients with body mass index < 30 was 24.74 minutes and for obese patients was 46.17 minutes. There was a statistically significant effect of body mass index on complication rate (P < .0001) and on procedure duration (P < .0001). The relationships between body mass index and intraoperative complications (P = .027) and early postoperative complications (P = .001) were significant. CONCLUSIONS: The tracheostomy-related complication rate is significantly higher for obese patients, especially for body mass index ≥ 35, especially in the intraoperative and early postoperative time periods. Procedure duration is significantly longer in obese patients.