Linking nursing students' professional identity, clinical learning environment, financial incentives, and career opportunities with migration intent: Structural equation modeling.

AIMS: To investigate how nursing students' professional identity, clinical learning environment, financial incentives, and career opportunities influence their intention to migrate. BACKGROUND: There is a preponderance of studies about nurse migration and its impact on the global nursing workforce. However, a critical gap remains about nursing students' intentions to migrate, particularly among developing countries like the Philippines. METHODS: Using a cross-sectional design, third- and fourth-year nursing students (n = 316) from the largest comprehensive university in Manila were conveniently recruited. Data were collected from November to December 2023 using five validated self-report scales. Descriptive (e.g., mean, standard deviation) and inferential statistics (e.g., Spearman rho, covariance-based structural equation modeling) were used to analyze data. RESULTS: The emerging model demonstrated acceptable model fit indices. Nursing students' professional identity (ß = 0.18, p = 0.043) and financial incentives (ß = 0.10, p = 0.046) significantly and positively influence the intention to migrate. The satisfaction with future career opportunities (ß = -0.12, p = 0.038) and clinical learning environment perception (ß = -0.15, p = 0.048) negatively influence the intention to migrate. These four predictors accounted for 4.60% of the total variance of intention to migrate. CONCLUSION: Nursing students' professional identity and financial incentives directly impact intent to migrate, whereas future career opportunities satisfaction and clinical learning environment inversely affect intent to migrate. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: This study underscores the imperative for nursing colleges and faculty to promote positive professional identity and provide a conducive clinical learning environment to develop sustainable nurses' migration policies.

Violence Exposure and Trauma Screener for Youth (VETSY).

BACKGROUND: Youth exposed to violence are at serious risk for physical, emotional, behavioral, and mental distress. Reliable and prompt detection is necessary to mitigate the psychological consequences of youth violence exposure and trauma. OBJECTIVE: To describe the initial creation of the VETSY screener and its construct validity and potential use. METHODS: From 2014 through 2022 we surveyed 20,532 at-risk youth aged 8-18 years from a diverse metropolitan community participating in the Defending Childhood Initiative (DCI). Youth completed a 17-item self-report screener. An Exploratory Factor Analysis (EFA) was used to determine the reliability and variable grouping for this brief screener. Violence exposure, violent behaviors, and trauma symptoms were assessed. Responses were evaluated based on youth demographics. A potential cutoff score meriting further assessment and intervention was established. RESULTS: Sixty-seven percent of youth reported at least one type of violence exposure within the last year, 55 % reported perpetrating at least one type of violent behavior, and 68 % of youth reported at least one trauma symptom. An Exploratory Factor Analysis (EFA) with a geomin (oblique) rotation was applied and yielded a three-factor model with high loadings and acceptable fit for violence exposure, violent behaviors, and trauma symptoms. Additional analyses showed the screener structure was the same across sex, race and age groups. CONCLUSIONS: The use of the brief screener to quickly and reliably assess violence exposure, violent behaviors, and trauma symptoms among youth provides an opportunity for mental health providers to detect and refer at-risk youth for additional assessment and treatment.

The effects of flavonoid supplementation on the mental health of postpartum parents.

Introduction: During the postpartum period, parents face psychological challenges and consequently, changes in mood and associated mood disorders have become increasingly prevalent in the 6-months following birth. Dietary flavonoids have been found to benefit mood and are therefore an appealing non-pharmacological option for potentially treating mood disorders in the postpartum. The aim of this study was to investigate whether a two-week dietary flavonoid intervention would improve mothers' and fathers' mental health in the immediate 6-month postpartum period. Method: The study employed a randomised, parallel groups, controlled design to explore the effects of a flavonoid intervention vs. control group on several outcomes, including mood (PANAS), postpartum depression (EPDS), postpartum anxiety (PSAS-RSF-C) and quality of life (WHOQOL). Sixty participants (mothers n = 40, fathers n = 20) in the 6-month post-partum period were randomised to either a "flavonoid" or "control" condition. The flavonoid group were asked to add two flavonoid-rich foods (approximate flavonoid intake 218 mg/day) into their daily diet whilst controls (n = 23) were asked to continue with their usual diet for two-weeks (ClinicalTrials.gov (NCT04990622). Results: Significant effects were found in the flavonoid group where mothers reported higher positive affect and lower postpartum depression after the two-week intervention relative to baseline. This finding is especially relevant as a clinical reduction in postpartum depression scores in the flavonoid group by an average 2.6 scoring points was observed, which equated to a reduction from "possible depression" at baseline to "little or no depression" at 2-weeks, which was not observed in the control group. Fathers' data was not analysed due to non-compliance with the intervention. Discussion: This study provides evidence for the benefits of a dietary flavonoid intervention for mood and mental health in new mothers, supporting the utility of non-pharmacological, self-administrable changes to the diet for improving positive mood outcomes and reducing symptoms of postpartum depression in mothers during an especially challenging time. Further research for the effect of dietary interventions on paternal mental health is needed. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT04990622.

Foot and Ankle Patient Education Materials and Artificial Intelligence Chatbots: A Comparative Analysis.

BACKGROUND: The purpose of this study was to perform a comparative analysis of foot and ankle patient education material generated by the AI chatbots, as they compare to the American Orthopaedic Foot and Ankle Society (AOFAS)-recommended patient education website, FootCareMD.org. METHODS: ChatGPT, Google Bard, and Bing AI were used to generate patient educational materials on 10 of the most common foot and ankle conditions. The content from these AI language model platforms was analyzed and compared with that in FootCareMD.org for accuracy of included information. Accuracy was determined for each of the 10 conditions on a basis of included information regarding background, symptoms, causes, diagnosis, treatments, surgical options, recovery procedures, and risks or preventions. RESULTS: When compared to the reference standard of the AOFAS website FootCareMD.org, the AI language model platforms consistently scored below 60% in accuracy rates in all categories of the articles analyzed. ChatGPT was found to contain an average of 46.2% of key content across all included conditions when compared to FootCareMD.org. Comparatively, Google Bard and Bing AI contained 36.5% and 28.0% of information included on FootCareMD.org, respectively (P < .005). CONCLUSION: Patient education regarding common foot and ankle conditions generated by AI language models provides limited content accuracy across all 3 AI chatbot platforms. LEVEL OF EVIDENCE: Level IV.

RETRACTED: Safety climate, quality of care, adherence to and compliance with standard precautions among nurses: Structural equation modeling.

AIMS: The aim was to investigate the interrelationships of nurses' safety climate, quality of care, and adherence to and compliance with standard precautions (SPs). BACKGROUND: Investigations about nurses' safety climate and quality care and their association with adherence to and compliance with SPs remain remarkably scant across literature, specifically among developing countries like the Philippines. DESIGN: Cross-sectional design and structural equation modeling (SEM) approach while complying with STROBE guidelines. METHODS: Participant nurses were recruited using convenience sampling (n = 870). Four validated self-report instruments were used to collect data from February to August 2022. Spearman rho, SEM, mediation, and path analyses were employed for data analysis. RESULTS: The emerging model showed acceptable model fit parameters. The safety climate positively influenced the quality of care and adherence to and compliance with SPs. Quality of care directly affected adherence to SPs, while adherence to SPs directly affected compliance with SPs. The quality of care mediated the relationship between safety climate and adherence to SPs. Whereas adherence to SPs mediated the relationships between safety climate and compliance with SPs and the quality of care and compliance with SPs. CONCLUSIONS: Nurses' safety climate directly affected the quality of care and SPs adherence and compliance. The quality of care mediated the impact of safety climate on SPs adherence. Finally, SPs adherence demonstrated a mediating effect among quality of care, safety climate, and SPs compliance. IMPLICATIONS FOR NURSING POLICY AND PRACTICE: Nursing policymakers and administrators can use the findings to design strategic policies and sustainable in-service educational courses fostering and maintaining nurses' safety climate, quality of care, and SPs adherence and compliance.

How old do I look? Aging appearance and experiences of aging among U.S. adults ages 50-80.

Appearance is an indicator of age and life stage, which are linked to socially salient stereotypes and prejudices. Older adults' appearance-related perceptions and behaviors may affect their experiences of aging within broader society, which may in turn influence health. This study examined associations between two measures related to aging appearance-assessment of one's aging appearance relative to same-age peers and investing time or effort to look younger-positive and negative experiences of aging, and health using multivariable regression. Cross-sectional data were from a nationally representative sample of 2006 U.S. adults ages 50-80 (Mage = 63, 52% women, 71% White) who completed Wave 6 of the National Poll on Healthy Aging in 2019. The majority (59%) reported appearing relatively younger than peers, while fewer reported appearing the same age (35%) or older (6%). About a third (35%) reported investing in looking younger. Appearing relatively younger was associated with more positive (p < .001) and less negative experiences of aging (p = .019). Appearing relatively older showed the opposite relationships (p values < .001). Investing in looking younger was associated with more positive and more negative experiences of aging (p values < .001). Few sociodemographic variations were detected. More positive and less negative experiences of aging were associated with better physical and mental health (p values < .001). While aging appearance is often the basis for jokes, it may affect the quality of older adults' experiences of aging and associated health outcomes. Nuanced findings caution against framing youthful biases in aging appearance and investments in looking younger as solely negative (or positive). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Ionic Pairing and Selective Solvation of Butylmethylimidazolium Chloride Ion Pairs in DMSO-Water Mixtures: A Comprehensive Examination via Molecular Dynamics Simulations and Potentials of Mean Force Analysis.

Ionic liquids (ILs) with dimethyl sulfoxide (DMSO) and water act as a promising solvent medium for the dissolution of cellulose in an efficient manner. To develop a proper solvent system, it is really important to understand the thermodynamics of the molecular solutions consisting of ILs, DMSO, and water. The ion-pairing propensity of the ILs in the presence of DMSO and water plays a crucial role in governing the property of the solvent mixtures. Employing all-atom molecular dynamics simulations, we estimate the potentials of mean force between BMIM+ and Cl- ions in DMSO-water mixtures. Analysis reveals a significant increase in the thermodynamic stability of both contact ion pair (CIP) and solvent-assisted ion pair (SAIP) states with a rising DMSO mole fraction. Thermodynamic assessments highlight the entropic stabilization of CIP states and SAIP states in pure water, in DMSO-water mixtures, and in pure DMSO. The structural analysis reveals that in comparison to the DMSO local density, the local water density is relatively very high around ion pairs, more specifically in the solvation shell of a chloride ion. Preferential binding coefficients also consistently indicate exclusion of DMSO from the ion pair in DMSO-water mixtures. To enhance our understanding regarding the solvent molecules kinetics around the ion pairs, the survival probabilities of DMSO and water are computed. The calculations reveal that the water molecules prefer a prolonged stay in the solvation shell of Cl- ions.

Diagnosis of Occult and Obscure Gastrointestinal Bleeding.

Occult and obscure bleeding are challenging conditions to manage; however, recent advances in gastroenterology and endoscopy have improved our diagnostic and therapeutic capabilities. Obscure gastrointestinal (GI) bleeding is an umbrella category of bleeding of unknown origin that persists or recurs after endoscopic evaluation of the entire bowel fails to reveal a bleeding source. This review details the evaluation of patients with occult and obscure GI bleeding and offers diagnostic algorithms. The treatment of GI bleeding depends on the type and location of the bleeding lesion and an overview of how to manage these conditions is presented.

Genetic gains in IRRI's rice salinity breeding and elite panel development as a future breeding resource.

KEY MESSAGE: Estimating genetic gains and formulating a future salinity elite breeding panel for rice pave the way for developing better high-yielding salinity tolerant lines with enhanced genetic gains. Genetic gain is a crucial parameter to check the breeding program's success and help optimize future breeding strategies for enhanced genetic gains. To estimate the genetic gains in IRRI's salinity breeding program and identify the best genotypes based on high breeding values for grain yield (kg/ha), we analyzed the historical data from the trials conducted in the IRRI, Philippines and Bangladesh. A two-stage mixed-model approach accounting for experimental design factors and a relationship matrix was fitted to obtain the breeding values for grain yield and estimate genetic trends. A positive genetic trend of 0.1% per annum with a yield advantage of 1.52 kg/ha was observed in IRRI, Philippines. In Bangladesh, we observed a genetic gain of 0.31% per annum with a yield advantage of 14.02 kg/ha. In the released varieties, we observed a genetic gain of 0.12% per annum with a 2.2 kg/ha/year yield advantage in the IRRI, Philippines. For the Bangladesh dataset, a genetic gain of 0.14% per annum with a yield advantage of 5.9 kg/ha/year was observed in the released varieties. Based on breeding values for grain yield, a core set of the top 145 genotypes with higher breeding values of > 2400 kg/ha in the IRRI, Philippines, and > 3500 kg/ha in Bangladesh with a reliability of > 0.4 were selected to develop the elite breeding panel. Conclusively, a recurrent selection breeding strategy integrated with novel technologies like genomic selection and speed breeding is highly required to achieve higher genetic gains in IRRI's salinity breeding programs.

Nurses' safety climate, quality of care, and standard precautions adherence and compliance: A cross-sectional study.

INTRODUCTION: Investigations about the interrelationships of nurses' safety climate, quality of care, and standard precautions (SP) adherence and compliance remain particularly scarce in the literature. Thus, we tested a model of the associations between nurses' safety climate, quality of care, and the factors influencing adherence and compliance with SPs utilizing the structural equation modeling (SEM) approach. DESIGN: Cross-sectional design complying with STROBE guidelines. METHODS: Using convenience sampling, nurses (n = 730) from the Philippines were recruited. Data were collected between April and September 2022 using four validated self-report measures. Spearman Rho, mediation and path analyses, and SEM were employed for data analysis. RESULTS: Acceptable model fit indices were shown by the emerging model. The safety climate is positively associated with quality of care and factors influencing adherence to and compliance with SPs. Quality of care directly affected factors influencing adherence to SPs. The factors influencing adherence to SPs directly affected SP compliance. Quality of care mediated between safety climate and the factors influencing adherence to SPs. Factors influencing adherence to SPs mediated between safety climate, quality of care, and SP compliance. CONCLUSIONS: The study's variables are not distinct but overlapping nursing concepts that must be examined collectively. Nurse administrators can utilize the emerging model to formulate strategies and regulations for evaluating and enhancing nurses' safety climate, quality of care, and SP adherence and compliance. CLINICAL RELEVANCE: Our findings may impact policymaking, organizational, and individual levels to improve nurses' clinical practice. PATIENT OR PUBLIC CONTRIBUTION: This study had no patient contribution or public funding.

An Assessment of Enhancement Patterns in Abnormal Parathyroid Glands on Three-Phase CT Imaging.

Background Four-dimensional computed tomography (4DCT) is increasingly used in the investigation of primary hyperparathyroidism. The objective of this study was to identify and analyse the usefulness of different enhancement patterns on 4DCT to improve its sensitivity. Methodology Retrospective data were collected on 100 glands. A consultant head and neck radiologist measured the Hounsfield units (HU) of the parathyroid gland and surrounding normal thyroid tissue in the pre-contrast, arterial and venous phases. Each gland was grouped according to the enhancement pattern, and the percentage change in HU was also calculated between the three phases. Results Thirty-five parathyroid glands demonstrated enhancement higher than the thyroid gland in the arterial phase and lower in the delayed phase and were placed into group A. Four parathyroid glands demonstrated enhancement higher than the thyroid gland in the arterial phase and also higher in the delayed phase and were placed into group B. Fifty-nine parathyroid glands demonstrated enhancement lower than the thyroid gland in the arterial phase and also lower in the delayed phase and were placed into group C. Two parathyroid glands demonstrated enhancement lower than the thyroid gland in the arterial phase and higher in the delayed phase and were placed into group D. Conclusions This study demonstrated that the classically described enhancement pattern of the parathyroid gland is not always present or the most frequent, thereby showing that the enhancement pattern cannot be relied upon in isolation. Instead, a thorough understanding of anatomy, embryology and possible ectopic gland locations is essential.

Moral Distress, Moral Resilience, Moral Courage, and Moral Injury Among Nurses in the Philippines During the COVID-19 Pandemic: A Mediation Analysis.

Investigations about moral resilience and moral courage as mediators between moral distress and moral injury remain underreported among nurses during the COVID-19 pandemic. Nurses (n = 412) from the Philippines were conveniently recruited via social media platforms and completed four self-report scales. The mediation model depicts that moral distress negatively impacts moral resilience and moral courage while positively affecting moral injury. Moral resilience and moral courage negatively impact moral injury, whereas moral resilience directly impacts moral courage. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury. Findings indicate that healthcare organizations and nurse managers should nurture morally resilient and courageous therapeutic practices among frontline healthcare professionals to mitigate the negative effects of moral distress and moral injury.

The mediating roles of moral courage and moral resilience between nurses' moral distress and moral injury: An online cross-sectional study.

AIMS: To investigate the mediating role of moral resilience and moral courage in the association between moral distress and moral injury. BACKGROUND: There is a preponderance of nursing literature about moral distress, moral resilience, moral courage and moral injury. However, examining moral resilience and moral courage as mediators remain underreported during the COVID-19 pandemic and in the context of a developing nation. DESIGN: Correlational, cross-sectional design compliant with the STROBE guidelines. METHODS: A convenience sample of nurses (n = 412) from the Philippines were recruited using social media platforms (e.g., Facebook, Messenger, Twitter). Four self-report and validated scales (8-item Moral-Distress Appraisal Scale, 21-item Nurses' Moral Courage Scale, 17-item Rushton Moral Resilience Scale and 10-item Moral Injury Symptom Scale: Healthcare Professionals Version) were used to collect data from January to July 2022. Pearson's r, bivariate analysis and multistage regression analyses were used for data analysis. RESULTS: This study afforded a model that depicted the interrelationships of moral distress, moral resilience, moral courage and moral injury. Moral distress has a negative impact on moral resilience and moral courage while positively affecting moral injury. Moral resilience positively influences moral courage while having a negative impact on moral injury. Moral courage has an indirect impact on moral injury. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury. CONCLUSIONS: Healthcare organizations, policymakers and nurse managers should include policies and programs that include improving approaches to modifying workplace conditions and evaluating nurses' moral resilience and courage. Nurse managers need to advocate ethics education and professionalism. Nurses must practice self-care strategies to strengthen morally resilient and courageous therapeutic practices.

Psychometric testing of the nurse professional competence scale Arabic version: An exploratory and confirmatory factor analyses.

AIM: To translate the Nurse Professional Competence Scale-Short Form English version into Arabic and psychometrically validate its properties among Saudi citizen nurses. BACKGROUND: Evaluating nurses' professional competence is vital in delivering safe, cost-effective care and developing healthcare systems. However, psychometrically reliable and validated nurse competence scales in Arabic-speaking countries remain scant. DESIGN: A descriptive cross-sectional design adhering to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. METHODS: Participant nurses (n = 598) were conveniently recruited from four government-owned hospitals and completed the Arabic-translated 35-item Nurse Professional Competence Scale-Short Form. We used Spearman's rank-order correlation, exploratory factor analysis, Kaiser-Meyer-Olkin test, and confirmatory factor analysis to analyze the data. RESULTS: After exploratory factor analysis and reliability analyses, several items of the Arabic-translated 35-item Nurse Professional Competence Scale-Short Form were omitted due to high inter-item correlations and low factor loading difference. The Arabic version of the Nurse Professional Competence Scale-Short Form was reduced to 21 items, consisting of a three-factor structure: Professional Care Pedagogics, Holistic Value-Based Care, and Direct Nursing Care. Results also demonstrated that the revised three-factor structure had good overall scale reliability, good subscale internal consistencies, and acceptable construct validity using the confirmatory factor analysis. CONCLUSION: The 21-item Nurse Professional Competence Scale-Short Form Arabic version is a useful scale, having demonstrated construct validity and reliability. Therefore, nurse managers in Arabic-speaking nations could assess their nurses' professional competence using the 21-item Nurse Professional Competence Scale-Short Form Arabic version to develop proactive programs that enhance professional competence.

Reverse coronal deformity: use of robotic total knee arthroplasty for identification and correction.

BACKGROUND: Despite continued advances in techniques and implant designs, a population of patients who are dissatisfied after total knee arthroplasty (TKA) remains. During robotic-assisted arthroplasty, real-time intraoperative assessment of patient knee alignment is performed. Here, we assess the prevalence of an under-appreciated deformity, reverse coronal deformity (RCD), and the benefits of utilizing robotic-assisted knee arthroplasty to help correct this dynamic deformity. METHODS: A retrospective study evaluating patients undergoing robotic-assisted cruciate-retaining TKA was performed. Intraoperative measurements were obtained using tibial and femoral arrays to assess coronal plane deformity at full extension and at 90° flexion. RCD was defined as ≥ 2° varus in knee extension that reversed to ≥ 2° valgus in flexion, or vice-versa. Coronal plane deformity was then reassessed after robotic-assisted bony resection and implant placement. RESULTS: Of 204 patients that underwent TKA, 16 patients (7.8%) were found to have RCD, with 14 patients (87.5%) transitioning from varus in extension to valgus in flexion. The average coronal deformity was 7.75°, with a maximum of 12°. These improved to an average coronal change of 0.93° post-TKA. Final medial and lateral gaps were all balanced to within 1° in extension and flexion. Another 34 patients (16.7%) had ≥ 5° change in coronal plane deformity from extension to flexion (average 6.39°), however, did not experience a reversal of their coronal deformity. Outcomes were assessed with KOOS Jr. scores postoperatively. CONCLUSION: Computer and robotic assistance were utilized to demonstrate the prevalence of RCD. We also demonstrated accurate identification and successfully balancing of RCD utilizing robotic-assisted TKA. An increased awareness of these dynamic deformities could aid surgeons in proper gap balancing even in the absence of navigation and robotic-assisted surgery.

Structural equation modelling of ethicomoral values and competence of nurses during the COVID-19 pandemic.

Background: The COVID-19 pandemic is a global health crisis that affected nurses' professional values and competence. Aim: Our study examined the relationship between nurses' professional values and competence in Saudi Arabia during the COVID-19 pandemic. Methods: This study used a descriptive cross-sectional design with 748 nurses from Saudi Arabia. Two self-report instruments were used to collect data. Structural equation modelling was conducted to analyse the data. Findings: The emerging model showed acceptable model-fit indices. Two dimensions of nurse professional values significantly affected professional competence: professionalism and activism. Professionalism significantly affected the other four facets (e.g., caring, activism, trust, and justice) of nurse professional values. The dimension of caring had a strong direct effect on activism. Justice had a moderate direct impact on trust, while activism had a weak direct impact on trust. Professionalism and caring had strong indirect effects on professional competence by mediating the dimension of activism. Discussion: The study's findings highlight the need for strategies to evaluate and strengthen the various areas of professional values to foster professional competence among nurses. Moreover, nurse administrators should encourage nurses to participate in continuing nursing education programs or provide in-service educational training to promote professional values and competence. Conclusion: This study provides a structural model of the interaction between nurses' professional values and competence during the pandemic. Nurse administrators can leverage the presented model to develop policies and strategies to evaluate and strengthen nurses' professional values and competence.

Nursing students' perceived stress, social support, self-efficacy, resilience, mindfulness and psychological well-being: A structural equation model.

Nursing students' stress, protective factors (e.g. resilience, social support, mindfulness and self-efficacy) and psychological well-being (PWB) have been well reported in the literature. However, the interactions of these variables were scarcely examined in the latter part of the COVID-19 pandemic and in the context of a developing country. This cross-sectional correlational study complying with STROBE guidelines tested a hypothetical model of the interrelationships of nursing students' stress, protective factors and PWB using structural equation modelling (SEM). Nursing students (n = 776) from five nursing schools in the Philippines were conveniently recruited from September 2022 to January 2023. Six validated self-report scales (Perceived Stress Scale, Multi-dimensional Scale of Perceived Social Support, Generalized Self-Efficacy Scale, Connor-Davidson Resilience Scale, Mindful Attention Awareness Scale, and Psychological Wellbeing Scale) were used to collect data. SEM, mediation analyses and path analyses were used for data analysis. The emerging model demonstrated acceptable model fit parameters. Stress negatively impacted protective factors, while all the protective factors positively influenced PWB. Social support mediated the influence of stress on resilience, mindfulness and PWB. Resilience is a significant mediator of stress, self-efficacy, social support and PWB. Mindfulness mediated the influence of stress, social support and self-efficacy on PWB. Finally, self-efficacy had a mediating role between resilience and mindfulness. Nursing institutions and nurse educators can use the proposed model as their basis for empirical and theoretical evidence in creating programmes that will strengthen nursing students' protective factors, thus reducing stress while improving PWB and learning outcomes.

Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis.

BACKGROUND: To decrease postoperative opioid consumption, nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, are considered a proper substitute with few side effects. Our null hypothesis is that a standard-dose, short-term ketorolac exposure does not increase the nonunion rate of a first metatarsophalangeal joint (MTPJ) arthrodesis. METHODS: In a retrospective cohort study, we included 181 primary first MTPJ arthrodeses from 2016 to 2020 in a single surgeon practice. The surgical technique was identical using a dorsal locking plate after preparing the joint with the cup-and-cone technique. A 30 mg intravenous dose of ketorolac was administered perioperatively, followed by a post-operative oral course of 10 mg oral ketorolac every 6 hours for 5 consecutive days. Patients were placed in a heel weight-bearing CAM boot for a minimum of 6 weeks. Union was determined radiographically at 3 months postoperative. Radiographic nonunion was also categorized clinically as symptomatic versus asymptomatic. RESULTS: At 3 months postoperative, a nonunion occurred in 15 (8.3%) patients. Of the 15 radiographic nonunions, 7 (45%) were clinically asymptomatic, while the other 8 (55%) were symptomatic. Six (75%) of the 8 symptomatic nonunions ultimately underwent revision surgery. The nonunion rate in our study compared to that described in the literature (5.4%) was similar and showed no significant difference (P = .067). CONCLUSION: The use of a short course of oral ketorolac (40 mg/day or less for a maximum of 5 days) does not seem to affect the union rate after first MTPJ arthrodesis and can be used safely and effectively in the management of post-operative pain to decrease opioid consumption following this procedure. LEVELS OF EVIDENCE: Level 4.