Magnetic resonance imaging for acute appendicitis in pregnancy: can clinical scores predict when imaging is needed?

PURPOSE: Advanced imaging may augment the diagnostic milieux for presumed acute appendicitis (AA) during pregnancy, however it is not clear when such imaging modalities are indicated. The aim of this study was to assess the sensitivity and specificity of clinical scoring systems with the findings on magnetic resonance imaging (MRI) of AA in pregnant patients. METHODS: A retrospective cohort study between 2019 and 2021 was performed in two tertiary level centers. Pregnant patients presenting with suspected AA and non-diagnostic trans-abdominal ultrasound who underwent MRI as part of their evaluation were identified. Patient demographics, parity, gestation, presenting signs, and symptoms were documented. The Alvarado and Appendicitis Inflammatory Response (AIR) score for each patient were calculated and correlated with clinical and MRI findings. Univariate analysis was used to identify factors associated with AA on MRI. RESULTS: Of the 255 pregnant patients who underwent MRI, 33 (13%) had findings of AA. On univariate analysis, presentation during the second/third trimester, migration of pain, vomiting and RLQ tenderness correlated with MRI findings of AA. Whilst 5/77 (6.5%) of patients with an Alvarado score ≤4 had signs of AA on MRI, a score of ≥5 had a sensitivity, specificity, negative and positive predictive value of 84.8%, 36.6%, 94.0% and 17.2%. For an AIR score ≥ 5, this was 78.8%, 41.5%, 93.0%, and 16.7%, respectively. CONCLUSIONS: Whilst clinical scoring systems may be useful in identifying which pregnant patients require MRI to be performed when AA is suspected, the low sensitivity implies further research is needed to refine the use of this valuable resource.

Varenicline for Gradual Versus Abrupt Smoking Cessation in Poorly Motivated Smokers With COPD: A Prematurely Terminated Randomized Controlled Trial.

Background: Although smoking is the leading cause of chronic obstructive pulmonary disease (COPD), many patients with COPD smoke, highlighting the need for effective smoking cessation interventions in this population. This study examined the efficacy and safety of varenicline in increasing smoking cessation rates through "gradual" versus "abrupt" cessation in COPD patients with low motivation to quit smoking. Methods: A randomized, open label, 30-week, controlled trial (ClinicalTrials.gov identifier: NCT02894957) was conducted between January 2019 and October 2020 at a center in Israel. Smokers with COPD, poorly motivated to quit, were randomized to 6 weeks of varenicline for smoking reduction and a target quit day (TQD) at the end of week 6 (gradual cessation group) or ad libitum smoking for 5 weeks, 1 week of varenicline, and a TQD at the end of week 6 (abrupt cessation group). After the pre-quit phase, both groups received 12-week regular varenicline treatment and 12-week follow-up. Primary outcome was biochemically-validated continuous abstinence for weeks 6-30. Secondary outcomes were: (1) biochemically-confirmed7-day point prevalence abstinence for weeks 4-30, (2) efficient smoking reduction (≥50% in number of cigarettes/day) in the pre-quit phase; and (3) number of cigarettes/day, motivation to quit, and changes in respiratory symptoms and spirometry from baseline through week 30. Results: A drug recall issued by the study sponsor stopped the study after 70/242 (28.9%) patients had been enrolled. The gradual cessation group (n=29) had significantly higher continuous abstinence rates from TQD through week 30 versus the abrupt cessation group (n=41): 20.7% versus 4.9% (odds ratio [OR]=5.09; 95% confidence interval [CI] 0.89-29.17; p=0.048) and higher 7-day point prevalence abstinence levels at all time points but week 18 (p=0.027 at week 6, 0.056 at week 7, and 0.096 at week 9). Motivation to quit increased (p=0.002) and the number of cigarettes/day decreased (p=0.002) over time in both groups. Respiratory symptoms, but not spirometry, improved in both groups at week 30. Treatment was safe and well tolerated. Conclusion: In poorly motivated smokers with COPD, using varenicline for a 6-week gradual smoking cessation before TQD, compared with abrupt cessation, significantly increased quit rates up to 6 months. Results were not affected by the smaller-than-expected sample size. Further studies are needed to confirm these data.

Functional and Existential Tasks of Family Caregiving for End-of-Life, Hospitalized Older Adults.

The current study examined how functional and existential coping factors are related to the sense of self-benefit among end-of-life (EOL) family caregivers caring for hospitalized older adults. A convenience sample of 92 family caregivers was interviewed in two Israeli hospitals using a structured questionnaire based on Pearlin's stress process model. Findings show that engagement in EOL existential tasks and motivations, such as life review, spirituality, multigenerational family relationships, and preparation for death, acted as a coping resource and was positively related with caregivers' sense of self-benefit. However, functional caregiving did not act as a significant stressor, as it was weakly related to care-givers' sense of self-benefit. Findings discuss the importance of training health professionals to recognize and discuss existential concerns with EOL family caregivers. [Journal of Gerontological Nursing, 42(7), 55-64.].

Reasons for choosing a career and workplace among occupational therapists and speech language pathologists.

OBJECTIVES: The purpose of this study was first to determine internal consistency reliability of the Ono Decision Making Career and Workplace (ODMCW) questionnaire. Next, a comparison of the reasons for a professional career and workplace choices of occupational therapists (OTs) and speech and language pathologists (SLPs) was evaluated. PARTICIPANTS: Participants consisted of 174 women (89 [51%] OTs and 85 [49%] SLPs). INSTRUMENT: The ODMCW questionnaire contains 17 items each scored on a 5 point scale in 2 parts (Career Choice and Workplace). The ODMCW was distributed to participants of both professions. RESULTS: Analysis of the questionnaire revealed 4 factors that together explained 56.87% of the variance of Career Choice with moderate to good Cronbach's alpha coefficients ranging from 0.524-0.789. The findings for both career and workplace choice show differences between the two professional groups, where SLPs give more weight to the factor of employment terms and benefits (p< 0.01) as well as work conveniences (p< 0.001), while OTs give more weight to professional and academic stature (p< 0.05). CONCLUSIONS: These initial findings should lead to more studies within these professions and others, as well as in different cultural groups to further understand the reasons and motives for Career Choices.

The relationship of sleep disturbance and symptom severity, symptom interference, and hospitalization among Israeli inpatients with cancer.

PURPOSE/OBJECTIVES: To examine the relationship of sleep disturbance and symptom severity, symptom interference, and hospitalization among inpatients with cancer. DESIGN: A descriptive, correlational, comparative design. SETTING: The oncology inpatient unit of a teaching hospital. SAMPLE: A convenience sample of 82 hospitalized patients. METHODS: Patients completed the Pittsburgh Sleep Quality Index (PSQI)-Home questionnaire, the MD Anderson Symptom Inventory (MDASI), and a demographic data information instrument within 72 hours of admission. Patients hospitalized for 10 days or more completed the PSQI-Hospitalization questionnaire and the MDASI. MAIN RESEARCH VARIABLES: Sleep disturbance, symptom severity, symptom interference, and hospitalization. FINDINGS: Although sleep disturbance scores were high at home and during hospitalization, the use of sleeping medication received the lowest score in the PSQI. Patients who were hospitalized for 10 days or more had significantly higher global PSQI scores at home than after being hospitalized for 10 days or more. A significant relationship was noted between global PSQI scores at home and symptom severity total mean scores, with the symptoms of numbness and tingling demonstrating the greatest correlation with sleep disturbance. A tendency existed for a significant relationship between global PSQI scores at hospital and symptom severity total mean scores. The symptom with the greatest correlation with global PSQI scores at hospital was sadness, followed closely by remembering. The interference items with the greatest correlation to global PSQI scores at hospital were patient's enjoyment of life, mood, and relations with others. CONCLUSIONS: Sleep disturbance was less of a problem for patients during their hospitalization than at home. Unlike other studies, numbness was found to be the symptom most closely correlated to sleep disturbance. IMPLICATIONS FOR NURSING: Additional investigation should be conducted to identify the factors that influence sleep disturbances in patients with cancer at home and the relationship between sleep disturbance and numbness and tingling.

Pain severity, satisfaction with pain management, and patient-related barriers to pain management in patients with cancer in Israel.

PURPOSE/OBJECTIVES: To examine pain severity, satisfaction with pain management, and patient-related barriers to pain management among patients with cancer in oncology units at a teaching hospital in Israel. DESIGN: Descriptive, cross-sectional, correlational design. SETTING: Oncology, hematology, and bone marrow trans-plantation (BMT) departments; oncology, hematology, and BMT daycare units; and a radiation department in an Israeli hospital. SAMPLE: Nonprobability convenience sample (N=144) of ambulatory (n=76) and hospitalized (n=68) patients experiencing pain in the past 24 hours. METHODS: Patients who had experienced pain in the past 24 hours completed the Revised American Pain Society-Patient Outcome Questionnaire, the Barriers Questionnaire-Short Form, and a demographic data questionnaire. MAIN RESEARCH VARIABLES: Pain severity, satisfaction with pain management, and patient-related barriers to pain management. FINDINGS: A significant inverse relationship was observed between patients' pain severity and their expectation of pain relief. Less-educated patients had significantly higher pain severity scores. Ambulatory patients waited longer for their pain medication than hospitalized patients. The greatest barriers to pain control were fear of addiction and the notion that medication should be saved in case the pain gets worse. In addition, ambulatory patients had higher pain barrier scores than hospitalized patients. CONCLUSIONS: The relationship between pain severity and the expectations of patients with cancer regarding pain relief indicate that patients' expected outcomes and barriers may impede optimal pain relief. This study also identified areas of possible weakness within the hospital's pain palliation program. IMPLICATIONS FOR NURSING: Nurses should assess for patients' expectations and barriers that could impede pain relief and provide appropriate interventions.