Short-Term Segmental Bioimpedance Alterations During 6° Head-Down Tilt.

As missions in space increase in duration and distance from Earth it is critical to understand the impact that exposure to microgravity has on the health and potential performance of crews. Segmental bioimpedance measurements can track resistances changes in tissues that result from fluid redistribution and could be a tool for continuous fluid shift monitoring in microgravity. In this work, the range of segmental (legs, arms, torso, and neck) 10 kHz and 100 kHz resistances and their relative changes during 4 hours of 6° head down tilt are reported as well as the observed resistance differences between left/right body segments throughout the protocol.

Utilizing a Five-Step, Direct-Call Reminder System to Increase Vaccination Compliance in a Federally Qualified Health Center: A Quality Improvement Process.

BACKGROUND: Childhood vaccines prevent more than 10 million illnesses and 33,000 deaths in the United States each year. Noncompliance rates for children 2 and under are higher in underserved and resource poor communities. OBJECTIVE: The aim of this project was to develop and implement a five-step, direct-call reminder system to increase vaccination rates among children ages 2 and under presenting to a federally qualified health center (FQHC). METHODS: This project examined whether direct phone contact with parents can increase office visits to discuss vaccine status over a 6-week period following implementation of a five-step, direct-call reminder system. RESULTS: 47 parents/guardians were contacted from a list of 455 patients. Thirty-six percent of parents contacted scheduled and kept appointments. CONCLUSIONS: This study found that the vaccines rates of a FQHC practice initiative are directly affected by methods of contact and knowledge of the vaccine schedule. Reaching out and discussing vaccine schedules with parents can increase vaccination rates. Yet, many of them have limited methods of contact. IMPLICATIONS FOR NURSING: A five-step, direct-call reminder system has a positive impact on vaccination compliance. Vaccination compliance is complicated, and approaches should be multifaceted.

Development and Implementation of a Postpartum Depression Screening Program in the NICU.

Postpartum depression (PPD) is higher among NICU mothers compared to mothers without infants in the NICU. Routine screening improves early PPD identification and treatment for mothers. Key national women and infant organizations endorse facility-based policies that address PPD screening. In addition to PPD screening, the key national organizations recommend facilities providing care to women and infants develop a method of referral for maternal PPD evaluation, treatment, and follow-up. Due to the timing, onset, and maternal predisposition to PPD, the NICU is a prime setting for PPD screening. Despite recommendations, PPD screening is not routine in the NICU. This article describes the development and assessment of a PPD screening program implemented in the NICU. Data analysis of 30 NICU mothers evaluated the risk of PPD based on screening tool scores, maternal diagnostic evaluation compliance, and documentation of maternal follow-up with designated NICU staff.

Tolvaptan for Autosomal Dominant Polycystic Kidney Disease: Pharmacokinetics and Implications for Practice.

Autosomal dominant polycystic kidney disease (ADPKD) is incurable and occurs once in every 1,000 births. Confirmation of AKPKD is made through imaging and a positive family history. Symptoms typically appear in mid-life and include kidney, side, and/or back pain related to the rupture of kidney cysts, renal stones, infection, pressure of cysts against other organs, and stretching of the renal capsule. In addition to end stage renal disease, cerebral aneurysm may also be a threat to individuals with this diagnosis. Recent clinical trials have shown that tolvaptan, a vasopressin-2 receptor antagonist, produced a moderate to significant reduction in total kidney volume and improved function, leading to its recent approval by the U.S. Federal Drug Administration for treatment of patients with ADPKD. This article provides a comprehensive look at the pathophysiology of ADPKD, pharmacokinetics and pharmacodynamics of tolvaptan, and tolvaptan's clinical implications, effects, and contraindications. In addition, we present a case study discussing tolvaptan's clinical usefulness and address patient concerns in an adult presenting with rapidly progressing ADPKD.

Evaluation and current treatments for urinary incontinence.

Although aging and urinary incontinence are often associated, urinary incontinence is not a normal part of aging. As the population ages, the challenge of urinary incontinence will place a greater demand on the healthcare system. NPs can effectively direct treatments to mitigate the symptoms of urinary incontinence, improving patient quality of life.

A School-Based Intervention to Increase HPV Vaccination Rates.

BACKGROUND: The human papillomavirus (HPV) is responsible for over 33,000 cancer diagnoses each year in the United States. HPV vaccination rates remain 25%-30% lower than other preteen immunizations. OBJECTIVE: The aim of this project was to increase the HPV vaccination rate among adolescents presenting to a school-based health center (SBHC) using provider recommendation and parent education. METHODS: This project examined whether HPV vaccine acceptance improved over 8 weeks following implementation of a clinic policy requiring immunization records to be reviewed at every visit, along with providing parents with written recommendations and education. RESULTS: Thirty-six students were found to be lacking HPV vaccination. Parents of these children received written recommendations and education on the HPV vaccine. Fifteen parents consented to the HPV vaccine for their child, a 1400% increase in HPV vaccine acceptance when compared to the same time period in 2017. CONCLUSIONS: This study found that a SBHC practice initiative led to an increase in HPV vaccine acceptance. There was also an increase in the acceptance of other vaccines such as Tdap, MenACWY, and Influenza. IMPLICATIONS FOR NURSING: Provider recommendation was influential in improving HPV vaccination rates. SBHC are an ideal alternative setting to improve vaccine acceptance among parents.

Person-Centered Care for Patients with Pessaries.

Pelvic organ prolapse is a common condition affecting women of any age but more likely to occur in the aging woman. Prolapse has a significant impact on quality of life, sexuality, and body image. Vaginal support pessaries have been used since ancient times and are a safe and effective nonsurgical treatment option. Fitting a pessary results in immediate symptom improvement. A comprehensive evaluation for pessary fitting is time intensive but necessary. Nurse providers perform direct pessary care and have a role in caring for women with prolapse expanding access to care. Caregiver and family involvement is important for pessary care and follow-up.

A Qualitative Study to Determine Barriers for Prostate Cancer Screening in Rural African-American Men.

INTRODUCTION: African-American men have higher rates of prostate cancer and more advanced cancer when diagnosed than men of other ethnicities. PURPOSE: To explore the perspectives and shared experiences of rural African-American men when it comes to interactions with healthcare providers, shared decision-making, and information on prostate cancer and screening. METHODS: A convenience sample of African-American men in four rural counties in the southeastern United States agreed to participate. Semi-structured interviews of 43 men were conducted in patients' homes, classrooms, offices, and local churches. Lincoln and Guba's (1985) naturalistic approach was used. RESULTS: Analysis of the rich, in-depth narratives gleaned from these African-American men revealed three themes: 1) limitations in knowledge of prostate cancer, 2) poor patient/provider communication, and 3) deficient health literacy skills. CONCLUSIONS: Participants' perspectives about limited knowledge regarding PCa, variation in provider-patient communication and the finding of low health literacy skills expand knowledge, inform clinical practice, and provide evidence for further investigation to better provider communication and patient education concerning PCa and decision making in this population.

Optimal Pessary Care: A Modified Delphi Consensus Study.

INTRODUCTION: Support pessaries are an important, low-risk treatment option for women with vaginal prolapse but evidence to inform optimal practice is lacking. Currently, gynecologists, urologists, and urogynecologists recommend silicone vaginal support pessaries as first-line treatment for symptomatic vaginal prolapse in women of all ages. It is unknown how many providers who are not physicians prescribe and care for women using pessaries. For this study we attempted to collect opinions of expert nurse providers who fit pessaries on topics related to pessary care and management in an effort to develop consensus to guide practice. METHODS: A 4-round modified Delphi technique was utilized and included one series of online surveys, 2 rounds of anonymous online questionnaires, and one series of face-to-face meetings at conferences. Respondents were invited to participate in all opportunities to provide opinion. For the first 3 rounds respondents were asked to rate statements on a 3-point scale, (agree, disagree, neutral) and provide written comments for those statements with which they did not agree. The goal of additional rounds was 80% agreement between participants, including no less than 6 nurse pessary experts. RESULTS: Greater than 80% consensus was achieved for 22 statements related to patient and provider education, terminology for documentation, pessary management, and follow-up care. Use of vaginal estrogen, antimicrobials, and prevention and management of mechanical injury were areas where no consensus was reached. DISCUSSION: Expert pessary providers were able to develop consensus recommendations to inform provider education and clinical care where the evidence base remains sparse. Areas where consensus was not achieved inform the future pessary-related research agenda needed to identify optimal cost-effective pessary care and educational methods for new pessary providers.

Health Seeking in Men: A Concept Analysis.

This article describes the analysis of the concept of health seeking in men. Men have shorter life expectancies and utilize health services less often than women, leading to poor health outcomes, but a gendered basis for health seeking remains poorly defined. Walker and Avant's framework was used to guide this concept analysis. Literature published in English from 1990-2015 was reviewed. Thematic analysis identified attributes, antecedents, and consequences of the concept. Based on the analysis, a contemporary definition for health seeking in men was constructed, rooted in the concept of health. The definition is based on the concept analysis and the defining attributes that were identified. This analysis provides a definition specifically for health seeking in American men, making it more specific and gender-based than the parent concept of "health." This concept analysis provides conceptual clarity that can guide development of a conceptual framework that may be uniquely relevant to providers in urology. Further exploration will uncover specific cultural, social, sexual, and geographic perspectives.