Neonatal abstinence syndrome and mother's own milk at discharge.

OBJECTIVE: To describe factors impacting receipt of mother's own milk (MOM) at discharge among California infants diagnosed with neonatal abstinence syndrome (NAS). STUDY DESIGN: Cohort study of the California Perinatal Quality Care Collaborative's Maternal Substance Exposure Database for infants with NAS and gestational age ≥ 34 weeks from 2019 to 2020. RESULT: 245 infants with NAS were identified. Variables with an increased likelihood of being discharged on MOM included maternal medication assisted treatment (p = 0.001), use of maternal addiction services (p < 0.001), receiving donor human milk (p = 0.001), being treated in the well baby unit (p < 0.001), rooming-in (p < 0.001), and kangaroo care (p < 0.001). Among infants with NAS for whom MOM was recommended (n = 84), rooming-in was the only factor associated with being discharged on MOM (p = 0.002); receiving formula was the only inversely associated factor (p < 0.001). CONCLUSION: Results suggest supporting the mother-infant dyad and using non-pharmacologic treatment methods, such as rooming-in, increase receipt of MOM at discharge.

Effects of a service-learning experience on health-related students' attitudes toward the homeless.

OBJECTIVES: A community engagement service-learning experience was planned to provide health services for the homeless during a local 1-day event. The objectives were to (a) determine the feasibility of a service-learning experience, and to (b) examine the effects on students' attitudes toward persons experiencing homelessness. METHODS: A quasi-experimental, institutional review board approved study, including health-related students enrolled in a local university or community college, was planned. The attitudes toward the homeless survey was administered before and after participation in the service-learning experience. Qualitative data were through student reflections of the experience. RESULTS: Participants (n = 106) completed a pre and post questionnaire and a self-reflection. A statistically significant t(26) = -2.2, p = .04 change in attitudes toward the homeless were found. Three themes were revealed from the reflections: inherent bias, individualized care, and the societal context of people experiencing homelessness. CONCLUSION: Both quantitative and qualitative findings may help students reflect on preconceived stereotypes; therefore, affecting their attitudes toward the homelessness.

Protecting Restricted Extremities: The Implementation of a Pink Wristband.

Nurses should protect the affected extremities of patients who have a permanent arteriovenous access for hemodialysis by avoiding blood pressure measurements and venipuncture on access extremities. National recommendations include labeling the affected extremity with an alert mechanism, such as a wristband, to notify patients and staff of arteriovenous access. A policy change was enacted at an academic medical center in the Southeast to identify restricted extremities with a pink "limb alert" wristband after review of national recommendations on hemodialysis access preservation, individual facility procedures, product cost-benefit analysis, and unit and system educational methods. Keeping simplicity, nursing workload, and flexibility at the forefront of implementation, evaluation, and process revision, an overall adherence rate of 84.2% was achieved three months after implementation of the policy.

Use of multiple pedagogies to promote confidence in triage decision making: a pilot study.

BACKGROUND: The purpose of this pilot study was to determine whether the addition of educational interventions to required clinical hours promotes confidence in triage decision making among nursing students enrolled in a final capstone course. METHODS: An experimental design was implemented with randomization of students (n = 14) to 1 of 3 intervention groups or the control group. The Triage Decision Making Inventory was used as a pretest-posttest. Educational strategies implemented included an Advanced Cardiac Life Support course and simulations with debriefing. Interventions were in addition to required clinical hours. RESULTS: A mixed analysis of variance was used to examine the 4 groups by time, with all groups exhibiting higher scores on the Triage Decision Making Inventory from the pretest to the posttest (F (3, 10) = 4.51, P = .03 (η(2) = .575). Students who received both the simulations and the Advanced Cardiac Life Support course demonstrated a significant difference across time. CONCLUSIONS: As nursing education evolves with the integration of technology, the combination of multiple pedagogies also can enhance confidence in triage decision making among experienced and novice nurses in emergency settings.

Retinal microvascular abnormalities and cognitive function in Latino adults in Los Angeles.

PURPOSE: Retinal vessels may provide a readily accessible surrogate approach to study vascular disease in brain small vessels. Previous epidemiologic studies of retinal microvascular abnormalities and cognition have not included large numbers of Latinos who have a high prevalence of diabetes and hypertension. METHODS: We used data from 809 elderly Latino participants in the Los Angeles Latino Eye Study (LALES) to assess whether retinal vessel caliber and microvascular abnormalities are cross-sectionally associated with lower cognitive function. Cognitive screening was conducted with the Cognitive Abilities Screening Instrument-Short form (CASI-S) and in-depth testing with the Spanish English Neuropsychological Assessment Scales (SENAS). Retinal photographs were used to identify retinopathy signs and measure retinal vessel caliber. RESULTS: A total of 65.8% had high blood pressure, 34.5% had diabetes; self-reported diagnoses of heart attack, heart failure, angina and stroke were rare. Retinal calibers and any retinopathy were not associated with the CASI-S, total SENAS or any SENAS cognitive factors assessed as continuous variables. The odds of a low CASI-S score were two times higher in subjects with generalized arteriolar narrowing (OR = 2.04, 95% CI = 1.14, 3.66), and one and half times as high in those with both generalized arteriolar narrowing and retinopathy signs (OR = 1.49, 95% CI = 0.47, 4.75) though this result was based on only four cases with both risk factors and confidence limits were wide and included the null. CONCLUSION: Retinal microvasculature imaging may provide insights into small blood vessel influences on cognition in Latino populations. Additional studies in diverse populations and prospective settings are needed.