Malnutrition coding and reimbursement in the hospital setting.

Professionals responsible for the nutrition care of hospitalized patients should understand the prevalence of malnutrition, how to accurately and consistently identify and communicate a diagnosis of malnutrition in the medical record, and the sophisticated payment systems used to reimburse hospitals for patient care. Insight into healthcare payment systems and the requirements for clarity, consistency, and accuracy can improve identification, coding, and billing for malnutrition. Hospitals receive reimbursement for services based on anticipated costs for diagnosis-based groups, and documenting the presence of a comorbidity, such as malnutrition, can increase the payment for a diagnosis. It is important to accurately document not only the supporting criteria used to diagnose malnutrition, but also the interventions used to address it during a patient's stay.

Structure Determination of a Chloroenyne from Laurencia majuscula Using Computational Methods and Total Synthesis.

Despite numerous advances in spectroscopic methods through the latter part of the 20th century, the unequivocal structure determination of natural products can remain challenging, and inevitably, incorrect structures appear in the literature. Computational methods that allow the accurate prediction of NMR chemical shifts have emerged as a powerful addition to the toolbox of methods available for the structure determination of small organic molecules. Herein, we report the structure determination of a small, stereochemically rich natural product from Laurencia majuscula using the powerful combination of computational methods and total synthesis, along with the structure confirmation of notoryne, using the same approach. Additionally, we synthesized three further diastereomers of the L. majuscula enyne and have demonstrated that computations are able to distinguish each of the four synthetic diastereomers from the 32 possible diastereomers of the natural product. Key to the success of this work is to analyze the computational data to provide the greatest distinction between each diastereomer, by identifying chemical shifts that are most sensitive to changes in relative stereochemistry. The success of the computational methods in the structure determination of stereochemically rich, flexible organic molecules will allow all involved in structure determination to use these methods with confidence.

Development and Implementation of a Survey to Assess Health-Care Provider's Competency, Attitudes, and Knowledge About Perinatal Palliative Care.

Perinatal palliative care is an emerging area of health care. To date, no published tools assess health-care provider's knowledge and level of comfort in providing such care. A 2-phase study was undertaken to develop and implement a survey to evaluate the self-assessed competency, attitudes, and knowledge of health-care providers working in perinatal palliative care. Phase 1 included a review of the literature and appraisal of palliative and death-related instruments to inform the initial draft of the Perinatal Palliative Care Survey (PPCS). Twenty-four Canadian pediatric palliative care specialists critiqued the PPCS, establishing its face and content validity. Phase 2 involved administering the PPCS at 4 sites across Canada, resulting in 167 responses from nurses, physicians, and midwives. The majority of participants responded that they possessed a degree of comfort in providing perinatal palliative care, particularly with assessing pain (76%), managing pain (69%), assessing other symptoms (85%), and managing other symptoms (78%). Two areas where participants level of confidence or extreme confidence was diminished included having conversations with families about the possibility of their infant dying (55%) and knowing and accessing community palliative care resources (32%). Responses in the knowledge section identified gaps related to opioid use, pharmacological interventions for breathlessness, pain behaviors, and tolerance developed to opioids and sedatives. Eighty-six percent of respondents stated that if education about palliative care was made available, they would participate with priority topics identified as communication with families (75%), managing symptoms (69%), pain management (69%), and ethical issues (66%). The PPCS provides a useful assessment to determine the educational needs of health-care providers delivering perinatal palliative care.

Methotrimeprazine for the management of end-of-life symptoms in infants and children.

OBJECTIVE: This retrospective chart review assessed the efficacy, dose, and safety of methotrimeprazine in palliating end-of-life symptoms in children and infants. METHODS: A retrospective chart review was conducted of 18 hospitalized pediatric patients who were treated with methotrimeprazine in their last two weeks of life. Data collected included age, diagnosis, symptoms, methotrimeprazine dose, route, efficacy, and any documented adverse effects. RESULTS: Patients' ages ranged from 16 days to 17 years. Underlying conditions included malignancies, trauma, and various neurodegenerative and congenital diseases. All patients (n = 18) were treated for symptoms of agitation, delirium, or restlessness. Most patients also experienced respiratory secretions/congestion (n = 15), pain (n = 13), and/ or dyspnea (n = 9). Less common symptoms included nausea/emesis (n = 5) and spasticity (n = 1). Methotrimeprazine dosages ranged from 0.02 mg/kg/dose to 0.5 mg/kg/dose. Routes of administration included intravenous (n = 13), oral/gastrostomy tube (n = 6), or subcutaneous (n = 4). Sedation (n = 6) was the only documented adverse effect, although when agitation was present, this was potentially an intended and perceived-to-be-beneficial effect. CONCLUSION: Methotrimeprazine, an old drug with diverse receptor activity and multiple routes of administration, appears to be an effective tool in treating complicated end-of-life symptoms in children and infants. This study provides a foundation for analysis with prospective and comparative trials, which may further quantify its benefit.

A journey within a journey: the lived experience of parents who do not live near their child's tertiary cancer center.

Much research has been directed at childhood cancer survivors and their families to learn how to best provide care. However, little is known about parents' experiences of transitioning to a time when their child has completed treatment for cancer when living at a distance to the tertiary cancer center. The purpose of this study was to talk to such parents about their experiences. Five Canadian parents of children who had completed treatment for cancer in the past 3 months to 5 years took part in qualitative opened-ended interviews using a phenomenological hermeneutic approach. Data analysis revealed the essence of the parents' lived experience as a journey within a journey; 4 themes characterized the essence. Parents living a 2.5- to 5-hour drive from the cancer center expressed a willingness to travel wherever necessary in order to receive specialized care for their child. Parents emphasized the importance of having a local health care provider in whom they trusted. Assessing families' needs, support systems, and readiness to return home are important nursing roles throughout the cancer trajectory.

Pain in children with central nervous system cancer: a review of the literature.

PURPOSE/OBJECTIVES: To explore the current state of the science regarding pain in children with cancer, with special attention to literature related to central nervous system (CNS) tumors. This review used the Human Response to Illness (HRTI) model as an organizing framework. DATA SOURCES: PubMed, CINAHL, and Scopus data-bases. DATA SYNTHESIS: The literature review is presented with the four components of the HRTI model, including the physiologic, pathophysiologic, experiential, and behavioral perspectives of the pain response related to childhood cancer and childhood CNS cancer. The person and environmental factors that may influence a child's pain response are described. CONCLUSIONS: Children with cancer, including CNS cancer, continue to experience pain despite the improvements in knowledge related to pain. Pain assessment and management strategies must continue to evolve and improve for nursing professionals to provide a high level of care to this patient population. The HRTI model provides an appropriate framework to gain insight into the pediatric oncology nursing role in the assessment, management, and evaluation of pain from childhood cancers. IMPLICATIONS FOR NURSING: Nurses play a vital role in pain assessment and management for children with cancer. The HRTI model can be used to identify areas of clinical practice, education, and research that require further improvements in relation to pain in children with CNS cancer.

Cancer survivorship in children and young adults: a concept analysis.

Survivorship has been described in a variety of ways. Understanding how survivorship is applied in the context of childhood cancer survivors is important to the practice of pediatric nursing because it will offer nurses new possibilities for providing guidance, support, and assistance in enhancing outcomes for childhood cancer survivors and their families. Accordingly, the purpose of this article is to provide a conceptual framework that will assist nurses in their efforts to attain the common goal of successful survivorship in childhood cancer survivors. The method of concept analysis developed by Walker and Avant is used. The result is a definition of survivorship that is relevant and useful for research and clinical practice in pediatric oncology.