Knowledge, Attitude, and Practices of Labor Analgesia Amongst Obstetric Residents: A Cross-Sectional Survey.

BACKGROUND: Labor analgesia plays a crucial role in ensuring a comfortable and positive birthing experience. It provides physiological benefits to both the mother and the child. Knowledge, awareness, and communication between the anesthesiologist and the obstetrician are essential for the safe conduct of labor analgesia. We conducted this cross-sectional online survey amongst obstetric residents to assess their knowledge, attitude, and practices of labor analgesia. METHODS: A structured questionnaire consisting of 19 questions was circulated amongst obstetric residents of various hospitals via electronic mode of communication. The responses were analyzed using statistical methods. RESULTS: Among the obstetric residents that we surveyed, 75.7% of them only sometimes employed labor analgesia for their patients. The most commonly employed methods of pain relief are opioids and non-steroidal anti-inflammatory drugs (NSAID). Most of them feel that pain-free labor is necessary because it makes the whole labor process a pleasurable one. Labor analgesia was mostly advocated at patients' request and demand. The barrier to using labor analgesia was most commonly found to be the non-availability of labor analgesia services. CONCLUSION: Despite the increasing awareness of labor analgesia there still lies a gap between the attitude toward it and the practice of it. Further education to rectify the misconceptions and barriers needs to be taken for providing beneficial services to pregnant females.

Yttrium-90 Anti-CD25-BEAM-Conditioning for Autologous Hematopoietic Cell Transplantation in Peripheral T Cell Lymphoma.

Peripheral T cell lymphomas (PTCL) have a poor prognosis with current treatments. High-dose chemotherapy followed by autologous hematopoietic cell transplant (AHCT) is used as a consolidation strategy after achieving clinical remission with first-line therapy, as well as in chemosensitive relapse if allogeneic transplant is not an option. CD25 is a targetable protein often highly expressed in PTCL. In this phase 1 clinical trial, we tested the addition of beta-emitting 90Y-labeled chimeric anti-CD25 basiliximab (aTac) to BEAM (carmustine, etoposide, cytarabine, melphalan) as conditioning for AHCT in patients with PTCL. Twenty-three AHCT-eligible patients were enrolled, and 20 received therapeutic 90Y-aTac-BEAM AHCT. Radiation doses of 0.4, 0.5 and 0.6 mCi/kg were tested. With no observed dose-limiting toxicities, 0.6 mCi/kg was deemed the recommended phase 2 dose. The most prevalent adverse effect, grade 2 mucositis, was experienced by 80% of patients. As of this report, 6 (30%) of the treated patients had died, 5 due to progressive disease and 1 due to multiple organ failure [median time of death 17 mo (range: 9-21 mo)] post-AHCT. Median follow-up was 24 mo (range: 9-26 mo) overall and 24 mo (range: 13-26 mo) for surviving patients. For patients who received therapeutic 90Y-aTac-BEAM AHCT, the 2-year progression-free and overall survival were 59% (95% CI: 34-77%) and 68% (95% CI: 42-84%), respectively. 90Y-aTac-BEAM appears to be safe as an AHCT conditioning regimen for PTCL, with no increased toxicity over the toxicities historically seen with BEAM alone in this patient population. This trial was registered at www.clinicaltrials.gov as # NCT02342782.

An Interpretive Description of Drug Withdrawal Among Pregnant Women in Jail.

OBJECTIVE: To explore the experience of drug withdrawal among pregnant women in jail. DESIGN: A qualitative interpretive descriptive approach. SETTING/PROBLEM: The care of incarcerated pregnant women constitutes a complex and significant public health problem. Many have substance use disorder (SUD) and cycle in and out of jails in their community, resulting in repeated experiences of drug withdrawal. Most jails do not provide medication-assisted therapy for management of withdrawal, a situation that violates standards of care set by leading health organizations. The experience of drug withdrawal among pregnant women in jail has not been qualitatively explored in the literature. PARTICIPANTS: Five women completed interviews for the study. INTERVENTION: In-depth, qualitative interviews. RESULTS: Five themes with subthemes emerged from the interviews: Framing the Story Through Life History: I Need You to Know Where I Come From, Patterns of Thinking About Substance Use, The Manifestations of Withdrawal: Body and Mind, Perceived Punishment for Drug Use During Pregnancy, and Mixed Perceptions of Withdrawal Treatment. CONCLUSION: Participants told a story beyond that of the physical withdrawal symptoms, revealing new insights into their maternal distress and the need for compassionate, nonstigmatized care to address physical and mental symptoms, as well as advocacy for the provision of an evidence-based standard of care. Nurses who care for pregnant women with SUD in the jail setting could benefit from collaborative relationships with other health care professionals in the community to reduce disparate health outcomes for this vulnerable population.

Original Research: A Real 'Voice' or 'Lip Service'? Experiences of Staff Nurses Who Have Served on Staffing Committees.

BACKGROUND: Nurse staffing committees offer a means for improving nurse staffing and nursing work environments in hospital settings by giving direct care nurses opportunities to contribute to staffing decision-making. These committees may be mandated by state law, as is the case currently in nine U.S. states, yet little is known about the experiences of staff nurses who have served on them. PURPOSE AND DESIGN: This qualitative descriptive study was conducted to explore the experiences of direct care nurses who have served on nurse staffing committees, and to better understand how such committees operate. METHODS: Participants were recruited by sharing information about the study through online nursing organization platforms, hospital nurse leadership, state chapters of national nursing organizations, social media, and nonconfidential nursing email lists. A total of 14 nurses from five U.S. states that have had nurse staffing committee legislation in place for at least three years were interviewed between April and October 2022. RESULTS: Four themes were identified from the data-a "well-valued" committee versus one with "locked away" potential: committee value; "who benefits": staffing committee beneficiaries; "not just the numbers": defining adequate staffing; and "constantly pushing": committee members' persistence. CONCLUSIONS: The results of this study highlight the importance of actualizing staff nurse autonomy within nurse staffing committees-and invite further exploration into how staff nurses' perspectives can be better valued by nursing and nonnursing hospital leadership. Nurse staffing committees generally recommend staffing-related policies and practices that address the needs of patients and nurses, and work to find areas of compromise between nursing and hospital entities. But to be effective, the state laws that govern nurse staffing committees should be enforceable and evaluable, while committee practices should contribute to positive patient, nurse, and organizational outcomes; otherwise, they're just another form of paying lip service to change.

Stimulation of Potent Humoral and Cellular Immunity via Synthetic Dual-Antigen MVA-Based COVID-19 Vaccine COH04S1 in Cancer Patients Post Hematopoietic Cell Transplantation and Cellular Therapy.

Hematopoietic cell transplantation (HCT) and chimeric antigen receptor (CAR)-T cell patients are immunocompromised, remain at high risk following SARS-CoV-2 infection, and are less likely than immunocompetent individuals to respond to vaccination. As part of the safety lead-in portion of a phase 2 clinical trial in patients post HCT/CAR-T for hematological malignancies (HM), we tested the immunogenicity of the synthetic modified vaccinia Ankara-based COVID-19 vaccine COH04S1 co-expressing spike (S) and nucleocapsid (N) antigens. Thirteen patients were vaccinated 3-12 months post HCT/CAR-T with two to four doses of COH04S1. SARS-CoV-2 antigen-specific humoral and cellular immune responses, including neutralizing antibodies to ancestral virus and variants of concern (VOC), were measured up to six months post vaccination and compared to immune responses in historical cohorts of naïve healthy volunteers (HV) vaccinated with COH04S1 and naïve healthcare workers (HCW) vaccinated with the FDA-approved mRNA vaccine Comirnaty® (Pfizer, New York, NY, USA). After one or two COH04S1 vaccine doses, HCT/CAR-T recipients showed a significant increase in S- and N-specific binding antibody titers and neutralizing antibodies with potent activity against SARS-CoV-2 ancestral virus and VOC, including the highly immune evasive Omicron XBB.1.5 variant. Furthermore, vaccination with COH04S1 resulted in a significant increase in S- and N-specific T cells, predominantly CD4+ T lymphocytes. Elevated S- and N-specific immune responses continued to persist at six months post vaccination. Furthermore, both humoral and cellular immune responses in COH04S1-vaccinated HCT/CAR-T patients were superior or comparable to those measured in COH04S1-vaccinated HV or Comirnaty®-vaccinated HCW. These results demonstrate robust stimulation of SARS-CoV-2 S- and N-specific immune responses including cross-reactive neutralizing antibodies by COH04S1 in HM patients post HCT/CAR-T, supporting further testing of COH04S1 in immunocompromised populations.

Experiences of Doctor of Nursing Practice (DNP)-prepared nurses choosing to pursue a Doctor of Philosophy (PhD) degree.

BACKGROUND: Increasingly, nurses with a Doctor of Nursing Practice (DNP) degree are seeking a Doctor of Philosophy (PhD) degree. This subset of students may provide valuable insight for bolstering the PhD-prepared workforce, which is in decline. PURPOSE: The purpose of this research was to understand the essence of the lived experience of DNP-prepared nurses choosing to pursue a PhD degree. METHOD: An existential phenomenological study was undertaken, with 10 DNP-to-PhD students interviewed. RESULTS: The DNP-to-PhD experience is about being On a Mission. The Nursing Hierarchy was an implicit force influencing students' missions, and their experiences were characterized by five themes: (a) Having Needs the DNP Can't Meet: "I had to go back and do more," (b) Considering Dreams and Circumstances: "Now's the time," (c) Developing Confidence: "You can do this!" (d) "I've been very supported"/"I had no support," and (e) "It had to be an internal drive for me." CONCLUSIONS: Study findings demonstrate profound effects of the nursing hierarchy on students' decisions as well as misperceptions that still surround DNP and PhD education and careers. Nursing academicians, organizational leaders, and researchers must address PhD program disinterest, intimidation, and imposter syndrome and improve messaging about both degrees.