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There has never been more opportunity for exercise professionals to become an enabled part of healthcare through both preventative and therapeutic care models. The development of the United States Registry of Exercise Professionals (USREPS) has created a utility for the verification of qualified professionals who meet competency standards for recognition in the health system aligned with the HL7 Physical Activity Implementation Guide. Apply It!: By reading this article, the reader will learn: • The importance of collaboration for the national registration system • How to access the USREPS at https://USREPS.org to see the registry • How to check their credentials or those of employees on the registry • How human resource departments can check multiple employees at one time [ABSTRACT FROM AUTHOR]

To develop and psychometrically test an instrument measuring the attitudes and practices towards vital signs (VS) monitoring in nurses caring for children on paediatric wards (Ped-V scale). This is a multicentre cross-validation study with a cross-sectional design. The Ped-V scale was developed by adapting the V-scale to the paediatric context and administered to a convenience sample of clinical nurses working in paediatric wards from January to May 2020. The content validity of the Ped-V scale was evaluated by a group of 10 experts. The psychometric properties of the scale were tested through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Overall, 10 Italian hospitals participated in the study, and 640 questionnaires were completed (87% female). At EFA a 30-item version of the scale and four factors emerged. This solution was confirmed at CFA: F1) 'Inaccuracy of VS monitoring and workload'; F2) 'Clinical competence and communication'; F3) 'Standardization and protocol adherence'; F4) 'Misconceptions about key indicators'. Cronbach's alpha ranged between 0.63 and 0.85. The Ped-V scale is valid and reliable for use in the paediatric context to identify barriers concerning nurses' self-efficacy, competences, and knowledge of clinical indicators of paediatric critical deterioration, attitudes towards accuracy, standardization, communication to senior team members and the appropriate use of technology in paediatric VS monitoring. The Ped-V scale may assist in identifying gaps in nurses' attitudes and devising strategies to change nurses' beliefs, knowledge, skills and decreasing individual, local cultural or organizational barriers towards VS monitoring. • Paediatric patients admitted to hospital wards are at risk of deterioration. • Nurses' attitudes and practices towards paediatric vital signs monitoring can vary. • The Ped-V scale was developed by adapting the V-scale to the paediatric context. • The Ped-V scale is valid and reliable for use in the paediatric hospital context. [ABSTRACT FROM AUTHOR]

• Most parents consult at least sometimes the primary care paediatrician. • Parents rarely use other primary care services. • Only a few parents know where the nearest community health centre is located. • Children previously admitted to the hospital use more community services. • Parents ask for more information about local healthcare services. Parents often take their children to the Paediatric Accident and Emergency Department (A&E) for non-urgent consultations rather than using community-based primary care services. This study describes the use of primary care services in parents taking their children to the A&E for non-urgent consultations. A cross-sectional study was conducted from July 2018 to June 2019, in a second-level Italian paediatric A&E of a tertiary-level children's academic research and hub hospital. Parents of children aged between 3 months and 6 years assigned with a white code at the triage were asked to complete a paper-and-pencil 40-item questionnaire after accessing the A&E for a non-urgent consultation. The questionnaire was completed by the parents of 237 children (males 58 %; median age = 2.3 years). Overall, 48.1 % (n = 114) of the parents reported consulting 'often/always' the primary care paediatrician, mainly when their child was sick and for check-ups (n = 182, 76.8 %). However, only 7.2 % (n = 17) of the parents 'often/always' used any other health service in the community. Most of them (n = 191, 82 %) did not even know where the community health centre was located. Parents accessing the A&E for non-urgent consultations should be better informed/educated on how to use community health services. [ABSTRACT FROM AUTHOR]

Purpose Evaluate didactic year physician assistant (PA) student competency in electronic health record (EHR) communication and data management. Methods This study used an Objective Structured Clinical Examination (OSCE) to measure PA students' EHR patient communication and data skills. Results Most students demonstrated good EHR communication skills overall, while few students moved the computer to better facilitate the visit or verified the patient's identity. Additionally, few students demonstrated EHR data skills by reviewing patient history and medications. Conclusions Utilizing an OSCE to assess EHR competence can highlight areas for curricular improvement in order to improve EHR skills. [ABSTRACT FROM AUTHOR]

• Prone position delivers relatively a lower skin dose than supine treatment technique. • Prone position can lead to lower dose in lumpectomy close to skin. • Skin dose needs to be evaluated in breast patients. • Lower dose to Organs at Risk in prone position compared to the supine position. • Skin dose in breast cancer radiation treatment is critical for the outcomes and cosmesis. To determine how the skin dose varies in patients receiving radiation treatment for breast cancer in the prone and supine positions. Fifty patients were scanned in the prone and supine positions. A radiation treatment plan was created for the left breast using a 6-MV beam for a prescribed dose of 42.66 Gy in 16 fractions. The dose was calculated using 1- and 2.5-mm calculation grid sizes and the surface dose was compared in both techniques. The median gantry angles relative to the skin surface at the central axis were 8 and 52 degrees for treatment in the prone and supine positions, respectively. The mean dose difference between the prone and supine techniques was statistically significant from 3- to 5-mm depth for both grid sizes. For the 1-mm calculation grid size, the doses at 3-, 4-, and 5-mm depths in the prone and supine techniques were 87.80% and 89.10% (P < 0.003), 91.92% and 94.50% (P < 0.00), and 95.30% and 98.20% (P < 0.00), respectively; for the 2.5-mm grid size, the respective doses were 87.10% and 88.59% (P < 0.00), 91.60% and 94.63% (P < 0.00), and 95.10% and 97.80% (P < 0.00), respectively. This study demonstrates that the prone technique facilitates a relatively lower skin dose than the supine technique. This observation is probably due to the beam angle. The beam is more perpendicular to the skin surface in the prone technique, whereas it is more tangential in the supine technique, which may deliver a higher skin dose. Thus, the dose to the skin should be evaluated in the prone technique, and if desired, the skin dose could be carefully augmented via a bolus or beam spoiler. [ABSTRACT FROM AUTHOR]

Stakeholder engagement is the basis of an emerging and innovative educational model called competency-based education. However, although several studies have analysed the stakeholders' perspective in nursing, few studies have analysed the stakeholders' perspective in competence-based curriculum design. Thus, the aim of this study was to analyse the opinions and perspectives of stakeholders about the development of a competency-based baccalaureate nursing curriculum with stakeholder engagement. A phenomenological study was conducted. This method combines descriptive features (Husserlian) and interpretive phenomenology (Gadamerian). The interviews were ended when data saturation was achieved, specifically the redundancy of themes. The content analysis identified three main categories: (1) a "bridge" that merges education and the work context, (2) stakeholder engagement – a contentious issue; and (3) stakeholder engagement – structuring a methodology. Through the stakeholder engagement, university could have a constant interaction between the didactics and professional practice and could improve professional identity and job satisfaction among nurses. • Stakeholder engagement is crucial in the development of a competence-based curriculum • Stakeholders' engagement may be implemented in the area of nursing education • Stakeholders engagement in nursing education favours a more effective correspondence between acquired and expected competencies. [ABSTRACT FROM AUTHOR]

Background: Caregiver contributions (CC) to heart failure (HF) self-care maintenance (ie, CC to maintaining HF stability) and management (ie, CC to dealing with HF signs and symptoms) improve patient outcomes, but it is unknown whether caregiver preparedness influences CC to self-care and whether caregiver confidence mediates this process. Objectives: We evaluated the influence of caregiver preparedness on CC to HF self-care maintenance and management and the mediating role of caregiver confidence. Methods: This is a secondary analysis of theMOTIVATE-HF study. Patients were 18 years or older, with a diagnosis of HF in New York Heart Association classes II to IV, who had insufficient self-care and did not have severe cognitive impairment. Patients' informal caregivers were those people inside or outside the family who gave most of the informal care to the patients. We used the Caregiver Preparedness Scale and the Caregiver Contribution to Self-Care of HF Index. We tested a path analysis model and the indirect effects. Results: Caregivers (n = 323)were 55 (SD, 15) years old on average and predominantly female (77%). The path analysis showed that higher scores in caregiver preparedness were associated with higher scores in caregiver confidence. In turn, higher caregiver confidence was associated with higher CC to self-care maintenance and management. Caregiver confidence mediated the association between caregiver preparedness and CC to self-care maintenance and management. Conclusions: Caregiver confidence may play a role in CC to self-care. Interventions to improve CC to HF self-care should not only be focused on improving caregiver preparedness but also should consider the role of caregiver confidence. [ABSTRACT FROM AUTHOR]

To compare dose to organs at risk (OARs) and biological evaluation using normal tissue complication probability (NTCP) for left-sided breast radiation therapy in 4 techniques: supine free breathing (SFB), supine deep inspiration breath hold (SDIBH), prone free breathing (PFB), and prone deep inspiration breath hold (PDIBH). Twenty-five patients with left-sided breast cancer suitable for this study underwent a computed tomography scan using SFB, SDIBH, PFB, and PDIBH. One radiation oncologist contoured the planning target volume and OAR (cardiac components). Dose-volume histograms and NTCPs for the heart, left ventricle (LV), left anterior descending artery (LAD), and left lung were calculated for all 4 techniques. The mean heart dose in PDIBH is 0.77 Gy, which is statistically significantly lower than in SFB (1.88 Gy, P <.0001), SDIBH (0.97 Gy, P <.001), and PFB (0.85 Gy, P <.001). The mean left lung dose is 0.69 Gy in PFB and 0.88 Gy in PDIBH. PFB and PDIBH have statistically significantly lower doses compared with SFB (6.09 Gy, P <.0001) and SDIBH (5.41 Gy, P <.0001). The mean NTCP in SFB for the heart, LV, and LAD is 0.27%, 0.62%, and 4.23%, respectively, and it is negligible for other techniques. We found that PDIBH had a dosimetrically lower mean dose for the heart and LV compared with the other 3 techniques. In addition, SDIBH, PFB and PDIBH had statistically significantly lower NTCP for the heart, LV, and LAD compared with SFB. NTCP for the left lung was statistically significantly lower for prone techniques compared with supine techniques. Therefore we concluded that, compared with SDIBH, PDIBH provides the added benefit of sparing the heart while keeping the benefit of sparing the lung as in the prone technique. [ABSTRACT FROM AUTHOR]

Aim To explore factors that influence intensive care nurses' experiences of being compliant with standard precautions (SP) during emergencies. Intensive care nurses can be exposed to a greater risk of biohazardous exposure during an emergency. The primary strategy to address the complex variety of biological hazards in clinical practice is represented by the implementation of SP guidelines. Previous research has indicated that nurses' compliance rates with SPs are suboptimal, but no study has focused on the factors influencing compliance during an emergency. A descriptive qualitative study was conducted in an Italian university hospital with 19 intensive care nurses who had at least two years of work experience in critical care. The nurses were interviewed in four focus groups and were asked about their experiences of being compliant with SPs during an emergency. Data were analyzed using conventional content analysis. Three themes emerged: conflict, competencies, and context. Conflict was reported regarding the need to save the patient and the need for self-protection through the use of SPs. In particular, nurses had to manage the pressure of limited time. Competencies were identified by nurses' knowledge, attitude, skills, training, and experience. Context was related to the work and organizational conditions during the emergency, including overcrowding. To support intensive care nurses' compliance with SPs during emergencies, conflict, competencies, and context should be audited regularly in clinical practice. The findings of this study could inform infection control programs and training that targets intensive care nurses. • ICU nurses' compliance with SP can reduce exposure to biohazards during an emergency. • Conflict, competencies, and context, can affect compliance for ICU nurses. • Conflict was noted when deciding to save the patient or prioritize the nurse's self-protection. • Infection control programs and training for ICU nurses should address these aspects. [ABSTRACT FROM AUTHOR]

While the initial reception of Alfred Hitchcock's Vertigo (1958) was unspectacular, it made its presence felt in a host of other films - from Chris Marker's Sans Soleil (1983), to Brian De Palma's Obsession (1976), and David Lynch's Mulholland Dr. (1999). What seemed to have eluded the critics at the time is that Vertigo is a film about being haunted: by illusive images, turbulent emotions, motion and memory, the sound and feeling of falling into the past, into a nightmare. But it is also a shrewdly reflexive film that haunts filmmakers, critics, and artists alike, raising fundamental questions about the ontology of moving images and the regime of fascination (exemplified by Hollywood) that churns them out. Douglas Gordon's Feature Film (1999), D.N. Rodowick's The Wanderers (2016), and Lynn Hershman's VertiGhost (2017) are contemporary examples of how the appropriation and contemplation of some the film's most iconic motifs (the figures of Madeleine, the spiral, the copy or fake, and the fetish), themes (liebestod, obsession, the uncanny) and strategies (mirroring, duplicity, and disorientation) ask us to rethink the relation of fetishism to fabulation, and supplementarity to dissimulation and social engineering. Feature Film, The Wanderers, and VertiGhost are supplementary works, but like the original film they are about duplicity, doppelgänger, and dissimulation. What interests us is how they challenge the authority over, or even proximity to, that which returns in the form of the supplement. And ultimately, attaching themselves to the chain of forgers and forgeries, these supplementary works take their place in the vertiginous sequence of substitutions the film established: a neat allegory for a reign of the digital ghosting that Hitchcock could never have anticipated. [ABSTRACT FROM AUTHOR]

Copyright of La Medicina del Lavoro is the property of Mattioli 1885 SpA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Pediatric Nursing is the property of W B Saunders and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

It is crucial that palliative care nurses feel competent to practice their profession in accordance with ethical principles, to personalize care, to remain sensitive, to ensure respect, and to communicate effectively. The aim of this study was to verify that higher levels of perceived professional competency predict better individual and organizational outcomes, such as job satisfaction and organizational citizenship behavior. An online cross-sectional survey was conducted with 107 Italian palliative care nurses. Structural equation modeling technique was used for data analysis. The model fitted the data well. Professional competency was positively associated with both job satisfaction (β = 0.39) and organizational citizenship behavior (β = 0.53). The more confidence palliative care nurses have in their professional competency, the more they are satisfied with their job and engage in organizational citizenship behavior. Fostering professional competency in palliative nursing can help not only patients and their families but also the nurses themselves, the organization, and their coworkers. [ABSTRACT FROM AUTHOR]

Background and Aims: Elevated serum uric acid (sUA) concentrations have been associated with worse prognosis in heart failure (HF) but little is known about elderly patients. We aimed to assess long-term additive prognostic value of sUA in elderly patients hospitalized for HF.Methods and Results: Clinical and echocardiographic characteristics of 310 consecutive elderly patients hospitalized for HF were collected. During index period, 206 had sUA concentrations available, which were obtained within 24 h prior to discharge; 10 patients were lost to follow-up, leaving 196 patients available. Patients had a median age of 77 (IQR 69-83) years, and were mostly male (64.5%). sUA ranges for tertiles I-III were: 1.5-6.1, 6.2-8.3, and 8.4-18.9 mg/dl, respectively. During a median follow-up of 27 months (IQR 10.5-39.5), 122 combined events occurred (87 deaths and 73 HF rehospitalizations). Four-year event-free survival for the combined endpoint was 46 ± 7% for tertile I, 34 ± 7% for tertile II, and 21 ± 5% for tertile III (P = 0.001). By multivariable Cox backward analysis, sUA was retained as a significant predictor. Compared with the lowest sUA tertile, tertile III showed a strong association with outcome, also after adjustment for other predictors (HR 1.84, 95% CI 1.16-2.93; P = 0.01). Importantly, addition of sUA to the other significant predictors of outcome resulted in improved risk classification (net reclassification improvement 0.19, P = 0.017).Conclusions: High sUA at discharge is a strong predictor of adverse outcome in elderly hospitalized for HF, and it significantly improves risk classification. Measuring sUA can be a simple and useful tool to identify high-risk elderly hospitalized for HF. [ABSTRACT FROM AUTHOR]

Quantitative image features, also known as radiomic features, have shown potential for predicting treatment outcomes in several body sites. We quantitatively analyzed 18 Fluorine–fluorodeoxyglucose ( 18 F-FDG) Positron Emission Tomography (PET) uptake heterogeneity in the Metabolic Tumor Volume (MTV) of eighty cervical cancer patients to investigate the predictive performance of radiomic features for two treatment outcomes: the development of distant metastases (DM) and loco-regional recurrent disease (LRR). We aimed to fit the highest predictive features in multiple logistic regression models (MLRs). To generate such models, we applied backward feature selection method as part of Leave-One-Out Cross Validation (LOOCV) within a training set consisting of 70% of the original patient cohort. The trained MLRs were tested on an independent set consisted of 30% of the original cohort. We evaluated the performance of the final models using the Area under the Receiver Operator Characteristic Curve (AUC). Accordingly, six models demonstrated superior predictive performance for both outcomes (four for DM and two for LRR) when compared to both univariate-radiomic feature models and Standard Uptake Value (SUV) measurements. This demonstrated approach suggests that the ability of the pre-radiochemotherapy PET radiomics to stratify patient risk for DM and LRR could potentially guide management decisions such as adjuvant systemic therapy or radiation dose escalation. [ABSTRACT FROM AUTHOR]

To investigate the simultaneous effects of work-related stress and job satisfaction on cardiovascular nurses' quality of work life. Prior research has investigated nurses' work-related stress, job satisfaction, and quality of work life as separate aspects and not in specific nursing settings, such as cardiovascular wards. Cardiovascular care settings can be particularly stressful for nurses, who are often faced with distress, depression and patients and caregivers' physical and psychological exhaustion. A multicenter cross-sectional study was conducted among 1126 cardiovascular nurses from 10 hospitals in Italy. Work-related stress, job satisfaction, and quality of work life were measured using valid and reliable questionnaires. Structural equation modeling was performed. Nurses working in critical cardiac care units experienced more stress than their colleagues working in other cardiac units. Nurses working in cardiac outpatient clinics reported lower quality of work life than those working in other cardiac settings. There was a negative relationship between work-related stress and nurses' quality of work life, which was partially mediated by job satisfaction, indicating that stress generated by the work environment negatively affect nurses' quality of work life by reducing their job satisfaction. Cardiovascular nurses' quality of work life is negatively affected by work-related stress. The work-related stress is mediated through job satisfaction. Nurse managers should maximize nurses' job satisfaction by providing comfort at work, supporting professional development opportunities, sharing organizational objectives, and actively listening and addressing nurses' concerns. When cardiovascular nurses' quality of work life is elevated, patients' care quality and outcomes are improved. • Cardiovascular nurses' quality of work life affects both their level of work-related stress and their job satisfaction. • Stress generated by the cardiovascular settings negatively affects nurses' quality of work life and reduce job satisfaction. • Work-related stress levels and the quality of life of cardiovascular nurses depend on the cardiac unit in which they work. [ABSTRACT FROM AUTHOR]