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The purpose of this review is to examine the state of science of simulation-enhanced orientation and its effect on graduate nurses (GNs).Background:GNs are essential to the alleviation of staffing deficits, mitigation of patient safety events, and provision of clinically adept care. Successful transition from academia to clinical practice is often influenced by factors that compromise retention, increase attrition, and impair professional development.Method:The method used was an integrative literature review.Results:There is a paucity of research in the literature regarding the effect of simulation-enhanced orientation on clinical competency, confidence outcomes, and other benchmarks of professional development that may influence retention or attrition.Conclusion:This integrative review confirmed the paucity of research of qualitative and quantitative outcomes of simulation-enhanced orientation on GNs. Stakeholders of organizational and educational institutions may find this review valuable, as it highlights the necessity for additional research. This integrative review confirmed the paucity of research of qualitative and quantitative outcomes of simulation-enhanced orientation on GNs. Stakeholders of organizational and educational institutions may find this review valuable, as it highlights the necessity for additional research. [[J Contin Educ Nurs. 2021;52(3):150–156.]

In the last year, New York City has had more than 600 confirmed measles cases. For each patient with measles, numerous neonates, unimmunized children, and susceptible adults can be exposed to the highly contagious virus. Working in an emergency department amid such an outbreak presents several challenges because of the crowded nature of the environment, the imperative for rapid identification and isolation of infected patients, and identification of vulnerable individuals who have been in the vicinity when a patient with measles presents. In this report, we discuss our process in navigating these challenges, collaboration with the city’s health department, postexposure prophylaxis for individuals exposed in the hospital and the community, and prevention initiatives.

Elderly critical care patients are one of the largest growing patient population groups according to Medicare data. Over 51% of elderly patients are discharged on inappropriate medications that have the potential to cause harm or interact adversely with other medications. Precision health has the potential to prevent adverse drug events and prescription of inappropriate medications. The purpose of this literature review was to define the concept of precision health and determine the state of science regarding interprofessional models of precision health for assessment of caregiver impact on polypharmacy in elderly intensive care unit patients. Results of the review yielded a paucity in the literature on precision health use by bedside nurses that resulted in a proposed interprofessional precision health model. Nurses are key members of the interprofessional healthcare team and should be leaders in conducting and utilizing research on precision health data collected at the bedside to bring about change in clinical practice and outcomes. The lack of research indicates the need for future research in the area of interprofessional research utilizing precision health in the elderly population.

Mature cystic teratomas are the most common type of ovarian germ cell tumors. In about 1% of cases, usually among postmenopausal women, a mature cystic teratoma can undergo malignant transformation. Among malignant transformations, squamous cell carcinoma is the most common histology, comprising approximately 80% of cases. In this report, we present the unique case of a 55-yr-old woman with a pelvic mass found to be a mature cystic teratoma with malignant transformation to adenocarcinoma with breast/adnexal, upper gastrointestinal, and neuroendocrine differentiation. The predominant malignant component was the adenocarcinoma exhibiting breast/skin adnexal differentiation, which was found to involve the omentum and a right para-aortic node. We provide an in-depth review of the pathologic findings, as well as a review of the current literature on malignant transformation to adenocarcinoma. This report aims to open a conversation regarding the management of these patients, with a specific focus on the role of molecular analysis and targeted therapies.

OBJECTIVE:: To evaluate whether laxatives and fiber therapies improve symptoms and bowel movement frequency in adults with chronic constipation. DATA SOURCES:: English language studies were identified from computerized MEDLINE (1966-1995), Biological Abstracts (1990-1995), and Micromedex searches; bibliographies; textbooks; laxative manufacturers; and experts. STUDY SELECTION:: Randomized trials of laxative or fiber therapies lasting more than 1 week that evaluated clinical outcomes in adults with chronic constipation MEASUREMENTS AND MAIN RESULTS:: Two independent reviewers appraised each trial's characteristics including methodologic quality. There were 36 trials involving 1,815 persons from a variety of settings including clinics, hospitals and nursing homes. Twenty-three trials were 1 month or less in duration. Several laxative and fiber preparations were evaluated. Twenty trials had a placebo, usual care, or discontinuation of laxative control group, and 16 directly compared different agents. Laxatives and fiber increased bowel movement frequency by an overall weighted average of 1.4 (95% confidence interval [CI] 1.1-1.8) bowel movements per week. Fiber and bulk laxatives decreased abdominal pain and improved stool consistency compared with placebo. Most nonbulk laxative data concerning abdominal pain and stool consistency were inconclusive, though cisapride, lactulose, and lactitol improved consistency. Data concerning superiority of various treatments were inconclusive. No severe side effects for any of the therapies were reported. CONCLUSIONS:: Both fiber and laxatives modestly improved bowel movement frequency in adults with chronic constipation. There was inadequate evidence to establish whether fiber was superior to laxatives or one laxative class was superior to another.

To evaluate whether laxatives and fiber therapies improve symptoms and bowel movement frequency in adults with chronic constipation.

OBJECTIVE:??To evaluate whether laxatives and fiber therapies improve symptoms and bowel movement frequency in adults with chronic constipation.DATA SOURCES:??English language studies were identified from computerized MEDLINE (1966-1995), Biological Abstracts (1990-1995), and Micromedex searches; bibliographies; textbooks; laxative manufacturers; and experts.STUDY SELECTION:??Randomized trials of laxative or fiber therapies lasting more than 1 week that evaluated clinical outcomes in adults with chronic constipationMEASUREMENTS AND MAIN RESULTS:??Two independent reviewers appraised each trial's characteristics including methodologic quality. There were 36 trials involving 1,815 persons from a variety of settings including clinics, hospitals and nursing homes. Twenty-three trials were 1 month or less in duration. Several laxative and fiber preparations were evaluated. Twenty trials had a placebo, usual care, or discontinuation of laxative control group, and 16 directly compared different agents. Laxatives and fiber increased bowel movement frequency by an overall weighted average of 1.4 (95% confidence interval [CI] 1.1-1.8) bowel movements per week. Fiber and bulk laxatives decreased abdominal pain and improved stool consistency compared with placebo. Most nonbulk laxative data concerning abdominal pain and stool consistency were inconclusive, though cisapride, lactulose, and lactitol improved consistency. Data concerning superiority of various treatments were inconclusive. No severe side effects for any of the therapies were reported.CONCLUSIONS:??Both fiber and laxatives modestly improved bowel movement frequency in adults with chronic constipation. There was inadequate evidence to establish whether fiber was superior to laxatives or one laxative class was superior to another.

Women with polycystic ovary syndrome (PCOS) often are resistant to insulin, and the latter condition has been associated with dyslipidemia. The investigators examined the hypothesis that troglitazone (TGZ), an insulin-sensitizing drug, would improve dyslipidemia in these patients. A total of 398 women with PCOS were randomly assigned to receive placebo or TGZ in a dose of 150, 300, or 600 mg daily for 44 weeks. At the outset, 35% of women had a total cholesterol of 200 mg/dL or higher, 31% had a low-density lipoprotein cholesterol (LDL-C) of 130 mg/dL or higher, 15% had a high-density lipoprotein cholesterol (HDL-C) less than 35 mg/dL, and 16% had triglycerides exceeding 200 mg/dL. Lipid levels did not correlate closely with parameters of insulin action. None of the lipid levels responded significantly to the lowest dose of TGZ. There were favorable but not significant trends in HDL-C and LDL-C as well as a trend toward decreased triglycerides with the 300- and 600-mg doses of TGZ. This was the case for both intention-to-treat analysis and for those completing the study. Treatment effects were minimal even when only patients with baseline dyslipidemia were analyzed. Indices of insulin action, including an oral glucose tolerance test, were not substantially different in patients who responded to TGZ and those who did not respond. Dyslipidemia is present in many of these women with PCOS, but treatment with an insulin-sensitizing drug had minimal effects on circulating lipid levels.