Search

Exposing new nurses to theoretical teaching strategies that help them to navigate the ethical challenges in clinical practice is essential for retention and long-term job satisfaction. This article explores the rationale for teaching ethics content in nurse residency programs and ways to navigate ethical decision-making in the clinical setting. Examples of evidence-informed teaching strategies that enhance knowledge retention and reduce the gap between ethical theory and practice are included., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: We initiated a prospective interventional study using a nurse-driven bedside dysphagia screen (BDS) in patients with cervical spine injury (CI) to address three objectives: (1) determine the incidence of dysphagia, (2) determine the utility of the new BDS as a screening tool, and (3) compare patient outcomes, specifically dysphagia-related complications, in the study period with a retrospective cohort., Methods: All patients with CI admitted to a Level I trauma center were enrolled in a prospective 12-month study (June 2016-June 2017) and then were compared with a previous 18-month cohort of similar patients. Our new protocol mandated that every patient underwent a BDS before oral intake. If the patient failed the BDS, a modified barium swallow (MBS) was obtained. Exclusion criteria were emergency department discharge, inability to participate in a BDS, leaving against medical advice, BDS protocol violations, or death before BDS. A failed MBS was defined as a change in diet and a need for a repeat MBS. Dysphagia was defined as a failed MBS or the presence of a dysphagia-related complication., Results: Of 221 consecutive prospective patients identified, 114 met inclusion criteria. The incidence of dysphagia was 16.7% in all prospective study patients, 14.9% in patients with isolated CI, and 30.8% in patients with spinal cord injury. The BDS demonstrated 84.2% sensitivity, 95.8% specificity, 80.0% positive predictive value, and 96.8% negative predictive value. There were no dysphagia-related complications. The prospective study patients demonstrated significantly less dysphagia-related complications (p = 0.048) when compared with the retrospective cohort of 276 patients., Conclusions: The introduction of the BDS resulted in increased dysphagia diagnoses, with a significant reduction in dysphagia-related complications. We recommend incorporating BDS into care pathways for patients with CI., Level of Evidence: Study type diagnostic test, level III.

Routine laboratory animal handling has profound effects on their anxiety and stress responses, but little is known about the impact of handling method. We found that picking up mice by the tail induced aversion and high anxiety, whereas use of tunnels or open hand led to voluntary approach, low anxiety and acceptance of physical restraint. Using the latter methods, one can minimize a widespread source of anxiety in laboratory mice.

Background: Traumatic aortic rupture is highly lethal, and its surgical treatment is complicated by a high rate of paraplegia., Methods: The charts of 263 patients with traumatic aortic rupture from vehicular accidents treated between 1971 and 1998 were reviewed. Patients were grouped according to four periods: group 1, 1971 to 1975, (n = 31); group 2, 1976 to 1985, (n = 83); group 3, 1986 to 1994, (n = 82); and group 4, 1994 to 1998 (n = 67). Seventy-one patients died of exsanguination before definitive care. One hundred-ninety two patients had surgical repair with the following techniques: clamp and sew, 6 in group 1, 22 in group 2, 54 in group 3, none in group 4; shunt, 23 in group 1, 39 in group 2, 2 in group 3; cardiopulmonary bypass, 2 in group 1, 1 in group 3. Forty-three patients had partial bypass with the centrifugal pump and heparin-coated circuits in group 4., Results: Operative mortality was 6 of 31 (19%) in group 1, 22 of 61 (36%) in group 2, 15 of 57 (26%) in group 3, and 7 of 43 (16%) in group 4. There was one case of paraplegia in group 1 (4%), ten in group 2 (18%), 11 in group 3 (26%), and none in group 4. This difference of paraplegia between the groups was significant (p<0.002). Significant factors for paraplegia were intraoperative hypotension (p<0.000002), cross-clamp time longer than 30 minutes (p<0.008), pump versus no pump (p<0.008), and younger age group (28+/-11 versus 39+/-17 years) (p<0.03)., Conclusions: There were no statistically significant improvements in mortality rate over the four periods, although, the mortality rate was lowest in the last period when partial bypass with the centrifugal pump was used exclusively. Further, the use of the centrifugal pump with heparin-coated circuits, with femoral vein cannulation into the right atrium and distal aortic perfusion, reduced paraplegia significantly.

The urinary excretion of dopamine and its metabolite homovanillic acid (HVA) were compared in 15 patients with malignant phaeochromocytoma. Six patients with increased dopamine and HVA excretion had disseminated malignancy and the poorest prognosis. Four patients with increased urinary dopamine levels but normal HVA excretion also had widespread metastases and poor prognosis. The best prognosis was for 5 patients who had normal excretion of dopamine and HVA, and minimal disease. When dopamine and HVA excretion were considered separately, it was found that duration of survival was significantly better for patients with normal dopamine excretion than those with increased dopamine excretion (p less than 0.003). There was no significant difference in survival time between patients with normal and increased HVA excretion. In this study dopamine excretion appeared to be a more discriminating biochemical index of malignancy, prognosis and disease progression than HVA excretion.

ABSTRACT Foliar diseases impose severe restrictions on the persistence and productivity of Medicago sativa, both of which may be increased by developing disease resistant and more competitive genotypes that can improve pasture quality. We found Curvularia geniculata as the principal alfalfa foliar pathogen in the Brazilian state of Rio Grande do Sul (RS). Growth chamber experiments evaluated the resistance of alfalfa genotypes ‘E1C4’, ‘CPPSul’, ‘ABT 805’ and ‘CUF-101’ to C. geniculata as compared the control ‘Crioula’ genotype. These genotypes were also evaluated in field trials at a sea level site in Eldorado do Sul in central RS and at two sites £200 m above sea level, one in Bagé municipality in south west RS and the other at a farm near the town of Alto Feliz in north east RS. Plants were spray-inoculated with 1.6 x 106 ml-1 of C. geniculata spores and visually evaluated for leaf damage 14 days later. The C. geniculata infection rates varied from zero to 100%. Alfalfa persistence and forage mean dry mass (DM) production at the Eldorado site were measured during different seasons from November 2013 to January 2015 by calculating the incidence of invasive plants and morphologically separating leaves from stems and calculating both leaf and stem DM. Data were analysed using mixed statistical models. The best results for persistence and forage DM were shown by the ‘CPPSul’ genotypes (DM = 16,600 kg ha-1) and ‘Crioula’ (DM = 15,750 kg ha-1). These two genotypes will be used for subsequent investigations and selection cycles.