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Neurofibromatosis type 1 is an autosomal dominant disorder which primarily affects the growth and development of neural cell tissues. It presents as multiple tumor-like growths over the skin that arises from the nerves and is associated with other abnormalities like pigmentation over the skin and bone deformities. Becker′s nevus or hairy pigmented epidermal nevus is a benign cutaneous hamartoma which is characterized by hyperpigmented macule with hypertrichosis. It is rarely associated with neurofibromatosis. We report a 22-years-old male with coexistent Becker′s nevus and type 1 neurofibromatosis.

Background: Quantitative research designs are broadly classified as being either experimental or quasi-experimental. Factorial designs are a form of experimental design and enable researchers to examine the main effects of two or more independent variables simultaneously. They also enable researchers to detect interactions among variables. Aim: To present the features of factorial designs. Discussion: This article provides an overview of the factorial design in terms of its applications, design features and statistical analysis, as well as its advantages and disadvantages. Conclusion: Factorial designs are highly efficient for simultaneously evaluating multiple interventions and present the opportunity to detect interactions amongst interventions. Such advantages have led researchers to advocate for the greater use of factorial designs in research when participants are scarce and difficult to recruit. Implications for practice: A factorial design is a cost-effective way to determine the effects of combinations of interventions in clinical research, but it poses challenges that need to be addressed in determining appropriate sample size and statistical analysis. [ABSTRACT FROM AUTHOR]

Background Quantitative research designs are broadly classified as either experimental or quasi-experimental. The main distinguishing feature of the quasi-experiment is the manipulation of the independent variable without randomisation. When randomisation or use of a control group is unfeasible, a researcher can choose from a range of quasi-experimental designs. Aim To present the features of the quasi-experimental 'non-equivalent control group post-test-only' design, which aims to demonstrate causality between an intervention and an outcome. Discussion This paper provides an overview of the non-equivalent control group post-test-only design in terms of its design features, applications and statistical analysis, as well as its advantages and disadvantages. Conclusion The non-equivalent control group post-test-only design can be used in natural settings, where randomisation cannot be conducted for ethical or practical reasons. Although the design is less complex than some other designs, with low error propagation, it is vulnerable to threats to internal validity. [ABSTRACT FROM AUTHOR]

Background: Clinical decision making is a fundamental aspect of nurses’ clinical practice and has a direct impact on the health and well-being of each patient. Method: An exploratory analysis of the concept of clinical decision making in nursing will be provided from the two predominant theoretical perspectives: the systematic-positivist model and the intuitive-humanistic model. The origin, aim, value, ontology and epistemology, assumptions, communicability, and context specificity of these two models are discussed. Results: As nurses work in ever-changing health care environments, either the positivist model or the intuitive model is adequate to describe the dynamic processes nurses use in clinical decision making. Therefore, it was suggested that the cognitive processes used in decision making were neither completely analytical nor completely intuitive. Conclusion: Clinical decision making is complex. A combination of scientific evidence-based knowledge in conjunction with intuition and contextual factors could enable nurses to utilize excellent clinical decision making. [ABSTRACT FROM AUTHOR]

Background An expedited recovery protocol for management of pediatric blunt solid organ injury (spleen, liver, and kidney) was instituted across two Level 1 Trauma Centers, managed by nine pediatric surgeons within three hospital systems. Methods Data were collected for 18 months on consecutive patients after protocol implementation. Patient demographics (including grade of injury), surgeon compliance, National Surgical Quality Improvement Program (NSQIP) complications, direct hospital cost, length of stay, time in the ICU, phlebotomy, and re-admission were compared to an 18-month control period immediately preceding study initiation. Results A total of 106 patients were treated (control = 55, protocol = 51). Demographics were similar among groups, and compliance was 78%. Hospital stay (4.6 vs. 3.5 days, p = 0.04), ICU stay (1.9 vs. 1.0 days, p = 0.02), and total phlebotomy (7.7 vs. 5.3 draws, p = 0.007) were significantly less in the protocol group. A decrease in direct hospital costs was also observed ($11,965 vs. $8795, p = 0.09). Complication rates (1.8% vs. 3.9%, p = 0.86, no deaths) were similar. Conclusions An expedited, hemodynamic-driven, pediatric solid organ injury protocol is achievable across hospital systems and surgeons. Through implementation we maintained quality while impacting length of stay, ICU utilization, phlebotomy, and cost. Future protocols should work to further limit resource utilization. Type of study Retrospective cohort study. Level of evidence Level II. [ABSTRACT FROM AUTHOR]

Background: Concerns have been raised over the practice of transferring nursing home residents to hospital at their end of life. Objective: To examine the family and facility factors that may influence the decision to transfer nursing home residents to hospital in the last month of life. Research design: Secondary data analysis includes a sample of 119 bereaved family members from 21 nursing homes located in Central Canada. Method: A binary logistic regression analysis was conducted to explore the predictors for hospital transfers. Results: Terminal hospital transfers were common: 70% of nursing home residents were sent to hospitals in the last month of their life, and the likelihood of terminal hospital transfers increased by having an adult child as decision-maker (odds ratio (OR) = 5.03; 95% confidence interval (CI) = 1.6, 16; significance level/probability value (p) = 0.007) or having a lower family income (OR = 2.9; 95% CI =1.1, 2.9; p = 0.027). Discussion and implications: The identified predictors for terminal hospital transfers are helpful in targeting and developing interventions to improve end-of-life care. Particular emphasis should therefore be placed on targeting families with low income and children of the nursing home residents for educational initiatives such as advance care planning awareness, in order to prevent terminal hospital transfers. It is hoped that policy-makers and practitioners can start addressing the findings of this study to reduce terminal hospital transfers at end of life and promote quality end-of-life care in nursing homes. [ABSTRACT FROM AUTHOR]

The purpose of this concept analysis paper is to delineate the meaning of good death in long term care (LTC) settings and examine its implications for nursing. The Walker and Avant (2011) method was chosen for this analysis. An in depth literature review identifies uses of the concept and determines the defining attributes of the good death. This paper also illustrates case presentations, antecedents, consequences, empirical referents and implications for clinical practice to clarify the concept of 'good death' in this population. In LTC, death is experienced frequently and is considered the ultimate outcome for most admissions. Much of the existing research on end-of-life care has focused on community dwelling cancer patients whose death trajectory is predictable and who may remain cognitively intact until actively dying. In contrast, the LTC population is older and more likely to suffer from dementia and experience chronic illness for long periods prior to death, and they follow a less predictable death trajectory. In this century, death became the province of older people and the assurance of a good death became the responsibility of those caring for them. [ABSTRACT FROM AUTHOR]

Long-term-care (LTC) facilities or nursing homes have become a common site where older Canadians live and die. The proportion of deaths occurring in Canadian LTC facilities has been increasing in the past 2 decades and is expected to reach 4 0% by 2020. The aim of this retrospective cohort study was to identify individual characteristics of LTC residents associated with place of death (hospital vs LTC) and transfers to hospital in the 180 days preceding death. The sample consisted of all 118 residents w ho died between April 2010 and March 2013 in a 116-bed not- for -profit LTC facility in Winnipeg, Manitoba, Canada. Outcome measures were place of death and frequency of terminal hospital transfers. Predictor variables included demographics, social and clinical factors, and cause of death. Data were drawn from Minimum Data Set assessments, medical charts, and death certificates. The results showed that 19% of the 118 decedents were transferred to hospital in the last 6 months of life; 94% died in the LTC facility. Male gender, absence of eating problems, less cognitive impairment, and less functional dependency not only predicted in-hospital death but also increased the likelihood of terminal hospital transfers. Individual characteristics play a significant role in explaining the variation between place of death and rate of terminal hospital transfers among LTC residents. Comfort care orders strongly and independently decreased the rates of hospital death and terminal hospitalization. [ABSTRACT FROM AUTHOR]

Background: Encephalitis is a severe neurological syndrome associated with significant morbidity and mortality. The California Encephalitis Project (CEP) enrolled patients for more than a decade. A subset of patients with acute and fulminant cerebral edema was noted., Methods: All pediatric encephalitis patients with cerebral edema referred to the CEP between 1998 and 2012 were reviewed. A case definition was developed for acute fulminant cerebral edema (AFCE) that included the CEP case definition for encephalitis and progression to diffuse cerebral edema on neuroimaging and/or autopsy, and no other recognized etiology for cerebral edema (eg, organic, metabolic, toxin). Prodromic features, demographic and laboratory data, neuroimaging, and outcomes were compared with non-AFCE encephalitis cases., Results: Of 1955 pediatric cases referred to the CEP, 30 (1.5%) patients met the AFCE case definition. The median age for AFCE and non-AFCE cases was similar: 8.2 years (1-18 years) and 8.0 years (0.5-18 years), respectively. Asian-Pacific Islanders comprised a larger proportion of AFCE cases (44%) compared with non-AFCE cases (14%, P < .01). AFCE cases often had a prodrome of high fever, vomiting, and profound headache. Mortality among AFCE patients was significantly higher than among non-AFCE patients (80% vs 13%, P < .01). A confirmed etiology was identified in only 2 cases (enterovirus, human herpes virus type 6), while 10 others had evidence of a respiratory pathogen.Thirty pediatric patients referred to the California Encephalitis Project with a unique, and often fatal, form of encephalitis are reported. Demographic and clinical characteristics, possible etiologies and a proposed case definition for acute fulminant cerebral edema (AFCE) are described., Conclusions: AFCE is a recently recognized phenotype of encephalitis with a high mortality. AFCE may be triggered by common pediatric infections. Here, we propose a case definition., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Quantitative research designs are broadly classified as either experimental or quasi-experimental. The main distinguishing feature of the quasi-experiment is the manipulation of the independent variable without randomisation. When randomisation or use of a control group is unfeasible, a researcher can choose from a range of quasi-experimental designs., Aim: To present the features of the quasi-experimental 'non-equivalent control group post-test-only' design, which aims to demonstrate causality between an intervention and an outcome., Discussion: This paper provides an overview of the non-equivalent control group post-test-only design in terms of its design features, applications and statistical analysis, as well as its advantages and disadvantages., Conclusion: The non-equivalent control group post-test-only design can be used in natural settings, where randomisation cannot be conducted for ethical or practical reasons. Although the design is less complex than some other designs, with low error propagation, it is vulnerable to threats to internal validity., Competing Interests: None declared, (©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)