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A prospective evaluation of 37 kidney and 20 kidney-pancreas transplant recipients was conducted to assess the relationship between pre- to posttransplant changes in heart rate variability (HRV) and quality of life (QoL). Assessments of 24-hour interbeat variability (pNN50 and rMSSD, SDNN, SDANN) and power spectral analysis of total, low (sympathetic), and high (parasympathetic)frequency components of HRV were performed. The Sickness Impact Profile was used to assess three dimensions of QoL (physical, psychosocial, and total functioning) prior to and at 6 months following transplantation. Changes in vagally mediated time domain measures of HRV were related to changes in physical and total functioning. Stronger correlations occurred between biobehavioral measures in kidney-pancreas recipients, with the strongest relationships occurring between changes in HRV frequency domain measures and changes in physical functioning. Findings indicate that changes in HRV and QoL are related, suggesting that interventions that enhance transplant recipients' HRV may also enhance their QoL.

Abstract Background Ingestion of carbohydrate (CHO) and protein (PRO) following intense exercise has been reported to increase insulin levels, optimize glycogen resynthesis, enhance PRO synthesis, and lessen the immuno-suppressive effects of intense exercise. Since different forms of CHO have varying glycemic effects, the purpose of this study was to determine whether the type of CHO ingested with PRO following resistance-exercise affects blood glucose availability and insulin levels, markers of anabolism and catabolism, and/or general immune markers. Methods 40 resistance-trained subjects performed a standardized resistance training workout and then ingested in a double blind and randomized manner 40 g of whey PRO with 120 g of sucrose (S), honey powder (H), or maltodextrin (M). A non-supplemented control group (C) was also evaluated. Blood samples were collected prior to and following exercise as well as 30, 60, 90, and 120 min after ingestion of the supplements. Data were analyzed by repeated measures ANOVA or ANCOVA using baseline values as a covariate if necessary. Results Glucose concentration 30 min following ingestion showed the H group (7.12 ± 0.2 mmol/L) to be greater than S (5.53 ± 0.6 mmol/L; p < 0.03); M (6.02 ± 0.8 mmol/L; p < 0.05), and C (5.44 ± 0.18 mmol/L; p < 0.0002) groups. No significant differences were observed among groups in glucose area under the curve (AUC) values, although the H group showed a trend versus control (p = 0.06). Insulin response for each treatment was significant by time (p < 0.0001), treatment (p < 0.0001) and AUC (p < 0.0001). 30-min peak post-feeding insulin for S (136.2 ± 15.6 uIU/mL), H (150.1 ± 25.39 uIU/mL), and M (154.8 ± 18.9 uIU/mL) were greater than C (8.7 ± 2.9 uIU/mL) as was AUC with no significant differences observed among types of CHO. No significant group × time effects were observed among groups in testosterone, cortisol, the ratio of testosterone to cortisol, muscle and liver enzymes, or general markers of immunity. Conclusion CHO and PRO ingestion following exercise significantly influences glucose and insulin concentrations. Although some trends were observed suggesting that H maintained blood glucose levels to a better degree, no significant differences were observed among types of CHO ingested on insulin levels. These findings suggest that each of these forms of CHO can serve as effective sources of CHO to ingest with PRO in and attempt to promote post-exercise anabolic responses.

Background: Nurse bedside shift report (BSR) improves satisfaction, quality and safety. Yet, postimplementation adoption rates remain low in hospitals where BSR has been introduced. Further research is needed to understand what content is most appropriate to discuss during BSR and what facilitators are from the clinical nurses' perspective. Aims: Identify and describe acute care clinical nurses' and nursing supervisors' experiences and opinions regarding: process of BSR, appropriate content for BSR and barriers and facilitators related to implementation of BSR. Design: A phenomenological qualitative study was conducted at an acute care 500 bed, not‐for‐profit academic medical centre located in the southern United States. Methods: Clinical nurses (N = 22) and nursing supervisors (N = 12) from every inpatient division were recruited and interviewed. The data were analysed for relationships, similarities and differences. Themes were then identified by two independent researchers. Results: Five themes were identified: (a) time constraints and clinical nurse's workflow must be taken into consideration; (b) a modified approach is necessary; (c) process and specific critical content should be individualized so that it is meaningful for all parties involved; (d) specific critical content that should be discussed outside the patient's room; and (e) specific critical content that should be discussed inside the patient's room. Conclusions: One way to minimize interruptions is to conduct BSR using a modified approach, where a portion of the hand‐off occurs inside and outside the patient's room. In addition, this study identified the nurses' preferred location where specific critical topics should be discussed. Relevance to clinical practice: Results from this study should be used to inform the practice BSR so the desired outcomes of patient and family satisfaction, nursing quality and patient safety can be realized. This study should influence future research aimed at identifying strategies for successful implementation and sustained use of BSR. The COREQ checklist was used to write manuscript. [ABSTRACT FROM AUTHOR]

In this article, the author describes how they established a nurse-led vulval clinic, with the aim of improving patient understanding, concordance with treatment, and self-management. The author also discusses the use of a 3D silicone vulva model to aid patient education within the clinic. [ABSTRACT FROM AUTHOR]

It is recognised that specialist nurses play a unique role in managing patients with vulval conditions, providing ongoing assessment, early intervention for deterioration, and the tailoring of treatments in reaction to symptoms and presentation. Standards documents have been published for vulval services in the UK, which includes nurse intervention and mirrors the NHS Health Education England (2017).' The focus of this clearly defines the rationale and benefits of embedding advanced clinical practice nursing roles within the NHS workforce. In view of this a nurse competency document Scope of Practice (SOP) has been developed to promote robust clinical governance, appropriate clinical supervision with clear pathways of communication supporting safe and effective practice. The document has been compiled by experienced clinicians in this field in collaboration with The British Society for the Study of Vulval disease (BSSVD). This article will give an overview of the document content with recommendations on how to implement in clinical practice. [ABSTRACT FROM AUTHOR]