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Objective: To determine whether initiating saline nasal irrigation after COVID-19 diagnosis reduces hospitalization and death in high-risk outpatients compared with observational controls, and if irrigant composition impacts severity., Methods: Participants 55 and older were enrolled within 24 hours of a + PCR COVID-19 test between September 24 and December 21, 2020. Among 826 screened, 79 participants were enrolled and randomly assigned to add 2.5 mL povidone-iodine 10% or 2.5 mL sodium bicarbonate to 240 mL of isotonic nasal irrigation twice daily for 14 days. The primary outcome was hospitalization or death from COVID-19 within 28 days of enrollment by daily self-report confirmed with phone calls and hospital records, compared to the CDC Surveillance Dataset covering the same time. Secondary outcomes compared symptom resolution by irrigant additive., Results: Seventy-nine high-risk participants were enrolled (mean [SD] age, 64 [8] years; 36 [46%] women; 71% Non-Hispanic White), with mean BMI 30.3. Analyzed by intention-to-treat, by day 28, COVID-19 symptoms resulted in one ED visit and no hospitalizations in 42 irrigating with alkalinization, one hospitalization of 37 in the povidone-iodine group, (1.27%) and no deaths. Of nearly three million CDC cases, 9.47% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data. Age, sex, and percentage with pre-existing conditions did not significantly differ by exact binomial test from the CDC dataset, while reported race and hospitalization rate did. The total risk of hospitalization or death (11%) was 8.57 times that of enrolled nasal irrigation participants (SE = 2.74; P = .006). Sixty-two participants completed daily surveys (78%), averaging 1.8 irrigations/day. Eleven reported irrigation-related complaints and four discontinued use. Symptom resolution was more likely for those reporting twice daily irrigation ( X 2 = 8.728, P = .0031) regardless of additive., Conclusion: SARS-CoV-2+ participants initiating nasal irrigation were over 8 times less likely to be hospitalized than the national rate., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Direct admissions (DAs) are a routine hospital entry portal with few guidelines to assess patient safety during this process. This study assessed the effectiveness of an institutional screen for patients presenting as DA. It investigated patient variables that may predict appropriateness for DA and those at high risk for deterioration., Methods: The study includes patients who received the institutional screen between June 1, 2019, and May 31, 2020. We placed charts into three groups: group 1 (stable), group 2 (unstable), and group 3 (stable then transferred to pediatric intensive care unit within 6 hours). We assessed effectiveness by calculating sensitivity, specificity, and predictive values. We used comparative analysis between groups to identify patients safe for DA and those at high risk for deterioration., Results: The screen was 80% sensitive and 100% specific, predicting 97.7% of stable patients. Of the 652 charts reviewed, 384 met the inclusion criteria. Group 1 (31.60, 26.45%, 5.23%) had lower respiratory rate, respiratory diagnosis, and oxygen requirement compared to group 2 (45.00, 78.13%, 15.63%) and group 3 (44.50, 75.00%, 50.00%). For SpO 2 , group 1 (98.70) was higher than group 2 (96.03). For the Pediatric Early Warning Score, group 2 (1.72) was higher than group 1 (0.31) and group 3 (0.63)., Conclusions: The institutional screen is an effective tool to identify patients presenting as DA needing immediate emergency department intervention and/or pediatric intensive care unit care. The screen benefits patients with a respiratory diagnosis, oxygen requirement, high respiratory rate or low SpO 2 ., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: This study aimed to improve the accuracy of Broselow tape (BT) weight prediction by adding midthigh circumference (MTC) and to compare and standardize the methods for measuring MTC., Methods: This prospective, observational study was conducted in a pediatric emergency department of a tertiary care children's hospital. Children up to 12 years of age presenting to emergency department were included. Children were excluded if obtaining the data would interfere with their acute management. The data collected included MTC, height, BT weight, and actual weight. Three models were built. Broselow tape-only model and MTC plus BT model used 2 methods for MTC measurements: visual approximation of thigh midpoint (visual MTC1) and Centers for Disease Control and Prevention (CDC)-defined method (CDC MTC2)., Results: A total of 430 children were enrolled during pre-coronavirus disease era. Of these, 234 were boys (54.4%) and 196 (45.6%) were girls. Data were categorized into children younger than 2 years (224 [52.1%]) and older than 2 years (206 [47.9%]). African American constituted 250 (58%); White, 136 (31%); and unspecified, 27 (6%). For the entire cohort, both models that included MTC were significantly better at weight prediction with larger adjusted R2 (visual MTC1, 0.921; CDC MTC2, 0.928) and smaller root mean squared (RMSE) (visual MTC1, 2.70; CDC MTC2, 2.56) compared with BT-only model (adjusted R2 = 0.843; RMSE, 3.80). Midthigh circumference plus BT models performed even better in children older than 2 years compared with BT-only model with adjusted R2 (visual MTC1, 0.859; CDC MTC2, 0.872 vs 0.616) and RMSE (visual MTC1, 3.18; CDC MTC2, 3.03 vs 5.27)., Conclusions: The inclusion of MTC with BT resulted in a more accurate weight prediction in children especially greater than 2 years old. Midthigh circumference model using CDC-defined method was slightly better predictor of actual weight than visual approximation., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: As health care education programs adopt electronic portfolios (eportfolios), a midwestern university baccalaureate nursing program faces challenges in transitioning from a 25-year-old paper-based system to eportfolio., Method: Process improvements and faculty development were implemented through collaboration with the information technology (IT) department and the involvement of students as ambassadors. Pre- and posttransition surveys and portfolio benchmarks were used to evaluate the efficacy of the new eportfolio system., Results: Results of faculty and student surveys revealed improved positive experiences regarding the value, clarity, and ease of use of the eportfolio system. Benchmark deficits decreased from six of eight portfolio criteria in Fall 2017 to none in Fall 2019., Conclusion: Buy-in through faculty and student involvement, along with a user-centered design, are essential for a successful eportfolio transition. Student and faculty engagement would be secured when they are well-informed in the transition process. [J Nurs Educ. 2020;59(12):705-708.]., (Copyright 2020, SLACK Incorporated.)

Optic nerve sheath diameter (ONSD) is used clinically as a noninvasive measure for elevated intracranial pressure (ICP). This study had two purposes: to investigate the immediate effects optic nerve sheath (ONS) dilation post-ICP increase on trabecular fibers connecting the optic nerve to the ONS and to document any changes in these fibers 30 days post-increased ICP. In a swine model, ICP was increased by inflating a Foley catheter balloon in the epidural space. Three control pigs received the catheter insertion without inflation (no increase in ICP) and four experimental pigs received the catheter with inflation (increased ICP). The control and two randomly selected pigs with increased ICP were euthanized immediately after the procedure. The two other pigs were euthanized 30 days post-catheter inflation. For all pigs, the ONS was removed and imaged using a scanning electron microscope, calculating percent porosity values. Porosity values for the experimental groups (Immediately measured [IM] μ = 0.5749; Delayed measured [DM] μ = 0.5714) were larger than the control group (μ = 0.4336) and statistically significant (IM vs. Control, p  = 0.0018; DM vs. Control, p  = 0.0092). There was no significant difference ( p  = 0.9485) in porosity of the DM group when compared with the IM group. This study demonstrated that the trabecular fibers immediately post-increased ICP (ONS dilation) were more porous than the control and remained statistically different (more porous) after 30 days. These results suggest a structural change that occurs in the ONS with elevations in ICP.

Introduction: While point of care ultrasound (POCUS) integration into clinical clerkships provides unique educational experiences for students, there are barriers to implementation, particularly in a distributed campus medical school model in clerkships where the faculty do not often perform POCUS, like family medicine (FM). The objective of this paper is to describe the implementation and evaluation of a POCUS curriculum in an FM core clinical clerkship in a state-wide medical school campus model., Methods: Seventeen Philips Lumify Ultrasound Systems were used in 20 clerkship sites with the requirement that students obtain abdominal aortic and inferior vena cava (IVC) images on patients evaluated during their rotation. Images were de-identified, transmitted to a university cloud-based storage account, and scored by medical school ultrasound faculty., Results: Students were able to obtain adequate images of the aorta and IVC without direct ultrasound-trained faculty at the performance site. Of the 183 students, 119 (65%) were able to successfully submit images for scoring with failure to upload to the cloud-based storage account as the most common reason students were unsuccessful (42%). The majority of students (62%) scored in the top quartile of image quality scoring with the percentage of those scoring in the top quartile improving during the academic year from 57% in the first four rotations to 67% in the last four rotations., Conclusion: Barriers to implementation of a POCUS curriculum into a FM clerkship in a distributed campus medical school model can be challenging due to equipment availability and issues around the successful transmission of images. These challenges can be overcome however with sufficient attention to implementation design that includes equipment sharing protocols and technical options that enhance the ease of image transmission., Competing Interests: Conflict of InterestThe authors declare that there is no conflict of interest., (© International Association of Medical Science Educators 2019.)

The study reported in this article explores the role child welfare workers play in elevating the financial capability (FC) of foster youths transitioning to adulthood. It draws on an examination of Opportunity Passport, a component of the Jim Casey Youth Opportunities Initiative, which operates across the United States. The authors held in-depth, structured interviews with eight staff and 38 current and former foster youths age 18 years and older in four sites across three states. Findings indicate that (a) program participants require professional financial assistance that is beyond the role of the traditional child welfare caseworker; (b) caseworkers who address FC in young adults face uncertainty in their roles; and (c) broader policies relevant to young adults transitioning to adulthood exhibit tension, if not conflict, regarding enhancing FC. The authors highlight the importance of expanding the role of caseworkers to incorporate elements of FC in serving the needs of foster youths.

Purpose: Our objectives were to determine the frequency of patient transfers to a tertiary care emergency department (Tertiary ED) due to a lack of radiology services in rural hospital EDs (Rural EDs), and examine the community and patient attributes that are associated with these transfers., Methods: This was a retrospective chart review of patients transferred to a Tertiary ED from Rural EDs. Transfers excluded from the study included pediatric patients (age <18 years old) and patients transferred for trauma surgeon evaluation. Only those patients who were transferred for radiology services were included in the final analysis., Results: Over a 12-month period, 1445 patients were transferred to the Tertiary ED with 73.8% (n = 1066) of this population being transferred from a Rural ED. Excluding 381 trauma and pediatric patients, 64.3% (n = 685) of patients were transferred from a Rural ED and were included in the study. Of these 685 transfers, 24.5% (n = 168) were determined to be due primarily to a lack of a radiology service., Discussion: Lack of radiology services in Rural EDs leads to numerous patient transfers to the Tertiary ED each year. A disproportionate number of these transfer patients are African American. These transfers place additional financial and social burdens on patients and their families. This study discusses these findings and alternative diagnostic options (ie, telemedicine and ultrasound video transfer) to address the lack of radiology services available in Rural EDs. The use of these alternate diagnostic options will likely reduce the number of patient transfers to Tertiary EDs., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this systematic review was to determine if patients receiving treatment for cancer experienced less treatment-related fatigue if they participated in a regular committed exercise regimen, compared to those who did not exercise regularly., Research Question: What is the relationship between treatment-related fatigue and exercise during chemotherapy and/or radiation?, Method: A systematic review of 19 English-language studies from the United States, Europe, and Australia, conducted between January 2000 and October 2006, investigating the effect of exercise on chemotherapy and/or radiation-related fatigue was completed. Included in the review were randomized controlled trials, pilot studies, and secondary analysis of previously reported studies such as systematic reviews. Ten studies that fit the preestablished criteria were retained for the review. The Priority Symptom Management (PRISM) system developed by the Oncology Nursing Society was used for leveling evidence., Findings: Eight of the ten studies showed regular committed exercise resulted in less fatigue among the experimental group participating in exercise programs. A limitation common to the studies included in this review was the lack of a universal definition for fatigue, and therefore, the lack of a universal measuring instrument to evaluate the effectiveness of interventions., Conclusions: There is evidence to include an individualized exercise program for patients on chemotherapy and/or radiation therapy. Studies showed no adverse effects of exercise such as increased fatigue or falls.