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Standard treatment for hepatic encephalopathy (HE) includes medications that reduce ammonia and bacterial translocation in the gut. Rifaximin can be used off-label for the reduction of overt HE. The study purpose was to determine efficacy of traditional rifaximin dosing (400 mg three times daily) compared with newer dosing (550 mg twice daily) via readmission rates for the prevention of recurrent HE. This was a retrospective, observational, cross-sectional pilot study conducted in a tertiary medical center. A total of 226 patients 18-89 years of age with documentation of HE via ICD-9 code who started rifaximin therapy while inpatient between April 2009 and June 2014 were evaluated. Data collected included rifaximin dosing, other medications used to treat HE, duration of therapy, time to readmission, and various laboratory values. There were no differences in readmission rates at 30 days, 60 days, or 6 months between treatment groups. Additionally, there was no difference in the odds of readmission between the treatment groups (OR = 0.77, 95% CI: [0.201, 4.365], P = 0.718). Patients had a low overall probability of readmission over the observational period. Based on average wholesale price data, the cost for a 9-day supply of rifaximin for the 400-mg dosing regimen is $952.56 versus $605.16 for the 550-mg dosing regimen. The rifaximin 550-mg dosing strategy should be utilized in hospitalized patients for the prevention of recurrent HE as there was no difference in readmission rate or time to readmission between dosing groups. The 550-mg regimen had a lower acquisition cost for a 9-day duration of treatment in the studied institution., (© 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Patterned after the integrated simulation approach utilized in the space industry, we report results of an innovative simulation in nursing, a 96-hour continuous simulated hospital environment. Training objectives for our study emphasized the integrative and critical thinking skills needed by new graduate nurses. The purpose of this study was to determine the process for development and the experience of participating in a simulated hospital environment. We sought to (a) translate space industry-integrated simulation techniques into development of a simulated hospital environment and (b) determine the experience of participating in an integrated simulation experience among undergraduate (UG) and graduate nursing students and nursing faculty. We used a qualitative mixed-methods design. Data were collected from participant focus groups, debriefing sessions, research team field notes, and electronic health record documentation. The sample, 72 student focus group participants, consisted of 12 baccalaureate-level soon-to-graduate students and 60 graduate nurse practitioner students as patient actors and providers. Important themes emerged from the project. We were able to design a simulated hospital environment that was true to life. Notably, student knowledge-practice gap was a major theme of the study, consistent with studies of employer concerns of new graduate nurses., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: In 2008, the empiric vancomycin dosing recommendation in children at our institution was changed from 40 to 60 mg/kg per day. Subsequently, an increased incidence of acute kidney injury (AKI) in patients receiving vancomycin was suspected. The objective of this study was to evaluate AKI in children receiving vancomycin and to determine risk factors for AKI development., Methods: Medical records of patients aged 30 days through 17 years who received vancomycin for at least 72 hours between January and December 2007 (40 mg/kg per day) and January and December 2010 (60 mg/kg per day) were reviewed. Patients with cystic fibrosis, an elevated baseline serum creatinine, or without a serum creatinine concentration obtained after receipt of vancomycin were excluded. Acute kidney injury was defined using adapted pediatric RIFLE criteria as an increase in serum creatinine from baseline of 50% or more., Results: Acute kidney injury occurred in 19.4% of the 859 children included, with no difference between the 2007 and 2010 periods (18.8% vs 20%, respectively; P = .636). Intensive care unit admission (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.20-2.94) and an initial vancomycin trough concentration ≥15 mg/L (OR, 2.18; 95% CI, 1.21-3.92) were determined to be significantly associated with AKI., Conclusions: These results suggest an initial vancomycin serum trough concentration of ≥15 mg/L and intensive care unit admission are predictors of AKI in this pediatric population., (© The Author 2013. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

The management of problem wounds by critical care nurses is a particular challenge in that their primary responsibilities revolve around emergent care and resuscitation of patients. However, with the identification of pressure wound development as a "never event" by Centers for Medicare & Medicaid Services and the escalating costs to more than $5 billion annually for treating chronic wounds in the US population, wound management has become a clinical imperative. The essence of nursing as a healing, caring profession should drive our efforts at reducing and/or eliminating any untoward complication that threatens the very being of our patients. Problem wounds represent such a challenge. This article examines wound management from both the science and art of nursing care. The science comprises advanced wound therapies including hyperbaric oxygen therapy, recombinant DNA growth factor therapy, human skin equivalents, V.A.C. Therapy, advanced support surfaces, and state-of-the-art dressings. The art of wound management resides in the development of a comprehensive wound center with both outpatient and inpatient capabilities including a hospital-based wound team of nursing specialists. The challenge of healing problem wounds requires a multidisciplinary approach, a dedication to measurable outcomes, and a passion for holistic, patient-centered interventions.

Published data are used to develop factors for predicting the viscosity-temperature relationship from the compositions of "soda-lime" type silicate glasses at specific temperatures in the range of 600 to 1300 °C. The effects of Na 2 O, K 2 O, CaO, MgO, Al 2 O 3 and their interactions are evaluated. The influence of minor amounts of BaO, B 2 O 3 , Li 2 O, and F 2 , in the temperature range of 700 to 1300 °C, is estimated.