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A study of intravenous infusion pump usage patterns showed that nurses frequently were using this device for convenience rather that for clinical need. Patient charges and actual cost savings were calculated based on substitution of a manual flow regulation device for an infusion pump. A potential savings of $674,508 in capital costs and $271,408 in annual patient costs were realized when nurses' practice was changed. [ABSTRACT FROM AUTHOR]

Alzheimer's disease and related dementias (ADRD) have been associated with alterations in both oral and gut microbiomes. While extensive research has focused on the role of gut dysbiosis in ADRD, the contribution of the oral microbiome remains relatively understudied. Furthermore, the potential synergistic interactions between oral and gut microbiomes in ADRD pathology are largely unexplored. This study aims to evaluate distinct patterns and potential synergistic effects of oral and gut microbiomes in a cohort of predominantly Hispanic individuals with cognitive impairment (CI) and without cognitive impairment (NC). We conducted 16S rRNA gene sequencing on stool and saliva samples from 32 participants (17 CI, 15 NC; 62.5% female, mean age = 70.4 ± 6.2 years) recruited in San Antonio, Texas, USA. Correlation analysis through MaAslin2 assessed the relationship between participants' clinical measurements (e.g., fasting glucose and blood cholesterol) and their gut and saliva microbial contents. Differential abundance analysis evaluated taxa with significant differences between CI and NC groups, and alpha and beta diversity metrics assessed within-sample and group compositional differences. Our analyses revealed no significant differences between NC and CI groups in fasting glucose or blood cholesterol levels. However, a clear association was observed between gut microbiome composition and levels of fasting glucose and blood cholesterol. While alpha and beta diversity metrics showed no significant differences between CI and NC groups, differential abundance analysis revealed an increased presence of oral genera such as Dialister , Fretibacterium , and Mycoplasma in CI participants. Conversely, CI individuals exhibited a decreased abundance of gut genera, including Shuttleworthia , Holdemania , and Subdoligranulum , which are known for their anti-inflammatory properties. No evidence was found for synergistic contributions between oral and gut microbiomes in the context of ADRD. Our findings suggest that similar to the gut microbiome, the oral microbiome undergoes significant modifications as individuals transition from NC to CI. Notably, the identified oral microbes have been previously associated with periodontal diseases and gingivitis. These results underscore the necessity for further investigations with larger sample sizes to validate our findings and elucidate the complex interplay between oral and gut microbiomes in ADRD pathogenesis.

Cellular senescence contributes to Alzheimer's disease (AD) pathogenesis. An open-label, proof-of-concept, phase I clinical trial of orally delivered senolytic therapy, dasatinib (D) and quercetin (Q), was conducted in early-stage symptomatic patients with AD to assess central nervous system (CNS) penetrance, safety, feasibility and efficacy. Five participants (mean age = 76 + 5 years; 40% female) completed the 12-week pilot study. D and Q levels in blood increased in all participants (12.7-73.5 ng ml -1 for D and 3.29-26.3 ng ml -1 for Q). In cerebrospinal fluid (CSF), D levels were detected in four participants (80%) ranging from 0.281 to 0.536 ml -1 with a CSF to plasma ratio of 0.422-0.919%; Q was not detected. The treatment was well-tolerated, with no early discontinuation. Secondary cognitive and neuroimaging endpoints did not significantly differ from baseline to post-treatment further supporting a favorable safety profile. CSF levels of interleukin-6 (IL-6) and glial fibrillary acidic protein (GFAP) increased (t(4) = 3.913, P = 0.008 and t(4) = 3.354, P = 0.028, respectively) with trending decreases in senescence-related cytokines and chemokines, and a trend toward higher Aβ42 levels (t(4) = -2.338, P = 0.079). In summary, CNS penetrance of D was observed with outcomes supporting safety, tolerability and feasibility in patients with AD. Biomarker data provided mechanistic insights of senolytic effects that need to be confirmed in fully powered, placebo-controlled studies. ClinicalTrials.gov identifier: NCT04063124 ., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: Family caregivers of patients with advanced cancer often have poor quality of life (QOL) and mental health. We examined the effectiveness of interventions offering support for caregivers of patients with advanced cancer on caregiver QOL and mental health outcomes., Methods: We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, and Cumulative Index to Nursing and Allied Health Literature databases from inception through June 2021. Eligible studies reported on randomized controlled trials for adult caregivers of adult patients with advanced cancer. Meta-analysis was conducted for primary outcomes of QOL, physical well-being, mental well-being, anxiety, and depression, from baseline to follow-up of 1-3 months; secondary endpoints were these outcomes at 4-6 months and additional caregiver burden, self-efficacy, family functioning, and bereavement outcomes. Random effects models were used to generate summary standardized mean differences (SMD)., Results: Of 12 193 references identified, 56 articles reporting on 49 trials involving 8554 caregivers were eligible for analysis; 16 (33%) targeted caregivers, 19 (39%) patient-caregiver dyads, and 14 (29%) patients and their families. At 1- to 3-month follow-up, interventions had a statistically significant effect on overall QOL (SMD = 0.24, 95% confidence interval [CI] = 0.10 to 0.39); I2 = 52.0%), mental well-being (SMD = 0.14, 95% CI = 0.02 to 0.25; I2 = 0.0%), anxiety (SMD = 0.27, 95% CI = 0.06 to 0.49; I2 = 74.0%), and depression (SMD = 0.34, 95% CI = 0.16 to 0.52; I2 = 64.4) compared with standard care. In narrative synthesis, interventions demonstrated improvements in caregiver self-efficacy and grief., Conclusions: Interventions targeting caregivers, dyads, or patients and families led to improvements in caregiver QOL and mental health. These data support the routine provision of interventions to improve well-being in caregivers of patients with advanced cancer., (© The Author(s) 2023. Published by Oxford University Press.)

Purpose: Telehealth allows patients to maintain contact with healthcare providers without necessitating travel, and is becoming increasingly utilized. The purpose of this study is to describe the components of telehealth palliative care interventions for patients with advanced cancer before the COVID-19 pandemic; identify any intervention components associated with improvements in outcomes; and evaluate reporting of interventions., Methods: This scoping review was registered on the Open Science Framework. We searched 5 medical databases from inception to June 19, 2020. Inclusion criteria were: age ≥ 18, advanced cancer, asynchronous or synchronous telehealth intervention, and specialized palliative care interventions in any setting. We assessed the quality of intervention reporting using the Template for Intervention Description and Replication (TIDieR) checklist., Results: Twenty-three studies met the inclusion criteria: 15 (65%) quantitative (7 randomized controlled trials, 5 feasibility trials, 3 retrospective chart reviews); 4 (17%) mixed methods, and 4 (17%) qualitative. Most quantitative and mixed methods studies were conducted in North America (12/19, 63%), reported on hybrid (in-person and telehealth) interventions (9/19, 47%), and were delivered by nurses (12/19, 63%) in the home setting (14/19, 74%). In most studies that reported improvements in patient- or caregiver-reported outcomes, the content was psychoeducational and resulted in improvements for psychological symptoms. No study provided complete reporting on all 12 TIDieR checklist items., Conclusion: Telehealth studies are needed that reflect palliative care's mission to provide multidisciplinary team-based care that improves quality of life in diverse settings, and that provide detailed reporting of interventions., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aims: The associations between prognostic awareness, acceptance of illness and psychological outcomes (anxiety, depression and spiritual well-being) remain unclear. This study examined the associations between prognostic awareness and various psychological outcomes and how they can be moderated by patient acceptance of illness (cancer)., Materials and Methods: In total, 1184 patients with stage IV solid cancer were recruited at major public hospitals across four Asian countries (China, India, Sri Lanka, Vietnam). Prognostic awareness and acceptance of illness were assessed through self-reported understanding of treatment intent and acceptance of illness, respectively. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, whereas spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale. Multivariate regressions were used to estimate the associations while controlling for patient characteristics., Results: Compared with being unaware of their prognosis (i.e. believing that their cancer is curable), being aware or unsure of their prognosis was associated with higher anxiety and depressive symptoms, and lower spiritual well-being scores. Acceptance of illness moderated these relationships and improved the psychological outcomes., Conclusions: The results suggest that disclosure of prognostic information should be provided in conjunction with psychological interventions that focus on acceptance of illness., (Copyright © 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Objectives: When patients with advanced cancer transition from systemic cancer treatments at MNJ Institute of Oncology to palliative and end-of-life care at a separate stand-alone non-governmental organisation-run hospice facility, there is insufficient transfer of health information, including details of cancer diagnosis and staging, past treatments, imaging reports and goals for future care. Without this information, the hospice care team is not adequately prepared to receive and deliver high-quality palliative care for these patients. This project aims to improve the care coordination between the hospital and hospice., Materials and Methods: The measures used are the self-reported confidence score on a scale of 0 to 10 related to knowledge about plan of care among staff who receives patients at hospice at baseline and during and after interventions. Interventions included recognizing the workplace culture and promoting ownership of the tasks, enhancing communication by creating user-friendly transfer forms and on-going assessment of the process., Results: Improvement in the care coordination in terms of communication of patient goals of care, from hospital to hospice., Conclusion: QI project and the steps involved helped the team to work towards solutions objectively. Seemingly excellent ideas may not be the most impactful and data collection demonstrates this and helps identify the most successful interventions., Competing Interests: There are no conflicts of interest., (© 2021 Published by Scientific Scholar on behalf of Indian Jounal of Palliative Care.)

Background: Medical Assistance in Dying comprises interventions that can be provided by medical practitioners to cause death of a person at their request if they meet predefined criteria. In June 2016, Medical Assistance in Dying became legal in Canada, sparking intense debate in the palliative care community., Aim: This study aims to explore the experience of frontline palliative care providers about the impact of Medical Assistance in Dying on palliative care practice., Design: Qualitative descriptive design using semi-structured interviews and thematic analysis., Settings/participants: We interviewed palliative care physicians and nurses who practiced in settings where patients could access Medical Assistance in Dying for at least 6 months before and after its legalization. Purposeful sampling was used to recruit participants with diverse personal views and experiences with assisted death. Conceptual saturation was achieved after interviewing 23 palliative care providers (13 physicians and 10 nurses) in Southern Ontario., Results: Themes identified included a new dying experience with assisted death; challenges with symptom control; challenges with communication; impact on palliative care providers personally and on their relationships with patients; and consumption of palliative care resources to support assisted death., Conclusion: Medical Assistance in Dying has had a profound impact on palliative care providers and their practice. Communication training with access to resources for ethical decision-making and a review of legislation may help address new challenges. Further research is needed to understand palliative care provider distress around Medical Assistance in Dying, and additional resources are necessary to support palliative care delivery.

Unlabelled: Lung volume reduction (LVR) is an effective therapy for end-stage emphysema. Preliminary and postprocedure imaging is usually limited to CT for anatomic delineation of the location and severity of the most acutely affected lung zones. The purpose of this study was to investigate the potential of using a new quantitative gas trapping index (GTI) derived from a (133)Xe ventilation scan to assess the severity of emphysema., Methods: Using the equilibration and washout phases of a (133)Xe ventilation study, a GTI was compared with visual National Emphysema Treatment Trial (NETT) CT scoring, semiautomated CT densitometry, and (99m)Tc perfusion scintigraphy in 28 patients being evaluated for LVR. The GTI was calculated as the percentage of (133)Xe gas retention in a 3-min washout image compared with the peak equilibrium image for 6 lung zones., Results: The GTI correlated best with the percentage of perfusion (-0.39, P<0.0001) and the CT density scoring with the percentage of severe emphysema (0.36, P<0.0001). There was less correlation with visual NETT CT scores (0.25, P<0.001)., Conclusion: This GTI, based on widely available (133)Xe imaging, shows good correlation with other quantitative measures of emphysema that are anatomically based. Because this GTI provides a more functional assessment of gas trapping and airway disease, these results suggest that additional study is warranted to investigate its use as a functional measure of emphysema before and after LVR.

Objective: To determine whether either bedside teaching alone (group A) or bedside teaching with written course materials (group B) improved written examination scores, satisfaction with the rotation, or clinical grades of rotating PGY1 residents., Methods: A prospective, controlled educational trial was conducted. Sixty-five PGY1 residents from diverse specialties rotated in the ED for one month over a ten-month study period, and were included in the study. The PGY1 residents were assigned to group by month of rotation. All the PGY1 residents received unstructured bedside teaching by emergency medicine (EM) residents and faculty. In addition, group B received written course materials on day 1., Results: Mean posttest scores were higher than mean pretest scores for the interns considered as a whole (p < 0.0001), but mean pretest, posttest, and clinical grades were comparable across instructional groups. Mean satisfaction ratings were higher for group A than for group B (p < 0.015). The interns specializing in EM achieved higher mean test scores (p < 0.013) and clinical grades (p < 0.003) than did the interns specializing in another medical specialty., Conclusion: Both instructional methods were associated with improved written test performance. Written course materials did not augment bedside teaching in terms of test scores, clinical grades, or satisfaction with the rotation. At a university-based, high-volume ED, bedside teaching offers educational benefit to rotating PGY1 residents that may not be augmented by written course materials.

Computerized care plans can save nurses time and generate consistent, readable documents. However, this does not ensure that they will be used effectively. The nurse manager must make informed decisions about content and amount of data to be collected if care plans are to be both individualized and consistent. A key consideration is whether they should be based on nursing diagnosis or on patient population type. Decisions about storage and use can influence efficiency, cost and continuity of care.

The computer has many applications for the management of a staff education department. One essential application is the recording and monitoring of the nursing staff's educational activities. Other pertinent activities may include the preparation of budget and department activities statistics reports. However, the array of computer software programs that is available for the management of data and administrative functions can be intimidating. By networking with users whose computer applications needs are similar to your own, and by communicating with members of your computer services department, the list of applications can be refined to a few software programs. These programs can provide efficiency and accuracy for monitoring and reporting on nursing staff education activities.

We surveyed 420 paramedics employed by a large metropolitan fire department to determine the effects of educational seminars on their knowledge base, perceptions, and attitudes about AIDS and hepatitis B. All surveys were completed on an anonymous, voluntary, and confidential basis. Our educational efforts improved the paramedics' knowledge base concerning the medical manifestations of AIDS, identification of risk factors, modes of transmission, and means of infection control, but had no impact on paramedics' fear of contracting AIDS. While paramedics have a strong fear of contracting AIDS, we note that they underestimate their risk of acquiring hepatitis B. Only 17% of paramedics surveyed had received the hepatitis vaccine, despite attending an infectious disease seminar addressing the occupational risks of acquiring hepatitis B infections during the previous year. Further educational efforts to address the paramedics' attitudes about AIDS, as well as to encourage paramedics to recognize hepatitis B exposure as a significant personal health risk, are currently being pursued.

The alternative birth movement is a consumer reaction to paternalistic and mechanistic medical obstetrical practices which developed in the United States early in this century. Alternative birth settings developed as single labor-delivery-recovery rooms in the hospital or as free-standing birth centers. Both alternatives offer family-centered, home-like, low technological maternity care. In order to overcome physician resistance to non-traditional maternity care, alternative birth center policies eliminate all women who are expected to have a complicated pregnancy or delivery. Physician resistance to alternative birthing is publicly based on the issue of maternal and infant safety. Additional issues, however, are that physicians fear economic competition and resist loss of control over obstetric practice. This paper (1) traces the historical antecedents and social factors leading to the alternative birth movement, (2) describes the types of alternative birthing methods, and (3) describes ways in which the obstetrical community has maintained and rationalized dominance over the birthing process.

First-line managers (head nurses) are increasingly accountable for all aspects of nursing care delivery and resource management on a unit. However, traditional methods of training head nurses may not adequately prepare them to meet their increasing responsibilities. A structured first-line manager development program can help correct this deficiency. However, the successful implementation of such a program requires an understanding of organizational culture as well as substantive knowledge about management. This article describes how a hospital-based first-line manager development program was designed and implemented by using strategies appropriate to the values, norms, and resources within the organization.

The communication of information in clinical settings is fraught with problems despite avowed common aims of practitioners and patients. Some reasons for the problematic nature of clinical communication are incongruent frames of reference about what information ought to be shared, sociolinguistic differences and social distance between practitioners and patients. Communication between doctors and nurses is also problematic, largely due to differences in ideology between the professions about what ought to be communicated to patients about their illness and who is ratified to give such information. Recent social changes, such as the Patient Bill of Rights and informed consent which assure access to information, and new conceptualizations of the nurse's role, warrant continued study of the communication process especially in regard to what constitutes appropriate and acceptable information about a patient's illness and who ought to give such information to patients. The purpose of this paper is to outline characteristics of communication in clinical settings and to provide a literature review of patient and practitioner interaction studies in order to reflect on why information exchange is problematic in clinical settings. A framework for presentation of the problems employs principles from interaction and role theory to investigate clinical communication from three viewpoints: (1) the level of shared knowledge between participants; (2) the effect of status, role and ideology on transactions; and (3) the regulation of communication imposed by features of the institution.

We report a study of occupational stress in 374 paramedics. Results indicate that this profession experiences a high degree of job-related stress relative to other medical personnel. In a component analysis of this stress the results show that job stress manifests itself as job dissatisfaction, organizational stress, and negative patient attitudes, but not as frequently as somatic distress.

We initiated a prospective study of the dizzy patient to identify key factors on which a directed evaluation could be based. This study used a standardized history, physical examination, and basic laboratory evaluation totalling 66 items to assist collection of relevant clinical information on 125 patients. Diagnosis was based on the emergency physicians' diagnosis. This was modified when necessary based on one month of follow-up using diagnostic criteria adapted from previous studies. The most common disorder was some form of peripheral vestibular disorder, found in 54 patients (43%). These patients were typically vertiginous and were managed successfully as outpatients. Despite correlations with multiple factors, this diagnosis was best predicted by positive Nylen-Barany test with either vertigo, vomiting, or both with 94% specificity and 43% sensitivity. Potentially serious causes were identified, including medication-related, seizure, stroke, transient ischemic attacks, vertebral-basilar insufficiency, hypertension, pericarditis, arrhythmias, and all those requiring hospitalization. The best predictors, either older age, lack of vertigo, or neurologic deficit, could identify 86% of "serious" dizziness with 42% specificity. The following tests were of low yield and may be done in a directed manner based on a brief history: Valsalva, carotid stimulation, Romberg and Quix tests, mental status examination, complete blood count, serum electrolytes, and BUN. Our results do support routine testing of glucose in all patients and monitoring rhythm in patients age 45 and older. Such a directed approach could rapidly classify a significant number of dizzy patients and forego many time- and cost-intensive elements of provocative examination and laboratory testing.

We conducted a study to assess the efficacy of the use of osteophony in the evaluation of shoulder trauma. Evaluation of the shoulder includes the physical examination and often a radiographic series. We studied the usefulness of the olecranon-manubrium percussion (OMP) test, a physical diagnostic procedure performed in shoulder trauma. The bell of the stethoscope is placed over the manubrium, both elbows are flexed at 90 degrees, and the olecranon is percussed. In the normal examination with no disruption of bony conduction, both sides should produce a crisp equal sound. In the event of a dislocation or fracture with disruption of bony conduction, the affected side should be duller in pitch and intensity. We evaluated the utilization of the OMP test to assess its accuracy when used as a screening test for radiographs in conjunction with the physical examination and radiographic examination. Ninety-six patients were prospectively evaluated by the OMP test and also received radiographs. In those patients who had radiographic abnormalities, 40 of 47 (85.1%) had an abnormal OMP sign. In those patients without radiographic abnormalities, none had an abnormal OMP sign. In assessing anterior shoulder dislocations, 11 of 13 (84.6%) had an abnormal OMP sign (P less than .02). After relocation, 100% had a normal OMP sign. Of those with clavicular fractures, nine of nine (100%) had abnormal OMP signs (P less than .005). Of those with a fracture of the humerus, 16 of 20 (80%) revealed an abnormal OMP test (P less than .01). The test was not significant in assessing acromio-clavicular joint abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)