Search

Purpose: The study sought to evaluate possible correlates of complete weaning outcomes by exploring physiological assessments and subjective perceptions of dyspnea, fatigue, and self-efficacy in patients undergoing initial weaning from [...]

Apparent digestibility and availability coefficients for protein and amino acids in menhaden fish meal (MEN), pet-food grade (PBM-pet,) and feed-grade poultry by-product meal (PBM-feed) were determined for market-size (500 g) sunshine bass in two consecutive trials using passive netting (1.6 mm mesh) followed by manual stripping of faeces. A reference diet resembling a commercial feed was formulated to meet or exceed all known nutritional requirements of hybrid striped bass. Test diets were formulated to contain a 70 : 30 mixture of reference diet to test ingredient with chromic oxide (1%) serving as the inert marker. Diets were extruded under commercial conditions and the reference diet was fed for two weeks in order to acclimate fish to experimental conditions. Each diet was randomly assigned to triplicate tanks containing 30 fish each. Fish were fed their respective diet twice daily to apparent satiation for two weeks, with faecal collections being conducted on the 7th and 14th day, in each trial. ADC values determined in the net method were highly variable and generally lower than ADCs obtained by stripping. Consistently lower and highly variable chromium concentrations were found in the net method faecal samples and suggest that marker loss relative to nutrient content, or dilution of marker with non-faecal matter, on the net collectors influenced results in that trial. In contrast, the standard errors of ADCs determined in the strip method were less than 5 percentage points in most cases. Protein digestibility ranged from a low of 51% (PBM-feed) to a high of 87% (PBM-pet) in the net method, and from a low of 80% (PBM-feed) to a high of 99% (MEN) in the strip method. With the exception of Lys, no differences in amino acid availabilities among diets were found in the net method. In the strip method, protein digestibility and amino acid availabilities in MEN were generally greater than those found in PBM-pet or PBM-feed, whereas ADCs were not significantly different between the two poultry by-products. Based on the conditions of the present study, net collection of faecal matter can not be recommended for determining the digestibility of nutrients in feed ingredients for market-size sunshine bass. Digestibility coefficients obtained by the strip method for feed and petfood grades poultry by-product were higher than those previously reported and will be facilitate more efficient and economical diet formulations for larger sunshine bass. [ABSTRACT FROM AUTHOR]

Three experiments were conducted that were designed to evaluate our ability to predict essential amino acid (EAA) needs of hybrid striped bass using the quantified lysine requirement and whole-body amino acid concentrations. In the first experiment, six diets containing various amino acid profiles were fed to triplicate groups of fish initially weighing 7.7 g per fish. At the end of the 8-week experiment, no significant differences were detected in growth rates or feed efficiencies (FE) between fish fed a practical diet containing 510 g kg−1 herring fish meal (FM) and fish fed a purified diet containing the amino acid profile of herring fish meal (CAA-FM). Growth responses of fish fed purified diets containing 100 (HSB), 110 (HSB110), 120 (HSB120) or 140 g 100 g−1 (HSB140) of the amino acid profile of hybrid striped bass whole-bodies were significantly lower than those of fish fed diet FM. In the second experiment, triplicate groups of fish (5.6 g per fish) were fed diets containing various energy : protein (E : P) ratios (34.8, 41.2, 47.5 and 53.9 kJ g−1 protein) and one of two amino acid profiles (CAA-FM and HSB120) in a 4 × 2 factorial design. Carbohydrate concentration was varied to achieve the desired energy concentrations. At the end of the 8-week experiment, weight gain and FE were significantly higher in fish fed diets formulated to simulate the amino acid profile of herring fish meal (CAA-FM) compared with fish fed diets formulated to contain 120 g 100 g−1 of the amino acid profile of hybrid striped bass whole-bodies (HSB120). Weight gain, FE and survival data indicated the optimum dietary E : P was 41.2 kJ g−1 protein. Dietary treatments in the final experiment included three amino acid profiles and four levels of lipid in a 3 × 4 incomplete factorial design. Dietary amino acid treatments included the amino acid profile of herring fish meal (CAA-FM) or 120 g 100 g−1 of the predicted EAA requirement profile for hybrid striped bass (HSB120). The amino acid profile of the remaining dietary treatment (PRED+) was similar to that of the HSB120 treatment, but contained additional threonine, isoleucine and tryptophan. Diets CAA-FM and HSB120 contained either 90, 130, 170 or 210 g kg−1 lipid, whereas diet PRED+ contained 130 g kg−1 lipid. Dietary treatments were fed for 10 weeks to triplicate groups of fish initially weighing 81.0 g per fish. Weight gain and FE were not significantly affected by dietary amino acid profile. Feed efficiency was significantly reduced in fish fed diets containing 210 g kg−1 lipid compared with fish fed diets containing 90–170 g kg−1 lipid. Intraperitoneal fat (IPF) ratio and hepatosomatic index (HSI) values generally increased as dietary lipid concentrations increased. Total liver lipid concentrations were significantly reduced in fish fed diets containing 210 g kg−1 lipid compared with those of fish fed 90–130 g kg−1 lipid. Results of this study indicate an appropriate dietary amino acid profile can be predicted for hybrid striped bass using the quantified lysine requirement and whole-body amino acid concentrations. Further, the optimum E : P appears to be 40 kJ g−1 protein. [ABSTRACT FROM AUTHOR]

We conducted three separate experiments designed to determine the dietary methionine requirement, ability of cyst(e)ine to spare methionine, and the total sulfur amino acid requirement (TSAA) of juvenile yellow perch when fed the maximal amount of cyst(e)ine. The purified basal diet used in each experiment contained 33.6 g of crude protein/100 g diet and 12.0 g of lipid/100 g diet. In the first experiment,;>L-methionine was added to eight diets providing methionine concentrations ranging from 0.37 to 1.77 g/100 g diet in gradations of 0.2 g/100 g diet. Diets were fed for 12 wk to juvenile yellow perch initially weighing 4.7 g/fish. Broken-line analyses of weight gain and feed efficiency data indicated that the dietary methionine requirement was 1.0 g/100 g diet (3.1 g TSAA/100 g dietary protein) and 1.1 g/100 g diet (3.4 g TSAA/100 g dietary protein), respectively. In the second experiment, various ratios of L-cyst(e)ine and L-methionine were added to the basal diet and fed for 12 wk to determine the cyst(e)ine replacement value of yellow perch initially weighing 19.3 g/fish. Weight gain and feed efficiency (FE) data indicated that cyst(e)ine spared up to 51% of the methionine requirement. In the final experiment, graded levels of cyst(e)ine plus methionine in a ratio of 51:49 were added to the basal diet in gradations of 0.1 g/100 g diet (0.5 to 1.2 g TSAA/100 g diet) to determine the dietary total sulfur amino acid requirement. Diets were fed to satiation for 10 wk to fish initially weighing 8. 1 g. Broken-line analyses of weight gain, feed intake and FE data indicated that the dietary TSAA requirement was 0.85, 0.87 and 1.0 g of TSAA/100 g diet (2.5 to 3.0 g of TSAA/100 g of dietary protein), respectively. The majority of dietary TSAA requirements of fish are in the range of 2 to 4 g/100 g of dietary protein and are generally similar to those of both birds and swine, but lower than estimates for rodents. [ABSTRACT FROM AUTHOR]

We conducted an 11-wk feeding trial to determine the dietary choline requirement of juvenile yellow perch (Perca flavescens) and to investigate whether dietary phosphatidylcholine (PC) could meet this requirement. Six dietary treatments contained choline concentrations of <0.11, 0.23, 0.34, 0.75, 1.22 or 3.37 g/kg diet. Two additional diets contained 31 g of lecithin/kg diet, with or without supplemental choline chloride (4.0 g choline/kg diet). The total sulfur amino acid concentration was maintained at 1.0 g/100 g diet (methionine/cyst(e)ine, 49:51). Diets were fed to satiation twice daily to triplicate groups of yellow perch initially weighing 16.0 g/fish. Weight gain, feed intake and carcass proximate composition were significantly affected by dietary choline. Weight gains and feed intakes increased as dietary choline increased from 0 to 0.75 g/kg. Both values tended to plateau in fish fed dietary choline levels above 0.75 g/kg. Broken-line analyses of weight gain and feed intake data indicated the dietary choline requirement was 0.598 and 0.634 g/kg diet, respectively. Hepatic lipid concentrations and feed efficiency values were not significantly different. Whole-body fat concentrations increased significantly, whereas ash levels decreased significantly in fish fed increasing levels of dietary choline. Weight gain and feed intake of fish fed diets containing PC were not significantly different from fish fed 0.75 g/kg of dietary choline. However, hepatic lipid concentrations were significantly higher in fish fed the diet containing PC and no choline chloride. Thus, yellow perch require a maximum of 0.598-0.634 g of choline/kg diet for maximum growth and this requirement may potentially be met with 31 g of lecithin/kg diet. [ABSTRACT FROM AUTHOR]

Background: Alcohol use affects 14.5 million Americans and high prevalence of use and potential for withdrawal among hospitalized patients presents a challenge for health care professionals to anticipate and manage effectively. Due to the acuity and fast-paced nature of the hospital environment, nurses need assessment tools that can be readily completed and drive efficient protocol-based treatment. The purpose of this study was to examine psychometric properties of the alcohol withdrawal assessment tool (AWAT)., Aims: The aims were to examine AWAT (1) reliability, (2) validity, and (3) usability., Methods: Patients ( n = 55) and nurses ( n = 47) were recruited from six hospitals within one health care system in the Midwest. Psychometric testing included inter-rater reliability and criterion-related validity testing, using the Clinical Institute Withdrawal Assessment of Alcohol Scale-Revised (CIWA-Ar) as a comparison. Usability was assessed with a 5-item Likert-type scale., Results: Findings supported strong agreement (ICC: .931) between raters on the AWAT and a moderate correlation (Pearson r : .548) between scores on the AWAT and CIWA-Ar. Nurses agreed/strongly agreed that the AWAT took 2 min or less to complete ( n = 42; 89%), was easy to use for assessment ( n = 42; 89%) was easy to learn ( n = 40; 85%), and they were confident using the AWAT ( n = 39; 83%)., Conclusions: Study findings provide evidence of reliability, validity, and usability of the AWAT in the hospital setting. The AWAT has potential to improve assessment efficiency and nurses caring for inpatients with mental health disorders should consider implementing the tool into practice., 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.

Objective: To explore the perspectives of women in the lay public in Indiana on the topic of maternal mortality., Design: Qualitative descriptive design., Setting: The state of Indiana., Participants: Women in the lay public (N = 20) who were recruited from Facebook groups aimed at women with children., Methods: We used semistructured phone interviews during which participants described their understanding of maternal mortality and their related experiences. We analyzed the transcribed interviews using content analysis to yield overall themes., Results: We identified three main themes that described participants' perspectives of maternal mortality: Women Are Not Worried About Mortality Until They Experience Pregnancy Complications, Women Have Limited Information on Maternal Mortality, and Women Often Feel Dismissed During Maternity Care., Conclusion: Our findings suggest that nurses and other health care providers should increase their efforts to effectively communicate about maternal mortality and the associated risk factors and to follow evidence-based guidelines for respectful maternity care., (Copyright © 2022 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To explore nurses' descriptions of maternal mortality when caring for women in the perinatal period in Indiana., Design: A qualitative descriptive approach was used to produce nurses' descriptions of maternal mortality., Setting/participants: Convenience sample of 16 nurses recruited from the Indiana Section of the Association of Women's Health, Obstetric and Neonatal Nurses., Measurements: Semistructured phone interviews were conducted, and participants were asked to explain their experiences related to maternal mortality. This information, which was summarized using content analysis, provided data related to nurses' descriptions of maternal mortality when caring for women in the perinatal period., Results: Analysis revealed three main themes that explain nurses' descriptions of maternal mortality: When It Comes to Maternal Mortality: Out of Sight Is Out of Mind, Nurses Express Detachment From Their Role in Preventing Maternal Mortality, and Experience With Maternal Mortality or a Near-Miss Event Is a Turning Point for Nurses., Conclusion: Nurses who have limited experience with maternal mortality and who approach the issue in a detached manner may miss opportunities to provide health education to women in the perinatal period. Nurses need education on substance use disorders in the perinatal period, guidance on how to support women in the postpartum period, and support for coping with death and dying in the perinatal period., (Copyright © 2022 AWHONN. Published by Elsevier Inc. All rights reserved.)

Aims and Objectives: To explore the similarities and differences in factors that influence nurses' and physicians' decision-making related to family presence during resuscitation., Background: Despite the growing acceptance of family presence during resuscitation worldwide, healthcare professionals continue to debate the risks and benefits of family presence. As many hospitals lack a policy to guide family presence during resuscitation, decisions are negotiated by resuscitation teams, families and patients in crisis situations. Research has not clarified the factors that influence the decision-making processes of nurses and physicians related to inviting family presence. This is the first study to elicit written data from healthcare professionals to explicate factors in decision-making about family presence., Design: Qualitative exploratory-descriptive., Methods: Convenience samples of registered nurses (n = 325) and acute care physicians (n = 193) from a Midwestern hospital in the United States of America handwrote responses to open-ended questions about family presence. Through thematic analysis, decision-making factors for physicians and nurses were identified and compared., Results: Physicians and nurses evaluated three similar factors and four differing factors when deciding to invite family presence during resuscitation. Furthermore, nurses and physicians weighted the factors differently. Physicians weighted most heavily the family's potential to disrupt life-saving efforts and compromise patient care and then the family's knowledge about resuscitations. Nurses heavily weighted the potential for the family to be traumatised, the potential for the family to disrupt the resuscitation, and possible family benefit., Conclusions: Nurses and physicians considered both similar and different factors when deciding to invite family presence. Physicians focused on the patient primarily, while nurses focused on the patient, family and resuscitation team., Relevance to Clinical Practice: Knowledge of factors that influence the decision-making of interprofessional colleagues can improve collaboration and communication in crisis events of family presence during resuscitation., (© 2017 John Wiley & Sons Ltd.)

Critical thinking is an essential skill for nurses who practice in complex health care systems. This study explored nursing faculty members' perceptions of teaching critical thinking to baccalaureate student nurses in clinical settings. Six clinical faculty members were interviewed using an ethnographic approach. Findings focus on two domain analyses that describe the nature of critical thinking and strategies to effectively teach it. Faculty members conceptualized critical thinking as "putting it all together" through information seeking, reflecting, assigning meaning, problem solving, predicting, planning, and applying information. Faculty members perceived that they teach critical thinking through a number of approaches that include asking questions, reviewing written products, conducting clinical conferences, and evaluating student journals. The findings of this study have implications for faculty who seek a clearer definition of critical thinking in nursing and a rich description of strategies to teach this skill.

Background: As costs related to mechanical ventilation increase, clear indicators of patients' readiness to be weaned are needed. Research has not yet yielded a consensus on physiological variables that are consistent correlates of weaning outcomes. Subjective perceptions rarely have been examined for their contribution to successful weaning., Objective: To explore the subjective perceptions of dyspnea, fatigue, and self-efficacy and selected physiological variables in patients being weaned from mechanical ventilation., Methods: Data were collected prospectively on 68 patients being weaned from mechanical ventilation. Subjective perceptions were measured by using 3 visual analog scales; physiological variables were measured by using the Burns Weaning Assessment Program and a patient profile. Weaning outcomes were recorded 24 hours after data collection., Results: Participants were primarily white women and required mechanical ventilation for a mean of less than 4 days. Participants reported mild dyspnea, moderate fatigue, and high weaning self-efficacy. High PaO2, low PaCO2, stable hemodynamic status, adequate cough and swallow reflexes, no metabolic changes, and no abdominal problems were associated with complete weaning (P = .05). Subjective perceptions were associated with physiological variables but not with weaning outcomes., Conclusions: Multidimensional assessment of both primary and secondary indicators of readiness to be weaned is necessary for timely, efficient weaning from mechanical ventilation. Primary assessments include physiological variables related to gas exchange, hemodynamic status, diaphragmatic expansion, and airway clearance. Secondary assessments include perceptions related to key physiological variables. Additional research is needed to determine the predictive value of physiological variables and perceptions of dyspnea, fatigue, and self-efficacy.

A study was conducted to examine the effects of dietary conjugated linoleic acids (CLA; 0, 0.5 or 1.0 g/100 g total CLA) and lipid source (menhaden oil, soybean oil or a 1:1 mixture of menhaden:soybean oil) on growth rates and fatty acid composition of yellow perch. Dietary treatments were fed to apparent satiation to triplicate groups of fish initially weighing 37.9 g/fish. At the end of the 9-wk feeding trial, no significant differences were detected in weight gain or feed intake among fish fed any of the dietary treatments. Dietary CLA, lipid source and/or their interaction significantly affected feed efficiency, total liver lipid concentration, and muscle and liver fatty acid concentrations. Feed efficiency (g gain/g feed) was significantly lower in fish fed diets containing soybean oil (0.51) compared with fish fed menhaden oil (0.58) or menhaden:soybean oil (0.60). Liver total lipid concentrations were significantly reduced in fish fed 0.5 and 1.0 g/100 g CLA compared with fish fed the diets containing no CLA and in fish fed menhaden oil compared with those fed soybean oil or a 1:1 mixture of menhaden:soybean oil. Total CLA levels increased in both liver and muscle as dietary CLA concentration increased, irrespective of lipid source. However, total CLA concentrations were significantly lower in liver and muscle of fish fed soybean oil. Total muscle CLA concentrations were 0, 1.26 and 2.92 g/100 g fatty acids in fish fed diets containing menhaden oil and 0, 0.5 and 1.0 g/100 g CLA, respectively. Mono- and polyunsaturated fatty acid (PUFA) concentrations were significantly lower in muscle and liver of fish fed CLA compared with fish fed the diets containing no CLA. In contrast, liver concentrations of saturated fatty acids, 14:0, 16:0 and 18:0, were significantly higher in fish fed 1.0 g/100 g CLA.

Conjugated linoleic acids (CLA) are the focus of numerous studies, yet the effects of these isomers of octadecadienoic acids have not been evaluated in many species of fish. In this study, graded amounts of CLA--0, 0.5, 0.75, or 1.0% of the diet--were fed to juvenile hybrid striped bass for 8 wk. Dietary treatments were fed to apparent satiation twice daily to triplicate groups of fish initially weighing 13.4 g/fish. Feed intake and weight gain of fish fed 1.0% CLA were significantly reduced compared to fish fed no CLA. Fish fed 0.5 and 0.75% CLA exhibited reduced feed intake similar to fish fed 1.0% CLA, but had growth rates that were not significantly different from those of fish fed no CLA. Feed efficiency improved significantly in fish as dietary CLA concentrations increased. Total liver lipid concentrations were significantly reduced in fish fed the diets containing CLA compared to those of fish fed the control diet, and intraperitoneal fat ratio was significantly lower in fish fed 1.0% CLA compared to fish fed no CLA. Fish fed dietary CLA exhibited significant increases in hepatosomatic index and moisture content of muscle and carcass. The CLA isomers were detected in liver and muscle of fish fed the diets containing CLA, while a low concentration of one isomer was detected in liver and muscle of fish fed the control diet. Dietary CLA resulted in a significant increase in 18:2(c-9,c-12) concentration in liver and muscle, but a significant reduction in 18:1n-7 in these tissues. Furthermore, feeding CLA resulted in a significant increase in the concentration of 20:5n-3 and 22:6n-3 in liver, but a reduction of these fatty acids in muscle. This study showed that feeding CLA elevated tissue concentrations of these fatty acid isomers, reduced tissue lipid contents, improved feed efficiency, and altered fatty acid concentrations in liver and muscle of fish.

While some family members of critically ill patients effectively manage the stress of critical illness, others invoke coping responses that are ineffective and hinder patients' recovery. Critical care nurses and advanced practice nurses can enhance positive coping strategies of family members. This study examines the use and effectiveness of coping responses of family members. Strategies are suggested to facilitate effective coping of family members during the crisis of critical illness, including family attendance during invasive procedures and resuscitation efforts.

We conducted an 8-wk feeding experiment to determine the dietary arginine requirement of juvenile yellow perch (Perca flavescens). The basal diet contained 33 g crude protein/100 g diet (23 g crude protein supplied by crystalline L-amino acids and 10 g crude protein supplied by casein and gelatin). Eight dietary treatments contained graded levels of L-arginine-HCl ranging from 0.44 to 1.84 g/100 g dry diet in gradations of 0.2 g/100 g diet. Diets were made isonitrogenous with L-glutamic acid and were fed to triplicate groups of fish with an initial weight of 11 g/fish. Dietary arginine significantly affected weight gain and feed efficiency but not survival. The best weight gain and feed efficiency values were 155. 3% increase from initial weight and 0.63, respectively. Quadratic regression analyses of weight gain and feed efficiency data indicated the dietary arginine requirement to be 1.61 and 1.41 g/100 g diet, respectively. We recommend 1.41 g L-arginine-HCl/100 g diet for juvenile yellow perch fed purified diets. The recently developed dietary arginine requirements of fish are surprisingly similar and generally higher than those of the ureotelic mammals and lower than the uricotelic birds.

Healthcare environments increasingly are becoming culturally diverse. A project to incorporate multicultural issues in curricula, identify cross-cultural student learning opportunities, and increase faculty skills in teaching transcultural concepts is described. Through regional networking, faculty members identified barriers to teaching cross-cultural concepts and strategies to address those barriers. Recommendations call for proactive approaches for sharing resources to strengthen cultural dimensions in schools of nursing, particularly in rural areas that lack cultural diversity.

Although testing of physiologic nursing diagnoses has occurred, critical care nurses have not validated the defining characteristics of the diagnoses, Spiritual Distress and Ineffective Individual Coping. This research report describes how critical care nurses rated the defining characteristics of these diagnoses. Specific strategies are given to assist nurses in recognizing the defining characteristics so that they can effectively intervene in the spiritual and coping needs of patients, thereby enhancing patient outcomes.

Background: Although there is a plethora of literature about osteoporosis, little is known about the attitudinal variables that may predict osteoporosis-preventive behaviors (OPBs) among postmenopausal women. This study examined the relationship between variables from the Health Promotion Model (HPM) and OPBs of calcium intake, exercise participation, and taking of estrogen/hormone replacement therapy (ERT/HRT)., Methods: One hundred women completed measures of benefits and barriers to calcium intake, exercise participation, ERT/HRT usage; self-efficacy; control of health; importance of health; and health status. Participants also reported their actual calcium intake, exercise participation, and use of ERT/HRT:, Results: Participants consumed an average of 1,243 mg of calcium from milk, yogurt, calcium-rich foods, and supplements; 81% participated in weight-bearing and resistant training exercise but on an irregular basis; and 31% were users of ERT/HRT at the time of data collection. There were significant relationships between some of the HPM variables and calcium intake and exercise participation. There was a significant difference between past and current users of ERT regarding benefits and barriers to taking hormones. Hormone users reported higher calcium intake and greater exercise participation than nonusers., Conclusion: There is early evidence that variables of the HPM are associated with OPBs. After continued testing, intervention programs for osteoporosis prevention may use variables of the HPM as a theoretical base for behavior changes.