Capacity building skills in the implementation of evidence-based practice for community health nurses: an exploratory descriptive cohort study.

Background: While nurses are strategically placed to support the achievement of universal health, their practice may not always be informed by evidence, especially in a context where research evidence is not commonly used to inform practice.Objective/Aim/Hypothesis: Improve management of clients with CNCDs in Caribbean community through evidence-based practice (EBP) capacity building workshops.Design/Methods: A descriptive, quantitative design was used for this study. Participants included Community Based Nurses who attended an initial and recall workshop on EBP in a Caribbean island. All participants were included as the sample. Data were collected as a Pre-Test and Post Test before the initial workshop and at the recall workshop. Analysis was done quantitatively. Since the sample was small, only descriptive statistics were used.Results: Data showed 64% of participants had no experience with EBP, 55% needed more essential resources to participate in EBP and 55% recognized a need to include EBP to change their clinical practice effectively.Conclusions: The nurses and district supervisors observed a high level of interest and commitment to initiating and completing EBP projects. However, the reality of significant workplace demands, and limitations in consistent logistical and supervisory support impacted long-term sustainability.

Heart failure: An update for nurses.

ABSTRACT: Heart failure (HF) is a chronic syndrome that requires patients to manage signs and symptoms and adhere to a complex medication regimen. This article discusses updates in HF care related to a universal definition and new therapies, focusing on the four pillars of therapy for HF with reduced ejection fraction.

Review of the valorization initiatives of brewing and distilling by-products.

Beer and spirits are two of the most consumed alcoholic beverages in the world, and their production generates enormous amounts of by-product materials. This ranges from spent grain, spent yeast, spent kieselguhr, trub, carbon dioxide, pot ale, and distilled gin spent botanicals. The present circular economy dynamics and increased awareness on resource use for enhanced sustainable production practices have driven changes and innovations in the management practices and utilization of these by-products. These include food product development, functional food applications, biotechnological applications, and bioactive compounds extraction. As a result, the brewing and distilling sector of the food and drinks industry is beginning to see a shift from conventional uses of by-products such as animal feed to more innovative applications. This review paper therefore explored some of these valorization initiatives and the current state of the art.

A Mentoring Workgroup for Academic Role Transition Among Clinical-Track Nursing Faculty.

BACKGROUND: With the current ongoing nurse faculty shortage, mentorship can aid in career advancement, promotion, and retention for clinical assistant professors (CAPs) when hiring clinical-track faculty. METHOD: The organization, experiences, and outcomes of a CAP mentorship workgroup within a multi-campus research-intensive college of nursing are described. RESULTS: The CAP mentorship workgroup was guided by senior faculty and met monthly to provide CAPs with a better understanding of the promotion process, motivation to pursue scholarship, and peer support. Through this workgroup, seven CAPs have completed their probationary review process, two CAPs are in the process of being promoted to clinical associate professors, and more than 90% of CAPs have been retained. CONCLUSION: Mentorship for clinical-track faculty can positively influence faculty productivity and aid in CAP retention, which contributes to the success of nursing programs. [J Nurs Educ. 2023;62(3):183-186.].

Individual and Combined Antioxidant Activity of Spices and Spice Phenolics.

The present study investigated the interaction effects (additive, synergistic, and antagonistic) of different groups of spices, their constituent phenolic compounds, and synthetic antioxidants on the total phenol (TP) content and antioxidant activity, as measured by the ferric-reducing antioxidant power (FRAP) of the mixtures. The results showed that there was an additive effect in all the groups studied, except for the group containing turmeric or curcumin. The groups containing turmeric or curcumin showed a moderate synergistic effect. Among the groups of spices, the highest summated TP (50.6 mg GAE/mL) and FRAP (106.2 mg Trolox/mL) values were observed in the group containing clove, cinnamon, pimento, rosemary, oregano, and cardamom. In the case of the groups of pure phenolics, the highest summated TP (364.96 mg GAE/mL) and FRAP (1124.25 mg Trolox/mL) values were observed in the group containing eugenol, acetyl eugenol, caffeic acid, and protocatechuic acid. The summated and combined TP and FRAP values of the samples correlated highly with the correlation coefficients (r2) of 0.976 and 0.988, respectively, inferring an additive nature of the interaction effect in most of the groups studied. The interactions of phenolics in mixtures are very complex, being affected by a number of factors, and requires more investigations. The current study will add considerable knowledge to the existing literature to understand the diversity and mechanisms of interactions.

Neuronal HLH-30/TFEB modulates peripheral mitochondrial fragmentation to improve thermoresistance in Caenorhabditis elegans.

Transcription factor EB (TFEB) is a conserved master transcriptional activator of autophagy and lysosomal genes that modulates organismal lifespan regulation and stress resistance. As neurons can coordinate organism-wide processes, we investigated the role of neuronal TFEB in stress resistance and longevity. To this end, the Caenorhabditis elegans TFEB ortholog, hlh-30, was rescued panneuronally in hlh-30 loss of function mutants. While important in the long lifespan of daf-2 animals, neuronal HLH-30/TFEB was not sufficient to restore normal lifespan in short-lived hlh-30 mutants. However, neuronal HLH-30/TFEB rescue mediated robust improvements in the heat stress resistance of wildtype but not daf-2 animals. Notably, these mechanisms can be uncoupled, as neuronal HLH-30/TFEB requires DAF-16/FOXO to regulate longevity but not thermoresistance. Through further transcriptomics profiling and functional analysis, we discovered that neuronal HLH-30/TFEB modulates neurotransmission through the hitherto uncharacterized protein W06A11.1 by inducing peripheral mitochondrial fragmentation and organismal heat stress resistance in a non-cell autonomous manner. Taken together, this study uncovers a novel mechanism of heat stress protection mediated by neuronal HLH-30/TFEB.

Consequences of In Utero Zika Virus Exposure and Adverse Pregnancy and Early Childhood Outcomes: A Prospective Cohort Study.

We aimed to describe adverse pregnancy outcomes among women who had symptomatic, RT-PCR-confirmed ZIKV infection and early childhood outcomes among their infants. We enrolled pregnant women with symptomatic, RT-PCR-confirmed ZIKV infection in a prospective cohort study, and their infants in a prospective pediatric cohort study. We defined adverse pregnancy and early childhood outcomes based on selected neurologic, ophthalmologic, auditory, musculoskeletal, and anthropometric abnormalities. We used RT-PCR and serologic tests to determine the ZIKV infection status of the child. Between 10 March and 24 November 2016, we enrolled 546 pregnant women with RT-PCR-confirmed ZIKV infection. The overall risk of adverse pregnancy and early childhood outcomes possibly related to in utero ZIKV exposure was 15.7% (95% CI: 12.8-19.0), distributed as follows: 3.6% (95% CI: 2.3-5.6) severe sequelae or fatality; 2.7% (95% CI: 1.6-4.5) major abnormalities; 9.4% (95% CI:7.1-12.2) mild abnormalities. The risk of severe sequelae or fatality was higher when ZIKV infection occurred during the first trimester (7.0%), compared to the second (2.7%) or third trimester (1.4%) (p = 0.02). Among the infants for whom ZIKV infection status could be determined, the vertical transmission rate was 3.0% (5/167) (95% CI: 1.1-7.2). Among pregnant women with symptomatic, RT-PCR-confirmed ZIKV infection, severe or major pregnancy or early childhood outcomes were present in 6.3% of fetuses and infants. Severe outcomes occurred more frequently in fetuses and infants whose mothers had been infected in the first trimester.

Exploring data management content in doctoral nursing handbooks.

OBJECTIVE: While data management (DM) is an increasing responsibility of doctorally prepared nurses, little is understood about how DM education and expectations are reflected within student handbooks. The purpose of this study was to assess the inclusion of DM content within doctoral nursing student handbooks. METHODS: A list of 346 doctoral programs was obtained from the American Association of Colleges of Nursing (AACN). Program websites were searched to locate program handbooks, which were downloaded for analysis. A textual review of 261 handbooks from 215 institutions was conducted to determine whether DM was mentioned and, if so, where the DM content was located. Statistical analysis was performed to compare the presence of DM guidance by type of institution, Carnegie Classification, and the type of doctoral program handbook. RESULTS: A total of 1,382 codes were identified across data life cycle stages, most commonly in the handbooks' project requirements section. The most frequent mention of DM was in relation to collecting and analyzing data; the least frequent related to publishing and sharing data and preservation. Significant differences in the frequency and location of codes were identified by program type and Carnegie Classification. CONCLUSIONS: Nursing doctoral program handbooks primarily address collecting and analyzing data during student projects. Findings suggest limited education about, and inclusion of, DM life cycle content, especially within DNP programs. Collaboration between nursing faculty and librarians and nursing and library professional organizations is needed to advance the adoption of DM best practices for preparing students in their future roles as clinicians and scholars.

Integrating Palliative Care Into Heart Failure Management.

BACKGROUND: The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families through the prevention and relief of suffering by assessment and treatment of physical, psychosocial, and spiritual problems. Any patient with chronic debilitating disease, including heart failure, is a candidate for interdisciplinary palliative care to manage their complex physical and psychosocial needs. CLINICAL RELEVANCE: The philosophy of palliative care has evolved to include a vision of holistic care extended to all individuals with serious illness and their families or caregivers that should be integrated throughout the continuum of care, including the acute phase. The critical care nurse will likely encounter patients with heart failure who are receiving or are eligible to receive palliative care at various time points during their illness. Critical care nurses therefore play a pivotal role in symptom palliation affecting the heart failure patient's quality of life. PURPOSE: To review the models of palliative care and the role that the critical care nurse plays in symptom palliation and preparation of the patient and their family for transition to other levels and settings of care. CONTENT COVERED: This review addresses the principles and models of palliative care along with how to integrate these principles into all phases of the heart failure disease continuum. Also included are recommendations for palliation of symptoms specific to heart failure patients as well as a discussion of the role of the critical care nurse and the importance of shared decision-making.

A survey of current practices in data management education in nursing doctoral programs.

BACKGROUND: The inclusion of data management instruction within nursing doctoral curricula has not been systematically examined. PURPOSE: The purpose of this study is to determine the extent of data management education within nursing doctoral programs. METHOD: Separate surveys were created for DNP (332) and PhD (138) program directors. Survey questions were based on the stages of the UK Data Service Research Data Lifecycle. RESULTS: One hundred and four nursing doctoral program directors responded, a 22% response rate. Sixty-seven (64%) were from DNP programs while 37 (35%) were from PhD programs. Although program directors reported that they were teaching stages of the research data lifecycle, data management is mostly being taught through individual mentoring or a single lecture within a required course, and that students' project data were not being preserved. CONCLUSIONS: Nursing doctoral programs need to develop consistent data management education, build an awareness of data policies, and clarify student project data sharing and ownership.

Reassessment of the risk of birth defects due to Zika virus in Guadeloupe, 2016.

BACKGROUND: In the French Territories in the Americas (FTA), the risk of birth defects possibly associated with Zika virus (ZIKV) infection was 7.0% (95%CI: 5.0 to 9.5) among foetuses/infants of 546 women with symptomatic RT-PCR confirmed ZIKV infection during pregnancy. Many of these defects were isolated measurement-based microcephaly (i.e. without any detected brain or clinical abnormalities) or mild neurological conditions. We wanted to estimate the proportion of such minor findings among live births of women who were pregnant in the same region during the outbreak period but who were not infected with ZIKV. METHODS: In Guadeloupe, pregnant women were recruited at the time of delivery and tested for ZIKV infection. The outcomes of live born infants of ZIKV non-infected women were compared to those of ZIKV-exposed live born infants in Guadeloupe, extracted from the FTA prospective cohort. RESULTS: Of 490 live born infants without exposure to ZIKV, 42 infants (8.6%, 95%CI: 6.2-11.4) had mild abnormalities that have been described as 'potentially linked to ZIKV infection'; all but one of these was isolated measurement-based microcephaly. Among the 241 live born infants with ZIKV exposure, the proportion of such abnormalities, using the same definition, was similar (6.6%, 95%CI: 3.8-10.6). CONCLUSIONS: Isolated anthropometric abnormalities and mild neurological conditions were as prevalent among infants with and without in-utero ZIKV exposure. If such abnormalities had not been considered as 'potentially linked to ZIKV' in the original prospective cohort in Guadeloupe, the overall estimate of the risk of birth defects considered due to the virus would have been significantly lower, at approximately 1.6% (95% CI: 0.4-4.1). TRIAL REGISTRATION: ClinicalTrials.gov (NCT02916732).

Impact of cold plasma processing on major peanut allergens.

Cold plasma is emerging as a novel food processing technology, with demonstrated efficacies for microbial inactivation and residual chemical dissipation of food products. Given the technology's multimodal action it has the potential to reduce allergens in foods, however data on the efficacy and mechanisms of action are sparse. This study investigates the efficacy of cold plasma on major peanut allergens (Ara h 1 and Ara h 2). For this purpose, dry, whole peanut (WP) and defatted peanut flour (DPF) were subjected to an atmospheric air discharge using a pin to plate cold plasma reactor for different treatment durations. With increases in plasma exposure, SDS-PAGE analysis revealed reduced protein solubility of the major peanut allergens. Alterations in allergenicity and structure of Ara h 1 and Ara h 2 were examined using ELISA and circular dichroism (CD) spectroscopy. Competitive ELISA with proteins purified from plasma treated WP or DPF revealed reduced antigenicity for both Ara h 1 and Ara h 2. The highest reduction in antigenicity was 65% for Ara h 1 and 66% Ara h 2 when purified from DPF. Results from CD spectroscopy analysis of purified proteins strongly suggests the reduction in antigenicity is due to modifications in the secondary structure of the allergens induced by plasma reactive species. Cold plasma is effective at reducing peanut protein solubility and causes changes in allergen structure leading to reduced antigenicity.

Increasing Health Literacy May Reduce Health Inequalities: Evidence from a National Population Survey in Ireland.

Background. Health literacy has been separately associated with socio-economic status and worse health status and outcomes. However, the magnitude of the associations between health literacy and health status and outcomes may not be evenly distributed across society. This study aims to estimate and compare the associations between health status, health behaviours, and healthcare utilisation within different levels of social status in the Irish population. Materials and methods. Data from Ireland collected as part of the 2011 European Health Literacy Survey were analysed. General health literacy was measured on a 0-50 scale, low to high. There were four binary outcomes: long-standing health conditions, smoking, hospital visits in the last 12 months, and self-rated health status. Logistic regression analysis was conducted to estimate the likelihood of each health outcome. Health literacy was treated as the main independent variable. Marginal effects were calculated using the delta method to demonstrate the change in likelihood of each outcome associated with a 5-point increase in health literacy score. The sample was grouped into tertiles based on self-reported social status, and models were replicated and compared for each tertile. Models were adjusted for known correlates of health literacy and health: age, gender, and education. Analysis was conducted using Stata V14. Results. Higher health literacy scores were associated with a lower probability of having a limiting illness within the low social status group only. Higher health literacy scores were associated with a lower probability of three or more hospital visits in the past 12 months in the low and middle social status groups. For people in the low and middle social status groups, higher health literacy levels were associated with a lower probability of being a current smoker. The associations between health literacy and self-rated health status were similar in each social status group. Conclusions: Improvement in population health literacy may reduce the prevalence of long-term chronic health conditions, reduce smoking levels, and result in fewer hospital visits. Whilst improved health literacy should improve behaviours and outcomes in all groups, it should have a more marked impact in lower social status groups, and hence contribute to reducing the observed social disparities in these health outcomes.

Dying to Belong: The Importance of Familiarity in Later Life.

Despite the large amount of research into loneliness, the evidence base around effective ways of tackling loneliness among older adults is limited. Up to one-half of all older adults regularly feel lonely, negatively impacting physical and mental health. In light of population aging, family dispersal, and in the aftermath of COVID-19, it is vital that we grow the evidence base around the lived experience of older people, knowing what they want and why, and ensuring community services and supports are meaningful to them. Method: Three focus groups were held with community-dwelling older adults in Ireland. Results: Loneliness is associated with the loss of familiarity and connection to community. Conclusions: Understanding loneliness in later life is increasingly important with population aging. As plans for ending confinement linked to COVID-19 are devised, a mechanism is urgently needed to sustain the positive changes to communities which have meaningfully connected with older adults.

Navigating Symptom Management in Heart Failure: The Crucial Role of the Critical Care Nurse.

High-acuity, progressive care, and critical care nurses often provide care for patients with heart failure during an exacerbation of acute disease or at the end of life. Identifying and managing heart failure symptoms is complex and requires early recognition and early intervention. Because symptoms of heart failure are not disease specific, patients may not respond to them appropriately, resulting in treatment delays. This article reviews the complexities and issues surrounding the patient's ability to recognize heart failure symptoms and the critical care nurse's role in facilitating early intervention. It outlines the many barriers to symptom recognition and response, including multimorbidities, age, symptom intensity, symptom escalation, and health literacy. The influence of self-care on heart failure management is also described. The critical care nurse plays a crucial role in teaching heart failure patients to identify and respond appropriately to their symptoms, thus promoting early intervention.

The association between symptom onset characteristics and prehospital delay in women and men with acute coronary syndrome.

BACKGROUND: A decision to delay seeking treatment for symptoms of acute coronary syndrome increases the risk of serious complications, disability, and death. AIMS: The purpose of this study was to determine if there was an association between gradual vs abrupt symptom onset and prehospital delay for patients with acute coronary syndrome and to examine the relationship between activities at symptom onset and gradual vs abrupt symptom onset. METHODS: This was a secondary analysis of a large prospective multi-center study. Altogether, 474 patients presenting to the emergency department with symptoms of acute coronary syndrome were included in the study. Symptom characteristics, activity at symptom onset, and prehospital delay were measured with the ACS Patient Questionnaire. RESULTS: Median prehospital delay time was four hours. Being uninsured (ß=0.120, p=0.031) and having a gradual onset of symptoms (ß=0.138, p=0.003) were associated with longer delay. A diagnosis of ST-elevation myocardial infarction (ß=-0.205, p=0.001) and arrival by ambulance (ß=-0.317, p<0.001) were associated with shorter delay. Delay times were shorter for patients who experienced an abrupt vs gradual symptom onset (2.57 h vs 8 h, p<0.001). Among men with an abrupt onset of symptoms and a ST-elevation myocardial infarction diagnosis, 54% reported that symptoms were triggered by exertion (p=0.046). CONCLUSION: Patients should be counselled that a gradual onset of symptoms for potential acute coronary syndrome is an emergency and that they should call 911. Men with ischemic heart disease or with multiple risk factors should be cautioned that symptom onset following exertion may represent acute coronary syndrome.

Impact of Physical Function on 1-Year Kidney Transplant Outcomes.

End-stage renal disease patients who have impaired physical function are denied for transplantation by clinicians concerned about graft/survival outcomes. The purpose of this study was to determine the impact of physical function on graft/survival outcomes at 1-year post-kidney transplantation. Data were analyzed from the Scientific Registry of Transplant Recipients regarding kidney transplantation patients (N = 218,657) between January 1, 2000 and September 2, 2014. The hazard ratio of 1-year graft failure for deceased donor transplantation recipients needing total assistance was 1.60 (95% confidence interval [CI] = [1.303, 1.965], p < .01). Patients needing none or some assistance did not demonstrate a significant difference in 1-year graft failure in either deceased or living donor transplantation. The hazard ratio of 1-year death for those needing total assistance was 2.52 (95% CI = [2.087, 3.045], p < .001) in deceased donor kidney transplantation.

Physical Symptom Cluster Subgroups in Chronic Kidney Disease.

BACKGROUND: Symptom burden associated with chronic kidney disease can be debilitating, with a negative effect on patient health-related quality of life. Latent class clustering analysis is an innovative tool for classifying patient symptom experience. OBJECTIVES: The aim of the study was to identify subgroups of patients at greatest risk for high symptom burden, which may facilitate development of patient-centered symptom management interventions. METHODS: In this cross-sectional analysis, baseline data were analyzed from 3,921 adults enrolled in the Chronic Renal Insufficiency Cohort Study from 2003 to 2008. Latent class cluster modeling using 11 items on the Kidney Disease Quality of Life symptom profile was employed to identify patient subgroups based on similar observed physical symptom response patterns. Multinomial logistic regression models were estimated with demographic variables, lifestyle and clinical variables, and self-reported measures (Kidney Disease Quality of Life physical and mental component summaries and the Beck Depression Inventory). RESULTS: Three symptom-based subgroups were identified, differing in severity (low symptom, moderate symptom, and high symptom). After adjusting for other variables in multinomial logistic regression, membership in the high-symptom subgroup was less likely for non-Hispanic Blacks and men. Other factors associated with membership in the high-symptom subgroup included lower estimated glomerular filtration rate, history of cardiac/cardiovascular disease, higher Beck Depression Inventory scores, and lower Kidney Disease Quality of Life physical and mental component summaries. DISCUSSION: Three symptom subgroups of patients were identified among patients with mild-to-moderate chronic kidney disease. Several demographic and clinical variables predicted membership in subgroups. Further research is needed to determine if symptom subgroups are stable over time and can be used to predict healthcare utilization and clinical outcomes.

NEJM Knowledge+ Question of the Week: A Novel Virtual Learning Community Effectively Utilizing an Online Discussion Forum.

Objectives: Asynchronous virtual learning communities provide learners with the ability to enhance their learning and contribute to their peers' learning in a safe environment. However, the tone and content of learner comments, the level of engagement among learners, and the role of moderators have not been well studied within non-course-related virtual learning communities. Therefore, we sought to explore these characteristics using the NEJM Knowledge+ Question of the Week (NEJM Knowledge+ QoW) forum, a web-based asynchronous virtual learning community. Methods: We reviewed 73 NEJM Knowledge+ questions posted on the QoW forum between 2015 and 2016. We then selected three QoWs to analyze through a multistep coding process based on three broad criteria that aligned with our study aims. Results: Learner comments reflected both positive and critical tones, with learners sharing their own clinical practice and local experiences to contextualize their perspectives and reactions to both the QoW answer and the responses of other learners. Learners also commonly requested moderators to act as expert referees. Conclusion: Asynchronous virtual learning communities can engage learners by providing the opportunity to enhance their knowledge through responding to proposed medical scenarios and sharing their experiences in a discussion forum. Future work should examine the impact that geographic region has on asynchronous virtual learning communities and the role of moderators in shaping the learning experience.

The Three Rs for Preventing Heart Failure Readmission: Review, Reassess, and Reeducate.

Despite improvements in heart failure therapies, hospitalization readmission rates remain high. Nationally, increasing attention has been directed toward reducing readmission rates and thus identifying patients with the highest risk for readmission. This article summarizes the evidence related to decreasing readmission for patients with heart failure within 30 days after discharge, focusing on the acute setting. Each patient requires an individualized plan for successful transition from hospital to home and preventing readmission. Nurses must review the patient's current plan of care and adherence to it and look for clues to failure of the plan that could lead to readmission to the hospital. In addition, nurses must reassess the current plan with the patient and family to ensure that the plan continues to meet the patient's needs. Finally, nurses must continually reeducate patients about their plan of care, their plan for self-management, and strategies to prevent hospital readmission for heart failure.