Evaluation of a Seizure Action Plan in an Adult Epilepsy Center.

Background: Seizure action plans (SAPs) provide valuable information for patients to manage seizure emergencies, but are underutilized in adult epilepsy centers. The purpose of this project was to implement a structured SAP for adult patients with epilepsy. Methods: A pre/postimplementation design was used. Provider SAP utilization rates were analyzed over a 16-week period. A pre and postimplementation survey assessed participant perceived impact of the SAP on knowledge and comfort associated with managing seizure emergencies. Provider barriers and facilitators were also assessed. Results: Average provider SAP utilization rate was 51.45%. A total of 204 participants completed the surveys, which showed a significant increase in knowledge and comfort for all items, p < 0.001. At postsurvey analysis, 98% of participants felt that all patients with epilepsy should have a SAP regardless of seizure burden. Discussion: Implementing a structured SAP increased provider utilization and patient and care partner knowledge and comfort of managing seizure emergencies.

Online Mindset Training for Prelicensure Nursing Students: A Randomized Longitudinal Study.

Introduction: Research suggests students with a growth mindset are more successful. Utilizing Dweck's growth mindset model, the study explored the benefits of mindset training within nursing education. Objective: To determine the impact of an online mindset training intervention on first-semester prelicensure nursing students' mindset beliefs and learning and studying strategies. Methods: This study employed a randomized longitudinal design, conducted entirely online. Sixty-eight participants completed all phases of the study. Data were collected using the Williams Inventory of Learning Strategies tool before and after participants viewed an online training. Results: Findings indicate that online mindset training positively influenced student learning, reducing fear of failure and increasing willingness to remediate. Conclusion: These results highlight the promising impact of an online learning approach in fostering a growth mindset among nursing students; suggesting the potential for integrating mindset training into the nursing curriculum to enhance student success, with recommendations for further research in larger-scale studies.

Racial implicit bias: Perspectives of nursing students.

BACKGROUND: Racial implicit bias contributes to healthcare disparities. While research has been conducted on other health professionals, there is a lack of evidence about nursing students' experiences with racial implicit bias. PURPOSE: This study described the perspectives of pre-licensure nursing students regarding racial implicit bias (RIB) and its impact on patient care. METHOD: A qualitative descriptive methodology utilizing focus groups was used to describe the students' perspectives. RESULTS: Data analysis revealed three main themes: RIB may not be on purpose, but wrong is wrong; Bad nurse versus good nurse; and This is not okay. CONCLUSION: As RIB continues to contribute to health care disparities, this study reveals the need for it to be addressed in nursing education, while students prepare to be front line health care professionals.

Economic Impact of Nursing Student Course Repetition.

BACKGROUND: Nursing student course repetition is a common occurrence and results in consequences for students and institutions. PURPOSE: This study sought to describe the costs of course repetition for nursing students and nursing programs. METHODS: A qualitative multiple case study approach was used to consider 4 cases, which were analyzed according to Stake's methodology. RESULTS: Students who repeated courses experienced loss of anticipated income, and additional expenses associated with extending their time in school. Institutions tended to have limited economic impact, so long as attrition was prevented. CONCLUSIONS: Nursing programs can consider altering policies to help those who repeat, or providing proactive support to prevent students from failing and needing to repeat.

Preclinical efficacy of a cell division protein candidate gonococcal vaccine identified by artificial intelligence.

A safe and effective vaccine is urgently needed to combat the global threat of multidrug-resistant (MDR) Neisseria gonorrhoeae. We screened 26 gonococcal proteins discovered by an artificial intelligence-driven platform called Efficacy Discriminative Educated Network (EDEN) trained to identify novel, protective vaccine antigens against pathogenic bacteria for efficacy in the mouse vaginal colonization model of gonorrhea. Combinations of two to three antigens adjuvanted with GLA-SE (induces TH1 responses) yielded 11 groups that were used to vaccinate mice. An inverse correlation was noted between the complement-dependent bactericidal activity of antisera from each of the 11 groups and the burden of gonococcal colonization. The combination of NGO1549 (FtsN; cell divisome protein) and NGO0265 (predicted cell division protein) most substantially reduced the burden of colonization by MDR strain WHO X. The EDEN prediction score for each group of antigens correlated positively with reductions in overall bacterial burden, providing evidence for its predictive potential. FtsN and NGO0265 administered either individually, in combination, or as a chimeric protein significantly attenuated gonococcal vaginal colonization by all three test strains. IgG in antisera from mice immunized with the chimeric NGO0265-FtsN protein supported the complement-dependent killing of all 50 (100%) gonococcal isolates tested. The efficacy of the chimeric NGO0265-FtsN vaccine required the membrane attack complex (C5b-9) of complement, evidenced by loss of efficacy in complement C9-/- mice. In conclusion, a chimeric molecule comprising NGO0265 and FtsN adjuvanted with GLA-SE elicits IgG with broad anti-gonococcal bactericidal activity, attenuates gonococcal colonization in a complement-dependent manner, and represents a promising gonococcal vaccine candidate.IMPORTANCEVaccines to curb the global spread of multidrug-resistant gonorrhea are urgently needed. Here, 26 vaccine candidates identified by an artificial intelligence-driven platform (Efficacy Discriminative Educated Network[EDEN]) were screened for efficacy in the mouse vaginal colonization model. Complement-dependent bactericidal activity of antisera and the EDEN protective scores both correlated positively with the reduction in overall bacterial colonization burden. NGO1549 (FtsN) and NGO0265, both involved in cell division, displayed the best activity and were selected for further development. Both antigens, when fused to create a chimeric protein, elicited bactericidal antibodies against a wide array of gonococcal isolates and significantly attenuated the duration and burden of gonococcal colonization of mouse vaginas. Protection was abrogated in mice that lacked complement C9, the last step in the formation of the membrane attack complex pore, suggesting complement-dependent bactericidal activity as a mechanistic correlate of protection of the vaccine. FtsN and NGO0265 represent promising vaccine candidates against gonorrhea.

Impact of Nursing Clinical Elective Courses on New Graduate Nurses' Clinical Practice: A Mixed-Methods Descriptive Study.

BACKGROUND: Clinical elective courses provide additional specialty knowledge for prelicensure nursing students; however, it is unknown how these courses impact nurses' clinical practice after graduation. PURPOSE: To describe how clinical nursing electives impact graduates' clinical practice. METHODS: A mixed-methods descriptive design was used. Students who graduated from a prelicensure nursing program were sent an electronic survey and participated in qualitative interviews. RESULTS: Thirty-three graduates completed the survey, with 9 participating in interviews. Sixteen graduates worked in clinical practice areas that were the same, or related to, the clinical elective they took. Many graduates felt that taking the elective course improved their confidence in the clinical setting and provided increased knowledge that put them at an advantage over their peers. CONCLUSION: Clinical electives may offer a means to meet health care system needs by preparing a more confident, knowledgeable new graduate in specialty areas in which nurses are needed most.

Effect of a Commercial NCLEX-RN Preparation Product on First Time Pass Rates.

Introduction: Passing the National Council Licensure Exam-Registered Nurse (NCLEX-RN) is the entry into the profession for nurses, and rates of passing the exam on the first attempt are used as an important outcome measure for schools, students, and accrediting agencies. Objective: This study was conducted in order to investigate if a commercial NCLEX-RN test preparation product impacted first time pass rates. Methods: Data were collected from 688 students from six institutions who were taking the NCLEX-RN for the first time. The intervention group (n = 396) received a 6-month subscription to a commercial product with which to prepare for the NCLEX-RN, and was compared to the control group (n = 292) to test for differences in demographics and test pass rates. Results: The intervention group was more likely to be younger than 25 years of age (n = 160, 55.8% vs. n = 76, 34.6%; p < .001) when compared with the control group. No other significant differences in demographics or NCLEX-RN pass rates were observed between the groups. Conclusion and Recommendations: This study failed to demonstrate a change in the likelihood of passing NCLEX-RN on the first attempt in a group of students who used a commercial test preparation product. We recommend that instructor-guided use of a test-preparation product, along with other interventions to support test success, be considered in creating an individualized plan for nursing students preparing for NCLEX-RN.

Alternative pathway amplification and infections.

The alternative pathway (AP) is the phylogenetically oldest arm of the complement system and may have evolved to mark pathogens for elimination by phagocytes. Studies using purified AP proteins or AP-specific serum showed that C3b amplification on bacteria commenced following a lag phase of about 5 min and was highly dependent on the concentration of complement. Most pathogens have evolved several elegant mechanisms to evade complement, including expressing proteases that degrade AP proteins and secreting proteins that block function of C3 convertases. In an example of convergent evolution, many microbes recruit the AP inhibitor factor H (FH) using molecular mechanisms that mimic FH interactions with host cells. In most instances, the AP serves to amplify C3b deposited on microbes by the classical pathway (CP). The role of properdin on microbes appears to be restricted to stabilization of C3 convertases; scant evidence exists for its role as an initiator of the AP on pathogens in the context of serum. Therapeutic complement inhibition carries with it an increased risk of infection. Antibody (Ab)-dependent AP activation may be critical for complement activation by vaccine-elicited Ab when the CP is blocked, and its molecular mechanism is discussed.

Nursing Education Practice Update 2022: Competency-Based Education in Nursing.

Introduction: Competency-based education (CBE) is increasingly emphasized in nursing. Professional organizations and regulatory bodies are calling for radical transformation in nursing education along with increased emphasis on developing clinical judgment. Methods: This practice update article provides a brief history of CBE in a variety of educational settings including health professions education and demonstrates the value of CBE strategies. The article also provides examples of the application of CBE to nursing education. Conclusion: CBE offers the opportunity to enhance interprofessional education, increase the use of simulation, and improve clinical judgment in new graduate and advanced practice nurses.

Dismantling structural racism in nursing research.

Dismantling structural racism in nursing research is key to achieving health equity for populations that experience disproportionate burden of health disparities. Several nursing organizations have advocated for the nursing profession to address structural racism in the discipline and the Future of Nursing 2020 to 2030: Charting a Path to Achieve Health Equity specifically calls for research that addresses equity and social justice. Bold calls to conduct research to address structural racism notwithstanding, what remains less clear are the strategies needed. We propose key considerations for the design of research to address structural racism and offer examples from behavioral and biobehavioral research designed to dismantle structural racism.

Neisseria gonorrhoeae Infection in Women Increases With Rising Gonococcal Burdens in Partners: Chlamydia Coinfection in Women Increases Gonococcal Burden.

BACKGROUND: Likelihood of Neisseria gonorrhoeae infection in women exposed to male sex partners with increasing N. gonorrhoeae burdens and enhancement by Chlamydia trachomatis is not defined. METHODS: We identified men with urethritis and their regular female sex partners. Exposure to N. gonorrhoeae burdens in men was compared in N. gonorrhoeae-infected versus -uninfected partners. Association of N. gonorrhoeae infection in women with burdens in male partners was estimated using logistic regression. Association of C. trachomatis coinfection and N. gonorrhoeae burdens in women adjusted for burdens in male partners was estimated by linear regression. RESULTS: In total, 1816 men were enrolled; 202 had ≥2 partners, 91 who confirmed monogamy and were enrolled; 77% were married. Seventy were partners of N. gonorrhoeae-infected men; 58 (83%) were N. gonorrhoeae infected, 26 (45%) C. trachomatis coinfected. Infected women had partners with 9.3-fold higher N. gonorrhoeae burdens than partners of uninfected women (P = .0041). Association of N. gonorrhoeae infection in women with upper quartiles of N. gonorrhoeae burdens in partners increased (odds ratios ≥ 2.97)compared to the first quartile (P = .032). N. gonorrhoeae burdens in C. trachomatis-coinfected women were 2.82-fold higher than in C. trachomatis-uninfected women (P = .036). CONCLUSIONS: N. gonorrhoeae infections increased in women whose partners were infected with higher N. gonorrhoeae burdens. C. trachomatis coinfection was associated with increased N. gonorrhoeae burdens in women.

An optimized Factor H-Fc fusion protein against multidrug-resistant Neisseria gonorrhoeae.

Novel therapeutics against the global threat of multidrug-resistant Neisseria gonorrhoeae are urgently needed. Gonococci evade killing by complement by binding factor H (FH), a key inhibitor of the alternative pathway. FH comprises 20 short consensus repeat (SCR) domains organized as a single chain. Gonococci bind FH through domains 6 and 7, and C-terminal domains 18 through 20. Previously, we showed that a chimeric protein comprising (from the N- to C-terminus) FH domains 18-20 (containing a point mutation in domain 19 to prevent lysis of host cells) fused to human IgG1 Fc (called FH*/Fc1) killed gonococci in a complement-dependent manner and reduced the duration and bacterial burden in the mouse vaginal colonization model of gonorrhea. Considering the N. gonorrhoeae-binding FH domains 18-20 are C-terminal in native FH, we reasoned that positioning Fc N-terminal to FH* (Fc1/FH*) would improve binding and bactericidal activity. Although both molecules bound gonococci similarly, Fc1/FH* displayed a 5-fold lower IC50 (the concentration required for 50% killing in complement-dependent bactericidal assays) than FH*/Fc1. To further increase complement activation, we replaced human IgG1 Fc in Fc1/FH* with Fc from human IgG3, the most potent complement-activating IgG subclass, to obtain Fc3/FH*. Bactericidal activity was further increased ~2.3-fold in Fc3/FH* compared to Fc1/FH*. Fc3/FH* killed (defined by <50% survival) 45/45 (100%) diverse PorB1B-expessing gonococci, but only 2/15 PorB1A-expressing isolates, in a complement-dependent manner. Decreased Fc3/FH* binding accounted for the limited activity against PorB1A strains. Fc3/FH* was efficacious against all four tested PorB1B gonococcal strains in the mouse vaginal colonization model when administered at a dose of 5 µg intravaginally, daily. Furthermore, Fc3/FH* retained bactericidal activity when reconstituted following lyophilization or spray-drying, suggesting feasibility for formulation into intravaginal rings. In conclusion, Fc3/FH* represents a promising prophylactic immunotherapeutic against multidrug-resistant gonococci.

Mental health outcomes in formerly incarcerated Black men: A systematic mixed studies review.

AIMS: The aim of this review was to evaluate the current state of scientific knowledge describing the mental health of Black men who have experienced incarceration. DESIGN: This systematic mixed studies review employed a sequential explanatory design integrating quantitative and qualitative published research. DATA SOURCES: PubMed, CINAHL, PsycINFO, Social Work and Criminal Justice databases were searched using search terms addressing core constructs of mental health, Black men, incarceration and re-entry, January 2010 through October 2021. REVIEW METHODS: Articles identified through a search protocol were screened for inclusion as: peer-reviewed original research, published in English and relevant to the mental health of formerly incarcerated Black men in the United States. RESULTS: Twenty-three articles met inclusion criteria. Quantitative findings demonstrated significant associations between incarceration history and poor mental health, including higher levels of psychological distress, increased severity of depressive and PTSD symptoms, and delayed mental health treatment. Discrimination, negative police encounters, solitary confinement and difficulty finding employment were associated with the relationship between incarceration and mental health outcomes. Four themes were identified from the qualitative synthesis: (1) Social Determinants of Mental Health (2) Pushing Through Emotional Despair (3) Challenges to Healthcare Engagement and (4) Gender, Race and Intersections between Social Identities. IMPACT: The United States has the highest rate of incarceration in the world and disproportionately incarcerates Black men. This review contextualizes the relationship between incarceration history and mental health in the lived experiences and perspectives of formerly incarcerated Black men. Findings indicate the need for interventions to support mental health needs and prevent downstream health consequences in this population. CONCLUSION: Mental health concerns are pervasive in formerly incarcerated Black men; to address key gaps in current scientific understandings future research should focus on how Black men navigate help-seeking experiences and use mental health services in the context of an incarceration history.

Development and Evaluation of a Web-Based Educational Toolkit on the Knowledge, Attitudes, and Practices of Psychiatric Prescribers Regarding Long-Acting Injectable Antipsychotics.

BACKGROUND: Long-acting injectable antipsychotics (LAIs) are unique and effective pharmacological treatment options for schizophrenia that are underutilized in clinical practice. Research surrounding prescriber barriers to the underuse of LAIs are limited to a few seminal studies which identified psychiatric prescriber barriers to the use of LAIs as knowledge deficits, uninformed attitudes, and poor prescribing practices. There is a gap in the literature regarding effective educational interventions to target the identified psychiatric prescriber barriers to the use of LAIs. AIMS: The study aimed to develop a web-based educational toolkit that would positively affect the knowledge, attitudes, and practices of psychiatric prescribers regarding LAIs. METHODS: A one-group, before and after design with a convenience, purposive sample of 17 psychiatric prescribers to assess the knowledge, attitudes, and practices (KAP) using a 20-item KAP questionnaire before and after a presentation of a web-based educational toolkit about LAIs was chosen. RESULTS: The web-based educational toolkit slightly improved the total and three subscales KAP scores of psychiatric prescribers. However, only the difference in total KAP scores was found to be statistically significant. CONCLUSIONS: The developed and evaluated web-based educational toolkit could provide a foundation for positive change to psychiatric prescribers' KAP regarding LAIs.

A National Study of Progression Policies and Course Repetition in Prelicensure Registered Nursing Programs.

BACKGROUND: The literature lacks description of the incidence of nursing students failing and repeating courses. Nursing student repeaters delay graduation and entry into the workforce; they are also at risk for attrition. AIM: The aim of the study was to describe the incidence of nursing student repeaters and progression policies in the United States. METHOD: A national survey of prelicensure nursing program deans and directors was conducted. RESULTS: Invitations were sent to 2,055 nursing programs; the response rate was 32 percent. The annual incidence of nursing student course repetition was found to be 11.5 percent. Progression policies varied widely. CONCLUSION: Nursing student repeaters are a significant population, and examination of progression policies is warranted.

Predicting intentions to meet fruit & vegetable recommendations among black emerging adult women.

ObjectiveTo examine Black emerging adult women's (ages 18-29) intention to meet the recommended daily intake of fruits and vegetables using the Theory of Planned Behavior (TPB). Participants: Black emerging adult women (BEAW; N = 100). Methods: A cross-sectional survey design. Results: Hierarchical regression analyses revealed that in Model 1, attitudes (p<.0001) and subjective norms (p<.05) were significant predictors of intentions to meet the recommended daily intake of fruits and vegetables. In Model 2, attitudes (p=.0001) and perceived behavioral control (p<.0001) were revealed to be significant predictors of intentions. The change in R squared from Model 1 (R2=.304) and Model 2 (R2=.559), was 0.255 (F = 40.08, p<.0001) with the addition of perceived behavioral control to the second model. Conclusion: The TPB may be a suitable framework to assess factors associated with fruit and vegetable intentions among BEAW. Interventions designed to increase fruit and vegetable intake in BEAW should prioritize modifying perceived behavioral control.

An integrative review: Chronic kidney disease awareness and the social determinants of health inequities.

BACKGROUND: Chronic kidney disease is a common and prevalent condition in the United States. However, 90% of individuals with chronic kidney disease are unaware of their diagnosis. AIMS: To summarize the empirical and theoretical literature to provide a comprehensive understanding of the social determinants of health inequities associated with CKD awareness. Social determinants of health inequities are underlying pathways that shape the health opportunities of individuals based on their social position. DESIGN: Integrative review. DATA SOURCES: (May 2020 through July 2020) Data sources included PubMed, sociological abstracts, ScienceDirect, CINAHL and Google Scholar. REVIEW METHODS: Quantitative, qualitative and theoretical articles describing the association of social determinants of health inequities and chronic kidney disease awareness were included. RESULTS: A total of 19 articles were reviewed: two qualitative, one theoretical and 16 quantitative. CONCLUSION: Findings from this review revealed that socioeconomic status, education, race and gender are consistently associated with patient chronic kidney disease awareness. These findings should serve as a basis for further research on interventions to improve chronic kidney disease awareness as well as guide nurses and health care professionals in caring for this population.

Self-Care of African Immigrant Adults with Chronic Illness.

This cross-sectional study aims to describe the self-care of adult African immigrants in the US with chronic illness and explore the relationship between acculturation and self-care. A total of 88 African immigrants with chronic illness were enrolled. Self-care was measured with the Self Care of Chronic Illness Inventory v3 and the Self-Care Self-Efficacy scale. Scores are standardized 0 to 100 with scores >70 considered adequate. Acculturation was measured using a modified standardized acculturation instrument and predefined acculturation proxies. The self-care scores showed adequate self-care, with the mean scores of 78.6, 77.9, and 75.6 for self-care maintenance, monitoring, and management. Self-care self-efficacy mean score was 81.3. Acculturation was not significantly associated with self-care. Self-care self-efficacy was a strong determinant of self-care maintenance (p < .0001), monitoring (p < .0001), and management (p < .0001). The perception of inadequate income was a significant determinant of poor self-care management (p = .03). Self-care self-efficacy and perceived income adequacy were better determinants of self-care than acculturation.

Efficacy of an Experimental Gonococcal Lipooligosaccharide Mimitope Vaccine Requires Terminal Complement.

A safe and effective vaccine against multidrug-resistant gonorrhea is urgently needed. An experimental peptide vaccine called TMCP2 that mimics an oligosaccharide epitope in gonococcal lipooligosaccharide, when adjuvanted with glucopyranosyl lipid adjuvant-stable emulsion, elicits bactericidal immunoglobulin G and hastens clearance of gonococci in the mouse vaginal colonization model. In this study, we show that efficacy of TMCP2 requires an intact terminal complement pathway, evidenced by loss of activity in C9-/- mice or when C7 function was blocked. In conclusion, TMCP2 vaccine efficacy in the mouse vagina requires membrane attack complex. Serum bactericidal activity may serve as a correlate of protection for TMCP2.