Encouragement for the Christian Nurse.

ABSTRACT: In today's difficult and chaotic time, nurses are reminded that their work is a calling from God. When overwhelmed and discouraged, biblical truths in this article may serve as reminders that God is present, carries burdens, comforts, and provides hope. God gives multiple spiritual resources for encouragement and enablement to do his work.

Spiritual Well-Being in Older Adults: A Concept Analysis.

This concept analysis of spiritual well-being (SWB) in the older adult seeks to improve nurses' integration of spiritual care. Using Walker and Avant's method, the author identified five defining attributes of SWB: personal faith, religious practices, spiritual contentment, productive engagement, and healthy interpersonal relationships. Antecedents to SWB include awareness of one's spiritual needs and seeking to live a meaningful and purposeful life. Model, borderline, and contrary cases are presented to illustrate the defining attributes of SWB. Nursing implications for practice are discussed.

Consumer choice as experienced in the user-choice food pantry environment: motivations and situational influences on food selection.

OBJECTIVE: While scholarship has investigated how to provide more healthy food options in choice pantry environments, research has just begun to investigate how pantry users go about making decisions regarding food items when the ability to choose is present. The present analysis sought to investigate the factors prohibiting and inhibiting food decision making in choice pantries from the perspective of frequent pantry users. DESIGN: Six focus group interviews were conducted with visitors to choice food pantries, to discuss the decision-making process involved in food selection during choice pantry visits. Each was provided a $US 15 remuneration for taking part. SETTING: A school-based choice food pantry in Anderson, Indiana, USA, a small Midwestern community. PARTICIPANTS: Thirty-one men and women, largely aged 45-64 years, who made use of choice food pantries at least once monthly to meet their family's food needs. RESULTS: Choice pantry visitors indicated that the motivation to select healthy food items was impacted by both individual and situational influences, similar to retail environments. Just as moment-of-purchase and place-of-purchase factors influence the purchasing of food items in retail environments, situational factors, such as food availability and the 'price' of food items in point values, impacted healthy food selection at choice pantries. However, the stigmatization experienced by those who visit pantries differs quite dramatically from the standard shopping experience. CONCLUSIONS: Choice pantries would benefit from learning more about the psychosocial factors in their own pantries and adapting the environment to the desires of their users, rather than adopting widely disseminated strategies that encourage healthy food choices with little consideration of their unique clientele.

Liposomal bupivacaine efficacy for postoperative pain following posterior vaginal surgery: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Effective postoperative pain management is a crucial component of recovery following surgery. Narcotics are a cornerstone of postoperative analgesia, but can require a redosing requirement, encompass a lengthy list of side effects and adverse reaction risks, as well as carry a dependency potential. The national focus on decreasing opioid use has directly impacted postoperative pain management. Previous studies have reported the beneficial use of a single intraoperative injection of extended-release liposomal bupivacaine in postoperative pain management, however the same results have not been extensively studied in the urogynecology literature. OBJECTIVE: We sought to evaluate cumulative postoperative vaginal pain on days 1 and 3 after posterior vaginal wall surgery comparing study medication (extended-release liposomal bupivacaine) to placebo (saline). Secondary aims were to evaluate vaginal pain on postoperative day 7 and total morphine-equivalent narcotic usage on days 1, 3, and 7. STUDY DESIGN: This is a randomized, double-blinded, placebo-controlled trial with 100 subjects recruited from Walter Reed National Military Medical Center urogynecology clinic. All subjects were age >18 years and scheduled for surgery involving the posterior vaginal wall or muscularis (including posterior colporrhaphy, colpocleisis, sphincteroplasty, perineorrhaphy), excluding those with regular narcotic usage or concurrent pain management requiring the use of epidural anesthesia. A sample size of 96 patients was calculated. Subjects were randomized to receive either 20 mL of extended-release liposomal bupivacaine (Exparel) (Pacira Pharmaceuticals Inc, Parsippany, NJ) or 20 mL of placebo (saline) at the end of surgery. Concealed syringes were used and injected immediately postoperative into the lateral vaginal wall/levator muscle area and perineal body. In-house morphine-equivalent narcotic usage was recorded along with the postoperative day 1 pain scores. Patients were contacted by telephone on postoperative days 3 and 7. Vaginal pain scores were evaluated using the Defense and Veterans Pain Rating Scale, cumulatively and on days 1, 3, and 7. Overall morphine-equivalent narcotics were compared between the 2 groups. RESULTS: From October 2014 through August 2017, 100 patients were enrolled and completed the study; 49 (49%) of the patients were randomized to the study group and 51 (51%) were in the placebo group. There was no significant difference between vaginal pain scores between the study group and the placebo group (postoperative day 1: study medication median score 1 [interquartile range 0-3], placebo median score 1 [interquartile range 0-3] [P = .59]; postoperative day 3: study medication median score 2 [interquartile range 0-3], placebo median score 1 [interquartile range 0-3] [P = .20]; postoperative day 7: study medication median score 3 [interquartile range 1-4], placebo median score 1.5 [interquartile range 0-3] [P = .06]). Cumulative pain scores postoperative day 1-7 were also not significant (study medication median score 6 [interquartile range 1-10], placebo median score 4 [interquartile range 1-8] [P = .14]). Multivariate model for the presence of vaginal pain was calculated and after controlling for body mass index, age, and combined laparoscopy surgery, there was no significant difference between the study and the placebo groups (P = .62). There was no statistically significant difference in morphine equivalents for the 2 groups: study medication 112.5 (interquartile range 45-207) and placebo 101.5 (interquartile range 37.5-195), P = .81. CONCLUSION: The use of extended-release liposomal bupivacaine in posterior vaginal wall surgeries, injected into the lateral posterior vaginal wall and perineal body, does not provide a significant decrease in postoperative pain or decrease narcotic medication usage when compared to saline.

The Health Belief Model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation.

The Health Belief Model (HBM) posits that messages will achieve optimal behavior change if they successfully target perceived barriers, benefits, self-efficacy, and threat. While the model seems to be an ideal explanatory framework for communication research, theoretical limitations have limited its use in the field. Notably, variable ordering is currently undefined in the HBM. Thus, it is unclear whether constructs mediate relationships comparably (parallel mediation), in sequence (serial mediation), or in tandem with a moderator (moderated mediation). To investigate variable ordering, adults (N = 1,377) completed a survey in the aftermath of an 8-month flu vaccine campaign grounded in the HBM. Exposure to the campaign was positively related to vaccination behavior. Statistical evaluation supported a model where the indirect effect of exposure on behavior through perceived barriers and threat was moderated by self-efficacy (moderated mediation). Perceived barriers and benefits also formed a serial mediation chain. The results indicate that variable ordering in the Health Belief Model may be complex, may help to explain conflicting results of the past, and may be a good focus for future research.

The prostaglandin E2 type 4 receptor participates in the response to acute oxidant stress in airway epithelial cells.

Oxidative stress is implicated in the pathogenesis of many inflammatory pulmonary diseases, including cystic fibrosis (CF). Delineating how oxidative stress stimulates CF transmembrane conductance regulator (CFTR) in airway epithelial cells is useful, both to increase the understanding of airways host defense and suggest therapeutic approaches to reduce the oxidant stress burden in the CF lung. Using the airway epithelial cell line Calu-3, we investigated the hypothesis that hydrogen peroxide (H2O2), which stimulates anion efflux through CFTR, does so via the production of prostaglandin E2 (PGE2). Using iodide efflux as a biochemical marker of CFTR activity and short circuit current (I(sc)) recordings, we found that the H2O2-stimulated efflux was abolished by cyclooxygenase-1 inhibition and potentially also involves microsomal prostaglandin E synthase-1 activity, implicating a role for PGE2 production. Furthermore, H2O2 application resulted in a rapid release of PGE2 from Calu-3 cells. We additionally hypothesized that the PGE2 subtype 4 (EP(4)) receptor was involved in mediating this response. In the presence of (4Z)-7-[(rel-1S,2S,5R)-5-((1,1'-biphenyl-4-yl)methoxy)-2-(4-morpholinyl)-3-oxocyclopentyl]-4-heptenoic acid (AH23848) (which blocks the EP4 receptor), the H2O2-stimulated response was abolished. To investigate this finding in a polarized system, we measured the increase in I(sc) induced by H2O2 addition in the presence and absence of AH23848. H2O2 induced a robust increase in I(sc), which was significantly attenuated in the presence of AH23848, suggesting some role for the EP4 receptor. In conclusion, with H2O2 as a model oxidant stress, stimulation of CFTR seems to involve PGE2 production and likely EP4 receptor activation in Calu-3 airway epithelial cells. This mechanism would be compromised in the CF airways.

Sources of uncertainty: experiences of Alzheimer's disease.

Uncertainty is an inherent part of most illness experiences and Alzheimer's disease in particular is fraught with uncertainties, especially for the family. In an investigation of sources of uncertainty, 33 adult children with a parent diagnosed with probable Alzheimer's disease were interviewed. Participants described medical, personal, and social sources of uncertainty related to their parent's diagnosis. This research contributes to literature on uncertainty management and addresses the specific illness experiences of families coping with uncertainty related to Alzheimer's disease. Recommendations are made for further research that focuses on the ways family members are affected by illness.

Sacral Neuromodulation for the Treatment of Persistent Genital Arousal Disorder.

BACKGROUND: Patients affected with persistent genital arousal disorder report unprovoked, excessive, and unremitting genital arousal unrelated to sexual desire. Those afflicted experience severe physical and psychological distress with significant feelings of shame, guilt, and frustration. Definitive treatment options for this disorder are limited. CASE: We present the case of a 32-year-old woman, gravida 1 para 1, with persistent genital arousal disorder after treatment of an uncomplicated urinary tract infection while in a military-deployed environment. After numerous treatment modalities failed, she responded to an implanted sacral neuromodulator. CONCLUSION: Persistent genital arousal disorder may be the result of upregulated sacral nerve pathways. We report the use of sacral neuromodulation using unique program settings, which may be an effective alternative in the treatment of this distressing disorder.

The cancer information overload (CIO) scale: establishing predictive and discriminant validity.

OBJECTIVE: Survey data suggests that approximately three-fourths of adults are overwhelmed by cancer information - a construct we label cancer information overload (CIO). A significant limitation of existing research is that it relies on a single-item measure. The objective of the current study is to develop and validate a multi-item measure of CIO. METHODS: Study 1 (N=209) surveyed healthcare and manufacturing employees at eight worksites. Colonoscopy insurance claims data were culled eighteen months later to evaluate the predictive validity of CIO. Study 2 (N=399) surveyed adults at seven shopping malls. CIO and cancer fatalism were measured to examine the properties of the two constructs. RESULTS: Study 1 identified a reliable 8-item CIO scale that significantly predicted colonoscopy insurance claims 18 months after the initial survey. Study 2 confirmed the factor structure identified in Study 1, and demonstrated that CIO, cancer fatalism about prevention, and cancer fatalism about treatment are best modeled as three distinct constructs. CONCLUSION: The perception that there are too many recommendations about cancer prevention to know which ones to follow is an indicator of CIO, a widespread disposition that predicts colon cancer screening and is related to, but distinct from, cancer fatalism. PRACTICE IMPLICATIONS: Many adults exhibit high CIO, a disposition that undermines health efforts. Communication strategies that mitigate CIO are a priority. In the short-term, health care providers and public health professionals should monitor the amount of information provided to patients and the public.

Usability study of a novel, self-lighted, disposable speculum: military applications.

STUDY DESIGN: Data collected from a postutilization questionnaire were used to evaluate the usability of the OfficeSPEC disposable vaginal speculum, specifically the effectiveness, efficiency, and acceptability, in clinical, hospital, and austere environments. RESULTS: Usability data analysis showed the OfficeSPEC speculum had an effectiveness rating of 4.6/5, efficiency rating of 4.5/5, and acceptability rating of 4.6/5; overall usability in deployed environments was favorable. The overall rankings were 3.4 for plastic, 4.2 for metal (p < 0.001), and 4.5 for OfficeSPEC (p < 0.001). Cost analysis of the OfficeSPEC placed the disposable speculum as a reasonable alternative with yearly cost of $129,200, compared to traditional metal ($209,100) and plastic ($319,175). CONCLUSION: By evaluating the OfficeSPEC speculum within a usability framework, it proved to be practical, viable alternative in all environments, particularly in the forward deployed environment.

Volume regulation in the human airway epithelial cell line Calu-3.

Cells regulate their volume in response to changes in the osmolarity of both their extracellular and their intracellular environments. We investigated the ability of the human airway epithelial cell line Calu-3 to respond to changes in extracellular osmolarity. Although switching Calu-3 cells from an isosmotic to a hyperosmotic environment resulted in cell shrinkage, there was no compensatory mechanism for the cells to return to their original volume. In contrast, switching to a hyposmotic environment resulted in an initial cell swelling response, followed by a regulatory volume decrease (RVD). Pharmacologic studies demonstrate that the voltage-activated K+ channels Kv4.1 and (or) Kv4.3 play a crucial role in mediating this RVD response, and we demonstrated expression of these channel types at the mRNA and protein levels. Furthermore, inhibition of the large- and intermediate-conductance Ca2+-activated K+ channels KCa1.1 (maxi-K) and KCa3.1 (hIK) also implicated these channels as playing a role in volume recovery in Calu-3 cells. This report describes the nature of volume regulation in the widely used model cell line Calu-3.