A prospective surveillance study to determine the prevalence of 16S rRNA methyltransferase-producing Gram-negative bacteria in the UK.

OBJECTIVES: To determine the prevalence of 16S rRNA methyltransferase- (16S RMTase-) producing Gram-negative bacteria in patients in the UK and to identify potential risk factors for their acquisition. METHODS: A 6 month prospective surveillance study was conducted from 1 May to 31 October 2016, wherein 14 hospital laboratories submitted Acinetobacter baumannii, Enterobacterales and Pseudomonas aeruginosa isolates that displayed high-level amikacin resistance according to their testing methods, e.g. no zone of inhibition with amikacin discs. Isolates were linked to patient travel history, medical care abroad, and previous antibiotic exposure using a surveillance questionnaire. In the reference laboratory, isolates confirmed to grow on Mueller-Hinton agar supplemented with 256 mg/L amikacin were screened by PCR for 16S RMTase genes armA, rmtA-rmtH and npmA, and carbapenemase genes (blaKPC, blaNDM, blaOXA-48-like and blaVIM). STs and total antibiotic resistance gene complement were determined via WGS. Prevalence was determined using denominators for each bacterial species provided by participating hospital laboratories. RESULTS: Eighty-four isolates (44.7%), among 188 submitted isolates, exhibited high-level amikacin resistance (MIC >256 mg/L), and 79 (94.0%) of these harboured 16S RMTase genes. armA (54.4%, 43/79) was the most common, followed by rmtB (17.7%, 14/79), rmtF (13.9%, 11/79), rmtC (12.7%, 10/79) and armA + rmtF (1.3%, 1/79). The overall period prevalence of 16S RMTase-producing Gram-negative bacteria was 0.1% (79/71 063). Potential risk factors identified through multivariate statistical analysis included being male and polymyxin use. CONCLUSIONS: The UK prevalence of 16S RMTase-producing Gram-negative bacteria is low, but continued surveillance is needed to monitor their spread and inform intervention strategies.

Exam Wrappers: It Is Time to Adopt a Nursing Student Metacognitive Tool for Exam Review.

ABSTRACT: Examining test performance, a common practice in nursing education, can be a vital learning tool, as well as a means of assessment. Exam or cognitive wrappers, performed by students after an exam but before the exam review, can explicitly teach students to discern between what they do and what they do not know. The process teaches metacognition, the highest level of critical thinking. Nursing students need to be proficient in metacognition for professional growth well beyond the classroom. However, little information about these cognitive exercises, known as exam wrappers, exists in nursing education today.

School Counselors' Perceptions of Necessary Attributes of Middle and High School Students Interested in a Career in Nursing.

AIM: The focus of this study was to examine which attributes school counselors perceive as necessary for middle and high school students interested in a career in nursing. BACKGROUND: School counselors play a pivotal role in secondary students' career development but were found to have limited knowledge about the need for increased academic rigor in nursing. METHOD: A national sample of 204 school counselors responded to a web-based survey that examined perceptions of necessary attributes of prospective nursing students. RESULTS: This is the first national study to identify school counselors' perceived attributes of prospective nursing students. Results included trustworthiness and caring; academic attributes ranked lower. CONCLUSION: School counselors in this study perceived nursing as a caring profession but not necessarily an academic one. Early intervention in middle school may alter preconceived images of nursing as exclusively female and caring but also as a profession that requires much academic preparation.

Breast Cancer Screening and Diagnosis, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology.

The NCCN Guidelines for Breast Cancer Screening and Diagnosis have been developed to facilitate clinical decision making. This manuscript discusses the diagnostic evaluation of individuals with suspected breast cancer due to either abnormal imaging and/or physical findings. For breast cancer screening recommendations, please see the full guidelines on NCCN.org.

Mindsets May Matter in Nursing Education.

Nursing education needs innovative and effective teaching models that are easily conveyed and economical. Dweck's mindset model harnesses the predictive power of noncognitive factors such as motivation, perseverance, effort, and academic tenacity to shape the learner's perceptions of intelligence for competency development. All individuals possess perceptions of intelligence; however, the mindset model demonstrates the immense potential associated with endorsement of the growth mindset and student success.

Using Acute Flaccid Paralysis Surveillance as a Platform for Vaccine-Preventable Disease Surveillance.

Surveillance for acute flaccid paralysis (AFP) is a fundamental cornerstone of the global polio eradication initiative (GPEI). Active surveillance (with visits to health facilities) is a critical strategy of AFP surveillance systems for highly sensitive and timely detection of cases. Because of the extensive resources devoted to AFP surveillance, multiple opportunities exist for additional diseases to be added using GPEI assets, particularly because there is generally 1 district officer responsible for all disease surveillance. For this reason, integrated surveillance has become a standard practice in many countries, ranging from adding surveillance for measles and rubella to integrated disease surveillance for outbreak-prone diseases (integrated disease surveillance and response). This report outlines the current level of disease surveillance integration in 3 countries (Nepal, India, and Nigeria) and proposes that resources continue for long-term maintenance in resource-poor countries of AFP surveillance as a platform for surveillance of vaccine-preventable diseases and other outbreak-prone diseases.

Eosinophil-associated processes underlie differences in clinical presentation of loiasis between temporary residents and those indigenous to Loa-endemic areas.

BACKGROUND: Loa loa has emerged as an important public health problem due to the occurrence of immune-mediated severe posttreatment reactions following ivermectin distribution. Also thought to be immune-mediated are the dramatic differences seen in clinical presentation between infected temporary residents (TR) and individuals native to endemic regions (END). METHODS: All patients diagnosed with loiasis at the National Institutes of Health between 1976 and 2012 were included. Patients enrolled in the study underwent a baseline clinical and laboratory evaluation and had serum collected and stored. Stored pretreatment serum was used to measure filaria-specific antibody responses, eosinophil-related cytokines, and eosinophil granule proteins. RESULTS: Loa loa infection in TR was characterized by the presence of Calabar swelling (in 82% of subjects), markedly elevated eosinophil counts, and increased filaria-specific immunoglobulin G (IgG) levels; these findings were thought to reflect an unmodulated immune response. In contrast, END showed strong evidence for immune tolerance to the parasite, with high levels of circulating microfilariae, few clinical symptoms, and diminished filaria-specific IgG. The striking elevation in eosinophil counts among the TR group was accompanied by increased eosinophil granule protein levels (associated with eosinophil activation and degranulation) as well as elevated levels of eosinophil-associated cytokines. CONCLUSIONS: These data support the hypothesis that differing eosinophil-associated responses to the parasite may be responsible for the marked differences in clinical presentations between TR and END populations with loiasis.

Achievement Goal Theory and Mindsets: Keys for Competency Development in Nursing.

BACKGROUND: Many nursing schools are transitioning to a competency-based model due to the increasing complexity of medical information, skills, task acuities, and cognitive overload. PROBLEM: Nursing faculty may not be familiar with the synergy between achievement goal theory and the growth mindset (GM) model to prepare nursing students within a competency-based model effectively. APPROACH: This article presents a persuasive argument for how integrating achievement goal theory and the GM model could effectively foster mastery goals essential for competency development. CONCLUSIONS: Mastery goals, a component of the GM model, can be used as tangible indicators for assessing and evaluating competency development.

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.

Let's go to camp! An innovative pediatric practice placement.

Each year, children living with disabilities escape from their families for 1 week at camp armed with their sun block, sleeping bags and talent-show costumes. In British Columbia, Canada, Easter Seals Camps offer such adventures to over 800 children/teens with physical/mental disabilities, providing free, overnight camping with on-site nurses. Easter Seals Camps offer pediatric placements to nursing students to work with nurses in a multidisciplinary team. In this paper, we describe this partnership, explain the role of camp nurse, portray student learning opportunities and offer recommendations to pediatric nurses who may consider participating in similar innovative placements in pediatric camps.

Reverse Mentoring in Nursing Education.

BACKGROUND: Nurse educators are challenged to prepare an expanding number of diverse students with various sociocultural and generational differences. Whether diversity, sociocultural, and/or generational divides are contributory, a perennial decline exists of historically disenfranchised students finishing nursing programs. Reverse mentoring is an innovative adaption of traditional mentoring. Reverse mentoring is a practice that reverses traditional mentor and mentee roles, which may mitigate diverse and intergenerational misconceptions. PURPOSE: To prepare a diverse nursing workforce, educators should integrate strategies to embrace differences, reduce biases, remove learning barriers, and value learning new teaching methods. METHODS: A literature review revealed few articles on reverse mentoring in nursing education. RESULTS: Reverse mentoring is a successful strategy in many Fortune 500 companies. Therefore, reverse mentoring may demonstrate promise in nursing education. CONCLUSION: Exploring reverse mentoring in nursing education may reveal strategies to elucidate and mitigate biases and barriers in nursing education.

Mapping the distribution of zero-dose children to assess the performance of vaccine delivery strategies and their relationships with measles incidence in Nigeria.

Geographically precise identification and targeting of populations at risk of vaccine-preventable diseases has gained renewed attention within the global health community over the last few years. District level estimates of vaccination coverage and corresponding zero-dose prevalence constitute a potentially useful evidence base to evaluate the performance of vaccination strategies. These estimates are also valuable for identifying missed communities, hence enabling targeted interventions and better resource allocation. Here, we fit Bayesian geostatistical models to map the routine coverage of the first doses of diphtheria-tetanus-pertussis vaccine (DTP1) and measles-containing vaccine (MCV1) and corresponding zero-dose estimates in Nigeria at 1x1 km resolution and the district level using geospatial data sets. We also map MCV1 coverage before and after the 2019 measles vaccination campaign in the northern states to further explore variations in routine vaccine coverage and to evaluate the effectiveness of both routine immunization (RI) and campaigns in reaching zero-dose children. Additionally, we map the spatial distributions of reported measles cases during 2018 to 2020 and explore their relationships with MCV zero-dose prevalence to highlight the public health implications of varying performance of vaccination strategies across the country. Our analysis revealed strong similarities between the spatial distributions of DTP and MCV zero dose prevalence, with districts with the highest prevalence concentrated mostly in the northwest and the northeast, but also in other areas such as Lagos state and the Federal Capital Territory. Although the 2019 campaign reduced MCV zero-dose prevalence substantially in the north, pockets of vulnerabilities remained in areas that had among the highest prevalence prior to the campaign. Importantly, we found strong correlations between measles case counts and MCV RI zero-dose estimates, which provides a strong indication that measles incidence in the country is mostly affected by RI coverage. Our analyses reveal an urgent and highly significant need to strengthen the country's RI program as a longer-term measure for disease control, whilst ensuring effective campaigns in the short term.

Marketing retail health clinics: challenges and controversies arising from a health care innovation.

Since their founding in 2000, retail-based health care clinics, also called convenient care clinics, have flourished but continue to generate controversy. This article examines the literature with respect to the industry's background, establishment of industry standards, types of services offered, marketing of retail health clinics, industry growth with new target markets, and patient demographics. It also examines the growing relationship with insurers and third-party payers, quality-of-care concerns by medical associations, and legal regulations and their potential impact on industry growth nationwide.

Nursing Students' Mindsets and Choice of Learning Strategies.

BACKGROUND: Nursing students may not use the most effective learning strategies. Offering students an academic success model such as Dweck's mindset model may improve student learning. The influence of nursing students' mindsets on study strategies has not been explored. PURPOSE: This study examined nursing students' mindset proclivity and choice of learning strategies. METHODS: This descriptive, cross-sectional quantitative pilot study used a web-based survey to examine a national sample of 151 nursing students' mindsets and learning habits. RESULTS: Students with a growth mindset demonstrated the use of more effective learning strategies than their fixed mindset peers. CONCLUSIONS: Nurse educators need to assess student learning because half of the students in this study had never had anyone teach them how to learn effectively. Early evidence is emerging that the growth mindset model may hold promise as an academic success model for nursing education.

Mindsets in health professions education: A scoping review.

The growth mindset model has been linked with enhancing academic success in college students. A scoping review was conducted detailing evidence of the growth mindset model's application in health professions. Databases searched included: MEDLINE, CINAHL, ERIC, Scopus, Conference Papers Index, Embase, and Education Database. A hand search was also carried out. 1296 articles were reviewed. Inclusion/exclusion resulted in 22 articles from health professions articles: medical education (10), nursing (3), veterinary (3), pharmacy (2), physiotherapy (1), and general health professions education (3). This study demonstrated that fixed mindset student learners may avoid constructive feedback, hide errors, and express negative maladaptive behaviors that threaten their learning. To cultivate an adaptive lifelong learning health professional, the growth mindset model shows promise and should be integrated into curricula. In closing, many articles were not empirical research. Implications: The growth mindset model shows promise for academic success in health professions education, but more robust studies are warranted.

Development of a Palliative Telehealth Pilot to Meet the Needs of the Nursing Home Population.

Many older adults will spend their final days in a skilled nursing facility because of multiple complex conditions. Patients with unclear goals of care are at higher risk of rehospitalization and burdensome care at end of life. Palliative care has been shown to improve outcomes for this patient population; however, access is limited because of the small number of boarded specialists nationwide. Telehealth offers the ability to expand the reach of palliative care to both underserved geographies and community settings. This quality improvement pilot project details the development and implementation of a telehealth palliative care program available to nursing home residents. Eight nursing homes, in the New England region of the United States, participated in the 4-month pilot. The palliative telehealth program offered real-time access to a palliative care specialist able to provide symptom management, goals-of-care discussions, and Medical Orders for Life-Sustaining Treatment completion. The pilot shows promising outcomes including code status change, Medical Order for Life-Sustaining Treatment form completion, and reduced hospitalizations supporting the benefit of comprehensive goals-of-care discussions for frail older adults living in a nursing home. As health care moves into the digital age, telemedicine plays a large role in the delivery of essential patient care. Provision of palliative specialists by telehealth allows the opportunity to address the unmet needs of this frail population.

Development of a Multiplex Tandem PCR (MT-PCR) Assay for the Detection of Emerging SARS-CoV-2 Variants.

The emergence of variants of SARS-CoV-2 has created challenges for the testing infrastructure. Although large-scale genome sequencing of SARS-CoV-2 has facilitated hospital and public health responses, access to sequencing facilities globally is variable and turnaround times can be significant, so there is a requirement for rapid and cost-effective alternatives. Applying a polymerase chain reaction (PCR)-based single nucleotide polymorphism (SNP) approach enables rapid (<4 h) identification of SARS-CoV-2 lineages from nucleic acid extracts, through the presence or absence of a panel of defined of genomic polymorphisms. For example, the B.1.1.7 lineage ("UK", "Alpha", or "Kent" variant) is characterised by 23 mutations compared to the reference strain, and the most biologically significant of these are found in the S gene. We have developed a SARS-CoV-2 typing assay focused on five positions in the S gene (HV69/70, N501, K417, E484 and P681). This configuration can identify a range of variants, including all the "Variants of Concern" currently designated by national and international public health bodies. The panel has been evaluated using a range of clinical isolates and standardised control materials at four UK hospitals and shows excellent concordance with the known lineage information derived from full sequence analysis. The assay has a turnaround time of about three hours for a set of up to 24 samples and has been utilised to identify emerging variants in a clinical setting.

Nursing Students' Mindsets Matter: Cultivating a Growth Mindset.

BACKGROUND: Dweck's growth mindset model, as a cognitive psychology model, details how various individuals perceive intelligence and academic ability. The growth mindset model has demonstrated academic success in students across many disciplines for more than 30 years. PROBLEM: The growth mindset model has not been examined in prelicensure nursing education. APPROACH: This article introduces the growth mindset model, highlights differences and implications on learning between the 2 mindsets, and offers suggestions to cultivate the growth mindset model in nursing education. CONCLUSIONS: Given the scholastic merits attributed to the growth mindset model, a closer investigation into the potential integration of the model into nursing education may be warranted.

Developing a risk-model of time to first-relapse for children and adolescents with a psychotic disorder.

Individuals treated for psychotic disorders and mood disorders with psychotic features have a high likelihood of relapse across the life course. This study examines the relapse rate and its associated predictors for children and adolescents experiencing a first-episode and develops a statistical risk-model for prediction of time to first-relapse. A multiyear, retrospective cohort design was used to track youth, under the age of 18 years, who experienced a first-episode of psychosis, and were admitted to 1 of 6 inpatient hospital psychiatric units (N = 87). Participants were followed for at least 2 years (M = 3.9, SD = 1.3) using survival analysis. Approximately 60% of subjects experienced relapse requiring hospital readmission by the end of follow-up, with 33% readmitted within the first year and 44% within 2 years. Median survival time was 34 months. Cox proportional hazards regression identified 4 key risk factors for relapse: medication nonadherence, female gender, receiving clinical treatment, and a decline in social support before first admission.