Feasibility of Providing Safe Mouth Care and Collecting Oral and Fecal Microbiome Samples from Nursing Home Residents with Dysphagia: Proof of Concept Study.

Individuals with dysphagia who reside in nursing homes often receive inadequate mouth care and experience poor oral health. From a policy perspective, the combination of absent evidence-based mouth care protocols coupled with insufficient dental coverage create a pool of individuals at great risk for preventable infectious illnesses that contribute to high health care costs. The purpose of the current study was to determine (a) the safety of a mouth care protocol tailored for individuals with dysphagia residing in nursing homes without access to suction equipment, and (b) the feasibility of collecting oral and fecal samples for microbiota analyses. The mouth care protocol resulted in improved oral hygiene without aspiration, and oral and fecal samples were safely collected from participants. Policies supporting ongoing testing of evidence-based mouth care protocols for individuals with dysphagia are important to improve quality, demonstrate efficacy, and save health care costs. [Journal of Gerontological Nursing, 43(9), 9-15.].

Case Presentation of a Neuroglial Cyst Causing Acute Hydrocephalus.

Neuroglial cysts are rare congenital cysts that seldom require surgical treatment. This case highlights a rare instance when a neurolglial cyst caused acute hydrocephalus in a 10-year old boy. Originally diagnosed and managed as pediatric-onset migraines, the patient presented to the emergency department with nausea, vomiting, and ataxia without clear pathology on neuroradiology. The neurosurgical team took him to the operating room based on his clinical picture and history and the cyst was discovered there. The pathology was benign, and he has had a complete resolution of symptoms.

End-of-Life Education in a Prelicensure Nursing Program.

The demand for palliative and end-of-life nursing is increasing with the aging US population. The American Association of Colleges of Nursing published recommendations for incorporating palliative and end-of-life care across nursing curriculum to prepare the future workforce. However, recommendations regarding teaching end-of-life content are limited. This project aimed to integrate and evaluate the outcomes of end-of-life education introduced in a prelicensure nursing program. Using a documentary created by the American Nurses Foundation, students had the opportunity to discuss common themes in end-of-life care, practice morgue care in the simulation laboratory, and practice reflective journaling. The students' preevaluations and postevaluations indicated that the educational program significantly increased their confidence in providing end-of-life care and support to patients and families, demonstrating the importance of end-of-life curricula in nursing school.

The QSEN Competency Legacy Threaded Through the Entry-Level AACN Essentials: Shaping the Future.

BACKGROUND: For the last 17 years, the Quality and Safety Education for Nurses (QSEN) prelicensure competencies and knowledge, skill, and attitude (KSA) statements were integrated into nursing curricula. PROBLEM: With the publication of the competency-based American Association of Colleges of Nursing (AACN) Essentials , it is important to determine the overlap of the QSEN competencies. APPROACH: We developed a QSEN-AACN prelicensure crosswalk to help faculty map and integrate the 2021 AACN Essentials into their curriculum. OUTCOMES: The 6 QSEN competencies match to the 10 AACN Essentials domains except for evidence-based practice, which is listed as a concept. Fifty graduate-level QSEN KSAs were found to better align with prelicensure education and therefore important to integrate into the crosswalk. All but 1 of the original prelicensure QSEN KSA statements and all but 2 of the 50 transferred graduate-level QSEN KSAs were found in the AACN Essentials . CONCLUSION: Faculty implementing the QSEN framework can use the QSEN-AACN competency crosswalk and QSEN teaching strategies to guide their AACN Essentials journey.

Anosognosia for Hemiplegia and Falls After Stroke: A Prospective Correlational Study.

PURPOSE: The aim of this study was to explore the association between the presence and severity of anosognosia for hemiplegia (AHP) and falls in stroke survivors. DESIGN: A prospective, correlational research design was utilized. METHODS: Primary instrumentation included demographic information and the Visual-Analogue Test for Anosognosia for motor impairment (VATA-m). Correlational and regression analyses were performed between a priori variables. RESULTS: There was no statistically significant relationship found between AHP and falls. An incidental finding included that clinicians erroneously charted that their patients were aware of their physical limitations 100% of the time, which indicates that there is discord between clinicians and patients regarding physical limitations. CONCLUSIONS: Though no statistically significant relationship was found between AHP and falls, the incidental finding of dissonance between the patient and the clinician has important clinical implications. RELEVANCE: The relationship between AHP and stroke rehabilitation outcomes is still not understood, and incorporating part of the VATA-m into patient assessment could improve clinician understanding of patient awareness.

Value of Using a Structured Improvement Approach: A Dedicated Education Unit Exemplar.

ABSTRACT: Using a structured approach to improvement that integrates methodological frameworks and commonly used improvement tools and techniques allows an improvement team to systematically implement and evaluate an intervention. Authors from one academic medical center will describe our four-step structured improvement approach in the design of a dedicated education unit (DEU) pilot to potentially meet a critical post-COVID-19 workforce need. Using our structured improvement approach, we successfully piloted a DEU with a unit-based clinical educator and 16 nursing students over 26 clinical days and received 13 preintervention surveys from participants. Although the DEU pilot was small with limited data, the structured improvement approach resulted in an organized and systematic way of designing, implementing, and evaluating improvement.

Understanding Anosognosia for Hemiplegia After Stroke.

BACKGROUND: Anosognosia for hemiplegia (AHP) after stroke is a complex cognitive behavioral disorder that removes awareness of one-sided paralysis (hemiplegia). As a result, stroke survivors afflicted with AHP may be more likely to have unrealistic expectations for stroke rehabilitation, display unsafe behaviors and experience falls, and ultimately suffer the physical and psychological consequences of frequent falling. OBJECTIVE: The purpose of this article is to describe AHP by discussing anosognosia within the context of contemporary theoretical understandings, examining current imaging evidence of the disorder, and summarizing emerging interventions designed to reinstate self-awareness in anosognosic patients. METHOD: Systematic review with a focus on defining and describing AHP based on human experimental studies was conducted within a 10-year period. RESULTS: Eleven studies were identified. The content and foci of the 11 studies fell into one of three categories: theory testing, imaging evidence, and interventions for individuals with AHP.

Attenuation of cocaine-seeking by progesterone treatment in female rats.

Clinical research suggests that gender differences exist in cocaine dependence. Similarly, preclinical studies have shown that female rats exhibit higher response rates during cocaine self-administration, early extinction, and cocaine-primed reinstatement of drug-seeking. These effects are also estrous cycle dependent and inversely related to plasma progesterone, in that proestrus females (high progesterone) exhibit less cocaine-seeking, while estrous females (low progesterone) show the greatest cocaine-seeking. Based on these findings, we hypothesized that progesterone would attenuate cocaine-seeking behavior in intact, freely cycling animals. The role of the estrous cycle on cocaine-seeking behavior during early (first acquisition day) versus late (last maintenance day) cocaine self-administration was also examined. Female, Sprague-Dawley rats self-administered cocaine (0.5 mg/kg/infusion, IV) along a FR1 schedule, followed by daily extinction sessions in the absence of cocaine reinforcement. Once responding was extinguished, rats received an injection of cocaine (10 mg/kg, IP) immediately prior to reinstatement testing. Progesterone (2 mg/kg, SC) or vehicle was administered 20 and 2h prior to the first day of extinction (early cocaine withdrawal) and the reinstatement trials. To determine estrous cycle phase, we assessed vaginal cytology prior to the first acquisition and last maintenance days of cocaine self-administration, the first day of extinction training, and each reinstatement test. During early and late cocaine self-administration, proestrus and estrous females exhibited the greatest levels of active lever responding, respectively. A significant increase in responding also occurred during cocaine-primed reinstatement for estrous versus nonestrous females, an effect that was selectively attenuated by progesterone. However, progesterone was not effective at reducing cocaine-primed reinstatement for females in other phases of the estrous cycle, nor was it effective at reducing cocaine-seeking during early withdrawal. Taken together, these results suggest that progesterone may be a useful therapeutic for preventing relapse in abstinent female cocaine users, especially when the likelihood of relapse is greatest.

Of Fur, Feather, and Fin: Human's Use and Concern for Non-Human Species.

The public's concern for animal welfare is evolving and it is important to consider factors that are related to concern for animals and their use by humans. An online survey of 825 U.S. residents was conducted. Relationships between approval of animal uses and stated concern for animal welfare were examined. More than 90% of respondents reported that using animals for egg production, service or therapy, pets, and milk production was acceptable to them. Respondents who were younger or reported being female less frequently found most uses acceptable than older or male respondents. Half of respondents reported concern for the welfare of bison while 40% or more stated concern for the welfare of elk, beef cattle, and dairy cattle. Respondents who stated they were concerned for the welfare of dairy cattle less frequently reported accepting using animals for meat production, livestock shows, and hunting. Thus, self-reported concern for animal species and acceptance of the use of animals were related in some instances. A better understanding of the factors related to acceptance of animal uses and concern for animal welfare will help animal-related industries and wildlife agencies develop practices that are consistent with public attitudes.

Perceptions of Hunting and Hunters by U.S. Respondents.

Public acceptance of hunting and hunting practices is an important human dimension of wildlife management in the United States. Researchers surveyed 825 U.S. residents in an online questionnaire about their views of hunting, hunters, and hunting practices. Eighty-seven percent of respondents from the national survey agreed that it was acceptable to hunt for food whereas 37% agreed that it was acceptable to hunt for a trophy. Over one-quarter of respondents did not know enough about hunting over bait, trapping, and captive hunts to form an opinion about whether the practice reduced animal welfare. Chi-square tests were used to explore relationships between perceptions of hunters and hunting practices and demographics. Those who knew hunters, participated in hunting-related activities, visited fairs or livestock operations, or were males who had more favorable opinions on hunting. A logistic regression model showed that not knowing a hunter was a statistically significant negative predictor of finding it acceptable to hunt; owning a pet was statistically significant and negative for approving of hunting for a trophy.

Social desirability bias in reporting of holiday season healthfulness.

Respondents participating in survey or interview based research often tend to give answers that put themselves in a favorable light, displaying social desirability bias (SDB). Understanding the susceptibility of individuals to underreport their perceived unhealthy holiday behaviors or over report holiday behaviors they perceive as healthy has important implications for health promotion and health policy surrounding the holiday season. This study examines SDB specific to the reporting of holiday food consumption and health-related behaviors. An online survey of 620 U.S. consumers was utilized to collect data in which SDB was accounted for via indirect questioning. The online survey was conducted by Purdue University from November 17-19, 2014. Up to 64% of respondents displayed SDB for the eight holiday health statements studied. Respondents over the age of 45 and without children more frequently displayed social desirability bias. Respondents who displayed SDB with respect to acceptable health related holiday food consumption behaviors may be more susceptible to social pressures surrounding other consumption decision making. Understanding SDB in health and behavior reporting, in particular for the traditionally challenging, in terms of health outcomes, holiday season is critical for health practitioners as they seek to promote healthy behaviors.

Subsite-specific colorectal cancer incidence rates and stage distributions among Asians and Pacific Islanders in the United States, 1995 to 1999.

OBJECTIVE: This study examined subsite-specific colorectal cancer incidence rates and stage distributions for Asians and Pacific Islanders (API) and compared the API data with data for Whites and African Americans. METHODS: Data included 336,798 invasive colorectal cancer incident cases for 1995 to 1999 from 23 population-based central cancer registries, representing about two thirds of API population in the United States. Age-adjusted rates, using the 2000 U.S. standard population, and age-specific rates and stage distributions were computed by anatomic subsite, race, and gender. All rates were expressed per 100,000. SEs and rate ratios were calculated for rate comparison. A significance level of 0.05 was used for all analyses. RESULTS: Overall, age-adjusted colorectal cancer incidence rates were significantly lower in API than in Whites and African Americans across anatomic subsites, particularly for proximal colon cancer in which rates were 40% to 50% lower in API males and females. Exception to this pattern was the significantly (10%) higher rectal cancer incidence rate in API males than in African American males. The incidence patterns by anatomic subsite within API differed from those of Whites and African Americans. Among API, the rate of rectal cancer (19.2 per 100,000) was significantly higher than the rates of proximal (15.2 per 100,000) and distal (17.7 per 100,000) colon cancers in males, with little variations in rates across anatomic subsites in females. In contrast, among White and African American males and females, proximal colon cancer rates were over 25% higher than the rates of distal colon and rectal cancers. Increases in age-specific rates with advancing age were more striking for proximal colon cancer than for distal colon and rectal cancers in Whites and African Americans, while age-specific rates were very similar for different subsites in API with parallel increases with advancing age, especially in API males. Similar to Whites and African Americans, in API, proximal colon cancers (32% to 35%) were also less likely to be diagnosed with localized stage compared with distal colon (38% to 42%) and rectal (44% to 52%) cancers. CONCLUSION: The patterns of subsite-specific colorectal cancer incidence in API, especially API males, differ from those of Whites and African Americans. Similar to Whites and African Americans, lower percentage of localized disease in API for proximal colon cancer than for distal colon and rectal cancers was also observed.