Irritable bowel syndrome: Clinical practice update.

ABSTRACT: Irritable bowel syndrome (IBS) is a common and burdensome disorder characterized by chronic recurrent abdominal pain and altered bowel habits. IBS remains misunderstood, leading to delayed diagnosis, impaired quality of life, and substantial healthcare costs. Advancing clinicians' understanding of this complex biopsychosocial process, using a positive diagnostic strategy rather than a diagnosis of exclusion, and incorporating a multimodal treatment approach expedite time to diagnosis, facilitate symptom relief, and reduce financial expenditure.

When and How to Utilize Pudendal Nerve Blocks for Treatment of Pudendal Neuralgia.

Chronic pelvic pain is a common cause of pain in reproductive age women with debilitating consequences for affected women's health and quality of life. Treatment providers must be well versed in all treatment options for these patients, understanding the overlap in the management and treatment of chronic pelvic pain caused by pudendal neuralgia, myofascial pelvic pain, and vulvodynia. Pudendal blocks are a simple and quick procedure that can be performed in the office and often helps improve all the above conditions when used along with other treatment options. We review the anatomy and methodology on when and how to perform pudendal blocks in the office to better inform the general gynecologist on how to implement offering this treatment in the outpatient clinical setting.

The nurse wellbeing self-assessment supports the model of leadership influence for health professional wellbeing.

BACKGROUND: Despite emerging evidence of effective strategies for reducing burnout among health professionals, health professional burnout continues increasing. PURPOSE: A systematic Model of Leadership Influence for Health Professional Wellbeing is presented suggesting steps to measurably improve wellbeing by managing or mitigating stressors that generate burnout. METHOD: This paper examines (a) the psychometric properties of the Nurse Wellbeing Self-Assessment's (NWSAT)© four 10-item scales and (b) whether and how the Model of Leadership Influence can apply NWSAT results to reduce burnout. Using nurse survey data (N = 1,394) from one large eastern US healthcare system, the four NWSAT scales are psychometrically evaluated. FINDINGS: Predictive tests demonstrate the fit of the Model of Leadership Influence by documenting associations between NWSAT and burnout. All four NWSAT scales are strongly and inversely associated with burnout. DISCUSSION: Leaders can use NWSAT to systematically implement and evaluate a variety of strategies to improve staff wellbeing in one or more domains of NWSAT to manage or mitigate specific stressors that may otherwise contribute toward burnout.

Application of the model of leadership influence for health professional wellbeing during COVID-19.

BACKGROUND: Nurse burnout is a top patient safety concern. Workplace stress and burnout results in high turnover rates, costs, and lessened productivity and quality care. Although the relationship of burnout to patient outcomes and communication has been proposed, there is little available in terms of a theoretical framework to guide leaders in developing a comprehensive and effective approach to promoting wellbeing and reducing burnout. PURPOSE: This paper demonstrates a theoretical application of the Model of Leadership Influence for Health Professional Wellbeing to support staff wellbeing by developing targeted approaches that address the four dimensions of whole person wellbeing. METHOD: Published literature from the COVID-19 pandemic is used for context to demonstrate the use of the model. FINDINGS: The model can be used to facilitate exploration and navigation of the complex issues surrounding burnout and wellbeing. DISCUSSION: Leaders may find the model can be a useful tool to promote staff wellbeing.

Early Cardiac Rehabilitation to Reduce Heart Failure Readmissions.

PURPOSE: This research was conducted to determine whether early participation in cardiac rehabilitation (CR) reduces readmissions following heart failure (HF) hospitalization. METHODS: A retrospective quasiexperimental comparison group design was used. Electronic medical records were abstracted for HF patients discharged between March 2013 and December 2017. The treatment group was defined as patients with HF who attended ≥1 CR session within 6 wk following discharge. The comparison group was defined as patients with HF without additional HF hospitalizations during the previous year, discharged to home/self-care, and did not attend CR within 6 wk. Readmission rates at 30 d and 6 wk were compared between groups using χ 2 analysis and logistic regression. RESULTS: Out of 8613 patients with HF, 205 (2.4%) attended ≥1 CR within 6 wk post-discharge. The treatment group had lower, but not statistically significant, readmission rates than the comparison group for 30-d readmissions for HF ( P = .13), and 6-wk readmission rates for HF ( P = .05). The treatment group had lower all-cause readmissions at 30 d (P < .01) and 6 wk ( P < .01) than the comparison group. Multivariable logistic regression revealed that early CR attendance was associated with reduced 30-d all-cause readmissions (adjusted OR = 0.4: 95% CI, 0.2-0.7) and 6-wk all-cause readmissions (adjusted OR = 0.5: 95% CI, 0.3-0.8). CONCLUSIONS: This study contributes to the existing evidence for allowing early unrestricted CR participation with the aim of improving the health of patients with HF and reducing rehospitalization rates.

Pain management consultation for acute pancreatitis: impact on length of stay and opioid utilization.

Aim: The purpose of the study was to understand the impact of a pain management consult for acute pancreatitis patients on their inpatient length of stay, morphine milligram equivalences (MMEs) and pancreatitis severity. Materials & methods: Adult patient data were extracted from the electronic health records from 1 October 2016 to 31 December 2018. Results & conclusion: Of 277 patients with a single acute pancreatitis hospitalization, 23 had a pain consultation (treatment group), whereas 254 did not (control group). There were statistically significant differences in median length of stay, median MME total and median MME per day between the treatment and control groups with comparable severity and pain scores (6.8 vs 3.1 days, 196.5 vs 33.8 MMEs, 30.9 vs 12.1 MMEs, respectively, p < 0.0001). This study emphasizes the complexity of pain management and the importance of further research in the field.

Examination of the Moderating Effect of Race on the Relationship between Vitamin D Status and COVID-19 Test Positivity Using Propensity Score Methods.

INTRODUCTION: With a well-established role in inflammation and immune function, vitamin D status has emerged as a potential factor for coronavirus disease-2019 (COVID-19). OBJECTIVE: The purpose of this study was to evaluate the moderating effect of race on the relationship between vitamin D status and the risk of COVID-19 test positivity, and to compare propensity score (PS) model results to those obtained from classical bivariate and multivariable models, which have primarily comprised the literature to date. METHODS: Electronic health record (EHR) data from TriNetX (unmatched n = 21,629; matched n = 16,602) were used to investigate the effect of vitamin D status, as measured by 25-hydroxyvitamin D [25(OH)D], on the odds of experiencing a positive COVID-19 test using multivariable logistic regression models with and without PS methodology. RESULTS: Having normal (≥ 30 ng/mL) versus inadequate 25(OH)D (< 30 ng/mL) was not associated with COVID-19 positivity overall (OR = 0.913, p = 0.18), in White individuals (OR = 0.920, p = 0.31), or in Black individuals (OR = 1.006, p = 0.96). When 25(OH)D was analyzed on a continuum, a 10 ng/mL increase in 25(OH)D lowered the odds of having a positive COVID-19 test overall (OR = 0.949, p = 0.003) and among White (OR = 0.935, p = 0.003), but not Black individuals (OR = 0.994, p = 0.75). CONCLUSIONS: Models which use weighting and matching methods resulted in smaller estimated effect sizes than models which do not use weighting or matching. These findings suggest a minimal protective effect of vitamin D status on COVID-19 test positivity in White individuals and no protective effect in Black individuals.

A practical approach to selecting a colorectal cancer screening test.

ABSTRACT: Colorectal cancer is the second leading cause of cancer-related deaths in the United States, but timely, effective, and adherent screening can reduce the number of cases. Screening tests continue to evolve, creating opportunities and challenges. Medical societies offer varying guidelines about optimal screening tests and when to begin screening. This article reviews available and emerging colorectal cancer screening tests and discusses how to educate patients, advise them in selecting an appropriate test, and promote increased participation in colorectal cancer screening.

Brief Mindfulness Practice Course for Healthcare Providers.

OBJECTIVE: The aim of this study was to examine the short-term and sustained effect on well-being, burnout, and mindful awareness of an abbreviated mindfulness practice course designed for nurses and other healthcare professionals. BACKGROUND: Most mindfulness programs are impractical for frontline healthcare providers because of the intensive, off-site initial training and prolonged practice commitment. A psychiatric nurse educator developed a brief training program tailored for healthcare providers. METHODS: Two institutional review board-approved studies examined the abbreviated mindfulness practice course for healthcare providers: the first, a single-group pretest-posttest design with 25 nursing employees in an academic medical center, and the second, a randomized controlled trial with 83 healthcare professionals. RESULTS: Significant improvement in mindful awareness and at least 1 indicator of burnout were demonstrated. Improvements in quality of life were noted with nurses. CONCLUSIONS: Findings support the short-term and sustained impact of this brief mindfulness curriculum on mindful awareness, quality of life, and aspects of burnout for healthcare professionals.

A Longitudinal Study of the Impact of Schwartz Center Rounds on Moral Distress.

Moral distress occurs when moral integrity is compromised and can affect any healthcare professional. This study examined the impact of Schwartz Center Rounds (SCRs) on moral distress using a longitudinal, quasi-experimental design to examine SCR attendees from 2015 to 2019. Data were collected via a 2-part survey composed of demographics and Moral Distress Thermometer (MDT) readings before rounds and immediately after rounds. Most participants experienced either no change in moral distress (50.6%) or a decrease in moral distress (33.7%) after attending one of the SCRs. Participants who worked with adult populations had higher moral distress after participation for most topics. An increase in moral distress was associated with a longer time in the current position. Fifty percent of the physicians had a decrease in their moral distress immediately after the rounds. Schwartz Center Rounds is a promising approach to foster high-functioning teams while promoting wellness and mitigating moral distress among employees.

Pediatric and Neonatal Tracheostomy Caregiver Education with Phased Simulation to Increase Competency and Enhance Coping.

PURPOSE: Infants and children with medically complex needs depend on their caregivers for activities of daily life and specialized care of various devices they need to survive. Caregiver education is a primary goal in discharge planning to ensure safe, competent home care for these medically fragile children. Standard of care is bedside teaching. The Family Tracheostomy Program complements traditional training with a phased process of simulation. The purpose of this QA/QI project was to increase caregiver competency and decrease anxiety level for pediatric tracheostomy care through simulation training. METHOD: For two years, the pediatric and neonatal intensive care units trained twenty caregivers of new tracheostomy patients with the supplementation of simulation to standard bedside training. Using a five-point rating scale, caregivers completed pre- and post- tests for separate skills and scenario training sessions. RESULTS: Skills scores were hypothesized to increase after simulation training. In a small sample (n = 20), scores increased from pre-test (µ = 11.45, SD = 4.88) to post-test (µ = 22.6, SD = 2.01). This change was significant (t(19) = 10.78, p < 0.001). Scenario scores were hypothesized to increase after simulation training. In another small sample (n = 15), scores increased from pre-test (µ = 23.40, SD = 7.11) to post-test (µ = 28.73, SD = 2.31). This change was significant (t(14) = 3.78, p < 0.001). CONCLUSION: Simulation as a complement to bedside caregiver education increased caregiver competency and decreased anxiety levels for these samples. PRACTICE IMPLICATIONS: Organizations caring for neonatal and pediatric tracheostomy patients might consider providing additional support with a phased method of simulation as part of caregiver education.

The Nurse Manager's Experience of Moral Distress.

The purpose of this study was to describe the moral distress experiences of nurse managers. Moral distress has been studied among direct patient care providers including nurses and physicians. The moral distress experience among nurse managers is less understood. We conducted a qualitative descriptive study with 19 nurse managers from 5 healthcare institutions in Virginia. Interview data were analyzed using a directed content analysis, as the structural components of the moral distress phenomenon are already known. Participants suffered moral distress when they were unable to achieve or maintain effective unit function and felt caught in the middle between their units' and employees' needs and organizational directives. System-level causes of moral distress are common among nurse managers. Future research should involve measurement of moral distress among nurse managers and exploration of effective interventions.

Evaluation of engineered sorbents for the sorption of mercury from contaminated bank soils: a column study.

As a global environmental pollutant, mercury (Hg) threatens our water resources and presents a substantial risk to human health. The rate and extent of immobilization of Hg2+ (hereafter, Hg) on engineered sorbents (Thiol-SAMMS®, pine biochar, SediMite™, Organoclay™ PM-199, and quartz sand as a control) was evaluated using flow-through column experiments. The effectiveness of the sorbents was based on (1) the percentage of Hg removed in relation to the total amount of Hg passing the sorbent column, and (2) the rate of Hg uptake compared to the nonreactive tracer bromide (Br-). All sorbents removed Hg to a certain extent, but none of the sorbents removed all the Hg introduced to the columns. Thiol-SAMMS showed the highest mean percentage of Hg removed (87% ± 2.9%), followed by Organoclay PM-199 (71% ± 0.4%), pine biochar (57% ± 22.3%), SediMite (61% ± 0.8%), and the control quartz sand (11% ± 5.6%). Thiol-SAMMS was the only sorbent to exhibit retardation of Hg in comparison to the conservative tracer Br-. For the remaining sorbents, Br- along with low concentrations of Hg were eluted within the first 3 pore volumes, indicating limited retardation of Hg. Overall, removal of Hg by sorbents was substantial, suggesting that sorbents might be suitable for deployment in contaminated environments. High concentrations of DOM leaching from the soil columns likely influenced the speciation of Hg and inhibited sorption to the sorbents. Incomplete removal of Hg by any sorbent suggests that additional optimization is needed to increase efficiency.

Bras for Breast Support After Sternotomy: Patient Satisfaction and Wear Compliance.

BACKGROUND: For women undergoing median sternotomy, especially those with a bra cup size C or larger, breast support can reduce pain, wound breakdown, and infection. This study addressed a gap in research, identifying the best bra after sternotomy in terms of patient satisfaction and wear compliance. OBJECTIVES: To evaluate larger-breasted women's satisfaction and compliance with wearing 3 commercially available front-closure bras-with a hook-loop closure (the hospital's standard of care), a zipper closure, or a hook-eye closure-after cardiac surgery. METHODS: This study used a posttest-only, 3-group randomized controlled design. A convenience sample of participants were sized and randomly assigned a product that was placed immediately postoperatively. Participants agreed to wear the bra at least 20 h/d until the provider cleared them for less wear. At inpatient day 5 or discharge, and at the follow-up outpatient visit, subjects completed investigator-developed surveys. Data were analyzed from 60 participants by using the χ2 test and Kruskal-Wallis analysis of variance; also, patterns were identified within written comments. RESULTS: Participants were most satisfied with the hook-eye front-closure product before (P = .05) and after (P = .02) discharge. Participants recommended the hook-eye and zipper products over the hook-loop bra (H = 8.39, P = .02). Wear compliance was strongest in the group wearing the hook-eye bra. CONCLUSIONS: The hook-eye closure product had the most satisfaction and greatest wear compliance, and it received the highest recommendation. A practice change was made to fit and place the hook-eye bra in the operating room immediately after surgery.

Hazardous substances as the dominant non-methane volatile organic compounds with potential emissions from liquid storage tanks during well fracturing: A modeling approach.

Chemical additives used in hydraulic fracturing fluids (HFFs) are made up of various organic compounds that are potential human carcinogens. To estimate the emissions from these organic constituents in on-site liquid storage tanks, studies were performed using the AP-42 model on data collected from 72,023 wells put into production using hydraulic fracturing between 2008 and 2014 in the United States. Results show that a total of 8.11 × 105 kg volatile organic compounds (VOCs) were potentially emitted from liquid storage tanks during fracturing operations, which was relatively low compared to other sources/activities in well fracturing. The median well emission roughly increased from 0.110 to 0.786 kg per well in 2008 and 2014, respectively, and was primarily due to the increase in the volume of chemical additives for fracturing one well. Of NMVOC emissions, 95.1% was contributed by 60 compounds listed on the priority list of hazardous substances defined by the Agency for Toxic Substances & Disease Registry (ATSDR), while 16.7% was caused by 15 carcinogenic compounds. Specially, methanol, formaldehyde, 2-propanol, and ethanol accounted for 55.5%, 16.6%, 11.7%, and 8.31% of NMVOC emissions. Our study highlights methanol, formaldehyde, 2-propanol, and ethanol as the targeted compounds for reducing organic emissions and occupational inhalation exposures related to storage tank operations.

Reducing Waste in the Clinical Setting.

Nurses have the capacity and opportunity to alter their organization's environmental footprint. This article addresses how they can strengthen efficiency and environmental sustainability initiatives in their facilities by engaging in, monitoring, and supporting environmentally friendly clinical practices and programs at the point of care. Included are practical tips and examples of projects in which nurses identified sources of waste-the relaundering of unused linens; disposal of unused products; and improper sorting of pharmaceutical waste, recycling, and regulated medical waste-and realized significant cost savings as well as improved efficiency and environmental sustainability.

Being a Research Mentor: A Qualitative Study.

OBJECTIVES: This qualitative study was designed to describe the experiences of mentors for a nursing research fellowship at a southeastern US academic medical center. BACKGROUND: Mentoring is an important aspect of nursing and is a key strategy to develop nurse leaders and faculty. Research mentors have been identified as essential for novice researchers to be able to complete clinical studies. However, there has been limited research on the experience of nursing research mentors, despite the emphasis on the critical nature of this role. METHODS: Eight mentors for 23 studies over 8 years of a nursing research fellowship participated in a study outlining their experiences as research mentors. RESULTS: Common themes emerged from mentors' identification of key components in the research mentoring process and elements necessary for effective support of frontline nurse researchers. CONCLUSIONS: Recommendations for developing effective, confident research mentors are drawn from the analyses.

Interpersonal Gun Violence Research in the Social Work Literature.

Interpersonal gun violence remains a major public health issue in the United States and beyond. This article explores the research on interpersonal gun violence published in peer-reviewed social work journals since the mid-1990s. Findings from this review indicate that the existing scholarship offers some important insights into this topic, particularly related to risk factors for and the effects of exposure to gun violence. These findings, however, also point to some shortcomings in the literature, including problems with the measurement and analytic treatment of exposure to gun violence and a lack of research with direct victims and perpetrators of gun violence. Implications for future research are discussed.

In situ transformation of hydraulic fracturing surfactants from well injection to produced water.

Chemical changes to hydraulic fracturing fluids (HFFs) within fractured unconventional reservoirs may affect hydrocarbon recovery and, in turn, the environmental impact of unconventional oil and gas development. Ethoxylated alcohol surfactants, which include alkyl ethoxylates (AEOs) and polyethylene glycols (PEGs), are often present in HFF as solvents, non-emulsifiers, and corrosion inhibitors. We present detailed analysis of polyethoxylates in HFF at the time of injection into three hydraulically fractured Marcellus Shale wells and in the produced water returning to the surface. Despite the addition of AEOs to the injection fluid during almost all stages, they were rarely detected in the produced water. Conversely, while PEGs were nearly absent in the injection fluid, they were the dominant constituents in the produced water. Similar numbers of ethoxylate units support downhole transformation of AEOs to PEGs through central cleavage of the ethoxylate chain from the alkyl group. We also observed a decrease in the average ethoxylate (EO) number of the PEG-EOs in the produced water over time, consistent with biodegradation during production. Our results elucidate an overlooked surfactant transformation pathway that may affect the efficacy of HFF to maximize oil and gas recovery from unconventional shale reservoirs.