An Analysis and Review of the Use of State Legislator Clinical Site Visits to Increase Advocacy for Nurse Anesthesiologists.

Nurse anesthesiologists have successfully influenced legislative change to include full practice authority across the United States. These legislative changes directly impact the scope of practice as well as patient care and the advancement of the nursing profession. However, nurse anesthesiologists remain hesitant to embrace health policy advocacy as a professional responsibility. To act as advocates, awareness must exist around professional responsibility to engage in political advocacy, and how to engage in this role. We describe successful statewide strategies involving members of a professional state organization for nurse anesthesiologists. Leaders from the state organization incorporated clinical site visits to create a shared vision and inform legislators about their role and its influence on providing safe, quality, cost-effective care to patients. These efforts were effective in moving the policy agenda forward. Additionally, this process of educating legislators within the hospital has empowered a new generation of nurse anesthesiology advocates.

Virtual Peer Support in Women's Health for Pregnant People and Mothers With Substance Use Disorder.

OBJECTIVE: To evaluate the effectiveness of a virtual peer support group associated with a women's health unit for mothers and pregnant people with substance use disorder. DESIGN: The project was guided by the Centers for Disease Control and Prevention's Framework for Program Evaluation in Public Health. Pre-/postintervention surveys were used to evaluate outcomes. SETTING: Women's health unit in a 325-bed hospital with 900 births a year in the U.S. Midwest and a virtual online meeting format. PARTICIPANTS: Thirteen people with substance use disorder. INTERVENTION/MEASUREMENTS: Participants were recruited by nurses on the womens health unit and from existing online peer support meetings. Participants attended a 12-week session of facilitated substance use disorder peer support meetings through an online virtual format. Surveys included the Depression, Anxiety, and Stress Scale; the Alcoholics Anonymous Intention Scale; and pre-/postintervention surveys developed by the authors. Descriptive statistics and narrative description of qualitative data were used. RESULTS: The Depression, Anxiety, and Stress Scale scores were reduced, on average, by 25%, indicating that participants showed improvement in these conditions. Responses to open-ended questions showed that participants found the meetings helpful for developing coping mechanisms. The virtual space was seen as a comfortable, safe space where participants were able to develop community. CONCLUSION: Substance use disorder treatment continues to challenge health care providers across the United States. Peer support meetings have been effective in the treatment of people with substance use disorder. Nursing has the holistic historical precedence of creating effectual education and support programs. This program evaluation exemplifies that women's health units are an appropriate location where nurses can integrate this established evidence-based treatment modality.

Diagnosis of pulmonary contusions with point-of-care lung ultrasonography and thoracic radiography compared to thoracic computed tomography in dogs with motor vehicle trauma: 29 cases (2017-2018).

OBJECTIVE: To determine the accuracy of lung ultrasound (LUS) using the Veterinary Bedside Lung Ultrasound Examination (VetBLUE) protocol and 3-view thoracic radiographs (TXR) compared to thoracic computed tomography (TCT) for diagnosing the presence and quantification of pulmonary contusions (PC). DESIGN: Prospective cohort study conducted from February 2017 to June 2018. SETTING: Private emergency and referral center. ANIMALS: Thirty-two dogs having sustained motor vehicle trauma were consecutively enrolled. Three dogs were excluded from statistical analysis. All dogs survived to hospital discharge. INTERVENTIONS: Within 24 hours of sustaining trauma, dogs had LUS, TXR, and TCT performed. Using the VetBLUE protocol, LUS PC were scored according to the presence and number of B-lines and C-lines, indicating extravascular lung water. Thoracic radiographs and TCT were scored for PC in a similar topographical pattern to the VetBLUE protocol. Lung ultrasound and TXR were compared to "gold standard" TCT for the presence and quantification of PC. MEASUREMENTS AND MAIN RESULTS: On TCT, 21 of 29 (72.4%) dogs were positive and 8 of 29 (27.6%) dogs were negative for PC. When LUS was compared to TCT, 19 of 21 dogs were positive for PC (90.5% sensitivity) and 7 of 8 dogs were negative (87.5% specificity) for PC. LUS PC score correlated strongly with TCT PC score (R = 0.8, P < 0.001). When TXR was compared to TCT, 14 of 21 dogs were positive for PC (66.7% sensitivity) and 7 of 8 dogs were negative (87.5% specificity) for PC. TXR PC score correlated strongly with TCT PC score (R = 0.74, P < 0.001). CONCLUSIONS: In this population of dogs with motor vehicle trauma, LUS had high sensitivity for diagnosis of PC when compared to "gold standard" TCT. LUS provides reliable diagnosis of PC after trauma. More patients with PC were identified with LUS than with TXR, and additional studies are warranted to determine whether this increased sensitivity is statistically significant.

Pancreatic torsion in a dog.

A 6-month-old male intact Cane Corso mastiff dog was presented for a recent history of vomiting, abdominal pain, and lethargy. A diagnosis of pancreatic torsion was made during abdominal exploratory surgery and was confirmed with histopathology. The dog underwent partial pancreatectomy and recovered with no complications.

Torsion pancréatique chez un chien. Un chien mastiff Cane Corso mâle intact âgé de 6 mois a été présenté pour une anamnèse récente de vomissements, de douleurs abdominales et d'abattement. Un diagnostic de torsion pancréatique a été posé durant une chirurgie exploratoire abdominale et a été confirmé par histopathologie. Le chien a subi une pancréatomie partielle et s'est rétabli sans complications.(Traduit par Isabelle Vallières).

Boredom proneness in a psychiatric inpatient population.

BACKGROUND: Boredom has been reported as a common experience for service users of acute psychiatric wards. It has been associated with negative mental and physical health. Research has yet to show what factors are associated with boredom proneness within the acute psychiatric population. AIMS: (1) To investigate the distribution of boredom proneness in a population of mentally ill inpatients according to age, gender, diagnosis, Mental Health Act status and length of stay in hospital. (2) To test the hypothesis that boredom proneness is negatively correlated with autonomous activity levels. METHOD: Two self-report questionnaires were used with 55 inpatients of acute psychiatric wards: the Boredom Proneness Scale (Farmer & Sundberg, 1986) and the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983). Questions were also asked about individuals' activity engagement during their current admission. Data on age, gender, diagnosis, ethnicity, Mental Health Act status and length of stay were collected from case notes. RESULTS AND CONCLUSIONS: The highest incidence of boredom proneness was in participants with depression. Those detained under the Mental Health Act appeared less boredom prone than those admitted voluntarily. Boredom proneness was not associated with age, gender or length of stay. There was an association between engagement in more autonomous activities and lower boredom proneness.

Hypercalcemia of malignancy in a cat with bronchogenic adenocarcinoma.

A 16-year-old, neutered male, domestic shorthaired cat was presented with a history of progressive lethargy and decreased appetite. Serum biochemical profile demonstrated hypercalcemia, and thoracic radiographs and computed tomography were consistent with pulmonary neoplasia. A thoracotomy was performed, and a pulmonary mass was removed. Histopathology diagnosed a bronchogenic adenocarcinoma, and calcium levels returned to normal limits after excision of the mass. While bronchogenic adenocarcinoma has been a suspected cause for hypercalcemia in cats, to the authors' knowledge, this is the first proven account.

Evaluation of oxidative stress markers for the early diagnosis of allograft rejection in feline renal allotransplant recipients with normal renal function.

The purpose of this study was to identify oxidative damage to renal allografts during graft rejection by evaluating changes in oxidative markers and plasma lactate levels in feline renal allotransplant recipients. Heterotopic renal allotransplantations were performed between 8 adult feline cross-matched donors. Following 14 d of immunosuppression, the drugs were discontinued to allow allograft rejection. Baseline and serial postoperative evaluations of serum creatinine, plasma lactate, plasma thiobarbituate reactive substances (TBARS), plasma creatol, urine creatol, and renal sonographic cross-sectional area were performed. When sonographic evaluation revealed the absence of blood flow to the allograft, the rejected kidney was nephrectomized and evaluated histopathologically. Allograft rejection occurred in all cats by day 26. A significant elevation in body temperature occurred during the rejection period. No significant change was observed between any of the time periods for plasma TBARS, creatol, or urine creatol. There was a significant decrease in plasma lactate levels throughout the study. Markers of oxidative stress from venous blood did not reflect renal allograft rejection in cats with a normally functioning native kidney. Renal allograft rejection may be associated with significant increases in body temperature and warrants further investigation.

Use of fetal skeletal mineralization for prediction of parturition date in cats.

OBJECTIVE: To determine the relationship between parturition date and fetal skeletal mineralization detected radiographically in cats. DESIGN: Prospective clinical trial. ANIMALS: 31 queens and their 49 pregnancies. PROCEDURE: Seventeen pregnant queens were radiographed with a computed radiography system every 2 to 3 days from 1 week after pregnancy was identified by abdominal palpation until parturition. Radiographs were evaluated to determine the first identifiable mineralization of 16 bony structures and teeth during each pregnancy. This information was used to establish a table of expected parturition dates on the basis of fetal mineralization. Single radiographs from an additional 32 pregnant cats were evaluated, and predictions of parturition dates were made on the basis of the mineralization table. RESULTS: Mineralization was first detected 25 to 29 days prior to parturition (dpp). Mineralization was determined for the spinal column (22 to 27 dpp), skull (21 to 27 dpp), ribs (20 to 25 dpp), scapula (17 to 24 dpp), humerus (20 to 24 dpp), femur (19 to 23 dpp), radius (15 to 22 dpp), tibia (15 to 21 dpp), ulna (5 to 21 dpp), pelvis (8 to 20 dpp), fibula (0 to 17 dpp), tail (8 to 16 dpp), metacarpals and metatarsals (3 to 14 dpp), phalanges (0 to 11 dpp), calcaneus (0 to 10 dpp), and teeth (1 to 6 dpp). Date of parturition was predictable within 3 days in 75% of cats. CONCLUSIONS AND CLINICAL RELEVANCE: Identification of bony structures in the fetus is useful in estimating the time to parturition in queens.

Quality assurance in school health.

School nurses need to become more influential administrators, managers, and entrepreneurs. They must learn to lead and collaborate effectively in designing, implementing, and evaluating coordinated school health programs. Quality assurance is an essential ingredient in this process that requires accurate, timely, and confidential incident reporting and data analysis structures. These structures, in turn, can serve as the foundation of evidence-based practice and overall system improvement. School nurses can and should assume a key role in the process and thereby continue to meet the challenges of the more sophisticated school health services that today's student population requires. In this way, school nurses will continue to protect and advance the health and safety of the students who are entrusted to their care.

Sonographic and scintigraphic evaluation of acute renal allograft rejection in cats.

The sonographic features of acute renal allograft rejection in humans and dogs are manifested by increase in renal cross-sectional area and reduction in renal cortical blood flow. These changes have not been investigated in cats. The objectives of this study were to evaluate sonographic and scintigraphic changes during acute renal allograft rejection in cats. Eight SPF, intact, adult, male cats received heterotopic renal allotransplantations. Immunosuppressive doses of cyclosporine and prednisolone were administered for 14 days and then discontinued to allow acute allograft rejection to occur. Serial measurements of renal cross-sectional area, resistive index (RI), echogenicity, and glomerular filtration rate (GFR) were performed to evaluate changes during acute rejection. Upon sonographic confirmation of absent diastolic blood flow or a 20% increase in cross-sectional area of the allograft, a nephrectomy and histopathologic evaluation were performed. Acute allograft rejection was confirmed histologically in all cats. Significant increases in renal cross-sectional area (P < 0.001) occurred postoperatively and during rejection. There were no significant changes in RI (P = 0.43) at any time. A subjective increase in medullary echogenicity and a decrease in corticomedullary demarcation were observed in the rejection period. While GFR decreased significantly in the immediate postoperative period (P < 0.001), no further change occurred during rejection (P = 0.42). Changes in RI and GFR do not appear to be sensitive indicators of acute renal allograft rejection in cats. Serial measurements of renal cross-sectional area appear to be a sensitive method for the early diagnosis of allograft rejection in feline renal transplant recipients.

Body condition of feral cats and the effect of neutering.

Considerable debate exists regarding the most appropriate methods for controlling feral cat populations, both from humane and logistical points of view. The physical condition of feral cats has not been reported, and it is not known if these cats benefit from neutering. This study investigates the body condition of feral cats by measuring body weight (BW), body condition score (BCS; Burkholder, 2000; Laflamme, Kealy, & Schmidt, 1994), and falciform fat pad. The study includes lateral abdominal radiographs taken at the time of neutering of 105 adult feral cats for measurement of falciform fat pad depth and area. At that time we also assessed BW and BCS. One year later we assessed the effects of neutering on body condition by evaluating a subsample of 14 cats. At the time of surgery, the cats were lean but not emaciated (BW 3.1 +/- 0.9 kg; BCS 4 +/- 1; based on a 1 to 9 scale ranging from 1 [emaciated] to 9 [grossly obese]). Falciform fat pad depth and area averaged 7.1 mm and 197.4 mm2, respectively, indicating a small amount of fat. Fourteen cats, reevaluated 1 year after neutering, increased 260% + 90% in falciform fat pad depth, 420% +/- 390% in fat pad area, 40% +/- 4% in BW, and 1 level in BCS ranking (1 to 9 scale; all differences p <.001). Similar to confined socialized cats, feral cats gained significant weight and body fat after neutering.