Bezoars: Culprits of gastrointestinal obstruction that may lead to surgical intervention and potentially surgical complications.

Key Clinical Message: Bezoars can cause gastrointestinal obstruction and may require surgery. Surgery carries the risk of complications. Medical professionals should perform detailed history in diet and behaviors for patients presenting with abdominal pain to identify risk factors for bezoars, then educate these patients and their families about risks and complications of bezoars. Abstract: Bezoars are solid masses of undigested material that can cause obstruction of the gastrointestinal tract. There are different types of bezoars; phytobezoar, trichobezoar, pharmacobezoar, lactobezoar, and bezoars containing tissue paper or polystyrene foam. This case report is of a 13-year-old Hispanic male who suffered a postsurgical complication after removal of bezoar. He had a past surgical history of appendectomy and presented to the hospital with a 1-day history of right lower quadrant abdominal pain associated with fever and diarrhea. X-radiation images and computed tomography scans aided in the diagnosis of pelvic abscess as a complication of postsurgical enterotomy and closure of the enterotomy to remove bezoar from the small bowel. The initial bezoar removal and the postsurgical complication of pelvic abscess resulted in the patient staying for 19 days in the hospital. At discharge, the patient and his guardian were advised to follow up with the patient's primary care physician and surgical team. The patient made an uneventful recovery. He did not experience any long-term complications and fully recovered. This report demonstrates that although bezoars are rare, they can cause significant obstruction of the gastrointestinal tract leading to the need for management, such as surgery, which carries its own risks. It is important to note that the postsurgical complication of pelvic abscess can occur due to surgery itself and not because of bezoar specifically. Abdominal surgery in general poses the risk of pelvic abscess. The consideration is to expectantly decrease the occurrence of bezoars so that consequently there will not be a need for surgery in removal of bezoars due to obstruction. The effects of bezoars can be prevented through educating the community and addressing underlying psychiatric disorders.

Serial Magnetic Resonance Imaging for Aortic Dilation in Tetralogy of Fallot With Pulmonary Stenosis.

Aortic dilation occurs in patients with repaired tetralogy of Fallot (TOF), but the rate of growth is incompletely characterized. The aim of this study was to assess the rates of growth of the aortic root and ascending aorta in a cohort of pediatric and adult patients with sequential magnetic resonance angiography Magnetic Resonance Imaging (MRI) data. Using serial MRI data from pediatric and adult patients with repaired TOF, we performed a retrospective analysis of the rates of growth and associations with growth of the aortic root and ascending aorta. Patients with pulmonary atresia or absent pulmonary valve were excluded. Between years 2005 to 2021, a total of 99 patients were enrolled. A follow-up MRI was performed an average of 5.9 ± 3.7 years from the initial study. For the cohort aged ≥16 years, the mean rate of change in diameter was 0.2 ± 0.5 mm/year at the ascending aorta and 0.2 ± 0.6 mm/year at the sinus of Valsalva. For the entire cohort, the mean change in cross-sectional area indexed to height at the ascending aorta was 7 ± 12 mm2/m/year and at the sinus of Valsalva was 10 ± 16 mm2/m/year. Younger age was associated with higher rates of growth of the sinus of Valsalva while the use of ß blockers or angiotensin-converting enzyme inhibitors was associated with a slower rate of growth. There were no cases of aortic dissection in this cohort. We conclude that serial MRI demonstrates a slow rate of growth of the aorta in the TOF.

An Evaluation of Audiovisual Discussion Boards in a Graduate-Level Nursing Course: Innovation During the Pandemic.

ABSTRACT: The COVID-19 pandemic challenged nurse educators to develop and implement effective learning environments at a distance and refine distance education instructional strategies that were used in the past. A quality improvement project implemented in a graduate-level nursing course incorporated audiovisual discussions as an innovative pedagogy. Students chose whether to participate in class discussions by either a narrative discussion board or an audiovisual discussion method with faculty feedback in the same format. Students who chose the audiovisual discussion board found the ability to see and hear others to be helpful, suggesting audiovisual methods may improve student satisfaction and learning outcomes.

Communicating With Head Start Families About Children's Weight Status: A Phenomenological Approach.

BACKGROUND: To support the early identification of childhood obesity, Head Start (HS) implemented a body mass index screening program. This program provides opportunities for HS to communicate with families about children's weight status. Limited research is available describing the methods used to communicate this information. OBJECTIVE: Explore common experiences of HS health/nutrition managers (HNM) when communicating information to families about children's weight status. STUDY DESIGN, SETTINGS, AND PARTICIPANTS: Twenty-eight in-depth telephone interviews with HNM across North Carolina (n = 15) and Ohio (n = 13). STUDY DESIGN/ANALYSIS: Phenomenology guided the study design and analysis. The themes focused on HNM's lived experiences with their body mass index screening program. Interviews were recorded and transcribed verbatim. RESULTS: Four emergent themes identified: (1) strategies for communicating weight status to families; (2) family response to communication strategies; (3) educational, staff support, and counseling opportunities for families; and (4) challenges engaging families in childhood obesity prevention efforts. CONCLUSIONS AND IMPLICATIONS: Head Start programs acknowledged the importance of communicating children's weight status; however, there are inconsistencies in methods used and information communicated across programs. Head Start programs have community partners who support obesity prevention efforts; however, these partnerships may be underused. More research is needed to explore effective and sensitive communication methods for HS families regarding children's weight status.

Student safety in middle school: Implications for school nurse and teacher collaboration.

OBJECTIVE: Adolescent suicide is a public health crisis. School connectedness, a protective factor, may be especially important in low-income rural schools, with fewer resources and higher rates of suicide as compared to urban schools. The purpose of this study was to explore teacher perceptions of safety and school connectedness in a low-income, rural middle school, and implications for collaborative practice between school nurses and teachers. DESIGN AND SAMPLE: A qualitative secondary data analysis was used. Data were taken from transcripts from four focus groups comprised of middle school teachers (n = 20). MEASUREMENT: An inductive approach to content analysis was conducted using in vivo Coding and Venn diagrams. RESULTS: Three themes were identified: (1) defiant and aggressive student behaviors were safety concerns, as teachers perceived they may be obscuring mental health needs; (2) teachers were sometimes placed in a position to assist students with safety management strategies; and (3) managing safety concerns was an obstacle to building connectedness, as reflected in safety and school connectedness. CONCLUSION: Collaborative strategies between school nurses and teachers are essential to identify student behaviors that may be masking mental health needs. Strategies have the potential to enhance school connectedness and support student safety.

Rotational Position of the Aortic Root is Associated with Increased Aortic Dimensions in Marfan and Loeys-Dietz Syndrome.

Progressive aortic dilation is common in Marfan syndrome (MFS) and Loeys-Dietz syndrome (LDS). Risk factors for progression are poorly understood. Normal variation in the aortic root (AoR) rotational position relative to the left ventricular base may impact this risk. We aimed to assess the relationship between the rotational position of the AoR and aortic dimensions in this population. Patients with a genetic diagnosis of MFS or LDS were included. AoR and ascending aorta (AAo) dimensions were measured from the first and most recent transthoracic echocardiogram. The AoR rotational angle was measured in the parasternal short-axis plane in diastole. Linear regression was used to study the correlation between AoR rotation angle and aortic dimensions. 53 MFS and 14 LDS patients were included (age 11.5 ± 5.8 years at first TTE and 21.2 ± 7.2 years at most recent, 68% male). The mean indexed AoR and AAo values were 2.26 ± 0.58 cm/m2 and 1.64 ± 0.35 cm/m2 at the first TTE and 1.98 ± 0.39 cm/m2 and 1.45 ± 0.25 cm/m2 at the most recent TTE, respectively. The mean AoR rotational angle was 8 ± 14°. AoR rotational angle was central (- 9 to + 14°) in 42, clockwise (≥ + 15°) in 19, and counterclockwise (≤ -10°) in 6. The six outliers with counterclockwise position were excluded. There was a positive association between the AoR rotation angle and most recent TTE indexed AoR (r2 = 0.08, p = 0.02) and AAo sizes (r2 = 0.08, p = 0.02). There was no association between AoR rotational angle and rate of change in indexed AoR size (p = 0.8). There was a positive association between AoR rotation angle and rate of change in indexed AAo size (r2 = 0.10, p = 0.01). There is an association between clockwise rotational position of the AoR and increased AoR and AAo dimensions in children and young adults with MFS and LDS patients. The rotational position of the AoR may guide follow-up in these patient populations. However, this potential risk factor for dilation warrants further investigation.

The Role of the School Nurse in Suicide Interventions: An Integrative Review.

Suicide rates among children and adolescents have continued to rise over the past decade indicating the need for school-based suicide prevention programs. School nurses (SNs) are well positioned to assist in assessment, early identification, and intervention of at-risk students. This integrative review aimed to (1) critically examine the role of the SN in school-based suicide interventions, (2) explore potential barriers preventing the SN from participating in suicide interventions, and (3) recommend strategies to build capacity for principles of school nursing practice in suicide intervention. The National Association of School Nurses' Framework for 21st Century School Nursing Practice was used to categorize interventions and outcomes related to suicide prevention. Findings demonstrate a lack of reported nursing interventions directly linked to student outcomes and suggest obscurity in the role of the SN. Recommendations for future research and strategies to build capacity for principles of school nursing practice are provided.

Experiential Learning to Engage Millennial Learners in an Undergraduate Nursing Research Course.

Baccalaureate-prepared nurses are expected to participate in evidence-based practice by identifying clinical questions, critiquing evidence, and integrating theory into practice. This presents a challenge for faculty to facilitate a research course in a way that is valued by nursing students and will ultimately prepare them to successfully enter the workforce. This article describes an innovative strategy to engage millennial learners in an undergraduate research course by implementing a two-part evidence-based practice project. Student feedback has been positive with expressed interest in the project's application to practice.

Mid-term Outcomes of the Supported Ross Procedure in Children, Teenagers, and Young Adults.

The Ross procedure in children, teenagers, and young adults, especially among those with a bicuspid aortic valve with aortic regurgitation, has been associated with neoaortic root dilatation and recurrence of aortic regurgitation. We have shown that at intermediate follow-up, patients who underwent a supported Ross technique were less likely to have neoaortic root dilatation. This study summarizes our most recent outcomes. This was a retrospective review of 40 consecutive pediatric and young adult patients undergoing a supported Ross procedure from 2005 to 2018. Clinical outcomes were reviewed in addition to echocardiographic measures of neoaortic dimension and neoaortic valve function. The median age at surgery was 16.0 years (range 10 - 35 years). Preoperative diagnosis was aortic regurgitation in 15 (37.5%) and mixed regurgitation/stenosis in 20 (50%). Median follow-up was 3.5 years (1.4-5.6) with 3 patients followed for more than 10 years. There were no deaths. Five patients had a reintervention, but only 1 on the aortic valve. One patient returned to the operating room on postoperative day 1 for revision of the right coronary button. Two patients required biventricular pacemakers for reduced ejection fraction. One patient developed aortic regurgitation and underwent mechanical valve replacement and another required a reintervention on the homograft with a percutaneously placed pulmonary valve replacement. At last follow-up, 39 patients had mild or less aortic regurgitation with median sinus z-score of 1.40 (0.48-2.07). Mid-term follow-up of pediatric and young adult patients undergoing a supported Ross operation for various aortic valve pathologies demonstrate excellent results with minimal neoaortic root dilation and reintervention.

Fostering scholarship in doctoral education: Using a social capital framework to support PhD student writing groups.

The shortage of nurse scientists in the United States complicates nursing's ability to sustain research-intensive environments, build knowledge for translation, and advance nursing science. More emphasis is needed on the preparation of PhD doctoral students to better equip them for a career of scholarship. Four recent PhD graduates participating in a writing group, examined the influence of social capital on their ability to develop capacity for scholarship. They found that a strong social factor supported their efforts to engage as scholars, be accountable for their writing, and make contributions to the research community. Although the writing group provided a space to practice scholarly writing and increased scholarly productivity, the experience was transformative in building capacity for scholarship. This article includes recommendations for academic leaders to both create and support writing groups within doctoral nursing programs using a social capital framework. Strategies are provided using the three dimensions of social capital: structural, relational, and cognitive. Investing in strategies that build social capital within a community can directly impact the advancement of science by elevating capacity for scholarship.

Atretic anomalous left subclavian artery as part of an unusual vascular ring.

In this report, a unique case of a symptomatic vascular ring formed by right aortic arch, aberrant left subclavian artery, and left ligamentum arteriosus in which there is atresia of the proximal left subclavian artery is described. Imaging modalities were non-diagnostic and the patient was sent to surgery based on strong clinical suspicion. Her anatomy was delineated in the operating room and the ring was successfully repaired.

Moral Distress Among School Nurses.

School nurses are well positioned to provide care to a diverse population of school-age children, but their role and work environment can present a variety of moral dilemmas leading to moral distress. The purpose of this study is to identify the moral distress level that exists in school nurses and to describe its relationship to common moral dilemmas and school nurse characteristics. Data were collected through face-to-face attendance at school nurse meetings in North Carolina where 307 school nurses participated in the survey. Moral distress was measured using the moral distress thermometer, and common moral dilemmas were identified using a researcher developed questionnaire. Almost all of the school nurses (97.3%) experienced some degree of moral distress. Each of the common moral dilemmas was positively correlated with moral distress levels. The findings suggest that many of the common moral dilemmas experienced by school nurses are strongly related to moral distress.

Seizing the Moment: Experiences of School Nurses Caring for Students With Overweight and Obesity.

School nurses are well positioned to assess, intervene, and evaluate efforts to positively impact students who are overweight or obese. The purpose of this qualitative, descriptive study was to explore the experiences of school nurses providing care to children living with overweight and obesity. Data were collected through face-to-face, tape-recorded, in-depth, open-ended interviews with 10 school nurses from rural areas of North Carolina working with minority and low-income children in the public school setting. The text of the interviews was transcribed and analyzed into codes, categories, and themes. Three themes and eight subthemes were identified. The three themes were identified as (1) "jumping hurdles," (2) "seize the moment," and (3) "moral distress." The findings of this study can be used to provide a better understanding of the experiences of school nurses caring for children with overweight and obesity that is necessary for planning successful school-based interventions.

Is there postoperative evidence of implicit learning following aural stimuli at moderate hypnotic BIS levels during general anesthesia?

Patients may develop behavioral changes after the administration of a general anesthetic without a triggering stimulus. This phenomenon, referred to as implicit learning, continues to be debated. Some researchers have denied the phenomenon takes place, while others have demonstrated behavioral changes not related to recall. In previous studies it was difficult to determine the effects of taped messages or suggestions, as anesthesia techniques were not standardized, and true depth of anesthesia was impossible to determine. The development of bispectral index (BIS) monitoring allows practitioners to determine the depth of anesthesia based on neuronal activity. In the present study, we compared 2 randomized groups of patients from a convenience sample of patients scheduled to undergo elective spinal surgery at a Department of Veterans Affairs Medical Center. All patients were screened for normal hearing acuity. The control group listened to tapes of white noise, while the experimental group listened to a word list and short story selection. Both groups listened to the tapes at similar BIS levels. A posttest was administered to determine explicit recall, as well as implicit memory formation. No patients had explicit recall. There was no difference in the implicit memory scores between patients in the experimental group and the control group.