Medication administration error prevention among nurses working in intensive care units: A secondary analysis.

BACKGROUND: The intensive care unit (ICU) brings together high-risk patients and interventions in a complex environment. Based on this consideration, medication administration error is the most common type of error that occurs in ICUs. Literature confirms that human factors (lack of knowledge, poor practices and negative attitudes) of nurses are the main contributors to the occurrence of medication administration errors in ICUs. AIM: To examine and compare the knowledge, attitudes and behaviour scores on medication administration error according to nurses' sociodemographic and professional variables. STUDY DESIGN: This is a secondary analysis of data from a cross-sectional international study based on a survey. Descriptive statistics were computed for all items of the questionnaire. Non-parametric tests (Kruskal Wallis and Mann Whitney U tests) were used to carry out the comparison between groups. RESULTS: The international sample consisted of 1383 nurses in 12 different countries. Statistically significant changes were seen in knowledge, attitudes and behaviour scores among several subgroups of the international population. Eastern nurses were more likely to show adequate knowledge about medication administration error prevention than Western nurses; concurrently, Western nurses were significantly more likely to show positive attitudes than Eastern nurses. No statistically significant differences in the behaviour scale were found in this study. CONCLUSIONS: The findings show a difference between knowledge and attitudes in relation to cultural background. RELEVANCE TO CLINICAL PRACTICE: Decision makers in ICUs should consider cultural background when planning and implementing prevention strategies for medication administration errors. Further research is needed to investigate the effectiveness of educational systems on the decrease of the incidence of medication administration errors in ICU.

Development and validation of a case study to aid in the diagnostic reasoning of nursing students and nurses.

PURPOSE: The aim of this study is to develop and validate a case study to aid in the diagnostic reasoning of nursing students and nurses. METHODS: It is a validation study using a case study based on Lunney's method including (1) content validation of the case study by nurse experts through the Delphi technique, (2) identification of nursing diagnoses (NDs) in the case, (3) evaluation of diagnostic accuracy, and (4) establishment of a priority diagnosis by nurse experts. FINDINGS: The case study was developed from the findings of a narrative literature review on the cues of the NDs with a prevalence > 50% in patients with peripheral arterial occlusive disease. Two rounds of expert evaluation were required to validate the case study. The experts identified 18 NDs with different degrees of accuracy. The highly accurate diagnoses most frequently identified by the experts were: Ineffective peripheral tissue perfusion (100%), impaired walking (83%), impaired comfort (50%), and chronic pain (50%). The diagnosis considered a priority by all experts was ineffective peripheral tissue perfusion. CONCLUSIONS: The case study was developed and had its content validated. High-accuracy diagnoses were identified, and a priority was determined. IMPLICATIONS FOR NURSING PRACTICE: The validated case study may be used by students and nurses to facilitate the development of diagnostic reasoning and critical thinking in practice, teaching or research.

Association between health literacy and nursing care in hospital: A retrospective study.

AIMS: To describe the health literacy (HL) levels of hospitalised patients and their relationship with nursing diagnoses (NDs), nursing interventions and nursing measures for clinical risks. DESIGN: Retrospective study. METHODS: The study was conducted from December 2020 to December 2021 in an Italian university hospital. From 146 wards, 1067 electronic nursing records were randomly selected. The Single-Item Literacy Screener was used to measure HL. Measures for clinical risks were systematically assessed by nurses using Conley Index score, the Blaylock Risk Assessment Screening Score, Braden score, and the Barthel Index. A univariable linear regression model was used to assess the associations of HL with NDs. RESULTS: Patients with low HL reported a higher number of NDs, interventions and higher clinical risks. HL can be considered a predictor of complexity of care. CONCLUSIONS: The inclusion of standardised terms in nursing records can describe the complexity of care and facilitate the predictive ability on hospital outcomes. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: HL evaluation during the first 24 h. From hospital admission could help to intercept patients at risk of higher complexity of care. These results can guide the development of interventions to minimise needs after discharge. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection.

Electrochemical remediation of synthetic and real marine sediments contaminated by PAHs, Hg and As under low electric field values.

To date, remediation, protection, and restoration of contaminated sites is a global concern. The current technologies to restore sediments characterized by heterogeneous characteristics, several pollutants, fine grains, and low hydraulic permeability are poorly effective; hence their remediation is still challenging. A promising approach for the sediment's remediation could be the electrochemical route since it is a not-expensive, effective and noninvasive in situ technology. Electrochemical remediation (ER) is commonly studied under relatively high electric fields (E ≥ 1 V cm-1) and using costly processing fluids in a three compartments cell aiming to desorb and transport the contaminants into the processing fluids (secondary dangerous effluent). In this work, contaminated marine sediments were electrochemically treated focusing on the insertion of electrodes directly in the sediments and adopting, for the first time for real sediments, low E values (≤ 0.25 V cm-1) for 4-days period. It was observed that PAHs can be simultaneously transported and degraded in situ preventing the production of a secondary dangerous effluent and reducing the energy consumption. Firstly, clay marine sediments dragged from Capo Granitola Coast (Trapani, Italy) spiked with five PAHs congeners (5PAHs), Hg and As were used as a simplified model matrix and treated to simulate a real case study. A total PAHs removal efficiency of 57% was reached after 96 h of treatment under 0.05 V cm-1. Then, real polluted marine sediments from Augusta Bay (Syracuse) and Bagnoli-Coroglio Bay (Naples) in the southern Italy were treated as real contaminated sediments to be restored, to validate the proposed approach for real cases. A quite good removal efficiency of PAHs was reached after 96 h of electrochemical treatment coupled with a low energetic consumption due to the rather E values adopted. In addition, it was observed that this approach, under the adopted conditions, is unsuitable for the remediation of Hg and As.

A chemical remediation technique for a nearly-total removal of arsenic and mercury from contaminated marine sediments.

After decades of industrial exploitation of the coast and consequent contamination of the sites and marine sediments, it became essential to recover the marine ecosystem by remediation methods to remove toxic contaminants. In this work, a remediation method was developed to clean marine sediments contaminated by arsenic (As) and mercury (Hg). The method can be applied to mobile platforms and is based on an environmentally friendly approach designed to minimise further contamination. The method was tested on two artificially contaminated sediments and two real samples collected from two highly contaminated sites in southern Italy, Augusta Bay and Bagnoli Gulf, characterised by high Hg and As concentrations, respectively. The method consists of four steps: washing with sodium hydroxide (NaOH) to remove metals associated with humic acid; Fenton-reaction using α-CycloDextrin (aCD) to stabilise Fe(II) at natural pH and oxidise As (III) and Hg (0 or I); complexation reaction with aCD; and complexation with sodium sulfide (Na2S) to remove Hg as soluble Hg-polysulfides. Compared to other remediation experiences in literature, this technique provides the best removal efficiency for As and Hg (ranging between 26 -71 % and 57-95 %, respectively). Considering the residual concentrations of As and Hg and the contamination threshold fixed by European Regulation for re-use, the treated sediment can be used in several civil and industrial contexts. The presented method operates in line with the principles of the circular economy to preserve natural resources, prevent secondary pollution, and promote the effective re-use of clean environmental matrices (soils, sediments and aqueous solutions), thus minimising landfill waste.

Predictors of self-care behaviors in individuals with heart failure in Brazil.

OBJECTIVE: To identify the predictors of self-care behaviors in individuals with heart failure. METHOD: A cross-sectional study including 405 patients with heart failure. Self-care behaviors were assessed by the Self-Care of Heart Failure Index. Sociodemographic and clinical characteristics were investigated as predictors of self-care maintenance, management and confidence through logistic regressions. RESULTS: The predictors of self-care maintenance were number of children (p<0.01), left ventricular ejection fraction (p<0.01), positive feeling about disease (p=0.03), obesity (p=0.02) and dialytic chronic kidney disease (p<0.01). The predictors of self-care management were having married children (p<0.01) and sleep apnea (p<0.01). The predictors of self-care confidence were family income (p<0.01), number of hospitalizations in the previous 12 months (p=0.01), number of daily medication doses (p<0.01) and sedentarism (p<0.01). CONCLUSION: Some predictors related to the self-care behaviors were found, so some intensified education and social aid should be aimed at patients with these specific characteristics.

Data Science Implementation Trends in Nursing Practice: A Review of the 2021 Literature.

OBJECTIVES: The goal of this work was to provide a review of the implementation of data science-driven applications focused on structural or outcome-related nurse-sensitive indicators in the literature in 2021. By conducting this review, we aim to inform readers of trends in the nursing indicators being addressed, the patient populations and settings of focus, and lessons and challenges identified during the implementation of these tools. METHODS: We conducted a rigorous descriptive review of the literature to identify relevant research published in 2021. We extracted data on model development, implementation-related strategies and measures, lessons learned, and challenges and stakeholder involvement. We also assessed whether reports of data science application implementations currently follow the guidelines of the Developmental and Exploratory Clinical Investigations of DEcision support systems driven by AI (DECIDE-AI) framework. RESULTS: Of 4,943 articles found in PubMed (NLM) and CINAHL (EBSCOhost), 11 were included in the final review and data extraction. Systems leveraging data science were developed for adult patient populations and were primarily deployed in hospital settings. The clinical domains targeted included mortality/deterioration, utilization/resource allocation, and hospital-acquired infections/COVID-19. The composition of development teams and types of stakeholders involved varied. Research teams more frequently reported on implementation methods than implementation results. Most studies provided lessons learned that could help inform future implementations of data science systems in health care. CONCLUSION: In 2021, very few studies report on the implementation of data science-driven applications focused on structural- or outcome-related nurse-sensitive indicators. This gap in the sharing of implementation strategies needs to be addressed in order for these systems to be successfully adopted in health care settings.

Multicomponent Antibiofilm Lipid Nanoparticles as Novel Platform to Ameliorate Resveratrol Properties: Preliminary Outcomes on Fibroblast Proliferation and Migration.

The well-being of skin and mucous membranes is fundamental for the homeostasis of the body and thus it is imperative to treat any lesion quickly and correctly. In this view, polyphenols might assist and enhance a successful wound healing process by reducing the inflammatory cascade and the production of free radicals. However, they suffer from disadvantageous physico-chemical properties, leading to restricted clinical use. In this work, a complex mixture of PEGylated lipid, Glyceryl monoester, 18-ß-Glycyrrhetinic Acid and Menthol was designed to entrap Resveratrol (RSV) as the active ingredient and further produce lipid nanoparticles (LNPs) by homogenization followed by high-frequency sonication. The nanosystem was properly characterized in terms of particle size (DLS, SEM), zeta potential, drug loading, antioxidant power (DPPH), release behaviour, cytocompatibility, wound healing and antibiofilm properties. The optimized lipid mixture was homogeneous, melted at 57-61 °C and encapsulated amorphous RSV (4.56 ± 0.04% w/w). The RSV-loaded LNPs were almost monodispersed (PDI: 0.267 ± 0.010), with nanometric size (162.86 ± 3.12 nm), scavenger properties and suitable DR% and LE% values (96.82 ± 1.34% and 95.17 ± 0.25%, respectively). The release studies were performed to simulate the wound conditions: 1-octanol to mimic the lipophilic domains of biological tissues (where the First Order kinetic was observed) and citrate buffer pH 5.5 according to the inflammatory wound exudate (where the Korsmeyer-Peppas kinetic was followed). The biological and microbiological evaluations highlighted fibroblast proliferation and migration effects as well as antibiofilm properties at extremely low doses (LNPs: 22 µg/mL, corresponding to RSV 5 µM). Thus, the proposed multicomponent LNPs could represent a valuable RSV delivery platform for wound healing purposes.

Standardized Nursing Diagnoses in a Surgical Hospital Setting: A Retrospective Study Based on Electronic Health Data.

Introduction: In electronic health records (EHRs), standardized nursing terminologies (SNTs), such as nursing diagnoses (NDs), are needed to demonstrate the impact of nursing care on patient outcomes. Unfortunately, the use of NDs is not common in clinical practice, especially in surgical settings, and is rarely included in EHRs. Objectives: The aim of the study was to describe the prevalence and trend of NDs in a hospital surgical setting by also analyzing the relationship between NDs and hospital outcomes. Methods: A retrospective study was conducted. All adult inpatients consecutively admitted to one of the 15 surgical inpatient units of an Italian university hospital across 1 year were included. Data, including the Professional Assessment Instrument and the Hospital Discharge Register, were collected retrospectively from the hospital's EHRs. Results: The sample included 5,027 surgical inpatients. There was a mean of 6.3 ± 4.3 NDs per patient. The average distribution of NDs showed a stable trend throughout the year. The most representative NANDA-I ND domain was safety/protection. The total number of NDs on admission was significantly higher for patient whose length of stay was longer. A statistically significant correlation was observed between the number of NDs on admission and the number of intra-hospital patient transfers. Additionally, the mean number of NDs on admission was higher for patients who were later transferred to an intensive care unit compared to those who were not transferred. Conclusion: NDs represent the key to understanding the contribution of nurses in the surgical setting. NDs collected upon admission can represent a prognostic factor related to the hospital's key outcomes.

Relationships between Depressive Symptoms, Appetite, and Quality of Life in Heart Failure.

This analytical, cross-sectional study aimed to analyze the relationship between depressive symptoms, appetite, and quality of life (QoL) in 86 patients hospitalized with heart failure. Patients were assessed for depressive symptoms, appetite, and QoL using the Beck Depression Inventory-II, the Simplified Nutritional Appetite Questionnaire, and the Minnesota Living with Heart Failure Questionnaire, respectively. Relationships between sociodemographic and clinical variables, depressive symptoms, appetite, and QoL were analyzed using bivariate tests and linear regression models, with p < .05 considered significant. The factors associated with QoL were dependence for four activities of daily living (ADLs) (estimate = 15.4, 95% CI = 0.23 to 30.64, p = .046), minor depressive symptoms (estimate = -20.0, 95% CI = -28.3 to -11.73, p < .001), and appetite (estimate = -11.08, 95% CI = -20.5 to -1.62, p = .022). These results can support multi-professional assessment and development of interventions to promote better QoL, including addressing impaired appetite and food intake, the presence or increased intensity of depressive symptoms, especially in patients dependent for ADLs.

Effectiveness of the Primary Nursing Model on nursing documentation accuracy: A quasi-experimental study.

AIMS AND OBJECTIVES: To analyse the Primary Nursing Model's effect on nursing documentation accuracy. BACKGROUND: The Primary Nursing is widely implemented since it has been considered as the ideal model of care delivery based on the relationship between the nurse and patient. However, previous research has not examined the relationship between Primary Nursing and nursing documentation accuracy. DESIGN: A pretest-posttest-follow-up design was used. METHODS: The study was conducted from August 2018 to February 2020 in eight surgical and medical wards in an Italian university hospital. The Primary Nursing was implemented in four wards (study group), while in the other four, the Team Nursing was practised (control group). Nursing documentation accuracy was evaluated through the D-Catch instrument. From the eight wards, 120 nursing documentations were selected randomly for each time point (pre-test, post-test and follow-up) and in each group. Altogether, 720 nursing documents were assessed. The study adhered to the TREND checklist. RESULTS: The Primary Nursing and Team Nursing Models exhibited significant differences in mean scores for documentation accuracy: assessment on admission, nursing diagnosis, nursing intervention and patient outcome accuracy. No differences between the two groups were found for record structure accuracy and legibility between the posttest and follow-up. CONCLUSION: Primary Nursing exerts an overall positive effect on nursing documentation accuracy and persists over time. RELEVANCE TO CLINICAL PRACTICE: The benefits from Primary Nursing implementation included better-documented patient outcomes. The use of Primary Nursing linked with the use of the nursing process allowed for a more individualised and problem-solving approach. Nurse managers should consider the implementation of Primary Nursing to improve care quality.

Persistent Organic Pollutants and Fatty Acid Profile in a Typical Cheese from Extensive Farms: First Assessment of Human Exposure by Dietary Intake.

Dairy products represent an important source of beneficial substances for humans. At the same time, they can expose the consumers to environmental contaminants ingested by animals through their diet, influencing their health negatively. This experiment aims to evaluate the risk and benefits related to the consumption of typical stretched cheeses, considering their fatty acid (FA) profile and persistent organic pollutants (POPs) content. Six representative farms, two of them organic, raising Cinisara cattle were selected, considering the typical extensive management systems, based on feeding of natural pasture integrated with concentrate and hay depending on the availability of forage on pastures. A total of 18 cheeses produced in winter, spring and summer with bulk milk of each farm were sampled and analyzed. The chemical composition of cheeses was influenced by farm management, and the FA profile mainly by the season. In particular, cheeses made in spring showed a healthier FA profile with the content of polyunsaturated fatty acids (PUFA), of omega3-PUFA and omega6/omega3 ratio pair to 7.29%, 1.44% and 1.32, respectively, while in winter 5.44%, 0.98% and 2.55, respectively, and in summer 4.77% 0.49% and 3.04, respectively. Due to high levels of feeding integration, cheese made in winter presented unhealthier characteristics compared to the cheeses made in spring and summer, showing high levels of saturated FA (66.2%, 64.2% and 65.5%, respectively), and large contents of polycyclic aromatic hydrocarbons (PAH) (57.07 ng/g fat, 36.25 ng/g fat and 10.22 ng/g fat, respectively) and polychlorinated biphenyls (PCBs) (36.19 ng/g fat, 4.68 ng/g fat and 3.73 ng/g fat, respectively), mainly in those from non-organic farms. Levels of PCBs considered to be hazardous to human health were found in nine samples.

Buccal Thin Films as Potent Permeation Enhancers for Cytisine Transbuccal Delivery.

Cytisine (CYT) is a powerful anti-smoking compound which could greatly benefit from transbuccal delivery because of both its unfavorable pharmacokinetics after oral administration and its intrinsic ability to permeate the buccal mucosa. This work aims to design CYT-loaded buccal thin films suitable for transbuccal drug delivery due to its capability of promoting the interaction between CYT and the buccal membrane. The solvent casting method was employed to prepare several thin films combining various excipients such as matrixing polymers, mucoadhesion agents, plasticizers and other compounds as humectants and sweeteners, component ratios and solvents. A total of 36 compositions was prepared and four of them emerged as the most promising in terms of aspect and flexibility. They all demonstrated homogeneity, thinness, low swelling degree, and controlled drug release according to the Power Law and Peppas-Sahlin mathematical models. Mainly, they proved able to interact with the ex vivo porcine buccal mucosa producing mucoadhesive effects, and act as potent permeation enhancers. In particular, Film B emerged as suitable as it produced a 10.6-fold Kp enhancement and a great Js value (52.33 µg/cm2·h-1), even when compared to highly concentrated CYT solutions.

Spray-Dried Cytisine-Loaded Matrices: Development of Transbuccal Sustained-Release Tablets as a Promising Tool in Smoking Cessation Therapy.

Cytisine (CYT) has emerged as a promising molecule to treat nicotine addiction, since it acts as a partial agonist of nicotinic acetylcholine receptors. However, its unfavorable pharmacokinetic properties lead to multiple administrations per day, reducing the patient's compliance and increasing the side effects. To overcome these drawbacks, CYT buccal administration is here proposed. Firstly, CYT stability in the buccal environment was assessed and its intrinsic ability to permeate/penetrate the tissue was determined by applying CYT solutions at increasing concentrations. Furthermore, a spray-drying method was selected and optimized as it is an eco-friendly, easily scalable and effective technique to obtain uniform and reproducible CYT-loaded (5% w/w) pharmaceutical powders, which were directly compressed, thus obtaining different buccal delivery systems (BDSs). The obtained BDSs were homogeneous and reproducible and embedded CYT in its amorphous form. The mechanism of CYT release was evaluated in vitro and found to be mainly driven by a Fickian diffusion phenomenon. Predominantly, the ex vivo permeation assays highlighted the ability of the BDSs to enhance CYT permeation, also producing high drug fluxes through the mucosa. Speculative mathematical evaluations based on the already-known CYT pharmacokinetic parameters showed that CYT-loaded BDSs could potentially be sufficient to obtain a therapeutic effect, thus making the reported formulations suitable candidates for further in vivo trials.

Health Literacy in Patients' Clinical Records of Hospital Settings: A Systematic Review.

Introduction: Health literacy (HL) can be defined as the individual's ability to understand and process health information. A low level of HL can be viewed as a stronger predictor of a person's health status than age, education level, and race. Although HL is an important determinant of health, it is often underestimated. This systematic review investigates the evidence on HL assessment in hospital settings. Methods: PubMed Medline, CINAHL, Scopus, Web of Science and Educational Resources Information Centre databases were searched, with the date last searched being 16 March 2020. The PRISMA guidelines were applied, and the protocol of the study was registered with PROSPERO (CRD42021236029). The quality of the included studies was appraised using the STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. Results: Five studies reported HL assessments in hospital patients' clinical records. Four main strategies were used to implement HL routine assessment in hospitals: multidisciplinary teams, stakeholders, training, and monitoring. Different performance measures were used to monitor the feasibility of incorporating HL assessment into electronic health records (EHRs). Conclusion: This review examined how inpatients' HL is recorded in hospital settings. HL is poorly measured in a hospital setting. These results guide hospital leadership in involving nurses in HL assessment implementation in hospitals and support nurses in creating a specific performance measure dashboard to monitor effective HL assessments in hospitals.

Data Science Trends Relevant to Nursing Practice: A Rapid Review of the 2020 Literature.

BACKGROUND: The term "data science" encompasses several methods, many of which are considered cutting edge and are being used to influence care processes across the world. Nursing is an applied science and a key discipline in health care systems in both clinical and administrative areas, making the profession increasingly influenced by the latest advances in data science. The greater informatics community should be aware of current trends regarding the intersection of nursing and data science, as developments in nursing practice have cross-professional implications. OBJECTIVES: This study aimed to summarize the latest (calendar year 2020) research and applications of nursing-relevant patient outcomes and clinical processes in the data science literature. METHODS: We conducted a rapid review of the literature to identify relevant research published during the year 2020. We explored the following 16 topics: (1) artificial intelligence/machine learning credibility and acceptance, (2) burnout, (3) complex care (outpatient), (4) emergency department visits, (5) falls, (6) health care-acquired infections, (7) health care utilization and costs, (8) hospitalization, (9) in-hospital mortality, (10) length of stay, (11) pain, (12) patient safety, (13) pressure injuries, (14) readmissions, (15) staffing, and (16) unit culture. RESULTS: Of 16,589 articles, 244 were included in the review. All topics were represented by literature published in 2020, ranging from 1 article to 59 articles. Numerous contemporary data science methods were represented in the literature including the use of machine learning, neural networks, and natural language processing. CONCLUSION: This review provides an overview of the data science trends that were relevant to nursing practice in 2020. Examinations of such literature are important to monitor the status of data science's influence in nursing practice.

Diuron environmental levels effects on marine nematodes: Assessment of ecological indices, taxonomic diversity, and functional traits.

Coastal marine systems are the most sensitive zones to emerging pollutants. The present study aims to investigate the effect of Diuron on the meiofaunal assemblages, collected from the Bizerte channel (Tunisia). Microcosm experiments were set up using four increasing Diuron concentrations [D1 (10 ng g-1 dry weight (DW)), D2 (50 ng g-1 DW), D3 (250 ng g-1 DW) and (1250 ng g-1 DW)] compared to non-contaminated sediments (controls) and all plots were incubated for 30 days. Our results show that Diuron-supplemented sediments provoked the significant decrease of meiofaunal abundance as well as a change in nematodes' diversity and structure composition. All univariate indices, as well as the cumulative k-dominance, were lower in the Diuron than the control plot. Additionally, the ordination of treatments according to the two-dimensional nMDS plots analysis showed a clear structural separation of the Diuron treated replicates from the controls based on the functional groups lists. These current data emphasize the utility of the use of biological traits in the detection of disturbances in the aquatic biotope.

Filling a gap in standardized nursing terminology. Development of a new nursing diagnosis proposal on heart failure self-care.

PURPOSE: Heart failure is a highly prevalent chronic health problem associated with poor quality-of-life and negative outcomes. Self-care is a cornerstone in patients suffering from heart failure. Nurses are commonly engaged in enhancing patients' self-care behaviors, but the specific condition of deficit on self-care is not clearly identified by nurses. No nursing diagnoses focused on self-care of heart failure patients is currently available. This study aimed to develop a new nursing diagnosis that focuses on self-care in heart failure patients. DATA SOURCES: A concept and content analysis were used. Some steps of the concept analysis were performed through an integrative literature review conducted searching in PUBMED and CINAHL databases to identify attributes, antecedents, and consequences of the diagnosis. Forty-five articles were selected from the 1450 studies found. Then, the content analysis was performed by an international panel of 29 experts. Two Delphi rounds were used to achieve consensus and an item content validity index was calculated for each diagnostic element. DATA SYNTHESIS: Integrative review proposed four diagnostic labels, two definitions, 15 defining characteristics, and 44 related factors. After the two Delphi rounds a consensus was reached for each diagnostic indicator with a content validity index ranging from 82.8% to 100%. The nursing diagnosis-labeled heart failure self-care deficit-was validated with a definition, eight defining characteristics, 15 related factors, and five at-risk populations. CONCLUSIONS: This diagnosis allows nurses to document patients' self-care in daily clinical practice through a standard nursing terminology, by naming this health problem, describing its etiology, and clinical manifestations. IMPLICATIONS FOR NURSING PRACTICE: This new diagnosis is expected to assist nursing clinicians, educators, and students in clinical reasoning with the aim to improve diagnostic accuracy in identifying patients with a heart failure self-care deficit, to select the most appropriate interventions and pursue better outcomes.

Lipid Nanocarriers-Loaded Nanocomposite as a Suitable Platform to Release Antibacterial and Antioxidant Agents for Immediate Dental Implant Placement Restorative Treatment.

Immediate implant placement is a single-stage restorative approach for missing teeth widely used to overcome the ridge remodeling process occurring after dental extractions. The success of this procedure relies on opportune osseointegration in the surrounding tissues. To support this process, a multifunctional nanocomposite, to be applied in the fresh post-extraction socket, was here designed, prepared, and characterized. This formulation consists of quercetin (QRC)-loaded nanostructured lipid carriers (NLCs) entrapped in a chitosan-based solid matrix containing ciprofloxacin (CPX). QRC-NLCs were prepared by homogenization followed by high-frequency sonication, and thereafter this dispersion was trapped in a chitosan-based CPX-loaded gel, obtaining the nanocomposite powder (BioQ-CPX) by lyophilization. BioQ-CPX displayed desirable properties such as high porosity (94.1 ± 0.5%), drug amounts (2.1% QRC and 3.5% CPX). and low swelling index (100%). Moreover, the mechanism of drug release from BioQ-CPX and their ability to be accumulated in the target tissue were in vitro and ex vivo elucidated, also by applying mathematical models. When trapped into the nanocomposite, QRC stressed under UV light exposure (50 W) was shown to maintain its antioxidant power, and CPX and QRC under natural light were stable over nine months. Finally, both the measured antioxidant power and the antimicrobial and antibiofilm properties on Staphylococcus aureus demonstrated that BioQ-CPX could be a promising platform to support the single-stage dental restorative treatment.

Data Science Methods for Nursing-Relevant Patient Outcomes and Clinical Processes: The 2019 Literature Year in Review.

Data science continues to be recognized and used within healthcare due to the increased availability of large data sets and advanced analytics. It can be challenging for nurse leaders to remain apprised of this rapidly changing landscape. In this article, we describe our findings from a scoping literature review of papers published in 2019 that use data science to explore, explain, and/or predict 15 phenomena of interest to nurses. Fourteen of the 15 phenomena were associated with at least one paper published in 2019. We identified the use of many contemporary data science methods (eg, natural language processing, neural networks) for many of the outcomes. We found many studies exploring Readmissions and Pressure Injuries. The topics of Artificial Intelligence/Machine Learning Acceptance, Burnout, Patient Safety, and Unit Culture were poorly represented. We hope that the studies described in this article help readers: (1) understand the breadth and depth of data science's ability to improve clinical processes and patient outcomes that are relevant to nurses and (2) identify gaps in the literature that are in need of exploration.