Prophylactic Ureteral Catheters for Colectomy: A National Surgical Quality Improvement Program-Based Analysis.

BACKGROUND: Despite improvement in technique and technology, using prophylactic ureteral catheters to avoid iatrogenic ureteral injury during colectomy remains controversial. OBJECTIVE: The aim of this study was to evaluate outcomes and costs attributable to prophylactic ureteral catheters with colectomy. DESIGN: This was a retrospective study. SETTINGS: The study was conducted at a single tertiary care center. PATIENTS: The colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2014 was queried. MAIN OUTCOME MEASURES: The primary end point was the rate of 30-day ureteral injury after colectomy. Univariate and multivariate analyses determined factors associated with ureteral injury and urinary tract infection in patients undergoing colectomy. RESULTS: A total of 51,125 patients were identified with a mean age of 60.9 ± 14.9 years and a BMI of 28.4 ± 6.7 k/m; 4.90% (n = 2486) of colectomies were performed with prophylactic catheters, and 333 ureteral injuries (0.65%) were identified. Prophylactic ureteral catheters were most commonly used for diverticular disease (42.2%; n = 1048), with injury occurring most often during colectomy for diverticular disease (36.0%; n = 120). Univariate analysis of outcomes demonstrated higher rates of ileus, wound infection, urinary tract infection, urinary tract infection as reason for readmission, superficial site infection, and 30-day readmission in patients with prophylactic ureteral catheter placement. On multivariate analysis, prophylactic ureteral catheter placement was associated with a lower rate of ureteral injury (OR = 0.45 (95% CI, 0.25-0.81)). LIMITATIONS: This was a retrospective study using a clinical data set. CONCLUSIONS: Here, prophylactic ureteral catheters were used in 4.9% of colectomies and most commonly for diverticulitis. On multivariate analysis, prophylactic catheter placement was associated with a lower rate of ureteral injury. Additional research is needed to delineate patient populations most likely to benefit from prophylactic ureteral stent placement. See Video Abstract at http://links.lww.com/DCR/A482.

An innovative interprofessional education simulation for athletic training and prelicensure nursing students: Development, implementation, and student perspectives.

BACKGROUND: The purpose of this article is to describe the development, implementation, and evaluation of a Simulation Interprofessional Education (Sim-IPE) activity for healthcare students from different disciplines (athletic training [AT] and nursing). The objective for the Sim-IPE activity was to engage AT and prelicensure nursing students in a realistic healthcare scenario to enhance knowledge about one another's profession, develop interprofessional skills, collaborate with one another, and communicate effectively as a team as they performed care. METHODS: This mixed methods study employed a one-time posttest design for a convenience sample of AT and prelicensure nursing students following a simulation intervention. Students completed the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) survey and answered open-ended response questions. RESULTS: Thirteen students (N = 13) from Cohort 1 and 12 students (N = 12) from Cohort 2 completed the SPICE-R survey. Most students strongly agreed/agreed for each of the SPICE-R survey questions. Qualitative findings indicated the students positively perceived the Sim-IPE activity as it helped them discover the value of interprofessional patient care. DISCUSSION: The quantitative findings indicated that the students found the Sim-IPE an effective learning methodology to achieve the objectives while the qualitative findings gave further insight into the students' perceptions of interprofessional teamwork and the value of the prebrief session conducted before the simulation. The findings will inform future Sim-IPE activities involving additional groups of healthcare students.

Adapting a Nurse-Managed Mobile Simulation Program to Meet Rural Health Nursing Continuing Education Needs.

BACKGROUND: Rural nurses often practice in settings with limited access to continuing education resources. A hospital alliance in southeastern North Carolina developed a unique nurse-led mobile simulation program as a shared regional asset, for the purpose of meeting continuing education needs of rural nurses. METHOD: The alliance used a hub-and-spoke model to deliver education to staff in rural, critical access hospitals in order to reduce costs associated with education travel, the resulting staffing shortages, and delays in critical training. Continuing education credit was awarded to nurses participating in the learning activity. RESULTS: Fully mobile simulation can be an effective delivery mode for continuing and just-in-time education for nurses practicing in rural settings. Establishing the program as a regional shared resource can make this a financially viable option for rural hospitals. CONCLUSION: Lessons learned during the mobile simulation program's evolution and the resulting financial sustainability are discussed. [J Contin Educ Nurs. 2020;51(2):82-86.].

A nationwide evaluation of robotic ventral hernia surgery.

BACKGROUND: The purpose of this study was to examine outcomes of robotic ventral hernia repair(RVHR) versus laparoscopic ventral hernia repair(LVHR). METHODS: The Nationwide Inpatient Sample was queried from October 2008 to December 2013 for ventral hernia repairs. Demographics, morbidity, mortality, and charges were compared between RVHR and LVHR. RESULTS: From 2008-2013, 149,622 ventral hernia surgeries were identified; 117,028 open, 32,243 laparoscopic, and 351 robotic. Open repairs were excluded. RVHR rose annually with 2013 containing 47.9% of all RVHRs. RVHR patients were more likely to be older and have more chronic conditions. There was no difference between length of stay. Pneumonia rates were higher with RVHR; however, after controlling for confounding variables, there was no difference in pneumonia rates. Mortality and other major complications were similar. Total charges were increased for RVHR in univariate and multivariate analysis. RVHR was more common in teaching hospitals and wealthier zip codes. CONCLUSION: RVHR demonstrates comparable safety to the laparoscopic technique, with increased charges and increased volume in urban teaching hospitals and patients from areas of higher median income.

Success of Minimally Invasive Pectus Excavatum Procedures (Modified Nuss) in Adult Patients (≥30 Years).

BACKGROUND: Minimally invasive repair of pectus excavatum (MIRPE) has become standard for pediatric and young adult patients, but its use for older adults is controversial. METHODS: We retrospectively reviewed electronic medical records of adults (≥18 years of age) who underwent MIRPE from January 1, 2010, through April 30, 2015, and collected demographic data, operative details, and information about outcomes. Cardiac function was measured before and after repair by intraoperative transesophageal echocardiography. We divided patients by age: 18 to 29 years of age and 30 years of age and older. RESULTS: Of 361 patients, 207 were 30 or older (mean, 40 years; range, 30 to 72 years; 71.5% men). Of the older patients, 151 had primary repairs. MIRPE was successfully used in 88.7% of patients older than 30 years of age versus 96.5% of those 18 to 29 years of age. For patients 30 years of age and older, open-cartilage resection, sternal osteotomy, or both was more common with increasing age (mean, 47.8 years versus 39.5 years; p = 0.0003) and higher mean Haller index (7.7 versus 5.5; p = 0.0254). Mean operative time for MIRPE was significantly longer for older patients (≥30 years of age) compared with younger adults (121 [60 to 224] minutes versus 111 [62 to 178] minutes; p = 0.0154). Right ventricular output increased 65.2% after repair in older adults. Although greater, the frequency of bar rotation requiring reoperation was not significantly increased in the older patients (p = 0.74). CONCLUSIONS: The majority of adult patients with PE can have successful repair with modified MIRPE. The use of cartilage or sternal osteotomy, or both, increased with patient age and defect severity.

Diagnostic value of tissue harmonic imaging compared with conventional sonography.

The purpose of this study was to determine if tissue harmonic imaging (THI) produced diagnostic images more frequently than conventional sonography. A prospective study was performed on 33 patients, to compare the diagnostic value of THI with conventional sonography. Each examination was performed using THI (transmit frequency=2.0 MHz, receive frequency=4.0 MHz) and conventional sonography at 2.5 and 4.0 MHz. The different sonographic techniques were then graded as to whether they produced diagnostic images. THI produced diagnostic images in 33 of 33 examinations (100%), 2.5 MHz conventional sonography produced diagnostic images in 26 of 33 examinations (79%), and 4.0 MHz conventional sonography produced diagnostic images in 26 of 33 examinations (79%). THI produced diagnostic images significantly more frequently than 2.5 MHz conventional sonography (p=.0233) and 4.0 MHz conventional sonography (p=.0233). The THI technique produced diagnostic images more frequently than conventional sonography.

Astrocyte Reactivity: A Biomarker for Retinal Ganglion Cell Health in Retinal Neurodegeneration.

Retinal ganglion cell (RGC) loss in glaucoma is sectorial in nature and preceded by deficits in axonal transport. Neuroinflammation plays an important role in the pathophysiology of glaucoma in the retina, optic nerve and visual centers of the brain, where it similarly appears to be regulated spatially. In a murine model, we examined the spatial characteristics of astrocyte reactivity (migration/proliferation, hypertrophy and GFAP expression) in healthy retina, retina with two glaucoma-related risk factors (aging and genetic predisposition) and glaucomatous retina and established relationships between these reactivity indices and the spatial organization of astrocytes as well as RGC health. Astrocyte reactivity was quantified by morphological techniques and RGC health was determined by uptake and transport of the neural tracer cholera toxin beta subunit (CTB). We found that: (1) astrocyte reactivity occurs in microdomains throughout glaucomatous retina as well as retina with risk factors for glaucoma, (2) these astrocyte microdomains are primarily differentiated by the degree of retinal area covered by the astrocytes within them and (3) percent retinal area covered by astrocytes is highly predictive of RGC health. Our findings suggest that microdomains of astrocyte reactivity are biomarkers for functional decline of RGCs. Based on current and emerging imaging technologies, diagnostic assessment of astrocytes in the nerve fiber layer could succeed in translating axonal transport deficits to a feasible clinical application.

Spatial regulation of interleukin-6 signaling in response to neurodegenerative stressors in the retina.

Neuroinflammation, defined as the induction of immune-related processes within the central nervous system, is recognized as a component of many neurodegenerative disorders, including glaucomatous degeneration of retinal ganglion cells (RGCs). Previous work in vitro identified IL-6 as a potential neuroprotective factor for RGCs, particularly those challenged by glaucoma-related stressors. Here we examined the temporal and spatial characteristics of IL-6 signaling in response to two stressors related to RGC neurodegeneration: age and elevated intraocular pressure (IOP). Using ELISA, immunoblotting, immunolabeling and quantitative microscopy, we measured and compared whole retina and RGC-related expression of IL-6 and IL-6Rα in normal retina (young C57), retina susceptible to glaucomatous neurodegeneration (young DBA/2), aging retina (aged C57) and aging retina challenged by elevated IOP (aged DBA/2). We found that: 1) neurodegenerative stressors induce alterations in whole retina expression of IL-6 and IL-6Rα, 2) these whole retina changes do not reflect the immediate milieu of RGCs, where IL-6 and IL-6Rα expression is spatially variable and 3) the extent and magnitude of this spatial variability is stressor-dependent. Our data provide the first evidence that neurodegenerative stressors produce microenvironments of IL-6 signaling in retina and that the nature and magnitude of spatial regulation is dependent on the identity of the stressor.

Nitrogen decreases and precipitation increases ectomycorrhizal extramatrical mycelia production in a longleaf pine forest.

The rates and controls of ectomycorrhizal fungal production were assessed in a 22-year-old longleaf pine (Pinus palustris Mill.) plantation using a complete factorial design that included two foliar scorching (control and 95% plus needle scorch) and two nitrogen (N) fertilization (control and 5 g N m(-2) year(-1)) treatments during an annual assessment. Ectomycorrhizal fungi production comprised of extramatrical mycelia, Hartig nets and mantles on fine root tips, and sporocarps was estimated to be 49 g m(-2) year(-1) in the control treatment plots. Extramatrical mycelia accounted for approximately 95% of the total mycorrhizal production estimate. Mycorrhizal production rates did not vary significantly among sample periods throughout the annual assessment (p = 0.1366). In addition, reduction in foliar leaf area via experimental scorching treatments did not influence mycorrhizal production (p = 0.9374), suggesting that stored carbon (C) may decouple the linkage between current photosynthate production and ectomycorrhizal fungi dynamics in this forest type. Nitrogen fertilization had a negative effect, whereas precipitation had a positive effect on mycorrhizal fungi production (p = 0.0292; r (2) = 0.42). These results support the widely speculated but poorly documented supposition that mycorrhizal fungi are a large and dynamic component of C flow and nutrient cycling dynamics in forest ecosystems.

Measuring external mycelia production of ectomycorrhizal fungi in the field: the soil matrix matters.

Assessing mycorrhizal fungi production in field settings has been hindered by the inability to measure external mycelia. Recently, external mycelia production was measured in the field using a novel in-growth core technique with acid-washed sand as the in-growth matrix. Here, we tested the assumption that external mycelia production in acid-washed sand is representative of that in native soil. External mycelia production was estimated as the difference in fungal growth between closed (allowing only saprotrophic fungal production) and open (allowing mycorrhizal and saprotrophic fungal production) cores using a factorial design of soil matrices (acid-washed sand vs native) and fertilization treatments (control vs nitrogen (N)) in a longleaf pine (Pinus palustris) plantation. In native soils, the ectomycorrhizal to saprotrophic fungal biomass signal was strong and consistent facilitating the assessment of external mycelia production, which was 300% higher than corresponding rates in acid-washed sand and inversely correlated with soil N. These results demonstrate the efficacy and importance of using native soil as the in-growth matrix to measure ectomycorrhizal fungi external mycelia production in field settings.