Budget Impact Analysis of Preoperative Radioactive Seed Localization.

BACKGROUND: This study models costs in implementing a radioactive seed localization (RSL) program for nonpalpable breast lesions at a large Canadian tertiary hospital to replace existing wire-guided localization (WGL). METHODS: All direct and indirect operating costs of localization per lesion from the hospital's perspective were determined by retrospectively reviewing patient data and costs from January 2014 to December 2016. A budget impact analysis and sensitivity analysis were performed to calculate the mean cost per lesion, the minimum and maximum cost per lesion, operational costs, and initial costs. RESULTS: There were 265 WGL lesions in 2014 and 170 RSL lesions in 2016 included in cost calculation. The mean cost per localization was $185 CAD for WGL ($148-$311) and $283 CAD ($245-$517) for RSL using preloaded seeds, adjusted to 2016 Canadian dollars. The annual operational expenditure including all localizations and overhead costs was $49,835 for WGL and $80,803 for RSL. Initial costs for RSL were $22,000, including external training and new equipment purchases. CONCLUSIONS: Our budget impact analysis shows that RSL using preloaded radioactive seeds was more expensive than WGL when considering per-lesion localization costs and specific costs related to radiation safety. Manually loading radioactive seed could be a cost-saving alternative to purchasing preloaded seeds. Our breakdown of costs can provide a framework for other centres to determine which localization method best suit their departments.

Pain medication management in nursing homes and nursing scope of practice.

Inadequate pain medication management is pervasive in nursing homes (NHs). Licensed practical nurses (LPNs) deliver the majority of licensed nursing care, but LPNs are neither trained nor licensed to provide comprehensive pain assessment and medication management. In this study, we describe how pain medication management occurs in NHs by exploring LPNs' management approaches, while considering scope-of-practice differences between RNs and LPNs. Using comparative case studies of 10 NHs in North Carolina and Minnesota, we found practice variations in pain detection, assessment, and medication administration. Differences clustered in three areas: (a) the extent to which RNs and LPNs connected formally and informally to provide pain care, (b) the degree to which RNs and LPNs were considered interchangeable with one another, and (c) the RN-to-LPN ratio. Results highlight quality issues and suggest ways to improve pain medication management in NHs.

Using unfolding case studies in a subject-centered classroom.

The recently published report of the Carnegie Foundation's National Study of Nursing Education points out significant problems with classroom teaching in schools of nursing. This article suggests Palmer's idea of the subject-centered classroom as a way to transform nursing school classrooms into collaborative learning communities. For Palmer, the subject is the big idea of nursing practice-the nurse-patient/client/family/community relationship-that should take the lead in stimulating inquiry and discussion. The article goes on to describe how teachers can develop and use unfolding case studies to bring the subject to the center of the classroom. By doing so, the classroom becomes a place where students learn a sense of salience, develop their clinical imagination, and begin their formation as professional nurses.

Meaningful inclusion of diverse voices: The case for culturally responsive teaching in nursing education.

Communication and diversity are essential features of safe and effective health care and of a safe and effective nursing workforce. Fostering diversity and meaningful inclusion of diverse perspectives in nursing school classrooms, labs and clinical learning environments are important steps toward building a stronger nursing workforce and health care system. This paper presents an argument for the importance of replacing the single, dominant voice in nursing education with culturally responsive teaching and offers strategies nurse educators can use to encourage students to share alternative perspectives and engage in alternative methods of discourse and communication. This essay reflects a review of the theoretical background to culturally responsive teaching and discusses how this method connects to nursing education. By engaging in culturally responsive teaching, nurse educators will prepare a nursing workforce that is ready to add multiple diverse voices to the health care team and contribute to the redesign of a safer and more effective health care system.

Broadening your horizons: Self-expanding activities promote desire and satisfaction in established romantic relationships.

In the early stages of romantic relationships, sexual desire is often intense, but over time, as partners get to know each other, desire tends to decline. Low sexual desire has negative implications for relationship satisfaction and maintenance. Self-expansion theory suggests that engaging in novel activities with a long-term romantic partner can reignite feelings of passion from the early stages of a relationship. Across 3 studies using dyadic, daily experience, longitudinal, and experimental methods, we find evidence for our central prediction that engaging in self-expanding activities with a partner is associated with higher sexual desire. In turn, we found that higher desire fueled by self-expansion is associated with greater relationship satisfaction. Self-expansion, through sexual desire, is also associated with an increased likelihood that couples will engage in sex, and when they do engage in sex, they feel more satisfied with their sexual experiences. We also demonstrate that the benefits of self-expansion for relationship satisfaction are sustained over time, and that the effects cannot be attributed solely to increases in positive affect, time spent interacting with the partner or closeness during the activity. Implications for self-expansion theory and sexual desire maintenance in relationships are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The effects of 53 hours of sleep deprivation on moral judgment.

STUDY OBJECTIVES: Functional neuroimaging studies suggest a prominent role for the medial prefrontal cortex in the formation of moral judgments. Activity in this region has also been shown to decline significantly during sleep loss. We therefore examined the effects of 2 nights of sleep deprivation on several aspects of moral judgment. DESIGN: Participants made judgments about the "appropriateness" of various courses of action in response to 3 types of moral dilemmas at rested baseline and again following 53 hours of continuous wakefulness. SETTING: In-residence sleep laboratory at the Walter Reed Army Institute of Research. PARTICIPANTS: Twenty-six healthy adults (21 men, 5 women). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Compared to baseline, sleep deprivation resulted in significantly longer response latencies (suggesting greater difficulty deciding upon a course of action) only for Moral Personal (i.e., emotionally evocative) dilemmas, whereas response times to Moral Impersonal (less emotionally evocative) and Non Moral dilemmas did not change significantly with sleep loss. The effect of sleep deprivation on the willingness to agree with solutions that violate personally held moral beliefs was moderated by the level of emotional intelligence, as measured by the Bar-On EQ-i. Persons high in emotional intelligence were less susceptible to changes in moral judgments as a function of sleep loss. CONCLUSIONS: These findings suggest that sleep deprivation impairs the ability to integrate emotion and cognition to guide moral judgments, although susceptibility to the effects of sleep loss on this ability is moderated by the level of emotional intelligence.

Is Comparison the Thief of Joy? Sexual Narcissism and Social Comparisons in the Domain of Sexuality.

Are people who are high in sexual narcissism more sensitive to information comparing their sex lives with the sex lives of others? Does this sensitivity explain narcissists' lower sexual and relationship satisfaction? We conducted three studies to address this question. Participants completed the Sexual Narcissism Scale (Widman & McNulty, 2010), and then either recalled (Study 1), imagined (Study 2), or actually made (Study 3) a sexual comparison. We found that people high in sexual narcissism (compared with those lower in sexual narcissism) were more bothered when comparing themselves with someone with a higher sexual frequency and felt better about a comparison with someone with a lower sexual frequency. In turn, narcissists' greater sensitivity to upward social comparisons predicted lower sexual and relationship satisfaction. These results suggest that those high in sexual narcissism may use downward sexual comparisons to maintain their grandiose self-views and be particularly sensitive to upward sexual comparisons.

How implicit theories of sexuality shape sexual and relationship well-being.

How do people believe they can best maintain sexual satisfaction in their romantic relationships? In the current research, we draw upon the literature on implicit theories of relationships to develop and validate a scale examining 2 types of lay beliefs about how sexual satisfaction can be maintained over time. Individuals high in sexual growth beliefs think that sexual satisfaction is attained from hard work and effort, whereas individuals high in sexual destiny beliefs think that sexual satisfaction is attained through finding a compatible sexual partner. Across 6 studies (2 cross-sectional online studies, a 21-day daily experience study, 2 dyadic studies, and an experimental manipulation; N = 1,896), we find evidence that those higher in sexual growth beliefs experience higher relationship and sexual satisfaction, and have partners who are more satisfied. Conversely, the effects of sexual destiny beliefs on satisfaction are contingent upon signs of partner compatibility: When individuals high in sexual destiny beliefs experience greater sexual disagreements in their relationship, they experience lower relationship quality. These results are independent of general relationship implicit beliefs, providing evidence for the uniqueness of these 2 constructs and the importance of examining implicit beliefs in the domain of sexuality. Overall, these results provide novel evidence that individuals' lay beliefs about maintaining sexual satisfaction are important for understanding the quality of their sex lives and relationships. (PsycINFO Database Record

The power of nursing: An innovative course in values clarification and self-discovery.

Teaching for a practice is more than the dissemination of knowledge and information to the learner. Professional nursing education requires teachers to facilitate students' self-reflection and awareness and assimilation of core professional and personal values in order for the new nurse to anchor and internalize these values as part of a professional identity. To achieve this, nursing educators recognize the importance of learning opportunities centered in the affective domain and the importance of teaching for professional formation that supports nursing students' commitment to the values of their chosen community of practice. This paper describes the development, implementation and evaluation of a learning innovation for pre-RN students. The Power of Nursing: Embracing the Healer's Art, a five-session, 15-hour discovery model course that uses guided reflection and personal sharing is described, as are course outcomes for 68 students from four nursing schools in the U.S. Overall students' reports were strongly favorable and the learning experience was valued and identified as unique within the nursing curriculum.

Tetrahydrobiopterin Supplementation Improves Endothelial Function But Does Not Alter Aortic Stiffness in Patients With Rheumatoid Arthritis.

BACKGROUND: Rheumatoid arthritis is a systemic inflammatory condition associated with increased cardiovascular risk that may be due to underlying endothelial dysfunction and subsequent aortic stiffening. We hypothesized that supplementation with tetrahydrobiopterin (BH4) would recouple endothelial nitric oxide synthase and thus improve endothelial function and consequently reduce aortic stiffness. METHODS AND RESULTS: We conducted 2 randomized, double-blinded, placebo-controlled crossover studies examining 2 separate regimens: an acute regimen, with a single dose of BH4 400 mg versus placebo (n=18), and a short-term regimen, composed of a 1-week treatment with BH4 400 mg once daily versus placebo (n=15). Flow-mediated dilatation and aortic pulse wave velocity were studied 4 times, before and after each treatment phase. Acute BH4 supplementation led to an improvement of flow-mediated dilatation, whereas placebo had no effect (mean±SD of effect difference 2.56±4.79%; P=0.03). Similarly, 1-week treatment with BH4 improved endothelial function, but there was no change with placebo (mean±SD of effect difference 3.50±5.05%; P=0.02). There was no change in aortic pulse wave velocity following acute or short-term BH4 supplementation or placebo (mean±SD of effect difference: acute 0.09±0.67 m/s, P=0.6; short-term 0.03±1.46 m/s, P=0.9). CONCLUSION: Both acute and short-term supplementation with oral BH4 improved endothelial function but not aortic stiffness. This result suggests that BH4 supplementation may be beneficial for patients with rheumatoid arthritis by improving endothelial dysfunction and potentially reducing risk of cardiovascular disease. There appears to be no causal relationship between endothelial function and aortic stiffness, suggesting that they occur in parallel, although they may share common risk factors such as inflammation.

To do it or not to do it? How communally motivated people navigate sexual interdependence dilemmas.

The current research investigates how people make sexual decisions when romantic partners' sexual desires conflict, situations we refer to as sexual interdependence dilemmas. Across an experimental study, a retrospective recall study, and a 21-day daily experience study, we found that people who were motivated to meet their partner's sexual needs--those high in sexual communal strength--were more willing to engage in sex with their romantic partner, even when their own desire was low, and as a result, both partners reported enhanced relationship and sexual satisfaction. The benefits of sexual communal strength were due to communally oriented people's increased desire to promote their partner's interests and decreased desire to pursue their own interests. This is the first set of studies to investigate how people make decisions in sexual interdependence dilemmas and show that communally motivated individuals navigate these situations in a way that is beneficial for relationships.