Barriers, facilitators, and opportunities for Doctor of Nursing Practice engagement in translational research.

BACKGROUND: Little is known about how Doctor of Nursing Practice (DNP) graduates apply translational research competencies in the practice setting. PURPOSE: This qualitative descriptive study aimed to explore the barriers, facilitators, and opportunities for engaging in translational research among DNPs in practice. METHODS: We conducted semi-structured interviews with 11 DNPs working within an 8-hospital health system from November 2020 through July 2021. DISCUSSION: We identified four themes related to barriers (invisibility of the DNP degree and skillset; lack of role clarity and organizational structure for DNPs; lack of time for engagement in translational research; lack of support for engagement in translational research), one theme related to facilitators (encouragement from colleagues and supervisors), and two themes related to opportunities (DNP education promotes recognition of nurse role in translational research; DNPs are interested in role expansion to include translational research). CONCLUSION: DNPs have the interest and training to engage in translational research but face structural barriers to doing so.

Improved 30-Day Heart Failure Readmissions Following Implementation of an Advanced Cardiovascular Education (ACE) Academy.

BACKGROUND: Heart failure readmissions are common, though some are preventable through evidence-based management. LOCAL PROBLEM: Despite outperforming national benchmarks for 30-day readmissions, compliance with an evidence-based institutional heart failure management pathway was inconsistent. The purpose of this project was to reduce 30-day heart failure readmission rates through an educational intervention and an electronic health record (EHR) redesign. METHODS: The cardiac services nursing leadership team conducted an education and documentation needs assessment to identify knowledge gaps and practical barriers to effective utilization of evidence-based interventions for heart failure management. INTERVENTIONS: This intervention included an Advanced Cardiovascular Education (ACE) Academy and an EHR workflow redesign for clinical and supportive nursing staff. RESULTS: The 30-day heart failure readmission rates reduced immediately following the intervention, and rates continued to decrease over a 3-year follow-up. CONCLUSIONS: Even among hospitals outperforming national benchmarks, 30-day heart failure readmissions can be reduced and sustained with enhanced education and EHR redesign.

Quality of work-life among advanced practice nurses who manage care for patients with heart failure: The effect of resilience during the Covid-19 pandemic.

Background Clinician burnout, stress and job dissatisfaction among Advance Practice Registered Nurses (APRNS) may have impacted work-related quality of life (WRQoL) during the COVID-19 pandemic. No studies describe burnout and resilience in APRNs who manage care for patients with HF. Objectives Among APRNs who manage care for patients with HF, study aims included: 1) Describe burnout and WRQoL levels; 2) Determine the relationship between burnout and WRQoL; 3) Examine whether resilience moderates the association between WRQoL and burnout. METHODS: An online survey of American Association of Heart Failure Nurses and the Heart Failure Society of America APRN members were queried. INCLUSION CRITERIA: APRN's who practiced in ambulatory or inpatient cardiology settings at least 8 h weekly. OUTCOMES MEASURED: Burnout, WRQoL, and resilience. Results Participants' (N = 101) mean age was 50 (±10) years and 93% identified as female. APRNs worked more than 42 h weekly and reported moderate levels of resilience, high levels of personal (M = 51.7, norm-referenced mean: 35.9) and work-related burnout (M = 50.1, norm-referenced mean: 33.0). Correlations between high levels of burnout and low WRQoL (r range: -0.74 - -0.39 -, p<.001) were found. Burnout moderated the relationships among resilience and WRQoL. Conclusion APRNs had high levels of burnout during the COVID-19 pandemic. Patient-related burnout was not high. Level of burnout influenced the relationships among resilience and WRQoL suggesting that burnout is from workplace and personal sources, and that level of resilience could not overcome the effect of burnout. Interventions are needed regarding systems changes to uplift and support our workforce.

Dual-isotope SPECT/CT impact on hospitalized patients with suspected diabetic foot infection: saving limbs, lives, and resources.

BACKGROUND: Foot ulcer with suspected infection is one of the most common reasons for hospitalization and a major factor contributing to morbidity and high healthcare-related expenses among diabetic patients. Many patients will require amputation; however, major amputation is associated with an alarmingly high 5-year mortality rate. In this study, we assess the diagnosis and management of suspected foot infection in diabetic patients using dual-isotope (DI) single-photon emission computed tomography/computed tomography (SPECT/CT) compared with conventional imaging. METHODS: The diagnostic accuracy in and management of 227 patients who had undergone DI SPECT/CT was compared with that of 232 similar patients who had undergone conventional imaging including plain radiography, CT, planar bone scanning, planar indium-111 white blood cell scanning, and MRI. The duration of hospitalization was additionally compared between these two groups of patients after excluding patients with other active comorbidities. RESULTS: Soft-tissue infection, osteomyelitis with or without soft-tissue infection, and other bony pathologies were more accurately and confidently identified with DI SPECT/CT than with conventional imaging. DI SPECT/CT use was associated with significantly fewer major amputations and more selective bony resection as well as with shorter duration of hospitalization when compared with conventional imaging. CONCLUSION: In this large population of diabetic patients with suspected foot infection DI SPECT/CT was more accurate in diagnosing and localizing infection compared with conventional imaging. In addition, DI SPECT/CT provided clear guidance and promoted many limb salvage procedures. Of equal importance to health economics, DI SPECT/CT use was associated with considerably reduced length of hospitalization compared with conventional imaging.

Working conditions and masked hypertension.

INTRODUCTION: Masked hypertension, i.e., normal clinic blood pressure but elevated blood pressure during normal daily activities as measured by ambulatory monitoring, is a common problem and a serious cardiovascular risk factor. Given previously reported associations between work stressors and ambulatory blood pressure, an inquiry into the relationship between work stressors and masked hypertension is warranted. OBJECTIVE: To assess the relationship between working conditions and masked hypertension. DESIGN: Cross-sectional study. SETTING: Hospital and home care employers in New York City. STUDY PARTICIPANTS: Forty-five male and 119 female hospital and home care employee volunteers wore an ambulatory blood pressure monitor during working hours. MAIN OUTCOME MEASURES: Masked hypertension was defined as work systolic ambulatory blood pressure ≥135 mmHg or diastolic ambulatory blood pressure ≥85 mmHg, and casual blood pressure <140/90 mmHg with no use of antihypertensive medications. Associations between work stressors and masked hypertension were tested by multiple logistic regression. RESULTS: Masked hypertension, observed in 24.0% of males and 17.6% of females with normal casual office obtained blood pressure, was associated with evening, night or rotating shiftwork (odds ratio (OR) 8.25, 95% confidence interval (CI) 2.11-40.31) and with the combination of job strain and effort-reward imbalance (OR 2.97, 95% CI 1.02-8.60) after controlling for age. Associations remained substantial, and statistically significant for shiftwork, after individual adjustment for each of 10 potential confounders. Masked hypertension was not associated with total weekly work hours. CONCLUSIONS: Masked hypertension is a significant individual and public health concern. Additional research is needed to clarify the role of work-related risk factors in the development of masked hypertension, and to develop an appropriate clinical and public health strategy for diagnosis, treatment and prevention.

Coronary artery and thoracic aorta calcification is inversely related to coronary flow reserve as measured by 8²Rb PET/CT in intermediate risk patients.

BACKGROUND: The strength and nature of the relationship between myocardial perfusion imaging (MPI), coronary flow reserve (CFR), and coronary artery calcium (CAC) and thoracic aorta calcium (TAC) remain to be clarified. METHODS: Dynamic rest-pharmacological stress (82)Rb positron emission tomography/computed tomography MPI with CFR, CAC, and TAC was performed in 75 patients (59 ± 13 years; F/M = 38/37) with intermediate risk of coronary artery disease. RESULTS: A total of 29 (39%) patients had ischemic and 46 (61%) had normal MPI. CAC was correlated with TAC (ρ = 0.7; P < .001), and CFR was inversely related with CAC and TAC (ρ = -0.6 and -0.5; P < .001, respectively). By gender-specific univariate analysis, age (P = .001), CAC (P = .004), and CFR (P = .008) in males, but CFR (P = .0001), age (P = .002), and TAC (P = .01) in females were significant predictors of ischemic MPI. By multiple regression, the most potent predictor was CFR [odds ratio (OR) = 0.17, P = .01), followed by age (OR = 1.07, P = .02), gender (OR = 4.01, P = .03), and CAC (OR = 1.002, P = .9). CONCLUSIONS: Combination of MPI, CFR, CAC, and TAC has complementary roles in intermediate risk patients.

Lymphoscintigraphy and triangulated body marking for morbidity reduction during sentinel node biopsy in breast cancer.

Current trends in patient care include the desire for minimizing invasiveness of procedures and interventions. This aim is reflected in the increasing utilization of sentinel lymph node biopsy, which results in a lower level of morbidity in breast cancer staging, in comparison to extensive conventional axillary dissection. Optimized lymphoscintigraphy with triangulated body marking is a clinical option that can further reduce morbidity, more than when a hand held gamma probe alone is utilized. Unfortunately it is often either overlooked or not fully understood, and thus not utilized. This results in the unnecessary loss of an opportunity to further reduce morbidity. Optimized lymphoscintigraphy and triangulated body marking provides a detailed 3 dimensional map of the number and location of the sentinel nodes, available before the first incision is made. The number, location, relevance based on time/sequence of appearance of the nodes, all can influence 1) where the incision is made, 2) how extensive the dissection is, and 3) how many nodes are removed. In addition, complex patterns can arise from injections. These include prominent lymphatic channels, pseudo-sentinel nodes, echelon and reverse echelon nodes and even contamination, which are much more difficult to access with the probe only. With the detailed information provided by optimized lymphoscintigraphy and triangulated body marking, the surgeon can approach the axilla in a more enlightened fashion, in contrast to when the less informed probe only method is used. This allows for better planning, resulting in the best cosmetic effect and less trauma to the tissues, further reducing morbidity while maintaining adequate sampling of the sentinel node(s).

Using the intraoperative hand held probe without lymphoscintigraphy or using only dye correlates with higher sensory morbidity following sentinel lymph node biopsy in breast cancer: a review of the literature.

BACKGROUND: There are no studies that have directly investigated the incremental reduction in sensory morbidity that lymphoscintigraphy images (LS) and triangulated body marking or other skin marking techniques provide during sentinel lymph node biopsy (SLNB) compared to using only the probe without LS and skin marking or using only dye. However, an indirect assessment of this potential for additional sensory morbidity reduction is possible by extracting morbidity data from studies comparing the morbidity of SLNB to that of axillary lymph node dissection. METHODS: A literature search yielded 13 articles that had data on sensory morbidity at specific time points on pain, numbness or paresthesia from SLNB that used radiotracer and probe or used only dye as a primary method of finding the sentinel node (SN). Of these, 10 utilized LS, while 3 did not utilize LS. By matching the data in studies not employing LS to the studies that did, comparisons regarding the percentage of patients experiencing pain, numbness/paresthesia after SLNB could be reasonably attempted at a cutoff of 9 months. RESULTS: In the 7 studies reporting on pain after 9 months (> 9 months) that used LS (1347 patients), 13.8% of patients reported these symptoms, while in the one study that did not use LS (143 patients), 28.7% of patients reported these symptoms at > 9 months (P < 0.0001). In the 6 studies reporting on numbness and/or paresthesia at > 9 months that used LS (601 patients), 12.5% of patients reported these symptoms, while in the 3 studies that did not use LS (229 patients), 23.1% of patients reported these symptoms at > 9 months (P = 0.0002). Similar trends were also noted for all these symptoms at < or = 9 months. CONCLUSION: Because of variations in techniques and time of assessing morbidity, direct comparisons between studies are difficult. Nevertheless at a minimum, a clear trend is present: having the LS images and skin markings to assist during SLNB appears to yield more favorable morbidity outcomes for the patients compared to performing SLNB with only the probe or performing SLNB with dye alone. These results are extremely pertinent, as the main reason for performing SLNB itself in the first place is to achieve reduced morbidity.

Dietary supplementation with bean extract improves lipid profile in overweight and obese subjects.

The aim of this study was to evaluate the long-term effects of a dietary supplementation of bean extract on serum lipids, nutritional parameters, and fat excretion in feces.Sixty-two overweight and obese (body mass index > 25 kg/m(2)) volunteers were randomized to receive the dietary supplement (n = 31, supplement group) or the placebo (n = 31, placebo group). There were 41 women and 21 men, ages 22 to 66 years. Two capsules of a dietary supplement or a placebo were administered three times daily for 3 mo. The supplement group was then invited to participate in an open-label study for 9 mo. Twenty-four subjects (7 men and 17 women) were randomized to receive two or four capsules of the supplement three times daily. Lipids and nutritional blood parameters were measured at baseline, after 3 mo, and at 12 mo. Excretion of fat in feces was measured. At 3 mo, reduction in serum concentration of cholesterol was found in the supplement group but not in the placebo group. High-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triacylglycerols in serum did not change in either group. In the 9-mo open-label study, no further reduction in serum cholesterol was observed. Low-density lipoprotein and the ratio of low- to high-density lipoprotein decreased, whereas triacylglycerols remained unchanged. Serum vitamin B12 and folic acid decreased but remained within the normal range. Ferritin and albumin in serum remained unchanged. No differences were observed in serum lipids and nutritional parameters between groups. The bean extract significantly increased fat excretion in feces. In conclusion, this dietary supplementation improved lipoprotein profile and enhanced fat excretion in feces in overweight and obese subjects.