Perception of the Scholarly Work Project by DNP/DNAP Graduates: A Preliminary Survey.

The purpose of this descriptive pilot survey was to understand the experiences of students completing scholarly work projects for practice doctorate programs. With this work, we hoped to fill the literature gap and to inform curriculum. A descriptive survey was used to answer the question: How do graduates of entry level and completion degree Doctor of Nursing Practice (DNP) and Doctor of Nurse Anesthesia Practice (DNAP) programs perceive the scholarly work requirements? The Chi-square test of independence was used to compare whether there was a statistically significant association between the responses to the survey question and the demographic variable. Only 46 DNP/DNAP graduates (4%) completed the survey. The survey results indicated that students in completion programs believed that their scholarly work empowered them to conduct future scholarly work as compared with the entry-topractice cohorts. Variables addressing each aspect of scholarly work project were described by the participants. This preliminary work provides a glimpse into the experience of scholarly work projects for the practice doctorate. To provide greater depth and understanding of this important aspect of doctoral education, a larger sampling of graduates is needed. A collaborative study might be beneficial.

Factor V Leiden: Development of VTE in Surgery and Trauma Patients: A Systematic Review.

BACKGROUND: Factor V Leiden (FVL) is a hereditary thrombophilia, which causes the blood to be more hypercoagulable; in essence, the blood tends to clot more easily, especially under certain circumstances. It is the most common genetic mutation, causing thrombophilia in patients of white background. Patients that have FVL are at a higher risk to develop venous thromboembolism (VTE) after surgery and trauma. OBJECTIVE: The purpose of this review is to identify FVL as a risk factor, which may impede optimum acute cardiopulmonary management which may contribute to a longer length of stay (LOS) in the hospital. METHODS: This article is a systematic review of the literature involving research printed in peer-reviewed journals from 2015 to 2018. The University of Tennessee Health Science Center online library, PubMed, and Google Scholar were used for the literature search. RESULTS: The results of this study determined that although FVL is in fact a risk factor, which may impede optimum acute cardiopulmonary management which may contribute to a longer LOS, management of VTE is no different for a person with FVL compared with those without FVL. CONCLUSION: Factor V Leiden is a risk factor for the development of VTE, specifically deep vein thrombosis, in surgical, trauma, pregnant, and hormone replacement therapy patients, thus increasing LOS and recurrence of such events. Regardless of FVL status, management of VTE should be initiated promptly and discontinued when appropriate.

Opioid-Free Anesthesia and Certified Registered Nurse Anesthetists: Barriers to Implementation.

While knowledge surrounding opioid-free anesthesia (OFA) has increased in current literature, there is an absence of research specific to nurse anesthesia practice. This study aimed to identify the number of surveyed Certified Registered Nurse Anesthetists (CRNAs) who incorporated OFA into practice and uncovered barriers to its implementation. This quantitative survey solicited data from 2,883 CRNAs across the United States. Of the participants, 81% administered OFA, and 88% felt that OFA techniques are beneficial in anesthesia practice. The results of the survey revealed that gender may be a barrier to the implementation of OFA. Female respondents were less likely to administer OFA often due to the facility culture. The level of education also influenced how CRNAs perceived their facility's culture as a barrier. Perceived access to a variety of multimodal anesthetics was also problematic. While most of those surveyed had administered OFA and acknowledged its benefit, barriers to wider implementation still exist.

Occurrence of multidrug resistant Salmonella in antimicrobial-free (ABF) swine production systems.

This cross-sectional study was conducted to determine the prevalence and antimicrobial resistance of Salmonella species in swine reared in the intensive (indoor) and extensive (outdoor) ABF production systems at farm and slaughter in North Carolina, U.S.A. We sampled a total of 279 pigs at farm (extensive 107; intensive 172) and collected 274 carcass swabs (extensive 124; intensive 150) at slaughter. Salmonella species were tested for their susceptibility against 12 antimicrobial agents using the Kirby-Bauer disk diffusion method. Serogrouping was done using polyvalent and group specific antisera. A total of 400 salmonellae were isolated in this study with a significantly higher Salmonella prevalence from the intensive (30%) than the extensive farms (0.9%) (P<0.001). At slaughter, significantly higher Salmonella was isolated at the pre- and post-evisceration stages from extensively (29% pre-evisceration and 33.3% post-evisceration) than the intensively (2% pre-evisceration and 6% post-evisceration) reared swine (P<0.001). The isolates were clustered in six serogroups including B, C, E1, E4, G and R. Highest frequency of antimicrobial resistance was observed against tetracycline (78.5%) and streptomycin (31.5%). A total of 13 antimicrobial resistance patterns were observed including the pentaresistant strains with ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, tetracycline resistance pattern observed only among isolates from the intensive farms (n=28) and all were serotype Salmonella typhimurium var. Copenhagen. In conclusion, this study shows that multidrug resistant Salmonella are prevalent in ABF production systems despite the absence of antimicrobial selection pressure. In addition, it also highlights the possible role played by slaughterhouse and other environmental factors in the contamination and dissemination of antimicrobial resistant Salmonella in ABF production systems.

Antibody levels to hepatitis E virus in North Carolina swine workers, non-swine workers, swine, and murids.

In a cross-sectional serosurvey, eastern North Carolina swine workers (n = 165) were compared with non-swine workers (127) for the presence of antibodies to hepatitis E virus as measured by a quantitative immunoglobulin enzyme-linked immunosorbent assay. Using a cutoff of 20 Walter Reed U/ml, swine-exposed subjects had a 4.5-fold higher antibody prevalence (10.9%) than unexposed subjects (2.4%). No evidence of past clinical hepatitis E or unexplained jaundice could be elicited. Swine (84) and mice (61), from farm sites in the same region as exposed subjects, were also tested. Antibody prevalence in swine (overall = 34.5%) varied widely (10.0-91.7%) according to site, but no antibody was detected in mice. Our data contribute to the accumulating evidence that hepatitis E may be a zoonosis and specifically to the concept of it as an occupational infection of livestock workers.