Facial Swelling After Dental Work Done: A Case of Ludwig's Angina.

Ludwig's angina is a fast-spreading cellulitis located on the floor of the oropharynx and neck (Tami, Othman, Sudhakar, & McKinnon, 2020). Patients may present with a wide range of symptoms depending on the severity of the condition (Reynolds & Chow, 2007). Emergency nurse practitioners need to promptly identify, diagnose, and treat patients with this problem, with close attention to the patient's airway. A compromised airway is the leading cause of mortality from this condition (McDonnough et al., 2019). The diagnosis is generally made with a comprehensive history and physical examination, laboratory values, and imaging studies such as computer tomography (Bridwell, Gottlieb, Koyfman, & Long, 2021). Management includes admission to the hospital, broad-spectrum antibiotics, and specialist surgical consultation (Bridwell et al., 2021).

Scombroid Poisoning: An Overview for the Emergency Nurse Practitioner.

Scombroid poisoning is a common fish-borne disease in clinical settings. Fish that has not been adequately stored after catching can allow bacteria to proliferate, which causes the conversion of histidine to histamine. Once histamine has formed, freezing or cooking the fish will not remove the histamine content. Once the fish is consumed, histamine is released, causing toxicity to the patient with symptoms including cutaneous, gastrointestinal, and anaphylactoid. Emergency nurse practitioners should identify, appropriately diagnose, and treat individuals with scombroid poisoning and avoid misdiagnosing it as fish allergy.

The Relationship Between Functional Connectivity and Interoceptive Sensibility.

Background: Interoceptive signals related to changes in heartbeat, respiration, and gastric functioning continuously feedback to the brain. The interpretation of these signals influences several cognitive, affective, and motoric functions. Previous research has highlighted the distinction between the ability to accurately detect interoceptive information (i.e., interoceptive accuracy) and an individual's beliefs about his or her interoceptive abilities (i.e., interoceptive sensibility). Although numerous studies have delineated the neural substrates of interoceptive accuracy, less is known about the brain areas involved with interoceptive sensibility. Materials and Methods: In the current study, 28 healthy participants completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), a self-report measure of interoceptive sensibility, before undergoing a 7-min resting-state functional magnetic resonance imaging scan. IRB ethics approval was obtained prior to data collection. Results: Overall MAIA scores, as well as scores on its eight subscales, were entered as covariates in subsequent region-of-interest and independent-component analyses. These analyses yielded three key results. First, interoceptive sensibility was negatively correlated with the functional connectivity of visual regions. Second, the cerebellar resting-state network showed positive correlations with two MAIA subscales, suggesting that this structure plays a role in interoceptive functions. Finally, the functional connectivity of the insula, a structure critical for interoceptive accuracy, was not correlated with any of the MAIA scores. Conclusion: These results demonstrate that the brain areas associated with individual differences in interoceptive sensibility show relatively little overlap with those involved with the accurate detection of interoceptive information. Impact statement The current research demonstrates that individual differences in interoceptive sensibility (i.e., self-reported sensitivity to interoceptive information) are related to differences in resting-state functional connectivity. These data also indicate that the brain areas related to interoceptive sensibility are different than the brain areas involved with interoceptive accuracy (i.e., the objective detection of interoceptive signals). This latter finding suggests that although the insula is critical for many interoceptive processes, our subjective beliefs about our interoceptive abilities involve other neural structures, particularly visual regions and the cerebellum.

Endometriosis: a guide to investigations and treatment in the emergency department.

Endometriosis is an oestrogen-dependent disorder where endometrial tissue forms lesions outside the uterus, causing chronic inflammation and scarring. Women who have endometriosis may experience a highly variable range of non-specific signs and symptoms, including pelvic pain. Endometriosis is often misdiagnosed, partly because its signs and symptoms can easily be attributed to more common conditions that cause pelvic pain in women, resulting in delayed diagnosis and treatment. This article describes the pathophysiology, aetiology, risk factors for, and signs and symptoms of endometriosis. It also outlines how endometriosis should be investigated and treated in the emergency department (ED). Its aim is to support nurses to deliver effective care to women of reproductive age presenting to the ED with severe pelvic pain.

Winged scapula: an overview of pathophysiology, diagnosis and management.

Patients commonly present to the emergency department (ED) with shoulder injuries and shoulder pain. Winged scapula is one potential underlying cause of shoulder pain which is often forgotten or ill-defined. This non-traumatic skeletal condition typically presents as a prominent protrusion of the medial border of the bone from its normal position in the back. It often results from damage to and/or compression of the long thoracic nerve, which innervates the serratus anterior muscle. History taking, physical examination and imaging are needed to correctly diagnose winged scapula. Conservative management is often sufficient to resolve the condition. However, in some cases further investigations and more invasive treatment modalities are needed. This article provides an overview of the pathophysiology of winged scapula and its diagnosis and management in the ED.

Use of simulation for global health pre-departure training.

BACKGROUND: Opportunities for students to participate in global health mission trips have expanded. However, lack of pre-departure training is often reported and has been associated with negative outcomes for participants. Simulation is an effective method for providing customized situational learning. OBJECTIVE: To evaluate the effectiveness of a Pre-Departure Training program incorporating simulation for advanced practice registered nursing (APRN) students prior to a global health mission trip. DESIGN: This program employed a pre-posttest design with surveys administered at baseline, after a computer-based learning module, and after a simulation-based learning experience. SETTING: A university in the Southeastern United States. PARTICIPANTS: Twenty-two APRN students in their first clinical rotation of the program. METHODS: APRN students with interest in global health missions partake in a pre-departure training program. Pre-departure training includes a computer-based learning module followed by an outdoor simulation replicating a low-income setting. Pre-posttest surveys assessed students' perceptions of confidence, skill, knowledge and comfort regarding global health. A skills checklist was used to evaluate student clinical patient presentation during the simulation. RESULTS: Students' preparedness scores increased after the computer-based learning and significantly increased after the simulation. In the simulation, 42% of students successfully completed their patient presentation during their first attempt while 58% required remediation. CONCLUSION: After the pre-departure program, students felt more confident in their global health knowledge, and felt significantly more prepared to provide health care in a low-income country. Schools of nursing offering global health mission trips or study abroad programs should consider implementing pre-departure programs using simulation as a teaching method.

Barriers and Facilitators of Asthma Management as Experienced by African American Caregivers of Children with Asthma: An Integrative Review.

INTRODUCTION: African American children with asthma demonstrate significant health disparities and poor health outcomes. Understanding the burdens faced by parents and caregivers of children with asthma may be helpful to develop future interventions to address this disparity. PURPOSE: The purpose of this integrative review was to reveal the barriers and facilitators of child asthma management experienced by African American caregivers. METHOD: Whittemore and Knafl's (2005) method of integrative review was used to review 40 articles. The integrative review involved appraising the quality of the literature, conducting a thematic analysis, and evaluating the barriers and facilitators of pediatric asthma management experienced by African American caregivers. RESULTS: Barriers and facilitators were identified as themes. Barriers included caregiver burdens, and lack of home and neighborhood safety. Facilitators were family and community support, education and empowerment, and culturally competent healthcare providers. DISCUSSION: To improve the care of African American children with asthma, nurses should work to engage, communicate, and foster trust with families. Nurses should assess and address the family caregivers' burdens while emphasizing support systems.

Psychological and Socioeconomic Burdens Faced by Family Caregivers of Children With Asthma: An Integrative Review.

INTRODUCTION: Asthma affects nearly 1 in every 12 children in the United States. Caring for a child with asthma poses significant challenges for the parent or caregiver. The purpose of this integrative review was to identify the psychological and socioeconomic burdens faced by family caregivers of children with asthma. METHOD: An integrative review was conducted to review and appraise 80 studies. RESULTS: Psychosocial burdens included decreased mental health, quality of life, sleep, family stress, educational deficits, cultural and health disparities, and health care communication challenges. Socioeconomic burdens included poor access to care, as well as work and financial challenges. Studies demonstrated a link between family caregiver health and child health outcomes. Facilitators included education and empowerment, social support, and use of technology. DISCUSSION: As the family caregiver's health directly affects the asthmatic child's health, addressing the burdens of family caregivers should be a key consideration in pediatric asthma care.

Charcot's foot: a clinical update for emergency nurses.

Charcot neuropathy osteoarthropathy, known as Charcot's foot, is a condition of the foot most frequently related to diabetes mellitus. It is associated with a high mortality rate, especially among patients with diabetes, therefore prompt identification and management of the condition by nurses in emergency departments is important. This article describes the pathophysiology, signs and symptoms and diagnosis of Charcot's foot, and offers guidance for initial care in emergency settings. Emergency nurses in the UK have an important role in recognising patients with this condition to ensure they receive optimal treatment and follow-up.

Mallet finger injuries: the signs, symptoms, diagnosis and management.

Patients commonly present to UK emergency departments with injuries to the tips of their fingers. Mallet finger is one of the most common injuries, resulting from an injury to the extensor tendon over the dorsal surface of the distal phalanges of the hand. Timely recognition, diagnosis and management are required to prevent complications. This article provides an overview of the pathophysiology, signs, symptoms, diagnosis and management of mallet finger injuries.

Assessment and treatment of cutaneous leishmaniasis in the emergency department.

Cutaneous leishmaniasis is endemic in more than 70 countries worldwide. It is a non-fatal disease caused by the Leishmania parasite that is transmitted to humans via bites of infected female sandflies. Cutaneous leishmaniasis causes skin lesions on areas of exposed skin, such as the face and limbs, which often produce scarring and atrophy. If untreated, cutaneous leishmaniasis can develop into mucocutaneous leishmaniasis, which is potentially life-threatening. Furthermore, patients with cutaneous leishmaniasis commonly experience psychosocial issues such as anxiety, distress, stigma and rejection. Cutaneous leishmaniasis is spreading outside of its traditional endemic areas because of the effects of environmental changes such as urbanisation and climate change. In the UK, healthcare professionals may encounter the disease in migrants from endemic areas, members of the armed forces, tourists and expatriates. Therefore, emergency nurses need to be able to assess and support patients who present with symptoms suggestive of cutaneous leishmaniasis. This article provides an overview of the epidemiology, aetiology, pathophysiology, clinical presentation, diagnosis, treatment and prevention of the disease.

Virtual Simulation in Nursing Education: A Systematic Review Spanning 1996 to 2018.

STATEMENT: As virtual simulation is burgeoning, faculty and administrators are asking for evidence of its effectiveness. The objective of this systematic review was to identify how virtual simulation impacts nursing student learning outcomes. Applying the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, 80 studies were reviewed. Results indicate that most research (n = 69, 86%) supported virtual simulation as an effective pedagogy to support learning outcomes while highlighting gaps and areas of bias. Adding search terms could have expanded the findings. The body of evidence supports virtual simulation as an effective pedagogy. Future studies should use more robust research designs, prioritize curricular integration of virtual simulation, and determine best practices in virtual simulation methodology.

Impact of DECISION + 2 on patient and physician assessment of shared decision making implementation in the context of antibiotics use for acute respiratory infections.

BACKGROUND: DECISION + 2, a training program for physicians, is designed to implement shared decision making (SDM) in the context of antibiotics use for acute respiratory tract infections (ARTIs). We evaluated the impact of DECISION + 2 on SDM implementation as assessed by patients and physicians, and on physicians' intention to engage in SDM. METHODS: From 2010 to 2011, a multi-center, two-arm, parallel randomized clustered trial appraised the effects of DECISION + 2 on the decision to use antibiotics for patients consulting for ARTIs. We randomized 12 family practice teaching units (FPTUs) to either DECISION + 2 or usual care. After the consultation, both physicians and patients independently completed questionnaires based on the D-Option scale regarding SDM behaviors during the consultation. Patients also answered items assessing the role they assumed during the consultation (active/collaborative/passive). Before and after the intervention, physicians completed a questionnaire based on the Theory of Planned Behavior to measure their intention to engage in SDM. To account for the cluster design, we used generalized estimating equations and generalized linear mixed models to assess the impact of DECISION + 2 on the outcomes of interest. RESULTS: A total of 270 physicians (66% women) participated in the study. After DECISION + 2, patients' D-Option scores were 80.1 ± 1.1 out of 100 in the intervention group and 74.9 ± 1.1 in the control group (p = 0.001). Physicians' D-Option scores were 79.7 ± 1.8 in the intervention group and 76.3 ± 1.9 in the control group (p = 0.2). However, subgroup analyses showed that teacher physicians D-Option scores were 79.7 ± 1.5 and 73.0 ± 1.4 respectively (p = 0.001). More patients reported assuming an active or collaborative role in the intervention group (67.1%), than in the control group (49.2%) (p = 0.04). There was a significant relation between patients' and physicians' D-Option scores (p < 0.01) and also between patient-reported assumed roles and both D-Option scores (as assessed by patients, p < 0.01; and physicians, p = 0.01). DECISION + 2 had no impact on the intention of physicians to engage in SDM. CONCLUSION: DECISION + 2 positively influenced SDM behaviors as assessed by patients and teacher physicians. Physicians' intention to engage in SDM was not affected by DECISION + 2. TRIAL REGISTRATION: ClinicalTrials.gov trials register no. NCT01116076.