Addressing the challenges of early career rural nursing to improve job satisfaction and retention: Strategies new nurses think would help.

AIMS: To (a) explore the experiences of early career registered nurses in rural hospitals in Australia and (b) identify strategies they believe would help increase job satisfaction and retention. DESIGN: Qualitative descriptive design. METHODS: Thirteen registered nurses located in outer regional, remote or very remote (herein 'rural') Australian hospitals participated in semi-structured interviews. Participants had graduated from a Bachelor of Nursing program in 2018-2020. Data were analyzed using thematic analysis and an essentialist, bottom-up approach. RESULTS: Seven themes related to the experiences of rural early career nursing: (1) appreciate diverse scope of practice; (2) rewarding sense of community and opportunity to give back; (3) staff support determines the quality of experience; (4) feeling underprepared and the need for ongoing education; (5) diverse views on the optimal length of rotation and level of input into choice of clinical area; (6) difficulty maintaining work/life balance due to work hours and rostering; and (7) lack of staff and resources. Strategies to improve nurses' experiences included: (1) assistance with accommodation and transport; (2) social gatherings to enhance connection; (3) sufficient orientation and supernumerary time; (4) increased frequency of contact with clinical facilitators and multiple mentors; (5) prioritizing clinical education across diverse topics; (6) greater involvement in choice of rotations and clinical areas; and (7) desire for more flexible work hours and rostering. CONCLUSIONS: This study highlighted the experiences of rural nurses and explored their suggestions for how to overcome challenges in their roles. Greater consideration of early career registered nurses' needs and preferences is vital to improving and maintaining a satisfied, dedicated and sustainable rural nursing workforce. IMPACT: Many of the strategies for improving job retention identified by nurses in this study could be actioned at a local level, with little financial or time investment. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Heterakis isolonche Infection Associated with Severe Nodular Typhlitis and Suspect Aberrant Pulmonary Migration in a Golden Pheasant (Chrysolopus pictus).

This case report describes the clinical, parasitologic, pathologic, and histologic characteristics of a golden pheasant (Chrysolopus pictus) with an infection of Heterakis isolonche in Mississippi. An approximately 2-yr-old golden pheasant from a flock of 8 to 10 birds was submitted to the Poultry Research and Diagnostic Laboratory in Pearl, MS, for necropsy. Clinical history indicated that three flock mates had died of unknown causes in the past. At necropsy, the submitted pheasant showed severe nodular typhlitis associated with the presence of numerous whitish small nematodes inside the cecal walls and lumen with morphologic features consistent with H. isolonche. The histologic examination showed multifocal to coalescing, nodular, granulomatous, and lymphocytic typhlitis with fibroplasia, and multiple intralesional nematodes. Furthermore, the presence of similar nematodes in the lung indicated a possible aberrant migration of Heterakis sp. to this organ. The flock was subsequently treated with an oxfendazole-containing dewormer and suffered no further losses.

Reporte de Caso- Infección por Heterakis isolonche asociada a tiflitis nodular severa y posible migración pulmonar aberrante en un faisán dorado (Chrysolopus pictus). Este informe de caso describe las características clínicas, parasitológicas, patológicas e histológicas de un faisán dorado (Chrysolopus pictus) con una infección por Heterakis isolonche en Mississippi. Un faisán dorado de aproximadamente dos años de edad de una parvada de ocho a diez aves fue remitido al Laboratorio de Investigación y Diagnóstico Avícolas en Pearl, Mississippi, para su necropsia. La historia clínica indicó que tres aves de la misma parvada habían muerto previamente por causas desconocidas. En la necropsia se observó tiflitis nodular grave asociada con la presencia de numerosos nematodos pequeños blanquecinos dentro de las paredes cecales y en el lumen con características morfológicas compatibles con H. isolonche. El examen histológico mostró tiflitis multifocal nodular coalescente, granulomatosa y linfocítica con fibroplasia y múltiples nematodos intralesionales. Además, la presencia de nematodos similares en el pulmón indicó una posible migración aberrante de Heterakis sp. a este órgano. Posteriormente, la parvada fue tratada con un antiparasitario que contenía oxfendazol y no presentó más pérdidas por mortalidad.

An Investigation of the Cause of Wild Turkey Mortality in Mississippi.

Lymphoproliferative disease virus (LPDV) is an exogenous alpharetrovirus that sporadically causes fatal lymphoid neoplasia in affected turkeys. Previous studies of wild turkeys (Meleagridis gallopavo) in the United States have demonstrated geographically widespread LPDV infection and frequent coinfection with avian poxvirus (APV) and reticuloendotheliosis virus (REV). This study was conducted to better understand health risks to Mississippi wild turkeys, including the relative importance of LPDV, APV, and REV in contributing to mortality. Thirteen wild turkeys, which died naturally or were euthanized due to illness, were submitted to Mississippi State University's Poultry Research and Diagnostic Laboratory for postmortem examinations. Birds originated from nine counties across the state over the past 5 yr. Carcasses were submitted as fresh (nonfrozen) or frozen. At autopsy, 9 of 13 turkeys had severe, proliferative cutaneous lesions on the head and neck, with diphtheritic or proliferative oral and esophageal lesions. Samples were collected for molecular diagnostic testing (LPDV and REV PCR), histopathology, and bacterial culture and isolation. External and internal parasites were preserved in formalin for identification. APV (cutaneous and/or diphtheritic forms) was diagnosed in 9 of 13 birds by identification of pathognomonic histologic lesions (including intracytoplasmic inclusion bodies). Interestingly, all birds with APV were also REV PCR positive. Furthermore, eight turkeys were positive for LPDV, and LPDV was commonly associated with coinfections with APV and REV.

El virus de la enfermedad linfoproliferativa (LPDV) es un Alfaretrovirus exógeno que esporádicamente provoca una neoplasia linfoide mortal en los pavos afectados. Estudios previos de pavos salvajes (Meleagridis gallopavo) en los Estados Unidos han demostrado que la infección por la enfermedad linfoproliferativa está geográficamente extendida y es una coinfección frecuente con el virus de la viruela aviar (APV) y el virus de la reticuloendoteliosis (REV). Este estudio se realizó para comprender mejor los riesgos para la salud de los pavos salvajes de Mississippi, incluida la importancia relativa de enfermedad linfoproliferativa, el virus de la viruela aviar y el virus de la reticuloendoteliosis en la contribución a la mortalidad. Trece pavos salvajes, que murieron naturalmente o fueron sacrificados por enfermedad, fueron enviados al Laboratorio de Investigación y Diagnóstico Avícola de la Universidad Estatal de Mississippi para exámenes post-mortem. Las aves provenían de condados de todo el estado durante los últimos cinco años. Las canales se enviaron tanto frescas (no congeladas) como congeladas. A la necropsia, 9 de 13 pavos mostraron lesiones cutáneas proliferativas graves en la cabeza y el cuello, con lesiones orales y esofágicas diftéricas o proliferativas. Se recolectaron muestras para pruebas de diagnóstico molecular (LPDV y REV PCR), histopatología y cultivo y aislamiento bacterianos. Los parásitos externos e internos se conservaron en formalina para su identificación. Se diagnosticó viruela aviar (formas cutáneas y/o diftéricas) se diagnosticó en 9 de 13 aves mediante la identificación de lesiones histológicas patognomónicas (incluidos los cuerpos de inclusión intracitoplasmáticos). Curiosamente, todas las aves con viruela aviar también fueron positivas a la presencia del virus de la reticuloendoteliosis por PCR. Además, ocho pavos fueron positivos para el virus de la enfermedad linfoproliferativa, y se asoció comúnmente con coinfecciones con viruela aviar y con el virus de la reticuloendoteliosis.

Angiostrongylus cantonensis infection in captive Geoffroy's tamarins (Saguinus geoffroyi).

CASE DESCRIPTION: 3 Geoffroy's tamarins (Saguinus geoffroyi) in a zoo in east central Alabama developed neurologic signs shortly after a tamarin kept in the same enclosure was found dead. CLINICAL FINDINGS: Neurologic abnormalities varied among animals and were progressive. One female tamarin with a head tilt, nystagmus, mild ataxia, and paresis of a thoracic limb had gram-positive cocci present in an ear canal with otitis media and interna suspected. Another female with mild ataxia attributed to previous tail amputation developed seizures, and a male tamarin with tail tip trauma also developed ataxia. TREATMENT AND OUTCOME: The tamarin with suspected otitis received cephalexin and prednisolone, but neurologic signs worsened, and the patient died. Preliminary examination of necropsy samples revealed severe meningoencephalitis in both deceased tamarins. Prednisolone and phenobarbital treatment was initiated for the tamarin with seizures, but rapid neurologic deterioration led to euthanasia. Further histologic examination of the 3 deceased tamarins revealed meningitis and acute perivascular hemorrhage in the meninges. Parasites morphologically consistent with Angiostrongylus (Parastrongylus) cantonensis were present in the lungs of 1 animal and in the meninges of 2. The surviving tamarin received cephalexin for tail tip trauma and prednisolone and albendazole for presumed meningoencephalitis and parasitic infection but had permanent neurologic deficits. CLINICAL RELEVANCE: To our knowledge, these represent the first cases of A cantonensis infection in Geoffroy's tamarins and the first report of its presence in the United States not associated with a major shipping port. The presence of a mature worm in the lungs of 1 tamarin suggested completion of the parasite life cycle, previously reported only in rats.

The effect of personal relevance on learning stroke symptoms/response.

The aim of this study was to test the effect of increasing the personal relevance of stroke symptom information on learning stroke symptoms/emergency response. A randomized pretest-posttest double-blind study design was used. A total of 173 community-dwelling adults participated. Treatment participants read the personally relevant statement, "Learn about stroke to save someone you love," completed the Stroke Action Test pretest, read the National Institute of Neurological Disorder and Stroke pamphlet titled Know Stroke. Know the Signs. Act in Time, and responded to the Stroke Action Test posttest. The control condition differed only in the omission of the personally relevant statement. The treatment group learned significantly more than the control group, F(1, 170) = 7.46, p < .007, eta2 = .02. The mean items learned by the treatment group was 8.3 (SD = 5.67) compared to the control group mean of 6.2 (SD = 5.76). Prefacing stroke prevention information with the statement, "Learn about stroke to save someone you love," could result in greater learning of stroke symptoms/response.

Diagnosis of Amanita toxicosis in a dog with acute hepatic necrosis.

Poisoning with amanitin-containing hepatotoxic mushrooms demands extensive efforts from clinicians, toxicologists, and pathologists. Presumptive diagnoses are established by positive identification of the suspect mushroom along with the occurrence of consistent clinical signs. If the animal dies, hepatic lesions may suggest exposure to amanitin-containing mushrooms; however, lesions are nonspecific. A 15-week-old female Dachshund was presented to the referring veterinarian for acute onset of lethargy that quickly progressed to sternal recumbency. Despite supportive care, the dog remained lethargic and died approximately 12 hours after initial presentation. A pale tan liver was noted at necropsy. Microscopically, the liver showed panlobular coagulative necrosis of hepatocytes. A presumptive diagnosis of amanitin poisoning was based on suspect history of exposure to mushrooms, clinical signs, and pathologic findings. Exposure to amanitin was confirmed through detection of alpha-amanitin in the liver by liquid chromatography/mass spectrometry. The objective of this case report is to illustrate the essential components to a successful diagnostic work-up of a suspect case of hepatotoxic mushroom poisoning. Although hepatotoxic mushroom poisoning has been documented in dogs before, confirmatory techniques for biologic specimens have not been used previously in diagnostic investigations.

Intravenous plus oral amiodarone, atrial septal pacing, or both strategies to prevent post-cardiothoracic surgery atrial fibrillation: the Atrial Fibrillation Suppression Trial II (AFIST II).

BACKGROUND: The effect of a hybrid intravenous and oral prophylactic amiodarone regimen on postcardiothoracic surgery (CTS) atrial fibrillation (AF) is unknown. The impact of active atrial septal pacing on post-CTS AF has not been well characterized. In addition, the effect of using both amiodarone and atrial septal pacing together to prevent atrial fibrillation is unknown. METHODS AND RESULTS: Patients (n=160) were randomized to amiodarone or placebo and then to pacing or no pacing using a 2x2 factorial design. All therapies began within 6 hours post-CTS. Amiodarone was given by intravenous infusion for the first 24 hours (1050 mg total) followed by oral therapy for 4 postoperative days (4800 mg total). Atrial septal pacing was given for 96 hours. Amiodarone reduced the risk of AF by 43% and the risk of symptomatic AF by 68% (P=0.037 and P=0.019) versus placebo. Atrial septal pacing did not reduce AF or symptomatic AF incidence versus no pacing. The risk of post-CTS AF in the patients receiving amiodarone+pacing was lower than the placebo+no pacing and the placebo+pacing groups (57.9% and 60.5% reductions, P=0.047 and P=0.040, respectively). CONCLUSIONS: Amiodarone given as both an intravenous and oral regimen is effective at reducing post-CTS AF but atrial septal pacing is ineffective. Combining amiodarone and pacing is better than placebo with or without pacing but not amiodarone alone.