The use of Community/Public Health Nursing Competencies during the COVID-19 pandemic.

OBJECTIVES: (1) Ascertain the use of the Quad Council Competencies for Community/Public Health Nursing (QCC-C/PHN) Competencies by community/public health nurses (C/PHNs) during the COVID-19 pandemic; (2) Inform from a systems-level the need to sustain the C/PHN workforce; (3) Assess the C/PHN infrastructure for response capacity. DESIGN: Cross-sectional. Statewide email distribution lists were used for dissemination. SAMPLE: Convenience sample (n = 169) obtained using emailed Qualtrics link with the eligibility criteria of self-identification as a C/PHN who works in the state of Missouri. MEASUREMENTS: Demographic questions included employment sector, nursing education level, years of nursing, and C/PHN experience. Two Likert-type questions and one optional open-text question were created for the eight domains. RESULTS: One hundred sixty-nine participants' data were analyzed. One hundred fifty-four were employed in a local public health agency. Total 63.2% held a bachelor's degree in nursing or higher. The average number of years of nurse experience was 20.84, and C/PHN experience was 9.84. The domain of Communication Skills scored highest and Cultural Competency was the lowest. Three themes emerged from the open-ended questions including vulnerabilities of the public health system. CONCLUSION: Understanding the experiences of C/PHNs in Missouri related to the utilization of QCC-C/PHN competencies informs efforts to strengthen public health infrastructure and target resources to equip Missouri's C/PHNs.

Prenatal aneuploidy screening in a low-risk Hispanic population: price elasticity and cost-effectiveness.

BACKGROUND: In October 2015, the Massachusetts Medicaid program temporarily stopped reimbursement for procedures in which the International Classification of Diseases, Tenth Edition, code for serum aneuploidy screening used by certain communities was stipulated. This change led to a substantial number of patients who went without aneuploidy screening for approximately 3 years. OBJECTIVE: This study aimed to determine the change in use and cost-effectiveness of prenatal aneuploidy serum screening in a low-risk Hispanic Medicaid population in Massachusetts. STUDY DESIGN: We conducted a retrospective chart review of Spanish-speaking pregnant patients younger than 35 years of age who underwent aneuploidy serum screening at a Massachusetts community health center. The study compared the aneuploidy serum screening rates for the periods before and after May 2016 when the Massachusetts Medicaid program, MassHealth, temporarily discontinued reimbursement for the screening. Based on these rates, we developed a Markov cohort simulation model to assess the economic value of reimbursed aneuploidy screening vs nonreimbursed or limited screening. Clinical outcomes included trisomy 21, live births, and therapeutic abortions for a trisomy 21 diagnosis. Economic outcomes included discounted quality-adjusted life years and lifetime medical costs, net health benefit, and incremental cost-effectiveness ratios. RESULTS: Before the MassHealth policy change, 69% (55/80) of pregnant individuals selected quad or sequential screens in comparison with only 9% (10/112) who selected screens after the policy change. Traditional aneuploidy serum screening in a low-risk (aged <35 years) Hispanic population was considered to be cost-saving (ie, led to lower incremental costs and higher incremental benefits when compared with nonreimbursed or limited screening). CONCLUSION: From a United States healthcare payer perspective, aneuploidy serum screening for Hispanic pregnant individuals under 35 years of age is economically advantageous when compared with limited screening.

Efficacy of implementing a BRCA screening protocol in primary care.

ABSTRACT: Breast cancer is the second leading cause of cancer death for women, whereas ovarian cancer is the deadliest gynecological cancer. Breast cancer gene 1 ( BRCA1 ) and breast cancer gene 2 ( BRCA2 ) mutations can increase the risk of developing breast and ovarian cancer. Screening can assist in prevention and early detection. This study aimed to increase provider knowledge of BRCA mutations, the use of BRCA screening tools, and genetic referrals. An Institutional Review Board-approved study was implemented for providers for training on BRCA1 and BRCA2 mutations and the importance of screening and referral for those at risk. Measures included provider confidence and knowledge after training as well as number of patient referrals. A standardized webinar was required with further education provided in multiple modalities. The number of BRCA screenings and referrals for genetic screening was monitored through the electronic health record (EHR). Eight providers including five nurse practitioners and three medical doctors participated in the complete project. As a result, 56 patients were BRCA screened, and four referrals were made to receive genetic counseling. Education enhanced knowledge, increased screening tool use, and resulted in improvement in genetic referrals through the EHR.

Barriers to a Timely Diagnosis of Endometriosis: A Qualitative Systematic Review.

OBJECTIVE: The diagnosis of endometriosis, a common gynecologic condition, is characterized by delays of up to 11 years. During this time, women may experience persistent symptoms that affect their quality of life, productivity, and relationships, and the disease may progress. It is therefore a priority to understand the factors that contribute to this delay to help improve the diagnostic pathway. Our objective was to describe the diagnosis barriers of endometriosis from the patient and health care professional perspectives using a qualitative evidence synthesis. DATA SOURCES: We searched MEDLINE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature using combinations of the synonyms of endometriosis, diagnosis, and qualitative research. The search was restricted to English-language articles from database creation until May 2022. METHODS OF STUDY SELECTION: The initial search yielded 899 articles. Studies were included if they explored the experiences or views of affected women or health care professionals on the diagnosis of endometriosis and used qualitative methods for data collection and data analysis. Risk of bias was assessed with the Critical Appraisal Skills Programme checklist. TABULATION, INTEGRATION, AND RESULTS: Thirty-seven articles were considered for full review, with 13 eligible articles identified for inclusion. Thematic synthesis was used to identify four key themes: 1) individual factors (n=6), 2) interpersonal influences (n=6), 3) health system factors (n=13), and 4) factors specific to endometriosis (n=13). These encompassed 12 subthemes that represented barriers to the diagnosis of endometriosis: 1) difficulty establishing pathologic symptoms from normal menstruation and the use of self-care techniques; 2) menstrual stigma and the normalization of menstrual pain; 3) attitudes and lack of training for health care professionals, delayed referrals to specialist services, and poor explanation of oral contraceptive pill use in the diagnostic process; and 4) variability in presenting symptoms, overlap with other conditions, lack of a noninvasive method of diagnosis, and concerns about the value of a diagnosis. CONCLUSION: This review identified barriers to the timely diagnosis of endometriosis from the perspective of affected individuals and health care professionals. It highlights areas for improvement along the diagnostic pathway, which may guide future strategies to reduce delays.

A Light-Promoted Innate Trifluoromethylation of Pyridones and Related N-Heteroarenes.

We report a practical, light-mediated perfluoroalkylation using Langlois' reagent (sodium trifluoromethylsulfinate) that proceeds in the absence of any photocatalyst or additives. This method has allowed for the facile functionalization of pyridones and related N-heteroarenes such as azaindole. This protocol is operationally simple, uses readily available materials, and is tolerable for electron-neutral and -rich functional pyridones. Cyclic voltammetry was utilized as a mechanistic probe, and preliminary data suggest the reaction may involve an electrophilic radical mechanism.

Dementia in care homes: increasing the diagnosis rate among undiagnosed residents.

It has been estimated that 70% of care home residents have dementia on admission or develop it after admission, but that many do not have or receive a formal diagnosis of dementia. People with dementia often have significant care needs and it is important that the condition is diagnosed even at an advanced stage. This will enable nurses to predict the person's care needs, develop appropriate care plans and arrange pre-emptive decisions. In 2021-22, a quality improvement project took place in care homes in West Norfolk. This project piloted an abbreviated memory assessment model based on the Diagnosing Advanced Dementia Mandate (DiADeM) tool to increase the rate of diagnoses among residents showing signs and symptoms of cognitive impairment but not formally diagnosed with dementia. Out of 109 residents assessed, 95 were diagnosed with dementia. The pilot is being extended locally and replicated across England.

Shared Core Facilities Serve as Hubs for Biomedical Research Network at Institutions of Emerging Excellence.

We analyzed co-authorship patterns within the National Institutes of Health Center of Biomedical Research Excellence in Matrix Biology program from 2014 to 2022. In this study, we analyzed junior investigators, senior researchers, and research scientists within a shared core facility. Social network analysis techniques were applied to evaluate the co-authorship network based on journal publications from members of the center. The results indicated that co-authorship network visualization and analysis is a useful tool for understanding the relationship between a shared core facility and young investigators within a research center. Young investigators collaborated with and relied upon the individual research scientists of the shared core facility to serve as contributing members of their extended research team. This reliance on the shared core facility effectively increases the size and productivity of the research team led by the young investigator. Our results indicate that shared core facility staff may serve as hubs within the network of biomedical researchers, particularly at institutions with a growing research emphasis. Listen to this article.

Ocular Safety and Toxicokinetics of Bevacizumab-bvzr (Zirabev), a Bevacizumab Biosimilar, Administered to Cynomolgus Monkeys by Intravitreal Injection.

Purpose: Bevacizumab-bvzr (Zirabev®), a recombinant humanized monoclonal antibody targeting vascular endothelial growth factor and a biosimilar to bevacizumab, is approved for intravenous administration for various indications worldwide. The objectives of this study were to evaluate the ocular toxicity, systemic tolerability, and toxicokinetics (TKs) of bevacizumab-bvzr following repeat intravitreal (IVT) injection to cynomolgus monkeys. Methods: Male monkeys were administered saline, vehicle, or bevacizumab-bvzr at 1.25 mg/eye/dose once every 2 weeks (3 doses total) for 1 month by bilateral IVT injection, followed by a 4-week recovery phase to evaluate the reversibility of any findings. Local and systemic safety was assessed. Ocular safety assessments included in-life ophthalmic examinations, tonometry (intraocular pressure, IOP), electroretinograms (ERGs), and histopathology. In addition, concentrations of bevacizumab-bvzr were measured in serum and in ocular tissues (vitreous humor, retina, and choroid/retinal pigment epithelium) and ocular concentration-time profiles and serum TKs were evaluated. Results: Bevacizumab-bvzr was tolerated locally and systemically, with an ocular safety profile comparable to the saline or vehicle control group. Bevacizumab-bvzr was observed in both serum and in the evaluated ocular tissues. There were no bevacizumab-bvzr-related microscopic changes or effects on IOP or ERGs. Bevacizumab-bvzr-related trace pigment or cells in vitreous humor (in 4 of 12 animals; commonly associated with IVT injection) and transient, nonadverse, mild ocular inflammation (in 1 of 12 animals) were noted upon ophthalmic examination and fully reversed during the recovery phase. Conclusions: Bevacizumab-bvzr was well tolerated via biweekly IVT administration in healthy monkeys, with an ocular safety profile comparable to saline or its vehicle control.

How to Develop a Grant Writing Course for Undergraduate Students.

Grant writing is an important skill to develop, allowing students to envision solutions to issues that impact their local, regional, and global communities. Additionally, grant writing, like other research-associated activities, can improve student success in and out of the classroom. Grant writing can help students understand the alignment between research activities and a "big picture" understanding of the common good and societal impact of the research. Grant writing can improve students' ability to articulate the significance and broader impacts of research. Faculty mentors can play a major role in grant writing activities by helping to guide undergraduate students through the process. A course-based approach can help instructors who mentor students in research by providing scaffolding and scheduling tools. This article provides an overview of a grant writing course used as an efficient and effective way for undergraduate students to be guided through the grant proposal writing process with a greater potential for positive outcomes. We discuss why undergraduate students should learn how to write grant proposals, the advantages of teaching grant writing in a course-based format, time management, learning outcomes, and ways to assess student learning. © 2023 Wiley Periodicals LLC.

EBP on the Go! An Education Case Report: When Time, Budget, and a Global Pandemic Limit Your Options for Nursing Education, Create Your Own!

In an era when resources, time, and attention spans are limited, nursing education must be delivered in a manner that is economical and convenient while retaining the ability to hold consumers accountable for their learning. This article highlights one organization's solution to a gap in evidence-based practice education. Professional development practitioners utilized their own creative acumen to develop high-quality, organization-specific resources that provide education in an engaging, portable, and user-friendly format.

Dual Energy X-Ray Absorptiometry (DXA) Extended Femur Scans to Support Opportunistic Screening for Incomplete Atypical Femoral Fractures: A Short Term in-vivo Precision Study.

BACKGROUND: Atypical femoral fracture (AFF) is documented as a known but rare complication of bisphosphonate use for the treatment of osteoporosis. These present in an incomplete form prior to failure, which results in a complete fracture requiring surgical intervention. Dual energy x-ray absorptiometry (DXA) is the gold standard for the diagnosis of Osteoporosis and for monitoring the response to therapeutic interventions. This provides an opportunity to use routine DXA scans to identify incomplete atypical fractures, which can subsequently be monitored for progression and pre-fracture intramedullary nailing undertaken where necessary. DXA manufacturers have developed extended femur scans to assess and measure the femoral cortex for incipient atypical femoral fractures. The aim of this study was to evaluate the precision errors related to the cortical measurements and for hip bone mineral density using the extended femur setting. METHODOLOGY: A single operator performed duplicate same day in-vivo measurements of the femur in 30 consenting participants, with repositioning between scans, during their visit for routine DXA scanning. The study was performed on a single GE Lunar Prodigy scanner (GE Lunar, Bedford, UK). Root mean squared standard deviation (RMS SD) and coefficient of variation (RMS CV%) were calculated for the cortex measurements known as beaking index (BI) and hip bone mineral density (BMD) measurements. RESULTS: The use of the extended femur scan software yielded an RMS SD (RMS CV%) of 0.011 (1.43%) for the total hip and 0.015 (2.05%) for the femoral neck. The BI measurement RMS SD (RMS CV%) was 0.473 (38.10%) Visual assessment of the femoral cortex discounted all positive BI anomalies as software generated in this dataset. CONCLUSIONS: The use of extended femur scan software did not affect the precision errors of the BMD measurements at the hip when compared to the literature on focused hip scans, however this study is unique with nothing similar being found in the published literature. The BI precision errors were much greater than those seen at the hip and therefore unreliable unless accompanied by visual assessment which is recommended to avoid unnecessary investigation in around one fifth of the scan population.

Incorporating Faith into Ethics Education.

ABSTRACT: Preparing students for ethical situations they will face in practice should be incorporated into nursing curricula, especially programs with a Christian focus. Linking ethical concepts with tenets from Scripture can increase students' confidence in their ability to respond through a biblical worldview to ethical dilemmas in nursing practice. Specific assignments can be geared to help students think critically about the Code of Ethics for Nurses with Interpretive Statements (Code) and biblical responses to ethical situations. Sample assignments are presented for the nine provisions of the Code.

Prioritization of THose aWaiting hip and knee ArthroplastY(PATHWAY): protocol for development of a stakeholder led clinical prioritization tool.

AIMS: The extended wait that most patients are now experiencing for hip and knee arthroplasty has raised questions about whether reliance on waiting time as the primary driver for prioritization is ethical, and if other additional factors should be included in determining surgical priority. Our Prioritization of THose aWaiting hip and knee ArthroplastY (PATHWAY) project will explore which perioperative factors are important to consider when prioritizing those on the waiting list for hip and knee arthroplasty, and how these factors should be weighted. The final product will include a weighted benefit score that can be used to aid in surgical prioritization for those awaiting elective primary hip and knee arthroplasty. METHODS: There will be two linked work packages focusing on opinion from key stakeholders (patients and surgeons). First, an online modified Delphi process to determine a consensus set of factors that should be involved in patient prioritization. This will be performed using standard Delphi methodology consisting of multiple rounds where following initial individual rating there is feedback, discussion, and further recommendations undertaken towards eventual consensus. The second stage will then consist of a Discrete Choice Experiment (DCE) to allow for priority setting of the factors derived from the Delphi through elicitation of weighted benefit scores. The DCE consists of several choice tasks designed to elicit stakeholder preference regarding included attributes (factors). RESULTS: The study is co-funded by the University of Aberdeen Knowledge Exchange Commission (Ref CF10693-29) and a Chief Scientist Office (CSO) Scotland Clinical Research Fellowship which runs from 08/2021 to 08/2024 (Grant ref: CAF/21/06). Approval from the University of Aberdeen Institute of Applied Health Sciences School Ethics Review Board was granted 22/03/2022 - Reference number SERB/2021/12/2210. CONCLUSION: The PATHWAY project provides the first attempt to use patient and surgeon opinions to develop a unified approach to prioritization for those awaiting hip and knee arthroplasty. Development of such a tool will provide more equitable access to arthroplasty services, as well as providing a framework for developing similar approaches in other areas of healthcare delivery.Cite this article: Bone Jt Open 2022;3(10):753-758.

Overview on Grant Writing for Graduate Student Research.

Grant writing is an important skill to develop during graduate school. This article provides an overview of grant writing for graduate students. Specific topics covered include understanding your funding needs, identifying appropriate grant opportunities, analyzing the guidelines for the proposal, planning and time management, understanding the priorities of the funding agency or organization, proposal organization and writing strategies, additional forms and letters of support that may be required, the editing and revising process, and submission of your grant proposal. Courses and workshops are an efficient and effective way to be guided through the grant proposal writing process with a greater potential for positive outcomes. © 2022 Wiley Periodicals LLC.

Impact of Surface Chemistry of Ultrasmall Superparamagnetic Iron Oxide Nanoparticles on Protein Corona Formation and Endothelial Cell Uptake, Toxicity, and Barrier Function.

Ultrasmall superparamagnetic iron oxide nanoparticles (USPIONs) have been investigated for biomedical applications, including novel contrast agents, magnetic tracers for tumor imaging, targeted drug delivery vehicles, and magneto-mechanical actuators for hyperthermia and thrombolysis. Despite significant progress, recent clinical reports have raised concerns regarding USPION safety related to endothelial cell dysfunction; however, there is limited information on factors contributing to these clinical responses. The influence of USPION surface chemistry on nanoparticle interactions with proteins may impact endothelial cell function leading to adverse responses. Therefore, the goal of this study was to assess the effects of carboxyl-functionalized USPION (CU) or amine-functionalized USPION (AU) (approximately 30 nm diameter) on biological responses in human coronary artery endothelial cells. Increased protein adsorption was observed for AU compared with CU after exposure to serum proteins. Exposure to CU, but not AU, resulted in a concentration-dependent decrease in cell viability and perinuclear accumulation inside cytoplasmic vesicles. Internalization of CU was correlated with endothelial cell functional changes under non-cytotoxic conditions, as evidenced by a marked decreased expression of endothelial-specific adhesion proteins (eg, vascular endothelial-cadherin and platelet endothelial cell adhesion molecule-1) and increased endothelial permeability. Evaluation of downstream signaling indicated endothelial permeability is associated with actin cytoskeleton remodeling, possibly elicited by intracellular events involving reactive oxygen species, calcium ions, and the nanoparticle cellular uptake pathway. This study demonstrated that USPION surface chemistry significantly impacts protein adsorption and endothelial cell uptake, viability, and barrier function. This information will advance the current toxicological profile of USPION and improve development, safety assessment, and clinical outcomes of USPION-enabled medical products.

Health Literacy Profiles of Early Intervention Providers: Use of the Health Literacy Questionnaire.

BACKGROUND: Early intervention (EI) providers work with parents of children with or who have risk factors of developmental delay or disability through Part C of the Individuals with Disabilities Education Act. Many parents in the United States have low health literacy; therefore, EI providers should be aware of and address families' health literacy needs. EI providers need to be health literate themselves to implement evidence-based recommended practices. OBJECTIVE: This study aimed to measure health literacy levels of interdisciplinary EI providers and investigate associations between health literacy levels and demographic variables. METHODS: A survey containing the Health Literacy Questionnaire (HLQ) was completed by EI providers working at 10 EI centers in Massachusetts. Scale scores were calculated and compared across demographic variables, including EI job role, age, years of EI experience, and highest education level. KEY RESULTS: Of 715 EI providers invited to participate, 376 surveys were completed (52.6% response rate). Most participants were women (92.6%, n = 348), reported race as White (85.4%, n = 321), had a mean age of 43.1 years (standard deviation [SD] 12.9) ranging from 20 to 74 years, and English as their primary language (89.6%, n = 337). EI providers scored the lowest on HLQ Scale 5 "Appraisal of health information" (mean [M] = 2.99 (SD 0.50) [confidence interval (CI) 2.93, 3.04]), and Scale 7 "Navigating the healthcare system" (M = 3.83 (SD 0.58) [CI 3.77, 3.89]). EI providers having stronger health literacy profiles were generally older, with a higher education level, were licensed providers, or had more years of EI work experience. CONCLUSIONS: EI providers require adequate health literacy to manage their health needs and to effectively provide services to EI families. Study results may inform future targeted professional development to support improvement of EI providers' health literacy skills, including appraisal of health information and navigation of the health care system. [HLRP: Health Literacy Research and Practice. 2022;6(2):e128-e136.] Plain Language Summary: EI providers' health literacy profiles have not been previously investigated. Study results reveal EI providers struggled with health literacy skills of appraising health information and navigating the health care system, which are vital for EI practice. Health Literacy Questionnaire results can inform targeted professional development to improve EI providers' health literacy levels and their clinical practice.

Suicidality in Rural College Students: An Integrative Review.

Suicide, as the third leading cause of death among individuals aged 15 to 24 years, is substantially more frequent in non-metropolitan/rural counties, where college/university students may be at particular risk; however, little is known about risk and protective factors and prevention strategies specific to this population. The current integrated review was completed to explore such factors and evidence-based interventions. A systematic literature search was performed, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and using computerized databases, for studies published from 2008 to 2021; nine met inclusion criteria. Data were classified into subgroups, which included risk and protective factors for suicidality, stressors and risk factors for psychological distress, and barriers to psychological help-seeking. Key findings included depression as a risk factor, religiosity as a protective factor, decreased social support as a stressor, and various barriers to help-seeking. No evidence-based interventions for this population have been identified in the literature. Research is needed to explore evidence-based interventions for rural college/university students. [Journal of Psychosocial Nursing and Mental Health Services, 60(9), 15-23.].

Participation in Cost-offset Community Supported Agriculture by Low-income Households in the U.S. is Associated with Community Characteristics and Operational Practices.

OBJECTIVE: Subsidized or cost-offset community supported agriculture (CO-CSA) connects farms directly to low-income households and can improve fruit and vegetable intake. This analysis identifies factors associated with participation in CO-CSA. DESIGN: Farm Fresh Foods for Healthy Kids (F3HK) provided a half-price, summer CO-CSA plus healthy eating classes to low-income households with children. Community characteristics (population, socio-demographics, health statistics) and CO-CSA operational practices (share sizes, pick-up sites, payment options, produce selection) are described and associations with participation levels examined. SETTING: Ten communities in New York (NY), North Carolina (NC), Vermont, and Washington states in USA. PARTICIPANTS: Caregiver-child dyads enrolled in spring 2016 or 2017. RESULTS: Residents of micropolitan communities had more education and less poverty than in small towns. The one rural location (NC2) had the fewest college graduates (10%) and most poverty (23%), and poor health statistics. Most F3HK participants were white, except in NC where 45.2% were African American. CO-CSA participation varied significantly across communities from 33% (NC2) to 89% (NY1) of weeks picked-up. Most CO-CSAs offered multiple share sizes (69.2%) and participation was higher than when not offered (76.8% vs. 57.7% of weeks); whereas 53.8% offered a community pick-up location, and participation in these communities was lower than elsewhere (64.7% vs. 78.2% of weeks). CONCLUSION: CO-CSAs should consider offering choice of share size and innovate to address potential barriers such as rural location and limited education and income among residents. Future research is needed to better understand barriers to participation, particularly among participants utilizing community pick-up locations.