Veterans Affairs Nurses' Perception of a Dignified Death.

A dignified death is described as a good death or dying with dignity. Nurses caring for veterans are aware of the honor veterans can receive at the time of death. The purpose of this study was to describe and compare perceptions of a dignified death in nurses who care for veterans in Veterans Affairs settings. This descriptive, exploratory design used an online survey including scales of dying with dignity and a good death. Subjects were nurses who worked at Veterans Affairs facilities. Dying with dignity scores were high and moderately high for a good death. Good death items of wishes, peace, spirituality, and pain free were considered essential by most nurses. There was no difference in scores based on age or end-of-life experiences. Veterans Affairs nurses had a good perception of a dignified death providing a foundation for veteran support before, during, and after death.

A Concept Analysis of Cultural Appreciation in Addressing the Wholistic Health Needs of Indigenous People.

Aim: Cultural appreciation is found within the arts, psychology, counseling, health disciplines, and education. Currently, in the literature, there is not a strong link between cultural appreciation, nursing, and Indigenous people. The aim of this concept analysis is to analyze the concept of cultural appreciation for nurse educators, nurse researchers, and nurse leaders to apply to culturally appreciate Indigenous people within their geographical areas which can result in meeting their wholistic care needs. Design: This concept analysis of cultural appreciation uses Walker & Avant's (2019) approach to define cultural appreciation, antecedents, empirical referents, and consequences. Results: The antecedents of cultural appreciation are cultural appropriation, oppression, cultural prejudice, privilege, and lack of knowledge to integrate the wholistic health of Indigenous people into practice, education, and research. The defining attributes of cultural appreciation are awareness, knowledge acquisition, and desire. The consequence of cultural appreciation is wholistic care of Indigenous people as defined by their ways of knowing and being. Conclusion: The concept analysis of cultural appreciation integrates Indigenous wholistic health beliefs and ways of knowing and being that can advance holistic nursing knowledge for nurses, educators, and researchers.

Nova Metodologia de Ensino de Oftalmoscopia Direta e Indireta para Médicos.

As doenças oftalmológicas podem refletir a presença de doenças sistêmicas em animais. Assim, os especialistas em medicina veterinária devem dominar a técnica do exame de fundoscopia. Para auxiliar na aquisição dessa habilidade, desenvolvemos uma metodologia de ensino utilizando um modelo de baixo custo que permite o exame da retina para ensinar as técnicas de oftalmoscopia direta e indireta em medicina veterinária.

Bioinformatic Design of Dendritic Cell-Specific Synthetic Promoters.

Next-generation DNA vectors for cancer immunotherapies and vaccine development require promoters eliciting predefined transcriptional activities specific to target cell types, such as dendritic cells (DCs), which underpin immune response. In this study, we describe the de novo design of DC-specific synthetic promoters via in silico assembly of cis-transcription factor response elements (TFREs) that harness the DC transcriptional landscape. Using computational genome mining approaches, candidate TFREs were identified within promoter sequences of highly expressed DC-specific genes or those exhibiting an upregulated expression during DC maturation. Individual TFREs were then screened in vitro in a target DC line and off-target cell lines derived from skeletal muscle, fibroblast, epithelial, and endothelial cells using homotypic (TFRE repeats in series) reporter constructs. Based on these data, a library of heterotypic promoter assemblies varying in the TFRE composition, copy number, and sequential arrangement was constructed and tested in vitro to identify DC-specific promoters. Analysis of the transcriptional activity and specificity of these promoters unraveled underlying design rules, primarily TFRE composition, which govern the DC-specific synthetic promoter activity. Using these design rules, a second library of exclusively DC-specific promoters exhibiting varied transcriptional activities was generated. All DC-specific synthetic promoter assemblies exhibited >5-fold activity in the target DC line relative to off-target cell lines, with transcriptional activities ranging from 8 to 67% of the nonspecific human cytomegalovirus (hCMV-IE1) promoter. We show that bioinformatic analysis of a mammalian cell transcriptional landscape is an effective strategy for de novo design of cell-type-specific synthetic promoters with precisely controllable transcriptional activities.

New Direct and Indirect Ophthalmoscopy Teaching Methodology for Veterinary Doctors.

Ophthalmic diseases can reflect the presence of systemic disease in animals. Thus, specialists in veterinary medicine must master the technique of fundus examination. To aid in the acquisition of this skill, we developed a teaching methodology using a low-cost model that students can build themselves and a device that allow for the examination of the animal's retina to teach the techniques of direct and indirect ophthalmoscopy in veterinary medicine.

Metaboloma use in ophthalmology / Uso de metaboloma em oftalmologia: uma revisão narrativa

ABSTRACT It is part of the omic sciences to search for an understanding of how the cellular system of organisms works as well as studying their biological changes. As part of the omic sciences, we can highlight the genomics whose function is the study of genes, the transcriptomics that studies the changes in the transcripts, the proteomics responsible for understanding the changes that occur in proteins, and the metabolomics that studies all the metabolic changes that occur in a certain system when it is submitted to different types of stimuli. Metabolomics is the science that studies the endogenous and exogenous metabolites in biological systems, which aims to provide comparative quantitative or semi-quantitative information about all metabolites in the system. This review aims to describe the main applications of metabolomics science in ophthalmolog. We searched the literature on main applications of metabolomics science in ophthalmology, using the MEDLINE and LILACS databases, with the keywords "metabolomics" and "ophthalmology", from January 1, 2009, to April 5, 2021. We retrieved 216 references, of which 58 were considered eligible for intensive review and critical analysis. The study of the metabolome allows a better understanding of the metabolism of ocular tissues. The results are important to aid diagnosis and as predictors of the progression of many eye and systemic diseases.

RESUMO Faz parte das ciências ômicas buscar entender como funciona o sistema celular dos organismos e estudar suas alterações biológicas. Como parte das ciências ômicas, destacam-se a genômica, cuja função é o estudo dos genes; a transcriptômica, que estuda as mudanças nos transcritos; a proteômica, responsável por entender as mudanças que ocorrem nas proteínas, e a metabolômica, que estuda todo o metabolismo das alterações que ocorrem em um determinado sistema quando ele é submetido a diferentes tipos de estímulos. A metabolômica é a ciência que estuda os metabólitos endógenos e exógenos em sistemas biológicos, visando fornecer informações comparativas quantitativas ou semiquantitativas sobre todos os metabólitos do sistema. Esta revisão teve como objetivo descrever as principais aplicações da ciência metabolômica na oftalmologia. Trata-se de revisão narrativa desenvolvida por um grupo de pesquisa da Universidade Federal de São Paulo, em São Paulo (SP). Buscaram-se, na literatura, as principais aplicações da ciência metabolômica em oftalmologia, utilizando as bases de dados Medline® e Lilacs, com as palavras-chave "metabolomics" e "oftalmologia", de 1º de janeiro de 2009 a 5 de abril de 2021. Foram recuperadas 216 referências, das quais 58 foram consideradas elegíveis para revisão intensiva e análise crítica. O estudo do metaboloma permite um melhor entendimento do metabolismo dos tecidos oculares. Os resultados são importantes para auxiliar no diagnóstico e como preditores da progressão de muitas doenças oculares e sistêmicas.

The voice of adolescents: Perceptions of isolation during hospitalization.

ABSTRACT: There is a lack of understanding of the pediatric patient experience in isolation. This qualitative, descriptive study interviewed adolescent patients during their hospital stay about their perception of isolation. This article analyzes the themes gleaned from the interviews as well as nursing practice implications and strategies in caring for young patients in isolation.

A Retrospective Look at Patient, Procedural, and Follow-up Characteristics Associated With WATCHMAN Implantation.

BACKGROUND: Persons with atrial fibrillation (AF) are at risk for stroke. Atrial fibrillation-related strokes most often result for emboli arising from the left atrial appendage (LAA). Stroke prevention includes the use of anticoagulants and/or antiplatelets. These medications can result in bleeding complications. An alternative to anticoagulants is the WATCHMAN device, which is delivered in the left atria resulting in closure of LAA. OBJECTIVE: The aim of this study was to describe patient, procedural, and follow-up characteristics in patients who have undergone WATCHMAN implantation. METHODS: This study used a retrospective design to review data previously collected and entered into the National Cardiovascular Data Registry database. RESULTS: During a 2-year period, 41 patients underwent the WATCHMAN procedure at our facility. The most common indication for the procedure in this population of patients with nonvalvular AF on oral anticoagulants was bleeding in the gastrointestinal or genitourinary systems. (Gastrointestinal/genitourinary bleed does not limit candidacy for surgical closure of the LAA.) There was only 1 postprocedure adverse event that included a groin hematoma. A transesophageal echocardiogram at 45 days indicated that the LAA seal showed no leak or flow around the device or a leak less than 5 mm. At 1 year, 95% (n = 36) of patients were only taking a single antiplatelet drug with aspirin. Eight patients were on a single antiplatelet medication at the time of follow-up 2 years after the procedure. DISCUSSION: A skilled team including a designated AF clinical nurse specialist contributed to program success measured by efficient placement of the WATCHMAN device and discontinuation of anticoagulation.

Aß31-35 Decreases Neprilysin-Mediated Alzheimer's Amyloid-ß Peptide Degradation.

Alzheimer's disease is associated with the deposition of extracellular senile plaques, made primarily of amyloid-ß (Aß), particularly peptides Aß1-42 and Aß1-40. Neprilysin, or neutral endopeptidase (NEP), catalyzes proteolysis of the amyloid peptides (Aß) and is recognized as one of the major regulators of the levels of these peptides in the brain, preventing Aß accumulation and plaque formation. Here, we used a combination of techniques to elucidate the mechanism of Aß binding and cleavage by NEP. Our findings indicate that the Aß31-X cleavage products remain bound to the neprilysin active site, reducing proteolytic activity. Interestingly, it was already shown that this Aß31-35 sequence is also critical for recognition of Aß peptides by other targets, such as the serpin-enzyme complex receptor in neuronal cells.

Knowledge and Fears of Parents of Children Diagnosed with Epilepsy.

PURPOSE: Describe the knowledge and fears of parents of children diagnosed with epilepsy in the hospital and clinic settings. DESIGN AND METHODS: Descriptive, comparative study design. Knowledge was measured with the 16-item Epilepsy Knowledge Scale and epilepsy-related fears was operationalized by the Epilepsy-related Fears in Parents Questionnaire (EFPQ) addressing short and long-term fears. The sample included 40 parents of children diagnosed with epilepsy who were cared for on a pediatric ortho/neuro hospital unit (N = 27) or pediatric neurology clinic (N = 13). RESULTS: Parents were middle aged adults (mean 39 years), mostly mothers with 80% college education. Their children ranged in ages from less than one to 18 years of age (Mean = 8.5) across a variety of ethnic backgrounds who were most often diagnosed with epilepsy at a young age (<1 year to 3 years). Percentage of correct answers ranged from 31% (5 correct) to 100% (16 correct); mean 12 correct or 75%. Subjects/parents were afraid! They had many fears: Short-term (possible range 8-40) with responses ranging from 9 to 40 (mean 28); Future/long-term (possible range 9-45) ranging from 9 to 45 (mean 32). They were afraid when their child is in the care of others - something might happen, and their child could die during a seizure. There was no statistically significant difference in responses between hospital or clinic parents. DISCUSSION: Parents who participated in this study were knowledgeable but fearful with immediate and long term concerns. PRACTICE IMPLICATIONS: Nurses need to provide verbal and written education materials. Address triggers. Talk to parents about their fears related to epilepsy. Identify parental support. Validate parents' skills in knowing what to do when their child has a seizure.

Family perceptions related to isolation during COVID-19 hospitalization.

ABSTRACT: During the COVID-19 pandemic, visitor limitations were implemented in hospitals and long-term-care facilities to prevent transmission of the virus from patients to family members. It is unknown how the context of visitor limitations due to COVID-19 influenced the state of emotions and experiences in family members unable to physically visit their loved ones in person during hospitalization. This article details a study of the perceptions of family members related to being isolated from patients who are hospitalized with confirmed positive COVID-19.

Sleep in Aneurysmal Subarachnoid Hemorrhage Patients During Critical and Acute Care.

BACKGROUND: Nurses caring for intensive care patients diagnosed with an aneurysmal subarachnoid hemorrhage (aSAH) conduct frequent neurological assessments and vital signs over an extended period during which patients are at risk of vasospasm. The frequency of assessments can negatively impact sleep, resulting in altered thought processes and mood, including delirium. There are 2 types of sleep during the night: non-rapid eye movement (non-REM) sleep and REM sleep (also called stage R). Non-REM sleep is subdivided into 3 stages: stage N1, stage N2, and stage N3. These 4 stages of sleep are referred to as sleep architecture. OBJECTIVE: The aim of this study was to explore patterns of sleep in patients with aSAH over time during hospitalization. METHODS: Sleep data of stages and cycles were collected with use of a Fitbit activity tracker in this pilot, exploratory research study. Demographic data included age and gender. Six English-speaking patients, diagnosed with an aneurysmal SAH, confirmed by diagnostic angiogram, were followed in neuro-intensive care unit (ICU), neuro-step-down, neuroscience unit, and inpatient rehabilitation. RESULTS: There were a total of 226 sleep events. A sleep event encompassed a recorded start and end time on a single date. Each event included several sleep cycles. Each sleep cycle consisted of wakefulness, light sleep, deep sleep, and REM sleep. In 79 sleep events, light and deep sleep did add up to more than 4 hours; only 38 sleep events indicated more than 90 minutes of REM/night; 61 events showed the cycle of light-deep-light-REM cycles; 80 events showed 3 to 5 REM periods/night; and only 46 events demonstrated that the early-morning REM cycle was the longest. The average number of REM cycles increased from ICU (n = 4.6) to rehabilitation (n = 6.5). The percentage of days with sleep cycles also increased from ICU to rehabilitation (42 to 64). DISCUSSION: "Normal" sleep patterns are disrupted in aSAH patients throughout their hospitalization. Data in this study revealed that the patients do sleep; however, it is rarely organized. Patients were not always able to progress through the expected sleep cycle of light to deep to light to REM. Hospitalized aSAH patients do engage in REM sleep, but its pattern is abnormal. Staff should strategize on minimizing interruptions, clustering care, and minimizing sounds. Nurses should advocate for the frequency of assessments and vital signs based on hospital/unit policy and individual patient needs.

Effects of Reiki on Pain and Anxiety in Women Hospitalized for Obstetrical- and Gynecological-Related Conditions.

Purpose: To determine the effect of Reiki on pain and anxiety in women in antepartum, intrapartum, postpartum, gynecology, and gyn/oncology, settings. Method: This exploratory, comparative study used a Likert-type scale of 0 to 10 to measure pain and anxiety, and a survey asking about lingering effects of treatment. Results: Mean pain scores after Reiki significantly decreased from 3.24 to 1.52 (n = 203; z = -11.67, p < .001). Mean anxiety scores after Reiki significantly decreased from 3.56 to 1.28 (n = 195; z = -11.42, p < .001). Women were asked if the effects lingered for any length of time post-Reiki treatment, and 91 of 101 responded affirmatively that decreased pain and/or anxiety continued. Conclusion: Findings from this study confirm the positive and lingering effects of Reiki in women hospitalized for obstetrical and gynecological conditions.

Music therapy and retinopathy of prematurity screening: using recorded maternal singing and heartbeat for post exam recovery.

OBJECTIVE: Explore a music therapy (MT) intervention to support infant recovery post retinopathy of prematurity (ROP) exam. STUDY DESIGN: Prospective, double-masked, randomized, parallel group study of 100 preterm infants exposed to MT (recorded maternal singing/heartbeat) or standard care (SC). Premature Infant Pain Profile (PIPP) measured at: baseline, during the exam, and 1 and 5 min post exam. RESULTS: Recovery PIPP scores were less with MT vs. SC, but statistical significance not achieved (Mean ± sd: MT 1 min [5.81 ± 2.93] and 5 min [3.91 ± 1.73] vs. SC 1 min [6.40 ± 2.78] and 5 min [4.76 ± 2.07], p = 0.07). Recovery PIPP sores were significantly higher with SC compared to MT when eye exams were longer (p = 0.049) or when exams were more painful (p = 0.04). CONCLUSION: Recorded maternal singing and heartbeat can support recovery post ROP exam. For longer/more painful ROP exams, MT may be more effective than SC promoting recovery post exam.