Comprehensive radiation shield minimizes operator radiation exposure in coronary and structural heart procedures.

OBJECTIVES: This study evaluated the efficacy of a novel comprehensive shield designed to minimize radiation exposure (RE) to Physicians performing coronary and structural heart procedures. BACKGROUND: The Protego™ radiation shielding system (Image Diagnostics Inc., Fitchburg, Ma) is designed to provide comprehensive protection from RE and has been State certified sufficient to allow operators to perform procedures without orthopedically burdensome lead aprons. METHODS: This single center two-group cohort study assessed the efficacy of this shield in a large number of cardiac procedures (coronary and structural), comparing operator RE compared to standard protection methods (personal lead apparel and "drop down" shield). RESULTS: The Protego™ system reduced operator RE by 99 % compared to Standard Protection. RE was significantly lower at both "Head" level by thyroid median dose 0.0 (0.0, 0,0) vs 5.7 (2.9, 8.2) µSv (p < 0.001), as well as waist dose 0.0 (0.0, 0.0) vs 10.0 (5.0, 16.6) µSv (p < 0.001). ("Zero" Total RE was documented by Raysafe™ in 64 % (n = 32) of TAVR cases and 73.2 % (n = 183) of the coronary cases utilizing Protego™. In contrast, standard protection did not achieve "Zero" exposure in a single case. These dramatic differences in RE were achieved despite higher fluoroscopy times in the Protego™ arm (11.9 ± 8.6 vs 14.3 ± 12.5 min, p = 0.015). Per case procedural exposure measured by Dose Area Product was higher in the Protego™ group compared to standard protection (115.4 ± 139.2 vs 74.9 ± 69.3, p < 0.001). CONCLUSION: The Protego™ shield provides total body RE protection for operators performing both coronary and structural heart procedures. This shield allows procedural performance without the need for personal lead aprons and has potential to reduce catheterization laboratory occupational health hazards.

Nurses' Experiences of "Being Swamped" in the Clinical Setting and Association with Adherence to AWHONN Nurse Staffing Guidelines.

PURPOSE: Being swamped is defined as "when you are so overwhelmed with what is occurring that you are unable to focus on the most important thing." The purpose of this study was to explore the experience of being swamped in the clinical setting among nurses who are members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the relationship of the level of being swamped to adherence to the nurse staffing guidelines. STUDY DESIGN AND METHODS: A 25-item survey was sent to ~21,000 AWHONN members by email in the Fall of 2018. It was completed by 1,198 members, representing 49 states and the District of Columbia. Questions explored timing and causes of being swamped, its effect on health care team members and patients, what helps when a nurse feels swamped, and nurses' reports of their hospital following the AWHONN nurse staffing guidelines. RESULTS: Twenty-eight percent of nurses reported being swamped daily or multiple times per day. Situations that contribute to being swamped include assignments that are too heavy, interruptions, critical patient situations, and mistakes made by others that nurses are expected to catch and fix. Teamwork and someone stepping in to help without being asked were identified as most helpful when a nurse feels swamped. Nurses practicing in hospitals following the AWHONN nurse staffing guidelines always or most of the time reported less frequency of being swamped as compared with those in hospitals that followed the guidelines some of the time, or rarely (p < 0.001). CLINICAL IMPLICATIONS: Being swamped is a common phenomenon among AWHONN members responding to the survey. The reported incidence of being swamped daily is significantly associated with the extent to which hospitals follow the AWHONN nurse staffing guidelines. Nurse leaders, hospital administrators, and staff nurses must work together to identify and initiate timely, feasible nurse staffing solutions that support the safety of patients and nurses.

Development of the Self-Rated Abilities for Health Practices-Adolescent Version: A Self-Efficacy Measure.

BACKGROUND AND PURPOSE: An instrument to measure wellness behaviors in adolescent females did not appear in the literature. The purpose of this article is to describe the development and evaluation of the Self-Rated Abilities for Health and Practices Scale-Adolescent Version (SRAHP-A). METHODS: Initial psychometric testing was conducted with a sample of 265 adolescents and young adults aged 13-24 years. Data collection occurred through paper and pencil surveys. RESULTS: Exploratory factor analysis using maximum likelihood factor extraction method and oblique ration was conducted. A four-factor structure consisting of Exercise, Nutrition, Health Practices, and Well-Being emerged. CONCLUSIONS: Initial psychometric testing suggested that it is a valid and reliable measure of wellness behaviors in adolescent females. Further testing is necessary; however, it appears this instrument has the potential to move wellness care for adolescents and young adults forward.

A comparison of metered-dose inhaled albuterol versus endotracheal liquid bolus albuterol for the treatment of bronchoconstriction.

INTRODUCTION: Aerosolized albuterol delivery is a mainstay treatment for bronchoconstriction; however, almost no data exist that evaluate the clinical outcome of instillation of an endotracheal liquid bolus (ELB) of a bronchodilator directly into the airway. METHODS: This randomized trial sought to evaluate the efficacy of albuterol lavage via artificial airway with accompanied patient positioning. Subjects receiving mechanical ventilation for acute respiratory failure with clinical manifestations of bronchoconstriction were assigned to initially receive either traditional albuterol via metered-dose inhaler (MDI) or albuterol via ELB lavage with follow-up administration of the other therapy after a 4-h washout period. Clinical data were collected at baseline and at 5 and 30 min post-treatment. RESULTS: Fourteen subjects (5 males, 9 females; mean age of 57.5 y) were included in this study. In the group receiving initial ELB, peak airway pressure decreased significantly (P = .02), and a significant decrease in airway resistance mean scores was seen from baseline to 30 min post-treatment (P < .001) and from 5 to 30 min post-treatment (P = .003), with no significant effects seen with follow-up MDI. In the initial MDI treatment group, no significant effect on peak airway pressure or airway resistance was noted. S(pO2) increased at 5 min post-treatment with ELB. In contrast, S(pO2) decreased 30 min post-treatment with MDI. Mean arterial pressure decreased post-treatment with ELB. The pattern in heart rate change post-treatment with ELB was similar to that post-treatment with MDI, with a significant increase at the 5-min interval from baseline (P < .01), followed by a significant decrease at the 30-min interval (P < .001). There were no differences in dynamic compliance at each time interval following administration of both the MDI (P = .92) and ELB conditions (P = .18). CONCLUSIONS: ELB albuterol lavage may be a viable option to reverse bronchoconstriction in intubated patients with limited response to traditional aerosolized albuterol via MDI.

Expectations and self-efficacy of African American parents who discuss sexuality with their adolescent sons: an intervention study.

OBJECTIVE: Despite research that suggests parental communication may help deter high-risk sexual behavior among adolescents, parents report a lack of confidence in their ability to answer sexually related questions. The purpose of this study was to test the effect of a multimedia intervention on outcome expectations and perceived self-efficacy for the sex educator role for parents of African American adolescent males. DESIGN AND SAMPLE: A pilot study using mixed methods was conducted. A nonprobability sample (N = 61) was obtained from a large urban community using a combination of convenience and snowball recruitment methods. MEASURES: Self-efficacy and outcome expectations were measured using self-reported questionnaires. INTERVENTION: A multimedia intervention for use at home and incorporating an audio CD and associated activities was implemented over a 3-week time period. RESULTS: Outcome expectations and self-efficacy both significantly improved after the intervention (p < .001). CONCLUSIONS: Findings indicate that using a multimedia approach may be effective in improving parents' outcome expectancy and self-efficacy for talking about sex with adolescent sons.

The effect of a wellness program on adolescent females.

Guided by Bandura's Social Cognitive Theory, the purpose of this study was to examine the effect of a comprehensive wellness intervention on total wellness, physical fitness, and self-efficacy for health promoting behaviors in adolescent females, ages 14 to 19, enrolled in physical education (PE) classes in Grades 9 to 12. The intervention was administered in an experimental pre-test, post-test, two group design in rural east Texas. Participants (n = 153) were randomly assigned to a 12-week intervention or control group. Independent t-tests to determine differences between the intervention and control groups were nonsignificant for overall wellness and physical fitness. The Wellness Essential-Self subscale score was significantly higher in the intervention group, t(64, 36) = 2.67, p = .005, d = .84. Self-Efficacy Health Promotion subscale scores for the intervention group were also significantly higher, t(20,28) = 2.60, p = .006, d = .74. The intervention has potential to improve overall wellness in adolescent females.

Effect of the Power Balance® band on static balance, hamstring flexibility, and arm strength in adults.

The purpose of this study was to determine the effect of Power Balance® bands on strength, flexibility, and balance. Strength and flexibility were measured using the MicroFit system. Strength was measured via a bicep curl and flexibility via the sit-and-reach method. Balance was measured by the BIODEX System SD. There were 4 different conditions for the balance test: eyes open on a firm surface (EOFS), eyes closed on a firm surface (ECFS), eyes open on a foam surface (EOFoS), and eyes closed on a foam surface (ECFoS). There were 24 subjects in the study (10 men and 14 women). A counterbalance, double-blind, placebo, controlled within-subject design was used. Each of the subjects participated in 3 treatment sessions, consisting of Power Balance®, placebo band, and no band. An alpha level of p ≤ 0.05 was set a priori. There were no significant differences in strength, flexibility, or balance with regard to the treatments used. There was a significant difference between the conditions in the balance test (p = 0.000): EOFS (0.51), ECFS (0.68), EOFoS (0.99), and ECFoS (2.18); however, these were independent of the treatment conditions. The results indicate that the Power Balance® bands did not have an effect on strength, flexibility, or balance.