Venous thromboembolism prevention in cancer care: implementation strategies to address underuse.

Background: Evidenced-based interventions have been developed to prevent venous thromboembolism (VTE) in ambulatory patients with cancer, including VTE-risk assessment for all patients and targeted primary thromboprophylaxis for high-risk patients. Despite supportive evidence and recommendations, oncologists rarely assess VTE risk or provide primary prophylaxis. Our previous work identified barriers and facilitators to using VTE prevention interventions in oncology practice. Objectives: To identify potential strategies that address the identified barriers and leverage facilitators to achieve successful implementation of evidence-based interventions for VTE prevention in oncology practice. Methods: We used the Implementation Research Logic Model, an implementation science framework, to map the relationships among barriers and facilitators, feasible and effective implementation strategies, and implementation and clinical outcomes that will be used to evaluate the implementation strategies. Results: We identified 12 discrete implementation strategies (eg, conducting clinician education and training and staged implementation scale-up) that address barriers and leverage facilitators through their mechanisms of action (eg, increased clinician awareness of evidence and targeting the highest effectiveness). We identified key implementation (eg, penetration, adoption, acceptability, fidelity, appropriateness, and sustainability), system (eg, integration of VTE-risk assessment into clinical workflow), and clinical (eg, lower VTE rates) outcomes targeted by the selected strategies. Conclusion: Using the Implementation Research Logic Model framework and building on our knowledge of barriers and facilitators, we identified implementation strategies and important outcomes to evaluate these strategies. We will use these results to test and measure the strategies to improve the uptake of evidence-based recommendations for VTE prevention in oncology practice.

CE: Nursing Orientation to Data Science and Machine Learning.

ABSTRACT: Nurses collect, use, and produce data every day in countless ways, such as when assessing and treating patients, performing administrative functions, and engaging in strategic planning in their organizations and communities. These data are aggregated into large data sets in health care systems, public and private databases, and academic research settings. In recent years the machines used in this work (computer hardware) have become increasingly able to analyze large data sets, or "big data," at high speed. Data scientists use machine learning tools to aid in analyzing this big data, such as data amassed from large numbers of electronic health records. In health care, predictions for patient outcomes has become a focus of research using machine learning. It's important for nurses and nurse administrators to understand how machine learning has changed our ways of thinking about data and turning data into knowledge that can improve patient care. This article provides an orientation to machine learning and data science, offers an understanding of current challenges and opportunities, and describes the nursing implications for nurses in various roles.

Antimicrobial resistance in urine and skin isolates in Timor-Leste.

OBJECTIVES: High rates of antimicrobial resistance (AMR) are seen throughout Southeast Asia. However, limited AMR data exist for Timor-Leste, which is situated on the south-eastern portion of the Malay Archipelago. The purpose of this study was to identify AMR in bacteria isolated from urine and skin swabs from patients in Dili, the capital of Timor-Leste. METHODS: Urine and skin swabs were collected from symptomatic patients in Timor-Leste and were processed for bacterial culture. Isolates were processed in Australia using a VITEK®2 system for bacterial identification and to determine antimicrobial susceptibility according to Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: A total of 154 urine isolates and 57 skin isolates were analysed. Of the Enterobacteriaceae, 35% were resistant to ceftriaxone with an extended-spectrum ß-lactamase (ESBL)-producing phenotype. Carbapenem resistance was not observed in any of the Gram-negative isolates. Of the Staphylococcus aureus isolates, 11% were of the community-associated methicillin-resistant S. aureus (CA-MRSA) phenotype. CONCLUSIONS: A moderately high proportion of Gram-negative urine isolates in Timor-Leste demonstrate phenotypic ESBL production, and a relatively low proportion of S. aureus isolates were methicillin-resistant. Improved understanding of AMR rates in Timor-Leste can help guide antimicrobial prescribing and inform antimicrobial stewardship strategies.

Proteomic response of Trichoderma aggressivum f. europaeum to Agaricus bisporus tissue and mushroom compost.

A cellular proteomic analysis was performed on Trichoderma aggressivum f. europaeum. Thirty-four individual protein spots were excised from 2-D electropherograms and analysed by ESI-Trap Liquid Chromatography Mass Spectrometry (LC/MS). Searches of the NCBInr and SwissProt protein databases identified functions for 31 of these proteins based on sequence homology. A differential expression study was performed on the intracellular fraction of T. aggressivum f. europaeum grown in media containing Agaricus bisporus tissue and Phase 3 mushroom compost compared to a control medium. Differential expression was observed for seven proteins, three of which were upregulated in both treatments, two were down regulated in both treatments and two showed qualitatively different regulation under the two treatments. No proteins directly relating to fungal cell wall degradation or other mycoparasitic activity were observed. Functions of differentially produced intracellular proteins included oxidative stress tolerance, cytoskeletal structure, and cell longevity. Differential production of these proteins may contribute to the growth of T. aggressivum in mushroom compost and its virulence toward A. bisporus.

A systematic review of school-based interventions aimed at preventing, treating, and responding to suicide- related behavior in young people.

BACKGROUND: Suicide, in particular among young people, is a major public health problem, although little is known regarding effective interventions for managing and preventing suicide-related behavior. AIMS: To review the empirical literature pertaining to suicide postvention, prevention, and early intervention, specifically in school settings. METHOD: MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials (CCRCT) as well as citation lists of relevant articles using terms related to suicide and schools were searched in July 2011. School-based programs targeting suicide, attempted suicide, suicidal ideation, and self-harm where intent is not specified were included. No exclusion was placed on trial design. All studies had to include a suicide-related outcome. RESULTS: A total of 412 potentially relevant studies were identified, 43 of which met the inclusion criteria, as well as three secondary publications: 15 universal awareness programs, 23 selective interventions, 3 targeted interventions, and 2 postvention trials. LIMITATIONS: Overall, the evidence was limited and hampered by methodological concerns, particularly a lack of RCTs. CONCLUSIONS: The most promising interventions for schools appear to be gatekeeper training and screening programs. However, more research is needed.

Sexual offender treatment: a positive approach.

This article describes a treatment program for sexual offenders that is a modification of cognitive-behavioral therapy (CBT) and that emphasizes a positive approach. Several issues that characterize most CBT programs for sexual offenders are challenged and alternatives are offered. The overall features of the positive approach are then described. Finally outcome evaluations of the effects of CBT programs are described and compared with the long-term outcome of the current positive program. This comparison suggested that the positive program is more effective than the traditional CBT approach.

Assessment of the effectiveness of nontransdermal energy patches on muscle endurance and power.

Claims of recently developed energy patches suggest that organic nanoscale biomolecular "antennas" produced by L and D-stereoisomers resonate at frequencies in unison with molecules in the cells inducing electron flow to assists in recruiting calcium ions, allowing greater muscle fiber recruitment during muscle contraction. The purpose of the study was to assess the efficacy of energy patches in the performance of selected muscle power and endurance measures. After a 5-minute warm-up and stretch, 41 college varsity football players (age, 20.37 +/- 1.24 years; height, 169.91 +/- 7.44 cm; weight, 109.45 +/- 19.85 kg) were pre-tested on 102-kg maximal bench press repetitions, standing vertical jump, grip strength, peak torque, torque to body weight, total work, average power, and average torque as measured by 50 repetitions of leg extensions at 180 degrees .s. The following week, the players were randomly assigned the experimental or placebo patches. After placement of the patches, the participants again completed a 5-minute warm-up, followed by the identical pre-test protocol. Repeated-measures ANOVAs were used to compare resultant data. No significant group interaction effects were found between experimental and placebo patches for maximal bench press repetitions (p = 0.48), vertical jump distance (p = 0.39), grip strength (p = 0.29), total work (p = 0.26), torque to body weight (p = 0.05), average peak torque (p = 0.08), and average power (p = 0.05). A significant increase occurred in the experimental group for peak torque (p = 0.04). It was concluded that the energy patches significantly improved performance over placebo patches in one of the eight variables tested and registered near significance in two additional variables. However, inconsistency in overall results demands further studies to determine the reliability in improvement of performance in the presence of energy patches.

The construction and preliminary validation of the Internet Behaviours and Attitudes Questionnaire (IBAQ).

This study describes the construction and preliminary validation of a measure of the attitudes and behaviours of convicted men whose offences are related to Internet child 'pornography' (abusive images). An initial measure was constructed through the generation of items with reference to the emerging literature on these offenders. Phase 1 involved piloting this first version of the measure with 40 Internet sexual offenders incarcerated in Her Majesty's Prison Service. Phase 2 involved the validation of an improved version of the IBAQ with 123 Internet sexual offenders both incarcerated in Her Majesty's Prison Service and subject to community dispositions. The measure had excellent internal consistency. Following factor analysis a two factor solution, 'distorted thinking', and 'self-management' emerged from the attitudinal items. The attitude measure was not influenced by social desirability, and was able to discriminate participants who disclosed the greater number of 'offending behaviours'. These results are discussed in terms of their clinical implications.