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1.
Rheum Dis Clin North Am ; 46(1): 103-118, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757279

RESUMO

Adolescence and young adulthood represents a vulnerable period in the life of patients with rheumatic diseases, many of whom struggle with self-management of their chronic disease and adjustment to care with adult rheumatologists. Many adult rheumatologists are uncomfortable caring for young adults, especially those with pediatric-onset diagnoses. The recent development of evidence-based best practices, expert opinion recommendations, and validated tools can assist pediatric and adult rheumatologists in caring for adolescent and young adult patients. Uptake of these guidelines and resources remains low, underscoring the need for rheumatologists and trainees to receive explicit training in the application of transition best practices.

2.
Talanta ; 206: 120196, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31514893

RESUMO

Nitroxyl (HNO), generated from nitric oxide (NO) in biological system, plays distinct biological roles in physiological process, but the role of endogenous HNO in biosystems still remains unclear, because of lacking of specific and sensitive detector to monitor HNO in real time. The conventional methods indicate the level of HNO through detecting the ultimate product nitrous oxide (N2O) of HNO dimerization and dehydration, which could easily result in inaccurate data. Therefore, developing an assay that can directly apply to detect HNO is of significance for understanding the function mechanism of HNO in biological system. In this study, we describe a near-infrared fluorescent probe 4-(2-(4-(dicyanomethylene)-4H-chromen-2-yl)vinyl) phenyl-2-(diphenylphosphanyl)-benzoate (CPN) that employs (2-(4-hydroxystyryl) -4H-chromen-4-ylidene) malononitrile (CP-OH) as a fluorophore and 2-(diphenylphosphino) benzoate as a recognition group. This probe, CPN, shows rapid-response to HNO which compared to other current probes. The fluorescent intensity reaches plateau in 20 min in vitro and in 2 min in vivo, respectively, which is important to monitor dynamic and transient state of HNO in biological system. In addition, CPN probe with a large Stokes' shift (150 nm) and near-infrared emission (700 nm) that is suitable for biological imaging. This probe has a potential of elucidating the biological function of HNO in biosystem.

3.
N Biotechnol ; 54: 52-61, 2020 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-31398512

RESUMO

Next-generation sequencing (NGS) analyses on DNA derived from archived Formalin-Fixed Paraffin-Embedded (FFPE) clinical material can provide a powerful tool in oncology research and clinical diagnostics. Although several studies have established that NGS can be performed using DNA from FFPE tissue, the accuracy and reproducibility of such analyses, as well as their robustness to the biomolecular quality of the samples used, remains a matter of debate. Excellent reviews have recently been published, providing evidence-based best practices for FFPE DNA extraction. Alternative fixatives exist, although their implementation in clinical practice is difficult. In this article, we present (i) a review of fixed tissue DNA preanalytics with a special focus on DNA extraction and fixed tissue sample qualification and (ii) results from comparisons between different methods of DNA extraction from tissue samples that have been fixed or stabilized by different methods, in terms of NGS metrics and different DNA quality metrics.

4.
Phys Med Rehabil Clin N Am ; 31(1): 185-194, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31760991

RESUMO

Registries are a powerful tool for clinical research. Clinical registries for cerebral palsy can aid in comparative effectiveness research, especially using the practice-based evidence model. The Cerebral Palsy Research Network (CPRN) was initiated in 2014 as a patient-centered, multidisciplinary registry. The leadership group initiated a 4-stage participatory action research process: listen, reflect, plan/analyze, and take action. CPRN also joined with CP NOW, an advocacy group, to create a research agenda for cerebral palsy. With more than 20 centers and growing, CPRN hopes to generate evidence for developing best practices and measure their implementation and impact for individuals with cerebral palsy throughout North America.

5.
Rev. Esc. Enferm. USP ; 53: e03518, Jan.-Dez. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1020379

RESUMO

RESUMO Objetivo Verificar o conhecimento de estudantes sobre o plano individual de parto e conhecer sua opinião a respeito da utilização dessa estratégia de ensino-aprendizagem e das boas práticas obstétricas. Método Estudo descritivo, com alunos de Obstetrícia que cursavam estágios na atenção básica. A coleta dos dados realizada de 01/2017 a 05/2017, por meio digital, na Plataforma Google Formulários®. A análise foi realizada por estatística descritiva de categorização de enunciados. O estudo seguiu os padrões éticos exigidos. Resultados O formulário foi enviado a 97 discentes e respondido por 40% deles. Todos os respondentes informaram conhecer o plano de parto, e 87% aplicaram-no durante o atendimento de pré-natal. Os apontamentos mais frequentes (45%) acerca do plano de parto foram os que promoviam empoderamento e autonomia à mulher. As sugestões metodológicas mais citadas para a sua aplicação foram focar o conteúdo (76%) e aumentar o número de encontros (50%). O plano individual de parto foi reconhecido por 79% dos participantes como importante estratégia de ensino. Conclusão Além de conhecerem o plano de parto e aplicá-lo, os estudantes o consideram muito relevante para o ensino e a aprendizagem das boas práticas obstétricas.


RESUMEN Objetivo Verificar el conocimiento de estudiantes acerca del plan individual de parto y conocer su comprensión respecto de la utilización de dicha estrategia de enseñanza aprendizaje y de las buenas prácticas obstétricas. Método Estudio descriptivo, con alumnos de Obstetricia que cursaban pasantías en la atención básica. La recolección de datos fue realizada de 01/2017 a 05/2017, por medio electrónico, en la Plataforma Google Formularios®. El análisis fue llevado a cabo por estadística descriptiva de categorización de enunciados. El estudio siguió los estándares éticos exigidos. Resultados El formulario fue enviado a 97 discentes y respondido por el 40% de ellos. Todos los respondedores informaron conocer el plan de parto, y el 87% lo aplicaron durante la atención de prenatal. Los planteamientos más frecuentes (45%) acerca del plan de parto fueron los que promovían empoderamiento y autonomía a la mujer. Las sugerencias metodológicas más citadas para su aplicación fueron enfocar el contenido (76%) y aumentar el número de encuentros (50%). El plan individual de parto fue reconocido por el 79% de los participantes como importante estrategia de enseñanza. Conclusión Además de conocer el plan de parto y aplicarlo, los estudiantes lo consideran muy relevante para la enseñanza y el aprendizaje y de las buenas prácticas obstétricas.


ABSTRACT Objective To verify students' knowledge about individual birth planning and learn their opinion about the use of this teaching-learning strategy for good obstetric practices. Method This is a descriptive study conducted with midwifery students who made primary health care internships. Data collection was performed digitally from 01/2017 to 05/2017 through the Google Forms®Platform. The analysis was performed by descriptive categorization statistics of statements. The study followed the required ethical standards. Results The form was sent to 97 students and answered by 40% of them. All respondents reported knowing the birth planning, and 87% applied it during prenatal care. The most frequent (45%) points about the birth plan were those that promoted women's empowerment and autonomy. The most cited methodological suggestions for its application were to focus on content (76%) and increase the number of meetings (50%). Individual birth planning was recognized by 79% of the participants as an important teaching strategy. Conclusion In addition to knowing birth planning and applying it, the students consider it very relevant for teaching and learning good obstetrical practices.


Assuntos
Humanos , Estudantes , Educação Superior , Parto Humanizado , Prática Clínica Baseada em Evidências , Aprendizagem , Obstetrícia
7.
BMC Health Serv Res ; 19(1): 772, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666047

RESUMO

BACKGROUND: Health care researcher-research user partnerships, referred to as integrated knowledge translation (IKT), have been adopted on an international basis, and are an effective means of co-generating and implementing evidence into policy and practice. Prior research suggests that an initiation period is essential for establishing functional partnerships. To characterize IKT initiation and describe determinants of IKT initiation success, this study explored IKT initiation processes, enablers, and barriers among researchers and research users involved in IKT partnerships. METHODS: A descriptive qualitative approach was used compliant with COREQ standards. Canadian researchers and research users in research collaborations were identified on publicly-available directories and web sites, and referred by those interviewed. They were asked to describe how partnerships were initiated, influencing factors, the length of initiation, and interventions needed to support initiation. Sampling was concurrent with data collection and analysis to achieve thematic saturation. Data were analyzed using constant comparative technique by all members of the research team. RESULTS: In total, 22 individuals from 6 provinces were interviewed (9 researchers, 11 research users, 2 connectors). They confirmed that IKT initiation is a distinct early phase of partnerships. The period ranged from 6 months to 2 years for 75.0% of participants in pre-existing partnerships, to 6 years for newly-formed partnerships. High-level themes were: Newly identifying and securing partners is an intensive process; Processes and activities take place over a protracted period through multiple interactions; Identifying and engaging committed partners is reliant on funding; and Partnership building is challenged by maintaining continuity and enthusiasm. Participants underscored the need for an IKT partner matching forum, IKT initiation toolkit, and funding for non-research activities required during IKT initiation to establish functional researcher-research user partnerships. Themes were largely similar regardless of participant years of experience with IKT or being involved in a new versus pre-existing partnership. CONCLUSIONS: IKT initiation is a recognized and important early phase of IKT that establishes functional partnerships, and once established, ongoing partnership for subsequent projects is likely. Further research is needed to develop and evaluate approaches recommended by participants for stimulating IKT initiation.

8.
Artigo em Inglês | MEDLINE | ID: mdl-31686337

RESUMO

INTRODUCTION: Rapid improvement of psoriasis is valued by patients and should be considered to be an important factor in treatment selection. We investigated Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) response rates within the first 12 weeks of treatment to compare the rapid response of 11 biologic therapies for moderate-to-severe psoriasis using Bayesian and Frequentist network meta-analyses (NMA). METHODS: A systematic literature review was conducted to identify phase 3, double-blind, randomized, controlled trials for adult patients with moderate-to-severe psoriasis treated with interleukin (IL)-17 (brodalumab, ixekizumab, secukinumab), IL-12/-23 (ustekinumab), IL-23 (guselkumab, risankizumab, tildrakizumab), or tumor necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, infliximab). Outcome measures extracted from 32 publications were ≥ 75, ≥ 90, or 100% improvement in PASI score (PASI 75, PASI 90, or PASI 100, respectively) at weeks 2, 4, 8, and 12 and DLQI    (0,1), where score (0,1) indicates no effect on patient's life, at week 12. Bayesian NMA (BNMA) used fixed-treatment effect and random-baseline effect, normal independent models. Frequentist NMA (fNMA) was conducted as sensitivity analyses to test the robustness of the findings. RESULTS: Based on BNMA and fNMA, brodalumab and ixekizumab showed the most rapid treatment effects on PASI 75 at weeks 2, 4, and 8 and on PASI 90 and PASI 100 at weeks 2, 4, 8, and 12; ixekizumab overlapped with risankizumab on PASI 75 at week 12. Brodalumab, ixekizumab, and secukinumab yielded higher DLQI (0,1) gains at week 12 compared to all of the other biologics studied. Additional measures of quality of life were not assessed in this report. CONCLUSIONS: Ixekizumab and brodalumab provide the most rapid response and earliest clinical benefit at week 2 among all of the biologics studied, including other biologic treatments such as secukinumab, ustekinumab, guselkumab, adalimumab, and etanercept. BNMA and fNMA results showed similar relative effect estimates and treatment rankings. FUNDING: Eli Lilly and Company.

9.
J Med Internet Res ; 21(11): e14068, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31687936

RESUMO

BACKGROUND: Clinical practice variation that results in poor patient outcomes remains a pressing problem for health care organizations. Some evidence suggests that a key factor may be ineffective internal and professional networks that limit knowledge exchange among health care professionals. Virtual communities have the potential to overcome professional and organizational barriers and facilitate knowledge flow. OBJECTIVE: This study aimed to explore why health care professionals belong to an exemplar virtual community, ICUConnect. The specific research objectives were to (1) understand why members join a virtual community and remain a member, (2) identify what purpose the virtual community serves in their professional lives, (3) identify how a member uses the virtual community, and (4) identify how members used the knowledge or resources shared on the virtual community. METHODS: A qualitative design, underpinned by pragmatism, was used to collect data from 3 asynchronous online focus groups and 4 key informant interviews, with participants allocated to a group based on their posting behaviors during the previous two years-between September 1, 2012, and August 31, 2014: (1) frequent (>5 times), (2) low (≤5 times), and (3) nonposters. A novel approach to focus group moderation, based on the principles of traditional focus groups, and e-moderating was developed. Thematic analysis was undertaken, applying the Diffusion of Innovation theory as the theoretical lens. NCapture (QRS International) was used to extract data from the focus groups, and NVivo was used to manage all data. A research diary and audit trail were maintained. RESULTS: There were 27 participants: 7 frequent posters, 13 low posters, and 7 nonposters. All participants displayed an external orientation, with the majority using other social media; however, listservs were perceived to be superior in terms of professional compatibility and complexity. The main theme was as follows: "Intensive care professionals are members of ICUConnect because by being a member of a broader community they have access to credible best-practice knowledge." The virtual community facilitated access to all professionals caring for the critically ill and was characterized by a positive and collegial online culture. The knowledge found was credible because it was extensive and because the virtual community was moderated and sponsored by a government agency. This enabled members to benchmark and improve their unit practices and keep up to date. CONCLUSIONS: This group of health care professionals made a strategic decision to be members of ICUConnect, as they understood that to provide up-to-date clinical practices, they needed to network with colleagues in other facilities. This demonstrated that a closed specialty-specific virtual community can create a broad heterogeneous professional network, overcoming current ineffective networks that may adversely impact knowledge exchange and creation in local practice settings. To address clinical practice variation, health care organizations can leverage low-cost social media technologies to improve interprofessional and interorganizational networks.

10.
Clin J Sport Med ; 29(6): 486-493, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31688180

RESUMO

OBJECTIVE: To better understand the level of concussion knowledge of youth female hockey coaches and to identify preferred methods of knowledge translation for this population. DESIGN: Cross-sectional survey. SETTING: Participants independently completed written surveys before in-person concussion information sessions or online surveys through link provided in emails. PARTICIPANTS: Convenience sampling yielded 130 coaches of youth female hockey from Canada. MAIN OUTCOME MEASURES: Knowledge level on concussion, resources from which coaches obtained information on concussion, opinions on the current level of concussion knowledge, and knowledge translation. RESULTS: Coaches demonstrated adequate knowledge on concussion, achieving 84% correct on true-false questions and 92% correct on symptom identification accuracy. However, coaches showed limited awareness of concussion specific to mechanisms for injury (identification) and postconcussion symptoms. Internet resources were rated as the most used resources for concussion yet were not rated very helpful. Nonetheless, coaches indicated online courses and web sites as the most preferred method for concussion knowledge translation. CONCLUSIONS: Youth female hockey coaches have overall adequate knowledge of concussion; however, gaps in knowledge do exist. Future efforts to raise the concussion knowledge among coaches of female youth hockey should include information specific to the mechanism of injury, along with sign and symptom identification, with particular attention paid to emotional symptoms. Given the reported preferences and the widespread availability of the Internet, further exploration and research validation of online courses and web sites tailored to the youth female hockey community is encouraged.

11.
J Neurosci Nurs ; 51(6): 308-312, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31688282

RESUMO

INTRODUCTION: Limited access to specialized technicians and trained neurologists results in delayed access to electroencephalography (EEG) and an accurate diagnosis of patients with critical neurological problems. This study evaluated the performance of Ceribell Rapid Response EEG System (RR-EEG), which promises fast EEG acquisition and interpretation without traditional technicians or EEG-trained specialists. METHODS: The new technology was tested in a community hospital intensive care unit in Northern California. Three physicians (without previous training in EEG) were trained by the manufacturer of the RR-EEG and acquired EEG without the help of any EEG technicians. Time needed from order to EEG acquisition was noted. Quality of EEG and diagnostic information obtained with the new EEG technology were evaluated and compared with the same information from conventional clinical EEG system. RESULTS: Ten patients were tested with this new EEG technology, and 6 of these patients went on to have conventional EEGs when the EEG technicians arrived at the site. In these cases, the conventional EEG was significantly delayed (11.2 ± 3.6 hours) compared with RR-EEG (5.0 ± 2.4 minutes; P < .005). Use of RR-EEG helped clinicians rule out status epilepticus and prevent overtreatment in 4 of 10 cases. RR-EEG and conventional EEG systems yielded similar diagnostic information. CONCLUSION: RR-EEG can be set up by nurses, and diagnostic information about the presence or absence of seizures can be appreciated by nurses. The RR-EEG system, compared with the conventional EEG, did not require EEG technologists and enabled significantly faster access to diagnostic EEG information. This report confirms the ease of use and speed of acquisition and interpretation of EEG information at a community hospital setting using an RR-EEG device. This new technology has the potential to improve emergent clinical decision making and prevent overtreatment of patients in the intensive care unit setting while empowering nursing staff with useful diagnostic information in real time and at the bedside.

12.
Cleve Clin J Med ; 86(11): 741-749, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31710587

RESUMO

Primary care physicians can help their patients with migraine modify their triggers, and thereby mitigate the severity and frequency of their symptoms, by offering lifestyle modification counseling based on the mnemonic SEEDS (sleep, exercise, eat, diary, and stress). The authors review evidence associated with each of these factors and provide best-practice recommendations.

13.
Artigo em Inglês | MEDLINE | ID: mdl-31715274

RESUMO

BACKGROUND & AIMS: Changes in serum levels of transaminases immediately after initiation of treatment for autoimmune hepatitis (AIH) might be associated with biochemical markers of remission and liver-related events. We assessed the outcomes of patients with vs without rapid responses to treatment of AIH in a large international cohort. METHODS: We performed a retrospective cohort study, collecting data from 2 independent cohorts of adults with AIH from 12 centers in 7 countries in Europe. We collected information on patient demographics; serologic, histologic, and biochemical analyses; and treatment. We used a receiver operating characteristic curve and Youden index to calculate the optimal percentage decrease in level of aspartate aminotransferase (AST) after 8 weeks of treatment that associated with normalization of transaminase levels after 26 weeks of treatment with predniso(lo)ne (primary outcome) in the first (discovery) cohort (n = 370). We evaluated the results in the second (validation) cohort (n = 370). Secondary outcomes were liver-related death or transplantation. We performed univariate and multivariable logistic and Cox regression with correction for confounders. RESULTS: A significant decrease in level of AST after 8 weeks of treatment was significantly associated with normalization of transaminase levels at 26 and 52 weeks (P<.001); a decrease of more than 80% in level of AST was associated with optimal normalization. In both cohorts, rapid responders (≥80% decrease in level of AST after 8 weeks) were more likely to achieve normalization of transaminases at 26 and 52 weeks when compared to non-rapid responders. Rapid responders in the discovery cohort had lower risk of liver-related death or transplantation (adjusted hazard ratio 0.18; 95% CI 0.05-0.63; P=.007), although this was not confirmed in the validation cohort. Results from measurement of alanine aminotransferase did not differ significantly from those of AST for the primary outcome. Slow responders (without normalization of transaminases after 1 year) had the highest risk of liver transplantation or liver-related death. CONCLUSIONS: In a retrospective study of patients with AIH, we found that a rapid response to treatment, based on level of AST after 8 weeks, associates with normalization of transaminase levels in the following year. Patients with a rapid response also have a lower risk of liver-related death or transplantation than patients without this rapid response.

14.
J Appl Gerontol ; : 733464819886449, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31718379

RESUMO

Despite widespread use and acceptance of alcohol, discussions of age-related changes that impact alcohol consumption behaviors are rare. The objective of this community-engaged qualitative research study was to gain insight into how to promote knowledge dissemination regarding newly developed low-risk drinking guidelines for older adults. A convenience sample of 66 older adults and service providers participated in three Knowledge Café dialogue workshops and discussed their opinions about alcohol use in later life and ideas for sharing alcohol-related research evidence with the community. Participants discussed (a) low-risk drinking knowledge dissemination, (b) personal choice in drinking alcohol and adherence to low-risk drinking guidelines, and (c) preferences for engaging in discussions about alcohol use. Community dialogues fostered knowledge dissemination while participants engaged in rich conversations about a rarely discussed topic. Sharing evidence-based clinical advice with community stakeholders through dialogue events offers an innovative opportunity for health promotion efforts.

15.
Phys Ther ; 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711211

RESUMO

BACKGROUND: Despite increasing evidence on intensive task-specific practice and aerobic exercise in stroke rehabilitation, implementation remains difficult. The factors influencing implementation have been explored from therapists' perspectives; however, despite an increased emphasis on patient involvement in research, patients' perceptions have not yet been investigated. OBJECTIVE: The study aimed to investigate factors influencing implementation of higher intensity activity in people with stroke and to compare this with therapists' perspectives. DESIGN: The design was a cross-sectional qualitative study. METHODS: The study used semi-structured interviews with people with stroke who were part of a randomized clinical trial, the Determining Optimal post-Stroke Exercise (DOSE) study, which delivered a higher intensity intervention. An interview guide was developed and data analyzed using implementation frameworks. Factors emerging from people with stroke were compared and contrasted to factors perceived by rehabilitation therapists. RESULTS: Ten people with stroke were interviewed before data saturation was reached. Participants had a positive attitude regarding working hard, and were satisfied with the graded exercise test, high intensity intervention, and the feedback monitoring devices. Therapists and patients had contrasting perceptions about their beliefs of intensive exercise and the content of the intervention, with therapists more focused on the methods and patients more focused on the personal interactions stemming from the therapeutic relationship. CONCLUSIONS: People with stroke perceived no barriers regarding the implementation of higher intensity rehabilitation in practice and were positive towards working at more intense levels. Contrastingly, from the therapists' perspective, therapists' beliefs about quality of movement and issues around staffing and resources were perceived to be barriers. In addition, therapists and people with stroke perceived the contents of the intervention differently, highlighting the importance of involving patients and clinicians in the development and evaluation of rehabilitation interventions.

16.
Methods ; 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31711930

RESUMO

Functional RNA structures are prevalent in viral genomes, and have been shown to play roles in almost every aspect of their biology. However, the majority of viral RNA remains structurally uncharacterized. This is likely to remain true as the cost of sequencing decreases much faster than the cost of structural characterizations. Because of this, there is a need for rapid, inexpensive methods to highlight regions of viral RNA which are ideal candidates for structure-function analyses. The ScanFold method was developed as a single sequence alternative to traditional RNA structural motif pipelines, which rely heavily on well curated sequence alignments to identify conserved RNA structures. ScanFold focuses on identifying (based on their more stable than expected folding energies) the most likely functional structures encoded within a single large RNA sequence, while allowing predicted motifs to be tested for evidence of structural conservation later. Decoupling these processes can be a benefit to researchers studying viruses lacking the ideal phylogenetic depth to yield evidence of structural conservation. Here, we demonstrate how the most significant ScanFold predicted structures correspond to higher base pairing probabilities, SHAPE reactivities, and predict known functional structures within the ZIKV and HIV-1 genomes with accuracy. Best practices and examples are also shown to aid users in utilizing ScanFold for their own systems of interest. ScanFold is available as a Webserver or can be downloaded (https://github.com/moss-lab/ScanFold) and run locally.

17.
Artigo em Inglês | MEDLINE | ID: mdl-31713465

RESUMO

Aim: To examine the efficacy of strategies used by the police for missing persons with dementia. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, we searched peer-reviewed and gray literature of existing police practices used for missing persons with dementia. Data from the studies were analyzed descriptively. Results: The literature described 16 articles and 18 websites. Strategies ranged from identification tools, successful field techniques, locating technologies and community engagement/education. Overall scientific evidence was low, with only three studies evaluating the usability and effectiveness of the suggested strategies. Conclusion: More rigorous research is required to demonstrate the efficacy of best police practices for missing persons with dementia, which in turn could assist in the development of a best practice guideline.

18.
J Healthc Qual Res ; 34(5): 228-232, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31713518

RESUMO

AIM: Determine the effect of an intervention to reduce the length of stay (LOS) in appendectomies. METHODS: A four-quarter quality improvement initiative was developed after approval by the facility Quality Management Department, including educational sessions about the best practices regarding the hospital care for patients with appendicitis and recommendations to limit the LOS for no complicated appendicitis unless associated conditions were present, monitoring of the LOS and feedback to the staff and leaders. RESULTS: 692 appendectomies were performed, 365 (52.7%)) of them during the intervention. The mean LOS was 3.94 days with a decreasing trend during the study period. The complicated appendicitis had a mean LOS of 6.42 days (SD, 3.85) during the baseline and 5.27 days (SD 2.50) during the intervention (p=0.03), representing a 17.9% reduction. The not complicated appendicitis during baseline had LOS of 3.82 days (SD 4.17) with a subsequent reduction to 2.95 days (SD 1.53) in the intervention. The total saving bed days during the intervention were 338.04 days, which 254.04 days (75.2%) were in non complicated appendectomies. One patient required readmission during the intervention because of an organ space surgical site infection, with proper recovery after antibiotic treatment. CONCLUSION: Our study provides evidence about the possibility to optimize the bed use with a simple educational intervention, and should be considered a step to achieve additional reductions in the hospital stay of patients who undergo laparoscopic appendectomies.

19.
Nurs Educ Perspect ; 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31714435

RESUMO

AIM: The aim of this literature review was to determine the state of the science related to clinical informatics competencies of registered nurses and to determine best practices in educational strategies for both nursing students and faculty. BACKGROUND: Continued emphasis on the provision of evidence-based patient care has implications for requisite informatics-focused competencies to be threaded throughout all levels of nursing educational programs. METHOD: Whittemore and Knalf's five-step integrative review process guided this research. An extensive search yielded 69 publications for critical appraisal. RESULTS: Results suggest nursing educational programs do not adhere to standardized criteria for teaching nursing informatics competencies. Another identified literature gap was the scarcity of research related to informatics training requirements for nurse educators. CONCLUSION: Findings support the need for continued research to provide clear direction about the expected clinical informatics competencies of graduate nurses and what training faculty need to facilitate student learning.

20.
Hypertension ; 74(6): 1279-1293, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31679421

RESUMO

Hypertension is a complex and modifiable condition in which environmental factors contribute to both onset and progression. Recent evidence has accumulated for roles of diet and the gut microbiome as environmental factors in blood pressure regulation. However, this is complex because gut microbiomes are a unique feature of each individual reflecting that individual's developmental and environmental history creating caveats for both experimental models and human studies. Here, we describe guidelines for conducting gut microbiome studies in experimental and clinical hypertension. We provide a complete guide for authors on proper design, analyses, and reporting of gut microbiota/microbiome and metabolite studies and checklists that can be used by reviewers and editors to support robust reporting and interpretation. We discuss factors that modulate the gut microbiota in animal (eg, cohort, controls, diet, developmental age, housing, sex, and models used) and human studies (eg, blood pressure measurement and medication, body mass index, demographic characteristics including age, cultural identification, living structure, sex and socioeconomic environment, and exclusion criteria). We also provide best practice advice on sampling, storage of fecal/cecal samples, DNA extraction, sequencing methods (including metagenomics and 16S rRNA), and computational analyses. Finally, we discuss the measurement of short-chain fatty acids, metabolites produced by the gut microbiota, and interpretation of data. These guidelines should support better transparency, reproducibility, and translation of findings in the field of gut microbiota/microbiome in hypertension and cardiovascular disease.

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