Tragedy or transformation? Online survey of nurse spirituality during the COVID pandemic.

AIM: To describe positive and negative spiritual responses to providing COVID-related nursing care among nurses working in hospitals. BACKGROUND: The COVID pandemic has intensified and publicised the threats to nurse well-being. Absent from the recommendations for promoting nurse well-being is recognition of how nurses' spirituality and/or religiosity is affected by the strain of COVID caring or how it may be affecting their well-being. DESIGN: Cross-sectional, descriptive observational, mixed methods study. METHODS: Data were collected from 523 registered nurses employed in three Southern California hospitals during March-May, 2022 when these hospitals' COVID case counts were <15%. Using Online survey methods, data were obtained using the Religious/Spiritual Struggles Scale-Short Form, Moral Injury Symptom Scale-Healthcare Professionals, Post-traumatic Growth Inventory and demographic and work-related items. STROBE guidelines for cross-sectional observational studies were observed. RESULTS: The mean for religious/spiritual struggles was 1.98 (range of 1-5, comparable to a little bit). Although roughly half of the sample reported the struggles were not experienced/did not apply, 23%-36.5% reported experiencing these struggles at least somewhat. The most frequent struggle was to find ultimate meaning. The mean observed for moral injury was 6.5 (range of 1-10); applying established criteria indicated it was troubling for at least 50%. The mean for post-traumatic growth was 4 (on a scale of 0-6); using established criteria, 41% experienced PTG. Quantitative findings were illustrated by the qualitative responses that occasionally expressed spiritual tragedy and transformation concurrently. CONCLUSION: The professional work of nursing impacts nurses in invisible, spiritual ways that can be tragic and/or transformative. RELEVANCE TO CLINICAL PRACTICE: Interventions to address nurses' mental health challenges must include attention to these invisible struggles. Nurses' mental health challenges must be met in part by addressing how they can surmount spiritual tragedy-and allow spiritual transformation.

Frequency of nurse-provided spiritual care: An international comparison.

AIMS AND OBJECTIVES: To compare the frequency of nurse-provided spiritual care across diverse cultures. BACKGROUND: Given an ethical imperative to respect patient spirituality and religiosity, nurses are increasingly taught and expected to provide spiritual care. Although nurses report positive attitudes toward spiritual care, they typically self-report providing it infrequently. Evidence about the reported frequency of spiritual care is constrained by substantial variation in its measurement. DESIGN: This cross-sectional, descriptive study involved secondary analysis of data collected in multiple sites globally using one quantitative instrument. METHODS: Data were collected from practicing nurses using the Nurse Spiritual Care Therapeutics Scale and analysed using descriptive statistics and a meta-analysis procedure with random-effect modelling. Datasets from 16 studies completed in Indonesia, Iran, Malaysia, Philippines, Portugal, Taiwan, Turkey and the United States contributed to a pooled sample (n = 4062). STROBE guidelines for cross-sectional observational studies were observed. RESULTS: Spiritual care varied between countries and within countries. It was slightly more frequent within Islamic cultures compared with predominantly Christian cultures. Likewise, frequency of spiritual care differed between nurses in palliative care, predominantly hospital/inpatient settings, and skilled nursing homes. Overall, "Remaining present…" was the most frequent therapeutic, whereas documenting spiritual care and making arrangements for the patient's clergy or a chaplain to visit were among the most infrequent therapeutics. CONCLUSIONS: In widely varying degrees of frequency, nurses around the world provide care that is cognisant of the spiritual and religious responses to living with health challenges. Future research should be designed to adjust for the multiple factors that may contribute to nurses providing spiritual care. RELEVANCE TO CLINICAL PRACTICE: Findings offer a benchmark and begin to inform nurse leaders about what may be normative in practice. They also encourage nurses providing direct patient care that they are not alone and inform educators about what instruction future nurses require.

Sanctification of work and hospital nurse employment outcomes: An observational study.

AIM: To explore nurse ascriptions of sacredness to work and measure its association with the employment outcomes of job satisfaction, burnout, organisational commitment, employee engagement and turnover intention. BACKGROUND: High portions of hospital nurses experience burnout. Many factors contributing to burnout also contribute to job dissatisfaction and other negative employment outcomes. Personal factors, such as religiosity, help nurses to cope with work. METHODS: Questionnaires measuring study variables were distributed to all nursing personnel at a faith-based hospital in Los Angeles; 463 responded. Regression analyses allowed measurement of how sacredness ascribed to work (measured by Sanctification of Work Scale) and religiosity (measured by Duke Religiosity Index) were associated with the various employment outcomes. RESULTS: Sanctification of work consistently was found to be associated with less burnout and intention to leave, and more job satisfaction, employee engagement and organisational commitment. CONCLUSION: The sacredness with which a nurse views work explains, in part, positive employment outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Nurturing a sense of sacredness for work in nurses may provide them with an internal buffer against negative employment outcomes. Suggestions for creating rituals and educating nurses are offered.

An in vitro investigation comparing methods of minimizing excess luting agent for cement-retained implant-supported fixed partial dentures.

STATEMENT OF PROBLEM: The use of cement-retained implant-supported prostheses is a well-established treatment option. Techniques have been proposed to reduce the amount of residual excess cement (REC) around cement-retained single-implant restorations. However, studies evaluating the effectiveness of such techniques related to cement-retained implant-supported fixed partial dentures (CRISFPDs) are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the effectiveness of various cement application techniques for CRISFPDs. MATERIAL AND METHODS: Two implant analogs were placed in the lateral incisor sites in a maxillary, 3D printed cast with 4 missing incisors. Twenty standardized, removable, printed soft-tissue replicas, 40 milled titanium custom abutments, and 20 milled zirconia CRISFPDs were fabricated. Two cement application techniques, the brush on technique (BOT), and the polyvinyl siloxane index (PI) technique were compared. Two cementation techniques, without bib (control) (n=10) and with a polytetrafluoroethylene (PTFE) bib (test) (n=10), were used. A premeasured amount of interim cement was used to cement the CRISFPDs. The CRISFPDs were retrieved after cementation, and standardized photographs of 4 quadrants of each abutment-CRISFPD assembly were made by using a software program that is used to calculate the ratio between the area covered with REC and the total specimen area. The extension of the REC on both the abutment and soft-tissue replica was measured at sites before and after cleaning the REC. A generalized linear mixed-model procedure was used for statistical analysis (α=.05). RESULTS: For cement application, the polyvinyl siloxane (PVS) index technique had significantly less REC than the brush on technique (P<.05). The use of a PTFE bib led to significantly less REC than when no bib was used (P<.05). CONCLUSIONS: The use of the PVS index technique along with a PTFE bib was effective in reducing REC for CRISFPDs.

Online Survey of Nurses' Personal and Professional Praying.

This study explored how nurses' prayer beliefs and practices are associated with their offering to pray with patients. Participants (N = 423) completed an online survey. Those with higher prayer experience scores were 9% more likely to offer prayer to patients; those working in religious settings were 2.5 times more likely offer prayer to patients.

Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program with comparison to medications.

OBJECTIVE: To determine if an anti-reflux induction program relieves laryngopharyngeal reflux (LPR) symptoms more effectively than medication and behavioral changes alone. STUDY DESIGN: Retrospective study. SETTING: Tertiary care academic center. SUBJECTS AND METHODS: A database was populated with patients treated for LPR. Patients were included in the study group if they completed a two-week anti-reflux program (diet, alkaline water, medications, behavioral modifications). Patients were included in the control group if they completed anti-reflux medications and behavioral modifications only. Patients completed the voice handicap index (VHI), reflux symptom index (RSI), cough severity index (CSI), dyspnea index (DI) and eating assessment tool (EAT-10) surveys and underwent laryngoscopy for examination and reflux finding score (RFS) quantification. RESULTS: Of 105 study group patients, 96 (91%) reported subjective improvement in their LPR symptoms after an average 32-day first follow-up and their RSI and CSI scores improved significantly. No significant differences were found in VHI, DI, or EAT-10 scores. Fifteen study patients who had previously failed adequate high-dose medication trials reported improvement and their CSI and EAT-10 scores improved significantly. Ninety-five percent of patients with a chief complaint of cough reported improvement and their CSI scores improved significantly from 12.3 to 8.2. Among 81 controls, only 39 (48%) patients reported improvement after an average 62-day first follow-up. Their RSI scores did not significantly change. CONCLUSION: The anti-reflux program yielded rapid and substantial results for a large cohort of patients with LPR. It compared favorably with medication and behavioral modification alone. It was effective in improving cough and treating patients who had previously failed medications alone.

Comparison of Nonpenetrating Titanium Clips versus Continuous Polypropylene Suture in Dialysis Access Creation.

BACKGROUND: Nonpenetrating titanium surgical clips (clips) offer a theoretical advantage of inducing less intimal hyperplasia at an anastomosis because of less endothelial injury. Whether this translates into improved outcomes when used in the creation of arteriovenous fistulas (AVFs) remains unclear. We sought to compare the maturation, patency, and failure rates of anastomoses created using traditional continuous polypropylene suture and clips. METHODS: All primary AVF created at a single Veterans Administration Medical Center were reviewed over a 6-year period. Anastomoses were created with either clips or suture based on surgeon preference. Patient characteristics and surgical outcomes were collected. Comparisons were made between the 2 groups. RESULTS: Over a 6-year period, 334 fistulas were created (29% suture and 71% clips) in 326 patients. The mean age was 64.8 ± 11 years with 98% males. Comorbidities included diabetes (70%), hypertension (96.1%), and tobacco use (52.9% previous or current). Approximately half the patients were predialysis. Comparison of patient characteristics showed no differences between the suture and clip groups. There was no significant difference in maturation rate (suture 79% versus clips 72%, P = 0.25), median time to maturation (suture 62 ± 35 versus clips 71 ± 13 days, P = 0.07), 1 year primary patency rate (suture 37.4% versus clips 39.6, P = 0.72), 1 year assisted primary patency rate (suture 82.4% versus clips 76.3%, P = 0.31), or overall failure rates (suture 62% versus clips 58%, P = 0.56). Median time to initial failure or reintervention was not significantly different in the clip group (suture 615 [range, 239-991] versus clips 812 [range, 635-989] days, P = 0.72). CONCLUSIONS: Compared to traditional polypropylene suture creation of upper extremity AVFs, nonpenetrating clips had equivalent maturation, 1-year patency, and overall failure rates. Neither clips nor suture offers any clear advantage in the creation of AVF.

Savary dilation is a safe and effective long-term means of treatment of symptomatic cricopharyngeal bar: a single-center experience.

GOALS: Dilation of a cricopharyngeal (CP) bar can be a safe and effective means of nonsurgical treatment as elderly patient population has high morbidity and is at a higher risk of surgical complications. BACKGROUND: CP bar is a relatively uncommon radiologic finding, which is an infrequent cause of oropharyngeal dysphagia in the elderly population. METHODS: Patients were included in study from January 2007 to January 2012, if their dysphagia was solely attributed to CP bar on predilation radiologic imaging by either modified barium swallow or barium esophagogram. A functional outcome swallowing score (FOSS) was calculated at 1, 4, and 6 months from initial and last dilation performed. RESULTS: A total of 31 patients with a mean age of 71.65 (54 to 88) years and mean body mass index 27.81 (15 to 41) were included in the study. Over the time period of 5 years, a total of 53 dilations were performed. The median predilation FOSS was 3. The median postdilation FOSS was 1 at the end of 6 months from last dilation performed. There were no immediate or remote complications. CONCLUSIONS: On follow-up from first dilation, 65% patients had statistically significant improvement in FOSS lasting for at least 6 months. Savary dilation seems to be a safe and effective treatment for symptomatic CP bar patients.

Association of TV watching with sleep problems in a church-going population.

Sensory stimuli/inactivity may affect sleep. Sleep problems are associated with multiple health problems. We assessed TV habits in the Adventist Health Study-2 at baseline and sleep problems in the Biopsychosocial Religion and Health Study 1 to 4 years later. After exclusions, 3914 subjects split equally into TV watchers less than 2 hours per day or 2 or more hours per day. Watching TV 2 or more hours per day predicted problems falling asleep, middle of the night awakening, and waking early with inability to sleep again in multiple logistic regression. Excess TV watching disturbed sleep induction and quality, though the relationship may be bidirectional. TV habits should be considered in individuals with sleep problems.

Clinical and Anatomical Variation During Assessment of Maximum Glottic Angle.

INTRODUCTION: Quantitative measurement and analysis of glottic abduction is used to assess laryngeal function and success of interventions; however, the consistency of measurement over time has not been established. This study assesses the consistency of glottic abduction measurements across visits in healthy patients and anatomic factors impacting these measurements. METHODS: Review of patients with two sequential flexible stroboscopic exams over seven months from 2019-2022. Images of maximal glottic abduction were captured and uploaded into and measured with ImageJ. Cadaver heads were used to assess the impact of visualization angles on glottic measurements with a monofilament inserted into the supraglottis of each cadaver as a point of reference. Comparisons were done with a paired T-test, T-test, or Mann-Whitney U test as appropriate. RESULTS: Fifty-nine patients and twenty-six cadaveric exams were included. Absolute change in maximum glottic abduction angle (MGAA) was 6.90° (95% CI [5.36°, 8.42°]; p < 0.05). There were no significant differences in change in MGAA by gender or age. Twenty percent of patients had a change of at least 25% in their MGAA between visits. Absolute differences in glottic angle between nasal side for cadaveric measurements was 4.77 ± 4.59° (p < 0.005)-2.22° less than the change in MGAA seen over time (p = 0.185). CONCLUSION: Maximal glottic abduction angles varied significantly between visits. Factors considered to be contributing to the differences include different viewing windows between examinations due to the position and angulation of the laryngoscope and changes in patient positioning, intra- and inter-rater variations in measurement, and patient effort. LEVEL OF EVIDENCE: N/a Laryngoscope, 134:2793-2798, 2024.

Preserving the Bedside Nurse: Grip Strength and Orthopedic Problems Among Nurses and Nursing Students.

BACKGROUND: Bedside nurses and nursing students are at increased risk of musculoskeletal injury due to the physicality and complexity of their work. The purpose of this study was to explore the relationship between grip strength and orthopedic injuries or pain among nurses and nursing students. METHODS: A cross-sectional study of nursing staff and nursing students at a health sciences university was conducted. The survey consisted of work-related demographics, exercise habits, and validated scales. The Nordic Musculoskeletal Questionnaire was used to collect information on musculoskeletal problems. Anthropomorphic measures included height, weight, body mass index (BMI), and grip strength. Logistic regression was performed. FINDINGS: Participants with grip strength at or above the national average had significantly lower odds of self-reported orthopedic problems, B = 0.86, OR = 2.35, p =.01, indicating participants with grip strength at or above national average were 135% less likely to report orthopedic problems compared to participants with grip strength below the national average. CONCLUSION/APPLICATION TO PRACTICE: Healthcare workers in direct patient care who have lower grip strength may be at increased risk for injuries. Nursing staff and students with below average grip strength were more likely to experience orthopedic problems. Increased muscle mass and grip strength are known to effectively reduce the risk of upper extremity injuries. Nurse leaders may benefit from promoting grip strengthening activities among employees to prevent workplace injuries. Further research is needed to understand the biophysiological mechanisms, confirm the findings of this study and evaluate effective interventions.

Nursing values and moral identity in baccalaureate nursing students.

BACKGROUND: Professional nursing identity formation requires alignment with the values and moral norms of the nursing profession. PURPOSE: This study sought to explore professional nursing identity formation by comparing differences in nursing values and moral identity between students enrolled in generic Bachelor of Science in nursing (BS) programs and Accelerated Second-degree Bachelor of Science in nursing (ASBS) programs who were nearing graduation. Secondary aims were 1) to explore the relationship between nursing values and moral identity and, 2) to analyze the influence of moral identity and being in an ASBS program on nursing values in baccalaureate students." METHODS: The descriptive, correlative study used a 42-item survey that included the Nursing Professional Values Scale-3 (NPVS-3), the Moral Identity Scale (MIS), and four demographic questions. An emailed invitation to take the online survey was distributed to senior students enrolled at four universities in California. RESULTS: No significant differences in NPV-3 scores or MIS scores between BS students and ASBS students were found. Overall, students scored lowest in the NPV-3 activism subfactor. A positive, statistically significant relationship between nursing values and moral identity was revealed. Regression modeling detected that every 1-point increase on the MIS significantly corresponded to an increase of 1.26 points on the NPVS-3 after adjusting for age and gender. Enrollment in an ASBS program did not have a statistically significant influence on nursing values. CONCLUSIONS: Findings suggest that students in both BS and ASBS programs who are nearing graduation are fully engaging with being a nurse. Overall, students ascribe more importance to the NPVS-3 subfactor of caring, and less importance on the NPVS-3 subfactors of activism and professionalism. Nursing values as measured by the NPVS-3 and moral identity as measured by the MIS are distinct concepts that together provide a salient measure of Professional Nursing Identity Formation in baccalaureate students.

Burnout, Self-Efficacy, and Resilience in Haitian Nurses: A Cross-Sectional Study.

Purpose of Study: Though nursing burnout is a global problem, research on nurse burnout in Haiti is scarce. In a context of multiple personal, social, and environmental challenges, this study assessed burnout and associated factors among Haitian nurses. Design of Study: A multi-site cross-sectional study. Methods: A survey in French and Haitian Creole was conducted in five Haitian hospitals using forward and back translated scales measuring burnout (emotional exhaustion [EE], depersonalization [DP], personal accomplishment [PA]), self-efficacy, nursing work environment, resilience, and demographics. Findings: Haitian nurses (N = 179) self-reported moderate EE (M = 21, SD = 11.18), low DP (Mdn = 2.0, range = 29), and high personal accomplishment (Mdn = 41.0, range = 33). General self-efficacy (M = 32.31, SD = 4.27) and resilience (M = 26.68, SD = 5.86) were high. Dissatisfaction with salary, autonomy, and staffing were evident. Conclusions: It is noteworthy that burnout was lower than expected given the scarce resource, difficult socio-politico-economic environment. High levels of self-efficacy and resilience likely mitigated a higher level of burnout. Adaptation enables these nurses to manage their critical conditions and practice holistic nursing, which may inspire hope among nurses in similar contexts.

Voice and Airway Outcomes of Montgomery T-tube Placement in Laryngotracheal Stenosis.

OBJECTIVES: To describe voice and airway outcomes and complications experienced by patients with laryngotracheal stenosis following Montgomery T-tube placement. METHODS: Retrospective chart review of all patients with laryngotracheal stenosis and Montgomery T-tube placement treated at a tertiary referral center from 2012 to 2021. RESULTS: Eighteen patients met criteria with laryngotracheal stenosis, seven including the level of the glottis and 11 without glottal involvement. Eleven were completely aphonic before T-tube placement and the remainder had severe dysphonia. There was improvement of Voice Handicap Index-10, Reflux Symptom Index, and GRBAS grade following T-tube placement in patients compared to their preoperative values. Improvement of grade was greater in patients without glottal involvement. Complications of chronic indwelling T-tube included granulation in 14 patients (78%), tracheitis in two patients (11%), and mucus plugging in three patients (17%) with one T-tube related mortality. Five patients were eventually decannulated, six returned to tracheostomy tube, and seven retained the T-tube at last follow-up (average: 30 months, range: 4-80 months). CONCLUSIONS: Montgomery T-tube placement improves voice in patients with severe dysphonia secondary to laryngotracheal stenosis with and without glottal involvement though the degree of improvement is greater in patients without glottal involvement. T-tube can help reestablish long-term laryngotracheal continuity in patients with no other surgical options. The potential benefits in phonation should be weighed against the possibility of rare but serious adverse events.

Recent Laryngology Fellowship Graduates: Where Are They Now?

OBJECTIVES: Over the past 30 years laryngology fellowships have grown in number and diversity. This study investigated the career trajectories of recent laryngology fellowship graduates with the purpose of informing residents considering fellowship. STUDY DESIGN: Cross-sectional survey. SETTING: Academic medical center. METHODS: The directors of all 27 US laryngology fellowships that graduated/recruited fellows from 2010 to 2019 were contacted, and a list of former fellows was compiled. A short survey was administered in person or via email or phone. Additional data was gathered through internet searches. RESULTS: One hundred eighty-three fellows were identified having completed American laryngology fellowships between 2010 and 2019 (100M:83F). Fifteen percent now practice internationally and 68% are in academic practice. A higher proportion of women than men enter laryngology fellowship after otolaryngology residency. One hundred twenty-nine fellows responded to our survey. Two-thirds of former fellows report current participation in laryngology research. Seventy-two percent of former fellows are still in their first job after fellowship and 53% believe they have their ideal practice. Women were more likely to enter academics than men after laryngology fellowship. Responders were overwhelmingly satisfied with their fellowship experience, with 95% saying they would choose to pursue fellowship training again. CONCLUSIONS: Most former laryngology fellows enter academia, contribute to laryngology research, practice away from their training institution, and believe they have found their ideal practice. The results of this study may be useful to residents considering fellowship training, centers considering establishing laryngology fellowships, and practices recruiting fellowship graduates.

Chronic Refractory Cough: Objective Improvement With Aerodynamic-Focused.

OBJECTIVE: Previous investigations have reported that a chronic cough that is refractory to medical therapies improves with behavioral therapies. However, the treatment parameters that may account for improvement in cough symptoms have not yet been objectively documented. The purpose of this study was to document changes in chronic refractory cough using a breath training protocol. METHODS: The charts of 27 patients with a long-term chronic cough (>6 months) refractory to various medical treatments were reviewed. These patients received 2-4 sessions of breath training therapy over a 6-month period. Treatment sessions consisted of breathing modification exercises such as those reported in the literature. Aerodynamic parameters including mean estimated subglottal air pressure, mean airflow rate, laryngeal airway resistance, and maximum phonation time were obtained before treatment and 6 months after therapy. Patients also completed the Cough Severity Index at the first visit and 6 months after treatment. RESULTS: Twenty four of the 27 patients (M:F = 6:21), with a mean age of 62.4 (range = 28-78, median = 66) had significant Cough Severity Index improvement from 16.74 to 10.04 (P< 0.001) after therapy. Maximum phonation time increased significantly from 12.00 to 16.38 seconds (P= 0.006); mean estimated subglottic air pressure decreased significantly from 7.58 to 6.36 cm H2O (P= 0.004); laryngeal airway resistance decreased significantly from 52.97 to 40.64 ppm (P= 0.013). CONCLUSION: This investigation provides evidence that patients who followed a protocol that focused on a breath training program reduced their chronic cough. Significant relationships between patient self-assessment of chronic cough and aerodynamic measures of subglottic pressure and glottal airway resistance were found in this group.

Comorbid Dysphagia and Malnutrition in Elderly Hospitalized Patients.

OBJECTIVE/HYPOTHESIS: Elderly individuals account for one-third of all hospitalizations. The goal of this study was to evaluate the prevalence of dysphagia in elderly patients admitted to a tertiary care center. It also sought to investigate how dysphagia is identified, how it covaries with malnutrition and other conditions, and how it impacts hospital stay. STUDY DESIGN: Case Series. METHODS: A retrospective chart review was performed. All patients >65 years admitted to a tertiary care center in January and February 2016 were included. Patients with primary psychiatric diagnoses and patients with upper aerodigestive tract malignancy or surgery were excluded. RESULTS: A total of 655 patients were identified. Mean age was 76.6 years. Twenty-four percent (155 patients) had dysphagia while 43% (282 patients) had malnutrition. Thirteen percent (84 patients) had both dysphagia and malnutrition. Fifty percent of patients who had malnutrition were seen by speech language pathology (SLP). One hundred percent of malnourished patients that saw SLP were identified as having dysphagia. Three hundred and eighty-two patients (58%) were seen by the dietician but not by SLP. Multiple logistic regression indicated that the presence of dysphagia was positively associated with age, presence of malnutrition, admission to either cardiology or neurology service as compared to medicine service, and history of stroke. CONCLUSIONS: One-quarter of elderly patients admitted to our tertiary care center had dysphagia. Dysphagia, especially when linked with malnutrition, has poorer outcomes and increased healthcare costs. Our data suggests a possible disconnect between malnutrition diagnosis and dysphagia identification. This is an important area of intervention that has the potential to improve the treatment and outcomes of these patients. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2441-2447, 2021.

Endotracheal Tube Placement Confirmation with Bedside Ultrasonography in the Pediatric Intensive Care Unit: A Validation Study.

Critically ill patients who are intubated undergo multiple chest X-rays (CXRs) to determine endotracheal tube position; however, other modalities can save time, medical expenses, and radiation exposure. In this article, we evaluated the validity and interrater reliability of ultrasound to confirm endotracheal tube (ETT) position in patients. A prospective study was performed on intubated patients with cuffed ETTs. The accuracy of ultrasound to confirm correct ETT placement in 92 patients was 97.8%. Sensitivity, positive predictive value, and agreement of 97.7, 93.3, and 91.3% were found on comparing ultrasound to CXR findings. Ultrasound is feasible, reliable, and has good interrater reliability in assessing correct ETT position in children.

Better Etiquette for Effective Paging (B.E.E.P.)-Improving Daily In-hospital Communications in the Pediatric ICU.

INTRODUCTION: Paging is a vital part of patient care that allows quick contact between physicians and other hospital personnel. There was no structured way to send a page to physicians at our institution. We hypothesized that by standardizing paging format, scheduling laboratory draw times, and using order clean-up sheets, through a bundle of interventions called Better Etiquette for Effective Paging, we would decrease the number of pages received on the pediatric intensive care unit (PICU) resident pager by 15%. METHODS: This project was a quality improvement initiative in a 25-bed multidisciplinary PICU in a tertiary children's hospital. Baseline data collection was performed in December 2015, categorized by time of day received and type of page. Interventions were paging standards to include relevant information, scheduling laboratory draw times, and order clean-up sheets. We collected postintervention data over 3 years to monitor for sustained change. RESULTS: The average number of pages decreased from a baseline of 4.71 pages/patient/d in 2015 to 3.70 in 2016 (21% decrease), 3.32 in 2017 (30% decrease), and 2.74 in 2018 (42% decrease). The average PRISM 3 score remained similar in all sets (2.52, 2.50, 2.10, and 2.35). The standardized mortality ratio was not adversely affected by the decrease in pages (0.58, 1.07, 1.19, and 0). CONCLUSION: Standardizing the format of pages and using scheduled laboratory times with order clean-up sheets has decreased the number of pages/patient/d in the PICU by 42% without adversely affecting patient care. We can continue to improve communication among the patient care team by emphasizing efficient, standardized communication using Better Etiquette for Effective Paging.

Racial Difference in the Association of Long-Term Exposure to Fine Particulate Matter (PM2.5) and Cardiovascular Disease Mortality among Renal Transplant Recipients.

Ambient air pollutants are known risk factors for cardiovascular disease (CVD) morbidity and mortality with significant racial disparities. However, few studies have explored racial differences among highly susceptible subpopulations, such as renal transplant recipients (RTRs). Despite improvements in quality of life after transplantation, CVD remains the major cause of mortality, especially among Black recipients. This study aimed to evaluate potential racial differences in the association between long-term levels of PM2.5 and the risk of all-cause, total CVD, and coronary heart disease (CHD) mortality among RTRs. This retrospective study consists of 93,857 non-smoking adults who received a renal transplant between 2001 and 2015. Time-dependent Cox regression was used to assess the association between annual concentrations of PM2.5 and mortality risk. In the multivariable-adjusted models, a 10 µg/m3 increase in ambient PM2.5 levels found increased risk of all-cause (HR = 3.45, 95% CI: 3.08-3.78), CVD (HR = 2.38, 95% CI: 1.94-2.92), and CHD mortality (HR = 3.10, 95% CI: 1.96-4.90). Black recipients had higher risks of all-cause (HR = 4.09, 95% CI: 3.43-4.88) and CHD mortality (HR = 6.73, 95% CI: 2.96-15.32). High levels of ambient PM2.5 were associated with all-cause, CVD, and CHD mortality. The association tended to be higher among Black recipients than non-Blacks.