Consideration of Testicular Torsion in Young Males With Abdominal Pain Is Essential: A Case Review.

Testicular torsion is a surgical emergency and requires prompt recognition and treatment. Health care personnel often forget this differential diagnosis in males who present with abdominal pain as their only complaint. There is a 4- to 6-hour window from the onset of symptoms to the surgical intervention to salvage the testes. It is imperative for health care personnel to consider testicular torsion in any male presenting with abdominal pain and to complete a genitourinary examination. The purpose of this case review is to highlight the importance of a genitourinary examination in recognizing testicular torsion.

Correction: Long-term persistence and function of hematopoietic stem cell-derived chimeric antigen receptor T cells in a nonhuman primate model of HIV/AIDS.

[This corrects the article DOI: 10.1371/journal.ppat.1006753.].

Long-term persistence and function of hematopoietic stem cell-derived chimeric antigen receptor T cells in a nonhuman primate model of HIV/AIDS.

Chimeric Antigen Receptor (CAR) T-cells have emerged as a powerful immunotherapy for various forms of cancer and show promise in treating HIV-1 infection. However, significant limitations are persistence and whether peripheral T cell-based products can respond to malignant or infected cells that may reappear months or years after treatment remains unclear. Hematopoietic Stem/Progenitor Cells (HSPCs) are capable of long-term engraftment and have the potential to overcome these limitations. Here, we report the use of a protective CD4 chimeric antigen receptor (C46CD4CAR) to redirect HSPC-derived T-cells against simian/human immunodeficiency virus (SHIV) infection in pigtail macaques. CAR-containing cells persisted for more than 2 years without any measurable toxicity and were capable of multilineage engraftment. Combination antiretroviral therapy (cART) treatment followed by cART withdrawal resulted in lower viral rebound in CAR animals relative to controls, and demonstrated an immune memory-like response. We found CAR-expressing cells in multiple lymphoid tissues, decreased tissue-associated SHIV RNA levels, and substantially higher CD4/CD8 ratios in the gut as compared to controls. These results show that HSPC-derived CAR T-cells are capable of long-term engraftment and immune surveillance. This study demonstrates for the first time the safety and feasibility of HSPC-based CAR therapy in a large animal preclinical model.

The Power of Topical Anesthetics and Distraction for Peripheral Intravenous Catheter Placement in the Pediatric Perianesthesia Area.

Placing a peripheral intravenous catheter is a painful procedure and produces much anxiety for the pediatric patient, as well as for their parents and nursing staff. There is a heightened need for having effective pain control during this process, which will lead to increased cooperation and decreased anxiety for the patient, making the placement of a peripheral intravenous catheter successful. Topical analgesics and distraction are powerful tools that can make inserting a peripheral intravenous catheter easier for the patient, and also easier for a nurse with limited pediatric experience. The purpose of this article is to educate nursing staff of the importance of using topical analgesics such as LMX4 and EMLA, needle free lidocaine injections, as well as different methods of distraction to successfully place a peripheral intravenous catheter in a pediatric patient on first attempt.

Situation, Background, Assessment, and Recommendation-Guided Huddles Improve Communication and Teamwork in the Emergency Department.

PROBLEM: Thousands of people die annually in hospitals because of poor communication and teamwork between health care team members. Standardized tools and strategies help increase the amount and quality of communication. Two structured communication methods include implementing huddles and the use of the situation, background, assessment, and recommendation (SBAR) communication framework. METHODS: To improve communication among nurse practitioners and registered nurses within a pediatric emergency department, a performance-improvement project with the structured processes of a joint patient evaluation and huddle was implemented. Data were gathered from 32 nurses and 2 nurse practitioners using structured observation and pre- and post-implementation surveys. The following outcomes were measured: presence or absence of joint patient evaluation and SBAR-guided huddle, verbalization of treatment plan, communication, teamwork, and nurse satisfaction. RESULTS: Eighty-three percent of patient encounters included a joint evaluation. A huddle structured with SBAR was conducted 86% of the time. Registered nurses and nurse practitioners verbalized patients' treatment plans in 89% of cases and 97% of cases, respectively. Improved teamwork, communication, and nursing satisfaction scores were demonstrated among the nurse practitioners and registered nurses. IMPLICATIONS FOR PRACTICE: This project showed the feasibility of a simple and inexpensive joint nurse practitioner-registered nurse patient evaluation followed by a structured huddle, which improved communication, teamwork, and nurse satisfaction scores. This performance-improvement project has the potential to enhance efficiency by reducing redundancy, as well as to improve patient safety through the use of structured communication techniques.

Improving Patient Flow and Decreasing Patient Length of Stay in the Pediatric Emergency Department Through Implementation of a Fast Track.

Increased utilization of the emergency department (ED) for low acuity concerns saturates EDs, leading to overcrowding. As the ED becomes crowded, the quality of care threatens patient safety and increases length of stay. To improve the efficiency of evaluation and discharge of low acuity patients in the pediatric ED, a performance improvement project was implemented to develop a Fast Track. An interdisciplinary team developed the process of Fast Track, as well as guidelines for low acuity patients who would be evaluated in the designated area by an advanced practice provider and registered nurse team. Within 14 months of operating, length of stay of low acuity patients triaged an emergency severity illness score of 4 or 5 dropped 36% (from 144 to 92 min). Pediatric patients who present to the ED with low acuity concerns can be effectively and efficiently cared for in a timely fashion in a pediatric ED Fast Track.