A Pediatric-Specific View on Improved Nurse-Sensitive Indicators Related to Increased BSN or Higher Rates Over Time.

BACKGROUND: Nurses obtaining higher levels of education has been recommended nationally for more than a decade to support improved patient outcomes. LOCAL PROBLEM: Organizational strategies were implemented to achieve a highly educated workforce at the project site over 14 years. However, there was no evaluation of relationship with increasing education levels and pediatric patient outcomes. METHODS: A quality improvement project explored the relationship of Bachelor of Science in Nursing (BSN) or higher prepared nurses with 9 different nurse-sensitive indicators (NSIs). Educational preparation and NSI data were retrieved retrospectively from hospital databases from up to 14 years. RESULTS: Moderate to moderately strong correlations were noted between the proportion of BSN or higher prepared nurses and 2 NSIs (central line-associated bloodstream infections, r = -0.55 and surgical site infections, r = -0.71). Four of the 9 indicators were approaching moderate correlation. CONCLUSIONS: Increasing the proportion of highly educated nurses at the project site correlated with improvements in select NSI outcomes.

The role of trust in public attitudes toward invasive species management on Guam: A case study.

Public attitudes toward invasive alien species management and trust in managers' ability to effectively manage non-native species can determine public support for conservation action. The island of Guam has experienced widespread species loss and ecosystem transformation due to invasive species, most notably, the brown treesnake (Boiga irregularis). Despite Guam's long history with invasives and extensive efforts to eradicate them, we know little about the sociological context of invasive species and drivers of public support or opposition on the island. Using focused group discussions, we explore public attitudes toward invasive species management measures. Respondents were familiar with the common invasive species on Guam and recognized that they were not native. They expressed support for management activities, interest in more effective and frequent management initiatives, and desire to participate directly in conservation actions. Participants also expressed frustration with government institutions and lack of confidence in managers' ability to control invasive species. Perceptions of managers' trustworthiness, communication with managers, and positive personal experiences with managers were related to positive attitudes about management and support for existing initiatives, indicating the important role of trust and engagement for invasive species management.

Correlation of sociodemographic and clinical parameters with depression and distress in patients with hematologic malignancies.

A quarter of cancer patients struggle with distress or depression during their illness. Multiple organizations including the National Comprehensive Cancer Network recommend universal screening for distress and depression. Herein, we describe a universal screening program in patients with hematologic malignancies and factors associated with distress and depression. Between December 2013 and February 2015, patients with hematologic malignancies took the Patient Health Questionnaire 9 (PHQ-9) and Distress Thermometer (DT) prior to receiving their first outpatient parenteral chemotherapy. Patient demographic information as well as information regarding visit burden and baseline use of psychiatric medications were recorded. A PHQ-9 score of ≥ 9 and a DT score ≥ 4 suggested a high risk of major depression and distress. Intergroup comparisons of categorical and continuous variables were performed via chi-square and Wilcoxon rank-sum tests. Multivariate models were constructed using the stepwise selection technique using all potential variables. Two hundred forty-six patients with a median age at diagnosis 65 years (range 18-94 years) were included. In the multivariate analysis, a PHQ-9 score ≥ 9 was associated with living alone (P = 0.007), positive PHQ-2 (P = 0.003), and high Charlson comorbidity index (CCI; P = 0.02), while a DT score ≥ 4 was associated with being married (P = 0.03) and female (P = 0.03). There was no other association with high scores on either questionnaire. Patients with hematologic malignancies often have prolonged treatment and surveillance. We identified subpopulations within this group who may be at high risk of developing distress and depression and who should be aggressively screened even when universal screening programs are not available.

Patient-reported distress and survival among patients receiving definitive radiation therapy.

OBJECTIVE: Patient-reported distress (PRD) has not been well assessed in association with survival after radiation therapy (RT). The aims of this study were to evaluate the association between PRD level and survival after definitive RT and to identify the main causes of distress in definitive RT patients. METHODS AND MATERIALS: A total of 678 consecutive patients receiving definitive RT at our institution from April 2012 through May 2015 were included. All patients answered a PRD questionnaire that contained 30 items related to possible causes of distress, which could be rated from 1 (no distress) to 5 (high distress). Additionally, patients were asked to rate their overall distress level from 0 (no distress) to 10 (extreme distress). This overall distress level was our primary patient-reported distress measure and was examined as a continuous variable and as a categorical variable with 3 PRD levels (low, 0-3 [n = 295]; moderate, 4-6 [n = 222]; and high, 7-10 [n = 161]). RESULTS: As a continuous variable in multivariable Cox regression analysis, a higher overall PRD level was associated with poorer survival after RT (hazard ratio [HR], 1.39; P = .004). As a categorical variable, compared with patients with low distress, survival was poorer for patients with moderate distress (HR, 1.62; P = .038) or high distress (HR, 1.49; P = .12), but the latter difference was not significant. When the moderate and high distress levels were combined, survival was significantly poorer compared with the low distress level (HR, 1.57; P = .034). The top 5 specific causes of distress that patients mentioned were "How I feel during treatment," "Fatigue," "Out-of-pocket medical costs," "Pain that affects my daily functioning," and "Sleep difficulties." CONCLUSIONS: PRD before or during RT is a prognostic factor associated with decreased survival. Distress screening guidelines and interventions should be implemented for patients receiving definitive RT.

Sleep and Heart Failure.

Sleep deprivation occurs for many reasons but, when chronic in nature, has many consequences for optimal health and performance. Despite its high prevalence, sleep-disordered breathing is underrecognized and undertreated. This is especially true in the setting of heart failure, where sleep-disordered breathing affects more than 50% of patients. Although the optimal strategy to best identify patients is currently unknown, concerted and consistent efforts to support early recognition, diagnosis, and subsequent treatment should be encouraged. Optimization of guideline-directed medical therapy and concurrent treatment of sleep-disordered breathing are necessary to improve outcomes in this complex high-risk population.

Genomic Characterization of Interspecific Hybrids and an Admixture Population Derived from Panicum amarum × P. virgatum.

Switchgrass (Panicum virgatum L.) and its relatives are regarded as top bioenergy crop candidates; however, one critical barrier is the introduction of useful genetic diversity and the development of new cultivars and hybrids. Combining genomes from related cultivars and species provides an opportunity to introduce new traits. In switchgrass, a breeding advantage would be achieved by combining the genomes of intervarietal ecotypes or interspecific hybrids. The recovery of wide crosses, however, is often tedious and may involve complicated embryo rescue and numerous backcrosses. Here, we demonstrate a straightforward approach to wide crosses involving the use of a selectable transgene for recovery of interspecific [P. virgatum cv. Alamo × Panicum amarum Ell. var amarulum or Atlantic Coastal Panicgrass (ACP)] F1 hybrids followed by backcrossing to generate a nontransgenic admixture population. A nontransgenic herbicide-sensitive (HbS) admixture population of 83 F1 BC1 progeny was analyzed by genotyping-by-sequencing (GBS) to characterize local ancestry, parental contribution, and patterns of recombination. These results demonstrate a widely applicable breeding strategy that makes use of transgenic selectable resistance to identify and recover true hybrids.

An interpretive study of nursing students' experiences of caring for suicidal persons.

Suicide is a worldwide public health problem. Although preparing nursing students to care for suicidal persons has been a standard part of nursing education for many years, nurses consistently report that they lack competencies in caring for this population of patients. The purpose of this phenomenological and hermeneutical study was to understand the experiences undergraduate nursing students had in regard to caring for suicidal persons. The aim of the study was to obtain insights into the basic preparation of students in the care of suicidal persons to inform pedagogical approaches pertaining to suicide and improve the nursing care for these individuals. Twelve senior nursing students were recruited for the study. Data were collected using in-depth, unstructured interviews. The study themes indicated that (a) when participants read about suicidal persons' mental status and behavior in patient, records they initially feared interacting with and caring for these individuals; (b) participants' abilities to gather information about suicide risk was influenced by how much patients talked with them about their suicidal tendencies; and (c) participants' capacity to provide safe and therapeutic suicide prevention interventions was impacted by judicious critical thinking skills. Teaching strategies that align with the themes are provided.

Optimization of whole-body zebrafish sectioning methods for mass spectrometry imaging.

Mass spectrometry imaging (MSI) methods and protocols have become widely adapted to a variety of tissues and species. However, the MSI literature contains minimal information on whole-body cryosection preparation for the zebrafish (ZF; Danio rerio), a model organism routinely used in developmental, toxicity, and carcinogenicity studies. The optimal medium for embedding and cryosectioning a whole organism or soft-tissue specimen for histological examination is a synthetic polymer mixture that is incompatible with MSI as a result of ion suppression. We describe the optimal methods and results for embedding and cryosectioning whole-body ZF for MALDI-MSI. We evaluated 13 distinct embedding media formulations and found a supportive hydrogel with the consistency of cartilage to be the optimal embedding medium. The hydrogel medium does not interfere with MSI data collection, aids in tissue stability, is readily available for purchase, and is easy to prepare and handle during cryosectioning. Additionally, we decreased the matrix cluster interference commonly caused by α-cyano-4-hydroxycinnamic acid by adding ammonium phosphate to the solvent spray solution. The optimized methods developed in our laboratory produced high-quality cryosections, as well as high-quality mass spectral images of sectioned ZF.