Parents' Perception of Fall Risk and Incidence of Falls in the Pediatric Ambulatory Environment.

PURPOSE: To identify the parents' perspective of fall incidence and risks in the pediatric ambulatory environment. DESIGN AND METHODS: A prospective descriptive correlational study was conducted in two large quaternary pediatric hospitals. Parents who accompanied their children to the clinic appointment were surveyed about falls their child experienced while at the clinic. Parent reported falls were compared to those reported in adverse event reporting systems (AERS) for the same period. RESULTS: Data from 2327 completed parent surveys were analyzed. Parents reported 48 children fell and 139 falls. Only three falls were recorded in the AERS. Stepwise logistic regression was used to identify predictors of falls and a nomogram was created from the final model to facilitate patient fall risk screening. Three predictors of falls were identified: children under the age of five, children described by their parents as falling more at home than other children of the same age, and children who had a medical condition that impacts their ability to walk. A nomogram is provided to estimate the probability of falling for patients under 18 years of age in the ambulatory environment. CONCLUSIONS: Parents may provide more reliable data regarding the incidence and risk factors for falls in the ambulatory environment than AERS, and it is possible to predict the probability of a fall given information from the parents. PRACTICE IMPLICATIONS: Knowing who is at risk for falls creates opportunities for organizations to modify clinic procedures, train staff, and create physical environments that promote increased patient safety.

Call to Action: Addressing Pediatric Fall Safety in Ambulatory Environments.

BACKGROUND: Pediatric falls in the ambulatory environment are a patient safety concern. Historically, fall safety efforts have focused on inpatient settings and are not transferrable to ambulatory environments. Minimal research and absence of ambulatory-specific guidelines from regulatory and global benchmarking bodies contribute to the void of knowledge. Consequently, there has been minimal progress in developing fall reduction strategies for the ambulatory environment. PURPOSE: To review research evidence and findings from environmental assessments that included interprofessional stakeholder feedback to make recommendations for improving fall safety in the pediatric ambulatory environment. METHODS: Implementation science was employed in two large pediatric quaternary hospitals to identify existing gaps and provided the foundation for translation of findings in the development of fall safety practice recommendations in the ambulatory environment. RESULTS: Recommendations from the findings included identified barriers and tangible interventions within three broad categories: equipment and furniture, environment, and people. Purposeful inclusion of all areas in the ambulatory environment, integration of high reliability concepts, and partnering with parents were identified as pertinent factors associated with these recommendations. CONCLUSION: This call to action recognizes the importance of utilizing an evidence-based approach for improvement and provides a framework for conducting an environmental assessment, which is an essential starting point to improve fall safety in the pediatric ambulatory environment. Guidance and support from research, regulatory and collaborative bodies, and healthcare organizations remains a critical need in improving fall safety.

Interrater Reliability of the Braden and Braden Q by Skin Champion Nurses.

The interrater reliability of the Braden Q skin risk assessment scale has never been reported. The purpose of the study was to assess the interrater reliability among pediatric Skin Champion (SC) nurses with the use of the Braden and Braden Q scales. The pilot study included 16 paired SC nurses. Each pair of nurses attempted to assess 8 patients using the Braden and Braden Q scales. However, patient care requirements at the time of the study assessments limited the number slightly. The actual number of assessments with the Braden scale was n = 52 and the Braden Q was n = 63. The Intra-class Correlation Coefficient (ICC) for the Braden scale was 0.894, 95% confidence interval (CI) (0.823, 0.938), which is excellent agreement. The ICC for the Braden Q was 0.726, 95% CI (0.585, 0.824), which is fair to good agreement. Among the six subcategories on the Braden scale, mobility and activity had higher agreement scores among the SC nurses. Among the seven subcategories on the Braden Q scale, mobility and sensory perception had higher agreement scores. Nutrition and friction/shear subcategories on both scales had the lowest agreement scores. Subcategories with the lowest agreement usually have the greatest measurement error. Possible sources of error include unclear definitions of scoring criteria, different clinical data pulled from different locations in the chart. Error can be reduced by clarifying the subcategory definitions and standardizing the data used for the assessment and the location of each data point in the EMR. A high interrater agreement is the goal because it provides confidence that the scale is used reliably to identify high risk patients who require additional care to prevent harmful events.

Bedside Usability Surveys: Adding Authentic User Detail to the Assessment.

Errors in healthcare are a leading cause of death in the United States. Equipment usability and user interfaces remain an area not fully elucidated. Infusion pumps play a vital role in care delivery, often essential for critical therapies. While pump function is comparatively simple, their programming, configuration, and form provide opportunity for error. Our purpose was to assess qualities nurses identified as important to pump operation by electronic survey. A self-developed usability survey was distributed to a random sample of 500 nurses, stratified by unit type and employed at the large academic quaternary care hospital. The overall response rate was 48% (n = 240). Descriptive and inferential statistics describe the responses and represent more than 5500 weekly infusions. Nurses described confident use of the system with some differences by unit type. Ninety percent of respondents indicated they have omitted use of the dose error reduction system, which should raise safety concerns. Users reported issues with the user interface and error prevention systems. Qualitative items elicited suggestions for improving aspects of the pump. Employing a usability survey in a clinical area proved to be a simple, inexpensive way to gather more information on the use and potential improvements of infusion pumps.

The great American cookie experiment: engaging staff nurses in research.

PURPOSE: The purpose of this study was to engage staff nurses in research in an informative and fun way by determining nurses' preference for sugar-free chocolate chip cookies versus regular chocolate chip cookies. DESIGN AND METHODS: A descriptive, crossover, double-blinded study was performed using a convenience sample of 300 staff nurses. RESULTS: Nurses preferred the texture, flavor, and overall preference of the regular chocolate chip cookie as compared with the sugar-free chocolate chip cookie (p<0.001). IMPLICATIONS: The Great American Cookie Experiment remains a creative teaching strategy to enhance knowledge and engage nurses in the research process.

Oral probiotic administration attenuates postexercise inflammation in horses.

Probiotics are commonly incorporated into equine diets to impart health and performance benefits; however, peer-reviewed evidence supporting their efficacy in horses is limited. Interestingly, bacteria from the Bacillus genus are gaining interest for their unique ability to impact metabolic, immune, and inflammatory pathways. The objective of this trial was to evaluate a selection of Bacilli for their role in altering the inflammatory response in horses to exercise. Eighteen horses were utilized in a randomized cross-over trial. Horses were randomly assigned to one of 6 starting treatments including a negative and positive control, and groups that received one of 4 probiotics (Bacillus coagulans GBI-30, 6086, Bacillus subtilis-1, Bacillus subtilis-2, or Bacillus amyloliquefaciens) top dressed to their daily ration at a rate of 8 billion CFU/d mixed into dried whey powder. All horses received a similar base diet of grass hay offered at 2.0% of bodyweight daily along with 4.54 kg of a commercially available textured horse feed. Each 3-wk phase of the trial consisted of a 2-wk dietary acclimation followed by a 1-wk exercise challenge and sample collection. Between phases, horses were offered only their base diet. On the day of exercise, horses were offered their 0700 ration and then subjected to a 2-h standardized exercise test. Blood samples were obtained prior to starting exercise and then again at 0, 2, 4, 6, 8, 24, 48, and 72-h postexercise. Horses in the positive control group were administered 0.23 mg/kg BW flunixin meglumine immediately following the 0-h sampling. Samples were analyzed for serum amyloid A (SAA), interleukin-6 (IL-6), and prostaglandin E2 (PGE2) concentrations. Data were evaluated via ANOVA using the MIXED procedure in SAS 9.4. Exercise-induced inflammation as evidenced by SAA, IL-6, and PGE2 increases postexercise. Horses consuming B. coagulans GBI-30, 6086 had reduced production of SAA, IL-6, and PGE2 compared to all other probiotic-fed groups and the negative control (P < 0.001). The positive control successfully ameliorated the postexercise inflammatory response. These data highlight the potential for B. coagulans GBI-30, 6086 to be incorporated into equine rations as a method to support optimal response to exercise or other inflammation-inducing challenges. Additional research is ongoing to elucidate the methodology by which these results occur.

A framework to foster accessibility in post-pandemic virtual higher education.

The SARS-CoV-2 Coronavirus pandemic (COVID-19) forced educational institutions to move their programmes to the virtual world. Several tech-based solutions -including virtual training and tutoring, discussion forums, access to content and information, collaborative platforms, and Open Educational Resources (OER)- were implemented to address this shift and continue to be used in the post-pandemic era due to the advantages they offer, especially for hybrid and blended learning. However, the implementation of these tech-based solutions also revealed several accessibility issues that need to be addressed to fully leverage the technological benefits. This study aims to provide a framework to facilitate the adoption of good practices related to technological accessibility in virtual Higher Education. The implementation of the framework is divided into four basic actions, each of which should be tailored to the constraints and needs for improving accessibility in Higher Education Institutions (HEIs). The framework's instantiation in four HEIs serves as a proof-of-concept in real-world scenarios. The preliminary results suggest that the proposal is promising, as it was adaptable to the specific needs of each HEI fostering accessibility and inclusion through technological alternatives that align with their organisational structures and current levels of attention to accessibility.

The Texas Children's Hospital Pediatric Advanced Warning Score as a predictor of clinical deterioration in hospitalized infants and children: a modification of the PEWS tool.

UNLABELLED: The purpose of this study was to examine the psychometric properties of the Texas Children's Hospital Pediatric Advanced Warning Score (PAWS) instrument as an indicator of clinical deterioration in infants and children. DESIGN AND METHODS: A retrospective chart review of 150 infants and children was performed. RESULTS: The overall Cronbach's alpha score was 0.75. The estimate of interrater reliability was 0.740. IMPLICATIONS: The Texas Children's Hospital Pediatric Advanced Warning Score instrument was found to be reliable and valid.

Communication and patient safety in simulation for mental health nursing education.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) found that 65% of medical sentinel events or medical errors are associated with communication breakdowns. In addition to the JCAHO, The Institute of Medicine, in their Core Competencies for health care professional education, recommend improvement in professional communication, collaboration, and a patient-centered approach to provide safety. Consistency of opportunities for students to practice their communication and collaboration skills is limited based on the variety of clinical experiences that are available. Simulation would provide consistency in students' experiences. Students can practice giving a structured report, providing and receiving peer feedback, and obtaining patient feedback in a safe setting through a simulation experience. A structured hand-off shift report using a technique such as SBAR communication has been found to improve patient safety in health care environments. This paper examines the implementation of a simulation experience for students taking a Mental Health course in a Bachelor of Science in Nursing (BSN) Program to support their practice of patient and professional communication, as well as, collaboration skills with a patient-centered approach using a standardized patient simulation.

How nurse preceptors provide help to new nurses influences perceived relationship quality.

BACKGROUND: In many hospitals, newly-hired registered nurses (RNs) enter into preceptorships, where they are paired with more experienced nurse preceptors who are responsible for ensuring effective transition to practice. Although high-quality relationships between preceptors and newly-hired nurses facilitate nurses' learning and integration into their medical institutions, preceptors have little guidance for what tactics develop such relationships. OBJECTIVES: To investigate whether the type of help provided by preceptors (i.e., autonomous or dependent help) influences preceptees' evaluations of relationship quality and psychological safety with their preceptor. Furthermore, we investigate the role of instrumental support and emotional support as explanatory mechanisms. DESIGN/SETTINGS/PARTICIPANTS/METHODS: Convenience sampling was used to collect data via a cross-sectional survey of 217 in-patient RNs hired between June 2016 and May 2018 to a magnet hospital within the Southwestern United States. Recently hired nurses evaluated their preceptor's help-giving tendencies, and reported on their perceived support, relationship quality and feelings of psychological safety with their preceptor. RESULTS: Dependent help was positively related to instrumental support. Conversely, autonomous help was positively related to both relationship quality and psychological safety, and these relationships were partially mediated by perceived instrumental support and emotional support. CONCLUSION: Findings illustrate the multiple benefits of autonomous help for encouraging high-quality relationships between preceptors and preceptees. This study identifies autonomous help-giving as a useful tactic for nurse preceptors (or other organizational insiders, such as mentors or supervisors) to establish high-quality relationships with recently hired nurses.

Multi-context genetic modeling of transcriptional regulation resolves novel disease loci.

A majority of the variants identified in genome-wide association studies fall in non-coding regions of the genome, indicating their mechanism of impact is mediated via gene expression. Leveraging this hypothesis, transcriptome-wide association studies (TWAS) have assisted in both the interpretation and discovery of additional genes associated with complex traits. However, existing methods for conducting TWAS do not take full advantage of the intra-individual correlation inherently present in multi-context expression studies and do not properly adjust for multiple testing across contexts. We introduce CONTENT-a computationally efficient method with proper cross-context false discovery correction that leverages correlation structure across contexts to improve power and generate context-specific and context-shared components of expression. We apply CONTENT to bulk multi-tissue and single-cell RNA-seq data sets and show that CONTENT leads to a 42% (bulk) and 110% (single cell) increase in the number of genetically predicted genes relative to previous approaches. We find the context-specific component of expression comprises 30% of heritability in tissue-level bulk data and 75% in single-cell data, consistent with cell-type heterogeneity in bulk tissue. In the context of TWAS, CONTENT increases the number of locus-phenotype associations discovered by over 51% relative to previous methods across 22 complex traits.

Revisioning aging: Indigenous, crip and queer renderings.

In this article, we re-vision Anishinaabe, crip and queer futures of aging against and beyond dominant successful aging narratives by drawing on our archive of digital/multimedia videos (short documentaries) produced in conjunction with older/e/Elder persons and the Re•Vision: Centre for Art and Social Justice. These documentaries are directed and come from the lives of those older and e/Elder persons whose aging embodiments intra-sect with their Indigenous, disabled and queer selves. Disrupting hegemonic successful aging narratives, and specifically heteronormative and ableist trajectories of aging, these alternative renderings of aging futures offer rich, affective relationalities and cyclical timescapes of older experience that draw on the past even as they reach into divergent futurities. Anishinaabe, crip and queer aging emerge. While we discern resonances in relationalities and temporalities among and between the Anishinaabe and non-Indigenous stories, we also identify significant differences across accounts, indicating that they cannot be collapsed together. Instead, we argue for holding different life-ways and futures alongside one another, following the 1613 Two Row Wampum Treaty between the Dutch and the Haudenosaunee, in which each party promised to respect the other's ways, and committed to non-interference, as well as to the development and maintenance of relationship.

Metabolomic Profiles in Starved Light Breed Horses during the Refeeding Process.

The large population of emaciated horses continues to be an issue troubling the equine industry. However, little is known regarding the collection of equine metabolites (metabolome) during a malnourished state and the changes that occur throughout nutritional rehabilitation. In this study, ten emaciated horses underwent a refeeding process, during which blood samples were collected for a blood chemistry panel and metabolomics analysis via ultrahigh performance liquid chromatography-high resolution mass spectrometry (UHPLC-HRMS). Significant differences among blood chemistry analytes and metabolite abundance during the critical care period (CCP; Days 1-10 of rehabilitation) and the recovery period (RP; the remainder of the rehabilitation process) were observed. Potentially toxic compounds, analytes related to liver, kidney, and muscle function, as well as energy-related metabolites were altered during the refeeding process. The combination of blood chemistry and metabolomics analyses on starved equine during rehabilitation provide vital biological insight and evidence that the refeeding process has a significant impact on the equine metabolome.

Compliance with a law to reduce alcoholic beverage sales and service in Zacatecas, Mexico.

BACKGROUND: Research on the effects of restricting bar opening hours and alcohol sales in middle-income countries is very limited. We assessed compliance with and possible effects of a law enacted in Zacatecas, Mexico on December 30, 2017 and implemented in 2018 and 2019 that established a 2 AM bar closing time and 10 PM cut-off for alcohol sales by off-premises stores. METHODS: Monthly observations of bars and off-premises stores and alcohol mystery shopping visits from 2018 to early 2020 were conducted to assess compliance with the law. Breath tests were conducted in 2018 and 2019 with samples of pedestrians in the nighttime entertainment districts of Zacatecas and a comparison city (Aguascalientes). Surveys of bar owners/managers and staff, emergency medical personnel (EMP), and police officers were conducted in Zacatecas in 2018 and 2019 to assess awareness and support of the law and possible effects of the law on alcohol-related problems such as violence and injuries. RESULTS: Monthly observations indicated that a substantial percentage of bars and off-premises package stores did not comply with the law. Pedestrian breath tests in 2018 and 2019 indicated significant reductions in blood alcohol concentration and heavy drinking among pedestrians in Zacatecas from 11 PM to 2 AM compared to Aguascalientes, but not after 2 AM. Surveys of bar owners/managers indicated that most were aware and supportive of the law. EMP surveys indicated reductions in incidents of physical fighting and drunk or injured customers during the annual September fair in Zacatecas. CONCLUSIONS: This study suggests that restricting bar opening hours and alcohol sales may not result in full compliance by bars and off-premises stores, but may help to reduce excessive alcohol use and related harms in a middle-income country. A more rigorous evaluation with pre-intervention data is needed, however, to fully address this latter question.

The Effect of a Seaweed-Derived Calcium Supplement on Gastric Juice pH in the Horse.

Low gastric pH for extended periods of time can increase the risk of gastric ulceration in horses. Therefore, nutritional interventions that buffer stomach acid may be helpful to decrease ulcer risk. The objective of this trial was to evaluate whether the incorporation of calcified Lithothamnion corallioides and Phymatolithon calcareum (Calmin; Celtic Sea Minerals, Cork, Ireland) into an equine ration would buffer equine gastric juice. Nine mature, Thoroughbred-cross horses, including 6 geldings and 3 mares (524 ± 49 kg) were housed in stalls and fed 2 kg/day of a texturized concentrate (Purina Omolene 100) and 1.5% BW grass hay/day. On testing days 0, 7, and 14, the horses received one of three pelleted dietary treatments (CON, MIN1 ×, MIN2 ×) in a randomized, crossover design. CON contained no added Calmin, MIN1 × provided Calmin at a 1 × concentration, and MIN2 × provided a 2 × dose. All horses underwent gastroscopy (Karl Storz, El Segundo, CA) prior to feeding the treatments, and at 2 and 4 hours postfeeding. Gastric juice was aspirated and pH measured using a benchtop pH meter (ThermoOrion pH Meter Model 410A). Overall, there was a significant time effect (P < .0001) with an increase in gastric juice pH from time 0 (2.31 ± 0.58) to 2 hours (5.52 ± 0.48) and 4 hours (3.59 ± 0.48). Gastric juice pH at 2 hours was higher (P = .0122) in MIN1 × (5.92 ± 0.58) and MIN2 × (5.92 ± 0.57) than CON (5.08 ± 0.58). These results demonstrate that adding Calmin to a meal increases buffering capacity at 2 hours postfeeding.

Plasma Hepatocyte Growth Factor for Diagnosis and Prognosis in Light Chain and Transthyretin Cardiac Amyloidosis.

BACKGROUND: Delays in diagnosis of cardiac amyloidosis are common, usually resulting from nonspecific findings on clinical examination and testing. A discriminatory plasma biomarker could result in earlier diagnosis and improve prognosis assessment. OBJECTIVES: To determine the diagnostic and prognostic utility of hepatocyte growth factor (HGF) in light chain and transthyretin cardiac amyloidosis. METHODS: 188 patients with cardiac amyloidosis, amyloidosis without cardiac involvement, or symptomatic heart failure with left ventricular hypertrophy (LVH) or reduced ejection fraction (HFrEF) were enrolled prospectively. Serum biomarkers were measured at study enrollment, and all patients with amyloidosis were followed for all-cause mortality, cardiac transplant, or left ventricular assist device implant. Multinomial logistic regression and Kaplan-Meier survival estimates tested the association of biomarker levels with cardiac amyloidosis and clinical outcomes, respectively. Harrell's C-statistic and the likelihood ratio test compared the prognostic accuracy of plasma biomarkers. RESULTS: HGF was significantly higher in patients with cardiac amyloidosis (p<0.001). An HGF level of 205 pg/mL discriminated cardiac amyloidosis from LVH and HFrEF with 86% sensitivity, 84% specificity, and an area under the curve of 0.88 (95% CI 0.83-0.94). In patients with amyloidosis, elevated HGF levels were associated with worse event-free survival over a median follow-up period of 2.6 years (p<0.001) with incremental prognostic accuracy over NT-proBNP and troponin-T (p<0.001). CONCLUSIONS: HGF discriminates light chain and transthyretin cardiac amyloidosis from patients with symptomatic HF with LVH or HFrEF, and is associated with worse cardiac outcomes. Confirmation of these findings in a larger, multi-center study enrolling confirmed and suspected cases of cardiac amyloidosis is underway.

Design and outcome measures for the AB InBev Global Smart Drinking Goals evaluation.

We describe the rationale for and design of an independent evaluation of the Global Smart Drinking Goals (GSDG) program. The primary purpose of this program, supported by the AB InBev Foundation, is to reduce harms associated with alcohol use by 10%. Our evaluation focuses on the effects of prevention strategies sponsored by the Foundation that are being implemented in six city pilots located in as many countries. These strategies are designed to reduce heavy episodic drinking, underage drinking, drink driving, and alcohol-related violence. Each city pilot has been matched with a comparison city in which the GSDG program will not be implemented. In this quasi-experimental community trial, we will assess each city pilot's progress toward reaching its harm reduction goals, relative to its comparison city, by means of annual adult and youth surveys. We will then supplement these analyses with the use of pertinent local archival data, where available. We discuss several challenges related to this evaluation and its quasi-experimental design. These include operating in a fluid and unpredictable environment in regard to the implementation, adaptation, and (on occasion) abandonment of the prevention strategies selected by each city pilot. We also discuss issues concerning our decision to accept funding from the alcohol industry and the measures we have taken to ensure the independence of our evaluation.

On-the-job and off-the-job embeddedness differentially influence relationships between informal job search and turnover.

Whereas informal job search (i.e., using personal contacts for job search) is positively associated with the receipt of job offers, research has yet to consider the extent to which informal job search translates into current employees' turnover decisions or to investigate factors that may restrain (or facilitate) the translation of informal job search into turnover decisions. In this study, we propose that on-the-job and off-the-job embeddedness play distinct roles in strengthening or weakening the positive relationship between informal job search and turnover intentions and behavior. We assert that on-the-job embeddedness reduces the likelihood that informal job search translates into turnover decisions, whereas off-the-job embeddedness strengthens the positive association between informal job search and turnover decisions. We tested these hypotheses across two samples of employed nurses. Although results were mixed, we found evidence that on-the-job embeddedness dampened the positive relationships of informal job search with turnover intentions and behaviors, whereas off-the-job embeddedness facilitated the positive relationships between informal job search and turnover decisions. Taken together, findings suggest that on-the-job and off-the-job embeddedness influence informal job search processes differently. We discuss the implications of these findings for how organizations manage employees' informal job search activities as well as how researchers approach the study of job embeddedness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Cost and Quality Analysis of Utilizing a Rectal Catheter for Medication Administration in End-of-Life Symptom Management.

Technology that can improve the ability to provide quick symptom control while decreasing the cost and burden of care could help hospice agencies deal with current hospice industry challenges. This paper describes how the use of a new rectal medication delivery technology at a large hospice in western New York has improved patient care and nursing efficiency while at the same time decreasing the cost of care.