Evidenced-Based Strategies to Increase Cervical Cancer Screening Rates

Purpose/Background Cervical cancer is the fourth leading cause of cancer affecting women worldwide (Staley et al., 2021). With cervical cancer being a preventable disease, an effective method of reducing healthcare costs and mortality is primary prevention, such as screenings. Financial burdens and barriers to accessing medical care may result due to the lack of proper cervical cancer screenings. Detecting cervical cancer includes screening women 21 to 65 years old with a Papanicolaou (PAP) test every three years. Women aged 30 to 65 years old can extend the screening of cervical cancer by having a Human Papillomavirus (HPV) test along with a PAP test conducted every five years, according to the United States Preventative Service Task Force (USPSTF) (National Cancer Institute, 2022). The cessation of cervical cancer screening can occur for women aged 65 years or older who have had three sequential negative PAP tests or two sequential negative HPV results within ten years (U.S Preventive Services Task Force [USPSTF], 2008). Patient education emphasizing the benefits of cervical cancer screenings has been shown to improve compliance with screening recommendations. Methods A retrospective chart review at a metropolitan underserved primary clinic in the Midsouth was conducted consisting of 29 charts from women ages 18 and above with visit dates between January 1, 2023 and August 31, 2023. Descriptive statistics were generated and analyzed of the women’s age, race, visit date, insurance type, and their presence of an up-to-date pap smear per USPSTF guidelines. Results Between January 4, 2023 and August 15, 2023, 29 women (N=29) met eligibility criteria. Women’s ages ranged from 24 to 66 (M=46.97, SD 10.39). Findings indicate that 16 women (55.2%) had up-to-date PAP smear testing per USPSTF guidelines. Women who received up-to-date PAP smear testing had a mean age of 45.1 compared to the mean age of 49.3 in women without up-to-date screening. Implications for Nursing Practice The results of this retrospective chart review provide valuable insight into how many women prioritize having an up-to-date PAP smear in a primary care clinic. While the data indicates that 55.2% of women had up-to-date PAP smear testing, the mean age of women without up-to-date screening was only 4 years older (49.3) than the mean age of those who did have up-to-date PAP smear testing (45.1). At the same time, only slightly more than half of women had up-to-date PAP smear testing, leaving a significant portion of women still requiring valuable education. While further study is required to better understand the prevalence of cervical cancer screening, it is evident that further education on proper cervical cancer screening is recommended

Referral to In-Person Smoking Cessation Counseling as a Smoking Cessation Aid

Referral to In-Person Smoking Cessation Counseling as a Smoking Cessation Aid Purpose/Background Smoking increases an individual’s risk of acute and chronic disease morbidity and mortality, as well as creating a financial burden for the individual and healthcare system. In the United States, tobacco smoking is the leading cause of preventable death. There are an estimated 5 million tobacco-related deaths each year due to tobacco smoking. Additional healthcare costs are also seen due to the need for increased treatments, medical supplies, and staffing. Previous research for smoking cessation resources has primarily focused on traditional primary care offices. Research shows that in-person counseling may be used as a behavioral modification tool to increase smoking cessation rates. Individual counseling alone was seen to be effective and increase the likelihood of cessation compared to less intense treatment. The purpose of this quality improvement project is to assess the number of patients who are current tobacco smokers and were referred to in-person smoking cessation counseling. Methods Electronic medical records (EMR) from a metropolitan underserved primary care clinic in Memphis, TN were queried for patient-reported smoking and tobacco use from January 1, 2023-June 30, 2023. Fifty EMRs were identified and reviewed for the number of patients referred to an in-person smoking cessation counseling program. For the study population, patients were randomly selected and had to be 18 years or older. Included were adult patients ages 30-78 with a diagnosis of tobacco/ smoking use documented in the EMR. Of the individuals referred, groups were divided by gender and by those who attended in-person counseling and those who did not. Results Of the 50 identified patients, 29 (58%) were referred to an in-person smoking cessation counseling program. Patients referred were predominantly female (72.4%) with a mean age of 52.8 [range 30-78] years. Among those referred, 55.2% attended the counseling program. Implications for Nursing Practice In-person smoking cessation counseling is an effective aid for smoking cessation, with more than half of those referred attending the program. Females are more likely to be referred to smoking cessation counseling and attend. Implementing referrals to smoking cessation counseling may be an effective smoking cessation intervention, specifically for females. More research is needed regarding patient follow-up and long-term smoking cessation, as this study did not include these measures. This study is feasible and may be replicated in practice. In-person counseling is another method that may be used to aid in smoking cessation. Future research should include identification of patient demographics, like smoking history, socioeconomic status, current comorbidities, and previous attempts at smoking cessation

Examining the Shared Decision-Making Preferences of Adult Black Men with Hypertension in the U.S. Mid-South Region: A Mixed Methods Approach

Purpose. This study aimed to explore what factors are related to Black men’s shared decision-making (SDM) preferences for selecting hypertension (HTN) treatment and management options with a healthcare clinician. Methods. Researchers employed an exploratory sequential mixed methods design to explore factors influencing Black adult men\u27s preferences for involvement in SDM regarding HTN treatment. Qualitative interviews with N=16 Black men identified factors related to SDM involvement, while a quantitative phase with N=105 Black men examined factors that could predict the level of involvement in SDM for HTN treatment. Results. Trust and having a female clinician were a significant independent predictor of decision-making involvement among men in this study (b = 9.09; t(102) = 3.07; p = .003). Engaging in the SDM process with a female clinician increased the desired level of decision-making involvement for HTN treatment and management. Conclusion. Findings from this study suggest that clinician gender is a key factor that influences SDM involvement preferences. Future research should focus on targeted questions to delve deeper into the specific aspects of SDM in gender-discordant patient-clinician relationships

Identifying Contributors to Acute Stroke Transfer Delays from Lower to Higher Level Stroke Centers

The intricate process of efficiently transferring patients within the healthcare setting has proven to be complex however, it is a critical component to ensure timely access to essential medical interventions. Navigating these complexities presents a multifaceted challenge that is not fully understood. For patients suffering a stroke, these transfer delays may render them ineligible for treatment and left with disabling disability. This collective work aims to identify contributors to delays in transfer from lower to higher levels of care in the acute stroke populations. Three papers emerged from this thesis. First, a narrative review of the literature published between January 1996 to April 2020 found that several factors are associated with improved stroke outcomes. The availability of resources such as vascular neurologists or dedicated stroke units, training ambulance personnel in the early identification of stroke symptoms and stroke management, and focusing on internal performance efficiencies in the emergency department to administer clot busing medication for the treatment of ischemic stroke have all improved outcomes. However significant gaps in knowledge of what contributes to delays exist with no objective data available on stroke transfer delays in the published literature. Summation from the narrative review was used to develop a qualitative study. Web-based interviews with stroke coordinators at primary stroke centers were conducted where they discussed their lived experience in transferring patients from a primary stroke center to a higher level of care. The results were published in Stroke: Vascular and Interventional Neurology journal in March of 2023. Comprising the narrative review of the known causes of transfer delays and gaps in knowledge and the collective insight of stroke coordinators at primary stroke centers across the United States, a data collection instrument was designed and tested at primary stroke centers on patients that required transfer to a higher level of care. The instrument was divided into two main sections. The first section consisted of time process indicators that included information pertinent to activities associated with patient presentation, evaluation, and diagnostic work-up in the emergency department until departure to the higher level of care hospital. The second section consisted of 24-Likert scale questions designed to understand the transferring team’s perception of the quality and timeliness of the entire transfer process. The data collection instrument allowed us to examine the contributors to door-in, door-out (DIDO) times at a granular level. The median DIDO time for the overall sample was 130 minutes which exceeds the recommended DIDO time of less than 120 minutes. The greatest single contributor to DIDO time was from transport request to actual transport departure times which alone was responsible for 38% or 49.5 minutes of the total DIDO time. Collectively, these papers have broadened knowledge of why transfer delays exist when moving acute stroke patients from lower to higher level of hospital services. Continued work to further identify contributors to transfer delays within each category is warranted, along with development of interventions to improve efficiency across the entire system of care. In conclusion, delays in transfer continue to be one of the leading causes for stroke treatment ineligibility due to worsening irreversible brain damage. Improving stroke systems of care will improve treatment eligibility, reduce stroke related disability and death, and reduce the financial burden of post-stroke care

The Impact of Social Determinants of Health on Adherence to Urinary Tract Infection Treatment: A Scoping Review

Purpose/Background Urinary tract infections (UTIs) are a common diagnosis among children. Patients must fully comply with treatment regimens to reduce the risk of recurring UTIs and prevent long-term complications. This scoping review aims to evaluate the literature and examine the association between screening for social determinants of health (SDH) and adherence to UTI treatment. Methods A thorough literature search via PubMed, Cochrane Library, Elsevier Clinical Key, CINAHL, and JAMA was conducted with the following keywords: Pediatric UTI, Adherence to Treatment Plans, Social Determinants of Health, Social Needs Screening, and others. Ten articles were appraised for their evidence and quality. The articles focus on the diagnosis of a UTI in the pediatric population, social needs screening, SDH, and treatment compliance. A synthesis of results table was composed to examine SDH and evaluate the association between social needs screening and improved outcomes. Results The literature review indicates a correlation between unmet social needs and patient outcomes. UTIs can affect patients and their families, and in-person interventions can improve compliance and health outcomes. Two studies reported improved health outcomes following social needs screening and allocation of resources. Two studies highlight the importance of the medical home and provider\u27s role in assisting with social needs. Implications for Practice The results of this scoping review highlight the need for social needs screening and provide insight into the effects that unmet social needs can have on treatment compliance. Providers can strive to improve patient outcomes by screening for social needs and allocating resources. This review highlights the need for further research into implementing social needs screening in clinical practice to reduce UTIs and improve compliance in the pediatric population

Nursing Without Boundaries: Creating the Opportunity for Wellbecoming through Dialogue Guided by Health as Expanding Consciousness

The inaugural Dr. Margaret A. Newman Distinguished Visiting Professorship lecture on Aug. 6, 2024, drew 228 nurses and nursing students to the FedEx Event Center to hear about the impact of nursing theory on nursing practice. Associate Professor Jane Flanagan, PhD, RN, AHN-BC, ANP-BC, FAAN, was the keynote speaker. Dr. Flanagan is a department chair at the Connell School of Nursing at Boston College and editor of the International Journal of Nursing Knowledge

Comparing the Effects of the Induction of Anesthesia with Etomidate to the Induction of Anesthesia with Midazolam on the Incidence of In-Hospital Mortality: A Scoping Review

Purpose/Background The induction of anesthesia using hypnotic sedatives, such as etomidate and midazolam, is common practice. Etomidate and midazolam are commonly employed in the induction of anesthesia in the septic patient population, each with its unique advantages and drawbacks. This scoping review aims to synthesize evidence on the effects of anesthetic induction with etomidate versus midazolam in adult septic patients, focusing on the incidence of mortality and associated adverse effects during hospitalization. The purpose is to establish a standard of care for anesthetic induction in this population. Methods A literature review was conducted from September 2022 to March 2023 utilizing CINAHL Complete, SCOPUS, Access Medicine, Cochrane Library, and PubMed databases. Over 100 articles were found utilizing our keywords, which included induction agent, etomidate, midazolam, critical illness, sepsis, septic shock, severe sepsis, mortality, and hospital length of stay. Of these, 25 articles met the author’s inclusion criteria and underwent Rapid Critical Appraisal (RCA) to assess the quality and validity of the studies. This appraisal yielded ten articles that were further synthesized and classified by their level of evidence table. Results Ten studies were examined to assess the effects of etomidate and midazolam on septic patients. The results showed that when etomidate is used to induce anesthesia in septic patients, it can lead to increased in-hospital mortality rates and longer ICU and hospital lengths of stay. Additionally, six studies found that etomidate can cause adrenal gland suppression. On the other hand, midazolam was associated with lower mortality rates when used to induce anesthesia in septic patients. However, there is insufficient data concerning its ability to produce profound anesthesia in septic patients without causing undesirable hemodynamic changes. Based on the available data, midazolam is considered to be the safer option for inducing anesthesia in septic patients. Implications for Nursing Practice The results of the scoping review support that etomidate usage is linked to longer stays in the ICU and hospital and higher hospital-wide mortality compared to midazolam. These findings indicate that the use of midazolam to induce anesthesia in septic patients is preferred but not without risks to patients. Anesthesia personnel should be educated when utilizing midazolam, blood pressure should be monitored closely, and timely intervention should be conducted to prevent hemodynamic changes. The results of this scoping review highlight the need for a standard of care to be established on what medications to use during the induction of anesthesia in septic patients. Further research is needed to guide nurse anesthesia practice for improved septic patient outcomes

Police Versus Non-Police Response to 988 Crisis Calls

Purpose/Background The 988 Suicide & Crisis Lifeline is a mental health-specific emergency line that became nationally available in July of 2022. This resource allows callers in crisis to connect with trained mental health professionals. Despite the initiation of this new dispatching service, there is still a significant shortage of trained mental health professionals to respond to these calls when they require emergency intervention. The present scoping review aims to determine whether non-police crisis responses correlate to improved outcomes when compared to police response as evidenced by reduced inpatient admissions, reduced arrests, and decreased presence of intrusive traumatic symptoms following intervention. Methods CINAHL and PubMed were searched using the University of Tennessee Health Science Center (UTHSC) library from September 2022 until November 2023. These search terms yielded 377 articles. Of those articles, only 335 were published in English, 200 were published after 2013, 198 had full-text publications available, and 21 were either a review or systematic review rather than an article or abstract. The remaining 21 articles were assessed using a Rapid Critical Appraisal tool. Ten articles remained after critical appraisal; the results of these articles were charted within the scoping review. Results This scoping review compared police versus non-police response to crisis calls. The synthesized results were obtained by critically appraising ten articles. This scoping review indicates that non-police response may result in the following improved patient outcomes: a decrease in involuntary hospital admission, arrest, and violence between the crisis caller and police. However, the shortage of quality experimental evidence limits the power of this indication. Implications for Nursing Practice The results of this scoping review indicate that non-police response to 988 calls may result in better patient outcomes. Due to this topic\u27s recency, nurses should advocate for more quality research to provide patients with the best possible evidence-based crisis response

Procedural Oxygen Mask Use for Inpatient Bariatric Endoscopy: A Scoping Review

Purpose/Background Hypoxia is a severe adverse event that is often associated with sedated endoscopy procedures, and bariatric patients have a significantly higher risk for complications related to oxygenation during sedation due to pathophysiological changes to the respiratory system. This scoping review compares the rate of hypoxemic events with the use of a binasal cannula versus a procedural oxygen mask during inpatient endoscopic procedures in patients aged 19-64 with a BMI greater than 40. Methods The scoping review includes control trials with and without randomization, case-control/cohort studies, systematic reviews, and qualitative/descriptive studies. With limited research regarding the PICOT, extending the age of qualifying articles beyond the desired five years was necessary. This scoping review focuses on utilizing the POM mask to prevent hypoxia during upper endoscopies and some alternative approaches. Databases utilized for this review include EBSCO, CINAHL, Pubmed, and Medline. The literature search initially resulted in 10,525 articles, which then were narrowed down to 10 based on their pertinence to the PICOT question. Results Many outcomes were reported, the most commonly being hypoxemic events with a BMI \u3e30 without preoxygenation, hypoxemic events with a BMI \u3e30 with preoxygenation, hypoxia with a bi-nasal cannula, and procedural termination with preoxygenation. Data from randomized control trials and case-control studies showed a decrease in both hypoxemic events and early termination of the procedure with adequate preoxygenation. Four reports of decreased instances of hypoxemia were reported with the bi-nasal cannula; however, there were also four reports of increased instances, leaving mixed results. Implications for nursing practice A summary of the evidence supports using the procedural oxygen mask in the bariatric population undergoing endoscopy procedures. Current research indicates that the POM should be the new standard of care due to this population\u27s dramatic decrease in hypoxemic events. Anesthesia providers should stay updated on the standard of care and best practices related to bariatric endoscopies

Targeting Coenzyme A Biosynthesis for Antifungal Development.

An estimated 1.5 million people die each year from invasive fungal infections (IFIs) involving dissemination to the deeper organs via the bloodstream, with estimated healthcare costs of over $7 billion in the U.S. alone. Collectively, several Candida species account for more than 75% of disseminated fungal infections in the U.S., with attributable mortality rates ranging 35-75%. Unfortunately, the prospect of curing these infections is limited by the modest efficacy of the available antifungal drugs: the azoles, echinocandins, and amphotericin B. Approximately one-third of patients with disseminated Candida infections are non-responsive to treatment with the azoles, and favorable response rates are just 52-73% for the echinocandins and just 62% for amphotericin B. As such, there is an urgent need for development of new antifungal drugs with improved clinical efficacy. Coenzyme A (CoA) is a universal and essential cofactor for several key metabolic pathways including fatty acid oxidation and synthesis, the tricarboxylic acid cycle, and sterol biosynthesis. Nearly all organisms must synthesize their own CoA from pantothenic acid (vitamin B5-PA) through a five-step sequence of reactions requiring ATP and cysteine. Several bacterial species can take up exogenous PA through the PanF transporter, or produce it de novo from beta-alanine and pantoate, in a reaction catalyzed by pantothenate synthetase (PS). Similarly, the model yeast, Saccharomyces cerevisiae, can acquire exogenous PA through the pantothenate symporter (Fen2p) or synthesize it de novo using PS, encoded by the PAN6 gene. In contrast, mammalian cells lack the enzymes required for endogenous PA production, instead depending upon a sodium-driven multivitamin transporter to import from exogenous sources. Thus, this has raised interest in exploiting the fundamental difference in physiology to develop pathogen-selective antimicrobial agents targeting enzymes involved in PA production. Pantothenate kinase (PanK), encoded by the CAB1 gene in S. cerevisiae, catalyzes the first step in the conversion of PA to CoA. PanK has been confirmed to be essential for the viability of S. cerevisiae as well as several bacterial species. However, the CoA biosynthetic pathway is not well characterized in one of the most medically important human fungal pathogens, C. albicans. Therefore, we sought to investigate the importance of pantothenate uptake, synthesis, and conversion to CoA for C. albicans survival and virulence. A Candida albicans fen2∆/∆ mutant was viable in vitro and virulent in a mouse model of disseminated infection. In contrast, the growth of C. albicans strains with doxycycline repressible expression of PAN6 (PTETO-PAN6) or CAB1 (PTETO-CAB1), was arrested in the presence of doxycycline, even in medium supplemented with pantothenate. Furthermore, overexpression of C. albicans FEN2 was not sufficient to restore growth of PTETO-PAN6 even in the presence of PA. This suggests that C. albicans is unable to uptake sufficient exogenous PA to support growth. Moreover, neither strain was virulent in doxycycline treated mice. Collectively, these results establish that Cab1p and Pan6p are essential for C. albicans survival and virulence, and therefore, are valid targets for antifungal development. To facilitate the discovery of Pan6p or Cab1p inhibitors, we validated high-throughput compatible screening assays. Target-based whole-cell and biochemical screens identified small molecules that specifically target C. albicans Cab1p or Pan6p. This includes a compound that targets CaCab1p and has broad spectrum antifungal activity as well as in vivo efficacy. In addition, we solved the first eukaryotic pantothenate synthetase crystal structure, C. albicans PS, to support identification and optimization of compounds that specifically interact with the fungal protein in an effort to expand development of novel antifungal therapies with improved patient outcomes