Self-Similar Propagation and Amplification of Parabolic Pulses in Optical Fibers

Ultrashort pulse propagation in high gain optical fiber amplifiers with normal dispersion is studied by self-similarity analysis of the nonlinear Schrödinger equation with gain. An exact asymptotic solution is found, corresponding to a linearly chirped parabolic pulse which propagates self-similarly subject to simple scaling rules. The solution has been confirmed by numerical simulations and experiments studying propagation in a Yb-doped fiber amplifier. Additional experiments show that the pulses remain parabolic after propagation through standard single mode fiber with normal dispersion

Patient Compliance with Colorectal Cancer Screening: A Scoping Review

Purpose/Background Colorectal cancer (CRC) is a leading cause of cancer deaths for women and men. Routine screening based on current national guidelines can decrease morbidity and mortality. Unfortunately, patient compliance with CRC screening remains low. This scoping review will evaluate the literature and examine the association between colorectal cancer screening modality and patient compliance. Methods Individual searches within PubMed, EBSCO, and Medline were completed using MeSh with the following key words: colorectal cancer screening, patient compliance, stool-based screening, direct visualization, and others. A literature review was completed for 10 critically appraised articles published between 2010 and 2020. The association of the modality of CRC screening, patient compliance, and patient education was assessed and compared. A summary evaluation table was composed to determine the associations between CRC screening and patient compliance. Results The articles included consisted of four systematic reviews/meta-analysis, three randomized controlled trials, one controlled trial without randomization, and two cohort/case-control studies. Of the study sample (N=10), all but one demonstrated statistically significant findings concerning patient education, CRC screening, and compliance. Noninvasive stool-based studies have a higher patient compliance rate than direct visualization tests. Direct visualization tests offer same-session detection and biopsy with polyp removal leading to decreased mortality. Implications for Nursing Practice Results provided in this scoping review highlight the importance of colorectal cancer screening in decreasing mortality. Patient compliance can be improved with comprehensive education, discussing the risks and benefits of screenings, and evaluating individual health beliefs or fears. Patients still hesitant with direct visualization tests should begin with noninvasive studies. All positive screenings from stool-based screenings require follow-up with a colonoscopy

The Utilization of Depression Screening Tools in Patients with Diabetes Type 2

Purpose/Background Diabetes and depression are highly prevalent and concerning conditions impacting millions worldwide. Evidence-based guidelines recommend regular depression screening of individuals with type II diabetes (DM2) to appropriately diagnose and treat depression and proactively enhance clinical outcomes. The gold standard for determining depression in patients with chronic disease is the diagnostic clinical interview; however, many clinicians have turned to brief, self-reported screening tools such as the PHQ-2 and the PHQ-9 whose use are recommended by evidence-based guidelines. This study aims to assess the utilization of the PHQ-2 and PHQ-9 versus no screening on DM2 patients in a primary care setting. Methods In this retrospective chart review, 29 charts of patients ages 18 and older diagnosed with DM2 were assessed to determine if a depression screening was completed. For subjects who met the study’s inclusion criteria, we obtained the sex, age, whether the patient was screened for depression at the office visit, and if they were screened, which depression screening tool was utilized. Results Between November 15, 2018, and November 8, 2021, 29 patients met the inclusion criteria for our retrospective chart review. In total, the patients were seen for a total of 102 visits, with 68% of patients screened for depression using either the PHQ-2 or the PHQ-9 screening tool. The average number of visits per patient was 3.5 visits. The average age of the patients was 52.8, with a median age of 51. Twenty-one of the subjects were female, while eight were male. Implications for Nursing Practice Based on the data collected, more research is needed to determine if the utilization of a screening tool such as the PHQ-2 and PHQ-9 would indeed be beneficial in treating depression in patients with chronic diseases such as diabetes. Confounding variables that hindered obtaining sufficient data include clinic participation in screening, readily available screening forms, and time constraints. Additionally, variables that could have resulted in a more robust study include a larger sample size, the collection of the patient’s ethnicity, hemoglobin A1c, PHQ-2, and PHQ-9 scores, and the initiation or referral for psychiatric treatment. Further areas of research are needed to determine the benefits of screening for depression in patients with chronic diseases such as diabetes

Medication-Assisted Therapy and First Episode Psychosis: Evaluating Treatment and Readmission Rates: A Scoping Review

Purpose/Background: There is limited research aimed at addressing the reoccurrence of admission rates for first-episode psychosis. Research shows that early interventions for first-episode psychosis lead to remissions and prevention of relapses. Research also estimates that approximately one-half of first-episode clients have a history of cannabis abuse or dependence and one-third have a current cannabis use disorder (Wisdom et al., 2011). This study looks to determine whether Medication-assisted therapy (MAT) impacts readmission rates for patients who have substance use disorder and first-episode psychosis within six months of discharge. Methods: A comprehensive literature search was conducted using several electronic databases, including PubMed, Cochrane Library, and CINAHL. The search was limited to articles published in English between 2011 and 2021 using The University of Tennessee Health Science Center (UTHSC) database. All articles utilized human subjects who met diagnostic criteria for psychosis and were able to consent to treatment. Key words included: medication-assisted therapy, first episode psychosis, psychosis, substance use disorders, and others. Eleven articles were initially found that met the criteria. After a rapid critical appraisal and in-depth discussion of the articles, the remaining nine were chosen for the final selection. Findings: The key areas assessed in the articles include various types of MAT, and substance use disorders including alcohol use, cannabis, and opiate use disorders. The results of the studies showed that the use of MAT in individuals with first-episode psychosis improved treatment outcomes and reduced readmission rates. Implications for Nursing Practice: The results of the scoping review suggest that MAT may be effective in reducing readmission rates and improving treatment outcomes for those with first-episode psychosis and comorbid substance use disorder. However, more research is needed to determine specific types of MAT, dosage, and duration of MAT in this specific patient population

Adverse Childhood Experiences and Urinary Incontinence in Elementary School Aged Children

Purpose/Background: Adverse Childhood Experiences (ACEs) have an impact on health throughout the lifespan (Filletti et al., 1999; Hughes et al., 2017). These experiences range from physical and mental abuse, substance abuse in the home, parental separation or loss, financial instability, acute illness or injury, witnessing violence in the home or community, and incarceration of family members (Hughes et al., 2017). Understanding and screening for ACEs in children with urinary incontinence can help practitioners identify psychological stress as a potentially modifiable risk factor. Methods: A 5-month chart review was performed identifying English speaking patients ages 6-11 years presenting to the outpatient urology office for an initial visit with a primary diagnosis of urinary incontinence. Charts were reviewed for documentation of individual or family risk factors for ACEs exposure, community risk factors for ACEs exposures, and records where no related documentation was included. Results: For the thirty-nine patients identified, no community risk factors were noted in the charts. Seventy-nine percent of patients had one or more individual or family risk factors documented. Implications for Nursing Practice This chart review indicates that a significant percentage of pediatric, school-aged patients presenting with urinary incontinence have exposure to ACEs. A formal assessment for ACEs at the time of initial presentation would be helpful to identify those at highest risk. References: Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med. 1998;14:245–258 Hughes, K., Bellis, M.A., Hardcastle, K.A., Sethi, D., Butchart, D., Mikton, C., Jones, L., Dunne, M.P. (2017) The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health, 2(8): e356–e366. Published online 2017 Jul 31.doi: 10.1016/S2468-2667(17)30118-4 Lai, H., Gardner, V., Vetter, J., & Andriole, G. L. (2015). Correlation between psychological stress levels and the severity of overactive bladder symptoms. BMC urology, 15, 14. doi:10.1186/s12894-015-0009-

Evaluating the efficacy of thoracoscopy and talc poudrage versus pleurodesis using talc slurry (TAPPS trial): protocol of an open-label randomised controlled trial

INTRODUCTION: The management of recurrent malignant pleural effusions (MPE) can be challenging. Various options are available, with the most efficacious and widely used being talc pleurodesis. Talc can either be applied via a chest drain in the form of slurry, or at medical thoracoscopy using poudrage. Current evidence regarding which method is most effective is conflicting and often methodologically flawed. The TAPPS trial is a suitably powered, multicentre, open-label, randomised controlled trial designed to compare the pleurodesis success rate of medical thoracoscopy and talc poudrage with chest drain insertion and talc slurry. METHODS AND ANALYSIS: 330 patients with a confirmed MPE requiring intervention will be recruited from UK hospitals. Patients will be randomised (1:1) to undergo either small bore (<14 Fr) Seldinger chest drain insertion followed by instillation of sterile talc (4 g), or to undergo medical thoracoscopy and simultaneous poudrage (4 g). The allocated procedure will be performed as an inpatient within 3 days of randomisation taking place. Following discharge, patients will be followed up at regular intervals for 6 months. The primary outcome measure is pleurodesis failure rates at 3 months. Pleurodesis failure is defined as the need for further pleural intervention for fluid management on the side of the trial intervention. ETHICS AND DISSEMINATION: The trial has received ethical approval from the National Research Ethics Service Committee North West-Preston (12/NW/0467). There is a trial steering committee which includes independent members and a patient and public representative. The trial results will be published in a peer-reviewed journal and presented at international conferences, as well as being disseminated via local and national charities and patient groups. All participants who wish to know the study results will also be contacted directly on their publication. TRIAL REGISTRATION NUMBER: ISRCTN47845793

The Effectiveness of Increasing Frequency of Central-Line Dressing Changes and Monitoring on CLABSI Rates: A Scoping Review

Abstract Purpose/Background Central lines provide many benefits to critically ill patients; however, there are additional risks with them, including central line-associated bloodstream infections (CLABSIs). CLABSIs place patients at increased risk for morbidity and mortality, longer length of stay, and higher medical costs. Studies evaluating various methods of reducing CLABSIs have been performed. This scoping review was completed to determine the effectiveness of frequent central-line dressing changes and increased monitoring on the incidence of central-line associated blood stream infections in adults with central-lines. Methods An extensive database search through the University of Tennessee Health Science Center (UTHSC) Online Library was performed between September of 2019 and November of 2022. EBSCO/CINAHL, PubMed, Cochrane, and Scopus databases were utilized, using key terms: monitoring, CLABSI, dressing changes, central line, infection, bundle care, and central venous catheter. Of the 2,341 articles resulted, 15 articles were chosen based on relevance, results, and quality of the articles. Tables were created to identify levels of evidence and evidence outcomes. Results Out of the fifteen articles selected, eight reported a decrease in CLABSI rates. Many facilities reduced their CLABSI rate while lowering frequency of CVC dressing changes. Increased CVC bundle compliance, CVC surveillance, improved documentation, and use of checklists contribute to these reduced rates, but confound the results. Implications for Nursing Practice The articles revealed that the utilization of CVC surveillance decreased CLABSI rates. It is unclear how the frequency of CVC dressing changes affects CLABSI rate. Most studies failed to mention dressing changes, and when mentioned, the frequency of dressing changes was reduced with continued reduction in CLABSI rate. Further studies isolating these variables is recommended

Hepatitis C Virus Screening Strategies to Improve Early Identification and Treatment: ​ A Scoping Review​

Purpose/Background Hepatitis C virus (HCV) is the most common bloodborne infection in the United States (Ludden et al., 2022). Sadly, over half of the individuals living with chronic HCV are unaware of their condition (Halket et al., 2022). Due to rising numbers, HCV screening guidelines have been updated to recommend that every adult be screened at least once (Patel et al, 2021). Despite these guidelines, screening rates remain low. This scoping review aims to examine current research on HCV screening and strategies to improve early diagnosis and treatment. Methods This review began with a literature search using CINAHL and PubMed and the key phrases hepatitis C, screening, birth cohort, CDC, electronic medical record (EMR), and lifestyle risk. Inclusion criteria were publication within the last five years, English language, and full-text availability. Seven of the 28 articles meeting this criteria were selected based on their applicability, high-quality, and rigor. Specific data points were abstracted from these articles and compiled in an Excel spreadsheet. Results Three studies that evaluated the effectiveness of universal screening versus risk and/or birth cohort screening found that universal screening resulted in higher screening rates. EMR interventions based on risk and/or birth cohort were evaluated in six of the studies, with all six reporting increased screening rates. Additionally, one study found that screening rates increased when EMR-based interventions were paired with provider education. Implications for Nursing Practice The results of this review suggest that application of universal screening and the incorporation of EMR-based interventions lead to an appreciable increase in HCV screening and diagnosis, but studies that implement these interventions based on universal screening guidelines are needed. Most importantly, this review revealed that healthcare providers and patients need education on current screening guidelines, testing, and treatment so HCV can be diagnosed and treated early

Teach-Back Method to Reduce CHF Readmissions: A Scoping Review

Purpose/Background The purpose of this scoping review is to evaluate the effectiveness of the teach-back method on education as it relates to congestive heart failure readmission rates. Congestive heart failure (CHF) is the most common cause of hospitalizations among those 65 years and older in the United States. CHF readmission rates in Tennessee are higher than the already elevated national average. The current literature suggests a need to reduce 30-day readmissions, improve patient outcomes, and enhance self-efficacy in patients with CHF. The research proposes a correlation between high readmission rates and poor knowledge retention of patients with CHF, but small sample sizes and poor follow-up have interfered with accurate results. We reviewed the existing research regarding the impact of teach-back education on readmission rates and associated outcomes in patients with CHF. Methods The articles included were written in the English language, issued in medical or nursing journals, published within the past decade, involved human participants, consisted of an adult patient population (classified as by age \u3e 18 years), encompassed a diagnosis of heart failure, used the teach-back method, and evaluated the outcome of 30-day readmissions. Articles included in this review are systematic reviews/meta-analyses, randomized control trials, case-control/cohort studies, and qualitative/descriptive studies. The databases were searched from October 2020 to October 2022: CINAHL, Cochrane, JAMA, Medline, and Ovid. Results Ten articles published between 2013 and 2022 evaluated the use of teach-back education for patients diagnosed with heart failure in the acute care setting. Teach-back reduced 30-day readmissions in 9/10 articles (unchanged in one), increased patient knowledge of heart failure among all the articles, improved self-management capability (9/10), and promoted treatment adherence (7/10; not examined in 2). Implications for Nursing Practice When educating patients with CHF, incorporating the teach-back method has proven to reduce 30-day hospital readmissions and improve patient outcomes

Direct Measurement of Perchlorate Exposure Biomarkers in a Highly Exposed Population: A Pilot Study

Exposure to perchlorate is ubiquitous in the United States and has been found to be widespread in food and drinking water. People living in the lower Colorado River region may have perchlorate exposure because of perchlorate in ground water and locally-grown produce. Relatively high doses of perchlorate can inhibit iodine uptake and impair thyroid function, and thus could impair neurological development in utero. We examined human exposures to perchlorate in the Imperial Valley among individuals consuming locally grown produce and compared perchlorate exposure doses to state and federal reference doses. We collected 24-hour urine specimen from a convenience sample of 31 individuals and measured urinary excretion rates of perchlorate, thiocyanate, nitrate, and iodide. In addition, drinking water and local produce were also sampled for perchlorate. All but two of the water samples tested negative for perchlorate. Perchlorate levels in 79 produce samples ranged from non-detect to 1816 ppb. Estimated perchlorate doses ranged from 0.02 to 0.51 µg/kg of body weight/day. Perchlorate dose increased with the number of servings of dairy products consumed and with estimated perchlorate levels in produce consumed. The geometric mean perchlorate dose was 70% higher than for the NHANES reference population. Our sample of 31 Imperial Valley residents had higher perchlorate dose levels compared with national reference ranges. Although none of our exposure estimates exceeded the U. S. EPA reference dose, three participants exceeded the acceptable daily dose as defined by bench mark dose methods used by the California Office of Environmental Health Hazard Assessment