Educating Oncology Nurse Practitioners to Provide Basic Palliative Care

Background: Approximately 1.66 million Americans are diagnosed with cancer each year and another 589,430 die from the disease. As treatment options have expanded, many cancer patients are living longer with worsening symptoms and disabilities and an increased illness burden. These patients are ideal candidates for palliative care. Palliative care involves care delivered by a team of clinicians with specialty training and a focus on improving the quality of life for patients with serious illnesses. A number of major organizations have made formal recommendations regarding the integration of palliative care into comprehensive cancer care including the American Society of Clinical Oncology and the National Comprehensive Cancer Network. With an advanced education and scope of practice, a holistic orientation, and an evidence-base that substantiates their provision of safe and effective care, nurse practitioners (NPs) are well positioned to improve access to palliative care; yet, many NPs lack basic knowledge of palliative care and do not have competencies to provide such care. Objectives: This project aimed to measure differences in NPs’ knowledge of basic palliative care concepts and their self-rated self-competence in the provision of its care before and after a formal education program. Methods: This study used a one-group pre-post test design and valid and reliable instruments to measure the effects of an education intervention on NPs’ knowledge of basic palliative care and self-reported self-competence. The content for the education intervention, which was drawn from the End of Life Nursing Education Consortium’s (ELNEC) Advanced Practice Registered Nurse (APRN) curriculum, was delivered in one 8-hour program. The sample included NPs who practiced in the regional network sites of a National Cancer Institute designated comprehensive cancer center. Statistical differences were tested using paired t-tests, and a Wilcoxon Signed Ranks test. Results: A total of 37 NPs participated in the program. Knowledge, as measured by the ELNEC KAT increased from a mean of 89.03 to a mean of 90.49. Paired samples t tests revealed a statistically significant difference between the mean pre and mean post-test scores (t =-2.165, df =36, p= .037). Self-reported self-competence as measured by the PCNSC increased from a mean of 3.21 to a mean of 4.10. Paired samples t tests revealed that the difference between the mean pre and mean post PCNSC score was statistically significant (t =-9.202, df =36, p= .001). Conclusion: A one-day course based upon the ELNEC APRN clinical modules was effective in improving both knowledge, and self-competence of basic palliative care among oncology NPs

ICU Delirium: Detection with and without CAM-ICU Screening

Purpose/Background Delirium is a form of brain malfunction marked by abnormalities in cognition, disorientation, memory, and awareness. This scoping review\u27s aim is to examine bodies of research on the effects of length of stay (LOS) in the ICU using Confusion Assessment Method-Intensive Care Unit (CAM-ICU). Methods Adults age 18 and older admitted to the ICU, of any race or ethnicity, and any gender were all included in the study articles. Nine articles satisfied the search criteria after publications underwent rapid critical appraisal. Results were evaluated for ICU LOS, hospital LOS, mortality, restraint use, medication use, delirium screening tool use, and screening tool efficacy. Results One article demonstrated a decrease in ICU LOS with CAM-ICU delirium detection. Four articles demonstrated detection of delirium by using the CAM-ICU tool. Hospital LOS without CAM-ICU showed increased LOS in three articles and decreased LOS in one article. No effect was reported or examined for ICU LOS without delirium detected by CAM-ICU. Mortality increased for patients with delirium detected by CAM-ICU and non-CAM-ICU tool in two articles and decreased in one article. Mortality without delirium decreased in one article. Other outcomes such as high-risk medication and restraint usage were found in four other articles. These articles demonstrated our desired outcomes and highlight the need for future research on the impact of LOS with early detection of delirium with the CAM-ICU screening tool. Implications for Nursing Practice As nurse practitioners, it is our responsibility to be aware of the effects of ICU delirium and to promote the use of CAM-ICU as evidence-based practice to detect delirium to lessen its effects, which in turn reduces mortality and hospital LOS. Keywords: ICU and hospital length of stay (LOS) for CAM-ICU, ICU and hospital LOS for non-CAM tool delirium mortality with delirium, mortality without delirium, restraint usage, high-risk medication usage, effectiveness of screening tool, and screening tool usag

Pruning the regulatory tree

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62897/1/457534a.pd

Improving Tree-Thinking One Learnable Skill at a Time

Introducerande artikel inom Läslyftsmodulen Från Vardagsspråk till ÄmnesspråkIntroduction to language sensitive teaching a s part of a Skolverket professional development module in the program Reading Boost

Epiploic appendagitis – clinical characteristics of an uncommon surgical diagnosis

<p>Abstract</p> <p>Background</p> <p>Epiploic appendagitis (EA) is a rare cause of focal abdominal pain in otherwise healthy patients with mild or absent secondary signs of abdominal pathology. It can mimick diverticulitis or appendicitis on clinical exam. The diagnosis of EA is very infrequent, due in part to low or absent awareness among general surgeons. The objective of this work was to review the authors' experience and describe the clinical presentation of EA.</p> <p>Methods</p> <p>All patients diagnosed with EA between January 2004 and December 2006 at an urban surgical emergency room were retrospectively reviewed by two authors in order to share the authors' experience with this rare diagnosis. The operations were performed by two surgeons. Pathological examinations of specimens were performed by a single pathologist. A review of clinical presentation is additionally undertaken.</p> <p>Results</p> <p>Ten patients (3 females and 7 males, average age: 44.6 years, range: 27–76 years) were diagnosed with symptomatic EA. Abdominal pain was the leading symptom, the pain being localized in the left (8 patients, 80 %) and right (2 patients, 20%) lower quadrant. All patients were afebrile, and with the exception of one patient, nausea, vomiting, and diarrhea were not present. CRP was slightly increased (mean: 1.2 mg/DL) in three patients (33%). Computed tomography findings specific for EA were present in five patients. Treatment was laparoscopic excision (n = 8), excision via conventional laparotomy (n = 1) and conservative therapy (n = 1).</p> <p>Conclusion</p> <p>In patients with localized, sharp, acute abdominal pain not associated with other symptoms such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of EA should be considered. Although infrequent up to date, with the increase of primary abdominal CT scans and ultrasound EA may well be diagnosed more frequently in the future.</p

How to survey displaced workers in Switzerland ? Sources of bias and ways around them

Studying career outcomes after job loss is challenging because individually displaced worker form a self-selected group. Indeed, the same factors causing the workers to lose their jobs, such as lack of motivation, may also reduce their re-employment prospects. Using data from plant closures where all workers were displaced irrespective of their individual characteristics offers a way around this selection bias. There is no systematic data collection on workers displaced by plant closure in Switzerland. Accordingly, we conducted our own survey on 1200 manufacturing workers who had lost their job 2 years earlier. The analysis of observational data gives rise to a set of methodological challenges, in particular nonresponse bias. Our survey addressed this issue by mixing data collection modes and repeating contact attempts. In addition, we combined the survey data with data from the public unemployment register to examine the extent of nonresponse bias. Our analysis suggests that some of our adjustments helped to reduce bias. Repeated contact attempts increased the response rate, but did not reduce nonresponse bias. In contrast, using telephone interviews in addition to paper questionnaires helped to substantially improve the participation of typically underrepresented subgroups. However, the survey respondents still differ from nonrespondents in terms of age, education and occupation. Interestingly, these differences have no significant impact on the substantial conclusion about displaced workers' re-employment prospects

Measurement of the inclusive and dijet cross-sections of b-jets in pp collisions at sqrt(s) = 7 TeV with the ATLAS detector

The inclusive and dijet production cross-sections have been measured for jets containing b-hadrons (b-jets) in proton-proton collisions at a centre-of-mass energy of sqrt(s) = 7 TeV, using the ATLAS detector at the LHC. The measurements use data corresponding to an integrated luminosity of 34 pb^-1. The b-jets are identified using either a lifetime-based method, where secondary decay vertices of b-hadrons in jets are reconstructed using information from the tracking detectors, or a muon-based method where the presence of a muon is used to identify semileptonic decays of b-hadrons inside jets. The inclusive b-jet cross-section is measured as a function of transverse momentum in the range 20 < pT < 400 GeV and rapidity in the range |y| < 2.1. The bbbar-dijet cross-section is measured as a function of the dijet invariant mass in the range 110 < m_jj < 760 GeV, the azimuthal angle difference between the two jets and the angular variable chi in two dijet mass regions. The results are compared with next-to-leading-order QCD predictions. Good agreement is observed between the measured cross-sections and the predictions obtained using POWHEG + Pythia. MC@NLO + Herwig shows good agreement with the measured bbbar-dijet cross-section. However, it does not reproduce the measured inclusive cross-section well, particularly for central b-jets with large transverse momenta.Comment: 10 pages plus author list (21 pages total), 8 figures, 1 table, final version published in European Physical Journal