Pediatric Skin Integrity Practice Guideline for Institutional Use: A Quality Improvement Project

Superior skin care is a nurse-sensitive outcome measure (Young, T., & Clark, M. (2009). Re-positioning for pressure ulcer prevention (protocol). The Cochrane Database of Systematic Review (2009) 3). This study sought to decrease incidence and risk of skin breakdown in the pediatric cardiac intensive care unit (PCICU). The study was conducted in a large hospital in upstate New York. A practice guideline was created and guided PCICU nurses on the interventions for potential skin-breakdown issues in their patients. The patients had a significant change in skin breakdown with a one-sided Fisher\u27s Exact Test (p=.0422). A logistic regression model showed intervention as a significant factor in reducing incidence of pressure ulcers and length of stay (p=.0389)

Twitter Chats as a Research Tool: A Study of Young Adult Financial Decisions

Many researchers collect online survey data because it is cost-effective and less time-consuming than traditional research methods. This paper describes Twitter chats as a research tool vis-à-vis two other online research methods: providing links to electronic surveys to respondents and use of commercially available survey panels through vendors with readily available respondents. Similar to a face-to-face focus group, Twitter chats provide a synchronous environment for participants to answer a structured series of questions and to respond to both the chat facilitator and each other. This paper also reports representative responses from a Twitter chat that explored financial decisions of young adults. The chat was sponsored by a multi-state group of land-grant university researchers, in cooperation with WiseBread, a personal finance website targeted to millennials, to recruit respondents for a more extensive month-long online survey about the financial decisions of young adults. The Twitter chat responses suggest that student loans were the top concern of participants, and debt and housing rounded out the top three concerns. The internet, both websites and social media, was the most frequently cited source of financial information. The article concludes with a discussion of lessons learned from the Twitter chat experience and suggestions for professional practice

Get Some Skin in the Game: Best Practices for Pediatric Skin Care

Care of patients’ skin is a nurse-sensitive outcome measure established by the American Nurses Association (Young & Clark, 2009). Maintaining skin integrity in the critical-care environment is difficult because of patient acuity and the highly invasive interventions and therapies they receive (Galvin & Curley, 2012). The prevalence, prevention, and treatment of skin breakdown have been studied in adults, but research is lacking for children (Groeneveld et al., 2003). Pediatric patients have different anatomic, physiologic and developmental factors that alter their risk of obtaining and presentation of hospital acquired pressure ulcers (HAPUs), (Noonan, Quigley & Curley, 2013). Medical devices monitoring has become standard of practice for the acute care environment and clinicians have recognized that medical devices placed against the skin or mucosal membranes can lead to pressure ulcer development (Noonan et al., 2013). Medical Device Related (MDR) pressure ulcers are different then pressure ulcers derived on bony prominences because they are produced from unrelieved tissue compression on the site where the medical device is in contact with skin or mucosal membranes (Noonan et al., 2013). Due to the acute nature of the patients in critical care settings, nursing interventions focus on support of vital functions; and skin breakdown is generally not the main concern during admission (Smitt, Woensel, & Bos, 2011). Ensuring that nurses in the critical care area regard preventive skin care as a priority is critical for success in skin-breakdown interventions (Drake, Wendi, Sherburne, Nugent, & Simpson, 2012). Current work is being done by Martha Curley to create a risk prediction tool for MDR HAPUs that will inform and optimize prevention and treatment (Noonan et al, 2013). With this new knowledge, and in the absence of any current national standards it was identified, through a pilot project in a pediatric Cardiac Intensive Care Unit (PCICU) in a large hospital in Upstate New York, that there was a lack of standardization in device related skin care for patients. For the pilot project a practice guideline was created that guided PCICU nurses on the interventions for potential skin-breakdown issues in their patients. The patients had a significant change in skin breakdown with a one-sided Fishers Exact Test (P=.0422). A logistic regression model showed intervention as a significant factor in reducing incidence of pressure ulcers, skin breakdown, and length of stay (P=.0389). The current study is looking at the effects of an educational intervention with nurses, and implementation of the skin care practice guideline across all pediatric care areas. Disseminating the results and tools to replicate the practice guideline is essential for implementing current evidence based best practice across pediatrics, and is timely with the anticipation of the release of risk prediction tool for MDR HAPUs

The impact of human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) on nutritional outcomes

Background: Patients undergoing (chemo) radiotherapy for oropharyngeal squamous cell carcinoma (OPSCC) are at high risk of malnutrition during and after treatment. Malnutrition can lead to poor tolerance to treatment, treatment interruptions, poor quality of life (QOL) and potentially reduced survival rate. Human papillomavirus (HPV) is now known as the major cause of OPSCC. However, research regarding its effect on nutritional outcomes is limited. The aim of this study was to examine the relationship between HPV status and nutritional outcomes, including malnutrition and weight loss during and after patients&rsquo; (chemo) radiotherapy treatment for OPSCC. Methods: This was a longitudinal cohort study comparing the nutritional outcomes of HPV-positive and negative OPSCC patients undergoing (chemo) radiotherapy. The primary outcome was nutritional status as measured using the Patient Generated-Subjective Global Assessment (PG-SGA). Secondary outcomes included loss of weight, depression, QOL and adverse events. Results: Although HPV-positive were less likely to be malnourished according to PG-SGA at the beginning of treatment, we found that the difference between malnutrition rates in response to treatment was not significantly different over the course of radiotherapy and 3 months post treatment. HPV-positive participants had significantly higher odds of experiencing &gt;10% weight loss at three months post-treatment than HPV-negative participants (OR = 49.68, 95% CI (2.7, 912.86) p &le; 0.01). Conclusions: The nutritional status of HPV positive and negative patients were both negatively affected by treatment and require similarly intense nutritional intervention. In acute recovery, HPV positive patients may require more intense intervention. At 3- months post treatment, both groups still showed nutritional symptoms that require nutritional intervention so ongoing nutritional support is essential.</jats:p

Assessment of nutritional status and nutrition impact symptoms in patients undergoing resection for upper gastrointestinal cancer: Results from the multi-centre nourish point prevalence study

Background: Identification and treatment of malnutrition are essential in upper gastrointestinal (UGI) cancer. However, there is limited understanding of the nutritional status of UGI cancer patients at the time of curative surgery. This prospective point prevalence study involving 27 Australian tertiary hospitals investigated nutritional status at the time of curative UGI cancer resection, as well as presence of preoperative nutrition impact symptoms, and associations with length of stay (LOS) and surgical complications. Methods: Subjective global assessment, hand grip strength (HGS) and weight were performed within 7 days of admission. Data on preoperative weight changes, nutrition impact symptoms, and dietary intake were collected using a purpose-built data collection tool. Surgical LOS and complications were also recorded. Multivariate regression models were developed for nutritional status, unintentional weight loss, LOS and complications. Results: This study included 200 patients undergoing oesophageal, gastric and pancreatic surgery. Malnutrition prevalence was 42% (95% confidence interval (CI) 35%, 49%), 49% lost ≥5% weight in 6 months, and 47% of those who completed HGS assessment had low muscle strength with no differences between surgical procedures (p = 0.864, p = 0.943, p = 0.075, respectively). The overall prevalence of reporting at least one preoperative nutrition impact symptom was 55%, with poor appetite (37%) and early satiety (23%) the most frequently reported. Age (odds ratio (OR) 4.1, 95% CI 1.5, 11.5, p = 0.008), unintentional weight loss of ≥5% in 6 months (OR 28.7, 95% CI 10.5, 78.6, p < 0.001), vomiting (OR 17.1, 95% CI 1.4, 207.8, 0.025), reduced food intake lasting 2–4 weeks (OR 7.4, 95% CI 1.3, 43.5, p = 0.026) and ≥1 month (OR 7.7, 95% CI 2.7, 22.0, p < 0.001) were independently associated with preoperative malnutrition. Factors independently associated with unintentional weight loss were poor appetite (OR 3.7, 95% CI 1.6, 8.4, p = 0.002) and degree of solid food reduction of <75% (OR 3.3, 95% CI 1.2, 9.2, p = 0.02) and <50% (OR 4.9, 95% CI 1.5, 15.6, p = 0.008) of usual intake. Malnutrition (regression coefficient 3.6, 95% CI 0.1, 7.2, p = 0.048) and unintentional weight loss (regression coefficient 4.1, 95% CI 0.5, 7.6, p = 0.026) were independently associated with LOS, but no associations were found for complications. Conclusions: Despite increasing recognition of the importance of preoperative nutritional intervention, a high proportion of patients present with malnutrition or clinically significant weight loss, which are associated with increased LOS. Factors associated with malnutrition and weight loss should be incorporated into routine preoperative screening. Further investigation is required of current practice for dietetics interventions received prior to UGI surgery and if this mitigates the impact on clinical outcomes

Conceptualizing Health and Financial Wellness: Using Facilitated Discussion to Collect Input from Professionals

Determinants of health and financial security are complex. Individuals and families must often weigh decisions about their health against considerations of their financial resources, and vice-versa. Financial wellness and capability influence consumers’ health outcomes both directly and indirectly. This article documents a facilitated discussion at the 2018 Biennial Conference of Family Economics and Resource Management Association (FERMA) that bridged the domains of health and personal finance. Organizers summarized connections between health and financial stress, well-being, and wellness, and discussed definitions of health literacy and financial literacy. Attendees shared perspectives about how consumers’ financial wellness and capability influence their education and outreach activities and consumers’ health outcomes. They also worked together to create integrated models of health and financial wellness that could increase the number of Americans who are healthy and financially well at every stage of life. Insights will guide future scholarship focused on intersections of health and financial wellness

Advancing Methodology: From Mapping to Mobile Messaging Campaign

This article describes the progression of the Health Insurance Literacy (HIL) Action Team’s efforts from the initial charge by the Extension Committee on Organization and Policy (ECOP) of identifying priorities for Cooperative Extension health programming to developing and testing a national mobile messaging campaign designed to change health insurance knowledge, confidence, and behaviors of millennials. It highlights relevant empirical literature, summarizes the results of a national pulse online survey administered to Extension professionals and how they were applied to this project, reviews the Design Thinking and concept mapping process, and describes the development and testing of mobile messages. Anticipated outcomes of the mobile messaging campaign are discussed. Sources of data are the national pulse online survey along with insights gleaned from Extension professionals who participated in workshops, an eXtension Design-a-thon, and responses to a survey of millennials about experiences using health insurance, social media, and texting. This effort contributes to advancing Extension’s capacity to deliver programming related to health insurance education in innovative and effective ways

Preoperative nutrition intervention in patients undergoing resection for upper gastrointestinal cancer: Results from the multi-centre nourish point prevalence study:Results from the Multi-Centre NOURISH Point Prevalence Study

Background: Preoperative nutrition intervention is recommended prior to upper gastrointestinal (UGI) cancer resection; however, there is limited understanding of interventions received in current clinical practice. This study investigated type and frequency of preoperative dietetics intervention and nutrition support received and clinical and demographic factors associated with receipt of intervention. Associations between intervention and preoperative weight loss, surgical length of stay (LOS), and complications were also investigated. Methods: The NOURISH Point Prevalence Study was conducted between September 2019 and May 2020 across 27 Australian tertiary centres. Subjective global assessment and weight were performed within 7 days of admission. Patients reported on preoperative dietetics and nutrition intervention, and surgical LOS and complications were recorded. Results: Two-hundred patients participated (59% male, mean (standard deviation) age 67 (10)). Sixty percent had seen a dietitian preoperatively, whilst 50% were receiving nutrition support (92% oral nutrition support (ONS)). Patients undergoing pancreatic surgery were less likely to receive dietetics intervention and nutrition support than oesophageal or gastric surgeries (p 2 weeks had lower mean (SD) percentage weight loss than those who did not (1.2 (1.8) vs. 2.9 (3.4), p = 0.001). In malnourished patients, total dietetics appointments ≥3 was independently associated with reduced surgical complications (odds ratio 0.2, 95% confidence interval (CI) 0.1, 0.9, p = 0.04), and ONS >2 weeks was associated with reduced LOS (regression coefficient −7.3, 95% CI −14.3, −0.3, p = 0.04). Conclusions: Despite recommendations, there are low rates of preoperative dietetics consultation and nutrition support in this population, which are associated with increased preoperative weight loss and risk of increased LOS and complications in malnourished patients. The results of this study provide insights into evidence–practice gaps for improvement and data to support further research regarding optimal methods of preoperative nutrition support

Use of Case Study Videos and Peer Mentoring to Promote Health Habits in First-Semester College Students

Poster from the 2019 Food & Nutrition Conference & Expo. Poster Session: Food/Nutrition Science; Education; Management; Food Services/Culinary; Research

Enhancing breast milk production with Domperidone in mothers of preterm neonates (EMPOWER trial)

BACKGROUND: The use of mother’s own breast milk during initial hospitalization has a positive impact not only in reducing potential serious neonatal morbidities but also contribute to improvements in neurodevelopmental outcomes. Mothers of very preterm infants struggle to maintain a supply of breast milk during their infants’ prolonged hospitalization. Galactogogues are medications that induce lactation by exerting its effects through oxytocin or prolactin enhancement. Domperidone is a potent dopamine D(2) receptor antagonist which stimulates the release of prolactin. Small trials have established its ability in enhancing breast milk production. EMPOWER was designed to determine the safety and efficacy of domperidone in mothers experiencing an inadequate milk supply. METHODS/DESIGN: EMPOWER is a multicenter, double masked, randomized controlled phase-II trial to evaluate the safety and effectiveness of domperidone in those mothers identified as having difficulty in breast milk production. Eligible mothers will be randomized to one of two allocated groups: Group A: domperidone 10 mg orally three times daily for 28 days; and Group B: identical placebo 10 mg orally three times daily for 14 days followed by domperidone 10 mg orally three times daily for 14 days. The primary outcome will be determined at the completion of the first 2-week period; the second 2-week period will facilitate answering the secondary questions regarding timing and duration of treatment. To detect an estimated 30% change between the two groups (from 40% to 28%, corresponding to an odds ratio of 0.6), a total sample size of 488 mothers would be required at 80% power and alpha = 0.05. To account for a 15% dropout, this number is increased to 560 (280 per group). The duration of the trial is expected to be 36–40 months. DISCUSSION: The use of a galactogogue often becomes the measure of choice for mothers in the presence of insufficient breast milk production, particularly when the other techniques are unsuccessful. EMPOWER is designed to provide valuable information in guiding the practices for this high-risk group of infants and mothers. The results of this trial will also inform both mothers and clinicians about the choices available to increase and maintain sufficient breast milk. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT0151222