Strategies to Reduce Ventilator-Associated Pneumonia Incidence in Mechanically Ventilated Pediatric Critical Care Patients: A Scoping Review

Purpose/Background Ventilator-associated pneumonia (VAP) is a severe problem in pediatric intensive care units (PICUs), resulting in increased morbidity, mortality, duration of stay, and healthcare expenses. Traditional preventative measures are well-established, but the influence of ventilator filters in preventing VAP is unknown. The current evidence on the efficacy of VAP bundles and ventilator filters is variable and challenging to address. This scoping review aims to determine how VAP bundle compliance and ventilator filter utilization impact the incidence of VAP in mechanically ventilated pediatric critical care patients. Methods A scoping review was carried out per the Population, Concept, and Context (PCC) framework. We conducted a scoping literature review utilizing CINAHL and PubMed databases. 241 articles were initially identified and assessed, yielding 12 that met qualifying standards and were accepted. The Rapid Critical Appraisal (RCA) instrument from Ohio State University College of Nursing was used for data extraction, classification, and quality assessment. An outcome synthesis table and level of evidence table were used to synthesize the results. Results The scoping review included data from various Level I to VII studies, highlighting the importance of ventilator filters and VAP bundles. Although VAP bundles were consistently shown to reduce the incidence of VAP, the effects of HEPA filters varied in research findings. No literature discussed the direct correlation between HEPA filters and VAP incidence. This review concluded that the implementation of VAP bundles was consistent with a decrease in the duration of mechanical ventilation, hospital stay, ventilator-associated pneumonia incidence rates, mortality rates, and economic cost. Implications for Nursing Practice Ventilator filters, especially the HEPA variants, can stop disease spread. Numerous studies revealed modest reductions, underscoring the necessity for context-specific research. Since there are limitations due to the variability of patient demographics and interventions among studies, future research should adopt standardized methodologies to improve generalizability and identify the most effective preventative treatments for ventilator-associated pneumonia in pediatric critical care

Using online teaching resources to increase nursing students\u27 knowledge and assessment skills of skin cancer

Nurses are in an excellent position to teach the public about skin cancer prevention and perform cancer screenings. This study was designed to test an educational intervention intended to teach nursing students about skin cancer so they can reach competence and be certified by faculty to educate their patients. Similarly, students are educated and certified in other areas, namely asthma and naloxone administration. By conducting this quasi-experimental study, the researchers sought to evaluate the effectiveness of adding online skin cancer education to traditional educational methods. Using a quasi-experimental design, we assigned nursing students (n = 146) to either an intervention group, which received an online educational treatment, or to a control group, which did not receive any such treatment. Both groups then completed a post-test measure assessing their knowledge about skin cancer (‘knowledge’), sun protective behaviours (‘behavior’), and perceptions about the role of the nurse in skin cancer prevention (‘role’). Participants in the intervention group had significantly higher scores on the ‘behavior’ and ‘role’ measures, suggesting that the intervention had successfully impacted these dimensions

Mirror Dark Matter

There appear to be three challenges that any theory of dark matter must face: (i) why is $\Omega_{DM}$ of the same order as $\Omega_{Baryons}$ ? (ii) what are the near solar mass objects ($\sim 0.5 M_{\odot}$) observed by the MACHO microlensing project ? and (iii) understanding the shallow core density profile of the halos of dwarf as well as low surface brightness galaxies. The popular cold dark matter candidates, the SUSY LSP and the axion fail to meet these challenges. We argue that in the mirror model suggested recently to explain the neutrino anomalies, the mirror baryons being 15-20 times heavier than familiar baryons, can play the role of the cold dark matter and provide reasonable explanation of all three above properties without extra assumptions.Comment: Latex, 10 pages; Invited talk presented in PASCOS99 workshop, held in Lake Tahoe, Dec. 1999 and DM2000 workshop held in Los Angeles, February, 200

Job satisfaction and career development of men in nursing

Background: Men are a growing minority in nursing. A deeper understanding of their motivation, career paths, and job satisfaction is needed to target recruitment and retention efforts. Currently the largest male cohort entering nursing is by second career. This study examines if job satisfaction differs for men who choose nursing as their first choice of career, as a convenience after exploring other options, or as a second career. Methods: This mixed-method study examined the relationship between men entering nursing by choice, convenience or second career and their resultant job satisfaction. A convenience sample of 238 men answered an online survey. Entry path, current practice position, and future career plans in five years was by self report. Job satisfaction was measured using Lester’s instrument. Results: Second career men were significantly more likely to work in specialty practice and more likely to aspire to advanced practice than those entering by choice or convenience early in their careers. No significant differences in job satisfaction were found between entry paths. Conclusions: These data raise provocative issues relating to recruiting men and the impact of men on the profession of nursing. Despite the steady but slow growth in the percent of men in nursing, its image remains overwhelmingly female. This survey does not identify substantial differences in job satisfaction between men who enter through different career paths or substantial differences with other studies of male and female nurses

Using appreciative inquiry as a framework to enhance the patient experience

The following case depicts the journey of a non-profit hospital in an under-served community and its attempts to turn around suffering patient experience. The Hospital turned to the theories of Appreciative Inquiry and the power of a strengths-based approach to create a framework to support the patient experience initiatives. Hospital leadership led the formation of a Patient Experience Team to implement ten initiatives in order increase the top box score in the domain of willingness to recommend the hospital, as that was selected as a global measure of success for the overall improvement project

Punica granatum (Pomegranate) juice provides an HIV-1 entry inhibitor and candidate topical microbicide

BACKGROUND: For ≈ 24 years the AIDS pandemic has claimed ≈ 30 million lives, causing ≈ 14,000 new HIV-1 infections daily worldwide in 2003. About 80% of infections occur by heterosexual transmission. In the absence of vaccines, topical microbicides, expected to block virus transmission, offer hope for controlling the pandemic. Antiretroviral chemotherapeutics have decreased AIDS mortality in industrialized countries, but only minimally in developing countries. To prevent an analogous dichotomy, microbicides should be: acceptable; accessible; affordable; and accelerative in transition from development to marketing. Already marketed pharmaceutical excipients or foods, with established safety records and adequate anti-HIV-1 activity, may provide this option. METHODS: Fruit juices were screened for inhibitory activity against HIV-1 IIIB using CD4 and CXCR4 as cell receptors. The best juice was tested for inhibition of: (1) infection by HIV-1 BaL, utilizing CCR5 as the cellular coreceptor; and (2) binding of gp120 IIIB and gp120 BaL, respectively, to CXCR4 and CCR5. To remove most colored juice components, the adsorption of the effective ingredient(s) to dispersible excipients and other foods was investigated. A selected complex was assayed for inhibition of infection by primary HIV-1 isolates. RESULTS: HIV-1 entry inhibitors from pomegranate juice adsorb onto corn starch. The resulting complex blocks virus binding to CD4 and CXCR4/CCR5 and inhibits infection by primary virus clades A to G and group O. CONCLUSION: These results suggest the possibility of producing an anti-HIV-1 microbicide from inexpensive, widely available sources, whose safety has been established throughout centuries, provided that its quality is adequately standardized and monitored