Improving pressure injury nurse awareness and decision-making in the cardiac intensive care unit: a quality improvement project.

Abstract Background/Significance: Hospitalized patients with pressure injuries have 5 times greater death compared to a patient without a pressure injury. A needs assessment identified the problem of pressure injuries in the CVICU with the goal to improve nurse awareness and decision-making to decrease pressure injuries in the CVICU. Purpose: The purpose of this project was to increase nurse awareness of pressure injury prevention via an education workshop and evidence-based pressure injury decision tree in the Cardiovascular ICU. Methods: A MeSH search was conducted to identify pressure injury interventions and nurse awareness of pressure injuries which resulted in 17 publications. The LEGEND model appraisal tool was used to evaluate study quality. The Plan Do Study Act Model for Improvement was used to guide the process change. Intervention: There were 20 CVICU nurses who participated in an education workshop and completed the APuP pre- and post-intervention over a 4-week duration. Results: The Wilcoxon Signed Rank test demonstrated that an improvement in the median score difference pre- to post intervention supported PI prevention, nurse confidence, and nurse awareness of a decision- making algorithm. Conclusion: This quality improvement project improved awareness of decision-making algorithms for pressure injury prevention interventions, increased awareness of screening for high-risk pressure injury patients, and led to 0 HAPIs occurring in the project timeframe. Keywords: pressure injury, interventions, prevention, decision-making, nurse awarenes

Spatial Solutions for the Environmental Protection Agency “Brownfields to Healthfields” Program: Utilization of Mixed Methods to Assess Application Effectiveness and Usability

Geographic Information Systems (GIS) can serve as a planning tool to promote community health at many levels, such as the policy, organizational and public levels. The Brownfields to Healthfields (B2H) program involves creating new opportunities to support community public health, including the development of park spaces and new hospital facilities. However, there was no existing portal for organizations to access a map of brownfields data to meet the required criteria of the organization in seeking a space for transformation to a “healthfield” or other public services facility. Since the various types of community and demographic data were scattered, it was necessary to combine the data in a web application available to all stakeholders. This paper discusses the utilization of a new concept of operation, which includes participative and volunteered approaches that are addressed to include the contribution of various stakeholder groups, and to further improve planning for public health.

A straightforward meta-analysis approach for oncology phase I dose-finding studies

Phase I early-phase clinical studies aim at investigating the safety and the underlying dose-toxicity relationship of a drug or combination. While little may still be known about the compound's properties, it is crucial to consider quantitative information available from any studies that may have been conducted previously on the same drug. A meta-analytic approach has the advantages of being able to properly account for between-study heterogeneity, and it may be readily extended to prediction or shrinkage applications. Here we propose a simple and robust two-stage approach for the estimation of maximum tolerated dose(s) (MTDs) utilizing penalized logistic regression and Bayesian random-effects meta-analysis methodology. Implementation is facilitated using standard R packages. The properties of the proposed methods are investigated in Monte-Carlo simulations. The investigations are motivated and illustrated by two examples from oncology.Comment: 30 pages, 11 figures, 8 table

Bridging the gaps: a global review of intersections of violence against women and violence against children.

BACKGROUND: The international community recognises violence against women (VAW) and violence against children (VAC) as global human rights and public health problems. Historically, research, programmes, and policies on these forms of violence followed parallel but distinct trajectories. Some have called for efforts to bridge these gaps, based in part on evidence that individuals and families often experience multiple forms of violence that may be difficult to address in isolation, and that violence in childhood elevates the risk of violence against women. METHODS: This article presents a narrative review of evidence on intersections between VAC and VAW - including sexual violence by non-partners, with an emphasis on low- and middle-income countries. RESULTS: We identify and review evidence for six intersections: 1) VAC and VAW have many shared risk factors. 2) Social norms often support VAW and VAC and discourage help-seeking. 3) Child maltreatment and partner violence often co-occur within the same household. 4) Both VAC and VAW can produce intergenerational effects. 5) Many forms of VAC and VAW have common and compounding consequences across the lifespan. 6) VAC and VAW intersect during adolescence, a time of heightened vulnerability to certain kinds of violence. CONCLUSIONS: Evidence of common correlates suggests that consolidating efforts to address shared risk factors may help prevent both forms of violence. Common consequences and intergenerational effects suggest a need for more integrated early intervention. Adolescence falls between and within traditional domains of both fields and deserves greater attention. Opportunities for greater collaboration include preparing service providers to address multiple forms of violence, better coordination between services for women and for children, school-based strategies, parenting programmes, and programming for adolescent health and development. There is also a need for more coordination among researchers working on VAC and VAW as countries prepare to measure progress towards 2030 Sustainable Development Goals

What therapies alleviate symptoms of polycystic ovary syndrome?

Q: What therapies alleviate symptoms of polycystic ovary syndrome? A: Treatment of polycystic ovary syndrome (PCOS) in women not actively seeking to become pregnant is symptom-specific. Lifestyle modification (LSM) reduces body weight by 3.5 kg (strength of recommendation [SOR]: A, meta-analysis) and metformin reduces it by 3 kg (SOR B, cohort trial). LSM may be better tolerated; adding metformin to LSM doesn't lead to additional weight loss (SOR: B, randomized controlled trial [RCT]). Spironolactone improves hirsutism scores by an absolute 8% to 22% (SOR: A, multiple RCTs); adding metformin to spironolactone improves Ferriman-Gallwey (FG) hirsutism scores an additional absolute 1.4% (SOR: B, RCT). Oral contraceptive pills (OCPs) are 12 times more likely to result in complete menstrual regularity than metformin (SOR: A, meta-analysis). Combining OCPs with metformin improves hirsutism scores by 8% over using an OCP alone (SOR: A, metaanalysis)

The quantitative assessment of damage to the environment in major accidents caused by natural events

The release of hazardous materials induced by natural events affecting industrial facilities presents peculiar characteristics because of the huge potential extension of the affected areas. The reduction of both the likelihood and the magnitude of such events represents an essential step to reduce the risk associated with Natech accidents. Nevertheless, the evaluation of damage to the environment in Natech events has been poorly addressed. In the present study, past accidents analysis was carried out, using both a detailed description of specific accidents and an extended database of Natech events. Lessons learnt as well as possible common patterns and main features related to such accidents were identified and discussed. The results of the present study can be intended as a preliminary step for the development of models for the quantitative assessment of damage to the environment in major accidents caused by natural events

Enzyme-dependent fluorescence recovery of NADH after photobleaching to assess dehydrogenase activity of isolated perfused hearts.

Reduction of NAD(+) by dehydrogenase enzymes to form NADH is a key component of cellular metabolism. In cellular preparations and isolated mitochondria suspensions, enzyme-dependent fluorescence recovery after photobleaching (ED-FRAP) of NADH has been shown to be an effective approach for measuring the rate of NADH production to assess dehydrogenase enzyme activity. Our objective was to demonstrate how dehydrogenase activity could be assessed within the myocardium of perfused hearts using NADH ED-FRAP. This was accomplished using a combination of high intensity UV pulses to photobleach epicardial NADH. Replenishment of epicardial NADH fluorescence was then imaged using low intensity UV illumination. NADH ED-FRAP parameters were optimized to deliver 23.8 mJ of photobleaching light energy at a pulse width of 6 msec and a duty cycle of 50%. These parameters provided repeatable measurements of NADH production rate during multiple metabolic perturbations, including changes in perfusate temperature, electromechanical uncoupling, and acute ischemia/reperfusion injury. NADH production rate was significantly higher in every perturbation where the energy demand was either higher or uncompromised. We also found that NADH production rate remained significantly impaired after 10 min of reperfusion after global ischemia. Overall, our results indicate that myocardial NADH ED-FRAP is a useful optical non-destructive approach for assessing dehydrogenase activity

Con luz conocí la noche cómo viven las relaciones de pareja las personas en condición de discapacidad

Ésta fue una de las frases que me hizo querer inmiscuir en el mundo de las personas en condición de discapacidad. Me pregunté ¿Por qué no tratar el tema de sexualidad en personas con discapacidad? Me pueden llamar entonces caprichosa, pero sobre eso era mi proyecto. Palabras como es solo un trabajo de grado, haga cualquier cosa hicieron de mi vida durante la tesis algo complicado, siempre tenía ese dilema, hacer o no lo que yo quería. Un día escuché una palabra que me dejó pensando, de una mujer que estaba hablando sobre personas con Síndrome de Down, dijo es que ellos son muy enamoradizos , eso me dejo pensando sobre ¿cómo serán estas personas en condición de discapacidad con sus relaciones de pareja?, ¿tendrán novia o novio?, ¿será fácil para ellos conseguir pareja? Y lo más alarmante, un tema que maneja doble tabú, ¿cómo serán las relaciones sexuales en la vida de estas personas? Así que bueno, decidí emprender un viaje en las profundidades de la discapacidad, y cómo ésta se maneja en Colombia. Comprendí la importancia de enterarme más del tema e investigar sobre qué campañas se realizan en diferentes países para enseñarle a la sociedad sobre la sexualidad en personas con discapacidad, tanto cognitiva como física y sensorial.Comunicador (a) SocialPregrad

“Entre o desprezo e a estima habitam pombos, ou, como se conviver com o cotidiano não amado”

Este trabalho pretende abordar uma reflexão a respeito das diversas relações entre pessoas e pombos urbanos no contexto da cidade de Santos, especialmente no porto – que se faz como local foco de minha pesquisa. Essas reflexões partem da noção de unloved others, de Deborah Rose e Thom van Dooren (2011), bem como da antropologia da vida, de Eduardo Kohn (2007; 2013). Nota-se, a partir dos dados trazidos, tanto por meio de notícias, quanto de minha pesquisa de campo, dois pressupostos antitéticos de relações entre pessoas e pombos, os quais apontam para interações de combate, nojo, controle e apreciação, proteção, convívio por parte das pessoas. Espera-se trazer, então, ao debate, questões referentes às possibilidades de convivência, ou, como se propõe neste contexto de discussão, o viver entre animais. Entendendo que estas interações se dão de maneiras diversas, procuro refletir como a noção de unloved others pode auxiliar para se pensar os pombos, uma vez que, estes, em determinados contextos e situações, podem se tratar de uma espécie tida como não querida pelas pessoas. Também se fará necessário mostrar o contraste das relações, isto é, situações em que pombos são apreciados pelas pessoas, bem como o contraste com outras espécies animais que se aproximam, ou distanciam, destas posições de apreço e desgosto. Desta maneira, trago alguns dados iniciais de meu campo que apontam para possibilidades ambíguas de se conviver com os pombos, bem como no que diz respeito aos espaços por eles habitados, principalmente o Porto de Santos