Knowledge, attitudes, and practice behaviors of oncology advanced practice nurses regarding advanced care planning for patients with cancer.

Purpose/Objectives: To establish initial reliability and validity of a Web-based survey focused on oncology advanced practice nurses\u27 (APNs\u27) knowledge, attitudes, and practice behaviors regarding advanced care planning, and to obtain preliminary understanding of APNs\u27 knowledge, attitudes, and practice behaviors and perceived barriers to advanced care planning. Design: Descriptive, cross-sectional, pilot survey study. Setting: The eastern United States.Sample: 300 oncology APNs.Methods: Guided by the Theory of Planned Behavior, a knowledge, attitudes, and practice behaviors survey was developed and reviewed for content validity. The survey was distributed to 300 APNs via e-mail and sent again to the 89 APNs who responded to the initial survey. Exploratory factor analysis was used to examine the construct validity and test-retest reliability of the survey\u27s attitudinal and practice behavior portions. Main Research Variables: Respondents\u27 demographics, knowledge, attitudes, practice behaviors, and perceived barriers to advanced care planning practice. Findings: Exploratory factor analysis yielded a five-factor solution from the survey\u27s attitudes and practice behavior portions with internal consistency using Cronbach alpha. Respondents achieved an average of 67% correct answers in the 12-item knowledge section and scored positively in attitudes toward advanced care planning. Their practice behavior scores were marginally positive. The most common reported barriers were from patients\u27 and families\u27 as well as physicians\u27 reluctance to discuss advanced care planning. Conclusions: The attitudinal and practice behaviors portions of the survey demonstrated preliminary construct validity and test-retest reliability. Regarding advanced care planning, respondents were moderately knowledgeable, but their advanced care planning practice was not routine.Implications for Nursing: Validly assessing oncology APNs\u27 knowledge, attitudes, and practice behaviors regarding advanced care planning will enable more tailored approaches to improve end-of-life care outcomes

Ecto- and arbuscular mycorrhizal symbiosis can induce tolerance to toxic pulses of phosphorus in jarrah (Eucalyptus marginata) seedlings

In common with many plants native to low P soils, jarrah (Eucalyptus marginata) develops toxicity symptoms upon exposure to elevated phosphorus (P). Jarrah plants can establish arbuscular mycorrhizal (AM) and ectomycorrhizal (ECM) associations, along with a non-colonizing symbiosis described recently. AM colonization is known to influence the pattern of expression of genes required for P uptake of host plants and our aim was to investigate this phenomenon in relation to P sensitivity. Therefore, we examined the effect on hosts of the presence of AM and ECM fungi in combination with toxic pulses of P and assessed possible correlations between the induced tolerance and the shoot P concentration. The P transport dynamics of AM (Rhizophagus irregularis and Scutellospora calospora), ECM (Scleroderma sp.), non-colonizing symbiosis (Austroboletus occidentalis), dual mycorrhizal (R. irregularis and Scleroderma sp.), and non-mycorrhizal (NM) seedlings were monitored following two pulses of P. The ECM and A. occidentalis associations significantly enhanced the shoot P content of jarrah plants growing under P-deficient conditions. In addition, S. calospora, A. occidentalis, and Scleroderma sp. all stimulated plant growth significantly. All inoculated plants had significantly lower phytotoxicity symptoms compared to NM controls 7 days after addition of an elevated P dose (30 mg P kg−1 soil). Following exposure to toxicity-inducing levels of P, the shoot P concentration was significantly lower in R. irregularis-inoculated and dually inoculated plants compared to NM controls. Although all inoculated plants had reduced toxicity symptoms and there was a positive linear relationship between rank and shoot P concentration, the protective effect was not necessarily explained by the type of fungal association or the extent of mycorrhizal colonization

Consensus statement on abusive head trauma in infants and young children

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature

Dementia: A Providers\u27 Guide

Objectives: Review a framework for providers to care for patients with dementia Address issues around time of diagnosis Address palliative care issues with dementia Discuss caregiving issues across the dementia timeline Review the new G0505 code and care, documentation and billing issues, and work of CPC+ dementia workgrou

Osteoporosis

Objectives Review importance of bone health Define and identify osteopenia and osteoporosis Learn treatment options for osteopenia How to counsel patients How to use FRAX calculator to assist with treatment decisions Learn treatment options for osteoporosis Become familiar with treatment guidelines and option

Palliative Care and ALS: Maintaining hope during serious illness

Outline of talk: Part 1: The disease: What is ALS? The approach: Medicine versus Science Our approach: Medicine, Science, Patients Together Part 2 Palliative Care and ALS Develop standardized approach for decision-making and symptom management Become more comfortable with making a hospice recommendation Presentation: 53:3

Caregiver Evaluation of a Palliative Care Consultation Team Using the Jefferson Teamwork Observation Guide (JTOG) by Caregivers of Severely Ill Patients

Background: Palliative care teams strive to improve the quality of life of patients and their families who are faced with life threatening illnesses by addressing the physical, psychosocial and spiritual aspects of their care (World HealthOrganization, 2017). The palliative care team is an interprofessional team made up of physicians, nurses, social workers and chaplains and often partners with many other disciplines. Palliative care has been shown to increase quality of life in patients with cancer and help improve communication amongst patients, their families and their care teams (Temel, 2010; Seow, 2008). Additionally, many studies have sought to prove the effectiveness of palliative care using validated tools such as the FAMCARE survey with mixed results (Parker, 2013). The goal of this project was to use a different validated tool, the JTOG, to analyze the effectiveness of our interprofessional team. Because palliative care is not a medical specialty whose effectiveness can be measured by procedural outcomes, teams often seek using satisfaction scores as a means of measuring how well they are doing. The JTOG replaced our prior patient satisfaction survey. The results are described below

An Interprofessional Falls Assessment Clinic Model to Develop Collaborative Team Skills among Health Professional Students

BACKGROUND Older adults are at increased risk for falls and fall related injuries, leading to loss of independence, disability, and increased mortality. Preventing injury and falls is a national Healthy People 2010 objective. However, physicians and other health professionals frequently fail to incorporate known evidence into usual care. Screening for falls is not consistently performed as an essential assessment in older adults by primary care providers. Multidisciplinary assessment can be an important component in preventing falls in community dwelling adults. In new practice models, such as the Chronic Care Model, there is an emphasis on interdisciplinary collaboration, however health professions students have little or no opportunity to practice together during their educational training. Students need innovative and comprehensive learning experiences in which they work collaboratively with other disciplines to solve healthcare problems in a growing geriatric population

Racial Differences in Patient Satisfaction With the Hospital Experience Undergoing Primary Unilateral Hip and Knee Arthroplasty: A Retrospective Study

Background: Press Ganey (PG) inpatient survey is widely used to track patient satisfaction with the hospital experience. Our aim was to use the PG survey to determine if there are racial differences in overall hospital experience and perception of nurses and surgeons following hip and knee arthroplasty. Methods: We retrospectively analyzed Black and White patients from hip and knee arthroplasty registries from a single institution between July 2010 and February 2012. The overall assessment score for the hospital experience and perception of the nurse and surgeon questions from the PG inpatient survey were dichotomized as “not completely satisfied” or “completely satisfied”. Multivariable logistic regression models were developed to determine the impact of race on the likelihood of being ‘completely satisfied’ in the hip and knee cohorts. Results: There were 2517 hip and 2114 knee patients who underwent surgery and completed the PG survey, of whom 3.9% were Black and 96.0% were White. Black patients were less likely to be completely satisfied with their hospital experience compared to White patients in the hip (odds ratio 0.62, confidence interval 0.39-1.00, P = .049) and knee (odds ratio 0.52, confidence interval 0.33-0.82, P = .005) cohorts. Black patients were also less likely to be completely satisfied with multiple aspects of care they received from the nurse and surgeon in both cohorts. Conclusions: We found that the PG Survey shows Black patients were less likely to be completely satisfied than White patients with the hospital experience, including their interactions with nurses and surgeons. More work is needed to understand this difference