The forgotten ones\u27 improving the onboarding of clinical staff in the ambulatory care setting

A robust, comprehensive onboarding program was created for the outpatient clinical staff including simulation, extensive preceptorship and competency completion to ensure patient safety and quality is met before the new employee even steps into their new role independently

Nurse Educator Perceptions of Faith-Based Organizations for Service-Learning

Knowledge about service-learning for nursing students in faith-based organizations (FBOs) is limited. This descriptive study explored the perceptions of nurse educators about using FBOs for service-learning clinical sites. Participants (N=112) relayed specific benefits and barriers to using FBOs for service-learning clinical experiences. Recommendations are made for effective school–FBO partnerships

A Faculty-Friendly Framework for Improving Teaching and Learning through Service-Learning

This manuscript highlights benefits of service-learning (SL) as a promising pedagogical approach to improving teaching and learning in college classrooms. Drawing on the collective experiences of integrating SL projects in university courses, the authors share a framework aimed at assisting faculty in higher education in designing, implementing, and evaluating SL projects across diverse higher education courses. A case example illustrating how SL projects can be infused in a graduate course is offered, and recommendations are provided for faculty who wish to integrate SL projects with the goal of improving teaching and learning in their college courses

An Evolutionary Analysis of Membrane-Associated Guanylate Kinase Protein Family

Gene families come into being through gene and/or genome duplication followed by mutation over time which results in the evolutionarily-related genes having somewhat different nucleotides, amino acids, gene structure, and functions. The membrane-associated guanylate kinase protein family has twelve members in humans: DLG1, DLG2, DLG3, DLG4, CASK, MPP1, MPP2, MPP3, MPP4, MPP5, MPP6, and MPP7. This gene/protein family is characterized by the presence of three specific protein domains: PDZ, SH3, and GUK, all of which aid in protein-protein interactions. These proteins are known to interact with cytoskeletal proteins and also are involved in signal transduction. A characteristic member of this family is the DLG3 gene, is responsible for encoding a synapse associated protein (SAP102). The goal of this study was to better understand the evolutionary relationships among the protein/gene family members. To attain this goal, two evolutionary investigations were undertaken. First, phylogenetic trees, which are the traditional method of analysis, were constructed using the amino acids. This analysis indicated evidence for three distinct sub-groups: group A contained CASK, MPP1, MPP2, MPP6; group B contained MPP3, MPP4, MPP5, MPP7; and group C contained DLG 1, DLG2, DLG3, DLG4. Next, the phylogenetic relationship based on the exon structure was undertaken. Briefly, multiple alignments were combined exon boundary information to generate a visual map of similarities and differences in exon structure among the gene family members. This visualization and its comparison to the traditional phylogenetic analysis will be presented

Coordination of Care for Breast Reconstruction Patients: A Provider Survey

OBJECTIVES: Communication between medical oncologists (MOs) and plastic surgeons (PSs) is important to optimize outcomes for patients with breast cancer seeking breast reconstruction. We sought to evaluate the knowledge MOs and PSs have of each others' fields, roles expected of each other, and frequency of communication. METHODS: A cross-sectional survey was conducted in a convenience sample of MOs and PSs. The survey included knowledge questions about reconstruction and chemotherapy, questions about provider and patient responsibilities for timely chemotherapy initiation, and questions about communication with other specialties. RESULTS: MOs and PSs had similar knowledge scores (MOs, 59%; PSs, 56%; P = .5), but both lacked knowledge about aspects of the other specialty's field related to breast reconstruction. The MOs and PSs agreed on the MOs' degree of responsibility for timely chemotherapy initiation (MOs mean, 4.6; PSs mean, 4.4 (out of 5); P = .2). However, they disagreed about the PS's responsibility for timely chemotherapy initiation (MOs mean, 3.8; PSs mean, 3.0; P = .01). Communication occurred about 2.5 times more often for patients with complications than patients without complications (P < .0001). CONCLUSION: MOs and PSs have deficits in knowledge about each other fields and differ in their opinion regarding the burden of responsibility in ensuring timely chemotherapy initiation, suggesting room for improvement in communication and understanding

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

A Multidisciplinary Breast Cancer Brain Metastases Clinic: The University of North Carolina Experience

Breast cancer brain metastasis (BCBM) confers a poor prognosis and is unusual in requiring multidisciplinary care in the metastatic setting. The University of North Carolina at Chapel Hill (UNC-CH) has created a BCBM clinic to provide medical and radiation oncology, neurosurgical, and supportive services to this complex patient population. We describe organization and design of the clinic as well as characteristics, treatments, and outcomes of the patients seen in its first 3 years

A framework for human microbiome research

A variety of microbial communities and their genes (the microbiome) exist throughout the human body, with fundamental roles in human health and disease. The National Institutes of Health (NIH)-funded Human Microbiome Project Consortium has established a population-scale framework to develop metagenomic protocols, resulting in a broad range of quality-controlled resources and data including standardized methods for creating, processing and interpreting distinct types of high-throughput metagenomic data available to the scientific community. Here we present resources from a population of 242 healthy adults sampled at 15 or 18 body sites up to three times, which have generated 5,177 microbial taxonomic profiles from 16S ribosomal RNA genes and over 3.5 terabases of metagenomic sequence so far. In parallel, approximately 800 reference strains isolated from the human body have been sequenced. Collectively, these data represent the largest resource describing the abundance and variety of the human microbiome, while providing a framework for current and future studies

Application of Latent Variable Methods to the Study of Cognitive Decline When Tests Change over Time

The way a construct is measured can differ across cohort study visits, complicating longitudinal comparisons. We demonstrated the use of factor analysis to link differing cognitive test batteries over visits to common metrics representing general cognitive performance, memory, executive functioning, and language