Effects of Pediatric Fever Education on Caregivers in the Emergency Department

Fever in children is a common concern for parents and one of the most frequent presenting complaints seen in the emergency department (ED). Fever can be defined as a temperature above 100.4 degrees Fahrenheit. Fever is considered a normal response to many conditions, with the most common one being infection (Ward, 2019). The biggest issue seems to be a lack of understanding by the caregivers on how to measure temperature, treat fever, and when to be concerned about temperature reading. Educating caregivers may enhance their self-management and sense of control, reduce healthcare-seeking behavior, and lower antibiotic prescriptions. The purpose of this evidence-based project was to design and implement a pediatric fever education program to present in the emergency department setting to increase recognition and the use of appropriate antipyretic treatments in the home setting, decrease caregiver anxiety and fever phobia, and improve their satisfaction with the information provided to them during their emergency department visit. The pre-education questionnaire, brochure, post-education questionnaire, and survey were utilized to measure and enhance the caregivers’ knowledge by providing them with information explaining the definition of fever, signs, and symptoms of fever, when to call the doctor or go to the emergency room, how to treat the child’s fever, how to take the child’s temperature, how to use a thermometer, and a brief explanation on febrile seizures. A standard approach to caregiver education regarding pediatric fever is not currently available in this rural emergency department setting. The education protocol was carried out over a 30-day period with caregivers of pediatric patients ages 6 months-10 years who presented to the emergency department with a chief complaint of fever. The results of the intervention show overall the caregivers were satisfied and had less anxiety about fever with the information provided via the brochure and reassurance of the DNP student. An executive summary was given to the emergency department medical director and nurse manager of the findings. After the executive summary was provided, the director and manager report future consideration of implementing this protocol in the ED

Increasing Palliative Medicine Presence in Heart Failure Admissions

The Palliative Medicine team at a 182-bed hospital in a suburban area desired to grow its presence in the heart failure population by increasing consultation rates. A DNP project created at the site included the Palliative Medicine team, telemetry unit staff, and a quality improvement team. Using a Palliative Medicine Screening Tool for Heart Failure (PM-HF) by the nursing staff and overnight admission review by the group’s nurse coordinator, heart failure admissions were screened for potential needs. During the implementation process, sixty-four patients were reviewed by unit staff and sixty-three were reviewed by the Palliative Medicine nurse coordinator. Eighteen consultations were obtained from the 127 total reviews. Compared to the previous 6-month period prior to implementation, the Palliative Medicine team improved 19.8% regarding involvement in heart failure-related admissions. Due to the COVID-19 pandemic that occurred during project implementation, overall Palliative Medicine consultations for all diagnoses decreased by 1.3%. This project served the Palliative Medicine team and the hospital by highlighting gaps in delivery of heart failure-related care and opportunities for increased Palliative Medicine involvement. The PM-HF tool can be modified to include other diagnoses for future study and hospital quality improvement staff are reviewing ways to impact heart failure care based on this project’s findings. The addition of a Heart Failure Navigator to hospital staff would assist in providing excellent education and support for patients as well as encourage early identification of patients admitted with heart failure that have Palliative Medicine needs.D.N.P

What you know makes a difference: Physical activity maintenance and adherence of collegiate students

For decades, exercise psychology researchers dismissed health/exercise knowledge as a determinant of physical activity (PA). We sought to overturn this misconception, showing that psychological theory may serve as a basis for informing physical education curriculum. Based on social cognitive and self-determined motivation theories, we examined health/exercise knowledge as a determinant of collegiate students’ PA maintenance (i.e., ≥ 6 months of regular PA involvement); adherence to United States Department of Health and Human Services (USDHHS) 2008 PA guidelines; and PA types (i.e., aerobic, weight training). Collegiate students (n = 231) provided data via online survey. ANOVA analyses revealed that knowledge scores differentiated: a) participants in the maintenance stage from non-active participants (medium effect size); b) guideline adherents from non-adherents (medium-large effect size); and c) engagement in both PA types compared to only aerobic (large effect size). Males reported significantly higher perceived knowledge than females (medium-large effect size) though actual scores were not significantly different. This study provided evidence that knowledge is relevant to collegiate students’ PA. Future research may aid physical educators in determining knowledge types, based on psychological theory, that increase PA maintenance/adherence

Effects on Initial Fixation of Cementless Tibial Trays in Total Knee Arthroplasty

Bone mineral density (BMD), among other factors, largely effect the initial stability of the cementless tibial tray component in a total knee replacement (TKR), where increased motion at the tray-bone interface hinders bony ingrowth. With a lack of bony ingrowth, the cementless implant will not experience long-term success. Understanding which factors influence initial stability yields insight into surgical technique considerations and help inform a surgeon’s implant choice. The objective of this study was to evaluate factors influencing the initial stability of cementless tibial trays using a 6-degree of freedom (6-DOF) robotic joint simulator, the AMTI VIVO, and combined loading scenarios replicating physiological loads experienced in vivo such as gait, stair descent and deep knee bending cycles. Prior to testing, cadaveric tibia were implanted with either cementless DePuy Attune RP, cementless DePuy Attune FB or cementless Stryker Triathlon FB and were impacted with either a traditional mallet or the Kincise, an automated surgical impaction device by a board certified orthopaedic surgeon. Medial, central and lateral markers were then placed on the anterior portion of the tibia and tibial tray to accurately measure displacements using a Digital Image Correlation (DIC) camera and software. Preoperative CT scans of the tibia were used to perform a virtual surgery on the specimen, and the segment of the tibial bone from the proximal cut to the distal tip of the tray’s central cone were isolated. This tibial segment was meshed with 0.8-mm tetrahedral elements (Hypermesh, Altair, Troy, MI) and Hounsfield units for each element were extracted from the DICOM using custom Matlab scripting and converted to bone mineral density using the known densities of the phantom. The ratio of tray coverage, the tibial plateau area of the tray within the peripheral border, was approximated and evaluated as a potential factor influencing initial stability. BMD was found to be a strong contributing factor to initial stability, especially for RP tibial trays. Conversely, tray coverage was not a strong contributing factor. The Kincise yielded positive results as compared to the mallet for tibia with high BMD values and tibia implanted with RP tibial trays. These findings assist in reforming surgical technique and help discern variables a surgeon should consider when selecting the optimal implant for a patient

A Meta-Analysis of Functional Magnetic Resonance Imaging Studies of Divergent thinking using Activation Likelihood Estimation

There are conflicting findings regarding brain regions and networks underpinning creativity, with divergent thinking tasks commonly used to study this. A handful of meta‐analyses have attempted to synthesise findings on neural mechanisms of divergent thinking. With the rapid proliferation of research and recent developments in fMRI meta‐analysis approaches, it is timely to reassess the regions activated during divergent thinking creativity tasks. Of particular interest is examining the evidence regarding large‐scale brain networks proposed to be key in divergent thinking and extending this work to consider the role of the semantic control network. Studies utilising fMRI with healthy participants completing divergent thinking tasks were systematically identified, with 20 studies meeting the criteria. Activation Likelihood Estimation was then used to integrate the neuroimaging results across studies. This revealed four clusters: the left inferior parietal lobe; the left inferior frontal and precentral gyrus; the superior and medial frontal gyrus and the right cerebellum. These regions are key in the semantic network, important for flexible retrieval of stored knowledge, highlighting the role of this network in divergent thinking.A meta‐analysis of fMRI studies into divergent thinking, with a comparison to default mode, multiple demand and semantic control networks. This found four clusters; the left inferior parietal lobe; the left inferior frontal and precentral gyrus; the superior and medial frontal gyrus and the right cerebellum. The largest overlap is with the semantic control network, highlighting the role of this network in divergent thinking

The value of prognostic ultrasound features of breast cancer in different molecular subtypes with a focus on triple negative disease

The ultrasound (US) features of breast cancer have recently been shown to have prognostic significance. We aim to assess these features according to molecular subtype. 1140 consecutive US visible invasive breast cancers had US size and mean stiffness by shearwave elastography (SWE) recorded prospectively. Skin thickening (> 2.5 mm) overlying the cancer on US and the presence of posterior echo enhancement were assessed retrospectively while blinded to outcomes. Cancers were classified as luminal, triple negative (TN) or HER2 + ve based on immunohistochemistry and florescent in-situ hybridization. The relationship between US parameters and breast cancer specific survival (BCSS) was ascertained using Kaplan–Meier survival curves and ROC analysis. At median follow-up 6.3 year, there were 117 breast cancer (10%) and 132 non-breast deaths (12%). US size was significantly associated with BCSS all groups (area under the curve (AUC) 0.74 in luminal cancers, 0.64 for TN and 0.65 for HER2 + ve cancers). US skin thickening was associated most strongly with poor prognosis in TN cancers (53% vs. 80% 6 year survival, p = 0.0004). Posterior echo enhancement was associated with a poor BCSS in TN cancers (63% vs. 82% 6 year survival, p = 0.02). Mean stiffness at SWE was prognostic in the luminal and HER2 positive groups (AUC 0.69 and 0.63, respectively). In the subgroup of patients with TN cancers receiving neo-adjuvant chemotherapy posterior enhancement and skin thickening were not associated with response. US skin thickening is a poor prognostic indicator is all 3 subtypes studied, while posterior enhancement was associated with poor outcome in TN cancer

Molecular line profiles as diagnostics of protostellar collapse: modelling the `blue asymmetry' in inside-out infall

The evolution of star-forming core analogues undergoing inside-out collapse is studied with a multi-point chemodynamical model which self-consistently computes the abundance distribution of chemical species in the core. For several collapse periods the output chemistry of infall tracer species such as HCO+, CS, and N2H+, is then coupled to an accelerated Lambda-iteration radiative transfer code, which predicts the emerging molecular line profiles using two different input gas/dust temperature distributions. We investigate the sensitivity of the predicted spectral line profiles and line asymmetry ratios to the core temperature distribution, the time-dependent model chemistry, as well as to ad hoc abundance distributions. The line asymmetry is found to be strongly dependent on the adopted chemical abundance distribution. In general, models with a warm central region show higher values of blue asymmetry in optically thick HCO+ and CS lines than models with a starless core temperature profile. We find that in the formal context of Shu-type inside-out infall, and in the absence of rotation or outflows, the relative blue asymmetry of certain HCO+ and CS transitions is a function of time and, subject to the foregoing caveats, can act as a collapse chronometer. The sensitivity of simulated HCO+ line profiles to linear radial variations, subsonic or supersonic, of the internal turbulence field is investigated in the separate case of static cores.Comment: Accepted to MNRAS; 20 pages, 13 fig

Pharmacotherapy in Coronavirus Disease 2019 and Risk of Secondary Infections: A Single-Center Case Series and Narrative Review

OBJECTIVES: Since the onset of the coronavirus disease 2019 pandemic, immune modulators have been considered front-line candidates for the management of patients presenting with clinical symptoms secondary to severe acute respiratory syndrome coronavirus 2 infection. Although heavy emphasis has been placed on early clinical efficacy, we sought to evaluate the impact of pharmacologic approach to coronavirus disease 2019 within the ICU on secondary infections and clinical outcomes. DATA SOURCES: PubMed (inception to March 2021) database search and manual selection of bibliographies from selected articles. STUDY SELECTION AND DATA EXTRACTION: Articles relevant to coronavirus disease 2019, management of severe acute respiratory syndrome coronavirus 2-associated respiratory failure, and prevalence of secondary infections with pharmacotherapies were selected. The MeSH terms COVID-19, secondary infection, SARS-CoV-2, tocilizumab, and corticosteroids were used for article identification. Articles were narratively synthesized for this review. DATA SYNTHESIS: Current data surrounding the use of tocilizumab and/or corticosteroids for coronavirus disease 2019 management are limited given the short follow-up period and conflicting results between studies. Further complicating the understanding of immune modulator role is the lack of definitive understanding of clinical impact of the immune response in coronavirus disease 2019. CONCLUSIONS: Based on the current available literature, we suggest prolonged trials and follow-up intervals for those patients managed with immune modulating agents for the management of coronavirus disease 2019

Bitopic binding mode of an M1 muscarinic acetylcholine receptor agonist associated with adverse clinical trial outcomes

The realisation of the therapeutic potential of targeting the M1 muscarinic acetylcholine receptor (M1 mAChR) for the treatment of cognitive decline in Alzheimer's disease has prompted the discovery of M1 mAChR ligands showing efficacy in alleviating cognitive dysfunction in both rodents and humans. Among these is GSK1034702, described previously as a potent M1 receptor allosteric agonist, which showed pro-cognitive effects in rodents and improved immediate memory in a clinical nicotine withdrawal test but induced significant side-effects. Here we provide evidence using ligand binding, chemical biology and functional assays to establish that rather than the allosteric mechanism claimed, GSK1034702 interacts in a bitopic manner at the M1 mAChR such that it can concomitantly span both the orthosteric and an allosteric binding site. The bitopic nature of GSK1034702 together with the intrinsic agonist activity and a lack of muscarinic receptor subtype selectivity reported here, all likely contribute to the adverse effects of this molecule in clinical trials. We conclude that these properties, whilst imparting beneficial effects on learning and memory, are undesirable in a clinical candidate due to the likelihood of adverse side effects. Rather, our data supports the notion that "pure" positive allosteric modulators showing selectivity for the M1 mAChR with low levels of intrinsic activity would be preferable to provide clinical efficacy with low adverse responses