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Increasing Colorectal Cancer Screening Adherence: A Scoping Review
Get PDFPurpose/Background Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Rates have steadily increased in recent years due to high rates of obesity, smoking, and sedentary lifestyles. Screening for the disease can lead to early detection and reduced morbidity/mortality, yet screening rates remain low. Existing literature is extensive in discussing methods to increase CRCS adherence; therefore, a scoping review allows for increased understanding of barriers to CRCS and how to address those barriers to increase screening compliance.
Methods A literature search was completed from September 2020 to October 2021. Multiple databases were used, including SCOPUS, CINAHL Complete, Science Direct, Medline, Discovery Search, and PubMed. The main search term was “colorectal cancer,” and keywords such as “adherence,” “compliance,” “benefits,” “barriers,” and “methods” were added to narrow the results. Studies eligible for the scoping review were those published from the year 2011 to 2021, full-text, peer-reviewed, and written or translated to English.
Results Investigators found a variety of sources: one qualitative study, three randomized controlled trials, one retrospective single-center study, one scoping review, two surveys, and lastly, several discussion-based articles about increasing CRCS. 66.7% of the articles increased CRCS. 91.7% of the articles had new methods to increase CRCS rates. 75% of the articles achieved improved patient perception of CRCS. 91.7% of the articles discussed educating about the importance of CRCS.
Implications for Nursing Practice This scoping review offers a foundation for future research. Specifically, the next steps for CRCS research would involve developing a PICOT, conducting a systematic review, and then making recommendations for practice. This would provide specific insight into studies that have been conducted on increasing CRCS. While there is certainly room for further research in this area of medicine, providers can begin increasing CRCS rates based on the interventions we proposed
Advantages of Early Utilization of Palliative Care in the Pediatric ICU: A Scoping Review
Get PDFAbstract Purpose/Background Despite the increased use of palliative care in adults, only a tiny percentage of children with life-limiting illnesses or life-threatening conditions receive palliative care before dying. Palliative care has low utilization, and consults are often made late in a child’s hospitalization or diagnosis. Palliative care remains underutilized among hospitalized pediatric patients resulting in unnecessary treatments, costly and lengthy hospitalizations, and deaths occurring in the intensive care unit (ICU) rather than at home. The purpose of this scoping review is to evaluate current literature to determine the use and effect of pediatric palliative care, specifically, whether consultation of palliative care for pediatric patients cared for in the inpatient setting for at least three days decreases death in the ICU setting.
Methods A literature search was conducted using an online database utilizing MeSH headings from 2013 until 2021. Eligibility criteria included peer-reviewed articles from any country but available in English. An annotated literature table was developed to synthesize findings. A critical appraisal tool was then used to narrow the six articles for scoping review.
Results Literature analysis noted that early palliative care involvement could affect mortality, patient and family quality of life, and financially impact hospitals. Palliative care was shown to reduce mortality in the ICU, shift the location of death out of ICU, and provide cost savings to hospitals from unnecessary treatments, and decrease hospitalizations.
Implications for Nursing Practice The scoping review yields insight into the utilization of pediatric palliative care and how it reduces mortality in the ICU and at the same time there are cost savings to hospitals. The adaptation of clear consult criteria has the potential to increase palliative care use in children and be beneficial to children, their families, and to hospitals
Using a Food Insecurity Screening Tool in the NICU
Get PDFPurpose/Background: Infants admitted to the NICU are disproportionately born to low-income families. This, combined with unique financial challenges of their long-term stay, may predispose caregivers to food insecurity (FI). FI among caregivers has far reaching implications for the health of infants who are already vulnerable related to comorbidities from their NICU stay.
Methods: Using the Iowa model to successfully engage key stake holders and begin a small pilot study, a randomized preintervention chart audit was performed (n=30) to evaluate if FI was identified by NICU Social Worker (SW). The FI screening tool was administered by nursing to a separate group of randomly selected families (n=30). If FI was identified, resources were provided to those families to assist with respite from FI. Comparison of the two groups was made to determine if a larger percentage of families were identified as having FI with the screening tool.
Results: The preintervention chart audit identified 36% (n=11) of families with FI. The standardized FI screening tool yielded 40% (n=12) of families with FI. Families who identified as having FI by SW showed that 34.6% of respondents who identified as white had FI and 33% of respondents who identified as Black had FI. Conversely, the FI screening tool showed that 37.5% of respondents who identified as white had FI and 50% of respondents who identified as Black had FI
Implications for Nursing Practice: Screening for FI should become routine practice in the NICU. This in combination with the administration of resources to alleviate FI among caregivers should be considered. Further research needs to be performed to evaluate effectiveness of interventions among families and infants
Transferring Patients to a Higher Level of Care
Get PDFThe purpose of this study is to determine whether the transfer of critically ill patients, who require a higher level of care, to another facility impacts morbidity and mortality within 24-72 hours post transfe
A Neurophysiological Investigation of Listening Effort in Normal Hearing Adults Using fNIRS and Pupillometry
Get PDFReal-world conversations are often accompanied by some sort of interference that challenges the clarity of the speaker’s message, causing listeners to exert more effort to understand speech. Previous research has demonstrated that when listening to speech becomes difficult, various regions of the brain are recruited beyond those which engage during optimal listening conditions. However, the neural correlates that underly listening effort are not fully understood. Importantly, the pupillary response can be used to index listening effort, such that pupil size increases with increasing cognitive demand. I proposed that pupillometry can be used to characterize the cortical response, such that changes in pupil size would be associated with neural activation that directly relates to effortful processing. The primary goal of this study was to investigate the physiological mechanisms underlying recognition of realistic cochlear implant (CI) speech simulations (i.e., vocoded speech) and examine how effort might be alleviated with access to semantic information. To achieve this, I implemented a speech recognition task and manipulated the semantic content of the sentence (Predictability), spectral degradation (Speech Quality), and the way participants reported their response (Task Mode). Concurrent measurements of speech recognition, pupillary responses, and cortical activation via functional near infrared spectroscopy (fNIRS) were recorded from 41 normal hearing (NH) adults. As expected, challenging vocoded speech resulted in larger pupil sizes than did non-vocoded speech, and use of semantic information reduced listening effort. Interestingly, the largest exertion of listening effort was produced after the sentence presentation ended. Neural data revealed Predictability effects in frontal, temporal, and parietal cortices, such that activation in frontal regions responded to higher-level semantic representations of speech, and posterior brain regions were more sensitive to Task Mode which modulated the cortical mechanisms used to resolve Predictability. Positive correlations between the strength of the neural response and peak pupil response were observed in the Middle Frontal Gyrus (MFG) and Inferior Parietal Cortex (IPC), revealing cortical regions related to listening effort. Surprisingly, pupil size just prior to the sentence onset positively predicted individual speech recognition score, suggesting that the degree to which participants were engaged (or prepared) at the start of the trial predicted their overall speech recognition performance. On the other hand, pupil size right after sentence offset was negatively associated individual capacity to exploit semantic information, suggesting that listeners with smaller improvement from Low- to High-Predictability conditions had engaged more effort after the sentence was presented. Overall, the findings presented here indicate that the MFG and IPC carry out cortical mechanisms related to effortful processing, and listeners with a stronger MFG response were more impacted by the degraded listening conditions as they exhibited more effort (larger pupil size) and lower benefit in performance from semantic information. Therefore, it appears that the effect of listening effort on communication (i.e., speech recognition score and semantic capacity) is determined by the individual physiological response of the listener
Comparison of a Dynamic Ankle Orthosis to a Walking Boot for Preserving Ankle Joint Motion and Reducing Tibial Bone Load and Strain
Get PDFTibial stress fractures are a common overuse injury accounting for 21.9 – 69% of stress fractures among runners and 24 – 51.2% of stress fractures in military cadets. Current treatment involves wearing a walking boot for 3 – 12 weeks, which limits ankle motion and causes lower limb muscle atrophy. A Dynamic Ankle Orthosis (DAO) provided a distractive force that offloaded the ankle and retained sagittal ankle excursion during walking. It remains unclear how tibial loading is affected by a walking boot or the DAO. This thesis presents a feasibility study confirming the offloading effects of the DAO on tibial loads and Achilles tendon forces during treadmill walking, and a cadaveric study evaluating the offloading effects of the DAO on distal tibia strain. The objective of study 1 was to determine the effects of the DAO and walking boot on tibial compressive force and ankle motion during treadmill walking. Twenty healthy young adults walked on a split-belt instrumented treadmill at 1.0 m/s in two brace conditions: DAO and walking boot. A 3D motion capture system recorded kinematic data, force treadmill recorded ground reaction forces, and vertical force insoles measured in-shoe vertical reaction force. Kinetic and kinematic variable calculations were used to determine the peak tibial compressive force. Target offloading of the DAO was 10% body weight. The DAO moderately reduced peak tibial compressive force (10.9%) and Achilles tendon force (12%) compared to the walking boot. Sagittal plane ankle motion during stance phase was largely reduced by 54.9% in the walking boot compared to the DAO. The objective of study 2 was to evaluate changes in strain magnitude due to the offloading effect of the DAO on tibial bone mechanics compared to standard-of-care walking boot using fresh frozen cadaver specimens. Three fresh frozen cadaver legs were placed in a robotic testing platform and dynamically loaded to 900N at a rate of 3.2mm/s in the DAO and walking boot. Linear strain gauges were attached to the distal tibia and midshaft tibia to measure the compressive strain at specific points along the longitudinal axis of the tibia. Vertical force sensing insoles measured in-shoe vertical reaction force. Target offloading of the DAO was 10% of the applied load. Peak strain was significantly reduced at the distal tibia (23.31%) wearing the DAO compared to the walking boot. Pearson correlations showed moderate to strong negative linear relationship between the compressive strain and vertical reaction force measurements within subjects at both the distal and midshaft tibia. These findings indicate the DAO moderately reduced tibial compression force and Achilles tendon force while providing greater sagittal ankle excursion compared to a walking boot. In addition to reproducing similar strain data to previous literature, the DAO strongly reduced the peak strain primarily at the distal tibia as well as reduced vertical reaction force. Moderate to strong linear correlations occurred between the external vertical reaction force and internal strain magnitude. This body of work provides evidence that the DAO could function as an alternative rehabilitation device for treating tibial stress fractures by reducing bone strain and tibial loading during walking
Review: Management of midshaft clavicle fractures in adolescents
Get PDFClavicle fractures are common injuries that occur across all age ranges, but are largely seen in young, active males. The majority of these fractures (70-80%) occur in the midshaft of the clavicle. The purpose of this review was to compare non-operative treatment to operative treatment of midclavicular fractures and determine whether treatment for adolescent clavicle fractures more closely aligns with pediatric or adult management. Adolescent clavicle fractures are increasingly treated with open reduction and internal fixation, especially in the 15 to 19 age group. Nevertheless, there remains a lack of high-level studies comparing outcomes of operative and conservative treatment specifically for the adolescent population to justify this recent trend. These findings expose the need for a prospective study to provide a framework for treatment, and they suggest that physicians have become overaggressive in their management of mid-shaft clavicle fractures in adolescents
Impact of Social Determinants of Health on Adherence to Urinary Tract Infection Treatment Recommendations: A Scoping Review
Get PDFPurpose/Background: Pediatric health is significantly affected by social determinants of health. Screening for and addressing social determinants of health helps to decrease negative effect on health outcomes. The purpose of this project is to determine if there is an association between addressing or not addressing social determinants of health by the healthcare provider and parents’ adherence to treatment recommendations in children with urinary tract infections.
Methods: Between October 2020 and November 2021, a literature review was performed to obtain data from studies regarding urinary tract infections, social determinants of health and adherence to treatment recommendations. The University of Tennessee Health Science Center (UTHSC) online databases, Pubmed, CINAHL, Medline and EBSCO were used to obtain data using the search terms listed above and others. Using these methods and a modified version of the PICOT question, “In children who experience urinary tract infections, how do provider inquiries regarding social determinants of health affect caregiver adherence to treatment plans?”, data were obtained from relevant articles. The primary goal was to determine if addressing or not addressing social determinants of health affected treatment adherence in patients with urinary tract infections.
Results: During research and data collection, 13 articles were cited and consisted of cross sectional surveys, controlled trials without randomization, randomized controlled trials, quality improvement projects, case controlled/case-case study and an expert panel report. Four articles maintain a positive relationship between race/ethnicity, socioeconomic status and risk of urinary tract infection. Also, comprehensive education of parents on urinary tract infections improves outcomes.
Implications for Nursing Practice: Provider screening for and addressing social determinants of health can help mitigate the negative effects of these social determinants of health on the family. This and equipping parents with knowledge will also help in the care of their children with urinary tract infection
Annual Hepatitis C Screening QI: A Scoping Review
Get PDFPurpose/Background Despite the surge in HCV prevalence among pregnant women and the threat of perinatal HCV transmission, infants exposed to HCV in the United States are inadequately screened (Chappell et al., 2018). It is estimated that between 4% and 8% of babies exposed to HCV during pregnancy become infected (Watts et al., 2017). Incorporating Hep C screening with other mandated prenatal screening will play an essential role in reducing the complications associated with Hep C transmission to the newborn.
Methods Article search was done in the first three weeks of the fall 2021 semester, and a total of 63 articles were screened to exclude those that only focused on men (N=2) and women who were not pregnant (N=5). Six final articles were selected for scoping review, comparing the outcomes of women between 18 and 35 years of age who were at high risk of HCV and who received prenatal HCV screening to those who were not screened. The study further explores the health outcome associated with early detection of HCV in high-risk pregnant women and the vertical transmission rate from mother to newborn baby.
Results According to the reviewed studies, early screening and prompt treatment during pregnancy can prevent most mother-to-child transmissions and thus most childhood cases of HCV. Interventions and outcomes noted in the articles selected are to increase screening in infants at risk for perinatal HCV acquisition by including technology to improve the transfer of maternal HCV status to the pediatric record and increase pediatric provider awareness regarding HCV screening guidelines.
Implications for Nursing Practice The studies demonstrate that universal HCV screening is efficient, cost-effective, and beneficial when long-term needs are present (Baranoski, 2016). Following the recommendations, universal HCV screening with HCV antibodies and reflex HCV RNA testing may soon become standard practice in the United States. Therefore, it is imperative to review and incorporate this into the curriculum and training proactively.
References
Baranoski, A. S., Cotton, D., Horsburgh, C. R., Kubiak, R. W., Heeren, T., Nunes, D. (2016). Clinical liver disease progression among hepatitis C infected drug users with CD4 cell count less than 200 cells/mm3 is more pronounced among women than men. Open Forum Infectious Diseases, 3(1). https://doi-org.ezproxy.uthsc.edu/10.1093/ofid/ofv214.
Chappell, C. A., Hillier, S. L., Crowe, D., Meyn, L. A., Bogen, D. L., & Krans, E. E. (2018). Hepatitis C Virus Screening Among Children Exposed During Pregnancy. Pediatrics, 141(6), e20173273. https://doi.org/10.1542/peds.2017-3273.
Watts, T., Stockman, L., Martin, J., Guilfoyle, S., & Vergeront, J. M. (2017). Increased Risk for Mother-to-Infant Transmission of Hepatitis C Virus Among Medicaid Recipients - Wisconsin, 2011- 2015. MMWR. Morbidity and mortality weekly report, 66(42), 1136–1139. https://doi.org/10.15585/mmwr.mm6642a
A Rodent Animal Model for Forelimb to Lower Jaw Reorganization in Primary Somatosensory Cortex (SI) Barrel Field
Get PDFThe goal of this study is to examine mechanisms underlying cortical reorganization in rat primary somatosensory (SI) cortex that follows forelimb deafferentation. The majority of human patients suffering from limb loss or brachial plexus avulsion injury, as well as patients that receive brachial plexus anesthesia, report phantom limb sensations/pain which are often associated with cortical reorganization. Patients with upper-limb deafferentation report sensations of the missing hand during tactile stimulation of the face, and this phenomenon has been termed hand-to-face remapping. We sought to develop a rodent model of deafferentation; our model system is the rat SI cortex barrel field present at the cortical layer IV, where neural cell clusters, called barrels, represent localized regions of the skin surface. The forepaw barrel subfield (FBS), consisting of approximately 26 barrels, receives somatotopically organized input from the contralateral glabrous and hairy skin surfaces of the forepaw. When input from the forelimb is no longer available following limb amputation, brachial plexus nerve cut or brachial plexus anesthesia, neurons in the deafferented FBS begin responding to previously unexpressed input from the lower jaw; here, we define this phenomenon as hand-to-face cortical reorganization. In this dissertation, electrophysiological mapping of SI was used to examine hand-to-face cortical reorganization in the FBS. Immediately following each type of deafferentation, lower jaw input became expressed in the rostral part of the FBS; conversely, 9-to-27 weeks after limb amputation, lower jaw input became expressed throughout the entire FBS. Anatomical tracers were used to explore the source(s) of the newly expressed lower jaw input in the deafferented rostral and caudal FBS. We identified a corticocortical projection from the neighboring lower jaw barrel subfield (LJBSF) to the rostral part of the FBS and speculate that the caudal FBS is served by a subcortical source. The present study, along with ongoing work in our lab, documents cortical reorganization in a rodent animal model, explores the source(s) of the newly expressed input, and speculates on cortical and subcortical mechanisms underlying reorganization. The goal of experiment group one was to study the lower jaw skin representation at rat somatosensory cortex (SI) as an essential first step for understanding its possible role in cortical reorganization. We performed an electrophysiology mapping of the lower jaw barrel subfield (LJBSF) in SI of Sprague-Dawley rats. In order to analyze the whole area, carbon fiber electrodes were used to record single and multiple unit responses within the layer IV of the LJBSF. Analysis of the lower jaw skin surface was performed in order to have a precise nomenclature of the skin surface to relate the structural (morphological) organization to the functional organization (physiological map) of the lower jaw in layer IV of SI. The goal of experiment group two was to report the phenomenon of hand-to-face remapping after a transient peripheral lesion (brachial plexus nerve cut, forelimb amputation) or nerve block (brachial plexus nerve anesthesia), and a permanent lesion (forelimb amputation) to study rapid remapping or delayed in time respectively. Electrophysiology mapping of the FBS was done in rapid remapping before and immediately after the forelimb deafferentation; for delayed remapping the FBS map and analysis of hand-to-face phenomenon were done after 9-to-27 weeks of the forelimb deafferentation. The goal of experiment group three was to examine the possible role of intra cortical and subcortical connections between the lower jaw and forepaw representations that likely underlies the rapid and delayed hand-to-face cortical reorganization respectively. Neural tracers, Biotinylated Dextran Amine (BDA) and Cholera Toxin B (CT-B) were used to analyze intrinsic connectivity between LJBSF and FBS areas, and also possible thalamocortical connectivity between ventral posteromedial nucleus (VPM) and LJBSF-FBS areas. In conclusion, in this study we developed a rodent animal model to study hand to face reorganization in SI using deafferentations similar to those observed in the clinic. We used anatomical tracers to examine the source(s) of the observed reorganization. Our study, may provide insight in understanding hand-to-face reorganization in humans, where we think that this may be useful for understanding cortical reorganization following major limb amputation in humans