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Evaluating the Efficacy of Discharge Education on Readmission Rates in Pediatric Patients with Chronic Conditions: A Scoping Review
Full text linkAbstract Assignment
Purpose/Background
Children with multiple chronic health conditions account for a significant portion of hospital readmission and healthcare expenses. A scoping review was completed to analyze and summarize the available research regarding the effectiveness of discharge education on readmission rates and associated outcomes in children with chronic conditions. The following PICOT question was created: In pediatric patients with chronic disease, how does a discharge education bundle compared to no discharge education bundle affect readmission rates within 30 days of discharge?
Methods
A systematic approach was utilized for analysis to determine article eligibility. The initial search yielded 30 articles; however, through critical appraisal 10 articles met specified criteria. The types of available evidence were mainly a mix of meta-analyses, systematic reviews, and quality improvement projects. These articles are depicted in the synthesis table to visualize data points of interest including 30-day readmission rates, impacts on healthcare utilization and costs, and the effectiveness of discharge bundle components in reducing readmission rates. Data points of interest were analyzed to evaluate the impact of discharge education practices (discharge education bundle vs no bundle) on 30-day readmission rates in pediatric patients with one or more chronic diseases.
Results
100% of the literature analyzed demonstrated the benefits of a discharge education bundle, whether through verbal or written education or specific elements of the discharge bundle, on readmission rates. Specifically, studies explicitly found decreased healthcare costs (90%), decreased readmission rates (80%), increased patient satisfaction (60%), and reduced healthcare utilization (30%) associated with proper discharge education.
Implications for Nursing Practice
The findings that a discharge education bundle reduces 30-day readmission rates, healthcare utilization, and costs indicate the need for the implementation of core discharge education bundles with specific methods for common chronic pediatric diagnoses. In the future, these results should be used to study the efficacy of the various discharge education methods and protocols to identify the most effective teaching strategies for optimal patient education. Focusing additional research on more specific data will help identify evidence-based education methods to continue improving discharge education bundles and further reduce pediatric hospital readmissions of chronic pediatric patients within 30 days of discharg
Dexmedetomidine as an Adjunct to Local Anesthetics in Neuraxial Anesthesia: A Scoping Review
Full text linkPurpose/Background
Neuraxial anesthesia is key for pain management and comfort during surgery. While local anesthetics and opioids have notable side effects, Dexmedetomidine (DEX) offers a promising alternative. Early studies suggest DEX improves pain control, prolongs anesthesia duration, and reduces opioid-related side effects. This review explores the benefits of incorporating DEX into neuraxial anesthesia for better patient safety and comfort
Methods
This scoping literature review took place from August 2023 to April 2024, utilizing PubMed, CINAHL, Cochrane Library, and Google Scholar for sources. After reviewing over 2,000 abstracts, 25 articles met the inclusion criteria, with nine selected as most relevant. Four were level-one systemic reviews and meta-analyses, while the others were level-two randomized controlled trials. The findings were compiled into an outcomes synthesis table.
Results
Despite variations in the studies, a clear conclusion emerged: using Dexmedetomidine (DEX) in neuraxial anesthesia enhances pain relief and prolongs its duration more effectively than opioid adjuncts. Patients experienced fewer opioid-related side effects, such as nausea and itching, and although hypotension occurred with DEX, its incidence was similar to that of opioids, indicating no greater risk.
Implications for Nursing Practice
Dexmedetomidine is an effective adjuvant for neuraxial anesthesia, enhancing both the quality and duration of spinal and epidural anesthesia. It also reduces some side effects associated with opioids, leading to safer and better patient outcomes
Characterization of Novel Hantaviruses in Paraguay
No full textThe genus Orthohantavirus, is a group of tripartite, negative-sense RNA viruses of which some members are the etiologic agents for hemorrhagic fever with renal syndrome (HFRS) or orthohantavirus cardiopulmonary syndrome (HCPS) in the Old and New Worlds, respectively. Sampling of wild rodents for these viruses has increased our knowledge of their host range and continues to lead to the discovery of new orthohantaviruses species and strains. HFRS and HPS have case fatality rates of up to 15% and 40%, respectively. And in some years, morbidity rates of up to 100,000 cases can be reached, globally. The epidemiological evidence of human-to-human transmission of the South American orthohantavirus, Andes virus (ANDV), suggests the pandemic potential of orthohantaviruses. Orthohantaviruses persist in their rodent hosts for their lifetime without apparent disease although fecundity has been noted. Ecological studies have shown there is a higher odds of male rodent infection than female rodent infection, and epidemiological studies show this likelihood in humans too. While literature suggest sex-based differences, the mechanism driving this is not fully understood. We also do not know how sex might influence the wildlife epidemiology and spread to humans In this thesis, I present an amplicon-based, multiplex RT-PCR and next-generation sequencing strategy that I used to characterize the Juquitiba virus (JUQV) harbored by Oligoryzomys, from rodent field samples collected in Paraguay. Using Bayesian inference and using the sequences that I and others from the Jonsson laboratory obtained, I estimated spatial and temporal evolutionary parameters using BEAST. The results suggest that the JUQV population circulating in rodents in Paraguay is under-sampled. The JUQV population characteristics of the viral genome differ and cluster by geographical location. The BEAST program estimated that the S segments of JUQV have higher substitution and mutation rates than the M segment and that the ancestor of the S segment is more recent (2004) than that of the M segment (1950). Moreover, I found that my analyses suggest that the founder virus is located in the Caaguazú Department of Paraguay. Further sampling will be necessary to verify this proposition. Pseudotyping studies of the JUQV glycoprotein (GP) using the Vesicular Stomatitis Virus (VSV) system were used to investigate the phenotypic consequences of several mutations that showed a negative selecting pressure using a DataMonkey Server that examined all JUQV GP sequences available (unpublished results of Dr. Brianna Spruill-Harrell). Preliminary studies suggest that Q292H and V504I reduced the number of cells infected by each pseudotype when compared to wild (WT) VSV pseudotype, however, only V504I VSV pseudotypes led to a statistically significant reduction in the number of cells. Lastly, I present an additional research approach to accelerate primer design so as to obtain a full reference genome of novel orthohantaviruses. In these studies, I used both vRNA and cRNA primers to amplify the segment from rodent tissue and identify an initial reference genome which is presumably composed of vRNA, cRNA and mRNA. This research will help to accelerate primer design to study the vRNA which is in the virion and transmitted from animal to animal or animal to human. Finally in this thesis, I led review of the research efforts directed toward vaccine development for the prevention of orthohantavirus infection. This research shows that, overall, translation to clinical effectiveness of and pan-protection by vaccine candidates in the human population remains the biggest challenge
Investigating Synovial Fluid Electrochemical Properties Against Orthopaedic Alloys
No full textIntroduction. Cobalt-chromium-molybdenum (CoCrMo) femoral components are widely used in total knee arthroplasty (TKA). However, recent retrospective clinical trials associate moderate adverse local tissue reactions (ALTRs) with CoCrMo release in the knee. Additionally, gaps persist in our understanding of the fundamental corrosion processes that occur at the CoCrMo-synovial fluid interface. The first study investigates the electrochemical behavior of CoCrMo in human synovial fluid obtained at the time of primary TKA, using CoCrMo in phosphate-buffered saline (PBS) as a comparison. The second study compares the synovial fluid properties, both physical and electrochemical, in necropsy TKA and contralateral (native) knee specimens. Methods. In the first study, synovial fluid was collected from 118 patients immediately before arthroplasty (IRB approval number: 16-04802-XP and 21-08403-XP). In the second study, synovial fluid was collected from 20 deidentified pairs of necropsy TKA and native knees (IRB approval number: 22-09069-XP). Synovial fluid volume was recorded for each patient/necropsy specimen Synovial fluid from each respective study was then transferred to a three-electrode electrochemical cell with a wrought CoCrMo alloy working electrode. To quantify electrochemical properties, open circuit potential (OCP), electrochemical impedance spectroscopy (EIS), and linear polarization (LP) tests were run. Specifically for the first study, 10 comparison tests using PBS were run using the same methodology. For the first study, A Welch’s t-test (α=0.05) was used to determine significant differences between human synovial fluid and electrochemical data. A Pearson’s correlation test was used to determine if a correlation existed between the two group’s electrochemical data and to determine if a correlation existed between the human synovial fluid’s pH and electrochemical data. For the second study, a Wilcoxon signed-rank test was performed ot determine differences in the physical and electrochemical properties of human synovial fluid. Results. For the first study, synovial fluid electrochemical properties varied on a patient-by-patient basis and significantly differed (p\u3c 0.05) from comparison tests performed in PBS. In human synovial fluid, OCPs ranged between -0.38 and 0.15 V and corrosion potentials (Ecorr) values ranged between -0.95 and -0.2 V. Additionally, instantaneous corrosion rates (1/Rp) spanned nearly four orders of magnitude. For the second study, synovial fluid volumes from the TKA specimens were significantly higher than in native knee specimens (p=0.0001). Synovial fluid pH was found to be more acidic in the TKA specimens than the native knee specimens (n=15, p=0.048). Significant differences in OCP values were not identified (p\u3e0.05). Approximate instantaneous corrosion rates were significantly higher in TKA specimens than native knee specimens (p=0.007). Conclusion. For the first study, synovial fluid properties varied by a patient-by-patient basis which could suggest that the electrochemical properties of CoCrMo implants may depend on the patient’s local physiological environment, influenced by the biological and chemical components of synovial fluid. The second study compared the physical and electrochemical properties of synovial fluid from necropsy TKA and native knee specimens. In the TKA group, synovial fluid volume and 1/Rp values were significantly higher than their native counterparts. Additionally, the pH tended to be more acidic in the TKA group. Future research will investigate the metal ion content in the synovial fluid to find correlations in metal ion content and the physical and electrochemical properties of synovial fluid
Impact and Effectiveness of PHQ-9 Training for School Counselors on Mental Health Referrals for High School Students
No full textPurpose/Background
Adolescents\u27 mental health has worsened and become a public health issue, with depression being a primary concern. There is an urgent need for early screening, school-based referral pathways, and interventions to address common problems in high schools. Patient Health Questionnaire-9 (PHQ-9) is a validated, evidence-based tool for detecting depression; however, its systematic use in school-based counseling settings through organized training has not been studied for implementation in high schools. This review assesses the current literature on the impact and effectiveness of PHQ-9 training for school counselors on mental health referrals among high school students, with a focus on early identification and referral rates.
Methods
A comprehensive search of peer-reviewed literature was conducted using PubMed, MEDLINE, CINAHL, PsycINFO, Scopus, ScienceDirect, the Cochrane Library, and Google Scholar for studies published between 2016 and 2024. Inclusion criteria targeted peer-reviewed studies involving high school students (ages 14–18) and school counselor training on the PHQ-9, with measurable outcomes related to mental health referral rates and mental health literacy. Non-peer-reviewed studies and those not in English were excluded. Six studies meeting these criteria were evaluated and synthesized.
Results
The findings of the review suggest that PHQ-9 training for school counselors enhances early identification and referral of high school students experiencing symptoms of depression. The results demonstrate that counselors who receive training in using the PHQ-9 are more confident in their screening abilities and are more likely to make mental health referrals.
Implications for Nursing Practice
The PHQ-9 consistently demonstrated reliability, sensitivity, and specificity in screening for depression. Future research should focus on long-term outcomes, expanded PHQ-9 training programs, and the establishment of partnerships between schools and mental health providers to ensure proper follow-up care. Schools should implement mandatory training workshops to enhance counselor readiness and address stigma through awareness campaigns that target both students and parents
Incorporating Social Determinants of Health Into a Screening Tool Using Machine Learning to Predict Lung Cancer Diagnosis Among High Risk Patients
No full textThis research aims to assess the impact of incorporating social determinants of health (SDoH) into prediction screening models for predicting lung cancer among high risk-patients. Lung cancer is typically diagnosed at a later stage when surival and health outcomes are poor. Screening guidelines are currently in place; however, patients at high risk can be missed. There is a need for short-term predictions, to better identify patients at an earlier stage. SDoH features, such as socioeconomic satus, can provide social context that improves identification of patients who might have otherwise been overlooked. The proposed framework includes developing an early detection tool that will incorporate more inclusive criteria for predicting lung cancer while using data that is routinely collected in EHR databases and can be feasibly incorporated into clinical settings. This research demonstrated that including SDoH features within prediction models allows for better identification of patients at risk of developing lung cancer. First, the study assessed the associations social determinants and lung cancer incidence. Specific clinical features, along with higher vulnerability in the SDoH domains of ethnic and minority status and housing type and transportation, were identified as significant features associated with lung cancer. These findings demonstrated that social and environmental factors contribute meaningfully to risk beyond traditional clinical variables. Second, this study developed a screening model for high risk patients, that includes SDoH features. Results showed that adding SDoH to prediction model improves model performance in identifying high risk patients. Lastly, this study evaluated models, with and without SDoH, for algorithmic unfairness across specific subgroups. It was demonstrated that the addition of SDoH to the prediction model improved fairness for some subgroups, but reduced overall performance for others. These findings emphasize the heterogeneous effects of prediction models, demonstrating that while risk identification can be enhanced for some populations, biases may be exacerbated for other populations. This research can help to better identify patients who are at risk at an earlier stage, as well as capture patients who would have traditionally been missed. Early identification of patients at high risk for developing lung cancer will allow clinicians to efficiently implement recognized screening guidelines, identify lung cancer at earlier stages, and ultimately, decrease adverse health outcomes amongst patients with the highest risk of developing lung cancer. Future work could evaluate integration of individual-level SDoH, and assess model performance over a longer follow-up duration
The Impact of the Utilization of Shared Decision-Making Tools in Contraceptive Counseling on Patient Satisfaction in Adolescents: A Scoping Review
Full text linkPurpose/Background
Robust adolescent contraceptive counseling requires deep understanding of the specific context in which adolescents are receiving reproductive health care. As teen pregnancy rates rise, particularly in places across the Deep South, providers must find ways to engage their adolescent patients about their sexual and reproductive health. Professional organizations like the American College of Obstetricians and Gyencologists and the American Academy of Pediatrics both offirm the need for robust contraceptive counseling for adolescents. The purpose of this is to ascertain the impact of utilizing shared-decision making aids during contraceptive counseling on patient satisfaction in adolescent populations.
Methods
A systematic literature review was conducted using CINAHL, PubMed and Cochrane databases from October 2022- November of 2024. The Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) process guided this search. Key search phrases included contraception, shared decision-making, patient satisfaction, and adolescents. Articles were reviewed to ensure they met the specific inclusion criteria and rapid critical appraisal tools were used to determine the quality of the research. Ten articles were chosen to be included in the study, and their outcomes were synthesized utilizing an outcomes table.
Results
By utilizing databases such as CINAHL, PubMed, and Cochrane Reviews the total number of articles found from our search was 22. After removing the duplicates, 20 articles remained, and their abstracts and full texts were reviewed. Four of the 20 articles did not meet our PICOT criteria and were removed, leaving 16 articles for assessment of quality. After assessing the quality of these studies, 10 articles remained. From these 10 articles, we found that adolescents who use shared decision-making tools report greater satisfaction with their birth control choices and increased engagement in the decision-making process.
Implications for Nursing Practice
Midwives are uniquely positioned to bridge the gap in reproductive health care for adolescents by strategically and routinely incorporating evidence-based shared decision-making tools into their contraceptive counseling. Though further research is needed related to the specific ages of 12-18 years and shared decision-making tools, patients who use shared decision-making tools report greater satisfaction with their contraception choices
Smoking Cessation Education in Caregivers of Pediatric Patients Hospitalized with Asthma Exacerbation
Full text linkPurpose/Background
Pediatric asthma is rising globally, currently affecting over 300 million individuals and projected to reach 400 million by 2025. This scoping review aims to summarize existing evidence on the impact of providing smoking education to caregivers during hospitalization on reducing pediatric asthma exacerbations, with the goal of encouraging further research.
Methods
The search spanned from August 2022 to November 2024, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria focused on studies involving human participants and caregivers of children receiving smoking cessation education in relation to asthma exacerbation and hospital admission. Databases searched included PubMed, NIH, UpToDate, Access Medicine, CIHNL, Google Scholar, and DynaMed, using MeSH headings such as “smoking cessation education in pediatric caregivers” and “smoking cessation and asthma exacerbation.” 10 out of 24 met criteria by addressing smoking cessation education for caregivers of pediatric asthma patients.
Results
This scoping review compared education given to not given in terms of smoking cessation and hospital readmission rates. The results are based on 10 critically appraised articles. All articles discussed smoking cessation and its benefits to the pediatric patient population. This scoping review determined that direct caregivers of pediatric patients or more specifically asthmatic patients who received smoking cessation education during inpatient admission were more likely to stop smoking within 6 months of discharge compared to those who did not receive education.
Implications for Nursing Practice
The evidence demonstrates that providing caregivers adequate education on smoking cessation during a child’s hospitalization for asthma exacerbation improves the caregivers understanding of smoking effects, therefore increasing smoking cessation rates and reducing readmission rates. This can help positively impact pediatric asthma outcome
A Semi-Mechanistic Model of Immune Tolerance Induction to Support Preclinical Development of a Human Monoclonal Antibody
Full text linkAdministration of human monoclonal antibodies (mAb) in preclinical species often triggers an immunogenic response, leading to the formation of anti-drug antibodies (ADA). ADA can bind to the mAb and reduce their systemic exposure by enhancing immune-complex mediated clearance. Thus, ADA complicates the accurate assessment of preclinical pharmacokinetics and toxicology studies. To mitigate this effect, we explored short-term immunosuppressive therapy (methotrexate or combination of tacrolimus and sirolimus) to induce prolonged immune tolerance towards a human mAb, erenumab, in rats. The results demonstrated that tacrolimus/sirolimus but not the methotrexate regimens prevented ADA formation in all treated animals relative to the non-immunocompromised control group. A semi-mechanistic model of immune tolerance induction was developed to support model-based simulations of ADA responses to prolonged erenumab exposures following initial immune tolerance induction with tacrolimus/sirolimus. The model adequately described the observed ADA magnitude-time profiles in both the control and tacrolimus/sirolimus groups and reasonably simulated the kinetics of selected immune cells (CD4+ T-helper and T-regulatory) responsible for ADA formation. The model successfully captured the impact of tacrolimus/sirolimus treatment on ADA formation, demonstrating that the regimen effectively suppressed ADA responses and induced tolerance. Simulation of a 6-month toxicology study suggested that immune tolerance induced with an initial treatment cycle of tacrolimus/sirolimus can maintain a T-regulatory cell-mediated tolerance with continued antigen challenge, thereby facilitating the conductance of chronic toxicology studies for 6 months of duration without ADA formation. This work demonstrates the utility of modeling approaches in prospective planning of long-term toxicology studies to support preclinical development of mAbs
