Abstract The diagnosis of pheochromocytoma or paraganglioma (PGL) during pregnancy is extremely rare, with 2 large case series suggesting that the prevalence is between 0.0002% and 0.007%. Here, we ...present a case of a 38-year-old woman who presented during pregnancy with clinical features suggestive of preeclampsia and was found to have a norepinephrine-secreting inferior laryngeal nerve PGL, which was diagnosed after pregnancy. She underwent uncomplicated surgical resection and genetic testing revealed a succinate dehydrogenase subunit B (SDHB) pathogenic variant. In conclusion, PGLs diagnosed during pregnancy and hypersecreting head and neck PGLs are both rare clinical entities. Hyperfunctioning PGLs may mimic pregnancy-induced hypertension or preeclampsia. Metanephrine testing should be considered in patients with atypical features and can be reliably assessed using nonpregnant reference ranges. Overall, maternal and fetal mortality has improved considerably with early diagnosis and treatment.
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Background: In addition to patient-reported outcome measures, the use of patient-reported experience measures (PREMs) is also developing as a patient-centred method for evaluating ...health performance. PREMs are tools that measure patients’ experience of health care including accessibility, the physical environment of services, and their interactions with health service providers and clinicians. This systematic review aimed to explore the use and impact of PREMs in the clinical care of cancer patients and survivors. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An a priori protocol was established and systematic searches of major databases (CINAHL, Medline, PsycINFO, Ovid Emcare and Scopus) were conducted between 2009 and 2019. Quantitative studies of adult or paediatric populations were eligible for inclusion. Articles reporting patient satisfaction only were excluded. Quality appraisal was conducted using the Johanna Briggs Institute Critical Appraisal Tools. A narrative synthesis of findings was conducted. Results: A total of 3246 articles were screened for eligibility with 45 studies included in the systematic review. The majority of included studies (n=37) were cross-sectional in design with a variety of PREMs used, most commonly the National Cancer Patient Experience Survey. Most studies were assessed as ‘moderate’ to ‘high’ for quality. Studies were categorised according to the use of the PREM with the majority (n=40) utilising a PREM to evaluate cancer services at the service or national level, and five using a PREM to evaluate a specific clinical intervention. Various gaps in care were identified across studies highlighting areas for improvement such as time to diagnosis and information provision. Few studies reported the barriers or enablers to PREM collection or discussed service improvement initiatives arising from them. Conclusions: Whilst PREM collection is becoming more common in oncology settings, the use and impact of this valuable data is not well reported. Patients willingly share their experiences of oncology care, yet planned or complete actions resulting from the data to improve care are seldom reported. The collection of PREMs should be met with a commitment to service improvement and longitudinal collection of PREMs is recommended to evaluate quality improvement initiatives.
In the International Year of the Nurse and Midwife 2020, nurses in Australia and around the world are being encouraged to lend their voices to lead change. The COVID-19 global health crisis has ...highlighted the critical role of nurses in our community in ensuring that the challenges to our health care system are being met and overcome. It has also brought attention to existing health inequities in our community, in particular the poorer health of refugees, some culturally and linguistically diverse communities and Aboriginal and Torres Strait Islander peoples.
To call on nurses and nurse leaders to take greater action to improve health equity.
This paper presents a discussion with regard to the importance of equitable and safe clinical practice and the urgent need to address organisational and system-level barriers to the provision of equitable health care.
Clinicians’ abilities and capacities to provide equitable care is ultimately shaped by health care organisations and the broader historical, political, social and economic context of our community.
Equity should not only be reflected in clinical practice, but also in organisational policies and procedures, embedded in key performance indicators and supported by adequate funding and resources.
Systemic inadequacies are likely to be further amplified during times when the health system is under additional pressure. Nurses and nurse leaders should take this opportunity to reflect upon the integral role they play in addressing organisational and system-level change to ensure equity in health care delivery. We call on nurse leaders and the nursing profession to lead us all to a more equitable health care system and society.
Samples extracted from a binder jet printed stainless steel 316L block with variations in grain and pore characteristics were studied using X-ray computed tomography (XCT) and ultrasonic testing ...(UT). Ultrasonic group velocity (wave speed) and attenuation were mapped over the gauge region of tensile samples, and 3D pore reconstructions were developed with XCT. The limits of ultrasonic testing to detect porosity were probed by drawing correlations between 2D pore metrics and attenuation and wave speed. In areas where porosity was low and grain size large, the grain size was found to dominate the ultrasonic response, a dependence validated using scattering-based models. In high porosity areas, attenuation correlated to the pore area perpendicular to the wave displacement and, as expected, to the volume fraction of porosity. Wave speed decreased more drastically in the presence of networked pores than for equal volume fractions of isolated pores, a finding linked to the effect of interconnected pores on effective elastic stiffness. Tensile properties and fracture location were analyzed relative to the XCT and UT results. Converting the 3D pore reconstructions to 2D heat maps aided in prediction of failure location with high accuracy, while ultrasound showed promise in identifying regions of interest for possible fracture.
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•Grain size effects dominate the ultrasonic response in <0.5% porosity areas, with larger grains causing increased wave speed.•Large, networked pores caused drastically lower ultrasonic wave speed, hindering direct correlations to porosity parameters.•Location of maximum through-thickness average pore volume from XCT was predictive of failure location.
Protein S deficiency is associated with increased risk of venous thromboembolism, complicating the perioperative management of such patients. We present a patient with sickle cell disease (Hb SC ...genotype) and inherited protein S deficiency who underwent a living-donor renal transplant. To minimize thrombotic risk and sickle cell complications, both plasma exchange and red blood cell (RBC) exchange transfusion were performed pre-operatively.
Plasma exchange was utilized to increase protein S levels and to reduce the risk of post-operative venous thromboembolism, including allograft thrombosis, while RBC exchange was performed to reduce the risk of acute post-operative sickle cell disease complications.
With the use of combined pre-operative plasma exchange and RBC exchange transfusion, this patient with protein S deficiency and Hb SC underwent a successful renal transplant without acute sickle cell complications or thrombotic complications.
This case demonstrates the potential use of pre-operative plasma exchange in patients with protein S deficiency undergoing high thrombotic risk procedures.
Children enter kindergarten with a variety of experiences and skills. In this transition to formal school, they are expected to adapt quickly to new demands such as remembering specific pieces of ...information, knowing when to retrieve this information, and understanding how to use this information to complete specific tasks. These skills have been referred to as children’s deliberate memory skills and are thought to serve children’s long term academic success. However, limited research has focused on specific aspects of children’s everyday contexts that play a role in the development of these skills – such as adult-to-child language exchanges in home and school settings. Therefore, the goals of the current study were to (a) understand the role of children’s every day, lived experiences such as parent–child reminiscing and teacher– child linguistic exchanges (i.e., cognitive processing language in classrooms) on the initial acquisition and sustained use of mnemonic strategies across the kindergarten and first-grade years, and (b) describe the interplay between individual-level factors – such as other components of children’s cognition – and these adult-to-child scaffolding practices on children’s memory development.Drawing on a sample of 79 children nested in 10 kindergarten classrooms, children’s deliberate memory skills were assessed at 6 timepoints from kindergarten entry to the end of first grade. Kindergarten teachers’ instruction was recorded using GoPro cameras during regular mathematics and language arts lessons; these recordings were subsequently coded for the prevalence use of cognitive processing language (Coffman et al., 2008; 2019). Parent–child dyads took part in a parent-child reminiscing task in which they were asked to reminisce about two recent events. Conversations were coded for parents’ elaborative reminiscing style (Reese et al., 1993; Langley et al., 2017). Finally, children’s executive function and self-regulation skills were assessed during the kindergarten year using the Dimensional Change Card Sort Task (Zelazo, 2006) and the Head Toes Knees Shoulders Task, (Ponitz et al., 2009; McClelland et al., 2014) respectively. Results from a series of growth curve models using a multilevel modeling framework revealed significant predictors of children’s deliberate memory skills at the start of kindergarten and at the end of first grade, as well as of the rate at which changes in these skills occurred as a function of home-, school-, and individual-level factors. First, although children of parents with high levels of elaborative reminiscing entered kindergarten with higher levels of deliberate memory skills, it was children who had parents who used lower levels of elaborative reminiscing who developed more rapidly over the course of the kindergarten and first grade years. Second, children who were exposed to teachers who used higher levels of cognitive processing language (CPL) in kindergarten developed strategic sorting skills more rapidly over the course of first grade and ended the year with higher levels of deliberate strategy use than their peers who were exposed to lower levels of cognitive processing language. Finally, for children with lower self-regulation skills, those exposed to higher levels of CPL in kindergarten evidenced higher levels of deliberate strategy use at the end of first grade than their peers who were exposed to lower levels of CPL. Taken together, these findings provide insight to the role of parent-child and teacher-child processes on the development of children’s deliberate memory skills during the first two years of elementary school. Strengths, limitations, and future directions for researchers and educators are discussed.
•Specialist nurses identified the need for greater definition and delineation of specialist and advanced practice nurse roles.•Non-standardised nomenclature and pay, and poorly defined career ...pathways, were perceived as barriers to succession planning.•Specialist gynae-oncology nurses suggested guidelines for practice could assist standardisation and regulation of practice.
Over recent years there has been a proliferation in specialist nurse roles that require expertise and advanced practice in a particular field of nursing. In Australia and New Zealand, specialist nursing care of women with gynaecological cancers is recommended, however the role remains largely undefined and unregulated.
To determine Australian and New Zealand gynaecological oncology specialist nurses’ perspectives on the future of their role, and make recommendations for future practice and education.
An interpretive descriptive methodology was adopted for this study. Gynaecological oncology specialist nurses participated in individual and focus group interviews and a thematic analysis of transcribed data was conducted.
Nineteen specialist nurses participated in the study and three major themes were derived from the interview data: The first theme, ‘Delineation of roles’ highlighted the challenges for specialist nurses inherent in new, poorly defined roles. ‘Identifiable career path’ explored the lack of clear education and career pathways and disparate nomenclature for their roles, which they believed impeded succession planning. The theme, ‘What should I be doing’, related to the bespoke development of participants’ current roles due to the paucity of formal guidelines for practice.
Gynaecological oncology specialist nurse roles have emerged and developed with limited direction from the nursing profession. Poor role legitimacy and a weak professional identity were evident among participants.
Gynaecological oncology specialist nurses identified standardised nomenclature, defined career and education pathways, guidelines for practice, and succession planning as important elements in the progression of their roles.
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