When faced with a hand hygiene compliance rate of 44% of nursing students in clinical courses, faculty took on the challenge of meeting the hospital's expectation of 90% compliance or greater. A ...multidimensional approach to improve students' hand hygiene compliance was used to implement interventions in the school's simulation center and to create supports in the clinical area. This approach showed positive, sustainable improvement.
While use of simulation to improve teamwork skills has been established in a variety of clinical settings, it is unclear how teamwork skills of nursing students are developed using simulation.
The ...purpose of this review was to synthesize literature on how simulation is used to teach teamwork skills to prelicensure nursing students.
The integrative review of the literature was conducted using the Whittemore and Knafl 5-stage methodology and the TeamSTEPPS framework.
Twenty-one articles were included in the review. Each of the articles reviewed used a component of TeamSTEPPS. The most common TeamSTEPPS concept addressed in the simulations was communication followed by mutual support.
While simulation appears to be an appropriate methodology to teach teamwork skills to prelicensure nursing students, it is evident that some of those skills are not being taught using the TeamSTEPPS framework.
Improving the health of communities requires creating partnerships and leveraging partner resources. Engagement with key stakeholders or partners who engage in collaborative community needs ...assessments has been linked to improved community health outcomes. Understanding how to engage community stakeholders, identify mutual goals, and establish a shared vision can maximize resources to improve the community's health. We applied our experience to an existing model for community engagement and leveraging of resources to improve the community's health and translate the model to a community case.
Interprofessional education (IPE) is important in the education of all health care students, yet limited IPE training has been provided to preceptors who train these students in the clinical setting. ...Simulation using the standardized student model has been used to train health care preceptors in medicine. To our knowledge, there are no reports utilizing interprofessional objective structured teaching exercises (iOSTE) to train pharmacy preceptors. The primary objectives of this pilot study were to evaluate the effects of iOSTE on the pharmacy preceptors’ perceived importance of the Interprofessional Education Collaborative (IPEC) core competencies and confidence in precepting interprofessional students. Additionally, data were collected regarding pharmacy preceptors' prior experiences in simulation and debriefing.
Preceptors (n=23) participated in an iOSTE and debriefed with trained standardized nursing and pharmacy students caring for a trained standardized asthma patient.
Pre- versus post-iOSTE survey data showed statistically significant improvements in all self-confidence related items, including the following abilities: precept students from different disciplines (p=0.004), facilitate a simulation activity (p=0.001), conduct the debriefing process (p<0.001), and discuss with students the IPE core competencies (p=0.001). Additionally, responses to post-iOSTE survey questions assessing the learning activity showed high ratings (median=5, interquartile range=4 to 5). Pharmacy preceptors increased their teaching ability and confidence level in communicating with students from other health care professions.
These findings indicate that iOSTE is a useful and well-received method for preceptor development.
Abstract
Ratios of polycyclic aromatic hydrocarbon (PAH) vibrational bands are a promising tool for measuring the properties of the PAH population and their effect on star formation. The photometric ...bands of the MIRI and NIRCam instruments on JWST provide the opportunity to measure PAH emission features across entire galaxy disks at unprecedented resolution and sensitivity. Here we present the first results of this analysis in a sample of three nearby galaxies: NGC 628, NGC 1365, and NGC 7496. Based on the variations observed in the 3.3, 7.7, and 11.3
μ
m features, we infer changes to the average PAH size and ionization state across the different galaxy environments. High values of F335M
PAH
/F1130W and low values of F1130W/F770W are measured in H
ii
regions in all three galaxies. This suggests that these regions are populated by hotter PAHs, and/or that the PAH ionization fraction is larger. We see additional evidence of heating and/or changes in PAH size in regions with higher molecular gas content as well as increased ionization in regions with higher H
α
intensity.
To compare antimüllerian hormone (AMH) patterns by cancer status and treatment exposures across 6 years after incident breast cancer using administrative data.
In a cross-sectional design, AMH levels ...in patients who developed incident breast cancer between ages 15-39 years during 2005-2019 were matched 1:10 to levels in females without cancer in the OptumLabs Data Warehouse. Modeled AMH patterns were compared among cyclophosphamide-based chemotherapy, non-cyclophosphamide-based chemotherapy, no chemotherapy, and no breast cancer groups.
Commercially insured females in the United States.
Females with and without breast cancer.
Breast cancer, cyclophosphamide- and non-cyclophosphamide-based chemotherapy.
AMH levels.
A total of 233 patients with breast cancer (mean age, 34 years; standard deviation, 3.7 years) contributed 278 AMH levels over a median of 2 years (range, 0-6.7 years) after diagnosis; 52% received cyclophosphamide-based chemotherapy, 17% received non-cyclophosphamide-based chemotherapy (80% platinum-based), and 31% received no chemotherapy. A total of 2,777 matched females without cancer contributed 2,780 AMH levels. The pattern of AMH levels differed among the 4 groups. Among females without cancer and breast cancer survivors who did not undergo chemotherapy, AMH declined linearly over time. In contrast, among those who received cyclophosphamide-based and noncyclophosphamide-based chemotherapy, a nonlinear pattern of AMH level of initial fall during chemotherapy, followed by an increase over 2-4 years, and then by a plateau over 1-2 years before a decline was observed.
In breast cancer survivors, AMH levels from administrative data supported ovarian toxicity of non-cyclophosphamide-based chemotherapy in breast cancer and efficiently depicted the timing and duration of changes in ovarian reserve to reflect the residual reproductive lifespan.
To estimate the effect of platinum-based chemotherapy on live birth (LB) and infertility after cancer, in order to address a lack of treatment-specific fertility risks for female survivors of ...adolescent and young adult cancer, which limits counseling on fertility preservation decisions.
Retrospective cohort study.
US administrative database.
We identified incident breast, colorectal, and ovarian cancer cases in females aged 15-39 years who received platinum-based chemotherapy or no chemotherapy and matched them to females without cancer.
Platinum-based chemotherapy.
We estimated the effect of chemotherapy on the incidence of LB and infertility after cancer, overall, and after accounting for competing events (recurrence, death, and sterilizing surgeries).
There were 1,287 survivors in the chemotherapy group, 3,192 in the no chemotherapy group, and 34,147 women in the no cancer group, with a mean age of 33 years. Accounting for competing events, the overall 5-year LB incidence was lower in the chemotherapy group (3.9%) vs. the no chemotherapy group (6.4%). Adjusted relative risks vs. no chemotherapy and no cancer groups were 0.61 (95% confidence interval CI 0.42-0.82) and 0.70 (95% CI 0.51-0.93), respectively. The overall 5-year infertility incidence was similar in the chemotherapy group (21.8%) compared with the no chemotherapy group (20.7%). The adjusted relative risks vs. no chemotherapy and no cancer groups were 1.05 (95% CI 0.97-1.15) and 1.42 (95% CI 1.31-1.53), respectively.
Cancer survivors treated with platinum-based chemotherapy experienced modestly increased adverse fertility outcomes. The estimated effects of platinum-based chemotherapy were affected by competing events, suggesting the importance of this analytic approach for interpretations that ultimately inform clinical fertility preservation decisions.
Abstract
We compare mid-infrared (mid-IR), extinction-corrected H
α
, and CO (2–1) emission at 70–160 pc resolution in the first four PHANGS–JWST targets. We report correlation strengths, intensity ...ratios, and power-law fits relating emission in JWST’s F770W, F1000W, F1130W, and F2100W bands to CO and H
α
. At these scales, CO and H
α
each correlate strongly with mid-IR emission, and these correlations are each stronger than the one relating CO to H
α
emission. This reflects that mid-IR emission simultaneously acts as a dust column density tracer, leading to a good match with the molecular-gas-tracing CO, and as a heating tracer, leading to a good match with the H
α
. By combining mid-IR, CO, and H
α
at scales where the overall correlation between cold gas and star formation begins to break down, we are able to separate these two effects. We model the mid-IR above
I
ν
= 0.5 MJy sr
−1
at F770W, a cut designed to select regions where the molecular gas dominates the interstellar medium (ISM) mass. This bright emission can be described to first order by a model that combines a CO-tracing component and an H
α
-tracing component. The best-fitting models imply that ∼50% of the mid-IR flux arises from molecular gas heated by the diffuse interstellar radiation field, with the remaining ∼50% associated with bright, dusty star-forming regions. We discuss differences between the F770W, F1000W, and F1130W bands and the continuum-dominated F2100W band and suggest next steps for using the mid-IR as an ISM tracer.
Abstract
We explore the relationship between mid-infrared (mid-IR) and CO rotational line emission from massive star-forming galaxies, which is one of the tightest scalings in the local universe. We ...assemble a large set of unresolved and moderately (∼1 kpc) spatially resolved measurements of CO (1–0) and CO (2–1) intensity,
I
CO
, and mid-IR intensity,
I
MIR
, at 8, 12, 22, and 24
μ
m. The
I
CO
versus
I
MIR
relationship is reasonably described by a power law with slopes 0.7–1.2 and normalization
I
CO
∼ 1 K km s
−1
at
I
MIR
∼ 1 MJy sr
−1
. Both the slopes and intercepts vary systematically with choice of line and band. The comparison between the relations measured for CO (1–0) and CO (2–1) allow us to infer that
R
21
∝
I
MIR
0.2
, in good agreement with other work. The 8
μ
m and 12
μ
m bands, with strong polycyclic aromatic hydrocarbon (PAH) features, show steeper CO versus mid-IR slopes than the 22 and 24
μ
m, consistent with PAH emission arising not just from CO-bright gas but also from atomic or CO-dark gas. The CO-to-mid-IR ratio correlates with global galaxy stellar mass (
M
⋆
) and anticorrelates with star formation rate/
M
⋆
. At ∼1 kpc resolution, the first four PHANGS–JWST targets show CO-to-mid-IR relationships that are quantitatively similar to our larger literature sample, including showing the steep CO-to-mid-IR slopes for the JWST PAH-tracing bands, although we caution that these initial data have a small sample size and span a limited range of intensities.
Abstract Description Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is ...lacking. Methods Pancreatic Pain working groups reviewed information on pain mechanisms, clinical pain assessment and pain treatment in CP. Levels of evidence were assigned using the Oxford system, and consensus was based on GRADE. A consensus meeting was held during PancreasFest 2012 with substantial post-meeting discussion, debate, and manuscript refinement. Results Twelve discussion questions and proposed guidance statements were presented. Conference participates concluded: Disease Mechanism : Pain etiology is multifactorial, but data are lacking to effectively link symptoms with pathologic feature and molecular subtypes. Assessment of Pain : Pain should be assessed at each clinical visit, but evidence to support an optimal approach to assessing pain character, frequency and severity is lacking. Management : There was general agreement on the roles for endoscopic and surgical therapies, but less agreement on optimal patient selection for medical, psychological, endoscopic, surgical and other therapies. Conclusions Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care.
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