Dementia advance care planning perspectives within an Alabama community: A theory guided qualitative study.

Advance Care Planning (ACP) is a process that supports decision-making about end-of-life goals. Dementia ACP is recommended during the early stages of the disease to empower the individual living with dementia to express wishes for quality of life before experiencing significant cognitive decline. ACP during early dementia is rare, and hesitancy to initiate difficult and emotional conversations may be a contributing factor to delaying ACP.

Perspectives on the Dementia Public Health Exposome.

Dementia is a public health concern in the aging population with an estimated 55 million people impacted globally. Public health initiatives that focus on minimizing dementia risk factors may support efforts to reduce the incidence of dementia in at-risk populations. Exposomics considers both modifiable and non-modifiable risk factors for disease, including genetic changes with age and lifetime exposures to environmental, social, and behavioral risk factors.

Segmental Tissue Resistance of Healthy Young Adults during Four Hours of 6-Degree Head-Down-Tilt Positioning.

(1) Background: One effect of microgravity on the human body is fluid redistribution due to the removal of the hydrostatic gravitational gradient. These fluid shifts are expected to be the source of severe medical risks and it is critical to advance methods to monitor them in real-time. One technique to monitor fluid shifts captures the electrical impedance of segmental tissues, but limited research is available to evaluate if fluid shifts in response to microgravity are symmetrical due to the bilateral symmetry of the body.

Short-Term Segmental Bioimpedance Alterations During 6° Head-Down Tilt.

As missions in space increase in duration and distance from Earth it is critical to understand the impact that exposure to microgravity has on the health and potential performance of crews. Segmental bioimpedance measurements can track resistances changes in tissues that result from fluid redistribution and could be a tool for continuous fluid shift monitoring in microgravity. In this work, the range of segmental (legs, arms, torso, and neck) 10 kHz and 100 kHz resistances and their relative changes during 4 hours of 6° head down tilt are reported as well as the observed resistance differences between left/right body segments throughout the protocol.

Effects of patient education to reduce antibiotic prescribing rates for upper respiratory infections in primary care.

Background: Antibiotic stewardship programs in primary care are necessary to reduce the estimated 30% of inappropriately written antibiotic prescriptions and reduce the spread of microbial resistance. Most programs focus on educating prescribers, but this intervention focused on educating patients.

Objectives: To develop and implement an antibiotic stewardship program in a primary care clinic to educate patients with upper respiratory infections (URIs) about antibiotic use and to assess the effectiveness of the program through antibiotic prescribing rates.

Utilizing a Five-Step, Direct-Call Reminder System to Increase Vaccination Compliance in a Federally Qualified Health Center: A Quality Improvement Process.

Background: Childhood vaccines prevent more than 10 million illnesses and 33,000 deaths in the United States each year. Noncompliance rates for children 2 and under are higher in underserved and resource poor communities.

Objective: The aim of this project was to develop and implement a five-step, direct-call reminder system to increase vaccination rates among children ages 2 and under presenting to a federally qualified health center (FQHC).

A School-Based Intervention to Increase HPV Vaccination Rates.

Background: The human papillomavirus (HPV) is responsible for over 33,000 cancer diagnoses each year in the United States. HPV vaccination rates remain 25%-30% lower than other preteen immunizations.

Objective: The aim of this project was to increase the HPV vaccination rate among adolescents presenting to a school-based health center (SBHC) using provider recommendation and parent education.

Tolvaptan for Autosomal Dominant Polycystic Kidney Disease: Pharmacokinetics and Implications for Practice.

Autosomal dominant polycystic kidney disease (ADPKD) is incurable and occurs once in every 1,000 births. Confirmation of AKPKD is made through imaging and a positive family history. Symptoms typically appear in mid-life and include kidney, side, and/or back pain related to the rupture of kidney cysts, renal stones, infection, pressure of cysts against other organs, and stretching of the renal capsule.

Development and Implementation of a Postpartum Depression Screening Program in the NICU.

Postpartum depression (PPD) is higher among NICU mothers compared to mothers without infants in the NICU. Routine screening improves early PPD identification and treatment for mothers. Key national women and infant organizations endorse facility-based policies that address PPD screening.

Evaluation of the (qSOFA) Tool in the Emergency Department Setting: Nurse Perception and the Impact on Patient Care.

In the emergency department (ED) setting, nurses perform the initial evaluation of patients, thereby placing ED nurses in a prime position to recognize sepsis and greatly influence prompt implementation of treatment. The quick Sequential Organ Failure Assessment (qSOFA) tool was first introduced as part of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) as a predictor of both increased mortality and longer intensive care unit (ICU) stays. Designed for use outside the ICU, the qSOFA tool functions as a simple bedside tool to quickly identify patients at risk for developing sepsis.

Adenosine Triphosphate-Bioluminescence Technology as an Adjunct Tool to Validate Cleanliness of Surgical Instruments.

Perioperative and sterile processing department personnel commonly use visual inspection to validate surgical instrument cleanliness. This validation process does not detect microbes (eg, bacteria, viruses) and the resultant inadequately decontaminated instruments can put patients at risk for developing surgical site infections. Sterile processing department personnel should use a rapid, straightforward method to validate surgical instrument cleanliness objectively.

A Qualitative Study to Determine Barriers for Prostate Cancer Screening in Rural African-American Men.

Introduction: African-American men have higher rates of prostate cancer and more advanced cancer when diagnosed than men of other ethnicities.

Purpose: To explore the perspectives and shared experiences of rural African-American men when it comes to interactions with healthcare providers, shared decision-making, and information on prostate cancer and screening.

Methods: A convenience sample of African-American men in four rural counties in the southeastern United States agreed to participate.

Evaluation and current treatments for urinary incontinence.

Although aging and urinary incontinence are often associated, urinary incontinence is not a normal part of aging. As the population ages, the challenge of urinary incontinence will place a greater demand on the healthcare system. NPs can effectively direct treatments to mitigate the symptoms of urinary incontinence, improving patient quality of life.

Person-Centered Care for Patients with Pessaries.

Pelvic organ prolapse is a common condition affecting women of any age but more likely to occur in the aging woman. Prolapse has a significant impact on quality of life, sexuality, and body image. Vaginal support pessaries have been used since ancient times and are a safe and effective nonsurgical treatment option.

Optimal Pessary Care: A Modified Delphi Consensus Study.

Introduction: Support pessaries are an important, low-risk treatment option for women with vaginal prolapse but evidence to inform optimal practice is lacking. Currently, gynecologists, urologists, and urogynecologists recommend silicone vaginal support pessaries as first-line treatment for symptomatic vaginal prolapse in women of all ages. It is unknown how many providers who are not physicians prescribe and care for women using pessaries.

Health Seeking in Men: A Concept Analysis.

This article describes the analysis of the concept of health seeking in men. Men have shorter life expectancies and utilize health services less often than women, leading to poor health outcomes, but a gendered basis for health seeking remains poorly defined. Walker and Avant’s framework was used to guide this concept analysis.

Pessary Practices of Nurse-Providers in the United States.

Objectives: Our purposes were to describe pessary-care practices and education of a sample of nurse providers in the United States and identify a cohort of high-volume providers.

Methods: An e-mail survey was sent to members of 3 related nursing professional organizations. Questions addressed general pessary care within the respondent's practice and specific pessary care choices of responding direct providers.

An Evidence-Based Protocol for Protecting Newborns From Pertussis.

Pertussis, also known as whooping cough, is a vaccine-preventable disease most commonly affecting infants and young children. This article describes a project to develop an evidence-based protocol for implementing prenatal vaccination and cocooning in a major medical center in Georgia.