Implementation of Provider-Focused Education to Improve Laboratory Screening for Pediatric Patients With Elevated Body Mass Index in Primary Care: A Quality Improvement Project.

Introduction: Children with elevated body mass index (BMI) do not consistently receive recommended laboratory screenings. This project aimed to increase provider screening rates and knowledge of screening guidelines for this population.

Method: This project utilized the Rosswurm and Larrabee evidence-based practice model.

Cultivating Sense of Belongingness Among Graduate Nursing Students: A Virtual Fitness Challenge.

Sense of belongingness in the academic environment has been associated with positive student outcomes and increased student success. To cultivate belongingness, graduate nursing students were invited to participate in a virtual fitness challenge. Sense of belongingness was measured through pre- ( n = 103) and post-intervention ( n = 64) surveys with three subscales: other students, faculty, and the university.

Periosteal block versus intravenous regional anesthesia for reduction of distal radius fractures: A randomized controlled trial.

Objective: We compare periosteal block and intravenous regional anesthesia (IVRA) as anesthetic techniques for reduction of distal radius fractures when performed by emergency department (ED) clinicians following brief training.

Methods: This was a single-center, nonblinded randomized controlled trial of a convenience sample of patients presenting with distal radius fractures requiring closed reduction. Primary outcome measure was patient reported fracture reduction pain score, rated on a 100-mm visual analog scale.

Reduced telomere length in amniocytes: an early biomarker of abnormal fetal development?

Telomeres protect chromosome ends and control cell division and senescence. During organogenesis, telomeres need to be long enough to ensure the cell proliferation necessary at this stage of development. Previous studies have shown that telomere shortening is associated with growth retardation and congenital malformations.

Agonist Treatment for Opioid Dependence Syndrome: The Impact of Current Understanding upon Recommendations for Policy Initiatives.

The provision of opioid agonist treatments (OATs), as a standard approach towards opioid dependence syndrome, differs widely between countries. In response to access disparities, in 2014, the Council of Europe's Pompidou Group first brought together an expert group on framework conditions for the treatment of opioid dependence. The group used a Delphi approach to structure their discussions and develop guiding principles for the modernisation of OAT regulations and legislation.

A Wellness Program to Decrease Pediatric Postanesthesia Care Unit Staff Compassion Fatigue.

Introduction: Health care workers, especially those in pediatrics, have a high risk for compassion fatigue (CF). A wellness program (WP) might help decrease CF and increase compassion satisfaction (CS).

Method: This project implemented and evaluated a WP in a pediatric postanesthesia care unit at a large children's hospital.

Challenges for the future: the gastroenterology specialist workforce in New Zealand.

Aim: New Zealand has among the highest rates of colorectal cancer and inflammatory bowel disease in the world. With the imminent rollout of the National Bowel Screening Programme, we sought to determine the capacity of and demand faced by the current gastroenterology specialist workforce, and to compare it with other countries.

Method: Specialists in gastroenterology were asked to complete a questionnaire on their education, number of FTE in the public and private sectors, number of colonoscopies performed, anticipated years to retirement and other associated information.

Assessment of Disease Progression in Patients With Repaired Tetralogy of Fallot Using Cardiac Magnetic Resonance Imaging: A Systematic Review.

Aims: Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease with a growing population of adult survivors. Late pulmonary outflow tract and pulmonary valve postoperative complications are frequent, leading to long-term risks such as right heart failure and sudden death secondary to arrhythmias. Cardiac magnetic resonance imaging (CMR) is the gold standard for assessment of cardiac function in patients with repaired ToF.

Minimization of bias in measures of gestational weight gain.

Gestational weight gain (GWG) is an important predictor of adverse pregnancy outcomes including gestational diabetes, preterm birth, delivery by caesarean and post-partum weight retention. The Institute of Medicine guidelines on GWG are widely adopted, and GWG is widely researched as an outcome of interest in lifestyle interventions during pregnancy. However, estimation of prepregnancy weight and measurement of weight prior to delivery introduce bias into measures of GWG.

Clinically Asymptomatic Sleep-Disordered Breathing in Infants with Single-Ventricle Physiology.

Objectives: To assess clinically asymptomatic infants with single-ventricle physiology (SVP) for sleep-disordered breathing (SDB) in the supine and car seat positions using polysomnography. Polysomnography results also were compared with results of a standard Car Seat Challenge to measure the dependability of the standard Car Seat Challenge.

Study Design: This was an observational study of 15 infants with SVP.

Diagnostic delays and treatment challenges in children with coeliac disease: The New Zealand Coeliac Health Survey.

Aim: Coeliac disease (CD) is an increasingly common immune-mediated disorder. Treatment is a life-long gluten-free diet. The aim of this study was to describe the presenting symptoms, delays in diagnosis and difficulties associated with managing CD in children.

Is One-Pen, One-Patient Achievable in the Hospital? A Quality Improvement Project to Reduce Risks of Inadvertent Insulin Pen Sharing at a Large Academic Medical Center.

Background: The Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Institute for Safe Medicine Practices (ISMP) have issued warnings regarding the risk of potential transmission of blood-borne diseases if an insulin pen is used for more than one person. Many hospitals continue to use insulin pens due to their benefits of decreased risk of dosing error and improved work efficiency. Best practices for insulin pen use have been published; however, little is known about how these perform in hospitals.

The cost of diabetes-related hospital care to the Southern District Health Board in 2016/17.

Aim: To estimate the cost of diabetes-related hospital admissions to the Southern District Health Board for the year 2016/17.

Methods: Unidentified data with an ICD-10-AM diagnostic code for any type of diabetes were obtained for admissions to Dunedin and Southland Hospitals. Each admission was categorised according to whether the diabetes diagnostic code was listed first, second or subsequently, and by diagnostic group within each of these three categories.

A handheld platform for target protein detection and quantification using disposable nanopore strips.

Accessible point-of-care technologies that can provide immunoassay and molecular modalities could dramatically enhance diagnostics, particularly for infectious disease control in low-resource settings. Solid-state nanopores are simple and durable sensors with low-energy instrumentation requirements. While nanopore sensors have demonstrated efficacy for nucleic acid targets, selective detection and quantification of target proteins from sample background has not been demonstrated.

Addition of Exogenous γ-Glutamyl Hydrolase Eliminates the Need for Lengthy Incubation of Whole-Blood Lysate for Quantitation of Folate Vitamers by High-Performance Liquid Chromatography-Tandem Mass Spectrometry.

Background: Measurement of folate monoglutamates by HPLC-tandem mass spectrometry (HPLC-MS/MS) in whole-blood lysate (WBL) requires lengthy incubation before analysis, risking degradation of labile folate vitamers.

Objective: We explored whether the addition of a commercially available recombinant exogenous γ-glutamyl hydrolase (exoGGH) enzyme reduced the required incubation time of WBL for measurement of folate as monoglutamates.

Methods: For conventional deglutamylation of polyglutamates, WBL was incubated for 4 h at 37°C.

Lactating Canadian Women Consuming 1000 µg Folic Acid Daily Have High Circulating Serum Folic Acid Above a Threshold Concentration of Serum Total Folate.

Background: Consumption of high-dose folic acid supplements is common throughout pregnancy and lactation in several countries, including Canada, Brazil, and the United States, and may lead to high levels of circulating unmetabolized folic acid.

Objective: The objective of the study was to characterize serum and whole-blood folate forms in Canadian lactating women regularly consuming a daily high-dose folic acid supplement.

Methods: One-hundred and seventeen Canadian lactating women aged between 18 and 42 y, with a geometric mean ± SD prepregnancy body mass index (kg/m2) of 23.

[Modernising the framework conditions for medicine treatments in opioid dependence syndrome].

Opioid medicines prescribed on a long-term basis for opioid dependence syndrome have historically been deemed « substitution treatments » and misunderstood as involving the "replacement of an illicit drug by a legal drug". Prior authorisation schemes, in addition to ordinary procedures for authorising medicines and supervising professionals, interfere with access to treatment. In order to guide the countries in their efforts to modernise their regulations, the Pompidou Group mandated a group of health and legal experts, who identified 62 guiding principles and developed four strategic recommendations : 1) the removal of prior authorisation schemes, 2) the removal of financial barriers, 3) supervision by a national consultative body and 4) The adoption of neutral, precise and respectful terminology.

Iron, Zinc, Folate, and Vitamin B-12 Status Increased among Women and Children in Yaoundé and Douala, Cameroon, 1 Year after Introducing Fortified Wheat Flour.

Few data are available on the effectiveness of large-scale food fortification programs. We assessed the impact of mandatory wheat flour fortification on micronutrient status in Yaoundé and Douala, Cameroon. We conducted representative surveys 2 y before and 1 y after the introduction of fortified wheat flour.

Deep Tissue Pressure Injury: A Clinical Review.

: A deep tissue pressure injury (DTPI) is a serious type of pressure injury that begins in the muscle closest to the bone and may not be visible in its early stages. Its hallmark is rapid deterioration despite the use of appropriate preventive interventions. In 2007, the National Pressure Ulcer Advisory Panel added suspected deep tissue injuries to the traditional classification system, and by 2010 DTPIs had accounted for about 9% of all pressure injuries and were for the first time more prevalent than stage 3 or 4 pressure injuries.

Correlations between Maternal, Breast Milk, and Infant Vitamin B12 Concentrations among Mother-Infant Dyads in Vancouver, Canada and Prey Veng, Cambodia: An Exploratory Analysis.

Vitamin B12 plays an essential role in fetal and infant development. In regions where animal source food consumption is low and perinatal supplementation is uncommon, infants are at risk of vitamin B12 deficiency. In this secondary analysis, we measured total vitamin B12 concentrations in maternal and infant serum/plasma and breast milk among two samples of mother-infant dyads in Canada (assessed at 8 weeks post-partum) and in Cambodia (assessed between 3-27 weeks post-partum).

Modelling of occupational exposure to inhalable nickel compounds.

The aim of this study was to estimate average occupational exposure to inhalable nickel (Ni) using the German exposure database MEGA. This database contains 8052 personal measurements of Ni collected between 1990 and 2009 in adjunct with information on the measurement and workplace conditions. The median of all Ni concentrations was 9 μg/m and the 95th percentile was 460 μg/m.

Risk Factors Associated With Pressure Ulcer Formation in Critically Ill Cardiac Surgery Patients: A Systematic Review.

Background: Cardiac surgery patients are among those most at risk for developing pressure ulcers (PUs), with a reported incidence as high as 29.5%. Although numerous studies documenting PU risk factors and prevention strategies exist, the availability of literature examining risk factors specific to the cardiac surgery population is limited.

Endoscopic sinus surgery dissection courses using a real simulator: the benefits of this training.

Introduction: Endonasal surgeries are among the most common procedures performed in otolaryngology. Due to difficulty in cadaver acquisition and the intrinsic risks of training residents during operations on real patients, nasosinusal endoscopic dissection courses utilizing real simulators, such as the Sinus Model Otorhino Neuro Trainer are being developed as a new technique to facilitate the acquisition of better anatomical knowledge and surgical skill.

Objective: To evaluate the efficacy of nasosinusal endoscopic dissection courses with the Sinus Model Otorhino Neuro Trainer simulator in the training of otolaryngology surgeons.