The Role of Pain Medications in Modulating Peripheral Nerve Injury Recovery.

Peripheral nerve injuries (PNIs) are common, costly, and cause significant pain. Effective management of PNIs involves tailoring medications to the injury type as well as understanding the pharmacokinetics/pharmacodynamics to support nerve regeneration and reduce pain. Opioids act on opioid receptors to significantly reduce pain for many patients, but there are significant addiction risks and side effects.

Teaching Future Physician Assistants to Provide ADEPT-CARE to Disabled Patients: A Novel Application of Disability Curriculum.

Introduction: Physician assistant (PA) students will be certain to provide care to patients with disabilities in their future careers. However, there is a dearth of literature on disability-related education in PA training. This curriculum sought to fill this need.

Resource stewardship and Choosing Wisely in a children's hospital.

Objectives: Evidence suggests that approximately 30% of the tests and treatments currently prescribed in healthcare are potentially unnecessary, may not add value, and in some cases cause harm. We describe the evolution of our hospital's Choosing Wisely (CW) program over the first 5 years of existence, highlighting the enablers, challenges, and overall lessons learned with the goal of informing other healthcare providers about implementing resource stewardship initiatives in paediatric healthcare settings.

Methods: We describe the development of de novo "top 5" CW lists of recommendations using anonymous surveys and Likert scale scoring.

Incidental Findings Protocol Implementation at a Level-I Trauma Center: A Review of Patient Follow-Up.

Objectives: Pan scanning in trauma patients has become routine, resulting in increased identification of incidental findings (IF), findings unrelated to the reason for the scan. This has posed a conundrum of ensuring patients have appropriate follow-up for these findings. We sought to evaluate our compliance and follow-up for patients after implementation of an IF protocol at our level-I trauma center.

Real-World Budget Impact of Fidaxomicin versus Vancomycin or Metronidazole for In-Hospital Treatment of Clostridioides difficile Infection.

Fidaxomicin, a macrocyclic antibiotic, selectively kills Clostridioides difficile and reduces C. difficile infection (CDI) recurrence compared with vancomycin, but some studies and guidelines report fidaxomicin as being less cost-effective. The aim of this study was to compare the cost-effectiveness and budget impact of fidaxomicin versus vancomycin or metronidazole for treating CDI in a real-world UK setting.

Antifungal stewardship in solid-organ transplantation: What is needed?

Background: Antifungal stewardship (AFS) lags behind antimicrobial stewardship (AMS) in terms of implementation, evidence base, and workforce experience. Solid-organ transplantation (SOT) carries a significant risk of invasive fungal infection, with high associated mortality, and is therefore associated with significant opportunities to optimize antifungal use.

Methods: A literature search for the terms "antifungal stewardship" and "solid-organ transplant" revealed a small evidence base to support AFS programs in this patient group.

Advance Care Planning and Communication Skills Improve after an Interprofessional Team Simulation with Standardized Patients.

Background: Improving rates of advance care planning (ACP) and advance directive completion is a recognized goal of health care in the United States. No prior study has examined the efficacy of standardized patient (SP)-based student interprofessional ACP trainings.

Objectives: The present study aims to evaluate an interprofessional approach to ACP education using SP encounters.

Electrospun electroconductive constructs of aligned fibers for cardiac tissue engineering.

Myocardial infarction remains the leading cause of death in the western world. Since the heart has limited regenerative capabilities, several cardiac tissue engineering (CTE) strategies have been proposed to repair the damaged myocardium. A novel electrospun construct with aligned and electroconductive fibers combining gelatin, poly(lactic-co-glycolic) acid and polypyrrole that may serve as a cardiac patch is presented.

Violence Exposure, Child Asthma Morbidity, and Maternal Depressive Symptoms: A Longitudinal Analysis of Cumulative Risk.

Low-income mothers of children with uncontrolled asthma are an underserved population at risk for psychological distress. We examined the impact of violence exposure and child asthma morbidity on depressive symptoms in mothers of youths with uncontrolled asthma. Asthma symptoms and health care utilization, socio-demographics, and standardized measures of depressive symptoms and violence exposure were ascertained by self-report.

Mechanisms of Injury Among the Amish Population in Central Pennsylvania.

Background: Individuals presenting with traumatic injury in rural populations have significantly different injury patterns than those in urban environments. With an increasing Amish population, totaling over 33 000 in our catchment area, their unique way of life poses additional factors for injury. This study aims to evaluate differences in mechanism of injury, location of injury, and demographic patterns within the Amish population.

An Overview of Amish Mortalities at a Level I Trauma Center.

Background: The Amish population is a unique subset of patients that may require a specialized approach due to their lifestyle differences compared to the general population. With this reasoning, Amish mortalities may differ from typical trauma mortality patterns. We sought to provide an overview of Amish mortalities and hypothesized that there would be differences in injury patterns between mortalities and survivors.

Differential antibiotic dosing in critical care: survey on nurses' knowledge, perceptions and experience.

Background: With the discovery of new antibiotics diminishing, optimizing the administration of existing antibiotics has become a necessity. Critical care nurses play a crucial role in combating antimicrobial resistance and are involved in preparing and administering antibiotics as well as monitoring their effects on patients. A dosing strategy proposed to reduce the development of ever-evolving antimicrobial resistance involves differential dosing regimens such as prolonged/continuous infusions.

Mimicking cardiac tissue complexity through physical cues: A review on cardiac tissue engineering approaches.

Cardiovascular diseases are the number one killer in the world. Currently, there are no clinical treatments to regenerate damaged cardiac tissue, leaving patients to develop further life-threatening cardiac complications. Cardiac tissue has multiple functional demands including vascularization, contraction, and conduction that require many synergic components to properly work.

Safety and Efficacy of Intermittent High-Dose Liposomal Amphotericin B Antifungal Prophylaxis in Haemato-Oncology: An Eight-Year Single-Centre Experience and Review of the Literature.

Triazoles remain first-line agents for antifungal prophylaxis in high-risk haemato-oncology patients, but their use is increasingly contraindicated due to drug-drug interactions and additive toxicities with novel treatments. In this retrospective, single-centre, observational study, we present our eight-year experience of antifungal prophylaxis using intermittent high-dose liposomal Amphotericin B (L-AmB). All adults identified through our Antifungal Stewardship Programme as receiving L-AmB prophylaxis at 7.

A Creative Action Plan for Mental Wellness: Tools for Primary Care in Rural and Underserved Settings.

Primary care settings have many opportunities to support patients who have anxiety and/or depression, but resources are often scarce. Our faculty team developed an education tool to support mental health awareness and provide suggested wellness activities. Health-care professionals from various disciplines and settings have demonstrated eagerness to use this tool with patients and with health-care students to improve resilience and mental wellness.

Assessment and Management of Delirium in Critically Ill Veterans.

Background: Delirium is a complex syndrome prevalent in the intensive care unit. It has been associated with significant morbidity including distress, longer hospital stays, prolonged cognitive impairment, and increased mortality.

Objective: To describe a nurse-led interdisciplinary quality improvement initiative to increase nurses' knowledge of delirium, documentation of delirium assessment, and patient mobility.

Rapid Facial Cryotherapy for Combat Sports: A Comparison of Materials and Methods for Cooling Facial Tissues in 60 Seconds or Less.

Context: Athletes in combat sports who have sustained facial hematomas during competition have traditionally been treated with an enswell. These treatments take place between rounds of the competition and generally last less than 60 seconds. The efficacy of this modality has not been studied.

Improving pediatric experience of pain during vaccinations: a quality improvement project.

Purpose: The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance.

Stability of Meropenem After Reconstitution for Administration by Prolonged Infusion.

Meropenem is a parenteral carbapenem antibiotic which has a broad spectrum of activity against aerobes and anaerobes. Meropenem's bactericidal activity is determined by the time during which meropenem concentration remains above the minimal inhibition concentration (MIC) during the dosing interval. Thus, prolonged infusion is the optimal way to maximize the time-dependant activity.

Double Network Hydrogels that Mimic the Modulus, Strength, and Lubricity of Cartilage.

The development of a hydrogel-based synthetic cartilage has the potential to overcome many limitations of current chondral defect treatments. Many attempts have been made to replicate the unique characteristics of cartilage in hydrogels, but none have simultaneously achieved high modulus, strength, and toughness while maintaining the necessary hydration required for lubricity. Herein, double network (DN) hydrogels, composed of a poly(2-acrylamido-2-methylpropanesulfonic acid) (PAMPS) first network and a poly( N-isopropylacrylamide- co-acrylamide) [P(NIPAAm- co-AAm)] second network, are evaluated as a potential off-the-shelf material for cartilage replacement.

Implementation of influenza point-of-care testing and patient cohorting during a high-incidence season: a retrospective analysis of impact on infection prevention and control and clinical outcomes.

Background: During high-incidence influenza seasons, a robust infection prevention and control policy is imperative to reduce nosocomial transmission of influenza.

Aim: To assess the impact of influenza point-of-care testing (POCT) in an emergency department (ED) and patient cohorting on an influenza ward on infection prevention and control and clinical outcomes.

Methods: Influenza POCT was operational in the study ED from 21 January 2018 and patient cohorting was operational on an influenza ward from 25 January 2018.

Effectiveness of an antifungal stewardship programme at a London teaching hospital 2010-16.

Background: The need for antifungal stewardship is gaining recognition with increasing incidence of invasive fungal infection (IFI) and antifungal resistance alongside the high cost of antifungal drugs. Following an audit showing suboptimal practice we initiated an antifungal stewardship programme and prospectively evaluated its impact on clinical and financial outcomes.

Patients And Methods: From October 2010 to September 2016, adult inpatients receiving amphotericin B, echinocandins, intravenous fluconazole, flucytosine or voriconazole were reviewed weekly by an infectious diseases consultant and antimicrobial pharmacist.

Developing drugs for treatment of atopic dermatitis in children (≥3 months to <18 years of age): Draft guidance for industry.

Atopic dermatitis is the most common chronic skin disease, and it primarily affects children. Although atopic dermatitis (AD) has the highest effect on burden of skin disease, no high-level studies have defined optimal therapy for severe disease. Corticosteroids have been used to treat AD since the 1950s and remain the only systemic medication with Food and Drug Administration approval for this indication in children, despite published guidelines of care that recommend against this option.