RESUMEN
We aimed to determine if a programme change to 12 hourly injections of FSH (150 IU per injection) for the first 2 days of stimulation in women with high ovarian reserve (AMH ≥ 30 pmol/L), followed by 24 hourly injections, would elicit increased earlier follicular recruitment, higher egg yields and blastocyst embryos for cryopreservation, leading to potential higher cumulative pregnancy rates, than conventional daily injections throughout. For safety reasons, the approach required mandatory cryopreservation of all blastocysts (mFET group; n = 74), after ovulation trigger with GnRH-agonist, in GnRH-antagonist controlled cycles. The 'Comparator group' (n = 91) comprised women with the same high AMH levels treated with the same base dose of FSH, with the aim of fresh blastocyst transfer and cryopreservation of supernumerary embryos, treated over the preceding 2 years. There was no difference in age, AMH, weight or BMI between the groups. The mFET group achieved higher egg (17.7 versus 11.7; p < 0.001) and embryo (10.9 versus 7.2; p < 0.001) yields and fewer cases with sub-optimal embryo yields (7% versus 22%; p = 0.018). The cumulative live birth rate was superior in the mFET group (73% versus 43%), as was the safety profile, and negligible rate of treatment plan modification.
Asunto(s)
Tasa de Natalidad , Hormona Folículo Estimulante , Embarazo , Femenino , Humanos , Fertilización In Vitro/métodos , Vitrificación , Inducción de la Ovulación/métodos , Índice de Embarazo , Hormona Liberadora de Gonadotropina , Blastocisto/fisiología , Nacimiento VivoRESUMEN
BACKGROUND: There is limited evidence identifying best practices to promote competency of accurate assignment of the Emergency Severity Index (ESI) acuity level to patients who present to the emergency department (ED) triage. LOCAL PROBLEM: Triage-trained nurses do not receive competency training in an ESI triage tool. METHODS: A retrospective chart review of 150 patients was completed to evaluate mistriage rates before and after triage-trained nurses completed an ESI competency assessment. RESULTS: The retrospective chart review showed no statistically significant difference in mistriage from pre- to postintervention ( P = .8535). CONCLUSIONS: Implementation of an ESI annual competency assessment aligns well with an emerging theme in the literature that ED nurses should be provided with ongoing education that reinforces knowledge and implementation of ESI triaging.
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Servicio de Urgencia en Hospital , Triaje , Humanos , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: The use of telehealth technology in various health care settings continues to expand. Such technology allows intensive care units to monitor patients living in remote locations and to intervene early when a patient's condition declines or a critical event occurs. The use of telehealth can also support nurses and help meet staffing challenges, which have increased in intensive care units during the COVID-19 pandemic. Currently, however, there are no formal requirements for telehealth education in nursing education or for telehealth orientation in nursing practice. OBJECTIVE: To develop a telehealth curriculum based on telehealth competencies that would be broad enough to encompass all educational levels of nursing students and to support the current nursing workforce. INTERVENTION: A telehealth curriculum was designed that included an overview of telehealth, camera considerations, equipment, troubleshooting, reimbursement, legislation, and quality measures. These topics were then organized and developed into 6 online interactive video modules and simulation experiences. The curriculum topics pertinent to the tele-intensive care unit are discussed in this article. CONCLUSIONS: Completion of the telehealth curriculum or a formal telehealth orientation session may provide nurses with an understanding of the principles of telehealth and the skills needed to provide high-quality patient care using telehealth best practices. As the use of telehealth continues to expand, nursing education and practice should work together to address the needs of the nursing workforce and staffing challenges, specifically in the intensive care unit setting.
Asunto(s)
COVID-19 , Educación en Enfermería , Telemedicina , Humanos , Unidades de Cuidados Intensivos , Pandemias , SARS-CoV-2RESUMEN
ABSTRACT: Telehealth improves access to health care and has seen rapid expansion in recent years. Nurse practitioner (NP) students are expected to be able to use telehealth to provide health care on graduation; however, many programs of study do not include telehealth in the academic preparation of students. As a result, students feel unprepared to use telehealth to provide care to patients. To meet this need, a land-grant institution developed evidence-based competencies and curriculum to educate NP students in the area of telehealth. Curriculum included presentations, assignments, and simulation in the area of telehealth. Participants included 156 female and 15 male family nurse practitioner (FNP) students. Using a Likert scale from 1 (very unprepared) to 4 (very prepared), students indicated their knowledge and skill level for each telehealth competency area before and after the content delivery. Each competency demonstrated a significant increase in FNP student confidence and ability when comparing the pretest and posttest mean (p = .000). Outcomes of the project demonstrated the importance of including telehealth concepts into the curriculum for NP students to meet the needs and expectations of health care systems.
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Enfermeras Practicantes , Telemedicina , Curriculum , Atención a la Salud , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Telehealth is becoming increasingly integral in providing improved access to care, especially for patients who reside in frontier and rural areas. Nurse practitioner (NP) faculty are charged with preparing NP students through curriculum and clinical experiences that align with the health care environment and the health care access needs of the populations they serve. METHOD: To meet this need, NP faculty at a land-grant university located in a frontier and rural midwestern state reinforced NP student telehealth curriculum and competency through application in a clinical environment. RESULTS: Participants included 22 family NP (FNP) students and 19 clinical preceptors. According to the evaluations, the FNP students met seven of the eight competency criteria, and the preceptors met eight of the 13 evaluation criteria. CONCLUSION: Outcomes indicate telehealth curriculum competency can be reinforced through application in a clinical setting to prepare NP students to meet the needs of patients and changing health care environments. [J Nurs Educ. 2020;59(7):413-417.].
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Curriculum , Enfermeras Practicantes , Telemedicina , Competencia Clínica , Curriculum/tendencias , Humanos , Enfermeras Practicantes/educaciónRESUMEN
Elevated drug-cue elicited brain activity is one of the most widely cited, transdiagnostically relevant traits of substance dependent populations. These populations, however, are typically studied in isolation. The goal of this study was to prospectively investigate the spatial topography of drug-cue reactivity in a large set of individuals dependent on either cocaine, alcohol, or nicotine. Functional MRI data was acquired from 156 substance dependent individuals (55 cocaine, 53 alcohol, and 48 nicotine) as they performed a standardized drug-cue exposure task. Clusters of significant activation to drug-cues relative to neutral cues ('hot spots') were isolated for each individual. K-means clustering was used to classify the spatial topography of the hotspots in the data set. The percentage of hotspots that would be reached at several distances (2-5 cm) of transcranial magnetic stimulation (TMS) were calculated. One hundred and three participants had at least one cluster of significant frontal cortex activity (66%). K-means revealed 3 distinct clusters within the medial prefrontal cortex (MPFC), left inferior frontal gyrus/insula, right premotor cortex. For the group as a whole (and for alcohol users and nicotine users independently), medial prefrontal cortex (BA 10) was the location of the greatest number of hotspots. The frontal pole was cortical location closest to the largest percentage of hotspots. While there is individual variability in the location of the cue-elicited 'hot spot' these data demonstrate that elevated BOLD signal to drug cues in the MPFC may be a transdiagnostic endophenotype of addiction which may also be a fruitful neuromodulation target.
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Señales (Psicología) , Imagen por Resonancia Magnética , Motivación , Corteza Prefrontal/fisiopatología , Trastornos Relacionados con Sustancias/fisiopatología , Adulto , Mapeo Encefálico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estimulación Magnética Transcraneal , Adulto JovenRESUMEN
Infection with Erysipelothrix rhusiopathiae has a significant economic impact on pig production systems worldwide. Both inactivated and attenuated vaccines are available to prevent development of clinical signs of swine erysipelas. The ability of a live attenuated E. rhusiopathiae strain to become persistently established in pigs after intranasal exposure and its potential to cause clinical signs consistent with swine erysipelas after being administered directly into the nasopharynx of healthy pigs was evaluated. Five, E. rhusiopathiae-negative pigs were vaccinated by deep intranasal inoculation then followed for 14 days. Nasal swabs were collected daily for 5 days and clinical observations were made daily for 14 days post-vaccination. Nasal swabs were cultured for E. rhusiopathiae with the intent of back-passaging any recovered organisms into subsequent replicates. No organism was recovered from nasal swabs in the first vaccination replicate. A second replicate including 10 pigs was initiated and followed in an identical manner to that described above. Again, no E. rhusiopathiae was recovered from any pigs. No pigs in either replicate showed any signs of clinical swine erysipelas. The live attenuated E. rhusiopathiae strain evaluated in this study did not appear to become persistently established in pigs post-vaccination, did not cause any local or systemic signs consistent with swine erysipelas, and was therefore unlikely to revert to a virulent state when used in a field setting.
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Vacunas Bacterianas/uso terapéutico , Infecciones por Erysipelothrix/inmunología , Erysipelothrix/inmunología , Enfermedades de los Porcinos/inmunología , Vacunas Atenuadas/uso terapéutico , Administración Intranasal , Animales , Vacunas Bacterianas/administración & dosificación , Temperatura Corporal , Erysipelothrix/aislamiento & purificación , Erysipelothrix/patogenicidad , Infecciones por Erysipelothrix/fisiopatología , Mucosa Nasal/microbiología , Nariz/microbiología , Seguridad , Porcinos , Virulencia , Aumento de PesoRESUMEN
The role of digital imaging is increasing as these systems are becoming more affordable and accessible. Advantages of computed radiography compared with conventional film/screen combinations include improved contrast resolution and postprocessing capabilities. Computed radiography's spatial resolution is inferior to conventional radiography; however, this limitation is considered clinically insignificant. This study prospectively compared digital imaging and conventional radiography in detecting small volume pneumoperitoneum. Twenty cadaver dogs (15-30 kg) were injected with 0.25, 0.25, and 0.5 ml for 1 ml total of air intra-abdominally, and radiographed sequentially using computed and conventional radiographic technologies. Three radiologists independently evaluated the images, and receiver operating curve (ROC) analysis compared the two imaging modalities. There was no statistical difference between computed and conventional radiography in detecting free abdominal air, but overall computed radiography was relatively more sensitive based on ROC analysis. Computed radiographic images consistently and significantly demonstrated a minimal amount of 0.5 ml of free air based on ROC analysis. However, no minimal air amount was consistently or significantly detected with conventional film. Readers were more likely to detect free air on lateral computed images than the other projections, with no significant increased sensitivity between film/screen projections. Further studies are indicated to determine the differences or lack thereof between various digital imaging systems and conventional film/screen systems.
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Enfermedades de los Perros/diagnóstico por imagen , Neumoperitoneo/veterinaria , Tomografía Computarizada por Rayos X/veterinaria , Medicina Veterinaria/instrumentación , Animales , Cadáver , Costos y Análisis de Costo , Perros , Neumoperitoneo/diagnóstico por imagen , Curva ROC , Intensificación de Imagen Radiográfica , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/economía , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/normas , Medicina Veterinaria/métodos , Medicina Veterinaria/normas , Pantallas Intensificadoras de Rayos XRESUMEN
A total of 100 Pseudomonas aeruginosa (P. aeruginosa) isolates were collected over a 1.5-year period from cases of canine otitis. Sensitivities to enrofloxacin, marbofloxacin, and orbifloxacin were determined using minimum inhibitory concentration testing (MICT). Isolates were also tested for sensitivities to enrofloxacin and marbofloxacin using disk-diffusion susceptibility testing (DDST). Isolates were significantly more sensitive to marbofloxacin than to enrofloxacin (z = -4.57; P<0.05) or orbifloxacin (z = -5.02; P<0.05). Agreement was 87% between MICT and DDST for marbofloxacin, with approximately equal numbers of overestimation and underestimation errors. Agreement was 74% between MICT and DDST for enrofloxacin, but DDST tended to overestimate the number of enrofloxacin-susceptible strains. These results suggest that marbofloxacin is more effective against P. aeruginosa than either enrofloxacin or orbifloxacin and that relying on DDST may lead to ineffective enrofloxacin treatment.
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Antibacterianos/farmacología , Enfermedades de los Perros/tratamiento farmacológico , Fluoroquinolonas/farmacología , Otitis/veterinaria , Infecciones por Pseudomonas/veterinaria , Pseudomonas aeruginosa/efectos de los fármacos , Animales , Ciprofloxacina/análogos & derivados , Ciprofloxacina/farmacología , Recuento de Colonia Microbiana , Perros , Relación Dosis-Respuesta a Droga , Farmacorresistencia Bacteriana , Farmacorresistencia Bacteriana Múltiple , Enrofloxacina , Pruebas de Sensibilidad Microbiana/veterinaria , Otitis/tratamiento farmacológico , Otitis/microbiología , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/aislamiento & purificación , Quinolonas/farmacología , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
Dilated cardiomyopathy is a relatively common pathology in captive flying foxes (Pteropus spp.). The goal of this study was to establish quantitative reference range measurements that could be used to support a diagnosis of cardiac disease in these animals. Lateral and ventrodorsal thoracic radiographs from apparently healthy flying foxes (n = 66) of three species (Rodriguez island flying fox, P. rodricensis, n = 18; small island flying fox, P. hypomelanus, n = 16; and Malaysian flying fox, P. vampyrus, n = 32) were evaluated objectively to describe the cardiac appearance. Absolute and relative cardiac dimensions also were measured. The same methods were used to evaluate radiographs from flying foxes (n = 9) with known dilated or acute cardiomyopathy. The following ratios were most appropriate for categorizing normal cardiac silhouette size. In the ventrodorsal projection, heart width to thoracic width and heart width to clavicle length were the preferred measurements. In the lateral projection, heart width compared with thoracic height was the preferred measurement. From radiographs of the bats with known dilated and acute cardiomyopathy, the apicobasilar heart length compared with thoracic height and heart width compared with thoracic height on lateral films were the most sensitive ratios for diagnosing cardiomegaly.
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Quirópteros/anatomía & histología , Corazón/anatomía & histología , Corazón/diagnóstico por imagen , Animales , Animales Salvajes , Cardiomiopatía Dilatada/diagnóstico , Cardiomiopatía Dilatada/diagnóstico por imagen , Cardiomiopatía Dilatada/veterinaria , Femenino , Cardiopatías/diagnóstico , Cardiopatías/diagnóstico por imagen , Cardiopatías/veterinaria , Masculino , Radiografía Torácica/veterinaria , Valores de Referencia , Especificidad de la EspecieRESUMEN
Serological tests were performed on 380 cats with necropsy-confirmed heartworm disease to compare the performance of currently available commercial laboratory and point-of-care heart-worm serological tests in a heartworm-endemic area. Overall, antigen tests detected 79.3% to 86.2% of heartworm infections and were highly specific. Most cats with false-negative antigen tests had a single male worm. Antibody tests detected 62.1% to 72.4% of heartworm infections and had a wider range of false-positive results (1.4% to 19.1%) than antigen tests (0.3% to 2.0%). Serological tests for feline heartworm infection varied in diagnostic performance. Combining results from antigen and antibody tests achieved greater sensitivity than using either test alone.
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Anticuerpos Antihelmínticos/sangre , Antígenos Helmínticos/inmunología , Enfermedades de los Gatos/diagnóstico , Dirofilaria/inmunología , Dirofilariasis/diagnóstico , Animales , Enfermedades de los Gatos/sangre , Gatos , Dirofilariasis/sangre , Femenino , Masculino , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Pruebas Serológicas/veterinariaRESUMEN
OBJECTIVE: To determine the pharmacokinetics of enrofloxacin in neonatal kittens and compare the pharmacokinetics of enrofloxacin in young and adult cats. ANIMALS: 7 adult cats and 111 kittens (2 to 8 weeks old). PROCEDURE: A single dose of 5 mg of enrofloxacin/kg was administered to adults (i.v.) and kittens (i.v., s.c., or p.o.). Plasma concentrations of enrofloxacin and its active metabolite, ciprofloxacin, were determined. RESULTS: The half-life of enrofloxacin administered i.v. in 2-, 6-, and 8-week-old kittens was significantly shorter and its elimination rate significantly greater than that detected in adults. The apparent volumes of distribution were lower at 2 to 4 weeks and greater at 6 to 8 weeks. This resulted in lower peak plasma concentration (Cmax) at 6 to 8 weeks; however, initial plasma concentration was within the therapeutic range after i.v. administration at all ages. Compared with i.v. administration, s.c. injection of enrofloxacin in 2-week-old kittens resulted in similar Cmax, half-life, clearance, and area under the curve values. Enrofloxacin administered via s.c. injection was well absorbed in 6- and 8-week-old kittens, but greater clearance and apparent volume of distribution resulted in lower plasma concentrations. Oral administration of enrofloxacin resulted in poor bioavailability. CONCLUSIONS AND CLINICAL RELEVANCE: In neonatal kittens, i.v. and s.c. administration of enrofloxacin provided an effective route of administration. Oral administration of enrofloxacin in kittens did not result in therapeutic drug concentrations. Doses may need to be increased to achieve therapeutic drug concentrations in 6- to 8-week-old kittens.