Andrewslauritzen6834

The current study presents for the first time a combination of the gel electromembrane extraction (GEL-EME) and switchable hydrophilicity solvent-based homogeneous liquid-liquid microextraction (SHS-HLLME) methods which can be used as an efficient hyphenated extraction procedure. This coupled method, which was followed by GC-FID, was applied for quantification of antidepressants (desipramine, clozapine, and citalopram) in biological and wastewater samples. The effective parameters of both GEL-EME and SHS-HLLME procedures were optimized. Using an agarose gel membrane, analytes were extracted from 7.0 mL of the sample solution to 500 µL of the aqueous acceptor solution. The maximum extraction of analytes of interest was obtained under the optimized conditions (pH of acceptor solution, 5.0; pH of gel membrane, 5.0; pH of sample solution, 7.0, voltage value, 30 V; and extraction time, 30 min). Then, the acceptor solution was transferred to the extraction cell and the SHS-HLLME procedure was conducted again under the optimized conditions. Dipropylamine (50 µL) was selected as an extraction solvent. The introduced technique exhibited good linearities with coefficients of determinatin (R2) higher than 0.983 and an acceptable linear range of 5.0-1000 ng/mL. Accordingly, the limit of detection was ≤ 1.0 ng/mL (S/N = 3) for all analytes, and the high enrichment factors were obtained in the range of 178.7-194.8. Moreover, the corresponding repeatability was from 4.0 to 8.7% (n = 3). The proposed method was successfully utilized to determine trace levels of the drugs in human serum, wastewater, and breast milk samples. V.BACKGROUND AND OBJECTIVE Visual dizziness occurs when high visual dependence interferes with compensation for a vestibular lesion and leads to intolerance in situations of visual conflict. The Visual Vertigo Analogue Scale (VVAS) is a self-administered, valid and reliable questionnaire that serves to assess visual dizziness. The use of questionnaires in different cultures and languages requires that they be translated and adapted to the local culture. There is no version of the VVAS in Argentina. The objectives of this study were to translate and carry out a cross-cultural adaptation of the VVAS into Spanish for use with vestibular patients in Argentina. MATERIALS AND METHODS This study was carried out from November 2015 to January 2016 in the Kinesiology Service of a public hospital in the city of Buenos Aires. Patients were Argentines older than 18 years who suffered from a vestibular disorder. The translation and cross-cultural adaptation were based on the guide to the process of cross-cultural adaptation of self-administered measurements by Beaton et al. RESULTS 39 patients were included in the VVAS cross-cultural adaptation process. All changes made by the committee of experts were for the purpose of ensuring the semantic, idiomatic, experimental and conceptual equivalence of the two versions. CONCLUSION The original version of the VVAS has been translated into Spanish and adapted for use in the Argentine population with vestibular disorders. OBJECTIVE To compare two different blastocyst biopsy protocols. DESIGN Retrospective single-center cohort study. SETTINGS Private in vitro fertilization center. PATIENT(S) The study included 1,670 frozen-thawed embryo transfers (FETs) with preimplantation genetic testing for aneuploidy (PGT-A). INTERVENTION None. MAIN OUTCOME MEASURE(S) Survival rate (SR) after thawing, clinical pregnancy rate (CPR), ongoing implantation rate (IR), and live birth rate (LBR). RESULT(S) Eight hundred thirty-five FETs with PGT-A cycles including only embryos biopsied in the sequential blastocyst hatching and biopsy protocol paired with the ablation of one-fourth of the zona pellucida (ZP) were matched with 835 FETs with PGT-A cycles including only embryos biopsied in the day 3 prehatching protocol by female age (±1 year), number of embryos transferred, use of gestational carrier or egg donor, and day of blastocyst transfer. Only FETs with euploid blastocysts graded no lower than 4BB were included, and cycles with fewer than five oocytes were excluded. SR after thawing, CPR, ongoing IR, and LBR were significantly higher in the FET cycles with the embryos biopsied in the sequential hatching and biopsy protocol. Four cases of monozygotic twin pregnancies were reported with the day 3 prehatching protocol and none with the sequential hatching and biopsy protocol. CONCLUSION(S) Our results show, for the first time, that using different blastocyst biopsy protocols can affect clinical outcomes. Because the study was retrospective, our findings should be validated in a prospective trial. Plasma B-type natriuretic peptide (BNP) and its N-terminal pro-form, NT-proBNP, can predict outcomes in patients with severe aortic stenosis (AS). However, their prognostic value in moderate AS is currently unknown. The present study included 261 patients diagnosed with moderate AS (1.0 888 pg/dl). During a median follow up of 2.7 years, there were 136 (52%) deaths. Mortality rate was much higher in patients with higher-median NT-pro BNP compared to those with lower-median NT-pro BNP levels (p less then 0.001). Higher-median NT-pro BNP level was significantly associated with higher mortality rate (hazard ratio 3.11; 95% confidence interval 1.78 to 5.46, p less then 0.001) even after adjusting for confounders. Aortic valve replacement (AVR) was performed in 82 (31%) patients and median time to AVR was 2.1 years. Patients with higher-median NT-pro BNP had higher mortality rate compared to patients with lower-median NT-pro BNP even after AVR (p less then 0.01). In conclusion, higher NT-proBNP level is associated with higher mortality rates in patients with moderate AS even among those undergoing AVR. Neurogenic orthostatic hypotension (nOH), a drop in blood pressure upon standing resulting from autonomic malfunction, may cause debilitating symptoms that can affect independence in daily activities and quality-of-life. nOH may also be associated with cardiovascular comorbidities (e.g., supine hypertension, heart failure, diabetes, and arrhythmias), making treatment decisions complicated and requiring management that should be based on a patient's cardiovascular profile. Additionally, drugs used to treat the cardiovascular disorders (e.g., vasodilators, β-blockers) can exacerbate nOH and concomitant symptoms. When orthostatic symptoms are severe and not effectively managed with nonpharmacologic strategies (e.g., water ingestion, abdominal compression), droxidopa or midodrine may be effective. Droxidopa may be less likely than midodrine to exacerbate supine hypertension, based on conclusions of a limited meta-analysis. In conclusion, treating nOH in patients with cardiovascular conditions requires a balance between symptom relief and minimizing adverse outcomes. We examine the import of a Comparative Health Care Immersion Program in South Korea to prepare entry-level Master of Science in Nursing (MSN) students studying to become clinical nurse leaders (CNLs) who can dynamically engage the complex issues facing health systems in the United States (U.S.). Following passage of the Affordable Care Act, clinical nurse leaders are being expected to have insight into systems level issues and ameliorate them when they are related to poor patient outcomes. Examination of South Korea's health care system provides U.S. students an opportunity to see the design and action of a highly functional system and thus benchmark the U.S health care system. South Korea provides a useful comparator given their rapid development of a universal, single-payer health care system that uses advanced centralized computing and provides outcomes on par and surpassing the U.S. We explore implementation of a CNL competency-based curriculum, including financing, informatics, and health care efficiencies within the context of short-term study abroad. Published by Elsevier Inc.This paper highlights questions about Canadian nurse regulators' adoption of the U.S.-based NCLEX-RN examination, effective 2015, as the only route to initial registered nurse licensure in all jurisdictions, excluding Quebec. The decision for this change was made by the Canadian Council of Registered Nurses Regulators (CCRNR), an umbrella association of CEO's of provincial regulatory bodies in collaboration with the National Council of State Boards of Nursing (NCSBN). EX 527 molecular weight Adoption and implementation of this new policy was accomplished by the Council of each provincial regulatory body. This change, representing the first international adoption of NCLEX-RN, was deemed successful by CCRNR and NCSBN. However, the Canadian Association of Schools of Nursing (CASN) described the decision as unilateral and unwise, questioning the applicability of NCLEX-RN in the Canadian context, citing significant French language translation issues and unacceptable pass rates. Both authors have had extensive academic nursing experience in U.S. and Canada. Both had many conversations with Canadian colleagues who described the impact on nursing education as disastrous. Most of our American colleagues knew nothing about this change, but once informed, expressed some concerns similar to those of their Canadian counterparts. We suggest that international adoption of a US-based examination for initial licensure merits wider discussion by nursing faculty here and abroad. BACKGROUND Nurses provide education on medications to hospitalized patients and this intervention is measured by patient's satisfaction on the Hospital Consumer Assessment of Healthcare Providers and Systems Survey [HCAHPS] (Center for Medicare & Medicaid Services[CMS], 2008). PURPOSE Nursing students implement the teach-back method in a quality improvement project to improve patients' knowledge of medications and satisfaction on the HCAHPS survey. Specific aim 1 increase nursing students use of teach-back from the current state of 0% to 80% of their patient encounters; Specific aim 2 ensure that 80% of the patients approached can state the name, purpose and side effects of their current medications; Specific aim 3 have 80% of the patients satisfied with their medication teaching. METHODS The Model for Improvement framework from the Institute for Healthcare Improvement was used (Ogrinc et al., 2012). Process and outcome measures and Plan-Do-Study-Act cycles were analyzed. RESULTS Senior nursing students used teach back on 82.9%% of their patient encounters. Of the N = 55 patients who received the intervention, 58.2% could state the name and purpose, and 50.9% knew the side effects of their medications. HCAHPS survey responses did not achieve the benchmarks of 77.2% and 52.3% for "always" responses for medication education questions. However, patient satisfaction was measured at 96.4% with the One Minute Evaluation (Appendix A) by nursing students following the intervention. CONCLUSION Integrating QI into the clinical environment is a method to not only increase patient outcomes but also exposes students to the methods of QI. Although the intervention did not meet the benchmark for patient satisfaction in "Communication about Medicines" category as measured by HCAHPS survey results, the teach-back method was an effective evidence-based tool for improving patient knowledge of medications.