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Sepsis is a deadly and costly condition, but effectively managing sepsis in the emergency department (ED) can help to improve patient outcomes. A key part of sepsis management is improving compliance with sepsis bundles, which can be challenging in the ED setting. Bedside nurses in the ED have a unique opportunity to facilitate early identification and treatment of patients with sepsis, which increases sepsis bundle compliance and improves patient outcomes. Interventions reviewed in this article can help to improve early identification and treatment, along with ways to standardize care, provide education, and implement feedback. Faculty mentoring of undergraduate students is an essential and necessary component in helping students achieve exposure and success in cocurricular activities that they may not get in the classroom. It is through these cocurricular activities that faculty can expose students to the realms of various clinical activities, nursing research and education, and various service-related opportunities, such as tutoring and committee work. The intrinsic and extrinsic awards of watching your students succeed and grow into nursing leaders make mentoring worth it. This article outlines the benefits and difficulties experienced by 1 faculty member in his crusade to mentor undergraduate nursing students. Mental illness is one of the leading causes of disability in the United States. Delays in outpatient treatment result in visits to emergency rooms and unnecessary inpatient hospitalizations, which cause an increase in overall medical costs. Nurses come in contact with individuals who struggle with mental illness on a regular basis, and the profession must intervene. This article introduces the mental health outpatient nurses in interprofessional teams model that could have a positive impact on the quality and accessibility of care of outpatient services for individuals struggling with mental illness. As novice nurses enter the workforce, they are supported by their organizations in multiple ways. During the transition period, they are developing efficiencies that are important as they become advanced beginner nurses and then competent nurses. It is important for nurses to receive support in their journey to competency to gain efficiency while providing quality patient outcomes. This article explores opportunities to develop efficiencies as nurses enter practice. There are opportunities in personal support and with system support. Nurse leaders support novice nurses by facilitating proper professional experiences and proper system support. The complexity and rapidly changing environment of health care places significant pressure on nurses. How nurses make decisions within this environment has been an area of inquiry in the literature. Clinical decision making is the application of distinct thinking patterns and analysis of data at hand used to make judgements about patient care. Models of clinical decision making provide a foundation for understanding how nurses make decisions. Key factors associated with clinical decision making include experience, intuition, use of information and sources, and environment. Further work is needed to increase understanding of the processes by which nurses make clinical decisions. Nurse bedside shift report (NBSR) focuses on patient-centered care, and implementing the change starts with buy-in from management and a strong educational platform. Based on that platform, nurse champions grow to help foster education to their peers. Education and tools were provided to Registered Nurses and Certified Nursing Assistants. The pilot was implemented in 2 phases onto the Medical Oncology unit, and an incentive program ran concurrently. A prepilot revealed the following projected barriers time to complete NBSR, concerns with the Health Insurance Portability and Accountability Act, attending to patient needs, and being able to perform NBSR. To meet the significant increase in the demand for home health care, retention of home health nurses is essential. Job satisfaction is the major determinant of retention. Assessment of satisfaction indicators is a useful method to inform a home health agency plan to improve job satisfaction of home health nurses. Satisfaction was assessed using a standardized instrument, the Home Healthcare Nurse Job Satisfaction scale. The outcomes of a quality improvement process informed the development of a retention plan strategy to help leaders retain this important nursing work force in home health. Nurses need to actively embrace strategies to improve population health outcomes and reduce health and other disparities. Effective strategies include a focus on the broad range of factors and conditions that have a strong influence on health, advocacy directed at reducing barriers to improved population health, and engagement in policy making. Media engagement is an important tool for amplifying messages about societal problems amenable to public policy, educating stakeholders, bringing diverse stakeholders together for a common purpose, and promoting policy change. Development of clinical nurses in Magnet-designated organizations is enhanced through a commitment to shared governance principles, a relevant and visible professional practice model, and engagement of clinical nurses in shared decision making. Cultivating practice innovations and reward and recognition programs further assist to sustain this development and leads to growth of future leaders. Emerging nurse leaders are not adequately prepared to handle the pervasive health care problems and threats related to the changing environment. Nurse educators prepare nurses for an extensive variety of roles and responsibilities necessary to meet the health care needs of society. The Penn State College of Nursing implemented several initiatives to support environmental sustainability within the college and nursing education. The inclusion of environmental sustainability in nursing education is foundational if students are to become informed members and emerging leaders of a broader health care team, advocates for conscientious and ethical resource use, and contributors to improved patient outcomes. The Paul Strauss Center day-care accompaniment department ("SSAJ") is an oncologic supportive day-care, also an alternative to conventional hospitalization. In order to follow the SSAJ department's activity, in the "ambulatory turnover" context, we compared the 2008 and 2016 four first months activity. In 2016, there was an average of 4.96 patients per day versus 5.62 in 2008 (P less then 0.001); average day incoming of 653€ per stay in 2016 versus 775€ in 2008 (P less then 0.001). In 2016, there was an average 63.9 % of imagery done versus 27.7 % in 2008 (P less then 0.001). The 2016 average patient following period was of 84.7 days versus 67.6 days in 2008 (P=0.019). Average time between first day-care visit and death was 161.7 days in 2016 versus 133.5 days in 2008 (P=0.0033). Average day activity is lower in 2016 than 2008, nonetheless number of total stays and inpatients has increased on the four months period. The SSAJ intervenes more precociously in 2016 than 2008. Hospital technical platform is better used, but average per-stay incoming has statistically lowered. The SSAJ limits and prepares complete hospitalizations. Inpatient close reevaluation after a "shorter-willing" stay, home issues anticipation and identification with the home-care team, and worsening prevention gives this activity all its meaning. see more According to international clinical practice guidelines, low-molecular-weight heparins are advocate for the treatment and the prevention of cancer associated thrombosis. Direct oral anticoagulants recently introduced represent an alternative to vitamin K antagonists and low-molecular-weight heparins since their use doesn't require coagulation monitoring or daily subcutaneous injections. Recent studies comparing direct oral anticoagulants and low-molecular-weight heparins have shown a trend towards a reduction of venous thromboembolism events of direct oral anticoagulants but an increased risk of major bleeding. Recent French inter-group recommendations on the treatment of venous thromboembolism in cancer patients, favor low molecular weight heparins over direct oral anticoagulants as curative agents. In the light of recent studies, the objective of this review is to re-evaluate the place of low-molecular-weight heparins in the management of patents with cancer-associated thrombosis and to focus on the recent updates of international guidelines. PURPOSE Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related deaths with high recurrence after surgery due to a paucity of effective post-surgical adjuvant treatments. DC vaccines can activate multiple anti-tumor immune responses but have not been explored for post-surgery PDAC recurrence. Intraperitoneal (IP) delivery may allow increased DC vaccine dosage and migration to lymph nodes. Here, we investigated the role of prophylactic DC vaccination controlling PDAC tumor growth with IP delivery as an administration route for DC vaccination. METHODS DC vaccines were generated using ex vivo differentiation and maturation of bone marrow-derived precursors. Twenty mice were divided into four groups (n = 5) and treated with DC vaccines, unpulsed mature DCs, Panc02 lysates or no treatment. After tumor induction, mice underwent three magnetic resonance imaging scans to track tumor growth. Apparent diffusion coefficient (ADC), a quantitative magnetic resonance imaging measurement of tumor microstructure, was calculated. Survival was tracked. Tumor tissue was collected after death and stained with hematoxylin and eosin, Masson's trichrome, terminal deoxynucleotidyl transferase dUTP nick end labeling and anti-CD8 stains for histology. RESULTS DC-vaccinated mice demonstrated stronger anti-tumor cytotoxicity compared with control groups on lactate dehydrogenase assay. DC vaccine mice also demonstrated decreased tumor volume, prolonged survival and increased ΔADC compared with control groups. On histology, the DC vaccine group had increased apoptosis, increased CD8+ T cells and decreased collagen. ΔADC negatively correlated with % collagen in tumor tissues. DISCUSSION Prophylactic DC vaccination may inhibit PDAC tumor growth during recurrence and prolong survival. ΔADC may be a potential imaging biomarker that correlates with tumor histological features. Sleep disturbances, posttraumatic stress disorder, and traumatic brain injury are highly prevalent in military personnel and veterans. These disorders can negatively impact military performance. Although literature evaluating how posttraumatic stress disorder and traumatic brain injury directly impact military performance is limited, there is evidence supporting that these disorders negatively impact cognitive and social functioning. What is not clear is if impaired performance results from these entities individually, or a combination of each. Further research using standardized evaluations for the clinical disorders and metrics of military performance is required to assess the overall performance decrements related to these disorders.