Gunnbutler5162

Nurses in nonclinical roles desire to be involved in responses to emergency events, but not as direct care providers. Involvement enables them to feel valuable despite nonclinical roles. During emergency events, nursing leaders should mobilize the talents of this workforce segment, offering role choice when feasible.

This study examined nurses' perspectives about the barriers and facilitators to implementing research findings and evidence into practice.

Work environments play an essential role in implementation and innovation; however, much of the research regarding evidence-based practice focuses on nurses' knowledge and skills, leaving the work environments unexamined.

A mixed method survey design was used. Data collection included an electronic survey and open questions. Analysis included descriptive statistics and narrative analysis using the Consolidated Framework for Implementation Research.

Attitudes about implementing evidence into practice were positive. Identified barriers included lack of time and knowledge, change fatigue, and complex internal processes; facilitators included supportive colleagues, knowledgeable mentors, and access to libraries and other resources.

Implementing evidence into practice is facilitated by committing organizational resources, fostering supportive work environments, integrating evidence into quality improvement projects, offering continuing education, and reducing the complexity of translating evidence into practice and the number of institution-wide initiatives.

Implementing evidence into practice is facilitated by committing organizational resources, fostering supportive work environments, integrating evidence into quality improvement projects, offering continuing education, and reducing the complexity of translating evidence into practice and the number of institution-wide initiatives.This month's column highlights the attributes, competencies, and qualifications for consideration when selecting the ideal advanced practice leader, one that is collaborative and skilled in providing leadership at the executive or health systems level.As the 1st community-acquired case of COVID-19 struck the Pacific Northwest, healthcare organizations prepared to respond by implementing emergency systems. Leaders navigated away from their routine daily operations to manage crisis efforts. This article highlights 6 leadership strategies used in the early days of the pandemic. Reviewing these lessons learned and revisiting the strategies used during this time will help today's leaders continue to lead through the COVID-19 pandemic and beyond.The COVID-19 pandemic exacerbated long-standing challenges in the workforce, resulting in a shortage of nurses that has now reached crisis levels. At the same time, there is a concerning "skills gap" that has been emerging for some time. Leaders have typically relied on legacy recruitment and retention strategies to mitigate these challenges, but these will not be sufficient to address staffing gaps. In this article, the authors discuss how current staffing challenges differ from previous workforce shortages and propose 7 executive strategies for C-suite leaders to prepare for the future nursing workforce.The Magnet Recognition Program® completed a crosswalk between the National Academy of Medicine (NAM) recommendations in the 2020-2030 Future of Nursing report and the recently released 2023 Magnet Application Manual. In comparing the 2 documents, it was determined the Magnet® framework aligns with several of the NAM recommendations. Both the NAM and Magnet program emphasize health equity and diversity in patient care, education, and nurse wellness. In this column, one can learn how both documents establish guidelines for empowering the nursing profession as the primary means to improving health equity and outcomes for the 21st century.The National Academies of Medicine consensus study committee reported that US healthcare workers experience high levels of burnout resulting from external pressures on the healthcare system and the organization of work. Nurse managers are especially susceptible to burnout. This column provides evidence-based strategies to improve the work environment, reduce the burden of job demands, and promote well-being among nurse managers.

Permanent perioperative vision loss is caused by ischemic optic neuropathy (ION) or central retinal artery occlusion (CRAO). Whereas diffusion restriction of the optic nerve (ON) on brain magnetic resonance imaging has been previously reported in perioperative posterior ION (PION), there are no reports of ON diffusion restriction in patients diagnosed with acute perioperative CRAO. We present a case of perioperative CRAO to highlight this neuroimaging finding for neuroradiologists and neurologists.

A 71-year-old male without vascular risk factors underwent maxillary bilateral antrostomy and septoplasty for chronic sinusitis. Twenty to thirty minutes upon awakening, he complained of painless left eye vision loss. Ophthalmoscopic examination showed retinal whitening, segmented arterioles, and hyperemic disc. Brain MR-diffusion weighted imaging/apparent diffusion coefficient revealed ON diffusion restriction in the proximal segment. Despite attempted reperfusion, left eye remained with no light perception atgnetic resonance imaging can be diagnostic of proximal thromboembolic CRAO. Future studies should evaluate the diagnostic utility and accuracy of MR-diffusion weighted imaging/apparent diffusion coefficient in perioperative visual loss.The BRCA1-associated protein 1 (BAP1) gene encodes a tumor suppressor that functions as a ubiquitin hydrolase involved in DNA damage repair. BAP1 germline mutations are associated with increased risk of multiple solid malignancies, including mesothelioma, uveal melanoma, renal cell carcinoma, and high-grade rhabdoid meningiomas. Here, we describe the case of a 52-yr-old woman who experienced multiple abdominal recurrences of an ovarian sex cord-stromal tumor that was originally diagnosed at age 25 and who was found to have a germline mutation in BAP1 and a family history consistent with BAP1 tumor predisposition syndrome. Recurrence of the sex cord-stromal tumor demonstrated loss of BAP1 expression by immunohistochemistry. Although ovarian sex cord-stromal tumors have been described in mouse models of BAP1 tumor predisposition syndrome, this relationship has not been previously described in humans and warrants further investigation. The case presentation, tumor morphology, and immunohistochemical findings have overlapping characteristics with peritoneal mesotheliomas, and this case represents a potential pitfall for surgical pathologists.Uterine leiomyoma with massive lymphoid infiltration is characterized by a dense lymphoid infiltrate and germinal centers sparing the adjacent myometrium. Only few reports describe this entity and its etiology is unknown. This rare lesion may also exhibit lymphocytic vasculopathy but this has only been reported in the setting of GnRH agonist exposure. We report 2 cases of uterine leiomyoma with massive lymphoid infiltration in which only 1 patient was exposed to GnRH agonists. In both cases, histopathologic analysis showed thick-walled vessels with swollen endothelial cells showing evidence of intramural lymphocytic infiltration, red blood cell extravasation, and medial edema. This constellation of findings represented frank vascular damage and lymphocytic vasculopathy. Our findings suggest that lymphocytic vasculopathy in these lesions may be secondary to factors other than GnRH agonists. Furthermore, both cases showed an angiocentric disposition of germinal centers that has scarcely been alluded to in prior reports. This finding may provide a clue in accurately recognizing leiomyoma with massive lymphoid infiltration. Recognition of this lesion will allow one to avoid mistaking it for mimickers such as inflammatory myofibroblastic tumor, lymphoid malignancies, or other inflammatory processes.

Shortening and deformity of the tibia commonly occur during the treatment of congenital pseudarthrosis of the tibia (CPT). The role of osteotomies in lengthening and deformity correction remains controversial in CPT. This study evaluates the approach to and outcome after osteotomy performed in CPT.

We performed an IRB approved retrospective review of consecutive patients with CPT treated at our institution from 2010 through 2019. Patients who underwent osteotomies were included in this study.

Nine patients (10 osteotomies-5 proximal metaphyseal and 5 diaphyseal) with a median age at osteotomy of 8.9 years (range 4 to 21 y) were included. Six patients had neurofibromatosis-1, 1 had cleidocranial dysplasia, and 2 patients had idiopathic CPT. Four osteotomies were performed for deformity correction, 3 osteotomies to allow intramedullary instrumentation, and 3 osteotomies for lengthening. Five osteotomies were preceded by zolendronate treatment before surgery. Nine were fixed with a rod supplemented with exnged, this study suggests, somewhat surprisingly, that preconsolidation can occur frequently in lengthening procedures.

Level IV-case series.

Level IV-case series.Therapies for metastatic SDHB-dependent pheochromocytoma and paraganglioma (PPGL) are limited and poorly efficient. New targeted therapies and identification of early non-invasive biomarkers of response are thus urgently needed for these patients. We characterized an in vivo allograft model of spontaneously immortalized murine chromaffin cells (imCC) with inactivation of the Sdhb gene by dynamic contrast-enhanced MRI (DCE-MRI) and 18FDG-PET. We evaluated the response to several therapies IACS-010759 (mitochondrial respiratory chain complex I inhibitor), sunitinib (tyrosine kinase inhibitor with anti-angiogenic activity), talazoparib (poly ADP ribose polymerase (PARP) inhibitor) combined or not to temozolomide (alkylating agent), pharmacological inhibitors of HIF2a (PT2385 and PT2977 (belzutifan)) and molecular inactivation of HIF2a (imCC Sdhb-/- shHIF2a). Multimodal imaging was performed, including magnetic resonance spectroscopy (1H-MRS) to monitor the level of succinate in vivo. The allografted model of Sdhb-/- imCC reflected SDHB-deficient tumors, with increased angiogenesis and a particular avidity for 18FDG. After 14 days of treatment, IACS-010759, sunitinib and talazoparib at high doses allowed a significant reduction of the tumor volumes. In contrast to the tumor growth inhibition observed in Sdhb-/- shHIF2a imCC tumors, pharmacological inhibitors of HIF2a (PT2385 and belzutifan) showed no antitumor action in this model, alone or in combination with sunitinib. 1H-MRS, but not DCE-MRI, enabled the monitoring response to sunitinib, which was the best treatment in this study, promoting a decrease in succinate levels detected in vivo. This study paves the way for new therapeutic options and reveals a potential new early biomarker of response to treatment in SDHB-dependent PPGL.

Telehealth technology is an excellent solution to resolve the problems of health care delivery. However, this technology may fail during large-scale implementation. As a result, business models can be used to facilitate commercialization of telehealth products and services.

The purpose of this study was to review different types of business models or frameworks and their components used in the telehealth industry.

This was a systematic review conducted in 2020. The databases used for searching related articles included Ovid, PubMed, Scopus, Web of Science, Emerald, and ProQuest. Google Scholar was also searched. These databases and Google Scholar were searched until the end of January 2020 and duplicate references were removed. Finally, articles meeting the inclusion criteria were selected and the Critical Appraisal Skills Programme (CASP) checklist was used for appraising the strengths and limitations of each study. Data were extracted using a data extraction form, and the results were synthesized narratively.