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Successful implementation requires adequate support for teamwork and ensuring team members can work according to their clinical competency. Nurses practicing in expanded roles need clear role guidelines and adequate time to function in these roles.Congregate settings such as psychiatric units have an increased risk of disease transmission because of the milieu setting and the inability to isolate patients. Interventions to prevent infection and cross-contamination are discussed including monitoring of patient temperatures, personal protective equipment, remote care, monitoring of human resources, and reinforcement of infection prevention strategies. We discuss the effectiveness of those interventions and the lessons learned, including implications for psychiatric clinical care, during future pandemics or a next wave of COVID-19.The coronavirus disease (COVID-19) pandemic has been a source of disruption, unexpected illness, stress, and adversity for people, worldwide. As the reality of the COVID-19 pandemic unfolded in early 2020, many healthcare organizations found themselves in the midst of their Magnet appraisals-just short of the 3rd appraisal phase, the Site Visit Phase. In response, the Magnet Recognition Program devised strategies to maintain the integrity of the appraisal process, despite the turbulence associated with the unexpected changes that healthcare organizations were confronting while contending with the impact of COVID-19. In this month's Magnet Perspectives column, we explore how the virtual site visit has provided healthcare organizations with the opportunity to complete this phase of their appraisal process while addressing the safety and well-being of the organization's staff as well as that of the Magnet appraisers.

The ongoing U.S. opioid epidemic threatens quality of life and poses substantial economic and safety burdens to opioid abusers and their communities, physicians, and health-care systems. Public health experts have argued that prescription opioids are implicated in this epidemic; however, opioid dosing following surgical procedures remains controversial. The purpose of this study was to evaluate the relationship between initial opioid prescribing following total hip arthroplasty (THA) and total knee arthroplasty (TKA) and the risk and quantity of long-term opioid use.

Patients undergoing THA or TKA from January 1, 2016, to June 30, 2016, were identified. Preoperative 30-day opioid and benzodiazepine exposures were evaluated using the Rhode Island Prescription Drug Monitoring Program. Cumulative morphine milligram equivalents (MMEs) in the postoperative inpatient stay, initial outpatient opioid prescription, and prescriptions filled from 31 to 90 days (prolonged use) and 91 to 150 days (chronic use) followiV. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Because unresolved debris in the ear canal or middle ear of newborns may produce high false positive rates on hearing screening tests, it has been suggested that an outer/middle ear measure can be included at the time of hearing screening. A potential measure is power absorbance (absorbance), which indicates the proportion of power in a broadband acoustic stimulus that is absorbed through the outer/middle ear. Although absorbance is sensitive to outer/middle dysfunction at birth, there is large variability that limits its accuracy. Acoustic leaks caused by poor probe fitting further exacerbate this issue. The objectives of this work were to (1) develop criteria to indicate whether a change in absorbance occurs in association with probe fit; (2) describe the variability in absorbance due to poor fitting; and (3) evaluate test-retest variability with probe reinsertions, excluding poor fits.

An observational cross-sectional design was used to evaluate changes in absorbance due to probe fit and probe reinserte that variability in absorbance was reduced by minimizing acoustic leaks. Pending further validation, the probe-fit criteria developed in this work can be recommended to ensure proper probe fit.

Salivary tumors are uncommon among children but are more likely to be malignant compared with adults. A lack of experience makes consensus in treatment elusive. Amidst recent publication of large institutional and national series, this review aims to discuss the epidemiology, diagnosis, investigation, and treatment for pediatric epithelial salivary malignancies.

Pediatric salivary malignancies are often low grade and carry a favorable prognosis. High-grade tumors portend an increased risk of recurrence and a decreased survival. BMS-794833 in vivo Surgeons should strive for oncologic resection with clear margins and avoid enucleation and excisional biopsies. Overt nodal metastases require concurrent neck dissection, whereas elective neck dissections may be reserved for cases with high risk of occult disease, such as advanced stage and high-grade neoplasms. Adjuvant radiation should be considered in high-grade tumors.

The paucity of high-level evidence clouds treatment decisions and further encourages pediatric salivary malignancies to be treated in an experienced center with a multidisciplinary approach.

The paucity of high-level evidence clouds treatment decisions and further encourages pediatric salivary malignancies to be treated in an experienced center with a multidisciplinary approach.

To test the hypothesis that water exchange (WE), when compared with carbon dioxide (CO2) insufflation, significantly reduces the right colon adenoma miss rate (rAMR) in a blinded randomized controlled trial with cap-assisted colonoscopy.

The unblinded consecutive group observational data showed that WE significantly decreased rAMR. The unblinded data are limited by potential bias.

Consecutive patients aged 45 years or more were randomized to undergo insertion with WE or CO2. Withdrawal and polypectomy were performed with CO2 in both groups to the hepatic flexure. The colonoscope was reinserted to the cecum. A second colonoscopist re-examined the right colon. The second colonoscopist was unaware, but made a guess, of the initial insertion method. The number of additional adenomas divided by the total number detected in both examinations equaled rAMR.

Among 262 patients (131/group), demographic variables were similar. The body mass index was significantly higher in the WE group. Compared with CO2, WE significantly decreased rAMR [18.