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More nurses without critical care experience are being hired by intensive care units. Eleven newly hired nurses participated in a phased program designed to improve the efficiency of intensive care unit orientation. A pre-post implementation design demonstrated that although there was a 14% reduction in orientation time, there were no statistically significant changes in new hire or preceptor satisfaction nor in first-year registered nurse turnover rates. Expansion of the program is needed to demonstrate its impact.Evaluating Nurse Transition programs has undergone an evolutionary process to more accurately report outcomes. Based on a previous work, this project used the Clinical Nurse Transition Program-Evaluation Tool to externally evaluate the effectiveness of nurse transition programs within the U.S. Army Nurse Corps. The results support the belief that a new graduate nurse performs better at 24 weeks within the Clinical Nurse Transition Program than at 12 weeks. In addition, new graduates perform above standards 6 months postgraduation.Federally Qualified Health Centers (FQHCs) have been essential in response to COVID-19 outbreaks among vulnerable populations. Our rural FQHC had a primary role in early detection of and response to a poultry plant-related outbreak at the outset of the pandemic that disproportionately and gravely affected the local Hispanic community. The health center activated a rapid local response that included the community's first mass testing event and first acute respiratory treatment clinic, both of which were central to abatement. Lessons learned from this experience provide important guidance for the potential role of FQHCs in infection outbreak preparedness in marginalized communities.

Cardiac resynchronization therapy (CRT) is indicated in patients with systolic heart failure (HF), severe left ventricle (LV) dysfunction and interventricular dyssynchrony.In prospective observational research, we aimed to evaluate whether CRT-induced LV reverse remodelling and occurrence of ventricular arrhythmias (VT/VF) independently contribute to prognosis in patients with CRT defibrillators (CRT-D).

In 95 Italian cardiological centres, after a screening period of 6 months, patients were categorized according to VT/VF occurrence and CRT response, defined as LV end-systolic volume relative reduction >15% or LV ejection fraction absolute increase >5%. The main endpoint was death or HF hospitalizations.

Among 1308 CRT-D patients (80% male, mean age 66 years), at 6 months, follow-up 71% were identified as CRT responders and 12% experienced appropriate VT/VF detections. The main endpoint was significantly and independently associated with previous myocardial infarction, New York Heart Association Class, VT/VF occurrence and with CRT response. CRT nonresponder patients who suffered VT/VF in the screening period had a risk of death or HF hospitalizations [HR = 7.82, 95% confidence interval (CI) = 3.95-15.48] significantly (P < 0.001) higher than CRT responders without VT/VF occurrence. This risk is mitigated without VT/VF occurrence (HR = 3.47, 95% CI = 2.03-5.91, P < 0.001) or in case of CRT response (HR = 3.11, 95% CI = 1.44-6.72, P = 0.004).

Our data show that both CRT response and occurrence of VT/VF independently contribute to the risk of death or HF-related hospitalizations in CRT-D patients. Early VT/VF occurrence may be identified as a marker of disease severity than can be mitigated by CRT response both in terms of all-cause mortality and long-term VT/VF onset.

URL https//www.clinicaltrials.gov. Unique identifier NCT00147290 and NCT00617175.

URL https//www.clinicaltrials.gov. Unique identifier NCT00147290 and NCT00617175.

We conducted a prospective clinical trial of patients receiving radiation (RT) for brain metastases to identify clinical predictors of pre-RT and post-RT health-related quality of life (hrQoL).

Patients with brain metastases completed overall (European Organisation for Research and Treatment of Cancer QLQ C15-PAL) and brain tumor-specific (QLQ-BN20) hrQoL assessments pre-RT (n=127) and 1 (n=56) and 3 (n=45) months post-RT. Linear and proportional-odds models analyzed patient, disease, and treatment predictors of baseline, 1-, and 3-month hrQoL scores. Generalized estimating equations and repeated measures proportional-odds models assessed predictors of longitudinal hrQoL scores.

Most patients underwent stereotactic radiosurgery (SRS) (69.3%) and had non-small-cell lung (36.0%) metastases. Compared with SRS, receipt of whole brain RT was associated with a higher odds of appetite loss (baseline P=0.04, 1 mo P=0.02) and greater motor dysfunction (baseline P=0.01, 1 mo P=0.003, 3 mo P=0.02). Receipt of systpatients with reported better hrQoL in various as well as domains after intracranial RT.

Despite inconclusive evidence that prescription drug monitoring programs (PDMP) reduce opioid-related mortality, guidelines recommend PDMP review with opioid prescribing. Some reported barriers to use include time-consuming processes to obtain data and workflow disruptions.

We provided access to a PMDP-electronic health record (EHR) integrated program to 123 clinicians in one healthcare system. Remaining clinicians within the healthcare system and metropolitan area did not receive PDMP-EHR integration program access. We identified changes in opioid prescribing by linking prescription data available in the state PMDP database to individual clinicians. The primary outcome was change in receipt of high dose opioid prescriptions (>90 mg morphine equivalents) by Colorado residents before and after program integration. check details Secondary outcomes included changes in long-acting opioid receipt and overlapping opioid and benzodiazepine prescription days. Next, we surveyed clinicians to assess their perspectives on PDMP data acquisition before and after PDMP-EHR integration program access.

High-dose opioid receipt decreased significantly across all 3 clinician groups [PDMP-EHR integration program access (27.6%, to 6.9%, P < 0.001); no program access in the same healthcare system (4.8% to 2.9%, P < 0.001), and no program access across the metropolitan area (13.5% to 6.1%, P < 0.001)]. Clinicians reported improved access to PDMP data using the PDMP-EHR integrated program compared to the state PDMP website (98.6%).

Further study of PDMP-EHR integration programs on patient and clinician outcomes may illuminate the role of this technology in public health and in clinical practice.

Further study of PDMP-EHR integration programs on patient and clinician outcomes may illuminate the role of this technology in public health and in clinical practice.

Physical distancing measures aim to reduce person-to-person contact, a key driver of SARS-CoV-2 transmission. In response to unprecedented restrictions on human contact during the COVID-19 pandemic, studies measured social contact patterns under the implementation of physical distancing measures. This rapid review synthesizes empirical data on the changing social contact patterns during the COVID-19 pandemic.

We conducted a systematic review using PubMed, Medline, Embase, and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We descriptively compared the distribution of contacts observed during the pandemic to pre-COVID data across countries to explore changes in contact patterns during physical distancing measures.

We identified 12 studies reporting social contact patterns during the COVID-19 pandemic. Eight studies were conducted in European countries and eleven collected data during the initial mitigation period in the spring of 2020 marked by government-declared lockdowns. Some studies collected additional data after relaxation of initial mitigation. Most study settings reported a mean of between 2-5 contacts per person per day, a substantial reduction compared to pre-COVID rates, which ranged from 7-26 contacts per day. This reduction was pronounced for contacts outside of the home. Consequently, levels of assortative mixing by age substantially declined. After relaxation of initial mitigation, mean contact rates increased but did not return to pre-COVID levels. Increases in contacts post-relaxation were driven by working-age adults.

Information on changes in contact patterns during physical distancing measures can guide more realistic representations of contact patterns in mathematical models for SARS-CoV-2 transmission.

Information on changes in contact patterns during physical distancing measures can guide more realistic representations of contact patterns in mathematical models for SARS-CoV-2 transmission.

Given the potential risks of x rays in imaging, it is necessary to evaluate the radiation safety of medical x-ray imaging rooms and radiation information of radiographers. A descriptive study has been carried out in Qazvin, Iran, in the form of a questionnaire answered by radiography technologists in private and public imaging centers to assess the level of knowledge, attitude, and performance about x-ray exposure and safety against it. Afterward, the radiation doses of public areas of the radiography centers were measured by a survey meter. A checklist was also completed, containing items about availability of ventilation facilities in x-ray rooms, radiation warning signs, radiation work schedules, documents of periodic blood test monitoring, exposure history of radiographers by film badge, and documents of the quality control of x-ray devices. The data analysis was performed by SPSS 16 using descriptive study, t-test, ANOVA, and Pearson's correlation coefficient test. The mean attitude and knowledge scoreance of the staff was somewhat good. Almost all x-ray imaging centers had good radiation protection conditions. The annual quality control of x-ray imaging devices was ensured. The radiation protection awareness among the medical radiographers in Qazvin city needs to be improved, especially among the experienced staff.

Understanding of the behavior and effects of plutonium (Pu) in the environment is an important aspect of developing responsible and effective strategies for remediation and environmental stewardship. This work studies the sorption and uptake of 239Pu by common environmental bacteria, Escherichia coli DH10β and Pseudomonas putida KT-2440. Plutonium was directly incorporated into growth media prior to inoculation (0.12 kBq mL-1), and samples from the liquid cultures of E. coli and P. putida were analyzed over a 15-d growth period through liquid scintillation counting (LSC) of plutonium in cell pellets and cell culture media following centrifugation. To improve its solubility in the liquid cultures, Pu was complexed with citrate prior to inoculation. P. putida cultures were also grown without citrate to examine potential impact of P. putida's ability to use citrate as a food source. The accumulation of Pu in P. putida cells was found to increase both with and without citrate complexation for the first 5 d and ystem, multiple mechanisms are at play.Despite more than 80% of interventional operators reporting one or more orthopedic injuries attributed to the X-ray laboratory, there has been limited adoption of various strategies and equipment to minimize these injuries. A comprehensive review of these methods to reduce musculoskeletal strain is lacking in the current literature, and is essential in order to ensure a long, healthy, and productive interventional career.