Notes

Indian native coastal oceans: the mix involving sewer signal microorganisms! An assessment about pastime shorelines.
Firearm injury was significantly and independently associated with an increased risk of post-injury firearm weapon carriage (Relative Risk = 2.08,95% CI[1.34, 3.22],p < 0.01) and higher PTSD symptom levels (Beta = 3.82,95% CI[1.29, 6.35],p < 0.01).

Firearm injury survivors are at risk for firearm carriage and high PTSD symptom levels post-injury. The significant decrease in the high-risk behavior of firearm weapon carriage at 3-6 months post-injury suggests that there is an important post-injury "teachable moment" that should be targeted with preventive interventions.

ClinicalTrials.gov NCT02655354.
ClinicalTrials.gov NCT02655354.
We aimed to compare discharge opioid prescriptions pre- and post-Enhanced Recovery After Surgery (ERAS) implementation.

ERAS programs decrease inpatient opioid use, but their relationship with post-discharge opioids remains unclear.

All patients undergoing hysterectomy between October 2016-November 2020 and pancreatectomy or hepatectomy between April 2017-November 2020 at one tertiary care center were included. For each procedure, ERAS was implemented during the study period. Propensity-score matching (PSM) was performed to compare pre- vs. post-ERAS patients on discharge opioids (number of pills and oral morphine equivalents [OME]). Patients were matched on age, gender, race, payor, American Society of Anesthesiologists score, prior opioid use, and procedure. Sensitivity analyses in open versus minimally invasive surgery (MIS) cohorts were performed.

3,983 patients were included (1929 pre-ERAS; 2054 post-ERAS). Post-ERAS patients were younger (56.0 vs. 58.4 years; p<0.001), more often female (95.8% vs. 78.1%; p<0.001), less often white (77.2% vs. 82.0%; p<0.001), less often had prior opioid use (20.1% vs. 28.1%; p<0.001), and more often underwent hysterectomy (91.1% vs. 55.7%; p<0.001). After PSM, there were no significant differences between cohorts in baseline characteristics. Matched post-ERAS patients were prescribed fewer opioid pills (17.4 pills vs. 22.0 pills; p<0.001) and lower OMEs (129.4 mg vs. 167.6 mg; p<0.001) than pre-ERAS patients. Sensitivity analyses confirmed these findings [Open (18.8 pills vs. 25.4 pills; p<0.001 | 138.9 mg vs. 198.7 mg; p<0.001); MIS (17.2 pills vs. 21.1 pills; p<0.001 | 127.1 mg vs. 160.1 mg; p<0.001).

Post-ERAS patients were prescribed significantly fewer opioids at discharge compared to matched pre-ERAS patients.
Post-ERAS patients were prescribed significantly fewer opioids at discharge compared to matched pre-ERAS patients.
To investigate postoperative functional connectivity alterations across impaired cognitive domains and their causal relationships with systemic inflammation.

Postoperative cognitive dysfunction commonly occurs after cardiac surgery, and both systemic and neuroinflammation may trigger its development. Whether functional connectivity alterations underlying deficits in specific cognitive domains after cardiac surgery are affected by inflammation remain unclear.

Seventeen patients, who underwent cardiac valve replacement, completed a neuropsychological test battery and brain MRI scan before surgery and on days 7 and 30 after surgery compared to age-matched healthy controls. Blood samples were taken for TNF-α and IL-6 measurements. Seed-to-voxel FC of the left dorsolateral prefrontal cortex (DLPFC) was examined. Bivariate correlation and linear regression models were used to determine the relationships among cognitive function, FC alterations and cytokines.

Executive function was significantly impaired aftmmation may trigger these transient FC changes and executive function impairments.Although heart-focused anxiety is a common experience of patients following a myocardial infarction, it is one rarely addressed in nursing research. I used Rodger's evolutionary method of concept analysis to review uses of heart-focused anxiety in literature from several disciplines including nursing and synthesized a definition to guide future research. Heart-focused anxiety is an experience of avoidance, fear, and heart-focused attention that follows from cardiac diagnoses, somatic symptoms, and familial factors and results in adverse health outcomes, reassurance seeking, disruption of life, and recurrent chest pain. Although heart-focused anxiety is an evolving concept, the updated definition should help provide a foundation for future research. A Supplemental Digital Content video abstract is available at http//links.lww.com/ANS/A32.The theory of planned behavior has been prominently applied in nursing, but no known critique of the theory has been published. Using Fawcett and Desanto-Madeya's framework, we scrutinized and assessed the theory to determine its appropriateness for nursing investigations of behavior. The theory makes explicit assertions regarding human social behavior, incorporating some nursing metaparadigm concepts. Although not derived from the discipline, the theory's scope, content, and context are relevant to nursing, and its significance to nursing research and practice is clear. Studies incorporating all the theory's concepts and relationships are needed to confirm its testability and empirical and pragmatic adequacy.Instead of instilling in nursing students critical thinking to challenge injustice and oppression in nursing practice, nurse educators often rely on outdated traditional approaches to education. This situation is certainly true in traditional methods of evaluation that often propagate a banking mode of learning. One of the most commonly used methods of evaluating students is traditional examinations, which have recently become a source of pedagogical conflict among educators. In this article, we outline how educators unknowingly encourage surface learning, uncaring practices, oppression, inequity, and cheating when they rely on traditional examinations. We draw on critical caring pedagogy and universal design for learning to advocate for increased use of authentic assessment in nursing education. A Supplemental Digital Content video abstract is available at http//links.lww.com/ANS/A31.The crucible of the COVIDicene distills critical issues for nursing knowledge as we navigate our dystopian present while unpacking our oppressive past and reimagining a radical future. Using Barbara Carper's patterns of knowing as a jumping-off point, the authors instigate provocations around traditional disciplinary theorizing for how to value, ground, develop, and position knowledge as nurses. The pandemic has presented nurses with opportunities to shift toward creating a more inclusive and just epistemology. Moving forward, we propose an unfettering of the patterns of knowing, centering emancipatory knowing, ultimately resulting in liberating the patterns from siloization, cocreating justice for praxis.This study describes and evaluates the AACN Synergy Model for Patient Care that aligns nurses' competencies with the needs of patients and their families, developed by the American Association of Critical-Care Nurses. The description focuses on objectively explaining the theory, while the evaluation is based on established standards to determine its viability for application in nursing practice. This study applies Chinn and Kramer's (2011) theoretical description method and Fawcett and DeSanto-Madeya's (2013) theory analysis method to evaluate the AACN Synergy Model for Patient Care. Focusing on the patient-nurse relationship, the theory is appropriate for various nursing applications.This study aimed to conceptualize the empowerment of patients with coronary artery disease (CAD) using a hybrid model. In the final phase, "perceived competence and knowledge on lifestyle management," "sense of control of one's own health care," "self-acceptance to change," and "motivation for voluntary behavior" were identified as intrapersonal aspects; "information search," "active communication between patients and health care professionals," and "supportive relationships" were identified as interactional aspects; "self-management in one's life" and "coping behavior with disease" were identified as behavioral aspects. A concept accurately reflecting CAD characteristics may facilitate the implementation of risk factor management.The Theory of Planned Behavior was developed to explain human behaviors. The theory has been broadly applied to health-related behaviors in nursing science but has not been examined in depth based on a critical nursing framework. This article systematically analyzes and evaluates the theory based on Fawcett and DeSanto-Madeya's 2013 framework. The theory reflects nursing metaparadigm concepts and has both social and theoretical significance as well as pragmatic adequacy, and its testability is supported by abundant empirical evidence. However, the theory's internal consistency and clarity could be improved with use of consistent terms for its concepts and relationships.
To investigate the therapeutic effect of transcutaneous electrical nerve stimulation (TENS) on neurogenic overactive bladder (NOAB) that is refractory to pharmacotherapy.

This randomized trial recruited 83 participants with NOAB that were non-responsive to 3 months first-line anticholinergic drug treatment. Participants were randomized into treatment and control groups. TENS current consisting of biphasic square wave with pulse durations of 150 μs and pulse frequency set at 20 Hz were applied to for 30 min once a day for 90 days. Stimulation was provided over the lateral aspect of the sacrum bilaterally of the electrodes. Patients in the TENS group stopped taking the anticholinergic drugs. The control group continued to receive anticholinergic drugs for 90 days. The participants' Overactive Bladder Symptom Score (OABSS), Medical Outcomes Study 36-Item Short Form Survey (SF-36) scores, urodynamic values, and voiding diary data were assessed before and after the therapy.

The TENS treatment group had significantly decreased OABSS scores compared with the control group (P < 0.001); additionally, half of the SF-36 scores were significantly improved in the TENS group (P < 0.05). ALK inhibitor drugs The patients treated with TENS improved significantly voiding diary parameters at P < 0.05. Similarly, urodynamic values at P < 0.05 favoured the experimental group over the control group.

Applying daily TENS over the sacral region for 90 days to patient with neurogenic overactive bladder improved OAB symptoms of patients whose response to anticholinergic drugs is far inferior.
Applying daily TENS over the sacral region for 90 days to patient with neurogenic overactive bladder improved OAB symptoms of patients whose response to anticholinergic drugs is far inferior.
The objective of this study is to determine the association between biases related to attrition, missing data, and the use of intention to treat (ITT) and changes in effect size estimates in Physical Therapy (PT) randomized trials. A meta-epidemiological study was conducted. A random sample of RCTs included in meta-analyses in the PT discipline were identified. Data extraction including assessments of the use of intention to treat principle, attrition related bias, and missing data was conducted independently by 2 reviewers. To determine the association between these methodological issues and effect sizes, a 2-level analysis was conducted using a meta-meta-analytic approach. 393 trials included in 43 meta-analyses, analyzing 44,622 patients contributed to this study. Trials which did not use the ITT principle (ES = -0.13; 95%CI -0.26; 0.01), or which were assessed as having inappropriate control of incomplete outcome data tended to underestimate the treatment effect when compared with trials with adequate use of ITT and control of incomplete outcome data (ES = -0.
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