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Congenital heart defects (CHDs) affect 40,000 U.S. infants annually. One fourth of these infants have a critical CHD, requiring intervention within the first year of life for survival. Over 80% of CHDs have an unknown etiology. Fine particulate matter ≤2.5 (PM2.5) and ozone (O3) may be air pollutants associated with CHD.

The purpose of this study was to explore relationships between first-trimester maternal exposure to air pollutants PM2.5 and O3 and a critical CHD diagnosis.

A retrospective cohort study with nested case controls was conducted using data from January 1, 2014, to December 31, 2016, and consisted of 199 infants with a diagnosed critical CHD and 550 controls. Air pollution data were obtained from the U.S. Environmental Protection Agency air monitors. Geographic information system software was used to geocode monitoring stations and infant residential locations. Data analysis included frequencies, chi-square, independent t-test analysis, and binary logistic regression for two time periods the entire first trimester (Weeks 1-12) and the critical exposure window (Weeks 3-8 gestation).

Critical CHD odds were not significantly increased by exposure during the first trimester. However, weekly analyses revealed CHD odds were higher in Weeks 5 and 8 as PM2.5 increased and decreased in Week 11 with increased O3 exposure.

Our study shows no evidence to support the overall association between air pollutants PM2.5 and O3 and a critical CHD diagnosis. However, analyses by week suggested vulnerability in certain weeks of gestation and warrant additional surveillance and study.
Our study shows no evidence to support the overall association between air pollutants PM2.5 and O3 and a critical CHD diagnosis. However, analyses by week suggested vulnerability in certain weeks of gestation and warrant additional surveillance and study.Mystical and spiritual experiences have been reported throughout human history. Causal explanations for these range from psychopathology of mental illness, drugs such as hallucinogens, neurological disorders including temporal lobe epilepsy, and genuine mystical or spiritual awakening. There is a common core of phenomena in such experiences, as described both in historical accounts and recent research, but also evidence of cultural specificity. This article is a personal account of such an experience, which occurred in a postanesthetic state. A striking feature of the experience was noesis a sense of revelation and complete understanding. I argue that while there must be a neural basis to these phenomena, it is difficult to reduce the subjective meaning of the experience purely to a brain dysfunction. Reconciling mechanism and meaning of such experiences remains a challenge for both neuroscience and philosophy.
The purpose of this study was to explore the definition and application of systems thinking (ST) in interprofessional practice and improved patient outcomes.

Nurse educators need a universal definition of ST to implement in curricula to foster quality and safety while enhancing outcomes for nursing students.

The QSEN RN-BSN Task Force used the hybrid model of concept analysis to identify the process of fostering ST in clinical and didactic learning experiences and how ST changed over time from the perspective of educators.

The definition of ST in the context of interprofessional practice and outcomes was "a dynamic, analytical process that looks at complex patterns, relationships, and connections within elements and structures, resulting in the ability to recognize the whole picture."

The concept of ST in the context of interprofessional practice and improved patient outcomes may be integrated within nursing curricula.
The concept of ST in the context of interprofessional practice and improved patient outcomes may be integrated within nursing curricula.This innovative teaching strategy sought to evaluate authentic literature as the primary textbook in a nursing theory course. Arts-based pedagogy can potentiate students' development of critical thinking skills, which are necessary for sound clinical judgment. At the end of the course, students responded to an online survey to better understand their experience of using authentic literature in nursing. Students reported a high level of agreement on the interconnectedness of themes in the authentic literature with the course purpose and content. Authentic literature provided a contextual perspective for analysis, debate, and formation of clinical nursing judgment.This study examined the impact of a nursing course redesign from traditional face-to-face to a hybrid format on student outcomes, workload allocation, and associated costs. In this quasi-experimental study, baccalaureate students received either traditional (n = 47) or hybrid delivery (n = 46); each group had equal degree-type representation. Average exam scores were analyzed using an independent t-test, with no significant differences found between groups. Faculty workload decreased by one third, and there was a 16.6 percent reduction in overall costs to implement the course. Course redesign can be effective for reducing faculty workload and costs while achieving course outcomes.This study aimed to examine the acceptance and predictors of remote education through Internet-based learning among undergraduate nursing students in Jordan. An online survey was used with a sample of 344 students to assess satisfaction with remote education. Responses indicated that undergraduate nursing students were unsatisfied with remote education for several reasons. Many students (n = 188, 55 percent) strongly agreed that problems and obstacles were encountered when they studied subjects electronically. The acceptance of remote education was predicted by educational level (p = .01), device used (p = .001), and Internet reliability p = .001).
The purpose of this study was to identify factors influencing the decision to teach lesbian, gay, bisexual, transgender, and queer (LGBTQ) content in baccalaureate nursing programs and determine priority areas for future intervention.

LGBTQ people face a variety of health disparities. Lack of LGBTQ-focused education in nursing schools contributes to these disparities.

Using the theory of planned behavior as a framework, nurse educators from across the United States (n = 111) were surveyed on concepts that influenced their intention to teach LGBTQ content.

Average scores on items related to barriers, outcomes, control, norms, and attitudes were found to significantly correlate with the intention to teach LGBTQ content.

Participants reported positive attitudes and some measure of control over curricula but did not indicate an intent to incorporate LGBTQ content. Lack of time, knowledge/competence, resources, and training were barriers. A toolkit to facilitate teaching LGBTQ content may increase inclusion in nursing curricula.
Participants reported positive attitudes and some measure of control over curricula but did not indicate an intent to incorporate LGBTQ content. Lack of time, knowledge/competence, resources, and training were barriers. A toolkit to facilitate teaching LGBTQ content may increase inclusion in nursing curricula.Diabetes process and outcome measures are common quality measures in payment reform models, including Alternative Payment Models (APMs) and value-based insurance design (VBID). In this commentary we review evidence from selected research to examine whether these payment models can improve the value of diabetes care. We found that higher-risk APMs yielded greater improvements in diabetes process measures than lower-risk APMs, and that VBID models appeared to improve medication adherence but not other quality measures. selleck products We argue that these models are promising first steps in redesigning the payment system to improve diabetes care. However, greater coordination and alignment across models is needed to enhance their impact on providers' behavior, diabetes care processes, and patient health outcomes.This systematic review identified studies of nonmedical interventions designed to reduce risk for and improve clinical outcomes for type 2 diabetes. Specifically, this review sought to identify interventions that target structural racism and social determinants of health. To be included, studies were published in English; published between database initiation and January 2022; conducted in the United States; measured an intervention effect using a clinical trial, quasi-experimental, or pre-post design; included a population of adults at risk for or with type 2 diabetes; and targeted hemoglobin A1c levels, blood pressure, lipids, self-care, or quality of life as outcomes. The findings of our review indicate that interventions with targeted, multicomponent designs that combine both medical and nonmedical approaches can reduce risk for and improve clinical outcomes for type 2 diabetes. HbA1c levels improved significantly with the use of food supplementation with referral and diabetes support; the use of financial incentives with education and skills training; the use of housing relocation with counseling support; and the integration of nonmedical interventions into medical care using the electronic medical record. Our findings demonstrate that the literature on nonmedical interventions designed to address relevant social factors and target structural racism is limited. The article offers actionable strategies and identifies policy opportunities for targeting structural inequalities and decreasing social risk among adults with type 2 diabetes.Managing patients with type 2 diabetes takes time. Clinicians in primary care, where most diabetes visits take place, lack that time. Planned visits by diabetes care managers-nurses, pharmacists, social workers, and other team members-assist clinicians and are associated with improved glycemic control. Particularly effective is care management featuring nurses or pharmacists adjusting medications without prior physician approval. Care management programs need to pay close attention to inequities in diabetes care and outcomes. The widespread implementation of diabetes care management in primary care faces several barriers lack of an adequate, diverse, trained care manager workforce; regulations limiting care managers' scope of practice; and financial models not supportive of care management. Wide-ranging policies are needed to address these barriers. In particular, payment reform is needed to stimulate the spread of diabetes care management adding fee-for-service codes that adequately pay care managers for their work, adopting shared savings models that channel savings back to primary care, and increasing the percentage of health care spending dedicated to primary care. In this article we explore key questions around type 2 diabetes care management, review the published evidence, examine the barriers to its wider use, and describe policy solutions.The proliferation of diabetes quality measures in the US since the mid-1990s has increased the burden of measurement without commensurate improvements in the quality of care or health outcomes. Measures in use today do not represent or incentivize achievement of care goals in all domains of quality that are necessary to achieve optimal diabetes health. We recommend reimagining and improving diabetes quality measurement through the following propositions widespread adoption of new measures and modernization of existing measures across six domains of quality; use of a subset of new and modernized metrics as top-line measures for reporting and reimbursement; and optional use of the remaining new and modernized measures for evaluative purposes at all levels of the care delivery system to identify and address gaps in care quality and outcomes. These propositions would support practices and policies at all levels of the health care system to improve the health of people with diabetes.
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