Notes

Mapping your Effect: The Nexus Evaluation Approach to Handling Food Access.
Within 24 hours of insertion, 50% of feeding tubes had migrated forward. selleck inhibitor Repeated-measures analysis showed a greater likelihood of migration in patients with an endotracheal tube (relative risk, 3.46 [95% CI, 1.14-10.53]; P = .03).

No tubes migrated retrograde into the stomach or esophagus, challenging the practice of verifying placement every 4 hours. Verification every 24 hours may be adequate if migration is not suspected. Also, lack of visible anatomical structures on insertion tracings from an electromagnetic placement device make subtle changes in postpyloric placement difficult to identify accurately.
No tubes migrated retrograde into the stomach or esophagus, challenging the practice of verifying placement every 4 hours. Verification every 24 hours may be adequate if migration is not suspected. Also, lack of visible anatomical structures on insertion tracings from an electromagnetic placement device make subtle changes in postpyloric placement difficult to identify accurately.
Although clinical care is multidisciplinary, intensive care unit research commonly focuses on single-discipline themes. We sought to characterize intensive care unit research conducted by physicians and nurses.

One hundred randomly selected reports of clinical studies published in critical care medical and nursing journals were reviewed.

Of the 100 articles reviewed, 50 were published in medical journals and 50 were published in nursing journals. Only 1 medical study (2%) used qualitative methods, compared with 9 nursing studies (18%) (P = .02). The distribution of quantitative study designs differed between medical and nursing journals (P < .001), with medical journals having a predominance of cohort studies (29 articles [58%]). Compared with medical journal articles, nursing journal articles had significantly fewer authors (median [interquartile range], 5 [3-6] vs 8 [6-10]; P < .001) and study participants (94 [51-237] vs 375 [86-4183]; P < .001) and a significantly lower proportion of male study participants (55% [26%-65%] vs 60% [51%-65%]; P = .02). Studies published in medical journals were much more likely than those published in nursing journals to exclusively involve patients as participants (47 [94%] vs 25 [50%]; P < .001). Coauthorship between physicians and nurses was evident in 14 articles (14%), with infrequent inclusion of authors from other health care disciplines.

Physician research and nurse research differ in several important aspects and tend to occur within silos. Increased interprofessional collaboration is possible and worthwhile.
Physician research and nurse research differ in several important aspects and tend to occur within silos. Increased interprofessional collaboration is possible and worthwhile.
A recent randomized trial of bereaved family members of patients who died in an intensive care unit identified symptoms of depression and posttraumatic stress in recipients of semistructured condolence letters.

To explore family member and clinician experiences with receiving or sending handwritten sympathy cards upon the death of patients involved in a personalized end-of-life intervention, the 3 Wishes Project.

Interviews and focus groups were held with 171 family members and 222 clinicians at 4 centers to discuss their experiences with the 3 Wishes Project. Interview transcripts were searched to identify participants who discussed sympathy cards. Data related to sympathy cards were independently coded by 2 investigators through conventional content analysis.

Sympathy cards were discussed during 32 interviews (by 25 family members of 21 patients and by 11 clinicians) and 2 focus groups (8 other clinicians). Family members reported that personalized sympathy cards were a welcome surprise; they experienced them as a heartfelt act of compassion. Clinicians viewed cards as an opportunity to express shared humanity with families, reminding them that they and their loved one were not forgotten. Signing cards allowed clinicians to reminisce individually and collectively with colleagues. Family members and clinicians experienced sympathy cards as a meaningful continuation of care after a patient's death.

Inviting clinicians who cared for deceased patients to offer personalized, handwritten condolences to bereaved family members may cultivate sincere and individualized expressions of sympathy that bereaved families appreciate after the death of patients involved in the 3 Wishes Project.
Inviting clinicians who cared for deceased patients to offer personalized, handwritten condolences to bereaved family members may cultivate sincere and individualized expressions of sympathy that bereaved families appreciate after the death of patients involved in the 3 Wishes Project.
Residential exposure to greenness is associated with better birth outcomes, but it remains unknown whether this is explained by maternal characteristics associated with both place of residence and birth outcomes. We examined whether changes in residential greenness are associated with preterm birth (PTB) and birthweight.

We examined cross-sectional associations between maternal exposure to residential greenness [normalized difference vegetation index (NDVI)] and PTB (<37 weeks of gestation) and birthweight in grams, using all births in Michigan (1990-2012) linked by mother (n = 1730424). We used maternal fixed effects analysis to estimate associations within mothers across multiple pregnancies and associations for mothers who did not move, but for whom greenness changed between pregnancies, to mimic an intervention.

Each 0.1-unit change in NDVI was associated with 0.98 [95% confidence interval (CI) 0.97, 0.99] times lower odds of PTB and a 9.0 (95% CI 8.1, 9.9)-gram increase in birthweight after adjusting for individual and neighbourhood covariates. When we controlled for time-invariant maternal unmeasured confounders; these associations were close to null [odds ratio (OR) 1.00 (95% CI 0.98, 1.01); β -0.3 (95% CI -2.0, 3.6)]. We did not find a relationship between greenness and birth outcomes among women who did not move between pregnancies, but for whom greenness changed within their residential location (as in an intervention).

Residential greenness does not predict birth outcomes, after controlling for time-invariant maternal characteristics, using longitudinal evidence. Future research should explore residential selection factors, spatial and individual heterogeneity and experimental study designs.
Residential greenness does not predict birth outcomes, after controlling for time-invariant maternal characteristics, using longitudinal evidence. Future research should explore residential selection factors, spatial and individual heterogeneity and experimental study designs.
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