Explore the vast range of titles available.

Objectives Cognitive impairments associated with cancer and cancer treatments have yet to determine definitive causes, gold-standard assessments, or effective treatments to offset or mitigate symptoms. The purpose of the current study was to determine relationships between women with breast cancer and the negative memory impact of treatment and other factors. Materials and methods This online study included 171 participants receiving at least one type of treatment for breast cancer. This descriptive correlational study used two measures to assess memory and one for stress. The survey included demographics, treatments received, and memory. Results Results indicated increased perceived impairments among variables of age, stress, surgery, chemotherapy, radiation, and hormonal treatment modalities. Discussion This study established relationships between memory/cognitive impairments and the variables of age, four treatment modalities, three agents, and stress. Conclusion The results from this study demonstrate the importance of developing standardized assessments to identify the presence and severity of cancer and treatment-related cognitive impairments. The study will be used as a first step to developing a memory support strategy using a web-based nursing intervention considering the impact of stress.

Introduction The management of blunt splenic injury has evolved to include splenic artery embolization in addition to non-surgical management, and splenic surgery. Though research has been conducted examining outcomes between management approaches, the inferential findings are often limited by single-site study designs and small sample sizes. However, results from large-scale prior studies can inform inference if a non-frequentist (Bayesian) framework is used. Therefore, the purpose of this study was to examine mortality and length of stay associated with blunt splenic injury management using both frequentist and Bayesian methods. Methods A total of 56 patients presenting with blunt splenic injury were included in this retrospective, single-center, quantitative study from January 1, 2021 to December 31, 2022 to inform both methodological approaches. Findings from a national retrospective sample of 117,743 patients presenting with blunt splenic injury between 2007 and 2015 were included in the prior distribution for the Bayesian estimates to provide sufficient statistical power and improve internal validity and generalizability of findings. Results Mortality rates and hospital mean length of stay were not significantly different between blunt splenic injury management approaches of non-operative management (n=43), surgery (n=7), and splenic artery embolization (n=6) using a frequentist approach (9.3%, 0%, and 0%, P=.52; and 10.8 (15.8), 10.8 (4.7), and 4.6 (1.8), P=.86, respectively). Bayesian 95% highest density interval (HDI) estimates of the likelihood of mortality ([0.02; 0.18], [-6.4 ; 0.3], and [-2.2 ; 0.3]) and hospital mean length of stay ([7.7; 8.3], [11.0; 12.3], and [8.7; 10.2]) provided reduced uncertainty in point and dispersion estimates. Conclusions The inclusion of findings from large high-quality studies provides increased certainty in estimates from smaller studies. Posterior estimates can inform predictive models for testing in future studies.

Recent revisions of national field triage guidelines recommend the addition of age-specific systolic blood pressure (SBP) measurement for identifying the most severely injured children requiring transport to a trauma center. The purpose of this study was to determine the frequency in which blood pressures are documented by Emergency Medical Service (EMS) providers and the role this measurement has had, among other factors, in triage decisions. This is an exploratory descriptive study with a retrospective review from the trauma registry database of all pediatric trauma admissions that arrived by EMS at a level II pediatric trauma center from January 1, 2019 to December 31, 2022. Two hundred ninety-eight patient records of patients aged 0 to 14 were included. EMS providers documented blood pressure in 70.1% of the total sample. A significant difference in the frequency of this documentation was seen between ages zero to nine and = > 10 years (χ (1,298) = 28.98 p <0.001). No children ages zero to nine years had SBP of < 70 mmHg + (2x age in years) documented by EMS. There were two children aged = > 10 who had a documented SBP < 90 and 12 children with documented EMS heart rate > SBP. Many children transported by EMS in this hospital's catchment area did have a field blood pressure measurement documented, but the frequency was significantly less in younger-aged children. The blood pressure measurements of children determined to have severe injuries in the sample did not meet the inclusion criteria for high risk of serious injury by the newly established national guidelines. This suggests other prehospital criteria, such as mechanism of injury or visual cues, prompted EMS to transport these pediatric trauma patients to a regional trauma center for specialized care.

Although numerous risk factors and prediction models affecting morbidity and mortality in geriatric hip fracture patients have been previously identified, there are scant published data on predictors for perioperative Surgical Intensive Care Unit (SICU) admission in this patient population. Determining if a patient will need an SICU admission would not only allow for the appropriate allocation of resources and personnel but also permit targeted clinical management of these patients with the goal of improving morbidity and mortality outcomes. The purpose of this study was to identify specific risk factors predictive of SICU admission in a population of geriatric hip fracture patients. Unlike previous studies which have investigated predominantly demographic, comorbidity, and laboratory data, the present study also considered a frailty index and length of time from injury to presentation in the Emergency Department (ED). A total of 501 geriatric hip fracture patients admitted to a Level 1 trauma center were included in this retrospective, single-center, quantitative study from January 1, 2019, to December 31, 2022. Using a logistical regression analysis, more than 25 different variables were included in the regression model to identify values predictive of SICU admission. Predictive models of planned versus unplanned SICU admissions were also estimated. The discriminative ability of variables in the final models to predict SICU admission was assessed with receiver operating characteristic curves' area under the curve estimates.  Frailty, serum lactate > 2, and presentation to the ED > 12 hours after injury were significant predictors of SICU admission overall (P = 0.03, 0.038, and 0.05 respectively). Additionally, the predictive model for planned SICU admission had no common significant predictors with unplanned SICU admission. Planned SICU admission significant predictors included an Injury Severity Score (ISS) of 15 and greater, a higher total serum protein, serum sodium <135, systolic blood pressure (BP) under 100, increased heart rate on admission to ED, thrombocytopenia (<120), and higher Anesthesia Society Association physical status classification (ASA) score (P = 0.007, 0.04, 0.05, 0.002, 0.041, 0.05, and 0.005 respectively). Each SICU prediction model (overall, planned, and unplanned) demonstrated sufficient discriminative ability with the area under the curve (AUC) values of 0.869, 0.601, and 0.866 respectively. Finally, mean hospital Length of Stay (LOS) and mortality were increased in SICU admissions when compared to non-SICU admissions. Of the three risk factors predictive of SICU admission identified in this study, two have not been extensively studied previously in this patient population. Frailty has been associated with increased mortality and postoperative complications in hip fracture patients, but this is the first study to date to use a novel frailty index specifically designed and validated for use in hip fracture patients. The other risk factor, time from injury to presentation to the ED serves as an indicator for time a hip fracture patient spent without receiving medical attention. This risk factor has not been investigated heavily in the past as a predictor of SICU admissions in this patient population.

Nurses are critical to the research enterprise. However all nurses are not prepared to participate as members of the research team since education and training in clinical research nursing and nurse-specific Good Clinical Practice are not consistently included in nursing curricula. The lack of nurse education and training in clinical research and Good Clinical Practice leaves research participants vulnerable with a nursing workforce that is not prepared to balance fidelity to protocol and patient quality care and safety. A collaborative network of nurses within Clinical and Translational Science Awards and beyond was established to address this education and training need. Over a 2-year period, using expert opinion, Delphi methods, and measures of validity and reliability the team constructed curriculum and knowledge test items. A pilot modular electronic curriculum, including knowledge pretest and post-tests, in clinical research nursing and nurse-specific Good Clinical Practice competencies was developed. As the scope and setting of clinical research changes, it is likely that all practicing nurses, regardless of their practice setting or specialty, will care for patients on research protocol, making all nurses, in essence, clinical research nurses. The curriculum developed by this protocol will address that workforce education and training need.

Introduction: Cognitive impairments associated with cancer and cancer treatment are side effects that have and continue to elude the oncology world. Cognitive impairments related to chemotherapy are also known as “chemo-brain” or “chemo-fog” and encompasses deficits in cognitive domains that include memory, verbal fluency, attention, and concentration, and one’s ability to recall information. Patients who experience cognitive impairments during and after cancer treatments, chemotherapy in particular, are often afflicted with impaired executive functioning, problems with memory and recall, loss of control and decreased sense of self, increased stress and depression, role conflicts when returning to work, and impaired quality of life. While the treatment may impact patients’ cognitive function, other factors, including personal characteristics and other stressors, may also influence their memory. Objectives: The purpose of this descriptive correlational study is to determine relationships between women with breast cancer who are currently receiving or who have received at least one type of treatment and the negative impact that these treatments and other factors have or have had on their memory as reported by these participants. Methods: A descriptive correlational approach was used for this study. A one-time questionnaire was sent via email to participants, including two instruments to assess memory; one measure of stress and questions obtaining demographics; information related to treatments received; stress and the negative impact of these factors on memory. Tools used to assess memory included the Everyday Memory Questionnaire (EMQ) and the Functional Assessment of Cancer Therapy-Cog (FACT-Cog). The tool used to assess stress was the Perceived Stress Scale (PSS). Of the 171 participants of this study, they were predominately White/Caucasian (89.5%), college educated (49.7%), and married or partnered (76%). Ages of participants in this study ranged from 24 to 80 years old (mean age was 53.8 years). For eligibility requirements, all participants in this sample were female. Results: The results of this study indicate that age had an impact on memory/cognition on this sample, with EMQ, p = .01; Perceived Cognitive Impairments Subscale, p = .01; and Chi-square (yes/no self-reported stress), p = .02. A statistically significant difference was shown in Perceived Cognitive Abilities in those who had surgery versus those who did not, p = .05. Those who received chemotherapy demonstrated a statistical difference than those who did not receive chemotherapy using Chi-square (yes/no self-reports of stress), p = .01. There was a statistical difference in those who received radiation and those who did not receive radiation on the EMQ, p = .03; and Perceived Cognitive Impairments, p = .05. There was a statistical significance between those who received hormonal therapy versus those who did not using Chi-square (yes/no self-reports of stress), p = .02. Adriamycin was shown to be statistically significant using Chi-square (yes/no self-reports of stress), p = .02. Those receiving Cytoxan were statistically significant than those not receiving this medication on the EMQ, p = .01. Tamoxifen shown statistically significant results in Perceived Cognitive Impairments, p = .05; and in Chi-square self-reports of stress (yes/no), p = .05. PSS meanings, indicating low, moderate, and high levels of stress demonstrated significance on EMQ scores with p < .01. PSS raw scores (total non-categorical scores) were statistically significant using both parametric correlations (Pearson product-moment correlation coefficient), p ≤ .01 and non-parametric correlations (Spearman’s rho), p < .01. Statistically significant results were also found in the PSS meaning (low, moderate, high stress level) and FACT-Cog scores, p ≤ .01. Conclusions: In this study, age was shown to have an effect on both memory and cognition among the sample utilizing the EMQ and the Perceived Cognitive Impairments Subscale of the FACT-Cog. Participants who received chemotherapy and hormonal therapy had more self-reported memory impairments than those who did not receive these treatment modalities. Those receiving radiation had lower scores on the PCI subscale and thus more perceived cognitive impairments. On the contrary, those who did not receive radiation were shown to have higher EMQ scores indicating more memory problems than participants who did receive radiation. Participants in this study experiencing moderate and high levels of stress had higher EMQ scores, indicating more memory problems than those with low stress. The results from this study indicate that many factors, including age, certain treatment modalities, particular medications, and stress can have a negative impact on an individual’s memory or cognition. This signifies an importance for future research to be conducted in relation to cognitive impairments to distinguish and identify probable causes, increase awareness and education among healthcare providers to directly benefit patients through knowledge, and the development of potentially beneficial therapeutic treatments.

Advanced airway management and ventilation of trauma patients are often needed during acute stabilization and resuscitation and later, in those admitted. In addition to endotracheal intubation for advanced airway management, tracheostomy is commonly used in critically ill patients when prolonged mechanical ventilation is required. However, the outcomes associated with airway management approaches and the timing of a tracheostomy in critically ill patients are mixed. This protocol intended to compare the effect of tracheostomy in major trauma patients vs. management with non-invasive techniques and endotracheal intubation during admission, examine complications and outcomes associated with the three types of airway management approaches, and explore the association of clinical and social determinants of health variables with complications in patients requiring advanced airway management. A total of 911 adult trauma patients admitted to a Level 1 trauma center surgical intensive care unit (SICU) were included in this retrospective, single-center, quantitative study from 2019 to 2021. Descriptive and correlational analyses were used to examine outcomes of ventilator days, length of stay, pneumonia, readmission, mortality, and associations with the airway management approach. The outcomes of ventilator days and length of stay were compared between groups with a one-way ANOVA, and differences between groups on outcomes of pneumonia, readmission, and mortality were estimated using crosstabulations and chi-square (x²) statistics. Hypothesized relationships of clinical and social determinants of health variables associated with outcomes of ventilator days, hospital length of stay, pneumonia, readmission, and mortality in patients requiring advanced airway management ≥ four days were estimated. There was no significant difference in outcomes of pneumonia and mortality between the advanced airway management groups (p=0.856 and p=0.167, respectively). There were significant differences in ventilator days, length of stay (LOS), and readmission. Between the groups: endotracheal intubation only, early (<10 days post-intubation) tracheostomy, and late (>10 days post-intubation) tracheostomy in SICU patients (p <0.001, p=0.028, and p=0.003, respectively). Specifically, patients in the early tracheostomy group had a higher readmission rate (33.3%) as compared to endotracheal tube patients (2.3%) and late tracheostomy patients (0.0%). Social determinants of health variables (smoking and functional dependence) were also significantly correlated with readmission in the early tracheostomy and endotracheal tube airway management groups (p=.047 and p=.022, respectively). Additionally, clinical variables of injury severity scores, ED arrival systolic blood pressure (SBP), and presence of pre-existing comorbidities were found to be significantly associated with complications of pneumonia, readmission, and mortality within the patients (n=229) requiring advanced airway approaches. Adult trauma patients with early tracheostomy airway management may experience a higher readmission rate related to the complexity of their injuries than patients managed with endotracheal intubation or late tracheostomy. Clinical and social determinants of health factors may be associated with complications. Further studies examining these associations in larger samples are needed to examine the validity of these findings.