Lynggissel3739

The CFIR model was paired with the Plan-Do-Study-Act (PDSA) quality improvement methodology to operationalize workflow and sustain project aims. Results and conclusions Eighty-four percent of all eligible patients were screened during their routine sickle cell appointments resulting in a 110% increase in multidisciplinary pain management referrals. Future interventions and PDSA cycles are targeted at improving attendance at scheduled appointments, reducing hospitalizations, decreasing 30-day readmissions, and shortening length of stay.Background One of the critical components in pain management is the assessment of pain. Multidimensional measurement tools capture multiple aspects of a patient's pain experience but can be cumbersome to administer in busy clinical settings. Aim We conducted a systematic review to identify brief multidimensional pain assessment tools that nurses can use in both ambulatory and acute care settings. Methods We searched PUBMED/MEDLINE, PsychInfo, and CINAHL databases from January 1977 through December 2019. Eligible English-language articles were systematically screened and data were extracted independently by two raters. Main outcomes included the number and types of domains captured by each instrument (e.g., sensory, impact on function, temporal components) and tool characteristics (e.g., administration time, validity) that may affect instrument uptake in practice. Results Our search identified eight multidimensional assessment tools, all of which measured sensory or affective qualities of pain and its impact on functioning. Most tools measured impact of pain on affective functioning, mood, or enjoyment of life. One tool used ecological momentary assessment via a web-based app to assess pain symptoms. Time to administer the varying tools ranged from less than 2 minutes to 10 minutes, and evidence of validity was reported for seven of the eight tools. Conclusions Our review identified eight multidimensional pain measurement tools that nurses can use in ambulatory or acute care settings to capture patients' experience of pain. The most important element in selecting a multidimensional pain measure, though, is that one tool is selected that best fits the practice and is used consistently over time.The most critical parameter for the quality control of the rabies vaccine is potency, which is evaluated by challenge test in mice while using a large animal number. Because the 3Rs concept is applied worldwide, it becomes necessary to develop alternative methods to demonstrate the production consistency of these vaccines and reduce the number of animals used for performing assays. Hence, the present study evaluated the impacts of reducing the number of mice used in the NIH test for such vaccines. A retrospective data analysis compared vaccines tested in the standard test with the results of the reduced test using only the first cages of each dilution and considering the second cages as their replicates. The relevance of the reduced assay was evaluated using Bland- Altman plot and CCC. Reliability was assessed by CV% and confidence intervals, while the impact of the reduced mouse number was evaluated by the analysis of the confidence interval of potency results and regression, linearity and parallelism parameters. The results demonstrated the feasibility of reducing to eight mice per dilution in routine assays, with complete statistical validation of the resulting potency, allowing the number of animals used for the test vaccines to be reduced by 50%.Purpose To estimate racial/ethnic-stratified effects of maternal prepregnancy BMI on size for gestational age at birth, by comparing siblings within families. Methods This study examined linked vital statistics and patient discharge data from 580,960 infants born to 278,770 women in the State of California (2007-2012). To control for family-level confounding, we used fixed effects multinomial regression, modeling size for gestational age (small [SGA], appropriate, large [LGA]) as a function of maternal BMI (underweight, normal weight, overweight, obesity class I, II, III) and time-varying covariates. We conducted overall and race/ethnicity-stratified (non-Hispanic white, black, Asian; Hispanic) analyses. For comparison, we fit analogous random effects models, which do not control for family-level confounding. Results In fixed effects models, maternal BMI was most strongly associated with LGA in non-Hispanic white women, reaching 6.7 times greater for class III obesity (OR [95% CI] 6.7 [5.1, 8.7]); and weakest in black women (OR [95% CI] 3.0 [1.5, 5.7]). Associations with SGA were similar across race/ethnicity. Compared with random effects estimates, fixed effects were most attenuated for LGA associations among racial/ethnic minority women. Conclusions Maternal prepregnancy BMI was differentially associated with size for gestational age across racial/ethnic groups, with the strongest family-level confounding in racial/ethnic minority women.This study aimed to demonstrate whether Helicobacter pylori is able to survive in co-culture with a protozoan, Acanthamoeba castellanii, in order to further investigate a possible aqueous environmental mode of transmission. Numbers of H. pylori in co-culture with A castellanii were assessed by colony forming unit (CFU) assay and cell morphology was observed by electron microscopy. Viable and intact H. pylori in co-culture were detected and the number of H. pylori in co-culture with A. castellanii was significantly higher than in bacterial single culture. It was also shown that co-culture of H. pylori with A. castellanii physically separated by a filter membrane negated this survival effect, suggesting that adherence of H. pylori to A. castellanii affects its survival. Scanning electron microscopy revealed helical forms of H. pylori in co-culture with A. Midostaurin castellanii, but not in single culture. These results imply that mutual interaction between H. pylori and A. castellanii in the environment is critical for survival of H. pylori. In addition, the H. pylori gene expression profile was found to differ between single and co-cultured cells using RNA-sequence analysis.