BACKGROUND:Discarding paper-packaged sterile supplies from bedside supply carts between patients in pediatric intensive care units (PICUs) is a potential practice to target for environmental stewardship. OBJECTIVES:To determine opinions about this practice, including what evidence should be required to implement and what evidence would be adequate to abandon it. METHODS:A survey was distributed to all pediatric intensivists engaged in multicenter research in Canada and to all PICU nurses at one institution in Canada. RESULTS:The response rate was 75 of 254 (30%). The practice occurred in 54 (72%) of the respondents' units. Ten respondents (13%) agreed the practice was effective in preventing nosocomial infections. Most respondents agreed the practice should be based on empirical evidence, including a combination of improved patient outcomes (n = 57, 76%), rate of contamination of supplies within the supply carts (n = 55, 73%), and survivability of pathogens inoculated onto paper (n = 56, 75%). Most respondents agreed they would be comfortable with a randomized controlled trial (n = 52, 69%) and would support action based on the results (n = 54, 72%). The potential trial outcome most highly ranked was next-patient nosocomial infection with pathogen from the previous patient (n = 23, 31%); this was ranked more often by intensivists (P = .005). Other outcomes highly ranked included next-patient colonization with pathogen from the previous patient (n = 44, 59%) and pathogen detection on supplies within the supply cart (n = 43, 57%). CONCLUSIONS:Most respondents agreed that the practice was not based on empirical evidence, agreed the practice should be based on empirical evidence, and would agree to a randomized trial with patient-important outcomes.
BACKGROUND:Having family members provide care to their loved ones in the intensive care unit (ICU) is a beneficial yet seldom implemented approach. For family members to perform caregiving, nurses must be willing to teach, and such willingness is a developing area of research. OBJECTIVES:To adapt an instrument validated in family members, the Family Willingness for Caregiving Scale, to address nurses' willingness to teach family members caregiving skills. METHODS:Purposive and snowball sampling were used to recruit 10 expert ICU nurses through the American Association of Critical-Care Nurses' research website and social media platforms. The researchers conducted cognitive interviews with the nurses to address the instrument's content validity. RESULTS:The scale was refined based on the participants' feedback. Items were deleted, added, and revised. Furthermore, scale instructions were adjusted to emphasize the willingness to teach families of patients receiving mechanical ventilation. Qualitative themes emerged related to barriers to family engagement, including time constraints, patient acuity, and nurse and family characteristics. CONCLUSIONS:Content validity of the scale was assessed, with future research aimed at pilot testing and evaluating construct validity before using the scale as a research instrument. Practical implications include using the scale as an evaluation tool to determine nurses' willingness to teach family members about caregiving. After evaluation, various strategies could be incorporated to enhance family engagement in adult ICUs.
BACKGROUND:Weighted blankets are used to help bring calm and promote sleep. Research has shown that the use of weighted blankets can alleviate stress and anxiety, but studies have not been conducted in acutely ill, hospitalized patients. OBJECTIVE:To determine the effectiveness of the use of a 15-pound (6.75-kg) weighted blanket in reducing self-reported anxiety in adult hospitalized patients. METHODS:This study involved a convenience sample of 54 patients admitted to a Midwestern academic medical center. It used a randomized, crossover design consisting of 2 back-to-back, 20-minute treatment periods. Participants were randomly assigned to receive a weighted blanket intervention in either the first or the second period, with usual care during the alternate period. Participants rated their anxiety on a scale of 0 to 10 before randomization, at the end of each treatment period, and then again 60 minutes after the beginning of the intervention. A linear mixed-effects model was fit to evaluate the effect of the weighted blanket intervention on anxiety ratings. RESULTS:During the first treatment period, the use of the weighted blanket intervention was associated with a 3.6-point lower mean anxiety rating compared with usual care (95% CI, -4.7 to -2.5). The effects of weighted blanket use persisted after the blanket was removed. CONCLUSION:This study demonstrated that use of a weighted blanket is an effective nonpharmacologic therapeutic intervention for hospitalized patients experiencing anxiety.
BACKGROUND:Workplace discrimination remains a concern in health care, contributing to burnout and turnover among nurses, particularly those belonging to racial and ethnic minority groups. Although evidence is growing for staff nurses, little is known about discrimination among hospital-based nurse practitioners. As nurse practitioners assume expanding roles in both primary and consultative inpatient care, they often navigate ambiguous professional boundaries and may be especially vulnerable to marginalization, particularly those from underrepresented groups. OBJECTIVE:To examine differences in workplace discrimination experiences between non-Hispanic White and racial and ethnic minority nurse practitioners. METHODS:This study analyzed data from 862 nurse practitioners across 397 hospitals in 10 US states using the 2024 Nurses4All Survey and American Hospital Association annual survey. Propensity score weighting was applied to address confounding factors, and weighted logistic regression was used to examine the association between nurse practitioners' racial and ethnic minority status and frequent workplace discrimination. RESULTS:Compared with non-Hispanic White nurse practitioners, racial and ethnic minority nurse practitioners had more than twice the odds of reporting frequent workplace discrimination (adjusted odds ratio [AOR], 2.09; 95% CI, 1.25-3.49). Odds of experiencing frequent workplace discrimination were particularly elevated among non-Hispanic Black (AOR, 2.63; 95% CI, 1.13-6.10) and multiracial (AOR, 3.45; 95% CI, 1.45-8.19) nurse practitioners. CONCLUSIONS:This study provides new evidence that discrimination in hospitals is a significant concern for racial and ethnic minority nurse practitioners, especially those who are Black or multiracial. Addressing institutional racism through system-level reforms is critical to improving workforce equity and retention.
BACKGROUND:Burnout among new nurses has been widely documented. Less is known about how years of professional experience relate to distinct components of professional quality of life, including compassion satisfaction and secondary traumatic stress. Early-career nurses appear particularly vulnerable to occupational strain, warranting examination of how years of experience may influence perceptions of professional well-being. OBJECTIVE:To examine the relationship between years of nursing experience and professional quality of life among critical care nurses. METHODS:A quantitative, cross-sectional pilot study was conducted using the Professional Quality of Life scale. A convenience sample of 55 nurses were recruited and consented from a rural hospital in the western United States. Descriptive statistics and Pearson correlations were used to examine relationships between years of experience and scores on the instrument's subscales. RESULTS:Forty nurses provided complete survey responses. Years of nursing experience correlated positively with compassion satisfaction and negatively with burnout. No significant relationship was found between years of experience and secondary traumatic stress. CONCLUSIONS:Greater professional experience was associated with higher compassion satisfaction and lower burnout but not with secondary traumatic stress. These findings suggest that experience may buffer against cumulative occupational strain, whereas trauma-related stress responses may persist across career stages. Structured mentoring and transition support may help to mitigate burnout among early-career nurses, and trauma-informed leadership approaches may warrant consideration in high-acuity environments.
BACKGROUND:In patients receiving pressure modes of mechanical ventilation, plateau pressure can be higher than peak inspiratory pressure when the patient has a strong drive to breathe. This report provides comprehensive evidence to support this observation. METHODS:Peak inspiratory pressure, plateau pressure, esophageal pressure, and tidal volume were observed at various levels of pressure support in a patient with absent cortical function but preserved brainstem function who was receiving mechanical ventilation. RESULTS:Positive end-expiratory pressure was 5 cm H2O for all pressure support settings. At pressure support of 0 cm H2O, plateau pressure was 13 cm H2O; peak inspiratory pressure was 5 cm H2O. The difference between plateau pressure and peak inspiratory pressure (8 cm H2O) reflected the patient's inspiratory effort. The driving pressure (8 cm H2O) generated a tidal volume of 619 mL. At pressure support of 10 cm H2O, plateau pressure was 12 cm H2O; peak inspiratory pressure was 15 cm H2O. The difference between plateau pressure and peak inspiratory pressure was -3 cm H2O, indicating absent inspiratory effort apart from triggering the breath. The driving pressure (7 cm H2O) generated a tidal volume of 563 mL. CONCLUSION:When plateau pressure can be accurately measured, the difference between plateau pressure and peak inspiratory pressure can be used at the bedside to evaluate a patient's respiratory drive. Ensuring protective goals by routinely monitoring plateau pressure regardless of the mode of mechanical ventilation is critical.
BACKGROUND:Prone positioning in patients with obesity remains uncommon because of concerns about feasibility, safety, and efficacy. OBJECTIVE:To evaluate the feasibility, safety, and clinical outcomes of manual prone positioning in patients with acute respiratory distress syndrome (ARDS) across different classes of obesity. METHODS:This was a retrospective cohort study involving patients with ARDS who underwent manual prone positioning across 15 hospitals between April 2014 and July 2024. Patients were stratified into 5 groups based on body mass index. Standardized prone positioning protocols were followed across institutions. RESULTS:A total of 1448 patients with ARDS underwent prone positioning. Across all obesity categories, prone positioning was associated with shorter intensive care unit and hospital stays, improved oxygenation, and better clinical outcomes. Notably, patients with class III obesity showed the greatest increase in gas exchange efficiency, with a 37% improvement in ratio of Pao2 to fraction of inspired oxygen, compared with 28% in patients with normal weight (P < .05). Complication rates were low across all groups. CONCLUSIONS:Prone positioning is feasible and safe in patients with ARDS across all obesity classes. Patients with class III obesity showed the greatest improvements in oxygenation. Future prospective studies should further explore the long-term impact of prone positioning in patients with class III obesity to refine clinical guidelines and optimize care.
BACKGROUND:In 2024, the American Association of Critical-Care Nurses (AACN) updated the Healthy Work Environment Assessment Tool (HWEAT), renamed HWEAT-Team. OBJECTIVE:Validating HWEAT-Team for interprofessional use. METHODS:This was a multisite, descriptive, nonexperimental correlation survey study. A demographics survey, the HWEAT, the HWEAT-Team, and the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture 2.0 (H-SOPS 2.0) were administered via REDCap to interprofessional staff across 11 pediatric intensive care units. Responses were aggregated as overall mean score and a score for each standard. Test-retest reliability and internal consistency were assessed. Construct validity was measured by correlating HWEAT, HWEAT-Team, and AHRQ H-SOPS 2.0 overall scores. Differences in HWEAT-Team scores by health care role also were examined. RESULTS:Among 733 participants (39% response rate), the overall HWEAT-Team mean score was 4.01. Test-retest reliability indicated a Spearman correlation coefficient of 0.85 overall score (range for standards, 0.68-0.80) and internal consistency revealed a Cronbach α of 0.78 (range, 0.71-0.91). Convergent validity between the HWEAT and HWEAT-Team revealed a correlation coefficient of 0.86 overall score (range for standards, 0.60-0.73), and for the HWEAT-Team and AHRQ H-SOPS 2.0, a correlation coefficient of 0.46. Direct care registered nurses rated the work environment less positively than physicians did for the Effective Decision-Making (P = .02) and Meaningful Recognition (P = .03) standards. CONCLUSIONS:The HWEAT-Team was reliable, valid, and supportive of interprofessional use. Active evaluation of care environments is essential to support clinical excellence and achievement of optimal patient outcomes. Understanding differences across health care roles can guide targeted improvements.
BACKGROUND:Goal-directed therapy allows clinicians to optimize perfusion and volume status in patients postoperatively. OBJECTIVE:To evaluate the effect of a machine learning algorithm to guide postoperative goal-directed fluid therapy in cardiac surgery patients. METHODS:A goal-directed fluid therapy program was implemented in a single center for coronary artery bypass patients with ejection fraction greater than or equal to 45% (implementation period: May 15, 2023, to May 31, 2024). Patient outcomes were compared with outcomes in matched historical control patients (control period: January 3 to October 31, 2022). The primary outcome was acute kidney injury. RESULTS:A total of 479 eligible patients were evaluated (246 in the control group and 233 in the goal-directed therapy group). The incidence of acute kidney injury on postoperative day 2 (P = .01), on postoperative day 7(P = .02), and at discharge (P = .008) was lower in the goaldirected therapy group than in the control group. CONCLUSIONS:Patients in the goal-directed therapy program had a lower incidence of acute kidney injury compared with historical control patients. Incorporating a machine learning algorithm to guide goal-directed fluid therapy was a safe and less invasive way to monitor selected patients in the intensive care unit after cardiac surgery.
Polyarteritis nodosa (PAN) is a rare systemic necrotizing vasculitis. It affects the medium-sized arteries. It attacks many parts of the body in very different ways. Therefore, it is difficult to diagnose and stage. 18F-fluorodeoxyglucose (18F-FDG) PET/CT combines anatomic and metabolic activity. This can show the complete extent of the disease in PAN very well. We report a 35-year-old man with fever, generalized myalgia, black stools and dry gangrene at the tip of his fingers. Laboratory tests revealed high C-reactive protein and high erythrocyte sedimentation rate. However, the anti-neutrophil cytoplasmic antibodies (ANCA) were negative. 18F-FDG PET/CT identifies multisystem lesions. The doctor thought that these lesions were there, but they could not be found by regular scanning. These lesions include high activity of many muscles, more absorption of the middle artery of the calf, local absorption of the skin between the toes, and absorption of the stomach wall. Tissue samples from many places confirmed necrotizing arteritis. After treatment with corticosteroids and targeted antibiotics, the patient's condition improved.
BACKGROUND:Recurrent hypopharyngeal carcinoma is associated with poor prognosis, yet the prognostic utility of maximum standardized uptake value (SUVmax) from 18F-FDG PET/CT and its relation to recurrence site remain insufficiently characterized. OBJECTIVE:This study aimed to evaluate the association of SUVmax and recurrence site with overall survival (OS) in patients with recurrent hypopharyngeal carcinoma. METHODS:We retrospectively analyzed 69 patients with biopsy-confirmed recurrent hypopharyngeal carcinoma without distant metastasis treated at Viet Nam National Cancer Hospital between 2019 and 2024. PET/CT scans performed at recurrence diagnosis were used to measure SUVmax at the primary tumor and/or metastatic lymph nodes. Patients were classified by recurrence site: primary tumor only (Tumor-only), lymph nodes only (Node-only), or both (Tumor + Node). OS was assessed using Kaplan-Meier estimates and Cox proportional hazards regression, adjusted for age, ECOG, time to recurrence and type of treatment. RESULTS:Mean SUVmax was 12.3 ± 6.3. Patients with SUVmax > 12 had a median OS of 11.45 months (95% CI: 7.1-37.1) vs. 13.06 months (95% CI: 6.7-37.4) for SUVmax ≤ 12 (P < 0.01). Tumor + Node recurrence had a median OS of 11.2 months (95% CI: 6.8-37.4) vs. 13.6 months (95% CI: 6.7-34.5) for Tumor-only/Node-only (P = 0.009). In multivariate Cox regression, SUVmax > 12 (HR = 2.69, 95% CI: 1.37-5.30, P = 0.004), Tumor + Node recurrence (HR = 2.96, 95% CI: 1.45-6.06, P = 0.003), Non-surgery treatment (HR = 2.98, 95% CI: 1.23-7.23, P = 0.016) and ECOG PS ≥ 2 (HR = 2.22, 95% CI: 1.12-4.41, P = 0.023) independently predicted reduced OS. CONCLUSION:Elevated SUVmax and combined tumor-nodal recurrence on PET/CT are significant predictors of reduced OS, supporting their role in prognostic stratification for recurrent hypopharyngeal carcinoma.
Fibroblast activation protein (FAP) is highly expressed in various sarcomas, including solitary fibrous tumors (SFTs). In recent years, radiolabeled FAPI tracers have emerged as potential therapeutic targets. In SFTs with high FAP expression, 90Y-FAPI-46 demonstrated promising therapeutic efficacy. These findings highlight the potential of FAPα expression as a clinically relevant biomarker for patient selection and establish 90Y-FAPI-46-based radiopharmaceutical therapy as a promising and meaningful therapeutic option for patients with malignant SFT.
OBJECTIVE:Immunotherapy plays a pivotal role in the treatment of colorectal cancer (CRC). PD-L1 has been identified to be a significant biomarker of response to treatment. The assessment of PD-L1 presently depends on biopsy samples - a problem that may be resolved with the help of a molecular imaging approach. This study devised and evaluated an 18F-and 89Zr-labelled albumin-binding PD-L1-targeted VHH for potential diagnostic imaging in CRC models. METHODS:PD-L1 expression was initially validated in HCT-116 cell-derived xenografts and CRC20-PDX tumors. An albumin-binding moiety was conjugated to a PD-L1-targeted VHH to construct SN-2D01. The 18F-labeled SN-2D01 was prepared using the AlF-RESCA chelation strategy and the probe was modified with DFO for a 89Zr radiolabeling process. The evaluation of [18F]F-SN-2D01 and [89Zr]Zr-SN-2D01 through PET imaging was performed on the two tumor models and a quantitative analysis of tumor uptake for each tracer. Ultimately, a biodistribution study of [89Zr]Zr-SN-2D01 at 120 h post-injection (p.i.) was performed in both tumor models. RESULTS:The HCT-116 cell-derived xenografts and CRC20-PDX tumors were both PD-L1-positive, with a higher expression observed in lesions from CRC20-PDX versus HCT-116 tumors. The 2 h p.i. of [18F]F-SN-2D01 PET showed clear visualization of HCT-116 and CRC20-PDX tumors, with tracer mostly cleared via hepatic and renal excretion. In PET imaging with [89Zr]Zr-SN-2D01, the tumor uptake in both HCT-116 and CRC20-PDX slowly increased from 24 h to 120 h p.i, which peaked at 120 h. Biodistribution at 120 h showed tumor uptake of 11.49 ± 1.32 %ID/g for the CRC20-PDX model and 8.12 ± 1.54 %ID/g for the HCT-116 model. CONCLUSION:In summary, we presented two PET probes to visualize PD-L1. Of these, [89Zr]Zr-SN-2D01 was found to have significant capability to evaluate PD-L1 expression in CRC. The PD-L1-targeted SN-2D01 may provide a new approach in radionuclide therapy targeting PD-L1 in CRC.
Prostate cancer (PCa) remains a leading cause of cancer-related morbidity and mortality worldwide, underscoring the need for improved molecular imaging strategies. Although prostate-specific membrane antigen (PSMA) positron emission tomography (PET) has changed prostate cancer imaging and treatment, its clinical utility is limited in some settings by heterogeneous tumor expression and substantial off-target uptake in organs such as the kidneys and salivary glands. Acid phosphatase 3 (ACP3), also known as prostatic acid phosphatase, has regained attention as an alternative prostate-associated target because of its abundant expression in prostate cancer and comparatively low expression in several normal tissues. Recent advances in high-affinity small-molecule ligands, including radiolabeled OncoACP3 derivatives, have enabled the development of ACP3-targeted PET radiopharmaceuticals. Preclinical studies and early clinical investigations demonstrate favorable biodistribution, high tumor-to-background contrast, and the capacity to detect lesions in PSMA-low or PSMA-negative disease. Moreover, ACP3-directed radioligand strategies highlight its potential in theranostic applications. Overall, ACP3 radiopharmaceuticals may provide a complementary approach for precision prostate cancer imaging and therapy.
