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INTRODUCTION: Dementia is an emergent health priority for Indigenous peoples worldwide, yet little is known about disease drivers and protective factors. METHODS: Database searches were conducted in March 2022 to identify original publications on risk, protective, genetic, neuroradiological, and biological factors related to dementia and cognitive impairment involving Indigenous peoples. RESULTS: Modifiable risk factors featured across multiple studies include childhood adversity, hearing loss, low education attainment, unskilled work history, stroke, head injury, epilepsy, diabetes, hypertension, hyperlipidemia, depression, low BMI, poor mobility, and continence issues. Non‐modifiable risk factors included increasing age, sex, and genetic polymorphisms. Education, ex‐smoking, physical and social activity, and engagement with cultural or religious practices were highlighted as potential protective factors. There is a paucity of research on dementia biomarkers involving Indigenous peoples. DISCUSSION: Greater understanding of modifiable factors and biomarkers of dementia can assist in strength‐based models to promote healthy ageing and cognition for Indigenous peoples. [ABSTRACT FROM AUTHOR]

Obesity is a risk factor for complications following autologous breast reconstruction. Little is known regarding outcomes based on the degree of obesity. This study compares breast reconstruction outcomes and complication rates for the three classes defined by the body mass index (BMI)-based WHO classification. The authors conducted a retrospective chart review identifying obese patients who underwent abdominally based breast reconstruction between January 2011 and January 2021. Patients were stratified by BMI class [class 1 (C1) = 30–34.99 kg/m2, class 2 (C2) = 35–39.99 kg/m2, and class 3 (C3) = 40 kg/m2 + ]. Outcomes were compared. A total of 232 patients (395 flaps) were included with 138 patients were classified as C1, 68 patients as C2, and 26 patients as C3. Rates of any complication (80%) and at least one major complication (31%) did not vary significantly (P = 0.057, 0.185). Individual rates of 30-day readmission (18%) or reoperation (26%) did not vary significantly (P = 0.588 and 0.059). Rates of seroma (C1 = 15%, C2 = 16%, and C3 = 35%), hernia (C1 = 0%, C2 = 4%, and C3 = 8%), and incisional dehiscence (C1 = 30%, C2 = 44%, and C3 = 62%) were associated with significantly increased risk with higher classes of obesity (P < 0.05). The rate of flap failure did not vary significantly (P = 0.573). The risk of major complications and total flap loss associated with abdominally based breast reconstruction does not differ between the classes of obesity. Although complication rates are high overall in the obese population, detrimental complications do not vary between the classes. Patients should be counseled regarding their individual risk without the need for arbitrary BMI cutoffs. [ABSTRACT FROM AUTHOR]

Background: The Improving Interpreting for Dementia Assessments (MINDSET) study aimed to upskill interpreters through an online co‐designed course in dementia and cognitive assessments. Methods: A single‐blinded randomized controlled digital trial conducted between June 2022 and November 2023. Interpreters were randomized to training or waitlist control conditions with 3‐ and 6‐month follow‐up. The primary outcome was a composite Z‐score comprising dementia and cross‐cultural knowledge, translation and ethical knowledge, and observed interpreting skills. Preliminary analyses were conducted using a mixed ANOVA with assessment period as the within‐subjects factor and intervention group as the between‐subjects factor, controlling for age. Results: 126 interpreters (Mage = 44.13 years (SD = 12.71) completed baseline (22 Arabic, 14 Cantonese, 6 Greek, 14 Italian, 64 Mandarin, 6 Vietnamese), 3m follow‐up (n = 100) and 6m follow‐up (n = 101). For the primary outcome, there were no significant main effects for assessment period F (2, 178) = 0.21, p =.814 nor intervention group F (1, 89) = 0.31, p =.548, and no significant interaction between intervention group and assessment period, F (2, 178) = 0.64, p =.526. Secondary outcomes revealed significant main effects for dementia knowledge (DKAS) for the assessment period, F (2, 98) = 8.80, p <.001, and intervention group F (1, 99) = 4.59, p =.035, with significantly higher scores at the 3‐ (mean difference = 1.308, SE =.31, p <.001, 95% CI.692, 1.924) and 6‐month follow‐up (mean difference =.814, SE =.31, p =.010, 95% CI.203, 1.425); and significantly higher scores in the intervention compared to control (mean difference =.842, SE =.393, p =.035, 95% CI.062, 1.621). A significant interaction between assessment period and intervention group F (2, 98) = 3.33, p =.040 indicated that the increase in scores at the 3‐ and 6‐month periods were greater for the intervention group. Conclusions: This is the first time a dementia training resource for interpreters has been trialled. Preliminary analyses revealed an improvement in interpreter's dementia knowledge. [ABSTRACT FROM AUTHOR]

Although Emergency Departments (ED) frequently provide care for patients with substance use disorders (SUD), there are many barriers to connecting them with appropriate long-term treatment. One approach to subside risk in this population is the Peer Recovery Coach (PRC). PRCs are individuals with a lived experience of the rehabilitation process and are a powerful resource to bridge this gap in care by engaging patients and their families and providing system navigation, self-empowerment for behavior change, and harm reduction strategies. The purpose of this project is to describe an ED-based PRC program, evaluating its feasibility and efficacy. This was a retrospective quality improvement project conducted at 3 suburban hospitals. All patients arriving to the ED were screened with a brief questionnaire in triage and patients identified as a high-risk had referral placed to a PRC if the patient consented. The PRC met with the patient at the ED bedside if possible. The PRC program members collected prospective data on patient engagement with the PRC at 30, 60, and 90 days post ED encounter. Using the EMR we identified the number of subsequent ED visits at 30, 60, and 90 days (for both medical and substance use disorder-related visits) from the index PRC visit. There were 448 individuals identified and included in this analysis between January 1, 2019 and June 30, 2020, of which 292 (66%) were male and the mean age was 44 (range 18–80). Most patients identified alcohol as the primary substance they used (289, 65%), followed by heroin/opiates (20%). At 30, 60, and 90 days, there were 110 (25%), 79 (18%), and 71 (16%) patients who were still actively engaged in the program, respectively. Among all patients in the cohort, there was essentially no decrease in mean visits before versus after the PRC engagement visit. However, among patients who had at least one prior ED visit, there were significant differences in mean visits across all visit-types: for patients with 1 prior ED visit, 90 day mean decrease in visits = 1.0 visits (95% CI 0.7–1.2), for patients with 5+ prior ED visits, 90 day mean decrease in visits = 3.6 visits (95% CI 2.4–4.8). We describe the implementation of an ED-based PRC program for patients with substance use disorders. While we demonstrated that it is feasible for the PRC to engage the patient while in the ED, there was poor follow-up with the program outpatient. For patients with at least one previous SUD visit to the ED, there was a statistically significant reduction in ED utilization after engaging with a PRC while in the ED, suggesting this may be a population that could be targeted to link patients to long term care and decrease repeated ED utilization. [ABSTRACT FROM AUTHOR]

Ulnar wrist denervation has been a successful treatment for patients with ulnar-sided wrist pain. The purpose of this study was to characterize the articular branches of the dorsal branch of the ulnar nerve (DBUN) and validate a technique for selective peripheral nerve blockade. In cadavers, we performed simulated local anesthetic injections using 0.5 mL of 0.5% methylene into the subcutaneous tissue at a point midway between the palpable borders of the pisiform and ulnar styloid. We then dissected the DBUN, characterized its articular branching pattern, and measured staining intensity of the DBUN and the ulnar nerve relative to a standard. The DBUN branched from the ulnar nerve 7.0 ± 1.2 cm proximal to the ulnar styloid. Among 17 specimens, the DBUN provided an average of 1.2 (range, 0–2) ulnocarpal branches and 1.0 (range, 0–2) carpometacarpal articular branches. A simulated local anesthetic injection successfully stained 100% of the DBUN articular branches at or proximal to their takeoff. There was no staining of the proper ulnar nerves. In all specimens, the DBUN supplied at least one articular branch. A point midway between the palpable border of the pisiform and ulnar styloid may be an effective location for selectively blocking the DBUN articular afferents. In this study, we were able to identify a point halfway between the pisiform and ulnar styloid that has the potential to produce a selective peripheral nerve block of the portion of the DBUN that supplies articular fibers to the ulnocarpal joint and the fifth carpometacarpal joint. This technique may prove useful to surgeons treating ulnar-sided wrist pain. [ABSTRACT FROM AUTHOR]

Lower extremity wounds associated with fractures and bony defects often require secondary orthopedic procedures after flap coverage has been performed. In this study, we compare complications between muscle and fasciocutaneous flaps after secondary orthopedic procedures. A retrospective chart review study of all lower extremity soft tissue reconstructions by a single surgeon over seven years yielded a subgroup of patients who underwent secondary orthopedic procedures, including hardware removal, hardware revision, and bone grafting after flap reconstruction. Of 355 lower extremity, soft tissue reconstructions for orthopedic coverage performed in the time period studied, 102 patients underwent secondary orthopedic procedures after flap reconstruction. Of these, 54 received muscle flaps (52.94%), and 48 received fasciocutaneous flaps (47.06%). Using this subgroup of 102 patients, we compared muscle and fasciocutaneous flaps using three categories of wound complications following these secondary procedures: There were no superficial wounds requiring local wound care only in the muscle flap group (0%, n = 0) versus 4.17% (n = 2; p = 0.130) in the fasciocutaneous flap group. There were 2 lost flaps requiring surgical debridement and additional skin grafting in the muscle flaps group (3.70%) versus 2 (4.17%; p = 0.904) in the fasciocutaneous flap group. In the third category, flap loss requiring additional soft tissue reconstruction was 18.52% (n = 10) in the muscle group versus 2.08% (n = 1; p = 0.008) in the fasciocutaneous flap group. Our data support the existing literature indicating that fasciocutaneous flaps can tolerate secondary procedures better than muscle flaps and should initially be considered in patients with higher probability of needing additional orthopedic procedures after reconstruction. [ABSTRACT FROM AUTHOR]

Objectives: To determine if behavioral activation (BA) delivered by trained staff decreases prevalence of clinically significant symptoms of depression among older adults living in residential aged care facilities (RACFs).Methods: Clustered, randomized, single-blinded, controlled trial of BA for adults aged over 60 years living permanently in a RACF with symptoms of depression (Patient Health Questionnaire, PHQ-9 ≥ 5). BA was delivered over 8-12 weeks using a structured workbook. The proportion of residents with PHQ-9 ≥ 10 at weeks 12, 26, and 52, as well as anxiety symptoms (GAD-7), physical (PCS), and mental (MCS) quality of life, loneliness, and loss to follow-up were main outcomes of interest RESULTS: We recruited 54 RACFs (26 intervention) and 188 of their residents (89 intervention). Participants were aged 61-100 years and 132 (70.2%) were women. PHQ-9 ≥ 10 interacted with BA at week 12 (OR = 0.34, 95%CI = 0.11-1.07), but differences between the groups were not statistically significant at any time-point. GAD-7 ≥ 10 interacted with BA at week 26 (OR = 0.12, 95%CI = 0.02-0.58), but not at any other time-point. Overall, the intervention had no effect on the scores of the PHQ-9, GAD-7, PCS, MCS, and loneliness scale. Loss to follow-up was similar between groups. Adherence to all stages of the intervention was poor (36.2%).Conclusions: Disruption by the COVID-19 pandemic and staffing issues in RACFs undermined recruitment and adherence. In such a context, a BA program delivered by RACF staff was not associated with better mental health outcomes for residents over 52 weeks. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) is a potentially devastating complication following abdominally based microsurgical breast reconstruction, with a reported incidence of 0.08–4%. The authors aim to describe disease presentation and clinical course following VTE diagnosis in patients within their practice. A retrospective chart review identified patients who underwent microsurgical breast reconstruction from January 2007 through December 2018. Patients with VTE diagnosed within 90 days of surgery were included. Demographics, co-morbidities, signs and symptoms, and characteristics of oncologic, surgical, and post-operative care were analyzed. Seven hundred one patients underwent microsurgical breast reconstruction. Eleven patients with pulmonary embolism (PE) and four with deep vein thrombosis (DVT) were identified, resulting in VTE incidence of 2.1% (0.57% DVT, 1.6% PE). Patients were on average 51 years old and had an average body mass index (BMI) of 31.7 kg/m2. Two had a history of VTE, and none had a known hypercoagulable disorder. Using the 2005 Caprini model, all were high risk and seven were highest risk. Among those with PE, the most common symptom was shortness of breath, and the most common signs were desaturation or supplemental oxygen requirements. VTE was diagnosed on average 14.2 days post-operatively (range 2–52 days). VTE is an infrequent complication following abdominally based microsurgical breast reconstruction. We recommend a high index of suspicion in women reporting shortness of breath or having desaturation, especially in those with high BMI, high Caprini scores, post-operative complications, or early return to the operating room. [ABSTRACT FROM AUTHOR]

Introduction: Unpaid carers have a crucial role in supporting older people with cognitive impairment and disability, but their own health and wellbeing are often impacted. There are limited data on how carer strain, depression and empowerment may be improved for carers. Methods: This was a cluster randomised controlled trial to compare the effect of a carer support program developed with a community-based participatory action research (PAR) approach to the delivery of information sessions to 100 carers of people aged 45 years or more living in four remote Aboriginal communities in Western Australia. Results: The mean age of carers was 38.3±14.9 years, 76% were female and 77% were children or grandchildren of the care recipient. Carer strain and empowerment measures did not change significantly between baseline and follow-up. A statistically significant decrease in depression scores was observed in the PAR group. However, decreases were observed in both the PAR and control groups, and the change in scores did not differ significantly between groups. Depression scores decreased most in those who had not attended high school. Overall, the proportion of participants meeting criteria for depression decreased from 18.8% at baseline to 8.3% at follow-up. Conclusion: A carer support program was of equivocal benefit, although this research demonstrates that the wellbeing of carers in remote Aboriginal communities can potentially be markedly improved by outreach strategies. [ABSTRACT FROM AUTHOR]

Background: The first wave of coronavirus disease 2019 was a global event for which nurses had limited time to prepare before receiving an influx of high-acuity patients and navigating new plans of care. Objectives: To understand nurses' lived experiences during the COVID-19 outbreak and to examine their resiliency. Methods: A convergent mixed methods design was applied in this study. For the quantitative portion, resiliency was measured by using the Brief Resilience Coping Scale. Colaizzi's phenomenological method was used for qualitative analysis. Results: A total of 43 nurses participated in the study. The mean score on the Brief Resilience Coping Scale was 14.4. From 21 robust narratives, Colaizzi's qualitative method yielded 5 themes to describe the experience of being a nurse during the pandemic. Conclusions: Understanding the lived experience provides a unique lens through which to view nursing during a global pandemic, and it serves as a starting point to ensure future safeguards are in place to protect nurses' well-being. [ABSTRACT FROM AUTHOR]

• Acquired brain injury is one of the most severe cause of permanent disability. • Following stroke, cognitive and psychosocial changes are present. • Caregivers play an important role in the care and prognosis of stroke patients. • The psychological and cognitive resources could protect caregivers from burden. • Cognitive functions improvement is related to a reduction of self-efficacy skill. Stroke is one of the severe cause of motor and cognitive disabilities. These type of disabilities occurred a strong impact on whole family system. Caregiver burden may determine in relatives of patients with brain injury a decreasement of mental and physical health. The present study aims to better clarify the mechanism through which chronic stress influence caregivers' cognitive functioning and how the psychological and cognitive resources may represent as a predictive factor. Caregivers were submitted to neuropsychological tests that evaluated level of mental health ad level of burden. Our results showed a significant correlation between cognitive reserve and self-efficacy skills in health care of patients. Findings suggested that the caregiver burden and the level of general distress influenced the cognitive performance. An improvement of cognitive functions is associated with a reduction of self-efficacy skills, causing a caregiver burden improvement. [ABSTRACT FROM AUTHOR]

Body mass index (BMI) has long been the proxy for patient selection in obese patients presenting for abdominally based breast reconstruction. BMI, however, fails to accurately reflect the distribution of abdominal adipose tissue. This study aims to quantify the effect of abdominal wall thickness on the incidence of post-operative complications and contrast abdominal wall thickness and BMI as predictors of post-operative morbidity. We performed a retrospective review of 106 consecutive patients who underwent abdominally based breast reconstruction. Abdominal wall thickness was quantified using preoperative CT angiograms. Primary outcomes included delayed wound healing (abdomen and/or breast), flap fat necrosis, return to OR in 30 days, infection, and flap loss. Patients experiencing delayed abdominal wound healing (n=38), delayed breast wound healing (n=27), and flap fat necrosis (n=24) had significantly thicker abdominal wall measurements (p<0.0015). Of the 24 patients with palpable fat necrosis, 11 required excision. Increasing abdominal wall thickness significantly increased the odds of delayed abdominal wound healing (p=0.0005), delayed breast wound healing (p=0.0009), flap fat necrosis (p=0.0028), and infection (p=0.0198). Compared to BMI, abdominal wall thickness proved to be a more accurate predictor of delayed breast wound healing, any delayed wound healing, flap fat necrosis, and infection. Our data indicate that as abdominal wall thickness increases, so does the risk of postoperative morbidity. Abdominal wall thickness outperformed BMI as a predictor of postoperative morbidity in several areas. This suggests that objective data obtained from preoperative CT scans may allow more accurate, individualized perioperative risk assessment. [ABSTRACT FROM AUTHOR]

Background: Dementia prevalence and incidence in Aboriginal Australians is three to five times that of the general population. Many of the known risk factors for dementia in this population are modifiable (e.g., head injury, hypertension, previous stroke and poor mobility). However, there is currently no evidence‐base on how to delay or prevent cognitive decline and dementia in Aboriginal Australians. Therefore, a comprehensive program to target dementia risk factors in this population is required. Method: In partnership with three Aboriginal Community Controlled Health Services (ACCHS) in Western Australia, we have developed an Aboriginal health practitioner‐led health program (DAMPAA) to target key dementia risk factors for Aboriginal people over 45 years. The DAMPAA program was co‐designed by the research team, Elders and Aboriginal community‐controlled organisations. Qualitative data to inform the co‐design was collected through ACCHS staff workshops, Elders yarning groups and interviews with DAMPAA Aboriginal and non‐Aboriginal researchers using a Theory of Change framework. Additionally, a small pilot study was conducted in 2020, which included participant exit interviews conducted by Aboriginal researchers. Qualitative data from all data sources was analysed thematically by a qualitative researcher, and member checked by two DAMPAA Aboriginal researchers and the Elders Governance group. Result: The DAMPAA program includes group physical activity, education, goal setting and medication management. Program enablers identified by ACCHS, research staff and participants include (but not limited to) group Aboriginal community controlled organisation based walking and yarning sessions, with additional activities such as aqua aerobics, tai chi and boot scooting, a buddy system for home exercising, connecting with others, transport, healthy food, being Aboriginal led, and the ACCHS partnership. An additional enabler identified by the Elders governance group include Aboriginal language education sessions. Program barriers identified include (but not limited to) family commitments, caring for grandchildren, travel for funerals and other appointments and participant contact details changed. Conclusion: The barriers and enablers identified from participants, ACCHS and DAMPAA staff have informed the development of the program protocol. DAMPAA will be evaluated through a randomised controlled trial implemented at four sites in Western Australia and process evaluation using a Theory of Change framework. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence of polypharmacy, under-prescribing and potentially inappropriate medicine use among Aboriginal Australians living in remote Western Australia.Design: Cross-sectional study.Setting: Six remote communities and the town of Derby in the Kimberley, Western Australia.Participants: Aboriginal people aged 45 years or more with complete medication histories.Main Outcome Measures: Proportions of patients with medicine histories indicating polypharmacy, potential under-prescribing of indicated medicines, or potentially inappropriate prescribing (including potential prescribing cascades or drug interactions).Results: Complete medicine histories were available for 273 participants. The mean number of prescribed medicines was 5.1 (SD, 3.6). At least one form of suboptimal prescribing was identified for 166 participants (61%), including polypharmacy for 145 (53%), potential under-prescribing of at least one indicated medicine for 33 (12%), and potentially inappropriate prescribing for 54 participants (20%). Potential prescribing cascades or drug interactions were identified for 12 participants (4%).Conclusions: Potentially suboptimal prescribing affected more than half the participating older Aboriginal Australians from the Kimberley. If generalisable to other remote Indigenous Australians, the prevalence of polypharmacy, potentially inappropriate prescribing, and under-prescribing of indicated medicines is problematic, and suggests that older Indigenous people in remote areas are at risk of medicine-related harm. [ABSTRACT FROM AUTHOR]

Abstract Tick microbiomes may play an important role in pathogen transmission. However, the drivers of microbiome variation are poorly understood, and this limitation has impeded mechanistic understanding of the functions of microbial communities for pathogen acquisition. The goal of this research was to characterize the role of the blood meal host in structuring the microbiome of Ixodes scapularis , the primary vector of Lyme disease in the eastern United States, and to determine if ticks that fed from different host species harbor distinct bacterial communities. We performed high-throughput 16S rDNA amplicon sequencing on I. scapularis nymphs that fed as larvae from known wildlife hosts: raccoon, Virginia opossum, striped skunk, red squirrel or gray squirrel. Using Analysis of Similarity, we found significant differences in the abundance-weighted Unifrac distance matrix among ticks fed from different host species (p = 0.048) and a highly significant difference in the weighted and unweighted Unifrac matrices for individuals within species (p < 0.01). This finding of associations between the blood meal host and I. scapularis microbiome demonstrates that the blood meal host may be a driver of microbiome variation that should be accounted for in studies of pathogen acquisition by ticks. [ABSTRACT FROM AUTHOR]

Summary The anterolateral thigh flap (ALT) is a workhorse for a spectrum of reconstructive problems including head and neck defects. Its versatility as a chimeric flap employing a variety of soft tissues with a robust pedicle is useful for three-dimensional defects. The authors investigated the anatomical relationship between the vascular supply to the ALT and anterior femur. We studied 16 fresh cadaver limbs to identify the typical branching patterns to the femur off the descending branch of the lateral circumflex femoral artery. These patterns can facilitate dissection of this type of chimeric ALT. The authors have integrated a bone component of vascularised femur in this flap off the lateral circumflex femoral artery system to address oral cancer defects in two patients. A retrospective review of these cases correlating with the anatomic study was undertaken. Both patients had recurrent disease with limited donor site options. Both had extensive floor of mouth and tongue defects as well as small mandible defects of 2 cm. Both went on to heal at the donor and recipient sites at 32 months' follow-up. [ABSTRACT FROM AUTHOR]

Due to the problem of tick-borne diseases, there is a need to better understand the importance of different host species in maintaining enzootic disease cycles. We explored the utility of stable isotope analysis to identify the larval hosts of questing ixodid ticks. In laboratory experiments, we used Ixodes scapularis and two host species that are important in the Lyme disease system in eastern North America. First, we tested how effectively a short-term dietary tracer ( 13 C in corn) was reflected in molted ticks. Second, we attempted to identify the host species (either white-footed mouse ( Peromyscus leucopus ) or eastern chipmunk ( Tamias striatus )), based on the isotopic signature of the ticks that had fed on them. The corn isotopic signal was easily detectable in the ticks that fed on corn-diet hosts despite the brief feeding period (96 h). However, we were not able to differentiate between flat Ixodes scapularis nymphs that had fed as larvae on mice vs. those fed on chipmunks. Isotopic signatures of fur from mice and chipmunks were also indistinguishable, probably due to the similar diets of these two species in the wild. We conclude that, while stable isotope analysis of ticks may not be able to distinguish between ecologically similar host species, it may be useful in sorting ticks to the level of feeding guild of the host. [ABSTRACT FROM AUTHOR]

Aim This review evaluates the impact of complementary therapies on psychosocial factors in women undergoing IVF. Background According to the CDC, nearly 7% of married women in the United States face infertility. Approximately 1.5% of all infants born in the U.S. annually are conceived through assisted reproductive technologies (ART), such as IVF. Women undergoing ART report distress, anxiety, and depression related to their treatment. Stress has been cited as the top reason why women terminate treatment. Complementary therapies, such as mind-body techniques, have been associated with decreasing stress and anxiety. Methods CINAHL and PubMED databases were searched for studies 1) published from January 2010 to 2017, 2) written in English, 3) that examined the effect of an complementary therapy on the psychological well-being of women undergoing, or about to be undergoing a cycle of IVF. Results The search revealed 11 studies published between 2010 and 2015 from a variety of countries. The most common research design was a randomized controlled trial (n = 7). The psychosocial factor most frequently measured was anxiety (n = 8). The forms of complementary therapy varied, with the most common being Hatha yoga, cognitive behavioral interventions, and mind-body therapies (n = 2 each). Conclusions Utilizing complementary therapies appears to be a positive way to decrease women's anxiety, depression, distress, and stress, and to increase fertility quality of life. This review informs providers that incorporating complementary therapies into the plan of care can lead to improved psychosocial health outcomes for women undergoing IVF. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate effectiveness of an educational intervention on pregnant women's nutritional knowledge. Despite national guidelines, women face personal and healthcare barriers to adequate nutrition education. This quasi-experimental study involved a convenience sample of pregnant women (n = 27). The Nutrition Knowledge Questionnaire (NKQ) was utilized for pre and post-tests. Additionally, participants were asked open-ended questions. Data analysis was performed using paired t-tests, linear regression, and qualitative thematic analysis. The mean pre-test and post-test scores on the NKQ were 30.0 and 38.96 respectively, representing a statistically significant increase (p ≤ 0.00). Six qualitative themes emerged including nutrition as “important” and “a real eye opener.” This study validates the use of an educational intervention based on MyPlate guidelines to increase pregnant women's knowledge of nutrition. [ABSTRACT FROM AUTHOR]

Summary Background Pediatric congenital heart disease patients are at risk for vascular injuries during surgical procedures or when the arterial system is accessed for monitoring or diagnostic studies. Our treatment of emergent situations in this patient population using microvascular techniques shows the feasibility of such techniques. Methods A retrospective chart review of patients aged 0–18 years with congenital heart disease identified six patients who underwent microvascular surgery by the senior surgeon from June 2007 to May 2015. We studied this series, highlighting technical aspects of surgery and perioperative care to determine their effect on outcome. Results Six patients with congenital cardiac defects requiring cardiothoracic surgery were studied, body weight ranging from 3.2 to 19.1 kg at the time of surgery. Five suffered iatrogenic arterial injury to the heart or vessels used for access or diagnostic studies, including coronary artery laceration, brachial artery thrombosis, and external iliac artery avulsion. Interventions included direct end-to-end repair and vein grafting. Vessel diameter averaged 1 mm. Patients received vasopressors intraoperatively and were on vasopressors and antihypertensives postoperatively. One patient died because of disseminated intravascular coagulation on postoperative day 17, but bypass graft was patent prior to death. The rest survived with clinical evidence of patency of the repaired vessel for a long-term. Conclusions Microsurgical intervention may be life-saving as a revascularization procedure to the heart by direct coronary repair or bypass grafting. Iatrogenic injuries to the limb may cause critical ischemia; limbs can be salvaged by microsurgical repair. Despite technical and physiological challenges, microsurgery is feasible and sometimes crucial in this patient population. [ABSTRACT FROM AUTHOR]

Chronic pain is considered a common disabling disease, frequently related to a high comorbidity with anxiety and depression. Several psychological techniques have demonstrated to be effective in the treatment of chronic pain, in particular, mindfulness-based interventions (MBIs) seem to reduce pain acting on self-regulatory individual's ability. In addition, this approach could develop cognitive strategies to decrease impulsivity. We selected a case of a patient with encephalomyelitis and spastic tetraparesis to assess the application and effectiveness of MBIs to reduce pain perception, improve anxiety and depressive symptoms. Our treatment showed a reduction in pain perception, and an improvement in anxious and depressive symptoms. In conclusion, MBIs could be useful to relieve disorders related to pain in neurological patients. • The study shows the application of mindfulness-based interventions in a patient with encephalomyelitis. • Mindfulness-based interventions have demonstrated to be effective in the treatment of chronic pain and emotional symptoms. • The intervention has favored an increase in the ability to regulate attention and emotional reactions. [ABSTRACT FROM AUTHOR]

The 6-item Rowland Universal Dementia Assessment Scale (RUDAS) is a simple, portable multicultural scale for detecting dementia. Items address executive function, praxis, gnosis, recent memory, and category fluency. It can be directly translated to other languages, without the need to change the structure or the format of any item. The RUDAS was administered to 151 consecutive, consenting, culturally diverse community-dwelling subjects of mean age 77 years, 72% of whom had an informant. Subjects were recruited from various clinics and healthcare programs. All were evaluated for cognitive impairment in a blinded manner by experienced clinicians in geriatric medicine. According to Diagnostic and Statistical Manual of Mental Disorder-IV criteria, 40% of the subjects were normal, 22% had cognitive impairment (not otherwise specified), and 38% had dementia; 84% of whom had questionable or mild dementia. In the primary analysis (normal subjects vs. those with definite dementia), the RUDAS accurately identified dementia, with an area under the receiver operating characteristic curve of 0.94 (95% confidence interval, 0.88-0.97); at the published cut point of less than 23/30, the positive likelihood ratio (LR) for dementia diagnosis was 8.77, and the negative likelihood ratio was 0.14. Additional analyses showed that the RUDAS performed less well when subjects with cognitive impairment (not dementia) were included. In all logistic regression models, the RUDAS was an independent predictor of dementia (odds ratio 0.64, 95% confidence interval, 0.52-0.79, primary analysis model), after adjusting for age, sex, years of education, and cultural diversity, none of which were independent predictors. Further studies are needed across the full spectrum of early dementia syndromes, and in additional ethnic minority groups. [ABSTRACT FROM AUTHOR]

Midwifery students with perinatal palliative care education develop a skillset to provide holistic midwifery care to women and families who are experiencing stillbirth or life-limiting fetal diagnoses. This paper presents a model of perinatal palliative care in a United States midwifery education program. By utilizing evidence based practices and national programs, perinatal palliative care can be threaded through midwifery curricula to achieve international standards of practice and competencies. Most importantly, enhancing perinatal palliative care education will better prepare future midwives for when a birth outcome is not what was expected at the outset of a pregnancy. [ABSTRACT FROM AUTHOR]

Background: Insidious cumulative brain injury from motor vehicle-induced whole-body vibration (MV-WBV) has not yet been studied. The objective of the present study is to validate whether whole-body vibration for long periods causes cumulative brain injury and impairment of the cerebral function. We also explored a preventive method for MV-WBV injury.Methods: A study simulating whole-body vibration was conducted in 72 male Sprague-Dawley rats divided into 9 groups (N = 8): (1) 2-week normal control; (2) 2-week sham control (in the tube without vibration); (3) 2-week vibration (exposed to whole-body vibration at 30 Hz and .5 G acceleration for 4 hours/day, 5 days/week for 2 weeks; vibration parameters in the present study are similar to the most common driving conditions); (4) 4-week sham control; (5) 4-week vibration; (6) 4-week vibration with human apolipoprotein A-I molecule mimetic (4F)-preconditioning; (7) 8-week sham control; (8) 8-week vibration; and (9) 8-week 4F-preconditioning group. All the rats were evaluated by behavioral, physiological, and histological studies of the brain.Results: Brain injury from vibration is a cumulative process starting with cerebral vasoconstriction, squeezing of the endothelial cells, increased free radicals, decreased nitric oxide, insufficient blood supply to the brain, and repeated reperfusion injury to brain neurons. In the 8-week vibration group, which indicated chronic brain edema, shrunken neuron numbers increased and whole neurons atrophied, which strongly correlated with neural functional impairment. There was no prominent brain neuronal injury in the 4F groups.Conclusions: The present study demonstrated cumulative brain injury from MV-WBV and validated the preventive effects of 4F preconditioning. [ABSTRACT FROM AUTHOR]

Aim: The aim of this meta-synthesis was to glean an understanding of healthcare providers' experience with prenatal screening for intimate partner violence (IPV). Background: Prenatal screening guidelines for IPV are in place; however, a gap exists between these recommendations and providers' practices. Methods: Noblit and Hare's (1988) approach to synthesizing qualitative research studies was utilized. Eight research reports were identified and produced a sample of 142 experienced women's healthcare providers from the United States, New Zealand, and Sweden. Results: The synthesis revealed five overarching themes: (1) therapeutic relationship, (2) understanding what she is not saying, (3) presence of partner, (4) variations of how and when to discuss, and (5) “lost in the maze” of disclosure. When analyzed as a whole, the five themes contribute to a lack of universal screening for IPV. Conclusions: Given that IPV is a social problem with long-term negative sequela, providers are poised to identify women during the perinatal timeframe to ensure adequate referrals and services to stop the cycle of violence. [ABSTRACT FROM AUTHOR]

The article discusses insights in the classroom and online settings for nursing education.