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Coral Gables, FL, United States

OBJECTIVE: The purpose of this study was to compare the occupational stressors, the perceived stress levels, and coping styles of 3 generations of medicalsurgical (MS) nurses.BACKGROUND: The literature supports that the nurse's role is stressful based on a variety of factors including physical labor, human suffering, work hours, staffing, and interpersonal relationships. Data indicate that there are generational differences in the response to stress. The 3 predominant nursing generations coexisting in the nursing workforce add to the complexity of the recognition and coping skills to address stress.METHODS: A correlational design was used. A convenience sample ofMSnurses participated in this study by completing 4 questionnaires.RESULTS: Occupational stressors were found to be significant predictors for perceived stress among all generations of nurses in this sample. Also, the higher the level of stress perception among nurses, the higher the use of coping behaviors. Generation Y reported a higher level of perceived stress and higher use of escape avoidance coping behaviors, while baby boomers reported higher use of self-controlling coping behaviors.CONCLUSIONS: By identifying the needs of each of the generational cohorts, nurse leaders, nurse educators, and policy makers can better assist the nursing workforce to remain at the bedside, improve patient outcomes, andmaintain a positivework environment. Copyright © 2014 Wolters Kluwer Health. Source

Shammeri O.A.,Qassim University | Bitar F.,Tufts University | Ghitelman J.,South Miami Hospital | Soukas P.A.,The Miriam Hospital
Annals of Saudi Medicine | Year: 2012

Background and objectives: In-stent restenosis in the femoropopliteal artery is common (20%-40%). Treatment of in-stent restenosis is challenged by poor patency rate. An ePTFE-covered stent-graft (Viabahn) is inert with a very small pore size that does not allow for significant tissue in-growth. Use of a Viabahn stent-graft may improve the patency rate in the treatment of in-stent restenosis. DESIGN AND SETTING: A retrospective chart review of the use of Viabahn stent grafts implanted in patients with symptomatic femoropopliteal artery in-stent restenosis performed from January 2004 to December 2008. PATIENTS AND Methods: We measured the primary patency rate using duplex ultrasound at 1 year and 3 years. We also examined the rate of secondary patency, acute limb ischemia and amputation. Results: Twenty-seven cases with in-stent restenosis of the femoropopliteal artery treated by Viabahn stentgraft were identified. The average lesion length was 24.5 cm; 52% of the lesions were total occlusion and 37% had critical limb ischemia. The 1- and 3-year primary patency rates were 85.1% and 81.4%, respectively. The secondary patency rate was 96%. All recurrent in-stent restenoses were focal at the proximal and distal edges and none had stent fracture. Conclusion: Our single center experience in a small number of patients showed a favorable patency of ePTFE-covered stent-graft for treatment of patients with in-stent restenosis in the femoropopliteal artery. Source

Banet N.,Johns Hopkins Hospital | Gown A.M.,Urologic | Shih I.-M.,Johns Hopkins Hospital | Shih I.-M.,Johns Hopkins University | And 10 more authors.
American Journal of Surgical Pathology | Year: 2015

Immunohistochemical expression of GATA-3 is seen predominantly in non-neoplastic bladder and breast epithelium and their respective carcinomas; however, data on expression in normal and lesional trophoblastic tissues are limited. Immunohistochemical staining for GATA-3 was assessed in a range of normal/lesional trophoblastic tissues and tumors in the differential diagnosis (n=445), including nonmolar products of conceptions/second and third trimester placentas/ectopic pregnancies, hydatidiform moles, placental site nodules, normal/exaggerated implantation sites, choriocarcinomas, epithelioid trophoblastic tumors, placental site trophoblastic tumors, atypical smooth muscle tumors (including leiomyosarcoma), and cervical and pulmonary squamous cell carcinomas. The extent of expression (0 to 4+) and intensity (weak to strong) were recorded. All cases with developing trophoblast/non-neoplastic trophoblastic proliferation and 81% of trophoblastic neoplasms were positive. Of all non-neoplastic trophoblast cell types, expression was observed in cytotrophoblast in 89% of cases, syncytiotrophoblast in 50%, intermediate trophoblast in 100%, and villous trophoblastic columns in 100%. Increasing gestational age was associated with a decrease in extent/intensity of expression in non-neoplastic cytotrophoblast and syncytiotrophoblast, whereas intermediate trophoblast maintained diffuse and strong expression from early to late gestation (P<0.0001). Eighty-nine percent of normal/exaggerated implantation sites showed 3+ or 4+ expression, whereas staining in 55% of placental site nodules was 1+ or 2+. Staining for GATA-3 was present in 78% of choriocarcinomas, 95% of epithelioid trophoblastic tumors, and 71% of placental site trophoblastic tumors. Although the number of choriocarcinomas and placental site trophoblastic tumors that showed a spectrum of expression ranging from negative to diffuse was relatively evenly distributed, 81% of epithelioid trophoblastic tumors had 3+ or 4+ staining. None of the atypical smooth muscle tumors and 3% of squamous cell carcinomas were positive, all of which exhibited weak staining. We conclude that GATA-3 is frequently expressed in normal and lesional trophoblastic tissues. It is also differentially expressed in intermediate trophoblast and cytotrophoblast/syncytiotrophoblast, which varies according to time during pregnancy. This study expands the spectrum of neoplasms known to express GATA-3. Thus, recognition of expression in trophoblastic tumors is important, because it can present a diagnostic pitfall in the assessment of suspected metastatic bladder or breast carcinomas involving the gynecologic tract. In the evaluation of diagnostically problematic tumors for which trophoblastic neoplasms are in the differential diagnosis, such as leiomyosarcoma and squamous cell carcinoma, GATA-3 can be included as part of an immunohistochemical panel particularly when other trophoblastic markers are either not available or yield ambiguous results. Copyright © 2014 by Lippincott Williams & Wilkins. Source

Alfonso B.,South Miami Hospital | Jacobson A.S.,New York University | Alon E.E.,The Chaim Sheba Medical Center | Via M.A.,Mount Sinai School of Medicine
Ear, Nose and Throat Journal | Year: 2015

Hypocalcemia is a well-known complication of total thyroidectomy. Patients who have previously undergone gastric bypass surgery may be at increased risk of hypocalcemia due to gastrointestinal malabsorption, secondary hyperparathyroidism, and an underlying vitamin D deficiency. We present the case of a 58-year-old woman who underwent a total thyroidectomy for the follicular variant of papillary thyroid carcinoma. Her history included Roux-en-Y gastric bypass surgery. Following the thyroid surgery, she developed postoperative hypocalcemia that required large doses of oral calcium carbonate (7.5 g/day), oral calcitriol (up to 4 μg/day), intravenous calcium gluconate (2.0 g/day), calcium citrate (2.0 g/day), and ergocalciferol (50,000 IU/day). Her serum calcium levels remained normal on this regimen after hospital discharge despite persistent hypoparathyroidism. Bariatric surgery patients who undergo thyroid surgery require aggressive supplementation to maintain normal serum calcium levels. Preoperative supplementation with calcium and vitamin D is strongly recommended. © 2015 Vendome Group. Source

Stefanescu B.M.,Vanderbilt University | Hetu C.,South Miami Hospital | Slaughter J.C.,Vanderbilt University
Contemporary Clinical Trials | Year: 2013

Background: Neonatal ventilator-associated pneumonia (VAP) is associated with increased morbidity and mortality. In adults on mechanical ventilation, timed oral care decreases the frequency of VAP, but this approach has not been studied in neonates. Objectives: To evaluate the feasibility of a randomized trial of timed oral care with Biotene OralBalance® gel and estimate the required sample size for such a trial. Methods: Infants were eligible for enrollment if they were born before 28. weeks of gestation, and were mechanically ventilated between 7 and 10 postnatal days. Infants were randomized to receive timed oral care with Biotene OralBalance® gel or sterile water. All subjects were treated with a standard bundle of procedures to reduce the risk of VAP. Results: We enrolled 41 of 46 eligible infants (89%). Compliance with timed oral care protocol was 97%. No local oral side effects of Biotene OralBalance® gel were observed. There were no significant group differences in mortality or short-term outcomes, except length of hospital stay which was significantly shorter in the Sterile water group (p=0.02). A lower rate of VAP was found in the Biotene group, although the difference was not statistically significant (9/1000 ventilator-days versus 17/1000 ventilator-days in the Sterile water group, respectively; p=0.16). Conclusions: The results of this pilot study support the feasibility of a randomized trial of timed oral care with Biotene OralBalance® gel for prevention of VAP in mechanically ventilated neonates. © 2013 Elsevier Inc.. Source

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