Martinsburg VA Medical Center

Burnout is a word currently used in discussions about the present nursing shortage. Hospice staff, because of their work with the terminally ill, are considered a high-risk group for burnout. Too frequently, the reason behind the decision to leave or take a sabbatical from hospice work is that the staff member reached the limits of his or her capacity to care and “couldn’t take it any more.” It is, therefore, important to discuss the concept of burnout and how it can affect hospice staff as well as the primary caregivers for hospice patients to ascertain the reasons behind it and take steps to lessen caregiver stress.

In the past 20 years of the Global War on Terror, the US has seen substantial improvements in its system of medical delivery in combat. However, throughout that conflict, enemy forces did not have parity with the weaponry, capability, or personnel of the US and allied forces. War against countries like China and Russia, who are considered near-peer adversaries in terms of capabilities, will challenge battlefield medical care in many different ways. This article reviews the experience of a medical team, Global Surgical and Medical Support Group, that has been providing assistance, training, medical support, and surgical support to Ukraine since the Russian invasion began in February 2022. The team has extensive experience in medicine, surgery, austere environments, conflict zones, and building partner nation capacities. This article compares and contrasts the healthcare systems of this war against the systems used during the Global War on Terror. The lessons learned here could help the US anticipate challenges and successfully plan for the provision of medical care in a future conflict against an adversary with capabilities close to its own.

Registered nurse (RN) job satisfaction is a major predictor of intent to stay and job turnover, serious concerns to health care leaders. Predictors of job satisfaction include autonomy, control over daily practice, nurse-physician collaboration, transformational leadership, group cohesion, job stress, structural empowerment, and psychological empowerment. In the model of psychological empowerment, stress resiliency is the product of persons' interpretive styles and influences psychological empowerment. This study has evaluated the influence of stress resiliency on job stress, psychological empowerment, job satisfaction, and intent to stay using causal modeling. Participants are 464 RNs employed in five acute care hospitals in West Virginia. The final model has provided a very good fit to the data. Stress resiliency is a predictor of psychological empowerment, situational stress, and job satisfaction. This study provides the first evidence of the influence of stress resiliency on job stress, psychological empowerment, job satisfaction, and intent to stay in a sample of RNs.

Group A meningococcal disease has been an important public health problem in sub-Saharan Africa for over a century. Outbreaks occur there annually, and large epidemics occur at intervals ranging between 8 and 12 y. The Meningitis Vaccine Project was established in 2001 with funding from the Gates Foundation with the goal of developing, testing, licensing, and introducing an affordable group A meningococcal conjugate vaccine into Africa. From 2003 to 2009 a monovalent group A conjugate vaccine, MenAfriVac(TM) , was developed at the Serum Institute of India, Ltd through an innovative public/private partnership. Preclinical studies of the new conjugate vaccine were completed in 2004 and a Phase 1 study began in India in 2005. Phase 2/3 studies in African 1-29 y olds were completed in 2009 showing the new meningococcal A conjugate vaccine to be as safe as currently licensed meningococcal polysaccharide vaccines, but much more immunogenic. After Indian market authorization (December 2009) and WHO prequalification (June 2010), MenAfriVac(TM) was introduced at public health scale using a single 10 µg dose in individuals 1-29 y of age in Burkina Faso, Mali, and Niger in December 2010. We summarize the laboratory and clinical studies leading to prequalification of MenAfriVac(TM). The 2011 epidemic season ended with no reported case of group A meningitis in vaccinated individuals.

It is well appreciated that high-density lipoprotein (HDL) and bone physiology and pathology are tightly linked. Studies, primarily in mouse models, have shown that dysfunctional and/or disturbed HDL can affect bone mass through many different ways. Specifically, reduced HDL levels have been associated with the development of an inflammatory microenvironment that affects the differentiation and function of osteoblasts. In addition, perturbation in metabolic pathways of HDL favors adipoblastic differentiation and restrains osteoblastic differentiation through, among others, the modification of specific bone-related chemokines and signaling cascades. Increased bone marrow adiposity also deteriorates bone osteoblastic function and thus bone synthesis, leading to reduced bone mass. In this review, we present the current knowledge and the future directions with regard to the HDL-bone mass connection. Unraveling the molecular phenomena that underline this connection will promote the deeper understanding of the pathophysiology of bone-related pathologies, such as osteoporosis or bone metastasis, and pave the way toward the development of novel and more effective therapies against these conditions.

BACKGROUND: Given the paucity of information on dose intensity, the objective of this study is to describe the use of adjuvant chemotherapy for stage III colon cancer, focusing on relative dose intensity (RDI), overall survival (OS) and disease-free survival (DFS). METHODS: Retrospective cohort of 367 patients diagnosed with stage III colon cancer in 2003-2008 and treated at 19 VA medical centers. Kaplan-Meier curves summarize 5-year OS and 3-year DFS by chemotherapy regimen and RDI, and multivariable Cox proportional hazards regression was used to model these associations. RESULTS: 5-fluorouracil/leucovorin (FU/LV) was the most commonly initiated regimen in 2003 (94.4%) and 2004 (62.7%); in 2005-2008, a majority of patients (60%-74%) was started on an oxaliplatin-based regimen. Median RDI was 82.3%. Receipt of >70% RDI was associated with better 5-year OS (p < 0.001) and 3-year DFS (P = 0.009) than was receipt of ≤70% RDI, with 5-year OS rates of 66.3% and 50.5%, respectively and 3-year DFS rates of 66.1% and 52.7%, respectively. In the multivariable analysis of 5-year OS, oxaliplatin + 5-FU/LV (versus 5-FU/LV) (HR = 0.55; 95% CI = 0.34-0.91), >70% RDI at the first year (HR = 0.58; 95% CI = 0.37-0.89) and married status (HR = 0.66; 95% CI = 0.45-0.97) were associated with significantly decreased risk of death, while age ≥75 (versus 55-64) (HR = 2.06; 95% CI = 1.25-3.40), Charlson Comorbidity Index (HR = 1.17; 95% CI = 1.06-1.30), T4 tumor status (versus T1/T2) (HR = 5.88; 95% CI = 2.69-12.9), N2 node status (HR = 1.68; 95% CI = 1.12-2.50) and bowel obstruction (HR = 2.32, 95% CI = 1.36-3.95) were associated with significantly increased risk. Similar associations were observed for DFS. CONCLUSION: Patients with stage III colon cancer who received >70% RDI had improved 5-year OS. The association between RDI and survival needs to be examined in studies of adjuvant chemotherapy for colon cancer outside of the VA.

In recent years, the advancement of eXtended Reality (XR) technologies including Virtual and Augmented reality (VR and AR respectively) has created new human-computer interfaces that come increasingly closer to replicating natural human movements, interactions, and experiences. In medicine, there is a need for tools that accelerate learning and enhance the realism of training as medical procedures and responsibilities become increasingly complex and time constraints are placed on trainee work. XR and other novel simulation technologies are now being adapted for medical education and are enabling further interactivity, immersion, and safety in medical training. In this review, we investigate efforts to adopt XR into medical education curriculums and simulation labs to help trainees enhance their understanding of anatomy, practice empathetic communication, rehearse clinical procedures, and refine surgical skills. Furthermore, we discuss the current state of the field of XR technology and highlight the advantages of using virtual immersive teaching tools considering the COVID-19 pandemic. Finally, we lay out a vision for the next generation of medical simulation labs using XR devices summarizing the best practices from our and others’ experiences.

The Test of Memory Malingering (TOMM) has not been adequately validated in a forensic psychiatric setting. Dissimulation of cognitive impairment, as assessed by the TOMM, was evaluated in a group of 25 forensic inpatients admitted for evaluation of Competency to Stand Trial (CST/MSO group), and hypothesized to be at higher risk for feigning cognitive impairment. A comparison group of 36 patients, who were either civilly committed or adjudicated Not Guilty by Reason of Insanity (CIVIL/NGRI group), were hypothesized to be less likely to feign cognitive impairment. Groups were comparable in age, education, premorbid intelligence, and psychiatric symptom severity. Significantly more CST/MSO patients (36%) scored below a recommended TOMM cutoff score relative to CIVIL/NGRI patients (6%). Findings indicate excellent specificity and modest sensitivity, and generally support the validity of the TOMM in a forensic psychiatric population. The utility of different cutoff scores and need for multiple indicators of effort are discussed.

The determinants of health promotive-behavior are proposed by Pender in the HPM. The exact impact of the various variables on singular behaviors or a lifestyle index, however, is far from conclusive. All the proposed factors have been supported through research, at least in part, as either directly or indirectly influencing the intent to participate in different health behaviors. The difficulty in concluding which variables are most critical is perhaps due to the variety of definitions, theoretical approaches (from different disciplines), and research methods. Of primary concern to this author is the overlap of activities among different "patterns" of behavior and the various definitions of such behavioral patterns. Little evidence exists on how specific types of behaviors relate to one another. Thus, knowing the determinants of a lifestyle index, for example, may be insignificant if the goal of nursing is to target priority behaviors that may indeed be influenced by more significant variables. For example, a person's perception of control may be a significant predictor of lifestyle behaviors in general; however, this variable may not impact on the person's decision to engage in changes related to exercise or activity behavior. Hence, because the motives behind various behaviors may be different, it seems more prudent to invest our research efforts on the impact of various factors on singular behaviors rather than lifestyle patterns. Finally, the efforts of nursing research on health behavior have been directed primarily at explaining the impact of various individual perceptions on the likelihood of behavior. Such focus has revealed some evidence of the significance of these variables, yet much unexplained variance remains. Perhaps it would be more prudent to direct attention at those variables such as situational or environmental factors that may impede or act as a cue to healthy behavior. Because the explanation of behavior has been individually focused (perhaps due to an "individualizing" theme in nursing education), the impact of the ecological model of behavior tends to be dismissed or underrated in nursing research. Knowledge of the impact of societal factors on behavior may be more appropriate to planning strategies for various groups rather than the behavioristic approaches that separate people from their social, physical, and economic environments. Thus, personal lifestyles may not be a simple matter of informed choice, and attention to the complex processes of societal opportunities, cultural interpretations, and group-specific attitudes must be studied further.

Obstructing esophageal cancer produces severe dysphagia with ensuing death within 90 days. Palliation is possible with modalities like stent placement, laser, and photodynamic therapy. However, these treatments have a high rate of complications, and the overall mortality is not altered. A new alternative treatment evaluated in this study is endoscopic intratumoral injection with cisplatin/epinephrine (CDDP/epi) gel. CDDP/epi gel injections were administered weekly for 3 to 8 weeks in nine patients, median age, 72 years; mean tumor volume (+/-SEM), 41.44 (+/-22.4) cm3. Eight patients had stage IV, and one had stage III esophageal carcinoma. The mean dysphagia score (+/-SEM) was 3.5 (+/-0.17). All patients were followed up until death. Dysphagia resolved in eight patients with reduction in mean dysphagia score (+/-SEM) from 3.5 (+/-0.17) to 0.75 (+/-0.28; p = 0.005). Tumor volume was reduced by 75% in one patient and by 50% in two patients. The median survival was 4 months. The longest follow-up has been 15 months (458 days). In this pilot study, intratumoral injection of CDDP/epi gel restored swallowing in eight of nine patients and was an effective and safe outpatient treatment in patients with obstructive esophageal cancer.

Summary Nasal secretion and serum neutralizing antibody responses of 22 elderly persons to vaccination with a bivalent inactivated influenza virus vaccine by local or parenteral routes were compared. Each 1.0 ml of vaccine contained 300 chicken cell agglutination (CCA) units each of A2/Taiwan/1/64 and A2/Japan/170/62, and 600 CCA units of B/Mass/3/66 influenza virus antigens. The titers and duration of IgA antibody in nasal secretions were higher and appeared to persist longer following repeated nasopharyngeal vaccination than after a single subcutaneous immunization. The frequency and duration of serum antibody responses induced by local administration of vaccine were not significantly different from those seen following parenteral vaccination.

The Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) that emerged in December 2019 as the causative agent of Coronavirus 2019 (COVID-19) and was declared a pandemic by the World Health Organization in March 2020 has several distinctive features, including extensive multiorgan involvement with a robust systemic inflammatory response, significant associated morbidity and mortality, and prolonged persistence of viral RNA in the clinical specimens of infected individuals as detected by Reverse Transcription Polymerase Chain Reaction (RT-PCR) amplification. This review begins with an overview of SARS-CoV-2 morphology and replication and summarizes what is known to date about the detection of the virus in nasal, oropharyngeal, and fecal specimens of patients who have recovered from COVID-19, with a focus on the factors thought to contribute to prolonged detection. This review also provides a discussion on the infective potential of this material from asymptomatic, pre-symptomatic, and convalescing individuals, to include a discussion of the relative persistence and infectious potential of virus in clinical specimens recovered from pediatric COVID-19 patients.

This review summarized the unique cellular responses to the direct CAP treatment on cancer cells.

Terrorism and naturally occurring catastrophic events provide fertile ground for nursing emergency preparedness, including deployment strategies. Are you ready to respond?

Cold atmospheric plasma (CAP) is a near-room-temperature, partially ionized gas composed of reactive neutral and charged species. CAP also generates physical factors, including ultraviolet (UV) radiation and thermal and electromagnetic (EM) effects. Studies over the past decade demonstrated that CAP could effectively induce death in a wide range of cell types, from mammalian to bacterial cells. Viruses can also be inactivated by a CAP treatment. The CAP-triggered cell-death types mainly include apoptosis, necrosis, and autophagy-associated cell death. Cell death and virus inactivation triggered by CAP are the foundation of the emerging medical applications of CAP, including cancer therapy, sterilization, and wound healing. Here, we systematically analyze the entire picture of multi-modal biological destruction by CAP treatment and their underlying mechanisms based on the latest discoveries particularly the physical effects on cancer cells.

Introduction: People living in many parts of the world have limited access to diagnostic studies and therapies for rheumatologic, musculoskeletal, and connective tissue diseases. The challenge has been particularly poignant for rural areas of low- and middle-income countries. Objectives: We report on the implementation of a telemedicine program in Iran for the evaluation and treatment of patients with rheumatologic and musculoskeletal diseases. More than 4,800 patients were seen remotely over a span of 5 years by a rheumatologist in the United States. The remote rheumatologist was aided by a general physician and a nurse at a local charity hospital in northeastern Iran that has a catchment area that includes rural regions extending to the border of Afghanistan. Seventy to 90 patients were evaluated online by the remote rheumatologist 3 days a week. A subset of patients was evaluated by the rheumatologist in person every 4 months. Materials and Methods: The population of rheumatology patients was evaluated using descriptive statistics. Information collected included demographic information consisting of age, gender, and primary rheumatologic diagnosis. Results: The average age of patients who were seen was 52 years and 89% of patients were women. Approximately 50% of patients were Afghan refugees. The most common disorders included osteoarthritis (1,149, 23.6%), rheumatoid arthritis (653, 13.4%), axial spondyloarthropathies (647, 13.3%), lumbar spinal stenosis (427, 8.8%), meniscal tear of the knee (326, 6.7%), and psoriatic arthritis (217, 4.5%). Certain conditions were lower than expected such as lupus (19, 0.4%) and fibromyalgia (169, 3.5%). Diagnostic tests included serologic tests (1,328, 27.3%), plain radiographs (946, 19.5%), magnetic resonance imaging (899, 18.5%), bone densitometry (147, 3.0%), and electromyography and nerve conduction study (132, 2.7%). The most common medications prescribed were non-steroidal anti-inflammatory drugs (791, 16.3%), methotrexate (764, 15.7%), pregabalin (234, 4.8%), duloxetine (230, 4.7%), sulfasalazine (177, 3.6%), etanercept (97, 2.0%), tofacitinib (64, 1.3%), adalimumab (18, 0.4%), and infliximab (9, 0.2%). Conclusions: Telemedicine is becoming more prevalent. We report the successful use of this service in evaluation and management of rheumatic diseases in a region with limited access to rheumatologic care. We have shown that patients can be seen, evaluated, and successfully treated with a variety of medications, including biologic agents.

Cold atmospheric plasma (CAP) is an ionized gas, the product of a non-equilibrium discharge at atmospheric conditions. Both chemical and physical factors in CAP have been demonstrated to have unique biological impacts in cancer treatment. From a chemical-based perspective, the anti-cancer efficacy is determined by the cellular sensitivity to reactive species. CAP may also be used as a powerful anti-cancer modality based on its physical factors, mainly EM emission. Here, we delve into three CAP cancer treatment approaches, chemically based direct/indirect treatment and physical-based treatment by discussing their basic principles, features, advantages, and drawbacks. This review does not focus on the molecular mechanisms, which have been widely introduced in previous reviews. Based on these approaches and novel adaptive plasma concepts, we discuss the potential clinical application of CAP cancer treatment using a critical evaluation and forward-looking perspectives.

Guillain-Barré syndrome (GBS) is an immune-mediated demyelinating disorder which attacks the peripheral nervous system. Antecedent infection or vaccine administration are known to precipitate the onset of this disorder. Its typical presentation leads to a symmetric, rapidly progressive, ascending paresis with associated sensory deficits and impaired reflexes. We present a rare case of a bi-facial diplegia variant of GBS, within four weeks of the COVID-19 vaccination. Due to its chronology, clinical manifestations, and cerebrospinal fluid (CSF) findings, we propose this case to be a rare complication of the COVID-19 vaccination.

Pancreatic cholesterol esterase catalyzes the esterincation and hydrolysis of a number of different sterols and sterol esters. The order of activity observed in the esterifying system with oleic acid was as follows: dihydrocholesterol cholesterol β-sitosterol sitosterol stigmasterol ergosterol. Of these sterols, only dihydrocholesterol and cholesterol were esterified with butyric acid. In the hydrolytic system all of the sterol butyrates tested were split very rapidly, with the exception of ergosterol butyrate. the order of splitting of the oleates in the first 4 hours was: cholesterol oleate sitosterol oleate stigmasterol oleate ergosterol oleate. The relation of enzyme activity to sterol structure is discussed.

OBJECTIVES: A 6-month pilot teleconsultative project linking Georgetown University Medical Center (GUMC) in Washington, DC, and City Hospital in Martinsburg, West Virginia, 90 miles away, was designed to assess the effectiveness of telemedicine on the clinical decision-making process for patients with urolithiasis. METHODS: The telemedicine system designed and tested for this project was based on a PC-based platform. Videoconferencing and review of the patient's imaging studies were performed over an Integrated Service Digital Network (ISDN) with 3 Basic Rate (BRI) ISDN lines providing a 336-kilobytes/s bandwidth through an Inverse Multiplexor (IMUX). Treatment options were recorded for the clinical trial group and a simulated study group by the consulting urologist after the initial telephone consultation, after the telemedicine consultation, and after examination of those patients transferred to GUMC. RESULTS: A total of 32 telemedicine consultations were performed: 14 in the clinical trial group and 18 in the simulated study group. The recommendation of the consulting urologist at the tertiary center was altered in 12 patients (37.5%) after the telemedicine consultation compared with the recommended treatment after the initial telephone consultation. CONCLUSIONS: In the evaluation of patients with urolithiasis, this telemedicine application enhanced the clinical decision-making process by allowing for improved quality of care through immediate access and effective transfer of information between the referring urologist, the patient, and the stone center specialist.