MultiCare Tacoma General Hospital

School-based mental health training can improve students' help-seeking behaviors, yet young people's voices are often underrepresented in program design and evaluation of these programs. Meaningfully integrating student-identified needs and lived experiences enables school-based mental and behavioral health team members, especially nurses, who are often the first point of contact, to better support youth. This study used a pre-post descriptive design to assess the implementation of Teen Mental Health First Aid (tMHFA) in schools that had not previously adopted tMHFA. Post-training findings indicated significant positive changes in culturally and linguistically diverse students. Focus groups with students ages 15-18 years revealed four key themes. Students strongly advocated for the widespread incorporation of tMHFA into schools, emphasizing the need to make the training more accessible. Additionally, students' comfort in seeking help was greatly influenced by adults' attitudes toward mental health concerns, their cultural awareness, and broader systemic barriers. Findings underscore the potential for school nurses to expand their roles in alignment with the National Association of School Nurses School Nursing Practice Framework, advocating for tMHFA integration into health education curricula, promoting culturally responsive approaches, and strengthening equitable, sustainable pathways to mental health support.

Low-titer group O whole blood (LTOWB) is increasingly used for prehospital hemorrhagic shock, yet real-world data from multi-agency EMS systems, particularly in medical hemorrhage, remain limited. This evaluation describes the first 11 months of a regional LTOWB program, focusing on operational timelines, physiologic response, protocol adherence, and product stewardship. In this quality-improvement evaluation, all prehospital blood activations in the Pierce County EMS (PCEMS) region of Washington State were reviewed. Operational metrics included dispatch-to-blood time, scene time, transfusion location, and dispatch-to-ED interval. Physiologic response was assessed using systolic blood pressure (SBP), heart rate, and shock index (SI), with shock resolution defined as SI <1 on ED arrival. Protocol adherence and stewardship (utilization and waste) were obtained from EMS documentation and transfusion-service logs. Eighty-nine activations occurred, and all patients received prehospital transfusion (47 trauma, 42 medical hemorrhage). Timelines demonstrated early initiation: median dispatch-to-blood 21.3 min, scene time 14.3 mins, and dispatch-to-ED 36.6 min. Protocol adherence was high, with frequent LTOWB-first transfusion, crystalloid avoidance, and TXA and calcium use. Among LTOWB recipients with serial vitals, SBP increased and SI decreased from initial assessment to post-transfusion and ED arrival. Across agencies, 189 units (LTOWB and components) were issued; of 182 with known disposition, 135 (74.2%) were transfused and 47 expired, yielding a utilization of 74% and waste rate of 26%. A regional multi-agency EMS system achieved early LTOWB initiation, high protocol adherence, and physiologic improvement across trauma and medical hemorrhage, with stewardship metrics characteristic of early implementation.

BACKGROUNDDiabetes mellitus (DM) is a significant risk factor for cardiovascular diseases and can worsen the risk of cardiovascular events among patients with hypertrophic cardiomyopathy (HCM). However, strong evidence is needed to show the impact of DM on all-cause mortality (ACM) and atrial fibrillation (AF), which we explored in this systematic review and meta-analysis.AIMTo determine the impact of DM on ACM and AF in patients with HCM.METHODSPubMed, Google Scholar, and EMBASE databases were searched for studies showing the effect of DM on ACM and AF in HCM. A binary random effects model with a 95% confidence interval (CI) was used to pool odds ratios (ORs) for ACM and AF outcomes. Study quality was assessed using the Joanna Briggs Institute’s critical appraisal tool and leave-one-out sensitivity analysis. P < 0.05 was considered statistically significant.RESULTSFourteen studies (n = 106138) with a mean age of 61.76 ± 19.84 years and 61.55% males were included in our systematic review; ten studies (n = 102882) were eligible for meta-analysis. In the unadjusted analysis, DM was not significantly associated with ACM (OR = 0.96; 95%CI: 0.43-2.15; P = 0.93). However, after adjustment, DM showed a significant association with higher ACM risk (adjusted OR = 1.37; 95%CI: 1.16-1.61; P < 0.01). DM was significantly associated with AF in both unadjusted (OR = 2.02; 95%CI: 1.14-3.58; P = 0.04) and adjusted analyses (adjusted OR = 2.68; 95%CI: 1.68-4.27; P = 0.01). The Joanna Briggs Institute tool revealed a low risk of bias. Leave-one-out sensitivity analysis, performed by sequentially excluding each study, demonstrated no significant change in the overall effect estimates, indicating the robustness and stability of our results.CONCLUSIONDM significantly increased the risk of ACM and AF, highlighting the importance of tighter glycemic control and cardiovascular risk factor modification among patients with HCM.

Managing asthma in the schools is complex and requires careful planning. This article highlights key steps in implementing guideline-based care for children with asthma in Washington State schools: assessing students, establishing acuity, communicating with parents, and training staff. Advance planning can improve outcomes for students, parents, and school staff in managing this complex and prevalent disease. NASN recently developed asthma management guidelines. Developing state-specific guidelines provides an opportunity to speak specifically to state laws and nurse practice acts while also reinforcing the importance of specialized practice to school nurses, school administrators and teachers, parents, and students.

First released in 1996, the S.T.A.B.L.E.® Program has provided evidence-based education in the postresuscitation and pretransport stabilization care of sick newborns to more than a quarter million multidisciplinary perinatal healthcare team members from around the world. The program, aimed at preventing the leading causes of neonatal mortality, continues to be the subject of published peer-reviewed research and is periodically updated to ensure relevancy and inclusion of current best evidence. S.T.A.B.L.E. is a mnemonic for the 6 essential assessment parameters taught in the program: Sugar and Safe care, Temperature, Airway, Blood pressure, Lab work, and Emotional support. This mnemonic was specifically chosen to serve as a memory tool to remind staff of "what to do" during those infrequent but stressful times when they were expected to assess and stabilize sick newborns. Course completion of the S.T.A.B.L.E. Program is obtained as a result of didactic training and successful completion of content testing. The program's test questions are periodically evaluated and revised on the basis of psychometric analysis. The 6th edition of the S.T.A.B.L.E. Program learner/provider manual is scheduled for release in 2012 and will reflect the latest in stabilization guidelines throughout the program's 6 modules and supplemental content.

This phase II trial assessed the activity and tolerability of a daily oral dose of 500 mg gefitinib (ZD1839, Iressa) in patients with recurrent or persistent epithelial ovarian or primary peritoneal carcinoma, and explored the clinical value of determining the status of the epidermal growth factor receptor (EGFR). Primary measure of efficacy was progression-free survival at 6 months. Mutations in exons 18 to 21 of EGFR and/or immunohistochemical expression of EGFR were evaluated in tumor specimens from patients enrolled in this trial as well as from patients not treated with gefitinib. Twenty-seven of 30 (90%) patients were eligible and evaluable for analysis of gefitinib efficacy and toxicity. Of these, four survived progression-free >6 months with one objective response (4%). The most commonly observed grade 3 toxicities were dermatologic (15%, 4 of 27) and diarrhea (30%, 8 of 27). Specimens from 26 of 26 or 25 of 26 patients were evaluable for immunohistochemical or mutation analysis, respectively. The response rate for patients with EGFR-positive tumors was 9% (1 of 11). EGFR expression was associated with longer progression-free survival (P = 0.008) and possibly longer survival (P = 0.082). The patient with the only objective response had a mutation in the catalytic domain of the tumor's EGFR (P = 0.04). Among 32 invasive tumors from patients not treated with gefitinib, one exhibited a catalytic domain mutation. Gefitinib was well tolerated but had minimal activity in unscreened patients with recurrent ovarian or primary peritoneal carcinoma. Prescreening patients for activating mutations in EGFR may improve response rate to gefitinib. This report is the first to document activating mutations in catalytic domain of EGFR in 3.5% (2 of 57) of ovarian cancers.