The validity and reliability of an instrument to assess nursing competencies in spiritual care

Aim.This study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses' competencies in providing spiritual care.Background.Measuring these competencies and their development is important and the construction of a reliable and valid instrument is recommended in the literature.Design.Survey.Method.The participants were students from Bachelor-level nursing schools in the Netherlands (n = 197) participating in a cross-sectional study. The items in the instrument were hypothesised from a competency profile regarding spiritual care. Construct validity was evaluated by factor analysis and internal consistency was estimated with Cronbach's alpha and the average inter-item correlation. In addition, the test-retest reliability of the instrument was determined at a two-week interval between baseline and follow-up (n = 109).Results.The spiritual care competence scale comprises six spiritual-care-related nursing competencies. These domains were labelled:1 assessment and implementation of spiritual care (Cronbach's alpha 0 center dot 82)2 professionalisation and improving the quality of spiritual care (Cronbach's alpha 0 center dot 82)3 personal support and patient counseling (Cronbach's alpha 0 center dot 81)4 referral to professionals (Cronbach's alpha 0 center dot 79)5 attitude towards the patient's spirituality (Cronbach's alpha 0 center dot 56)6 communication (Cronbach's alpha 0 center dot 71). These subscales showed good homogeneity with average inter-item correlations &gt; 0 center dot 25 and a good test-retest reliability.Conclusion.This study conducted in a nursing-student population demonstrated valid and reliable scales for measuring spiritual care competencies. The psychometric quality of the instrument proved satisfactory. This study does have some methodological limitations that should be taken into account in any further development of the spiritual care competence scale.Relevance to clinical practice.The spiritual care competence scale can be used to assess the areas in which nurses need to receive training in spiritual care and can be used to assess whether nurses have developed competencies in providing spiritual care.</p

Population Pharmacokinetic Model and Pharmacokinetic Target Attainment of Micafungin in Intensive Care Unit Patients

_Objective:_ To study the pharmacokinetics of micafungin in intensive care patients and assess pharmacokinetic (PK) target attainment for various dosing strateg

Selective accumulation of differentiated CD8+ T cells specific for respiratory viruses in the human lung

The lungs are frequently challenged by viruses, and resident CD8+ T cells likely contribute to the surveillance of these pathogens. To obtain insight into local T cell immunity to respiratory viruses in humans, we determined the specificity, phenotype, and function of lung-residing CD8+ T cells and peripheral blood CD8+ T cells in a paired analysis. The lung contained markedly higher frequencies of influenza (FLU)-specific and respiratory syncytial virus (RSV)-specific CD8+ T cells when compared with the circulation. This contrasted with an equal distribution of cytomegalovirus- and Epstein-Bar virus–specific CD8+ T cells. Noticeably, a substantial fraction of the lung-residing FLU- and RSV-specific CD8+ T cells had progressed to a relatively late differentiation phenotype, reflected by low expression of CD28 and CD27. Lung-derived FLU-specific CD8+ T cells had low activation requirements, as expansion of these cells could be initiated by cognate peptide in the absence of helper cell–derived signals. Thus, the human lung contains high numbers of differentiated FLU- and RSV-specific memory CD8+ T cells that can readily expand upon reexposure to virus. Resident lung T cells may provide immediate immunological protection against pulmonary virus infections

Feasibility of Diffuse Reflection Spectroscopy for Intraoperative Margin Assessment During Prostatectomy

Background and objective: A positive surgical margin (PSM) occurs in up to 32% of patients undergoing robot-assisted radical prostatectomy (RARP). Diffuse reflectance spectroscopy (DRS), which measures tissue composition according to its optical properties, can potentially be used for real-time PSM detection during RARP. Our objective was to assess the feasibility of DRS in distinguishing prostate cancer from benign tissue in RARP specimens. Methods: In a single-center prospective study, DRS measurements were taken ex vivo for RARP specimens from 59 patients with biopsy-proven prostate carcinoma. Discriminating features from the DRS spectra were used to create a machine learning–based classification algorithm. The data were split patient-wise into training (70%) and testing (30%) sets, with ten iterations to ensure algorithm robustness. The average sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) from ten classification iterations were calculated. Key findings and limitations: We collected 542 DRS measurements, of which 53% were tumor and 47% were healthy-tissue measurements. Twenty discriminating features from the DRS spectra were used as the input for a support vector machine model. This model achieved average sensitivity of 89%, specificity of 82%, accuracy of 85%, and AUC of 0.91 for the test set. Limitations include the binary label input for classification. Conclusions and clinical implications: DRS can potentially discriminate prostate cancer from benign tissue. Before implementing the technique in clinical practice, further research is needed to assess its performance on heterogeneous tissue volumes and measurements from the prostate surface. Patient summary: We looked at the ability of a technique called diffuse reflectance spectroscopy to guide surgeons in discriminating prostate cancer tissue from benign prostate tissue in real time during prostate cancer surgery. Our study showed promising results in an experimental setting. Future research will focus on bringing this technique to clinical practice.</p

Cerenkov Luminescence Imaging in Prostate Cancer:Not the only Light That Shines

Cerenkov luminescence imaging (CLI) is a novel imaging technology that might have the ability to assess surgical margins intraoperatively during prostatectomy using 68Ga-prostate-specific membrane antigen (68Ga-PSMA-11). This study evaluated the accuracy of CLI compared with histopathology and, as an exploratory objective, investigated the characteristics of the identified chemiluminescence signal. Methods: After intravenous injection of a mean 68Ga-PSMA-11 activity of 69MBq intraoperatively, all excised specimens were imaged with CLI. Areas of increased signal were marked for histopathologic comparison and scored for the likelihood of being a positive surgical margin (PSM) using a 5-point Likert scale. In addition, the chemiluminescence signal was investigated in 3 radioactive and 3 nonradioactive specimens using CLI. Results: In 15 patients, the agreement between CLI and histopathology was 60%; this improved to 83% when including close surgical margins (≤ 1mm). In 6 hot spots, CLI correctly identified PSMs on histopathology, located at the apex and mid prostate. In all 15 patients, an increased signal at the prostate base was observed, without the presence of the primary tumor in this area in 8 patients. This chemiluminescence signal was also observed in nonradioactive prostate specimens, with a half-life of 48 ± 11min. The chemiluminescence hampered the visual interpretation of 4 PSMs at the base. Conclusion: CLI was able to correctly identifymargin status, including close margins, in 83% of the cases. The presence of a diathermy-induced chemiluminescent signal hampered image interpretation, especially at the base of the prostate. In the current form, CLI is most applicable to detect PSMs and close margins in the apex and mid prostate.</p

Beyond Gleason grading:MRI radiomics to differentiate cribriform growth from non-cribriform growth in prostate cancer men

ObjectiveTo differentiate cribriform (GP4Crib+) from non-cribriform growth and Gleason 3 patterns (GP4Crib-/GP3) using MRI.MethodsTwo hundred and ninety-one operated prostate cancer men with pre-treatment MRI and whole-mount prostate histology were retrospectively included. T2-weighted, apparent diffusion coefficient (ADC) and fractional blood volume maps from 1.5/3T MRI systems were used. 592 histological GP3, GP4Crib- and GP4Crib+ regions were segmented on whole-mount specimens and manually co-registered to MRI sequences/maps. Radiomics features were extracted, and an erosion process was applied to minimize the impact of delineation uncertainties. A logistic regression model was developed to differentiate GP4Crib+ from GP3/GP4Crib- in the 465 remaining regions. The differences in balanced accuracy between the model and baseline (where all regions are labeled as GP3/GP4Crib-) and 95% confidence intervals (CI) for all metrics were assessed using bootstrapping.ResultsThe logistic regression model, using the 90th percentile ADC feature with a negative coefficient, showed a balanced accuracy of 0.65 (95% CI: 0.48-0.79), receiver operating characteristic area under the curve (AUC) of 0.75 (95% CI: 0.54-0.92), a precision-recall AUC of 0.35 (95% CI: 0.14-0.68).ConclusionThe radiomics MRI-based model, trained on Gleason sub-patterns segmented on whole-mount specimen, was able to differentiate GP4Crib+ from GP3/GP4Crib- patterns with moderate accuracy. The most dominant feature was the 90th percentile ADC. This exploratory study highlights 90th percentile ADC as a potential biomarker for cribriform growth differentiation, providing insights into future MRI-based risk assessment strategies